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sepsis class > SEPSIS > Flashcards

SEPSIS Flashcards

1
Q

What are the criteria for Sepsis (not septic shock)?

A

Presence of infection or suspicion of infection with two or more of the Systemic inflammatory response criteria (see below comment about PPT):

  • temp greater than 38 degrees or less than 36 degrees
  • heart rate greater than 90 beats per minute
  • resp greater than 20 breaths or PaCO2 greater than 32 mm Hg
  • WBC greater than 12,000 or less than 4000 mm or more than 10% immature (band forms) (HAMMOND INFO)

THE POWERPOINT INFO:

ADULTS
SBP less than or equal to 100
RR greater than 22/min
Altered LOC
Partial pressure of carbon dioxide less than 32 mm Hg
White blood cell count greater than 12,000/mm3 or less than 4,000/mm3 or greater than 10% immature neutrophils or bands

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2
Q

What is the difference between sepsis and septic shock?

A

Sepsis is a result of cardiovascular dysfunction which can progress to septic shock. The major difference is that individuals with septic shock experience a drastic decrease in blood pressure leading to a much higher likelihood of death.

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3
Q

What is septic shock? (from ppt and there’s a note that it’s important to know the MAP info)

A

Presence of infection and two of the following criteria:
ADULTS
SBP less than or equal to 100
RR greater than 22/min
Altered LOC
Partial pressure of carbon dioxide less than 32 mm Hg
White blood cell count greater than 12,000/mm3 or less than 4,000/mm3 or greater than 10% immature neutrophils or bands

The definition of septic shock includes the aforementioned definition of sepsis with the addition of the following criteria:
patient’s need for medicationto maintain an adequate blood pressure level(MAP > 65 mmHg)
Inadequate levels of oxygen present in the bloodstream despite adequate liquid provided(serum lactate level > 2 mmol/L)

MEAN ARTERIAL PRESSURE/MAP: 
MAP =SBP + 2 (DBP)
        3
MAP =83 +2 (50)
        3
MAP =83 +100
      3
MAP =183
     3
MAP = 61 mm HG
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4
Q

Describe sepsis, severe sepsis and septic shock

A

Sepsis: presence of infection or suspicoin of infection with two or more SIRS criteria

Severe sepsis: sepsis associated with organ dysfunction, hypoperfusion, or hypotension. hypoperfusion and perfusion abnormalities may include, but are not limited to latic acidosis, oliguria, or an acute alteration in mental status

Septic shock: sepsis-induced shock with hypotension despite adequate crystallloid resuscitation, along with the presence of perfusion abnormalities that may include, but are not limited to, lactic acidosis, oliguria, or an acute alteration in mental status. pts receiving inotropic or vasopressor agents may not be hypotensive at the time that perfusion abnormalities are measured

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5
Q

What is sepsis-induced hypotension?

A

A systolic blood pressure less than 90mm Hg. mean arterial pressure (MAP) less than 65 mm HG, or a reduction of 40mm Hg from baseline in the absence of other causes for hypotension.

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6
Q

How might a patient with sepsis present in the ED? (hammond)

A

Fever, chills, SOB, tachypnea, tachycardia, rash confusion

These mimic other diseases so can be hard to identify.

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7
Q

Who has a higher rate of sepsis?

A

elderly, children and infants

I also read somewhere pregnant women??

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8
Q

How does acute renal failure develop in sepsis? Is it reversible?

A

Develops as a result of endotoxins, which cause vasoconstriction

Renal damage is related to the degree and severity of sepsis

Acute tubular necrosis may occur due to ischemia

It’s reversible with careful monitoring of urine output, serum creatinine, and blood urea nitrogen

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9
Q

What are some causes of sepsis?

A

Causes of sepsis include: pneumonia, UTI, diarrhea, meningitis, cellulitis, arthritis, wound infection, endocarditis, and catheter-related infection

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10
Q

What is tissue hypoperfusion?

A

Tissue hypoperfusion is defined as an elevated serum lactate level or oliguria (the low output of urine)

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11
Q

What are the signs and symptoms of acute organ system failure related to cardio? (Sepsis)

A 
Cardiovascular
	• Tachycardia
	• Arrhythmias
	• Hypotension
	• Elevated central venous and pulmonary artery pressures
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12
Q

What are the signs and symptoms of acute organ system failure related to resp? (sepsis)

A

Respiratory
• Tachypnea
• Hypoxemia

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13
Q

What are the signs and symptoms of acute organ system failure related to renal? (sepsis)

A

Renal
• Oliguria
• Anuria
• Elevated creatinine

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14
Q

What are the signs and symptoms of acute organ system failure related to hematologic? (sepsis)

A 
Hematologic
	• Jaundice
	• Elevated liver enzymes
	• Decreased albumin
	• Coagulopathy
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15
Q

What are the signs and symptoms of acute organ system failure related to GI? (sepsis)

A

GI

• Ileus (absent bowel sounds)

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16
Q

What are the signs and symptoms of acute organ system failure related to hepatic? (sepsis)

A 
Hepatic
	• Thrombocytopenia
	• Coagulopathy
	• Decreased protein C levels
	• Increased D-dimer levels
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17
Q

What are the signs and symptoms of acute organ system failure related to neurologic? (sepsis)

A
  • Altered consciousness
    • Confusion
    • Psychosis
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18
Q

What is thrombocytopenia?

