Infection - Sepsis And Septic Shock

Question 1

Sepsis heart rate

Answer 1

> 90/min

Question 2

Sepsis resp rate

Answer 2

Tachypnea

Question 3

Sepsis mental status

Answer 3

Altered

Question 4

Sepsis plasma glucose

Answer 4

> 140 mg/dL in absence of diabetes

Question 5

Sepsis inflammatory variables

Answer 5

Leukocytosis (WBC >12,000), leukopenia (WBC 10% immature forms

Question 6

Sepsis hemodynamics

Answer 6

Arterial hypotension (SBP 40)

Question 7

Sepsis renal

Answer 7

Acute oliguria, creatinine increase >0.5

Question 8

Sepsis coagulation

Answer 8

INR >1.5 or aPTT >60 sec

Question 9

Sepsis GI

Answer 9

Ileus (absent bowel sounds)

Question 10

Sepsis platelets

Answer 10

Thrombocytopenia (

Question 11

Sepsis bilirubin

Answer 11

Hyperbilirubinemia (>4)

Question 12

Sepsis tissue perfusion

Answer 12

Hyperlactatemia (>1), decreased capillary refill, mottling

Question 13

Sepsis temperature

Answer 13

Fever (>38.3) or hypothermia (

Question 14

Shock

Answer 14

widespread abnormal cellular metabolism that occurs when oxygenation and tissue perfusion needs are not met to the level necessary to maintain cell function; “whole body” response

Question 15

Shock is a “syndrome”

Answer 15

the cellular, tissue, and organ events occur in a predictable sequence and can begin with any problem that impairs oxygen delivery to tissues and organs

Question 16

Distributive shock

Answer 16

occurs when blood volume is not lost from the body, but is distributed to the interstitial tissues where it cannot circulate and deliver oxygen

Question 17

Chemical-induced distributive shock

Answer 17

occurs when certain body chemicals or foreign substances in the blood and vessels start widespread changes in blood vessel walls

Question 18

Sepsis

Answer 18

widespread infection that triggers a whole-body inflammatory response; leads to distributive shock when infectious microorganisms are present in the blood

Question 19

Systemic Inflammatory Response Syndrome (SIRS)

Answer 19

inflammatory responses become enemy; leads to extensive hormonal, tissue, and vascular changes and oxidative stress; further impairs oxygenation and tissue perfusion; has short duration; manifestations are subtle; can be reversed if treated aggressively at this stage

Question 20

Pt that meets sepsis with SIRS criteria

Answer 20

notify health care provider or the Rapid Response Team

Question 21

Severe sepsis

Answer 21

all tissues are involved ad are hypoxic to some degree; some organs are experiencing cell death and dysfunction; pt may “look” better; aggressive interventions can still prevent septic shock; mortality is high; rapid downhill course to septic shock

Question 22

Clinical manifestations of severe sepsis

Answer 22

lower oxygen saturation; rapid resp rate; decreased to absent urine output; change in cognition and affect; widespread bleeding

Question 23

Septic shock

Answer 23

multiple organ failure; uncontrolled bleeding occurs; even with intervention, death rate in this stage is >50%; hypovolemic shock and hypodynamic cardiac function are present; capillary leak continues and cardiac contractility is poor

Question 24

Risk for sepsis and septic shock

Answer 24

malnutrition, immunosuppression, large open wounds, mm fissures in prolonged contact with bloody or drainage soaked packing, GI ischemia, exposure to invasive procedures, malignancy, older than 80 yo, infection with resistant microorganisms, cancer chemo, alcoholism, DM, CKD, transplantation recipient, hepatitis, HIV/AIDS

Question 25

Prevention - during care

Answer 25

aseptic technique; remove lines and drains asap; assess VS often; monitor lab values (esp lactate, WBC, and differential)

Question 26

Hallmark of sepsis (left shift)

Answer 26

increasing serum lactate level, normal or low WBC, and decreasing segmented neutrophil with rising band neutrophil

Question 27

Prevention for at risk pts - home

Answer 27

teach manifestations of local infection; teach how to use a thermometer; take temp 2x daily and when not feeling well; contact health provider if s/s sepsis arise; take full course of any prescribed abx

Question 28

Patient history for sepsis

Answer 28

age, medical history, drugs taken in the past week (some drugs may cause changes leading to shock; drug regimen may indicate a disease or problem that can contribute to sepsis [aspirin, abx, cancer therapy drugs])

Question 29

Cardiovascular manifestations of sepsis

Answer 29

early sepsis: decreased cardiac output and BP; Severe sepsis: increased cardiac output, HR, and BP, DIC, decreased oxygenation, increased risk for hemorrhage; septic shock: hypovolemia, decrease in cardiac output, BP, pulse pressure

Question 30

Respiratory manifestations of sepsis

Answer 30

RR increases, resp depth increases, ARDS may occur (caused by SIRS)

Question 31

Skin manifestations of sepsis

Answer 31

hypodynamic stages: blood is shunted away from the skin, pallor, cyanosis, or mottling; hyperdynamic stage: skin is warm and no cyanosis; septic shock: skin is cool and clammy with pallor, mottling, or cyanosis; DIC: petechiae and ecchymoses, blood may ooze

