Sepsis

Question 1

sepsis

Answer 1

-constellation of symptoms in response to infection
-dysregulated response and new organ dysfunction related to infection
-body’s extreme response to infection

Question 2

criteria for sepsis….. suspected of confirmed infection with two of the following:

Answer 2

-fever (greater than 100.9)
-hypothermia (less than 97F)
-HR >90
-Tachypnea >22
-SBP <100 mm Hg
-altered mental status
-edema or positive fluid balance
-Hyperglycemia (>140 w/o diabetes)
-WBC >12k
-WBC<4k
-arterial hypotension (SBP <, MAP <70, decrease in SBP >40)
-acute oliguria
-serum creatinine increase
coagulation abnormalities
-ileus (absent bowel sounds)
-thrombocytopenia
-hyperbilirubinemia
-decreased cap refill; or mottling

Question 3

first sign of sepsis

Answer 3

respiratory

Question 4

infection sources for sepsis

Answer 4

pneumonia, UTI, ETtube, foley, etc

Question 5

what is the MAP needed for adequate perfusion

Answer 5

greater than 60

Question 6

what MAP indicated sepsis/ septic shock?

Answer 6

> 65

Question 7

risk factors for sepsis

Answer 7

-immunosuppression (cancer, AIDs, transplant, chronic steroids, Lupus)
-extremes of age (less than 1 year, greater than 65)
-malnourishment
-chronic illness (DM, Hepatitis, CKD)
-invasive procedures
-emergent and/or multiple surgeries

Question 8

treatment for sepsis (1 hour bundle)

Answer 8

-obtain lactate
-obtain blood cultures x2
-administer broad spectrum ABX
-30mL/kg crystalloid (LR) for hypotension or lactate >4
-administer vasopressors during or after fluid to maintain MAP >65 (even peripheral line in emergencies)
remeasure lactate if initial, lactate is elevated (>2)

Question 9

lactate

Answer 9

normal lactate = 0.5 -2.2
high lactate can lead to lactic acidosis and depresses major organs

Question 10

blood cultures

Answer 10

-usually 2 sites (b/c could have embolism on skin
-must fill bottle to what is labeled
-must do cultures before administering antibiotic
-draw aerobic first then anaerobic

Question 11

why do we give LR?

Answer 11

closer to blood pH

Question 12

what size IV do you use for IV fluids during sepsis?

Answer 12

20g or higher

Question 13

what to watch for when infusing IV fluids

Answer 13

-IV infiltration
-SOB/difficulty breathing
-BP response

Question 14

vasopressors

Answer 14

-used to support BP
-must be in ICU
-must be administered via central line b/c caustic to skin
-only used if you can’t get BP up after install intervention

Question 15

examples of vasopressors

Answer 15

-epinephrine, norepinephrine

Question 16

tool used to predict mortality

Answer 16

qSOFA

Question 17

What BP is unstable?

Answer 17

SBP less than 100

Question 18

qSOFA assessment tool

Answer 18

if 2 or more of the following criteria is positive = bad
-altered mental status
-respiratory rate >22
-SBP <100

Question 19

Systemic Inflammatory Response Syndrome (SIRS)

Answer 19

-generalized inflammation in organs remote from initial insult

Question 20

causes of SIRS

Answer 20

-sepsis/microbial invasion (bacteria, fungus, viruses, parasites, etc.)
-trauma (burns, crush injuries, surgical procedures)
-abscess formation (intraabdominal/extremities_
-ischemic or necrotic tissues (vascular disease)
-post cardiac arrest
-shock states

Question 21

goal of SIRS

Answer 21

prevent progression

Question 22

what happens if SIRS progresses?

Answer 22

leads to Shock/MODS

Question 23

SIRS criteria

Answer 23

-tachycardia (>90)
-tachypnea (>20)
-fever or hypothermia
-leukocytosis, leukopenia, or bandemia
-don’t need to have an infection to meet SIRS criteria

Question 24

inter professional care goals

Answer 24

1. prevention and treatment of infection
2. maintenance of tissue oxygenation
3. nutritional and metabolic support
4. appropriate support of failing organs

Question 25

what are central venous catheters?

Answer 25

-long flexible catheter that internally dumps contents in or near heart
-quick intervention, fast & accurate delivery of medications

Question 26

why use a central line?

Answer 26

-long term administration of medications (chemo, ABX)
-administration of vesicant medications (vasopressors/chemo)
-provide fluid or nutrition
-complete certain tests

Question 27

are femoral central lines good long term?

Answer 27

no, but good in emergency b/c don’t need X-ray to confirm placement

Question 28

central line associated blood stream infections

Answer 28

-blood stream infections caused from a central line
-can lead to sepsis, SIRS, & MODS if line and site are not properly cared for

Question 29

preventing CLABSIs

Answer 29

-insert with sterile technique
-wear clean gloves and perform hand hygiene before accessing
-change dressing every 7 days or when soiled (2Rn change)
-bathing in chlorhexidine wipes daily
-flush each port every shift
-0obtain MD order for blood draws
-change caps after each blood draw, blood administration, & daily with TPN
-use curos caps, scrub for 30 seconds
-remove central line when it’s no longer needed