NOVEMBER 2013 Volume 11 Issue No. 11
CNA Professor
SEPSIS
Mark the correct response.
Name:
Date:
1. Sepsis occurs when the body has a severe reaction to
.
6. Early signs of septic shock include:
a. Fever
a. a food allergy
b. Tachycardia
b. infection
c. Hyperventilation
c. antibiotics
d. All of the above
d. septicemia
2. Which of the following is not one of the populations at
high risk for sepsis?
a. Infants
7. Sepsis can be challenging to diagnose because its
symptoms often mimic other conditions.
a. True
b. False
b. Elderly
c. Residents with AIDS
8. When sepsis occurs, the chemicals released into
the blood to fight an infection trigger widespread
inflammation, a reaction known as
d. Young, active adults
3. Urinary tract infection rarely leads to sepsis in long-term
care facilities.
a. NSAIDs
b. SIRS
a. True
c. UTI
b. False
d. SIDS
4. Which condition was formerly known as “blood poisoning”?
a. Septicemia
b. Septic shock
a. True
c. Sepsis
b. False
d. Hypothermia
5. To diagnose sepsis, a blood test is usually performed to
.
identify abnormalities in
a. red blood cells
b. hemoglobin
c. white blood cells
d. plasma
9. Since the elderly mount a strong febrile (fever)
response, this is a key symptom to look for when
identifying sepsis and septic shock.
10. Which of the following is not a suggested treatment
for sepsis?
a. Broad-spectrum intravenous antibiotics
b. Oxygenation
c. CT scan
d. Fluids
A supplement to CNA Training Advisor
CNA Training Advisor
November 2013
SEPSIS
This document contains privileged, copyrighted information. If you have not purchased it or are not otherwise
entitled to it by agreement with HCPro, any use, disclosure, forwarding, copying, or other communication of the
contents is prohibited without permission.
EDITORIAL ADVISORY BOARD
Associate Editorial Director
Todd Hutlock
Associate Editor
Melissa D’Amico
[email protected]
[email protected]
STAY CONNECTED
Interact with us and the rest of the HCPro
community at HCPro.com
Become a fan at
facebook.com/HCProInc
Follow us at
twitter.com/HCPro_Inc
Email us at
[email protected]
Questions? Comments? Ideas?
Contact Melissa D’Amico at mdamico@hcpro.
com or 781-639-1872, Ext. 3911.
Don’t miss your next issue
If it’s been more than six months since you
purchased or renewed your subscription to
CNA Training Advisor, be sure to check your
envelope for your renewal notice or call customer service at 800-650-6787. Renew your
subscription early to lock in the current price.
Relocating? Taking a new job?
If you’re relocating or taking a new job and
would like to continue receiving CNA Training Advisor, you are eligible for a free trial subscription. Contact customer service with your
moving information at 800-650-6787. At the
time of your call, please share with us the name
of your replacement.
CNA Training Advisor (ISSN: 1545-7028 [print]; 1937-7487 [online])
is published monthly by HCPro, Inc., 75 Sylvan Street, Suite A-101,
Danvers, MA 01923. Subscription rate: $149/year; back issues are
available at $15 each. • Copyright © 2013 HCPro, Inc. All rights
reserved. Printed in the USA. Except where specifically encouraged,
no part of this publication may be reproduced, in any form or by any
means, without prior written consent of HCPro, Inc., or the Copyright
Clearance Center at 978-750-8400. Please notify us immediately if
you have received an unauthorized copy. • For editorial comments
or questions, call 781-639-1872 or fax 781-639-7857. For renewal
or subscription information, call customer service at 800-650-6787,
fax 800-639-8511, or email [email protected]. • Visit our
website at www.hcpro.com. • Occasionally, we make our subscriber
list available to selected companies/vendors. If you do not wish to be
included on this mailing list, please write to the marketing department
at the address above. • Opinions expressed are not necessarily those
of CTA. Mention of products and services does not constitute endorsement. Advice given is general, and readers should consult professional
counsel for specific legal, ethical, or clinical questions.
