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NURS216B > Infection & Septic Shock I > Flashcards

Infection & Septic Shock I Flashcards

1
Q

What are the 2 steps of the nursing process for infection?

A
  1. Assess to diagnose

2. Get pathogen-specific

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2
Q

What 4 things to consider first when assessing?

A
  • “where is the illness”:
  • Sign and symptoms
  • Portal of entry
  • Immunity of the host (health history)
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3
Q

LATER SNAPS

A 
Location
Associated signs and symptoms
Timing (onset, duration, constancy)
Environmental/exposure factors
Relieving or alleviating factors
Severity/quantity
Nature/quality
Aggravating factors
Perspective of client
Significance to client
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4
Q

What are the three lab works to do next after the assessment?

A
  • Culture from source
  • CBC (complete blood count)
  • Antibody analysis
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5
Q

What to do after the culture result is out?

A

Identify the pathogen + classify the bacteria by iodine staining

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6
Q

E-coli, Klebsiella, Pseudomonas, Salmonella, Hib, Cholera, Syphillis, Gonorrhea, Nisseria M.

are examples of gram ____ bacteria

A

negative

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7
Q

Staphylococci, Streptococci (Pneumococci), Enterococci, Listeria, C-dif

are examples of gram ____ bacteria

A

positive

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8
Q

Empiric treatment is based on _______ bacteria

A

suspected (estimated pathogen, decision of antiinfection)

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9
Q

Why is it important to treat ASAP?

A

sepsis, severe infection, exhausted host

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10
Q

What are some considerations when treating infection?

A
  1. administration and distribution

2. patient’s complaints

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11
Q

4 side effects of antibiotics

A
  1. GI
  2. superinfection
  3. drug to drug interaction
  4. allergy
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12
Q

How is immunotherapy beneficial?

A

supply host with immunity

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13
Q

Immunotherapy has high efficacy for ______ infection

A

viral

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14
Q

Is immune globulin a biologic?

A

yes (antibiotics from donor)

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15
Q

Is immune globulin passive or active immunity?

A

passive

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16
Q

When should immune globulin be given?

A

shortly after exposure

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17
Q

What is the most common route for immunotherapy

A

IV (IVIG) (interferon alpha-2)

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18
Q

Immune globulin and cytokine are examples of

A

immunotherapy

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19
Q

What is the function of cytokines?

A

immune mediators that stimulate immune system (WBC synthesis, T cell stimulation)

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20
Q

Which is the main antibody found in breastmilk?

A

IgA

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21
Q

igA is specialized against?

A

intestinal infection

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22
Q

which is the main antibody that transfers readily from the other’s blood across the placenta?

A

igG

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23
Q

elderly have minimized ________

A

thymus gland

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24
Q

when does the thymus gland begin to atrophy (degenerate)

A

adolescence

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25
Q

elderly have decreased _____ and _____

A

WBC synthesis and specificity (B cells decreased differentiation –> autoimmune)

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26
Q

immunization is the administration of _____

A

antigen (dead or alive attenuated減弱的)

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27
Q

what do we want immunization to develop?

A

development of B cell antibodies

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28
Q

how does booster help?

A

increase recognition

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29
Q

what was the 1st successful immunization

A

smallpox virus

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30
Q

what are the 4 treatments for infections?

A
  1. prevention: immunization, boosters
  2. anti-infective therapy: antibiotic, antifungal
  3. immunomodulation: IVIG, cytokines
  4. surgery: removal of infected tissue
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31
Q

immune response occurs _____ to ____ and _____ to ____.

A

local to systemic (shock state)

general to specific (antigen-specific response)

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32
Q

is maternal-infant a passive or active immunity

A

passive

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33
Q

active immunity is ______ term and passive immunity is _____ term

A

long term; short term

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34
Q

how does infection lead to inflammation?

A

the infection leads to tissue damage –> acute inflammation

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35
Q

how fast is acute inflammation after infection?

A

within minutes

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36
Q

What’s the average maximum day for infection?

A

10 days

37
Q

chronic inflammation can lead to _______ and _____

A

organ dysfunction and necrosis

38
Q

why can inflammation lead to hypotension?

A

leakage of blood volume into tissues –> hypovolemia –> hypotension

39
Q

what does inflammation response activate?

A

endothelial cells, WBC, connective tissue cells, platelet

40
Q

septicemia means

A

pathogen is present in the blood

41
Q

A systemic inflammatory response can lead to

A

Sepsis

42
Q

what is sepsis

A

infection from any body part that causes an extreme inflammatory response

43
Q

sepsis is ______ a medical emergency

A

ALWAYS (shock if untreated)

44
Q

sepsis is pathogen in ____ or ____

A

blood or tissue

45
Q

sepsis causes vaso____

A

dilation

46
Q

what kind of infection causes 50% of sepsis?

A

respiratory infection

47
Q

meningitis, UTIs, skin infection, abdominal infection, surgical incisions, IV line contamination can cause

A

sepsis

48
Q

common pathogen for sepsis (state - or + and kind)

A

gram +, fungal, ANY pathogen can

49
Q

septic shock is presence of _______ and organ _____ in a septic patient

A

hypotension; hypoperfusion

50
Q

how does septic shock lead to overall ischemia (lack of o2 in blood)

A

hypotension –> hypoxia –> hypoxemia –> overall ischemia

51
Q

renal failure, disseminated intravascular coagulation, hyperglycemia

are often result from

A

septic shock

52
Q

distributive shock is also known as

A

vasodilatory shock or normovolemic shock

53
Q

distributive shock leads to ____ response, vaso

____, and ____shift.

A
  1. inflammatory response
  2. vasodilation
  3. fluid shift (plasma out –> swelling)
54
Q

what are the three types of distributive shock?

