Case Study.septic Shock

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In Partial Fulfillment of the Related Experience At Veterans Memorial Medical Center Diliman, Quezon city

Case Study of Septic Shock

Sumbitted by: Ariola, Irene mae V. Diongson Rolando V.

Submitted to: Sir Dave Tandoc RN,MAN Date Submitted: March 8, 2013

Introduction:Septic shock is a life-threatening condition that happens when your blood pressure drops to a dangerously low level. The fall in blood pressure is a reaction to a serious infection that develops in the blood. This causes a response from the body known as sepsis. If sepsis is not treated, it will lead to septic shock. Symptoms of septic Shock includes cold skin and an increased heartbeat. If you have septic shock, you will usually be admitted to an intensive care unit (ICU) so that your bodys functions and organs can be supported while the infection is treated.

Symptoms:Septic shock can affect any part of the body, including the heart, brain, kidneys, liver, and intestines. Symptoms may include: Cool, pale extremities High or very low temperature, chills Lightheadedness Low blood pressure, especially when standing Palpitations Rapid heart rate Restlessness, agitation, lethargy, or confusion Shortness of breath Skin rash or discoloration

elderly people Anyone who is taking immunosuppressive medications (such as transplant recipients) People who are being treated with chemotherapy drugs or radiation People who have had their spleen surgically removed (the spleen helps fight certain infections) People taking steroids (especially over the long term) People with longstanding diabetes, AIDS, or cirrhosis Someone who has very large burns or severe injuries People with infections such as o pneumonia,

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meningitis, cellulitis, urinary tract infection

Risk factors for septic shock include:

Diabetes Diseases of the genitourinary system, biliary system, or intestinal system Diseases that weaken the immune system such as AIDS Indwelling catheters (those that remain in place for extended periods, especially intravenous lines and urinary catheters and plastic and metal stents used for drainage) Leukemia Long-term use of antibiotics Lymphoma Recent infection Recent surgery or medical procedure Recent use of steroid medications

SepsisSepsis occurs when an infection spreads through the blood, causing symptoms to develop throughout the whole body. The term sepsis is sometimes used to refer to blood poisoning (septicaemia). This is not entirely accurate because sepsis is not just limited to the blood but affects the whole body, including the organs. Sepsis is usually caused by a bacterial infection, but it can sometimes be caused by viral or fungal infections.

The effects of sepsis:Sepsis can affect many of the vital processes of the body including: blood pressure

breathing organ function Sepsis can result in septic shock if it is not treated immediately.

Classification of shock:Shock is identified in most patients by hypotension and inadequate organ perfusion, which may be caused by either low cardiac output or low systemic vascular resistance. Circulatory shock can be subdivided into 4 distinct classes on the basis of underlying mechanism and characteristic hemodynamics, as follows:

Hypovolemic shock Obstructive shock Distributive shock Cardiogenic shock These classes of shock should be considered and systemically differentiated before establishing a definitive diagnosis of septic shock. Hypovolemic shock results from the loss of blood volume caused by such conditions as gastrointestinal (GI) bleeding, extravasation of plasma, major surgery, trauma, and severe burns. The patient demonstrates tachycardia, cool clammy extremities, hypotension, dry skin and mucus membranes, and poor turgor. Obstructive shock results from impedance of circulation by an intrinsic or extrinsic obstruction. Pulmonary embolism and pericardial tamponade both result in obstructive shock. Distributive shock is caused by such conditions as direct arteriovenous shunting and is characterized by decreased resistance or increased venous capacity from the vasomotor dysfunction. These patients have high cardiac output, hypotension, large pulse pressure, a low diastolic pressure, and warm extremities with a good capillary refill. These findings on physical examination strongly suggest a working diagnosis of septic shock. Cardiogenic shock is characterized by primary myocardial dysfunction, resulting in the inability of the heart to maintain adequate cardiac output. These patients demonstrate clinical signs of low cardiac output, while evidence exists of adequate intravascular volume. The patients have cool clammy extremities, poor capillary refill, tachycardia, narrow pulse pressure, and a low urine output.

