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Multiple organ failure occurs with the presence of altered organ function and when homeostasis cannot be maintained without intervention. Multiple organ dysfunction syndrome (MODS) is the severe end of the sepsis spectrum. MODS is classified as primary or secondary: · Primary MODS is the result of a well-defined insult in which organ dysfunction occurs early and can be directly attributable to the insult itself. · Secondary MODS is organ failure not in direct response to the insult itself, but as a consequence of a host response. It’s imperative for SIRS and severe sepsis to be recognized as early as possible. Progression to septic shock and MODS results in poor patient outcomes (Kaplow & Hardin, 2007). Identifying populations susceptible to developing sepsis leads to early recognition and better outcomes. According to Kaplow and Hardin, 2007, the following patients are at risk: · Ages less than 1 year and greater than 85 years · Immunocompromised · Severe community-acquired pneumonia · Intra-abdominal surgery · Meningitis · Chronic diseases such as cardiovascular disease, renal disease, and diabetes · Cellulitis · Urinary tract infection Pathophysiology The pathophysiology of sepsis is complex and involves many factors. For the purpose of this article, a simplified version will be explained using the inflammatory, procoagulant, and antifibrinolytic process. Cytokines are released during the inflammatory response. The cytokines cause other proinflammatory mediators, such as myocardial depressant factor to be released. This results in a decrease in the ejection fraction, a decrease in response to fluid resuscitation, and a decrease in blood pressure. The endothelium becomes procoagulant in response to the cytokines. This causes damage to the endothelium and leads to capillary leakage. When capillary permeability is disrupted, fluid shifts into the cells and the inflammatory process is further activated. This continuous cycle makes achieving homeostasis difficult (Kaplow & Hardin, 2007). Thrombin production is promoted by the endothelium injury induced by the cytokines. A decline of protein C and antithrombin III results in procoagulation. Thrombin changes fibrinogen into fibrin and when combined with platelets, clots are formed. These clots can block microvasculature and negatively impact cell and organ function (Kaplow & Hardin, 2007). Endothelial injury results in substances being produced to impair fibrinolysis. When fibrinolysis is impaired, the balance between clot formation and clot removal is disrupted. This imbalance can lead to disseminated intravascular clotting (DIC). DIC ultimately leads to MODS (Kaplow & Hardin, 2007). Recognition Early identification of sepsis results in better patient outcomes. Septic patients can be seen in the outpatient and inpatient setting (O’Brien et al, 2007). The presentation of symptoms varies; however, some common symptoms exist for each body system. The following table illustrates the common symptoms seen for each body system: System Symptoms General Fever, chills, fatigue, malaise, rigors, warm pink periphery Central Nervous System Confusion, anxiety, disorientation, apprehension, agitation, obtunded, comatose Cardiovascular Tachycardia, increase pulse pressure, hypotension
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Relationships among the Elderly: The Effects on One’s Health and Psychosocial Well Being
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Nurse’s Legal Plight
A poem...!
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Looks Can Be Deceiving
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Culturally Competent Nursing in Homecare
Homecare nurses must be culturally aware in order to appropriately care for homecare patients. Culture plays a part in the care of all types of patients but it plays a more important role in homecare.
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The Importance of Supporting Mothers Who Breastfeed
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Maximizing Pain Relief in Pediatric Patients
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TO GOWN OR NOT TO GOWN?
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Family Presence During CPR in the Emergency Department
A descriptive survey conducted in 2000 (Myers, et al 2000) investigated attitudes and beliefs of patients’ families and ER staff members about FWR. The survey reported that 98% of patients’ ...
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Keeping a Positive Outlook: My Clinical Experience as a Student Nurse
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Managing Diabetic Patients on Dialysis: The Nurse and Practitioners Role in Multidisciplinary Team Essentials
The chronic state of diabetes mellitus (DM) mainly type II, is an increasingly common cause of end stage renal disease (ESRD) in all countries, accounting for 51% of dialysis patients in the U.S. and ...
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A Solution for Solving the Nursing Shortage? Advantages and Disadvantages of Recruitment of Foreign-Trained Nurses
The Nursing shortage is not only an American dilemma but a phenomenon threatening the entire global community. Developed, as well as undeveloped, countries are experiencing an increasing number of ...
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Memories from a Haitian Cholera Treatment Center
In January and February of this year I worked in Haiti with United States NDMS DMAT and ImSurt teams providing medical and surgical care to the victims of the January 12th earthquake. What I ...
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