...Septic Shock Medical Careers Institute NUR 255 November 19, 2014 Instructor Y. Rogers Introduction Septic shock is the most common type of circulatory shock. Sepsis or septic shock is systemic inflammatory response syndrome (SIRS) secondary to a documented infection. This response is a state of acute circulatory failure characterized by persistent arterial hypotension despite adequate fluid resuscitation or by tissue hypoperfusion (manifested by a lactate concentration >4 mg/dL) unexplained by other causes. Sepsis can occur in stages that may progress from uncomplicated sepsis, to severe sepsis, to shock. Despite efforts to decrease shock with the use of antibiotics, the incidences continue. Septic shock is the leading cause of death in noncoronary ICU patients. More than 18 million cases of severe sepsis occur each year, this results in 1,400 deaths worldwide every day (Hinkle, 2014). Background In the past, the terms sepsis and septicemia have referred to several ill-defined clinical conditions present in a patient with bacteremia. These 2 terms have often been used interchangeably; however, only about half of patients with signs and symptoms of sepsis have positive results on blood culture. Serious bacterial infections at any site in the body, with or without bacteremia, are usually associated with important changes in the function of every organ system in the body. These changes are mediated mostly by elements of the host immune system against infection...
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...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...
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...Learner 2 ECS® Program for Nursing Curriculum Integration (PNCI®) Sepsis, Septic Shock and Multiple Organ Dysfunction Syndrome © 2008 METI, Sarasota, FL; Original Authors: Jami Nininger and Dawn Hughes, Mount Carmel College of Nursing, and Thomas J. Doyle, METI. Reviewer: Jami Nininger, Mount Carmel College of Nursing v.4 August 2008 References 1. Differentiate the following terms: • Systemic Infl ammatory Response Syndrome (SIRS) • Sepsis • Severe sepsis • Septic shock • Multiple Organ Dysfunction Syndrome (MODS) 2. Identify the nursing priorities in the care of the patient with sepsis and septic shock. 3. What class of bacteria is responsible for more than one half of the cases of septic shock? What are some common causes of this? 4. Explain why myocardial depression is almost always present in a patient with septic shock despite an initial rise in cardiac output. 5. Discuss the cascade of host infl ammatory responses that produce the major detrimental effects seen in sepsis due to gram-negative bacteria. 6. What is early goal directed therapy in the management of sepsis? 7. Identify the treatment guidelines currently recommended for the management of sepsis and septic shock. 8. Discuss how the drug dobutamine affects cardiac output. Identify the nursing implications with the administration of this drug. 9. Discuss how norepinephrine works and its indications for use. Identify the nursing implications with the administration of this drug. 10. Discuss...
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...CONTRACT SHORT PAPER Contract Short Paper Christopher A. Paul Sr. Ashford University Professor Buenger late to ask about the flood problem that existed. Once we moved in, we discovered that we had septic tank problems and problems with the water flowing into the county ditch. My wife and I had many people come and look at the problem and all of them gave the same answer about adding dirt and top soil to my property. One contractor came out and told me to come around to the side of my house near the garage; he then pointed up the street and showed me how my lot was cut to be a natural drain for the whole sub-division! This made me furious but as I sat and thought about it, this whole process was my fault because I didn’t take the time and examine all aspects of home buying and land purchasing The non- breaching party may have deducted the cost or fixed the problem if I would have caught it sooner but I didn’t mention it, therefore he didn’t either. It was no need in trying to contact any legal advice because contracts were signed and the deal was done. So, to all home buyers and land purchasers; please by mindful of what you are purchasing. I also recommend that you let a person who knows what to look for, tag along with you during every aspect of the purchase. This will help you avoid the thousands of dollars I have spent “out of pocket”, trying to fix my water flow problem whereas if I knew before hand, I could have chosen to make the contractor fix...
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...Sepsis Alert and Importance of Rapid Treatment for Sepsis Patients Brooke Blackstock Delaware Technical Community College Sepsis remains a huge source of morbidity and mortality in the United States. Although, the mortality rate from severe sepsis was noted to decrease from 39% in 2000 to 27% in 2007 in the United States, more patients required discharge to a long-term care facility. (Kumar, et al., 2011) Due to it’s high morbidity and mortality rate along with the cost for prolonged treatments a number of efforts have now been directed towards improving patient outcomes. Early intervention/treatment for patients suspected of shock is crucial in order to ensure the optimal outcome for the patient. “Early-goal directed” therapy such as patient specific sepsis bundles ordered by physicians, as well as standardized sepsis order sets has been consistently shown improvement in areas such as: time to antibiotics, time to fluid resuscitation, lactate clearance, and mortality. Ensuring that the administration of the appropriate broad-spectrum antibiotics is another important factor that has also decreased mortality. (Hayden, et al., 2016) In order to recognize the need for these interventions in a timely manner, the sepsis alert or “best practice alert” system is implemented into the electronic charting systems used by the facility. This alert system is programed into the hospital’s patient charting system to screen each electronic medical record for patients presenting with...
