septic shock

[nursingcrib]

does it help to lay a patient with septic shock on their side to facilitate lung expansion?

[ArmaniX, MSN, APRN]

I'm sorry what?

[jadelpn, LPN, EMT-B]

With septic shock, there is a heck of a great deal more going on than positioning. However, I would be really mindful of laying anyone flat on their backs without sufficient suction handy when they are critically ill.

[nursingcrib]

I understand that, but to to help improve oxygenation, respiratory mechanics, alveolar inflation, lung volume, drainage and secretions and to reduce ventilator associated injury is it a good idea to put someone on their side whilst doing your assessment to relieve some of the symptoms of hyperventilation and to decrease the amount the patient has to work to breath wasting valuable energy and easing patient distress....

[Dranger]

Septic shock:

Cultures

Lots of fluids

Pressors

Proper antibiotic coverage

Respiratory support with mechanical or non-mechanical means

Watching labs and electrolytes

That's the gist of it. If sepsis has turn into full blown ARDS they need to be proned which is another issues entirely

[JPINFV]

does it help to lay a patient with septic shock on their side to facilitate lung expansion?

Are we talking in the sense of a first aid "recovery position" type thing?

No. Assuming appropriate fluid resuscitation has been done (or else they technically aren't in septic shock), then they need a central line and vasopressors. If you're talking about rolling someone with an ET tube and mechanical ventilation, then you also have to consider the risk of dislodging the ET tube.

[nurseprnRN, BSN, RN]

What makes you ask this question? I'm curious, because I have recently read a paper on the idea of turning with pneumonia, and the researchers indicated their findings were that putting the "bad" lung dependent might not be such a bad idea after all. But that's not septic shock.

[Coffee Nurse, BSN, RN]

What makes you ask this question? I'm curious, because I have recently read a paper on the idea of turning with pneumonia, and the researchers indicated their findings were that putting the "bad" lung dependent might not be such a bad idea after all. But that's not septic shock.

That's what occurred to me, too. Can't make heads or tails of the OP's second post, though.

[MendedHeart]

In my opinion, any patient that cannot move themselves should be turned every 2 hours. Not only to protect skin but to keep secretions moving. As far as sepsis specifically, I wouldn't really do anything different unless they are unstable or have labored breathing.

[amoLucia]

I understand that, but to to help improve oxygenation, respiratory mechanics, alveolar inflation, lung volume, drainage and secretions and to reduce ventilator associated injury is it a good idea to put someone on their side whilst doing your assessment to relieve some of the symptoms of hyperventilation and to decrease the amount the patient has to work to breath wasting valuable energy and easing patient distress....

All this sounds like a quote from some published research/professional article and not really the 'language' of a nursing student.

And not to mention the use of the word "whilst".

[Dranger]

The only time I can thinking of turning being important is still in a severe ARDs situation, with manual proning or rotaprone means. Good lung/bad lung situation. Or both bad lungs....

[Jenngirl34RN]

I kind of get where you might have gotten to that answer, since poor oxygenation is a sign of septic shock, but it has more to do with circulation than lung expansion. If blood cannot circulate, tissues cannot be perfused, leading to organ failure. Putting someone on their side is not going to do much for them if they are in septic shock, plus it could be difficult if someone is ventilated (which they very often are) and could cause more trouble than help if the ET tube was dislodged.