Sepsis Infection Causes and Effects

Sepsis Infection Causes and Effects Sepsis affects 18 million people worldwide each year (Slade et al 2003). Sepsis remains life threatening and mortality rate remains high approximately 40-50 % (Opport et al2005). We, nurses in all areas of practice, will care for septic patients during our professional carreer.Many nurses receive little training in how to identify sepsis or how important early and aggressive treatment to help prevent the condition. I am very interested to discuss about sepsis, because I have looked after many patients with sepsis. The aim of this essay is to raise awareness of sepsis, so that nurses will have a greater understanding of this condition and feel more confident in the identification and treatment. The definition of sepsis is the presence of Systemic Inflammatory Response Syndrome (SIRS) criteria in the patients with a new infection. Once sepsis becomes complicated by a dysfunction in one or more organs, this defines severe sepsis. Bacteria cause 90% cases of sepsis. They are two types, gram negative and gram positive. Escherichia coli, Klebsiella, Enterobactor, Pseudomonas aeruginosa, Serratia, Proteus and Bacteroides fragilis are the gram-negative bacteria. Staphylococcus aureus, Streptococcus pneumonia, Alpha and beta-hemolytic streptococci are the gram-positive bacteria (Edwards 2001). Gram-negative bacterial infection causes most cases of sepsis. Viruses or fungi can also cause sepsis, particularly Candida spp (Cohen et al 2004). The surviving sepsis campaign (formed in2002) is an international collaboration to improve the diagnosis, management and treatment of sepsis. The main aims of the campaign are: To increase the awareness of sepsis, severe sepsis and septic shock among health care staff and the public. Develop evidence-based guidelines for the management of severe sepsis. Ensure that the guidelines put into practice to create a global standard of care for patients with sepsis. Reduce the mortality from sepsis worldwide by 25 percent in the five years following the publication of evidence-based guidelines in 2004 (Dellinger et al 2004). It is essential that nurses are aware of the evidence-based guidelines as our role is crucial to the success of the campaign. Nurses are in an ideal position to identify the first signs of a patient developing sepsis, and the sooner treatment begins the less likely the condition is to spread and result in organ dysfunction or failure (Ahrens and Tuggle 2004). Infection is a major reason for patients admitted to hospitals and some patients may develop infections while in hospital (DH2003). Infection can found in any system of the body. The most common sources of infection that can lead to sepsis are: Respiratory tract: community-acquired pneumonia or health care-associated pneumonia. Intra-abdominal-cavity: infection might result from diverticulitis, appendicitis, perforated bowel, and ischemic or necrotic bowel. Central nervous system-such as meningitis. Genitourinary system: urosepsis is an infection, which might result from an obstruction in the urinary system, or catheter related infection. Skin: wound infections, cellulitis or necrotizing infections of the skin and soft tissues with rapid destruction of tissue, such as necrotizing fasciitis. Intravascular Catheters: any invasive catheters (central venous catheter or peripheral canulae. Many organ systems may affect during the sepsis syndrome. Respiratory system: As the effects of of sepsis progress, acute respiratory distress syndrome (ARDS) may occur. During sepsis, there is a decrease in the performance of the ventillatory muscles, which leads to hypercapneic ventillatory failure and respiratory arrest These happens when metabolic demands on the ventillatory muscles. Tachypnoea,hypoxia and respiratory alkalosis are associated with the early onset of ARDS, followed after 48 hours by pulmonary infiltrates and respiratory failure (Mortelliti Manning). Sepsis leads to an increase in lung permeability, the sequestration of polymorphonuclear neutrophils and respiratory failure. These affect the function of respiratory system (Nagase, Uzumi Ishii). Cardio vascular system: The dysfunction of cardio vascular system is also observed in patients with sepsis, where both the heart and blood vessels show hypersensitivity. An increased amount of pro-inflammatory cytokines and vasoactive substances is present during sepsis. Following the increase in pro-inflammatory cytokines, production of nitric oxide is increase in both the vascular endothelium and smooth muscle. This leads to a fall in systemic vascular resistance, thereby hypotension (Patterson Webster). Renal Dysfunction: Normally, the kidney regulates perfusion and glomerular filtration via autoregulation, which is dependent on the afferent and efferent arterioles. Autoregulation of the kidney, is affected during sepsis. Coagulation system: Sepsis often associated with a disorder of coagulation secondary to the cytokine-mediated activation of the coagulation pathway. This secondary disorder, known as disseminated intravascular coagulation (DIC). It causes bleeding and micro vascular thrombi, both implicated in multiple organ failure and soft-tissue damage (Meijers Bouma). Diagnosis can base on the presence of fever and other abnormalities of vital signs, as well as the presence of one or more organ dysfunctions that are not the original site of infection or trauma (Ahamed). Sepsis syndrome is characterized by; alteration in body temperature