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NRSG 421 > Week 3 - Prioritization, Sepsis and MODS > Flashcards

Week 3 - Prioritization, Sepsis and MODS Flashcards

1
Q

for prioritization terminology, early refers to what?

A

in comparison to late

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2
Q

for prioritization terminology, best refers to what?

A

what is most helpful

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3
Q

for prioritization terminology, first refers to what?

A
  • may refer to first steps/ what you do first
  • use ADPIE
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4
Q

for prioritization terminology, next refers to what?

A
  • may refer to implement
  • what steps are next
  • use ADPIE
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5
Q

for prioritization terminology, effective refers to what?

A
  • may refer to evaluation
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6
Q

for prioritization terminology, most appropriate refers to what?

A

may refer to priority

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7
Q

for prioritization terminology, priority terms refers to what?

A
  • first
  • immediate
  • initial response
  • primary
  • highest priority
  • best
  • essential
  • think ABCs
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8
Q

for prioritization terminology, needs further education/ teaching refers to what?

A

the incorrect answer

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9
Q

for prioritization terminology, indicates understanding refers to what?

A

the correct answer

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10
Q

for prioritization terminology, which diagnostic is anticipated refers to what?

A
  • BEST response
  • which will be MOST definitive
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11
Q

What is SIRS?

A

inflammatory response

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12
Q

what are the signs of SIRS?

A
  • tachycardia (>90)
  • fever (>38 or <36)
  • tachypnea (>20)
  • change in LOC
  • WBC > 12.0X10/L or <3.0X10/L
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13
Q

how do you differentiate between sepsis and SIRS?

A

Sepsis needs blood cultures and a source SIRS does not

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14
Q

how do you know someone has sepsis?

A
  • SIRS plus confirmed infection sourse
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15
Q

What can lead to septic shock?

A

body’s reaction to an infection in the bloodstream > now systemic

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16
Q

what is the most common cause of sepsis?

A

gram + or - bacteria

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17
Q

what are the hallmark signs of septic shock

A

hypotension THEN sepsis

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18
Q

how do you calculate MAP?

A

double the diastolic bloop pressure and add the sum to systolic pressure then dived by 3

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19
Q

what does the cardiac output look like in the early and late stages of septic shock?

A

early stage
- normal or high

late stage
- drops when heart fails

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20
Q

what does septic shock cause?

A
  • vasodilation
  • increased capillary permeability
  • thrombi in microcirculation
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21
Q

what does the increased capillary permeability resulting from septic shock lead to?

A

decreased tissue perfusion (distributive shock)

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22
Q

what does MODS stand for?

A

M - multiple
O - organ
D - dysfunction
S - syndrome

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23
Q

what causes MODS?

A
  • failure of 2 or more organ systems in a client with sepsis
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24
Q

what are some signs of MODS?

A
  • altered LOC
  • declining resp status
  • adventitious lung sounds
  • refractory hypotension
  • long cap refill/ cool skin
  • decreased U/O
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25
Q

what are some things that put people at risk for septic shock?

A
  • suppressed immune system
  • elderly or infant
  • if you’ve received an organ transplant
  • invasive surgical procedure
  • foley catheter
  • central line
  • trach
  • chronic sickness
  • DM
  • alcoholism
  • renal failure
  • liver failure
  • had sepsis prior
  • TPN
  • immune suppressants
  • chemo/ XRT
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26
Q

what is the highest risk surgery for sepsis?

A

GI surgery

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27
Q

what are the diagnostic tests used for sepsis?

A
  • CBC
  • D-dimer
  • platelets
  • ABGs
  • thyroid
  • PCT
  • renal panel
  • liver panel
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28
Q

what invasive diagnostic tests are used for sepsis?

A
  • transesophageal doppler
  • CVP
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29
Q

what sources are used for diagnostic purposes for sepsis?

A
  • urine C&S
  • wound swab
  • sputum C&S
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30
Q

what does sepsis do to the acid/ base balance initially?