A

abnormally low platelets

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19
Q

What are the complications of sepsis?

A

Acute respiratory distress syndrome (ARDS)

Acute renal failure

GI complications

Disseminated intravascular coagulation (DIC)

Multiple organ dysfunction syndrome (MODS)

20
Q

What is ARDS?

A

Abrupt onset of respiratory distress with three components: severe hypoxemia, bilateral pulmonary infiltrates, and absence of heart failure or fluid overload

Three phases of ARDS:
• Acute exudative—profound hypoxemia, inflammation, and diffuse alveolar damage
• Fibroproliferative—decreased compliance and increased dead space
• Resolution—may take 6 to 12 months or longer

21
Q

How do GI complications occur in sepsis

A

Can develop when blood flow is redistributed

Stress ulcers in the stomach may occur

Bleeding is common and can occur 2 to 10 days after the insult

will likely be given PPIs or H2 antagonists

22
Q

What is DIC?

A

Caused by coagulation cascade activation

Clots are formed, blocking small vessels

Depletion of platelets and coagulation factors increases the risk of bleeding

Fibrin deposits in organs can cause ischemic damage and failure

23
Q

What is MODS?

A

multiple organ disfunction.

Occurs when multiple organs are damaged

Kidneys, liver, lungs, brain, and heart may be affected

Mortality rate increases with the number of failing organs

24
Q

what lab tests are done for sepsis?

A 
Lab tests include: 
	• Serum electrolytes
	• Complete blood cells count
 	• Coagulation studies
	• Arterial blood gas (ABG) analysis
	• Cultures of sputum, urine, cerebrospinal fluid, and wound drainage
25
Q

What is the treatment for sepsis?

A

Give 100% oxygen via non-rebreather mask

Obtain two separate blood cultures before antibiotic therapy

Initiate antibiotic therapy

Initiate fluid resuscitation

Measure the patient’s lactate and hemoglobin-A lactate levels

Insert a urinary catheter to monitor hourly urine output

prescribed treatment should be given within 2 hours or as soon as possible

need to give fluids ASAP to correct for hypotension

26
Q

If ABGs deteriorate or ph decreases (become acidotic) what will the patient require?

When blood culturing what should we keep in mind?

A

Metabolic demands may require intubation/mechanical ventilation if
ABGs deteriorate or blood pH decreases

Obtain two separate blood cultures: one percutaneously and one via each vascular access device unless recently inserted

27
Q

What are the protocols for antibiotic therapy in sepsis?

A

A broad-spectrum antibiotic is used initially; discontinued in 3 to 5 days (usually piptaz or vanco)

Therapy is modified after cultures

Single antibiotic therapy may last 7 to 10 days; may be longer in immunocompromised patients or in undrainable infections

The dosage is adjusted based on renal function
** INITATE WITH IN TWO HOURS OF ORGINAL ORDERS****

28
Q

What are the protocols for fluid resuscitation in sepsis?

A

Fluid resuscitation is a corner stone of sepsis therapy

Crystalloid solutions: 0.9 sodium chloride or lactated Ringer’s

Colloids: albumin

Keep mean arterial pressure above 65 mmHg, wedge pressure at 6-12 mmHg, and central venous pressure at 8-12 mm Hg

Fluid challenges may be given based on BP and urine output
Watch compatibility with Ringers-Lactate (think PipTaz and Ceftriaxone = incompatible!!)
Really keep that MAP over 65. Super important!!
ICU will use Norepinephrine, Vasopressin… or other meds
Boluses are likely.

29
Q

What is the correlation between lactate level and septic shock?

A

Septic shock is diagnosed when the lactate level is greater than 4 mmol/L in the presence of severe sepsis

30
Q

When would we consider a blood transfusion in septic shock?

A

Consider a blood transfusion for a patient with a low hemoglobin value

31
Q

What are some common medications for treating septic shock?

A

Antibiotics—should be started within the first hour (2 at most!)

Vasopressors—norepinephrine is the drug of choice to restore hemodynamic stability

Corticosteroids—indicated in adult patients with hypotension not responding to fluids or vasopressors

32
Q

What are some nursing interventions for sepsis?

