Septic Shock: Symptoms, Nursing Interventions and Priority of Care

This assignment analyzes a case study of a deteriorating patient with septic shock. It discusses symptoms of deterioration, priority area of care, and nursing interventions such as use of sterile technique, fluid challenge, IV antibiotics, and reducing hyperthermia. The paper emphasizes the importance of infection control to reduce the risk of septic shock.

Running head: SEPTIC SHOCK
SEPTIC SHOCK
Name of the student:
Name of the University:
Author note:

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Introduction:
The purpose of the assignment is to analyze a case study of a deteriorating patient. In this
regards the case of a patient with septic shock has been chosen for the assignment. Septic shock
is occurred due to the result of any infection within a person. It causes significant changes in the
body and leads to the consequence of life-threatening situation and even death as well (Angus et
al., 2015). There are three stages of sepsis or septic shock such as bloodstream infection and
inflammation, severe sepsis that affects the function of brain, lungs, kidney and heart and septic
shock due to significantly low blood pressure that leads to the consequence of heart and
respiratory failure and even death (Asfar et al., 2014). This infection arise when chemicals
released by the immune system to fight infection leak into the blood stream (Garay-Fernández,
2017) .The symptoms include low blood pressure, increased breathing rate and increased
temperature. The increase in temperature is due to stimulation of the thermostat in hypothalamus
while the low blood pressure is due to widened blood vessels when chemicals cause dilation
(Vassiliou, Orfanos, & Kotanidou, 2017). The increased heart rate is due to increased work rate
of the heart. There is also difficulty in breathing due to blood vessels leaking in the lungs.
According to the statistics, 12% of the world population die annually due to sepsis (Kaukonen et
al., 2014). Thus it is important to understand the pathophysiology in order to introduce adequate
treatment to manage the illness.
Case study:
The chosen case study for the assignment is about a indigenous male, Jedda Merinah
aged 33 years. He has been hospitalized in the Hematlogy/Oncology department due to the
emergency call for hypotension by the oncology day unit. To manage his acute myeloid

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leukemia he was receiving chemotherapy in the oncology unit. His health history has indicated
that he has been given chemotherapy for induction phase and reported about nil temperature and
blood culture has shown nil growth. In addition he has suffered from acute rheumatic fever in
childhood, however, no structural abnormalities were found except mild dilation of the left
ventricle. Depression and hypercholesteromia and has tried to attempt suicide as well. On
assessment increase heart rate, respiratory rate, low blood pressure, reduction in food intake due
to mouth ulcer, loose bowel action, reduction in urinary output and high temperature have been
found. Blood test has been done which has indicated lack of Hb and platelets and increase in
creatinine and urea. Center venous catheter line has been inserted by the senior register of ED.
Such situations have led to the deteriorating condition.
Purpose:
The following paper will discuss about the symptoms of deterioration and will provide
effective nursing interventions in order to improve the health condition off the patient in an
effective manner. In this regards the paper will provide one area of priority for clinical care and
introduce three relevant nursing interventions in order to manage the health condition of the
patient and help him to recover faster.
Signs and symptoms of deterioration:
As mentioned in the case study the two major symptoms or reason for the deteriorating
condition of the patient are high temperature that is 38.8 degree Celsius and low blood pressure
such as 92/65 mmHg. According to study high temperature such as 101 degree Fahrenheit or 38
degree Celsius is one of the early sign of septic shock and it should not be ignored (Coopersmith
et al., 2018). Thus, it can be said that such increase in the body temperature is one of the most

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important signs of deterioration in health condition of the patient. On the other hand low blood
pressure is another sign. It has been found that low blood pressure affect the cardiovascular
function in an effective manner. For example, due to low blood pressure less oxygen is able to
reach to the vital organs thus, heart needs to work harder in order to compensate and the heart
rate elevated significantly as found in the patient (Heart rate 118/min) (Lee, 2014). In addition
low blood pressure leads to the leakage of fluid from the blood vessel in the lungs that
accumulates and creates difficulties in breathing, which leads to the increase in the respiratory
rate (Leone et al., 2015). Due to such situation the respiratory rate of the patient elevated to 28
breaths/min. Furthermore, low blood pressure could lead to the consequence of hypovolemia as
well. The significant drop in the blood pressure could lead to shock state as it could cause blood
loss by 30% in individual that could lead to the consequence of hypovolemic shock (Chappell et
al., 2014). Thus, it can be said that such symptoms have contributed to the deteriorating
condition of the patient and need proper treatment to improve the health condition of the patient
in an effective manner.
Priority area of care:
The patient has been assessed with ABCD assessment method which has indicated
increase in heart rate, respiratory rate, low blood pressure and poor fluid intake. The central
venous catheter has been inserted by the senior register in the emergency department. With the
signs of high body temperature, low blood pressure that could cause hypovolemia the insertion
of catheter could lead to the consequence of infection. As found in the blood pathology the
decrease in the Hb and plasma has indicated the lack of blood volume and consequence of
hypovolemic shock. Increase in the creatinine and urea have led to the diagnosis that there is a
high chance that severe infection might have occurred. Such infection could increase the risk of

