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Adults 2 Final > Sepsis, Shock, SIRS, MODS > Flashcards

Sepsis, Shock, SIRS, MODS Flashcards

1
Q

Define shock

A

A syndrome in which there is not sufficient circulation (less oxygen being delivered than is required by tissues, switch from aerobic to anaerobic metabolism)

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2
Q

What are the aerobic vs anerobic metabolic byproducts

A

Aerobic metabolism byproducts= carbon dioxide and water
Anaerobic metabolism byproducts=lactic acid

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3
Q

What are the two keys things you need to successfully treat shock

A

treat early and aggressively

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4
Q

What population is most at risk for shock

A

Older adults and the young are at most risk because of inadequate compensatory responses

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5
Q

How do you calculate cardiac output

A

CO=Heart rate*stroke volume

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6
Q

How do you calculate MAP

A

(Cardiac Output*Systemic vascular resistance)+Central Venous Pressure)

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7
Q

MAP should be ___ to perfuse kidneys

A

65+

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8
Q

Name some Factors that influence MAP

A

total blood volume, cardiac contractility, and systemic vascular resistance

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9
Q

What are the 4 Phases of Shock

A

Initial, compensatory, progressive, refractory

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10
Q

Describe the Initial Phase of Shock

A

Not visible clinically many times; shift from aerobic to anaerobic metabolism begins which starts the buildup of lactic acid in the body

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11
Q

Describe the Compensatory Phase of Shock

A

blood shunted from non-vital organs to vital organs resulting in decreased BP; tachycardia and increased O2 consumption; V/Q mismatch is when part of your lung has too much or too little oxygen and blood flow; impaired GI motility; decreased UOP; cool, clammy skin

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12
Q

Describe the Progressive Phase of Shock

A

compensation starts to fail; mental status changes begin; BP drops significantly; organ failure begins due to poor perfusion; difficult to find peripheral pulses; patient is more profoundly acidotic and hypoxic; issues with each organ worsen

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13
Q

Describe the Refractory Phase of Shock

A

organ and system failure—body is unresponsive to therapies, ischemia and necrosis set in as well as toxins; client becomes profoundly acidotic, hypotension worsens as does mental status; multiple organs fail

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14
Q

What kind of labs indicate shock

A

ABGs (lactic acidosis/metabolic acidosis)
Blood Cultures
Renal function tests
DIC Screen (coagulation alterations)
Glucose level (increased)
Serum electrolytes (abnormal dependent)
Lactate (elevated)
Liver enzymes
CBC (elevated WBC)
Cardiac enzymes (r/o cardiogenic)

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15
Q

Why should you be wary of prolonged use of vasopressors

A

Long term use of (norepinephrine, phenylephrine, vasopressin, dopamine) causes peripheral ischemia and necrotic fingers/toes.

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16
Q

What meds might a patient with shock be taking

A

vasopressors (increase SVR and increase BP)
positive inotropes (to help with contractility)
Bicarb (if PH gets lower than 7.1)
Sedation/paralytics (for intubation)
Isotonic Fluids (if hypovolemic)
Insulin (to tx hyperglycemia secondary effect)

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17
Q

How should you give most vasopressors via

A

a central line

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18
Q

What injuries can cause hypovolemic shock

A

diuresis, GI losses, blood loss, burns, DKA

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19
Q

What is Third spacing

A

-fluid is still in the body, but moves to the interstitial spaces

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20
Q

____ ______ are at higher risk for hypovolemic shock

A

Older adults

because of decreased fluid intake and medications that cause dehydration—do not have as much reserve

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21
Q

What labs do you expect to draw for a patient with hypovolemic shock

A

Type and screen
ABGs (acidosis)
Lactate (high)
Electrolytes (may be concentrated, glucose (elevated) and renal labs
CBC: dependent on cause (blood loss vs dehydration)
Specific gravity Likely elevated

