Toxic shock syndrome (TSS): Nursing

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Toxic shock syndrome, or TSS, is an acute condition caused by a bacterial infection. TSS can be life threatening, as it involves multiple organ systems.

TSS is caused by the immune response to bacterial toxins produced by Staphylococcus aureus or Group A Streptococcus species, like Streptococcus pyogenes.

The most widely recognized risk factor for developing TSS is improper use of tampons during menstruation, but some contraceptive methods, such as a sponge or diaphragm, can also pose a risk. However, TSS can also present in other settings such as soft tissue infections, post-surgical infections, burns, or retained foreign objects such as nasal packing and dialysis catheters.

Now, let’s look at the pathophysiology of TSS. For example, TSS can happen when a tampon or a contraceptive device is left in the vagina for too long.

During menstruation, menstrual blood accumulates and provides a good medium for the bacteria to grow on.

Both Staphylococcus aureus and Streptococcus pyogenes produce exotoxins that are able to cross the vaginal mucosa through a mucosal break or via the uterus and enter the bloodstream.

For Staphylococcus aureus, the main culprit is called toxic shock syndrome toxin 1, or TSST 1 for short. That should be easy to remember! Streptococcus pyogenes, on the other hand, has an M protein in its structure that can overstimulate the immune system, causing TSS.

Alternatively, bacteria can also grow in infected tissues such as wounds or burns, and from there, they enter the bloodstream.


Toxic shock syndrome, or TSS, is caused by an immune response to bacterial toxins produced by bacteria such as Staphylococcus aureus or Streptococcus pyogenes. The main risk factor is improper use of tampons during menstruation, but intravaginal contraceptive devices can also pose a risk for TSS. Other sources, such as infected wounds or burns, can also be causative factors.

In TSS, the body initiates a systemic inflammatory response that involves multiple organ systems, leading to complications like capillary leakage, organ failure, and disseminated intravascular coagulation (DIC). Signs and symptoms of TSS include fever, hypotension, edema, myalgias, and a sunburn-like rash, as well as specific signs of complications and organ dysfunction. Diagnosis involves a thorough history and physical examination along with laboratory tests, and blood cultures

Treatment involves supportive therapy, including IV fluids, vasopressors, antibiotics, and immunoglobulins. Priority goals of nursing care are focused on eliminating the infection and monitoring for alterations in hemodynamic status. Client and family teaching centers on how to prevent toxic shock syndrome, recognizing signs and symptoms of TSS, and when to seek medical attention.


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