The topic on end of life care is always a sensitive subject for individuals because even though everyone knows that death is an inevitable part of the journey in life, it is an avoided topic due to the fear, sadness and grief that it brings to an individual, a family and even to a whole community. I believe that the topic of end of life is totally driven by the person’s beliefs and values.

Personally, I have not spent much time thinking about the matter, partly because I am young and the thoughts that currently occupy me are about loving God, enjoying life to the fullest, loving my family, having a successful career, and eventually starting my own family. However, if I were to decide now on what I would want in my living will and health proxies, I would definitely want the healthcare team to do everything they can to resuscitate me. This is because since I’m a fairly young individual, I believe I have a better prognosis if ever was in a situation where I was critically ill. In regards to who I can lean on to help me make crucial decisions regarding my care and life, I would choose both my parents in assisting me making the right decisions. I believe that both my parents would make the right decisions because I know that all they want is what is best for me. When my parents and I had this type of discussion, they actually voiced their opinion that yes, they would choose being resuscitated and have the healthcare team do everything they can to maintain life, instead of allowing the person to become DNR.

Like other families, our conversation was not smooth sailing because as previously mentioned, death is a sensitive topic for people to discuss.On the contrary, my classmates and I have actually discussed the topic as part of an assignment and we were able to talk about it without any sense of uneasiness.Based on my experience, I believe that in order for the discussion of end of life to be less stressful, it must be brought up at a time where everyone is at a place where their hearts and minds are not occupied with other stressful things in life. This is because bringing up this topic where people are not in a place of comfort will further add a burden to their hearts.

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I think the best way to address sepsis conditions is to PREVENT IT! We as healthcare providers take many precautions for our patients, but we can take it to another level with sepsis prevention protocols. Mortality is HIGH in sepsis conditions, from 30%-60%, so prevention is crucial and can save lives. In researching sepsis prevention, I found the following points and interventions:

• Hand Hygiene and aseptic technique as per protocol
• Avoid trauma to mucosal surfaces that can be colonized by bacteria
• Use Prophylactic topicals and sprays to prevent nosocomial infections
• Attention to DVT
• Note: Protective environments for patients at risk have not been considered successful because most infections have endogenous origins.
• Prevention of ventilator-associated pneumonia:
  • Use sedation vacations and bundle protocols:
    • Elevate HOB
    • Peptic ulcer prophylaxis
    • Preventing oral-tracheal contamination
    • Use of continuous-suctioning endotracheal tube
    • Perform oral care every 2 hours
  • Prevention of venous catheter-related bloodstream infections (Central Line Bundle):
    • Use maximum barrier insertion precautions and daily review of line necessity/removal
  • Surgical site care:
    • Pts with surgical site infections are 60% more likely to be in ICU, spend 7+ more days in hospital and 2x mortality rate; avoid shaving and give prophylactic antibiotics 1 hr prior to procedures. Maintain aseptic technique when changing dressings; pay close attention to normothermia and blood glucose control.
  • Prevent UTIs:
    • 25%-40% of UTis occur in pts with foley > 7 days;
    • Maintain aseptic technique, dependent drainage, minimize manipulation of drainage system.

It is interesting to note that there is contradicting information regarding patient isolation and if it is beneficial to patients, as most infections are considered to have endogenous origins.

I remember a senior last year whose project included tallying healthcare workers as they entered/existed a patient’s room to see if they performed proper hand hygiene. The fact that she observed any percentage of non-compliance shows that the simplest preventions can be overlooked. If a nurse cannot remember protocols, a flow-chart or check list should be followed. Additionally, printed “bundle” protocols can usually be found in every facility.

Sepsis is defined as a state of complete inflammation of the body found to be associated with a known or suspected infection.

Sepsis is a spectrum, the patients start with more mild symptoms and progress to more severe symptoms. At the severe end is septic shock. The first category is Systemic Inflammatory Response Syndrome or SIRS.

The patient must have 2 or more of the following symptoms to be considered septic:

They have a temperature above 100.5 degrees Fahrenheit or less than 96.8 degrees Fahrenheit, a heart reate above 90, a respiratory rate above 20 or PaC02 less than 32 (normally it’s 40), WBCs greater than 12,000 or less than 4,000 or greater than 10% band cells. If they do have two or more of these present or infection, then the protocol for sepsis is put into place and notify the physician, charge nurse, and have a secondary screening done.

Severe sepsis is sepsis plus some symptoms of end organ damage, lactic acid greater than 4, or systolic BP below 90.

Septic shock means that the healthcare team has done things to treat the hypotension like IV fluid boluses, steroids, evaluated lactic acid and the patient still has hypotension and needs pressors. This is when the patient has organ damage potential

At Cottage Hospital, the policy for sepsis has a well-known acronym called SLAY SEPSIS. The first word stands for Sepsis, Lactate/Labs, Activate the team/Antibiotics, Yell for fluids.

The second word stands for Straight to critical care, Early goal-directed treatment, Pressors, Scv02 Monitoring, Insulin, and Source Control/Steroids.

It is important to recognize sepsis early when it is reversible and before it advances to septic shock and irreversible failure of multiple organ systems. In fact, early recognition is soon to be a core measure.

Sepsis Questions and Answers”. cdc.gov. Centers for Disease Control and Prevention (CDC). May 22, 2014. Retrieved 27 October 2015

Cottage Health (n.d.). SLAY SEPSIS Resuscitation Protocol.

I found this online, and I thought it was a really neat tool to use and one that seems easy to utilize as well. Being aware of the warning signs before sepsis actually develops in the patient is ideal and we should be continually assessing our patient.

Any change in LOC, delirium, respiratory changes, (such as hyperventilation or shortness of breath) fever, and low blood pressure can all be signs of septicemia.

Take a look at the link below to see the interactive sepsis tool that one hospital uses to identity and care for patients with sepsis.

http://www.survivingsepsis.org/SiteCollectionDocuments/Protocols-St-Helens-Adult-Sepsis-Management-Pathway.pdf