Septic Shock: Management (Nursing)

00:01 So, here's back to that model.

00:04 Remember, we looked at that? I would love for you to take the time to look at that Layer 3 now, right? Look at those things. What do we do? Well, we have just spent time talking about all the cues that we want you to be able to recognize, right? We've talked about how to analyze them.

00:21 You're thinking, wow, this sepsis is a lack of oxygen to the cells, how are we going to fix this? So, hypothesis is we think they're in sepsis.

00:31 We know that we're going to, ooh, we're going to kind of look at what we want to do with them? What are things that we should take? So, we're going to talk about those actions that we take in the next section.

00:42 So, we're all in agreement.

00:44 You have to correct the underlying cause.

00:46 But I also want to look at some overall options for you, which you'll typically see in the treatment of a patient with sepsis.

00:53 First, IV fluids. Now, this is typically going to be Crystalloids.

00:57 Remember, these aren't the types of fluids that can carry oxygen.

01:00 That's why they're called Crystalloids.

01:02 Now, initially, when we're first trying this to see if we can resuscitate the patient, kind of get them back to normal.

01:07 You'll give 30 milliliters per kilogram.

01:10 Now, this is pretty standard. But certain hospitals or certain places have very specific protocols. So you may see this vary.

01:18 But as a general rule of thumb, this is what we'll try initially.

01:22 Now, if that doesn't work, there's other steps that we can take.

01:26 But how would you know if giving the IV fluids worked? If you said the blood pressure normalizes, Yes, celebrate.

01:36 If you didn't, it's okay. Just write yourself a note.

01:38 That's the purpose of giving IV fluids.

01:41 Think back to what was going on in the initial phase and the compensatory phase and those things.

01:45 Yes, giving IV fluids we're hoping will help raise that blood pressure.

01:50 You're going to shoot to keep their oxygenation, their saturation at 92 to 95.

01:55 That's a little lower than we take normally, but in this case, we're going to be really excited with a 92 to 95.

02:02 Now, we talked about the things we're going to give them IV Crystalloids, to try to get that pressure up.

02:10 But if that doesn't work, we're going to use vasopressors.

02:13 Now, vasopressors are these really fancy drugs that we give IV that cause vasoconstriction.

02:21 So, if the basic IV fluids don't work, we're going to add vasopressors to try to maintain that blood pressure, right? That's what our goal is.

02:31 That two other things, we're also going to give IV.

02:33 Antibiotics if that was the cause, right? And we use antibiotics here, because that's the most predominant cause, right? Number one was bacteria. What was number two? Fungi? And what was number three? Yeah, one percent viruses.

02:48 So, it's very likely you're going to be giving antibiotics.

02:51 And remember, you're going to be watching those culture reports to make sure we're on an appropriate antibiotic.

02:57 The other thing is glucocorticoids.

03:00 So, glucocorticoids, are going to try to suppress that inflammatory response.

03:04 So we use all of these things together to try to treat the patient.

03:09 Now, let's take a look at specific nursing care.

03:13 They're going to put a sensor on and why would we put it on their forehead? I mean, who wants a sticker on their forehead? Think about what you know about sepsis.

03:23 Remember, everything is clamping down.

03:26 So they have poor circulation in their fingers.

03:29 And that's why you put it on their forehead as a likely spot for us to get a more accurate picture of what their oxygen saturation is.

03:38 They're going to use a blood pressure cuff more than likely an automatic blood pressure reading.

03:44 You might even have an arterial line that gets you but you want a mean arterial pressure over 65.

03:51 And you want a CVP that is greater than six.

03:54 Okay, so those are two ranges to reach for.

03:56 Remember, this patient is likely going to be in a critical care setting at this way.

04:01 The other monitoring we're going to do is glucose levels.

04:04 We want to keep them lower than 180.

04:08 And that odd but glucose is something that we're looking at, as they're treating sepsis.

04:13 So, you may think, "Well, what if they're not not diabetic?" No, we monitor everyone's glucose or someone who's at this level of sepsis.

04:20 Now, the cues in shock will vary. Remember, depending on what? What phase you're in? So a great way to study.

04:28 Make yourself a chart, four columns, and compare.

04:32 What's the same? What's different? What changes? What progresses? Because the work that you do after doing this video with us will help it solidify in your brain and make it available when you need it.

04:43 Now, we come to this big overall chart.

04:46 Now, septic shock gets a little trickier than the others, right.

04:50 So, this seems is going to seem more confusing.

04:52 But just remember, there's four stages, right.

04:57 You've got initial, compensatory, progressive, and refractory, the saddest of them all.

05:06 So,pinning this down is really difficult because it matters, what happens to your cardiac output or your SVR, depending on which stage you're in.

05:15 So this one, you're just going to have to keep in mind, the values can vary and can be different.

05:21 There could be in cardiac output, if you look at there at septic shock, yes, initially, if you're able to compensate well enough that cardiac output is going to initially go up to try to compensate.

05:34 But eventually, things are going to wear out that cardiac output is going to drop off.

05:40 Heart rate. Remember, it's going to increase in the compensatory phase.

05:44 But eventually, as the systems wear out, you're going to see those dysrhythmias and problems and eventually tissue that's dying, you're really going to see changes in their heart rate.

05:56 CVP, we just went ahead and put it there might not be changed, might be.

06:00 You see that's a pattern with CVP in other types of shock too.

06:04 Now, wedge pressure, PCWP.

06:08 That's a reading that we get from that PA catheter that went into your right atrium and your right ventricle and over to the pulmonary artery, that will most likely be down.

06:18 But it's all going to hedge on where you are in the phase of shock.

06:23 So, SVR and you're going to be vasoconstricted, and then it's not going to be able to maintain that.

06:28 And the oxygen saturation, maybe up initially as you're compensating, but it's all going to kind of progressively get worse and be lower.

06:42 So, on this one, I want you to put a special note.

06:46 The others a lot more straightforward, right? You can pretty much see what those arrows are and things are going.

06:50 But on sepsis, putting big letters on there, it all depends on the phase.

06:56 And that will help you as you're progressing through your study of septic shock.