Helping children survive sepsis

while a vast amount of research and literature is available regarding the treatment of pediatric sepsis, the opportunities for continued investigation are innumerable. As research progresses, nursing practice must remain current to provide patients with interventions based on the strongest evidence available. ■ REFERENCES 1. Hartman ME, Linde-Zwirble WT, Angus DC, Watson RS. Trends in the epidemiology of pediatric severe sepsis. Pediatr Crit Care Med. 2013;14(7):686-693. 2. Farris RW, Weiss NS, Zimmerman JJ. Functional outcomes in pediatric severe sepsis: further analysis of the researching severe sepsis and organ dysfunction in children: a global perspective trial. Pediatr Crit Care Med. 2013; 14(9):835-842. 3. Dalton HJ, Carcillo JA, Woodward DB, Short MA, Williams MD. Biomarker response to drotrecogin alfa (activated) in children with severe sepsis: results from the RESOLVE clinical trial. Pediatr Crit Care Med. 2012;13(6): 639-645. 4. El-Wiher N, Cornell TT, Kissoon N, Shanley TP. Management and treatment guidelines for sepsis in > pediatric patients. Open Inflamm J. 2011;4(suppl 1-M11):101-109. pediatric septic shock. Pediatr Crit Care Med. 2011; 12(2):133-136. 5. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2): 580-637. 12. Zimmerman JJ, Williams MD. Adjunctive corticosteroid therapy in pediatric severe sepsis: observations from the RESOLVE study. Pediatr Crit Care Med. 2011;12(1):2-8. 6. Aitken LM, Williams G, Harvey M, et al. Nursing considerations to complement the Surviving Sepsis Campaign guidelines. Crit Care Med. 2011;39(7): 1800-1818. 13. Kleinpell R, Aitken L, Schorr CA. Implications of the new international sepsis guidelines for nursing care. Am J Crit Care. 2013;22(3):212222. 7. Goldstein B, Giroir B, Randolph A. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6(1):2-8. 14. Levy MM, Dellinger RP, Townsend SR, et al. Surviving sepsis campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Crit Care Med. 2010;38(2):367-374. 8. Brierley J, Carcillo JA, Choong K, et al. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med. 2009;37(2): 666-688. Mary K. Duffy is a clinical manager at Gilchrist Kids in Hunt Valley, Md. and Patricia A. Moloney-Harmon is a clinical nurse specialist in Children’s Services at Sinai Hospital of Baltimore, Baltimore, Md. 9. Cruz AT, Perry AM, Williams EA, Graf JM, Wuestner ER, Patel B. Implementation of goaldirected therapy for children with suspected sepsis in the emergency department. Pediatrics. 2011; 127(3):e758-e766. This article, which has been updated and adapted, originally appeared in Nursing2014CriticalCare. 2014;9(5):41-46. 10. Ranjit S, Aram G, Kissoon N, et al. Multimodal monitoring for hemodynamic categorization and management of pediatric septic shock: a pilot observational study. Pediatr Crit Care Med. 2014; 15(1):e17-e26. 11. MacLaren G, Butt W, Best D, Donath S. Central extracorporeal membrane oxygenation for refractory The authors and planners have disclosed no potential conflicts of interest, financial or otherwise. DOI-10.1097/01.NURSE.0000459786.78054.87 For more than 144 additional continuing education articles related to pediatric topics, go to NursingCenter.com/CE. < Earn CE credit online: Go to http://www.nursingcenter.com/CE/nursing and receive a certificate within minutes. INSTRUCTIONS Helping children survive sepsis TEST INSTRUCTIONS • To take the test online, go to our secure website at http:// www.nursingcenter.com/ce/nursing. • On the print form, record your answers in the test answer section of the CE enrollment form on page 41. Each question has only one correct answer. You may make copies of these forms. • Complete the registration information and course evaluation. Mail the completed form and registration fee of $21.95 to: Lippincott Williams & Wilkins, CE Group, 74 Brick Blvd., Bldg. 4, Suite 206, Brick, NJ 08723. We will mail your certificate in 4 to 6 weeks. For faster service, include a fax number and we will fax your certificate within 2 business days of receiving your enrollment form. • You will receive your CE certificate of earned contact hours and an answer key to review your results. There is no minimum passing grade. • Registration deadline is February 28, 2017. DISCOUNTS and CUSTOMER SERVICE • Send two or more tests in any