Septic Shock Paper
In this essay septic shock and Its complications will be analyzed wealth the Immunological, gastrointestinal, cardiovascular, respiratory and renal (Including the acid-base) systems. This essay will contain the general discussion of homeostasis and will study the homeostasis responses to septic shock In each system. Sepsis and Septic Shock sepsis may be defined as the state In which a person Is suffering from an Infection that causes a number of important physiological changes: namely high fever and pulse, elevated respiratory rate, and elevated white blood cell count.
Sepsis occurs when the body mounts a massive immune response to an infection. Usually the infection is caused by a bacteria that emits a toxin which causes the immune response. The problem is that the same chemicals that the body uses to fight the toxin also cause negative effects on the circulatory system, eventually leading to lowering of blood pressure and hypertension of the vital organs. This is illustrated well in our example with Mrs.. Little who shows the characteristic increase in pulse and fall in blood pressure.
This is causing hypertension of key organs, such as the rain and lungs, which is resulting in some of the symptoms of early septic shock such as shortness of breath and confusion. Septic shock is said to exist when the patient is unable to maintain blood pressure despite all resuscitation efforts and the hypertension is causing end organ damage. Unchecked, septic shock can cause numerous problems including multiple organ failure and respiratory failure (Health A-Z). Indeed, Mrs.. Little is in grave danger. In fact, septic shock is the most common cause of death in hospital critical care units.
In the United States septic shock counts for 100,000 deaths per year (Traitor & Grosbeaks). Ironically, hospital treatment itself may often be the cause of septic shock, as It is often seen In severely Ill patients with suppressed immune systems (for example cancer patients on chemotherapy) who contract an Infection while undergoing treatment. Homeostasis: The human body internal environment Is composed of cells, tissues, organs and other systems (Martini). External surroundings continuously affect the body Internal environment and the human body must use homeostasis control mechanisms to malting a stable environment.
The majority of Illnesses which affect homeostasis are mild and temporary (such as a mild or moderate fever however at times, when serious changes in the body occur, the alteration of homeostasis may become Intense and prolonged and in some instances may even fail and result in death. In order to prevent tons Trot unappealing positive Ana negative Teacake systems allow ten DOD condition to be repeatedly monitored, evaluated and changed (Traitor & Grosbeaks). Feedback systems include three basic components; a receptor, a control centre, and an effecter.
Receptors are an important part in feedback systems because they monitor changes within controlled conditions (blood pressure, body temperature, blood glucose level, etc. ). Any disruption in a controlled system (stimulus) then sends nerve impulses or chemical signals to the control centre. At the control centre the body recognizes the set values that the controlled conditions should be at and that processed information is then sent to the effecter in ways of nerve impulses, hormones or other chemical signals.
The effecter then responds to the information sent from the control system and any changes that need to be made to the controlled condition occur. When information is received by the control centre it can send an output to the effecter in one of two ways. It can either oppose the change in the controlled condition which displays a negative feedback loop or it can reinforce the change which occurs in a positive feedback loop (Traitor & Grosbeaks).
Negative feedback systems are involved in the majority of homeostasis control loops because they stabilize and reverse a change in a controlled condition which is usually what the body wants to achieve in homeostasis (Patten). When a receptor detects a change in a controlled condition it sends an input to the control centre. In a negative feedback system the control centre will recognize the problem that has occurred and will alter the controlled condition back to its regular state.
Some examples of negative feedback systems include blood pressure and body temperature. The negative feedback system will regulate blood pressure and body temperature back to its normal state that it should be within the body. However in positive feedback the outcome is the opposite. Although both feedback systems work in the same way positive feedback systems strengthen and reinforce the problem rather then oppose he change (Traitor & Grosbeaks). Positive feedbacks are not as common in the body but they still play a very important role.
Unlike negative feedback systems that bring the body back to its normal state, positive feedback systems send output from the control center to the effecter that will enhance the change in the body. The action of the positive feedback system will continue until it is interrupted by some mechanism outside the system. Positive feedbacks become important in situations like child birth and blood clotting. In blood clotting platelets are enforced to rapidly stick together. Although this is usually abnormal, it is important that this occurs so that blood can clot and serious bleeding is avoided.