regulation, tachycardia, lowered systemic vascular resistance, respiratory alkalosis, leococytosis, leucopenia and some form of organ dysfunction(Chistman, Holden and Blackhell).It does not discriminate between different ages, underlying disease, genetic background, infecting micro-organisms or sites of infection. Sepsis can occur in people who were previously healthy. The infecting organism may be a temporary defect in the hosts defense. Defects may be located in specific or non-specific cellular barriers, humoral immunity barriers and physical barriers such as the skin or mucous membranes and reflexes such as cough and peristalsis (Maskin, Fountain and Spinedi et al). In understanding the changes that happen to the body in severe sepsis, it is helpful to remind ourselves of the changes that occur during the normal immune response. Cells damaged by infection from bacteria, viruses, chemical agents or trauma produce the same non-specific defensive response of inflammation. Regardless of the cause, inflammation has three basic phases; vasodialatation and increased permeability of blood vessels; emigration of phagocytes; and tissue repair (Tortora and Grabowski, 2000). Vasodilatation brings more blood to the damaged area, and the increased permeability allows phagocytes and antibodies to pass out from the circulation. The clotting cascade is also activated. Clot formation is part of the normal immune response, and may be the bodys attempt to confine any invading organism to one area of body (Ahrens and Vollman, 2003). This inflammatory response and activation of the clotting system is to repair damaged tissues and prevent further damage. Clinical assessment is important in patients with sepsis. Any patients who triggers early warning score, should be assessed initially using the ABCDE approach. This systemic approach ensures that the life threatening problems are assessed and managed in order of importance. The Resuscitation Council 2006 also recommends that clinical staff should follow ABCDE approach when assessing and treating critically ill patients. It is sensible to adopt this systemic approach to the assessment of sepsis patient (ABC of sepsis). Airway: An assessment should be made of the patency of airway. If patient is alert and talking, there is less chance of an airway problem. Breathing: The bodys demand for oxygen rises in sepsis. As demand outstrips supply, lactic acidosis occurs. These processes combine to elevate the respiratory rate. The depth and pattern of respiratory rate should evaluate in addition to any asymmetry of chest movement. Listen for abnormal sounds include expiratory wheeze, suggesting obstruction of the lower airway and crepitating suggest the secretion, pulmonary oedema or consolidation. If a respiratory problem is identified, attention should be given to oxygen therapy and to the possible need for bronchodilators and physiotherapy. The response to therapy should be assessing repeatedly. Pulse oximetry is mandatory, and ABG and chest X-ray is helpful. Circulation: Attention should pay to the colour of the skin, particularly peripherally. Pallor is suggestive of hypo perfusion and may suggest a low cardiac output. Heart sound should auscultate to seek murmur. Feel for the peripheral skin temperature. In decompensated sepsis, where the cardiac output begins to fall, the peripheries may appear cool. Capillary refill time is useful test of perfusion. The heart rate and rhythm should asses by palpitation of peripheral pulses. Disability: Sepsis can produce confusion, agitation and reduced conscious level due to reduced cerebral perfusion. Fluid resuscitation can restore cerebral function. It is important to check blood sugar because; hypoglycemia can also produce these signs and is readily correctable. The conscious level can quickly asses and communicate using the AVPU scale.( A-Alert,V-responds to voice,P-responds to pain,U-unresponsive). Exposure: The patient should be examined from head to toe seeking the source of sepsis. Consideration should be given to the patients dignity during this assessment, and it should be recognized that exposure can cause rapid temperature loss. Therefore, it is essential to check peripheral temperature. When treating patients with sepsis, the first hour known as the golden hour because the treatment given or not given during that time can have significant impact on the survival (ACS 1997).To be able to treat patients in the `golden hour` we must first be able to recognize it confidently. Studies have shown that patients admitted to intensive care unit from the wards are often not referred early enough. Sometimes receive suboptimal care, which can increase patients mortality (McQuillan et al1998).Vincent et al 2002 suggest that some patients with sepsis are recognized late and are not treated appropriately before transfer to ICU. In March 2004, the Surviving Sepsis Campaign produced comprehensive guidelines on the management of patients with severe sepsis. Initial treatment within one hour of diagnosis is, Give supplemental oxygen therapy, via facemask, to achieve SpO2>94%. Obtain blood specimen lactate, full blood count, urea and electrolytes, glucose, liver function tests, coagulation screen and blood culture two sets. Samples from sputum, urine, wound swab etc as appropriate. Blood cultures should be taken before antibiotics are given to identify any microorganisms that may be in the blood and it should from a peripheral vein and from any invasive catheters that the patient may have in situ.Blood cultures