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Group3 :
Asniati. S
HelenaModouw
SherlySuebu
VerenBella
James Mokan
Julius Magai
Julius Sarongallo

NURSING CARE FOR PATIENTS WITH MULTIPLE ORGAN

DYSFUNCTION SYNDROME (MODS)
INTRODUCTION
Background Behind
Initially syndrome failure multi organ allegedly as consequence from sepsis. Idea
this is based on observation that onset early from failure respiratory after a number
incident stress incident with response septic on Lots patient. Response This
between other covers fever, leukocystosis, enhancement cardiac output and
decreased vascular resistance peripheral. Researcher demonstrated that more from
50% patient experience failure multi system organ without proof exists infection. In
addition, Nuytinck, et al, found that patients with multiple failures Deceased organs
had evidence of acute and chronic inflammation throughout organ they.
CONCEPT OF THEORY
Understanding
Multiple Organ Dysfunction Syndrome(MODS) previously more knowndengan
multiple Orbro Failure (M.OF) atau multisystem Orbro Failure (mSOF) is
defined as a decrease in organ function in patients with the disease acute that causes
an inability to maintain homeostasis without intervention, usually involve two or
more system organ (SCCM Consensus Conference Committee, 1992). Incident
MODS part big caused by infection. Reason other is traumatized And process
inflammation non-infectious.Description MODS First time confirm connection the
incident with infection latent or No controlled, Which most common is peritonitis
And pneumonia. However, infection No must always There is And its nature more
often follow, than precede, occurrence of MODS. In more than 1/3 of MODS
patients, no focus of infection is found. (Tabrani Wed, 2007).
Etiology
Reason MODS covers network
Which dead, network Which injury,
deficit perfusion, And source
inflammation Which persistent (Black
& Hawks, 2014). Whereas person
Which risky tall experience MODS is
person Which own response immune
Which low like elderly, client with
disease chronic, client with nutrition
bad,client with cancer, trauma victims
heavyAndclientWhichsuffer sepsis
(Black & Hawks, 2014). According to
Balk R.A (2000 in Herwanto &
Amen, 2009)
factor risk tall happen MODS is Systemic
Inflammatory Response Syndrome (SIRS), shock
And hypotension prolonged, traumatized heavy,
operation big, fail
heartstadiumend,infarctionintestines ,dysfunction
heart, > 65Year.
1. Bleeding Which massive (oligenic)
2. Extracardiac obstruction
3. Cardiogenic
4. Dysfunction myocardialMaldistribution on
microdistribution blood
5. All form shock (shock hypovolemic, shock
anaphylaxis, shock cardiogenic, etc.)
6. Infection
7. Injury network
Classification
There is two type MODS, primary And secondary. MODS primary is failure Which obtained
direct from trauma/injury That Alone. MODS secondary happen from inflammation systemic
Which widespread, happen after trauma, And cause dysfunction organ Which No involved in
traumatized beginning (Black & Hawks, 2014). Client enter process hypermetabolic on day to 14-
21 day, except process This No can stopped so patient will ended on death (Black & Hawks,
2014).
MechanismMODS
•Dysfunction progressive from system organ Which become characteristics from MODS on
generally follow order Which explained by Marshall J.C become 4 phase as following:

1. Stage 1: the patient experiences an increased need for fluid volume, alkalosis respiratory light,
accompanied with oliguria, hyperglycemia, And enhancement need insulin.

2. Stage 2: the patient experiences tachypnea, hypocapnia, hypoxemia, liver dysfunction moderate,
And Possible abnormality hematology.

3. Stadiums 3 : happen shock with azotemia And disturbance balance acid base, as well as
abnormality coagulation Which significant

4. Stadiums 4: patient need vasopressors, experience oliguria/anuria, followed colitis ischemic

And acidosis lactate
EnforcementDiagnosis
Manifestation Which seen on patient MODS can become criteria Which used For diagnose MODS.
Wrong One criteria Which used For diagnose MODS is Apache II Which consists from (Black &
Hawks, 2014):

1. Cardiovascular failure (available one or more things following)

2. Failure Respiration

3. Failure Kidney

4. Failure Neurological

5. Various Failure Hepatic

6. Failure Gastrointestinal

7. System Endocrine

8. Hematology
Manifestation Clinical
1. Syndrome respiratory distress
ALIlooksat 60%-70%patient withsevere sepsis. MatterThis be marked with exists infiltrate lungsonX-ray
without exists fail heart left(PaWP< 18 mmHg). There is failure in exchange gas lungs Which be marked
ratio PaO2/FiO2 <300 For ALI or <200 For ARDS
2.Coagulation intravascular
Decline cell blood red without exists bleedingAnddecreased platelets< 100,000/mm3often found. Sepsis add
coagulationand lower fibrinolysis. Endogenous activated Proteins C which prevents thrombosis
microvasculatureAlsodown duringsepsis.

