Pathophysiology
What is the difference between chemical and physical injurious agents?
Physical agents include mechanical objects causing trauma to tissues, excessive heat or cold, and radiation. Chemical agents include external irritants (e.g., strong acids, alkalis, poisons, irritating gases) and internal irritants (substances manufactured within the body, such as excessive hydrochloric acid in the stomach).
What signs do increased permeability present as in the patient? (1)
Swelling/edema, electrolyte imbalances
What are some interventions to help with pain associated with inflammation? (3)
Analgesics, heat/cold therapy, distraction techniques, and relaxation techniques
What does SIRS stand for?
Systemic Inflammatory Response Syndrome
Why are NSAIDs preferred over corticosteroids?
Less side effects
What are the three stages of inflammation?
Vascular and cellular response
Exudate production
Reparative
What signs do vasodilation present as in the patient? (3)
Low blood pressure, redness, warmth
What interdisciplinary areas should we get involved and why? (3)
Surgeons, nutritionist, physical therapy, pharmacy, social worker, etc.
What is the biggest goal for sepsis management/treatment?
Early identification and intervention
What is the most effective treatment for a patient in septic shock?
IV fluid or blood administration
What are three causes of inflammation?
Autoimmune Diseases
Infection
Cellular Injury
Why would a patient present with a decreased platelet count?
Platelet stores are depleted after large amounts are produced and leaked into interstitial areas.
What are some interventions to help with the swelling caused by inflammation? (3)
Diuretics, low salt diet, elevation, compression, movement
What are normal BUN and creatinine levels and how would sepsis affect these levels if there was decreased perfusion?
BUN: 7-20 mg/dL
Creatinine: 0.6-1.2 mg/dL
Sepsis would increase these levels due to a decline in kidney function.
What is the main nursing consideration when giving Vancomycin to a patient with systemic inflammation?
Systemic inflammation causes decreased perfusion, which may affect the kidneys. Vancomycin is metabolized in the kidneys so it can lead to further kidney damage, possibly failure.
Is the inflammatory response specific or nonspecific and why?
Nonspecific, because the same response occurs regardless of the situation/cause.
What are the five Hallmark signs of inflammation?
Pain
Redness
Swelling
Heat
Impaired function of body part
How do we promote adequate oxygenation? (3)
Incentive spirometer use, supplemental oxygen, elevate HOB, administer bronchodilators, deep breathing/coughing
What are the SIRS criteria?
Temperature above 100.4F (38C) or below 96.8F (36C)
Heart rate above 90 bpm
Respiratory rate above 20 bpm
White blood cell count outside of the 4-12 range
Why don't we give corticosteroids to patients with systemic infections?
Corticosteroids suppress the immune response
What histamine receptors are involved in the inflammatory process?
H1 and H4
What two organs are most affected by decreased perfusion due to systemic inflammation?
Brain and kidneys
What interventions should we focus on for a patient with an increased lactic acid level and why?
Interventions to promote adequate oxygenation, because lactic acid is an indicator that anaerobic metabolism is occurring so the body needs more oxygen.
Why does DIC occur in sepsis patients?
Sepsis injures blood cells, causing platelet aggregation and decreased blood flow. As a result, blood clots form throughout the microcirculation. The clotting slows circulation further while stimulating excess fibrinolysis. As the body’s stores of clotting factors are depleted, generalized bleeding begins.
What is one short term effect and one long term effect of corticosteroid use?
Short term: glaucoma, fluid retention, hypertension, mood swings, and weight gain
Long term: cataracts, hyperglycemia, increased risk of infections, osteoporosis, increased risk of fractures, suppression of adrenal gland hormone production, bruising, thin skin, delayed wound healing, and growth suppression in children