Septic Shock: Causes and Treatments

Septic Shock: Causes and Treatments Jessica Jensen North Mohave Community College Nursing 222 Monika V. Wise, RN, BSN, MS Septic Shock It knows no boundaries. It is not biased or racist, and it is a killer. It will affect any age or gender. It is cunning, quick to manifest itself, and life-threatening, it is septic shock. Sepsis is a crafty syndrome that most people may not even realize they have until a family member realizes they are acting different and takes them to the emergency department. First it starts with an infection, then early sepsis, which if not treated it turns into septic shock. Sepsis is defined by the Surviving Sepsis Campaign as a life-threatening organ dysfunction caused by a dysregulated host response to infection (Society of Critical Care Medicine, 2017, p. 489). Septic shock is defined as a subset of sepsis with circulatory and cellular/metabolic dysfunction associated with a higher risk of mortality (Society of Critical Care Medicine, 2017, p. 489).Sepsis and septic shock are major health problems around the world, killing millions of people each year. It is estimated that one in four people die from sepsis each year (Society of Critical Care Medicine, 2017, p. 489). Septic shock starts from an infection, the invading bacteria go untreated and invade the bodys tissues. This invasion provokes an inflammatory response that activates inflammatory mediators, such as tumor necrosis factor and interleukins, and biochemical mediators like cytokines. These inflammatory mediators impair the microvasculature, which results in increased capillary permeability and vasodilation (Hinkle Cheever, 2014, p. 302; Wagner Hardin-Pierce, 2014, p. 866). The increased capillary permeability and vasodilation interrupt the bodys ability to provide adequate oxygenation and perfusion to the tissues and cells (Hinkle Cheever, 2014, p. 302). When the proinflammatory and anti-inflammatory mediators (cytokines, interleukins, etc.) are released it activates the coagulation system, and clots begin to form regardless of bleeding being present (Hinkle Cheever, 2014, p. 302). These cascades of clotting and inflammation are critical elements of the progression of sepsis. The clinical manifestations of sepsis are the patient has a temperature of more than 38 degree Celsius or less than 36 degree Celsius, heart rate greater than 90 beats per minute, respiratory rate greater than 20 breaths per minute, and a white blood cell count greater than 12,000 mL or less than 4,000 mL, or an immature (band) forms greater than 10%, and an infection is confirmed (Wagner Hardin-Pierce, 2014, table 36-8). Severe sepsis is associated with organ dysfunction, hypotension, and hypoperfusion. Along with the previous symptoms lactic acidosis, oliguria, or acute alteration in mental status are evident (Wagner Hardin-Pierce, 2014, table 36-8). Septic shock is associated with hypotension despite fluid resuscitation, and the other manifestations already mentioned (Wagner Hardin-Pierce, 2014, table 36-8). As sepsis worsens the patients extremities will be cold and mottling may be present, lactate levels rise, and ScvO2 decreases (Wagner Hardin-Pierce, 2014, p. 867). It is important for hospitals to have a protocol in place to recognize and treat sepsis. The Surviving Sepsis Campaign has suggested that all hospitals have a sepsis screening for critically ill and high risk patients. It is recommended that blood cultures be obtained immediately before antibiotic therapy is started, and antibiotics should be administer one hour after the diagnosis of sepsis is made (Society of Critical Care Medicine, 2017, p. 494). An empiric broad spectrum antibiotic with one or more antimicrobial is usually chosen, to cover all likely pathogens, until the invading pathogen is identified. When the pathogen is identified the patient is switched to an antibiotic that is more effective for the pathogen found (Society of Critical Care Medicine, 2017, p. 494-495). A lactate level should also be drawn because it is an indicator of tissue oxygenation and a high level is closely associated with shock (Wagner Hardin-Pierce, 2014, p. 268). Fluid resuscitation should begin w ithin the first three hours and 30 mL/kg IV crystalloid fluids should be given (Society of Critical Care Medicine, 2017, p. 491). If the patient is in severe sepsis heading toward septic shock vasoactive drugs are recommended to increase the patients hemodynamic status. Norepinephrine is the recommended first-line drug for sepsis, and low-dose dopamine should be used to for renal protection. If the patient is not responding to vasopressors and fluids, IV corticosteroids can be used at a dose of 200 mg per day (Society of Critical Care Medicine, 2017, p. 504-506). Tight glucose control should be maintained. It is recommended that glucose levels should be under 180 mg/dL (Society of Critical Care Medicine, 2017, p. 514). If the patient is ventilated they should be sedated and given analgesic medication (Society of Critical Care Medicine, 2017, p. 513.) Venous thromboembolism prophylaxis should be initiated to prevent blood clots. It is recommended that a low molecular weight heparin be used along with sequential compression devices (mechanical prophylaxis). A proton pump inhibitor or histamine-2 receptor antagoni st should be used to prevent stress ulcers if there is a high risk for gastrointestinal bleeding (Society of Critical Care Medicine, 2017, p. 516-518). Nutritional therapy should be initiated twenty-four to forty-eight hours after admission to address the hypermetabolic state (Hinkle Cheever, 2014, p.304). Enteral nutrition is recommended route of administration (Society of Critical Care Medicine, 2017, p. 518). It is also very important to communicate with the patient and family. Septic shock can be fatal. If the patient is in multiple organ dysfunction syndrome, and the patient is refractory to treatment, end-of-life care should be discussed with the family. Treatment is aggressive and it could take time for the patient to get better. Keeping the family updated and educated in the process assist with the patients outcome. Sepsis is no laughing matter. It takes lives. That is why it is essential to know what the signs of sepsis are, and once the patient is diagnosed, strict measures of treatment need to be enforced. It is also important to know the hospitals sepsis policy. Immediate action will assist in a more positive outcome for the patient. References Hinkle, J. L., Cheever, K. H. (2014). Shock and multiple organ dysfunction syndrome. In Brunner Studdarths Textbook of Medical-Surgical Nursing (13th ed.) (pp. 285-309). Philadelphia, PA: Wolters Kluwer Health Lippincott Williams Wilkins. Society of Critical Care Medicine. (2017). Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Critical Care Medicine, 45(3), pp. 486-552. http://dx.doi.org/10.1097/CCM.0000000000002255 Wagner, K.D., Hardin-Pierce, M.G. (2014). Shock states. In High-Acuity Nursing (6 ed.) (pp. 850-874). Boston, MA: Pearson.

