Bacteremia Nursing Care Plans Diagnosis and Interventions
Bacteremia NCLEX Review and Nursing Care Plans
Bacteremia is a medical condition wherein there is a presence of pathogenic bacteria in the bloodstream. It is commonly known as “blood poisoning” in layman’s terms.
Bacteremia can be due to daily activities, such as vigorous brushing of the teeth. It can also result from undergoing simple procedures, such as routine teeth cleaning, tooth extraction, minor procedures or surgeries, medical devices (e.g., breathing tubes, venous access devices, and indwelling catheters), active infections (e.g., urinary tract infection or pneumonia), and severe burns or injuries.
Bacteremia may be asymptomatic, especially in healthy people. On the other hand, the pathogens may cause a bloodstream infection. In this case, bacteremia results in sepsis, which can lead to organ damage and can be fatal if left untreated.
Signs and Symptoms of Bacteremia
Some mild cases of bacteremia may not exhibit clinical manifestations as the immune system is able to kill the bacteria in the bloodstream. However, moderate to severe cases of bacteremia may show signs and symptoms of an infection, such as:
- Nausea and vomiting
- Changes in mentation, such as confusion
Causes and Risk Factors of Bacteremia
Many types of bacteria can result in bacteremia. However, there are specific groups of pathogens that can develop bacteremia into bloodstream infection or sepsis.
These bacteria include Staphylococcus aureus, Group A Streptococcus, Pneumococcal bacteria, Escherichia coli, Salmonella, and Pseudomonas aeruginosa.
The risk factors that may increase the likelihood of bacteremia include:
- Use of long-term internal or invasive medical devices
- Undergoing dental, medical, or surgical procedures
- Intravenous drug delivery
- Infected skin ulcers or other infections
- Age – elderly patients are prone to community-acquired bacteremia due to gram-negative bacteria such as Pseudomonas aeruginosa and E. coli
- Uncontrolled diabetes
- HIV infection, ongoing chemotherapy, or other illnesses that may cause immunosuppression
- Chronic hemodialysis for kidney disease
Complications of Bacteremia
- Sepsis. Sepsis is a life-threatening bodily response that can result from bacteremia. It can occur due to the release of chemicals by the immune system into the bloodstream in order to fight the infection. If left untreated, sepsis can result in septic shock. The symptoms of sepsis include changes in mentation, low blood pressure, rapid heart rate, clammy skin, fast breathing, and decreased urination.
- Secondary infections. Bacteremia may also cause complications to specific organs or areas of the body. These include pneumonia (lungs), meningitis (meninges of the brains), endocarditis (inner lining of the heart), arthritis (joints), cellulitis (skin), peritonitis (peritoneum of the abdomen), and osteomyelitis (bones). A patient who is at high risk of developing bacteremia is usually given prophylactic antibiotics prior to a dental, medical, or surgical procedure.
Diagnosis of Bacteremia
- Blood culture and sensitivity test- the collection of a venous blood sample from the patient’s arm to test for the presence of bacteria in the blood
- Sputum culture or other types of culture – may be done if the patient has symptoms of an active respiratory infection or is using a breathing tube; swabbing wounds, obtaining specific body fluids (e.g., peritoneal fluid, cerebrospinal fluid, etc.), or medical devices that the patient have may be required to confirm bacteremia
- Blood tests – the patient may have increased white cell count and neutrophil count, elevated C-reactive protein (CRP), ESR, and procalcitonin levels
- Imaging tests – to check for the potential sites of infection, an X-ray, ultrasound, or CT scan may be ordered
Treatment for Bacteremia
- Medications. The doctor will prescribe broad-spectrum antibiotics that need to be given immediately to start treating bacteremia and to prevent it from progressing into sepsis. Once the blood culture shows the type of bacteria, the doctor may shift the medication to the antibiotics that are specific to the causative agent. These are typically given between 1 to 2 weeks.
- Intravenous fluid therapy and other medications to treat the symptoms such as fever
- Removal of sources of the pathogens. If the culture findings show positive results from swabbing the suspected source of bacteria, the physician will order to remove such source. This may mean taking out indwelling catheters and other medical devices, or cleansing and re-dressing a surgical wound site.
Prevention of Bacteremia
- Active management to treat underlying diabetes
- Maintaining good hygiene
- Getting the pneumococcal vaccine which is 75% efficacy rate in reducing the risk of developing bacteremia in healthy people age 65 and above
Nursing Diagnosis for Bacteremia
Bacteremia Nursing Care Plan 1
Nursing Diagnosis: Hyperthermia related to bacteremia secondary to pneumonia as evidenced by temperature of 38.5 degrees Celsius, rapid and shallow breathing, flushed skin, profuse sweating, and weak pulse.
