Class 6 (02|15|22) Multiple Organ Dysfunction

Question 1

Describe Continuous Renal Replacement Therapy?

Answer 1

• Acts like a kidney outside the body
• Dialysate goes in one direction counter-current to blood creating a pressure gradient - change in hydrostatic pressure
• Molecules begin to move across semipermeable membrane to filter

Question 2

Common uses of CRRT

Answer 2

• Heart failure
• Fluid overload
• MODS: kidneys and lungs fail
• Kidney dysfunction

Question 3

What happening hemodynamically during MODS? (edema)

Answer 3

• Being to see intra abdominal hypertension: fluid is seeping into tissue space
• Increase edema
• Cerebral edema/increase intracranial pressure
• Build pushes on organs in belly
• Worsen respiratory failure due to increased pressure in abdomen

Question 4

Multiple Organ Dysfunction Syndrome

Answer 4

Failure of two or more organ systems in an acutely ill patient such that homeostasis cannot be maintained without intervention

Question 5

SIRS

Answer 5

Systemic Inflammatory Response Syndrome

Question 6

Incidence of MODS

Answer 6

• difficult to determine
• develops with acute illnesses with compromise tissue perfusion
• often follows sustained SIRS

Question 7

MODs typical order in which organs are affected?

Answer 7

• Respiratory first
• cardiovascular
• neurological
• renal
• GI
  
  • liver
• hematological

Question 8

What are risk factors for MODS?

Answer 8

• advanced age
• malnutrition
• coexisting conditions/chronic illness
• immunosuppression
• surgical or traumatic wounds

Question 9

In MODS, what is happening at a cellular level to tissue?

Answer 9

Tissue becomes hypoperfused at both a microcellular land microcellular level

Question 10

Signs of hypermetabolic state (4)

Answer 10

• hyperglycemia
• hyperlacticacidemia: excess lactic acid in blood
• increasing BUN
• auto catabolism: sever loss of skeletal muscle mass

Question 11

Goals of all shock states.

Answer 11

• to reverse the tissue hypoperfusion and hypoxia

- if effective tissues perfusion is respited before organs become dysfunctional

Question 12

What are the initial warning signs of MODS?

Answer 12

subtle changes in mentation and a gradual rise in temperature along with risk factors

Question 13

Nursing management in MODS

• primary interventions
• support

Answer 13

• care plan is the same as septic shock
• Primary nursing interventions: supporting the patient & monitoring organ perfusion until primary organ insults are halted
• providing information and support to the family

Question 14

Describe the communication approach in MODS.

Answer 14

• encourage frequent and open communication about treatment modalities
• informed about goals of rehabilitation (especially because of skeletal muscle mass loss causing for a slow progress)

Question 15

Incidence of Primary MODS.

Answer 15

Directly relates to insult or injury

Question 16

Incidence of Secondary MODS

Answer 16

• SIRS/septic continuum
• dysfunction of organs not involved in initial insult
• a complication of any form of shock caused by inadequate tissue perfusion
• frequently occurs toward the end of the continuum of septic shock

Question 17

What are the early clinical presentations? (Resp, cardio, metabolism, blood glucose)

Answer 17

• Respiratory → progressive dyspnea & respiratory failure
• Cardiovascular → usually hemodynamically stable
• Hypermetabolic state → hyperglycemia. hyperlactic academia & increased BUN
• metabolic rate may be 1.5-2x basal metabolic rate
  sever loss of skeletal muscle mass

Question 18

What is the progressive clinical presentation of MODS? (Renal, liver, haematological, cardio, neurological)

Answer 18

Approximately 7-10 days

• renal → increased Cr; anuria
• Liver → elevated bilirubin & live function tests
• Hematological → worsening immunocompromised, increase risk of bleeding
  
  • DIC: disseminated intravascular coagulation
  • a complication of an underlying disorder
  • clotting cascade abnormally active (excess clotting & decreased perfusion) AND clotting factors care consumed (bleeding +)
• Cardiovascular → unstable and unresponsive to vasoactive agents
• neurological → progressive to state of unresponsiveness/coma

Question 19

What is DIC

Answer 19

DIC: disseminated intravascular coagulation
serious condition that disrupts your blood flow. It is a blood clotting disorder that can turn into uncontrollable bleeding. DIC can affect people who have cancer or sepsis

Question 20

What are the treatment goals in MODS? (4)

Answer 20

• reverse hyperperfusion & hypoxia
• control initial event
• promote adequate organ perfusion
• nutritional support

Question 21

What are some treatments for the management of MODS?

Answer 21

• oxygenation: mechanical ventilation/ VAP prevention
• optimize cardiac output → IV fluids & vasoactive agents
• optimize nutrition → increase calories & TPN
• control blood glucose → insulin
• patient and family support
• discussion about end of life