According to Urden, Stacy, and Lough (2006), shock is a life-threatening condition that can lead to ineffective tissue perfusion or may further progress to multiple organ dysfunction and death. The different types of shock include hypovolemic shock, cardiogenic shock, anaphylactic shock, neurogenic shock, and septic shock (Urden, Stacy, & Lough, 2006). This essay will analyze septic shock based on the analysis of a presented case study. To further understand this concept, a review of treatment and management of septic shock as used in the writer’s practice setting will be discussed.
The writer chooses the “case study one” as an issue of septic shock because Karen’s vital signs, ...view middle of the document...
Outside these indicators of shock, Karen’s history of recent surgery with the use of invasive devices, foley catheter, and possible compromised immune system with cancer treatment, could be precipitating factor for the development of infection hence causing septic shock (Bench, 2004). In addition, massive vasodilatation which usually occurs during the early stage of septic shock may have caused Karen to become hyperdynamic and as a result present with hot and dry skin (Urden, Stacy & Lough 2006). Karen’s restlessness and anxiety may be an early sign related to stress with the imbalance with the sympathetic nervous system (Urden, Stacy & Lough 2006).
Treatment of Septic Shock as in Current Practice/International Guidelines
As the occurrence of septic shock increases over time, goals of treatment in writer’s hospital are; to identify and treat the cause of infection, stabilize organ systems to limit tissue damage, and cure the infection. The registered nurse is in position to assess, identify, and notify the physician of possible signs of sepsis. The standard septic shock protocol at writer’s practice environment includes; insertion of arterial line by respiratory therapist, sending blood, urine, sputum, and other cultures to the laboratory to identify the bacterial. Also included are immediate starts of antibiotics usually broad spectrum unless bacterial is identified and fluid resuscitation with systolic blood pressure (SBP) less than 90mmHg or mean arterial pressure (MAP) less than 70mmhg. An early fluid therapy is initiated with the following parameters; the above range of SBP and MAP, central venous pressure less than 8mm Hg, urine output less than 60cc in two hours, and venous oxygen saturation less than 70%.
This therapy included in the protocol allow nurses to administer two litres of NaCl 0.9% to increase preload, ensure adequate cardiac output and maintain MAP in other to ensure tissue perfusion. As the above therapy becomes ineffective, the nurse progress to the use of Norepinephrine infusion to achieve the desired MAP. If still venous oxygen saturation is less than 70%, the nurse can progress to the use of dobutamine in a D5W to improve oxygen delivery and decrease lactate levels.
The use of Hydrocortisone may also be a drug of choice by the ordering physician. Hydrocortisone is used to boost the immune system and stimulate the systemic nervous system in response to norepinephrine and epinephrine (Urden, Stacy & Lough 2006). This is administered after obtaining the cortisol level of the patient. The protocol also indicate the use of...