2. DEFINITION:
Toxic shock syndrome is a toxin mediated acute life
threatening illness, usually precipitated by the
infection either by staphylococcus aureus and
streptococcus pyogens.
It is a disease caused by toxin produced by common
strain of bacteria that spreads to the bloodstream.
3. INCIDENCE:
Most cases reported in western countries still
involve mensurating women under the age 30.
TSS still occurs in about 17 out of 1,00,000
mensurating girls and women each year.
Between 5% and 10% of patients with TSS die.
In developing countries TSS often affects children.
It can affect Children, postmenopausal women and
also men.
4. CAUSES:
In most common form of toxic shock syndrome,
the bacteria live in the vagina of women who
are infected and the bacterial growth is
encouraged by the presence of a tampon.
However, these toxins can be produced from
bacteria in other locations in the body as well.
5. Most cases of TSS are caused by a bacterium
called staphylococcus aureus, which is
associated with mensurating women using
tampons
Some cases of TSS are caused by staphococcus
pyogens, the same bacterium that causes strep
throat s.pyogens. This often comes from a skin
infection and causes more serious form of TSS
than s.aureus.
6. POSSIBLE ROUTES OF INFECTION:
Vagina
Nose( nasal packing)
Surgical wound
Childbirth
Any skin wound
7.
8. CLINICAL MANIFESTATION:
Patients may experience a fewdays of mild flu like
symptoms before the TSS develops, but TSS itself is
characterized by rapid onset of specific symptoms
including,
High fever greater than 102 degree F( 38.9 degree C)
Abdominal pain
Nausea
Vomiting
Diarrhea
Sore throat
cough
9. Low blood pressure
Myalgia
Chills and malaise
Widespread of skin rashes
This will usually progress to,,
Worsening of low blood pressure
Dizziness
Confusion or disorientation
Desquamation especially of palms and soles after
1-2 weeks of acute illness
Diffuse macular erythroderma
10.
11. Toxic shock syndrome can affect most organ in the
body and cause
Hepatic damage
Respiratory distress syndrome
Thromocytopenia
Coagulopathy
Renal impairment
Ultimately multiorgan failure may develop and
this leads to death un approximately 5% of all
those affected.
12. DIAGNOSTIC EVALUATION :
No specific test exists to diagnose toxic shock
syndrome
History
-Difficult to diagnose until the characteristics
symptoms evolves and source of infection is
identified.
Physical examination ( which includes a pelvic
examination in women)
Blood test usually ordered and might include
white blood cell count ( to look for signs of
infection)
13. Blood cultures ( evaluating for possible bacteria in
the blood stream)
Evaluation of kidney and liver function
Specimens for culture should be taken from any
lesions, the nose, throat, vagina and blood.
An ECG,chest X-ray and or CT sacns of the
abdomen or pelvis can be ordered to evaluate the
internal organs, depending on the results of initial
evaluation
14. MANAGEMENT :
People with TSS are admitted to the hospital’s
intensive care unit for treatment.
MEDICAL MANAGEMENT :
-Administer intravenous fluid (IV) fluids to
stabilize blood pressure .
-IV Medications to increase blood pressure may
include dopamine or epinephrine.
-IV Antibiotics to fight the source of infection are
prescribed. Antibiotics effective against s. Aureus
and s. Pyogens are given.
15. Initial antibiotics may include cephalosporins,
nafcillin, oxacillin, penicillin or
vancomycin.The addition of clindamycin or
gentamycin reduces toxin production and
reduces mortality.
Antipyretics to normalize body temperature
Oxygen administration and mechanical
ventilation to assist breathing
Dialysis if kidney failure develops.
16. SURGICAL MANAGEMENT :
- a surgical intervention is required to drain
the source of the infection in cases of an abscess.
- If infection is found to be in deeper
tissues,extensive surgery is often necessary to
remove the infected and dead tissue called
debridement.
17. NURSING MANAGEMENT:
History collection
-Use of tampons
-Recent surgery
-Past history of toxic shock syndrome
- childbirth
Physical examination
Head to foot examination
Monitoring vital signs
18. NURSING DIAGNOSIS :
Altered body temperature related to infection
Impaired skin intergrity related to peeling of
skin
Risk for septic shock related to presence of
infection
Risk for fluid volume deficit related to
vomiting and diarrhea
Anxiety realted to change in health status
Knowledge deficit related to disease
condition
