Page 436 - Critical Care Nursing Demystified

Chapter 9 CARE OF THE PATIENT WITH CRITICAL HEMATOLOGIC NEEDS 421

NURSING ALERT

Seventy percent of all septic shock is caused by Escherichia coli, Klebsiella pneumo-
niae, Seratia, Enterobacter, and Pseudomonas. Culturing the patient’s secretions
and wound sites are important before starting on antibiotics.

Hallmark Signs and Symptoms
Warm Shock
Increased temperature above 38°C (100.4°F) and below 36°C (96.8°F) from
endotoxin release
Tachycardia

Full and bounding pulses
High cardiac output and decreased SVR
Change in the level of consciousness (LOC)
Tachypnea and hypopnea
Decreased urinary output less than 30 mL/hr

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Decreased temperature below 36°C (96.8°F)

Hypotension
Increased SVR, decreased CO; decreased PAOP
Worsening of LOC
Crackles and gurgles
Mottling of extremities
Cyanosis

Decreased or absent urinary output

NURSING ALERT

All may not be well if the patient is warm. In the early stage of septic shock, the pa-
tient maybe hyperthermic.

Treatment

Identify patients at risk, which includes immunocompromised patients and
those with antibiotic resistance.