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Adult Care 1 > Sepsis > Flashcards

Sepsis Flashcards

1
Q

which is NOT a part of the one hour bundle?
- Draw Lactate levels
-Obtain blood cultures
-Administer antibiotics
-Medicate for pain

A

medicate for pain

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2
Q

what is the 1 hour bundle?

A

-drawing lactate and blood cultures
-administering broad spectrum
antibiotics
-administering IV fluids
-giving vasopressors if needed

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3
Q

what lab is indicative of sepsis?
- decreased lactate
- increased lactate
-decreased potassium
-positive wound cultures

A

increased lactate

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4
Q

what are the hallmarks of sepsis?

A

rising serum procalcitonin levels
increasing serum lactate levels
abnormal white blood cell count

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5
Q

what does a rising serum procalcitonin level indicate?

A

inflammatory cytokine reponse

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6
Q

what should the nurse report to a HCP?
-pain at the surgical site
-serous drainage from surgical site
-mild edema surrounding surgical site
-redness of surgical site

A

redness- indicates infection

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7
Q

what is a priority action when adminisering antibiotics in a pt with sepsis?
-administer antibiotics within 2 hours
-obtain VS
-obtain informed consent
-ensure blood cultres were drawn

A

ensure blood cultures were drawn

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8
Q

which of the following indicates organ dysfuntion?
-temperature 97.5 F
-Capillary refill less than 3 seconds
-O2 sat 95%
-urinary output 15mL/hr

A

urinary output 15mL/hr

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9
Q

how many of the criteria are to be met to be considered SIRS?

A

2/4

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10
Q

the nurse is caring for a pt with suspected sepsis. the nurse knows that the following criteria is included in SIRS (systemic inflammatory reponse syndrome) criteria:
HR<80bpm
Elevated lactic acid levels
increased capillary refill
hypoglycemia

A

elevated lactic acid levels

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11
Q

which assessment findings would alert the nurse of the possibility of sepsis?
Inc HR, Inc, RR, and Inc BP
Inc HR, Inc RR, dec BP
dec HR, inc RR, dec BP
inc HR, inc RR, hypertensive crisis

A

increased HR and RR with a decreased BP

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12
Q

a nurse educating clients on sepsis prevention includes teaching that the risk of sepsis is increased with:
adequate nutrition
undergoing surgery
being 25 years old
having a hx of headaches

A

undergoing surgery

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13
Q

the nurse is caring for a client with sepsis. the nurse should question orders for
blood cultures
lactate levels
central venous pressure monitoring
administration of a vasodilator

A

administration of a vasodilator

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14
Q

when caring for a client with sepsis, the nurse knows that the following should be performed first:
give a broad spectrum abx
give a narrow spectrum abx
obtain blood cultures
obtain a type and cross match for blood products

A

obtain blood cultures

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15
Q

at what stage of the sepsis spectrum may a client look better?
sepsis
severe sepsis
septic shock
organ failure

A

severe sepsis

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16
Q

when caring for a client with sepsis, the nurse knows that the pathophysiology of sepsis includes
vasoconstriction
hyoxia
decrease in pro-inflammatory cytokines
decreased utilization of clotting factors

A

hypoxia

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17
Q

the nurse caring for a client with sepsis knows that an elevated lactic acid level indicates
cellular hypoxia
infection
increased bleeding risk
decreased kidney function

A

cellular hypoxia

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18
Q

the nurse caring for a pt with sepsis knows that a gram-negative bacteria is most likely cause. gram-negative bacteria does NOT include:
psudomonas auruginosa
escherichia coli
klebisiella
staphylococcus

A

staphylococcus

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19
Q

the nurse is caring for a client who has sepsis and is hypotensive. the nurse should give the following of amount of fluids intravenously
30mL/kg
35mL/kg
40mL/kg
45mL/kg

A

30mL/kg

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20
Q

What is the sepsis spectrum?

A

SIRS, sepsis, septic shock, mods, death

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21
Q

What is SIRS?

A

Systemic inflammatory response syndrome

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22
Q

How is SIRS Dx?

A

Two of the four:
- body temp >100.5 or <96.8
-HR>90bpm
-RR>20 or PaCO2<32 mmHg
-leukocyte count >12k or <4k or >10% immature bands

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23
Q

What is sepsis

A

SIRS and confirmed infection, no longer localized->infection spreads system wide

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24
Q

What are s/s of septic shock?

A

Warm:compensated, low systemic vascular resistance,increased/ normal CO, warm extremities, reduction in cap refill
Cold: decompensated, increased vascular resistance, decreased CO, cold extremities, blood shunted to core, hypotension, decreased O2 sat, rapid RR, decreased output, LOC changes

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25
Q

What stage of sepsis has the highest rate/risk of death than sepsis alone?

A

Septic shock

26
Q

What stage of sepsis may the patient “look better”?

A

Sepsis/early septic shock… pooling of blood and capillary leak stimulates increased CO, HR, SBP—> warm extremities and little to no cyanosis… WBC lower bc marrow can’t keep up

27
Q

What does septic shock require?

