M7 Immunity 2 Flashcards
MODS
Multiple organ distress syndrome
MODS is characterized by
failure of a t least 2 major organs
hemostasis cannot be achieved without intervention
SIRS leads to _ leads to
MODS
Shock
Causes for mods
Severe injury or illness
Muscle or tissue trauma
Shock
Which shock is most common with mods
Septic
MODS Patho
Uncontrolled inflammation
Vasodilation
Protein mediators leak into interstitial space
Coagulation cascade activates
Hypotension leads to decreased perfusion/micro emobli
this decreases flow to
Lungs
Kidneys
Heart
Liver
MODS leads to ARDs
Acute respiratory distress syndrome 101
Increased capillary permeability
Fluid moves from vessels to alveoli, edema
Surfactant decreases, alveoli collapse
ARDs is indicated by
VQ mismatch
Pulmonary hypertension
Increased resp rate
hypoxia
Bilateral infiltrates
Cardiac mods symptoms
Myocardial depression
BP Drop
Increased HR
Increased permeability causes albumin to go into tissue with fluid
Neuro MODS symptoms
Confusion agitation combativeness letharby
Renal MODS symptoms
AKI
RAAS system stimulation
Aldosterone mediated Sodium and water reabsorption
Tubular necrosis
GI and MODS
Mucosal ischemia
GI Bleed
Hepatic and MODS
Hepatic Encephalopathy
Diagnostics for mods
12 lead EGK
Echocardiography
Stress tests
Immaging for MODS
Xray
CT
MRI
Labs for mods
Lytes
CBC
Renal panel
Liver panel
Cardiac biomarkers
Thyroid
Coagulation factors
MODS medical history
recent injury/surgery
chronic illness - aids, copd, cancer etc.
immunosuppressant meds
MODS interventions
Tissue oxygenation
Volume management
Nutrition management
Organ support
Support for organs
Dialysis or CRRT
Ventilation
When is care withdrawn
Three or more organ systems worsen despite intervention
Death is inevitable with doctor judgment
Life support major interventions
Ventilator
Dialysis
TPN
Blood transfusion
Lab work
Withdrawal of care
Obtain DNR
Start comfort meds
Care for fam
Talk to social work/chap
document
Comfort meds
Fentanyl
Hydromorphone
Propofol
2 Major contributing infections to sepsis
UTI
Pneumonia
Biggest lab value for sepsis
LACTATE
What does lactate indicate
Switching from aerobic to anaerobic metabolism = inflammation
Skin problems that can lead to spesis
Pressure ulcers
Cellulitis
3 Biggest sepsis bacteria
Staph
Strep
E. Coli
Why are diabetics at risk for sepsis
Bacteria love sugar
Best thing to start first with sepsis
Fluids
Hyperbaric therapy used for wounds
why and how
helps wounds health
provides 100% oxygenation to the wound
How soon do you need to do CBC and Lactate cultures for sepsis
Within 6h
Aminoglycoside drugs names end in
can result in what toxicities
Myocin
Renal
Hearing
How to measure Aminoglycoside toxicity…
what labs
First measure Trough
Measure in hour to check Peak
BUN, Creatinine
Biggest number indicator of BP
MAP
Less than 65 PROBLEM
Is SIRS a disease
NO
its a syndrome, first stage of sepsis
Only reason for AIDS patients to get admitted to hospital
Overwhelming infection
Type of Pneumonia that is common with AIDS
Pneumocystis Jerovic
(PJP)
Once you have AIDS, if your CD4 goes up past 200 can you go back to HIV
NO
HIV pregnant mothers can only deliver via
C section
Meningitis that affects HIV pts
Cryptococcal meningitis
Very Dangerous
Skin cancer most common with HIV AIDS
Kaposi Sarcoma
Red spots all over skin
CDC Categories for HIV
Above 500 Cat A
Between 499 and 200 Cat B
Below 200 Cat C
ELISA HIV test is same name as
EIA
HIV Pneumonia jerovic treatment
