SIRS and MODS Flashcards
what does sirs mean?
a systemic inflammatory response to variety of insults to the body
( crushing, sepsis, etc )
systemic inflammatory response syndrome
How can SIRS be triggered?
by mechnical tissue trauma
( burns, crush )
by abscess formation
by ischemic or necrotic tissue
what does mods stand for ?
multiple organ dysfunction syndrome
what is the patho or definition of mods?
failure of 2 or more organ system in an acutely ill patient such that homeostasis cannot be maintained without intervention
mods after results from what ?
sirs
most of the time when patient reaches mods, what happens ?
they won’t really survive
Notes
consequences of inflammatory response
- release of mediators
- direct damage to endothelium
- hypermetabolism
- increase in vascular permeability
- activation of coagulation cascade
organ and metabolic dysfcuntion
- hypotension
- decreased perfusion
- formation of microemboli
- redistribution or shunting of blood
respiratory system
- alveolar edema
- decrease in surfactant
- increase in shunt
- v/q mismatch
- ends with ARDS
Cardiovascular system
- Myocardial depression and massive vasodilation
- Results in decreased SVR and BP
- Baroreceptors respond to enhance CO
- Albumin and fluid move out of blood vessels
- Increased CVP and PAWP
Neurologic system
- Mental status changes due to hypoxemia, inflammatory mediators, or impaired perfusion
- Often early sign of MODS
- Confusion, agitation, combative, lethargy
Renal system
- Acute kidney injury (AKI)
- Hypoperfusion
- Release of mediators
- Activation of renin-angiotensin-aldosterone system
- Nephrotoxic drugs, especially antibiotics
GI system
- Motility decreased: abdominal distention and paralytic ileus
- Decreased perfusion: increased risk for ulceration and GI bleeding
- Potential for bacterial translocation
Hypermetabolic state
- Hyperglycemia-hypoglycemia
- insulin resistance
- Catabolic state
- Liver dysfunction
- Lactic acidosis
Hematologic system
- DIC
- Electrolyte imbalances
- Metabolic acidosis
what is the goal for patients with mods?
prevent it from getting to this point
interprofessional care for patients with SIRS and MODS focuses on
1. prevention and treatment
2. maintaining tissue oxygenation
3. nutritional and metabolic support
4. appropriate support of individuals failing organs
A patient with a history of alcohol use is admitted to the ICU with hemorrhage from esophageal varices. Admission VS are BP 84/58 mm Hg, HR 105, and RR 32 breaths/min. The nurse recognizes the onset of systemic inflammatory response syndrome (SIRS) upon finding:
A. dysrhythmias.
B. pulmonary edema.
C. absent bowel sounds.
D. decreasing blood pressure.
B. pulmonary edema.
A patient admitted to the hospital from a long-term care facility appears to be in the late stage of shock with SIRS. Which order implemented by the nurse has the highest priority?
A. Insert two large-bore IV catheters.
B. Insert an indwelling urinary catheter.
C. Start 0.9% normal saline at 100 mL/hr.
D. Apply 100% oxygen by non-rebreather mask.
D. Apply 100% oxygen by non-rebreather mask.
