Sepsis, Shock, & Multiple Organ Dysfunction Syndrome Flashcards
Stages Of Shock-
Compensatory Stage
- Normal Blood pressure
*Adequate cardiac output
*“Fight or flight” response
Clinical manifestations
* Inadequate perfusion
*Respiratory rate ≥ 22
* PaCO2 < 32 mm Hg
* Heart rate ≥ 100 beats/minute (Tachycardia)
* Decreased Urinary Output
*Anxiety
* Confusion
*Respiratory alkalosis
*Elevated Sodium and glucose levels
Nursing Managment:
*Monitor tissue perfusion
* Reduce anxiety
*Clarify advanced directives
*Promote safety
*Gerontological considerations
Early Interventions:
*Identifying the cause of shock, *Administering intravenous (IV)
fluids and oxygen
*Obtaining necessary
laboratory tests to rule out
and treat metabolic
imbalances or infection.
Stages Of Shock-
Progressive Stage
Clinical Manifestations
-Cold & Clammy Skin
Cardiovascular changes:
*MAP ≤ 65 mm Hg
*Systolic BP ≤ 100 mm Hg
*Heart rate ≥ 150 beats/minute
*Chest Pain
Cellular Hypoxia:
*Deteriorating respiratory status
* Metabolic acidosis
- Mental status changes
- Acute kidney injury
*Liver failure
Coagulation Changes:
*GI bleeding
* Abnormal bruising and petechiae
Nursing Management:
*Monitoring blood levels of medications
*Observing invasive vascular lines and catheters for signs of infection
*Checking neurovascular status, if arterial lines are inserted, especially in the lower extremities.
Early Interventions:
* Complication prevention Reduce VAP
-HOB 30 Degrees
-Sedation Vacation
-Aseptic Suction Technique
-Turning
-Frequent Oral Care
*Promote rest and comfort
*Support family
Stages Of Shock-
Irreversible (Refractory) Stage
Clinical Manifestations:
*Severe organ damage
*Unable to maintain BP & MAP with treatment
*Unable to oxygenate with ventilatory support
* Multiple organ dysfunction
*Complete organ failure
* Low Urine output (oliguria)
Irreversible Stage Management:
*Treat underlying cause
*Respiratory support
*Circulatory support
*Nutritional support
* Experimental treatments
*Simple comfort measures
*Palliative care
*Support and education for family and friends
*Honesty regarding diagnosis
General Management of Shock-
Fluid replacement, also referred to as fluid resuscitation, is given in all types of shock.
Fluid replacement
*Crystalloid-. 0.9% sodium chloride solution (normal saline) and lactated Ringer’s solution
*Colloid solutions- Albumin
*Blood components (packed red blood cells, fresh-frozen plasma, and platelets).
Vasopressor & nursing Mgt-Dosages of vasoactive medications must be tapered, with frequent monitoring of BP (e.g., every 15 minutes)
Nutritional support-
Patients in shock may require more than 3000 calories daily. The release of catecholamines early in the shock continuum causes rapid depletion of glycogen stores.
Fluid Resuscitation is adequate if:
*MAP >65 mm Hg
*Urine Output of 0.5/kg/hr
*ScvO2 of 70% (Central venous blood oxygen Saturation)
Cardiogenic Shock-
Clinical Manifestation
*Angina
*Arrhythmias
*Fatigue
*Feelings of impending doom
Diagnostics:
*EKG changes
*Increased cardiac enzymes and biomarkers
* B-type natriuretic peptide (BNP)
*Troponin
*Serum lactate
Cardiogenic Shock-
Pathophysiology
*Heart is no longer able to contract and pump blood
*Oxygen supply is inadequate for the heart and tissues
Causes:
Coronary
*Anterior wall MI Noncoronary
*Conditions that stress the myocardium
*Conditions that cause ineffective myocardia function
Cardiogenic Shock-
Pharmacological Management
Inotropic Agents- Increases cardiac Output
Dobutamine
Vasodilators-Decrease afterload, reducing work load of the heart & oxygen demand.
Nitroglycerin
Vasopressor Agents (Antihypotensive) Constricts blood vessels and raises BP
Dopamine, Epinephrine, Norepinephrine
Antiarrythymic - Stabilize the heart rate.
Septic Shock- Risk Factors
*Immunosuppression
*Extremes in age (< 1 year; > 65 years)
* Malnourishment
*Chronic illness
*Invasive procedures
*Emergent and/or multiple surgeries
Septic Shock-Prevention
*Hand Hygiene
*Early removal of invasive devices
*Promote Ambulation
*Debridement of wounds
*Standard Precautions
*Use of Aseptic Technique
*Proper cleaning of equipement
Septic Shock-
Nursing Managment
*Prevent infection
* Sequential Organ Failure
Assessment (SOFA)- Greater or equal to 2 =Sepsis
* Quick SOFA (qSOFA)
* Modified Early Warning
System (MEWS) - Greater than 4= Sepsis
*Specimen collection
* Medication administration
*Close monitoring
Anaphylactic Shock
Nursing Management
*Prevention-The nurse must assess all patients for allergies or previous reactions to antigens
*Early Recognition- When administering any new medication, the nurse observes all patients for allergic reactions.
Neurogenic Shock-
Nursing Management
Nursing
*Maintain HOB at least 30⁰ when receiving spinal or epidural anesthesia
*Spinal immobilization for spinal cord injury
*Frequent assessments
*Passive range of motion
Multiple Organ Dysfunction Syndrome
Pathophysiology
The precise mechanism by which MODS occurs remains unknown, but it is most commonly seen in patients with sepsis as a result of inadequate tissue perfusion.
Organ failure usually begins in the lungs, and cardiovascular instability, as well as failure of the hepatic, GI, renal, immunologic, and central nervous systems, follows
Hypovolemic Shock-
Medical Management
- Restore and redistribute intravascular volume with fluid and blood replacement
- Treat underlying cause
*Fluid and blood replacement - Redistribution of fluid (Passive Leg Raising)
*Vasoactive medications- vasodilators (Nitroprusside)
*Prevention
Hypovolemic Shock-
Nursing Management
*Close monitoring of those at risk
*Safe administration of fluids, medications, and blood products (IV NS 0.9%, IV Norepinephrine/Dopamine)
*Supplemental oxygen
*Comfort measure
*Modified Trendelenburg Position- Promotes Venus blood return (Lower HOB)
