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.
review all the things
Concepts Covered:
- Cardiovascular
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Newborn Complications
- Liver & Gallbladder Disorders
- Lower GI Disorders
- Multisystem
- Neurological
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Medication Administration
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Basics of NCLEX
- Communication
- Understanding Society
- Immunological Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Eating Disorders
- Prenatal Concepts
- Anxiety Disorders
- Depressive Disorders
- Oncology Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Gastrointestinal Disorders
- Circulatory System
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Nervous System
- Microbiology
- Hematologic Disorders
- Emergency Care of the Trauma Patient
- Newborn Care
- Digestive System
- Urinary Disorders
- Postpartum Care
- Infectious Respiratory Disorder
- Integumentary Disorders
- Terminology
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Postoperative Nursing
- Neurological Emergencies
- Vascular Disorders
- Disorders of Thermoregulation
- Statistics
- Neurological Trauma
- Cardiovascular Disorders
- Basic
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Delegation
- Perioperative Nursing Roles
- Developmental Considerations
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Renal Disorders
- Concepts of Pharmacology
- Integumentary Important Points
- Fetal Development
- Renal and Urinary Disorders
- Community Health Overview
- Developmental Theories
- Labor and Delivery
- Infectious Disease Disorders
- Musculoskeletal Disorders
- Basics of Human Biology
- Psychological Emergencies
- Adulthood Growth and Development
- Growth & Development
- Female Reproductive Disorders
- Sexually Transmitted Infections
- Proteins
- Hematologic Disorders
- Tissues and Glands
- Somatoform Disorders
- Oncologic Disorders
- Skeletal System
- Basics of Sociology
- Bipolar Disorders
- Emotions and Motivation
- Peripheral Nervous System Disorders
- Central Nervous System Disorders – Spinal Cord
- Neonatal
- Male Reproductive Disorders
- Prioritization
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System