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Sepsis and Septic Shock
Generalist Nursing Practice IV: Tertiary Care Across the Lifespan (NURS 4889)
Temple University
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Sepsis and Septic Shock:
Shock: - Syndrome characterized by decreased tissue perfusion and impaired cellular metabolism - Imbalance in supply/demand for O 2 and nutrients
Stages of Shock: - Initial Stage – Metabolism changes from aerobic to anaerobic – lactic acid accumulates - Compensatory Stage – Decreased blood flow to kidneys & GI system, increased venous return to improve CO, BP and tissue perfusion. Decrease in arterial O2. - Progressive Stage – Progressive tissue hypoxia, decreased CO, metabolic acidosis, interstitial & pulmonary edema, peripheral & myocardia ischemia, dysrhythmias, GI bleeding, kidney injury, MODS o Assess skin, extremities, turn pts - Irreversible Stage – Accumulation of lactic acid, hypotension, hypoxia
Sepsis: - Sepsis: Life-threatening organ dysfunction caused by dysregulated host response to infection - Septic Shock: Subset of sepsis with circulatory and cellular/metabolic dysfunction associated with higher risk of mortality - 250,000 die each year from sepsis
Septic Shock (Distributive): Clinical Manifestations: - ↑ Coagulation and inflammation - ↓ Fibrinolysis o Formation of microthrombi Petechiae on feet o Obstruction of microvasculature Decreased perfusion to skin and extremities - Hyperdynamic state: increased CO and decreased SVR o Beyond 24 hours - ominous finding and is often associated with increased hypotension and MODS
Septic Shock: Clinical Manifestations: - Tachypnea/hyperventilation o Respiratory alkalosis (early) o Respiratory acidosis develops when compensation stops - Respiratory failure – 85% - ARDS – 40% - Temperature dysregulation – warm & flushed
- ↓ Urine output – decreased blood flow to kidney
- Altered neurologic status
- GI dysfunction – risk for paralytic ileus
Collaborative Care: - Screening and Management of Infection - Screening for Organ Dysfunction and Management of Sepsis - Identification and Management of Initial Hypotension
Screening and Management of Infection: - Signs of Sepsis: o Confusion or Disorientation o Shortness of breathe o Tachycardia
o Fever, shivering, or feeling very cold o Extreme pain or discomfort o Clammy or sweaty skin
- Patients at higher risk of infection and sepsis: o 65-years or older o Chronic medical diseases (DM, lung & kidney disease, cancer o Weakened immune systems o Children younger than 1-year
- Lungs (Pneumonia), Urinary Tract- UTI, Skin, GI
- Staphylococcus aureus (staph), Escherichia coli (E. coli), and some types of Streptococcus.
Surviving Sepsis: Campaign Bundle of Care: - Measure lactate level. Remeasure if > 2 mmol/L - Obtain blood cultures prior to administration of antibiotics - Administer broad spectrum antibiotics - Begin rapid administration of 30 ml/kg crystalloid for hypotension or lactate greater than 4 mmol/L (complete within 3-hours) o Usually NS - Apply vasopressors if patient is hypotensive during or after fluid resuscitation to maintain MAP > 65 mm Hg o Assess pt, UO, if no improvement -> vasopressor (Norepinephrine)
Collaborative Care: - Norepinephrine (Levophed) drug of choice to support BP - Epinephrine and vasopressin can be started after norepinephrine - Optimize cardiac output - Hemodynamic monitoring – CVP o CVP 5- o Once fluid is optimized, give pressors - Oxygenation & ventilation - Initiate nutrition within 24-hours - Blood glucose < 180 md/dL - Stress ulcer prophylaxis - DVT prevention
Hemodynamic Changes in Shock:
Sepsis and Septic Shock
Course: Generalist Nursing Practice IV: Tertiary Care Across the Lifespan (NURS 4889)
University: Temple University
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