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Unit 4 > Infection - Sepsis And Septic Shock > Flashcards

Infection - Sepsis And Septic Shock Flashcards

1
Q

Sepsis heart rate

A

> 90/min

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2
Q

Sepsis resp rate

A

Tachypnea

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3
Q

Sepsis mental status

A

Altered

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4
Q

Sepsis plasma glucose

A

> 140 mg/dL in absence of diabetes

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5
Q

Sepsis inflammatory variables

A

Leukocytosis (WBC >12,000), leukopenia (WBC 10% immature forms

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6
Q

Sepsis hemodynamics

A

Arterial hypotension (SBP 40)

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7
Q

Sepsis renal

A

Acute oliguria, creatinine increase >0.5

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8
Q

Sepsis coagulation

A

INR >1.5 or aPTT >60 sec

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9
Q

Sepsis GI

A

Ileus (absent bowel sounds)

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10
Q

Sepsis platelets

A

Thrombocytopenia (

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11
Q

Sepsis bilirubin

A

Hyperbilirubinemia (>4)

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12
Q

Sepsis tissue perfusion

A

Hyperlactatemia (>1), decreased capillary refill, mottling

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13
Q

Sepsis temperature

A

Fever (>38.3) or hypothermia (

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14
Q

Shock

A

widespread abnormal cellular metabolism that occurs when oxygenation and tissue perfusion needs are not met to the level necessary to maintain cell function; “whole body” response

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15
Q

Shock is a “syndrome”

A

the cellular, tissue, and organ events occur in a predictable sequence and can begin with any problem that impairs oxygen delivery to tissues and organs

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16
Q

Distributive shock

A

occurs when blood volume is not lost from the body, but is distributed to the interstitial tissues where it cannot circulate and deliver oxygen

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17
Q

Chemical-induced distributive shock

A

occurs when certain body chemicals or foreign substances in the blood and vessels start widespread changes in blood vessel walls

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18
Q

Sepsis

A

widespread infection that triggers a whole-body inflammatory response; leads to distributive shock when infectious microorganisms are present in the blood

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19
Q

Systemic Inflammatory Response Syndrome (SIRS)

A

inflammatory responses become enemy; leads to extensive hormonal, tissue, and vascular changes and oxidative stress; further impairs oxygenation and tissue perfusion; has short duration; manifestations are subtle; can be reversed if treated aggressively at this stage

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20
Q

Pt that meets sepsis with SIRS criteria

A

notify health care provider or the Rapid Response Team

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21
Q

Severe sepsis

A

all tissues are involved ad are hypoxic to some degree; some organs are experiencing cell death and dysfunction; pt may “look” better; aggressive interventions can still prevent septic shock; mortality is high; rapid downhill course to septic shock

22
Q

Clinical manifestations of severe sepsis

A

lower oxygen saturation; rapid resp rate; decreased to absent urine output; change in cognition and affect; widespread bleeding

23
Q

Septic shock

A

multiple organ failure; uncontrolled bleeding occurs; even with intervention, death rate in this stage is >50%; hypovolemic shock and hypodynamic cardiac function are present; capillary leak continues and cardiac contractility is poor

24
Q

Risk for sepsis and septic shock

A

malnutrition, immunosuppression, large open wounds, mm fissures in prolonged contact with bloody or drainage soaked packing, GI ischemia, exposure to invasive procedures, malignancy, older than 80 yo, infection with resistant microorganisms, cancer chemo, alcoholism, DM, CKD, transplantation recipient, hepatitis, HIV/AIDS

25
Q

Prevention - during care

A

aseptic technique; remove lines and drains asap; assess VS often; monitor lab values (esp lactate, WBC, and differential)

26
Q

Hallmark of sepsis (left shift)

A

increasing serum lactate level, normal or low WBC, and decreasing segmented neutrophil with rising band neutrophil

27
Q

Prevention for at risk pts - home

A

teach manifestations of local infection; teach how to use a thermometer; take temp 2x daily and when not feeling well; contact health provider if s/s sepsis arise; take full course of any prescribed abx

28
Q

Patient history for sepsis

A

age, medical history, drugs taken in the past week (some drugs may cause changes leading to shock; drug regimen may indicate a disease or problem that can contribute to sepsis [aspirin, abx, cancer therapy drugs])

29
Q

Cardiovascular manifestations of sepsis

A

early sepsis: decreased cardiac output and BP; Severe sepsis: increased cardiac output, HR, and BP, DIC, decreased oxygenation, increased risk for hemorrhage; septic shock: hypovolemia, decrease in cardiac output, BP, pulse pressure

30
Q

Respiratory manifestations of sepsis

A

RR increases, resp depth increases, ARDS may occur (caused by SIRS)

31
Q

Skin manifestations of sepsis

A

hypodynamic stages: blood is shunted away from the skin, pallor, cyanosis, or mottling; hyperdynamic stage: skin is warm and no cyanosis; septic shock: skin is cool and clammy with pallor, mottling, or cyanosis; DIC: petechiae and ecchymoses, blood may ooze

