Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Test 1 🏁 > Sepsis > Flashcards

Sepsis Flashcards

1
Q

what type of shock is septic shock?

A

distributive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the risk factors for sepsis?

A

People with weakened immune systems such as:
- pregnant patients (compensatory mechanism to prevent fetal rejection)
- Oncology patients
- Patients taking steroids chronically
- Asplenic patients
- Pre-existing infections
- Pre-existing co-morbidities (like diabetes or alcoholism)
- Severe injuries (such as large wounds)
- Invasive lines, drains and/or tubes
- Adults older than 65 years of age & the very young
- Patients who have had surgery or invasive procedures
- Hospitalized patients and sepsis survivors
- diabetes (bacteria loves sugar)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what organisms cause sepsis?

A

Bacterial
viral
fungal
parasite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Sepsis Patho

A
  • The body’s overwhelming & life-threatening response to infection which can lead to tissue damage, organ failure & death.
  • precipitating event> vasodilation > activation of inflammatory response> vasopermiability >fluid shifts (relative hypovolemia)> decreased venous return= decreased cardiac output> decreased perfusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what Qs should i ask or systems should i look for in order to identify early recognition?

A
  • Do I suspect a new or worsening infection?
  • Are there two or more SIRS present?
  • Are there signs of new organ dysfunction?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

list the s/s of sepsis
???

A
  • Hyperthermia > 38.3°C (100.9°F)
  • Hypothermia < 36° C (96.8°F)
  • Tachycardia > 90 bpm
  • Tachypnea > 20 breaths/minute
  • WBC count > 12,000µL or < 4,000µL
  • Normal WBC with >10% bands
  • increased Lactate
  • low urine output
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

sepsis nursing intervention

A
  • Initiate cardiac & pulse-ox monitoring
  • *VS (full set) q15m until stable
  • Administer oxygen as necessary to keep saturation > 92%
  • Place second IV for fluid resuscitation/dual antibiotic administration as necessary.
  • Complete fingerstick for blood glucose
  • Monitor renal function; ensure UOP is > 0.5ml/kg/hr
  • Monitor tissue perfusion; ensure capillary refill is < 2 sec.
  • lactate monitoring
  • Monitor changes in LOC
  • blood cultures (2 specimens)
  • sterile technique on all procedures
  • oral care
  • frequent position changes
  • nutritional support
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

sepsis medical management

A
  • 2 large bore IV
  • blood cultures (2 sets)
  • broad spectrum/ specific antibiotics
  • fluids
  • cardiac BP monitoring
  • serum Lactate monitoring
  • medication (vasopressors if fluid doesn’t work)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the 1 hour bundle (within 3 hours of admission)

A
  • Measure lactate level
  • Re-measure if initial lactate elevated >2 mmol/L)
  • Obtain blood cultures before administering ABX
  • Administer broad-spectrum ABX
  • Begin rapid administration of 30 mL/kg crystalloid for hypotension or lactate > 4 mmol/L
  • Apply vasopressors if hypotensive during or after fluid resuscitation to maintain MAP > 65 mmHg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Interventions after 6 hours

A
  • recheck lactate Q2h
  • admin vasopressors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

sepsis RN expectations

A
  • Screen Every Patient
  • At Triage - On Admit/Discharge/Transfer - Every shift (8h) - - When there is an acute change in the patient’s condition
  • Clear, SBAR communication with attending provider
  • Call Sepsis Alert/Code Sepsis
  • Initiate the Standardized Procedure
  • Facilitate Treatment
  • Follow Infection Control Measures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What Sepsis is NOT:

A
  • An infection
  • “Blood poisoning”
  • Contagious
  • Rare
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Common Infections

A
  • lung infection
  • a urinary tract infection
  • type of gut infection
  • a skin infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Sepsis Trajectory

A
  • SIRS
  • Sepsis
  • Severe Sepsis
  • Septic Shock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Sepsis definition

A
  • Infection
  • 2 or more SIRS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Sepsis cycle

A
  • Inflamation
  • Vasodilation
  • Vasopermeability
  • Activation of adhesion molecules
  • Coagulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

SIRS signs

A
  • Hyperthermia > 38.3°C (100.9°F)
  • Hypothermia < 36° C (96.8°F)
  • Tachycardia > 90 bpm
  • Tachypnea > 20 breaths/minute
  • WBC count > 12,000µL or < 4,000µL
  • Normal WBC with >10% bands
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is key to prevention

