FINAL EXAM REVIEW
IMMUNITY & INTERPERSONAL
IMMUNITY
SIRS
SYSTEMIC INFLAMMATORY RESPONSE SYNDROME
SIRS- Inflammation throughout the whole body. Exaggerated defense response to stressor
(ex. Infection (sepsis), surgery/trauma, pancreatitis, ischemia, malignancy)
S/S
● increased HR
● decrease low BP
● low or high temp
● low or high WBC count
● may lead to MOD (multiple organ failure), sepsis, shock
CAUSES:
● dehydration
● ischemia or necrotic tissue: (pancreatitis, vascular disease, MI)
● inflammation
● Mechanical trauma: (burns, crush injuries, surgical procedures)
● Infection: (Microbial invasion bacteria, viruses, fungi, parasites)
● Sepsis: systemic response to INFECTION
● Endotoxin release: Gram-negative and gram-positive bacteria
● Abscess formation: intraabdominal, extremities
BOTTOM LINE: Sepsis is SIRS plus a documented infection source
SIRS- 2 OR MORE SEPSIS (ANY COMBINATION)
● Temp over 100.4 ● Fever or cooler than normal
● Respirations over 20 bpm ● Confusion
● Pulse over 90 bpm ● Pulse over 90 bpm
● WBC over 12,000 ● Lab work reveal organ problems
● Trauma or infection may be a cause ● Caused by infection
● Normal Bp, urine output, oxygen, ● Low Bp, urine output, oxygen level,
breathing SOB
MODS-multiple organ dysfunction syndrome is failure of 2 or more organ system in an acutely
ill patient such that homeostasis cannot be maintain w/o intervention
1
,Interprofessional care for pts. w/ SIRS AND MODS
1. Prevention and Tx of infection
2. Maintaining tissue oxygenation
3. Nutritional and metabolic support
MANIFESTIONS AND MANAGEMENT OF SIRS & MODS
MANIFESTIONS MANAGEMENT
RESPIRATORY SYSTEM
● Development of ARDS ● Mechanical ventilation
● Bilateral fluffy infiltrates on chest ● Positive end-expiratory pressure
X-rays ● Lung protective modes
● Decrease compliance ● Permissive hypercapnia
● Dyspnea (severe) ● Positioning
● PAWP<18 mm Hg ● Continuous lateral rotation therapy,
● Pulmonary hypertension prone positioning
● Refractory hypoxemia
● Tachypnea
● Ventilation-perfusion mismatch
CARDIOVASCULAR SYSTEM
● Biventricular failure ● Volume management to increase
● Decrease BP, MAP, SVR preload
● Increase HR, CO, SV ● Monitor hemodynamic
● Massive vasodilation ● Monitor arterial pressure >65 mm Hg
● Systolic, diastolic dysfunction ● Vasopressors
● Balance O2 supply & demand
● Continuous ECG monitoring
● Circulatory assist devices
● VTE prophylaxis
CENTRAL NEROUS SYSTEM
● Acute change in neurologic status ● Evaluate for hepatic or metabolic
● Confusion, disorientation, delirium encephalopathy
● Fever ● Optimize cerebral blood flow
● Hepatic encephalopathy ● Decrease cerebral O2 requirements
● seizures ● Prevent secondary tissue ischemia
2
, ● Ca channel-blockers (reduce cerebral
vasospasm)
ENDOCRINE SYSTEM
Hyperglycemia-Hypoglycemia Provide continuous infusion of insulin and
glucose
Maintain 140-180 mg/dl
RENAL SYSTEM
● Prerenal: renal hypoperfusion ● Diuretics
● BUN/creatinine >20:1 ● Loop diuretics (furosemide)
● Decrease urine Na <20 mEq/L ● May need to increase dosage d/t
● Increased urine osmolality decreased glomerular filtration rate
● Urine specific gravity >1.020
● Intrarenal: acute tubular necrosis ● Continuous renal replacement therapy
● BUN/creatinine ratio <10:1-15:1
● Increased urine Na >20
● Decrease urine osmolality
● Urine specific gravity 1.010
GI SYSTEM
● GI bleeding ● Stress ulcer prophylaxis
● Hypoperfusion- decrease peristalsis, ● Antacids (Maalox)
paralytic ileus ● Proton pump inhibitors (omeprazole)
● Mucosal ischemia ● Sucralfate
● Decrease intramucosal pH ● Monitor abdominal distention
● Potential translocation of gut bacteria ● Intraabdominal pressures
● Potential abdominal compartment ● Dietitian consult
syndrome ● Enteral nutrition
● Mucosal ulceration on endoscopy ● Stimulate mucosal activity
● Provide essential nutrients & optimal
calories
HEPATIC SYSTEM
● Bilirubin >2 mg/dl ● Maintain adequate tissue perfusion
● Hepatic encephalopathy ● Provide nutritional support (enteral
● Jaundice nutrition)
