Sepsis and Septic Shock
med surg, medical surgical, Shock
Hi friends today. We're going to talk about sepsis and septic shock. So if you guys like these videos, make sure to give it a thumbs up and subscribe to my channel. I create content related to nurses and nursing students. To help you guys pass nursing school and passing NCLEX and become nurses. So make sure to check out below I have a link of all free educational content, and I also have links to my click study guide and some other resources as well, but okay.
Let's get into it. So sepsis and septic shock.
So sepsis is a systemic response to an infection it's manifested by two or more of the Sears, which is systemic inflammatory response syndrome criteria. As a consequence of documented or presumed infection, septic shock is associated with sepsis. It's characterized by the symptoms of sepsis plus. Both tension and hypoperfusion, despite adequate fluid volume replacement.
So let's look at the pathophysiology of sepsis. The following is a process of how sepsis works its way inside of our body. We have a microorganism that invades the body tissue and in turn patients exhibit a immune responses to some type of infection, either immune response provokes the activation of biochemical cytokines and mediators associated with inflammatory response, then increased.
Capillary permeability and vasodilation interrupts the body ability to provide adequate perfusion, oxygen and nutrients to the tissues and cells pro-inflammatory and anti-inflammatory cytokines released during the inflammatory process and activates the coagulation system that forms clots, whether or not there is bleeding and the imbalance of the inflammatory response and the clotting
and fibrolysis cascades are critical elements of the physiological process of sepsis in an infected patient.
So the epidemiology, so annually, an estimated 750,000 people in the United States are affected by sepsis in 2010, the rate had increased up to a million cases per year. Elderly patients are at the most risk for developing sepsis because of a decreased physiological reserves and an aging immune system.
Gram-positive bacteria accounts for 50% of cases of septic shock. And it's also estimated that 20 to 30% with severe sepsis may never identify the site of infection. So causes include patients with immunosuppression have a greater chance of acquiring septic shock because they have a decreased immune system, which makes it easier for the microorganism to invade the body tissue extremes of age.
So elderly people and infants are more prone to septic shock because of their weak immune systems. Malnourishment can lower the body's defenses, making it susceptible to invasion of pathogens chronic illness put patients at risk for sepsis because the body's immune system is already weakened by the existing pathogens and invasive procedures can introduce microorganisms inside the body that lead to sepsis.
So clinical manifestations, the signs and symptoms that are associated with septic shock include. That the heart compensates by pumping faster to help provide the body with oxygen and nutrients. Hypotension occurs because of vasodilation to compensate for the decreased oxygen concentration.
The patient tends to breathe faster and also to eliminate more carbon dioxide from the body. And the inflammatory response is activated because of the invasion of pathogens there can be a decreased urine output. Cause the body is conserving water to avoid undergoing dehydration because of the inflammatory process.
There's changes in mental status as the body slowly becomes more acidotic and the mental status also deteriorates and there can be elevated lactic levels because there is a maldistribution of blood within the body. So as nurses, how do we prevent sepsis and septic shock? So the best way is before sepsis, we want to help to not let microorganisms invade the patient's body.
So to prevent that occurrence, we want to use strict infection control practice which includes effective a septic techniques and interventions. We want to prevent central line infections by implementing efficient programs to prevent central line infections. This can be the most dangerous route that can be involved in sepsis.
We want to use early debriding of wounds. So that necrotic tissue will be removed and we want to practice equipment cleanliness especially the ones that involve invasive procedures. These have to be properly cleaned and maintained to avoid harboring harmful microorganisms that can enter the body.
So complications in severe sepsis. It can lead to symptoms of organ dysfunction, hypotension, hypoperfusion, lactic acidosis, olguria, altered level of consciousness, coagulation disorders, and altered hepatic function, which can then also lead to multiorgan dysfunction syndrome. This refers to the presence of an altered function of one or more organs in an acutely ill patient requiring intervention and support of the organs to achieve physiologic functioning required for homeostasis.
So different assessment and diagnostic findings. We use early assessment and diagnosis of the infection to help avoid its progression. So we can use blood cultures to identify microorganisms responsible for the disease. This could be a blood culture would also look at liver function tests, which can be performed early to detect any alterations in the functioning of the liver and blood studies, because hematologic tests can be performed to check on the perfusion of the blood.
So medical management of septic shock and sepsis includes identifying and eliminating the case of infection. We can also use fluid replacement therapy to create correct that tissue hypoperfusion. So aggressive fluid resuscitation may be implemented and we can also use nutritional therapy. Aggressive nutritional supplement is critical to managing septic shock because malnutrition further impairs the patient's resistance to the infection, our nursing assessment.
Can include signs and symptoms. So we're going to assess the patient if they have a positive blood culture. See if they're currently receiving antibiotics, had an exam or chest x-ray or had a suspected infected wound. Signs of acute organ dysfunction, we'll assess for, so the presence of hypotension tachypnea tachycardia decreased urine output clotting disorders and hepatic abnormalities.
And remember decreased urine output is usually less than 30 MLS per hour. So our diagnoses, these are just some examples. There are tons of diagnoses, so risk for deficient fluid volume related to. vasodilation risk for decreased cardiac output related to decreased preload impaired gas exchange related to interference with oxygen delivery and risk for shock related to infection.
So our planning and goals for these patients include patient will display hemodynamic stability. Patient will verbalize understanding of disease process and patient will achieve timely wound healing. Our nursing interventions pertaining to sepsis should be done timely and appropriately to maximize the effects.
These interventions include infection control. So again, we're using that aseptic technique and we're having good hand hygiene collaboration. We collaborate with other members of the healthcare team to find the source of sepsis. Pacific organisms involved. We're going to manage the patient's fever. So we're monitoring those vital signs and for signs of a fever, such as shivering when we can use pharmacologic interventions.
So we administer prescribed IV fluids and medications, including antibiotics and vasoactive medications. We're going to monitor blood pressures. And blood levels. So we'll monitor for antibiotic toxicity changes in bun, creatine, white blood cell count, hemoglobin hematocrit, platelet levels, and coagulation studies.
We'll assess physiological status. Looking at that hemodynamic status, the fluid intake and output and the nutritional status of the patient. So our evaluation, again, these are going to be based on our diagnoses and our interventions, and then what we evaluate, what the outcome of those things are. But here are just some examples.
Patient displayed, hemodynamic stability, patient verbalized, understanding of disease process and patient achieved timely wound healing and our discharge and home care plannings. The patient must be taught how to establish a care regimen at home. Cause we want them to be able to prevent shock episodes.
So we should teach the patient and the family about strategies to prevent these shock episodes by identifying the factors that led to the initial episode. So if it was a wound, we want to teach them about wound care and. Skin integrity and things like that. If it's, whatever the reason for the first or the recent septic shock and sepsis infection, we want to try to avoid those in the future.
Instructions on assessments of the patient and families should be taught how to. Needs to identify the complications that may occur after discharge. And we also want to have different treatment modalities. So teaching the patient and family about treatments, such as emergency administration of medications, IV therapy, parenteral or entral nutrition, skincare, exercise, and ambulation.
So once that's all done, our document guidelines should include individual risk factors for the patient, our assessment findings, laboratory tests, diagnostic tests, plan of care and teaching plan. Client's response to the treatment. Teaching and actions performed and modifications of the plan of care. So that was the video on sepsis and septic shock.
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