A

Vasopressor therapy to maintain at least 65mmHg AND have a serum lactate level of greater than 2mmol/L despite fluid resuscitation

28
Q

What complications may occur during septic shock?

A

MODS and ARDS

29
Q

What is MODS

A

2 or more organs that need medical intervention for homeostasis

30
Q

What is ARDS

A

Acute respiratory distress syndrome; caused by free radicals of oxygen that damage lung cells

31
Q

What is the inflammation process?

A

WBC->Cytokines->trigger local inflammation(constrict small veins and dilate arterioles in are to inc perfusion)-> increased WBCs->kill bacteria->inflammation ceases when infection is gone.

32
Q

What is septic shock?

A

Subset of sepsis where there are circulatory, cellular, and metabolic abnormalities that increase the risk of death over sepsis alone

33
Q

How do you check the progress of infection?

A

Look for a down-trend in ESR (normal= <20-23mm/hr) and CRP (normal= >1mg/dL); this tracks inflammation

34
Q

What is the fluid dosing for treating septic shock?

A

30mL/kg

35
Q

What two components make up septic shock?

A

Sepsis and hypotension

36
Q

Criteria for SIRS

A

Body temp, HR, RR, WBC count

37
Q

What must the body temp be to meet SIRS criteria?

A

Above 100.5 or below 96.8

38
Q

What must the HR be to meet SIRS criteria?

A

Above 90 (tachycardia)

39
Q

What must the RR be to meet SIRS criteria?

A

Above 30bpm or PaCo2 <32mmHg

40
Q

What must the WBC count be to meet SIRS criteria?

A

Above 12,000 or below 4,000 or greater than 10% immature bands

41
Q

Where is the invading organism usually at?

A

Tissues rather than the blood, WBC must get into tissues=vasodilation=dec vascular resistance, capillary leak=edema=harder to oxygenate cells

42
Q

If you are not able to clear the infection locally, what develops?

A

Early sepsis
Mild hypotension
Inc RR
Mild low urinary output
Fever varies
Microthrombi forming
Hyperdynamic cardiac function(blood pools so skin=warm to touch)

43
Q

Late sepsis

A

DIC and hypoxia
Anaerobic metabolism- metabolic acidosis
Increased stress on body=inc cortisol=hyperglycemia
The more severe the response = the higher the glucose
Rapid RR
Decreased/absent urinary output
LOC changes
WBC elevated or normal (exceeding available WBC)

44
Q

Septic shock components

A

Organ dysfunction
Require vasopressor to maintain MAP of at least 65 and serum lactate greater than 2

45
Q

Warm shock

A

Compensated stage of shock
Systemic vascular resistance low
Normal/inc CO
Warm extremities
Cap refill normal

46
Q

Cold shock

A

Decompensated stage
Peripheral vascular resistance inc
Shunt blood to non vital organs
Cold extremities
Low CO
Delayed cap refill
Organ dysfunction and organ failure
Uncontrolled bleeding may occur

47
Q

MODS signs

A

Low BP, CO
Tachycardia
Cool,clammy, mottling skin
Cyanosis
Hypotensive despite fluids
Poor clotting uncontrolled bleeding

48
Q

Who are at risk for sepsis

A

Immunocompromised, open wounds, central lines, malnutrition, older than 80, DM, invasive procedures, hepatitis, transplants, cancer, alcoholism, HIV/AIDS

49
Q

what is the qSOFA

A

Quick sequential organ failure assessment

50
Q

What does the qSOFA look at

A

SBP less than 100
RR > 22
Change in LOC
Scores 2 or 3=needs an in depth screening

51
Q

What is the SOFA

A

Sequential organ failure assessment

52
Q

Where is the SOFA used

A

ICU

53
Q

qSOFA used in

A

Non ICU settings

54
Q

What does the SOFA look at?

A

Resp effort
PLT count
Liver function (bilirubin)
Hypotension
Neurological GCS
Renal (creatinine)
Scored 1-4
The higher the score, the higher the pt is at risk for organ failure/poor outcome/death

55
Q

Ideal SOFA score

A

1 or less

56
Q

Sepsis labs

A

WBC(inc)
PLT/clotting factors(low)
Lactate(inc)
Procalcitonin(inc, bacterial infection)
BUN/Creatinine
Hemoglobin and Hematocrit(changes in late sepsis)
Blood cultures
ABGs

57
Q

One hour bundle

A
  1. Measure lactate level
  2. Obtain blood cultures before abx admin
  3. Admin board spectrum abx
  4. Begin rapid admin of 30mL/kg crystalloid for hypotension or lactate > or equal to 4 mmol/L
  5. Apply vasopressors if hypotensive during or after fluid resuscitation to maintain MAP of 65 mm Hg or greater
58
Q

ABG values

A

PH 7.35-7.45
PaCO2 45-35 (resp)
HCO3 22-26 (metabolic)

59
Q

HCO3 is associated with… in ABGs

A

Metabolic

60
Q

PaCO2 is associated with… in ABGs

A

Respiratory

61
Q
A

Adult Care 1 (6 decks)

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