Sepsis: A Simulation for Healthcare Education

Summary

In 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.