is a syndrome characterized by clinical signs and symptoms of severe infection that may progress to septicemia
and septic shock.
implies the presence of an infection of the blood caused by rapidly multiplying
microorganisms or their toxins, which can result in profound physiological changes and systemic sepsis. The pathogens
can be bacteria, fungi, viruses, or rickettsiae. The most common causes of septicemia are Gram-negative bacteria (and
endotoxins), staphylococci, and
If the defense system of the body is not effective in controlling the invading
microorganisms, septic shock may result, characterized by altered hemodynamics, impaired cellular function, and
multiple system failure.
Patients at highest risk for bacteremia and septic shock include the elderly, infants, and immunosuppressed patients
with chronic diseases (e.g., diabetes); postoperative patients; and those with ventilators, invasive lines, and catheters.
Early signs and symptoms may be vague, and sepsis can develop subtly until sudden, overwhelming septic shock is
present, affecting multiple organ systems.
Although severely ill patients may require admission to an intensive care unit (ICU), this plan addresses care on an
inpatient acute medical-surgical unit.
Chronic obstructive pulmonary disease (COPD) and asthma
Fluid and electrolyte imbalances
Metabolic acidosis (primary base bicarbonate deficiency)
Psychosocial aspects of care
Pulmonary tuberculosis (TB)
Renal Failure: Acute
Total nutritional support: parenteral/enteral feeding
Ventilatory assistance (mechanical)
Patient Assessment Database
Data depend on the type, location, duration of the infective process and organ involvement.
Mental status changes, e.g., withdrawn, lethargic
Respiration/heart rate increased with activity
Blood pressure (BP) normal/slightly low-normal range (as long as cardiac output remains
elevated); profound hypotension (late stage)
Peripheral pulses bounding, rapid (hyperdynamic phase); weak/thready/easily obliterated,
extreme tachycardia (shock)
Heart sounds: Dysrhythmias and development of S
suggest myocardial dysfunction,
effects of acidosis/electrolyte imbalance
Skin warm, dry, flushed (vasodilation); or pale, cold, clammy, mottled (vasoconstriction)
Urinary output decreased, concentrated; progressing to oliguria, anuria
Urine cloudy, malodorous