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Module 7 > Sepsis Lecture > Flashcards

Sepsis Lecture Flashcards

1
Q

Labs values across the SIRS and Sepsis spectrum

A

CBC
CMP
ABG
Procalcitonin
Lactate
Prothrombin time ( PT)
C reactive protein ( CRP)
Creatine Phosphokinase

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2
Q

CBC

A

WBC
Platelets
H&H

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3
Q

When do we transfuse

A

When h&h is less than 7

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4
Q

CMP

A

Electrolytes
Potassium
Sodium

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5
Q

ABG

A

What our body is balancing
Acidic or alkalosis?

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6
Q

Procalcitonin

A

Comes up when an infection is present
Anytime inflammation starts there is swelling.
That’s what happens when we have an infection , inflammation starts so that’s what causes Procalcitonin goes up. Leave is typically less than 0.1.

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7
Q

Lactate

A

Goes up when there is no o2
Body starts producing this

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8
Q

Prothrombin time (PT)

A

How fast do they clot?
About 12 seconds is normal
Less than 5 ..too fast
Takes a minute.. thin

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9
Q

C reactive protein (CRP)

A

Measures how much inflammation ..higher it is the more inflammation

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10
Q

CPK

A

Measures muscle injury .. goes up when there is muscle injury

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11
Q

Bands

A

Immature leukocytes.. babies
More than 10% bands shows us our body has used up all of its mature leukocytes
Very sick pt and has been sick for awhile

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12
Q

Vitals that we look at in SIRS that must have 2 of the following

A

Temp (high or low)
HR
RR
Paco2
WBC count & bands

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13
Q

Temp requirement for SIRS

A

Greater or equal to 100.5F
OR
Less or equal to 96.8F

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14
Q

HR requirement for SIRS

A

Greater than or equal to 90 bpm

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15
Q

RR requirement for SIRS

A

Greater than or equal to 20 bpm

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16
Q

Paco2 requirement for SIRS

A

Less than or equal to 32 mmhg

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17
Q

WBC count for SIRS /bands

A

> or equal to 12,000
Or < or equal to 4,000
OR
Greater than 10% bands

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18
Q

Nursing management when it comes to maintaining tissue oxygenation

A

Monitor labs (hemoglobin >7)
Sleep
Low stimulation
Administer sedation as ordered

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19
Q

Nursing management for prevention and treating infection for SIRS

A

Advocate for removal of lines ASAP
Urinary catheters
CVL

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20
Q

Mobility nursing management for SIRS

A

How we can promote tissue oxygenation we want to encourage movement to move secretions
active ROM
Passive ROM

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21
Q

Nutritional support with SIRS

A

Start tpn or tube feedings within 24 hours
Parenteral or enteral
NGT or OGT

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22
Q

SIRS med treatment variety

A

Antibiotic ( broad, narrow)
Anti fungal
Fluid for dehydration
RA meds
DM control
Gluccosteriods
Antipyretics

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23
Q

Sepsis clinical criteria “SOFA”

A

Sepsis related
Organ
Failure
Assessment
>2

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24
Q

S/s of sepsis

A

PaO2/Fio2- 200 or less
Hypotension Or vasopressors
Platelets <150,000
Glasgow coma scale 3-8
Billiruben - increased
Creatine increase , oliguria ( decrease UO)

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25
Q

How much urine out put we want in the ICU

A

0.5 mL/kg/Hr

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26
Q

How we figure out the fluid resuscitation?

A

30mL/kg

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27
Q

How many hours is fluid resuscitation done over for a sepsis patient

A

Over 3 hours

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28
Q

How many hours is a fluid resuscitation done over for a septic shock patient?

A

Over one hour

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29
Q

What CVP do we want a septic patient at

A

8-12 mmHg

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30
Q

What do we want our MAP to be over for septic pt

A

I over 65 mmHg

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31
Q

Two labs we are monitoring for sepsis pt to see if progressing?

A

Pro calcitonin and lactic acid

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32
Q

Criteria for a septic shock pt

A

SIRS plus confirmed infection
MAP <65 mmHg
Serum lactate > or equal to 2 molecules/l
Vasopressors
Organ dysfunction

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33
Q

Serious organ dysfunction occurs in

A

Heart , lungs, liver, kidneys

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34
Q

Lactic acid lab in septic shock

A

Repeat if > or equal to 2 mmol/l

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35
Q

ABG in septic shock pt

A

Pao2 <60

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36
Q

Sign of kidney failure in septic shock

A

Creatine >2.0 or urine output <0.5/mL/kg/hr

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37
Q

Liver lab septic pt

A

Bilirubin >2 mg /dL

38
Q

Hematology labs septic shock

A

Platelets <100,000
INR >1.5 or PTT >60 seconds
CRP and ESR

39
Q

What do we want to maintain the paO2 in septic shock treatment

A

Pao2 >75 preferably 80

40
Q

DIC lab values

A

Decrease fibroses
Decrease platelet count
Increase activated PTT and PT
Increase D-dimer

41
Q

Types of blood products

A

Plasma
Platelets
Cryo
RBC
Albumin

42
Q

Which blood products need a consent form

A

Plasma, platelets, cryo, RBC

43
Q

Why should you give blood with NS

A

Lactated ringers will clot the blood

44
Q

PRBC

A

No clotting factored
Give for strictly hemoglobin to increase o2 status

45
Q

What is important to do before giving blood products

A

Assessing vitals such as fever to assess baseline

46
Q

Why should we stay with the pt after giving blood

A

Assess for allergic reaction

47
Q

If pt starts complaining they feel funny after receiving blood products what do you do

A

Stop the infusion , d/c the line and call the doc

48
Q

Platelets blood product

A

From multiple or single donor
Does have coag
If low on platelets give this

49
Q

FFP

A

Albumin , givin for volume and for time?

