Last updated: January 27, 2021

[social_warfare]

The new mRNA vaccines for COVID are being distributed, and as a nurse, it is important to know these vaccines, how they work, and their safety data!

Our patients respect our medical opinion, and we need to give accurate information so they can make an informed decision.

This article mainly focuses on the mRNA vaccines (Pfizer and Moderna), as they are currently the vaccines being distributed as they have obtained FDA emergency use authorization.

With these vaccines being so new – it leaves many wondering, “is it’s safe?”

I’m going to go over what the data tells us and hopefully give you enough insight into making an informed decision, and help your patients do the same!

Quick Note: I want to preface this article by first stating that I am a nurse practitioner and I see many COVID patients on the frontlines in the ED. I am not, however, an epidemiologist or scientist who works directly with COVID in a lab, so I am simply basing my own opinions on what the data says, as well as my understanding of the virus by seeing it firsthand.

1. How do mRNA Vaccines Work?

Vaccines generally work by introducing a dead or weakened virus, or part of a virus into your bloodstream via an Intramuscular or subcutaneous injection.

This creates an immune response that helps your body be able to attack the real virus whenever it comes into contact with it in the future. Typical vaccines include those with:

• A live but weakened or “attenuated” virus, which leads to a better immune response, but can actually cause the disease in very few people – mainly those who are immunocompromised.
• A dead or “inactivated” virus, in which the virus has been inactivated and is unable to replicate and cause disease. This doesn’t create as good of an immune response so it may need multiple doses or boosters. An example of this is the flu shot or hepatitis A.
• Those that contain a piece of the virus, like part of its specific protein. This also cannot replicate or cause disease. Examples include hep B, meningitis, and HPV.
• There’s also some vaccines that contain a toxoid that the virus creates, such as tetanus or diphtheria, like the Tdap vaccine.

The mRNA Vaccines (Pfizer and Moderna) actually do not inject the virus or any of it’s parts into you.

Instead, it contains mRNA which codes for the COVID spike protein – a protein specifically found on the COVID virus.

RNA is a single-stranded molecule that normally takes information from your DNA in the nucleus of the cell, and brings it to the ribosome of the cell to create proteins which basically keep the cell running and functioning appropriately.

So what scientists at Pfizer and Moderna have done is isolated the genome sequence of the mRNA which codes for the spike protein in the coronavirus, as this protein is not naturally found within your body. So what does the body do with this mRNA?

The mRNA is absorbed into your cells and carried to your ribosome where it is used as instructions to create the spike protein of COVID.

This protein cannot lead to disease, but it should lead to an immune response. Your body sees this foreign entity and creates antibodies to kill it and any future proteins it detects.

If the actual COVID virus now enters your body, your body should be able to detect it, and your immune system will target the cell and destroy it before it has a chance to replicate enough to cause disease and hopefully prevent you from spreading it.

2. Are mRNA Vaccines Safe?

This isn’t an easy question since it is so new, but so far it seems to be very safe and effective.

While mRNA vaccines have not actually been used in the US, researchers have been studying them for decades and have tested them on humans before for viruses like rabies, flu, CMV, and Zika.

In order to test the safety and efficacy of these new vaccines, clinical trials were conducted.

Pfizer and Moderna injected this vaccine into willing people and followed them for any adverse side effects, as well as those who ended up getting symptomatic COVID or severe disease.

Over 30,000 people were enrolled in the Moderna trial and over 40,000 people in the Pfizer trial.

Those who got the Pfizer vaccine get 2 injections, 21 days apart. Those who got the Moderna vaccine get 2 injections, 28 days apart.

Pfizer was tested on people 16 years and older, and Moderna was tested on adults 18 years and older.

Long story short – what they found was that most symptomatic covid cases were occurring in the placebo groups, which means those who did not receive the vaccine. Severe cases of COVID almost exclusively occurred in the placebo group!

