Infection: Septicemia Exemplar

Question 1

What is Septicemia?

Answer 1

The presence of pathogens in the blood

Question 2

Define Sepsis

Answer 2

A systemic inflammatory response resulting from an infection

Question 3

Define severe sepsis

Answer 3

Sepsis with acute associated organ failure

Question 4

Define septic shock

Answer 4

A persistently low mean arterial blood pressure as a result of overwhelming infection despite adequate fluid resuscitation

Question 5

Define refractory septic shock

Answer 5

Persistently low mean arterial blood pressure despite vasopressor therapy and adequate fluid resuscitation

Question 6

What happens when someone has systemic inflammatory response syndrome?

Answer 6

The infection triggers a systemic inflammatory response that leads to adverse events including vasodilation, increased capillary permeability, and hypercoagulability. It also activates cells like platelets, neutrophils, macrophages, and endothelial cells. the response that these cells make is over-exaggerated.

Question 7

What are some sources of infection?

Answer 7

1. bacteria
2. viruses
3. fungi

Question 8

What is bacteremia?

Answer 8

The presence of bacteria in the blood

Question 9

What populations are at the most risk for developing sepsis or septic shock?

Answer 9

1. hospitalized patients
2. debilitating chronic illnesses
3. poor nutritional status
4. invasive procedures or surgery

Question 10

What are the clinical manifestations of sepsis

Answer 10

1. Fever or hypothermia
2. Tachycardia
3. tachypnea
4. peripheral vasodilation
5. septic shock
6. mental status changes

Question 11

What lab results are consistent with sepsis?

Answer 11

1. abnormal CBC
2. alteration in clotting factors
3. elevated liver enzyme
4. C-reactive protein

Question 12

What are the clinical manifestations for the early phase of septic shock?

Answer 12

1. hypotension
2. thready increased pulse
3. rapid and deep respirations
4. warm and flushed skin
5. alert, oriented, and anxious
6. normal urine output
7. fever, chills
8. weakness, nausea, vomiting, diarrhea, decreased central venous pressure

Question 13

What is the early phase of septic shock sometimes referred to as?

Answer 13

The warm phase

Question 14

What are the late signs of septic shock?

Answer 14

1. hypotension
2. tachycardia, arrhythmias
3. rapid, shallow, dyspneic respirations
4. cool, pale, and edematous skin
5. Lethargic to comatose
6. oliguria to anuria
7. normal-decreased body temperature, decreased central venous pressure

Question 15

What is the late phase of septic shock often referred to as?

Answer 15

The cold phase

Question 16

What tests are done to determine if someone has sepsis, to prevent sepsis, and to determine the severity?

Answer 16

1. Hemoglobin and hematocrit
2. ABGs
3. Serum electrolytes
4. BUN, serum creatinine level, urine specific gravity, and osmolality
5. Blood cultures
6. WBC count and differential
7. Serum enzymes
8. Hemodynamic monitoring

Question 17

What are the primary types of medications used for sepsis?

Answer 17

Antimicrobials

Question 18

What should all patients with septic shock have?

Answer 18

Oxygen therapy (even those who have adequate respirations) during the first 4-6 hours of care

Question 19

What is the most effective treatment for septic shock?

Answer 19

Fluid replacement

Question 20

What is the optimal fluid balance for patients with sepsis?

Answer 20

+3 L at 12 hours after presentation with a central venous pressure of less than 8 mmHg

Question 21

What are the manifestations of sepsis in infants?

Answer 21

1. Temperature instability
2. Abdominal distension
3. Poor feeding
4. Lethargy
5. Respiratory distress
6. Hepatomegaly
7. Vomiting
8. Jaundice

Question 22

What are the manifestations of septic shock in infants?

Answer 22

1. Tachycardia
2. Tachypnea
3. Fever
4. Warm extremities
5. Bounding pulse
6. Rapid cap refill

Question 23

Why are older adults more likely to get septic shock?

Answer 23

They have cardiac changes due to old age and do not have compensatory responses for septic shock.

Question 24

What are the interventions for sepsis?