nursing journal published by Lippincott Williams & Wilkins together by mail, and deduct $0.95 from the price of each test. • We also offer CE accounts for hospitals and other healthcare facilities on nursingcenter.com. Call 1-800-787-8985 for details. PROVIDER ACCREDITATION Lippincott Williams & Wilkins, publisher of Nursing2015 journal, will award 2.0 contact hours for this continuing nursing education activity. Lippincott Williams & Wilkins is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. Lippincott Williams & Wilkins is also an approved provider of continuing nursing education by the District of Columbia and Florida #50-1223. This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 2.0 contact hours. Your certificate is valid in all states. 40 l Nursing2015 l February www.Nursing2015.com Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. 2.0 ANCC CONTACT HOURS Helping children survive sepsis GENERAL PURPOSE: To provide information about sepsis in pediatric patients. LEARNING OBJECTIVES: After reading this article and taking this test, you should be able to: 1. Differentiate between pediatric SIRS and sepsis. 2. List treatment goals for pediatric sepsis according to the SSC guidelines. 3. Identify recommended management strategies for children with sepsis. 1. The SSC definition of pediatric sepsis depends upon age-specific heart rate, respiratory rate, and a. platelet count. b. red blood cell count. c. WBC count. 7. Initial respiratory interventions include administration of supplemental oxygen via face mask or a. high-flow nasal cannula. b. partial rebreather mask. c. mechanical ventilation. the RESOLVE study found that outcomes in pediatric patients in severe septic shock who received hydrocortisone were a. better. b. no different. c. worse. 2. Which of the following is one of two required criteria for pediatric SIRS? a. abnormal temperature b. hyperglycemia c. hypotension 8. Fluid resuscitation begins with I.V. bolus administration of isotonic crystalloid solution or albumin in increments up to a. 10 mL/kg over 2 to 5 minutes. b. 20 mL/kg over 5 to 10 minutes. c. 30 mL/kg over 10 to 15 minutes. 3. Pediatric sepsis is defined as SIRS in the presence of, or as a result of, suspected or proven a. acute respiratory failure. b. left ventricular dysfunction. c. infection. 9. Signs of fluid overload in children include a. hepatomegaly. b. wheezing. c. hypotension. 14. A patient presenting with fluidrefractory, catecholamine-resistant shock should receive hydrocortisone therapy if the patient has a. acute kidney injury. b. diabetes mellitus. c. adrenal insufficiency. 4. The SSC algorithm for management of hemodynamic support guides treatment of pediatric sepsis according to a. age. b. severity. c. time. 5. For patients in septic shock, initial goals of resuscitation include capillary refill of a. 2 seconds or less. b. 3 seconds or less. c. 4 seconds or less. 15. The initial hemoglobin target during the acute period of shock with hypoxemia should be a. 7 g/dL. b. 10 g/dL. c. 13 g/dL. 10. After severe sepsis is identified, empiric antibiotic therapy should be administered a. within 1 hour. b. after obtaining blood culture specimens. c. after receiving blood culture results. 16. For patients on mechanical ventilation, SSC guidelines recommend tidal volumes of a. 6 to 8 mL/kg. b. 9 to 11 mL/kg. c. 12 to 14 mL/kg. 11. Which drug used in the management of shock may increase susceptibility to infection? a. amrinone b. dopamine c. epinephrine 17. Additional BP support may be needed during mechanical ventilation due to a. decreased intrathoracic pressures. b. increased afterload. c. decreased venous return. 12. For select patients with persistent low cardiac output associated with high systemic vascular resistance and normal BP, the SSC guidelines recommend a. inotropes. b. antiarrhythmics. c. vasoconstrictors. 6. The initial therapeutic goal for central venous oxygen saturation is a. ≥ 60%. b. ≥ 70%. c. ≥ 80%. 18. Which blood glucose level is recommended for pediatric patients with sepsis? a. 120 mg/dL or less b. 150 mg/dL or less c. 180 mg/dL or less 13. Comparing outcomes in children who didn’t receive hydrocortisone therapy, Enrollment Form Nursing2015, February, Helping children survive sepsis A. 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