Septic Shock

Septic Shock

1. Diagnosis

   • complication of sepsis
     • dysregualtion response to an infection
       • infections of: pneumonia, urinary tract infection,, influenza, skin infections ect.
     • Blood PH decreases
       • Less than 7.35
     • adrenal insufficiency
   • persistant hypotension
     • Blood pressure of Systolic <90, mean arterial pressure of <65
   • culture results showing infection
     • Complete blood count, BUN and serum electrolytes and creatinine levels
     • sputum culture
       • to rule out pneumonia
     • Lumbar puncture
       • To rule out meningitis, and obtain a culture of cerebral spinal fluid
   • life threatening organ dysfunction
     • critical reduction in tissue perfusion
     • acute failure of multiple organs
       • liver
       • lungs
       • kidneys
   • Features of systematic inflammatory response syndrome
     • mental changes, hyperventilation distributive hemodynamics, hyperthermia or hypothermia, reduced, shifted or elevated WBC
   • obtaining patients medical history
   • imaging scans
     • X-rays: pneumonia or damage around the lungs
     • MRI and CT Scan: Swelling or inflammation around the brain caused by meningitis

2. Pathogenisis

   • Inflammatory stimulus
     • production of proinflammatory mediatiors
       • tumor necrosis factor (TNF) & interlekin-1 (IL-1) cytokines
       • causing cell adhesion
       • activates the clotting mechanism
       • generates microthrombi
   • warm shock arteries and arterioles dilate
     • decreasing peripheral arteriol resistance
   • cardiac output may decrease
     • Blood pressure falls
     • features of shock appear
   • Increased cardiac output
     • blood flow bypasses capillary exchange vessels
     • decreases delivery of oxygen
     • impairs removal of C02 and waste products
   • decreased perfusion
     • dysfunction or failure of organs

3. Collaborative care

   • Fluid resuscitation
   • Optimize oxygen delivery
   • Optimize cardiac output
     • central venous pressure monitoring
   • Vasopressors
   • Correct acidosis
   • Obtain cultures
   • Antibiotics
   • prevent infection
     • Asepsis
       • foley catheter
       • central venous catheter

4. Causes

   • pneumonia
   • exposure to invasive devices
     • urinary tract infection
       • urospesis
         • catheter removed and new one put in
   • stomach infections
   • skin infections
   • chronic illnesses
     • diabetes
     • cirrhosis
     • cancer
     • AIDS/HIV
     • heart disease
     • kidney disease
   • meningitis

5. Complications

   • Respiratory failure
     • lungs not taking in enough oxygen
   • Heart failure
     • heart cannot effectively pump blood to bodies organs
       • stroke
   • Kidney failure
   • abnormal clotting
     • body tissues start to die
       • amputations
   • post-sepsis symptoms
     • depression
     • insomnia
       • fatigue
     • cognative decline
     • Post-tramatic stress disorder (PTSD)
   • Death
     • mortality rate of 40%-60%
       • complete organ failure

6. Assessment

   • medical history
   • clinical presentation
     • difficulty breathing
       • >20 per minute
         • inflammatory response syndrome
     • Low blood pressure/ orthopenia
     • palpitations, thready pulses
     • oliguria
       • disseminated intravascular coagulation and low BP= AKF
     • Hyperthermia or hypothermia
       • temp higher than 38C or lower than 36C
     • cool, pale arms and legs
       • decreased tissue perfusion
         • peripheral cyanosis and molting
         • delayed cap refill >3 seconds
     • Abdomen pain
     • organ dysfuncation
     • altered mental status
   • diagnostic imaging
   • Laboratory findings
     • platelet count, prothrombin time and D-Dimer
       • platelets to low= unwanted tiny clots. PTT too high = blood not clotting well. D-Dimer too high= clots
     • CBC
       • increase WBC = infection

7. Nursing Interventions

   • patient status
   • explain procedures and routines
     • decrease stress
     • decrease fear and anxiety
   • encouraging feelings of expression
   • involve family in patient's care
   • establish contacts with necessary resources
   • facilitate problem solving and decision making
   • address goals of care
     • treatment plans
     • end-of life planning

8. Treatment

   • oxygen support
     • hypoxemia
   • IV therapy
     • Broad-spectrum antibioitics
       • monitor response to therapy
     • IV fluids
       • crystalloid fluid challenge of 30 mL/kg
         • assessment of response
       • initial bolus
     • vasopressors
       • Norepinephrine
     • blood products
   • Source control
     • debridment
     • surgery
   • Supportive measures
     • corticosteroids
     • insulin
     • DVT propholaxis
     • mechanical ventilation
   • nutrition

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