T10: SIRS & MODS

Question 1

SYSTEMIC INFLAMMATORY RESPONSE SYNDROME (SIRS)

Answer 1

systemic inflammatory response to a variety of insults; generalized inflammation in organs

Question 2

what can result in SIRS

Answer 2

Infection (sepsis), ischemia, infarction and injury (burns, crush injury, CPR) can result in SIRS

Question 3

labs for liver

Answer 3

glucose and blood clotting, AST ALT

Question 4

labs for kidney

Answer 4

BUN, CRE, GFR, electrolytes, UA

Question 5

labs for heart

Answer 5

troponin, BNP, EKG, Echo

Question 6

labs for lung

Answer 6

ABG, chest x-ray

Question 7

labs for brain

Answer 7

CBC (problem with the pituitary), brain CT, glucose and sodium

Question 8

MULTIPLE ORGAN DYSFUNCTION SYNDROME (MODS):

Answer 8

failure of two or more organ systems (results from SIRS)

Question 9

RELATIONSHIP OF SHOCK, SIRS AND MODS

Answer 9

SIRS –> Shock states –> MODS

Question 10

SIRS and MODs can cause DIC because

Answer 10

the bone marrow is a system
o Clots form and bleeding at the same time; eventually the body will be depleted of platelets and the patient will continue to bleed

Question 11

the respiratory system is often the first system to

Answer 11

show signs of dysfunction in SIRS and MODS

Question 12

SIRS and MODS: respiratory

Answer 12

o Alveolar edema, decrease in surfactant, increase in shunt, V/Q mismatch
- End result: ARDS (vent setting with PEEP)

Question 13

SIRS and MODS: CV

Answer 13

Myocardial depression and massive vasodilation, results in decreased SVR and BP which increases HR to compensate, albumin and fluid move out of blood vessels

Question 14

SIRS and MODS: neuro

Answer 14

o Mental status changes (confused, agitated, combative, disoriented, lethargic or comatose) due to hypoxemia, inflammatory mediators, or impaired perfusion
o Often early sign of MODS

Question 15

SIRS and MODS: renal

Answer 15

Hypoperfusion of the kidneys activates the renin-angiotensin-aldosterone system resulting in systemic vasoconstriction
o Nephrotoxic drugs, especially antibiotics (monitor drug levels)

Question 16

SIRS and MODS: GI

Answer 16

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

Question 17

SIRS and MODS: hypermetabolic state

Answer 17

o Hyperglycemia-hypoglycemia
o Insulin resistance-Catabolic state
o Liver dysfunction
o Lactic acidosis

Question 18

lactic acid > than…

Answer 18

> 4 something is wrong also look at pH for LACTIC ACIDODS LOOK AT LIVER (liver cannot clear out toxins)

Question 19

SIRS and MODS: Prevention and treatment of infection

Answer 19

o ANTIBIOTICS
- Send appropriate cultures and start broad-spectrum antibiotic therapy, as ordered. Adjust therapy based on the culture results, if needed.
- Strict asepsis for invasive lines (urinary catheters, IVs, ET tubes, arterial lines)

Question 20

SIRS and MODS: Maintenance of tissue oxygenation

Answer 20

may need to be intubated or on a ventilator
- Decrease O2 demand and increase O2 delivery
· MORPHINE! A vasodilator so that the coronary artery gets more O2
· We can also decrease O2 demand by bed rest, cluster care, maintaining body temperature, sedation, and reducing stimuli

Question 21

support for DIC

Answer 21

appropriate blood products (look at CBC differential to determine what blood products are needed)

Question 22

support for ARDS

Answer 22

aggressive O2 therapy and mechanical ventilation

Question 23

support for renal failure

Answer 23

continuous renal replacement therapy