32
Q

Kidney manifestations of sepsis

A

low urine output compared with fluid intake indicates shock; kidney function decreases and serum creatinine levels increase

33
Q

Psychosocial manifestations of sepsis

A

change in affect or behavior, may seem slightly different in reaction to greetings, comments, or jokes, less patient, restless, fidgety, “I feel as if something is wrong, but I don’t know what”

34
Q

Laboratory findings with sepsis

A

bacteria in blood from culture; DIC causes decreased Hct, Hgb, fibrinogen, platelets; serum lactate is elevated; serum bicarb is decreased, low activated protein C; elevated plasma D-dimer; IL-6 elevate; IL-10 remain normal or decrease; blood calcitonin elevates

35
Q

Blood procalcitonin (PCT)

A

increases when bacteria enter the blood stream and continues to rise as the blood bacterial concentration increases; can be an indication of therapy effectiveness as the levels drop

36
Q

Sepsis Bundle: to be completed within 3 hrs of presentation

A
  1. measure lactate level
  2. obtain blood cultures prior to abx administration
  3. administer broad spectrum abx
  4. administer 30 mL/kg crystalloid for hypotension or lactate >4 mmol/L
37
Q

Sepsis Bundle: to be completed within 6 hrs of presentation

A
  1. administer vasopressin for hypotension that does not respond to initial fluid resuscitation to maintain MAP >65
  2. In the event of persistent hypotension after initial fluid administration (MAP
38
Q

Documentation of reassessment of volume status and tissue perfusion

A

EITHER: repeat focused exam after initial fluid resuscitation including VS, cardiopulmonary, cap refill, pulse, and skin findings
OR two of the following: measure CVP, measure ScvO2, bedside cardiovascular ultrasound, dynamic assessment of fluid responsiveness with passive leg raise or fluid challenge

39
Q

Oxygen therapy for sepsis

A

given via mask, hood, nasal cannula, nasopharyngeal tube, endotracheal tube, or tracheostomy tube; more likely to be mechanically ventilated

40
Q

Drug therapy for sepsis

A

IV antibiotics, corticosteroids, vasoconstrictors, inotropic agents, insulin therapy, heparin therapy, synthetic activated protein C, blood replacement therapy

41
Q

Home care management for sepsis

A

Assess pt for clinical manifestations of infection; assess pt and caregiver’s adherence ot an understanding of infection prevention techniques; assess home environment (cleanliness, soap availability, pets)

42
Q

Patient teaching for sepsis

A

avoid crowds; do not share utensils or bathroom articles; bathe daily; wash pits, groin, genitals, rectal area 2x daily with antimicrobial soap; run toothbrush through dishwasher or bleach 2x weekly; wash hands frequently; wash dishes with hot soapy water or use dishwasher; do not drink water that has been standing >15 min; do not reuse cups/glasses; do not change litter box; take temp 2x daily; refrigerate and prepare food appropriately; report s/s infection immediately; do not garden; use antibacterial cleansers to clean kitchen and bathroom 2x weekly; use condom; take drugs as prescribed

43
Q

Transfusion therapy: before infusion

A

assess lab values; verify prescription; assess VS, output, skin color, and hx of transfusion reaction; obtain venous access with central cath or 20-gauge needle; obtain blood product from blood bank (transfuse asap after safety checks)

44
Q

Transfusion therapy: during infusion

A

administer product using appropriate filtered tubing; dilute blood products with only NS; remain with pt for 15-30 minutes of infusion; infuse at prescribed rate; monitor VS; never infuse or add other drugs with blood products

45
Q

Transfusion therapy: after infusion

A

discontinue infusion; dispose of bag and tubing properly; document

46
Q

Drug therapy: ceftriaxone

A

inhibits bacterial cell wall synthesis, causing cell death; bactericidal effect; take with food if GI upset

47
Q

Drug therapy: ciprofloxacin/levofloxacin

A

bactericidal action on gram-positive and -negative; drink 6-8 glasses water daily; avoid caffeine; avoid operating hazardous machinery; photosensitivity is side effect; report dizziness, nausea, vomiting, diarrhea, flatulence, abd cramps, tinnitus, rash, tendon rupture

48
Q

Drug therapy: dobutamine

A

increases myocardial contraction; increases heart rate; increases blood pressure; avoid abrupt discontinuation; monitor intake/output; assess for chest pain

49
Q

Drug therapy: norepinephrine

A

vasoconstrictive actions; used in place of dobutamine; added to D5W or NS; continuously monitor cardiac and BP; taper slowly; assess IV site; extravasation causes tissue necrosis

50
Q

Drug therapy: epinephrine

A

causes bronchodilation, enhanced cardiac performance, and vasoconstriction (to improve BP); monitor for tachycardia, cardiac dysrhythmias, HTN, and angina

Unit 4 (4 decks)

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