Sepsis Case Studies

Competency Development:

1. Reflection on demonstrating competence in caring for the patient with

Impaired and/or altered haemostatic function.

In one of the meetings with the mentor regarding altered and/or impaired homeostatic function, a case study of a patient admitted with sepsis was discussed. Assessment, care and evolving treatment provided was looked into. Following the discussion, the management of sepsis has been examined further by the learner as she was not familiar with the bundle of six sepsis mentioned by the mentor. The learner looked on the situation and reflected back on the occurrence that took place realizing if appropriate measures were implemented and how things can be different in future practice (Schon, 1987). This

Daniels (2011) said that sepsis is one of the leading causes of death in hospital patient worldwide and severe sepsis causes around 37,000 deaths in the UK every year. Czura (2011) has defined it as a life-threatening condition that arises when the body’s response to infection injures its own tissues and organs and sepsis can be present in any patient and in any clinical setting. Based on the learner’s reading, she became aware of the importance of identifying the early inflammatory markers such as temperature less than 36 degrees or more than 38.3 degrees, heart rate greater than 90 beats per minute (bpm), respiratory rate greater than 20 breaths/minute, altered mental state, white cell count lesser than 4g/l or greater than 12g/l and blood glucose greater than 7.7 millimoles for non-diabetic patients. Presence of any two of these will follow further test and if sepsis is indicated then commence the sepsis six care bundle within the hour, contact the doctor and critical care outreach team. The sepsis six care bundle which was developed by Daniels et al (2010) has shown to improve delivery of reliable care across a range of clinical settings which is now used in many UK

It is also placed for diagnostic evaluation of idiopathic normal pressure hydrocephalus according to Marmarou (2005). Hydrocephalus as defined by Sheppard & Wright (2006) is an abnormal increase in the volume of CSF within the brain. LDD placement is also used to reduce intracranial pressure (ICP) during craniotomy according to Grady et al (1999) and Samadani et al (2003) and as adjuvant therapy in the management of traumatically brain-injured patients added by Munch et al (2001). The knowledge gained from reading books and articles and the skills acquired and enhanced during the process of mentoring developed the confidence of the learner in looking after particular patient. To complete competency in this area and to advance knowledge and skills, it was suggested that learner have to increase exposure to particular patient group. This is experiential learning (learning by doing) recommended by Kolb (1984) where through repeated encounters thoughts are framed and modified. This support the advancement of the learner from ‘novice to expert’ (Benner, 1984) that occur as part of professional development.