Answer 24

1. Monitor the patient’s skin color, temp, turgor, and moisture
2. Monitor the patient’s cardiopulmonary function by assessing blood pressure, rate and depth of respirations, lung sounds, pulse oximetry, and peripheral pulses
3. Monitor the patient’s jugular vein distention
4. Take the patient’s blood pressure
5. Monitor the patient’s body temperature
6. Monitor the patient’s urinary output per Foley catheter hourly, using a urometer
7. Assess the patient’s mental status and level of consciousness.

Question 25

Why is a fever a sign of sepsis?

Answer 25

Elevated body temperature increases metabolic demands, depleting reserves of bodily energy, and it increases the oxygen needed for the heart.

Question 26

What are the criteria for SIRS?

Answer 26

1. temp greater than 100.4 or less than 96.8
2. Pulse greater than 20
3. RR greater than 20 or PaCO2 less than 32
4. WBC greater than 12,000 or less than 4,000

Question 27

The nurse is required to manage and minimize sepsis in a client with severe infection. Which would be an appropriate nursing intervention?

1. Limit the client’s fluid intake
2. Monitor the client’s vital signs
3. Enoucarge the client to perform mild activity
4. Limit the client’s food intake

Answer 27

The correct answer is: Monitor the client’s vital signs.

When caring for a client who is susceptible to developing sepsis, the nurse should monitor vital signs every 4 hours or as ordered medically, because changes may be the earliest indication of sepsis.

The nurse should also encourage the client to consume fluid and food intake, as sufficient intake helps restore biological defense mechanisms.
The client may be weak and therefore need not be encouraged to perform mild activity.

Question 28

A client is to have an amputation. The client is acutely ill and diagnosed with a gangrenous limb and related fever, disorientation, and electrolyte imbalances. Which of the following would be most important for the nurse to monitor in this client

1. Signs of sepsis
2. Signs of nausea and vomiting
3. Occurrence of allergic reactions
4. Reduced urine output

Answer 28

The correct answer is: Signs of sepsis

If the client is acutely ill with a gangrenous limb, related fever, disorientation, and electrolyte imbalances, the nurse should monitor for signs of sepsis and circulation in the limb for any changes such as severe pain, color changes, and lack of peripheral pulses. It is crucial for the nurse to inform the physician about the problems as they occur or else the surgery may become an emergency.

Monitoring for signs of nausea and vomiting, the occurrence of allergic reactions, and reduced urine output, although necessary, is not as crucial for the client.

Question 29

A nurse is assessing a neonate with sepsis. The nurse understands that most commonly the cause involves:

1. Herpesvirus
2. Enterovirus
3. Protozoa
4. Bacteria

Answer 29

The correct answer is: Bacteria

Neonatal sepsis can be caused by viruses such as herpes simplex or enteroviruses and by protozoa (e.g., Toxoplasma gondii). However, bacteria are typically the culprits.

Question 30

A nurse is monitoring a premature neonate for the development of neonatal sepsis. Which assessment finding is an early sign of neonatal sepsis?

1. Hypotension
2. Temperature instability
3. gastric retention
4. blood in the stool

Answer 30

The correct answer is: temperature instability

Neonatal sepsis is oftentimes difficult to diagnose because many of the symptoms are nonspecific in the beginning. Sometimes the nurse uses intuition and experience and describes the baby as “not looking right.” One of the first signs of sepsis is that the infant cannot maintain temperature and becomes hypothermic. Other symptoms include pallor, poor feeding, irritability, apnea and bradycardia, respiratory distress, and abdominal distention.

Hypotension may be seen in neonatal sepsis, but it is a late sign, not an early sign. In infants and children, the blood pressure is the last vital sign to exhibit a change. If hypotension has occurred, the infant is already very ill.
Gastric retention and blood in the stool are signs of necrotizing enterocolitis and should be monitored closely in infants who are at risk.

Question 31

An infection or the products of infection carried throughout the body by the blood is called:

1. Contamination
2. Infectious disease
3. Septicemia
4. Viral illness

Answer 31

The correct answer is: septicemia.