The Pfizer vaccine boasts 95% efficacy beginning 1 week after the second dose, and Moderna boasts 94.1% efficacy 2 weeks after the second dose.

Both mRNA vaccines essentially use the same mRNA, basically the same ingredients, and both had very similar findings in their trials. This in and of itself is reassuring and offers an element of reproducibility.

The data from these trials are overall VERY reassuring. You can read more about the Pfizer or Moderna trials to get more information!

3. What Side Effects Can be Expected?

Common side effects include local injection site pain, headache, and fatigue. These vaccines should not cause COVID symptoms such as cough or SOB. It is impossible for these vaccines to cause actual COVID disease.

These vague side effects are common and expected when getting a vaccination, and are often an indication of the body’s immune response. They are short-lived and not severe.

Symptoms after the first injection tend to be less severe, and symptoms after the second injection were more significant – although both were very short lived (1-2 days).

Anecdotal Note: I have received both injections from the Moderna Vaccine. After the first shot, I had arm soreness which was worse than a typical vaccine, but resolved over 1-2 days. The day after my second injection, I had body aches and fatigue which resolved by the next day.

These symptoms seem common based on my colleagues experiences as well. Those who had symptomatic COVID anecdotally reported worsened symptoms after the first dose, although still short-lived.

Are all side effects mild and short-lived? We’ll dive more into that in future questions!

4. Can the mRNA Vaccines cause Anaphylaxis?

Just like any medication or vaccine, allergic reactions can occur.

Anaphylactic reactions have occurred after COVID vaccine administration, although not common, and seem to mainly occur in those with a history of severe allergies.

Overall it seems to be very rare – 11 people per million. Regardless, we know how to treat anaphylaxis and allergic reactions very well – Benadryl, Solumedrol, and Pepcid!

The CDC recommends those without a history of anaphylaxis to wait 15 minutes after their injection for monitoring, and those with a history of anaphylaxis to wait 30 minutes – just to be on the safe side.

Related Article: “Adverse Drug Reactions Nurses Need to Know”

5. Can the mRNA Vaccines cause Facial Paralysis?

Bell’s palsy is unilateral facial paralysis that can occur, which is usually temporary.

In the COVID vaccine trials, there were 7 reported cases of Bell’s palsy, in the over 70,000 participants in Pfizer/Moderna’s clinical trials.

While there were slightly more cases in the vaccine groups than the placebo groups, this rate is consistent with bell’s palsy rates in the general public, so likely not statistically significant.

However, some viruses and vaccines have been associated with bell’s palsy in the past, although rare.

Even if there is a small rare chance of the COVID vaccine causing Bell’s Palsy – it is usually temporary and treatable, and the benefits outweigh the risks.

Related Article: “The Cranial Nerve Assessment for Nurses”

6. Can the mRNA Vaccines cause COVID?

No – it is physiologically impossible for it to cause COVID disease.

Vaccines that contain live “weakened” viruses do have the capacity to cause disease in those who are immunocompromised – an example being the MMR vaccine.

However, those with only pieces of the virus or mRNA that code for pieces of the virus cannot cause COVID. So mRNA Vaccines cannot cause COVID illness.

7. Will these Vaccines cause False Positive Results on Testing?

No, the vaccine should not alter PCR or antigen testing. Test swabs collect viral particles and test for their genetic code. These swabs are collected from areas where you are expressing the virus, like the nasopharynx.

While the mRNA causes your cells to produce the COVID spike protein, they are not expressed or spread outside of your body.

The PCR and antigen tests check for active infection and do not check for antibodies. The vaccine should not alter these test results. 

8. Do the Vaccines Change your DNA?

No. Only specific viruses can alter your DNA. These viruses are called retroviruses and require a specific protein called reverse transcriptase.

The mRNA in the COVID vaccines do not alter your DNA in any way.

9. Do the Vaccines Contain a Microchip?

No – this is nonsense and I’m not really sure what else to say about it.

