Sepsis Flashcards
What is Sepsis?
A time critical medical emergency associated with tissue damage and organ disruption. Prompt recognition and abs tx reduced risk of avoidable death.
Signs and symptoms of Sepsis: Airway.
Dyspnoea. Increase RR >20. New productive cough.
S/S Sepsis: circulation.
Hypotension SBP <90. HR >90. Cap. Refill >3 secs. MAP <60. Cold/mottled peripheries.
S/S Sepsis: disability.
New onset confusion. Decrease in level of consciousness. Meninigsm. Pain in abdo/distension. Pain in joints.
S/S Sepsis: exposure.
Febrile >38•c. hypothermia <36•c. Purpuric rash. Rigors. Rec. exposure to invasive surgeries or procedures. Wound infections. Invasive lines.
S/S Sepsis: fluids.
Dysuria & other s/s of UTI.
Oliguria or total urine output <0.5ml/kg/hr.
S/S Sepsis: glucose.
Hypoglycaemia in pt with no Hx of DM.
Serum lactate: >2.
SOFA score: what is it?
Criteria for pts with diagnosed of suspected infection.
SOFA score: more than 2 indicates what?
Sepsis.
SOFA score ax what?
Dyspnoea.
Systolic hypotension.
Alt. Mental status.
SOFA score: RR score indicative of sepsis?
> 20
SOFA score: SBP of what indicates sepsis?
<90.
SOFA score: RR, SBP and what makes a score?
Alt. Mental status.
Pathophysiology of Sepsis: what triggers inflammatory response?
Invading MO
Pathophysiology of Sepsis: what causes a pt to have Rigors and to be febrile?
Pro-inflammatory response rises temperature of body to kill off MO.
Pathophysiology of Sepsis: what causes hypotension in Pts?
Vasodilation.
Stunning of heart muscles: causing decreases in SV, VR and CO
Pathophysiology of Sepsis: why is ⬆️ cell permeability bad?
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.
Pathophysiology of Sepsis:what causes ⬆️ RR
⬆️ 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.
Pathophysiology of Sepsis: what causes the increase in lactate in septic pt’s?
⬆️ glycolosis in skeletal muscles causes an excess of pyruvate: more than the citric acid cycle can handle so body converts this to lactate.
Pathophysiology of Sepsis: why do pt’s get rash?
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
what must nurse for if you suspect sepsis?
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.
Nursing: Position pt with sepsis means?
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.
