Septic Shock 41
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motion exercises of the affected joint bid; otherwise, keep knee in resting
splint.
7. Diet: Regular diet.
8. IV Fluids: Heparin lock
9. Special Medications:
Empiric Therapy for Adults without Gonorrhea Contact:
-Nafcillin or oxacillin 2 gm IV q4h AND
Ceftizoxime (Cefizox) 1 gm IV q8h or ceftazidime 1 gm IV q8h or
ciprofloxacin 400 mg IV q12h if Gram stain indicates presence of Gram
negative organisms.
Empiric Therapy for Adults with Gonorrhea:
-Ceftriaxone (Rocephin) 1 gm IV q12h OR
-Ceftizoxime (Cefizox) 1 gm IV q8h OR
-Ciprofloxacin (Cipro) 400 mg IV q12h.
-May complete course of therapy with cefuroxime axetil (Ceftin) 400 mg PO
bid.
10. Symptomatic Medications:
-Acetaminophen and codeine (Tylenol 3) 1-2 PO q4-6h prn pain.
-Heparin 5000 U SQ bid.
11. Extras: X-ray views of joint (AP and lateral), CXR. Synovial fluid culture.
Physical therapy consult for exercise program.
12. Labs: CBC, SMA 7&12, blood C&S x 2, VDRL, UA. Gonorrhea cultures of
urethra, cervix, urine, throat, sputum, skin, rectum. Antibiotic levels. Blood
cultures x 2 for gonorrhea.
Synovial fluid:
Tube 1 - Glucose, protein, lactate, pH.
Tube 2 - Gram stain, C&S.
Tube 3 - Cell count.
Septic Shock
1. Admit to:
2. Diagnosis: Sepsis
3. Condition:
4. Vital signs: q1h; Call physician if BP >160/90, <90/60; P >120, <50; R>25,
<10; T >38.5
C; urine output < 25 cc/hr for 4h, O
2
saturation <90%.
5. Activity: Bed rest.
6. Nursing: Inputs and outputs, pulse oximeter. Foley catheter to closed drain-
age.
7. Diet: NPO
8. IV Fluids: 1 liter of normal saline wide open, then D5 1 NS at 125 cc/h
9. Special Medications:
-Oxygen at 2-5 L/min by NC or mask.
Antibiotic Therapy
A. Initial treatment of life-threatening sepsis should include a third-generation
cephalosporin (ceftazidime, cefotaxime, ceftizoxime or ceftriaxone), or
