Adult Meningococcal Septicaemia
Julie Blackman

Profile of Lecturer
Download Powerpoint version of this lecture
Reference List

Click on the images to enlarge slides.

Slide 1 Adult patients with meningococcal septicaemia display varying degrees of symptoms but in many cases progression of the disease can be rapid and lead to life threatening sequalae. The meningococcus bacterium invades the blood stream and endotoxins initiate the release of a complex cascade of chemical mediators which lead to the manifestations of septic shock - hypotension, hypovolaemia with vasodilation and severe capillary leak and metabolic acidosis. This ultimately may lead to multiple organ failure. The following slides describe an overview of the first 6 hours spent in Intensive Care of one such patient and look at the nursing role in the care of that patient.

Slide 2 The patient presented to the unit self ventilating. Oxygen requirements were minimal and peripheral oxygen saturations good. The patient was talking coherently but was in some discomfort and appeared frightened. Vital observations showed an acceptable blood pressure, slight tachycardia, normal respirations. Patient had already received a dose of antibiotics. The patient was pyrexial and the skin felt hot to the touch. Urine was being produced but in small amounts. Rapid fluid infusion was in progress and a low blood sugar was being treated with 50% dextrose. A widespread purpuric rash was already in evidence. Family were with the patient. The initial stages of admission for any ICU patient are invariably fraught with activity. Experience has shown that this is particularly the case with this type of patient when septic shock can progress with devastating speed. Having two nurses available, one to support patient and relative and one to manage supportive therapies and assist medical staff, is a necessity not a luxury. Close observation and monitoring, with aggressive fluid resuscitation to maintain blood pressure and organ perfusion plus support of patient and relative, are the primary goals for the nurse at this point.

Slide 3 Patient continued to self ventilate with good oxygen saturations but breathing pattern was becoming more shallow, rate more rapid and increasing drowsiness was evident although the patient remained conscious. Vital observations heart rate (HR),invasive blood pressure (BP) and central venous pressure (CVP) indicated increasing vascular collapse and required further fluid filling to improve hypovolaemic state and introduction of an inotrope agent - noradrenaline which acts to vasoconstrict a very dilated vascular system. Both these measures aim to improve BP. Using low dose steroids is likely to increase the patients responsiveness to noradrenaline. The patients negligible urine output is a sign of significant renal dysfunction. During this time close monitoring by the nurse with frequent reporting to the medical staff highlights the rapidly ensuing multi organ failure. Frequent assessment of the purpuric rash and any digit involvement is vital with checking of patients back a must. Talking to patient while doing things is a way of keeping patient and family informed whilst at the bedside. Time is taken by doctor and nurse to speak with family to fully inform them of the critical nature of the situation. Nursing staff enable family to stay with patient if they wish.

1 2 3 4 next>>

Back toTop