Question

nursing dx for sepsis related to Crohns dx

nuring interventions and rationals

Answer 1

Sepsis related to development of inflammatory process or worsening Crohn’s Disease.

Nursing  interventions	Rationale
Assess vital signs including temperature every 4 hours and as needed. Report any abnormal findings to the healthcare provider.	Fever is often one of the first signs of infection.
Assess mental status and level of consciousnesses every 4-6 hours.	Mental status changes, confusion, or any deterioration from baseline can signify infection.
Report and note any abnormal laboratory values (i.e. elevated WBC count) to the healthcare provider.	Certain abnormal laboratory results could be an indicator of infection.
Maintain or teach asepsis for dressing changes and wound care, peripheral IV and central venous management, and catheter care and handling.	Aseptic technique decreases the changes of transmitting or spreading pathogens to the patient. Interrupting the transmission of infection along the chain of infection is an effective way to prevent infection.
Encourage intake of protein-rich and calorie-rich foods.	Helps support the immune system responsiveness.
Encourage fluid intake	Fluids promote diluted urine and frequent emptying of bladder – reducing the stasis of urine, in turn, reduces risk for bladder infection or urinary tract infection.
Encourage coughing and deep breathing exercises; frequent position changes.	Helps reduce stasis of secretions in the lungs and the bronchial tree. When stasis occurs, pathogens can cause upper respiratory tract infections
Limit visitors.	Restricting visitation reduces the transmission of pathogens.

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