Sepsis: A Simulation for Healthcare Education
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
🏥 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.
⚠️ 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
💡Tachycardia
💡Lactate
💡Blood Culture
💡Hypertension
💡Antibiotics
💡Normal Saline Bolus
💡Vital Signs
💡Nurse Practitioner
💡Discharge Order
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.
Transcripts
[Music]
hi mr. Daniels this is an mer he'll be
the nurse that's taking over your care
today okay I'm just gonna let him know
what's been happening with you since you
last came in Daniels he's good
not very well all right this is mr.
James Daniel data for January 17 1986 no
known drug allergies came in around Oh
400 with complaints of fatigue fever and
malaise for the past three weeks says
his temps have ranged between 101 to 104
in the past week temps on admission was
around 100 point two orally
he's been taking acetaminophen and
ibuprofen every four to six hours at
home and thinks that it's helped a
little vitals are okay otherwise only
past medical history is B hypertension
and Raymond's disease
no past surgical or met at home labs are
okay too so NP wrote DC orders or just
waiting for his ride to arrive
okay thanks Kerry thank you mr. Daniels
I see you haven't had any medications
since you've been here what was the last
time had acetaminophen or ibuprofen just
before I left to come here around four
hours ago maybe I'm going to do an
assessment to see how you're doing right
now
your mouth at the time
blood pressure is 113 over 80
temperatures 101 pulse ox 95 percent
heart rate 110 respiratory rate 18 any
pain right now nope but I don't have any
energy at all I feel like I want to
sleep all the time hmm
what's your usual bullet pressure the
night nurse said you had pre
hypertension I think the top number is
usually 130 or 140 I guess I'm not sure
I had hoped when I came here they were
gonna help me but I guess if they think
I'm okay to go home I'll sleep better in
my own bed all right can you sit up for
a moment please I'm gonna have to take a
listen to your lungs
excuse me Wendy are you the nurse
practitioner for mr. Daniels yes see he
has a discharge order yes correct
well I'm concerned because his temp is
101 he's tachycardic
I understand the WBC's are normal but
the high temperature and the high heart
rate are two indicators of success seems
really unsafe to send him home without
ruling out the systemic bacterial
infection hey can you check on mr.
Daniels
I'm really concerned he just set up to
avoid and said he felt like he might
pass out yeah all right let's start him
on tele and let's start a 1 liter bolus
of normal saline and blood pressure
every 5 minutes
though can you get the charts nice
please we're gonna need some help what
do you need Sara can you start a normal
saline bolus please who's else has who
need some help
record everything that you see I just
started tele Sara starting normal saline
bolus and I have Zell checking bp's
every 5 minutes okay I am recording we
have sinus tach and BP is at 96 over 72
and I see temperature at 102.5 is now in
with saline wide open
okay saline bolus via right antecubital
20-gauge started at 1519 let's get a
lactate CBC chem 7 blood cultures and an
ABG orders for lactate CBC chem 7 blood
cultures and ABG in at 1519 I'll get the
blood gas started
what are you doing sir I'm gonna turn
that you might have an infection in your
blood
we're gonna run some tests to check
instead of sending you home right now
and a lactate of seven and a pH of seven
point two on the ice dad lactate of
seven and pH of seven point two start
his second leader normal saline bolus
try for an 18 gauge in his right arm
starting grandma vancomycin after you
get the blood cultures I'm going to call
the MICU for a bed okay
lactate of seven pH of seven points to
another normal saline bolus and second
IV access and one gram of vancomycin
ordered at 1526 Sara can you take over
for in murder can I talk to you for a
second
you were right to question that patients
discharge order I didn't think he was
that sick I've been working for five
nights straight I think I'm just tired I
think your knowledge on early sepsis
criteria may have saved this guy's life
good job
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