2
HCPRO.COM
6HSVLVLVDOLIHWKUHDWHQLQJLOOQHVVWKDWRFFXUVZKHQWKHERG\KDVD
V HYHUHLPPXQHUHVSRQVHWRDQLQIHFWLRQ7KHVHLQIHFWLRQVDUHPRVWFRP
PRQO\FDXVHGE\EDFWHULDEXWPD\DOVRUHVXOWIURPIXQJLDQGYLUXVHV
6HSVLVFDQRFFXUDQ\ZKHUHLQWKHERG\EXWDUHDVWKDWDUHPRVW
F RPPRQWRLQIHFWLRQLQFOXGHWKHEORRGVWUHDPERZHOVNLGQH\VOLQLQJ
RIWKHEUDLQOLYHURUJDOOEODGGHUOXQJVDQGVNLQ
:KHQVHSVLVRFFXUVWKHFKHPLFDOVUHOHDVHGLQWRWKHEORRGWR¿JKW
DQLQIHFWLRQWULJJHUZLGHVSUHDGLQÀDPPDWLRQ²DUHDFWLRQNQRZQDV
V\VWHPLFLQÀDPPDWRU\UHVSRQVHV\QGURPHRU6,567KLVLQÀDPPD
WLRQPD\OHDGWREORRGFORWVOHDN\EORRGYHVVHOVLPSDLUHGEORRGÀRZ
R[\JHQGHSULYDWLRQWRRUJDQVDQGWLVVXHVDQGRUJDQIDLOXUH
Who is at risk?
$OWKRXJKDQ\RQHFDQJHWVHSVLVFHUWDLQSRSXODWLRQVDUHDWHVSHFLDOO\
KLJKULVN7KHVHLQFOXGHWKHHOGHUO\LQIDQWVDQGFKLOGUHQSHRSOHZLWK
ZHDNHQHGLPPXQHV\VWHPVSHRSOHZLWKFKURQLFLOOQHVVHVHJFDQ
FHU$,'6GLDEHWHVOLYHUGLVHDVHDQGSHRSOHVXIIHULQJIURPVHYHUH
SK\VLFDOWUDXPD
Symptoms
7KHRFFXUUHQFHRIVHSVLVLVUDSLGDQGXQSUHGLFWDEOHPDNLQJSUH
YHQWLRQDQGHDUO\LGHQWL¿FDWLRQYLWDOWRWKHWUHDWPHQWDQGVXUYLYDORI
DIIHFWHGUHVLGHQWV&1$VVKRXOGEHDZDUHRIWKHFRPPRQV\PSWRPV
ZKLFKLQFOXGHIHYHUFKLOOVUDSLGEUHDWKLQJDQGKHDUWUDWHUDVKFRQIX
VLRQGLVRULHQWDWLRQDQGEUXLVLQJRUEOHHGLQJ
8QIRUWXQDWHO\PDQ\RIWKHVHV\PSWRPVFDQDOVRRFFXULQRWKHUFRQ
GLWLRQVPDNLQJVHSVLVYHU\GLI¿FXOWWRGLDJQRVHHDUO\RQ,WLVLPSRUWDQW
WRUHPHPEHUWKDWVHSVLVFDQQRWRFFXUDORQH²LWVWHPVIURPDQRWKHU
F RQGLWLRQ,IDUHVLGHQWKDVDGRFXPHQWHGLQIHFWLRQRU\RXVXVSHFWWKDW
DQLQIHFWLRQKDVGHYHORSHGDQGKHRUVKHLVH[SHULHQFLQJV\PSWRPVRI
VHSVLVLWLVFULWLFDOWRUHSRUWWKLVWRDFOLQLFLDQLPPHGLDWHO\
Diagnosis and treatment
:KHQV\PSWRPVRIVHSVLVDUHLGHQWL¿HGVHYHUDOWHVWVPD\EH
SHUIRUPHGWRIRUPDOO\GLDJQRVHWKHFRQGLWLRQ$EORRGWHVWLVXVXDOO\
SHUIRUPHGWRGHWHUPLQHLIWKHUHLVDQDEQRUPDOLW\LQZKLWHEORRGFHOO
FRXQW²DNH\LGHQWLI\LQJIDFWRULQVHSVLV%ORRGXULQHDQGVSXWXP
