A patient suffering from ALL and diagnosed with the suspected condition of Sepsis
Elodie is a 14-year-old girl who lives her mother and stepfather. She has three siblings, of whom two are step-siblings, and one is her biological sibling. Elodie seems to have a functional family with no associated conflicts between the parents or the siblings. Elodie had been previously diagnosed with Acute Lymphoblastic Leukemia (ALL). This condition was treated with chemotherapy. Elodie is brought to the emergency department by her mother with complaints of a three-day history of feeling generally unwell and malaise. The patient’s mother report that the Elodie is increasingly becoming withdrawn and quiet. Upon assessment, the patient was transferred to the pediatric hematology/oncology ward as a priority admission with the suspected condition of Sepsis that was secondary to an infected Hickman’s line.
Initial observations upon admission to the pediatric oncology/ hematology ward include:
The temperature of 38.4 orally
Her heart rate is 103 beats in a minute
Blood pressure was 102/67mmHG.
She is lethargic and diaphoretic in appearance
She had voided in the emergency room, and it was noted to be dark yellow
According to the patient, her mouth is dry, and she reports that she is thirsty but does not feel like taking anything. Furthermore, she feels so tired and very sick.
Blood cultures were taken from the Hickman’s catheter in the ED. After the reviewing of the blood culture for microscopy culture and sensitivities, the patient was noted to suffer from Sepsis.
Sepsis is described as a dysregulated inflammatory response that is as a result of a severe infection. IT can also be described as an overwhelming, exaggerated and uncontrolled systemic inflammatory response to an initial localized disease or injury of the tissue that may lead to severe Sepsis of septic shock if the situation is untreated. A septic shock, on the other hand, is an acute failure of the circulatory system, characterized by massive vasodilation, increased permeability of the capillaries and vascular resistance reduction in the body that results to causing refractory hypotension. This happens despite an adequate resuscitation of the fluids in the body. Sepsis has an interchangeable definition as the Systematic, inflammatory response syndrome (SIRS), which is caused by a sourced or a confirmed source that is infectious. Sepsis shock on the other had is defined by a sepsis patent with an underlying circulatory or metabolic abnormality that is increased with an increase in the mortality level. In this case, the patient in the case study is diagnosed with Sepsis and has a metabolic abnormality of ALL, thus classifying her as a sepsis shock patient.
Sepsis one of the leading causes of death among hospitalized patients. The recognition of Sepsis is a challenging task for many professionals. This is as a result of the symptoms of Sepsis can be subtle, and others can mimic the symptoms of other conditions, thus confusing the illness. Moreover, due to the high risk associated with Sepsis, when it comes to hospitalized patients, a professional should be able to have a high-quality suspicion and be able to consider the disease even through acute deterioration takes place. For one to be able to note a clinically deteriorating patient, is by taking note of the early warning signs before clinical decline takes place. Among some of the vital signs in detecting deterioration in hospitals include the respiratory rate, heart rate, systolic blood pressure, the consciousness level, temperature, and an hourly urinary output. Among the most used systems of detecting these signs is the modified Early warning system. The system consists of the entering of the vital signs of a patient, and the nurse assigns the number between 0-3 to every essential sign. The nurse then adds the results of the symptoms, and if they add up to a four or more, then clinical deterioration is noted.
Among one of the signs of deterioration is a rise in the respiratory rate, the standard respiratory rate for a stable patient is between 12- 20 breaths within a minute. In the case of Elodie, however, her respiratory rate was at 21 breaths per minute. This is one of the implications that she was deteriorating. In addition to this is the increase in the heart rate. A healthy heart rate is between 60-100 beats in a minute. The heart rate of Elodie was reported to be at 102 pounds at a minute. This increase in her heart rate caused the high in temperatures, as it observed to be at 38.4, causing her to have a fever. These are some of the signs and symptoms of a clinical deterioration among a patient. In the case of Elodie, she is a clinically deteriorating patient, and immediate medical attention is required.
Priority Problem
One of the most crucial problems to take note f when it comes to sepsis patients is their respiratory. Research indicates that most of the patients with a sepsis condition experience a respiratory problem. The damage on the lungs is mainly characterized pathologically as diffuse alveolar damage or commonly known as DAD. This condition ranges from an acute lung injury ALI to a mild ARDS. For these reasons and complications, the patients, therefore, need intubation and mechanical ventilation to help in optimal respiratory support. In the cases of Sepsis or even the sepsis shock, then intubation needs to be considered early into the disease. Elodie, the patient is suffering from Sepsis, and it is reported that the patient was admitted with a suspected condition of Sepsis that was secondary to an infected Hickman’s line. This means that the nurses in charge should be conscientious and be very aware of the patients’ respiratory progress. Although the patient did not complain of the respiratory complications, this information should not be ignored.
