Nursing Case Studies Septic Shock

Sepsis is both best known yet most poorly understood medical disorders [1]. Sepsis leads to shock, multiple organ failure and death if not recognized early and treated promptly [2]. It is a serious clinical condition that represents a patient’s response to infection and has a high mortality rate [3]. Sepsis remains the dominant challenge in the care of critically ill patients [4]. Up to 19 million cases of sepsis worldwide per annum is estimated. The true incidence is higher [1]. Sepsis is associated with a mortality rate of 25 - 30% and mortality due to septic shock is 50-85% [6-8]. Patients with sepsis requiring intensive care unit (ICU) admission had high rates of ICU and overall hospital mortality, ranging from 18 to 50% [9-12]. The most common sites of infection are

The systemic inflammatory response is the next step in the continuum and is a nonspecific inflammatory state that may be seen with an infection. Sepsis is the presence of the systemic inflammatory response syndrome (SIRS) with evidence of infection. As the bacteria invade the bloodstream, they release endotoxins that damage the endothelial cell lining and impair the vascular system, coagulation mechanism, and immune system. These endotoxins also trigger the immune and inflammatory responses, which results in the activation of macrophages and CD4 cells that release proinflammatory cytokines to create a systemic inflammatory response to the pathogen. Hospitalized patients may quickly progress from bacteremia to sepsis and finally to septic shock, even with treatment.

Sepsis is defined by the Surviving Sepsis Campaign (SSC) as “the presence (probable or documented) of infection together with systemic manifestations of infection” (Dellinger et al.,

Sepsis is a rapidly progressive illness that must be treated early with antibiotics and supportive care.

Under the Core measures, Sepsis is one of the problem-focused trigger for systemic infection and if untreated which can lead to death. In United States, it is the 11th leading cause of death and consumes the large amount of costs about $20.3 billion in 2011 (Jones et al.,2016). According to Centers for Disease Control and Prevention (CDC), more than 1.5 million people diagnosed with sepsis, and at least 250,000 patients die from that yearly (CDC, 2017). The evidence-based research revealed with results of certain pre existing conditions, pathophysiological studies, preventive measures and sepsis bundle for treating and preventing sepsis to save the life of the patients.

Septic shock results from bacteria that multiply in the blood and then releases toxins that decrease blood pressure, thus, impairing blood flow to cells, tissues and organs. It is an acute infection, usually systemic, that overwhelms the body (toxic shock syndrome) (Huether & Mccance, 2012). This

Sepsis is a phenomenon in which an infective agent results in a physiological response in excess of the pathogenic insult. Efforts to define and investigate sepsis have been somewhat fruitful in elucidating the nuances of this phenomenon. Yet, gaps exist in identifying and investigating sepsis. Recent efforts have streamlined the definition and identification criteria of sepsis and septic shock. The treatment of sepsis is based on the elements of identification, hemodynamic interventions (fluid and vasopressor resuscitation), and antimicrobial therapy/source control. A two-tiered approach employing the qSOFA (Quick Sepsis-Related Organ Failure Assessment) and SOFA (Sepsis-Related Organ Failure Assessment) tools now provide a succinct criteria for sepsis and septic shock. Various approaches may be taken to assess fluid responsiveness, provide fluid resuscitation, and determine the need for vasopressor support. Early, aggressive antimicrobial therapy is essential to the treatment of sepsis. Obtaining source control and considering early surgical

Severe Sepsis affects 750,000 Americans and causes more than 200,000 deaths annually. Sepsis is a complex condition that results from an infectious process that represents the body's response to infection and involves systemic inflammatory and cellular events that result in altered circulation and coagulation, endothelial dysfunction and impaired tissue perfusion (Kleinpell, 2005). Associated mortality rates with sepsis in the United States have remained largely unchanged for several decades. Through an international collaboration known as the

