Complex: Sepsis & Shock

Question 1

Sepsis: Describe early signs of sepsis

Answer 1

Recent infection
Elevated temperature
Tachycardia
Tachypnea
Elevated WBC
Elevated Lactate

Question 2

Sepsis: Describe the priority nursing actions when sepsis is suspected

Answer 2

Fluid resuscitation (30ml/kg)
Obtain blood cultures BEFORE administering antibiotics
Begin vasopressors
Administer broad-spectrum antibiotics

Question 3

Sepsis: Describe sepsis in terms of hemodynamics

Answer 3

When the sepsis cascade begins, the vessels dilate and the membranes become weak, causing capillary leaks. The vasodilation causes venous stasis and blood clots may form. The profound vasodilation and capillary leak causes the body to manifest a hypovolemic state and must try to compensate. Compensation occurs with elevated heart rate, elevated respiratory rate, and shunting of blood to vital organs.

Question 4

Shock: Describe Trendelenburg position and it’s use during shock

Answer 4

A patient who is in shock is hypovolemic and placing the patient in the Trendelenburg position (aka: passive leg raise) will promote blood flow to the vital organs

Question 5

Shock: Describe the 4 stages of shock

Answer 5

Initial stage- not enough O2 in blood to perfuse organs;
usually asymptomatic

Compensatory stage- HR increases, RR increases, Renin &
Angiotensin released to try to balance, organs begin to fail

Progressive stage- Progressive poor perfusion leads to
cold, clammy skin

Irreversible- Death is imminent

Question 6

Shock: Describe what is unique about neurogenic shock compared to other types of shock

Answer 6

Neurogenic shock occurs in patients with a high level spinal cord injury. Unlike other types of shock, patients in neurogenic shock become bradycardic due to the unopposed SNS and PNS