Furthermore, the respiratory rate of the patient indicates that it was high as they experienced 21 breaths per minute. The heart rate was also high as it was reported to be 102 beats per minute compared to the 60-100 beats per minute, the standard rate. This is an indication that the blood pressure was also high, thus indicating less supply of oxygen in the body. In this case, the respiratory distress of the patient is the priority problem.
Interventions
One o the best response that a nurse can use is Anti-inflammatory therapy. The function of platelets in the pathogenesis of lung injury causes by Sepsis is significant. According to some of the used preclinical models, aspirin, also known as the platelets inhibitor has been reported to help in such situations. The research report that aspirin help in the treatment of acute respiratory distress causes as a result of Sepsis. This is achieved through the deactivation of the inflammatory cascade and the reduction of the platelets confiscation in the lungs. Studies show that the use of aspirins prior hospitalization, help in reducing chances of ADRs in sepsis patients.
Besides, there is the option of the Polymyxin B hemoperfusion (PMX-HP). This is a device that helps in reducing the endotoxin levels in sepsis patients. This will help in regulating the respiratory distress experienced by sepsis patients. I the case study at hand, the use of aspirins before hospitalization may be out the window, but at least the PMX-HP device will help in regulating the respiratory distress.
Another intervention that would help rescues therapies. An example of rescue therapy is prone to poisoning. Research reports that Prolonged prone poisoning for more than or 16 hours and in patients who have a PF ration of 100-150mmHg would result in positive results in patients with ARDs or DAD. Prone poisoning aims at reducing the effects of ventilator-induced lung injuries. It also helps in increasing the hemodynamics.
In this case, the use of rescue therapies and anti-inflammatory therapy would be the most appropriate intervention for the nurses to take in the case of respiratory distress in a sepsis patient. These interventions would, therefore, help in the case of the patient.
Sepsis is a critical condition, and people who experience the disease experience emotional and psychological challenge that may avoid them from moving forward or making informed decisions. IN the present case study, the patient is a 14-year-old girl. Although she may not be in a prime position to express her emotions and feelings, the patient is anxious about their situation — a young girl who is in hospital and who also suffers from ALL. The patient ought to have a lot of questions and worry about her life and her medical conditions. The parents of the child, though having a right and functioning family, only the mother seems to care about her. According to the observation made in the hospital, the mother visits that patient, and she looks worried, anxious, and stressed. This case, the patient and the mother are stressed and anxious. The best way to help this family is through the patient-centered approach. The patient center care approach is a technique used by nurses in a hospital setting by treating the patient with dignity and respect and involving them in every decision possible about their healthcare. The approach consists of treating the patient with compassion, dignity an respect, proper communication with the patient about the care being given, supporting a patient in understanding their condition, helping the patients and family find better ways of being well and remaining healthy and independent on self and also tailoring the care to maintain it suit the needs of the patient. The approach involves the full involvement of the patient and family in the health caregiving process. This approach helps in ensuring that the patient is well aware of their condition and the treatment methods set for them, enables the patient ask any questions they have about their health to the professionals and the patient can be in light with their condition whether good or bad. The approach also builds up trust between the professionals and the patient. On to the family, the plan helps in ensuring that the family members are aware of the condition of the patient and also allowed to give any suggestion and ask questions about their patients. In the case of the young patient, the mother is actively involved in her wellbeing and treatment and decision making, since she is of underage. However, the patient should also be explained to their condition and progress regardless of age.
Conclusion
The discussion involves the discussion of a case study of a 14-year-old patient suffering from ALL and diagnosed with the suspected condition of Sepsis that was secondary to an infected Hickman’s line. The patient through observation was observed to have a high breathing rate, an elevated respiratory rate, and an increase in temperatures. According to the observed signs, the patient suffered from sepsis shock, and her condition was clinically deteriorating. IN addition to this, the patient sustained a priority problem of respiratory distress. Respiratory distress is one of the significant issues to look out for in sepsis patients. Besides, aspects of hypertension and brain dysfunction are also possible as the illness progresses. Some of these effects are experienced at the onset of the treatment or along the way. Sepsis is a syndrome that is a result of a systemic inflammatory response by an infection. The disease is one of the causes of high mortality rates, and therefore, it is significant that infections are well managed and proper support care is given to the patients, either at home or in hospitals.