Study sets, textbooks, questions
Upgrade to remove ads
Terms in this set (65)
What is the basic level at which systemic inflammation is initiated
The endothelium interfaces with the blood and is highly active in releasing chemical mediators that stimulate inflammatory responses.
Top 4 symptoms/findings of systemic inflammation
Elevated Leukocyte Count
Definition of SIRS
Two or more of the following:
- Temp <36 or >38
- Tachycardia >90
- Tachypnea >20 or PaCo2 <32
- WBC >12,000 mm3 or <4000 mm3
What is the connection between sepsis and Mods
When systemic inflammation overwhelms the body's ability to compensate, multiple organs fail
Mods Primary Pathway
Occurs from a specific event and onset is within 72 hrs of admission. Thought to be due to inadequate O2 and removal metabolic end products.
Mods Secondary Pathway
Response to toxin in the context of SIRS, not from a specific event.
Onset is later, often weeks after admission
4 pathological changes in MODS
Risk factors for Mods
Inadequate fluid resuscitation
Multiple blood transfusions
Persistent infectious process
How does increased capillary permeability associated with SIRS affect
1. the lungs
2. the brain
1. Lungs - Edema (ARDS)
2. Cerebral Edema
why is tissue hypoxia often un-recognized in pts leading up to MODS?
Because it can be regionally, and not registered on labs or SPO2. Particularly true in the intestines and brain.
How does hypoxia influence energy?
without o2, a shift from aerobic to anaerobic metabolism occurs and the tissues cannot perform protein synthesis
Which 3 organs have the most unregulated apoptosis?
What indicates an increased likelihood of mortality?
As each additional system fails, the morbidity increases
What are the 6 systems evaluated in SOFA?
SOFA = Sequential Organ Failure Assessment.
What is the quick SOFA?
A version of SOFA that can be performed by a bedside clinicial (RN)
MODS indicated by 2 of the following 3:
RR > 22
SBP <100 mmHg
What is the RNs 1st action with a positive SOFA?
Notify the provider.
What 2 factors define if the patient is in septic shock?
- Use of a vasopressor (like norepinephrine) in order to keep the MAP > 65
- Lactate greater than 2 mmol/L in the absence of hypovolemia (after you've given fluids)
How do children present differently?
They can lose 20-30% of their volume before the BP starts to drop.
-Watch skin sx
-Watch for tachycardia
Fluid resuscitation with sepsis for children.
What vital sign is measured to evaluate success?
20mL/kg/hr, same as trauma.
MAP is measured for evaluation, and is age specific.
How does a pt "buy a bed" in the ICU?
If someone is not hitting their MAP goals s/p fluid resuscitation, they'll have to get vasopressors which means they get moved to the ICU.
At what point do you start treating children like adults physiologically?
13 years old.
How quickly does the resuscitation protocol bundle need to be initiated? What do you need to do to make sure this happens
within 6 hrs.... means you have to get a blood culture sent off very quickly. Don't hesitate, because you'll need Abx.
Surviving Sepsis Campaign Initiative
All this within 6 hrs:
-Blood cultures X 2 BEFORE antibiotics
-Early antibiotic administration
-Fluid resuscitation bolus if hypotension or elevated lactate
-Maintain adequate CVP (preload)
-Vasopressors to keep MAP ↑ 65 (Norepinephrine)
Septic pt need what kind of GI treatment?
Peptic Ulcer Disease Prophylaxis
What peripheral complication needs prophylaxis in a septic pt?
MODS - Pulmonary involvement
Manifests as ARDS
-Widespread atelectasis 2' loss of surfactant
What is often the 1st system to show sx of organ failure in MODS?
The pulmonary system
What respiratory rate is a red flag?
40. They're gonna need to be ventilated.
Pulm. sx of failure
noncardiogenic pulmonary edema
crackles / wheezes
Pulmonary sx of dysfunction (3)
What kind of failure is ARDS?
How is pulm. involvement identified by nurses
What is VILI?
Ventilator Induced Lung Injury. These pt are at risk for it.
Mods Cardiovascular involvement
Hypotension that is unresponsive to fluids.
Oral care (Chlorhex)
Breathing trials every morning
What does a failed breathing trial look like?
Increased HR/BP, poor tolerance
Hypotension (MAP ↓ 70)
Myocardial depression → CO↓
Persistent capillary leak, peripheral edema
Massive edema (anasarca)
How does the RN evaluate for cardiovascular involvement?
MAP nml is 70-100.
Are they requiring vasopressors?
Mods - Kidneys
AKI most frequently accompanies Respiratory failure.
Meds given for cardiac sx in MODs
Inotropes for increased contractility
Vasopressors to increase MAP/Afterload
-Dopamine (note that its listed twice!)
Mods - Neuro
Presents as either altered LOC or peripheral neuropathy.
Glasgow Coma Scale is used.
How is renal involvement measured?
UOP - Oliguria
what often leads to renal injury in a septic pt?
Decreased CO... low renal perfusion
Mods GI involvement
Some say GI is a major driving force because shunting of blood to other organs during crisis leaves the GI system hypoperfused, initiating inflammation.
Clinical indications may be ileus or diarrhea.
↑Liver function tests and PTT
Sx of liver failure
Primary liver dysfunction indicator
High levels of bilirubin
What nursing considerations are associated with high ammonia?
-risk for falls
-risk for aspiration
low protein diet
Decreased bowel sounds
Intolerance of enteral feedings
Stress ulcers (GI bleed)
Necrosis of gut
- bacteria access to blood stream - exacerbates or causes sepsis
What would the RN monitor for coagulation?
Prevention of MODS
is prevention of infection.
How does Mods present in the hematological system?
DIC (bleeding and clots)
What does the RN need to monitor to detect MODS early? (6)
- VS (Temp and MAP especially)
- Serum Lactate
What happens to Pt/PTT, INR?
Top 4 goals for nurses regarding mods
- detection of infection
- Control DM
- Correct hypoxia
- tx of hypotension
What is done to address these?
- Early recog of sepsis
- early hemodynamic resuscitation
- Abx therapy for infection
- Tight Glycemic Control
- Mechanical Vent.
What is the recommended blood glucose goal for Mods?
Goal of 150, and keep it <180
Why is tight glucose control so important in sepsis?
b/c the sugar is feeding the infection, and impaired wound healing too.
Sets found in the same folder
Burns from Wagner
Cardiac Meds 6Q
Master List of values to know
Sets with similar terms
Sepsis, SIRS, MODS
Liver failure- Found on Quizlet
Critical Care Exam 3
Other sets by this creator
TNCC Primary and Secondary Assessments
ENA Influenza: Seasonal, Avian and Pandemic
ENA Critical Care DRAFT
ENA Behavioral Health (missing schizo)
Other Quizlet sets
MICROBIOLOGY CH 13
EE 2310.0U1 HW#4_2
First Quarter Rhetorical Terms
A&P 1 Lab Midterm Thrasher