PD\DOVREHWHVWHGIRUVLJQVRILQIHFWLRQ$FKHVW[UD\RUD&7VFDQ
PD\EHSHUIRUPHGWRKHOSSLQSRLQWWKHVLWHRIDQLQIHFWLRQ
5HVLGHQWVZLWKVHSVLVVKRXOGEHDGPLWWHGWRWKHKRVSLWDOIRUWUHDW
PHQWDVVRRQDVSRVVLEOHDQGDUHXVXDOO\WUHDWHGZLWKLQWKH,&82QFH
DGPLWWHGWKHJRDOVRIWUHDWPHQWLQFOXGH
© 2013 HCPro, Inc. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at copyright.com or 978-750-8400.
November 2013
CNA Training Advisor
SEPSIS
‡ 7UHDWLQJWKHLQIHFWLRQLQFOXGLQJDQWLELRWLFVDQG
RWKHUPHGLFLQHWRNLOOWKHEDFWHULDLISUHVHQW
‡ 6XVWDLQLQJWKHYLWDORUJDQVDQGUHGXFLQJWKHULVNRI
S
HUPDQHQWGDPDJH
‡ 3UHYHQWLQJDGURSLQEORRGSUHVVXUH
5HVLGHQWVZLOORIWHQUHFHLYHR[\JHQDQGLQWUDYHQRXV
,9ÀXLGVGXULQJWUHDWPHQWEXWPD\DOVRUHTXLUH
UHVSLUDWRUVRUNLGQH\GLDO\VLVWRFOHDURXWWKHVLWHVRI
LQIHFWLRQ,QVHYHUHFDVHVVXUJHU\PD\EHUHTXLUHG
Septicemia and septic shock
7KHWHUPV³VHSVLV´³VHSWLFHPLD´DQG³VHSWLFVKRFN´
DUHVRPHWLPHVXVHGLQWHUFKDQJHDEO\E\KHDOWKFDUH
S
URYLGHUV+RZHYHUWKHVHWHUPVDUHQRWV\QRQ\PV
/HW¶VVWDUWE\FODULI\LQJWKHWHUPLQRORJ\
‡ 6HSWLFHPLDLVDV\VWHPLFLQIHFWLRQLQWKHEORRG
VWUHDP%DFWHULDPXOWLSO\DQGUHOHDVHWR[LQVLQWRWKH
E
ORRGVWUHDPZKLFKVSUHDGVWKHWR[LQVWKURXJKRXW
WKHV\VWHP7KLVFRQGLWLRQZDVIRUPHUO\FDOOHG³EORRG
SRLVRQLQJ´
‡ 6HSWLFVKRFNLVWKHRXWFRPHRIDVHULRXVLQIHFWLRQ
XVXDOO\RQHFDXVHGE\*UDPQHJDWLYHEDFWHULDLW
RFFXUVZKHQWKHERG\DWWHPSWVWRGHVWUR\DQLQYDG
LQJSDWKRJHQ2QHJRDORIWUHDWPHQWIRULQIHFWLRQLV
WRSUHYHQWVHSWLFVKRFN7KHRQVHWRIVHSWLFVKRFNLV
KHUDOGHGE\K\SRWKHUPLDORZEORRGSUHVVXUHUDSLG
SXOVHLQDGHTXDWHWLVVXHSHUIXVLRQKHPRG\QDPLF
FKDQJHVDQGFRPSURPLVHGRUJDQIXQFWLRQ
Signs and symptoms of septic shock
6HSWLFVKRFNXVXDOO\RFFXUVZKHQWKHUHVLGHQWLV
E
HLQJWUHDWHGIRUDNQRZQLQIHFWLRQ,WVVLJQVDQGV\PS
WRPVGHSHQGRQKRZDGYDQFHGWKHFRQGLWLRQLVZKHQ
LWLVLGHQWL¿HG(DUO\VLJQVLQFOXGHIHYHUWDFK\FDUGLD
