Septic Shock: Introduction (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 Hi, I'm Professor Lawes. And welcome to this part of our video series, where we're going to talk about Septic Shock.

    00:07 Now, this is critically important no matter where you're working in the hospital, because you want to be able to recognize this when your patients showing you those signs.

    00:16 So, let's start from the beginning.

    00:18 I kind of want to help you see where we are.

    00:20 See, there's main types of shock.

    00:23 And you see them listed there, right? There are five types.

    00:26 So you've got cardiogenic shock, hypovolemic, anaphylactic, septic, and neurogenic.

    00:32 Now we have it there. So you can see what the causes are, right? Cardiogenic shock. That makes sense. It's due to heart problems.

    00:39 Hypovolemic shock that's caused because too little blood volume.

    00:44 Anaphylactic, that's when you have a major allergic reaction.

    00:48 Neurogenic shock is caused by damage to your nervous system.

    00:53 We're going to zero in on septic shock.

    00:56 And that's caused by infections. So, let's get started.

    01:01 Picture this is that big swath next to me. That's your skin.

    01:05 Now, how do we end up in septic shock? Well, it takes process. There are several steps.

    01:11 And we're going to go through those in this video series.

    01:13 But let's start at the very beginning, right.

    01:17 So you've got intact skin here.

    01:19 Your skin is amazing.

    01:21 It's what protects us from outside infection, when it's intact.

    01:26 It also helps keep all the juices on the inside that are supposed to be on the inside to keep us that M word, moist.

    01:33 But then let's say something happens.

    01:35 You cut yourself and you see there we have an opening in the skin.

    01:39 Now you're no longer protected. So in comes the bad guy.

    01:45 See him there? He is a little green guy.

    01:47 He's represents bacteria.

    01:49 Skins, no longer intact. Bacteria enters the body.

    01:53 Now there's lots of other ways bacteria can enter the body.

    01:57 Through your nose, to your mouth, something that gets inhaled into your lungs, any number of things.

    02:02 But for this example, we're just going to keep it simple.

    02:04 And talk about what happens when bacteria enters the body through the skin.

    02:09 Either way, the bacteria is eventually going to make it into the bloodstream.

    02:13 So, let's go. You see the little green guy.

    02:16 He is heading toward the skin.

    02:18 Now, he drops in there and he's starting, you got multiply, he's bringing lots of friends with him.

    02:23 Because he doesn't usually come with just one, right? Now, you'll see that little white box on there.

    02:29 We're going to dive down deep zoom in and look at what happens in the actual bloodstream.

    02:35 Now, take a look at this red rectangle that represents your bloodstream.

    02:39 So that's inside your blood vessels.

    02:41 Look what we have going on there. We have the normal blood cells.

    02:45 And those green guys, which are the bacteria that are now in the bloodstream.

    02:50 That means they are going to be super mobile.

    02:53 They're going everywhere.

    02:55 Now, sepsis is an extreme response to infection.

    02:59 You can have a bacteria into your body, enter your bloodstream, and not have this severe or super extreme response.

    03:06 But when it is extreme, that is what we're talking about when we say sepsis.

    03:11 Now, why is sepsis such a big deal? Well, when you're in sepsis, this is a life threatening situation.

    03:18 This could really damage your organs caused him to not be able to work.

    03:23 And it's because of this dysregulated host response.

    03:27 That's a really big way of saying, my body took into bacteria and then, Whoa, completely overreacted.

    03:34 Let's say that for a dysregulated host response.

    03:38 That's what happens.

    03:39 So when you're thinking about patients with sepsis, know that at some point, they developed an infection.

    03:46 Okay, so that's the first critical factor to be thinking about for a patient sepsis.

    03:51 Now, there are three stages of sepsis.

    03:53 First one is called, pretty catchy, sepsis.

    03:57 The second one is severe sepsis. And the third one is septic shock.

    04:03 Okay, this is when it is all alert.

    04:07 This patient is in severe danger when they are in septic shock.

