Pathophysiology: Disseminated Intravascular Coagulation (T

Immune chemicals cause widespread inflammation, leading to blood clots and reduced blood flow 2• 1

According to information published by the Mayo Clinic, sepsis has three stages: sepsis, severe sepsis and septic shock. The mortality rate for septic shock is nearly 50 per cent, and an episode of severe sepsis increases the risk of future infections. Severe sepsis causes blood flow to the vital organs, such as the brain, heart and kidneys, to become impaired. Sepsis can also cause blood clots to form in organs and extremities such as arms, legs, fingers and toes, which can lead to organ failure and tissue death (gangrene).

As sepsis progresses, tissues become less perfused and acidotic, compensation begins to fail, and the patient begins to show organ dysfunction. The cardiovascular system also begins to fail, the blood pressure does not respond to fluid resuscitation and vasoactive agents, and signs of end-organ damage are evident (e.g., renal failure, pulmonary failure, hepatic failure). As sepsis progresses to septic shock, the blood pressure drops, and the skin becomes cool, pale, and mottled. Temperature may be normal or below normal. Heart and respiratory rates remain rapid. Urine production ceases, and multiple organ dysfunction progressing to death occurs. Adventitious lung sounds occur throughout the lung fields, not just in the upper fields of the lungs.

This leads us to the next step in the pathophysiology of Sepsis. Stage 2 of sepsis, which is when SIRS plus the confirmation of an infection has been made. At this stage, the patient’s body has been continuously fighting something in their body and it is starting to have an effect on the patient. Signs and symptoms of sepsis are often nonspecific and include the following: Fever, chills, or rigors, Confusion, Anxiety, Difficulty breathing, Fatigue, malaise, Nausea and vomiting. It is important to identify any potential source of infection. Localizing signs and symptoms referable to organ systems may provide useful clues to the etiology of sepsis and are as follows: Head and neck infections: Severe headache, neck stiffness, altered mental

Thromboembolism the two primary complications include arterial thromboembolism and pump thrombosis. Thrombi forms due to low blood flow to certain areas (aortic valve, dilated ventricle) and infection this can lead to stroke. Hypotension can be an early sign of sepsis, hypovolemia, decreased cardiac output, filling pressure, hypovolemia, right ventricular failure, tamponade, arrhythmias, or device related complications. Hemorrhage or bleeding a major complication that can be caused either by underlying bleeding disorders

The unresolved infection has landed the patient on septic shock. Sepsis is the body’s response to inflammation of a particular or unknown infection. The presence of hypotension despite adequate fluid infusion and inadequate tissue perfusion is the result of septic shock. The treatment of shock is centered on the restoration of blood pressure to normal, the presence of adequate tissue perfusion, making sure organs return to functioning well, and avoiding further complications (Lewis, Dirksen, Heitkemper, Bucher, & Harding,

Not all bacteremias lead to sepsis. People have everyday bacteremia, particularly, from oral cavity, but sepsis develops rarely [27-31]. It occurs when the infection is resistant to host antibacterial defense. The latter is different in the bloodstream and tissues. If the infection develops locally (tissue, cavity, etc.) and then enters the bloodstream, there are two stages of sepsis: pre-septic (local) and septic (generalized). If infection enters the bloodstream directly from an external source (contaminated intravenous injection, bite, etc.), the pre-septic stage is absent. Local antibacterial defense is provided by phagocytosis (leukocytes and their local versions: resident macrophages), complement, NETs, etc., whereas in the bloodstream

When a patient has sepsis early symptoms will include those that define SIRS; abnormal body temperature, increased heart rate, increased respiratory rate, and/or abnormal white blood cell count. If these symptoms are left untreated, organ failure will start to occur. Signs of organ failure can include decreased urine output, sudden changes in mental status, difficulty breathing, decrease in platelets and abnormal heart rhythms. Decreased cardiac output and hypotension may also start to occur, which indicates septic

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, a potentially life-threatening complication of an infection, occurs when chemicals are released into the bloodstream to fight infection. These chemicals trigger inflammatory responses throughout the body (Mayo Clinic Staff, 2016). Sepsis can be triggered by any type of infection: bacterial, viral, or fungal. Contrary to popular belief, sepsis is responsible for a great number of deaths in the United States alone. Sepsis kills more than 258,000 Americans per year, is the number one cause of death in hospitals, and kills more Americans than prostate cancer, breast cancer, and acquired immunodeficiency syndrome (AIDS) combined. (Rory Staunton Foundation for Sepsis Prevention, n.d.) As cited in nursing journal, “Sepsis: Diagnostic and Therapeutic Challenges,” ‘One of the

Septic shock is the stage of sepsis when multiple organ failure is evident and uncontrolled bleeding of the body occurs. Septic shock results from the complication of an infection where toxins initiate a full body inflammatory response. Viral, fungal, and bacterial infections can all lead to septic shock, but the most common causes of sepsis are gram- negative bacteria and gram-positive bacteria. Sepsis causes severe hypovolemic shock and hypodynamic cardiac function to affect the body, platelets and clotting factors are consumed and thus the body cannot clot blood. Capillary leak occurs and cardiac contractility is poor from cellular ischemia (Ignatavicius & Workman, 2011). For a person to be diagnosed with septic shock, they must have symptoms

These patients are more at risk of developing sepsis because their immune system may not have the capacity to fight off the infection as the rest of the population (McClelland, 2014). If sepsis develops in a patient, especially a patient who is more at risk, it is important for the nurse to recognize that an infection has developed such as redness, swelling, fever, and drainage. The nurse should assess the patient for possible signs and symptoms of infection including a urinary tract infection, infection in a wound either from diabetes or a surgical wound and presence of a respiratory infection (Bernstein, 2013). An infection can occur anywhere in the body and completing an assessment is important when there is an infection present. If the infection is ignored or not treated, it can become systemic. A systemic infection will destroy the tissue and can eventually reach the blood stream causing a fever, increased heart and respiratory rate, decrease in blood pressure, increase in blood glucose, altered mental status and a severe increase or decrease in WBC. Once treatment has been initiated, how the body responds to the treatment will depend on the severity of the sepsis. If the body does not respond to the rapid fluid replacement or other measures to sustain life, then the patient is in septic shock (McClelland,

organ failure, and death, especially if it is not recognized and treated promptly. Sepsis remains

Sepsis is a condition of growing concern for nursing professionals, as the mortality rate has increased each year since its initial documentation in the early 1990s (Levy et al., 2012). Sepsis was first defined in 1991 as a systemic inflammatory response syndrome (SIRS). Since this time, improvements have been made in developing a worldwide definition of sepsis (Levy et al., 2012). Specifically, sepsis is considered to be a life-threatening dysfunction of the organs that results from the dysregulation of a host response to an infectious agent (American Association of Critical-Care Nurses, AACN, 2018).

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