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22
Q

Vasopressors are contraindicated for what type of shock

A

Hypovolemic

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23
Q

What is the first treatment for a patient experiencing severe hypovolemic shock

A

Fluids are the treatment of choice
Blood products if hemorrhaging
Increase oxygen availability-route and amount will depend on state the client is in
Find source of loss and stop it

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24
Q

What do you expect to do for a patient experiencing hypovolemic shock

A

hypovolemic shock decreased CVP
Will be on cardiac monitor
Possible arterial line
Possible CVP monitoring

25
Q

Define Cardiogenic Shock

A

finals stage of HF

Dysfunction of the heart’s pumping action resulting in decreased CO, SV and BP (aka: decreased MAP)
Can be systolic or diastolic in nature

Fluid backs up into the pulmonary system and then eventually the periphery
This further reduces oxygenation
Decreased CO can result in less blood flow to myocardium, therefore worsening insult to cardiac muscle

26
Q

Manifestations of Cardiogenic Shock

A

increased central venous pressure (CVP)

decreased blood flow to kidneys cause kidneys hold onto fluid causing edema, decreased urinary output

crackles in lungs

27
Q

cardiogenic shock labs

A

Cardiac enzymes
ABGs (metabolic acidosis)
BNP (elevated) (measure of fluid volume overload )
Lactate (elevated)
Specific gravity (elevated)

28
Q

Explain what diagnostic tests you would use to identify the cause of cardiogenic shock

A

EKG—check for MI and dysrhythmias
Echocardiogram—look for function of pump
Cardiac Cath—looking for blockage from potential MI

29
Q

What drugs are the first thing given when a pt is dx w/ cardiogenic shock

A

Positive Inotropic agents-Dobutamine and Dopamine to make the heart contract forcefully

Vasodilators—Nitroglycerine

Diuretics (furosemide) to reduce fluid load and CVP

30
Q

Bicarb is contraindicated if the pt’s fluid volume is ___.

A

low

31
Q

What are the three ways to treat a heart with end stage heart failure

A

IABP (INTRA-AORTIC BALLOON PUMP)—helps to improve perfusion of the myocardium

Impella (turbine that propels blood from weak left ventricle into system)

PCI (Percutaneous Coronary Intervention) (stent in coronary arteries) to revascularize myocardium

32
Q

Define Distributive Shock

A

Form of shock that results from systemic vasodilation (too big vasculature to push blood through)

33
Q

What are the 3 types of Distributive Shock

A

Septic
Neurogenic
Anaphylactic

34
Q

Describe the cause and effect of Septic shock

A

BACTERIA cause vasodilation due to cytokines (proteins we release that affect the growth of blood cells and other cells that help with the body’s immune and inflammation responses) released overstimulate the inflammatory response which causes vasodilation and increased permeability of endothelium.

Results in HYPOTENSION AND HYPOPERFUSION TO FINGERS/TOES

35
Q

Describe the cause and effect of Neurogenic shock

A

INJURY ABOVE THE MID-THORACIC REGION causes impairment in conduction of nervous system, vessels in periphery can no longer constrict

Results in HYPOTENSION AND BRADYCARDIA

36
Q

Describe the cause and effect of Anaphylactic shock

A

HISTAMINE causes vasodilation and increased permeability

Results in HYPOTENSION AND DECREASED O2 TO ORGANS

37
Q

What pathogen most commonly causes sepsis

A

gram negative bacteria

38
Q

Neurogenic shock occurs with injury…

A

above the T6 region

39
Q

What type of hypersensitivity cause anaphylactic reactions?

A

Type I Hypersensitivity

40
Q

What shock manifestation is specific to neurogenic shock?

A

bradycardia, flushed skin

41
Q

What shock manifestation is specific to anaphylactic shock?

A

angioedema, wheezing

42
Q

You might see a rash with what type of shock?

A

septic, anaphylactic

43
Q

What do you expect the ABG to be for Distributive Shocks

A

METABOLIC ACIDOSIS

44
Q

When should you check a patient’s inflammatory markers during an episode of Distributive Shock?

