low systemic vascular resistance and an

elevated cardiac output characterize septic shock. the disorder is thought to occur in response to infections that release microbes or one of the immune mediators. Usually a complication of another disorder or invasive procedure and has a mortality as high as 25%.

Any pathogenic organism can cause

septic shock. E. Coli Klebsiella Pneumoniae Many organisms that are normal flora on the skin and in the intestines are beneficial and pose no threat. However, when they spread throughout the body by the way of the bloodstream, they can progress to an overwhelming infection unless body defenses destroy them.

Bacteremia sepsis septic shock

Early (warm) septic shock Blood: normal- hypo Pulse: increase thready Respirations: rapid and deep Skin: warm, flushed Mental: alert/ oriented anxious Urine: normal Increased body temp. , chills, decreased CVP, weakness, N/V, diarrhea 2. Late (cold) Septic Shock BP: hypotension Pulse: tachyarrhythmias Respirations: shallow, rapid, dyspneic Skin: cool, pale, edematous Lethargic-coma Oliguria/ anuria Decreased CUP, decreased body temp.
1.

 Immunosuppression

Extremes of age (<1 yr. and >65 yr)

Malnourishment Chronic Illness

Invasive Procedures

 Blood cultures are (+) for the offending

offending organism. CBC- shows the presence/ absence of anemia and leukemia and usually the presence of thrombocytopenia. Blood Urea Nitrogen and Creatinine Levels Increase ECG- shows ST-segment depression, inverted T- waves and arrhythmias resembling M.I Urine Studies- show increase specific gravity (> 1.020) and osmolality and a decrease Na level

 Arterial Blood Gas Analysis

-demonstrates increased blood pH and partial pressure of arterial oxygen and decreased partial pressure of arterial CO2 with respiratory alkalosis in early stages. As shock progresses, metabolic acidosis develops the hypoxemia, indicated by decreased PaCO2 as well as decreasing PaCO2, bicarbonate and pH levels.

IV, Intraarterial or urinary drainage

catheter should be removed In patients who are immunosuppressed because of drug therapy, drugs should be D/C or reduced O2 therapy should be initiated to maintain arterial O2 sat >95%. Mechanical ventilations may be required if respiratory failure occurs

 Colloid or crystalloid infusions are

given to increased intravascular volume and raise blood pressure Diuretic (Furosemide) to maintain urine output above 20 ml/hr Vasopressor (Dopamine) if fluid resuscitation fails to increased BP Blood transfussion may be needed if anemia is present

 Nursing Diagnosis:

1. Impaired gas exchange related to ventilationperfussion imbalance and diffusion effect Nursing Interventions: 1. Maintain airway patency and monitor respiratory status. Provide supplemental oxygen a ordered and assist with intubation and mechanical ventilation if indicated.

2. Monitor oxygen saturation through continues pulse oximetry.

3. Assist with pulmonary artery catheter insertion if ordered. Monitor hemodynamic parameter as well as oxygen delivery and consumption.

 2. Risk for infection related to increase exposure

to pathogens and surgical interventions.

Nursing Interventions:
1. Be aware of the major sites for infection and constantly protect patients staff. 2. Identify patients at risk for bacteremia, sepsis or septic shock. Also consider the need to obtain culture when the patient has a fever or unknown origin or fails to improve despite antimicrobial therapy. 3. Observe for local signs of infection and symptoms of infection such as fever or an increased WBC count. 4. Administer antimicrobial drugs empirically as ordered. 5. Monitor closely for expected and adverse effect.