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SEPTIC SHOCK (DIAGNOSTICS (Blood cultures (Both anaerobic and aerobic…

- - - - Obtained prior to initiation of antimicrobial therapy, unless the blood cultures cause a significant delay of ≥45 minutes
- - - - Ambulating the client
  - - - Listen to what the client tells you about their thoughts and feelings.
- - - - Attempted at maintaining homeostasis
  - - - Ischemia
    - - Metabolic Acidosis
  - - - Ammonia
      - Urea
      - Lactate
      - CO2
  - - - Lactic Acid accumulation
- - - - Administer low molecular weight heparin or low-dose unfractionated heparin (e.g. enoxaparin)
    - - Continuous insulin and glucose used to maintain glucose levels between 4.44 and 6.11 mmol/L
  - - - Isotonic solutions
        
        30 mL/kg (1-2 L) over 30-60 minutes
      - Colloids (Hetastarch, Plasma Protein Fraction, Human Serum Albumin, Dextra)
      - Hypertonic (1.8%, 3%, 5%, NaCl)
      - IV corticosteroids
    - - Maintain CVP of 15mm Hg
      - Maintain PAOP of 10-12mm HG
    - - Ensure initial urine output ≥0.5 mL/kg/hr
      - Superior vena cava venous oxygen saturation ≥70%
      - Maintain mean arterial pressure ≥65 mmHg
      - Normalize lactate levels
      - Maintain central venous pressure of 8-12 mmHg
- - - - NEUROLOGICAL
        
        Anxiety, confusion, agitation, altered mentation, ↓LOC, fluctuating temperature
      - INTEGUMENTARY
        
        ↓ Capillarity refill, cyanosis, cool, clammy skin
      - CARDIOVASCUALR
        
        Hypotension, tachycardia, bounding pulses, , tachypnea, ↓CVP, ↓SpO2, respiratory failure ventilation-perfusion mismatch
      - GASTROINTESTINAL
        
        Reduced bowel sounds, hypoglycemia, paralytic ileus
      - HEPATIC
        
        ↑ Liver enzymes, ↑NH3, ↑ lactate levels
      - RENAL
        
        Urine output <0.5 mL/kg/hr, ↑ BUN, ↑ creatinine, ↑ Urine specific gravity ↑ Plasma
  - - - T- Temperature I- Infection M- Metal Decline E- Extremely ill
- - - - Women
        
        Especially while pregnant
      - Males
        
        More often effected
    - - HIV
      - Often in a hospital intensive care unit
      - Cancer / chemotherapy treatment
    - - Increased risk by 35%in colder months
  - - - Catheters & mechanical ventilation
    - - Antibiotics or corticosteroids usage
- - - - Broad spectrum followed by specific once causative factor is determined
      - Administered within the first hour of suspected shock
      - Reassess treatment daily
      - Assess duration of treatment & educate client about antibiotic resistance
    - - Reduces inflammation
    - - Administered to patients with viral origin (H1N1)
  - - - RBCs & Plasma