Sepsis for Certified Emergency Nursing (CEN)
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Toxicity Sepsis- Signs and Symptoms (Mnemonic)
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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
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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.
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54 Common Medication Prefixes and Suffixes
Alpha-fetoprotein (AFP) Lab Values
Carboxyhemoglobin Lab Values
Cardiac Terminology
Diagnostic Testing Course Introduction
Diagnostics Terminology
Digestive Terminology
Gamma Glutamyl Transferase (GGT) Lab Values
Growth Hormone (GH) Lab Values
Hematology Oncology & Immunology Terminology
Integumentary (Skin) Terminology
Mean Corpuscular Volume (MCV) Lab Values
Mean Platelet Volume (MPV) Lab Values
Medical Terminology Course Introduction
MedTerm Basic Word Structure
MedTerm Body as a Whole
MedTerm Prefixes
MedTerm Suffixes
Metabolic & Endocrine Terminology
Methemoglobin (MHGB) Lab Values
Musculoskeletal Terminology
Myoglobin (MB) Lab Values
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Pharmacology Terminology
Prealbumin (PAB) Lab Values
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Psychiatry Terminology
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ABGs Nursing Normal Lab Values
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Acute Confusion
Acute Kidney Injury Case Study (60 min)
Advocacy & Moral Judgement for Progressive Care Certified Nurse (PCCN)
AIDS Case Study (45 min)
Alanine Aminotransferase (ALT) Lab Values
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Cushing’s Syndrome Case Study (60 min)
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Diabetes Insipidus Case Study (60 min)
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Endocarditis Case Study (45 min)
Enteral & Parenteral Nutrition (Diet, TPN)
Erythroblastosis Fetalis
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How to Write A Nursing Progress Note
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Nursing Care Plan for Distributive Shock
Nursing Case Study for Hepatitis
Nursing Case Study for Maternal Newborn
Nursing Case Study for Pneumonia
Nursing Process – Assess
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Plant Alkaloids Topoisomerase and Mitotic Inhibitors
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Protein in Urine Lab Values
Red Blood Cell (RBC) Lab Values
Red Cell Distribution Width (RDW) Lab Values
Renal (Kidney) Failure Labs
Respiratory Acidosis (interpretation and nursing interventions)
Respiratory Alkalosis
Sepsis for Certified Emergency Nursing (CEN)
Sepsis Labs
Septic Shock (Sepsis) Case Study (45 min)
Shorthand Lab Values
Thyroid Stimulating Hormone (TSH) Lab Values
Thyroxine (T4) Lab Values
Total Bilirubin (T. Billi) Lab Values
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