Nursing Care of patients with Septic Shock and Acute Respiratory Failure in Emergency : Comparative Case Study

Abstract

Purposes: This study aims to compare nursing care for patients with septic shock and acute respiratory failure during the emergency phase, and to examine the outcomes and propose nursing guidelines for patients with septic shock and acute respiratory failure in two case studies.

Study designs: Comparative Case Study.

Materials and Methods : This study reviewed patient data on septic shock and acute respiratory failure in the emergency room. Data was collected using the FANCAS assessment tool and Functional Health Pattern assessment, and analyzed using content analysis.

Main findings : Case Study 1: A 77-year-old Thai female patient presented to the Emergency room with fatigue, shortness of breath, and diarrhea 9 hours prior to arrival. In ER BT 40.5 °C, PR 148 bpm, RR 34 bpm, and BP 86/57 mmHg. DTx. 294 mg/dl. She was diagnosed with Infective Diarrhea, Septic Shock, and Acute Respiratory Failure. She also had hypoxia and was ETT intubated, critical care was administered at the Emergency Room for 4.25 hours until her condition stabilized. She was then transferred to the Intensive Care Unit (ICU) for another 5 days until her condition improved, and she was discharged to home.  Case Study 2: A 73-year-old Thai male patient presented to the Emergency Room with fever, chills, and confusion one day prior. In ER, BT 38.8 °C, PR 134 bpm, RR 20 bpm, and BP 88/51 mmHg. DTx. was 244 mg/dl. He was diagnosed with septic shock and acute respiratory failure. He also had hypoxia, was intubated, and received critical care for approximately 4.18 hours in the Emergency Room until his condition stabilized. He was then transferred to the Intensive Care Unit (ICU) for another 6 days until his condition improved, and he was discharged to home.

Conclusion and recommendations : The nursing model for patients with Septic Shock and Acute Respiratory Failure in the Emergency Phase has a good outcome and can serve as a guideline for nursing care of such patients. Emergency department nurses must have knowledge and specific competency on the goals of Early Gold-Directed Therapy (EGDT) within 1 or 6 hours (1 or 6 hour bundle), within the hospital agreements of the team. Emergency department nurses and ward nurses themselves need to receive training in the knowledge, competencies, and skills of caring for Septic Shock and Acute Respiratory Failure patients. This includes the use of patient assessment tools such as the National Early Warning Score (NEWS Score) or other critical care assessment tools like qSOFA and SOFA Score to monitor the multi-organ dysfunction and the risk of death from sepsis. Ward nurses should also receive training in using assessment tools to detect warning signs of severe sepsis before it becomes septic shock or critical such as Search out Severity Score (SOS).