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septic shock in an effective manner (Garay-Fernández, 2017). Thus it is important to provide
adequate focus in infection control in order to reduce the risk of septic shock in an effective
manner.
Nursing interventions:
Use of sterile technique, keep patient in the isolation room, use of PPE:
In case of sepsis the infection is not restricted to a specific portion rather that it affects the
function of whole body, such as function of kidney, lungs, heart and brain as well (Angus et al.,
2015). Thus, it is important to use aseptic techniques in order to control the infection. Dressing
and medication need to be provided accurately (Berend et al., 2013). Personal protective
equipment such as gloves, mask, gown, eye protection and respiratory protection need to be used
by the nurse to avoid transmission of the infection (Tran & Major, 2015). As the infection could
be transmitted through air thus it is important to keep the patient in the isolation room to ensure
the safety of other patients (Berend et al., 2013). Study has indicated that using such aseptic
techniques help to control infection in an effective manner and reduce the risk of transmission of
infection (Lo et al., 2014).
SMART goal to evaluate the intervention:
Specific (S): Use of sterile technique, keep patient in the
isolation room, use of PPE.
Measurable (M): Blood test.
Attainable (A): Sterile technique such as dressing, use of
proper personal protection equipment and

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keep the patient in isolation room could be
done.
Relevant (R): It could help to control the infection and its
transmission to health staffs and other
patients.
Time (T): 72 hours.
A fluid challenge, use of IV and antibiotic:
In order to control infection and correct the hypovolemic state it is important to provide
the fluid challenge. In this regards, it is important to administer initial fluid challenge 30ml/Kg
crystalloid solution rapidly (Schnell et al., 2013). However, the patient has been given 250ml
NaCl 0.9% fluid challenge which is effective for improving the condition of the patient. The
fluid could be administered intravenously. Study has indicated fluid challenge could help to
elevate the BP and blood volume as well, thus could help to reduce the risk of hypovolemia
(Marik & Lemson, 2014). In addition, effective intravenous antibiotics could be provided to
control the infection. For example, ceftriaxone, azithromycin and ciprofloxacin could be
administered (Seymour et al., 2017).
SMART goal to evaluate the intervention:
Specific (S): Fluid challenge and using IV antibiotics.
Measurable (M): BP, electrolytes imbalance.
Attainable (A): 30ml/Kg crystalloid solution, IV antibiotics
such as ceftriaxone, azithromycin and

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ciprofloxacin could be provided.
Relevant (R): It would help to elevate BP, increase blood
volume, thus could reduce the risk of
hypovolemia. The antibiotics could help to
control the infection.
Time (T): 72 hours.
Reduce hyperthermia:
Another important nursing intervention is reducing hyperthermia in this case. In this
regards it is important to monitor the temperature of the patient in every four hours. The nurses
could provide antipyretics to control the temperature (Drewry et al., 2013). The nurse should also
provide tepid sponge baths and avoid the use of alcohol .Studies have shown that use of tepid
sponges considerably reduce fever. Alcohol on the other hand may lead to chills leading to
increased temperature and dehydration of the skin. The nurse should also provide cooling
blankets or cooling therapy to control the hyperthermia (Luehr et al., 2013).
SMART goal to evaluate the intervention:
Specific (S): Reduce hyperthermia.
Measurable (M): Body temperature.
Attainable (A): Tepid sponge bath, cooling blanket and
cooling therapy, antipyretics and proper
monitoring could be done.
Relevant (R): It could help to reduce the body temperature

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and maintain the normal temperature.
Time (T): 72 hours.
Conclusion:
From the above discussion it can be said that, the patient Jedda Merinah has been found
to be suffering from the symptoms such as high body temperature, low blood pressure, high heart
rate and respiratory rate, lack of HB and platelets and reduction in blood volume, increase in
creatinine reduction in fluid intake and urea level and decrease in urination. The symptoms have
indicated that severe infection might have occurred and there is a high risk of septic shock
induced by such infection. Thus, infection control has been identified as the priority of care. It is
expected that effective nursing interventions such as use of sterile technique, keep patient in the
isolation room, use of PPE, fluid challenge, IV antibiotics and reducing hyperthermia could help
the patient to recover faster and avoid the risk of septic shock in an effective manner.

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