Assessment of Septic Shock

Septic Shock. Mr. Jedda Merindah, a 33-year-old indigenous male has been admitted to hospital post a medical emergency call for hypotension. Mr. Merindah has currently undergone chemotherapy for Acute Myeloid Leukemia, he routinely self-monitors his temperature and has advised that has not had any high readings recently. On assessment Mr. Merindah has a GCS of 15, Heart rate of 118 beats per minute and an ECG reveals atrial fibrillation. This essay will critically detail two signs and symptoms of Mr. Merindah’s deteriorating condition using assessment data to support the findings. The clinical assessment data identified will highlight a direct link to the pathophysiology associated with Mr. Merindah’s current state of septic shock. A clinical plan of care will be developed including one priority of clinical care and identification of three nursing interventions that will directly address the clinical priority. Contemporary research evidence will be used to further support the clinical priority, nursing interventions, goals, and points of evaluation.  ‘Rationale’

Signs of Deterioration

Mr. Jedda Merindah has signs and symptoms of a deteriorating health condition. The Glasgow Coma Scale of 15 is worrying. Glasgow Coma Scale is an indication of Merindahs level of consciousness following a traumatic brain injury. Merindahs brain seems damaged and needs further attention. The patients might have suffered a severe brain injury and has not sought medical care in time to have the condition checked and treated. Glasgow Coma Scale is a reliable and objective means of measuring Merindah`s consciousness before and after a brain injury. Before arriving at the GCS score of 15, the following tests must have been done on him; eye-opening analysis, verbal response, and motor response. A Glasgow Coma Scale reading of 15 indicates a mild brain injury. The brain a sensitive and essential organ which should not be affected in any way to allow other body organs to function better. A mild brain injury could lead to temporary or permanent neurological dysfunction. Further tests such as neuroimaging tests and computerized tomography scans or magnetic resonance imaging should be done to establish the extent of the brain damage and have the issue sorted out as soon as possible.

The heart rate of 118 beats per minute is another sign of a deteriorating health condition. Merindah pulse rate can be described as being faster than usual that is hazardous (Moreno, Cacione, & Baptista-Silva, 2015). A heartbeat of more than one hundred beats per minute should be investigated, and corrective action is taken. Typically, for a healthy person, the accepted rate of pulse per minute should be between sixty to seventy pulses per minute. Merindah`s faster than normal heartbeat condition is called sinus tachycardia. An elevated heart rate of pulse can be associated with medical issues such as anemia, an underlying infection, increased thyroid hormone or a reaction to medication. Other medical conditions that result in an increased rate of heartbeat include the atrial fibrillation. Atrial fibrillation increases the likelihood of a patient suffering from stroke and heart damage.

Hypotension

Hypotension can be described as a condition of low blood pressure beyond normal. Hypotension can cause unsteadiness and victims to pass out (Imam, Pang, & Keena, 2018). Hypotension can lead to death if not checked. Issues such as dehydration and surgical disorders among many others can cause hypotension. Common symptoms of hypotension include dizziness, syncope, blurred vision, nausea, fatigue and lack of concentration.

Septic shock can also result from extreme levels of low blood pressure. Common symptoms of shock caused by low blood pressure include confusion mostly occurring in older people (Hallqvist, Martensson , Granath , Sahlen , & Bell, 2016). Another common sign is cold, clammy, pale skin due to lack of nourishment of the skin cells. Rapid shallow breathing is another symptom of septic shock due to low blood pressure. Lastly, weak and rapid pulses also indicate shock.

Various conditions have been established to cause low blood pressure that leads to septic shock. The situation includes pregnancy due to the expansion of the blood circulatory system making blood pressure to drop (Imam, Pang, & Keena, 2018). Heart and endocrine problems also lead to a fall in blood pressure that can be fatal. Dehydration, blood loss, septicemia, anaphylaxis and lack of appropriate nutrients in the diet can also lead to a fall in blood pressure (Corwin & Scarfone , 2018). There also exist medications that can cause low blood pressure leading to septic shock (Carrick, et al., 2016). These medications include water pills such as furosemide, alpha blockers like prazosin, beta blockers like atenolol among many others (Cimen, et al., 2015).

Although hypotension can occur to anyone, three risks factors can increase one chance of suffering from the disease. The risk factors are age, medications and a specific condition (Aslan, Randall, Krassioukov, Phillips, & Oyechkin, 2016). People aged above sixty-five years have high chances of contracting septic shock due to hypotension compared to those below the same age. People taking certain drugs also stand a high probability of suffering from the ailment (Moreno, Cacione, & Baptista-Silva, 2015). Lastly, illnesses such as the Parkinson`s disease, diabetes, and heart complications increase the risk of developing hypotension (Ong & Vera, 2016).

