02.17 Septic Shock for CCRN Review

Nursing Points

General

1. Septic Shock
   1. Caused by bacteria (usually gram -)
   2. At-risk
      1. Elders
      2. Severe burn
      3. Alcohol and drug abusers
      4. Surgery
      5. Immunosuppressed
      6. Long hospitalizations
   3. Patho
      1. Bacteria releases endotoxin -> many harmful substances released causes vasodilation (pool blood in capillary bed)
   4. First stage
      1. Confusion (due to endotoxin)
      2. Increased cardiac output (due to endotoxin)
      3. Increased RR (due to endotoxin)
      4. ABGs normal limits
      5. Normal BP
      6. Increased urine output (vasodilation)

1. 1. Second stage
      1. Endotoxins phase away (30 min.- 72 hrs)
      2. Low BP (blood pooled in capillaries)
      3. Lethargic (lack of blood to brain = lack of oxygen)
      4. Decreased urinary output
      5. ABGs bad
      6. Decreased cardiac output (no endotoxins)
      7. Metabolic acidosis
   2. Organ failure
   3. Treatment
      1. Fluids
      2. Antibiotics
      3. Vasopressors (Levophed) -> causes vessels to constrict
      4. Goal -> MAP 65