Page 118 Complete Your CE Test Online - Click Here ● ● Disabling muscle and joint pains. ● ● Extreme fatigue. ● ● Poor concentration. ● ● Decreased mental (cognitive) functioning. ● ● Loss of self-esteem and self-belief. A national cohort study conducted by Iwashyna et al. (2010) showed that older sepsis survivors, an average age of 76, were 3 times more likely to suffer cognitive impairment and 1.5 times more likely to suffer physical impairment than others their age with a different diagnosis (Iwashyna et al., 2010). Cognitive and physical impairment of the sepsis survivor is associated with an increased need for a caregiver, admission to long-term care facilities, depression, and mortality, and is a significant health problem for patients, families, and the health care system (Iwashyna et al., 2010). Postsepsis syndrome may be linked to lasting physical impairments, such as amputations resulting from poor blood circulation and gangrene, and lasting damage to the lungs, kidneys, and liver. Glossary of conditions, pathogens, and terms associated with sepsis There are numerous health conditions, diseases, and various pathogens that may predispose or cause a person to develop sepsis. The following list includes a brief overview of diseases, pathogens, and terms associated with sepsis (Sepsis Alliance, n.d.). ● ● Appendicitis: Inflammation and infection of the appendix from blocked stool or lymphatic tissue can lead to rupture of the appendix if not surgically removed. The rupture of the appendix can allow normally occurring bacteria from within the appendix to escape into the abdomen and possibly throughout the body. ● ● Bacteremia: The presence of bacteria in the blood. ● ● Burns: Skin that is compromised by a burn can allow bacteria to enter the bloodstream. The risk of infection is greater, depending on the severity and extent of the burn. ● ● Clostridium difficile: Clostridium difficile is a bacterium that causes inflammation in the gut or colon. It is one of the most common health care acquired infections (HAIs), but it can also be found in the community. It is found in the stool of persons infected and is spread readily from direct or indirect contact. Sepsis can develop as the body tries to fight the infection. ● ● Cancer: Patients being treated for cancer and are immunocompromised are at high risk for developing sepsis. Patients with cancer are highly susceptible to acquiring health care-acquired infections and are at risk for infection from surgeries, indwelling urinary catheters, and any procedure that compromises skin integrity, such as an infusion. Patients with cancer may also suffer from malnutrition, which makes them more vulnerable to infections. ● ● Cellulitis: Cellulitis is an infection of the skin and tissue beneath the skin. Any time the integrity of the skin is compromised bacteria (most commonly group A streptococcal bacteria) can enter the body and lead to infection. Cellulitis can result from a simple cut or scrape, a bug bite or sting, burns, or surgical incisions. The most common site for cellulitis is in the lower extremities. Those most at risk for developing cellulitis include patients who: ○ ○ Are immunocompromised. ○ ○ Have diabetes. ○ ○ Have lymphedema. ○ ○ Have skin conditions (such as eczema, shingles, chicken pox). ○ ○ Are obese. ○ ○ Have a history of cellulitis. ● ● Chronic obstructive pulmonary disease (COPD): COPD is a chronic and progressive respiratory disease that affects those with emphysema, bronchitis, and asthma. It causes poor airflow in the lungs and increased mucous production. Those with COPD are at extreme risk for developing pneumonia, the leading cause of sepsis. ● ● Dental issues: Infections can occur in the gums, lips, palate, cheeks, tongue, or within and below teeth. A cavity or broken tooth can allow bacteria to enter the pulp of the tooth, which houses blood vessels, nerves, and connective tissue. Subsequently, a dental abscess forms and bacteria can move out of the tooth to the bone and tissue. Infections can occur after any dental work when bacteria are introduced to a scrape or cut in the mouth following such procedures as cleanings, fillings, root canals, or tooth extractions. Patients who are more likely to develop infections during dental work include those with a joint replacement and cardiac issues. These patients are typically give a prophylactic antibiotic to prevent development of infection. ● ● Diabetes: Patients with diabetes are at risk for developing sepsis because of the tendency to have wounds and scrapes that take longer to heal and are a port of entry for bacteria. ● ● Ebola: Ebola is a virus that originated in animals and was first seen in humans in West Africa in 1976. Since that time, it has spread and has recently become a concern for travelers worldwide. As the body tries to fight the Ebola virus, sepsis often sets in, followed by septic shock. Those who die from Ebola die from complications of septic shock (Bente, Gren, Strong, & Feldmann, 2009). ● ● Gallstones: Gallstones are hard deposits that form from a collection of cholesterol or bilirubin in the gallbladder. The gallbladder stores bile from the liver to aid in digestion. Gallstones can cause the gallbladder to become inflamed and block the flow of bile, which can lead to infection. Sometimes surgery, another risk for infection, is necessary to remove the gallbladder because of gallstones that are persistent and painful. ● ● Gastrointestinal perforation: The gastrointestinal tract may become perforated by any number of conditions leading to leaking of gastrointestinal contents and causing a subsequent infection. These conditions include the following: ○ ○ Appendicitis. ○ ○ Diverticulitis. ○ ○ Ulcerative colitis. ○ ○ Toxic megacolon. ○ ○ Strangulated hernia. ○ ○ Peptic ulcer disease. ○ ○ Forceful vomiting. In addition, the GI tract can be perforated by a traumatic injury to the abdomen, such as a knife or gunshot wound or swallowing a corrosive or foreign object. If the contents of the GI tract leak into the abdomen, peritonitis may occur. If the perforation is in the bowel, the condition is known as perforated bowel. ● ● Group B streptococcus: Group B Streptococcus is found in the GI tract. Typically, most healthy people do not develop infections from this bacterium. Newborns are most at risk for developing an infection from group B Streptococcus, but patients who are older or immunocompromised may develop an infection from Streptococcus B in their bloodstream, lungs (as pneumonia), skin or soft tissue, or bones or joints. ● ● Health care-associated infections (HAIs): Health care-associated infections (also known as nosocomial infections) can arise from any health care setting. HAIs are common in those who are elderly, young, or immunocompromised through an exposure to a concentrated number of germs from invasive procedures. Following are the most common types of invasive procedures associated with HAIs: ○ ○ Central intravenous catheters (central lines): Central lines are placed in the chest, groin, or neck in large veins to administer specific treatments that cannot be given via smaller veins. There is an increased risk for infection to spread rapidly in these lines because the access to the heart is more direct. ○ ○ Urinary catheters: Indwelling catheters that drain urine from hospitalized patients account for nearly 75% of all urinary tract infections in the hospital. It is the most common HAI. ○ ○ Surgical site infection: Surgical sites, as with any breakdown in skin integrity, can be a site for bacteria to enter the body. After a patient undergoes surgery, he is at risk for developing HAIs. ○ ○ Ventilator-associated pneumonia (VAP): Patients mechanically ventilated are at an increased risk of bacteria entering the lungs via the endotracheal tube used to assist breathing. Common bacteria that cause HAIs include methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile (C. diff.), and