Septic Shock: Causes, Symptoms and Nursing Management

Definition of Septic Shock:

Septic shock is a clinical syndrome of life-threatening organ dysfunction caused by a dysregulated response to infection. In septic shock, there is critical reduction in tissue perfusion; acute failure of multiple organs, including the lungs, kidneys, and liver, can occur. Common causes in immune- competent patients include many different species of gram-positive and gram-negative bacteria.

Septic Shock
Fig: Septic Shock

Sign and Symptoms of Septic Shock:

Early symptoms should not be ignored. These include:

  • Fever usually higher than 101°F (38’C),
  • Low body temperature (hypothermia),
  • Fast heart rate,
  • Rapid breathing or more than 20 breaths per minute.

Symptoms of Severe Septic Shock include:

  • Noticeably lower amounts of urine,
  • Acute confusion,
  • Dizziness,
  • Severe problems breathing,
  • Bluish discoloration of the digits or lips (cyanosis),
  • Low blood pressure, especially when standing,
  • Palpitations,
  • Rapid heart rate,
  • Restlessness, agitation, lethargy, or confusion,
  • Shortness of breath.

Causes of Septic Shock:

1. Causative organism:

  • Bacterial infection.
  • Fungi, such as candida, and
  • Viruses can also sometimes lead to sepsis, although this is rare.
  • Bacterial infections that cause sepsis often develop while a person is in hospital (Hospital Acquired infection).
  • Gram-negative bacteria (i.e., Escherichia coli, Klebsiella, Enterobacter, Seratia, Pseudomonas, Bacteroides, Proteus) produce a substance called an endotoxin.
  • Gram positive bacteria.

2. Endocrine diseases-

3. Drugs-

  • Corticosteroid,
  • Chemotherapy,
  • Long-use of antibiotics,
  • Injecting Recreational,
  • Neuromuscular blocking agent.

4. Immune System-

  • Cancer AIDS Transplant patient,
  • Blood diseases,
  • Lymphoma,
  • Leukemia,
  • Disseminated intravascular coagulation (DIC).

5. GIT-

  • Liver cirrhosis,
  • Biliary system infections,
  • Appendicitis,
  • Medical devices Drainage tubes.

6. Cardiovascular system– Valvular heart diseases

7. Nervous system– Meningitis

8. Hospital acquired complications-

  • DVT,
  • Lines sepsis,
  • Bed sores,
  • Air embolism.

Complications of Septic Shock:

Septic shock can cause a variety of very dangerous and life-threatening complications that can be fatal. Possible complications include:

  • Heart failure,
  • Abnormal blood clotting,
  • Kidney failure,
  • Respiratory failure,
  • Stroke,
  • Liver failure,
  • Loss of a portion of the bowel,
  • Loss of portions of the extremities.

Nursing Management of Septic Shock:

  1. Place the patient flat in the bed with the feet elevated if necessary until hypotension is resolved.
  2. Avoid the use of Trendelenburg position, as it may increase afterload to the left ventricle and decrease stroke volume. Respiratory excursion is compromised in this position.
  3. Maintain 30-45 degree head-of-bed elevation to prevent Ventilator-associated pneumonia and aspiration.
  4. Obtain a history, examine the patient and make a “best guess.
  5. Provide a rapid, cursory initial head -to-toe physical assessment.
  6. The initial assessment goal is to identify major problems and gross abnormalities
  7. Perform focus assessment of specific injuries or problems after shock is stabilized,
  8. Perform diagnostic, CBC, Blood culture
  9. Ensure that the airway is protected and maintain a patent airway B= Breathing
  10. Assess for the presence of noisy respirations and check for airway obstruction.
  11. Auscultate the lung sounds to determine adequate air movement
  12. Respiratory rate is considered to be one of the most sensitive indicators of critical illness, yet it is a vital sign that is often neglected (Stevenson, 2004)
  13. Assess the respiratory rate and effort to evaluate the adequacy of breathing, Administer Oxygen through face mask and, if intubated, commence mechanical ventilation.
  14. Restore circulating volume with fluid resuscitation, invasive monitoring and vasopressors if necessary.
  15. Palpation of the radial or brachial pulse during deflation of the blood pressure cuff. When palpation is used, the first palpable pulse noted during deflation of the cuff is the systolic BP. Document the BP such as (e.g, 90/palp.).
  16. Use of Doppler instrument.
  17. By arterial line connected to continuous monitoring.
  18. Place the ECG monitor electrodes on the patient’s shoulders than on the chest.
  19. Temperature monitoring:

An indwelling flexible rectal probe connected to a continuous display monitor is more accurate and less traumatic than intermittent rectal temperature measurements with a standard thermometer.

Tympanic temperatures are commonly used in critical care setting:

  • Start empiric antimicrobials,. Antibiotics are often started before a diagnosis has been confirmed.
  • Administer Drotrecoginalfa (activated protein C). It is an artificially produced human protein that can help to prevent inflammation and blood clotting, reducing the risk of death.
  • Surgery

In severe cases of sepsis or septic shock, surgery may be required to remove the dead tissues.

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