Serotonin & Depression :: Biology Essays Research Papers

Serotonin & Depression In the brainstem, the most primitive part of the brain, lie clusters of serotonin neurons. The nerve fiber terminals of the serotonergic neurons extend all throughout the central nervous system from the cerebral cortex to the spinal cord. This neurotransmitter is responsible for controlling fundamental physiological aspects of the body. In the central nervous system (CNS), serotonin has widespread and often profound implications, including a role in sleep, appetite, memory, learning, temperature regulation, mood, sexual behavior, cardiovascular function, muscle contraction, and endocrine regulation. Not only does this bioamine control physiological aspects of the body, but it also has an involvement in behaviors like eating, sleeping and aggression. Serotonin has been noted to produce an inhibitory effect on the nervous system that calms, soothes and generates feelings of general contentment and satiation. Not surprisingly, serotonin is implicated in a broad range of serotonin disorders like depression, schizophrenia, and Parkinson's disease (3).. Serotonin deficiencies have been one of the factors to blame for ailments such as anorexia, bulimia, obsessive compulsive disorders, migraines, social phobias and schizophrenia. (9). (12). I am not taking a stance that serotonin has its hand in all of these different pots, but after the research that I have completed for this paper, I feel comfortable talking about serotonin in reference to depression. No one can say for certain what exactly "causes" depression. But in this paper, I hope to give further insight into serotonin's specific role as a possible predeterminant for major depression and some hopes for those suffering from this illness. Approximately 5% of the United States' population experiences a depressive episode that requires psychopharmacological treatment; in any one year, 10-12 million Americans are affected by depression, with the condition twice as common in females than in males. It has been estimated that 15% of patients hospitalized for depression will commit suicide. These figures are incredible, so finding the root of the problem when it comes to depression is extremely important. "Alterations in serotonin metabolism may be an important factor in the etiology and treatment of depression." (7). Although historically depression has been considered a character condition, evidence has accumulated suggesting the role of a biological substrate, namely serotonin, in subgroups of depressed patients. This accumulated evidence supports the indoleamine hypothesis of depression, which suggests that major depression results from a deficiency of available serotonin or inefficient serotonin. (16). We see that depletions of serotonin from certain regions of the brain such as the hypothalamus, amygdala, and cortical areas involved in cognition and other high processes, can have a great impact in contributing to depression.

