Module 2: Mai Flashcards

Question

What happens when severe sepsis develops?

Answer 1

- Neonatal sepsis, a neonate’s systemic response to infection, manifests itself in a number of body systems and organs. - In neonates, when severe sepsis develops, multisystem and multi-organ involvement often ensue and can rapidly progress towards a life-threatening health challenge known as septic shock.

Answer 2

- an inability of the circulatory system to adequately perfuse the body cells.

Answer 3

- blood volume—the amount of circulating blood - rate and force of the heart beat—pumping action - vascular tone—resistance, tension within the blood vessels

Answer 4

- blood volume - cardiac pump - vascular tone **Shock results from the loss of integrity of one of three essential components of circulation

Answer 5

Regardless of the etiology, the final common pathway of shock is cell destruction caused by inadequate perfusion.

Answer 6

- hypovolemic shock—occurs due to an inadequate blood volume - cardiogenic shock—occurs due to an inadequate pump (heart) function - distributive or maldistributive shock—occurs due to a malfunction in vascular tone **Shock is a progressive disorder.

Answer 7

Shock is a progressive disorder. - Despite the varying causes of shock and their associated etiologies—hypovolemic, septic or distributive, and cardiogenic—all result in inadequate tissue perfusion. - As shock progresses, the body attempts to adapt to the inadequate perfusion and preserves vital organ function. —> If not treated, inadequate tissue perfusion eventually causes hypoxia, acidosis, and cell death

Answer 8

- caused by acute blood loss or fluid and electrolyte losses

Answer 9

- acute blood loss arising from placenta previa - spotting during the last trimester - abruptio placenta - twin-to-twin transfusion - birth asphyxia - birth injuries such as rupture of umbilical vessels, spleen or liver

Answer 10

- intraventricular hemorrhage - pulmonary hemorrhage - disseminated intravascular coagulation - vitamin K deficiency - other iatrogenic causes of reduction in blood volume include accidental disconnection of or a loose connection in the tubing of an umbilical arterial catheter

Answer 11

- Loss of volume may also be in the form of plasma, extracellular fluid, or a combination of all three. - Loss of blood and/or fluid from intravascular spaces does not necessarily entail losses from the body. - Volume may be lost from vascular spaces into interstitial spaces (edema) or into cerebral ventricles (IVH). - Any decreases in blood volume disrupt the delicate balance necessary for normal circulation.

Answer 12

Cardiogenic shock results from any condition that causes the heart to fail as a pump, such as: congestive heart failure CHF PPHN perinatal asphyxia hypoxic/ischemic episodes hypothermia hypoglycemia and acidosis congenital heart defects CHD anemia pneumothorax pneumopericardium diaphragmatic hernia CDH airway obstruction acute hypovolemia severe pulmonary interstitial emphysema PIE

Answer 13

- Distributive shock is characterized by excessive vasodilation and abnormal distribution of blood in the circulatory system. - This kind of shock is an abnormal distribution that occurs due to altered elasticity of blood vessels, causing the vessels to dilate. **Remember that blood vessels are elastic, not rigid, and have the ability to dilate or constrict.

Answer 14

- septic shock - anaphylactic shock - neurogenic shock

Answer 15

neonatal sepsis

Answer 16

- Once activated, the immune system releases neutrophils, immune globulins, and other components of the immune defense system into the blood. - In order to rapidly deliver these components to sites of infection, the circulatory system dilates. - The toxins released by certain microorganisms also causes vasodilation. **When massive vasodilation occurs, blood tends to pool in the peripheral circulation. As a result, less blood is available for central circulation. In this way, the blood volume is maldistributed.

Answer 17

- septic shock

Answer 18

Escherichia coli and Group B streptococcus

Answer 19

- When massive vasodilation occurs, blood tends to pool in the peripheral circulation. - As a result, less blood is available for central circulation. - In this way, the blood volume is maldistributed.

Answer 20

- beginning with sepsis —> progressing to septic shock, —> then to multisystem organ dysfunction

Answer 21

- early stage - middle stage - late stages

Answer 22

- Infant responses during the early stage are usually subtle, nonspecific, and insidious. - An infant may be described as “not doing well,” “not right,” or “not handling well.” - Some infants in the early phase may be lethargic and not feeding well, with unstable temperatures. ***Knowing an infant and his/her usual behaviours is very helpful in terms of recognizing responses during the early stage of septic shock.

