Multiple Organ Dysfunction Syndrome (MODS)

Question 1

Description: Progressive physiologic failure of two or more separate organ systems. Hemostasis cannot be maintained without interventions.
Not the COPD pt who comes in and develops renal failure because of high dose abx therapy
Pt comes in with COPD and have systemic inflammatory response and that causes systemic inflammation and end organ perfusion issues and causes other organ systems to fail
High-Risk Populations - runs across the board
Cause - 2 categories
CM
Medical management
Nursing management

Answer 1

MODS

Question 2

Infection
Surgery
Shock episode
Acute pancreatitis
Sepsis
Burns
Aspiration
Multiple blood transfusions
Surgical complication

Answer 2

High-Risk Populations - runs across the board

Question 3

Primary:
Secondary:

Answer 3

Cause - 2 categories

Question 4

Consequence of initial insult.
Develops from injuries that cause severe systemic tissue ischemia, hypoxia, or inflammation. for example, asphyxiation, crush syndrome, and extreme hyperthermia - heat stroke
See in specific pops - something causes gen tissue ischemia, hypoxia, or inflammation
Drowning pt

Answer 4

Primary:

Question 5

Occurs as a result of the patient’s response to an illness, often sepsis, rather than a direct insult to the organ
Seen more often/common
Result of response to illness
Often after sepsis and other organs start to fail - because of inflammatory response

Answer 5

Secondary:

Question 6

Abnormal assessments of specific organ systems
MODS - pt needs to have 2 or more organ systems affects; 1+ sx from each list then diagnosed with it
Gastrointestinal
Liver
Gallbladder
Metabolic and Nutrition
Cardiovascular - Hyperdynamic
Cardiovascular - Hypodynamic
Central Nervous System
Coagulation or Hematologic
Immune
Pulmonary
Kidney

Answer 6

CM

Question 7

Abdominal distention and ascites
Intolerance to enteral feedings
Paralytic ileus
Upper or lower gastrointestinal bleeding
Diarrhea
Ischemic colitis
Mucosal ulceration
Decreased bowel sounds
Bacterial overgrowth in stool

Answer 7

Gastrointestinal

Question 8

Jaundice
Hepatomegaly
Increased serum bilirubin (hyperbilirubinemia)
Increased liver enzymes
Increased serum ammonia
Decreased serum transferrin

Answer 8

Liver

Question 9

Right upper quadrant tenderness or pain
Abdominal distention
Unexplained fever
Decreased bowel sounds

Answer 9

Gallbladder

Question 10

Decreased lean body mass
Muscle wasting
Severe weight loss
Negative nitrogen balance
Hyperglycemia
Hypertriglyceridemia
Increased serum lactate
Decreased serum albumin, serum transferrin, prealbumin, and retinol-binding protein

Answer 10

Metabolic and Nutrition

Question 11

↓ PAOP
↓ SVR
↓ CVP
↓ LVSWI
↑ oxygen consumption
↑ CO & CI
↑ HR

Answer 11

Cardiovascular - Hyperdynamic

Question 12

↑ SVR
↑ CVP
↑ LVSWI
↓ oxygen delivery and consumption
↓ CO & CI

Answer 12

Cardiovascular - Hypodynamic

Question 13

Lethargy
Altered level of consciousness
Fever
Hepatic encephalopathy

Answer 13

Central Nervous System

Question 14

Thrombocytopenia
Disseminated intravascular coagulation

Answer 14

Coagulation or Hematologic

Question 15

Infection
Decreased lymphocyte count
Anergy

Answer 15

Immune

Question 16

ARDS
Pulmonary hypertension

Answer 16

Pulmonary

Question 17

Increased serum creatinine and blood urea nitrogen
Oliguria, anuria, or polyuria consistent with prerenal azotemia or acute kidney injury
Urinary indices consistent with prerenal azotemia or acute kidney injury

Answer 17

Kidney

Question 18

Focused on Identification and treatment of the underlying source of inflammation or infection
Maintenance of tissue oxygenation
Nutritional and metabolic support

Answer 18

Medical management

Question 19

Infection = gangrenous great toe - surgery quicker rather than abx therapy for extended period
Surgical intervention to remove the source of infection
Appropriate antibiotics - get cultures and get specific abx for specific infection; not do broad spectrum

Answer 19

Focused on Identification and treatment of the underlying source of inflammation or infection

Question 20

Upmost importance
No maintain - organs that failing will not have enough O2 rich blood to heal
Maintain adequate oxygenation to maintain oxygen delivery/oxygen consumption balance
Sedation, mechanical ventilation, rest, temperature & pain management decrease
Proning - promote alveoli on posterior surface of the lungs

Answer 20

Maintenance of tissue oxygenation

Question 21

The goal of nutrition support is the preservation of organ structure and function - adequate nutrition so have fuel to heal

Answer 21

Nutritional and metabolic support

Question 22

Mirrors medical management - focus on oxygenation and ventilation
Administer meds as prescribed
Decrease O2 demand - make sure pt properly sedated - not too deep but not too wake where respond to external stimuli
Vigilant in reviewing labs and letting provider know the trends of the labs - WBC that starting to trend up - need to treat early
Support oxygen transport
Support oxygen use
Decrease oxygen demand
Identify underlying cause of inflammation and treat accordingly
Treat individual organ dysfunction
Prevent and maintain surveillance for complications, particularly infection.
Provide comfort and emotional support.

Answer 22

Nursing management

Question 23

Establish a patent airway.
Initiate mechanical ventilation.
Administer oxygen.
Administer fluids (crystalloids, colloids, blood, and other blood products).
Administer vasoactive medications.
Administer positive inotropic medications.
Administer antidysrhythmic medications.
Ensure sufficient hemoglobin and hematocrit.

Answer 23

Support oxygen transport

Question 24

Identify and correct cause of lactic acidosis.
Ensure adequate organ and extremity perfusion.

Answer 24

Support oxygen use

Question 25

Administer sedation or paralytics.
Administer antipyretics and external cooling measures and use cooling blankets - maintain normal caloric temp
Administer pain medications. - manage pain
Without these - increase metabolic demand which increases O2 demand

Answer 25

Decrease oxygen demand

Question 26

Remove infected organs or tissue.
Administer antibiotics.
Initiate nutrition support.

Answer 26

Identify underlying cause of inflammation and treat accordingly

Question 27

Gastrointestinal
Hepatobiliary
Pulmonary
Renal
Cardiovascular
Coagulation system

Answer 27

Treat individual organ dysfunction