Bundle Up
Time Matters
Critical Thinking
The Continuum
Hemodynamics
100
When does a patient meet criteria for a 30 ml/kg fluid bolus?
What is lactate >= 4 or hypotension
100
What is our goal time to hang our first antibiotic?
What is within 1 hour.
100
This is the most common source of infection for sepsis
What is pneumonia
100
Your patient presents with chills, rigors and lethargy. You review his vitals. Name the vital sign that makes him qualify for severe sepsis and not SIRS. HR 120, temperature of 38.1, RR 31, BP 88/50, WBC 3.5.
What is BP 88/50
100
This is the target MAP for a septic patient on vasopressors
What is > 65 mmHg
200
Name all four SIRS criteria
What is HR > 90, RR > 20, WBC <4 or >12 or 10% bands, Temp <100.9 or 96.8 degrees
200
Your patient meets severe sepsis (lactate is 2.5) criteria at 0400. What time do we need to make sure the repeat lactate is collected ?
What is 1000
200
Your patient screens positive for septic shock. You anticipated the provider to order a weight-based fluid bolus of NS but instead, they order 250 mL NS x1. Name one resource available to help you advocate for appropriate treatment.
What is the RN/Physician SBAR tool. Nursing Chain of Command. Physician Chain of Command.
200
Name the stage on the sepsis continuum at which we implement the bundles?
What is Severe Sepsis
200
This is the lab value for inadequate tissue perfusion
What is Lactic Acid
300
Your patient presents with increased confusion. VS are: Temp 101.2, HR 88, BP 84/65, RR 32, SPO2 92% RA, Weight 100 kg. How much crystalloid solution should you administer?
What is 3 Liters
300
This is the increased mortality rate per hour delay in administering antibiotics.
What is 8%
300
Name one type of patient that may have SIRS or an elevated lactate with no evidence of infection?
What is burns, traumas, pancreatitis
300
What stage in the sepsis continuum is the following patient in? BP 94/56, HR 120, Temp 96.0, RR 22, lactate 6.0
What is septic shock
300
This is the reason we repeat a lactate if the initial is elevated.
What is to check lactic clearance. We give fluids to treat an elevated lactate. If our tissues/organs are being adequately perfused our lactate level will not be elevated.
400
If an initial lactate is great than _____ we need to repeat a lactate within 6 hours of time zero.
What is 2
400
Your patient is being treated for community acquired pneumonia. You notice new onset lethargy and confusion at 12:15. Recent vital signs: HR > 90 @ 11:00, temp 39.5 @ 12:00. Name time zero.
What is 12:15
400
Your transplant patient is immunosuppressed and returns to the floor after a liver biopsy with rigors, a fever of 38.3, HR 125. BP is 130/80 unchanged from baseline. Name the lab you should order per protocol.
What is lactate. This patient has 2 SIRS and per protocol the RN can order a lactate with a suspected infection. This patient is high risk due to both being immunocompromised and a recent biopsy.
400
A patient is transferred to your unit, chief complaint on admission: vomiting, fever and diarrhea x3 days. History of small bowel transplant and multiple episodes rejection and line infection. You review his VS trend and see over the last 6 hours, temp increasing to 102.5, HR increasing from 80s to 131, BP 75/47. You activate a RRT and the severe sepsis protocol is started. After administering fluid resuscitation, the patient's BP is still low at 87/53. Name the stage on the continuum that the patient is currently presenting and what should be initiated next?
What is septic shock. Vasopressors.
400
What will we see clinically in our patients whose kidneys are hypoperfused?
What is decreased urine output (<0.5 ml/kg/hr x 2 hours) and elevated Creatinine (>2)
500
Your septic patient has a BP of 70/50. They are given 30 mL/kg of fluid. Their repeat BP is 75/55. What would you expect the patient would need next?
What is a Vasopressor (Levophed)
500
You are having difficulty getting a second set of blood cultures on your patient. You realize it has not been one hour from time zero and you are waiting to hang your antibiotics. What should you do?
What is hang the antibiotic. This is a significant delay in starting the antibiotic. Document that the patient had multiple attempts to obtain the BC but you were unable to obtain blood.
500
An 80 year old female was admitted for UTI and pneumonia, stable VS. Overnight she becomes very confused and restless. You being the astute nurse check her VS and not that the patient now has a BP of 80/50. What do you do next?
What is call an RRT in order to facilitate the bundles being initiated. Anticipate a 30mL/kg of fluid order.
500
Mr. Sepsy was admitted for abdominal pain. His most recent vital signs are HR 112, RR 24, SPO2 91% RA, Temp 102.5, BP 95/62 Labs: WBC 25.0, Creatinine 3.1, Lactate 1.9, Total Bili 1.6 What stage in the sepsis continuum is he in?
What is Severe Sepsis. The Creatinine of 3.1 is "organ dysfunction."
500
Why does your body go into an anaerobic state during severe sepsis/septic shock?
What is decreased perfusion. Vasodilation occurs, capillary leaking, and microvascular clotting.
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