    04:10 So, I can be septic and not be in septic shock.

    04:14 Because a lot of times you'll hear people talk about oh, so and so's in the hospital.

    04:17 I think they have sepsis, That's okay. Not a good thing.

    04:21 But it's not nearly as intense or an emergency as septic shock.

    04:26 So our job as healthcare providers, is to make sure we recognize when a patient is in sepsis, and to stop them from progressing to severe sepsis or shock.

    04:37 Because remember, in shock, your organs are not getting perfused and that is not good for lifespan, right? All organs need oxygen to work.

    04:47 So, when your immune system goes into this overdrive response to an infection, sepsis may develop as a result.

    04:54 Now, septic shock is a part of that three stages, right? You had sepsis, severe sepsis, and septic shock.

    05:02 But this is one when you are really in danger.

    05:04 So, septic shock is part of that continuum, But you've got an incredibly larger increase in mortality risk.

    05:13 So, if someone is in septic shock, they have a much higher risk of not surviving than someone who is just septic. Okay? That's because this circulatory and cellular metabolic abnormalities all kinds of havoc breaks out. Your body just can't function safely if we can't reverse this, or turn it around.

    05:33 Okay, now that may seem like a lot of time talking about definitions.

    05:38 But when you're putting things into your brain in an orderly fashion, this will help you retain them when you need to on an exam and with patient care.

    05:47 So, we're talking about a bacterial cause of sepsis, that is an over dysregulated kind of response.

    05:53 We try to prevent it from going into severe sepsis, and then life threatening septic shock.

    05:59 Now, let's get into some of the fun stuff.

    06:02 I know, might sound really nerdy, but this is cool.

    06:05 When you can take a look, you're in clinical.

    06:07 You see your patients.

    06:09 You can take a look at their lab work.

    06:10 I want you to look at what a typical CBC.

    06:13 What it would look like for somebody who is in sepsis, okay.

    06:17 So we're looking at a complete blood count.

    06:20 Now, before we get started in breaking down these words, there's two things I want you to pay attention.

    06:25 See at the end of that first word? P-E-N-I-A.

    06:29 I want you to write that down in your notes.

    06:32 And remember, that means not enough or decreased.

    06:35 And look at the next word, you see nutrophilia.

    06:39 Anytime you see that -philia ending, that means you've got extra, from the field to love. There you go.

    06:46 So, how does this help you and other tests? Well, when you see this word at the end, this ending -penia or philia, you're going to be able to recognize like, oh, whatever is in front of that, That's telling me what's going on.

    07:00 So, let's look at the first one.

    07:02 Lymphocytopenia. So, that means I have a decreased level of lymphocytes. You see that? Okay, you may think like, "Excuse me, but I knew that.

    07:14 Hey, anytime we can give you a study tip, we're going to do it.

    07:18 And if you know it, celebrate because that's super cool.

    07:22 Everyone has to celebrate when they're in school when they know something. But if you didn't, it's going to help you out on lots of other vocabulary.

    07:29 So, CBC in a patient with sepsis.

    07:33 Lymphocytopenia, means you have decreased, less lymphocytes.

    07:38 Neutrophilia means you're going to have elevated white blood cells.

    07:42 Eosinophilia also means elevated. So when you're looking at the CBC, you're going to look for a eosinophils, and they will also be elevated.

    07:51 Thrombocytopenia. Wow, that means low platelets.

    07:56 That's not good. We're going to have trouble with bleeding and clotting.

    08:00 As a beginning student, knowing the impact on lymphocytes, neutrophils, eosinophils, and thrombocytes are going to be your most important values on a CBC.

    08:10 So we're looking at the etiology and what causes it, right? Let's start there.

    08:15 Now, it could be a community acquired or hospital acquired.

    08:19 So, why are we talking about that? Well want you to be focused that someone can come into the hospital having developed the infection outside of the hospital.

    08:28 And that's what kicks off the sepsis, severe sepsis, septic shock.

    08:33 But patients can also develop sepsis inside the hospital, and that's called hospital acquired.