10. Do the mRNA Vaccines cause Infertility Issues?

There is no convincing evidence to suggest that the mRNA vaccines cause infertility.

This idea was picked up and used by anti-vax propaganda. This myth started when a German Epidemiologist and a former Pfizer employee asked the FDA to not grant authorization to use the vaccine.

They said that the COVID vaccine’s mRNA is similar to the syncytin-1 protein which is used in mammals to help create placenta during pregnancy.

While the proteins do share a minimal amount of similar code, the scientist and medical community at large reject the notion that it could cause infertility.

While it is still so new – it cannot be said with certainty because we don’t have the data. However, 23 women did conceive during these trials, and they are still being followed.

11. Can Pregnant Patients Get an mRNA Vaccine?

This is a decision that should be discussed with the patient’s OBGYN, and they can come to a decision together.

The clinical trials did not study vaccination in pregnant mothers, so we don’t have specific data regarding pregnant individuals. There were some animal studies that looked promising.

The American College of Obstetricians and Gynecologists (ACOG) recommends that COVID-19 vaccines should not be withheld from pregnant individuals who meet the criteria for vaccination based on priority groups. 

This means it is likely a good idea for pregnant mothers who are at an increased risk of getting COVID to get the mRNA vaccine.

What we do know is that pregnant mothers are at increased risk from side effects and complications if they get COVID.

They are more likely to be hospitalized, placed in the ICU, ventilated, and die than if they weren’t pregnant.

12. Can Breastfeeding Mothers get the Vaccine?

Again – this decision should be made with the patient’s OBGYN and Pediatrician.

There is just not enough data studying this to make a sweeping recommendation.

It is unlikely that the vaccines would be unsafe for the baby, and there is a possibility of passing on some passive immunity obtained from the vaccine to a breastfeeding infant.

13. Can those with Autoimmune Diseases get the Vaccine?

While there doesn’t appear to be any specific contraindications, this is something that should be discussed with the patient’s physician / Rheumatologist.

The risks of getting symptomatic COVID may be worse than the risks of getting the COVID vaccine.

14. Should Patients who had Symptomatic COVID get the Vaccine?

The idea is that if you had symptomatic COVID – you should have natural antibodies already for the virus – so why get the vaccine?

This is a decision you have to decide on with your Provider. It likely won’t hurt and could help, so the CDC is in favor or those who had COVID to also get vaccinated.

While it may be recommended to wait 90 days after symptomatic covid for the infection, this is not a rule and there is no specific timeline established.

This is more to allow those who have not built any immunity to receive the vaccine first.

You should get the vaccine after you recover from symptomatic COVID and when you feel it is appropriate.

Related Article: “These 8 COVID nursing tips could save your life”

15. What if you or your Patient doesn’t get the Vaccine?

As of today COVID has killed over 400,000 people in the US and 2.15 million people worldwide. This number is rising very quickly.

Even if COVID doesn’t kill you or your patients, it can cause many long-lasting side effects.

During an active COVID infection, it can cause multifocal pneumonia and respiratory failure leading to hospitalization, ventilation, and possibly death.

Severe COVID can also cause blood clots leading to pulmonary embolisms and embolic strokes.

It can cause inflammation of your brain and heart as well, leading to irreversible damage in some cases.

There have been observational studies done which show that up to one-third of patients who had symptomatic COVID had persistent symptoms after resolution of the virus. These include:

• Fatigue
• Dyspnea (Shortness of breath)
• Chest Pain
• Cough
• Anosmia (loss of smell)
• Ageusia (loss of taste)
• More (joint pains, headaches, myalgias, etc)

There may still be other long-term side effects that we still don’t know about. 

So what’s riskier? Getting a vaccine that seems to be very safe and doesn’t seem to have any serious long-lasting side effects, or take your chances with getting COVID?

I can’t make that decision for you or your patients.

