Septic Shock (Sepsis) | Pathophysiology and Nursing Interventions
Summary
TLDRSepsis is a severe systemic infection that begins with bacterial invasion and can lead to multiple organ failure. It results from a dysregulated immune response following a breach in the body's defenses, causing widespread inflammation, blood clotting, low blood pressure, and poor tissue perfusion. Risk factors include infections, wounds, hospitalizations, immune deficiencies, and chronic diseases. Symptoms range from fever and malaise to hypotension, tachycardia, and organ dysfunction. Sepsis progresses through stages, from infection to systemic inflammatory response syndrome (SIRS), severe sepsis, septic shock, and ultimately, multiple organ dysfunction syndrome (MODS), which can lead to death if untreated.
Takeaways
- 🦠 Sepsis is a systemic infection that can lead to multiple organ failure, starting with bacterial invasion.
- 🩸 Sepsis involves a breach in the host's skin or mucous membranes, leading to a dysregulated immune response.
- 🧬 Inflammatory mediators cause vasodilation, increased capillary permeability, and low blood pressure (hypotension).
- 🧪 The immune response triggers the coagulation cascade and leads to clotting in blood vessels, resulting in poor tissue perfusion and damage.
- 🚨 Risk factors for sepsis include wounds, infections, ICU admission, immune system deficiencies, surgeries, indwelling medical devices, and extremes of age.
- ⚠️ Early signs of sepsis are non-specific, including malaise, fever, hypotension, tachycardia, edema, and hypoxemia.
- 🔬 Lab results show increased white blood cell count, inflammatory markers, serum lactate, and markers of organ damage, with positive blood cultures.
- 💉 Sepsis occurs on a continuum, starting with infection and potentially progressing to systemic inflammatory response syndrome (SIRS), then severe sepsis, septic shock, and multiple organ dysfunction syndrome (MODS).
- 📊 SIRS is diagnosed when two or more criteria are met (e.g., abnormal temperature, heart rate, respiratory rate, or white blood cell count).
- 💀 If untreated, sepsis can result in multiple organ dysfunction and death, with symptoms like respiratory failure, liver and kidney impairment, and cardiac arrest.
Q & A
What is sepsis?
-Sepsis is a continuum of systemic or widespread infection in the bloodstream that starts with bacterial invasion and can lead to multiple organ failure. It is characterized by a dysregulated immune response in the host.
How does sepsis begin?
-Sepsis often begins with a breach in the host's barrier, such as the skin or mucous membranes, which triggers a dysregulated immune response. This response involves inflammatory mediators, vasodilation, increased capillary permeability, and activation of the coagulation and complement cascades.
What are some common risk factors for sepsis?
-Risk factors for sepsis include wounds (pressure injuries, traumatic wounds, chronic non-healing wounds), infections (such as kidney or lung infections), hospital or ICU admission, immune system deficiencies (HIV, cancer), recent surgeries, indwelling medical devices (central lines, urinary catheters), very young or old age, chronic disease, and genetics.
What are the early symptoms of sepsis?
-Early symptoms of sepsis include general, non-specific signs such as malaise and fever. As sepsis progresses, hypotension and tachycardia may develop due to vasodilation and increased capillary permeability.
How does the immune response in sepsis lead to tissue damage?
-In sepsis, the immune system releases pro-inflammatory mediators that cause detrimental effects such as clotting in the blood vessels. This clotting blocks blood flow, leading to poor tissue perfusion and tissue damage.
What laboratory markers are elevated in sepsis?
-Laboratory markers in sepsis include an increased white blood cell count (with immature white blood cells indicating a left shift), increased inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate, and markers of hypoperfusion such as elevated serum lactate.
What are the clinical manifestations of sepsis as it progresses?
-As sepsis progresses, clinical manifestations include hypotension, tachycardia, edema, tachypnea, hypoxemia, and low urine output due to poor perfusion and kidney damage. Signs of organ damage such as increased creatinine and bilirubin levels may also be seen.
What is Systemic Inflammatory Response Syndrome (SIRS), and how is it related to sepsis?
-SIRS is a widespread inflammatory reaction that can occur as a response to infection or other inflammatory causes. Sepsis is diagnosed when SIRS criteria are met, and there is a diagnosed source of infection. SIRS involves two or more symptoms, including abnormal temperature, heart rate, respiratory rate, and white blood cell count.
