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Terms in this set (45)
What is the leading cause of death in the ICU?
What is the 11th leading cause of death in the US?
Only about 2% of people who come to hospital are admitted with sepsis. What does this indicate?
Most people develop sepsis while they are in the hospital.
What happens to the mortality as the number of organs that dysfunction increase?
The mortality rate increases
When treating sepsis it is important to...
Recognize the signs early and respond rapidly.
What is the first state of sepsis?
Systemic Inflammatory Response Syndrome or SIRS
-An out of control reaction of the body to an insult...trauma, bacteria, or disease
What is the second stage of sepsis?
Systemic Inflammatory Response Syndrome plus a documented infection.
What is the third stage of sepsis?
Infection and SIRS plus the beginning of organ dysfunction
What is the fourth stage of sepsis?
Sepsis not responsive to fluid resuscitation needing vasopressors
List what you know about the pathophysiology of Sepsis:
Circulatory dysfunction caused by immunologic over activity
Increased capillary permeability and release of proinflammatory mediators
Decrease blood flow to organs and tissue
Cells switch from aerobic to anaerobic metabolism causing lactic acid to build up.
What are early signs and symptoms of systemic inflammatory response syndrome?
Temperature greater than 100.4 or lower than 96.8 (temperature drop is more common in elderly)
Heart Rate greater than 90 bpm
Respiratory rate greater than 20 breaths per minute
WBC count greater than 12,000 or less than 4,000
What are the signs and symptoms that show that sepsis has set in?
Presence of two of the SIRS criteria along with a know or suspected infection. At this point you do not want to wait to treat this individual.
What are the signs and symptoms that show severe sepsis has set in?
Client meets sepsis criteria and shows signs and symptoms of one organ failing.
Rapid, aggressive treatment is needed in the ICU setting
What are cardiovascular signs of organ failure?
Poor cap refill
Increased Heart Rate (Tachycardia)
Decreased Blood Pressure (Hypotension)
What are respiratory signs of organ failure?
Increased respiratory rate (Tachypnea)
Decreased Oxygen Saturation
Abnormal Chest X-Ray
What are GI/Hepatic signs of organ failure?
Ileus (Bowel obstruction)
Change in bowel sounds
Elevated liver enzymes (AST/ALT/ALP)
Elevated Bilirubin greater than 4 mg/dl
What are Neurological signs of organ failure?
Change in LOC
What are hematologic signs of organ failure?
Leukocytosis- greater than 10,000
Thrombocytosis or Thrombocytopenia
Prolonged PT, PTT
Elevated INR- greater than 1.5
What are renal signs of organ failure?
Decreased Urine output
Less than 30 ml/hr
Lab finding elevated Creatinine. Greater than 0.5
If the serum procalcitonin level is greater than 2 ng/ml it means that
the person is septic
If the serum procalcitonin level is greater than 10 ng/ml it means they are
going through septic shock
When taking care of someone who is suspected to be septic it is important to take blood cultures.What are the parameters for collecting blood samples?
A minimum of two sets of blood cultures. One should be anaerobic and aerobic
1 blood culture should be percutaneously
1 blood culture should be obtained through each vascular access device that has been in longer than 48 hours.
If the blood cultures are positive for growth then the nurse should:
Begin treatment immediately
Antibiotics must be started within an hour of recognition
What other lab findings could be pertinent?
Lactic acid- greater than 4 mmol/L
C reactive protein - elevated
List the aspects of managing sepsis:
Recognize clinical symptoms of sepsis through screenings
Establish IV access
Administer broad spectrum antibiotics within one hour of suspected sepsis
Fluid management- NS/LR
Anticipate transfer to ICU
What are additional interventions that can be done to manage sepsis?
Start oral or enteral feedings within 48 hours of diagnosis
Keep blood glucose less than 180 mg/dl
Begin insulin if needed
Initiate DVT prophylaxis with SCDs or TEDS
Discuss daily progress and being end-of-life planning with family
How often should the sepsis screening be completed?
Every shift (every 12 hours)
When using the lab values when you are filling out the sepsis screening tool how long is lab work good for?
How long are blood culture results good for?
When filling out section B what antibiotics should not be counted as treatment?
Antibiotics they were taking at home
What do you do if the patients normal in regards to labs is different from the normal for others?
Do not mark an abnormal lab that is chronically abnormal for that person on the sepsis screening
If you move on to section C of the sepsis screening you should call:
However if the MD is already aware of the patients status it is not necessary to call unless there is a...
What is the definition of MRSA?
Methicillin Resistant Staphylococcus
A type of staph bacteria that is resistant to certain antibiotics
What are symptoms of MRSA?
Infection of wounds, skin around invasive tubes/catheters, blood, lung, urinary tract
Who is most at risk for contracting MRSA?
Weakened immune systems
Open or broken skin
What is used to diagnose MRSA?
How does MRSA spread in the community?
Skin to skin
Crowded living condition
How does MRSA spread in hospitals?
How do we treat MRSA?
Incision and drainage of abscess
What is VRE?
Entercocci that becomes resistant to Vancomycin
Usually develops in the hospital
Has the same risk of MRSA
Who is at risk for VRE?
Those previously treated with vancomycin
Prolong antibiotic use
Weakened immune system
Colonized with VRE
How does VRE spread?
How is VRE treated?
Antibiotics other than Vancomycin
Removal of catheters/tubes
What are ways nurses can manage MRSA and VRE?
Good hand hygiene
Ensure invasive tubes or needles are inserted under sterile conditions
Do not share equipment
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