Page 148 nursing.elitecme.com Complete Your CE Test Online - Click Here ● ● Triage nurse. ● ● Staff nurse. ● ● Laboratory technician. ● ● Laboratory supervisor. ● ● Admissions clerk. Additional team members could include these professionals: ● ● CCM physician. ● ● House officer. ● ● ICU charge nurse. ● ● Infectious disease physician. Nursing consideration: Nurses should advocate for a sepsis response team in their institution so they have the option for a member of the team to evaluate a patient they are concerned may have sepsis. PROGNOSIS Sepsis continues to have a high mortality rate. Long-term studies have shown a mortality rate as high as 37% to 52% for patients with sepsis (Liu et al., 2014). Septic shock carries a mortality rate approaching 50%, and the degree of organ failure and the number of organs involved are directly correlated to mortality (Mayr et al., 2014). Half of those who have a more severe form of sepsis are readmitted to the hospital in the two years following their discharge ( Korošec Jagodič,, Jagodič, & Podbreger, 2006). Patients who survive a more severe case of sepsis often have long- lasting effects that interfere with daily life. A study by Korošec Jagodič, Jagodič, and Podbregar (2006) found that 82% of patients who were treated in an ICU for sepsis or trauma had a moderate to extreme problem with at least one of the following: activities of daily living, self-care, pain or discomfort, and anxiety and depression. For elderly people who survive septic shock, it has been shown that there are long-term cognitive effects and functional disabilities that result from hypoperfusion (Iwashyna, Ely, Smith, & Langa, 2010). Those who survive sepsis are at risk for developing postsepsis syndrome. EBP alert! Postsepsis syndrome (PSS) occurs in up to 50% of patients who survive sepsis (Sepsis Alliance, n.d.). With this condition, physical or psychological symptoms may persist after the patient has been discharged from the hospital after being treated for sepsis. Postsepsis syndrome Postsepsis syndrome (PSS) occurs in up to 50% of patients who survive sepsis (Sepsis Alliance, n.d.). With this condition, physical or psychological symptoms may persist after the patient has been discharged from the hospital after being treated for sepsis. Symptoms of postsepsis syndrome can be physical or psychological and vary in severity (Sepsis Alliance, n.d.): ● ● Insomnia, difficulty getting to sleep or staying asleep. ● ● Nightmares, vivid hallucinations, and panic attacks. ● ● 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