Week 3 - Prioritization, Sepsis and MODS Flashcards
1
Q
for prioritization terminology, early refers to what?
A
in comparison to late
2
Q
for prioritization terminology, best refers to what?
A
what is most helpful
3
Q
for prioritization terminology, first refers to what?
A
- may refer to first steps/ what you do first
- use ADPIE
4
Q
for prioritization terminology, next refers to what?
A
- may refer to implement
- what steps are next
- use ADPIE
5
Q
for prioritization terminology, effective refers to what?
A
- may refer to evaluation
6
Q
for prioritization terminology, most appropriate refers to what?
A
may refer to priority
7
Q
for prioritization terminology, priority terms refers to what?
A
- first
- immediate
- initial response
- primary
- highest priority
- best
- essential
- think ABCs
8
Q
for prioritization terminology, needs further education/ teaching refers to what?
A
the incorrect answer
9
Q
for prioritization terminology, indicates understanding refers to what?
A
the correct answer
10
Q
for prioritization terminology, which diagnostic is anticipated refers to what?
A
- BEST response
- which will be MOST definitive
11
Q
What is SIRS?
A
inflammatory response
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
13
Q
how do you differentiate between sepsis and SIRS?
A
Sepsis needs blood cultures and a source SIRS does not
14
Q
how do you know someone has sepsis?
A
- SIRS plus confirmed infection sourse
15
Q
What can lead to septic shock?
A
body’s reaction to an infection in the bloodstream > now systemic
16
Q
what is the most common cause of sepsis?
A
gram + or - bacteria
17
Q
what are the hallmark signs of septic shock
A
hypotension THEN sepsis
18
Q
how do you calculate MAP?
A
double the diastolic bloop pressure and add the sum to systolic pressure then dived by 3
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
20
Q
what does septic shock cause?
A
- vasodilation
- increased capillary permeability
- thrombi in microcirculation
21
Q
what does the increased capillary permeability resulting from septic shock lead to?
A
decreased tissue perfusion (distributive shock)
22
Q
what does MODS stand for?
A
M - multiple
O - organ
D - dysfunction
S - syndrome
23
Q
what causes MODS?
A
- failure of 2 or more organ systems in a client with sepsis
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
25
what are some things that put people at risk for septic shock?
- 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
26
what is the highest risk surgery for sepsis?
GI surgery
27
what are the diagnostic tests used for sepsis?
- CBC
- D-dimer
- platelets
- ABGs
- thyroid
- PCT
- renal panel
- liver panel
28
what invasive diagnostic tests are used for sepsis?
- transesophageal doppler
- CVP
29
what sources are used for diagnostic purposes for sepsis?
- urine C&S
- wound swab
- sputum C&S
30
what does sepsis do to the acid/ base balance initially?
- interstitial fluid increases RR
- CO2 blown off > low CO2 leads to resp. alkalosis
- alkalosis leads to vasoconstriction
31
what does sepsis do to the acid/ base balance as it progresses from initial phase?
- leads to severe tissue hypoxia
- increases lactate which leads to metabolic acidosis
32
hyperlactatemia is worsened by anaerobic glycolysis, how do you treat this if the glucose level is > 10mmol/L
treat with insulin
33
if your BMR is increased, what does this indicate?
increased glucose metabolism
34
metabolic acidosis can also be caused from what?
- severe sepsis
- septic shock
35
why does lactate build up ?
due to decreased excretion from acute or worsening hepatic function
36
what does lactate come from?
- skeletal muscle
- skin
- brain
- intestines
- erythrocytes
37
what does glycolysis increase?
lactate production
38
what assessment tool indicates late sepsis?
SOFA
39
what are early signs of septic shock?
- wam/ flushed skin due to vasodilation
- decreased BP
- hyperthermia
- high CO
- increased HR
- decreased systemic vascular resistance
- tachycardia
- tachypnea
- lethargic
- anxiety
40
what are the late signs of septic shock?
- skin pale, cool, clammy
- severe hypotension
- oliguria
- coma
- hypothermia
- depressed heart function
- increased HR
41
in regards to the late signs of septic shock, depressed heart function results in what?
low cardiac output and vasoconstriction
42
when would you administer norepinephrine to a septic patient?
- still hypotensive after bolus
- positive inotrope increases CO
43
what is norepinephrine ?
vasopressor
44
when would you administer a crystalloid (fluid) bolus to a septic patient?
- hypotensive
- replace lost fluids
45
how much crystalloid (fluid) bolus would you administer to a septic patient?
30mL/kg over 3 hours
46
what is the only medication with a strong recommendation to administer to a septic patient ?
norepinephrine
47
when would you administer hydrocortisone to a septic patient?
