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INTRODUCTION

KNOWLEDGE COMPETENCIES

  1. Identify the relationship between the cellular mediators and clinical manifestations of sepsis and septic shock.

  2. Describe the etiology, pathogenesis, clinical manifestations, patient needs, and principles of management of sepsis and septic shock.

  3. Compare and contrast the pathogenesis, clinical manifestations, patient needs, and management approaches for multisystem problems resulting from sepsis, septic shock, and overdoses.

  4. Describe prone ventilation and nursing care for the prone patient.

  5. Describe the symptoms and pharmacologic management of the patient experiencing alcohol withdrawal syndrome.

  6. Describe treatment considerations for pressure injuries.

  7. Identify factors related to the development of healthcare-associated infections (HAIs).

SEPSIS AND SEPTIC SHOCK

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, with 1 in 3 hospital deaths occurring in patients who experience sepsis (CDC, 2022). Early recognition and immediate treatment are key factors in reducing the impact of sepsis.

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.

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 remain hypotensive after fluid resuscitation, require vasopressors, and have a serum lactate greater than 2 mmol/L. Hospital mortality from septic shock is over 40%.

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. Most patients with sepsis have signs consistent with SIRS. However, SIRS is also present when a patient has an appropriate systemic inflammatory response to an infection or other insult and not a dysregulated response that can lead to organ dysfunction. A tool for identifying organ dysfunction is the Sequential Organ Failure Assessment (SOFA) (see Table 11-1). SOFA is not a screening tool for sepsis but may be used to assess the degree of organ dysfunction.

TABLE 11-1.SEQUENTIAL (SEPSIS RELATED) ORGAN FAILURE SCORE

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