are not always positive in patient with sepsis. Cohen et al (2004) suggest that care should take when obtaining blood cultures to prevent them becoming contaminated and giving a false positive result. Administer intravenous broad-spectrum antibiotics. In severe sepsis antibiotics should be given within one hour of diagnosis (Dellinger et al, 2004). Giving prompt antibiotic therapy may reduce mortality by 10-15 percent, compared with patients in whom antibiotic therapy is delayed (Wheeler Bernard, 1999). Any septic patient who has a lactate level above 4mmol/L should be considered to have severe sepsis even if the blood pressure is within the normal range. If patient is hypotensive, fluid resuscitate up to 3boluses of 500ml normal saline to maintain MAP>65/systolic 100mmhg (Trusts sepsis care pathway). Consider catheterization to maintain fluid balance. If the patient have signs of severe sepsis, needs referral to ICU. Signs of severe sepsis are; Systolic blood pressure below 90mmHg or MAP below 65mmHg, lactate above 2mmol/L, urine output below 0.5ml/kg/hr for 2 hours, INR above1.5, bilirubin above 34mol/L, platelets below 100mol/L, creatinine above 177mmol/L. Some patients develop severe sepsis from infections they acquire while in hospital. One in ten NHS hospital patients are affected by healthcare associated infections(HCAIs) each year(DH2003).The most common of these infections are urinary infections as a result of indwelling urinary catheters and pneumonia.Therefore,nurses must make continued efforts to play an active part in reducing the number of HCAIs as this can potentially lead to fewer patients developing sepsis . Ahrens and Tuggle (2004) suggest that it may also be beneficial to raise the publics awareness of the Surviving Sepsis Campaign and the warning signs of developing sepsis. This may help to achieve the main aim of the campaign, which is to reduce mortality.Sepsis, is a common condition and can be fatal. A good knowledge of the signs and symptoms of sepsis is the key to prompt recognition. Every patient suspected having sepsis should have blood taken for a serum lactate level. In patients with severe sepsis, early aggressive treatment and adherence to evidence-based guidelines can help to save lives. In addition, efforts to reduce HCAIs can aid in the reduction of the incidence of sepsis.

Leadership Succession

Is it necessary for Citigroup to have a leadership succession plan? Why? Leadership succession planning is very important from two perspectives. First of all, it helps to select highly-potential candidates, who have strong leadership abilities and possess all necessary qualities to assume high administrative positions in the future. Besides, leadership succession plan also includes the measures on giving a wide range of learning, training and development opportunities for such individuals in order to improve their professional performance, proficiency, managerial abilities, leadership skills, and so on.Undoubtedly, if Citigroup does not pay attention on the situation around Sandy Weill right now, the company’s risk to be left without an effective leader will be increasing. Sandy Weill is a man over 70, and at this age his professional abilities as an executive can get worse at any time. That is why, I suppose, there is an urgent vital need for the company to select and start p reparing someone who would be able to succeed Mr. Weill.2. Who should have the responsibility of preparing a succession plan?For large organizations and corporations specialists suggest establishing special Leadership Planning Boards, which would carry out the main activities on leadership succession planning. Such activities have to include identifying critical positions, establishing criteria and identifying the best candidates (at least two for one position), reviewing and monitoring their professional progress and personal development, interviewing and evaluating every candidate and coming up with some conclusions and suggestions.Undoubtedly, such departments as Business Human Resources Units or Corporate Human Resources Departments have to be also involved in leadership succession planning process. They have to assist Leadership Planning Boards and give all necessary information about potential candidates. Top managers from Board of Directors or Chief Officers have to take all the responsibilities on supervising and controlling the effectiveness of leadership succession planning process (Tennessee Valley Authority, 2000).3. Should the succession plan include insiders? Outsiders? Or both?I think that it is preferable for any company or organization to select the candidates from the insiders. If there are qualified and talented managers, who worked and had opportunity to develop together with the company for some time, they are certainly better aware of the specifics of company’s business, strategies of management, organizational culture and traditions, etc. Moreover, they could already win some reputation and respect of the employees; therefore, they are potentially effective leaders or top managers.But there can be a situation when there are good outside candidates, who had no experience of working with the company. In such case, I suppose, it is necessary not only to interview such candidates and estimate their potential effectiveness, but also in volve them into business activities of the company as soon as possible. I strongly believe that working closely with the leaders and learning more and more from them is a key factor for good performance of