Chapter 38 Multiple Organ Dysfunction Syndrome Flashcards
1) A patient admitted with an infected wound is demonstrating signs of improvement. The nurse would attribute this improvement to which physiologic process?
1. Cortisol released from the adrenal glands
2. Hypothalamus activating white blood cells
3. Endothelial cells releasing mediators to contain the infection
4. Mediators that decrease permeability of vessel walls
Answer: 3
Explanation: 1. The wound infection was not contained because of the release of cortisol by the adrenal glands.
2. The hypothalamus does not activate white blood cells.
3. Mediators, bioactive substances that stimulate physiologic changes in cells, are released from endothelial cells. It is these mediators that control inflammation, activate coagulation, deposit fibrin, and inhibit fibrinolysis to contain the inflammatory activity to the site of the infection.
4. Permeability of the vessel walls is increased in order to contain infection.
2) A patient tells the nurse that he is upset because his surgical wound is infected, and everyone else that he knows who had the same surgery did not have the same problem. How should the nurse respond to this concern?
1. “There really is nothing that could be done to prevent it.”
2. “You should talk to your surgeon about your concerns.”
3. “At least you are in the hospital when the infection started and not at home.”
4. “Developing an infection depends on many factors, even things like age and gender.”
Answer: 4
Explanation: 1. The nurse has no way of knowing if there was a way to prevent this patient’s infection.
2. The nurse can offer some explanation about the development of infection instead of referring the patient to the surgeon.
3. Commenting about being in the hospital instead of home when the infection developed does not address the patient’s concerns.
4. How endothelial cells respond to alterations in the environment differ, according to the host genetics, age, gender, nature of the pathogen, and location of the vascular bed. The nurse should explain to the patient that the development of a wound infection depends on these variables.
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3) A patient who underwent transurethral resection of the prostate 5 days ago comes to the emergency department with the report of feeling “worse than before the surgery.” After assessing the patient and obtaining laboratory results, the nurse notes a temperature of 96.6°F, a respiratory rate of 26, and a white blood cell (WBC) count of 3000 mm3. The nurse anticipates additional treatment for which disorder?
1. Systemic inflammatory response syndrome
2. Homeostasis
3. Localized inflammation
4. Multiple organ dysfunction syndrome
Answer: 1
Explanation: 1. Systemic inflammatory response syndrome is correct because the clinical manifestations include a respiratory rate of greater than 20 breaths per minute and a white blood cell count below 4000/mm3. These findings meet the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference criteria of sepsis.
2. Homeostasis is incorrect because the clinical manifestations are not compatible with the state of equilibrium found in homeostasis.
3. Localized inflammation may exist and contribute to the patient’s condition, but is not the specific problem of concern.
4. There is no indication of the failure of organ systems.
4) The nurse is admitting a patient into the intensive care unit and is planning preventative measures to avoid the onset of the systemic inflammatory response syndrome (SIRS). Which assessment findings would increase the patient’s risk of developing this syndrome?
1. Age 36
2. Body mass index of 23
3. Asian ancestry
4. History of Crohn’s disease
Answer: 4
Explanation: 1. Patient-related risk factors for developing systemic inflammatory response syndrome include older age.
2. A normal body mass index does not increase risk for SIRS.
3. There is no indication that those of Asian ancestry are at higher risk of developing SIRS.
4. Compromised gut integrity, such as is seen in Crohn’s disease, is a risk factor for the development of SIRS.
5) A patient involved in a motor vehicle accident was admitted to the intensive care unit with a closed head injury. Which clinical manifestation would warn the nurse that the patient’s condition was progressing to multiple organ dysfunction syndrome (MODS)?
1. Urine output less than 400 mL/day
2. Decreased PaO2 with an increase in FiO2
3. Alteration in level of consciousness
4. Hypotension that responds to fluids
Answer: 2
Explanation: 1. Urine output less than 400 mL/day develops later in the course of multiple organ dysfunction syndrome.
2. Decreased PaO2 with an increase in FiO2 is correct because the lungs are usually the first organs to show signs of dysfunction and is the main organ affected in multiple organ dysfunction syndrome.
3. Alteration in level of consciousness is probably already present with the closed head injury, and it also can occur with hypoperfusion, microvascular coagulopathy, or cerebral ischemia and not necessarily progress to multiple organ dysfunction syndrome.
