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Sepsis, Septic Shock, and Systemic Inflammatory Response Syndrome

Sepsis, Septic Shock, and Systemic Inflammatory Response Syndrome. Objective.

michael-warren
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Sepsis, Septic Shock, and Systemic Inflammatory Response Syndrome

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  1. Sepsis, Septic Shock, andSystemic Inflammatory Response Syndrome

  2. Objective The learner will be able to identify the risk factors, signs, and symptoms associated with sepsis, septic shock, and systemic inflammatory response syndrome (SIRS), and describe the appropriate immediate interventions required.

  3. Systemic Inflammatory Response Syndrome vs. Sepsis and Septic Shock • Sepsis/septic shock are terms previously used to describe many inflammatory processes. • SIRS is the systemic response to the presence of infection/bacteremia in the blood, with two or more of the following present: • Temperature > 38°C (100.4°F) or < 36°C (98.6°F) • Heart rate > 90 beats/minute • Respiratory rate > 20 breaths/minute • WBC > 12,000 mm3, < 4,000 mm3, or > 10% bands.

  4. Sepsis and Septic Shock • Sepsis is the systemic inflammatory response to clinical insults of the body, manifesting at least two or more of the SIRS criteria. • Occurs in response to overwhelming bacterial infection in the bloodstream • Associated with organ dysfunction, hypotension, and hypoperfusion of organs • Septic shock is sepsis with organ hypoperfusion and hypertension that is unresponsive to fluid resuscitation. • Life-threatening; requires immediate and rapid evaluation and treatment

  5. Signs of Severe Sepsis(Vasodilation) • Fever, shaking chills/rigors • Hypotension • Tachypnea, tachycardia, bounding pulse • Mental status changes • Decreased urine output • Abnormal blood values (pancytopenia or leukocytosis/hyperglycemia) Due to immunosuppressed status, neutropenic patients may not present with any significant symptoms except fever.

  6. Signs of Septic Shock(Hypoperfusion) • Cold, clammy skin • Lethargy, coma • Hypotension, tachycardia, weak/thready pulse • Tachypnea, decreased breath sounds • Rales, pulmonary edema • Worsening electrolyte values

  7. Risk Factors • Venous access devices/other indwelling catheters or tubes/devices • Very young or > 65 years • Comorbidities • Immunosuppressed status • Chemotherapy/radiation therapy • Antibiotics/immunosuppressive agents • Blood transfusions • Splenectomy/other surgical procedures

  8. Diagnosis/Assessment • History: Review of complete cancer treatment, immunosuppressive/antibiotic treatment/recent blood administration, invasive devices, comorbidities • Physical: Evaluation for fever, productive cough, shortness of breath, mental status changes, urinary symptoms, diarrhea; examination of potential sites of infection source (oral, perianal, skin, catheter exit sites)

  9. Diagnostic Studies • Blood – CBC with differential and cultures • Urinalysis and culture • Stool culture • Culture of any catheter exit sites • Culture of any suspected body fluids (sputum) or site • Metabolic panel • Chest x-ray • ECG

  10. Treatment • Critical care support • Respiratory support • Fluid support • Antibiotics – may be mono or combination therapy depending on source and severity • Antifungals • Vasopressors • Electrolyte support • Other supportive drugs as required

  11. References Gobel, B.H., & Peterson, G.J. (2010). Sepsis and septic shock. Clinical Journal of Oncology Nursing, 14, 793797. Gobel, B.H., Triest-Robertson, S., & Vogel, W.H. (2009). Advanced oncology nursing certification review and resource manual. Pittsburgh, PA: Oncology Nursing Society. National Comprehensive Cancer Network. (2011). NCCN Clinical Practice Guidelines in Oncology: Prevention and treatment of cancer-related infections [v.2.2011]. Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/infections.pdf

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