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KNOWLEDGE COMPETENCIES
Identify the relationship between the cellular mediators and clinical manifestations of sepsis and septic shock.
Describe the etiology, pathogenesis, clinical manifestations, patient needs, and principles of management for sepsis and septic shock.
Compare and contrast the pathogenesis, clinical manifestations, patient needs, and management approaches for multisystem problems resulting from sepsis, septic shock, and overdoses.
Describe the symptoms and pharmacologic management of the patient experiencing alcohol withdrawal syndrome.
Describe treatment considerations for pressure injuries.
Identify factors related to the development of healthcare-associated infections (HAIs).
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SEPSIS AND SEPTIC SHOCK
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Sepsis is a serious global healthcare condition, affecting millions of patients annually. Older adults and those with underlying disease are disproportionally affected by sepsis. Despite advances in the treatment of infection, sepsis continues to be associated with high mortality rates, leading to death in 1 of every 4 patients affected and causing more than 30% of in-hospital deaths in the United States. However, early recognition and immediate treatment may reduce mortality rates significantly.
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The basic elements of sepsis are infection, a dysregulated host response, and subsequent organ damage. A challenge in identifying patients with sepsis is that there is no single diagnostic test that indicates its presence. The diagnosis depends on analysis of an array of clinical data including abnormal vital signs, patient symptoms, physical examination findings, and lab values. Recognizing patients who are at risk for sepsis and closely monitoring their clinical status is essential to improving outcomes in the management of this disorder.
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In 2016, the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) defined sepsis as a dysregulated host response to an infection leading to life-threatening organ dysfunction. Septic shock, a subset of sepsis, occurs when patients with sepsis who have undergone fluid resuscitation remain hypotensive, require vasopressors, and have a serum lactate greater than 2 mmol/L. Hospital mortality from septic shock is over 40%.
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Previous definitions of sepsis focused on the systemic inflammatory response syndrome (SIRS), which occurs in response to a clinical insult, such as an infection, inflammation, or injury. Research reviewed for the development of the Sepsis-3 definitions raised the concern that SIRS criteria are not specific for the dysregulated response that characterizes sepsis and septic shock. Data suggests that most patients with sepsis demonstrate SIRS criteria. However, use of SIRS to identify sepsis may result in the inclusion of patients who have an appropriate systemic inflammatory response to an infection or other insult and not a dysregulated response that extends beyond source control and leads to organ dysfunction.
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Etiology, Risk Factors, and Pathogenesis
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The infection that causes sepsis may be bacterial, viral, fungal, or on rare occasions, rickettsial or protozoal. Immune and inflammatory responses to infection occur as natural processes that are protective. Normally, an innate system of “checks and balances” controls these responses. In sepsis, through mechanisms that are not completely understood, the ...