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Pathophysiology > Sepsis > Flashcards

Sepsis Flashcards

1
Q

Key goals when recognizing and responding to sepsis

A
  • timely recognition of early infection
  • early treatment with antibiotics and IV fluids
  • appropriate escalation to ICU care
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2
Q

Inflammatory Cascade

A
  • Injury/infection
  • Activates cellular immune response
  • Complement protein and cytokines are manufactured
  • Results in increased blood flow
  • WBC to area
  • Consume foreign/injured cells
  • WBC release histamines that amplify and perpetuate the immune system
  • Fibroblasts repair tissue
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3
Q

SIRS

A

Systemic inflammatory Response Syndrome

Two of the SIRS criteria (HRTWA)

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4
Q

SIRS Criteria

A

HRTWA
H - heart rate greater than 90
R - Respiratory rate greater than 20 breaths per minutes
T - Temperature greater than or equal to 38 or less tan 36
W - WBC count greater than 12 or less than 4
A - Altered mental Status (GCS score < 15)

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5
Q

Symptoms of Respiratory Infection

A

Cough/sputum/chest pain/SOB

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6
Q

Symptoms of GI infection

A

Abdominal pain/distension/vomiting/diarrhea

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7
Q

Symptoms GI infection

A

Dysuria (pain while urinating)/frequency/indwelling catheter

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8
Q

Symptoms of MS Infection

A

Skin or joint pain/swelling/redness/mottled skin/cold extremities

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9
Q

Sepsis

A

Condition where the body’s response to infection damages its tissues and organs.
Can lead to multi-organ failure if not treated promptly
Sepsis = Suspected source + 2 of the SIRS criteria (HRTWA)

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10
Q

If patient has TWO of SIRS criteria and a suspected source of infection the nurse should…

A

Call physician and report assessment findings and discuss initiation of early sepsis investigation and treatment orders

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11
Q

4 Key Interventions for Sepsis

A
  1. Labs/Diagnostics
  2. Intravenous fluids
  3. Antibiotics
  4. Monitoring
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12
Q

Severe Sepsis

A
  • Patient is showing signs of hypo perfusion to one organ system (kidneys, brain, skin, abdomen)
  • severe sepsis = Sepsis + Hypo perfusion of 1 organ
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13
Q

Septic Shock

A
  • Severe sepsis with hypotension that does not resolve despite IV fluid resuscitation
  • Septic shock = severe sepsis + persistent hypotension
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14
Q

Intravenous Fluids:

A
  • Ensure at least #20 gauge IV access is in place
  • Start IV bolus
  • May insert second IV access as necessary
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15
Q

Antibiotics

A

IV Antibiotics
Do not wait longer than 30 minutes before administering
Early administration of broad spectrum until source of infection can be determined by culture and sensitivity.

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16
Q

How is Sepsis Treated?

A
  • Act fast to prevent sepsis from becoming septic shock
  • Follow an evidence-based best practice treatment “bundle”
  • Early administration of broad spectrum antibiotics
  • Early, aggressive administration of IV therapy
  • Blood cultures are drawn
  • early and repeated lactate measurements
17
Q

What labs do we always need to ensure are drawn in query sepsis?

A
  • Blood culture

- Serum lactate

18
Q

What other labs do you think we would need in Sepsis?

A
  • CBC
  • Chemistry panel
  • Liver function test
19
Q

Other diagnostic tests are:

A
  • Chest x-ray
  • ECG
  • Wound CNS
  • Identify suspected source
20
Q

Monitoring:

A
  • Vital signs
  • GCS
  • Urine output
  • Call MD if any deterioration of vs or decreased urine output (<25cc/hr)
21
Q

Call MD and ICU outreach team if:

A
  • RR <10 or >30
  • O2 sat < 90%
  • P<40 or >140
  • Systolic BP < 90mmHg
  • Sudden change in LOC
  • Urine output < 100mL in 4h
22
Q

QSOFA

A

Quick Sepsis-Related Organ Failure Assessment

23
Q

QSOFA Criteria

A
  • Resp rate > 22 breaths/min
  • Systolic BP < 100mmHg
  • Altered mental status (GCS < 15)
  • Lactate greater than 4 mmol/hg
24
Q

If patient develops TWO of three QSOFA criteria…

A

Call most responsible physician and inform him/her the patient has SEPSIS and possible SEPTIC SHOCK and needs immediate assessment

25
Q

Other supportive treatments (6)

A
  1. Minimize risk for hospital acquired infections
  2. Source control. Once source of infection has been identified
  3. Aggressive pulmonary management. Ensuring deep breathing and coughing. Incentive spirometry.
  4. Reduce oxygen demand. and optimize oxygen delivery
  5. Providing early and optimal nutrition
  6. Providing tight glycemic control. Doing glucose checks, using glucometer
26
Q

MODS

A

Multiple Organ Dysfunction Syndrome

- altered function in 2 or more organs

27
Q

MODS Treatment

A
  • Maintaining adequate tissue oxygenation is the principal target
  • Best strategy is to prevent MODS
  • This means preventing sepsis

Pathophysiology (8 decks)

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