Septic Shock Flashcards

1
Q

Septic shock occurs when

A

circulatory and metabolic abnormalities are profound, greatly increasing mortality.

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2
Q

Multiple Organ Dysfunction Syndrome (MODS)

A

Altered function of > 1 organ system requiring interventions to achieve homeostasis.

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3
Q

Septic Shock causes

A

vasodilation which leads to pooling of blood in venous system; relative hypovolemia; decrease venous return.

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4
Q

Etiology of Septic Shock

A

Pneumonia
Urinary tract infections
Endocarditis
Abdominal infections
CAUTI
CLABSI

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5
Q

Septic Shock Risk Factors

A

Very old & very young
Chronic illnesses
Malnutrition
Broad spectrum antibiotic overuse
Surgical or invasive procedures
Immunosuppressed patients
Invasive Equipment: IVs & tubes: Foley, peg tube.

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6
Q

SIRS

A

Systemic Inflammatory Response Syndrome

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7
Q

Systemic Inflammatory Response Syndrome (SIRS) Parameters

A

2 or more of the following
Core temperature below 96.8 °F (36° C) or above 100.4° F (38° C)
Heart Rate > 90 beats/minute
Respiratory rate > 20 breaths/minute
WBC count > 12,000 cells/microliter
Altered mental status.
Blood glucose > 140 mg/dL in the absence of diabetes (stress hyperglycemia)

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8
Q

SOFA

A

Sequential Organ Failure Assessment

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9
Q

Signs of Organ Dysfunction or Hypoperfusion

A

Systolic BP <90 or MAP <65 MAP (70-105)
Or a decrease in pts. baseline systolic BP of >40 mmHg (ex:140/80 to 95/65)
**Lactate > 2-4 mmol/L (norm .5-1.0) WHY??
Increasing O2 need/ mechanical ventilator support.
Creatinine > 2.0 mg/dl
Urine output < 0.5 mL/kg/hr. (for at least 2 hours)
Bilirubin > 2 mg/dL
Platelet count < 100,000 µL
Coagulopathy (INR > 1.5 or aPTT > 60 secs)

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10
Q

Normal bilirubin

A

1.2 mg/dl under age 18, 1mg/dl

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11
Q

Normal PT

A

10-13.5 seconds

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12
Q

Normal INR

A

.8 to 1.2

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13
Q

Normal PTT

A

30-45 sec

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14
Q

Normal Lactate level

A

4.5mg/dl- 19.8mg/dl

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15
Q

Calculate MAP

A

SBP + 2 (DBP) / 3

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16
Q

Oliguria

A

urine of 400ml/24 hours
16ml/hr

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17
Q

Anuria

A

Urine output of 100 ml/24 hr
4ml/hr

18
Q

Septic Shock Symptoms – Early Stage

A

**known as warm shock: Due to Initial Inflammatory Response. Hyperdynamic state
SVR is low due to vasodilation.
**Warm, flushed skin extremities.
Fever, Hyperthermia
Tachycardia
Tachypnea
BP initially normal to low
CO initially increased R/T hyperdynamic state
**Decreased urine output.
Change in mental status (LOC) from time of admission.
May be subtle… listen to family!
State of relative hypovolemia

19
Q

Warm shock

A

A hyperdynamic state. Warm extremities associated with Septic Shock. But BP and HR similar to most other types of shock.

20
Q

Late Signs & Symptoms

A

**Late (cold shock) Unable to Compensate
Signs/symptoms related to specific organ failure.
Tachycardia & Hypotension
Decreased CO
Weak and thready pulses
Confusion and decreased LOC
Cool and pale extremities
Hypothermia & Peripheral cyanosis
Petechiae flat tiny red spots and/or purpura (rash of purple spots) & skin mottling

21
Q

Complications of Septic Shock

A

Disseminated Intravascular Coagulopathy (DIC)
Multi Organ Dysfunction System (MODS)

22
Q

Disseminated Intravascular Coagulopathy (DIC)

A

1st stage of DIC lasts hours to days.
A hematological disorder most often caused by sepsis.
Abnormal clots form inside blood vessels that effect the body’s clotting factors & cause massive bleeding in other areas.
Acute DIC: Clotting stage followed by bleeding stage.
Chronic DIC: Clotting

23
Q

Disseminated Intravascular Coagulopathy (DIC) Treatment

A

.9NS IVFs; Blood; FFP (plasma) & platelets (if acute)

24
Q

Multi Organ Dysfunction System (MODS)

A

Excessive inflammation related to severe injury or sepsis
First organ affected= Lungs. Acute Resp. Distress Syndrome (ARDS)
Other organs affected= Kidney, Liver and GI systems affected
Mortality rate for MODS= 40%
If neuro & cardiovascular systems affected, mortality rate increase to 100%

25
Q

Multi Organ Dysfunction System (MODS) Treatment

A

Oxygenate via ventilator; Replace Intravascular Volume; IV Antibiotics & Blood as needed

26
Q

Septic Shock Management

A

Protocols
Prevention (first line of therapy)
CLABSI prevention
CAUTI prevention

27
Q

Management protocols

A

Screening – “Time is Tissue”
Initiate interventions in FIRST HOUR after identifying sepsis.
Sepsis Alerts on Hospital Software

28
Q

Management Prevention

A

Handwashing
Aseptic technique
Minimize invasive procedures.

29
Q

Management CLABSI prevention

A

“Scrub the Hub”: Scrub the hub refers to cleaning the ports of the IV tubing with alcohol swab. Alternative is to replace the port with a new port hanging in strip on IV tubing.

30
Q

Sepsis & Septic Shock Medical Management

A

Labs/lactate
IV fluids
Broad spectrum antibiotics
New interventions

31
Q

When do we remeasure lactate levels?

A

if elevated > 2 mmol/L

32
Q

IV fluids

A

weight based (30 mL/kg) for hypotension or lactate ≥ 4 mmol/L
Isotonic fluids

33
Q

Isotonic fluids

A

Lactated Ringers
Normal Saline

34
Q

What is important about blood cultures?

A

Blood Cultures x2 and another culture (sputum, urine or wound) prior to starting antibiotics.

35
Q

If fluids do not increase BP (MAP of 65 or >) then?

A

Use vasopressors (dopamine, norepinephrine)

36
Q

Newer interventions

A

Vitamin C infusions, angiotensin II, thiamine, steroids

37
Q

Septic Shock Nursing Intervention

A

• Monitor VS & hemodynamic trends closely.
• Maintain IV fluids.
• Assess IV sites (18g or >)
• Medication administration
• Airway management
• Skin Assess for breakdown & necrosis.
• Assess for bleeding R/T DIC
• Glycemic Control
• Nutritional Support
• Meticulous handwashing
• Patient/ Family education

38
Q

Medication administration

A

Vasopressors
DVT prophylaxis
Gastric Stress ulcer prophylaxis (PPI)

39
Q

Airway management

A

Monitor pt. on ventilator.
Assess for VAP (vent. associated pneumonia)
Mouthcare every 4 hour to prevent VAP: ventilator associated protocols provide very good mouth care.

40
Q

Glycemic control

A

Check BS: Very ill pts get stress hyperglycemia.

41
Q

Nutritional support

A

TPN or tube feedings

42
Q

Pt and family education

A

handwashing/reverse isolation