Another example of a positive feedback mechanism is child birth, where levels of the hormone extinction are increased by the brain in response to stimulation of the woman’s cervix by the baby. Extinction causes the smooth muscles of the uterus to contract more forcefully, further stimulating the cervix, causing more oxidation to be released, and so on until the baby is delivered In order to survive, every living organism must maintain homeostasis (Martini). To regulate changes that may occur to the body (Martini). When problems such as septic shock occur, proper homeostasis is crucial to survival.
However, in septic shock bacteria and toxins can have a big impact on the human body and if homeostasis can not be maintained and the problem is not caught early enough homeostasis can become seriously altered, and death can ensue. Immune System: Malignantly instantaneous requires ten correlated efforts AT many Day mechanisms and systems. One such system is the immune system, which is designed to ward off millions of disruptive pathogens that may assault our bodies such as bacteria, virus and parasites. The immune system works closely with the lymphatic system in the body fight against infection.
The lymphatic system is responsible for three major primary functions; transporting dietary fluid, draining excess interstitial fluid, and carrying out immune responses (Traitor & Grosbeaks, 2003). The lymphatic system is a network of lymphatic vessels transporting fluid called lymph and also contains many structures and organs containing lymphatic tissue. Lymphatic vessels transport lipids and lipid-soluble vitamins (A,D,E and K) to the blood that are absorbed by the gastrointestinal tract (Traitor & Grosbeaks, 2003).
The lymphatic vessels within this system also drain excess interstitial fluid from tissue spaces and then return it to the blood. The lymphatic capillaries are unique because they permit interstitial fluid to flow into the capillary but not out. The Interstitial fluid enters the capillaries when the pressure of the interstitial fluid is greater then in the lymph. When this occurs the cells slightly separate allowing the interstitial fluid to enter into the lymphatic capillary. However, if the pressure is high in the lymphatic capillaries the cells adhere more closely and the lymph cannot escape back into the interstitial lid.
In the case where there is excess lymphatic fluid cells open more widely so that it is able to flow into the lymphatic capillary. This overload of fluid will result in tissue swelling (Traitor & Grosbeaks, 2003). The third main function of the immune system is to carry out immune responses. The blood circulating in our body contains three classes of lymphocytes including T cells, B cells, and natural killer cells. T cells destroy foreign cells directly and stimulate or inhibit the activities of other lymphocytes.
B cells differentiate into plasma cells and secrete antibodies that rotate us from disease by attacking foreign cells and natural killer cells attack a wide variety of infectious microbes (Martini). Just as these cells destroy foreign cells, two main phagocytes called interruption and macrophages ingest bacteria and dispose of dead matter through a process called phagocytes. Phagocytes is the process in which foreign agents are ingested and destroyed (Traitor & Grosbeaks, 2003). An adequate immune system promptly recruits interruption, macrophages, lymphocytes, and antibodies to the site of infection to prevent host colonization.
Through histograms these cells neutralize and eliminate microbes and their toxins. However, if these host defenses are overpowered by pathogens septic shock may follow (Cancer nursing). As the process of septic shock advances, it becomes increasingly difficult for the body to maintain homeostasis. The immune system becomes overwhelmed as it frantically attempts to prevent the spread of infection and toxin to other tissues. Moreover, the bacterial toxins hamper the body immune system response. We see in our example how Mrs.. Littlest blood work indicates an elevated white blood cell count, with increased interruption.
This is indicative off significant bacterial infection and subsequent inflammatory and immune response (Traitor and Grosbeaks, 2003). Mrs.. Little is displaying systemic inflammation as her body is trying to restore homeostasis by disposing of toxins and foreign material to prevent their spread to other tissues. When this occurs there is movement of phagocytes from the blood into the interstitial fluid and the normal homeostasis mechanism AT railing Interstitial Toll Ana restoring It to near circulating volume cannot be achieved.