But if you do decide to get the vaccine, what can you expect?

16. If you get the Vaccine, What can you Expect?

You can expect to get 2 injections, 21 days apart with Pfizer or 28 days apart with Moderna.

The full efficacy seems to be established about 1-2 weeks after the second injection, depending on the vaccine (1 week after Pfizer, 2 weeks after Moderna).

These were the timelines studied in the clinical trials.

17. Can I Stop Wearing Masks and Social Distancing once I’m Vaccinated?

Well – no, not immediately.

Remember that even a 94-95% efficacy still leaves that 5-6% of people who will still get symptomatic COVID.

These people will likely be contagious, and they still could get severe COVID and have to be hospitalized or worse.

Secondly, both Pfizer and Moderna require 2 shots before full efficacy is expected. The body takes time to build up an antibody response. It can take 1-2 weeks after the second dose for full efficacy.

Additionally, it has not been proven by evidence that these vaccines prevent you from spreading COVID. The trials only prove that they are 94-95% effective at reducing symptomatic COVID.

That’s right. Even if you don’t get symptomatic COVID – you could possibly spread it.

18. Could you get the COVID vaccine and be an Asymptomatic Spreader?

Theoretically, it is unlikely that you will be spreading the virus after vaccination.

Hopefully, your body has created an immune response and antibodies which will attack COVID before it can replicate and cause disease or be contagious.

HOWEVER – we don’t have the data to back this up, and there another important consideration – Mucosal Immunity.

We don’t know how well the antibodies penetrate the nasal mucosa. There is a possibility that the virus can still replicate in the mucosa of your nasopharynx.

While it may not cause symptomatic disease since you should have circulating antibodies – you might still spread it to others when coughing, sneezing, or even breathing.

This is something that we should have more data on soon.

This is why it is imperative to continue to wash our hands, wear our masks, and practice social distancing.

19. When will Herd Immunity be Established?

It is going to take some time for the majority of the US to become vaccinated.

This means we need about 70%+ of the population to be vaccinated or infected before some type of herd immunity can be expected and established.

Herd immunity occurs at different percentages of vaccinated/infected individuals based on each specific virus.

This number is unknown for COVID, but experts say at least 70% need to be vaccinated and/or infected for some type of herd immunity to protect us.

It is unlikely that mask mandates and social distancing will become a “thing of the past” until we get to this point.

20. Will the mRNA Vaccines Cover the New Strains?

Unfortunately, there are multiple mutated strains or variants popping up in the UK, Africa, and other places.

These strains are spreading fast as they are more contagious (30-70% more transmissible).

However, these don’t necessarily seem to be more deadly. However, with surges in COVID cases and hospitalizations, increased deaths could occur due to the burden put on the healthcare system.

As far as we know, these vaccines should be effective against these mutated variants.

However, preliminary data does suggest that the vaccines may not work as well against the South African variant! Just in case, Moderna has already begun production on a “booster shot” which would specifically target these variants.

21. How Long will Immunity Last from these mRNA Vaccines?

As mentioned above – complete immunity is not guaranteed.

However, if antibodies are created, it is unknown how long they will last.

What we do know is that immunity wanes over time. Those who get symptomatic illness tend to build a better immune response than those who get vaccinations.

Many patients who had symptomatic COVID in early 2020 still have antibodies – this is good news!

We don’t know how long immunity will last, and we don’t know how much further mutations will alter the effectiveness of the immunity.

22. Are there other Vaccines Available?

Pfizer and Moderna are mRNA vaccines which have already obtained emergency use authorization (EUA) from the FDA.

There are two other vaccines that may obtain approval as well. These are not mRNA vaccines. They include:

• Johnson & Johnson, which uses adenovirus to carry genetic material for COVID
• AstraZeneca, which uses a chimpanzee adenovirus to do this

These do not appear to be as effective as the mRNA vaccines, but may still prove helpful, and we must continue to follow the data.