Respiratory Rate

Respiratory rate is the number of breaths per minute. For an adult, the rate of respiratory can be between twelve to twenty breaths per minute. Various conditions affect a person’s degree of respiration (Carrick, et al., 2016). Common factors that alter the average respiratory rate include asthma, anxiety, pneumonia, congestive heart failure, lung disease and use of substances such as narcotics or taking overdose drugs (Ricci, De Caterina, & Fedorowski, 2015). The respiratory rate goes on to affect the level of blood pressure. Increased respiratory rate increases the rate of blood pressure while a decrease in the rate of respiratory lowers the blood pressure. Therefore, a respiratory rate that is below normal can lead to hypotension.

Clinical Priority Problem

The clinical priority problem for Mr. Merindah is inefficient tissue perfusion related to the progression of septic shock as evidenced by a blood pressure of 92/65mmHg, heart rate of 118 beats per minute, capillary refill time of < 3 seconds and cool peripheries. 

Nursing Interventions

Fluid Challenge

A fluid challenge is a small amount of intravenous fluid given within a short time. A fluid challenge is a diagnostics intervention designed to provide a sign of whether a patient with hemodynamic compromise will benefit from further fluid replacement (Aslan, Randall, Krassioukov, Phillips, & Oyechkin, 2016). As the fluid is, being administered to a patient a clinician can examine if the patient has a preload reserve that can be used to increase the stroke volume with the addition of more fluid.

Various reasons have made clinicians consider the fluid challenge. First, many health professionals find it a standard means of diagnosing fluid responsiveness. Secondly, the fluid challenge is used in the fluid management of patients in critical conditions (Corwin & Scarfone, 2018). Lastly, among the prevalent indications for the fluid challenge are hypotension and oliguria. Therefore, clinicians may administer a fluid challenge with the aim of simultaneously treating volume depletion while avoiding fluid overload (Hayreh, 2017). Furthermore, a fluid challenge may be used to differentiate hypovolemia from cardiac failure.

The nature of fluid to use in a fluid challenge depends on the clinical situation. Various clinical conditions use different fluids. For example where a balanced salt solution is required a crystalloid may be preferred (Hallqvist, Martensson, Granath, Sahlen, & Bell, 2016). Blood products may also be used in patients with massive haemorrhage. In cases of traumatic brain injury fluids such as albumin are not desired (Zhou, Liu, Yang, & Han, 2016). Fluids with starch are also avoided. Furthermore, fluids with excessive chlorine are also avoided due to their chemical properties and ability to react with body organs and cause more harm.

Isotopes

Isotopes are atoms with an equal number of protons by varying neurons hence a variation in their mass numbers. There exist two types of isotopes namely radioactive isotope and stable isotopes (Andrews, et al., 2017). Stable isotopes have a definite number and pattern of protons and neutrons hence static nuclei. It is impossible for stable isotopes to undergo radioactive decay. Stable isotopes do not pose severe hazards to living organism around them (Zhang, Zheng, Wei, & Lin, 2017). Radioactive isotopes in the other hand, undergo radioactive decay and in the process release harmful substances that can affect living organisms that is exposed to the rays. Stable isotopes such as isotopes of carbon, calcium, and vanadium are used to study various human disorders (Andrews, et al., 2017). Septic shock, which affects the brain, can be analyzed with stable isotopes, as they will not release harmful materials that affect brain cells.

Fluid Restriction – Initiation of Fluid Balance Chart

Fluid restriction is limiting the number of liquids taken into the body daily. Fluid restriction is desired where one body is holding water, hence becoming more than what the body requires. Fluid restriction leads to health complications such as damage to body tissues and blood vessels. Long-term swelling and undesired stress on the heart are some of the severe conditions resulting from fluid restriction.

A fluid restriction balance chart should be initiated whenever one feels the amount of body fluid is rising rapidly (Cimen, et al., 2015). For example, when one gains two pounds per day, and the skin become tight and shiny should be sufficient evidence to seek medical care to end fluid restriction.

There are various clinical interventions for fluid balance. Avoiding foods with high sodium content is one way of limiting the amount of body fluid (Bhateja, Saxe, Jacobson, & Jensen, 2018). Secondly, getting diuretic drugs that help the body remove unwanted fluid from the system (Zhou, Liu, Yang, & Han, 2016). A professional health provider should examine a person before recommending the type of fluid restriction mechanism to carry out.

References

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Aslan, S. C., Randall, D. C., Krassioukov, A. V., Phillips, A., & Ovechkin, A. V. (2016). Respiratory training improves blood pressure regulation in individuals with chronic spinal cord injury. Archives of physical medicine and rehabilitation, 97(6), 964-973.

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