Sepsis: A Simulation for Healthcare Education

Montgomery College

2 Nov 201806:31

Summary

TLDRIn this transcript, a nurse takes over the care of Mr. James Daniels, who was admitted with fever, fatigue, and malaise. While preparing him for discharge, another nurse notices his worsening condition, including a high temperature and heart rate, which suggests early signs of sepsis. After expressing concerns, the team starts immediate treatment, including IV fluids, antibiotics, and ordering additional tests. The timely intervention highlights the importance of careful observation and knowledge of sepsis criteria, ultimately preventing a potentially life-threatening situation for the patient.

Takeaways

👩‍⚕️ A nurse is handing over the care of Mr. James Daniels to a new nurse.
🗓️ Mr. Daniels was born on January 17, 1986, with no known drug allergies.
🤒 He came in with complaints of fatigue, fever, and malaise for three weeks, with temperatures between 101°F and 104°F.
💊 He has been managing his symptoms at home with acetaminophen and ibuprofen every 4-6 hours.
🩺 His vitals show a blood pressure of 113/80, a temperature of 101°F, a heart rate of 110, and a pulse ox of 95%.
🤔 The nurse questions his discharge, concerned about his high temperature and tachycardia, even though his WBC count is normal.
⚠️ After Mr. Daniels nearly passed out, the team starts a saline bolus and tele monitoring, suspecting sepsis.
🧪 Orders are placed for lactate, CBC, chem 7, blood cultures, and an ABG, indicating potential infection.
📉 Mr. Daniels' lactate level is 7, pH is 7.2, and the team begins treatment with vancomycin and additional IV fluids.
👏 The nurse is praised for recognizing early sepsis indicators, potentially saving Mr. Daniels' life.

Q & A

What were Mr. Daniels' main symptoms when he was admitted to the hospital?
-Mr. Daniels complained of fatigue, fever, and malaise for the past three weeks, with his temperature ranging between 101°F and 104°F in the past week.
What medications had Mr. Daniels been taking at home before coming to the hospital?
-Mr. Daniels had been taking acetaminophen and ibuprofen every four to six hours at home, which he thought helped slightly.
What were Mr. Daniels' vital signs when the nurse assessed him in the hospital?
-Mr. Daniels had a blood pressure of 113/80, a temperature of 101°F, a pulse oximetry reading of 95%, a heart rate of 110, and a respiratory rate of 18.
Why was the nurse concerned about Mr. Daniels' condition, despite the discharge orders?
-The nurse was concerned because Mr. Daniels had a high temperature of 101°F and tachycardia (heart rate of 110), both indicators of a potential infection, despite normal WBC levels.
What changes occurred in Mr. Daniels' condition that required immediate intervention?
-Mr. Daniels felt lightheaded and his blood pressure dropped to 96/72 while his temperature increased to 102.5°F, prompting the medical team to start immediate intervention.
What initial treatments were started for Mr. Daniels when his condition worsened?
-The medical team started Mr. Daniels on tele monitoring, administered a 1-liter bolus of normal saline, and monitored his blood pressure every 5 minutes.
What tests were ordered for Mr. Daniels after the medical team suspected an infection?
-The team ordered a lactate test, CBC, chem 7, blood cultures, and an ABG (arterial blood gas).
What were the significant results from Mr. Daniels' blood tests?
-Mr. Daniels had a lactate level of 7 and a pH of 7.2, indicating metabolic acidosis, which raised concerns about sepsis.
What further treatment was given to Mr. Daniels after confirming the risk of infection?
-The medical team started a second liter of normal saline, attempted a larger IV (18-gauge), and administered 1 gram of vancomycin after obtaining blood cultures.
How did the nurse’s decision impact the outcome of Mr. Daniels' care?
-The nurse's decision to question the discharge order and recognize early signs of sepsis potentially saved Mr. Daniels' life by preventing an unsafe discharge and initiating life-saving treatment.

Outlines

00:00

🏥 Patient Handover and Initial Assessment

The nurse introduces a new nurse, Mer, who will take over Mr. Daniels' care. Mr. Daniels, born January 17, 1986, has no known drug allergies. He was admitted after experiencing fatigue, fever, and malaise for three weeks, with recent temperatures ranging from 101 to 104 degrees Fahrenheit. On admission, his temperature was 100.2°F, and he's been taking acetaminophen and ibuprofen every 4-6 hours with mild relief. His vitals, except for a slight fever, are otherwise normal. His only medical history includes prehypertension and Raynaud's disease, and he is waiting for discharge orders from the nurse practitioner. After briefly speaking with Mr. Daniels, the nurse notes that his blood pressure is 113/80, temperature is 101°F, heart rate is 110, respiratory rate is 18, and pulse ox is 95%. Mr. Daniels expresses fatigue but denies any pain.

05:02

⚠️ Concerns About Discharge and Patient Condition

The nurse questions Mr. Daniels' discharge due to his high temperature and heart rate (tachycardia), despite normal white blood cell counts. They suspect a potential systemic bacterial infection. After checking on Mr. Daniels, the nurse notices he feels weak and faint. The nurse initiates telemetry, starts a 1-liter saline bolus, and orders frequent blood pressure monitoring. Another nurse assists in documenting and recording the vitals. Mr. Daniels is placed on a saline drip, and his BP drops to 96/72, with a rising temperature of 102.5°F. The team orders several tests, including lactate levels, CBC, and blood cultures, to investigate his condition.