A

Early recognition

19
Q

Sepsis Screening Practice #1:

80 YOF admitted from ED for ABD pain, weakness, watery diarrhea, fever & chills
Pertinent VS: 38.9C (102F) , 112, 24, 110/70, 94% RA
Pertinent labs: WBC 15.4, Lactate 3.0

A
20
Q

Sepsis Screening Practice #2:

28 YOF arrives in ED, c/o pain in foot. Stumbled off curb the evening before. Trouble walking.
Foot painful, red, swollen & warm. Abrasion/avulsion noted to anterior lateral aspect of fifth metatarsal
Pertinent VS: 38.5C (101.3F), 98, 18, 125/70, 99% RA
Pertinent Labs: WBC 17.1, Lactate 4.0

A
21
Q

Sepsis is a CMS Core Measure

A

“Core Measures” are national standards of care & treatment for common medical conditions
These standards reduce complications & lead to better patient outcomes
The sepsis core measure is called “SEP-1”

22
Q

SEP-1

A
  • Focused on adult patients with severe sepsis or septic shock
  • Requires completion of time sensitive interventions called “bundles”
  • SEP-1is a composite measure, meaning if one element of care is missed, the entire case fails. (i.e. the hospital gets a lower score for compliance)
  • Performance is publically reported
23
Q

SCCM Hour-1 Bundle

A
  • Measure lactate level
    — Re-measure if initial lactate elevated >2 mmol/L)
  • Obtain blood cultures before administering ABX
  • Administer broad-spectrum ABX
  • Begin rapid administration of 30 mL/kg crystalloid for hypotension or lactate > 4 mmol/L
  • Apply vasopressors if hypotensive during or after fluid resuscitation to maintain MAP > 65 mmHg
24
Q

SEP-1 Requirements for Severe Sepsis & Septic Shock:
Within 3 HOURS from Time of Presentation (TOP):

A
  • Measure serum lactate
  • Obtain two sets of blood cultures (& source cultures as indicated)
  • Administer appropriate antibiotics
  • Administer crystalloid fluid bolus(es) for hypotension and/or lactate > 4 mmol/L
25
Q

SEP-1 Requirements for Severe Sepsis & Septic Shock:
Within 6 HOURS from TOP:

A
  • Re-measure elevated lactates every 2h until < 2.0 mmol/L
  • Administer vasopressors for hypotension not responding to fluid resuscitation
26
Q

TOP for Severe Sepsis is when a patient has all of the following (within 6 hours):

A
  • Suspected or confirmed infection
  • Two or more SIRS
  • One or more organ dysfunction criteria
27
Q

TOP for Septic Shock:

A
  • when a patient has a lactate > 4mmol/L or hypotension (two consecutive BPs) following a 30ml/kg IVF bolus.
  • TOP can occur at any point in a patient visit.
    — Commonly it’s the ED triage time (≈ 80% of patients)
    — Usually correlates with a positive sepsis screen
28
Q

Citric Acid Cycle: The Basics

A
  • Normal process in aerobic organisms
  • Middle of three major steps in cellular respiration
  • Series of chemical reactions which harvest energy for cells to use
  • When there isn’t enough cellular oxygen delivery cardiac output is redistributed so more oxygen can be extracted from capillary blood.
  • Enough oxygen can’t be extracted from capillaries to support aerobic metabolism so cells begin using anaerobic sources of energy
  • Results in lactate production which is why lactate is considered a surrogate marker for tissue hypoxia
29
Q

Lactate & Sepsis
Ranges:

A
  • Normal ≤ 1.0
  • > 2.0 is an indication of severe sepsis
  • 4 is an indication septic shock
30
Q

Serial lactates more important

A
  • Must re-measure within 6 hours if initial lactate >2 mmol/L
  • “Lactime” (duration lactate > 2mmol/L) is predictive of organ failure and mortality
31
Q

Types of Lactic Acidosis
TYPE A

A

Due to poor tissue perfusion or oxygenation (hypoxic)
- Ischemia
- Hypovolemia
- Cardiac failure/arrest
- Severe asthma, COPD
- Respiratory failure
- Sepsis

