Page 434 - Critical Care Nursing Demystified

Chapter 9 CARE OF THE PATIENT WITH CRITICAL HEMATOLOGIC NEEDS 419

septic shock. Vasoactive substances like histamine, tumor necrosis factor, and
interleukins increase vasodilatation by increasing capillary permeability. Overall
this decreases systemic vascular resistance (SVR), which is seen in a dropped
BP and CO.

Results of Septic Shock

Decrease blood flow
↓
Increase cellular hypoxia
↓
Anaerobic metabolism
↓
Increase in irreversible cell damage

To compensate for a decreased circulation in septic shock, the sympathetic
nervous system increases the release of native catecholamines like epinephrine.
Epinephrine increases the heart rate and vasoconstricts the blood vessels to try
to maintain circulation to core organs like the heart and brain. Blood is shunted Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
to the heart and brain controlling vital functions and is decreased to the kid-
neys. The kidneys sense a decrease in renal blood flow and stimulate the renin-
angiotension-aldosterone system (RAAS) to conserve much-needed sodium
and water and maintain intravascular volume.
Those at risk for septic shock include patients with:
Genitourinary (GU), biliary, or intestinal diseases
Immunosuppressant therapy or AIDS

Indwelling catheters left for extended periods of time (central lines, urinary
catheters)
Use of long-term antibiotics and steroids
Recent infection or surgery
In recent years, terminology regarding septic shock has tended to become
more confusing. The terminology used in septic shock and their definitions are
listed in Table 9–6.
Visit these web sites for more information on septic shock: http://sites.google.
com/site/nursing211fall09/wk-9-spinal-cord-injury-burn-injury-septic-shock/
211a-group-5, http://www.xigris.com/Pages/sepsis-continuum-animation.aspx
(last accessed July 28, 2010).