Septic Shock

Septic Shock

1. Sepsis is the simultaneous activation of systemic inflammation and coagulation due to microbial invasion

   • Septic Shock
     • Characterized by maldistribution of blood flow and arterial hypotension (systemic arterial pressure <90mmHg), leading to respiratory, heart and failure of other organs, and death

2. Diagnosis

   • Pathophysiology
     • Invading microorganisms
       • Activation of CNS and endocrine systems
         • Hypermetabolic state
         • Decreased tissue perfusion
         • Cellular oxygen demand
       • Release of pro-inflammatory cytokines (TNF, IL-1, etc.)
         • Myocardial depression, peripheral vasodilation, increased capillary permeability, microemboli, selective vasoconstriction
           • Impaired cellular metabolism
           • Maldistribution of circulating blood volume
           • Decreased cellular oxygen supply
           • Decreased tissue perfusion
       • Endothelial damage
         • Increased membrane permeability
         • Microemboli
   • Diagnostic Studies
     • Blood
       • Low Hgb
         • Anemia
       • Abnormal glucose levels
       • ↑ WBC Count
       • Prolonged PT and PTT
       • ↑BUN/Cr
       • (+) blood cultures
     • Urine
       • ↑ Specific gravity
       • ↑ Osmolarity
     • Serum Electrolytes
       • ↑ Serum Lactate Levels
       • ↑ Liver Enzymes (ALT, AST, GGT)
       • K+ imbalances
       • Na imbalances
   • Etiology
     • Risk Factors
       • Poor nutrition
       • Major surgery
       • Predisposition to infections
       • Chronic disease
       • Long-term hospital stay
       • Immunosuppressed
         • Pregnant women
         • Infants
         • Clients on immunosuppressive agents
         • Males
         • Older adults

3. Nursing Care

   • Assessment
     • 1) Initial Stage
       • Metabolism changes at cellular level
         • Aerobic to anaerobic
           • Lactic acid buildup
       • Not clinically apparent
     • 2) Compensatory Stage
       • ↑ pro-inflammatory mediators
       • Massive vasodilation (↓SVR)
       • SNS:↑HR, ↓BP
       • Neurological status
         • Restlessness
         • Agitation
     • 3) Progressive Stage
       • ↑↑ vasodilation, with ↑capillary permeability
       • Hemodynamic instability
         • Hypovolemia
         • Hypotension
         • V/Q mismatch, l/t hypoperfusion
       • Organ failure
       • ↑SvO2
     • 4) Refractory Stage
       • Exacerbated anaerobic metabolism
         • ↑Peripheral vasoconstriction
         • ↓CO (lactic acidosis)
       • Decreased cerebral blood flow
         • Cerebral ischemia
       • Decreased coronary blood flow
         • Myocardial depression
   • Planning
     • Adequate tissue perfusion
     • Restoring normal or baseline BP
     • Recovery of organ function
     • Avoiding prolonged states of hypoperfusion
   • Implementation
     • Acute
       • The Sepsis Six
         • 1. Give 02 to keep sats above 94%
         • 2. Take blood cultures
         • 3. Give antibiotics
         • 4. Give a fluid challenge
         • 5. Measure lactate
         • 6. Measure urine output
       • ROS
         • Neurological
           • Monitor physical and emotional status
           • Assess orientation and LOC q1hr
         • Cardiological
           • Assess VS (BP, HR, CVP) frequently
           • ECG monitoring
           • Ausculate S3/S4
           • Monitor hemodynamic status
           • Capillary refill
           • Palpate peripheral pulses
           • Vascular IV
         • Respiratory
           • Monitor oxygenation
           • Patient airway
           • Assess ABGs levels
           • LS/VS (RR, depth, rhythm, SaO2 q1hr)
           • Chest Radiography
           • Mechanical ventilation
           • Frequent suctioning
           • HOB 30-45°
         • GI/GU
           • Assess BS q1hr
           • Abdominal distention
           • NG/stool: check for occult blood
           • Renal output >0.5ml/kg/hr
           • Assess BUN/Cr levels
         • Integumentary
           • Assess for...
             • T° q1hr
             • Pallor
             • Cyanosis
             • Diaphoresis
             • Edema
       • Personal Hygiene
         • Prevent skin breakdown and infection
         • Frequent oral care
         • Assess swallowing and gag reflex
     • Health Promotion
       • Prevention
         • Prevent Complications
           • LMW heparin
           • VTE prophylaxis
         • Identify patient at risk
         • Decrease risk of infections
           • Effective hand hygiene
           • Aseptic technique during invasive procdures
           • Equipment change as per institutional policies
       • Adequate rest
       • Pain management
       • Monitor fluid balance
       • Reposition q2hr
       • Encourage family members in pt care
       • Therapeutic Communication
         • Non-verbal
   • Evaluation
     • Systemic Inflammatory Response Syndrome (SIRS)
       • Characterized by ↑inflammation/coagulation not always related to infection
     • Multiple Organ Dysfunction Syndrome (MODS)

4. Complications

   • GI bleeding
   • Pressure/Stress Ulcer
   • Electrolyte Imbalance
   • ARDS
   • Anemia
   • Pneumonia

5. fucking treatment

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