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HGTC NUR 221 Sepsis

HGTC Sepsis NUR 221

A systemic response to infection/Infection of the bloodstream Sepsis
Sepsis is manifested by 2 or more of which clinical symptoms? temp ↑ than 110.4F (38C) or ↓ than 96.8F (36C), HR↑ than 90, RR ↑ 20, PP of CO2 ↓32 mm Hg, WBC count ↑ 12,000 cells mm3, less than 4,000 cells/mm3, or greater than 10% immature (bands), hyperglycemia and abnormal clotting and bleeding
What is the approx. mortality rate for a patient with sepsis? 30%-50%
Which of the following is included in the definition of systemic inflammatory response syndrome? PaCO2 lower than 32 torr
What is included in the organ dysfunction category of systemic inflammatory response syndrome? coagulation abnormalities
The cytokines and white blood cells that are released during sepsis trigger: vasodilation
Which of the following is a physical deficit that can contribute to the high risk of sepsis in the elderly? decreased gag and cough reflex
What is the community-acquired infection that most commonly progresses to sepsis? pneumonia
What increases the risk of nosocomial sepsis in the critical care setting? use of intravascular access
What is the most common causative agent for nosocomial infections? Staphylococcus aureus
What may be the first symptom of sepsis that is noted by clinicians? early organ dysfunction
What laboratory test can reflect the adequacy of hemodynamic resuscitation and is a diagnostic marker in septic patients? lactate level
In the treatment of sepsis, increasing cardiac output and oxygen delivery depend on: expansion of blood and plasma volume
In most patients with septic shock, cardiac output will be optimized at what pulmonary artery occlusion pressure? 12 to 15 mm Hg
If only central venous pressure monitoring is available, what levels should be targeted to optimize cardiac output? 8 to 12 mm Hg
When fluid administration fails to restore an adequate arterial pressure and organ perfusion, what therapy should be used? Vasopressors
When should antimicrobial therapy be initiated in a septic patient? as soon as cultures are taken
In a patient who is mechanically ventilated, what is the recommended tidal volume to prevent the risk of acute respiratory distress syndrome? 6 mL/kg
What should nurses monitor to detect an adverse reaction to the administration of activated protein C? serial hematocrits
Who is at most risk for sepsis? elderly and newborns, those with chronic illnesses such as diabetes and cancer, those who are immunocompromised (i.e. AIDS, on chemo), and malnourished and debilitated patients
Sepsis typically begins with_________ SIRS (systemic inflammatory response syndrome)
True or False. It is possible for a patient to have SIRS without being septic. True. Non infectious causes include burns, trauma, myocardial infarction, and inflammatory processes such as pancreatitis
Normal White Blood cell count 5,000-10,000/mm3
Normal paCO2 35-45 mm Hg
Signs of organ dysfuction include- altered mental status, acute oliguria (urine output less than 0.5/mL/kg/hr), hyperglycemia in the absence of diabetes, Hypoxemia, Coagulopathy (INR ↑ than 1.5), Gastric Ileus
Hypotension is when the patient's systolic BP is ↓ than __________ or MAP is ↓ than__________ 90 mm Hg, 60 mm Hg
What serum lactate level is a sign of hypoperfusion and organ dysfuction? ↑ than 2 mmol/L
Sepsis is present when a patient has _________ plus a documented____________. SIRS, Infection
Severe sepsis is defined as sepsis complicated by ___________, _________, or___________ organ dysfuction, hypotension, poor perfusion
What is characterized by persistent hypotension that does not improve even after adequate fluid resuscitation? Septic Shock
Albumin and packed red blood cells are_____________ colloids
Normal saline and lactated ringers are___________ crystalloids
If hypovolemia is suspected, a fluid challenge may be ordered by the physician consisting of 500 to 1000 mL of crystalloids or 300 to 500 mL of colloids infused over 30 minutes
Signs of pulmonary edema decreased oxygen sat. and crackles in the lungs
Hypotension cannot be used as an indicator of severe sepsis in which population? infants and children- (blood pressure does not decrease until the child is no longer able to compensate)
CVP is a measurement of blood entering the right side of the heart and is a close estimate of the right atrial pressure
What should be administered w/in the 1st hour of diagnosis of severe sepsis? IV Antibiotics
Doses of vasopressin should not exceed what level? 0.04 units/min (higher doses have been associated w/ myocardial ischemia and cardiac arrest)
What is the therapeutic effect an inotrope? increases the force of the heart's contraction, in order to increase cardiac output and improve tissue perfusion
Which inotrope is the 1st choice for patients w/ low cardiac output that does not improve with fluid resuscitation? Dobutamine (Dobutrex)
___________ is a potent vasoconstrictor and increases blood pressure without too much change in heart rate. Norepinephrine
What vasoconstrictor is commonly used in conjunction with norepinephrine to maintain adequate perfusion pressure? Vasopressin (Pitressin)
normal pH 7.35-7.45
Normal paCO2 35-45 mm Hg
Normal PaO2 80-100 mm Hg
What glucose level is the goal? Less than 150 mg/dL
How often should blood sugars be checked? Hourly until stable, and then on a regular basis, at least every 4 hours
Which patients are contraindicated for drotrecogin alfa activated (Xigris)? any increased risk for bleeding, recent stroke, has had head trauma, has an epidural catheter, or is on heparin therapy
Normal Hemoglobin 7-9 g/dL
Created by: Laurie2000