Professional Documents
Culture Documents
DYSFUNCTION SYNDROME)
Definition of Terms:
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, ischemia and haemorrhage.
SIRS-Sepsis-MODS Spectrum
SIRS
Sepsis
Severe Sepsis
Septic Shock
MODS
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:
MODS
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
PATHOPHYSIOLOGY:
Signs & Symptoms
Since the ability of the body to provide oxygen and nutrients is interrupted, the heart compensates by
pumping faster (increase 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.
(increase RR) or (increase PaO2)
The inflammatory response is activated because of the invasion of pathogens. (increase WBC)
Decreased urine output. The body conserves water to avoid undergoing dehydration because of the
inflammatory process. (normal: 30 ml/hr)
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.
Hemodynamic Alterations
Hyperdynamic State (Warm Shock)
Tachycardia.
Elevated or normal cardiac output.
Decreased systemic vascular resistance.
Hypodynamic State (Cold Shock)
Low cardiac output.
GI dysfunction
Hepatobiliary dysfunction
Pulmonary dysfunction
Renal dysfunction
Cardiovascular dysfunction
Coagulation system dysfunction
Hypoperfusion Ischemia of the gut Hypoperfusion Ischemia of the liver and gallbladder
Decreased peristalsis
Decreased integrity of ischemic hepatitis acalculous cholecystitis
the gut lining Colonization of
normal GI flora up
Translocation of normal into the orpharynx Jaundice Right upper pain and
GI bacteria into systemic tenderness
serum transaminase
circulation Abdominal distention
Aspiration of bacteria serum bilirubin
and initiation of a Unexplained fever
Systemic infection inflammatory response
Loss of bowel sounds
and SIRS in the lung
PREVENTION:
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.
MEDICAL MGT:
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.
NURSING MANAGEMENT:
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.