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Infection (Septic Shock) Sepsis is the presence of infection and activation of the inflammatory cascade. Systemic inflammatory response syndrome (SIRS) is a term used to define this clinical condition, and it is considered present if abnormalities exist in two of the following four clinical parameters: (1) body temperature, (2) heart rate, (3) respiratory rate, and (4) peripheral leukocyte count. Sepsis is defined as the presence of SIRS in the setting of infection. Severe sepsis is defined as sepsis with evidence of end-organ dysfunction as a result of hypoperfusion. Septic shock is defined as sepsis with persistent hypotension despite fluid resuscitation and resulting tissue hypoperfusion. Bacteremia is defined as the presence of viable bacteria in blood. Bacteremia may be primary (without an identifiable focus of infection) or, more often, secondary (with a focus of infection). Sepsis is a disease seen most frequently in older adults and in those with co-morbid conditions that predispose them to infection. Clients who are immunocompromised are especially at high risk and include those with cancer who are receiving chemotherapeutic agents, those with end-stage renal or liver disease, those with advanced HIV, or those receiving steroids for chronic conditions. Clients with indwelling vascular catheters and urinary catheters are particularly at high risk. Although sepsis is commonly associated with bacterial infection, bacteremia does not need to be present to activate the massive inflammatory response that results in severe sepsis. In fact, fewer than 50% of cases of sepsis are associated with bacteremia. Encouraging clients to treat infections immediately and completely may help reduce the incidence of septic shock. Older and immunocompromised clients should be monitored closely for infection, and treatment should begin immediately when infection is diagnosed. Identify high-risk clients and implement measures to prevent shock whenever possible.