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...diagnosed in more than 750,000 patients per year and has mortality rates as high as 28%-50%. Septic shock: Is the presence of sepsis with hypotension despite fluid resuscitation along with the presence of inadequate tissue perfusion. Multiple organ dysfunction syndrome (MODS): Is the failure of two or more organ systems in an acutely ill patient such that homeostasis cannot be maintained without intervention. Identify the nursing priorities in the care of the patient with sepsis and septic shock: Oxygenation -Provide supplemental O2 Intubation/mechanical ventilation, if necessary Monitor SvO2 or ScvO2 Circulation- Aggressive fluid resuscitation End points of fluid resuscitation: CVP 15 mm Hg Pawp 10-12 mm Hg Drug Therapies- Antibiotics as ordered Vasopressors (dopamine) Inotropes (dobutamine) Anticoagulants (low molecular –weight heparin) Drotrecogin alfa (xigris) for patients with high risk death Supportive Therapies- Obtain cultures (blood, wound ) before beginning antibiotics Monitor temperature Control blood glucose Stress ulcer prophylaxis What class of bacteria is responsible for more than one half of the cases of septic shock? What are some common causes of this? The main organisms that cause sepsis are gram- negative and gram- positive bacteria. Parasites, fungi, and viruses can also lead to the development of sepsis and septic shock. Explain why myocardial depression is almost...
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...Definitions of systemic inflammatory response syndrome (SIRS), sepsis, septic shock, and multiple organ dysfunction syndrome Systemic inflammatory response syndrome Two or more of the following clinical signs of systemic response to endothelial inflammation: • Temperature > 38°C or < 36°C x Heart rate > 90 beats/min • Tachypnoea (respiratory rate > 20 breaths/min or hyperventilation (Paco2 < 4.25 kPa)) • White blood cell count > 12 ⋅ 109/l or < 4 ⋅ 109/l or the presence of more than 10% immature neutrophils In the setting (or strong suspicion) of a known cause of endothelial inflammation such as: • Infection (bacteria, viruses, fungi, parasites, yeasts, or other organisms) • Pancreatitis x Ischaemia x Multiple trauma and tissue injury x Haemorrhagic shock x Immune mediated organ injury x Absence of any other known cause for such clinical abnormalities Sepsis Systemic response to infection manifested by two or more of the following: • Temperature > 38°C or < 36°C x Raised heart rate > 90/min • Tachypnoea (respiratory rate > 20 breaths/min or hyperventilation (Paco2 < 4.25 kPa)) • White blood cell count > 12 × 109/l or < 4 × 109/l or the presence of more than 10% immature neutrophils Septic shock Sepsis induced hypotension (systolic blood pressure < 90 mm Hg or a reduction of >40 mm Hg from baseline) despite adequate fluid resuscitation Multiple organ dysfunction syndrome Presence of altered organ...
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...extensive abrasions on his arms, legs, side, back, and buttocks. He was tachycardic, hypotensive, unresponsive, and ventilating poorly when admitted. He was placed on a mechanical ventilator and given IV fluids for shock. C.C. responded well to fluids, with an increase in blood pressure and an improvement in urine output. 1. Based on his case history and responsiveness to fluid therapy, what type of shock was C.C. experiencing? Hypovolemic shock 2. What other clinical findings would be helpful in confirming the type of shock? Capillary refill, tenting on skin turgor, pale skin due to perfusion, and may feel dizzy, faint, nauseated, or very thirsty. 3. Because of his many open wounds and invasive lines, C.C. is at risk for sepsis and septic shock. What clinical findings would suggest that this complication has developed? Bacteremia, high fevers, hot, flushed skin, elevated heart rate, hyperventilation, altered mental status, swelling, and low blood pressure 4. What is the link between sepsis and multiple organ dysfunction syndrome (MODS)? Sepsis causes MODS because the inflammatory and anti-inflmammatory reactions in the body, which cause the clotting cascade to be more active. Resulting in multiple thrombi forming throughout the body. The thrombi can effect multiple organs, which by definition would be MODS. the hypotension and hypoxia causes the release of free radicals which also damage the tissues throughout the body, including the...
