SIRS and MODS

Question 1

What is SIRS?

Answer 1

Systematic inflammatory response syndrome

Question 2

What is SIRS a response to?

the 4 I’s

Answer 2

Infection, ischaemia, infarction, injury

Question 3

What are the triggers of SIRS?

Answer 3

• Mechanical tissue trauma
• Abscess formation
• Ischemic or necrotic tissue
• Microbial invasion
• Perfusion deficits

Question 4

What is MODS?

Answer 4

Multiple organ dysfunction syndrome (MODS) is the failure of two or more organ systems

usually comes after SIRS

Question 5

What are the consequences of the inflammatory response?

Answer 5

• Release of mediators
• Direct damage to the endothelium
• Hyper-metabolism
• Increase in vascular permeability
• Activation of coagulation cascade

Question 6

How does the respiratory system respond to inflammation?

Answer 6

• Alveolar edema
• Decrease in surfactant
• Increase in shunt
• End result: ARDS (acute respiratory distress syndrome)

Question 7

How does the cardiac system respond to inflammation?

Answer 7

• Myocardial depression and massive vasodilation
• Baroreceptors respond to enhance Cardiac Output
• Albumin and fluid move out of blood vessels

Question 8

How does the neurological system respond to inflammation?

Answer 8

• Mental status changes due to hypoxemia, inflammatory mediators, or impaired perfusion
• Often early sign of MODS

Question 9

How does the renal system respond to inflammation?

Answer 9

• Acute kidney injury (AKI)
• Hypoperfusion
• Releases mediators
• Activation of renin-angiotensin-aldosterone system

Question 10

How does the gastrointestinal system respond to inflammation?

Answer 10

• Motility decreased: abdominal distention and paralytic ileus
• Decreased perfusion: risk for ulceration and GI bleeding
• Potential for bacterial translocation

Question 11

What is the care goal for SIRS?

Answer 11

prevent the progression of SIRS to MODS

Question 12

Collaborative care for patients with MODS focuses on?

Answer 12

• Prevention and treatment of infection
• Maintenance of tissue oxygenation
• Nutritional and metabolic support
• Appropriate support of individual failing organs

Question 13

For prevention and treatment of infection what is the collaborative care?

Answer 13

• Aggressive infection control strategies
• Strict asepsis
• Oxygen, fluid resuscitation and antibiotics are first line treatment
• Assess need for invasive lines

Question 14

For Maintenance of tissue oxygenation what is the collaborative care?

Answer 14

• Decrease O2 demand and increase O2 delivery
• Sedation
• Mechanical ventilation
• Analgesia
• Rest

Question 15

For Nutritional and metabolic needs what is the collaborative care?

Answer 15

• Goal is to preserve organ function

* Monitor plasma transferrin and prealbumin levels to assess hepatic protein synthesis

Question 16

How do we support the failing organs in ARDS, DIC and Renal Failure?

Answer 16

• ARDS: aggressive O2 therapy and mechanical
ventilation
• DIC (Disseminated intravascular coagulation: appropriate blood products
• Renal failure: continuous renal replacement therapy or dialysis

Question 17

A patient with a history of alcoholism 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) pulmonary edema.
b) cardiac dysrhythmias.
c) absent bowel sounds.
d) decreasing blood pressure.

Answer 17

a) pulmonary edema

All other answers will eventually occur although the respiratory response will be the first

Question 18

A patient admitted to the hospital from a long-term care facility appears to be in the late stage of shock with systemic inflammatory response syndrome (SIRS). Which order implemented by the nurse has the highest priority?

a) Insert an indwelling urinary catheter.
b) Insert two large-bore intravenous catheters.
c) Administer 0.9% normal saline at 100 ml/hr.
d) Administer 100% oxygen by non-rebreather mask.

Answer 18

d) Administer 100% oxygen by non-rebreather mask.

tissue perfusion is the priority