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Septic shock Introduction Septic shock is a life-threatening complication which results from sepsis which is due to an infection in the bloodstream. It is a serious medical condition which has a poor prognosis which has a high mortality rate among the patients it affects. The symptoms include labored breathing, low urine output, confusion dizziness, and change in skin color, (Gotts & Matthay, 2016). Nurses form an integral part in any hospital, they are the first health professionals patients come into contact with hence they need to be alert on some of the condition which may be life-threatening to the patient if they are not taken care of, (Angus & Van der Poll, 2013). As nurses, it is important to recognize early symptoms of septic shock because we are in a direct position to influence the treatment outcomes. The nurses are also in a position to directly impact sepsis-related morbidity and mortality. Early identification, treatment, and management of septic shock is the cornerstone of septic shock management, (Seymour & Rosengart, 2015). Objectives The main aim of this paper is to address the symptoms which are associated with septic shock and the symptoms which the patient presents with and the main nursing interventions which can be taken so as to save the life of the patient. According to ProCESS Investigators,(2014). There are several causes of septic shock and it is the duty of the nurses to recognize the underlying cause of septic shock and take the necessary step to prevent it from happening and progressing to a life-threatening situation, (ProCESS Investigators,2014). The patient in the case was brought into the hospital with symptoms of septic shock, the patient was presenting with atrial filtration, fast heart rate, low blood pressure and she was responsive when he was admitted. The patient later had a decreased respiratory collapse and there was not enough air entering the patient’s lung, he started being tachypnoeic and had difficulty breathing. She had decreased urinary output and dark urine which are a high indication that the patient was suffering from septic shock. On the examination of the blood results, it was noted that the patient had a low white blood cell count, the hemoglobin count and platelet was low compared to the main reference ranges. The patient also had a high INR value of 2.4 and APTT of 47 which indicated that the patient may be having DIC which may be affecting the patient. All the above symptoms of the patient are presenting with are indicative of the major symptoms of septic shock Etiology It is usually a result of bacteria or viruses which when present in the bloodstream result in bacteremia. This results in a myriad of conditions which are secondary to the infection that usually leads to the disruption of respiratory rate, heart rate, temperature and the reduction in the white blood cell count. Some of the symptoms in which the patient may be presenting with include, systemic vasodilation and hypotension, tachycardia, compromised nutrient flow to the organs resulting to organ damage and abnormal blood gas, (Ferrer et.al 2014). Presenting symptoms The main symptoms which the patient presented with which resulted in the nurses stating that the patient was suffering from septic shock were presenting with hypotension and tachycardia. These symptoms are one of the main landmarks in the assessment of a patient containing septic shock. The patient's non-invasive blood pressure was 92/65mmhg this indicated that the patient was hypotensive and it showed that cardiac contractility was compromised leading to hypotension. The ECG also showed that the patient had atrial fibrillation this could be contributing to the hypotension which the patient is experiencing. According to King, Bauzá, Mella & Remick, (2014). Hypotension can be presented as systemic vasodilation in which the blood vessels are vasodilated making it hard for the blood to flow to major organs and this may result in essential organ damage which may result in the patient death, (King, Bauzá, Mella & Remick, 2014). Mechanism of hypotension in septic shock Seymour & Rosengart, (2015) stated that this is an integral feature in septic shock it occurs in almost 99% of all the patients with septic shock. Even though cardiac dysfunction and hypovolemia contribute to the hypotension, loss of vascular muscle reactivity due to inflammation which leads to peripheral vasodilation is the major mechanism which leads to vasodilation. Peripheral vasodilation then results in the widening of the blood vessels which results in the failure of the normal vasoconstriction mechanisms resulting in the lowering of the blood vessels, (Seymour & Rosengart, 2015). Nursing interventions Infection control The main aim of infection control is to control the normal white blood count within the normal ranges and to achieve