Sherpath module 1- sepsis septic shock

localized infection symtom

Inflammation

Which symptom would the nurse expect to observe in a patient with a localized infection

fever

tacbycardia

decreased 02

inflammation

Fever

A localized infection typically only manifests as inflammation at the site of infection. Systemic symptoms should not be present if the infection remains localized.

Tachycardia

During the initial inflammatory response, the organism invades the tissue at the localized areas, white blood cells (WBCs) invade the infected source and cytokines are excreted which trigger local inflammation. This helps to prevent systemic infection that could lead to tachycardia.

Decreased oxygen saturation

Decreased oxygen saturation occurs with systemic infection. The body responds to localized infection with inflammation which is triggered in an attempt to keep the infection localized while the infectious source is neutralized.

Inflammation

Correct answer

When infection is confined to a local area, it should not lead to sepsis and shock. In the adult whose immunity and inflammatory responses are effective, the presence of organism invasion starts a helpful local response of inflammation, that confines and eliminates the organism and prevents the infection from becoming widespread.

Which symptom would the nurse expect to associate with sepsis and the early phases of septic shock?

Select all that apply. One, some, or all responses may be correct.

Elevated systolic blood pressure

Warm extremities

Lower oxygen saturation

Cyanosis

Change in cognition

Delayed capillary refill

low 02

change in cog

elevated systolic

warm extremeties

Box 31.7 Conditions Predisposing to Sepsis and Septic Shock

Malnutrition

Immunosuppression

Large, open wounds

Mucous membrane fissures in prolonged contact with bloody or drainage-soaked packing

GI ischemia

Exposure to invasive procedures

Cancer

Receiving cancer chemotherapy

Age above 80 years

Infection with resistant microorganisms

Alcoholism

Diabetes mellitus

Chronic kidney disease

Transplant recipient

Hepatitis

HIV/AIDS (HIV-III)

Patients and families can aid in early detection. This is especially important for patients discharged to home after invasive procedures or surgery.

Teach patients and families the signs and symptoms of:

Local infection

Local redness

Pain

Swelling

Purulent drainage

Loss of function

early sepsis signs

Fever

Urine output less than intake

Light-headedness

Which finding would the nurse score as a two or higher on the Sequential Organ Failure Assessment (SOFA)?

Glasgow Coma Scale (GCS) score of 10

Correct answer

A GCS score of <12 is indicative of central nervous system dysfunction. A score of 10 would warrant a score of 2 or higher on the SOFA.

hypovolemic shock RF

Diuretic therapy

Diminished thirst reflex

Immobility

Use of aspirin-containing products

Anticoagulant therapy

Cardiogenic shock RF

Diabetes mellitus

Presence of cardiomyopathies

distributive shock RF

Diminished immune response

Reduced skin integrity

Presence of cancer

Peripheral neuropathy

Stroke

Being in a hospital or extended-care facility

Malnutrition

Anemia

obstructive shock RF

Pulmonary hypertension

Presence of cancer

Hallmark sepsis labs

There is no single laboratory test that confirms sepsis and septic shock. Hallmarks of sepsis include:

Rising serum procalcitonin

Increasing serum lactate

Normal or low total white blood cell (WBC) count

Decreasing segmented neutrophils with a rising band neutrophils

Changes in WBC count.Differential leukocyte count may show a left shift.

Hematocrit and hemoglobin usually do not change until late in septic shock.At that point, hematocrit and hemoglobin levels, fibrinogen levels, and platelet count are low from DIC.

Serum lactate is above normal.

Serum bicarbonate is lower than normal.

Indicators for improvement in tissue perfusion include:

Arterial blood gases (pH, Pao2, and Paco2) within the normal range

Urine output maintained at ≥0.5 mL/kg/hr

Maintenance of mean arterial blood pressure ≥65 mm Hg

Absence of multiple organ dysfunction syndrome (MODS)

Capillary refill <3 seconds

Extremities warm without mottling

Box 31.8 Hour-1 Bundle for Management of Sepsis

Within 1 hour:

Measure lactate level.a

Obtain blood cultures before administering antibiotics.

Administer broad-spectrum antibiotics.

Begin rapid administration of 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.

