SIRS and MODS Flashcards
What is SIRS?
Systematic inflammatory response syndrome
What is SIRS a response to?
the 4 I’s
Infection, ischaemia, infarction, injury
What are the triggers of SIRS?
- Mechanical tissue trauma
- Abscess formation
- Ischemic or necrotic tissue
- Microbial invasion
- Perfusion deficits
What is MODS?
Multiple organ dysfunction syndrome (MODS) is the failure of two or more organ systems
usually comes after SIRS
What are the consequences of the inflammatory response?
- Release of mediators
- Direct damage to the endothelium
- Hyper-metabolism
- Increase in vascular permeability
- Activation of coagulation cascade
How does the respiratory system respond to inflammation?
- Alveolar edema
- Decrease in surfactant
- Increase in shunt
- End result: ARDS (acute respiratory distress syndrome)
How does the cardiac system respond to inflammation?
- Myocardial depression and massive vasodilation
- Baroreceptors respond to enhance Cardiac Output
- Albumin and fluid move out of blood vessels
How does the neurological system respond to inflammation?
- Mental status changes due to hypoxemia, inflammatory mediators, or impaired perfusion
- Often early sign of MODS
How does the renal system respond to inflammation?
- Acute kidney injury (AKI)
- Hypoperfusion
- Releases mediators
- Activation of renin-angiotensin-aldosterone system
How does the gastrointestinal system respond to inflammation?
- Motility decreased: abdominal distention and paralytic ileus
- Decreased perfusion: risk for ulceration and GI bleeding
- Potential for bacterial translocation
What is the care goal for SIRS?
prevent the progression of SIRS to MODS
Collaborative care for patients with MODS focuses on?
- Prevention and treatment of infection
- Maintenance of tissue oxygenation
- Nutritional and metabolic support
- Appropriate support of individual failing organs
For prevention and treatment of infection what is the collaborative care?
- Aggressive infection control strategies
- Strict asepsis
- Oxygen, fluid resuscitation and antibiotics are first line treatment
- Assess need for invasive lines
For Maintenance of tissue oxygenation what is the collaborative care?
- Decrease O2 demand and increase O2 delivery
- Sedation
- Mechanical ventilation
- Analgesia
- Rest
For Nutritional and metabolic needs what is the collaborative care?
- Goal is to preserve organ function
* Monitor plasma transferrin and prealbumin levels to assess hepatic protein synthesis
How do we support the failing organs in ARDS, DIC and Renal Failure?
• ARDS: aggressive O2 therapy and mechanical
ventilation
• DIC (Disseminated intravascular coagulation: appropriate blood products
• Renal failure: continuous renal replacement therapy or dialysis
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.
a) pulmonary edema
All other answers will eventually occur although the respiratory response will be the first
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.
d) Administer 100% oxygen by non-rebreather mask.
tissue perfusion is the priority
