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HGTC NUR 221 Sepsis
HGTC Sepsis NUR 221
| Question | Answer |
|---|---|
| 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
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