| Abstract |
Objective To summarize the comprehensive nursing experience of a critically ill patient with sepsis complicated by necrotizing fasciitis and acute kidney injury in an elderly, immunosuppressed state, and to explore the refined nursing strategies and their effects under a multidisciplinary collaboration model. Methods A retrospective analysis was conducted on the clinical data of a 71-year-old male patient (with underlying nephrotic syndrome and long-term steroid therapy) admitted in 2024. Addressing core issues such as sepsis, right lower limb necrotizing fasciitis, and acute kidney injury, the nursing team implemented the following priorities under the leadership of the medical team: 1) Multidisciplinary collaborative management: Collaborating with the Nursing Department, Orthopedics, Infectious Diseases, Dermatology, Wound Ostomy, and Nutrition Departments to dynamically assess, develop, and implement individualized nursing plans; 2) Detailed wound care: Closely monitoring changes in limb skin temperature, circumference, arterial pulses, and the extent of redness and swelling; performing sterile puncture and aspiration of fluid from pressure blisters followed by culture; applying Huang Bai solution, magnesium sulfate wet compresses, and microwave irradiation in accordance with standardized protocols; and later incorporating negative pressure drainage; 3) Antibiotic therapy and sepsis monitoring: Administer antibiotics precisely, closely monitor vital signs, inflammatory markers (WBC, NEU%, hsCRP, IL-6), and mental status, and be vigilant for sepsis-induced shock; 4) Renal replacement therapy and fluid management: Strictly adhere to continuous renal replacement therapy (CRRT) nursing protocols, reinforce catheter maintenance and monitor for complications (bleeding, coagulation), meticulously record fluid intake and output, monitor central venous pressure (CVP) and weight, control fluid intake, and prevent fluid overload; 5) Nutrition and supportive therapy: Collaborate with the nutrition department to develop and implement enteral and parenteral nutrition support plans to correct hypoalbuminemia and electrolyte imbalances; 6) Complication prevention: Implement basic nursing care (oral care, skin care, turning and back percussion), pain assessment and management (NRS scoring), bleeding monitoring, prevention of deep vein thrombosis (ankle pump exercises), and pressure injury prevention measures. Results After four weeks of comprehensive treatment and refined nursing care, the patient's infection was effectively controlled (normalized body temperature, WBC from 10.89 to 9.65 × 10⁹/L, NEU% from 91.6% to 65.0%, hsCRP decreased from 232.14 to 8.45 mg/L), the redness, swelling, and pain at the right lower limb necrotizing fasciitis wound significantly subsided, the affected area notably reduced, and granulation tissue grew well; Renal function improved (urine output increased from 200–400 ml/day to approximately 1,600 ml/day, serum creatinine decreased from a peak of 588.5 umol/L to 115 umol/L); Nutritional status improved (albumin increased from 19.46 g/L to 34.5 g/L); no severe bleeding, new deep vein thrombosis, or pressure injuries occurred. The patient's vital signs were stable (heart rate 68 beats/min, blood pressure 131/81 mmHg), mental status and appetite improved, and the patient was discharged in clinical remission. Conclusion For critically ill patients with sepsis, necrotizing fasciitis, and acute kidney injury who are elderly and immunocompromised, establishing an efficient multidisciplinary collaboration mechanism is the foundation for successful treatment. Implementing refined and systematic nursing measures centered on meticulous wound management, precise anti-infection monitoring, strict CRRT and volume control, individualized nutritional support, and comprehensive complication prevention is crucial. The professional assessment, standardized procedures, close monitoring, and team coordination capabilities of nurses are key factors in ensuring patient safety and promoting recovery.
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