A
  1. septic (most common)
  2. anaphylactic
  3. neurogenic
55
Q

best treatment against sepsis & septic shock

A

empiric antimicrobial therapy

56
Q

in septic shock, mortality rises _____% per hour without antibiotics treatment

A

10

57
Q

mortality in septic shock is ____%

A

80

58
Q

＿＿＿＿ are pinpoint, round spots that appear on the skin as a result of bleeding.

A

Petechiae

59
Q

Things to consider when doing physics assessment on skin

A

Rash?
When did it start?
What’s the distribution?
What does it look like?

60
Q

What are the 8 ways to treat septic shock?

A
  1. Antimicrobial therapy (emperical to focal)
  2. Fluid resuscitation 500ml adult and 20ml/kg peds)
  3. Adrenergic/ inotropes: treat hypotension MAP>60mmHg (norepi, dopamine, dobutamine)
  4. O2 therapy: maintain >92% saturation
  5. Source control (e.g. appendectomy)
  6. Analgesia: tylenol, ibuprofen, opioids
  7. Treat complication
  8. Isolation
61
Q

are all sepsis caused by bacteria?

A

no; 70% failure rate

62
Q

what are the complications for sepsis/septic shock?

A 
renal failure
metabolic acidosis
GI
Hyperglycemia
DIC
Fever
63
Q

why there is a renal failure in sepsis/septic shock?

A

hypotension and organ hypoperfusion –> renal ischemia

64
Q

In humans, the kidneys together receive roughly __% of cardiac output.

A

20% of cardiac output

65
Q

how many minutes of ischemia can start to affect renal function?

A

15-20

66
Q

s&s of renal failure?

A

oliguria 少尿 (aka. less than 0.5 mL/kg/h)

67
Q

treatment of renal failure

A
  1. catecholamines (dopamine): improve renal blood flow and glomerular filtration rate
  2. fluid resuscitation: have enough fluid to be circulated
68
Q

______ _____ occurs when lactic acid production exceeds lactic acid clearance, caused by impaired tissue oxygenation.

A

Lactic acidosis

69
Q

s&s of metabolic acidosis

A 
Kussmaul respiration (hyperventilation)
headache
decreased BP
hyperkalemia
muscle twitching
warm flushed skin (vasodilation)
N&V, diarrhea
changes in LOC
70
Q

normal pH is ____ to ____

A

7.35 to 7.45

71
Q

how is pH balanced?

A

bicarbonate and hydrogen ions (H+)

72
Q

What happens intracellularly and to the lungs and renals when there is a failure to regulate pH?

A

intracellular: inflammatory reactions and cellular hypoxia increase anaerobic cellular metabolism (lactic acid as a byproduct)
lungs: increased in CO2
renal: decreased renal clearance of H+

73
Q

_____ and _____ are byproducts made for cellular metabolism

A

H20 and C02

CO2 reacts with water to produce a hydrogen ion.

74
Q

how to treat pH imbalances?

A
  1. ABCs
  2. underlying cause
  3. optimize oxygenation and ventilation to decrease C02
  4. check electrolytes (K can increase due to potassium shifts from cell)
  5. sodium bicarbonate (BUT can lead to fluid shift)
75
Q

What is responsible for fever in sepsis?

A

pyrogen and inflammation mediators in circulation (e.g. Cytokines)

stimulate hypothalamic thermoregulation

76
Q

how does sepsis lead to hyperglycemia?

A

hypotension –> tissue hypoxia –> decreased cellular metabolism and transport of glucose to cells

stress situation –> release cortisol and catecholamines –> hepatic glucose production = hyperglycemia

77
Q

how to treat hyperglycemia in sepsis

A

insulin IV and enteral nutrition

78
Q

why nutrition is given enterally not parenterally to treat hyperglycemia in sepsis

A

parenteral causes a further fluid shift

79
Q

how does sepsis lead to DIC?

A

tissue injury leads to activation of coagulation and decreased hepatic perfusion (aka. function)

80
Q

what is the function of the liver with regards to coagulation

A

produce plasmin for clot lysis and form coagulation factors

81
Q

how to treat DIC in sepsis?

A
  1. anticoagulants to inhibit thrombin (heparin, LMWH)

2. blood products (whole blood, platelets, vitamin K for clotting factors)

82
Q

why is there a risk of bleeding in sepsis?

A

widespread coagulation –> depletion of platelets and clotting factors –> risk of bleeding

83
Q

treatment of GI in sepsis

A
  1. nasogastric feeding
  2. PPI and H2 receptor antagonist
  3. antiemetics
84
Q

s&s of GI ischemia

A

N&V
abdominal pain
bowel necrosis
acute hemorrhage (2-10 days post)

85
Q

how does meningitis progress to shock?

A

meningitis –> meningcoccemia –> septic shock

86
Q

s&s of meningitis

A

NON SPECIFIC PRODROME

- headache, joint pain, vomiting, cough, sore throat

87
Q

s&s of meningeal bacteremia

A

rash (50% common) and seizure

88
Q

s&s of septic shock

A

cool extremities
hypotension
tachycardia

89
Q

GI ischemia will lead to ______________________, which increases GI acidity.

A

SNS activated mucosal vasoconstriction

NURS216B (6 decks)

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