What differentiates severe sepsis from septic shock?
-Severe sepsis is characterized by hypotension or hypoperfusion, leading to lactic acidosis and organ dysfunction. Septic shock occurs when hypotension persists despite adequate fluid resuscitation, indicating more severe circulatory failure.
What is Multiple Organ Dysfunction Syndrome (MODS), and how is it related to sepsis?
-MODS occurs when septic shock leads to the failure of two or more organs, such as respiratory failure, liver impairment, kidney impairment, neurological impairment, and cardiac impairment. If left untreated, MODS can result in death.
Outlines
🦠 Overview of Sepsis and its Progression
Sepsis is a severe and widespread infection that enters the bloodstream, which can lead to multiple organ failure if untreated. It begins with bacterial invasion, causing the immune system to become dysregulated. This results in vasodilation, capillary permeability, and activation of the coagulation and complement cascades. These immune responses can cause blood clots, poor tissue perfusion, and ultimately tissue damage. Risk factors include open wounds, infections like kidney or lung infections, hospital stays, immune deficiencies (HIV, cancer), recent surgeries, use of indwelling medical devices, extreme ages, chronic diseases, or genetics.
🌡️ Clinical Manifestations and Symptoms of Sepsis
The clinical signs of sepsis begin with non-specific symptoms such as malaise and fever. As the condition progresses, patients may experience hypotension, tachycardia, edema, tachypnea, and hypoxemia due to tissue damage and poor perfusion. Urine output may decrease, and lab results will show increased white blood cell counts with immature cells, higher inflammatory markers, markers of tissue damage, and positive blood cultures. Impaired coagulation is evident through increased bleeding times and abnormal platelet counts.
🔄 The Continuum of Sepsis: From Infection to MODS
Sepsis progresses along a continuum, beginning with a localized infection and potentially ending in multiple organ dysfunction syndrome (MODS) or death. Initially, localized inflammation occurs. If untreated, it can lead to a systemic inflammatory response syndrome (SIRS), characterized by symptoms such as abnormal temperature, heart rate, and white blood cell count. Sepsis is diagnosed when an infection source is identified, along with SIRS criteria. Severe sepsis involves hypotension and hypoperfusion, indicated by lactic acidosis and low blood pressure, progressing to septic shock if unresponsive to fluids.
🚨 Septic Shock and MODS
Septic shock is defined by persistent hypotension despite fluid resuscitation. This occurs when the body can no longer maintain adequate blood pressure after receiving treatment, indicating the severity of the condition. If septic shock continues, multiple organ dysfunction syndrome (MODS) may develop, where at least two organ systems begin to fail, such as respiratory failure, liver dysfunction, kidney impairment, and neurological decline. Without timely intervention, MODS can lead to death.
Mindmap
Keywords
💡Sepsis
💡Systemic Inflammatory Response Syndrome (SIRS)
💡Vasodilation
💡Capillary Permeability
💡Hypotension
💡Tachycardia
💡Multiple Organ Dysfunction Syndrome (MODS)
💡Hyperperfusion
💡Lactic Acidosis
💡Septic Shock
Highlights
Sepsis is a continuum of systemic or widespread infection in the bloodstream that can lead to multiple organ failure.
Sepsis begins with bacterial invasion, causing a dysregulated immune response with inflammatory mediators triggering vasodilation and increased capillary permeability.
Vasodilation and capillary permeability result in hypotension (low blood pressure) and activate the coagulation and complement cascades.
The immune response can cause clotting in blood vessels, leading to blocked blood flow, poor tissue perfusion, and tissue damage.
Risk factors for sepsis include wounds (pressure injuries, traumatic wounds, or chronic non-healing wounds) and infections (kidney or lung).
Other risk factors: ICU admission, immune system deficiencies (e.g., HIV, cancer), recent surgeries, indwelling medical devices, and extremes of age.
Sepsis begins with general non-specific symptoms such as malaise and fever, followed by hypotension and tachycardia as the condition progresses.
Inflammatory response and tissue damage cause tachypnea, hypoxemia, low urine output, and edema.
Laboratory findings: increased white blood cell count with immature cells, elevated inflammatory markers (CRP, ESR), and hyperperfusion markers like serum lactate.
Sepsis continuum: begins with infection, progresses through systemic inflammatory response syndrome (SIRS), severe sepsis, septic shock, and potentially ends in multiple organ dysfunction syndrome (MODS).
