Final chronic medsurg

Systemic inflammatory response to infection

• Cytokines are
• released – anti-inflammatory

• Stimulates
• coagulation cascade

Enhanced coagulation

Develop microemboli – impairs blood flow

• Fibrinolysis – to promote clot
• breakdown

• Coagulopathy – clots – breakdown – clots – breadkdown – prolongs clotting
• time, decreased platelets

• systemic infection - Two or more manifestations of SIRS present
• Temp > 38 C (100.4 F) or < 36 C (96.8 F),
• HR > 90 bpm,
• RR > 20 bpm or PCO2 < 32 mm Hg,
• WBC > 12,000 or < 4,000

organ dysfunction, hypotension, hypoperfusion

hypotension even with fluid resuscitation with lactic acidosis, oliguria, change in LOC

• progressive dysfunction of 2 or more organ systems as a
• result of uncontrolled inflammatory response to illness or injury. (ARDS, DIC, Acute tubular necrosis, liver failure, cerebral infarction, lactic acidosis)
• * lungs usaully first>ARDS
• * use inotropic drugs or vasopressors!

• bradycardia, hypotension
• * IV fluids, vasopressors, atropine
• Skin wamr,dry ,flushed.
• Hypothermic*rewarm slowly!
• DVT formation from venous pooling>PE
• Neuro deficits!

• Worry about volume- I&O, daily wts, limit blood tests, ABCs, position slight elevation of lower extremeties*improves venous return. SCDs TEDs
• Fluids: 250 mL to 2L(crystalloid)LR or NS(3ml/1ml blood lost)
• Colloids: Albumin, plasmanate. Synthetics-dextran, hetastarch, mannitol.1L/24hrs

• 18-20 gauge
• use NS-others cause cells to swell and burst.
• Do NOT infuse with meds!
• Filter
• Stop if reaction, D/C , NS to KVO, send to lab, call MD and Labe, document!

decreases hypermetabolism, bacteria translocation, diarrhea, and length of stay!

• decreased contractility, decreased CO, decreased o2 delivery and decreased coagulation.
• Also it increases stress on body.

• positive ionotropic agents-dopamine, dobutamine, norepinephrine.
• *increases hearts froce of contraction, improves SV and BP, increases workload of heart> increases o2 demand!
• * Note : becareful with ischemic heart disease!

• vasopressors
• epi
• norepi

nitro-lowers BP

• vasopressin-vasoconstrictors
• epi-increases contractilit and venous return
• nitro-decreases afterload and work of heart!

atropine! (bradycardia symptomatic)

• external and or internal volume loss.
• Hypotensive
• tachycardia
• tachypnea
• oliguria
• normothermic
• cool,paleskin
• decreased CO, CI,PAP,PAOP
• increase SVR
• cdecreased SVO2
• *Eliminate or treat cause!
• *fluid therapy!!!

• caused by gram neg or positive bacteria, viruses, fungi
• hypotensive
• tachycardic
• tachypnea
• increase UO, then oliguria
• increased temp then decreased
• skin warm then cool
• color flushed then pale
• increase CO, CI then decreased
• decreased PAP, PAOP then increased
• Decreased SVR
• increased SVO2 then decreased
• *antibiotics
• *fluids
• *vasopressors
• *inotorpic
• *recombinant human activated protein C

• Massive dilation
• decreased vascular tone
• decreased SVR
• decreased venous return
• decreased CO
• decreased tissue perfusion
• impaired cellular metabolism
• *vasopressors-dopamine-norepinephrine
• *fluids
• *REwarm slowly
• *atropine or pacemaker

• leukocyte incompatability
• *antipyretics, use washed or filtered products.
• *stop or slow!

• sensitivity to plasma proteins- itching rash
• *antihistamines!

• blood given to fast or whole blood, cardiac or renal insufficiency
• *diuretics and O2, slow transfusion, 1/2 unit at time.
• monitor I&O

bronchospasms or naphylaxis (24hrs)

• STOP INFUSION!
• *epi and steroids and O2
• washed or filtered blood

• STOP INFUSION!!!!
• TACHY
• HYPTENSIVE
• FEVER
• CHILLS
• SHOCK
• HAPPENS QUICK
• *ANTIBIOTICS AND NEED CULTURE!

• If replacement exceeds total blood volume within 24hr
• imbalance of blood elements
• citrate toxicity, hypothermia, hypocalcemia, hyperkalemia