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SYSTEMATIC

INFLAMMATORY
RESPONSE SYNDROME

MULTIPLE ORGAN
DYSFUNCTION
SYNDROME
Define SIRS / sepsis / severe sepsis - MODS septic
shock
Delineate difference between sepsis SIRS and MODS

and its underlying pathophysiology.


Early recognition of Sepsis

Discuss the syndrome of MOD

Describe common nursing diagnoses and


collaborative management to patients with MODS
Use nursing process as framework for care of
patients with MODS
Infection: A microbial phenomenon characterized by
an inflammatory response to the presence of
microorganisms or the invasion of normally sterile
host tissue by those organisms.
Bacteremia: The presence of viable bacteria in the
blood.
Systemic Inflammatory Response Syndrome (SIRS):
The systemic inflammatory response to a variety of
severe clinical insults (For example, infection).
Sepsis: The systemic inflammatory response to
infection.
Septic shock: serious medical condition that occurs
when sepsis , which is organ injury or damage in
response to infection, leads to dangerously low blood
pressure and abnormalities in cellular metabolism.
Causes/Etiology:

The causes of SIRS are broadly classified as


INFECTIOUS or NONINFECTIOUS.

When SIRS is due to an infection, it is considered


SEPSIS.

Non-infectious causes of SIRS include trauma, burns,


pancreatitis, ischemia and haemorrhage.
Epidemiology suggests there is a
general progression of pathologic
states
SIRS
Sepsis
Severe Sepsis
Septic Shock
MODS
SIRS RESPONSE OF BODY TO STRESS also
known as the CRITERIA:

Defined as 2 of the following:


Temperature abnormality
>38C or <36C
Hemodynamic distress ( >90 bpm)
Respiratory distress
>20 bpm &/or >32mmol, or hypoxia <70%
Inflammatory marker
WBC >12k, <4k, or 10% band forms
Sepsis:
Known or suspected infection, plus
>2 SIRS Criteria.
Severe Sepsis:
Sepsis plus >1 organ dysfunction due to
hypoperfusion
MODS.

Septic Shock:
Definition: sepsis plus 1 of the following:
decreased peripheral pulses (compared to
central pulses)
capillary refill:
>2 seconds
mottled or cool extremities (cold shock)
flash capillary refill (vasodilated / warm
shock)
decreased urine output (< 1 mL/kg/hr
Definition
progressive reversible dysfunction of 2 organs
from acute disruption of normal homeostasis
requiring intervention
Primary MODS
immediate systemic response to injury or insult
Needs mostly<1 week in ICU, better prognosis,
Secondary MODS
progressive decompensation from host
response & 2nd hits
Needs >1week in ICU, worse prognosis
Infection

Inflammatory Endothelial
Vasodilation
Mediators Dysfunction

Hypotension Microvascular Plugging Vasoconstriction Edema

Maldistribution of Microvascular Blood Flow

Ischemia

Cell Death

Organ Dysfunction
Since the ability of the body to provide oxygen and nutrients is
interrupted, the heart compensates by pumping faster ( HR)
HYPOTENSION occurs because of vasodilation.
To compensate for the decreased oxygen concentration, the
patient tends to breathe faster, and also to eliminate more
carbon dioxide from the body.
( RR) or ( PaO2)
The inflammatory response is activated because of the invasion
of pathogens.
Decreased urine output. The body conserves water to avoid
undergoing dehydration because of the inflammatory process.

Changes in mentation. As the body slowly becomes acidotic, the


patients mental status also deteriorates.

Elevated lactate level. The lactate level is elevated because there


is maldistribution of blood.
GI dysfunction
Hepatobiliary dysfunction
Pulmonary dysfunction
Renal dysfunction
Cardiovascular dysfunction
Coagulation system dysfunction
Hemodynamic Alterations
Hyperdynamic State (Warm Shock)
Tachycardia.
Elevated or normal cardiac output.
Decreased systemic vascular resistance.

Hypodynamic State (Cold Shock)


Low cardiac output.
Hypoperfusion Ischemia of the gut

Decreased peristalsis
Decreased integrity of
the gut lining Colonization of
normal GI flora up
Translocation of normal into the orpharynx
GI bacteria into systemic
circulation
Aspiration of bacteria
and initiation of a
Systemic infection inflammatory response
and SIRS in the lung
Hypoperfusion Ischemia of the liver and gallbladder

ischemic hepatitis acalculous cholecystitis

Jaundice Right upper pain and


tenderness
serum transaminase
Abdominal distention
serum bilirubin
Unexplained fever
Loss of bowel sounds
The lungs are usually the first organ affected
in secondary MODS.

Pulmonary dysfunction manifest as ARDS.

ARDS generally presents 24-48 hours after


the initial injury.
Hypoperfusion Ischemia of the Kidney
And
Renal Function
Renal toxic
drugs
Azotemia
Creatinine clearance
Fluid and electrolyte
imbalances
Fluid volume overload
Initial response Late response
Myocardial depression Ventricular dilatation
Right atrial pressure Diastolic
SVR compliance
Venous capacitance contractile
VO2
function
CO
CO
Ability to maintain
HR
BP without
vasopressors
Failure of the coagulation system is
manifested as DIC.
Results in simultaneous microvascular
clotting and hemorrhage in organ systems
because of the depletion of clotting factors.
Altered LOC
Impaired mentation
Confusion
Delirium
Psychosis
Strict infection control practices. To prevent the invasion
of microorganisms inside the body, infection must be put
at bay through effective aseptic techniques and
interventions.
Prevent central line infections. Hospitals must implement
efficient programs to prevent central line infections,
which is the most dangerous route that can be involved in
sepsis.
Early debriding of wounds. Wounds should be debrided
early so that necrotic tissue would be removed.
Equipment cleanliness. Equipment used for the patient,
especially the ones involved in invasive procedures, must
be properly cleaned and maintained to avoid harboring
harmful microorganisms that can enter the body.
Early assessment and diagnosis of the infection
must be established to avoid its progression.
Blood culture. To identify the microorganism
responsible for the disease, a blood culture must
be performed.
Liver function test. This should be performed to
detect any alteration in the function of the liver.
Blood studies. Hematologic test must also be
performed to check on the perfusion of the
blood.
The best management is prevention
The principle are
decrease the severity of the risk factor
Lessen the inflammation
Appropriate resuscitation and control of
infection
Avoid unsuitable operation and use of
antibiotic
Treat the dysfunction organ and malnutrition
The current treatment of SEPTIC SHOCK and
sepsis include identification and elimination of
the cause of infection.
Fluid replacement therapy. The therapy is done
to correct the tissue hypoperfusion, so
aggressive fluid resuscitation must be
implemented.
Pharmacologic therapy. Drotrecogin alfa is used
to act as antithrombotic, anti-inflammatory, and
profibrinolytic agent.
Nutritional therapy. Aggressive nutritional
supplementation is critical in the management
of septic shock because malnutrition further
impairs the patients resistance to infection.
Infection control. All invasive procedures must be carried
out with aseptic technique after careful hand hygiene.
Collaboration. The nurse must collaborate with the other
members of the healthcare team to identify the site and
source of sepsis and specific organisms involved.
Management of fever: The nurse must monitor the patient
closely for shivering.
Pharmacologic therapy. The nurse should administer
prescribed IV fluids and medications including a antibiotic
agents and vasoactive medications.
Monitor blood levels. The nurse must
monitor antibiotic toxicity, BUN, creatinine, WBC,
hemoglobin, hematocrit, platelet levels, and coagulation
studies.
Assess physiologic status. The nurse should assess the
patients hemodynamic status, fluid intake and output, and
nutritional status.

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