Her blood pressure naturally falls as her circulating volume is depleted. This results in tissue hypertension and further inflammation. Gastrointestinal system: Nutrients are needed to achieve homeostasis by building new body tissues, repairing damaged tissues and to gain chemical energy needed for our body to function. In order to attain these nutrients the gastrointestinal system breaks down consumed food into molecules through digestion.
In order for digestion to take place the digestive system has six basic processes including ingestion, secretion, mixing and propulsion, digestion, absorption and defecation (Traitor & Grosbeaks, 2003). These six major functions take place throughout the gastrointestinal tract of the human body. Through the gastrointestinal tract foods are broken down and then the majority of nutrients from these foods are absorbed through the mucosa of the intestinal villa. These nutrients are then passed into the blood or lymph and circulate to cells throughout the body (Married).
Since the gastrointestinal system contributes to homeostasis by absorbing water, minerals, and vitamins needed for growth and function of body tissues and eliminates wastes from body tissues in feces there are many blood vessels that allow nutrients to be delivered and wastes to be expelled (Torah & Grosbeaks, 2003). In order to carry out all of these functions, the human digestive system must have an extensive blood supply. Thus, in septic shock, and the subsequent drop in blood pressure that ensues, the digestive organs suffer considerable hypertension (cancer nursing and Medicine plus).
Because the gastrointestinal system is highly vascular it is more sensitive to the decrease in blood pressure and blood flow and in result there is a decrease in gastrointestinal mobility, and more ominously there can be actual tissue necrosis as portions of the bowel become chemic and die (cancer nursing). Mrs.. Littlest X-ray indicates that she has free air under her diaphragm which almost certainly is a result of this process as her bowels are likely leaking air as they deteriorate from the lack of blood supply.
As well as providing nutrients and expelling wastes to maintain homeostasis the gastrointestinal system actually contributes to homeostasis in the respiratory system. The pressure of the abdominal organs within the abdominal cavity actually exerts a pressure against the diaphragm, which helps expel air quickly during a forced exhalation. Any serious injury to the abdominal organs, such as an chemic one, causes less motility in the bowels and even the leakage of air which can both directly affect their ability to support the diaphragm in respiration (Traitor & Grosbeaks, 2003).
In our example, Mrs.. Little is experiencing abdominal pain which is likely on the basis of hypertension of her gut with subsequent schemas. There may even be direct infection of her bowels and other abdominal organs, causing inflammation and pain. Cardiovascular system: The cardiovascular system consists of three main components responsible for many homeostasis mechanisms in the body. These three components include blood, the heart, and blood vessels. Blood is responsible for transporting substances, regulating processes throughout the body and protecting against disease.
The heart then pumps the blood to the body through blood vessels where the blood then exchanges materials needed for the human body regular function (Traitor). Is composed AT two mall types AT cells, wanly assaults ten allover AT materials useful to the body. These two cells include white blood cells and red blood cells. White blood cells (leukocytes) are the main cells of the body that destroy pathogens and any foreign substances entering the body. Among white blood cells, interruption exposed most quickly to bacterial infection.
Interruption normally make up 55%-70% of white blood cells while in a complete blood count the normal amount of white blood cells in the blood is 4. 8-10. Xx per liter (traitor). In situations of extreme stress however, such as in a severe bacterial infection, the body releases very immature white blood cells called band cells (named because of their band or horse- shoe shaped nucleus). These band cells will increase the overall number of white blood cells and help to fight the infection. Red Blood cells (erythrocytes), unlike white blood cells, are shaped like biconcave CICS and are highly specialized for oxygen transport.
Hemoglobin, which is a major component of red blood cells and serves to assist in the carrying of oxygen, gives erythrocytes their characteristic red color. Hemoglobin is crucial for homeostasis because in order for the body to maintain its regular state hemoglobin must deliver enough oxygen to other parts of the body for proper function. Hemoglobin arises from red bone marrow Just as platelets do. Platelets are also essential to the body because they protect the body by clotting blood after injury so that bleeding stops quickly in a controlled manner (Traitor).