Production and distribution of the mRNA vaccines will prove tough, and additional effective vaccines will be helpful!

So Should you or your Patient get the Vaccine?

That’s for you to decide, based on the data and taking into account what your physician or healthcare provider recommends.

Additionally, it is for your patients to decide based on informed consent.

It is not your job to judge them or tell them what to do. All you can do is offer evidence-based recommendations and up to date information, and allow them to make that decision for themselves.

You can also lead by example and get the vaccine for yourself, trusting the science and once again being that hero that we were once called in the beginning of this pandemic.

I think frontline workers and those with a high risk should seriously consider getting vaccinated.

As far as everyone else – that’ a decision you (or they) have to make, but the data looks promising and this could be our chance at returning to a state of semi-normalcy.

Note: If you want more information – you should follow Dr. Kat the Epidemiologist on TikTok! She creates great content backed in science on all things COVID and mRNA Vaccines!

I got my vaccine! Did you? Why or why not? Let us know in the comments below!

You might like: “These 8 COVID nursing tips could save your life”

[social_warfare]

Early sepsis– while not clearly defined – is the presence of infection and bacteremia – which can and likely will progress to sepsis without intervention. Sepsis used to be identified using SIRS criteria– Systemic Inflammatory Response syndrome. This syndrome is defined as the presence of at least 2 of the following 4 clinical indicators: Fever >38C or <36C, HR >90bpm, RR > 22/min or PaCO2 <32 mmHg, or WBC >12,000/mm3, <4,000/mm3, OR 10% BANDS. Once SIRS is identified with suspected source of infection – sepsis diagnosis was met. However, the definition of sepsis has changed with 2016. Sepsis is now is defined as life-threatening organ dysfunction in response to infection. Organ dysfunction, usually from hypoperfusion, can be evidenced by hypotension, altered mental status, tachypnea, or increased sofa score by 2 points (see below).  Septic shockis defined as those patients who have received fluid resuscitation and still have a MAP <65 mmHg and a lactic >2.0 mmol/L. These patients require vasopressors and should be monitored in the ICU.

Sepsis can be very serious and even fatal. Because of this – it is important to kn ow the steps to take in sepsis management. Performing these correct steps can literally mean the difference between life and death.

1. Recognition and Early Intervention

The most important aspect of sepsis management is recognizing it’s presence and acting quickly. Common symptoms of sepsis include fever, chills, sweats, and confusion. Common signs include altered mental status, elevated temperature, tachypnea, tachycardia, and hypotension.

Initial management should include investigating the extensiveness of their infection, and applying initial measures to help them. After vital signs are taken an IV should be established and lab work drawn. If the patient’s blood pressure is low – consider starting 2 large-bore IVs. Be sure to draw at least 1 set of blood cultures per IV site (up to 2) as this will need ordered in all sepsis patients. Make sure the blood cultures get drawn before antibiotics are started.

Diagnostics should investigate the source of the infection – sometimes it is not obvious. If unsure – it is a good idea to obtain a urinalysis with culture to r/o UTI and a Chest x-ray to r/o pneumonia should be ordered. A wound culture, sputum culture, or abdominal imaging may be ordered if clinically indicated. Blood work will usually include blood cultures x 2, CBC with differential, CMP, and a lactic acid level. Sometimes in severe cases, an ABG can be ordered to evaluate acid-base status.

Lactic acid levels are very important in sepsis. Lactate is released from cells when they are forced to utilize glycolysis instead of the Kreb’s cycle (throwback to Cell Biology!). This means that there is decreased tissue perfusion due to decreased volume, increased oxygen demand, and decreased oxygen delivery. Lactic levels correlate with severity of sepsis.

Apply oxygen at 2 L/min unless contraindicated – titrate if SPO2 <92%. During sepsis, oxygen demand increases and delivery diminishes. Supplemental oxygen will help put less stress on the body and may help diminish lactic acidosis.