    08:40 We would really, really, really want to avoid that if we made somebody sicker while they were under our care in a hospital.

    08:47 So, community acquired, hospital acquired.

    08:51 And you know, the cool part, we actually know which types of organisms or bugs typically cause sepsis.

    08:58 So, it helps us accelerate how we know to treat the patient.

    09:02 But I get ahead of myself.

    09:03 So bacteria, they're the most common ones, right? That was a little green guy, you still saw going in there.

    09:08 Most commonly you're seeing gram positive over gram negative.

    09:13 Now, if I got to pick what type of bacterial infection I had? I would want to gram positive one, right? Those are a little easier to treat.

    09:20 Those gram negative guys are real nasty.

    09:22 They got extra walls, all this kind of stuff going on.

    09:25 So, gram positive is usually the most common.

    09:29 So sources of infection that can cause sepsis.

    09:32 These are just common ones.

    09:33 There are other things that can cause it, but you only have so much real estate in your brain.

    09:38 So these are the things I think are most important for you to remember.

    09:42 So sources of infection that can lead to sepsis, severe sepsis, and septic shock are pneumonia, and then followed by other things like an intra-abdominal administration, GU infection, so could a UTI lead to sepsis? Absolutely. What's the takeaway here? Well, I doubt that you'll see a question that says, What is the most common form of bacteria that will can cause sepsis.

    10:07 But you need to know it's often gram positive. Why? Because as a nurse, you're going to be looking at cultures of your patients.

    10:15 Now, when you first get your patient, they're going to order prophylactically, what they know are the most common causes of sepsis.

    10:22 But our jobs at the bedside is to make sure when those results come back, we make sure the antibiotics the patient is on will actually kill that particular bacteria.

    10:34 Part of that report is gram positive, or gram negative.

    10:37 So, you want to be sure that you're learning how to interpret those things, and to apply it to what your patient is receiving to making sure they're getting what they need.

    10:46 And remember, with an elderly client, if they're showing you a UTI, they may not show you fever, and everything else that we're used to, but they will show you confusion.

    10:57 So be on the lookout for that if you notice changes in an elderly client.

    11:01 So we've established sepsis is because of an infection, usually bacterial. But there's two other causes of infection.

    11:10 The next highest one is fungi, right? That sounds so gross, doesn't it? But about 20% of the cases could be considered caused by fungi.

    11:20 Now, lastly, the tiniest little bit that represents sepsis are viruses.

    11:26 This is only about 1% of the cases.

    11:29 So, if a patient comes in and you have the opportunity to see a patient who is in sepsis, or severe sepsis, or septic shock, make sure you take a look at what was the original cause of this problem.

    11:42 Predominantly, bacteria and gram positive is going to be the most common cause.

    11:47 Fungi are the next most common at about 20%.

    11:51 And then viruses represent a very, very small amount of the cases that cause sepsis.

    About the Lecture

    The lecture Septic Shock: Introduction (Nursing) by Rhonda Lawes, PhD, RN is from the course Shock (Nursing).

    Included Quiz Questions

    1. Fungi
    2. Viral infections
    3. Urinary tract infections
    4. Gram positive bacteria
    1. It can be acquired in the community or hospital
    2. It is easier to treat if it is caused by gram-positive organisms
    3. It can be caused by a urinary tract infection
    4. It is usually caused by gram-negative organisms
    5. It always develops into septic shock
    1. Decreased lymphocytes
    2. Increased white blood cells
    3. Increased lymphocytes
    4. Decreased white blood cells
    5. Increased platelets
    1. Sepsis
    2. Severe Sepsis
    3. Septic Shock
    4. Compensatory
    5. Regulatory
    1. Organ dysfunction caused by a dysregulated response to infection
    2. Blood infection caused by a normal host response
    3. Hypovolemia caused by a normal host response to infection
    4. Hypervolemia caused by a dysregulated response to infection

    Author of lecture Septic Shock: Introduction (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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