💉 Critical Findings and Further Actions

The tests reveal concerning results: Mr. Daniels has a lactate level of 7 and a pH of 7.2, suggesting a serious infection. A second saline bolus is initiated, and an 18-gauge IV is inserted in his right arm. The medical team administers 1 gram of vancomycin after collecting blood cultures and prepares to transfer him to the Medical ICU (MICU). The nurse in charge recognizes the importance of questioning the initial discharge and is praised for catching the early signs of sepsis, which may have saved Mr. Daniels' life. The nurse practitioner admits fatigue after five consecutive shifts, acknowledging the team effort in preventing a potentially dangerous outcome.

Mindmap

Keywords

💡Sepsis

Sepsis is a life-threatening condition that arises when the body's response to an infection causes injury to its own tissues and organs. In the video, the nurse expresses concern that Mr. Daniels may have sepsis due to his high temperature and high heart rate, despite his white blood cell count being normal. This highlights the need for careful observation and quick intervention in cases of suspected sepsis.

💡Tachycardia

Tachycardia refers to an abnormally high heart rate, typically defined as a rate exceeding 100 beats per minute. In the script, Mr. Daniels is noted to be tachycardic, with a heart rate of 110, which is one of the reasons the healthcare team is concerned about his condition. This symptom, combined with a high temperature, may indicate a serious underlying issue like sepsis.

💡Lactate

Lactate is a byproduct of anaerobic metabolism and is often measured to assess tissue oxygenation and the severity of sepsis. In the video, Mr. Daniels has a high lactate level of 7, indicating poor oxygen delivery to tissues and potential sepsis. This value helps the medical team gauge the severity of his condition and the urgency of treatment.

💡Blood Culture

A blood culture is a laboratory test that checks for the presence of bacteria or other microorganisms in the blood, which can indicate a bloodstream infection. The healthcare team in the video decides to perform blood cultures to identify any potential infection in Mr. Daniels' blood, which is crucial for diagnosing sepsis and determining the appropriate antibiotic treatment.

💡Hypertension

Hypertension, or high blood pressure, is a chronic medical condition where the force of the blood against the artery walls is too high. Mr. Daniels has a history of hypertension, as mentioned in the script. This background information is important for the healthcare team to consider when assessing his current health status and response to treatment.

💡Antibiotics

Antibiotics are medications used to treat bacterial infections. In the script, vancomycin, a potent antibiotic, is ordered for Mr. Daniels after blood cultures are taken. This step is part of the treatment protocol for suspected sepsis, where early administration of antibiotics can be life-saving by controlling the spread of infection.

💡Normal Saline Bolus

A normal saline bolus is a rapid infusion of saline solution, typically used to increase blood volume and pressure in cases of dehydration or shock. In the video, Mr. Daniels receives a saline bolus as part of his treatment to stabilize his blood pressure and improve circulation. This intervention is common in managing sepsis or dehydration.

💡Vital Signs

Vital signs are clinical measurements that indicate the state of a patient's essential body functions, including temperature, pulse, respiration rate, and blood pressure. Throughout the video, Mr. Daniels' vital signs are monitored closely, showing a temperature of 101°F and a heart rate of 110, which are key indicators that alert the medical team to his deteriorating condition.

💡Nurse Practitioner

A Nurse Practitioner (NP) is an advanced practice registered nurse who can provide high-level healthcare services, including diagnosis and treatment. In the script, the NP is involved in Mr. Daniels' care, making critical decisions such as revising the discharge plan based on his worsening symptoms. This role exemplifies the NP's importance in patient assessment and management.

💡Discharge Order

A discharge order is an instruction given by a healthcare provider that allows a patient to leave the hospital after treatment. Initially, Mr. Daniels has a discharge order, but concerns are raised due to his ongoing symptoms. This situation underscores the importance of reevaluating a patient’s condition before discharge to ensure safety and prevent complications.

Highlights

Mr. Daniels was admitted with fatigue, fever, and malaise for the past three weeks.

Temperature on admission was 100.2°F, with temps ranging from 101°F to 104°F over the past week.

Patient has a history of hypertension and Raynaud's disease.

Vitals taken: blood pressure 113/80, heart rate 110, respiratory rate 18, and oxygen saturation of 95%.

Nurse questions discharge order due to persistent tachycardia and fever of 101°F.

The patient expressed feeling very fatigued with no energy.

Concern raised about potential systemic bacterial infection due to tachycardia and fever.

Temperature increased to 102.5°F with sinus tachycardia and BP 96/72.

Normal saline bolus was started via a 20-gauge IV to stabilize blood pressure.

Orders placed for lactate, CBC, chem 7, blood cultures, and ABG due to suspected sepsis.

Lactate level reported as 7, indicating potential sepsis.

pH level of 7.2 was recorded, signaling acidosis.

Second liter of saline bolus initiated, along with 1 gram of vancomycin for infection treatment.

The decision to delay discharge and initiate treatment potentially saved the patient's life.

Nurse recognized for questioning the discharge order, demonstrating knowledge of early sepsis criteria.