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Running head: SEPSIS PROTOCOL

Sepsis Protocol
Annette Ramos
Cedar Crest College

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SEPSIS PROTOCOL
Abstract
The following scholarly paper discusses the important measures of sepsis protocol. The stages of
sepsis are described as well as diagnostic criteria and lab work. Priority medications and their
classes are described; with primary, secondary, and tertiary interventions that acknowledge the
importance of early recognition and prevention measures in sepsis.

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Sepsis Protocol
The protocols in cases of sepsis are crucial to the survival of Americans each year.
According to an article published by Nursing 2014 Surviving Sepsis, the author describes sepsis
as a systemic response to an overwhelming inflammatory process caused by an infection
(Miller, 2014, p. 24). In the United States alone Sepsis is said to cause 215,000 deaths per year
(Picard, ODonoghue, Young-Kershaw, & Russel, 2006, p. 43). Nurses play an important role in
recognizing the earliest signs and symptoms in order to prevent further systemic damage.
Overview
Sepsis begins with an infection that is no longer localized to one area of the body
(Workman, 2010). The infections may be caused by burn injuries, trauma (Bernstein, 2013) or
hospital acquired infections (Tazbir, 2012). When the infection is no longer localized, toxins
enter the blood stream (Workman, 2010) causing the first stage of sepsis, also known as
Systemic Inflammatory Response Syndrome (SIRS) (Nelson, LeMaster, Plost, & Zahner, 2009).
If left untreated, the systemic response will then progress into sepsis, severe sepsis, and finally
septic shock (Nelson et al., 2009). Septic shock is classified as a distributive shock that causes
vasodilation of the blood vessels (Tazbir, 2012). The outcome is severe hypotension, and poor
tissue perfusion, that ultimately ends in a high mortality rate for most individuals (Bernstein,
2013).
Diagnostic & Lab Exams
The human body is considered to be in the SIRS stage when two or more of the following
diagnostic symptoms are visible: temperature greater than 100.4 degrees Fahrenheit or below
96.8 degrees Fahrenheit, heart rate above 90 beats per minute, respirations above 20 breaths per
minute, and a white blood cell (WBC) count above 12,000 or less than 4,000 (Nelson et al.,

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2009, pp.42). During sepsis and septic shock, the symptoms associated with systemic
inflammatory response syndrome continue, while the hemodynamic variables of systolic blood
pressure (SBP), and mean arterial pressure (MAP) significantly decrease (Miller, 2014). Systolic
blood pressure will be less than 90 mmHg, and the mean arterial pressure will fall below 70
mmHg (Miller, 2014). Signs and symptoms of oliguria, absent bowel sounds, and decreased
capillary refill and mottling may also begin to manifest (Miller, 2014). The following lab values
delineated in Table 1 below express the typical abnormal lab values associated in sepsis and
septic shock according to Miller (2014).
Table 1
Abnormal Lab Values in Sepsis & Septic Shock
Sepsis
Serum creatinine

Severe Sepsis & Septic Shock

>0.5 mg/dL

>2.0 mg/dL

INR

>1.5

Levels stay the same

PTT

>60 seconds

Levels stay the same

<100,000/mm

Levels stay the same

Platelet count
Total bilirubin

>4 mg/dL

Serum lactate

>1 mmol/L

>2mg/dL
Levels stay the same
(Miller, 2014) Surviving Sepsis

Medications, Treatments, & Rationales

Antimicrobial Therapy
Antimicrobial therapy (such as with IV antibiotics) are top priority medications used for
the treatment of sepsis (Powers & Jacobi, 2006). Antibiotic use during sepsis is used in treating
underlying systemic infection; the quicker the antibiotics are started, the better the chance of

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recovery for the patient (Powers & Jacobi, 2006). Some examples of antibiotics used during
sepsis are: Vancomycin (classified as a Glycopeptide), Cefepime (classified as a Cephalosporin),
and Ciprofloxacin (classified as a Quinolone) (Powers & Jacobi, 2006).
Fluid Resuscitation
Fluid resuscitation is important in increasing tissue perfusion throughout the body
(Powers & Jacobi, 2006). It is typically used before the initiation of vasopressor therapy (Powers
& Jacobi, 2006). Crystalloids are the recommended choice of fluids during any form of
distributive shock (Ahrens, 2006) A example of a crystalloid used in the management of sepsis is
sodium chloride (Ahrens, 2006).
Vasopressors
Dopamine, Epinephrine, and Norepinephrine are examples of vasoconstricting
medications used in septic shock (Powers & Jacobi, 2006). These medications constrict the blood
vessels and increase mean arterial pressure, which improve hypotension in septic patients
(Powers & Jacobi, 2006).
Inotropics
Dobutamine is an example of an inotropic medication used to increase myocardial
contractility (Powers & Jacobi, 2006). This drug also helps improve ejection fraction levels
which help improve decreased perfusion levels seen in patients suffering from septic shock
(Powers & Jacobi, 2006).
Corticosteroids
Corticosteroids such as IV hydrocortisone and fludrocortisone (Florinef) are used to
prevent adrenal insufficiency, which may occur in sepsis when the body is under stress (Powers