SIRS is diagnosed with two or more criteria such as abnormal temperature, heart rate, respiratory rate, or white blood cell count.
Severe sepsis is identified by hypotension or hypoperfusion, leading to lactic acidosis and anaerobic metabolism, indicated by elevated lactate and low pH.
Septic shock is diagnosed when hypotension persists despite fluid resuscitation.
Multiple organ dysfunction syndrome (MODS) is the failure of two or more organs, which can include respiratory, liver, kidney, neurological, or cardiac impairments.
Untreated sepsis can lead to death due to widespread organ failure.
Transcripts
what is sepsis
sepsis is a continuum of systemic or
widespread infection in the bloodstream
that begins with bacterial invasion and
can lead to multiple organ failure
in sepsis a breach of the host barrier
often in the skin or mucous membranes
kicks off a dysregulated immune response
in the host
inflammatory mediators cause
vasodilation and increased capillary
permeability
these effects result in hypotension or
low blood pressure
they activate the coagulation cascade
and the complement cascade
the immune response involves the release
of pro-inflammatory mediators that cause
detrimental physiological effects such
as clotting in the blood vessels causing
blockage of blood flow and poor tissue
perfusion and tissue damage
risk factors for sepsis include an
existing wound such as a pressure
associated injury a traumatic wound or a
chronic non-healing wound
or infection such as a kidney or lung
infection
other risk factors include a hospital or
icu admission which puts a patient more
at risk for hospital-acquired infection
immune system deficiencies such as hiv
or cancer recent surgeries
indwelling medical devices like central
lines or urinary catheters very young or
very old age chronic disease or genetics
[Music]
general clinical manifestations for
sepsis
sepsis will begin with general
non-specific symptoms such as malaise
and fever
however as the inflammatory response and
tissue damage progresses we will observe
hypotension and tachycardia from the
vasodilation and capillary permeability
edema from the capillary permeability
tachypnea and hypoxemia due to tissue
damage and poor tissue perfusion
and low urine output due to poor
perfusion and kidney damage
laboratory results will show an
increased white blood cell count with a
greater number of young immature white
blood cells also known as a left shift
increased inflammatory markers such as
c-reactive protein and erythrocyte
sedimentation rate
markers of hyperperfusion such as
increased serum lactate and markers of
organ damage such as increased glucose
increased creatinine and increased
bilirubin
generally we will see positive blood
cultures as well
there will be signs of impaired
coagulation such as increased bleeding
times inr ptt and high or low platelet
count depending on the timing
sepsis occurs on a continuum
starting with infection and ending with
multiple organ dysfunction syndrome or
mods and then potentially death
initially a localized infection occurs
with localized inflammation
if not treated this can cause a
widespread inflammatory reaction called
systemic inflammatory response syndrome
also known as sirs
a sur's diagnosis is made of two or more
of the following occur
a temperature of greater than 38 or less
than 36 degrees celsius a heart rate
greater than 90 beats per minute a
respiratory rate over 20 a paco2 of less
than 32
a white blood cell count over 12 000 or
less than four thousand or greater than
ten percent bands
sepsis is diagnosed if there is a
diagnosed source of infection and the
patient meets ser's criteria
sirs may occur without an infection as
inflammation can occur for a number of
reasons
severe sepsis is accompanied by evidence
of hypotension or hypoperfusion
indicating lactic acidosis an sbp of
less than 90 or sbp drops greater than
or equal to 40 millimeters of mercury of
normal hypotension results in a decrease
of oxygen to the tissues causing
anaerobic metabolism and lactate
production
in this stage expect elevated lactate
low ph low bicarbonate and low blood
pressure
in septic shock hypotension remains
despite adequate fluid resuscitation
for example if a patient diagnosed with
severe sepsis received the fluid bolus
and had no improvement in their blood
pressure they would be considered to be
in septic shock
finally multiple organ dysfunction
syndrome mods is diagnosed when septic
shock is accompanied by evidence of two
or more organs failing
for example we may see respiratory
failure as impaired oxygenation and
ventilation that requires mechanical
ventilation
liver impairment that causes jaundice or
elevated liver enzymes kidney impairment
neurological impairment evidenced by
decreased mental status and cardiac
impairment as cardiac arrest
if left untreated mods can result in
death
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