Sepsis and Septic Shock have been my personal topic after the life of young Kamil Williams and a 31-year-old Texas man who both contacted a bacterial infection later turn into sepsis. Although I have not formally studied it during my school or university years, I still find the human body, how it can break down and react to certain ailments interesting. The next question would be why does this happen? Well when there is infection or insult upon the body’s immune system normal reacts and causing an inflammatory response. This normally a good thing and it promotes healing and the resolution of the insult, however in Septic Shock the inflammatory response comes explosive and uncontrollable. According to Allison Hotujec, the author of “Severe Sepsis and Septic Shock Protocols,” Sepsis has been called a “malignant intravascular inflammation.” The term malignant is because it is uncontrolled unregulated and self-perpetuating, in the usual immune response here is release of both pro-inflammatory and anti-inflammatory mediators, these balance to promote tissue

Kleinpell states, “Septic shock is the result of an overwhelming infection, leading to hypotension, altered coagulation, inflammation, impaired circulation at a cellular level, anaerobic metabolism, changes in mental status and multiple organ failure (as sited in Garretson & Malberti, Ignatavicius and Workman (2009), “sepsis is a widespread infection coupled with a more general criteria: body temperature higher than 380C or lower than 360C, heart rate greater than 90 beats per minute, respiratory rate greater than 20 breaths per minutes, and WBC count greater than 12,000/mm or lower than 4,000/mm or with more than 10% bands (Spaniol, Knight, Zebley, Anderson, Pierce, 2007). Endotoxins from gram-negative bacteria, such as Escherichia coli, can precipitate the common progression of events leading to septic shock. A patient experiencing SIRS is at risk for organ failure (severe sepsis), multiple organ dysfunction syndrome, and death. This paper will outline the details surrounding this condition, from a nursing standpoint.

An individual can get a septic infection from many sources, such as surgery, burns, injury, etc. The infectious source can be bacterial, parasitic, viral, or fungal. According to Bernstein& Lynn (2013), Systemic inflammatory response syndrome (SIRS) is a clinical syndrome that manifests itself as an acute, nonspecific illness. Sepsis is the first stage of the infection and it manifest itself in many ways, such as an 100.4F or below 96.8F body temperature, white cell count below 4,000 cells/mm3 or, or greater than 12 cell/mm3. If sepsis is not stopped early in its tracks it can lead to sever sepsis which causes acute organ dysfunction, organs such as the kidneys, lungs and heart. If the severe septic infection gets worse, it can lead to the life threating infection, septic shock. Septic shock will reduce the blood

The interventions should be focused on supporting the failing system and include the following: “(1) fluid replacement, (2) airway management, (3) antibiotic therapy, and (4) use of vasopressor” (Latto, 2008, p. 197). Fluid replacement is necessary to expand the blood and plasma volume in order to provide the adequate tissue perfusion and oxygen delivery to the organs. Vasopressors (dopamine, norepinephrine, epinephrine vasopressin) should be used in case the fluid replacement therapy fails to maintain adequate arterial pressure (Latto, 2008). The target central venous pressure should be more than 8 mmHG, the target central venous oxygen saturation should be over 70%. Wide-spectrum antibiotic should be administered as soon as the blood cultures are taken in order to treat the cause of the disease. Serum lactate level should be measured and treated with fluids “if greater than 1.5 times the upper limit of normal” (Latto, 2008, p. 198). Lactate is a byproduct of anaerobic cell metabolism and is one of the indicators of inadequate tissue oxygenation related to sepsis. Moreover, the glucose level, hematocrit and hemoglobin should be closely monitored.

Assessment Although a patient in severe sepsis may be transferred to the intensive care unit (ICU), medical-surgical nurses must be able to recognize early signs and symptoms of sepsis to ensure prompt treatment before the patient requires ICU admission. Severe sepsis Severe sepsis occurs when a patient with documented sepsis goes on to develop acute organ dysfunction with hypoperfusion and tissue hypoxemia. Simple prevention strategies Without proper assessment and early identification, patients with sepsis can deteriorate quickly, suffering compromised tissue oxygenation and organ dysfunction for many hours. Be aware that although blood pressure readings are crucial in assessing and planning care for the septic patient, mean arterial pressure

B. Pathophysiology – Sepsis is described as a generalized infection that is characterized by the presence of bacteria in the blood. The progression of how sepsis becomes septic shock is not completely understood. First the body will contract an infection and the bacteria will move beyond the “initial insult” into the blood stream, a.k.a bacteremia (Stork). As a response the body will start

A. Sepsis is a life threatening bacterial infection that causes the blood to clot, which will block the flow of blood to the main organs