any successor.4. Why do executives such as Weill avoid the succession issue?I think that Mr. Weill can have some personal reasons for doing this. Possibly, he does not take leadership succession as a reality or does not want someone to be on his back. Maybe he assumes any succession plan as the necessity of his resignation or as a sign of lack of trust from his colleagues. There’s also probability that he is trying to avoid all succession plan initiatives in order to prove own competence and uniqueness.Nevertheless, I believe that this situation is not a typical one, especially for such huge organizations as Citigroup. Usually, top managers and executives demonstrate concern about their organizations and get actively involved in succession planning. They can point on some p ossible successors, work with them, train and promote them in order to prepare such candidates for taking higher positions and make them understand, what the organization requires to remain successful.References:Leadership/Succession Planning. (2000) Tennessee Valley Authority. Retrieved June 29, 2007, from: . Ritter, J. (2003, April 15) Succession Planning: A Tool for Success. The Galt Global Review. Galt Western Personnel Ltd. Retrieved June 29, 2007, from: .

Reading Response to Devil in a Blue Dress

I enjoyed the manner with which Moslem used these two themes In particular to discuss some societal Issues. Starting with a brief summary of the novel, I intend to expatiate on these two themes in subsequent paragraphs. The Plot Set in Los Angels in 1948, the Devil in a Blue Dress is centered on the character of Ezekiel ‘Easy† Railings a black man who had fought in World War II and who has Just lost his Job at an aircraft company and desperate to find a means of earning an income to meet his financial needs especially his mortgage payment.Ease's aspiration leads him to accepting a Job from Dewitt Albright to find a young white lady Daphne Monet. Although Dewitt Albright had a questionable personality, Easy accepted the job after assurance from Albright that the task does not portend any significant problem with the law. Moreover, it was an opportunity to earn some money and considering his financial situation he had to accept the Job. As the story progresses, Easy comes t o realize that things are far more complicated than he could have thought. He Is accused of murder, at risk of being hurt by Albright henchmen Easy is expected to track down is not who they say she is.Easy along with Mouse have to find their way out of the predicament they find themselves while avoiding being dragged in by the nets of the law. The plot of the novel is typical of what to expect from a top-notch detective fiction novel, lots of deaths and intrigues and a proper dose of suspense. Moslem ensured that the chapters were brief yet; almost each of the chapters carried a new twist to the overall plot. Although the overriding theme is that or race and racism and the influence of money on the inhabitants of society, one can identify other inconspicuous issues raised in the novel such as sexual perversity, independence and war.Theme: Race and Racism A major theme in the novel is that of race and racism, the setting of 1948 is obviously a time when the United States of America h ad very visible racial segregation lines and it was refreshing to read a novel that captured this issue as it were back then. Moslem sought to highlight how racial inclinations dictated how the different characters relate with each other and/or how it affects the manner in which they respond to events. Even from Ease's first encounter with Albright- a white man, it was clear that their different racial backgrounds indicated problems ahead.Having fought alongside white men during the war, Easy must have been very disappointed to return only to see that segregation lines are still very visible. In a way, I think Ease's bewilderment was captured in his explanations of his wartime relationship with white men. Stating how he ate and slept with them, and even killed some blue-eyed young men during the war. For Easy, it was refreshing to know that white people were Just as afraid to die as he was (Moslem, 1990) the theme of racism was also inked to authority and how those who believe they are racially superior exerted it.This was evident in the way Albright consistently called Easy â€Å"boy' to send a clear message as to be racial superiority. Moreover, it was quite fascinating to see how Moslem used the novel to highlight and dispel insinuations that the issue of race and racism is well defined. For instance, Moslem showed that race and racism are not that clearly defined; for someone like Daphne Monet who feels lost not being able to clearly establish which side of the divide she belongs. Another case is that of Benny, Ease's former boss.Benny is of mixed racial background and despite Ease's description of him as being darker than most mixed-race blacks around, Benny considers himself racially superior to Easy. Furthermore, Moslem tries to show us how undefined race and racism is with the information that Daphne Monet is not white but black. Ease's response to this revelation is that of disbelief and rightly so. As far as Easy is concerned, Daphne Monet is white. â€Å"l looked at her to see the truth. But it wasn't there. Her nose, cheeks, and her skin color – they were white. Daphne was a white woman† (Moslem, 1990).Moreover, it is not all about the dark for race and racism in the Moslems work. The author in my view sought to highlight how people