50
Q

Cryo blood products

A

Has clotting factors

51
Q

When giving blood what do we keep in mind about tubing

A

Use the one with special filter
When priming the line put NS down first then the blood

52
Q

3 main focus on labs

A

CRP
Lactic acid
Procalcitonin

53
Q

106 F

A

Not compatible with life

54
Q

Improper thermoregulation

A

Hypothermic

55
Q

When a pt has a picc line what is important to assess

A

Touch the site, compare arm lengths and check for swelling or s/s of infection

56
Q

Tube feeding go through

A

NG , OG tube, enteral

You should never insert through IV line

57
Q

TPN

A

Through line, picc line, central line

Parenteral

58
Q

How do we know fluid resusitation is effective in sepsis

A

Increase BP
Cap refill comes back
Skin temp - warm ( not too warm or cold)
Urine output greater than 0.5mL /kg/hr
CVP - 8-12mmhg
MAP greater than 65

59
Q

Lab to monitor in sepsis

A

Lactic acid

60
Q

What is it important to maintain in sepsis

A

Bed rest , we want to maintain tissue oxygenation with pt
Keep them sedated

61
Q

If you are having problems with pt staying acidotic

A

NS is acidotic..see if you can change the fluid to d5 if you are trying to get the ptt out of being acidotic

62
Q

Sepsis treatment in orrrder

A

1)Administer crystalloid bolus for hypotension
2)Blood cultures
3)Antibiotics (within 3 hrs ) , continue until WBC is less than 10,000
4)measure lactate level -repeat >or equal to 2
Vasopressors if not responsive to fluid resusitation

63
Q

How quick to have antibiotics for pt in septic shock

A

Within 1 hr

64
Q

In sepsis treatment we administer vasopressors if the pt is not responsive to fluid .. what is our first in line we administer?

A

We would pick norepinephrine and a vasopressin (antidiuretic) to hold fluid to increase volume

We would not pick dopamine because it is like the incredible hulk

65
Q

Since respiratory blood vessels get damaged in septic shock.. what do we see in this?

A

Acute respiratory distress syndrome
Severe hypoxemia
Need to be mechanically ventilated

66
Q

When assessing a pt with septic shock- what cardiac vitals are we looking out for?

A

SBP <90 / and or MAP <65
We are looking for hypotension

67
Q

When drawing lactic acid.. what is important to keep in mind ?( septic shock nursing management slide but same as before)

A

Repeat if > 2 mg/dL
Put it on ice and take it to lab yourself

68
Q

Organ specific lab

A

Kidneys creatine >2.0 or urine output <0.5mL/kg/hr

69
Q

Vasopressors medication

A

Norepinephrine
Vasopressin
Pnenylephrine
Dopamine

70
Q

What kind of shock is DIC

A

Obstructive

71
Q

DIC leads to excessive bleeding such as

A

Bleeding from various sites
Petechiae
Hematuria
Oozing from IV sites
GI bleeding oozing gums

72
Q

DIC changes from obstructive shock to

A

Hypovolemic shock

73
Q

What makes a clot

A

Fibrinogen and platelet

Which is why it is decreased in DIC

74
Q

How can we identify early bleeding in DIC

A

Assess pt for bleeding
Thrombocytopenia
Petechiae
Bruising
Black tarry stools
Black or coffee grounds emesis
Black or bloody sputum or urine
Headache change in Vision
Cap refill prolong

75
Q

What can we teach pt with DIC management

A

Report pain in the extremity
Avoid meds that can prolong bleeding
Avoid garlic
Do not blow nose forcefully
Do not bed down head lower than waist
Do not use a suppository , enema ,or tampon
Mom at risk
Lovonox- as prevention

Consent form (plasma , platelets , cryo , RBC)

76
Q

Goal for DIC

A

Prevent or control hemorrhage

77
Q

What can be given as prevention for DIC

A

Lovonox

78
Q

What are things that can indicate DIC in assessment

A

Cap refill is unequal on both sides
If one arm is warm and the other is cold

79
Q

If pt is in the bleeding stage in DIC we should teach

A

Not to be taking ibuprofen , aspirin
Are they eating garlic?

80
Q

Why should someone at risk for DIC bend their head lower than the waist

A

Increase ICP and could cause hemorrhagic bleed in the brain

81
Q

RBC product MUST

A

Use blood tubing w filter and primed w 0.9% sodium chloride
Must be cross matched

No plasma no platelets

82
Q

AFH - blood transfusion reaction

A

Allergic
Febrile
Hemolytic

83
Q

“A”-allergic- mild

A

Mild
Facial flushing
Hives/rash

84
Q

A - allergic -severe

A

Increased anxiety
Wheezing
Decrease BP

85
Q

F- febrile

A

Headache
Tachycardia
Tachypnea
Fever/chills
Anxiety

86
Q

H- hemolytic

A

Decrease BP
Increased RR
Hemoglobulinuria
Chest pain

87
Q

Albumin

A

Does not require consent form
Pulls into the intravascular space

88
Q

What happens first typically when MODS is present

A

Pulmonary/resp dysfunction

89
Q

BROAD SPECTRUM

A

Broad spectrum - levofloxacin, piperacillin/tazobactam, ceftriaxone, meropenem, cefepime

90
Q

What do we maintain oxygenation at for sepsis shock

A

> 75 prefer 80

91
Q

What do we want our blood sugar at for SIRS

A

180 or less

Module 7 (24 decks)

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