Sepsis Pathophysiology (In 7 Simple Steps!) | Must-Know Key Points For The NCLEX®

Hey there, my friend. My name is Christina Rafano from nursingsos.com and in this video today we're walking through the pathophysiology of sepsis. I'm going to break it down for you in seven simple steps so you can understand it and remember it for your exams. And of course, I have a free sepsis cheat sheet for you too. So be sure to stay till the end of the video and I will let you know where you can snag that. Now hit that subscribe button and click the notification bell and let's dive in. I've broken down the process of sepsis into seven steps for you to follow to make it a little easier for you. Now, you won't see these steps in a textbook or anything. I just made them up for you to help make learning all of this easier. Pathophysiology can be a really difficult concept to learn about in nursing school, as you know. And I really think that having simple steps to follow it just makes it way, way easier. And if you like nursing school information broken down step by step for you, let me know in the comments below by commenting with the word love. That's what we do around here. I need to if you want more videos like this, if you like it this way. So if you do comment below the word love, that would be so helpful for me. So thanks for that, my friend. So sepsis can occur after the body has been invaded by a pathogen, like a bacteria, virus, a fungi or something like that. I like to call these the bad guys. So these are the bad guy pathogens. And when the bad guy pathogens enter the bloodstream, the body puts out an alert to the immune system to tell the immune system that it's been invaded by the these pathogens. And this is step number one of sepsis, where the bad guy pathogens enter the blood and the body puts out an alert to the immune system that it's been invaded. And now step number two, the immune system is going to go full force on these bad guy pathogens to try to get rid of them. So it's going to send the whole army of white blood cells to go and take care of them. Now, these white blood cells have weapons called inflammatory mediators and cytokines, namely interleukins, tumor necrosis factor, interferons and histamine. So the white blood cells will release these weapons into the blood, which leads to step number three of sepsis. These weapons the white blood cells released cause three things to happen. It triggers the blood vessels to dilate. This is called vasodilation. It triggers the small blood capillaries to actually kind of separate and leak out blood and fluid, which is called capillary leak, and it causes the blood to clot. Now, this vasodil dilation and the capillary leak, it causes the blood pressure to drop and it causes swelling in the body because more fluid is now leaking into the tissues from all that capillary leak. So there is less blood going to the body's organs, and it needs to be going to. Because that blood is now leaking out into the surrounding tissues instead. And because the blood is now clotting. Right? Remember that third thing that the white blood cell weapons do is cause the blood to clot, right? That blood can't get to the organs that it needs to get to, which of course decreases blood supply to those organs as well. So here's the biggest problem, and this is step number four of sepsis. The organs are not getting the blood that they need to function. And this is because of those inflammatory mediators, remember weapons the white blood cells release, right? These inflammatory mediators, they cause that vasodilation, that capillary leak, and the blood clotting. So as sepsis continues, the organs aren't getting the blood that they need to function, and therefore the organs don't have the oxygen that they need. So the organs start to die and they start to fail. On top of all this, because the body is not getting that oxygen that it needs to function, Metabolic acidosis can occur, which is step number five of sepsis. It's a complication, is metabolic acidosis. Now, metabolic acidosis, it means that the ph of the blood is too low now, meaning that it's acidic. So the blood is acidic. This can happen during sepsis because the organs aren't functioning like they should, and they can't get rid of all the carbon dioxide, the lactic acid, and the waste products that build up in the body over time. And all of those waste products are acids. So the more waste there is, the more acidic that blood will be. Plus, now, the kidneys usually make bicarbonate, which is a base, and that usually helps to balance out that pH. But in sepsis, the kidneys aren't getting enough blood here either, so they can't function well and make enough of that bicarbonate to help balance out that ph. So the blood becomes more and more acid acidic, and this can be really bad if it's not fixed. So the brain, the kidneys, the heart, the lungs, the liver, all the other organs, they're not getting enough blood to function because there is just so much of that vasodilation, that capillary leak and that blood clotting, and the blood is now becoming more and more acidic, which can lead to metabolic acidosis. Now, step number six is septic shock. And this is one thing that nursing exams love to test you on. Specifically, septic septic shock is sepsis, but it takes it one step further. In septic shock, sepsis is occurring, but it's not responding to treatment with fluid. So if we catch a patient with sepsis, give them enough fluids, that would usually help them to get better, and then their blood pressure does not improve, then that is considered septic shock. So for sepsis, we do what is called a fluid resuscitation. Now, this means that they get 30 milliliters of fluid per kilogram of their body weight. We want to try to get that blood pressure stable so they don't go into septic shock. So if they have sepsis and their blood pressure is not getting better with that fluid resuscitation and they need stronger medications to keep their blood pressure up, then they are considered to be in septic shock. Now, kind of the last stage of sepsis, this is step number seven, is called Multiple Organ Dysfunction syndrome, or MODS for short. Mods. This happens when two or more of the patient's organs have now failed. So in