1. Patho: hypvolemic results from decreased intravscular volume either from internal fluid shifts or external fluid loss. Common causes are: hemorrhage, diarrhea, vomiting, or G. I bleed. Patho for Septic: Associated with severe infection and occurs after bacteremia, the body responds to infection by the inflammatory response that leads to massive vasodilation and hypotension
2. TREATMENT: Infection, Hydration, Antibiotics, cooling measure, Fluid Volume resuscitation, maintain perfusion
3. Decreased Cardiac Output
   1. S/SX
      1. SIGNS/SYMPTOMS
         1. PT FINDINGS
      2. Decreased UO < 30cc's per hour
      3. Decreased periperal perfusion
      4. Hypotension
      5. Agitation or confusion
      6. Abnormal ABG's; acidosis or hypoxemia
   2. NIC
      1. NURSING INTERVENTIONS
         1. PT RESPONSE
      2. Monitor VS frequently
      3. Monitor for dysrhythmias
      4. Monitor urine output
      5. Place in position of shock if needed
      6. Admin inotropic agents or fluids if ordered
4. Risk for Ineffective Breathing Pattern
   1. S/SX
      1. SIGNS & SYMPTOMS
         1. PT FINDINGS
      2. Shallow respirations
      3. Dec Sao2 <90%
      4. Increased work of breathing
      5. skin color changing to cyanotic
      6. ABG's with Pao2 <60
   2. NIC
      1. NURSING INTERVENTIONS
         1. PT RESPONSE
      2. HOB up at 90 if dyspnea
      3. Keep Sao2 >90% with titrating 02
      4. Anticipate need for intubation
      5. Suction if needed
      6. Provide reassurance to pt and family
5. Deficient Fluid Volume
   1. S/SX
      1. SIGNS & SYMPTOMS
         1. PT FINDINGS
      2. hypotension
      3. tachycardia
      4. decreased Urine output
      5. dry mucous membranes
      6. poor skin turgor
      7. flat neck veins
   2. NIC
      1. Fluid Resuscitation to maintain SBP>90
         1. PT RESPONSE
      2. Obtain daily weights
      3. Monitor renal perfusion and output
      4. assess skin for improved turgor
      5. admin vaso active substances if prescribed
      6. oral care as needed
6. Actual Infection
   1. Pt Findings- Signs and Symptoms
   2. Infectious Process
      1. Presence of UTI or surgical wound
      2. Debilitated, elderly
      3. Multiple lines, central lines, catheters
   3. NURSING INTERVENTIONS
   4. Assess systems thoroughly: LOC, lungs, GU, infection
   5. maintain perfusion and SBP>90
   6. obtain cultures
   7. identify risk factors
   8. Assess for chills, temp, pulses, skin, and LOC
   9. Maintain temp
   10. Admin antibiotics timely and get troughs/peaks
   11. assess for changes in mentation or altered LOC