Nursing Care and Pathophysiology for Sepsis

So, sepsis begins as an infection of any kind in the body and becomes complicated because it leaks into the bloodstream causing a dysregulated inflammatory response by the body. Let’s dig deeper into the patho of sepsis.

So there is some sort of infection in the body that leaks into the bloodstream causing cytokines to be released. These cytokines alert the white blood cells that help is needed to fight off the infection, but in sepsis, homeostasis isn’t maintained. This means that the body’s processes aren’t able to function normally. This leads to vasodilation causing vascular leakage. The patient will then go into septic shock and their blood pressures will drop.

With the drop in pressures, the organs cannot be perfused with blood to provide the oxygen and nutrients they need. The body will begin producing energy without oxygen. This is called anaerobic metabolism and a product of this is lactate or lactic acid.  Without enough perfusion, eventually the patient will go into multiple organ dysfunction syndrome or MODS. The shutting down of organ systems eventually results in death of the patient. Check out the lesson on SIRS and MODS to get further details on them. Next I will explain the sepsis criteria.

So there are a variety of signs that will alert you and the physician that the patient is septic or in a systemic inflammatory response syndrome. The doctor will order a lab draw for lactate or lactic acid, and if it is greater than 2 they are likely septic because remember the body resorts to anaerobic metabolism to provide energy to the cells when they’re lacking oxygen perfusion, and lactate is the byproduct.  So the higher the lactic acid level, the less oxygen perfusion the patient’s organs have. So the doctor will order IV fluids to bring the lactate down. This works by increasing volume which better perfuses the tissues and organs.

The patient’s respirations may be higher than 20 because their body is super acidic from the buildup of lactic acid and more breathing helps blow off the CO2 which then decreases acid in the blood.

The white blood cell count will be abnormal either greater than 12,000, or lower than 4,000. They might be elevated because they are working hard trying to fight the infection, and they could be low if the immune system tires out and the bacteria is basically winning. Their heart rate may be greater than 90, and their temperature will probably be elevated greater than 100.5. When the patient goes into septic shock, their systolic blood pressure will drop below 100 and be difficult to bring up. Guys, these patients are VERY sick. I take care of septic patients often in the hospital, and sometimes you can push and push fluids and their blood pressures continue to drop and they become lethargic and confused from the lack of blood flow to the brain. Next let’s discuss the patient assessment.