K\SHUYHQWLODWLRQDQGZDUPGU\ÀXVKHGVNLQ
5HPHPEHUWKDWHOGHUO\SHUVRQVGRQRWPRXQWD
VWURQJIHEULOHUHVSRQVHIHYHUVRGRQRWGHSHQGRQ
QRUPRWKHUPLFWHPSHUDWXUHDVDGLDJQRVWLFVLJQ,Q
VWHDGORRNIRUWKHIROORZLQJV\PSWRPVDQGFRQGLWLRQV
‡ 6KDNLQJFKLOOV
‡ +\SRWKHUPLD
‡ +\SRWHQVLLRQDQGK\SR[LDZLWKUDSLGVKDOORZ
UHVSLUDWLRQVWDFK\FDUGLDDQGFRROFODPP\VNLQ
,QWKLVVWDJHWKHWHPSHUDWXUHGURSVWKHSXOVH
E
HFRPHVZHDNDQGWKUHDG\DQGSXOPRQDU\HGHPD
RFFXUV
‡ &UDFNOHVLQWKHOXQJV
‡ 'HFUHDVHLQXULQHRXWSXW
‡ 2OLJXULD
‡ 0HQWDOFKDQJHVGXHWRGHFUHDVHGR[\JHQDWLRQ
‡ %ORRGFORWWLQJDEQRUPDOLWLHV
‡ -DXQGLFH
‡ +\SHUJO\FHPLDRUK\SRJO\FHPLD
:LWKRXWWUHDWPHQWWKHERG\¶VFRPSHQVDWRU\PHFKD
QLVPVSURJUHVVLYHO\IDLOXOWLPDWHO\OHDGLQJWRGHDWK
Treatment
$UHVLGHQWZLWKVHSWLFHPLDRUVHSWLFVKRFNVKRXOG
EHWUDQVIHUUHGWRWKHKRVSLWDOLPPHGLDWHO\$JJUHVVLYH
WUHDWPHQWFRQVLVWLQJRIEURDGVSHFWUXP,9DQWLELRWLF
WKHUDS\ÀXLGVDQGR[\JHQDWLRQLVUHTXLUHG,QWKLV
VLWXDWLRQLWLVEHWWHUWRVWDUWWUHDWPHQWWKDQWRZDLW
KRXUVIRUFXOWXUHDQGVHQVLWLYLW\WHVWUHVXOWV
Sepsis and urinary tract infection
8ULQDU\WUDFWLQIHFWLRQ87,LVDV\PSWRPDWLF
LQIHFWLRQWKDWFDQRFFXUDQ\ZKHUHLQWKHXULQDU\WUDFW
:LWKLQORQJWHUPFDUHIDFLOLWLHV87,LVRQHRIWKHELJ
JHVWFXOSULWVOHDGLQJWRVHSVLV
8QIRUWXQDWHO\LGHQWLI\LQJVLJQVDQGV\PSWRPVRI87,
LVRIWHQGLI¿FXOWLQUHVLGHQWVZLWKFRPPXQLFDWLRQSURE
OHPVDQGFRJQLWLYHLPSDLUPHQWV7KLVLQFUHDVHVWKHULVN
RIERWKRYHUDQGXQGHUWUHDWPHQW$GGLWLRQDOO\V\PS
WRPVRID87,DUHXVXDOO\DW\SLFDODQGPD\EHPLOGRU
DEVHQW7KHUHVLGHQWPD\QRWPRXQWDIHEULOHUHVSRQVH
IHYHU&RPPRQQRQVSHFL¿FV\PSWRPVRI87,DUH
‡ 8QH[SODLQHGGHWHULRUDWLRQRISK\VLFDOIXQFWLRQ
‡ &KDQJHLQPHQWDOVWDWXV
‡ 1HZRUZRUVHQLQJFRJQLWLYHLPSDLUPHQW
‡ $JLWDWLRQRUUHVWOHVVQHVV
‡ /HWKDUJ\
‡ 'HFOLQHLQPRELOLW\
© 2013 HCPro, Inc. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at copyright.com or 978-750-8400.
