Septic Shock: Diagnoses and Nursing and Medical Management

Sepsis is one of the main reasons why geriatric clients are admitted into the ICU. To know more about what sepsis is and how septic shock happens, we will go into a bit of its pathophysiology, its diagnoses, and its nursing and medical management.

Let’s begin.

Sepsis

The main complication of sepsis is septic shock which is very dangerous for the client. However, how does one know if the sepsis is getting better or is getting worse?

When a client comes in with conditions like urinary tract infection, pneumonia, or even a cat bite, it develops into an infection. If that infection becomes severe that it reaches the bloodstream, the condition will be referred to as sepsis. If that infection in the blood circulates and starts to infect the other organs, it will mess around with organ function.

Blood’s primary function is to maintain perfusion while transporting drugs and nutrients to every part of the body. However, without oxygen, the body is compromised and eventually dies. This is what happens in sepsis.

Stages of Septic Shock

1. Early Sepsis – Low MAP

Initially, a client who is going into septic shock will first experience a decrease in mean arterial pressure (MAP).

Mean arterial pressure is referred to as the state in which a person has decreased blood perfusion around the body.

How does one get the mean arterial pressure?

First, add up two diastolic pressures; and then add the systolic pressure. Remember that the systolic pressure is the first number or the top number of your client’s blood pressure. Okay, so after adding two diastolic pressures and one systolic pressure, divide the sum by three. If the result is greater than 60, then you can breathe easy because your client will be fine. However, if the MAP is less than 60, it means that your client’s body is being suffocated from oxygen.

A drop in mean arterial pressure means that the infection has gone worse that it’s turning off some of the barrel receptors inside the body. Barrel receptors are the receptors in the blood vessels that help regulate the constriction of blood vessels.

On the other hand, massively widened vessels cause a decrease in resistance which will result in a decreased pressure; thus, creating low oxygen perfusion around the body.

2. Compensatory Stage

When your body is trying to compensate for any type of shock, not just septic shock, it will increase the heart rate and respiratory rate to get more oxygen since there is not enough blood perfusion.

3. Progressive Phase

The third phase of septic shock is the moment when the infection has become so severe that the body is compensating by igniting an inflammatory process. This inflammatory process is the body’s defense mechanism to fight off the infection. However, in septic shock, the inflammatory process has gone haywire, and it has become widespread and systemic.

The progressive stage is where the majority of clinical manifestations occur, mainly:

• Hypothermia – a temperature less than 97.
• Pneumonia – the alveoli are damaged and disrupt oxygen exchange.
• Decreased urinary output – glomeruli in the kidneys become inflamed. The dilated vessels cause reduced resistance and perfusion that the body compensates by holding on to volume; thus, decreasing urine output.
• High specific gravity – dark brown, thick, odorous, and very concentrated urine output.
• Bleeding – since the kidneys make erythropoietin, the inflammatory process will cause broken vessels

4. Refractory Stage

What happens when a client bleeds and how can it be stopped? Since this is a septic shock, the body will stop the bleeding by putting platelets on the affected areas to patch it up. However, there are occasions wherein a client develops disseminated intravascular coagulation (DIC) with septic shock.

The platelets will patch up the inflamed, bleeding organs in the body. The problem is, production of platelets inside the body is limited, and once they are used up, it will take a while for the body to regenerate the fibrin and fibrinogen – the receptors that help in blood clotting. 

Without platelets, the body will experience systemic bleeding that can cascade into DIC. Disseminated intravascular coagulation is severe bleeding that is hard to stop. This systemic bleeding leads to multiple organ dysfunction syndrome (MODS) that is basically multi-organ system failure, meaning all the body organs are shutting down.

On our next lecture, we will further discuss the other clinical manifestations and the nursing and clinical management of septic shock. Check it out at SimpleNursing.com.