Anatomy and Physiology:The respiratory system is situated in the thorax, and is responsible for gaseous exchange between the circulatory system and the outside world. Air is taken in via the upper airways (the nasal cavity, pharynx and larynx) through the lower airways (trachea, primary bronchi and bronchial tree) and into the small bronchioles and alveoli within the lung tissue. The lungs are divided into lobes; The left lung is composed of the upper lobe, the lower lobe and the lingula (a small remnant next to the apex of the heart), the right lung is composed of the upper, the middle and the lower lobes. The Nose The uppermost portion of the human respiratory system, the nose is a hollow air passage that functions in breathing and in the sense of smell. The nasal cavity moistens and warms incoming air, while small hairs and mucus filter out harmful particles and microorganisms. This illustration depicts the interior of the human nose. The prominent structure between the eyes that serves as the entrance to the respiratory tract and contains the olfactory organ. It provides air for respiration, serves the sense of smell, conditions the air by filtering, warming, and moistening it, and cleans itself of foreign debris extracted from inhalations. The Trachea, Bronchi Aviolar Ducts and Avioli: The trachea (windpipe) divides into two main bronchi (also mainstem bronchi), the left and the right, at the level of the sternal angle at the anatomical point known as the carina. The right main bronchus is wider, shorter, and more vertical than the left main bronchus. The right main bronchus subdivides into three lobar bronchi while the left main bronchus divides into two. The lobar bronchi divide into tertiary bronchi, also known as segmental bronchi, each of which supplies a bronchopulmonary segment. A bronchopulmonary segment is a division of a lung that is separated from the rest of the lung by a connective tissue septum.. This property allows a bronchopulmonary segment to be surgically removed

without affecting other segments. There are ten segments per lung, but due to anatomic development, several segmental bronchi in the left lung fuse, giving rise to eight. The segmental bronchi divide into many primary bronchioles which divide into terminal bronchioles, each of which then gives rise to several respiratory bronchioles, which go on to divide into 2 to 11 alveolar ducts. There are 5 or 6 alveolar sacs associated with each alveolar duct. The alveolus is the basic anatomical unit of gas exchange in the lung. There is hyaline cartilage present in the bronchi, present as irregular rings in the larger bronchi (and not as regular as in the trachea), and as small plates and islands in the smaller bronchi. Smooth muscle is present continuously around the bronchi. In the mediastinum, at the level of the fifth thoracic vertebra, the trachea divides into the right and left primary bronchi. The bronchi branch into smaller and smaller passageways until they terminate in tiny air sacs called alveoli. The cartilage and mucous membrane of the primary bronchi are similar to that in the trachea. As the branching continues through the bronchial tree, the amount of hyaline cartilage in the walls decreases until it is absent in the smallest bronchioles. As the cartilage decreases, the amount of smooth muscle increases. The mucous membrane also undergoes a transition from ciliated pseudostratified columnar epithelium to simple cuboidal epithelium to simple squamous epithelium. The alveolar ducts and alveoli consist primarily of simple squamous epithelium, which permits rapid diffusion of oxygen and carbon dioxide. Exchange of gases between the air in the lungs and the blood in the capillaries occurs across the walls of the alveolar ducts and alveoli. The Lungs: The lungs constitute the largest organ in the respiratory system. They play an important role in respiration, or the process of providing the body with oxygen and releasing carbon dioxide. The lungs expand and contract up to

20 times per minute taking in and disposing of those gases. Air that is breathed in is filled with oxygen and goes to the trachea, which branches off into one of two bronchi. Each bronchus enters a lung. There are two lungs, one on each side of the breastbone and protected by the ribs. Each lung is made up of lobes, or sections. There are three lobes in the right lung and two lobes in the left one. The lungs are cone shaped and made of elastic, spongy tissue. Within the lungs, the bronchi branch out into minute pathways that go through the lung tissue. The pathways are called bronchioles, and they end at microscopic air sacs called alveoli. The alveoli are surrounded by capillaries and provide oxygen for the blood in these vessels. The oxygenated blood is then pumped by the heart throughout the body. The alveoli also take in carbon dioxide, which is then exhaled from the body. Inhaling is due to contractions of the diaphragm and of muscles between the ribs. Exhaling results from relaxation of those muscles. Each lung is surrounded by a two-layered membrane, or the pleura, that under