Sepsis for Certified Emergency Nursing (CEN)
Included In This Lesson
Study Tools For Sepsis for Certified Emergency Nursing (CEN)
Outline
Sepsis
Definition/Etiology:
So, we know what sepsis is, right? It’s the presence or suspicion of infection with 2 or more of the SIRS criteria. Septic shock is the progression of sepsis to an emergency state. It is a sepsis-induced distributive shock with hypotension despite adequate fluid resuscitation. It is usually accompanied by lactic acidosis, oliguria, or an acute change in mental status.
Pathophysiology:
- Septic shock results when infectious microorganisms in the bloodstream induce a profound inflammatory response causing hemodynamic decompensation. The pathogenesis involves a complex response of cellular activation that triggers the release of a multitude of proinflammatory mediators. (Cascade of events)
- Let’s talk for a sec about distributive shock. What is happening? Blood fills the vessel and goes where it is supposed to without a problem. This is a vessel in distributive shock. Same amount of fluid present. See how it changes the flow? This is why we try to fill the vasculature with fluids initially. Can we just fill up the space? When that doesn’t work, we bring in the pressors to constrict those vessels and get the fluids where they need to be. (to the Organs)
- Don’t worry, there are a whole bunch of resources online if you want to get more into the patho of septic shock
Clinical Presentation:
The initial presentation is that of Sepsis:
- Fever >100.8F or <96.8F
- Tachycardia (>90 BPM)
- Tachypnea (>20)
- Altered mental status
- Lab values
- WBC >12000
- Serum Glucose >120 – non-diabetic
Severe sepsis –
- The above and:
- SBP <90 or MAP <65
- Cr >2.0 or urine output <0.5ml./kg x 2 hours
- Platelets <100,000
- Lactate >4.0
If the patient meets shock criteria and is hypotensive with SBP <90 which isn’t fixed with fluids, then ding ding ding…we win septic shock!
Collaborative Management:
Follow the sepsis protocol for your facility to start. It usually involves:
- Blood work including blood cultures x 2 and lactate levels
- O2
- VBG
- Fluid resuscitation
- Antibiotics (after cultures)
- If septic shock identified
- Consider RSI
- Central Line
- Pressors to maintain MAP >65
Try to treat underlying cause
Evaluation | Patient Monitoring | Education:
Is the patient improving? Monitor hemodynamic status. Don’t worry, if all goes according to plan (which of course it never does), these patients will be admitted to the ICU and be out of your department before you can truly see the results of your amazing intervention!
Linchpins: (Key Points)
- Going south – identify worsening progression
- Protocol! – Follow your sepsis guidelines
- Shocking – This is a form of shock, and we need to intervene as such
Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/
References:
- Emergency Nurses Association. (2022). Emergency Nursing Orientation 3.0. Cambridge, MA: Elsevier, Inc.
- Mahapatra S, Heffner AC. Septic Shock. [Updated 2022 Jun 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430939/
- Sheehy, S. B., Hammond, B. B., & Zimmerman, P. G. (2013). Sheehy’s manual of emergency care (Vol. 7th Edition). St. Louis, MO: Elsevier/Mosby.
Katies NCLEX
Concepts Covered:
- Test Taking Strategies
- Medication Administration
- Adult
- Emergency Care of the Cardiac Patient
- Microbiology
- Anxiety Disorders
- Depressive Disorders
- Nervous System
- Gastrointestinal Disorders
- Fundamentals of Emergency Nursing
- Dosage Calculations
- Understanding Society
- Circulatory System
- Concepts of Pharmacology
- Studying
- Newborn Care
- Adulthood Growth and Development
- Respiratory Disorders
- Pregnancy Risks
- Neurological
- Postpartum Complications
- Substance Abuse Disorders
- Bipolar Disorders
- Learning Pharmacology
- Psychotic Disorders
- Prenatal Concepts
- Tissues and Glands
- Factors Influencing Community Health
- Concepts of Population Health
- Community Health Overview
- Developmental Considerations
- Communication
- Legal and Ethical Issues
- Cardiovascular
- Emergency Care of the Neurological Patient
- Emergency Care of the Respiratory Patient
- Emergency Care of the Trauma Patient
- Delegation
- Multisystem
- Health & Stress
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Trauma-Stress Disorders
- Developmental Theories
- Concepts of Mental Health
- Gastrointestinal
- Newborn Complications
- Labor Complications
- Fetal Development
- Terminology
- Labor and Delivery
- Postpartum Care
- Prefixes
- Suffixes
- Proteins
- Statistics
- Med Term Basic
- Med Term Whole
- Cardiac Disorders
- Preoperative Nursing
- Intraoperative Nursing
- Vascular Disorders
- Noninfectious Respiratory Disorder
- Upper GI Disorders
- Central Nervous System Disorders – Brain
- Shock
- Immunological Disorders
- Postoperative Nursing
- Perioperative Nursing Roles
- Hematologic Disorders
- Disorders of Pancreas
- Neurological Trauma
- Neurological Emergencies
- Musculoskeletal Trauma
- EENT Disorders
- Peripheral Nervous System Disorders
- Respiratory Emergencies
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of the Thyroid & Parathyroid Glands
- Liver & Gallbladder Disorders
- Lower GI Disorders
- Respiratory
- Acute & Chronic Renal Disorders
- Disorders of the Adrenal Gland
- Documentation and Communication
- Oncology Disorders
- Female Reproductive Disorders
- Cognitive Disorders
- Renal Disorders
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Integumentary Disorders
- Urinary Disorders
- Integumentary Disorders
- Musculoskeletal Disorders
- Disorders of Thermoregulation
- Basics of NCLEX
- Integumentary Important Points
- Urinary System
- Neurologic and Cognitive Disorders
- Central Nervous System Disorders – Spinal Cord
- Renal and Urinary Disorders
- Respiratory System
- Infectious Disease Disorders
- EENT Disorders
- Eating Disorders
- Personality Disorders
- Psychological Emergencies
- Somatoform Disorders
- Prioritization
- Hematologic Disorders
- Cardiovascular Disorders
- Musculoskeletal Disorders
- Endocrine and Metabolic Disorders
- Oncologic Disorders
- Behavior
- Emotions and Motivation
- Growth & Development
- Intelligence and Language
- Psychological Disorders
- State of Consciousness
- Basics of Sociology
- Note Taking
- Basics of Human Biology