Читать книгу Understanding Anatomy and Physiology in Nursing - John Knight - Страница 46

Mary is 72 and has become extremely unwell over the last 24 hours. She has become increasingly breathless and is expectorating green sputum. She was seen by her GP who sent her into her local hospital as an emergency admission. On admission, Mary was fully conscious and alert but slightly confused. Her temperature was 38°C, her heart rate was 125, her blood pressure 110/58, respiratory rate 26 breaths per minute and oxygen saturation 92 per cent on room air. Mary’s vital signs were recorded using the NEWS 2 (National Early Warning Scoring) system (Royal College of Physicians, 2017) and her total score was calculated as 11. Any score of 7 or above should trigger an emergency response by a clinical team with experience in caring for critically ill patients.

Mary was seen by the critical care outreach team and transferred to the High-Dependency Unit where the Sepsis Six Pathway (Sepsis Trust, 2019) was initiated: oxygen was administered, blood cultures were taken, intravenous antibiotics were commenced and a urinary catheter was inserted to measure Mary’s urine output accurately. Serial lactates were checked. A raised serum lactate (> 4 mmol/L) is associated with a significantly increased mortality rate. Lactate levels rise during sepsis from both aerobic and anaerobic sources as well as reduced lactate clearance. Mary gradually recovered and was able to return home two weeks after her admission.

Mary’s case study highlights that although sepsis is immediately life-threatening, if it is recognised early and treatment initiated quickly, even elderly patients can recover.

Not all bacteria are pathogenic or harmful; indeed, some are essential to human survival and health. Bacteria are found in huge numbers within and on the surface of the human body where, together with other microorganisms, they form the microbial biome. It has been estimated that there are around 23 times more bacterial cells associated with the human body than human cells, and although it has been known for a long time that certain bacteria such as those found in the colon play key roles such as synthesising vitamin K (a key clotting factor), the complex roles of the microbial biome are still poorly understood.