Sepsis, DIC, MODS

38 flashcards

What is Disseminated Intravascular Coagulation (DIC)?: A condition characterized by hyperactive clotting or consumption coagulopathy leading to systemic blood clot formation - Often secondary to an underlying disorder.
What causes hyperactive clotting in DIC?: Triggered by microthrombi from sepsis, SIRS, trauma, and other conditions.
What is consumption coagulopathy?: A process in DIC where hyperactive clotting uses up available platelets and clotting factors, increasing the risk of hemorrhage.
How does clotting in DIC cause death?: Clotting in the capillaries blocks blood flow to vital organs ’ “ perfusion and gas exchange ’ hypoxia and ischemia ’ organ damage
What are the signs/symptoms in DIC?: 1. Bleeding (petechiae, ecchymoses (bruising)) 2. Renal Dysfunction (AKI, hematuria, ‘ kidney labs) 3. Hepatic Dysfunction (low clotting factors (factor V & VIII, fibrinogen, and platelet counts) 4. Respiratory Dysfunction (low O2 saturation and PaO2)
What is the primary intervention for DIC?: Assess for signs of bleeding and address the underlying cause of DIC. Ex. if DIC is related to sepsis, be prepared to administer aggressive broad-spectrum antibiotic treatment and other sepsis bundle interventions
What supportive measures may be needed for patients with DIC?: 1. Initiation or increase of oxygen and/or ventilatory support as needed. 2. Foley for urine monitoring 3. Fluid & blood replacement
What blood components are used to treat DIC?: RBC transfusion for severe bleeding Low-dose heparin to stop active hyperactive clotting, once severe bleeding stops Clotting Therapy - Coagulation factor replacement therapy - Plasma transfusion and/or platelet transfusion
Multiple Organ Dysfunction Syndrome (MODS): When 2+ organs began to fail after shock conditions continue for longer periods without help, increased metabolism causes so much cell damage in vital organs that they are unable to perform critical functions.
What organs are most common to be lost first in MODS?: Liver, heart, brain, and kidney function are lost first.
What is the most profound change in MODS?: The most profound change is damage to the heart muscle.
Symptoms of MODS: Symptoms depend on which organs are dysfunctioning. - Rapid loss of consciousness - Nonpalpable pulses - Cold, dusky extremities - Slow, shallow respirations - Unmeasurable O2 sat
How can nurses help make end of life decision making in MODS?: Requires end of life decision making as it is an acute fast dying process that is often not survivable. Use therapeutic communication with client and family; do not discuss organ donation.
What is Systemic Inflammatory Response Syndrome (SIRS)?: A syndrome resulting from an overwhelming inflammatory response by the body caused by various stressors, not always infection.
Why is systemic inflammation like in SIRS so dangerous to the body?: When inflammation occurs, blood vessels get larger, and fluid starts to leak through the vessels ’ eventually the vessels collapse (vasoconstriction) ’ perfusion decreases
What are the criteria for SIRS?: Two or more of the following 1. Temperature greater than 38 °C or less than 36 °C 2. HR greater than 90 bpm 3. RR greater than 20 breaths/min or PaCO2 less than 32 mmHg 4. WBC count greater than 12,000 or less than 4,000, or greater than 10% immature band forms
What is sepsis?: An extreme response to infection that can cause tissue damage, organ failure, and death if not treated promptly.
When is sepsis suspected?: S/S of severe infection manifested by 2 or more of the SIRS criteria as a consequence of documented or presumed infection
What clinical tool, usually found in med/surg floors, is useful in detecting early sepsis?: Modified Early Warning System (MEWS) Chart/Score - A bedside clinical tool used to identify early signs of patient deterioration by tracking vital signs - Score >4, then 30-minute rounding is needed to avoid further deterioration
What is the primary lab value used to diagnose sepsis?: Serum Lactate
What is serum lactate, and what is the normal value?: Byproduct of anaerobic metabolism - Normal serum lactate is < 2 mmol/L.
When does the body switch from aerobic metabolism to anaerobic metabolism?: Anaerobic metabolism occurs when the body doesn't have enough oxygen and has to create energy (ATP) with glucose ’ lactate is produced
What is procalcintonin, what is the normal value and what does abnormal levels indicate?: Procalcintonin is used to determine if an infection is bacterial or not - Normal < 0.15 ng/mL or less It may indicate a bacterial infection and help determine if antibiotics are needed.
What differentiates sepsis vs. severe sepsis vs. septic shock?: Sepsis is a systemic inflammatory response from an infection Severe sepsis is when organ dysfunction/tissue hypoperfusion occurs after sepsis Septic shock is when 1 hour sepsis bundle and fluid therapy occurred but hypotension isn't corrected
What defines septic shock?: Sepsis-induced hypotension that persists despite adequate fluid resuscitation.
What are common signs/symptoms of sepsis?: 1. Low cardiac output, hypotension, tachycardia 2. Difficulty breathing, hyperventilation, respiratory distress 3. Extreme pain 4. Pale, clammy, cool skin 5. Lethargy or confusion and agitated 6. Low urine output 7. Microthrombi formation. 8. INFECTION
When should nurses aim to start the sepsis bundle?: Initiation within 1 hour gives the best patient outcome(s)
What is included in the sepsis bundle for initial resuscitative therapy?: Intravenous fluids, labs (CBC, serum lactate, blood culture), and broad-spectrum antibiotics or antifungals.
What type of fluids are typically used in the sepsis bundle?: Isotonic crystalloids, usually given at 30 mL/kg of actual body weight.
In what order are labs drawn in the sepsis bundle?: 1. Serum lactate 2. CBC 3. Blood culture 4. ABGs 5. Procalcitonin (expensive and not always used)
What is the first-line vasopressor for hemodynamic support in septic shock?: Norepinephrine.
When are vasopressors used in septic shock?: Primarily used in septic shock not sepsis as fluids don't correct hypotension so adjacent vasopressors are needed Vasopressors like norepinephrine causes systemic vasoconstriction ’ ‘ BP ’ ‘ perfusion to the organs
What is the target MAP to maintain during sepsis management?: MAP should be kept > 65 mmHg.
What is the role of intropics in sepsis management?: Dobutamine ’ ‘ CO without vasodilation (perfect for this, as vasoconstriction is needed to maintain perfusion) Used for myocardial dysfunction (low CO) if there are signs of hypoperfusion despite fluids and adequate MAP
What additional treatment is needed for septic shock that isn't usually used for sepsis?: Since sepsis progresses into septic shock once fluids don't improve hypotension and low MAP Vasopressors and inotropics like dobutamine are used to assist in correcting BP and perfusion
What is the purpose of glucose control in sepsis management?: To manage hyperglycemia, more common, as the body tries to overproduce glucose for stress-induced compensation ’ eventually glucose will run out lead to hypoglycemia
What is the significance of monitoring urine output in sepsis?: Urine output should be > 0.5 mL/kg/hr or 30 mL/hr to assess kidney perfusion and function.
What does a serum lactate level return within 24 hours indicate?: Better outcomes in sepsis management.