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, physiological and behavioral symptoms are clear indicators of septic shock. Septic shock is described as the body’s inflammatory response to overwhelming infection (Urden, Stacy & Lough 2006). It is also classified as existence of an infection with hypotension despite fluid replacement along with the presence of tissue perfusion abnormalities (Urden, Stacy & Lough 2006). According to Bench (2004), the diagnostic criteria for septic shock include a heart rate greater than 90 beats per minute, a respiratory rate greater than 20 beats per minutes, an increased white cell count, hypotension, and temperature greater than 38 degrees or less than 36 degrees. Karen met these criteria with an increased temperature of 41 degrees which is usually an indicator of infection, increased heart rate and respiratory rate.

(Urden, Stacy & Lough 2006). According to Bench (2004), the diagnostic criteria for septic shock include a heart rate greater than 90 beats per minute, a respiratory rate greater than 20 beats per minutes, an increased white cell count, hypotension, and temperature greater than 38 degrees or less than 36 degrees. Karen met these criteria with an increased temperature of 41 degrees which is usually an indicator of infection, increased heart rate and respiratory rate.

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 insulin infusion to reduce the amount of sugar level in the blood as well as reducing nutrients for bacterial to feed on. Although this protocol is clearly printed out, some physicians may sometimes deviate from these therapies based on the unique nature of each case.

The intensive care unit physician may also consider the use of human activated protein C also known as Xigris for the treatment of septic shock, although rarely used. The use of blood products may also be used if indicated. As strongly recommended by Dellinger, levy, and Carlet et al, (2008), the writer’s hospital protocol is very similar to that of the “surviving sepsis international guidelines” agreeing with the early goal directed therapy within the first six hours. This therapy is initiated as soon as septic shock is suspected either at the emergency department or at the unit. The writer’s hospital also maintains a standard nutritious value to build immune system during treatment.

Strategies for Potential Issues with Family

The surviving sepsis international guidelines in agreement with RNAO best practice guideline have indicated the importance and the effectiveness of using the family centred care model. This model is proposed to address the need of not only the patient but also for that who the patient says is a family. The model allows the implementation of vital strategies such as; continuity of care programmed, addressing the need for family visitation, giving and receiving necessary feedbacks from family members, providing useful informational pamphlet for families, codeword identification for families, and social or emotional support for family members.

Coping with the unexpected Sudden Loss of a Client in Critical Care Setting

It is also important for nurses looking after the ill person to also care for themselves. The writer will assess and identify previous coping skills successfully used in the past. For example, practice reflection, communicating and providing emotional or social support for the family, talking to colleagues about the event, good rest after work, has been very effective in the past. The writer sometimes let tears role if uncontrollable. Also, resources such as useful literatures, theories, models, specialized person and professionals are always available if need be.

Conclusion

This essay has provided a in depth explanation of septic shock and protocol for treating the illness. It has broaden the knowledge and understanding of the care of the family and the person experiencing septic shock, as designated by surviving guidelines and current practice environment.