Question 32

Kidney manifestations of sepsis

Answer 32

low urine output compared with fluid intake indicates shock; kidney function decreases and serum creatinine levels increase

Question 33

Psychosocial manifestations of sepsis

Answer 33

change in affect or behavior, may seem slightly different in reaction to greetings, comments, or jokes, less patient, restless, fidgety, "I feel as if something is wrong, but I don't know what"

Question 34

Laboratory findings with sepsis

Answer 34

bacteria in blood from culture; DIC causes decreased Hct, Hgb, fibrinogen, platelets; serum lactate is elevated; serum bicarb is decreased, low activated protein C; elevated plasma D-dimer; IL-6 elevate; IL-10 remain normal or decrease; blood calcitonin elevates

Question 35

Blood procalcitonin (PCT)

Answer 35

increases when bacteria enter the blood stream and continues to rise as the blood bacterial concentration increases; can be an indication of therapy effectiveness as the levels drop

Question 36

Sepsis Bundle: to be completed within 3 hrs of presentation

Answer 36

1. measure lactate level 2. obtain blood cultures prior to abx administration 3. administer broad spectrum abx 4. administer 30 mL/kg crystalloid for hypotension or lactate >4 mmol/L

Question 37

Sepsis Bundle: to be completed within 6 hrs of presentation

Answer 37

5. administer vasopressin for hypotension that does not respond to initial fluid resuscitation to maintain MAP >65 6. In the event of persistent hypotension after initial fluid administration (MAP

Question 38

Documentation of reassessment of volume status and tissue perfusion

Answer 38

EITHER: repeat focused exam after initial fluid resuscitation including VS, cardiopulmonary, cap refill, pulse, and skin findings OR two of the following: measure CVP, measure ScvO2, bedside cardiovascular ultrasound, dynamic assessment of fluid responsiveness with passive leg raise or fluid challenge

Question 39

Oxygen therapy for sepsis

Answer 39

given via mask, hood, nasal cannula, nasopharyngeal tube, endotracheal tube, or tracheostomy tube; more likely to be mechanically ventilated

Question 40

Drug therapy for sepsis

Answer 40

IV antibiotics, corticosteroids, vasoconstrictors, inotropic agents, insulin therapy, heparin therapy, synthetic activated protein C, blood replacement therapy

Question 41

Home care management for sepsis

Answer 41

Assess pt for clinical manifestations of infection; assess pt and caregiver's adherence ot an understanding of infection prevention techniques; assess home environment (cleanliness, soap availability, pets)

Question 42

Patient teaching for sepsis

Answer 42

avoid crowds; do not share utensils or bathroom articles; bathe daily; wash pits, groin, genitals, rectal area 2x daily with antimicrobial soap; run toothbrush through dishwasher or bleach 2x weekly; wash hands frequently; wash dishes with hot soapy water or use dishwasher; do not drink water that has been standing >15 min; do not reuse cups/glasses; do not change litter box; take temp 2x daily; refrigerate and prepare food appropriately; report s/s infection immediately; do not garden; use antibacterial cleansers to clean kitchen and bathroom 2x weekly; use condom; take drugs as prescribed

Question 43

Transfusion therapy: before infusion

Answer 43

assess lab values; verify prescription; assess VS, output, skin color, and hx of transfusion reaction; obtain venous access with central cath or 20-gauge needle; obtain blood product from blood bank (transfuse asap after safety checks)

Question 44

Transfusion therapy: during infusion

Answer 44

administer product using appropriate filtered tubing; dilute blood products with only NS; remain with pt for 15-30 minutes of infusion; infuse at prescribed rate; monitor VS; never infuse or add other drugs with blood products

Question 45

Transfusion therapy: after infusion

Answer 45

discontinue infusion; dispose of bag and tubing properly; document

Question 46

Drug therapy: ceftriaxone

Answer 46

inhibits bacterial cell wall synthesis, causing cell death; bactericidal effect; take with food if GI upset

Question 47

Drug therapy: ciprofloxacin/levofloxacin

Answer 47

bactericidal action on gram-positive and -negative; drink 6-8 glasses water daily; avoid caffeine; avoid operating hazardous machinery; photosensitivity is side effect; report dizziness, nausea, vomiting, diarrhea, flatulence, abd cramps, tinnitus, rash, tendon rupture

Question 48

Drug therapy: dobutamine

Answer 48

increases myocardial contraction; increases heart rate; increases blood pressure; avoid abrupt discontinuation; monitor intake/output; assess for chest pain

Question 49

Drug therapy: norepinephrine

Answer 49

vasoconstrictive actions; used in place of dobutamine; added to D5W or NS; continuously monitor cardiac and BP; taper slowly; assess IV site; extravasation causes tissue necrosis

Question 50

Drug therapy: epinephrine

Answer 50

causes bronchodilation, enhanced cardiac performance, and vasoconstriction (to improve BP); monitor for tachycardia, cardiac dysrhythmias, HTN, and angina