this case, sepsis has continued. The organs haven't gotten the blood and the oxygen and the nutrients that they need to function, so they've stopped working. They're super unhappy and they've stopped working. So Multiple Organ Dysfunction syndrome, or mods, it happens when two or more of the patient's organs have stopped functioning. Now, I know that was a lot of information that I just threw at you, so let's walk through some NCLEX practice questions to really help it all come together for you and sink in. And be sure to print off that free sepsis cheat sheet that I have for you so that you can remember all of this information and these steps, whether you're at clinical or you're studying for your lecture class, you're at skills lab or anywhere. So I'll put the link to that in the description below this video for you to snag it. So let's dive into some practice questions for sepsis. Question number one. A nurse is taking care of a patient with sepsis. The nurse understands that the primary reason for fluid resuscitation in early sepsis is to counteract which of the following pathophysiological effects A increased cardiac contractility leading to increased oxygen demand, B peripheral vasoconstriction causing decreased tissue perfusion, C widespread vasodilation and capillary leak resulting in relative hypovolemia or D activation of the coagulation cascade leading to disseminated intravascular coagulation or dic. Now, anytime we read an NCLEX style question, we want to make sure that we're picking out the key words in the that question. And here's a key word that is used here. It's primary. What's the primary reason for fluid resuscitation? And the correct answer here is C, widespread vasodilation and capillary leak resulting in that relative hypovolemia. Now, this is the correct answer because the inflammatory mediators that are released in sepsis, they cause that vasodilation, which decreases blood flow and the capillary leak, causing fluid to shift out of that intravascular compartment, then into that interstitial space into the tissues. Now, this leads to hypovolemia and a drop in blood pressure, which doing a fluid resuscitation will help to fix, hopefully. And sepsis can increase metabolic demand, but the immediate drop in blood pressure is primarily due to that vast those vascular changes, not the increased cardiac contractility. So A is incorrect here. And then peripheral vasoconstriction, it doesn't cause hypotension and early distributive shock like sepsis, vasodilation does. So answer B is also wrong. And then for answer D, while that coagulation cascade is activated in sepsis, that can lead to a risk of DIC or disseminated intravascular coagulation, the immediate intervention of fluid resuscitation, it's meant to fix the hypovolemia caused by vasodilation and capillary leak. So great job with that one, my friend. Remember, sepsis causes that vasodilation and the capillary leak. Now let's go through another one here. Question number two. A nurse is educating a patient's family about the progression of sepsis. The nurse explains that multiple organ dysfunction syndrome, or mods, is a critical stage characterized by A a single organ system exhibiting severe failure, B the failure of two or more organ systems due to sustained hypoperfusion, C a temporary increase in inflammatory markers followed by stabilization, or D a rapid and complete recovery following antibiotic administration. So let's walk through this. The correct answer here is B, right? The failure of two or more organ systems due to that sustained hypoperfusion, so the organs are not getting the blood they need to function. So two or more organ systems have now failed. So MODS happens when two or more of the organ systems have failed because there's a, that continued lack of blood and oxygen and nutrients to those organs, so they just can't function properly. Answer A is incorrect because MOD specifically involves the failure of multiple organization systems, not just one. It's multiple organ dysfunction syndrome. And while the inflammatory markers they can fluctuate, MODS indicates a worsening state of that organ failure, not stabilization. So that answer C is incorrect. And then answer D is incorrect because MODS is organ failure, not organ recovery. And now let's walk through the third question. A patient with sepsis is receiving broad spectrum antibiotics. The nurse understands that the primary goal of this intervention is A directly counteract the effects of inflammatory mediators, B prevent the development of metabolic acidosis, C increase the patient's circulating blood volume, or D eliminate the underlying pathogen. So here, what do you think it is in this question? The correct answer is D to eliminate the underlying pathogen. Now this is because sepsis is caused by by a pathogen in the body, right? So the main reason we're giving antibiotics as an intervention is to kill that pathogen. We want to kill what the underlying pathogen that's causing the sepsis to be. If we don't kill it, then we're not really solving the underlying problem. Now answer A is incorrect because antibiotics target the pathogen, not the inflammatory mediators directly and then preventing metabolic acidosis. That's definitely a goal of overall sepsis management because it improves perfusion and it helps the organs to function. But the antibiotics are used to kill the pathogen that's causing it. So answer B is incorrect. And then within answer C, increase the patient's circulating blood volume. That's the goal of fluid resuscitation, which is different than antibiotics. And my friend, if you struggle with answering NCLEX style questions like these, be sure to click on this video here where I walk you through the top strategies for choosing the most correct answer on your nursing school exams. So, so helpful. And if you like this step by step breakdown, step by step guide for nursing school. And if you want me to do more videos like this, I love it. Write love in the comments below because that is what we do around here, my friend. And make sure to hit that like button, share it with your friends. And of course click subscribe and hit that 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 will see you next time on the nursing school show.