Nursing Care for Patients with Sepsis in Critical Care, Ranong Hospital

Abstract

Sepsis is a life-threatening emergency and high mortality rate, if the care is delayed (prolonged). To be a guideline for nursing care in sepsis and septic shock patients, two case studies between August, 2019 to January, 2020 will be presented.

Case Study 1: A 30-years-old male patient gave a history of 3 days before coming to the community hospital with fever, body aches and abdominal pain. In following days, he presented shock and acute kidney injury, physician referred him to Ranaong hospital. During referral system, he had worsened dyspnea. In Emergency department (ED), patient refused intubation and was admitted in Medical department. Two hours later, he had dyspnea and was inserted endotracheal tube and moved into ICU. Physician made a diagnose Adult Respiratory Distress Syndrome and have a treatment with Mechanical Ventilator, muscle relaxant, sedative drug, fluid resuscitation, antibiotic and vasopressors. On the 9^th day of treatment, the patient discharged from ICU. He was hospitalized for 10 days.

Case study 2: A 26-years-old female patient gave a history of 1 days before coming to the hospital with fever, chill, tachypnea and dysuria. Fifteen minutes before coming to the hospital with dyspnea, hurriedly and her colleague called EMS referred to ED of Ranong hospital. The patient was alert, extremities cool, high fever, found pus in cervix.  Physician detected sepsis prompt, taken hemoculture and gave broad-spectrum antibiotics before moved into ICU. Later, she had septic shock and worsened dyspnea. She was intubation and have a treatment with Mechanical Ventilator. On the 5^th day of the treatment, the patient improved symptoms and was discharged.

The results of the study showed that target sepsis with quality improvement initiatives will be develop by multidisciplinary team using nurse case manager, clinical practice guideline and care map. Sepsis fast track and new sepsis networking system will be created in Ranong province.