Sepsis Case Studies

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Sepsis & MODS CCRN Review Hildy Schell,RN,MS,CCRN,CCNS CNS, Adult Critical Care UCSF Medical Center Objectives By the end of class, the participant will be able to: 1. Identify the pathophysiologic mechanisms of sepsis that lead to MODS. 2. List the clinical presentation of a patient with severe sepsis & MODS. 3. List nursing priorities for monitoring & management of the patient with severe sepsis. 4. List the goals of therapy and priority interventions for severe sepsis & septic shock. Definitions •Colonization •Contamination •Infection •Bacteremia/Fungemia/Viremia •SIRS: •Sepsis •Severe Sepsis •Septic Shock •MODS: multiple organ dysfunction syndrome systemic inflammatory response syndrome Sepsis  Sepsis: systemic inflammatory…show more content…
Clinical Manifestations  Clinical Clinical Presentation of Sepsis Classic Hemodynamic Alterations: – HR –   CVP/PAOP – BP – CO/CI – SVR – Scv02 Effects: – Edema – Hypoperfusion/ Hypotension – Tachycardia – Tissue & cellular hypoxia – Altered organ function (renal, liver, CNS, coagulation, cardiovascular) Patient’s Clinical Presentation Hemodynamic Alterations: –HR –CVP/PCWP –BP –CO/CI –SVR –Scv02 128 10/14 90/50 (60) 8.9/5.4 614 (PVR 139) 77% on vasopressors     ICU day #1 PAC via Right IJ inserted Deadspace ratio performed (Vd/Vt) – Vd/Vt = 67% – AC 28, Vt 480 mLs, .70/14 – 7.32/40/64/20/-5/92% Activated Protein C (Xigris) started Calcium repleted (chloride & gluconate)  Vasopressin @ 0.04 units/min started  Fentanyl @ 25 mcg/hr & Versed at 3 mg/hr infusions started 6 Atypical Hemodynamic Presentation –HIGH –HIGH –LOW –LOW –LOW –LOW HR CVP/PAOP BP CO/CI SVR Scv02 Clinical Manifestations  Coagulopathy – Increased clotting stimulatedmicrothrombi (PAF) – Decreased fibrinolysis –↓ –↑ –↓ –↑ Platelets PT (INR) & PTT Fibrinogen D-dimers or FDPs/FSPs 75 K 24.5 (2.2)/>100 120 mg/dL 10,000 ng/mL (Plasminogen activator inhibitor) Clinical Manifestations  Clinical…show more content…
Fever, BP 88/59, HR 129, RR 26. RN anticipates initial orders for: 1. 2. Antipyretics and dopamine infusion CT scan of head & arm and drug screen Blood cultures, antibiotics, and rapid IV infusion IV fluids with MVI, thiamine, monitoring for signs of withdrawal, antipyretics Antipyretics and dopamine infusion CT scan of head & arm and drug screen 3. 4. Blood cultures, antibiotics, and rapid IV infusion IV fluids with MVI, thiamine, monitoring for signs of withdrawal, antipyretics When intracellular demand for oxygen exceeds the supply in the septic patient, the RN would expect to find: 1. 2. 3. 4. When intracellular demand for oxygen exceeds the supply in the septic patient, the RN would expect to find: An increase in carbon dioxide An increase in lactic acid A decrease in oxygen saturation A decrease in hydrogen ion concentration An increase in carbon dioxide An increase in lactic acid A decrease in oxygen saturation A decrease in hydrogen ion concentration 1. 2. 3. 4. 11 In the patient with sepsis, the RN would expect to find: In the patient with sepsis, the RN would expect to find: 1. 2. 3. 4. HR, HR, BP,

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