nursing.elitecme.com Page 99 Complete Your CE Test Online - Click Here advice. Elite Professional Education, LLC recommends that you consult a medical, legal, or professional services expert licensed in your state. Elite Professional Education, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation nor circumstances and assumes no liability from reliance on these materials. Quotes are collected from customer feedback surveys. The models are intended to be representative and not actual customers. Introduction Sepsis is a life-threatening condition that occurs when the body’s systemic inflammatory response to a source of infection causes injury to tissues and organs (Singer et al., 2016). It is a dysregulated immune response to infection that results in organ dysfunction and is the leading cause of death from infection if not recognized early and treated quickly (Singer et al., 2016). Any patient may develop sepsis; it is an overwhelming systemic response by the body to an infectious source. Septic shock is defined as sepsis with the presence of circulatory, cellular, and metabolic dysfunction associated with a higher risk of mortality than from sepsis alone (Singer et al., 2016). If sepsis is not recognized and treated promptly, it can quickly progress to septic shock and multiple organ failure and greatly increase the likelihood of a patient’s suffering a negative outcome. Early identification and prompt treatment of patients with sepsis is key to improving patient outcomes, decreasing length of hospital stays, and decreasing costs associated with sepsis and septic shock. Nurses play an integral role in helping to identify patients who have a suspected or confirmed infection and may develop sepsis. Through education and awareness of the signs and symptoms of sepsis, nurses can decrease morbidity and mortality related to sepsis and improve patient outcomes. New definition of sepsis and septic shock In 2016, a new definition for sepsis was introduced by a task force comprised of 19 experts from the Society of Critical Care Medicine (SSCM) and the European Society of Intensive Care Medicine (Singer et al., 2016). The new definition of sepsis (formerly known as severe sepsis) states that sepsis is a dysregulated immune response to infection that results in organ dysfunction (Singer et al., 2016). Before 2016, a patient with sepsis was considered to be any patient who had two or more symptoms of systemic inflammatory response syndrome (SIRS) plus a known or suspected infection. SIRS is a systemic inflammatory response, which is an appropriate response by the body to an infection or any other stimulus that activates inflammation (Society of Critical Care Medicine, 2016). SIRS is not exclusively the result of infection; in fact, there are many noninfectious causes of SIRS, such as myocardial infarction, cirrhosis, adrenal insufficiency, and autoimmune disorders. The previous definition of sepsis based on SIRS criteria was changed, as SIRS is a regulated immune response and does not have to be infectious in etiology (Society of Critical Care Medicine, 2016). The critical concept in the new definition is that sepsis is not a regulated response. Sepsis is characterized by alterations in homeostasis that results in hypotension, hypoperfusion, peripheral vasodilation, increased metabolic demands, and myocardial depression (Madhusudan, Vijayaraghavan, & Cove, 2014). Sepsis can quickly progress from tissue damage to organ failure and even death. The terms sepsis and severe sepsis historically were often used interchangeably, leading to confusion. As sepsis is already severe, the task force felt using the term severe was redundant (Singer et al., 2016). The host response to infection is critical to the progression of sepsis and is now included in the definition. Septic shock is defined as sepsis with the presence of circulatory, cellular, and metabolic dysfunction associated with a higher risk of mortality than sepsis alone (Singer et al., 2016). The task force wanted to include that definition of septic shock to emphasize the increased rate of mortality, as those patients who progress to septic shock have a mortality rate higher than 40% (Singer et al., 2016). Incidence and prevalence ● ● It is estimated that there are 19 million cases of sepsis worldwide per year, with incidence rising (de Pablo, Monserrat, Prieto, & Alvarez-Mon, 2014). ● ● Sepsis is the number one cause of death in patients in noncardiac ICUs (Angus et al., 2001). ● ● Adults older than 65 years of age make up 60% to 85% of those diagnosed with sepsis (Neviere, 2016). ● ● The mortality rates from sepsis are declining, but the number of people receiving a diagnosis of sepsis is on the rise, resulting in an increased number of deaths proportionally each year (Martin, 2012). ● ● Patients who receive a diagnosis of sepsis are hospitalized 75% longer than those with other diagnoses, and readmission rates are high in patients with sepsis (O’Brien, 2015). ● ● Sepsis was ranked as the sixth reason for hospitalization in 2009, equal to 836,000 inpatient stays (HCUP-AHRP, 2009). ● ● 258,000 Americans die from sepsis every year (Sepsis Alliance, n.d.). ● ● Sepsis is responsible for 20% of deaths annually, the same number of deaths that occur from acute myocardial infarction (Gauer, 2013). ● ● More people die from sepsis each year than from HIV, breast cancer, and stroke (Martin, 2012). ● ● Sepsis is the 10th leading cause of death in the United States (Artero, Zaragoza, & Nogueira, 2012). ● ● The incidence of sepsis increases overall in the winter months, attributable to an increased number of respiratory etiologies (Danai, Sinha, Moss, Haber, & Martin, 2007). ● ● There is a 13% higher incidence of mortality from sepsis in winter months than in summer months (Danai et al., 2007). ● ● Mortality rates are between 25% and 30% of patients with sepsis. If sepsis progresses to septic shock, mortality rates rise to 40% to 70% (Gauer, 2013). Associated costs The care and treatment of patients with sepsis is skyrocketing, and it is ranked as the most costly of hospital stays (O’Brien, 2015). It is estimated that sepsis costs in U.S. hospitals have reached $24 billion annually, or over $65 million per day (Sepsis Alliance, n.d.). Medicare costs associated with a sepsis diagnosis are rising, as patients 65 years of age and older are 13 times more likely to develop sepsis than their younger counterparts are (Artero et al., 2012). An increase in direct Medicare spending on sepsis hospitalizations rose from $6.03 billion in 1996 to $15.73 billion in 2008 (Iwashyna, Cooke, Wunsch, & Kahn, 2012). There are other costs to consider when evaluating the financial burden of sepsis, such as direct health care costs from disability, lost productivity, and the need for a caregiver, whether a paid worker or a family member who may lose wages to stay home and care for the sepsis survivor (Iwashyna et al., 2012). The treatment, length of stay, and personal financial impacts of sepsis have significant financial implications on health care costs. REVIEW OF THE IMMUNE SYSTEM RESPONSE When the body comes into contact with an infectious pathogen, the immune system is activated. There are two types of immunity that our body uses to help fight a foreign invader, or antigen. The first line of defense is known as innate immunity, and the second line of defense is known as acquired or adaptive immunity. Innate immunity Innate immunity is also known as natural immunity. It is the immunity we are born with and does not require previous exposure to an antigen to work effectively. Innate immunity includes phagocytic cells, natural killer cells, and polymorphonuclear neutrophils (PMNs); the complement system; and cytokines and chemokines.