Desired Outcome: Within 4 hours of nursing interventions, the patient will have stabilized body temperature within the normal range.
|Bacteremia Nursing Interventions||Rationale|
|Assess the patient’s vital signs at least every hour. Increase the intervals between vital signs monitoring as the patient’s vital signs become stable.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs administered.|
|Remove excessive clothing, blankets and linens. Adjust the room temperature.||To regulate the temperature of the environment and make it more comfortable for the patient.|
|Administer the prescribed antibiotic and anti-pyretic medications.||Use the antibiotic to treat bacterial infection, which is the underlying cause of the patient’s hyperthermia. Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature.|
|Offer a tepid sponge bath.||To facilitate the body in cooling down and to provide comfort.|
|Elevate the head of the bed.||Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.|
Bacteremia Nursing Care Plan 2
Nursing Diagnosis: Risk for Sepsis/ Septic Shock
Desired Outcome: The patient with establish normal vital signs, balanced input and output, and usual mentation.
|Bacteremia Nursing Interventions||Rationales|
|Assess the patient’s vital signs at least every hour. Increase the intervals between vital signs taking as the patient’s vital signs become stable.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs administered.|
|Start strict input and output monitoring. Measure the urine output hourly.||Decreased urinary output is a sign of diminished renal perfusion, indicating damage to the kidneys due to sepsis.|
|Assess for changes of level of consciousness/ mentation.||Decreasing level of consciousness indicate diminished cerebral perfusion and/or hypoxemia.|
|Administer intravenous fluid therapy.||To facilitate effective tissue perfusion and maintain circulatory blood volume.|
|Administer vasopressors and inotropic agents as prescribed.||To maintain blood pressure level and help improve organ perfusion.|
|Place the patient on bed rest. Assist him/her with important activities of daily living or ADLs.||To decrease myocardial workload and oxygen consumption.|
Bacteremia Nursing Care Plan 3
Nursing Diagnosis: Risk for Secondary Infection
Desired Outcome: The patient will be able to avoid the development of an infection.
|Bacteremia Nursing Interventions||Rationales|
|Assess vital signs and observe for any signs of infection as well as for any signs of respiratory distress, and gastrointestinal problems such as diarrhea, nausea, and vomiting.||To assess for the evidence of ongoing infection. Bacteremia may develop into secondary infections, and can be evidenced by fever accompanied by symptoms related to the specific body area that is affected (e.g., respiratory distress for pneumonia, gastrointestinal upset for peritonitis, etc.)|
|Prepare the patient for obtaining sample for culture.||Sputum culture or other types of culture through swabbing wounds, obtaining specific body fluids (e.g., peritoneal fluid, cerebrospinal fluid, etc.), or medical devices that the patient have may be required to check for secondary infections as a complication of bacteremia.|
|Teach the patient how to perform proper hand hygiene.||To maintain patient safety and reduce the risk for cross contamination.|
|Administer antibiotics as prescribed.||To treat the underlying infection with broad spectrum antibiotics, then switch with the type of antibiotics to which the causative bacteria are sensitive. This is also done to prevent the risk of developing sepsis in a patient with bacteremia and secondary infection.|
Bacteremia Nursing Care Plan 4
Nursing Diagnosis: Deficient Knowledge related to diagnosis and need for emergency treatment as evidenced by patient’s verbalization of “Why do I have bacteria in my blood?”
Desired Outcome: The patient will be able to have sufficient knowledge of bacteremia and its management.
|Bacteremia Nursing Interventions||Rationales|
|Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g., denial of diagnosis or poor lifestyle habits)||To address the patient’s cognition and mental status towards sepsis and to help the patient overcome blocks to learning.|
|Explain what bacteremia is, and how it could lead to sepsis, as well as how it might affect different body organs such as the kidneys, brain, and lungs. Avoid using medical jargons and explain in layman’s terms.||To provide information on bacteremia and its pathophysiology in the simplest way possible.|
|Educate the patient about proper nutritional intake and its role in fighting bacteremia as well as the underlying infection or other medical condition that has caused it.||To give the patient enough information on how good nutrition can help boost the immune system to fight the infection and can help him/her have optimal healing.|
|Review proper hand hygiene, overall personal hygiene, and environmental cleanliness.||To lessen the patient’s exposure to pathogens.|
|Inform the patient the details about the prescribed medications (e.g., drug class, use, benefits, side effects, and risks) that are being given to treat sepsis.||To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, and any possible adverse events.|
More Bacteremia Nursing Diagnosis
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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