Sepsis and Septic Shock

Question 1

What is sepsis?

Answer 1

SIRS + systemic infection
Bacteria breakdown causes endotoxins and other mediators to be released into the blood stream–> causes SYSTEM WIDE VASODILATION that leads to fluids leaking out into the tissues and organs are not perfused properly

Question 2

What are clinical manifestations of sepsis and septic shock?

Answer 2

1. First sign is fever > 100.9
2. Tachycardia > 90
3. Tachypnea > 20
4. WBC> 12,000 or <4000

Question 3

What are the shock table values for sepsis and septic shock?

Answer 3

BP↓ HR↑ CO↑ CVP↓ SVR↓

Question 4

What is septic shock specifically?

Answer 4

Sepsis + persistently low MAP secondary to infection despite fluid resuscitation (This is a perfusion problem)

Question 5

What are normal MAP levels?

Answer 5

70-100

Question 6

What is refractory septic shock?

Answer 6

It is irreversible and is a total body failure after fluid resuscitation and pressors are given

Question 7

What are risk factors of sepsis?

Answer 7

SEPSIS Causes Plenty Of Incredibly Bad Happenings, Understand?

Chronic illness
Poor nutritional status/pneumonia
Older adults
Burns
Infected cuts/invasive procedures/ immunocompromised patients 
Hospitalization
UTI

Question 8

What is the major diagnostic test done for sepsis?

Answer 8

Quick Sepsis related Organ Failure Assessment

Question 9

What shows that the patient has sepsis in the qSOFA assessment?

Answer 9

1. Hypotension where systolic BP is < 100
2. Altered mental status
3. Tachypnea where the respiratory rate is >22

2+ indicates a poor prognosis

Question 10

What does a positive lactate test mean in a patient with sepsis?

Answer 10

positive lactate labs show that there is a lack of fluid and there is dehydration
>2 means the nurse needs to intervene

Question 11

What are normal levels of procalcitonin?

Answer 11

procalcitonin should be less than 0.15

Question 12

What does a high procaclitonin level show?

Answer 12

indicates severity of septic shock and you want it to decline as sepsis improves

Question 13

What is the sepsis six?

Answer 13

Sepsis six are priority interventions done within the first hour of initial diagnosis of sepsis

Question 14

What are the sepsis six interventions?

Answer 14

1. High-flow oxygen to keep O2 > 80
2. Take blood cultures (HIGH PRIORITY) to determine the cause
3. Give IV antibiotics and give a broad spectrum immediately after lab draw, usually one that is effective against gram - bacteria
4. Give a fluid bolus
5. Measure lactate because it is a good indicator of sepsis
6. Measure urine output

Question 15

What medications can be given to raise BP in septic shock patients?

Answer 15

Give fluids FIRST, and then vasopressors such as norepinephrine and dopamine in drips to raise BP

Question 16

What is a broad spectrum medication that can be given to a sepsis patient after initial labs are drawn?

Answer 16

Vancomycin because it inhibits cell growth and reproduction of the causatave organism