Acute Care Nursing

The aim of this assignment is to critically discuss the nursing assessment individualised care and nursing interventions of the acutely ill patient. The patient discussed developed severe sepsis due to a urinary tract infection and her condition deteriorated during the recovery process in the nurse’s care. Lovick (2009) defines sepsis ‘as a known or suspected infection accompanied by evidence of two or more of the SIRS criteria’. SIRS is outlined as a ‘systemic inflammatory response’ consisting of two or more of the following symptoms ‘temperature >38 degrees Celsius or 90 beats per minute, respiratory rates greater than 20 breaths per minute and white blood count higher than 12,000 cells per microliter or lower than 4000 cells per microliter’(Latto 2008). Severe sepsis requires rapid diagnosis and treatment it can be described as ‘the presence of sepsis with organ dysfunction, hypotension or poor perfusion’. (Lovick, 2009). Mrs Mary Smith was the patient in the nurse’s care who developed severe sepsis; she was a 76 year old female with no-known drug allergies, admitted to the ward with laceration to the forehead due to fall, difficulty coping, upper urinary tract infection and was awaiting long term care. Mrs Smith had a history of chronic back pain, mild asthma and recurrent UTI’s, she had finished a seven day dose of Augmentin three days previous. The patient was MRSA negative and required minimal assistance with her Activities of Daily Living. The patients baseline observations were blood pressure of 130/ 80, pulse of 80 beats per minute, saturations of 98% on room air, temperature 36.5oC respiratory rate of 18 and a GCS of 15/15, eyes responded to light and the patient could lift both legs and arms on command. While carrying out routine morning observations deterioration in Mrs Smith’s vital signs were noted, she appeared confused and disorientated this alerted the nurse as ‘confusion may be the first sign of infection and sepsis in elderly patients’.