A
  • interstitial fluid increases RR
  • CO2 blown off > low CO2 leads to resp. alkalosis
  • alkalosis leads to vasoconstriction
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31
Q

what does sepsis do to the acid/ base balance as it progresses from initial phase?

A
  • leads to severe tissue hypoxia
  • increases lactate which leads to metabolic acidosis
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32
Q

hyperlactatemia is worsened by anaerobic glycolysis, how do you treat this if the glucose level is > 10mmol/L

A

treat with insulin

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33
Q

if your BMR is increased, what does this indicate?

A

increased glucose metabolism

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34
Q

metabolic acidosis can also be caused from what?

A
  • severe sepsis
  • septic shock
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35
Q

why does lactate build up ?

A

due to decreased excretion from acute or worsening hepatic function

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36
Q

what does lactate come from?

A
  • skeletal muscle
  • skin
  • brain
  • intestines
  • erythrocytes
37
Q

what does glycolysis increase?

A

lactate production

38
Q

what assessment tool indicates late sepsis?

A

SOFA

39
Q

what are early signs of septic shock?

A
  • wam/ flushed skin due to vasodilation
  • decreased BP
  • hyperthermia
  • high CO
  • increased HR
  • decreased systemic vascular resistance
  • tachycardia
  • tachypnea
  • lethargic
  • anxiety
40
Q

what are the late signs of septic shock?

A
  • skin pale, cool, clammy
  • severe hypotension
  • oliguria
  • coma
  • hypothermia
  • depressed heart function
  • increased HR
41
Q

in regards to the late signs of septic shock, depressed heart function results in what?

A

low cardiac output and vasoconstriction

42
Q

when would you administer norepinephrine to a septic patient?

A
  • still hypotensive after bolus
  • positive inotrope increases CO
43
Q

what is norepinephrine ?

A

vasopressor

44
Q

when would you administer a crystalloid (fluid) bolus to a septic patient?

A
  • hypotensive
  • replace lost fluids
45
Q

how much crystalloid (fluid) bolus would you administer to a septic patient?

A

30mL/kg over 3 hours

46
Q

what is the only medication with a strong recommendation to administer to a septic patient ?

A

norepinephrine

47
Q

when would you administer hydrocortisone to a septic patient?

A
  • hypotensive
  • when norepinephrine and fluid bolus is ineffective
  • retains Na+
48
Q

what is hydrocortisone?

A

corticosteroid

49
Q

when do you want to administer vancomycin to a septic patient ?

A

after source of infection is determined to be gram +

50
Q

what is vancomycin?

A

antibiotic

51
Q

what do you need to check prior to administering vancomycin for a septic patient ? why?

A
  • kidney function
  • medication is hard on them
52
Q

what is albumin? What does it do?

A
  • colloid
  • pulls fluid from interstitial space
  • maintains pressure
53
Q

when do you administer albumin to a septic patient ?

A

only after large volumes of crystalloids have been tried

54
Q

what is plasma protein?

A

colloid

55
Q

what is dobutamine?

A
  • vasoactive inotrope
56
Q

what is dobutamine used for?

A
  • hypoperfusion
  • HF
57
Q

what is epinephrine? what do you use it for?

A
  • vasopressor
  • cardiac arrest
58
Q

What are complications that are caused from sepsis?

A
  • DIC
  • Micro-clot
  • encephalopathy
  • ARDS
    acute renal failure
  • hepatic dysfunction
  • fluid shift
  • endocrine dysfunction
59
Q

what does DIC stand for?

A

disseminated intravascular coagulation

60
Q

how does sepsis cause DIC?

A

fibrinolysis is inhibited due to endothelial cell damage and impact on tPA

61
Q

how does sepsis cause micro-clots?

A
  • causes clots/ depletes body of platelets
  • increased thrombin formation due to endothelial damage
62
Q

how does sepsis cause encephalopathy?

A
  • changes in LOC due to inflammatory response
  • decreased perfusion
  • increased BBB permeability
63
Q

how does sepsis cause ARDS?

