INFECTION BEGINS
An infection occurs when microorganisms penetrate how many lines of the body's defenses?
What is three?
Sepsis begins with the body's response to what underlying problem?
What is infection?
A septic patient has HR 112. What is this finding called?
Answer: Tachycardia
In septicemia, the WBC count may be abnormally ______ OR abnormally ______.
Answer: High or low — leukocytosis or leukopenia
What type of antibiotics are included in the initial treatment listed for septicemia?
Answer: Broad-spectrum antibiotics
A patient has redness, warmth, edema, and pain surrounding an infected wound. Are these local or systemic manifestations?
What are local manifestations of infection?
Put these in the best progression:
Septic shock → Infection → systemic response/sepsis
Infection → systemic response/sepsis → septic shock
Which is considered a late manifestation?
A. Fever
B. Tachycardia
C. Tachypnea
D. Altered mental statu
Answer: D — Altered mental status
Which laboratory value in the lecture can become elevated and is especially concerning for impaired tissue perfusion?
Answer: Lactate
What treatment helps restore circulating volume and improve perfusion?
Answer: IV fluid resuscitation
A patient develops fever, weakness, headache, malaise, and nausea. The infection is no longer producing only local manifestations. These findings indicate what type of response?
What is a systemic response/manifestations of infection?
During a widespread inflammatory response, blood vessels dilate. What happens to systemic vascular resistance and blood pressure?
SVR decreases → blood pressure can decrease.
Which patient should concern you MOST?
Patient A: T 101.2°F, HR 105
Patient B: T 101.5°F, HR 110, BP 118/72
Patient C: T 100.8°F, HR 118, BP 82/48, confused
Answer: Patient C
They're showing hypotension + altered mental status, both late findings indicating significant deterioration.
Which TWO are inflammatory markers included in your lecture?
A. Troponin
B. CRP
C. Procalcitonin
D. Hemoglobin
Answer: B & C — CRP and procalcitonin
A septic patient's BP remains dangerously low. Which medication category in your lecture is used to support blood pressure?
Answer: Vasopressors
Gram-negative bacteria contain this substance in their cell wall that can be released when the bacterium dies and contribute to septic shock.
What are endotoxins?
Systemic inflammation → vasodilation + increased capillary permeability → ________ → decreased tissue perfusion → organ dysfunction
Answer: Hypotension/decreased circulating vascular volume
A patient with infection progresses from:
HR 104 → 120
BP 124/76 → 88/52
Urine output 45 → 15 mL/hr
Alert → confused
What is the overall trend?
Answer: Worsening systemic illness with decreased tissue/organ perfusion.
Patient's labs:
Combined with fever, tachycardia and hypotension, are these results reassuring or concerning?
Answer: Concerning for significant systemic infection/septicemia and deterioration.
Match the problem to the treatment:
1. Infection
2. Low circulating volume/perfusion
3. Persistent hypotension
A. Vasopressors
B. Broad-spectrum antibiotics
C. IV fluids
Answer:
1 → B
2 → C
3 → A
A patient has a small infected wound on their leg. Which finding would concern you MOST that the patient's response is becoming systemic?
A. Redness surrounding the wound
B. Tenderness at the wound
C. Fever and tachycardia
D. Purulent wound drainage
Answer: C — Fever and tachycardia.
WHY: A, B, and D can occur with a localized infection. Fever and tachycardia suggest the effects are becoming systemic.
A septic patient becomes hypotensive and produces only 15 mL of urine in one hour.
Explain WHY the patient's urine output is decreasing.
Answer: Hypotension → decreased renal perfusion → kidneys receive inadequate blood flow → decreased urine production/oliguria.
You receive report on four patients with infections. Who do you assess FIRST?
A. UTI patient reporting burning with urination
B. Wound infection patient with temperature 100.6°F
C. Pneumonia patient with HR 108 and temperature 101°F
D. Pneumonia patient with BP 84/46 and new confusion
Answer: D
WHY: Hypotension + altered mental status indicate deterioration and impaired perfusion.
0800: Lactate 2.1
1000: Lactate 3.4
1200: Lactate 4.6
What is more important: the individual numbers or the trend, and what does the trend tell you?
Answer: The upward trend is concerning because the patient's condition/tissue perfusion is worsening.
A patient with suspected septicemia has:
T 103°F | HR 128 | RR 28 | BP 82/44 | confused | lactate elevated
The provider orders:
Instead of simply naming the medications, explain the problem each treatment is trying to fix.
Answer:
Antibiotic → attacks the infectious cause
IV fluids → support circulating volume/perfusion
Vasopressor → supports vascular tone/BP when hypotension persists
Supportive care → supports affected body functions while the underlying problem is treated