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.
22 Jan – 28 Feb
Concepts Covered:
- Cardiovascular
- Circulatory System
- Nervous System
- Skeletal System
- Emergency Care of the Cardiac Patient
- Neurological
- Respiratory
- Urinary System
- Respiratory System
- Endocrine System
- Studying
- Tissues and Glands
- Medication Administration
- Hematologic System
- Digestive System
- Reproductive System
- Endocrine and Metabolic Disorders
- Muscular System
- Sensory System
- Basics of Human Biology
- Prefixes
- Suffixes
- Fetal Development
- Terminology
- Proteins
- Statistics
- Med Term Basic
- Med Term Whole
- Preoperative Nursing
- Integumentary Disorders
- Urinary Disorders
- Noninfectious Respiratory Disorder
- Cardiac Disorders
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Lower GI Disorders
- Central Nervous System Disorders – Brain
- Hematologic Disorders
- Delegation
- Perioperative Nursing Roles
- Acute & Chronic Renal Disorders
- Respiratory Emergencies
- Disorders of the Adrenal Gland
- Documentation and Communication
- Legal and Ethical Issues
- Factors Influencing Community Health
- Immunological Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Vascular Disorders
- Renal Disorders
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Gastrointestinal Disorders
- Newborn Complications
- Peripheral Nervous System Disorders
- Communication
- Microbiology
- Emergency Care of the Trauma Patient
- Integumentary Disorders
- Musculoskeletal Disorders
- EENT Disorders
- Postoperative Nursing
- Neurological Emergencies
- Disorders of Thermoregulation
- Neurological Trauma
- Basics of NCLEX
- Fundamentals of Emergency Nursing
- Integumentary Important Points
- Multisystem
- Test Taking Strategies
- Emergency Care of the Neurological Patient
- Neurologic and Cognitive Disorders
- Central Nervous System Disorders – Spinal Cord
- Renal and Urinary Disorders
- Respiratory Disorders
- Infectious Disease Disorders
- EENT Disorders
- Emergency Care of the Respiratory Patient
- Adult
- Anxiety Disorders
- Depressive Disorders
- Dosage Calculations
- Understanding Society
- Concepts of Pharmacology
- Newborn Care
- Adulthood Growth and Development
- Pregnancy Risks
- Postpartum Complications
- Substance Abuse Disorders
- Bipolar Disorders
- Learning Pharmacology
- Psychotic Disorders
- Prenatal Concepts