SIRS

Question 1

SIRS
What is it?

Answer 1

Systemic inflammatory response syndrome
exaggerated defense response of the body to a noxious stressor
-infection, trauma, surgery, acute inflammation

Question 2

SIRS
What are triggers?

Answer 2

Tissue trauma
-burns, crush injuries, surgical
Abscess
-intra-abdominal, extremities
Ischemic or necrotic tissue
-MI
Infection
post-cardiac resuscitation, shock state

Question 3

SIRS
Manifestations

Answer 3

Vasodilation
Inc capillary permeability
Tachycardia
Tachypnea or hypocapnia
Leukocytosis(infection)
Fever or hypothermia

Question 4

SIRS
Criteria (2 or more) 5

Answer 4

Tem greater than 38(100.4) or less than 36(96.8)
HR greater than 90
RR grater than 20 pr PaCOs less than 32
WBC count greater than12,000 or less than 4,000(45,00-11,000)

Question 5

Sepsis
definition

Answer 5

When the cause of SIRS is infection by an invading microorganism, it is called Sepsis

Question 6

Diagnosis criteria
Sepsis

Answer 6

Normal criteria as SIRS
Inc C-reactive protein(inflammation)
INR>1.5 (2-3)
PTT >60secs (normal 25 to 35 seconds)
hyperlactemia

Question 7

Sepsis
AT risk pt

Answer 7

Older pt
Pt with DM, CKD, HF
Pts receiving immunosuppressive therapy
ICU pt(indwelling lines)

Question 8

Septic shocks
Criteria

Answer 8

Hypotension despite fluid resuscitation
(AKA refractory hypotension)
SBP less 90,MAPless70 or SBP dec >40
massive vasodilation
Maldistribution of blood flow
Inc capillary permeability
Myocardial decompensation
Tissue hypoperfusion leads to organ dysfunction

Question 9

Stage of shocks
a) Initial stage-oh boy
b) Compensatory stage-let’s fix it
c) Progressive stage-organs!
d) Irreversible-not good

Answer 9

a) cell aerobic to anaerobic,inc lactic acid
dec CO, tissue perfusion
b) maintain homeostasis
maintain BP, CO, tissue perfusion
c) Compensatory mechanisms fail
agressive intervention is needed to prevent MODS
d) Body overwhelmed
Unresponsive to therapy
consider irreversivle

Question 10

Sepsis shock
early stage

Answer 10

High stage!
Tachycardia
Pulses bounding
Skin warm
Oliguria
Hyperthermia

Question 11

Sepsis shock
late stage

Answer 11

Cold stage!
Tachycardia
Pulses weak
Hypotension
Skin cool, pale
Bradypmnea
Dec LOC
Auria
Hypothermia

Question 12

Hour-1
Bundle
a) #1
b) #2
c) #3

Answer 12

a) Mesure lactate level
If initial lactate elevated greater than 2
b) Obtain blood culture
before antibiotics
c) Administer antibiotic ASAP

Question 13

Hour-1
Bundle
a) #4
b) #5

Answer 13

a) Rapid administration of crystalloid for hypotension
Lactate
b) Apply vasopressors if hypotensive during or after fluid

Question 14

What is vasopressors?

Answer 14

make blood vessels constrict or become narrow in people with low blood pressure
norepinephrine
epinephrine

Question 15

The nurse is assessing a pt in shock. The nurse chharacterizezes the hemodynamics of shock as?

Answer 15

Variations(a change or difference in condition) in cardiac outout and dec systemicvascular resistancein septic shock

Question 16

MODS
Criteria

Answer 16

Failure of two or more organ failur because of sepsis
NOT count chronic disease such as HF if is not cause by sepsis
Mortality rate 2 organs 60%

Question 17

Answer 17

Question 18

SIRS and MODS
Respiratory care

Answer 18

-First and worst hit

Question 19

SIRS and MODS
Cardiac care

Answer 19

Question 20

SIRS and MODS
Neuro care

Answer 20

Question 21

SIRS and MODS
Renal care

Answer 21

Question 22

SIRS and MODS
GI care

Answer 22

Question 23

The most accurate assessment parameters for the nurse to use to determine adequate tissue perfusion in the pt with MODS are?

Answer 23

LOC, urine output, and skin color and temp

Question 24

A patient is admitted to the emergency department vomiting bright red blood. The patient’s vital signs are BP of 78/58 mm Hg, pulse of 124 beats/min, respirations of 28 breaths/min, and temperature of 97.2° F (36.2° C). Which provider order should the nurse complete first?
Obtain a 12-lead ECG and arterial blood gases.
Rapidly administer 1000 mL normal saline solution IV.
Start norepinephrine (Levophed) by continuous IV infusion.
Insert a nasogastric tube and an indwelling bladder catheter.

Answer 24

Rapidly administer 1000 mL normal saline solution IV.
Rationale:
Isotonic crystalloids, such as normal saline solution, should be used in the initial resuscitation of hypovolemic shock. Vasopressor drugs (e.g., norepinephrine) may be considered if the patient does not respond to fluid resuscitation and blood products. Other orders (e.g., insertion of nasogastric tube and indwelling bladder catheter and obtaining the diagnostic studies) can be done after fluid resuscitation is started.

Question 25

The nurse would recognize which assessment finding as suggestive of sepsis?

Sudden diuresis unrelated to drug therapy
Hyperglycemia in the absence of diabetes
Respiratory rate of seven breaths per minute
Bradycardia with a sudden increase in blood pressure

Answer 25

Hyperglycemia in the absence of diabetes
Rationale:
Hyperglycemia in patients with no history of diabetes is a diagnostic criterion for sepsis. Oliguria, not diuresis, typically accompanies sepsis along with tachypnea and tachycardia.

Question 26

A patient’s localized infection has become systemic and septic shock is suspected. What medication would be given to treat septic shock refractory to fluids?
Insulin infusion
Furosemide IV push
Norepinephrine administered by titration
Administration of nitrates and β-adrenergic blockers

Answer 26

Norepinephrine administered by titration
Rationale:
If fluid resuscitation using crystalloids is not effective, vasopressor medications, such as norepinephrine (Levophed) and dopamine, are indicated to restore mean arterial pressure (MAP). Nitrates and β-adrenergic blockers are most often used in the treatment of patients in cardiogenic shock. Furosemide (Lasix) is indicated for patients with fluid volume overload. Insulin infusion may be given to normalize blood sugar and improve overall outcomes, but it is not considered a medication used to treat shock.