SIRS and MODs ppt

Question 1

Systemic Inflammatory Response Syndrome (SIRS)
&
Multiple Organ Dysfunction Syndrome (MODS)

Answer 1

1 Cause Sepsis = Hypoperfusion

2 Organs mainly affected
1. Heart 2. Lungs

Question 2

SIRS def and patho

Triggers
-Mechanical tissue trauma: burns, crush injuries, surgical procedures
-Abscess formation: intraabdominal, extremities
-Ischemic or necrotic tissue: pancreatitis, vascular disease, MI
-Microbial invasion: bacteria, viruses, fungi
-Endotoxin release: gram-negative bacteria
-Global perfusion deficits: postcardiac resuscitation, shock states
-Regional perfusion deficits: distal perfusion deficits

Answer 2

Systemic inflammatory response syndrome (SIRS) is a systemic inflammatory response to a variety of insults
Generalized inflammation in organs remote from the initial insult

Question 3

MODS = End of Continuum…(death)

Answer 3

Multiple organ dysfunction syndrome (MODS) is failure of two or more organ systems
Homeostasis cannot be maintained without intervention
Results from SIRS

NO DIC, No decubitus

Question 4

Relationship of Shock, SIRS, and MODS

Answer 4

Question 5

SIRS and MODSPathophysiology

**DIC = bleeding = no more platelets
Formation of microemboli. **

Answer 5

Organ and metabolic dysfunction
Hypotension
Decreased perfusion
Formation of microemboli
Redistribution or shunting of blood (VQ mismatch)

Question 6

SIRS and MODSPathophysiology #Always Lungs compromised 1st

Answer 6

Respiratory system
Alveolar edema
Decrease in surfactant
Increase in shunt – circulation passing your lungs w/o oxygenation
V/Q mismatch (increase in shunting???)
End result: ARDS (Hard fluid filled lungs)
RF -> inflammatory mediators (cytokines) = more aggressive

Question 7

SIRS and MODSPathophysiology: cardiovascular system

Answer 7

Myocardial depression and massive vasodilation (drop BP -> leads to drop CO)
Edematous – increased edema = increased capillary permeability = venous pooling
Results in drop SVR and BP
Baroreceptors respond to enhance CO
Fluid shift - Albumin and fluid move out of blood vessels

Question 8

NEURO
SIRS and MODSPathophysiology Neuro = Hypoxia= Hypo-perfusion= Confusion, Irritable, lethargic, Combative, Comatose

Answer 8

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

Question 9

Renal System
SIRS and MODS

Answer 9

Acute kidney injury (AKI)
Hypoperfusion : ↓ u/o, ↑ Cr
Release of mediators
Activation of renin-angiotensin-aldosterone system # Holds on to water#
Nephrotoxic drugs, especially antibiotics
ABX: Mycins

Question 10

GI
SIRS and MODSPathophysiology# Early stage: Blood is shunted out of GI

Answer 10

GI system
Motility decreased: abdominal distention and paralytic ileus
Decreased perfusion: risk for ulceration and GI bleeding
Potential for bacterial translocation from GI to circulatory system.

Intervention
Even with MODS, we want to feed the patient to maintain the stomach.

Question 11

SIRS and MODS
Gluconeogensis , increased BS

Hematologic system
1. DIC – causes simultaneous micro-clotting, combined with extra fibrinolysis, and decreased platelets.
2. Electrolyte imbalances
3. Metabolic acidosis
4. Hypoxia – decreased tissue oxygen perfusion -> lactic acidosis.

Answer 11

Hypermetabolic state
Hyperglycemia-hypoglycemia – glycogenesis ↑BS, insulin resistant
Insulin resistance
Catabolic state – fatty acid burns and ketones as fuel-> hypermetabolic state. Lean mass decreases.
Liver dysfunction – no albumin # key role in maintaining the plasma-oncotic pressure.
Lactic acidosis – infection, without oxygen

Question 12

Interprofessional Care SIRS and MODS

Answer 12

Prevention and treatment of infection
Aggressive infection control strategies to decrease risk for nosocomial infection
Strict asepsis
Assess need for invasive lines
Once an infection is suspected, institute interventions to control source

BURN pt. – early debridement of burns to avoid infection by microorganism.

Question 13

Interprofessional care SIRD and MODS - Oxygenation

Answer 13

Maintenance of tissue oxygenation
Decrease O2 demand and increase O2 delivery
Sedation
Mechanical ventilation
Analgesia
Rest

Question 14

Interprof. care - Nutirion

Answer 14

Nutritional and metabolic needs
Goal of nutritional support: preserve organ function
Total energy expenditure is often increased 1.5 to 2.0 times
Use of the enteral route is preferred to parenteral nutrition
Monitor plasma transferrin and prealbumin levels to assess hepatic protein synthesis
Provide glycemic control

Question 15

SIRS and MODS - support the failing organs

Answer 15

Support of failing organs
ARDS: aggressive O2 therapy and mechanical ventilation
DIC: appropriate blood products
Renal failure: continuous renal replacement therapy or dialysis

Question 16

Questions

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

ANS: A

This is the FIRST SIGN of SIRS.