A

Check CRP, ESR IF IMMUNOSUPRESSED

45
Q

How do you treat septic shock

A

Blood cultures before administration of antibiotics

FLUIDS BEFORE VASOPRESSORS
Fluids to get MAP to at least 70
Give 2L of fluid then move on to vasopressors

Mechanical ventilation
Control glucose levels-insulin
Sodium Bicarb if acidotic
Possible FFP (fresh frozen plasma)
Possible antipyretics to maintain normal temperature

46
Q

How do you treat Neurogenic shock

A

Stabilize the spine
Mechanical ventilation
Support with fluids
Maintain normal temperature
Possible vasopressors
Possible atropine if severely bradycardic

47
Q

How do you treat Anaphylactic shock

A

Mechanical ventilation
Administration of epinephrine
Administration of isotonic fluids if orthostatic or have incomplete response to epinephrine
Possible Corticosteroids

48
Q

What do you expect to do for a patient experiencing distributive shock

A

Administer fluids
Oxygen
Monitor patient VS
Will be on cardiac monitor
Possible arterial line

49
Q

Define Obstructive Shock

A

Physical obstruction to blood flow occurs (Ex: Cardiac tamponade, PE, Tension pneumothorax)

50
Q

Describe Sx of Obstructive Shock

A

chest pain, muffled and distant heart sounds
dyspnea, uneven lung expansion

51
Q

Describe Tx of Obstructive Shock

A

Fix Cause
Decompression of pneumothorax
Pericardial drain for cardiac tamponade
Anticoagulation/Thrombolytic for PE

52
Q

What do you expect to do for a patient experiencing Obstructive shock

A

Oxygen
Monitor patient VS
Will be on cardiac monitor
Possible arterial line

53
Q

What is SIRS and MODS stand for

A

Systemic Inflammatory Response Syndrome (SIRS), and Multiple Organ Dysfunction Syndrome (MODS)

54
Q

Describe SIRS

A

SIRS is a clinical response to a variety of severe clinical insults such as infection, trauma, pancreatitis, or burns. It is characterized by an exaggerated, widespread inflammatory reaction in the body. To diagnose SIRS, at least two of the following four criteria must be met:

Fever (temperature >38°C or <36°C)
Tachycardia (heart rate >90 beats per minute)
Tachypnea (respiratory rate >20 breaths per minute or PaCO2 <32 mm Hg)
Abnormal white blood cell count (either >12,000 or <4,000 cells/μL, or >10% immature bands)

55
Q

Describe MODS

A

MODS refers to the progressive failure of two or more organ systems due to an overwhelming inflammatory response.

SIRS can be seen as an early stage or precursor to MODS. The excessive and sustained inflammatory response that characterizes SIRS can lead to widespread tissue damage, impaired organ function, and ultimately, the development of MODS if not managed effectively.

Cannot maintain homeostasis without intervention

56
Q

What meds do you expect to administer a patient diagnosed with SIDS or MODS

A

Diuretics
Stress ulcer prophylaxis (PPI)
Vasopressors
Antibiotics
Isotonic fluids
Electrolyte replacement
Possible glucocorticoids

57
Q

What nutritional needs do you expect for a patient diagnosed with SIDS or MODS

A

Hypermetabolic state results in caloric expenditure of 1.5-2 times normal
Will need calories to replace to reduce mortality
Enteral is preferred, but can use PN if needed
Monitor glucose carefully

58
Q

What complications can you expect from a patient diagnosed with SIDS or MODS

A

Pulmonary edema
AKI
Ischemic bowel injury
Hypoglycemia
Liver dysfunction
DIC
Cardiac arrest
Death

59
Q

T/F: SIRS/MODS causes hypoglycemia and tachycardia/pnea whereas sepsis causes hyperglycemia and bradycardia

A

True

Adults 2 Final (3 decks)

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