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Nursing Acutely Ill > Sepsis > Flashcards

Sepsis Flashcards

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1
Q

What in sepsis/ infection causes the increase in core temperature

A

Macrophages, WBCs and injured tissue release pyrogens that act directly on the hypothalamus altering the internal thermostat to a higher temperature.

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2
Q

Examples of heat conserving mechanisms and their function

A

Vasoconstriction- directs blood away from skin surface, back into central circulation, to prevent heat loss from radiation and convection
Shivering- creates heat

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3
Q

Definition of a CRP test

A

C-reactive protein is a plasma protein who’s concentration increases during an inflammatory response

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4
Q

What are the 6 diagnostic indicators of sepsis?

A 
Elevated temperature. 
Warm dry skin. 
Bouncing pulse. 
Raised WBC count. 
Raised C-reactive protein. 
Positive blood cultures.
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5
Q

Pathway of inflammatory response from injury to healing

A

Injury
Histamine kinin release
White blood cell release with capillary leak
Debris phagocytosis with clotting and oedema
Redness, swelling, heat and pain
Blood supply and immobility
Healing

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6
Q

What is the purpose of inflammation?

A

Homeostatic response that aims to protect against infection

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7
Q

What is the tunica intima and what does it release during systemic inflammation?

A

Inner most layer of the arteries and veins.

Releases vasoactive chemicals

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8
Q

What do vasoactive chemicals do?

A

Vasodilation
Increase capillary permeability
Triggers clotting
Blood vessel capacity increases whilst central blood volume is decreased
Compromise of perfusion to organs
The state of pro-coagulation facilitates thrombus formation
Neutrophil activation increases oxygen consumption

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9
Q

Definition of sepsis

A

Life threatening organ dysfunction caused by a dysregulated response to infection

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10
Q

What happens in a dysregulated response to infection? And what is it known as?

A

The regulation of the inflammatory response has been lost resulting in high levels of pro-inflammatory mediators.
Systemic inflammatory response syndrome

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11
Q

How sepsis differ from infection?

A

Dysregulated inflammatory response and the presence of multi organ dysfunction.

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12
Q

What in the blood triggers the release of mediators from epithelial cells of the blood vessels?

A

Pathogens

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13
Q

What are example mediators?

A

Tumour necrosis necrosis factor
Interleukins
Nitric oxide
Platelet activating factors

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14
Q

What does the release of mediators trigger? 4things

A

Increased capillary permeability
Activation of the clotting cascade
Vasodilation
Neutrophil mobilisation

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15
Q

What in severe infection reduces cardiac output?

A

Radical oxide compounds

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16
Q

Following sepsis what are the clinical signs of septic shock?

A

Sepsis with persistent hypotension requiring vasopressors.

Lactate of more than 2mmol/L despite fluid resus

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17
Q

What are the systemic effects of sepsis?

A

Hypotension
Poor tissue perfusion leading to hypoxia
Free radical formation increasing capillary permeability resulting in hypovolaemia and odema
Leukocyte activation
Erythrocyte damage
Increased blood viscosity
Disseminated intravascular coagulation

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18
Q

In terms of heart rate, capillary permeability and fluid distribution what occurs during systemic inflammation? And why?

A

Heart rate increases to increase oxygen delivery to tissues
Vascular walls become more permeable allowing plasma proteins to seep out
Fluid moves from the intracellular and circulatory space into interstitial space

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19
Q

What is acute respiratory distress syndrome?

A

Wide spread inflammation of lungs

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20
Q

What does tachypnoea lead to?

A

Respiratory alkalosis

21
Q

What are the 3 abnormal blood results that indicate renal failure?

A

Metabolic acidosis.
Raised urea and creatinine
Hyperkalaemia

22
Q

What is tested for in the blood as an indication of renal failure?

A

Creatinine

23
Q

What is creatinine a biproduct of?

A

Muscle metabolism.