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

Answer: D

Question 19

While performing triage in the emergency department, the nurse determines that which of the following patients should be seen first?

a. A patient with a deformed leg indicating a fractured tibia; blood pressure 110/60 mm Hg, pulse 86 beats/min, respirations 18 breaths/min.
b. A patient with burns on the face and chest; blood pressure 120/80 mm Hg, pulse 92 beats/min, respirations 24 breaths/min.
c. A patient with type 1 diabetes in ketoacidosis; blood pressure 100/60 mm Hg, pulse 100 beats/min, respirations 32 breaths/min.
d. A patient with a respiratory infection with a cough productive of greenish sputum; blood pressure 128/86 mm Hg, pulse 88 beats/min, respirations 26 breaths/min.

Answer 19

ANS: C

because of low BP and high pulse and kussmaul respirations = shock

Disaster Planning PP

Question 20

Assessment of a male patient during the primary survey indicates delayed capillary refill of the extremities. He cannot explain the events before admission to the ED. Which action should the nurse take immediately?

A. Apply leads to the patient’s chest to initiate ECG monitoring.
B. Insert one or two large-bore IV catheters to start IV fluid resuscitation.
C. Continue the primary survey to complete a brief neurologic examination.
D. Initiate pulse oximetry by placing a monitoring device on the patient’s index finger.

Answer 20

Answer: d

Rationale: The primary survey focuses on airway, breathing, circulation, disability, and exposure/environmental control. It serves to identify life-threatening conditions so that appropriate interventions can be initiated. The nurse may identify life-threatening conditions related to airway, breathing, circulation (ABCs), and disability at any point during the primary survey. When this occurs, the nurse should start interventions immediately and before moving to the next step of the survey. The patient has decreased oxygenation, and further assessment with pulse oximetry is indicated.

Question 21

https://quizlet.com/120003973/hn-ch69-emergency-terrorism-and-disaster-nursing-flash-cards/

Question 22

What occurs during the refractory stage of shock?

A. Cardiac output (CO) is decreased, and tissue perfusion is threatened.
B. Compensatory mechanisms begin failing.
C. Homeostatic mechanisms begin to work.
D. Shock becomes unresponsive to therapy.

Answer 22

ANS: D

Question 23

Which kind of shock occurs from inadequate fluid volume in the intravascular space?

A. Anaphylactic
B. Cardiogenic
C. Hypovolemic
D. Neurogenic

Answer 23

ANS: C

Question 24

Triage Tags

Answer 24

-green: minor injury
-yellow: non life threatening injury
-red: life threatening injury
-blue: expected to die
-black: dead

Question 25

Septic shock is caused by which source?

a. Allergens
b. Loss of sympathetic tone
c. Microorganisms
d. Non-immunologic activation of mast cells and basophils

Answer 25

ANS: C

Question 26

A nurse witnesses a patient going into pulmonary edema. The patient exhibits respiratory distress, but the blood pressure is stable at this time. While waiting for help to arrive, the nurse performs the following actions in which order of priority?

a. Rechecks vital signs
b. Places the patient in high fowler’s position
c. Calls the respiratory therapy department for a ventilator
d. Places the patient on a pulse oximeter and cardiac monitor
e. Begins the patient’s oxygen at 2 liters by nasal cannula as needed
f. Administers the patient morphine sulfate intravenous injection as needed

Answer 26

B, E, D, A, F, C
(D then A because intervention then reassessment!)

MSC increases O2 supply by vasodilation!!!

Question 27

A patient is experiencing pulmonary edema as an exacerbation of chronic left-sided heart failure. The nurses assesses the patient for which of the following manifestations?

a. Weight loss
b. Bilateral crackles
c. Distended neck veins
d. Peripheral pitting edema

Answer 27

ANS: B

Pulmonary edema is the basis of ARDS - we see a component of pulmonary edema when pt goes into ARDS.

Question 28

During the emergent phase of burn injury, the nurse assesses for the presence of hypovolemia. In burns, hypovolemia occurs primarily as a result of

a. blood loss from injured tissue.
b. third spacing of fluid into fluid-filled vesicles.
c. evaporation of fluid from denuded body surfaces.
d. capillary permeability with fluid shift to the interstitium.

Answer 28

ANS: D

This is why swelling with burns is such a huge complication and needs to be assessed at all times.

Question 29

When monitoring initial fluid replacement for the patient with 40% TBSA deep partial-thickness and full-thickness burns, which of the following findings is of most concern to the nurse?

a. Urine output of 35 ml/hr
b. Serum K+ of 4.5 mEq/L
c. Decreased bowel sounds
d. Blood pressure of 86/72 mm Hg

Answer 29

ANS: D

No pulse pressure so no circulation.

Question 30

A patient recovering from second-and third degree burns over 30% of his body and is now ready for discharge. The first action the nurse should take when meeting with the patient would be to?

a. Arrange a return-to-the clinic appointment and prescription for pain medication.
b. Teach the patient and the caregiver proper wound care to be performed at home.
c. Review the patient’s current health care status and readiness for discharge to home.
d. Give the patient written discharge information and websites for additional information for burn survivors.

Answer 30

ANS: C

Question 31

https://quizlet.com/194466543/exam-4-powerpoint-questions-flash-cards/