from different racial backgrounds can along well with each other. Ease's reasonable relationship with Primp as well as his statement about the Negro and Mexican being the same lays credence to this as both blacks and Mexicans are both at the receiving end of racial discrimination from the whites (Moslem, 1990). Theme: Money The theme of money and how it directs the actions of the various characters in the novel Just like race and racism is a recurring issue in the novel.Throughout the plot, pushes some of the characters to the extreme. In fact, so evident is the theme of money in the plot of this novel that most of the deaths that occurred can be traced to the influence of money. Ea se's financial constraint and his acceptance of Albright offer sets the tone for the theme of money and from then we start to see how each character's financial gain influences their actions. Moreover, I found it interesting that Moslem sought to separate Easy from the rest of the pack. From the beginning, Moslem tried to show what was behind Ease's quest to achieve financial stability and reducibility.We are made to see Easy as a man that was so passionate of keeping his most priced assets, which is his house. Easy speaks dearly of his house as the only thing he has got and the only thing worth fighting for and this influences his decision to accept the Job from Albright with a view to earning some money to make his mortgage payment. This is in stark contrast to other characters in the novel whose aim to achieve some level of financial freedom stem from greed. Violence and War I believe a reader response on the Devil in a Blue Dress will not be complete without brief commentary on the theme of violence and war.Although in my opinion, nothing in particular stands out on these two issues in the novel, one cannot ignore the recurring nature of physical violence and war in the novel. Moslem did not disappoint in the area of physical violence as will be expected from a detective fiction novel, there are lots of deaths to evoke the air of mystery and to build up suspense. As for the theme of war, Easy could not shake off his experience of fighting in the Second World War and this is understandable considering the abundance of events hat sees him reminiscing and relating happenings in his environment to memories of the way.It is refreshing to see how his experience of war helps him to develop a balanced approach to things. Ease's war experience also helps him to see other ways of solving problems rather than resorting to violence like most other characters in the novel. To this, we have to acknowledge the influence of â€Å"the Voice† in helping Easy make the right choices and it worthy of note that â€Å"the Voice† was created in Ease's war days. Reference Moslem, W. (1990). Devil in a blue dress. Washington Square Press: New York

Harvard Business Simulation Free Essay Example, 1000 words

The proposed project should not exceed the proposed budget allocated. In this light, SNC will create a fixed budget that will accommodate intense product development that is in tune with the customer tastes and preferences. Since this is just a proposal, the time value of money should be calculated in order to ascertain whether by the time of its launch the project will have a return on initial investment. The purpose of capital budgeting is to analyze the proposed cash flow attributable to the new project and to decide whether adopting it (increasing client base) will add value to the firm. To achieve that, the management should transfigure the cash inflows expected in future to current-value equivalent. The simulator shows substantial increments in cash flows in SNC’s financial statements over the three-year phase. The historical sales figures for instance in the periods 2010-2012 remain stagnant and dismal. However, with the decision to expand and tap into the company’s wide clientele, the sales seem to increase as projected by the simulator in the present (2013-2016) and future periods (2016-2022). We will write a custom essay sample on Harvard Business Simulation or any topic specifically for you Only $17.96 $11.86/pageorder now The increase in sales directly influenced the earnings before interest and tax (EBIT). The decision to take on new customers has led to fundamental increases in EBIT consistently in the three-phase period. As expected, the net income increased due to increased sales in the phase one of the launch and subsequent phases. Moreover, there was a considerable increment in the free cash flow available to the company. Capitalizing on Supplier Discount An effective supply chain adopted by the organization is vital in maximizing profits of the firm. An effective supply chain would mean that good relations exist between the firm and the suppliers in question. Discounts on inventory from suppliers would mean that the company is able to purchase more at a lower cost. That is, lower opportunity costs in the sense that the saved cash will be redirected to other investment opportunities to draw additional revenue. The decision made is to undertake bulk purchasing in order to get discounts from the suppliers. It is however, imperative to note that the discounts will be ineffective if the level of stock turnover is lower. The rate of stock turnover should be high enough so that SNC can leverage on the discounts accorded to them by the suppliers. The simulator projects increases in the sales margins in the present and future phases as opposed to historical trading phases of the organization.