CHAPTER 3 Immune System^163
TREATMENT
- doxycycline, 100 mg bid (twice a day) ×14 to 21 days.
- aqueous penicillin G, 20 million units.
- ceftriaxone, 4 grams/day IM or IV.
NURSING DIAGNOSES
- Impaired skin integrity
- Impaired physical mobility
NURSING INTERVENTIONS
- Cover all exposed skin while outside.
- Use appropriate insect repellant.
- Inspect arms and legs for ticks when coming in from outside.
- Inspect pets.
- Educate on proper way to remove tick.
Septic Shock
WHAT WENT WRONG?
Septic shock starts with bacteremia, usually gram negative bacteria infecting the
blood. The sources are usually genito-urinary system, gastrointestinal tract, and
lungs. The infection may be underlying for some time before shock develops. Once
the cascade from bacteremia to septic shock starts, it may be difficult to halt the
process. Shock may occur more quickly in patients who are elderly, immune-
compromised, or with other comorbidities. In response to a bacterial infection,
TNF-alpha and other inflammatory chemicals are released into the blood, causing
an increase in the blood leaking from vessels into both the infected and non-
infected tissues (vascular permeability).
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