What do nurses need to know when someone has septic shock? - page 2

What do nurses need to know when someone has septic shock?... Read More

  1. by   Magsulfate
    First of all, write down ALL of the signs and symptoms of septic shock.

    Then, look up what the doctor would order for those signs and symptoms, and for septic shock itself.

    Then, look at the big picture. Like an earlier poster said, research what happens in the body during septic shock.

    Depending on the patient, and the history, the nursing care might be different, but you really need to look all of this up so that it will "click" for you.

    We can't just tell you, you'll never learn that way.
  2. by   Keepstanding
    honey, just do the work on your own. you will retain it better that way anyway. you never know when you might be getting wrong advice here. so just do your work and feel a sense of accomplishment.

    praiser :heartbeat
  3. by   Daytonite
    Quote from tamch
    what do nurses need to know when someone has septic shock?
    since this thread was not on the nursing student assistance forum earlier i must assume that it started elsewhere since i read just about every thread that is posted on this forum.

    i assume that you are a student looking for what you do/what you assess for when you get a patient that has this diagnosis. i advise students to look up these medical diagnoses and learn their pathophysiology and how the doctors treat them. learn what the signs and symptoms are. here on the students forums is another thread that has a huge list of helpful websites to help you look up information: Medical Disease Information/Treatment/Procedures/Test Reference Websites - medical disease information/treatment/procedures/test reference websites and we also have a sticky thread with websites to help students learn to do better assessments: Health Assessment Resources, Techniques, and Forms - health assessment resources, techniques, and forms.

    septic shock is covered on this website: http://www.ccmtutorials.com/infection/index.htm. other websites that information about septic shock or sepsis are:
    the online merck manual also has some nice information about septic shock (this is a weblink listed on the medical disease information/treatment/procedures/test reference websites thread): http://www.merck.com/mmpe/sec06/ch068/ch068a.html
  4. by   Hekate
    Quote from tamch
    what do nurses need to know when someone has septic shock?

    [font=book antiqua]to get you started, i think you should first learn and understand the pathophysiology of shock + sepsis/septic shock:

    def of shock: complex clinical syndrome of decreased blood flow to body tissues resulting in
    cellular dysfunction and eventual organ failure.

    clinical picture of shock:
    * tachycardia
    *cold, clammy skin
    * hypotension
    * oliguria
    * decreased mentation

    compensatroy mechanisms to correct shock
    * catecholamines
    * leads to sns activation via baroreceptors
    * a (alpha)= peripheral vasoconstriciton
    *b1 (beta 1)= increase sa node firing, conduction through av node, and force of contraction, and coronary artery dilation
    *b2= bronchiolar dilatation
    * arterial constriction
    * venous constriction
    * dopaminergic
    * increased respiratory rate
    ~chemoreceptor reflex
    * interstitial fluid shifts
    * increase release of renin and aldosterone
    * increase release of adh
    * thirst
    * cns ischemic response

    septic shock is a
    [font=book antiqua]subclass[font=book antiqua] of "distributive shock" : etiology
    * severe overwhelming infection~ shock
    [font=book antiqua] refers specifically to decreased tissue perfusion resulting in end-organ dysfunction
    [font=book antiqua] * component of sirs (systemic inflammatory response syndrome)
    * causes: the process of infection by bacteria or fungi can result in systemic signs and symptoms that are variously described. approximately 70% of septic shock cases are due to gram-negative bacilli that produce endotoxins.
    the condition develops as a response to certain microbial molecules which trigger the production and release of cellular mediators, such as tumor necrosis factors (tnf); these act to stimulate immune response. besides tnfα, other cytokines involved in the development of septic shock include interleukin-1β, interleukin-6 and interleukin-8.

    pathophysiology of septic shock
    * host response mediated by complex hormonal and chemical substances*
    * decreased myocardial function
    * decreased force of contraction, reduced preload (due to massive vasodilation),decreased ef, increased edv and pressure
    * alterations in peripheral circulation
    * massive vasodilation
    * maldistribution
    * increased capillary permeability
    [font=book antiqua]cytokines tnfα, il-1β, il-6 released in a large scale inflammatory response results in massive vasodilation, increased capillary permeability, decreased systemic vascular resistance, and hypotension. hypotension reduces tissue perfusion pressure and thus tissue hypoxia ensues. finally, in an attempt to offset decreased blood pressure, ventricular dilatation and myocardial dysfunction will occur.
    [font=book antiqua]
    septic shock: clinical manifestations
    * low arterial bp (
    systolic blood pressure < 90 mmhg, or a map < 60 mmhg or a reduction of 40 mmhg in the systolic blood pressure from baseline)
    [font=book antiqua] * low svr
    * altered o2 extraction
    * tachypnea (rr > 20 or paco2
    less than 32 mmhg)
    [font=book antiqua] * tachycardia
    * reduced myocardial contractility
    * wbc
    [font=book antiqua]count < 4000 cells/mm or > 12000 cells/mm
    [font=book antiqua] * temperature instability (witch means elevated or below normal)
    * other organs will start shutting down

