Page 138 nursing.elitecme.com Complete Your CE Test Online - Click Here ● ● Those previously admitted to the hospital, especially those with an infection. ● ● Those with a nosocomial infection. ● ● Patients who are immunocompromised. ● ● Infants and children under 10 years of age. ● ● Persons over age 65. ● ● Those with a chronic illness. ● ● Those who have diabetes, kidney disease, liver disease, HIV/ AIDS, or cancer. ● ● Those who have suffered a severe burn or a physical trauma. Sepsis can occur after an infection of common sites in patients who have a surgical procedure/incision, an indwelling catheter, or an intravenous catheter or who are mechanically ventilated. There may also be a genetic component to the likelihood of developing sepsis (Neviere, 2017). In general, African Americans have a higher incidence of sepsis that is likely to be more severe and are at a higher risk for developing septic shock than Whites are, possibly because of a genetic predisposition or a higher prevalence of comorbidities (Artero et al., 2012 ). Men are more likely to experience sepsis that has progressed and to develop septic shock than women are (Artero et al., 2012). Key points ● ● Populations at risk for sepsis include patients who are over age 65, have chronic diseases, are admitted to the ICU, are immunocompromised, or are burn or trauma victims. ● ● Infection can occur in surgical patients, those with indwelling catheters, and those who are mechanically ventilated. ● ● There may be a genetic predisposition to sepsis. Nursing consideration: Nurses should always be aware of the signs and symptoms of sepsis in every patient with documented or suspected infection. Nurses should be particularly vigilant in screening for sepsis in those patients who are highly susceptible to the development of sepsis, including patients who are immunocompromised, have a chronic disease, are very young or elderly, or have undergone an invasive procedure. Sepsis in the older adult The risk for developing sepsis is 13 times higher in patients who are over age 65 than in younger patients (Artero et al., 2012). Pneumonia is the most frequent cause of sepsis in older patients, followed by urinary tract infections (Surviving Sepsis Campaign, n.d. ). This population is also more likely to have gastrointestinal infections, skin tears or pressure sores, tooth infections, and health care-associated infections. There are numerous reasons that the older adult is more at risk than the younger adult for developing infection and sepsis, including these: ● ● Immune system changes and immunodeficiency. ● ● Nutritional deficits. ● ● Comorbidities. ● ● Exposure to health care-associated infections (HAIs) and community-acquired infections (CAIs). ● ● Altered clinical presentation. Immune system changes in the older adult The ability of the body to fight invaders declines as the body ages. The immune system in the older adult has less ability to recognize and kill foreign invaders leading to the development of more infections, malignancy, and autoimmune disorders (Azar & Ballas, 2017). The age-related changes in the immune system that result in the development of infections, malignancy, and autoimmune disorders is termed immunosenescence. Innate immune system changes As discussed before, the innate immune system is comprised of macrophages, neutrophils, pattern recognition receptors (PRRs), and natural killer cells. Natural killer cells responsible for killing tumor cells and viruses have been found to be less active in older adults, according to a study of nursing home patients, resulting in increased infection and death from infection (Ogata et al., 2001). In older adults, macrophage activity and function is decreased, possibly leading to longer presence of bacteria in the body and delayed wound healing (Azar & Ballas, 2017). Neutrophil phagocytic ability in older adults is also decreased (Azar & Ballas, 2017). All of these factors lead to increased risk of infection and cancer and may result in the development of sepsis in older adults. Adaptive immune system changes The adaptive immune system includes T cells and B cells and is responsible for immune response to previous invaders. T cells are produced in the bone marrow and travel to the thymus gland to reach maturity. As aging occurs, there is less activity in the thymus gland, and the functional components of the thymus gland are replaced with fatty tissue, thereby resulting in fewer T cells (Azar & Ballas, 2017). B cells respond to invaders through exposure to infections or vaccinations by producing antibodies. The number of B cell precursors and the number of B cells decline with advancing age, as do specific antibodies produced from previous infections or vaccinations (Azar & Ballas, 2017). The decline in the adaptive immune system is responsible for the decreased effectiveness of vaccines in older adults. Decreased effectiveness of vaccinations Immune system changes in the older adult make vaccinations less effective, presenting a challenge to protect the health of a very vulnerable population. In patients > 65 years of age, a number of strategies have been used to combat this difficulty, such as increased dosage of a vaccine, increased vaccine boosters, and use of different vaccine formulations. Vaccinations remain crucial to the older adult to help ward off infections and viruses that may have serious health effects. It is recommended that the older adult, > 65 years of age, receive vaccinations to protect against influenza, pneumococcal infections, diphtheria, pertussis, tetanus, and zoster (Azar & Ballas, 2017). Nursing consideration: Nurses are likely to administer vaccines and are in a position to educate the public on the importance of being properly vaccinated to protect against infections that may lead to sepsis. Immunodeficiency A deficient immune response by the older adult may be, in part, due to the decreased response of the immune system as the body ages. The clinician should be aware that there may be an underlying immunodeficiency that is not simply a normal consequence of aging. If there is a increase in the length, severity, or frequency of infections or infections caused by unusual or opportunistic pathogens, an immunodeficiency should be suspected (Azar & Ballas, 2017). Causes of immunodeficiency include the following (Azar & Ballas, 2017): ● ● Malabsorption. ● ● Malignancy and related immunosuppressant therapies. ● ● Metabolic disease (diabetes, liver disease, uremia). ● ● Prescription drugs that may immunosuppress as a side effect. ● ● Malnutrition. Nutritional deficiencies in older adults Nutritional deficiencies in older adults contribute to the decreased effectiveness of the immune system and lead to susceptibility of developing infections and illness. Nutritional deficiencies exist for a variety of reasons. Older adults may not have the income necessary to buy healthy and nutritionally dense foods. Or they may not be able to