Sepsis

Question 1

What is Sepsis?

Answer 1

A time critical medical emergency associated with tissue damage and organ disruption. Prompt recognition and abs tx reduced risk of avoidable death.

Question 2

Signs and symptoms of Sepsis: Airway.

Answer 2

Dyspnoea. Increase RR >20. New productive cough.

Question 3

S/S Sepsis: circulation.

Answer 3

Hypotension SBP <90. HR >90. Cap. Refill >3 secs. MAP <60. Cold/mottled peripheries.

Question 4

S/S Sepsis: disability.

Answer 4

New onset confusion. Decrease in level of consciousness. Meninigsm. Pain in abdo/distension. Pain in joints.

Question 5

S/S Sepsis: exposure.

Answer 5

Febrile >38•c. hypothermia <36•c. Purpuric rash. Rigors. Rec. exposure to invasive surgeries or procedures. Wound infections. Invasive lines.

Question 6

S/S Sepsis: fluids.

Answer 6

Dysuria & other s/s of UTI.
Oliguria or total urine output <0.5ml/kg/hr.

Question 7

S/S Sepsis: glucose.

Answer 7

Hypoglycaemia in pt with no Hx of DM.
Serum lactate: >2.

Question 8

SOFA score: what is it?

Answer 8

Criteria for pts with diagnosed of suspected infection.

Question 9

SOFA score: more than 2 indicates what?

Answer 9

Sepsis.

Question 10

SOFA score ax what?

Answer 10

Dyspnoea.
Systolic hypotension.
Alt. Mental status.

Question 11

SOFA score: RR score indicative of sepsis?

Answer 11

> 20

Question 12

SOFA score: SBP of what indicates sepsis?

Answer 12

<90.

Question 13

SOFA score: RR, SBP and what makes a score?

Answer 13

Alt. Mental status.

Question 14

Pathophysiology of Sepsis: what triggers inflammatory response?

Answer 14

Invading MO

Question 15

Pathophysiology of Sepsis: what causes a pt to have Rigors and to be febrile?

Answer 15

Pro-inflammatory response rises temperature of body to kill off MO.

Question 16

Pathophysiology of Sepsis: what causes hypotension in Pts?

Answer 16

Vasodilation.
Stunning of heart muscles: causing decreases in SV, VR and CO

Question 17

Pathophysiology of Sepsis: why is ⬆️ cell permeability bad?

Answer 17

Loss of intracellular fluid ➡️ loss of intercellular fluid ➡️ oedema and ⬇️ venous return due to vasodilation and ⬇️ c.o.
Causes endothelial dysfunction and micro circulation defects so blood can’t carry as much O2. o2 can’t get to major organs and causes organ distinction.

Question 18

Pathophysiology of Sepsis:what causes ⬆️ RR

Answer 18

⬆️ cell permeability.
⬇️ CO - not allowing O2 to circulate to major organs.
Acute Pulmonary Oedema (APO) & Acute Respiratory Distress Syndrome (ARDS)
Thicken blood due to ^ fibrin production makes O2 less likely to bind to RBCs.

Question 19

Pathophysiology of Sepsis: what causes the increase in lactate in septic pt’s?

Answer 19

⬆️ glycolosis in skeletal muscles causes an excess of pyruvate: more than the citric acid cycle can handle so body converts this to lactate.

Question 20

Pathophysiology of Sepsis: why do pt’s get rash?

Answer 20

Oedema causes clotting cascade activation which increases fibrin production. To pack together and clot holes in cells.
Fibronlytic pathway is suppressed and clots don’t break down.
Causes microthrombosis and blocks microvessels ➡️ poor perfusion

Question 21

what must nurse for if you suspect sepsis?

Answer 21

Act FAST.
Document clear communication if obs are not BTF commence thorough AG.
Pt may rapidly decline, increase freq. of obs (every 30 mins) stay w pt until back BTF.
Rapid response as per BTF criteria.
Position patient.
Commence Adult Sepsis Pathway.
Prepare for resuscitation.
Insert IVC and FBC.

Question 22

Nursing: Position pt with sepsis means?

Answer 22

Sats ⬇️: prop them in High Fowlers - admin 1-4 l/min via NP if ineffective 6-10 litres via Hudson Mask.

Hypotension: lay Pt on back with knees elevated.