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...Innovations Report, Nadukuppam Panchayat, Vilupuram District, Tamil Nadu, Pitchandikulam Bio Resource Centre, Tamil Nadu In Partnership for Development with AusAID and Quaker Service Australia Extract from Chapter 2: WATER INNOVATIONS WATER SUPPLY ANALYSIS COMMUNITY FEEDBACK ON WATER WATER QUALITY ANALYSIS TECHNOLOGY REVIEW RECOMMENDATIONS FURTHER WORKS ADDITIONAL INNOVATIVE OPTIONS FOR CONSIDERATION WASTE WATER TREATMENT ANALYSIS EDUCATIONAL SUPPORT MAINTENANCE REQUIREMENTS TECHNOLOGY REVIEW RECOMMENDATIONS All households in Devikulam use water from the village tank for drinking and cooking. Households in the village have their own taps linked to the village supply, however households in the colony are not directly linked to the village supply, they use a common tap to attain suitable drinking water. Access to the village tap for drinking water is only available for one hour in the morning and one hour in the evening, thus water is collected in large vessels for daily use. Households in the colony also have common taps, linked to the water tank in the colony, however due to the quality of this water it is not suitable for drinking and is used only for washing and cleaning. Water Supply Analysis The development of a safe and reliable water supply system has vast economic, social and environmental benefits to the Devikulum community. Currently, the community water is supplied from three different bores, one of which has been identified...
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...Physicians | Today | S/P (Status/Post) R total knee replacement | McNasty Ortho surgeon | Scenario Data | Learning Objectives | Note: This simulation is part of a Microbiology course (MICRO 290). The main learning objective is to use a simulation of sepsis to facilitate student visualization and understanding of the mechanisms of key chemical and biochemical events in the human body during a human pathological scenarioBy the end of this scenario, the participant will be able to: 1. Observes and discusses the use of patient history and assessment data in the early identification and management of patients at risk for or with sepsis, septic shock and multi-system organ dysfunction (ANALYSIS). 2. Observes and discusses the possible diagnostic orders and therapies including medications for the management of patients with sepsis, septic shock and multi-system organ dysfunction. Uses factor analysis to calculate doses of medication (COMPREHENSION, APPLICATION). 3. Applies the microbiology concepts learned throughout the course to explain the physiological outcomes involved in sepsis (COMPREHENSION, APPLICATION, ANALYSIS). The microbiology concepts are the following: a. Sepsis and the immune system – Relate the signs (including labs) and symptoms to the processes in the immune system - Ex....
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...Mid-Michigan 3340 Ranger Road Lansing, MI 48906 Ph. 517-321-3331 Fax 517-323-7228 pme@pmenv.com Metro Detroit 22655 S. Chrysler Drive Hazel Park, MI 48030 Ph. 248-336-9988 Fax 248-336-9989 pmehazelpark@pmenv.com West Michigan 1441 Arboretum Dr. SE, Suite 200 Grand Rapids, MI 49546 Ph. 616-285-8857 Fax 616-285-8026 pmegr@pmenv.com ISO 9001 REGISTERED CATEGORY-N BASELINE ENVIRONMENTAL ASSESSMENT OF THE FORMER ACTIVE HOMES MANUFACTURING BUILDING LOCATED AT 7876 VAN DYKE, MARLETTE, LAPEER COUNTY, MICHIGAN June 2, 2006 May 19, 2006 District Supervisor Remediation and Redevelopment Division Lansing District Office Constitutional Hall North Tower, 4th Floor 525 W. Allegan Street Lansing, Michigan 48909 RE: Category-N Baseline Environmental Assessment of Former Active Homes Manufacturing Building Located at 7876 Van Dyke, Marlette, Lapeer County, Michigan PM Environmental, Inc., Project No. 22-692A Dear District Supervisor: Enclosed is one copy of the above-referenced document prepared in accordance with the March 11, 1999 “Instructions for Preparing and Disclosing Baseline Environmental Assessments by PM Environmental, Inc., on behalf of Outlook Properties LLC. An affidavit signed by Mr. Bob Gilling, for a Disclosure Baseline Environmental Assessment has been included. If you have any questions regarding the information in this report, please contact our office at (248) 336-9988. Sincerely, PM Environmental, Inc. Rachael...