Erythrocytes, leukocytes and platelets are all very important to the body but in order for them to reach their targets the heart must pump them through two closed circuits: the systemic circulation and the pulmonary circulation. Pulmonary circulation moves degenerated blood from the right ventricle to the lungs and returns oxygenated blood from the lungs to the left atrium, while the systemic circulation transports oxygenated blood from the left ventricle through the aorta to all organs of the body and then delivers the degenerated blood back to the right atrium of the heart (traitor).
In order to pump blood through these circuits there must be a difference of pressure so that blood can flow from regions of high pressure to regions of lower pressure. This force of pressure which is exerted by blood against the walls of the heart is known as blood pressure. Blood pressure is influenced by the elasticity in the vessel walls. The more dilated the vessels are the lower the blood pressure will be (Traitor). The normal blood pressure of a middle-aged adult is 120/might and if it is dramatically decreased or increased blood flow will be disrupted throughout the body (fundamentals).
Along with blood pressure, heart rate assists in pumping the blood through the body. The regular heart rate is anywhere from 60 -beats/min. The amount of blood expelled by the heart with each contraction is known as the stroke volume and the amount of blood pumped by the heart in one minute is called the cardiac output. Stroke volume and cardiac output are both directly affected by one’s heart rate. In the short term, lowering one’s heart rate will lead too drop in blood pressure, while raising it causes blood pressure to increase. In this respect, heart rate is another important homeostasis mechanism (Traitor). In Mrs..
Littlest case, a major disruption of homeostasis within the cardiovascular system has taken place. Shock is a critical medical condition caused by a sudden drop in blood pressure. Septic shock occurs when antitoxins are released from certain bacteria Into ten D stream. I nose toxins Interact Walt our Immune system to cause vacillation and a subsequent drop in blood pressure (Webster). In Mrs.. Littlest case her blood pressure has dropped significantly to 80/might as a result of sepsis. As well, in an effort to maintain homeostasis, her pulse rate has increased to a tachycardia of 120 in an attempt to raise her blood pressure (fundamentals).
As hypertension and tissue hypertension continue, the effect on the body organ systems (like we saw with the digestive system) can be profound. We see in our example that Mrs.. Little is confused, has clammy and cold skin and is mildly hypothermia with a body temperature of 35 degrees Celsius. All of these findings can be explained by tissue hypertension secondary to hypertension caused by sepsis. She is confused because her brain is being hypertrophied and is not getting the oxygen it needs to maintain a normal level of consciousness.
Her skin as well is hypertrophied, looking mottled and feeling cool to the touch. Her fall in body imperative is likely secondary to skin hypertension, but also to a breakdown in the homeostasis mechanisms in the brain that regulate temperature (cancer nursing). Mrs.. Little is also experiencing some of the characteristic abnormalities seen in the blood as a result of septic shock. While sepsis normally causes an elevation, at least originally, in white blood cell count, often this leukocytes changes to a leukemia, or relative lack of white blood cells, as the disease progresses.
Sometimes this interruption is a pre-existing condition, such as with some chemotherapy patients or people with immune deficiency conditions. In other cases the interruption develops as the sepsis worsens and the white cells are used up inn an effort to fight the infection. In any event, interruption is regarded as a serious problem in sepsis since it means that the immune system’s ability to fight off the offending pathogen has been overwhelmed. Whereas a normal white blood count is 4. 8-10. Xx per liter Mrs.. Littlest white blood count in our example is 2. , a significant interruption with 70% interruption and 20% bands(Traitor). While the elevated band count does indicate an attempt to fight the infection, because there is a decrease in the white load cells there are still not enough interruption to destroy the pathogens. We also see in Mrs.. Littlest blood that her platelet and hemoglobin levels are falling. This is also a common finding in advanced sepsis and is caused by a variety of factors. To begin with, the hypertension and schemas at the tissue level causes a lot of leaking of fluids from the blood vessels and organs.
Platelets are used up in an effort to “plug” the vascular leaks, and hemoglobin is lost as the blood leaks out. As well, the general hypertension directly affects the bone marrow, as do the bacterial toxins. Since platelets and hemoglobin are produced in the marrow, they cannot be replaced at a fast enough rate (Midlines). It is not hard to imagine the significant effect this lack of hemoglobin especially will have on homeostasis as the body systems, already struggling with hypertension secondary to low blood pressure, now have to survive without adequate hemoglobin supplies and thus inadequate oxygenation.
Respiratory system: Blood contains many gases that are transported between the lungs and body cells in the cardiovascular system whereas the respiratory is responsible for the exchange of gases, oxygen (02) and carbon dioxide (CA). Gas exchange within our body is very important and occurs in three basic steps: pulmonary ventilation, external respiration, Ana Internal respiration (littoral). Pulmonary ventilation occurs when we inhale and exhale air into the lungs. The air which we inhale is then involved in gas exchange in external respiration.
In this process there is an exchange of gases between the spaces in the lungs and the blood in pulmonary capillaries where blood gains 02 and loses CA. After the blood gains 02 through the pulmonary capillaries oxygen is delivered to the tissue cells through the systemic blood in internal respiration. The blood then loses its 02 and gains the CA that is not needed by the body. 02 is a necessity and is used in the body through metabolic reactions where TAP is produced for energy for the body and CA is released. CA may produce an acidic environment toxic to the cells and so it is eliminated right away when oxygen is delivered (Traitor).
In order for the blood to deliver oxygen and pick up carbon dioxide it must circulate through the pulmonary circuits as we inhale and exhale. In exhalation as well as inhalation elevation and depression of the diaphragm allows the thoracic cavity to expand during inhalation hen 02 is inhaled into the lungs and contract in exhalation when CA is expelled (Traitor). Abdominal cavities in the GIG tract assist in respiration because it supports the diaphragm so in instances where there are problems in the GIG tract such as in septic shock it may affect breathing if the abdominal cavity can no longer support the diaphragm.
Respiration is controlled by respiratory centers that are regulated by nerve impulses being carried to respiratory muscles. This is so rhythm can be modified when certain chemical stimuli measure how quickly and how deeply we breathe (Traitor). Sensory neurons that are responsive to these chemicals stimuli are competitors which monitor CA, H, and 02 levels to ensure they remain constant and respond if they don’t (Traitor). If we are not getting enough oxygen to the body or carbon dioxide out of the body these receptors react by either increasing our breathing or decreasing our breathing to stabilize it.
The respiratory system is very important in homeostasis to make sure the body is getting the proper amount of gases needed. However, since Mrs.. Little is suffering from septic shock her Apace levels and Papa levels within her arteries are greatly affected. Since septic shock causes hypertension an increased heart rate results. Due to Mrs.. Littlest increased heart rate it is causing an abnormal deficiency in the concentration of 02 in the arterial blood which is also known as hyperemia (Webster). Hyperemia is evident in Mrs.. Littlest 02 sat which are 89% opposed too regular 100% (fundamentals).
In her case her Papa levels have become might from her regular McHugh and she is in desperate need for oxygen (traitor). In order for her body to receive the amount of oxygen necessary homeostasis mechanisms cause her to hyperventilate (increased reheating) causing an excessive intake of 02 while eliminating CA. Since CA is being eliminated from her body her Apace levels have also decreased from might to might. Mrs.. Littlest hyperventilation becomes necessary for survival and due to her hyperventilating her respiratory rate is increasing a large amount to breaths/ min from a regular adult respiration rate of 12-breaths/min (Traitor).
Hypertension and heart rate have a big impact on Mrs.. Littlest oxygen rates however if there is a fluid build up that develops in the lungs it also inhibits the passage of oxygen from the air into the blood stream. Through Mrs.. Littlest breath sounds few crackles have been heard which shows that she has a liquid build up in her lungs also Known as pulmonary edema. Pulmonary edema can result Trot septic smock due to the increased permeability of the pulmonary capillaries. In septic shock toxins and bacteria are trying to leave the blood through interstitial fluid.