a timely healing. Infection control also ensures that the infection does not spread to other body organs which may be compromising to the patient, (Gotts & Matthay, 2016). According to Miller III, et.al (2013) the first four hours are important in the management of the infection which the patient may be suffering from which may be caused by various bacteria in the bloodstream. First, administer a broad spectrum antibiotic to the patient so as to start an empirical treatment for the patient. A broad spectrum antibiotic is essential to ensure that all the bacteria causing the infection are covered. The antibiotic given should be IV for a faster onset of action. This will give time for blood cultures to be done so as to know the definitive cause septic shock. The broad spectrum should cover both gram negative and gram positive organisms (Miller III, et.al 2013). If the patient had been giving an antimicrobial treatment the patient should be given an empirical antifungal treatment. The most effective medication in such a situation is vancomycin with a 3rd generation cephalosporin will be effective in ensuring all the organism are covered, (Gotts & Matthay, 2016) noted that monitoring the vital signs of the patient, the nurses will be able to determine if septic shock is developing or not for example an increase in temperature and increase in breathing may indicate developing of sepsis, (Gotts & Matthay, 2016). Seymour et.al (2016) stated that encouraging a balanced diet is also crucial to boosting the immune system of the patient so that the body can be able to fight the disease-causing microorganisms. The patient should be encouraged to take foods rich in vitamins and proteins to help in the healing process, (Seymour et.al 2016). Correction of deficient fluid volume According to Dellinger et.al (2013) maintaining the normal fluid volume the patient will be able to increase capillary permeability and reduce massive vasodilation and ensure that cardiac contractility is normal. Assessment of vital signs are important, tachycardia, hypotension, and fever can signal the body's response to fluid loss hence ensuring that there sufficient fluids in the body it will help in the reduction of hypotension and tachycardia, (Dellinger et.al 2013). The nurses should also observe for excessively dry skin and mucous membrane if the patient has this signs then it indicates that the patient is losing a lot of fluid hence the need to ensure that the patient has an adequate fluid replacement, (Ferrer et.al 2014). Patient with septic shock usually has fluid loss hence by ensuring that they have a normal fluid replacement. It will help them in ensuring that they are healing normally. The patient was presenting with oliguria and hypotension this shows that the patient had lost a lot of blood. The main aim and rationale for fluid replacement therapy are to restore intravascular volume, improve cardiac output and oxygen delivery to the body. This will lead to the reduction of hypotension and tachycardia. The fluid is given IV to ensure that the fluid is replaced rapidly. The main choice for the fluid replacement therapy is normal saline 0.9% with proteins to improve body repair, (King, Bauzá, Mella & Remick, 2014). Assessing and optimizing cardiac output (Angus & Van der Poll, (2013) noted that in septic shock patients the cardiac output of the patients is usually compromised and the patient cannot even pump enough blood to the organs which may result in the organ damage. The nurses should communicate with other nurses on how to use non-invasive cardiac output monitoring measures to improve cardiac output in the patient or on how to use vasopressors in a bid to ensure that the patient is normal, (Angus & Van der Poll, 2013). In most of the patient with the septic shock, they may have altered mental status and their vital signs may not be within the normal range. By monitoring the vital signs and the mental status of the patient the nurses are able to ensure that the patient is aware in the surrounding they are, it ensures the patient can be included in the nursing care plan of the patient Conclusion’ Patients presenting with septic shock need prompt treatment because the condition can develop into a life-threatening condition which may result in the demise of the patient. Nurses need to know the priority of care so that they can ensure that all the symptoms of the patients are treated and the quality of life of the patient is improved. Septic shock can result in organ damage in the patient hence the need for the nurses to priorities the nursing interventions so as to save the patient. References Dellinger, R. P., Levy, M. M., Rhodes, A., Annane, D., Gerlach, H., Opal, S. M., ... & Osborn, T. M. (2013). Surviving Sepsis Campaign: international guidelines for management of	severe sepsis and septic shock, 2012. 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