4. The hypotension and dysrhythmias common in MODS do not respond to fluid therapy.
6) The nurse will calculate the pressure-adjusted heart rate for a patient with cardiovascular dysfunction associated with multiple organ dysfunction syndrome (MODS). Which information must the nurse obtain before this measurement can be calculated?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
1. Heart rate
2. Central venous pressure
3. Mean arterial pressure
4. Temperature
5. PaFiO2
Answer: 1, 2, 3
Explanation: 1. Heart rate is a part of this calculation.
2. Central venous pressure is used in this calculation.
3. Mean arterial pressure is used in this calculation.
4. Temperature is not part of this calculation.
5. PaFiO2 is not part of this calculation.
7) A patient with a history of alcoholism and esophageal varices was admitted to the intensive care unit and developed multiple organ dysfunction syndrome. Which laboratory results would confirm the nurse’s suspicion of hepatic involvement?
1. Increased fibrinogen level
2. Decreased blood urea nitrogen
3. Increased serum bilirubin
4. Increased serum albumin
Answer: 3
Explanation: 1. Abnormalities in the liver would be likely to result in decreased fibrinogen levels.
2. Blood urea nitrogen changes for several reasons and would generally increase in metabolic disorders.
3. Liver dysfunction typically manifests as high levels of serum bilirubin. An increased serum bilirubin level would confirm the suspicion of hepatic involvement.
4. Low serum albumin levels would indicate liver involvement.
8) The nurse would be most alert for the development of secondary pathway multiple organ dysfunction syndrome (MODS) in which patient?
1. A 40-year-old patient who went into neurologic shock following a fall
2. A patient whose leg laceration was severely contaminated with soil from a rodeo arena
3. A patient who has history of cirrhosis and diabetes who had chest injuries in an automobile accident
4. A teenager who was bitten by a stray dog three days prior to admission
Answer: 3
Explanation: 1. Persons over age 45 are at higher risk for developing secondary MODS. Neurologic shock increases this patient’s risk for primary MODS.
2. Sepsis, as may result from this wound contamination, increases risk for primary MODS. Sufficient treatment of this wound may prevent infection from occurring.
3. Higher number of preexisting conditions such as cirrhosis, ischemic heart disease, chronic lung diseases, and diabetes increases risk for secondary pathway MODS.
4. Being bitten by a dog increases risk for infection, but this patient is not at highest risk for secondary pathway MODS.
9) A patient is in the intensive care unit with multiple organ dysfunction syndrome. Which assessment finding would suggest to the nurse that the patient is experiencing failure of the gastrointestinal system?
1. Increased flatus
2. Abdominal cramps
3. Absent bowel sounds
4. Complaint of epigastric burning
Answer: 3
Explanation: 1. Increased flatus would indicate some degree of gastrointestinal functioning.
2. Abdominal cramps would indicate some degree of gastrointestinal functioning.
3. Because there is no objective measure of gastrointestinal function in the patient, the one assessment finding that could indicate dysfunction in this system would be the development of an ileus, which can be associated with the absence of normal bowel sounds.
4. Complaint of epigastric burning is not specific to gastrointestinal dysfunction.
10) Which nursing interventions should be implemented to help prevent the development of multiple organ dysfunction syndrome (MODS) in a critically ill patient who is being mechanically ventilated?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
1. Enforcing hand washing before and after touching a patient
2. Following an evidence-based ventilator bundle
3. Using urinary catheters to prevent perineal skin breakdown
4. Complying with turning and repositioning schedules
5. Restricting visitors to immediate family only
Answer: 1, 2, 4
Explanation: 1. Enforcing hand washing before and after touching a patient is correct because hand washing may prevent infections.
2. An evidence-based ventilator bundle should be implemented to help avoid ventilator-associated pneumonias.
3. Use of urinary catheters increases risk for infection and risk for multiple organ dysfunction.
4. Minimizing the risk for pressure ulcers by relieving pressure and shear points can help prevent development of MODS.
5. Restricting visitors is not necessary as long as universal precautions are followed.
14) A patient develops systemic inflammatory response syndrome (SIRS) after acute pancreatitis. The patient’s wife says, “I thought he didn’t have any infection.” How should the nurse respond?
1. “He probably had an infection that we did not recognize.”
2. “He developed SIRS after getting multiple organ dysfunction syndrome.”
3. “Infection isn’t necessary to develop SIRS, only a severe inflammation.”
4. “Your husband’s body is working against itself.”
Answer: 3
Explanation: 1. SIRS can occur in the absence of infection.
2. Multiple organ dysfunction syndrome follows SIRS.
3. Pancreatitis is a severe inflammatory illness. SIRS can develop without infection.
4. A general statement like this is not an adequate explanation.