24
Q

Why does infection/illness cause transient hyperglycaemia?

A

Stress response to critical illness and chemicals such as corticosteroids and adrenaline.

25
Q

What does hyperglycaemia trigger the release of in terms of inflammation?

A

Proinglammatory cytokines

26
Q

What is a blood complication as a result of sepsis?

A

Disseminated blood coagulation

27
Q

What are the stages of disseminated intravascular coagulation?

A

Wide spread coagulation and thrombus formation in small blood vessels.
Then consumption of clotting factors leading to wide spread bleeding and increased risk of haemorrhage.
Leading to under perfusion of tissues.
Organ dysfunction

28
Q

What does DIC stand for?

A

Disseminated intravascular coagulation

29
Q

What is disseminated intravascular coagulation?

A

Syndrome of consumptive clotting imbalance. Part of the dysregulated inflammatory response to cellular damage

30
Q

What are the clinical differences between early sepsis and septic shock?

A

Early sepsis CO= high; septic shock= low
Early sepsis CVP= decreased; septic shock= increased
Early sepsis systemic vascular resistance= decreased; septic shock= increased
Early sepsis skin= warm and flushed; septic shock= cool and mottled

31
Q

What factors put people at increased risks of sepsis?

A 
Being very young or old 
Trauma, surgery in past 6 weeks 
Impaired immunity 
Diabetes 
Indwelling lines or catheters 
IV drug users 
Skin breaks
32
Q

Common initial sights of infection that lead to sepsis

A

Lungs
Abdomen
Urinary tract
Pelvis

33
Q

Who may be diagnosed with neutropenic sepsis? And what are the 3 diagnostic criteria?

A

Patients having cancer treatment.
Neutrophil count <0.5x10^9/L
>38 degrees
Signs and symptoms unkeeping with sepsis

34
Q

What is the name of the scoring tool used to diagnose sepsis?

A

qSOFA

35
Q

What does qSOFA do?

A

Bedside prompt to identify patients with infection at risk of sepsis requiring ICU admission.

36
Q

What are the 3 diagnostic criteria in qSOFA?

A

Hypotensive <100mmHg
Tachypnoea >22 resps/min
GCS <15

37
Q

What is the qSOFA score out of?

A

3

38
Q

What are the sepsis 6? / What does BUFALO stand for?

A 
Blood cultures
Urine output 
Fluids 
Antibiotics 
Lactate 
Oxygen therapy
39
Q

How soon following signs for sepsis should abx be given?

A

<1 hour

40
Q

What is important to do before giving abx?

A

To have taken blood cultures

41
Q

What does fluid resuscitation aim to achieve in terms of CVP, MAP and UO?

A

CVP 8-12mmHg
MAP >65mmHg
UO >0.5mls/kg/hr

42
Q

What are the three interventions used to increase organ perfusion during sepsis? And what do they target in terms of BP?

A

Crystalloid fluid to increase pre-load
Vasopressors to increase SVR
Inotropes to increase CO

43
Q

What are 3 examples of drugs that act as vasopressors?

A

Noradrenaline
Vasopressin
Dobutamine

44
Q

What effect does noradrenaline have on CO, SVR and pre-load during sepsis?

A

CO=no effect
SVR=increased
Preload=no effect

45
Q

What effect does vasopressin have on CO, SVR and pre-load during sepsis?

A

CO=no effect
SVR=increased
Preload=no effect

46
Q

What effect does dobutamine have on CO, SVR and pre-load during sepsis?

A

CO=increased
SVR=decreased
Pre-load= no effect

47
Q

What in the management of sepsis helps to correct lactate levels?

A

Crystalloid fluid resus

48
Q

In a septic patient what would their ABG results present as?

A 
pH=low 
Lactate= High 
PaO2=Low 
HCO3-= low 
PaCO2=Low
BE=Low 
i.e. everything low but lactate

Nursing Acutely Ill (11 decks)

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