3.Fail kidney I
• Disturbance function kidney can happen with production urine Which normalnor reduce.
4.Bleeding intestines
• Ischemiasplanchnic andacidosis intramucosal happen duringsepsis.Clinical signs covers change function
muscle fineintestines andhappen diarrhea.
5.Fail heart
• Disturbance heart be marked with exists hepatomegaly And total bilirubin > 2mg/dl.
Complications
•There are many complications associated with multiple organ failure. Because Most
trauma patients are in the intensive care unit at the time of complications This arise, so
nurse units maintenance critical play role important in detect And prevent consequence
this.Nature not expected from traumatized tend strengthen flavor Afraid And anxiety.

•By Because That, care nursing Also must give psychosocial support to patient injury
heavy And family they through approach multidisciplinary Which know problem And
often give explanations.
Inspection Diagnostic
MODS diagnostic examination can be carried out using a Clinical Approach with System Scoring.
Score failure organ especially intended as tool descriptive For stratify And compare status patient in
ICU in matter morbidity, not mortality (except Logistic Organ Dysfunction System/ LODS)
(Herwanto & Amen, 2009).
Management
Prevention is step Which main And most importantly, done especially in patients Sick heavy,
Because until moment This Not yet found therapy Which Specific For M.O.F. Management
patient M.O.F Which especially is supportive, whereas therapy Specific directed For identify And
therapy disease base. Infection And sepsis is condition most common as reason M.O.F. By Because
That very need investigation was carried out to possibility exists infection active on every case
M.O.F with inspection culture from location infection until with inspection diagnostic other.
Draft Care Nursing
Assessment
According to Hidayat et al (2012), assessment is step beginning from process
stages nursing, Then in study must notice data base from patients, For
information Which expected from patient. Assessment nursing on all levels of
analysis (individual, family, community) consist of subjective data from somebody
or group, And data objective from inspection diagnostic And source other.
Individual assessment consists of medical history (subjective data) and examination
physique (data objective) (Weber & Kelley 2009).
Diagnosis Nursing
1. Disturbance ExchangeGasRelate With Imbalance Ventilation-Perfusion
2. ImbalanceRateGlucoseBloodRelate With ResistanceInsulin
3. PainfulI Relate With Agent Injurer Physiological
4. Risk Fall Proved With DeclineLevelAwareness
5. Risk Aspiration Proved With DeclineLevelAwareness

Implementation Nursing
Implementation or implementation is initiative from
planActionFor reach objectiveWhichSpecific.Stage
implementation started after
planActionarrangedAndshowedonplanstrategyFor
help reach objectivewhich inexpect. Bybecause
That,planActions thatSpecific held For modifyfactor-
factorWhichinfluence problemHealth.Objective from
implementation is help in reach
objectiveWhichhasinset, Whichcovers
enhancementHealth,prevention
disease,recoveryHealth andfacilitate coping(Efendu &
Makhfudli, 2009).
Evaluation Nursing
Evaluation isActionintellectual For
completeprocessnursingWhichsignify how much
Fardiagnosisnursing,plan actionAndits
implementation Already succeedinachieved.Objective
evaluation is see ability patient in reach objective.
MatterThis Can held with stage connection with
patient based on response patient
toActionnursingWhichgiven,so that nurse can take
decision. Processevaluation consists ontwostage that
is measure achievement objective patientWhichGood
cognitive, affective, psychomotorAndchange function
body as well as the symptoms as well as comparethat
datacollected with objectiveAndachievement
objective(Efendi & Makhfudi2019).
 MODS (Multiple Organ Dysfunction
Syndrome)is circumstances it's messy
physiology so functionorganNo can
guardhomeostasis. Factorrisk main
happenMODSadalagsepsis and SIRS,its weight
disease, shock andhypotension prolonged,there
isfocusednetwork dead,
traumatizedheavy,operation big,exists fail
heartstadiumend,infarctionintestines,dysfunction
heart,age>65Year,
Andabusealcohol.Management
patientMODSespecially is supportive,whereas
therapy Specific directed For
identifyAndtherapy disease base.
Conclusion
THAT IS ALL AND
THANK YOU