Sepsis Made Simple: NCLEX® Key Points + Memory Tricks

Sepsis is one of the trickier topics to learn about in nursing school, but you will be tested on it a lot in your nursing school exam, so we gotta know it. So in this video I'm gonna walk you through the must know key points for sepsis that you have to know, including the key critical thinking points so that you can pass your exams. I also have some fun memory tricks to help you remember all of these things faster and easier. So, so hit that subscribe button and click the notification bell and let's dive in. All right, so you know me and you know how I love to make nursing content super duper simple for you. So that is why I always really recommend, like highly recommend, starting with the pathophysiology first. Because once you know and understand what is actually happening inside the body with any disorder, then everything else, like the signs and symptoms, the, the nursing assessment, the nursing interventions, it's going to make it so much more easier to learn, going to make a whole lot more sense. We're going to cover a lot of ground in this video. So be sure to download my free sepsis cheat sheet where I have all this info laid out for you. So that way you have it and you can use it while you study. So the link to that is down below in the description for you to check that out. Now I've broken this process of sepsis down into seven steps for you to follow to make it a little easier for you. Now you won't see these steps, steps anywhere else. They're not in a textbook or anything. I just made them up for you to make learning this a whole lot simpler. I know pathophysiology can be really difficult to learn about in nursing school and I really, really think that having simple steps to follow for patho, it just makes it way easier to learn. So here with sepsis, it all starts with a pathogen. It could be something like bacteria, a virus or a fungus which is invading the body. Now I like to call these the bad guy pathogens. These are the bad guys. The bad guy pathogens, they enter at a specific site like the lungs or the urinary tract, and they sometimes can even make it into the bloodstream. This is called bacteremia. When this happens, the body puts out an alert, it signals the immune system, which is basically saying, hello, we've been invaded by all these bad guy pathogens. Now here's step number two. The immune system is going to go full force on these bad guys, on these bad guy pathogens to try to get rid of them. So it's going to send off the whole army of white blood cells to go take care of them. Now, these white blood cells, they have weapons, and these are called inflammatory mediators and cytokines, specifically interleukins, tumor necrosis factor, and interferons and histamine. Now, I know those are big words, but just think of them as the white blood cells, chemical weapons here. So the white blood cells, they are going to release these weapons into the blood. And here's where things get kind of messy. These weapons cause three major things to happen. And I have a memory trick for you to hopefully help out with this. VLC vasodilation. So the blood vessels get wider, and then leaky capillaries, the tiny blood vessels start leaking FL and then clotting, the blood starts forming clots everywhere. Now, this is step number three of sepsis, and it's a huge nclex point for you, okay? So remember VLC vasodilation, leaky capillaries and clotting. Now here's the biggest problem, and this is step number four of sepsis. Because of all of that vasodilation and the leaky capillaries and the clotting, the organs are not getting the blood that they need to function. So let's think about it. If the blood vessels are super wide and dilated, which is that vasodilation, the blood pressure is going to drop. And if the capillaries are leaking fluid all over the place, they're losing that blood volume in the vasculature. And if the blood is clotting, it can't flow to where it needs to get to. So the organs are literally going to be starving for oxygen and the nutrients that they need to function. The blood just can't get there. Now, this is the central problem of sepsis and its poor tissue perfusion really is the big problem. So here's your key critical thinking point. When the organs don't get the blood they need, they can't function. And then they start to die. Now, because the organs aren't getting the oxygen and the nutrients, the body cells, they have to switch from their normal way of making energy, which uses oxygen, to their backup method that doesn't use oxygen. But here's the problem. This backup method, it produces lactic acid as a waste product. So step number five here in sepsis is metabolic acidosis. The blood becomes acidic because all of this lactic acid build up and carbon dioxide and other waste products. And remember, the kidneys would normally help to balance all of this out by Making bicarbonate, and that's a base. But here in sepsis, the kidneys as well, they're not getting enough blood either, so they can't help. Now here's a memory trick. When cells can't get oxygen, they lactic acid and that makes the blood lack the right PH balance. So think lack for lack tick. It's lacking oxygen. Now, septic shock is step six, and this is one that nursing exams love to test you on specifically. So septic shock is sepsis, but it takes it one big step further. In septic shock, the patient's blood pressure, it is so low. And vasopressors are needed to help keep their mean arterial pressure or their map above 65. Plus, the serum lactate level is higher than 2 millimoles per liter, even though the patient is still receiving IV fluids. So that's the standard. Now here's your key NCLEX point. We do what's called a fluid challenge or fluid resuscitation. So that means 30ml of fluid per kg of the patient's body weight. If we give them all of that fluid and their blood pressure, it still is not improving and they need need those strong medications, those vasopressors to help keep their blood pressure up. Then that patient is in septic