A

Infection control measures: hand hygiene

Assessment and monitoring: vital signs, neurologic checks, signs of DIC, bleeding from invasive devices

Documentation

Communication with patient’s family

33
Q

What puts infants/ children at greater risk for sepsis?

A

Babies less than one month old are at the highest risk
Premature babies Low birth weight
Pediatric patient with an injury
Post-surgical patients
Mothers with symptoms of an infection
Genetic factors
Presence of an underlying illness (e.g. HIV, cancer, diabetes)
Males have a higher chance of being septic

34
Q

What are the stages of neonatal sepsis?

A

Early Onset (up to 72 hours after birth)
85% of newborns who develop early onset sepsis present symptoms within the first 24 hours
Early onset sepsis is usually caused by pathogens from the mother’s body

Late Onset (from 4 to 90  days after birth)
	Caused by pathogens from the home environment
35
Q

How do we prevent sepsis in children?

A

The most common childhood diseases are German measles and chicken pox
Furthermore, close attention to wounds and common infections is critical as they can escalate if left untreated.
Paying close attention to general hygiene will diminish the likelihood of developing sepsis.

36
Q

T or F- aboriginals are more likely to develop sepsis?

A

FALSE (but see the info below)

There is currently no evidence that sepsis itself has a higher or lower prevalence in Aboriginal populations or any racial population in Canada. However, there is evidence that suggests that Aboriginal populations are more likely to contract certain infections that can lead to sepsis.
For instance, the H1N1 viral infection pandemic of 2009 had a high occurrence in the Canadian Aboriginal population. One study found that a quarter of the study population who contracted H1N1 were Aboriginal. (Determinants of Health)
Aboriginal populations in theCanadian Prairiesand rural Australiaare more susceptible to developing a certain infection called MRSA (Methicillin-resistant Staphylococcus aureus) that can lead to sepsis.

37
Q

T or F - some studies in australia have shown that aboriginal neonates are more likely to develop sepsis?

A

True:

Neonatal early-onset group B streptococcal (GBS) infections can lead to sepsis in babies. It has been shown in AustraliaAboriginal babies born in hospitals were three times more likely to develop sepsis from GBS than non-Aboriginal babies.

38
Q

When evaluating for sepsis, what type of considerations should a triage nurse take into account?

A

-age (infants, children and elderly more likely)
-if recent or likely infection (e.g. recent surgery, injury)
-medication- e.g. a patient on a beta-blocker may not have a raised HR, people on corticosteriods have lowered immunity
-other medical hx- e.g. diabetes (diabetics are at greater risk for infection), immunocompromised
other- where do they live? if they lve in a LTC home, then the likelhood goes up

39
Q

In septic shock, hypoperfusion will continue despite fluid resuscitation? T or F

A

TRUE:

in septic shock the SBP will remain less than 90 mm Hg or the patients SBP will drop more than 40 mmHg

40
Q

What are the priorities of care for sepsis?

A

1) airway
2) breathing
3) volume resuscitation
d) antibiotic administration

41
Q

What is serum lactate and what does it identify in sepsis?

A

measures cellular level perfusion

an elevated serum lactate level can identify occult hypoperfusion

42
Q

what does procalcitonin measure/ identify in sepsis?

A

a prohormone of calcitonin

plasma concentrations are very low in healthy individuals, but increase in sepsis

43
Q

What type of cultures might be done in sepsis?

A

sputum, cerebral spinal fluid, urine, blood, wound cultures, and at least one blood culture from peripheral circulation (SLIDE SAYS TWO)

44
Q

What are the therapeutic interventions for sepsis (Hammond)

A
  • begin resuscitation immediately for pts ith hypotension and elevated serum lactate greater than 4mmol/L
  • oxygen (maintain spo2 at 93% or greater)
  • anticipate advanced airway management and possible rapid intubation –> this may reduce the work of breathing which reduces oxygen demand
  • measure venous oxygen saturations
  • large bore cateters for fluid resuscitation (250ml - 1000ml every 15 minutes)
  • maintain MAP of 65mm HG
  • if MAP less than 65, administer vasopressors (dobutamine, norepinephrine or dopamine)
  • insert CVC
  • source identification and control of infection
  • transfusion may be considered if hemoglobin drops
  • maintain head of bed at 30 degrees or more
  • glucose control (iv insulin)
  • montior blood glucose ever 1- 2 hours if iv insulin
  • DVT prophylaxis
  • stress ulcer prophylaxis
45
Q

Is BP a good indicater of sepsis in children?

A

NO –> relying solely on this is a mistake because many children maintain BP while they are in shock – also means that other signs may be apparent before hypotension

sepsis class (1 decks)

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