A
  • inflammatory response and increased permeability
  • results in fluid/ atelectasis of alveoli
64
Q

if a patient with sepsis develops a DIC complications, what signs/ symptoms would they have?

A
  • frank external bleeding
  • internal bleeding
  • respiratory distress from bleed/ clot into lungs
65
Q

where would external frank blood be coming from with a patient who has DIC?

A

venipuncture site

66
Q

where would a patient be bleeding internally if they had DIC resulting from sepsis?

A
  • petechiae
  • ecchymosis
  • hematuria
  • hematemesis
  • bloody stools
67
Q

what is petechiae?

A

rash on mucous membranes or skin

68
Q

what is ecchymosis?

A
  • bruising
  • bleeding under the skin
69
Q

if a patient with sepsis develops septic encephalopathy, what signs/ symptoms would they have?

A
  • disorientation
  • irritability
  • agitation
  • coma
  • myoclonic jerks
  • seizures
70
Q

if a patient with sepsis develops microvascular clotting, what signs/ symptoms would they have?

A
  • poor perfusion where clot is
  • tissue ischemia
71
Q

if a patient with sepsis develops ARDS, what signs/ symptoms would they have?

A
  • crackles
  • SOB
  • increased O2 demands
72
Q

if a patient with sepsis develops a DIC complication, how will it be treated?

A
  • treat infection
  • prevent occurrence
  • fresh frozen plasma
  • platelets
  • RBC
73
Q

if a patient with sepsis develops septic encephalopathy, how will it be treated?

A
  • treatment is symptomatic
  • antimicrobial therapy
74
Q

if a patient with sepsis develops microvascular clotting , how will it be treated?

A
  • low molecular weight heparin
75
Q

if a patient with sepsis develops ARDS, how will it be treated?

A
  • O2 therapy
  • ventilation
  • elevate HOB
76
Q

How does sepsis cause acute renal failure?

A
  • fluid imbalance
  • acid-base imbalance
  • low pressure
  • infection impacting renal perfusion
77
Q

how does sepsis cause hepatic dysfunction?

A
  • poor hepatic perfusion
  • impacting metabolism/ excretion capacity
78
Q

how does sepsis cause fluid shifts?

A
  • inflammatory process
  • vasodilation
  • increased vascular permeability
79
Q

how does sepsis cause endocrine dysfunction ?

A
  • adaptive metabolic response in attempt to increase resistance to different stressors by lowering cellular metabolic activity
80
Q

if a patient with sepsis develops acute renal failure, what signs/ symptoms would they have?

A
  • oliguria
  • elevated BUN and Creatinine
81
Q

if a patient with sepsis develops fluid shifting, what signs/ symptoms would they have?

A
  • crackles
  • pedal edema
82
Q

if a patient with sepsis develops hepatic dysfunction, what signs/ symptoms would they have?

A
  • jaundice
  • hypovolemia
  • bleeding
83
Q

if a patient with sepsis develops endocrine dysfunction, what signs/ symptoms would they have?

A

no typical findings

84
Q

once someone is diagnosed with sepsis what do you need to complete in the first 3 hours? list in order

A
  • measure lactate
  • obtain blood cultures
  • administer broad spectrum antibiotics
  • administer 30ml/kg crystalloid for hypotension of lactate > 4 mmol/L
85
Q

once someone is diagnosed with sepsis what do you need to complete in the first 6 hours? list in order

A
  • vasopressors to maintain MAP >65 mmHg if hypotension didn’t respond to initial fluids
  • if hypotension persists or initial lactate > 4mmol/L measure CVP and SCVO2
  • remeasure lactate if initial was elevated
86
Q

what is the normal range for central venous pressure? What part of the body is this measured from?

A
  • 8-12
  • internal jugular or subclavian
87
Q

what does CVP mean?

A

central venous pressure

88
Q

what does SCVO2 mean? what is the normal range for it?

A
  • central venous oxygen saturation
  • > 70

NRSG 421 (6 decks)

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