Sepsis Nursing

  1. Why is Mean Arterial Pressure (MAP) preferred over SBP as an indicator of perfusion pressure with a patient in shock?

    A. It gives minimum pressure in which to perfuse major organs
  2. What is the goal of urine output for a patient in shock? (in ml/kg/hr)
    greater than or equal to 0.5ml/kg/hr
  3. In the shock patient, this is elevated as a direct result of anaerobic tissue metabolism:

    C. Lactate levels as evidence of sepsis
  4. In describing CBC, a "shift to the left" means...

    B. Indications of beginning infections
  5. List infections most associated with sepsis (4)
    • PNA (top)
    • UTI
    • abdominal surgery
    • Bloodstream
  6. List values for SIRS criteria:

    • Temp: >38.5 or <36
    • Pulse: >90 (tachy)
    • RR: >20 
    • Altered mental status
    • WBC: >12,000 or <4,000
    • Hyperglylcemic
  7. How does a pt. meet SEVERE sepsis criteria? 
    List some of these conditions
    • Diagnostic creteria for SIRS/Sepsis present, PLUS at least one indicator of possible organ failure
    • Including:
    • Greatly reduced urine output
    • Abrupt change in mental status
    • Decreased platelet count
    • Abnormal HR or SOB
  8. What is defined as septic shock? Sepsis induced tissue hypoperfusion?
    • Septic Shock: A sepsis-induced HYPOtension persisting despite adequate fluid resuscitation. 
    • Sepsis induced tissue hypoperfusion: an infection-induced hypotension, elevate lactate or oliguria
  9. What is normal lactate leel?
  10. How will betablockers contribute to septic shock?
    It will prevent HR and BP from going up if they were bottoming down initially
  11. If a patient is going to get a fluid bolus of NS at 30ml/kg (Pt is 68kg) for septic shock, how much total volume will they receive and over what period of time? What will you set pump to (if possible)?
    • 2040mL over 15-20 minutes 
    • 2040 x 3 = +6000mL pump rate (cannot set pump that fast) so take it out of pump and use free flow.
  12. What are normal Procalcitonin levels?
  13. This lab value can help determine when to stop abx.
    Procalcitonin: returns to normal as patent is improving
  14. T or F: Norepinephrine is used as a first line vasopressor in septic shock
  15. List interventions within first 3 hours when patient screens positive shock (4)
    • 1. Measure lactate levels
    • 2. Get blood cultures BEFORE starting abx
    • 3. Start broad-spectrum abx within 1 hour
    • 4. Give 30ml/kg crystalloid bolus IF HYPOtensive or lactate >4 mEq/L
  16. Fill in: When giving crystalloid bolus to someone with positive screening of sepsis, the dose is __a__ ml/kg. They must either be HYPOtensive or lactate at __b__ mEq/L.
    • a. 30ml/kg
    • b. 4
  17. List interventions after positive sepsis screenings with a 6 hour bundle (4)
    • 1. Vasopressors for HYPOtension that is not corrected by fluids
    • 2. Central lines for persistent HYPOtension (measure CVP >8mmHg and ScVO2>70%)
    • 3. Re-measure lactate if previously elevated
    • 4. Documented re-assessment of volume status and tissue perfusion (MAP, cap refill, jugular veins)
  18. When someone is positive for sepsis, what are the 6 hour goals of each:
    1. CVP
    2. Central venous SAT
    3. MAP
    4. UO
    5. Lactate
    • 1. CVP: 8-12mmHg
    • 2. Central SAT: 65-70%
    • 3. MAP: >65mmHg
    • 4. UO > 0.5mL/kg/hr
    • 5. Lactate: decreasing or normalizing
  19. What are glucose controls for septic shock? (4)
    • 1. Treat if glucose above 180
    • 2. Keep it above 110
    • 3. Check q1-2h until stabilized 
    • 4. Enteral nutrition when possible (start low calorie)
  20. What is the max amount of days before you change c-line dressings?
    • Q7days for transparent, q2 for gauze 
    • - Unless soiled or non-intact drsg, change immediately
  21. How often do you change infusion set for continuous site? Intermittent? Caps?
    • Continuous = 72-96 hours
    • Intermittent = 24 hours
    • Cap = change q7days or after blood transfusion
  22. A pt has these values:
    Temp: 35.9
    P: 107
    RR: 25
    SpO2 90% on 2L
    BP: 92/53 (66)

    List interventions needed for positive sepsis
    • Notify MD
    • Sepsis screen
    • Initiate 3 hour bundle:
    •  - Blood cultures, serum lacate
    •  - broad spectrum abx within 1 hour
    •  - IV bolus for hypotension or lactate >3.9
  23. What is CARS?
    Compensatory Anti-inflammatory Response syndrome: this response can disregulate things and lead to higher death rate. Body can't respond to abx given
Card Set
Sepsis Nursing
MSE2 Lecture Notes