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...infection is by: A. adherence to universal precautions B. administration of gamma globulins C. active immunization D. double gloving E. administration of interferons 5) Pro-inflammatory mediators in shock, EXCEPT: A. IL-4 B. IL-2 C. TNF D. IL-6 E. IL-8 6) Hypotension occurs in healthy patients if blood volume is decreased by: A. 15-30% B. More than 40% C. Up to 15 % D. 30 – 40% E. Any of the above 7) This type of shock is characterized by hypotension, decreased peripheral vascular resistance and bradycardia: A. Traumatic shock B. High output septic shock C. Low output septic shock D. Hypovolemic shock E. Neurogenic shock 8) In a patient with swelling and paresthesia of the leg...
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...“Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values." (Sackett D, 2009) The nursing profession is liable to humanity for providing high-quality, cost-effective care for patients and families. Thus, the care provided by nurses must be continuously appraised and upgraded on the basis of new and polished research knowledge. The value of the outcome of nursing research not only affected the quality of care delivered to patient but also the power of nurses in making decisions in the health care delivery system. Evidence –Based Practice (EBP) is a continuing process, to address a practical problem with a quality study findings .It is a dynamic integration of ever-evolving clinical expertise and external evidence in day-to-day practice. The definitive goal of nursing process in an EBP is to promotes quality, cost-effective outcomes for patients, families, health care providers, and the health care system (Brown, 2009; Craig & Smyth, 2007; Cullum, Ciliska, Haynes, & Marks, 2008). Second to heart attacks, sepsis is the leading cause of death. As many as 750,000 patients progress into severe sepsis each year in U.S. hospitals, and approximately 200,000 of these patients do not survive yet it is preventable. September is Sepsis Awareness Month and September 13th is World Sepsis Day to raise awareness of sepsis in the hope to increase knowledge resulting in fewer preventable sepsis deaths. In treating sepsis,...
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...Thanksgiving is a wonderful time to enjoy with the family, eat lots of festive food, and even watch some football. While this is good for our mind and spirit, it can wreak havoc on our Brooklyn sewers. Holidays are an important time to monitor what is going down your drains, and be aware of any changes that could be happening within your home. Gathering for a thanksgiving meal and a day spent with family is an American tradition. This means moe people within our home, which puts extra strain on the various systems of your home, especially the sewer. Guests increase the frequency of discharges in the sewer, which stresses the system, and can lead to clogging. The spike in waste discharge needs to be monitored, so that a clog doesn’t ruin your...
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...Initial Coverage November 9, 2011 Junhua CHEN SFC CE Ref: AQH357 Environmental Services RESEARCH Initiate with BUY chenjunhua@cicc.com.cn Shuwei CHEN shuwei.chen@cicc.com.cn Beijing Originwater Technology (300070.SH) Outstanding Technology & Business Model 2010A 500 60 236 61 209 68 177 65 1.20 24 36.9 2.2 6 0.2 2011E 929 86 426 81 368 76 313 77 0.97 (20) 45.9 4.5 10 0.3 2012E 1,470 58 707 66 608 65 519 66 1.61 66 27.7 4.0 14 0.7 2013E 2,301 57 1,105 56 946 56 809 56 2.50 56 17.8 3.4 19 1.1 Financial highlights (Rmb mn) Revenue (+/- %) Gross Profit (+/- %) Operation Profit (+/- %) Net Profit (+/- %) EPS(Rmb) (+/- %) PE(X) PB(X) ROE (%) Dividend Yield(%) 2008A 221 7 92 7 81 8 75 6 0.68 6 65.3 22.3 34 0.3 2009A 314 42 146 59 124 53 107 43 0.97 43 45.6 15.2 33 0.1 Investment highlights With membrane bioreactor (MBR) technology, Beijing Originwater Technology achieves fast cross-regional expansion by creating joint ventures with local state-owned enterprises, a means of ensuring stable MBR sales in the medium-/long-term and riding on the steady growth of local sewage treatment markets. The company’s technological advantage matches the 12th FYP sewage treatment development strategy. 1) Urban sewage treatment regulations to be raised from Standard II to Standard IB, meaning 40% of waste water should be recycled in north China cities with water shortages; 2) MBR can produce better water quality than traditional technology, matching 12th FYP sewage treatment...
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