Septic Shock

Diagnosis
1. complication of sepsis
  1. dysregualtion response to an infection
    1. infections of: pneumonia, urinary tract infection,, influenza, skin infections ect.
  2. Blood PH decreases
    1. Less than 7.35
  3. adrenal insufficiency
2. persistant hypotension
  1. Blood pressure of Systolic <90, mean arterial pressure of <65
3. culture results showing infection
  1. Complete blood count, BUN and serum electrolytes and creatinine levels
  2. sputum culture
    1. to rule out pneumonia
  3. Lumbar puncture
    1. To rule out meningitis, and obtain a culture of cerebral spinal fluid
4. life threatening organ dysfunction
  1. critical reduction in tissue perfusion
  2. acute failure of multiple organs
    1. liver
    2. lungs
    3. kidneys
5. Features of systematic inflammatory response syndrome
  1. mental changes, hyperventilation distributive hemodynamics, hyperthermia or hypothermia, reduced, shifted or elevated WBC
6. obtaining patients medical history
7. imaging scans
  1. X-rays: pneumonia or damage around the lungs
  2. MRI and CT Scan: Swelling or inflammation around the brain caused by meningitis
Pathogenisis
1. Inflammatory stimulus
  1. production of proinflammatory mediatiors
    1. tumor necrosis factor (TNF) & interlekin-1 (IL-1) cytokines
    2. causing cell adhesion
    3. activates the clotting mechanism
    4. generates microthrombi
2. warm shock arteries and arterioles dilate
  1. decreasing peripheral arteriol resistance
3. cardiac output may decrease
  1. Blood pressure falls
  2. features of shock appear
4. Increased cardiac output
  1. blood flow bypasses capillary exchange vessels
  2. decreases delivery of oxygen
  3. impairs removal of C02 and waste products
5. decreased perfusion
  1. dysfunction or failure of organs
Collaborative care
1. Fluid resuscitation
2. Optimize oxygen delivery
3. Optimize cardiac output
  1. central venous pressure monitoring
4. Vasopressors
5. Correct acidosis
6. Obtain cultures
7. Antibiotics
8. prevent infection
  1. Asepsis
    1. foley catheter
    2. central venous catheter
Causes
1. pneumonia
2. exposure to invasive devices
  1. urinary tract infection
    1. urospesis
      1. catheter removed and new one put in
3. stomach infections
4. skin infections
5. chronic illnesses
  1. diabetes
  2. cirrhosis
  3. cancer
  4. AIDS/HIV
  5. heart disease
  6. kidney disease
6. meningitis
Complications
1. Respiratory failure
  1. lungs not taking in enough oxygen
2. Heart failure
  1. heart cannot effectively pump blood to bodies organs
    1. stroke
3. Kidney failure
4. abnormal clotting
  1. body tissues start to die
    1. amputations
5. post-sepsis symptoms
  1. depression
  2. insomnia
    1. fatigue
  3. cognative decline
  4. Post-tramatic stress disorder (PTSD)
6. Death
  1. mortality rate of 40%-60%
    1. complete organ failure
Assessment
1. medical history
2. clinical presentation
  1. difficulty breathing
    1. >20 per minute
      1. inflammatory response syndrome
  2. Low blood pressure/ orthopenia
  3. palpitations, thready pulses
  4. oliguria
    1. disseminated intravascular coagulation and low BP= AKF
  5. Hyperthermia or hypothermia
    1. temp higher than 38C or lower than 36C
  6. cool, pale arms and legs
    1. decreased tissue perfusion
      1. peripheral cyanosis and molting
      2. delayed cap refill >3 seconds
  7. Abdomen pain
  8. organ dysfuncation
  9. altered mental status
3. diagnostic imaging
4. Laboratory findings
  1. platelet count, prothrombin time and D-Dimer
    1. platelets to low= unwanted tiny clots. PTT too high = blood not clotting well. D-Dimer too high= clots
  2. CBC
    1. increase WBC = infection
Nursing Interventions
1. patient status
2. explain procedures and routines
  1. decrease stress
  2. decrease fear and anxiety
3. encouraging feelings of expression
4. involve family in patient's care
5. establish contacts with necessary resources
6. facilitate problem solving and decision making
7. address goals of care
  1. treatment plans
  2. end-of life planning
Treatment
1. oxygen support
  1. hypoxemia
2. IV therapy
  1. Broad-spectrum antibioitics
    1. monitor response to therapy
  2. IV fluids
    1. crystalloid fluid challenge of 30 mL/kg
      1. assessment of response
    2. initial bolus
  3. vasopressors
    1. Norepinephrine
  4. blood products
3. Source control
  1. debridment
  2. surgery
4. Supportive measures
  1. corticosteroids
  2. insulin
  3. DVT propholaxis
  4. mechanical ventilation
5. nutrition

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Septic Shock

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	Created by Renee Vanderhoeden about 6 years ago