Nursing care for patients with septic shock undergoing renal replacement therapy: A case study
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Abstract
Severe infections that progress to shock are caused by pathogens entering the
body and triggering an immune response, which leads to circulatory dysfunction
and hypotension. Therefore, the body requires fluids or medications that
stimulate vasoconstriction to prevent life-threatening complications.
Bloodstream infections are most commonly caused by severe bacterial pathogens
such as Acinetobacter baumannii and Pseudomonas aeruginosa, as well as fungi
and viruses. The body’s immune system responds to these infections by releasing
inflammatory mediators that lead to vasodilation, increased vascular
permeability and altered microcirculation. This results in hypotension,
microvascular occlusion, cellular oxygen deprivation and ultimately, vital organ
failure.
The role of critical care nurses is crucial in the management of patients with
septic shock. Comprehensive assessment, continuous monitoring and timely
interventions during the critical phase are essential to prevent potential
complications. Nurses apply the nursing process to the care of patients with
septic shock by conducting thorough assessments, establishing nursing
diagnoses, planning and implementing nursing interventions and evaluating
outcomes in accordance with professional standards to minimize complications.
In this case study, the patient developed complications such as acute respiratory
distress syndrome (ARDS) and acute kidney injury (AKI), requiring continuous
renal replacement therapy (CRRT) to support organ function and prevent further
organ failure. To enhance the quality of nursing care, this study integrates
evidence-based nursing standards with the case analysis through the use of
systematic assessment tools and appropriate medical technologies, combined
with holistic care, enabling nurses to plan and deliver care with the highest level
of effectiveness.
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เนื้อหาและข้อมูลในบทความที่ลงตีพิมพ์ในวชิรสารการพยาบาลถือเป็นข้อคิดเห็นและความรับผิดชอบของผู้เขียนบทความโดยตรง ซึ่งกองบรรณาธิการไม่จำเป็นต้องเห็นด้วย หรือร่วมรับผิดชอบใด ๆ ทั้งสิ้น
บทความ ข้อมูล เนื้อหา รูปภาพ ฯลฯ ที่ได้รับการตีพิมพ์ในวชิรสารการพยาบาล ถือเป็นลิขสิทธิ์ของวชิรสารการพยาบาล หากบุคคลใดหรือหน่วยงานใดต้องการนำทั้งหมดหรือส่วนหนึ่งส่วนใดไปเผยแพร่ต่อหรือเพื่อกระทำการใด ๆ จะต้องได้รับอนุญาตเป็นลายลักอักษรจากวชิรสารการพยาบาลก่อนเท่านั้น
References
Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med [Internet]. 2021;47(11):1181–247. Available from: http://dx.doi.org/10. 1007/s00134-021-06506-y
Bureau of Health Administration, Ministry of Public Health. Be Aware of Sepsis: Prevention, Early Detection, and Prompt Treatment. Sukhum Kanchanapimai, Suthat Rungruanghiranya, editors. 2019. (in Thai)
Wacharasint P, Piyavechviratana K, Piriyapatsom A, Morakul S, editors. Comprehensive hemodynamic critically ill patients (CHOC). 2nd ed. Bangkok, Thailand: Beyond Enterprise Co., Ltd.; 2020. (in Thai).
Hwang EHW, Hwang CW, Augustin B, Guirgis FW, Black LP. Updates and controversies in the early management of sepsis and septic shock. Emerg Med Pract. 2025;27(8):1-28. Available from: https://www.ebmedicine.net/media_library/files/Sepsis-Emergency-Medicine-2025.pdf
Thongyu S, Permpikul C. Guidelines for the Management of Adult Patients with Severe Sepsis/ Septic Shock. In: Suneerat Kongsayreepong, Duangmanee Laoprasittipong, editors. Guidelines for the Management of Adult Patients with Severe Sepsis/Septic Shock, Siriraj Hospital, Faculty of Medicine Siriraj Hospital, Mahidol University. 2013. p.17-22. (in Thai)
Rosenberg A, Johnson M, Patel R, Lee H, Torres E. Early norepinephrine initiation in septic shock: a randomized, controlled, open-label trial. Intensive Care Med. 2025;51(4):622-633.
Thimachai P. Hemodiafiltration and Hemofiltration. Bangkok: Nam Aksorn Kanphim. 2022. (in Thai)
Vongsanim S. Long-term Complications of Hemodialysis. Bangkok: Text and Journal Publication Co., Ltd.; 2019. (in Thai)
Deutsche Sepsis-Gesellschaft e.V. Update 2025 of the S3 guidelines: Sepsis-Prevention, Diagnosis, Therapy and Follow-up Care. Dtsch Arztebl Int. 2025;122(29-30):101-123.
Kusoom W. Critical Care Nursing: A Holistic Approach. 7th ed. Bangkok: P.K.K. Printing; 2022. (in Thai)
Fujishima S. Guideline-based management of acute respiratory failure and acute respiratory distress syndrome. J Intensive Care. 2023;11:10. doi:10.1186/s40560-023-00658-3.
Moschopoulos CD, Dimopoulou D, Dimopoulou A, Dimopoulou K, Protopapas K, Zavras N, et al. New Insights into the Fluid Management in Patients with Septic Shock. Medicina (Kaunas). 2023 May 29;59(6):1047. doi: 10.3390/medicina59061047. PMID: 37374251; PMCID: PMC10301281.
Eraky AM, Yerramalla Y, Khan A, Mokhtar Y, Wright A, Alsabbagh W, et al. Complexities, Benefits, Risks, and Clinical Implications of Sodium Bicarbonate Administration in Critically Ill Patients: A State-of-the-Art Review. J Clin Med. 2024;13(24):7822. doi:10.3390/jcm 13247822
Chaocheangtung W. Nursing care for a patient with septic shock: a case study. Journal of Nakhon Phanom Provincial Public Health Office. 2025;3(1). Available from: https://he02.tci-thaijo.org/index.php/ nkp/article/view/273361/187248 (in Thai)