shock. Now the final step is step seven and it's called mods, Multiple Organ Dysfunction Syndrome. So this happens when two or more of the patient's organs have now completely failed. So in this case, sepsis has continued. The organs haven't gotten the blood that they need, the oxygen or the nutrients that they for so long of a time that they just stopped working. So MODS is defined as the failure of two or more organ systems and at this point the risk of that patient dying is really, really high. And remember, I put all of this inside my free sepsis cheat sheet that I have for you. The link is down below in the description for you to snag that. I know this is a lot of info for you, so I wanted to make it easier by putting it all there for you in that cheat sheet. Now let's talk about signs and symptoms that you might see in a patient with sepsis and more importantly, why you would see them. So understanding the why behind it. This is the important critical thinking piece, my friend, and it makes it so much easier to remember the signs and symptoms and recognize these on your exams because you'll be able to better critically think about it. Now, I have a great memory trick for the main signs and symptoms of sepsis for you. So think shirt, sepsis shirt, S H I R T. So let's walk through each one of these. And just a side note, let me know in the comments if mnemonics are helpful for you in nursing school. I really want to give you more of them if they're helpful. And I'd love to get your feedback on which ones you love, which ones are better than others. Let me know in the comments. So here's the shirt mnemonic for you. Think sepsis shirt. So we've got a speedy heart rate or tachycardia, as the patient's blood pressure decreases and the organs become starved for blood, right? The heart, it tries to compensate by pumping faster to help improve circulation. So the heart is basically saying, hey, if I can't pump harder, I'll pump faster. And then hot and cold, fever and chills. The body's really, really trying to fight this infection. And so it raises the core body temperature, just like how exercise can heat up your body. But here's the key point. You get chills because the body's surface temperature around surface temperature hasn't caught up to that new higher internal temperature yet. So that causes those chills and then increased breathing. So this is tachypnea. Okay, Remember, blood carries oxygen, right? So when the organs, if they're not getting enough oxygen, enough oxygen, rich blood, then the lungs try to compensate by breathing faster to get more oxygen into the body. So the lungs are like, hey, maybe if I work overtime, I can fix this. They're really trying their best. And then reduced blood pressure or hypotension. So this happens because of our vlc, right, from earlier, that vasodilation, the leaky capillaries, which causes fluid to leave the blood vessels. And this causes that drop in blood volume and pressure. And then thinking problems are altered mental status. So the brain is so sensitive to oxygen deprivation and changes. So when blood flow to the brain is reduced, the patient can become confused, disoriented, or hard to wake up. This is actually one of the earliest signs of sepsis. Now, there are some other important signs too. You'll watch for decreased urine output where the kidneys are among the first organs really to lack blood flow during sepsis. So normal urine output should be at least 30 mils per hour. That's your standard. Anything less is a red flag. So that's a big NCLEX point for you. 30 mils, that's the cutoff. And then clammy skin or poor capillary refill. The skin might feel cool and clammy. And when you press on a fingernail and let go, it'll take longer than about two to three seconds for that capillary refill for the blood to come back again. So that shows poor circulation. Now, there are several lab tests as well that are crucial for sepsis. These are definitely, definitely things you're going to see on the NCLEX and your nursing school exams. So you can remember these with the memory trick. Can't live without blood pressure. Dude, I really, really like this one. So blood cultures, these must be drawn before giving antibiotics. You want to catch the bad guys right before you start the treatment. This is a huge critical thinking point for you. Okay? Draw cultures first before we start treatment. Now, a lactate level. So remember that lactic acid that we talked about a little bit earlier? A lactate level of 2 millimoles per liter or higher. That tells us if the organs aren't getting enough oxygen. Okay? So a higher lactate is. That means worse tissue perfusion for the patient. And then white blood cell count, you'd expect this to be high, right? So normal is between 4 to 10,000. But here's a tricky NCLEX point for you. Sometimes it's actually low in sepsis, which actually means it's a worse sign because it means that the body is so overwhelmed that it can't even make enough of those white blood cells. And then we've got BUN and creatinine. These go up when the kidneys aren't well because of that poor blood flow. And then P, this is for procalcitonin and platelets and coagulation times. So procalcitonin or pct, this is like a smoke detector for bacterial infection. So it goes up specifically when there's a serious bacterial infection happening, which helps us to know that we need to start antibiotics right away. And then platelets and those coagulation times. So with all of those used up platelets and the clotting factors, so you'll see those low platelets and the longer clotting times because of that. So a normal platelet value is between about 150,000 to 450,000. And then a D dimer, this is like a clot breakdown detector is what you can think of it as. When the body is forming and breaking down lots of little blood clots, that D dimer, it's going to go up. So normal is less than 0.5 milligrams per liter. But in sepsis, it's often significantly elevated. So here's your key Critical thinking point, when there's a high D dimer, that tells us that there's