Septic shock

Septic Shock

1. SEPTIC SHOCK NAVREET KAUR SAINI

2. OBJECTIVES Sepsis and septic shock Etiology of septic shock Sign and symptoms of septic shock Pathophysiology of septic shock Diagnostic tests for septic shock Medical and Nursing management of septic shock Complications Prognosis

3. SHOCK ?? A condition in which tissue perfusion is inadequate to deliver oxygen and nutrients to support vital organs and cellular function

4. SEPSIS ?? Sepsis is a potentially dangerous or life-threatening medical condition, found in association with a known or suspected infection (usually caused by but not limited to bacteria ) Sepsis happens when the body suffers from an infection and the chemicals released into the blood to fight the infection cause inflammation over the entire body.

5. SEPTIC SHOCK Septic shock is a serious condition that occurs when a body-wide infection leads to dangerously low blood pressure, multiorgan failure and death. Sepsis with hypotension (arterial BP <90mmhg or 40 mmhg less than patient’s normal blood pressure) for atleast 1 hour despite adequate fluid resuscitation. Need of vasopressors to maintain systolic blood pressure.

6. RISK FACTORS OF SEPTIC SHOCK Immunosuppression Extremes of age (<1 year and >65 year) Malnourishment Chronic Illness Invasive procedures

7. PATHOPHYSIOLOGY Infection Microbial Toxins Host defense system gets activated Inflammatory Response Adequate Excessive Inadequate Survival Tissue Injury Multiorgan failure Death

8. SIGN AND SYMPTOMS PHASE- I Hyperdynamic High cardiac output BP in normal limits Tachycardia, tachypnoea Fever, warm, flushed skin Normal or decreased urine output Nausea , vomiting,diarrhoea Confusion /agitation

9. SIGN AND SYMPTOMS Phase- II Hypodynamic (Irreversible) L ow Cardiac output, Low BP Not responding to vasoactive agents Organ failure Cool and pale skin Increased H/R and R/R

10. INVESTIGATIONS Identifying cause of infection All invasive lines are sent for culture CBC, Electrolytes,RFT , LFT, ECG, CVP Clotting Profile Chest X-Ray Ultrasonography ABG

11. MEDICAL MANAGEMENT Volume resuscitation Early antibiotic administration Early goal directed therapy Rapid source identification and control. Support of major organ dysfunction. Need of Mechanical Ventilation

12. HEMODYNAMIC, RESPIRATORY AND METABOLIC SUPPORT Primary Goal- Restore oxygen delivery to tissues and improve cellular metabolism. Administration Of oxygen, IV fluids Administration Of Vasopressors- Norepinephrine, Dopamine Blood transfusions, FFP, Platelets Broad Spectrum Antibiotics Diuretics, Steroids

13. GENERAL MEASURES Nutritional Supplementation Prophylactic heparanization Preventing skin breakdown Preventing stress ulcers Maintaining normal blood glucose levels

14. NURSING MANAGEMENT NURSING DIAGNOSIS Impaired cardiopulmonary tissue perfusion r/t widespread infection Impaired fluid electrolyte imbalance r/t capillary leakage s/t diseased condition Altered body temperature r/t widespread infection Risk of impaired skin integrity r/t diseased condition Risk of bleeding r/t diseased condition

15. NURSING INTERVENTIONS 1. To maintain cardiopulmonary tissue perfusion Assess vital signs every 2 hourly Administer oxygen as prescribed Assess skin for cyanosis, pallor Administer vasopressors as prescribed

16. 2. To maintain fluid electrolyte imbalance Assess sign and symptoms of fluid electrolyte excess/deficiency Administer IV fluids, vasoactive agents as prescribed Administer enteral feed as far as possible Administer diuretics as prescribed Monitor urine output every hourly

17. 3. To prevent infection Assess vital signs every 2 hourly Assess initial signs of infection Meticulous hand washing Carry out all invasive procedures using aseptic technique Administer antibiotics as prescribed

18. COMPLICATIONS Respiratory failure Cardiac Failure Any other organ failure Gangrene Death

19. PROGNOSIS Approx 40-60% of patients with septic shock die within 30 days Others die in mext 6 months as a result of complications

20. SUMMARY Sepsis and septic shock Etiology of septic shock Sign and symptoms of septic shock Pathophysiology of septic shock Diagnostic tests for septic shock Medical and Nursing management of septic shock Complications

21. CONCLUSION Meticulous handwashing , infection prevention techniques, following aseptic precautions are the key to prevent sepsis and septic shock.

22. REFERENCES Brunner & suddarth’s ,Text book of Medical Surgical Nursing,11 th edition,LWW pub,pg no 356-378 Harrison’s, T extbook of principles internal medicine, 17 th Edition, Chapter 265- Sepsis and septic shock Tintinalli’s ,Text book of Emergency Medicine,6 th edition,HTML file http://www.pubmedcentral.nih.gov Joyce M Black ,Medical Surgical Nursing,7 th edition,saunders publication,pg no 2433 -2476

23. QUESTIONS?? What is septic shock? What are risk factors of septic shock? What are clinical manifestation of septic shock?