HCPRO.COM
3
CNA Training Advisor
November 2013
SEPSIS
‡ )DOOV
‡ 1HZHSLVRGHRILQFRQWLQHQFHLQFUHDVHGIUHTXHQF\
RILQFRQWLQHQFHDQGRUQRFWXULD
‡ &RXJK
‡ 1DXVHDRUYRPLWLQJ
‡ $EGRPLQDOSDLQ
‡ &KDQJHLQDSSHDUDQFHFRORURURGRURIXULQHWKDW
GRHVQRWSURPSWO\UHVSRQGWRLQFUHDVHGÀXLGV
‡ %RG\ODQJXDJHRURWKHUEHKDYLRUVXJJHVWLQJSDLQ
:KHQWUHDWLQJDUHVLGHQWIRU87,EHFDUHIXOWRPRQL
WRUIRUWKHVLJQVDQGV\PSWRPVRIVHSVLVDVGHWDLOHG
HDUOLHULQWKHLVVXH
Limit UTI risk
+HUHDUHVRPHSRWHQWLDOO\HIIHFWLYHVXJJHVWLRQVIRU
OLPLWLQJWKHULVNRI87,
‡ (QFRXUDJHDQGKHOSUHVLGHQWVWRGULQNVXI¿FLHQW
ÀXLGV$OOUHVLGHQWVVKRXOGPHHWWKHGLHWLWLDQ¶V
PLQLPXPFDOFXODWHGUHTXLUHPHQWGDLO\0RQL
WRUDQGDVVHVVLQWDNHDQGRXWSXWLIÀXLGLQWDNHLV
LQDGHTXDWH
‡ 8VHVWDQGDUGSUHFDXWLRQVDQGDVHSWLFWHFKQLTXHIRU
SHULQHDOFDUH
‡ %DWKHZDVKWKHJHQLWDODUHDGDLO\IURPIURQWWR
EDFN6KRZHULQVWHDGRIWDNLQJDWXEEDWK
‡ &OHDQVHWKHJHQLWDODQGXULQDU\DUHDVIURPIURQWWR
EDFNZLWKVRDSDQGZDWHUDIWHUHDFKERZHOPRYHPHQW
‡ $YRLGWLJKW¿WWLQJSDQWV
‡ :HDUFRWWRQXQGHUZHDURUXQGHUZHDUZLWKD
F RWWRQOLQHULQWKHFURWFKFKDQJHGDLO\
‡ :HDUSDQW\KRVHZLWKDFRWWRQFURWFKFKDQJHGDLO\
‡ $YRLGSRZGHUEDWKRLODQGIHPLQLQHK\JLHQH
VSUD\V
‡ ,IXVLQJVDQLWDU\QDSNLQVFKDQJHDIWHUHDFKYRLGLQJ
‡ (QFRXUDJHDQGDVVLVWUHVLGHQWVWRXULQDWHIUHTXHQWO\
Prevention is key
3UHYHQWLRQLVWKHEHVWRSWLRQIRUUHGXFLQJWKHULVNRI
VHSVLVVHSWLFHPLDDQGVHSWLFVKRFNLQUHVLGHQWV/LPLWLQJ
H[SRVXUHWRLQIHFWLRQVWD\LQJXSWRGDWHRQYDFFLQDWLRQV
DQGREH\LQJK\JLHQHSURWRFROVDUHDOONH\FRPSRQHQWV
4
HCPRO.COM
RIOLPLWLQJLQIHFWLRQULVNWKDWFRXOGOHDGWRVHSVLV
2QHRIWKHHDVLHVWZD\VWROLPLWWKHVSUHDGRIJHUPVLV