Sulfamethoxazole trimethoprime
SMZ TMP
HIV Oral candidiasis treatment
Ketoconazole
Nystatin
Mycelex
CART
vs
HART
Combination antiretroviral
High antiretroviral
Best IV antiemetic
Zofran
Decreased cardia contractility results in a drop in stroke volume and cardiac output,
This leads to what other complications
Pulmonary congestion
Drop in body perfusion
Drop in heart perfusion
Cardiogenic shock S/S
Systolic BP below 90
Urine output below 30ml/h
Weak pulse
Cold clammy skin
Decreased bowel sounds
Mental and resp S/S of shock
confusion, lethargy
dyspnea, tachypnea, cyanosis
First line treatment for cardiogenic shock
Oxygenation
Fluids
Pain control
Hemodynamic monitoring
Monitor lab markers
Meds for cardiogenic shock
Dobutamine
Amrinone
Digoxin
Diuretics
Antiarrhythmics
Nursing management of cardiogenic shock
Monitor hemodynamics
Oxygenation
Admin IV fluids
Safety and comfort
Hemodynamic monitoring
I&O
Daily weight
MAP
CO
Swan-Ganz
Monitoring Heart changes with cardiac shock
ECG
Lytes
Oxygenation interventions with cardiac shock
Monitor respirations
Auscultate lungs
Observe for pink cough sputume
Admin O2
Elevate head
Perfusion monitoring with cardiac shock
Neuro checks
BUN/Creatinine
Temp
Arterial pulses
What to monitor with pulses
Rate Rhythm Quality
If there is a significant change in LOC with cardio shock
Report Immediately
Hypovolemic shock chain of path
Drop in volume
Drop in venous return
Drop in stroke volume
Drop in CO
Drop in perfusion
Dr. interventions for Hypovol shock
Treat cause
Give fluids
Give vasopressors
Nursing interventions for Hypovol shock
Admin fluids safely
Admin O2
Position for Hypovol shock
Modified Trendelenburg _/
Aneurysm
Abnormal bulging of vessels
Aneurysm types
Saccular
Fusiform
Major risks for anurisms
SMOKING
HYPERTENSION
Age over 55
Connective tissue disorders
Most common pain with anurisms
Left lower quadrant
Intense lower back
Other symptoms of anurisms
Syncope
Tachycardia
Hypotension
aka hammorrhage
Thoracic aortic aneurysm S/S
Trouble speaking, breathing and swallowing
Sharp ripping or tearing pain in anterior of chest shoulder or back indicates
Aneurism rupture
Nursing interventions for Aneurism
Prepare for MRI CT or XRay
Monitor for S/S of hypovolemic shock
Perform neuro checks
Post aneurism surgery interventions
Frequent vitals
Labs
Urine output
Bowel distension
Skin perfusion
labs to monitor post anurism surgery
CBC
MODS is a severe form of
Shock
Stages of shock
Initial
Compensatory
Progressive (failure of compensation)
Refractory (shift to end of life care)
First organ to get hit by MODS
Kidneys
Body holds on to sodium and water via what hormone
Aldosterone
EARLY signs of shock
1# CONFUSION
hypotension
MAP v
tachycardia
Hypoxia S/S
ON TEST
Restlessness
Irritability
Tachycardia
1 reason for ARDS
Pneumonia
Infection
Allographt transplants can be received from
Living
or
Cadaver
bodies
1 concern for organ transplants
Rejection
Med types for organ transplant
Corticosteroids
Antibiotics
Anticoagulants
Immunosuppressants
Most important part of organ transplant meds
Compliance
Normal CD4 count
HIV count
800-1000
below 200
Do we report HIV to health organizations
Is there and HIV vaccine
YES
YES, not a live one
HIV Neuro manifestations
LOC Changes
May be due to ENCEPHALOPATHY
Cryptococcus neoformans 101
S/S
Opportunistic neuro disease that prays on HIV patients
Stiff neck
Seizures
Mental changes
Fever
Most common HIV infection
S/S
Pneumonia
fever, chills, non productive cough
What to assess with HIV patients