32
Q

Types of Lactic Acidosis
TYPE B

A

No apparent hypoperfusion (non-hypoxic)
- Delayed clearance
- Renal or hepatic failure
- DM
- Malignancy
- Medications
- Seizures

33
Q

Antibiotics

A
  • Communicate with treating provider & obtain order(s) for appropriate antibiotic(s).
  • Goal is to administer ABX within the first hour after recognition of sepsis/septic shock.
34
Q

Fluid Resuscitation

A
  • Give 30 ml/Kg crystalloid as a fluid challenge
  • Look for hemodynamic improvement.
  • Albumin when patients require substantial amounts of crystalloid
35
Q

Post-Bolus Assessment

A

In the event of persistent hypotension (MAP < 65) after initial fluid administration or initial lactate ≥ 4 reassess & document volume status & tissue perfusion by EITHER:
- Repeat focused exam including:
- VS
- Cardio/pulmonary status
- Cap refill
- Peripheral pulse evaluation
- Skin exam

36
Q

Two of the following:
???

A
  • Measure central venous pressure (CVP)
  • Measure central venous oxygen saturation (ScvO2)
  • Bedside cardiovascular ultrasound
  • Assess fluid responsiveness with passive leg raise or fluid challenge
37
Q

Additional Nursing Interventions

A
  • Initiate cardiac & pulse-ox monitoring
  • VS (full set) q15m until stable
  • Administer oxygen as necessary to keep saturation > 92%
  • Place second IV for fluid resuscitation/dual antibiotic administration as necessary.
  • Complete fingerstick for blood glucose
  • Monitor renal function; ensure UOP is > 0.5ml/kg/hr
  • Monitor tissue perfusion; ensure capillary refill is < 2 sec.
38
Q

Supportive Therapies

A
  • Corticosteroids
  • Blood Administration
  • Glucose Management
  • ARDS management
  • VTE Prophylaxis
  • Stress Ulcer Prophylaxis
  • Renal Replacement Therapy
  • Nutrition
  • Advanced Care Planning
39
Q

What if the Provider Doesn’t Implement the Guidelines?

A
  • Inform the provider that you are concerned for sepsis & ensure that the provider is aware of the positive sepsis screen
  • Document that you have communicated with the provider
  • Follow the ‘Chain of Command’ when you have concerns regarding the quality of clinical care
  • Continue to monitor the patient for worsening signs/symptoms & repeat the sepsis screen if you notice deterioration in the patients condition
40
Q

During Hospitalization

A

Patients often experience:
- Sleep deprivation
- Poor nourishment
- Pain & discomfort
- Deconditioning
- Increased risk for sepsis
- ICU Delirium

41
Q

What Might Recovery be Like?

A
  • Many individuals fully recover
  • Many others are left with long lasting effects, such as:
  • Missing limbs or digits
  • Organ dysfunction (like kidney failure)
  • Post-Sepsis Syndrome
  • Post Traumatic Stress Disorder
42
Q

Post-Sepsis Syndrome

A
  • Affects up to 50% of sepsis survivors
  • Effects are less obvious
  • Symptoms may include:
    — Impaired cognitive functioning
    — Difficulty concentrating
    — Extreme fatigue
    — Muscle/joint pain
    — Sleep disturbance
    — Nightmares/hallucinations/flashbacks/panic attacks/PTSD
    — Loss of self-esteem
43
Q

Case Review
17:18 (Report) 96 YOM recently admitted from ED for failure to thrive & progressive dysphagia. Now presenting with increased SOB, productive cough (thick white sputum) & watery diarrhea (+ c-diff). AOx3 (baseline). PMH includes esophageal stricture, HTN & stroke (six years prior) with residual right arm weakness.
18:02: (VS) 36.8C (98.2F), 102, 23, 152/77(102), 98% RA
18:54: (Pertinent Labs) WBC 14.6

A

Infection suspected/confirmed?
- Yes: c-diff+, & thick white sputum with cough & dysphagia
Signs/Symptoms Present:
- Three SIRS present: HR, RR, WBC Organ Dysfunction present: None
Sepsis or Septic Shock?
- Undetermined. Patient had positive sepsis screen but a lactate is needed to rule out all organ dysfunction criteria.
18:47: Lactate results at 2.6 mmol/L
- Organ dysfunction now present so this is TOP for severe sepsis.

Test 1 🏁 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions