Sepsis

Sepsis & MODS
CCRN Review
Hildy Schell,RN,MS,CCRN,CCNS CNS, Adult Critical Care UCSF Medical Center

Objectives
By the finish of class, the participant will be able to:

1. Identify the pathophysiologic mechanisms of sepsis that asterisk to MODS. 2. List the clinical presentation of a patient with horrendous sepsis & MODS. 3. List nursing priorities for monitoring & management of the patient with weighty sepsis. 4. List the goals of therapy and priority interventions for severe sepsis & septic shock.

Definitions
Colonization befoulment Infection Bacteremia/Fungemia/Viremia SIRS: Sepsis Severe Sepsis Septic break MODS:
multiple organ disfunction syndrome systemic inflammatory reply syndrome

Sepsis
? Sepsis:

systemic inflammatory response to an infection. ? Characterized by 2 or more of following: T > 38º or < 36º C HR > 90 RR > 20 or PaCO2 < 32 WBC > 12k, < 4k, or > 10% bands.





Severe Sepsis
?Severe

Sepsis: Sepsis with manifestations of organ dysfunction AMS Hypoxemia Oliguria ? lactate levels

1

Septic Shock
?Septic

Shock: Severe sepsis plus hypotension/ proportional hypotension ?SBP < 90 or ?40 mmHg from baseline

SIRS
Pancreatitis

Infection

SEPSIS

Trauma Burns Other

affinity of Sepsis and SIRS

Sepsis
? ? ? ? ?

Emergency Department (1000)
? 49

A major cause of morbidness & mortality worldwide Leading cause of destruction in Non-?ICUs in U.S. ICU mortality is 4 x greater if severe sepsis is present 10th leading cause of death in U.S. Estimated that it costs over 17 billion $$$ annually to care for patients with severe sepsis

y.o. female, teacher, mother, wife cough, hemoptysis, SOB ? PMHx: negative ? Cool, clammy, diaphoretic ? Thready pulses, crackles/rhonci ? Awake, coherent ? HR 130, BP 80/45, T 36.4, RR 24 ? Sp02 92% on 4LPM via NC
? c/o

Risk Factors
Age Malnutrition continuing Illness: DM, ESRD, ESLD, CA, HIV Medications Medical/Surgical interventions
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