Case Study: Toxic Shock Syndrome

• Is a rare, potentially life threatening condition caused by a bacterial toxin secreted by Staphylococcus aureus in the blood stream.
• The cause is uncertain, but 70% of cases are associated with menstruation and tampon use.
• Research suggests that magnesium-absorbing fibers in tampons may lower magnesium levels in the body, thereby providing ideal conditions for toxic formations.
• It also occurred in non-menstruating people with conditions such as cellulitis, surgical wound infection, vaginal infections, and subcutaneous abscesses, and with the use of contraceptive sponges, diaphragms, and tubal ligation.
• Death may result from cardiovascular collapse and renal failure caused by shock.

Assessment

1. Sudden onset of high fever greater than 102°F (39°C).
2. Vomiting and profuse, watery diarrhea.
3. Rapid progression to hypotension and shock within 72 hours of onset.
4. Mucous membrane hyperemia.
5. Sometimes, sore throat, headache, and myalgia.
6. Rash (similar to sunburn) that develops 1 to 2 weeks after onset of illness as followed by desquamation particularly of the palms and soles.

Diagnostic Evaluation

1. Blood urine, throat, and vaginal or cervical cultures, and possibly cerebrospinal fluid culture, detect or rule out infectious organism.
2. Additional tests may be required to rule out other febrile illnesses: Rocky Mountain spotted fever, Lyme disease, meningitis, Epstein-Barr, or Coxsackie viruses.
3. Complete blood count, electrolytes, and renal function tests monitor condition.

Therapeutic Intervention

1. Fluid and electrolyte replacement to increase blood pressure and prevent renal failure.
2. Supportive care to maintain cardio-respiratory functions.

Pharmacologic Interventions

1. Vasopressors, such as dopamine, to treat shock.
2. Antibiotics, such as penicillin-resistant penicillin, or cephalosporins to decrease the rate of relapse.
3. Antipyretics to treat fever.
4. Use of corticosteroids and immunoglobulins is controversial.

Nursing Interventions

1. Monitor core body temperature.
2. Perform hemodynamic monitoring as indicated (ie, arterial line, central venous pressure, or pulmonary artery pressure).
3. Maintain strict intake and output measurement.
4. Insert indwelling catheter to monitor hourly urine output.
5. Monitor respiratory status for pulmonary edema and respiratory distress syndrome caused by fluid overload from increased fluid replacement, diuretics may be necessary.
6. Use cooling measures, such as sponge baths and hypothermia blanket, if indicated.
7. Tell patient to expect desquamation of skin, as in peeling sunburn.
8. Protect skin and avoid using harsh soaps and alcohol which cause drying.
9. Tell patient to apply mild moisturizer and avoid direct sunlight until healed.
10. Advise patient that reversible hair loss may occur 1 or 2 months after TSS.
11. Tell patient to expect fatigue for several weeks to months after TSS.
12. Tell patient to avoid using tampons to reduce risk of recurrence.
13. Encourage follow-up visits for examination and cultures.
14. Alternate use of pads with tampons; avoid super-absorbent tampons.
15. Change pads or tampons frequently and do not wear one longer than 4 hours.
16. Recognize and report symptoms of TSS.