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Focus on SIRS and MODS

Focus on SIRS and MODS. (Relates to Chapter 67, “Nursing Management: Shock, Systemic Inflammatory Response Syndrome, and Multiple Organ Dysfunction Syndrome,” in the textbook). SIRS. Systemic inflammatory response syndrome (SIRS) is a systemic inflammatory response to a variety of insults

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Focus on SIRS and MODS

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  1. Focus onSIRS and MODS (Relates to Chapter 67, “Nursing Management: Shock, Systemic Inflammatory Response Syndrome, and Multiple Organ Dysfunction Syndrome,” in the textbook)

  2. SIRS • Systemic inflammatory response syndrome (SIRS) is a systemic inflammatory response to a variety of insults • Generalized inflammation in organs remote from the initial insult

  3. SIRS • Triggers • Mechanical tissue trauma: burns, crush injuries, surgical procedures • Abscess formation: intra-abdominal, extremities • Ischemic or necrotic tissue: pancreatitis, vascular disease, myocardial infarction

  4. SIRS • Triggers • Microbial invasion: Bacteria, viruses, fungi • Endotoxin release: Gram-negative bacteria • Global perfusion deficits: Post–cardiac resuscitation, shock states • Regional perfusion deficits: Distal perfusion deficits

  5. MODS • Multiple organ dysfunction syndrome (MODS) is the failure of two or more organ systems • Homeostasis cannot be maintained without intervention • Results from SIRS

  6. MODS • SIRS and MODS represent the ends of a continuum • Transition from SIRS to MODS does not occur in a clear-cut manner

  7. Relationship of Shock, SIRS, and MODS Fig. 67-1

  8. SIRS and MODS • Consequences of inflammatory response • Release of mediators • Direct damage to the endothelium • Hypermetabolism • Vasodilation leading to decreased SVR • Increase in vascular permeability • Activation of coagulation cascade

  9. SIRS and MODSPathophysiology • Organ and metabolic dysfunction • Hypotension • Decreased perfusion • Formation of microemboli • Redistribution or shunting of blood

  10. SIRS and MODSPathophysiology • Respiratory system • Alveolar edema • Decrease in surfactant • Increase in shunt • V/Q mismatch • End result: ARDS

  11. SIRS and MODSPathophysiology • Cardiovascular system • Myocardial depression and massive vasodilation

  12. SIRS and MODSPathophysiology • Neurologic system • Mental status changes due to hypoxemia, inflammatory mediators, or impaired perfusion • Often early sign of MODS

  13. SIRS and MODSPathophysiology • Renal system • Acute renal failure • Hypoperfusion • Release of mediators • Activation of renin–angiotensin– aldosterone system • Nephrotoxic drugs, especially antibiotics

  14. SIRS and MODSPathophysiology • GI system • Motility decreased: Abdominal distention and paralytic ileus • Decreased perfusion: Risk for ulceration and GI bleeding • Potential for bacterial translocation

  15. SIRS and MODSPathophysiology • Hypermetabolic state • Hyperglycemia–hypoglycemia • Insulin resistance • Catabolic state • Liver dysfunction • Lactic acidosis

  16. SIRS and MODSPathophysiology • Hematologic system • DIC • Electrolyte imbalances • Metabolic acidosis

  17. SIRS and MODSCollaborative Care • Prognosis for MODS is poor • Goal: Prevent the progression of SIRS to MODS • Vigilant assessment and ongoing monitoring to detect early signs of deterioration or organ dysfunction is critical

  18. SIRS and MODSCollaborative Care • Prevention and treatment of infection • Aggressive infection control strategies to decrease risk for nosocomial infections • Once an infection is suspected, institute interventions to control the source

  19. SIRS and MODSCollaborative Care • Maintenance of tissue oxygenation • Decrease O2 demand • Sedation • Mechanical ventilation • Paralysis • Analgesia

  20. SIRS and MODSCollaborative Care • Maintenance of tissue oxygenation • Optimize O2 delivery • Maintain normal hemoglobin level • Maintain normal PaO2 • Individualize tidal volumes with PEEP

  21. SIRS and MODSCollaborative Care • Maintenance of tissue oxygenation • Enhance CO • Increase preload or myocardial contractility • Reduce afterload

  22. SIRS and MODSCollaborative Care • Nutritional and metabolic needs • Goal of nutritional support: Preserve organ function • Total energy expenditure is often increased 1.5 to 2.0 times

  23. SIRS and MODSCollaborative Care • Nutritional and metabolic needs • Use of the enteral route is preferred to parenteral nutrition • Monitor plasma transferrin and prealbumin levels to assess hepatic protein synthesis

  24. SIRS and MODSCollaborative Care • Support of failing organs • ARDS: Aggressive O2 therapy and mechanical ventilation • DIC: Appropriate blood products • Renal failure: Continuous renal replacement therapy or dialysis

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