03.01 Nursing Care and Pathophysiology for SIRS & MODS

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Outline

Overview

Pathophysiology: In SIRS the body is insulted by some infection and inflammation occurs. Cytokines are released and inflammation to attempt to repair. When the body can not regain control a systemic reaction occurs with the activation of multiple cascade systems causing massive inflammation and the end result is end-organ failure.

  1. Systemic inflammatory response syndrome (SIRS)
    1. Inflammatory reaction -> homeostasis isn’t maintained
  2. Multiple organ dysfunction (MODS)
    1. Failure of two or more organs or systems

Nursing Points

General

  1. SIRS criteria
    1. Fever >100.5
    2. High heart rate (>90)
    3. High respiratory rate (>20)
    4. Abnormal WBC (>12000 or <4000)
  2. Triggered by insult
    1. Infection-Sepsis
      1. Inflammatory response to bacteria in body
    2. Ischemia
      1. Low perfusion causing response
    3. Trauma
      1. Damage to body causing response
  3. Local cytokine production
  4. Cytokines released into circulation
    1. Recruit help in bloodstrem
    2. Goal = homeostasis
  5. Homeostasis isn’t restored
    1. Systemic reaction ->destruction
  6. Organ perfusion isn’t maintained –> organ failure
  7. Death

Assessment

  1. Vital signs
  2. Assess for source of infection
    1. Wounds
    2. Blood cultures
    3. Pain

Therapeutic Management

  1. Trauma ->stabilize patient
  2. Infection ->IV antibiotics
  3. IV fluids

Nursing Concepts

  1. Immunity -> SIRS = systemic immune response to insult without homeostasis
  2. Infection Control
    1. Sepsis ->SIRS ->MODS
  3. Perfusion
    1. SIRS unmaintained homeostasis –> decreased organ perfusion –> organ failure

Patient Education

  1. Infection prevention measures
  2. See doctor when sick
    1. Wound care
    2. Take full coarse of antibiotics
    3. Stay hydrated

Transcript

Welcome to the lesson where we will discuss what SIRS and MODS are and how we manage them. Let’s begin with SIRS.

SIRS is systemic inflammatory response syndrome. What happens is the body has an inflammatory reaction that basically goes out of control and homeostasis isn’t maintained. This means that the body’s normal processes are not able to occur to maintain itself.  There are criteria for determining if a patient is in SIRS. They might have a fever greater than 100.5, a heart rate greater than 90, and a respiratory rate greater than 20. Their white blood cells will be abnormal, either greater than 12,000 or less than 4,000. Okay, now let’s talk about what MODS is.

MODS is when two or more organs or systems of the body fail, or stop functioning correctly. For example, the renal system may fail leading to low or no urine output. The nervous system could be affected leading to confusion or delirium. The heart may malfunction causing tachycardia and drops in blood pressure. Many systems can be affected, and this most likely will result in the patient dying. Next let’s explore what causes SIRS and MODS. 

So the process begins with SIRS and turns to MODS, but what triggers the process to happen in the first place? Some type of insult occurs. This could be an infection that spreads in the blood as sepsis that makes the body react in an inflammatory response. Ischemia trigger SIRS where there is low perfusion causing a response. trauma where the body is damaged can also trigger SIRS. Let’s dig deeper into the patho of SIRS and MODS.

So something triggered this response, and local cytokine production begins. For example, let’s imagine this is an infected wound on the leg and the bacteria begin entering the bloodstream. These cytokines are released into circulation calling for help from the white blood cells. The goal for the body is to maintain homeostasis, but in this case it is not restored because this systemic inflammatory reaction that is happening is leading to destruction. Organs aren’t being perfused as they should, and they fail to function. The patient will eventually die if this isn’t treated quickly. Now let’s talk about how to assess the patient with SIRS or MODS.

Vital signs are super important as they are used to determine if the patient has SIRS by meeting the criteria. We need to assess the patient for sources of infection. Look over their body at the skin for any wounds or redness. The doctor will order tests depending on the other patient symptoms. For example, maybe the patient has burning and pain with urination along with back pain. The doctor in that case will check the urine for bacteria. Any infection in the body can lead to SIRS and MODS. Next let’s talk about management of SIRS and MODS. 

So first we want to stabilize this patient. If they experienced some sort of trauma that set off the SIRS response we need to treat that trauma first and foremost. If the patient is found to have some kind of infection, the doctor will order IV antibiotics to begin fighting that infection. A very important treatment of SIRS and MODS is IV fluids. You may be giving the patient boluses, or very fast rates, especially when the patient becomes hypotensive from the process. Next let’s talk about education to provide to the patient. 

We should teach the patient about preventing infection, like caring for wounds properly, washing hands, and so forth. They should not wait too long to see a doctor if they are ill with symptoms like fevers and redness or other signs of infections. They should always complete their antibiotic treatment ordered by the doctor. And hydration is very important, especially when fighting infections. 

Our priority nursing concepts for the patient with SIRS and MODS are immunity, infection control, and perfusion. 

Alright, now let’s review the key points on SIRS and MODS. SIRS in an inflammatory response that starts local and goes system wide and homeostasis isn’t maintained. The criteria for SIRS includes a fever greater than 100.5, heart rate greater than 90, respirations greater than 20, and abnormal white blood cells that could be too high or too low. MODS is when the failure of homeostasis causes the organs to lose perfusion causing them to fail. MODS results in death of the patient as the organ systems shut down. The causes of SIRS and MODS include infections, trauma, and ischemia. We assess this patient by checking frequent vital signs, and assessing for signs of infection. We manage by stabilizing the patient if a trauma occurred. IV fluids are key to treating the patient with SIRS. IV antibiotics are used to fight any infection that the patient may have. 

That’s it for the lesson on SIRS and MODS! No go out and be your best self today, and as always, happy nursing!