Answer 23

- During the middle stage of shock, some infants will look quite well perfused. - This is because of peripheral vasodilation. - Although pink with normal capillary refill times, infants are also often lethargic and hypotonic during this phase. - Temperature instability, apnea, and bradycardia may also be present.

Answer 24

The late stage of septic shock is often referred to as end-stage shock: - changes in capillary dynamics result in increased capillary permeability, - which, in turn, causes leakage of intracellular fluid into interstitial spaces. - which produces a decrease in circulating blood volume, - which results in decreased cardiac output. - which causes vasoconstriction, - which reduces tissue perfusion, - which, in turn, results in more hypoxia and tissue damage, - and eventually cell death.

Answer 25

- cold, clammy skin - pale, mottled gray color, cyanosis - sluggish capillary refill (> 3 seconds); infant looks poorly perfused - weak, thready, rapid peripheral pulses - hypotension - tachycardia - decreased urine output - lethargy

Answer 26

- providing ventilatory support - oxygen therapy - correction of mixed acidosis - antimicrobial therapy, if indicated - volume expansion - inotropic support

Answer 27

Volume replacement Inotropes Antibiotics

Answer 28

- DIC is a pattern of simultaneous, uncontrolled bleeding and clotting within the vascular system. - In addition, DIC is usually a symptom of an underlying pathologic event, such as sepsis.

Answer 29

Neonatal DIC is thought to - result when a severe insult, such as sepsis or hypoxia, - leads to endothelial tissue damage. - This damage activates the clotting cascade, - which promotes consumption of platelets and coagulation factors, - which results in bleeding. ***In addition, microthrombi can obstruct blood flow, leading to ischemic tissue damage and organ failure.

Answer 30

Laboratory tests and an infant’s clinical status confirm a diagnosis of DIC - platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen levels, and D-dimers, Factor V, VIII, X, XIII

Answer 31

- ventilatory support, - volume support, and - pressor support if the patient is hypotensive, - as well as close monitoring of neurologic and renal function - providing fresh frozen plasma (FFP), platelets, cryoprecipitate

Answer 32

- Multi-organ dysfunction (previously known as multisystem organ failure [MSOF]) is the presence of altered organ function in acutely ill patients such that homeostasis cannot be maintained without intervention. - It usually involves two or more organ systems. - Alteration in organ function can vary widely from a mild degree of organ dysfunction to completely irreversible organ failure.

Answer 33

- One of the problems with identifying organ failure is that it is not always easy to distinguish between organ dysfunction and organ failure. - This is particularly the case in neonatal nursing as the physiological condition rendered by MODS/MSOF may be indistinguishable from that which occurs as a result of prematurity and perinatal asphyxia.

Answer 34

- SIRS is the process that occurs when sepsis overstimulates the inflammatory response, - triggering a cascade of harmful physiological responses that could lead to MODS and death.

Answer 35

- This reaction induces the release of substances known as inflammatory mediators, - which contribute to the signs and symptoms and to the pathophysiological sequelae of sepsis.

Answer 36

- The physiological regulatory response to sepsis is “turned on” and remains activated. - Instead of remaining a local reaction, the infant’s response to the invader becomes diffuse, widespread, and inflammatory. - This initiates the pathophysiologic changes, tissue destruction and ultimate organ dysfunction and failure that can be seen in sepsis.

Answer 37

- Uncontrolled systemic vasodilation results in hypotension and decreased systemic vascular resistance. - Increased capillary permeability leads to third spacing, peripheral edema, and pulmonary edema. - Overstimulation of the clotting cascade may lead to disseminated intravascular coagulopathy (DIC).

Answer 38

SIRS (suspected infection) --> SEPSIS (SIRS and proven infection) --> SEVERE SEPSIS (sepsis and organ damage) --> SEPTIC SHOCK (severe sepsis and hypotension)

Answer 39

- The primary goal of treatment of neonatal MODS is to recognize, prevent, and limit tissue injury due to hypoxia and acidosis prior to the occurrence of permanent organ damage and death. - Delays in appropriate therapy that will improve ventilation and perfusion may exacerbate cellular injury in all organ systems and death may rapidly ensue.

Module 2: Mai Flashcards

(63 cards)