Since there are so many toxins and bacteria causing inflammation there is an increase of interstitial fluid which the lymphatic system can not handle. In result the liquid seeps through the pulmonary capillaries which become more permeable due to the toxins and seep onto the lungs (Merck Manual). This fluid in the lungs can become crucial resulting in adult respiratory distress syndrome which is a life-threatening condition. Renal System including acid-base: Acid-base balance within the body is one of the most crucial elements of the homeostasis mechanisms because it regulates pH levels of the body, which is necessary for survival.
One main organ of the body that helps maintain pH is the kidneys which are a part of the urinary system. The urinary system consists of two kidneys, two Reuters, one urinary bladder, and one urethra (Traitor & Grosbeaks, 2003). The kidneys contribute greatly to the regulation of blood pH which is a (Traitor). The pH of the body indicates the acidity of a solution according to the number of hydrogen ions. The greater amount of hydrogen within a body the more acidic state it is in (below 7. 35) and as the hydrogen count lowers the more basic the solution becomes (above 7. 45) (figure pig. 873 Patton).
However, through homeostasis mechanisms the level of pH within our body tries to stay at a stable state between acidic and basic between 7. 35 and 7. 45. These homeostasis mechanisms participating in the regulation of pH include buffer systems, exhalation of carbon oxide and kidney excretion of H+. The buffer systems bind excessive hydrogen ions and prevent acidity within the body (Traitor). If the pH in the body is low and acidic extra hydrogen ions are secreted from the blood into the urine and eliminated from the body. However if the blood pH is to high less amounts of hydrogen ions are excreted through the urine (Patton).
As well as hydrogen ions regulating pH HECK also does this by acting as a weak base. With a regular pH of 7. 4 HECK concentration is about meek/liter however Mrs.. Little only has 14. Therefore her pH may be more acidic because her decrease in HECK will not allow any excess basic ions to help regulate the PH. As well as maintaining pH within the body the kidneys are also responsible for regulating blood volume and blood pressure, maintaining blood similarity, producing hormones, regulating blood glucose levels and excreting wastes and foreign substances.
Regulating blood volume is very important in homeostasis because adjusting the blood volume in the body also causes a change in blood pressure. The kidneys are able to adjust blood volume by releasing particular amounts of rennin or by conserving or eliminating water in the urine. Therefore if the load volume is to low the kidneys will conserve water to help increase the blood volume as well as the blood pressure which occurs in septic shock (Traitor). Mrs..
Little who is experiencing septic shock is facing the side affects of decreased urinary output because of the result of low blood pressure that occurs in this disorder (medicine). Since blood pressure is so low in the human body during septic shock the kidneys within the renal system conserve liquid to increase the blood volume which in turn will increase blood pressure trying to achieve homeostasis. In result, the kidneys conserve as much liquid as possible causing Mrs.. Little to nave no water to excrete tongue ruler. Mrs..
Little Is also experiencing a slight decrease in her pH level at 7. 15. This is caused in relation to her decrease in urine output. Through homeostasis extra hydrogen ions which cause a decrease in pH are usually eliminated from the body through the urine. However, since Mrs.. Little has no urine output because she is trying to conserve her blood volume as well blood pressure hydrogen ions can not be excreted resulting in her lowered pH (Patton). PH regulation is very important and in result she will be given treatment in order to help he body try and reach a regular homeostasis state.
It is very important that she receives treatment immediately because kidney failure may occur which will only decrease urinary output even further (Merck). Conclusion: In conclusion, when external environments affect the body Just as bacteria affects the human body in septic shock homeostasis mechanisms become crucial for ones survival. Through positive and negative feedback systems homeostasis mechanisms must regulate conditions throughout the immunological, gastrointestinal, cardiovascular, respiratory, and renal and acid-base system.