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24 Cards in this Set

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  • Back
Early indications for development of sepsis include:
1. high temp
2. high HR
3. high respirations
T or F: septic shock is #1 cause of mortality in the ICU.
true
What are some factors that predispose to sepsis and septic shock?
1. alteration in host defenses
2. severe underlying illnesses
3. major surgery
4. presence of foreign bodies
5. obstructive process
6. treatment with cytotoxic or anti-metabolites
7. prior antibiotic therapy
What is the chain of events that causes sepsis and septic shock?
bacterial infection->bacteremia->inflammatory response->coagulation and decreased fibrinolysis->endothelial and vascular changes->hypoperfusion->organ failure
What is the definition of SIRS? What are the s/s?
1. systemic inflammatory response syndrome
2. 2 or more of the following: increased HR, temp, or respirations; changes in WBC count
Is SIRS always caused by infection?
no
If SIRS is caused by infection, what is this?
sepsis
What is sepsis syndrome?
sepsis + evidence of altered organ perfusion
From best to worst, what is the order of sepsis?
bacteremia->SIRS->sepsis->sepsis syndrome->septic shock->multiple organ dysfunction syndrome
What is septic shock?
septis syndrome + refractory hypotension
What is multiple organ dysfunction syndrome?
altered organ function in acutely ill patient such that homeostasis cannot be maintained without intervention
What bacteria are present in sepsis via UTI? Deep wounds? Nosocomial infections?
1. e. coli, klebsiella
2. anaerobes (clostridium)
3. staph spp.
What are some common bacterial agents of sepsis?
1. GNR
2. encapsulated pyrogens
3. staph spp.
4. beta-hemolytic strep
5. anaerobes
What is morphology for pseudomonas?
GNR, oxidase +, non-fermenting, opportunistic pathogen
What bacteria has a high mortality rate in sepsis?
pseudomonas
What patients might suffer from pseudomonas infection?
1. burns
2. immunocompromised
3. hot tubs
4. neutropenia
5. nosocomial
Pseudomonas lesions in minority of patients are called what?
ecthyma gangrenosum
What are s/s of sepsis syndrome?
1. apprehension
2. fever, chills (or hypothermia)
3. hyperventilation
4. hypotension
5. leukopenia or thrombocytopenia
6. altered organ function
Sequence of hemological events in sepsis?
capillary leakage and vasodilation->hypotension (becomes refractory to fluid replacement)->hypoperfusion->end organ damage
What are the key steps in the host inflammatory response in sepsis?
pattern recognition receptors on host cells detect foreign antigen->this causes activation of TNF, IL-1, and HMGB1->endothelium activates->increases secretion of coagulation products->coagulation increases and fibrinolysis decreases->end organ damage
What is protein C? What is PAI-1?
1. anticoagulant that inhibits PAI-1
2. PAI-1 decreases fibrinolysis
T or F: septic patients are hyperglycemic.
true
What is one of the key treatments to stop septic shock from progressing?
aggressive fluid replacement
What organism would likely be found in a URI?
strep pneumo