    [font=book antiqua]virtually all other organs are going to be affected =>[font=book antiqua]respiratory failure is common in the first 72 hours after the original insult. [font=book antiqua]in the gi, the blood flow to the gi mucosa is going to be altered resulting in decreased mucosa, [font=book antiqua] hepatic failure often follows,[font=book antiqua]clotting abnormalities,[font=book antiqua] and [font=book antiqua]gastrointestinal bleeding.[font=book antiqua] f[font=book antiqua]or the kidneys, we are going to see oliguria (abnormally small production of urine) then [font=book antiqua] renal failure[font=book antiqua]... decreased loc or changes in mentation and increased respiratory rate as it often develops into ards ...

    treatment of septic shock:
    * antibiotics
    * remove source of infection
    * fluid resuscitation
    * vasoactive meds
    * experimental tx: high dose steroids, naloxone, mediator inhibitors, monoclonal antibodies. recombinant activated protein c has been shown in large randomized clinical trials to be associated with reduced mortality in patients with multi-organ failure. it is also being reviewed for treatment of ards (which has a large incidence of pulmonary coagulopathy) with positive results.

    continuum of septic shock:
    * infection
    * sepsis
    * severe sepsis
    * septic shock
    * multiple organ dysfunction/failure
    * death
    => it begins with an infection or invasion of microorganisms => stimulates the systemic inflammatory response => we can say that sepsis is present when this
    systemic inflammatory response syndrome (sirs)[font=book antiqua] is activated in response to an infection => sepsis progresses to severe sepsis when that inflammatory response (because of the release of endo-toxins and secondary mediators) has become harmful resulting in => organ dysfunction, hypo-perfusion and hypotension. it then progresses to multiple organ dysfunction ( multiple organ dysfunction syndrome or mods[font=book antiqua]) and eventually death.
    multiple organ dysfunction syndrome is well established as the final stage of a continuum systemic inflammatory response syndrome -> sepsis ->severe sepsis ->multiple organ dysfunction syndrome.(from wikipedia)[font=book antiqua]

    i hope this helps....since i don't know the purpose of your question, i focused my answer on the mechanism of shock and septic shock, as well as its syptoms and a few treatment options. you will see however that the practice changes depending on the hospital and the intensivist in charge of the icu. for example, the use of
    [font=book antiqua]recombinant activated protein c is often used as a last ditched effort, which is often fruitless. some hospitals that cater to a "higher" socio economic population start using [font=book antiqua] activated protein c as soon as spesis is spotted with a much better outcome...
    ps: all the underlined words in dark are interactive links to the corresponding wikipedia page with definitions and explanation so you can look up the terms you don't understand.
    good luck!

    Last edit by Hekate on Apr 16, '09
  5. by   XB9S
    please could I ask all members to post on topic, further off topic comments will be removed.

  6. by   UM Review RN
    If the OP is still around.....

    Septic shock is such a very important illness. You really need to know this one inside and out. I learned much more about it during training at the hospital because new strides had been made in the dx and tx of this killer. So my learning was through reading and surfing the Net, very similar to the materials you've been given here. There was only a short blurb in the text that really didn't say much.

    All the angst proved worth it when I could count the lives that were saved because of early identification and treatment. This is a pretty good video about the topic. Bear in mind, this is for docs, but it includes nursing interventions like expecting fluid boluses for hypotension and drawing blood cultures prior to giving antibiotics:

    Identification and Management of Sepsis
    Last edit by UM Review RN on Apr 16, '09
  7. by   Natingale
    Since you asked ..and I take homework very seriously

    I just read what the staff wrote..so here:

    Even if you googled what you wrote in your post, you would have come up with a lot of information on your own.

    I did it for you. Heres the link http://www.google.com/search?hl=en&q...earch&aq=f&oq=

    Because you have this thread, go down to the third link and beyond.
    Last edit by Natingale on Apr 17, '09 : Reason: removed irrelevant fluff from post