The qSOFA (Quick Sequential Organ Failure Assessment) score is now starting to be used as a clinical tool for sepsis. This is usually used within the hospital to stratify the mortality of patients with sepsis (see infographic for more details).

2. Fluid Resuscitation!

Fluid resuscitation during sepsis is the staple of sepsis management. Evidence shows early fluid intervention decreases mortality. There is such a massive need for fluid because during sepsis there is poor tissue perfusion and often hypovolemia. To correct this – large amounts of fluids are needed.

Typically, 0.9% normal saline is used 9 times out of 10. The recommended standard volume is a 30 ml/kg bolus. So if a patient was 70 Kg, they would receive 2100 ml total. This should be given as quickly as possible – as tolerated. This amount is typically given to anybody recognized as possibly having sepsis, but is especially indicated in those with sever sepsis, fast heart rate, or low blood pressure. Traditionally even larger amounts of fluids were given (5-6 Liters), but several randomized control trials showed no difference in mortality compared with the now-recommended 2-3 Liters.

Exceptions to receiving this bolus includes those with active pulmonary edema. Those with a history of Heart Failure, end-stage renal disease, or severe liver disease should still receive fluids. However – it is recommended to give fluids in 500mL bolus increments and to reassess lung sounds and breathing status after each bolus. If pulmonary edema ensues – the bolus should be stopped and the patient may need diuretics.

3. Timely Antibiotic Administration

Another very important aspect of sepsis management is early antibiotics. The term empiric simply means antibiotics based on the best “clinical guess”.

The choice of empiric antibiotics will be selected based off of the patient’s signs or symptoms and where the likely source – since certain organisms are more likely from one source as opposed to another. This means the antibiotic regimen should be geared towards covering all likely gram-positive and gram-negative organisms. For sepsis – usually a broad spectrum antibiotic like Zosyn or a Carbapenem is combined with another antibiotic of a different lass – such as Vancomycin. Vanco is often added when the patient has risk factors for MRSA.

Correct regimen of antibiotics are important – however timely administration of those antibiotics are just as important. Antibiotics should be initiated within the first hour after suspecting sepsis – especially during severe sepsis or septic shock. This is because several observational studies have shown poorer outcomes with delayed antibiotic initiation. Once again, try to be sure you obtain both sets of blood cultures before you start the antibiotics!

As nurses, it is often up to you to choose which antibiotic to start first as both are often ordered concurrently. If you have both Zosyn and Vancomycin ordered – start with the broad-spectrum antibiotic first. But what exactly is broad-spectrum? This means heavy-hitter antibiotics that cover most pathogens – both gram positive and negative. Contrary to popular belief – vancomycin is NOT broad-spectrum. In fact, it has a very narrow spectrum specific for gram positive organisms such as Staph or Strep. Most cases of sepsis are from gram negative sources. This means starting the Zosyn first should be your priority. Additionally – Zosyn runs much quicker as a loading dose (4.5 grams over 30 minutes) – whereas vancomycin usually runs over 1.5 hours.

4. Hemodynamic Management

Sometimes when sepsis becomes severe – distributive shock can occur. This is termed septic shock. When this occurs – hemodynamic compromise is present.  If blood pressure remains low, the patient’s tissue perfusion continues to suffer and steps need to be taken to improve outcomes.

The patient may require more fluid if they are still hypovolemic after the initial bolus and can tolerate more fluids. However, the mainstay of treatment of septic shock is intravenous Vasopressors. For the most part – Norepinephrine (Levophed) is the go-to pressor for sepsis. However, other choices can be chosen based on clinician discretion (i.e. If very tachycardic consider Vasopressin which has no beta stimulation). Sometimes, multiple vasopressors may need to run concurrently to manage septic shock.