SURSHUKDQGZDVKLQJZKLFKUHPRYHVSDWKRJHQVIURP
WKHVNLQ,QIDFWKDQGZDVKLQJLVWKHVLQJOHPRVWLPSRU
WDQWWKLQJ\RXFDQGRWRSUHYHQWWKHVSUHDGRILQIHFWLRQ
5HPHPEHUWKHIROORZLQJ
‡ :DVKKDQGVEHIRUHDQGDIWHUDOOFOLHQWRUERG\ÀX
LGFRQWDFW,IZHDULQJJORYHVZDVKKDQGVDVVRRQDV
WKHJORYHVDUHUHPRYHG
‡ ,PPHGLDWHO\ZDVKKDQGVDQGRWKHUVNLQVXUIDFHV
WKDWDUHFRQWDPLQDWHGZLWKEORRGRUERG\ÀXLGV
‡ *HUPLFLGDOKDQGUXEVDUHUHFRPPHQGHGRQO\ZKHQ
\RXFDQ¶WZDVK
$OWKRXJK\RXVKRXOGFRQVXOW\RXUIDFLOLW\SURFHVVIRU
KDQGZDVKLQJWKHIROORZLQJLVDQH[DPSOHRISURSHU
KDQGZDVKLQJSURFHGXUH
5HPRYH\RXUZDWFKRUSXVKLWXS\RXUDUP
'RQ¶WWRXFKWKHVLQNZLWK\RXUKDQGVZKLOHZDVK
LQJ7XUQWKHIDXFHWRQZLWKDSDSHUWRZHO
8VHZDUPZDWHU+RWZDWHUPD\GU\WKHVNLQ
%DURUOLTXLGVRDSLVRND\,IXVLQJDEDUULQVHLW¿UVW
DQGKROGLWWKHZKROHWLPH\RXDUHODWKHULQJ6RDS
GRHVQRWKDYHWREHDQWLVHSWLFXQOHVV\RXDUHGRLQJ
DQLQYDVLYHSURFHGXUHVXFKDVFDWKHWHUL]DWLRQ
:HW\RXUZULVWVDQGKDQGV
$SSO\SOHQW\RIVRDS:RUNXSDWKLFNODWKHUDOORYHU
\RXUKDQGVDQGZULVWVEHWZHHQ\RXU¿QJHUVDQG
WKXPEVDQGRQWKHEDFNRI\RXUKDQGVDQGZULVWV
9LJRURXVO\UXEDOODUHDVRI\RXUKDQGV¿QJHUVDQG
ZULVWVIRUDPLQLPXPRIVHFRQGVLVEHWWHU
&OHDQXQGHU\RXUQDLOVE\XVLQJWKHQDLOVRQ\RXU
RWKHUKDQGRUUXE\RXUQDLOVLQWRWKHSDOPRI
\RXURWKHUKDQG
5LQVHZLWKZDUPZDWHUOHWWLQJZDWHUUXQGRZQ
IURPZULVWVWR¿QJHUWLSVDQGLQWRWKHVLQN
'U\ZLWKDFOHDQSDSHUWRZHODQGWKURZLWDZD\
7XUQRIIWKHIDXFHWZLWKDFOHDQGU\SDSHUWRZHO
DQGWKURZWKHWRZHODZD\
8VHORWLRQRQ\RXUKDQGVWRSUHYHQWLUULWDWLRQ
FKDSSLQJDQGGU\QHVVZKLFKPDNHVVNLQPRUH
SURQHWRLQIHFWLRQ H
© 2013 HCPro, Inc. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at copyright.com or 978-750-8400.