Multiple Organ Dysfunction Syndrome (MODS) Flashcards
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
MODS
Infection
Surgery
Shock episode
Acute pancreatitis
Sepsis
Burns
Aspiration
Multiple blood transfusions
Surgical complication
High-Risk Populations - runs across the board
Primary:
Secondary:
Cause - 2 categories
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
Primary:
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
Secondary:
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
CM
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
Gastrointestinal
Jaundice
Hepatomegaly
Increased serum bilirubin (hyperbilirubinemia)
Increased liver enzymes
Increased serum ammonia
Decreased serum transferrin
Liver
Right upper quadrant tenderness or pain
Abdominal distention
Unexplained fever
Decreased bowel sounds
Gallbladder
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
Metabolic and Nutrition
↓ PAOP
↓ SVR
↓ CVP
↓ LVSWI
↑ oxygen consumption
↑ CO & CI
↑ HR
Cardiovascular - Hyperdynamic
↑ SVR
↑ CVP
↑ LVSWI
↓ oxygen delivery and consumption
↓ CO & CI
Cardiovascular - Hypodynamic
Lethargy
Altered level of consciousness
Fever
Hepatic encephalopathy
Central Nervous System
Thrombocytopenia
Disseminated intravascular coagulation
Coagulation or Hematologic
Infection
Decreased lymphocyte count
Anergy
Immune
ARDS
Pulmonary hypertension
Pulmonary
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
Kidney
Focused on Identification and treatment of the underlying source of inflammation or infection
Maintenance of tissue oxygenation
Nutritional and metabolic support
Medical management
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
Focused on Identification and treatment of the underlying source of inflammation or infection
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
Maintenance of tissue oxygenation
The goal of nutrition support is the preservation of organ structure and function - adequate nutrition so have fuel to heal
Nutritional and metabolic support
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.
Nursing management
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.
Support oxygen transport
Identify and correct cause of lactic acidosis.
Ensure adequate organ and extremity perfusion.
Support oxygen use
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
Decrease oxygen demand
Remove infected organs or tissue.
Administer antibiotics.
Initiate nutrition support.
Identify underlying cause of inflammation and treat accordingly
Gastrointestinal
Hepatobiliary
Pulmonary
Renal
Cardiovascular
Coagulation system
Treat individual organ dysfunction
