Stuff to know from immune slides Flashcards
what is empiric therapy
abx therapy given before culture results
what is definitive therapy
abx given after culture results
what is prophylactic antibiotic therapy
preventative abx given before surgery
what is superinfection
abx eliminate or reduce normal flora, causing overgrowth of other bacteria or fungi
cause of pseudomembranous colitis or C. diff
abx disrupt normal gut flora creating overgrowth of c.diff
what does release of histamine in the body do
increase HR
vasodilation -> decreased BP
bronchoconstriction
increased gastric acid -> N&V
what does epinephrine help with
vasopressor (increase BP)
dilate airways
increase heart ability to pump blood
alpha/beta adrenergic agonists (receptor)
what are the requirements for SIRS (systemic inflamatory response syndrome)
Temp: <96.8 to >100.4F
Resp rate: >20
Heart rate: >90
WBC: > 12,000 or <4,000 &
>10% neutrophile bands
abnormal neutrophil range and band
50-70% normal >70% abnormal
0-8% normal >10% band abnormal
when to give antipyretic
> 102F
what conditions would the pt considered to be in sepsis
2 SIRS requirements
confirmed or suspect active infection
what condition is considered to be severe sepsis
confirmed sepsis, signs of end organ damage
Hypotension 120/80 normal (<90)
Lactate >4 mmol
what is considered septic shock
severe sepsis with persistent signs of end organ damage, hypotension, lactate >4 mmol
what does qSOFA score tell you
screen the likelihood of a pt having sepsis
list infections that are most commonly associated with sepsis
pneumonia
GI infections
kidney, bladder, urinary system infections
bacteremia (bloodstream infection)
normal WBC count
4.5-10 (4,500 - 10,000)
normal neutrophil band
0-8%
>10 is a SIRS
what is the CRP test tell you and range considered sepsis
C-reactive protein that the liver makes in response to inflammation
>3 is bad
normal platelet count
140-450 (10^3)
140,000 - 450,000 cells/mcL
Hbg count for male and female
male: 14 - 17
female: 12 - 15
overall 12- 17 ish
symptoms that are considered sepsis
patches of discolored skin
decreased urination
changes in mental status
low platelet count
issues breathing
abnormal heart fxn
chills
unconsciousness
extreme weakness
SEPSIS acronym
S: shivering, fever, very cold
E: extreme pain or general discomfort
P: pale or discolored skin
S: sleepy, difficult to rouse, confused
I: I feel like I might die
S: short of breath
4 nursing diagnosis that are related with sepsis
risk for deficient fluid volume
risk for decreased cardiac output
impaired gas exchange
risk for shock
5 step process to Sepsis hour-1 bundle
- measure lactate lvl
- obtain blood culture before giving abx
- administer broad spectrum antibiotics
- begin 30mL/kg crystalloid IV
- give vasopressors if hypotensive during or after fluid resuscitation to maintain MAP >=65 mmHg
what are the crystalloid solutions to give during sepsis
lactate or saline soln
what vasopressors to give during shock
epinephrine
dopamine
definition of shock
cellular and tissue hypoxia
what counts as distributive shock
blood vessels lose their tone -
anaphylactic shock
septic shock
neurogenic shock
3 big problems with septic shock
excess coagulation
exaggerated inflammation
impaired fibrinolysis
what does peak and trough mean
peak is when the conc of drug is highest in the BLOOD
trough is when the conc of the drug is highest in the TISSUE
when should trough levels be taken
1hr before dose
when should peak levels be taken
2hrs ish afterfor vancomycin
30mins after for IV, 60mins IM for gentamicin and tobramycin (aminoglycosides)