3
IMMUNITY & INTERPERSONAL
IMMUNITY
SIRS
SYSTEMIC INFLAMMATORY RESPONSE SYNDROME
SIRS- Inflammation throughout the whole body. Exaggerated defense response to stressor
(ex. Infection (sepsis), surgery/trauma, pancreatitis, ischemia, malignancy)
S/S
● increased HR
● decrease low BP
● low or high temp
● low or high WBC count
● may lead to MOD (multiple organ failure), sepsis, shock
CAUSES:
● dehydration
● ischemia or necrotic tissue: (pancreatitis, vascular disease, MI)
● inflammation
● Mechanical trauma: (burns, crush injuries, surgical procedures)
● Infection: (Microbial invasion bacteria, viruses, fungi, parasites)
● Sepsis: systemic response to INFECTION
● Endotoxin release: Gram-negative and gram-positive bacteria
● Abscess formation: intraabdominal, extremities
BOTTOM LINE: Sepsis is SIRS plus a documented infection source
SIRS- 2 OR MORE SEPSIS (ANY COMBINATION)
● Temp over 100.4 ● Fever or cooler than normal
● Respirations over 20 bpm ● Confusion
● Pulse over 90 bpm ● Pulse over 90 bpm
● WBC over 12,000 ● Lab work reveal organ problems
● Trauma or infection may be a cause ● Caused by infection
● Normal Bp, urine output, oxygen, ● Low Bp, urine output, oxygen level,
breathing SOB
MODS-multiple organ dysfunction syndrome is failure of 2 or more organ system in an acutely
ill patient such that homeostasis cannot be maintain w/o intervention
1
,Interprofessional care for pts. w/ SIRS AND MODS
1. Prevention and Tx of infection
2. Maintaining tissue oxygenation
3. Nutritional and metabolic support
MANIFESTIONS AND MANAGEMENT OF SIRS & MODS
MANIFESTIONS MANAGEMENT
RESPIRATORY SYSTEM
● Development of ARDS ● Mechanical ventilation
● Bilateral fluffy infiltrates on chest ● Positive end-expiratory pressure
X-rays ● Lung protective modes
● Decrease compliance ● Permissive hypercapnia
● Dyspnea (severe) ● Positioning
● PAWP<18 mm Hg ● Continuous lateral rotation therapy,
● Pulmonary hypertension prone positioning
● Refractory hypoxemia
● Tachypnea
● Ventilation-perfusion mismatch
CARDIOVASCULAR SYSTEM
● Biventricular failure ● Volume management to increase
● Decrease BP, MAP, SVR preload
● Increase HR, CO, SV ● Monitor hemodynamic
● Massive vasodilation ● Monitor arterial pressure >65 mm Hg
● Systolic, diastolic dysfunction ● Vasopressors
● Balance O2 supply & demand
● Continuous ECG monitoring
● Circulatory assist devices
● VTE prophylaxis
CENTRAL NEROUS SYSTEM
● Acute change in neurologic status ● Evaluate for hepatic or metabolic
● Confusion, disorientation, delirium encephalopathy
● Fever ● Optimize cerebral blood flow
● Hepatic encephalopathy ● Decrease cerebral O2 requirements
● seizures ● Prevent secondary tissue ischemia
2
, ● Ca channel-blockers (reduce cerebral
vasospasm)
ENDOCRINE SYSTEM
Hyperglycemia-Hypoglycemia Provide continuous infusion of insulin and
glucose
Maintain 140-180 mg/dl
RENAL SYSTEM
● Prerenal: renal hypoperfusion ● Diuretics
● BUN/creatinine >20:1 ● Loop diuretics (furosemide)
● Decrease urine Na <20 mEq/L ● May need to increase dosage d/t
● Increased urine osmolality decreased glomerular filtration rate
● Urine specific gravity >1.020
● Intrarenal: acute tubular necrosis ● Continuous renal replacement therapy
● BUN/creatinine ratio <10:1-15:1
● Increased urine Na >20
● Decrease urine osmolality
● Urine specific gravity 1.010
GI SYSTEM
● GI bleeding ● Stress ulcer prophylaxis
● Hypoperfusion- decrease peristalsis, ● Antacids (Maalox)
paralytic ileus ● Proton pump inhibitors (omeprazole)
● Mucosal ischemia ● Sucralfate
● Decrease intramucosal pH ● Monitor abdominal distention
● Potential translocation of gut bacteria ● Intraabdominal pressures
● Potential abdominal compartment ● Dietitian consult
syndrome ● Enteral nutrition
● Mucosal ulceration on endoscopy ● Stimulate mucosal activity
● Provide essential nutrients & optimal
calories
HEPATIC SYSTEM
● Bilirubin >2 mg/dl ● Maintain adequate tissue perfusion
● Hepatic encephalopathy ● Provide nutritional support (enteral
● Jaundice nutrition)
3