Apply vasopressors if hypotensive during or after fluid resuscitation to maintain a mean arterial pressure (MAP) ≥65 mm Hg.

aRemeasure lactate if the initial lactate is elevated (>2 mmol/L).

sepsis treatment-source control

The removal of the infection at its source of origin

Control of ongoing microbial contamination (Schmidt & Mandel, 2023)

Ideally, source control should be obtained within 6 to 12 hours to improve the chance of survival (Dugar et al., 2020). Examples of source control include:

Drainage of an abscess

Removal of an infected device/hardware/foreign bodyUrinary catheterVascular accessProsthetic device

Debridement of infected and necrotic tissue

sepsis treatment-timely antibiotics

To treat sepsis and septic shock, multiple antibiotics with broad-spectrum activity (usually directed against gram-positive and gram-negative bacteria, sometimes fungi, and rarely viruses) are prescribed until the actual causative organism is known (Schmidt & Mandel, 2023). The initial antibiotics chosen are based on the:

Site of infection

Most common geographic infections

Patient's history Recent infectionsDrug allergyComorbiditiesCurrent medicationsRecent or active chemotherapy

Kidney and liver function

Antibiotics available on formulary at the facility

The goal, using the Hour-1 Sepsis Bundle, is to start antibiotics as ordered within 1 hour of recognizing sepsis.

therapies to treat symptoms of sepsis and septic shock

Several therapies are used to treat the symptoms of sepsis and septic shock. Select each tab to learn more.

Steroid Therapy

Insulin Therapy

Bicarbonate Therapy

Heparin Therapy

Blood Replacement Therapy

Oxygen Therapy

Prophylaxis Therapy

Box 31.9 Home Health Care: The Patient at Risk for Sepsis

Assess the patient for any signs and symptoms of infection.

Temperature, pulse, respiration, and blood pressure

Color of skin and mucous membranes

The mouth and perianal area for fissures or lesions

Skin for the presence of exudate, redness, increased warmth, swelling

Any pain, tenderness, or other discomfort anywhere

Cough or any other symptoms of a cold or the flu

Urine; or ask patient whether urine is dark or cloudy, has an odor, or causes pain or burning during urination

Nausea, vomiting, or diarrhea

Fatigue or weakness

Assess patient's and caregiver's adherence to and understanding of infection prevention techniques.

Assess home environment, including:

General cleanliness

Kitchen and bathroom facilities, including refrigeration

Availability and type of soap for handwashing

Presence of pets, especially cats, rodents, or reptiles

Protecting frail patients from infection and sepsis at home is an important nursing function. Teach about the importance of:

Vaccines

Wound care

Self-care strategies

Good hygiene

Handwashing

Balanced diet

Rest and exercise

Skin care

Mouth care

How to take a temperature or read a thermometer, teach them

Obtain a return demonstration.

Notifying the primary health care provider immediately if fever or other signs of infection appear.

Taking antibiotics as directed if prescribed

Stopping an antibiotic early may lead to an incompletely treated infection, which may result in sepsi

Which laboratory value is indicative of a patient experiencing sepsis or septic shock?

decreased segmented neutrophils

Which treatment would the nurse associate with source control?

Wound debridement

Correct answer

Source control is the removal of an infection at the source of origin and control of ongoing microbial containment. Wound debridement is an example

Which criterion would the health care team use to determine if systemic inflammatory response syndrome (SIRS) is present?

Select all that apply. One, some, or all responses may be correct.

Body temperature

Hypotension requiring vasopressor support

Heart rate

Bilirubin

Leukocyte count

Body temp

HR

leukocyte count

peripheral neuropathy is what type of shock

distributive

asprin containing products is what type of shock?

hypovolemic

diabetes mellitis is what type of shock

cardiogenic

pulmonary hypertension is what type of shock

obstructive

Which factor would the nurse evaluate when assessing the home care patient at risk for sepsis?

Refrigeration availability

Presence of pets

Family understanding of infection prevention techniques

Oral fissures

Correct answer

Assessing the patient for any signs and symptoms of infection is part of the home care assessment for patients at risk for sepsis. This includes assessing the mouth and perianal area for fissures or lesions.

which symptom is indicitive of cold shock ?

decreased cardiac output