Pathophysiology
infection (localized infection), sepsis (systemic response to infection), severe sepsis and septic shock
What describes the stages of sepsis severity?
What are ways the nurse can prevent GI ulcers in septic shock patients?
bacterial, viral or fungal infection with confirmed SIRS criteria
What confirms the diagnosis of sepsis?
Persistent hypotension despite adequate fluid resuscitation and inadequate tissue perfusion which results in tissue hypoxia
What are the signs and symptoms of septic shock?
Vassopressor administration
What is done when the patient is not responsive to fluid resuscitation?
lactic acid >/=4
What level of lactic acid indicates septic shock?
Paralytic ileus, AKI/acute tubular necrosis, altered LOC, respiratory failure/ARDS
What are the complications of septic shock?
A precipitating event such as sepsis or trauma causing the consumption of platelets and clotting factors with secondary fibrinolysis that results in clinically significant bleeding
What is disseminated intravascular coagulation?
blood cultures followed by broad-spectrum antibiotic administration
What should be done immediately when sepsis diagnosis is confirmed?
increased or decreased WBCs, increased lactate >2, heart rate above 90, temperature>100.3 or < 96.8 and respiratory rate above 20
What is SIRS criteria?
petechiae, necrotic/black fingers and nose, bleeding from puncture sites, sclera, nose, mouth, gums, bright red/burgundy NGT output, pink frothy sputum from ET tube, weakness, joint pain and achy bones
What are the symptoms of disseminated intravascular coagulation?
Vasodilation, maldistribution of blood flow, micro emboli, and myocardial depression
What are the 4 major pathophysiologic effects of septic shock?
systolic blood pressure + 2 x diastolic blood pressure divided by three
How do you calculate MAP?
increased BG, procalcitonin, urine specific gravity, decreased urine sodium, and positive blood cultures
What are the expected lab findings for septic shock?
Sedation and analgesia
What is a way to preserve metabolism in septic patients?
mediator excess: cytokines, oxygen free radicals, etc., widespread endothelial injury and dysfunction, tissue edema, vasodilation and increased capillary permeability, and neutrophil entrapment in microcirculation
What is systemic inflammatory response syndrome?
Weeping of skin, cold and mottled skin, uncontrolled bleeding, and bradycardia
What are the late signs of septic shock which indicate the patient is about to code?
A guideline in which the higher the score, the worse the outcome is for the patient.
What is the sequential organ failure assessment (SOFA) score?
decreased SV, CO, BP or normal BP with widened pulse pressure, increased HR
What are the cardiovascular effects of sepsis?