widespread clotting happening around the body. There's clots forming and tiny blood vessels and then breaking down, which is exactly what's happening here in sepsis. Now, the treatment for sepsis needs to happen quickly. There's something called the hour one bundle. Now, this comes from the surviving sepsis campaign. This is a huge NCLEX topic, my friend. You need to do these things within the first hour. This is the standard, okay, fluid resuscitation, then labs, like cultures and lactate, antibiotics and vasopressors if needed. You can remember this with the mnemonic flavor, because sepsis interventions need to have some flavor to them, right, in order for them to be effective. So flavor stands for this, F for fluids, L for labs, A for antibiotics, V is for vasopressors, O is for outcome monitoring, and R is for reassess and revise. So think flavor, okay? These interventions, remember, need to have some flavor to save your patient's life. Now, if you remember from our pathophysiology that we talked about earlier, sepsis causes massive vasodilation, right? Capillary leak and blood clotting. So all of our nursing interventions, they're designed to counteract these problems that are happening. So F is for fluids, and this is your first intervention here for sepsis. We rapidly give that 30 milliliters per kilogram of IV fluids, typically normal saline. Now, here's your critical thinking point for this. Sepsis causes that massive vasodilation right in that capillary leak. So all of that fluid, it's leaking out of the blood vessels, and it's like it's trying to fill up that bucket that has holes in it. So we need to pour more and more fluids to try to keep that bucket full. But big nclex point for you here. This is called a fluid resuscitation, which is 30 milliliters per kilogram of body weight, and it's given rapidly to try to overcome that. And then L is for labs, lactate level and blood cultures are drawn immediately. Now, here's the rule. And again, big NCLEX point for you. Always draw cultures before starting antibiotics. We talked about that a little earlier. If you give antibiotics first, it could kill the bacteria and make the cultures come back negative. But we want to know what it is, right? So remember, cultures first and then antibiotics. And A, of course, is for antibiotics. So we start with broad spectrum antibiotics as soon as possible after those labs are drawn. So again, Key critical thinking point for you here. We want to start with those broad spectrum antibiotics because we don't know yet what specific bug bacteria is causing this infection yet. So the goal is to get these antibiotics started within one hour of recognizing sepsis. And V is for vasopressors like norepinephrine. And we use these if the blood pressure stays low despite those fluids. So a key critical thinking point for you here is that sepsis causes that massive vasodilation. So all those blood vessels, they're wide open, right? So vasopressors, what they're going to do is squeeze those vessels to increase that pressure. It's almost like putting your thumb over a garden hose, right? We want to maintain their mean arterial pressure. That map of at least 65. Now, O is for outcome monitoring. So watch for a rising map, improving urine output and that decreasing lactate level. Now, key critical thinking point for you here. The kidneys, they're like the canary in the coal mine. So good urine output means good kidney perfusion, which usually means that the other organs are getting blood flow too. So urine output is really good to assess. And then R is for reassess and revise sepsis care. It's going to be changing constantly, reassessing and adjusting. So once the cultures come back, we want to narrow down to specific antibiotics. If we can also think about controlling other things, like finding and fixing where the infection started, like draining an abscess that they might have or removing an infected catheter, we want to try to find the source. So remember that flavor fluids, labs before antibiotics, antibiotics within an hour, vasopressors if that's needed for their map of 65, and then outcome monitoring and reassess constantly. So remember, these sepsis interventions, they need to have some flavor to them to be effective. And like I said before, definitely let me know in the comments if these mnemonics are helpful for you. I want to know which one was the most helpful, which one you really liked, and which ones maybe you could do and live without. Now, for your nursing assessment, let's think of head to toe. And remember that you're looking for those signs of poor perfusion. So neurological. We're looking for any change in mental status. This is one of the earliest signs of sepsis. If the patient's confused, are they agitated, are they hard to wake up? And then cardiovascular signs. Check that blood pressure. We're looking for a systolic less than 100 or a map less than 65. Those are concerning. Watch their heart rate and their capillary refill time. And then respiratory, look for that tachypnea, that fast breathing, use of accessory muscles and low oxygen saturation. And then the renal system, we want to monitor their urine output closely. So anything less than 0.5 milliliters per kilogram per hour for more than two hours, that's oliguria. Now, skin, look for potential infection sources. We're looking for things like wounds, IV sites, catheters. Also, check modeling. So that is patchy, purplish skin color that shows really poor circulation. Now, a huge complication of sepsis. This is called dic, and this stands for disseminated intravascular coagulation. And man, oh, man, is this a. A big one. Big one that nursing exams and the NCLEX love to test you on. So click on this video here, and I'm going to walk you through everything that you need to know about DIC to pass your exams in nursing school. And hit that subscribe button and click the notification bell so you never miss a video. And as always, my friend, go become the nurse that God created only you to be. And I'll see you over there in that next video.