Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
45 Cards in this Set
- Front
- Back
|
What is the leading cause of death in the ICU's?
|
sepsis
|
|
|
What must be present to identify SIRS?
systemic inflammatory response syndrome |
2 or more of the following:
-temp above 100.4 or below 96.8 -hr above 90 bpm -RR above 20 or paCO@ less than 32 mmHg or mechanical ventilation -WBC above 12,--- or less than 4,00 or 10% mature neutrophils |
|
|
What are triggers of SIRS?
|
infection- commonly gram neg
injury- trauma, burn, surgery hypoperfusion- thrombo-embolism/low hemoglobin etc. |
|
|
When does a UTI become SIRS?
|
When the infection leaves the bladder and becomes systemic
|
|
|
What is present in severe sepsis?
|
hypoperfusion to any organ system
hypo tension organ dysfunction |
|
|
What causes septic shock?
|
severe sepsis with cardiovascular dysfunction. When body is no longer responsive to volume resuscitation you have septic shock
|
|
|
When there are still signs of hypoperfusion after volume resuscitation you have...
|
septic shock
|
|
|
What causes sepsis?
|
out of control systemic inflammatory response
|
|
|
The extent of the injury determines the extent of what?
|
Inflammatory response
|
|
|
What does vasodilation do during inflammation?
|
brings more WBC's to the area to perform phagocytosis.
|
|
|
What is the difference between physiologic inflammation and pathogenic inflammation?
|
physiologic is normal and healthy
pathogenic is not |
|
|
Pathogenic inflammation consists of:
|
-exaggerated systemic response that is not localized
-loss of regulation mediators that would typically localize the response |
|
|
Why does the inflammatory process not stay isolated to the injured area in pathologic inflammation?
|
Because of the rapid aggressive activation of inflammatory mediators (cytokines)
|
|
|
What causes the mal distribution of blood volume during SIRS?
|
as inflammatory mediators vasodilate, they become like soaker hoses.
Volume moves from vascular to extravascular space causing hypovolemia. |
|
|
What are symptoms of a shift in blood volume?
|
Urine output drops, BUN increases.
Blood shunts to heart, lungs and brain |
|
|
Does metabolism increase or decrease during sepsis?
|
Increase
|
|
|
What tissues are broken down during the increased metabolism of sepsis?
|
lean body mass and organs, this is why BUN increases.
|
|
|
What happens if the body continues to catabolize lean muscle and organ tissue?
|
MODS- multi organ dysfunction syndrome
|
|
|
What are symptoms of the body trying to compensate for decreased perfusion?
|
increased heart rate, increased respirations
|
|
|
What can trigger SIRS in an infection?
|
The release of endotoxins or exotoxins.
|
|
|
How do endotoxins escalate an infection to SIRS?
|
when gram negative bacteria die or multiply, endotoxins stored in the outer portion of the cell wall are released.
*Also, when we give antibiotics and cell walls are lysed, endotoxins are released and can cause endotoxin showers. This can manifest as a rapid escalation of the illness. Be prepared when giving antibiotics for symptoms to worsen. |
|
|
How do endotoxins get from the GI tract to the blood?
|
The GI tract is not a priority system for perfusion. During times of stress, endotoxins can move from the tract to the blood stream because of hypoperfusion or injury.
|
|
|
How do exotoxins escalate an infection to SIRS?
|
Gram positive bacteria release exotoxins during cell death. This may come as the result of using antibiotics. A common culprit is group A strep.
|
|
|
Clinical presentation of early shock:
|
-Fever
-High cardiac output -tachycardia -bounding pulse due to increased preload -peripheral vasodilation- warm skin, flushing -non cardiogenic pulmonary edema -hypoxia -initial respiratory alkalosis due to breathing quickly -SOB -Crackles, wheezes -SaO2 is WNL! |
|
|
What is happening during early shock?
|
There is just enough of a decrease in systemic vascular resistance to facilitate an increase in CO. , The person commonly does not feel well. As fluid leaks out, Pulmonary edema develops. As hypoxia and damage to pulmonary capillaries occurs, the cardiac output starts to decrease.
|
|
|
What does BP do during early shock?
|
Intermittent drops in BP
hypotension (decrease in systemic vascular resistance). |
|
|
What does late septic shock look like?
|
-decreased CO, decreased SVR
-Severe metabolic acidosis due to decreased oxygen transport and availability. -hypoglycemia as all energy stores are used -DIC -myocardial failure, left ventricular -CNA, coma -Decreased SaO2 levels -LATE sign: temperature falls -confusion irritability- hypoxia -cyanosis -oliguria |
|
|
what is a cardiovascular dysfunction that may occur during early shock?
|
Increased systemic vascular resistance so the blood has a hard time exiting left side of the heart, BUT BP doesn't go up because their volume is so low.
|
|
|
Where did all the volume go?
|
third space, but not usually tons of edema
|
|
|
What does increased serum lactate indicate?
|
late shock, lactic acid build up is causing metabolic acidosis. May also have respiratory acidosis because of a build up of CO2
|
|
|
How should antibiotic therapy be managed?
|
Give broad antibiotics as soon as possible. When C&S comes back, narrow spectrum of treatment.
|
|
|
What are common routes of infection leading to sepsis?
|
foleys
IV's Central liens, |
|
|
What are the treatment goals of sepsis and SIRS?
|
-maintain CO by providing adequate intravascular volume
-Maintain oxygenation -determine septic focus -treat with appropriate antibiotics |
|
|
What is a problem with giving colloidal fluids?
|
While they will initiatlly pull fluid out of the third space, due to ongoing vasodilation, the fluid will go back into the third space within 24-48 hours.
|
|
|
Identifying septic shock:
|
Only 50% of patients will have a positive blood culture.
|
|
|
Where do endotoxins cause damage
|
to entothelial tissues
|
|
|
What guides fluid replacement therapy?
|
Wedge pressure. Measured by a swan ganz catheter. it is key in determining volume status.
|
|
|
How much crystaloid fluids should be given for volume resuscitation?
|
May need to give as much as 10 L in one hour.
|
|
|
What is a complication of giving vaso constrictors without giving fluids?
|
limp amputation- lawsuit!
|
|
|
What MAP is needed to maintain perfusion of the kidneys?
|
60 mmHg or above
|
|
|
What is the purpose of maintaining a Blood glucose of less than 150?
|
decreases morbidity and mortality. Often they become hyperglycemic because of the stress response, they need to be on an insulin drip to control WBG
|
|
|
Why do we need to keep bowels stimulated?
|
If gut is left empty, bacteria may move from the gut into systemic circulation. Even if they are on TPN, they need some kind of nutrition going into their GI tract.
|
|
|
What needs to be given with crystaloid fluid therapy to be effective?
|
Packed red blood cells, otherwise you are just diluting their blood
|
|
|
What does a nurse need to anticipate due to the client's non cardiogenic pulmonary edema?
|
mechanical ventilation
|
|
|
What does dobutamine do?
|
enhances cardiac output with contractility and increased systemic resistance
|