Albumin, weight, BMI- malnutrition BIG problem
Biggest factor of HIV is viral load, the higher
the greater the progression to AIDS
HIV Precaution
Contact and standard
Where to take HIV PTs X rays
In room instead of lad to limit exposure
If HIV needlestick
Report to ED Immediately
Viral meds start w/in 2h of stick for at least 4 weeks
HIV penumonia treatment
Trimethoprim sulfamethoxazole
Pulmonary care - cough, deep breaths, postural drainage Q2H
Sulfamethoxazole trimethoprim side effect
Hyperkalemia
How to manage HIV Viral load
TAKE MEDS REGULARLY
How does HIV pneumonia start
Perianal and oral mucosa infections
Thrush/fungus
Skin integrity
HIV GI problems
Oral candidiasis
Diarrhea
Wasting syndrome
Most common HIV tests
EIA
Western Blot - confirms EIA
HIV Transmission
Sex
IV drugs
Birth
HIV Is transmitted in body fluids including
Amniotic fluids
Breast milk
blood
semen
vagina semen
1 med o promote nutrition
MEGACE (Megestrol)
ON TEST
10% weight loss
Chronic diarrhea
Weakness
Fever
and NO OTHER CUASE =
HIV wasting syndrome
A/B of MODS
metabolic ACIDOSIS
body going into anaerobic metabolism INCREASES lactic acid
1 organ to fail with MODS
Kidneys
Compensatory stage of mods S/S
VASOCONSTRICTION
cool clammy skin - body shunts blood from core
acidosis
Progressive stage of mods S/S
VASODILATION
hypoperfusion
Normal MAP is more than
60
Nutritional management for encephalopathy
Small frequent meals
Daily protein between 1.2-1.5 g/kg
protein is good
Lytes with encephalopathy
what to do
Hypokalemia
give lactulose
With encephalopathy and increasing ammonia first symptom is
LOC - SLEEPINESS
stupor
impaired thinking
Second encephalopathy S/S are
neuromuscular
Asterixis - liver shakes
Hyperreflexia
Too much lactulose would be indicated by
Diarrhea
Hypokalemia
Dehydration
How do you know lactulose is working
2-3 soft stools per day ***
For MODS and shock you want MAP to be
Greater than 65
Other things to maintain with MODS and shock
pH
Liver/GI function
Kidney function
watch for onset of DIC
Once multiple organs start failing
Switch care to comfort
If pt is an organ donor keep map at
100
or high as possible
Goal of family care
Keep fam informed of situation and process
SIRS glucose
Will be over 120 w/o Diabetes or other explanations
SIRS age risk categories
Adult over 65
Kid under 1
SIRS biggest infection causes
UTIs
Pressure ulcers
Most common bacteria types
Staph
Strep
Escherichia Coci
Consults for discontinuation of life support
DNR
Social worker
Chaplain
Have Dr. explain
SIRS S/S of worsening
Difficulty breathing
Drop in urine output
Hyperglycemia
^in lactic acid
Edema
With SIRS we try to prevent
HYPOTENSION
Bottoming out
Bad temperatures
OVER 100.4
UNCER 96.8
Why does lactic acid increase with SIRS
anaerobic metabolism
Treat drop in BP
Saline bolus
Norepi
Dopamine
With septic shock. blood pulls to extremities so
Skin will be warm as opposed to EVERY OTHER shock
Septic shock risk reduction
Up to date vaccines
Proper wound care
Hand hygiene
NO delays in antibiotics
Prior to surgery give _ to maintain hydration
What kind of bath
What med to give 30 min prior
LR
CHG wipe bath
Antibiotic
urinary sign of organ rejection
drop in urine output
less than 30ml/hr
Labs with low urine
Elevated BUN/Creatinine
Organ transplant post op care
VS q15m
check wound
NPO
Hydration
MONITOR PISS OUTPUT less than 30ml/hr
post surgery uncontrolled pain
something is wrong
CALL DR
Post surgery moving pain
CO2 pain
only treatment is more movement