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& Jacobi, 2006). Corticosteroid use is only recommended for patients who do not reach
hemodynamic stability by fluids and vasopressors (Miller, 2014).
Nursing Interventions
Primary Intervention
Prevention is a key primary nursing intervention (Neuman, 2005). Nurses play an
important role in preventing hospital-acquired infections that may occur from a urinary catheter,
central line, or surgical site (Tazbir, 2012). Therefore it is important that the nurse take proper
precautions in initiating preventative measures for high-risk patients (Tazbir, 2012). Primary
interventions that may be utilized in the prevention of hospital-acquired sepsis can be as simple
as utilizing proper hand hygiene (Posa, Harrison, & Vollman, 2006). The use of proper sterile
technique (such as in central line and catheter insertion) is another primary intervention that can
be used by nurses in order to prevent sepsis (Posa et al., 2006).
Secondary Intervention
Identifying the issue in the early stages of sepsis would be classified as a secondary level
of intervention (Neuman, 2005). Being able to identify the early symptoms associated in
systemic inflammatory response syndrome (SIRS) is an important intervention that can prevent
further systemic damage and mortality (Miller, 2014). Fluid resuscitation, drug therapy, and
oxygen therapy (typically done by mechanic ventilation in septic patients) are all examples of
secondary interventions utilized by the nurse caring for a patient in septic shock (Workman,
2010).
Tertiary Intervention
When the patient has recovered from their septic state, reeducating the patient in order to
prevent recurrent occurrences of sepsis is an important tertiary intervention (Workman, 2006).

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Educating high-risk patients on the importance of proper hygiene is one example of an
intervention that may be utilized (Workman, 2006). Educating the patient about the typical signs
and symptoms of infection, how to properly take a temperature, and when to call the physician
are all examples of tertiary interventions that may be taught to the patient (Workman, 2006).
Complications
Ventilation used in sepsis for oxygenation purposes may cause barotrauma or damage
the lung parenchyma (Picard et al., 2006 p. 44). The use of antimicrobial agents may cause
kidney damage (Picard et al., 2006 p. 44). Antimicrobial agent may also cause complications
related to strains of resistance in certain patients (Powers & Jacobi, 2006). Patients on
vasopressor therapy should be monitored for tachycardia (Powers & Jacobi, 2006).
Improvements in Patient Outcomes
Recognizing sepsis in its beginning stages is highly important for the survival of the
patient (). When treatments are initiated early it is said that the therapy improves the sepsis
survival rate by 16% (Ahrens, 2007 p. 39). Nursing 2014 published an article on guidelines to
surviving sepsis. The author of this article spoke of a patient recognized as Ms. C who sought
emergency care after stabbing her right foot with a fishhook three days before (Miller, 2014).
Ms. Cs symptoms consisted of an oral temperature of 101 degrees Fahrenheit, heart rate of 102,
respirations of 24, blood pressure of 88/42, and an MAP of 57 (Miller, 2014). Ms. C was
diagnosed with sepsis, and interventions were initiated quickly, allowing her to recover from the
systemic infection (Miller, 2014). In a different case study published by the American Journal of
Nursing (AJN) the author discusses the issue on a 70 year old patient admitted into the
emergency room from a nursing home, whos signs and symptoms of systemic inflammatory
response syndrome went unnoticed (Nelson et al., 2009). This patients cause of death was said

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to be septic shock, however death could have been prevented if early symptoms were recognized
(Nelson et al., 2009). Recognizing the very first symptoms of SIRS or sepsis, and initiating
timely care to prevent further systemic damage are crucial to the improvements in patient
outcomes for sepsis (Miller, 2014).
Conclusion
Overall, nurses are vital to the recognition of early symptoms associated with sepsis. The
recognition of early symptoms associated with sepsis is the key component in patient survival.
Once symptoms are recognized initiating timely interventions to prevent further damage will
save more lives, and prevent further suffering from the systemic infection known as sepsis.

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References
Ahrens, T. (2006). Hemodynamics in Sepsis. AACN Advanced Critical Care, pp. 435-445.
Retrieved from http://www.aacnadvancedcriticalcare.com
Ahrens, T. (2007). Sepsis: Stopping an insidious killer, What you must know to understand,
identify, and treat this lethal condition. American Nurse Today, pp. 36-40. Retrieved from
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Bernstein, M. (2013). Helping patient survive sepsis. American Nurse Today, pp. 24-29.
Retrieved from http://www.americannursetoday.com
Miller, J. (2014). Surviving Sepsis A review of the latest guidelines. Nursing2014, pp. 24-30.
doi: 10.1097/01.NURSE.0000444530.66327.de
Nelson, D. P., LeMaster, T. H., Plost, G. N., and Zahner, M. L. (2009). Recognizing Sepsis in
the Adult Patient. AJN, pp. 40-45. doi: 10.1097/01.NAJ.0000346928.90369.10
Neuman, B. (2005). The Neuman System Model of Nursing
http://www.neumansystemsmodel.org
Picard, K. M., ODonoghue, S. C., Young-Kershaw, D. A., and Russell, K. J. (2006).
Development and Implementation of a Multidisciplinary Sepsis Protocol. Critical Care
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Powers, J., and Jacobi, J. (2006). Pharmacologic Treatment Related to Severe Sepsis. AACN
Advanced Critical Care, pp. 423-432. Retrieved from
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Tazbir, J. (2012). Early Recognition and Treatment of Sepsis in the Medical- Surgical Setting.
MedSurg Nursing, pp. 205-209. Retrieved from
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