Executive Summary for Non Profit Essay

The Chinmaya Organization for Rural Development (CORD) was established in 1985 in Himachal Pradesh, India. CORD started its work by providing Rural Primary Health Care to the surrounding under developed villages in the area. However whilst engaging closely with the rural communities CORD soon realized that critical healthcare issues were inextricably intertwined with the harsh reality of rural India’s poverty, illiteracy, and gender discrimination, all of which hinted at the formidable walls of social and economic disparities to be overcome. The CORD program soon recharged and reshaped its approach to be more holistic and as a result, an integrated rural development model emerged which was successful and could be replicated with local modifications. Our mission at CORD is to facilitate integrated, sustainable social help programs in local communities and in the Indian subcontinent through processes of self-empowerment and enrichment. CORD programs and services have been designed based on dynamic and vibrant interactions with thousands of villagers. CORD’s strength and success has been due to its coalition with villagers, where there is cooperative effort to organize, build, and find relevant solutions to personal, familial, and communal concerns. The services provided by CORD are: Holistic Programs, Services and Course Modules Local Self Governance Community-Based Livelihood with access to micro credit through Self Help Groups, User Groups, and Activity Groups Health, Nutrition, Hygiene, and Sanitation Rehabilitation and Management of Persons with Disabilities Natural Resource Management Social Justice, Legal Assistance, and Gender Sensitization Program Community driven initiatives to change issues like gender discrimination, caste discrimination, female feticide, HIV-AIDS, adult literacy, optimal utilization of services, schemes, and infrastructure provided by the government, Outreach Rural Program to treat alcohol through â€Å"Sinclair Method† CORD has an urgent need for upgraded facilities to meet the increasing demand for trained workers to live and serve in rural India. CORD is seeking a total of $1.4 million for a New CORD Training Centre located in Sidhbari, Himachal Pradesh, India. The New CORD Training Centre will be an experiential learning institute where people will come to understand how to serve at the grassroots level of rural development and to implement projects in the developing world. Currently, the CORD Training Centre, which is being rented in Sidhbari, is not sufficient to meet CORD’s demand for on-site experiential learning. CORD has purchased 3,744 square meters of land near the existing CORD Training Centre in Sidhbari. The proposed New CORD Training Centre includes a multi-purpose hall, a presentation & exhibition hall, kitchen & dormitory building and a twin-sharing hostel. The aim is to have the Training Centre ready for use by 2017. Combining the New CORD Training Centre with its 28 years of rural development experiential learning, CORD has the opportunity to share its innovative approach to integrated participatory rural development for practitioners around the world. The New CORD Training Centre will allow CORD to leverage its role as a leading centre of experiential learning by expanding the number and type of participants and scope of programs offered. It will also enable CORD to develop and deliver a substantially broader and deeper set of rural development trainings to significantly greater numbers of participants than the current training outcomes. Academic training alone does not prepare development workers to face the breadth of challenges that they will encounter in the villages. This training offers advance advantage to trainees due to its emphasis on experiential learning. With the enhanced capabilities of the New CORD Training Centre, CORD will expand its mission of development in rural India as follows: Benefits of the New Training Centre Provide development practitioners and students with field-based practical tools and approaches to implement new and enhanced rural development projects worldwide. Serve as a technical resource and contribute to the base of knowledge on integrated, participatory approaches of rural development, particularly addressing gender inequality and women’s empowerment. Advocate for continued resources and focus on integrated, rural development issues in India. Provide accommodation and meeting space to meet increasing demand for additional trainings for those interested in rural development. Expand trainings to NGO, university, government, and corporate functionaries interested in rural development within India and the world. Over the past 28 years, CORD has worked to empower people through development rather than through welfare interventions. CORD has helped over 500,000 poor and marginalized Indians transform their own lives through programs driven by them. Through CORD’s high-impact, sustainable programs, over 1,000 villages in four Indian states are on the path of integrated transformation. CORD has trained over 33,000 functionaries from the government, non-profit, and banking sectors, as well as community leaders, to promote self-help groups and access to micro-credit. These trainings involved participants from throughout India and were conducted in collaboration with the National Bank of Agriculture and Rural Development (â€Å"NABARD)† and different departments of the Indian government. CORD is led by an inspiring and inspired team of individual and at the helm we have Dr Kshma Metre – National Director for CORD. Dr. Kshma Metre, a pediatrician by profession has dedicated her life to CORD. Her development work began in 1985 in Sidhbari, Himachal Pradesh with mother and child health services. Soon, with input and feedback from the community, forward and backward linkages were built based on their needs. The participatory development model which emerged as a result, empowered the community to be self respecting and self reliant. Dr. Kshma Metre has won numerous awards and recognitions for her contributions to rural development and women empowerment. CORD believes that empowerment is the key to change and development. Resources donated to the New CORD Training Centre will provide a premier facility for which CORD will be able to advance its mission of facilitating integrated and sustainable development in rural. The total cost of implementation for the training center is $1.4 million. Your investment of $50,000 will build towards the funding to fully implement this path breaking project, and we are excited about the prospect of partnering with you. Through your philanthropic donation you will not only be able to form a connection with and but empower those in need by making them self-reliant. Thank you for your consideration of our request.

Manager as a Change Agent - 956 Words

MANAGER IS A CHANGE AGENT The label â€Å"change agent† is often accompanied by misunderstanding, cynicism and stereotyping. Managers, employees and HR professionals alike have questioned the value of this role in their organization. However, as organizations of all kinds face unrelenting changes in their environment, the need for individuals who are capable of turning strategy into reality has created a new legitimacy for the change agent role – which is often located within the Human Resource function. There are several reasons for this trend: †¢ Human resource professionals have made significant strides over the past decade in becoming business partners; demonstrating the value they can add to the business †¢ Executives are†¦show more content†¦5) Solve Problems – Recommending solutions is not the same as solving problems. When it comes to the change agent role, the problems encountered are often loaded with emotional and political dynamics. The change agent must possess the insight to recognize the problem, the sensitivity to see its importance to those involved, the courage to take honest and often difficult measures to resolve it and the credibility to be heard. 6) Implement Plans to Achieve Change Goals – Successful organizational change on any significant scale can be attributed to the right strategy and appropriate change in organization culture. 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