When a patient is in septic shock with hemodynamic compromise – they should have a central venous catheter inserted and/or an arterial line. Vasopressors can be started in a peripheral line, but a central line should be ordered as vasopressors can be caustic and damaging to the peripheral vasculature. Additionally, these catheters can monitor CVP and continuous blood pressures. If a patient is in cardiogenic shock and has inadequate cardiac output – cardiac inotropes can be added such as dobutamine or epinephrine.

Sometimes during severe septic shock, IV glucocorticoids may or may not help. Usually this is ordered if fluid resuscitation and vasopressors have failed.

5. Monitoring

Monitoring is the essential last step to sepsis management. Patient’s with sepsis can respond well to the regimen – or they can decompensate unexpectedly. Sepsis has a high mortality and the patient’s should be monitored very closely.

If the patient has any hemodynamic compromise and are on pressors – they should be monitored in the ICU for a few days until they become stable. Patient’s with mild to moderate sepsis should be closely monitored on a med-surg or telemetry floor. Continuous cardiac monitoring is essential during sepsis. The increased tissue demand for oxygen places the heart at a greater risk for having cardiac events secondary to the sepsis. It is not uncommon for someone with sepsis and cardiac comorbidities to have secondary myocardial ischemia and/or infarctions.

Blood pressure should be monitored closely – especially initially. Normotensive blood pressure should be maintained (SBP >100). However – maybe even more importantly the MAP (mean arterial pressure) should be monitored closely. The goal of MAP should be >65mmHg – this ensures adequate tissue perfusion (i.e. brain). Heart rate is also an important metric to monitor. Tachycardia is usually present – often in the 120s-130s during fever and sepsis – sometimes higher. While giving fluids – heart rate should improve. This can be somewhat helpful in monitoring the response of fluid therapy. Fever should be monitored as well – as sometimes it can become very high and increases insensible water losses and further propitiates hypovolemia. Remember a rectal temperature is preferred in those with suspected sepsis – especially the elderly. Urine output is also often monitored during severe sepsis – as secondary hypoperfusion of the kidneys can cause acute kidney injury and decreased urine output.

Nursing assessments should include skin color and perfusion, mucous membranes (i.e. dry vs moist), mental status, and heart/lung sounds. Nurses should be vigilant in recognizing flash pulmonary edema or cariogenic shock which may develop after rapid administration of fluids with underlying comorbidities (i.e heart failure, ESRD, etc). 

If the initial lactic acid level is elevated > 2 mmol/L, then a repeat level should be drawn in 4 – 6 hours. The lactic acid level should respond quickly to changes in tissue perfusion. CBC should be trended each day to monitor for resolution of the leukocytosis, bandemia, and/or thrombocytopenia. Electrolytes and kidney/liver function should also be monitored closely dpeneding on which abnormalities are present.

6. Patient Disposition and Follow-Up

Last but certainly not least – the patient needs to be sent to the correct unit, needs the correct consults, and needs adequate follow-up. Almost all patients admitted to the hospital with sepsis will warrant an Infectious Disease consultation. Additionally, if they have any pre-existing comorbidities these consults should be made as well (i.e. cardiology for heart failure, nephrology for kidney disease).

Patients should have frequent nursing assessments and daily physician assessments, with close follow-up of labs. Blood cultures can start showing growth at about 24 hours. The pathologist will gram-stain the growth and give a report of “gram positive cocci” a similar description. This tells the clinician if they are on the right track and can guess at the offending organism. At about 48 hours, most clinically significant bacteria will be identified and a sensitivity is done to detect the bacteria’s sensitivity vs resistance to various antibiotics. Urine, wound, and sputum cultures have similar timelines. Antibiotics may be changed depending on the results. Remember, Infectious Disease should likely be involved in this decision.

And those are the six steps to sepsis management. Knowing the general steps to sepsis can help you as the nurse provide high quality care to your septic patients and help improve outcomes. As always, it is a collaborative team effort in offering you patients the best possible care.

Do you have any other sepsis tips? leave them in the comments below!