Transport of an infection or the products of infection throughout the body by the blood is known as septicemia. Sepsis, a term that means poisoning of tissues, often is used to describe the presence of infection.

Question 32

A nurse is caring for a full-term neonate who is 24 hours old. Assessment findings include axillary temperature of 96.8° F (36° C), apical heart rate of 188 beats/minute, and respiratory rate of 48 breaths/minute. The mother reports that the neonate is lethargic when she tries to breastfeed and looks “like a rag doll.” Pulse oximetry reveals saturation of 89% on room air, and the neonate has dusky mucous membranes.

The mother also has a low-grade fever. What are the most appropriate nursing interventions? Select all that apply.

1. Encourage the mother to breastfeed because the neonate is becoming dehydrated
2. Observe the neonate carefully, contact the physician, and explain her suspicions of early neonatal sepsis
3. Provide blow-by oxygen and monitor the neonate’s respiratory status
4. Keep the neonate in the nursery, monitor VS every 2 hours, and inform the physician of the neonate’s status when the physician makes routine rounds in the nursery
5. Inform the parents that she wants to monitor the neonate closely

Answer 32

The correct answers are: Observe the neonate carefully, contact the physician, and explain her suspicions of early neonatal sepsis, Provide blow-by oxygen and monitor the neonate’s respiratory status, and Inform the parents that she wants to monitor the neonate closely.

The neonate’s symptoms are consistent with early-onset neonatal sepsis. The oxygen saturation, respiratory rate, and cyanosis (evidenced by dusky mucous membranes) indicate that the neonate needs immediate oxygen support. The nurse should contact the physician immediately and continue to monitor the neonate closely. The tachycardia and tachypnea also indicate that the neonate is compromised and may deteriorate rapidly. Keeping the parents informed at this time is important and supports the mother by acknowledging her concerns.

There’s no evidence that the cause of the neonate’s problem is dehydration.
The neonate’s condition warrants taking vital signs more often than every 2 hours.

Question 33

The nurse is caring for a client diagnosed with systemic inflammatory response syndrome. Which illness is likely responsible for this diagnosis?

1. Acute renal failure
2. Sepsis
3. Anaphylactic shock
4. Respiratory arrest

Answer 33

The correct answer is: Sepsis

In severe bacterial infections (sepsis), large quantities of microorganisms in the blood result in the production and release of enormous quantities of inflammatory cytokines and the development of what is referred to as systemic inflammatory response syndrome. Systemic inflammatory response syndrome results in generalized vasodilation, increased vascular permeability, intravascular fluid loss, myocardial depression, and fatal circulatory shock.

Question 34

A client with a diagnosis of sepsis has received intravenous immune globulin (IVIg) as partial treatment. The nurse knows that which client response would best suggest an accurate understanding of IVIg treatment?

1. These antibodies in the solution have been collected from individuals who have successfully fought off the same infection
2. The IVIg should help stimulate fever, inflammation, and tissue repair in the fight against the infection
3. A big part of my IVIg treatment is actually stimulating and supplementing my immune system to do the work itself
4. The main effect of IVIg is to cause her body to produce more white blood cells to fight infection

Answer 34

The correct answer is: “A big part of my IVIg treatment is actually stimulating and supplementing my immune system to do the work itself.”

IVIg involves infusion of pooled antibodies which supplement and stimulate the client’s immune system to respond above and beyond its own capacities.

It is not collected from individuals who have had similar infections.
The primary effect of IVIg is not white blood cell production.
Stimulation of fever, inflammation, and tissue repair are more closely associated with cytokine therapy.

Question 35

A hospital client with a diagnosis of sepsis is in need of a specific response to microorganisms and long-lasting immunity to the pathogens in question. Which component of the client’s immune system is most able to meet these criteria?

1. Neutrophils
2. Lymphocytes
3. Macrophages
4. Natural killer cells

Answer 35

The correct answer is: Lymphocytes

Lymphocytes provide lifelong immunity and an antigen-specific response to harmful microorganisms. Neutrophils, macrophages, and natural killer cells do not provide an antigen-specific response.