- hypotensive
- when norepinephrine and fluid bolus is ineffective
- retains Na+
48
what is hydrocortisone?
corticosteroid
49
when do you want to administer vancomycin to a septic patient ?
after source of infection is determined to be gram +
50
what is vancomycin?
antibiotic
51
what do you need to check prior to administering vancomycin for a septic patient ? why?
- kidney function
- medication is hard on them
52
what is albumin? What does it do?
- colloid
- pulls fluid from interstitial space
- maintains pressure
53
when do you administer albumin to a septic patient ?
only after large volumes of crystalloids have been tried
54
what is plasma protein?
colloid
55
what is dobutamine?
- vasoactive inotrope
56
what is dobutamine used for?
- hypoperfusion
- HF
57
what is epinephrine? what do you use it for?
- vasopressor
- cardiac arrest
58
What are complications that are caused from sepsis?
- DIC
- Micro-clot
- encephalopathy
- ARDS
acute renal failure
- hepatic dysfunction
- fluid shift
- endocrine dysfunction
59
what does DIC stand for?
disseminated intravascular coagulation
60
how does sepsis cause DIC?
fibrinolysis is inhibited due to endothelial cell damage and impact on tPA
61
how does sepsis cause micro-clots?
- causes clots/ depletes body of platelets
- increased thrombin formation due to endothelial damage
62
how does sepsis cause encephalopathy?
- changes in LOC due to inflammatory response
- decreased perfusion
- increased BBB permeability
63
how does sepsis cause ARDS?
- inflammatory response and increased permeability
- results in fluid/ atelectasis of alveoli
64
if a patient with sepsis develops a DIC complications, what signs/ symptoms would they have?
- frank external bleeding
- internal bleeding
- respiratory distress from bleed/ clot into lungs
65
where would external frank blood be coming from with a patient who has DIC?
venipuncture site
66
where would a patient be bleeding internally if they had DIC resulting from sepsis?
- petechiae
- ecchymosis
- hematuria
- hematemesis
- bloody stools
67
what is petechiae?
rash on mucous membranes or skin
68
what is ecchymosis?
- bruising
- bleeding under the skin
69
if a patient with sepsis develops septic encephalopathy, what signs/ symptoms would they have?
- disorientation
- irritability
- agitation
- coma
- myoclonic jerks
- seizures
70
if a patient with sepsis develops microvascular clotting, what signs/ symptoms would they have?
- poor perfusion where clot is
- tissue ischemia
71
if a patient with sepsis develops ARDS, what signs/ symptoms would they have?
- crackles
- SOB
- increased O2 demands
72
if a patient with sepsis develops a DIC complication, how will it be treated?
- treat infection
- prevent occurrence
- fresh frozen plasma
- platelets
- RBC
73
if a patient with sepsis develops septic encephalopathy, how will it be treated?
- treatment is symptomatic
- antimicrobial therapy
74
if a patient with sepsis develops microvascular clotting , how will it be treated?
- low molecular weight heparin
75
if a patient with sepsis develops ARDS, how will it be treated?
- O2 therapy
- ventilation
- elevate HOB
76
How does sepsis cause acute renal failure?
- fluid imbalance
- acid-base imbalance
- low pressure
- infection impacting renal perfusion
77
how does sepsis cause hepatic dysfunction?
- poor hepatic perfusion
- impacting metabolism/ excretion capacity
78
how does sepsis cause fluid shifts?
- inflammatory process
- vasodilation
- increased vascular permeability
79
how does sepsis cause endocrine dysfunction ?
- adaptive metabolic response in attempt to increase resistance to different stressors by lowering cellular metabolic activity
80
if a patient with sepsis develops acute renal failure, what signs/ symptoms would they have?
- oliguria
- elevated BUN and Creatinine
81
if a patient with sepsis develops fluid shifting, what signs/ symptoms would they have?
- crackles
- pedal edema
82
if a patient with sepsis develops hepatic dysfunction, what signs/ symptoms would they have?
- jaundice
- hypovolemia
- bleeding
83
if a patient with sepsis develops endocrine dysfunction, what signs/ symptoms would they have?
no typical findings
84
once someone is diagnosed with sepsis what do you need to complete in the first 3 hours? list in order
- measure lactate
- obtain blood cultures
- administer broad spectrum antibiotics
- administer 30ml/kg crystalloid for hypotension of lactate > 4 mmol/L
85
once someone is diagnosed with sepsis what do you need to complete in the first 6 hours? list in order
- 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
what is the normal range for central venous pressure? What part of the body is this measured from?
- 8-12
- internal jugular or subclavian
87
what does CVP mean?
central venous pressure
88
what does SCVO2 mean? what is the normal range for it?
- central venous oxygen saturation
- >70
