General
What is the spread of disease beyond continental boundaries identified as
Pandemic
SIRS acronym stands for
Systemic Inflammatory Response Syndrome
A decrease in adult urine output
< ____ per hour may be an indication of poor kidney perfusion
30ml
Identify 3 clinical manifestations of anaphylactic shock.
Anxiety, confusion, dizziness, Sense of impending doom, Chest pain, Incontinence, Swelling of lips and tongue, angioedema, Wheezing, stridor due to laryngeal edema, Flushing, pruritus, urticaria, Respiratory distress and circulatory failure
What is the goal (range), mean arterial pressure (MAP) when administering Norepinephrine (Levophed)?
MAP 60-65
This can happen when an organism has developed a resistance to one or more broad-spectrum antibiotics,indicating that the organism will be hard to treat effectively.
Multi-drug resistant organism (MDRO)
will accept "multi drug resistance"
A sepsis patient receiving Norephinephrine (levophed) requires vital sign assessment how often
Every 15 min (at least)
3 letter acronym for condition with marked decrease in platelets and clotting factors during the advanced septic shock phase
DIC- Disseminated Intravascular Coagulation
During the compensatory stage of shock, the nurse would assess bowel sounds as
hypoactive, or decreased
A patient is identified as possible sepsis in the ER. Prior to a broad spectrum antibiotic being administered, what action should be taken after allergies have been confirmed?
take blood/specimen cultures
This classification of antibiotic agents prevents the growth of bacteria
Bacteriostatic
To be diagnosed with SIRS you must meet 2 (of the 4) criterion. Identify 2 criterion used to diagnose SIRS.
(must give #values)
body temp >38C (or 100.4F) or <36C (or 96.8F)
HR >90
RR>20 or PaCO2<32
WBC >12,000 or <4,000
In cardiogenic shock, identify one + inotrope that can help to increase cardiac contractility.
dobutamine, miltronone, dopamine are all acceptable + inotropes
As shock continue to worsen, abdominal skin color changes and results in poor pallor, and or cyanosis (significantly to hands and feet first) and is described as what?
Mottling
NS & LR are what type of fluids, typically initiated for replacing fluids in the septic patient
Crysalloids
This type of infection can be caused by antibiotic use or oral steroids. This bacteria lives in warm places like the groin, axillary, abdominal folds and mouth.
Candidiasis (yeast infection)
When is the criterion for sepsis met
SIRS + the identification of the infection/source.
In this stage of shock, organ damage is so severe that the patient does not respond to treatment and cannot survive
Refractory, Irreversible
These biomarkers for sepsis progressively increase as the patient continue to decline and include __________ and __________ levels.
Lactate (lactic acid) and procalcitonin
Aggressive Nutrition Therapy for Sepsis patients in a hypermetabolic state include initiating enteral feedings when?
24-48hr
Identify 3 causative factors of Hospital Acquired Infections (HAI)
Poor Hand hygiene, foley's, central lines, ventilator assisted pneumonia (VAP), c-dif and yeast infection from multiple antibiotic use, surgery
With sepsis, it is crucial that treatment begin promptly, starting in the ER. Identify 3 (of the 6) steps that should be taken within 60 min once the identification of sepsis has been made.
Fluids, Antibiotic, blood cultures, urine output, draw lactate (lactic acid), administration of oxygen
The clinical characteristics of neurogenic shock are signs of parasympathetic stimulation. Identify 2 s/s that are seen in neurogenic shock vs other types of shock
warm, flushed skin and bradycardia
In shock, this hormone (released by the brain) causes the kidney's to retain more water in an effort to raise blood volume and BP.
Antidiuretic hormone (ADH)
Identify 1 medication that is administered to prevent stress ulceration or GI bleed in the patient with septic shock.
H2 blockers- Pantoprazole [Protonix] or Famotidine (Pepcid)