Multiple Organ Dysfunction Syndrome MODS

INTRODUCTION High Risk Patients Diagnosis Nursing management

• Multiple organ dysfunction syndrome (MODS), also known as • Trauma patients In order for a person to be diagnosed with MODS, there has to Nursing Diagnosis
multiple organ failure (MOF), total organ failure (TOF) or • Shock episode associated with a rupture aneurysm, acute pancreatitis, be dysfunction in two or more organs and evidence of wide- • Septic shock related to systemic hypo perfusion
multisystem organ failure (MSOF) sepsis, burns, or surgical complications. spread inflammation in the body for (SIRS) include: • Disseminated intravascular coagulation (DIC) related to
• MODS Contributes to about 50% of ICU deaths Failure of 2 to • Patients > 65 years of age because of their decreased organ reserve and • Increased body temperature activation of clotting mechanisms
3 organs is associated with 90% mortality. the presence of co-morbidities • Increased heart rate at rest • Organ ischemia/dysfunction (multiple organ dysfunction
• Organ recovery is frequently the rule in surviving patients CLASSIFICATION OF MODS • Increased breathing rate syndrome [MODS]) related to:
without pre-existing organ disease 1. Immediate type(primary): Dysfunction/Fai occurring simultaneously in two • Increased amount of white blood cells (WBC) in the body o hypo perfusion of major organs associated with septic
(white blood cells are the immune cells that help repair shock
Definitions or more organs due to primary disease. damaged tissue and fight off infection). o microvascular thrombosis associated with DIC if it
• Multiple organ dysfunction syndrome (MODS), also known Medical Treatment occurs.
as multiple organ failure (MOF), total organ failure (TOF) 2. Delayed type(secondary): Dysfunction occurred in one organ other organs
• Treatment of MODS is based on treatment of the underlying Nursing action for Septic shock
or multisystem organ failure (MSOF), is sequent fail. insult and organ-specific supportive measures. Assess for and report signs and symptoms of septic shock: systolic
altered organ function in an acutely ill patient • The treatment of patients with septic shock consists of the B/P less than 90 mm Hg
requiring medical intervention to achieve homeostasis. 3. Accumulation type: Dysfunction is cause by chronic disease. It is
following 3 major goals: - rapid, weak pulse
• It usually involves two or more organ systems irreversible08:51 AM 1. Resuscitate the patient from septic shock using supportive - restlessness, agitation, confusion
• MODS is the presence of altered organ function in acutely ill measures to correct hypoxia, hypotension, and impaired - urine output less than 30 ml/hour
patients such that homeostasis cannot be maintained Clinical manifestation
tissue oxygenation. - cool, pale, and/or cyanotic extremities
without intervention. It usually involves two or more organ SIRS is a nonspecific presentation of these insults and is defined 2. Identify the source of infection and treat with antimicrobial - capillary refill time greater than 3 seconds
systems. Systemic in ammatory response syndrome therapy, surgery, or both. - diminished or absent peripheral pulses
• SIRS is a systemic inflammatory response to a variety of by the presence of 2 or more of the following:
3. Maintain adequate organ system function guided by Implement measures to maintain adequate tissue perfusion .If
insults including infection, ischemia, infarction, and injury, it • Temperature greater than 38.0°C or less than 36.0°C cardiovascular monitoring and interrupt the pathogenesis of signs and symptoms of septic shock occur:
leads to disorders of microcirculation, organ perfusion and multi organ system dysfunction. - maintain intravenous fluid therapy as ordered
finally secondary organ • Heart rate higher than 90 beats/min
General supportive care - maintain oxygen therapy as ordered
• Respiratory rate higher than 20 breaths/min or arterial carbon • several parenteral antibiotics, removal or drainage of infected - administer antimicrobials as ordered
Causes
dioxide tension below 32 mm Hg foci, treatment of complications, and pharmacologic - administer vasopressors (e.g. dopamine, norepinephrine) and/or
• The condition usually results from infection
interventions to prevent further harmful . positive inotropic agents (e.g. dobutamine) as ordered to
• injury (accident, surgery) • White blood cell (WBC) count higher than 12,000/µL, lower than • Administer supplemental oxygen to any patient who is septic maintain adequate perfusion pressure and cardiac output
• hypoperfusion and hypermetabolism.
4000/µL with hypoxia or respiratory distress. If the patient's airway is - prepare client for transfer to critical care unit and insertion of
• The primary cause triggers an
not secure or respirations are inadequate, perform hemodynamic monitoring devices (e.g. central venous catheter,
uncontrolled inflammatory response. • Most commonly Respiratory Failure followed by the endotracheal intubation and mechanical ventilation. volume intra-arterial catheter) and ventilator support.
• Sepsis is the most common cause of Multiple Organ
cardiovascular, renal, and hematologic systems. infusion The nurse is caring for a patient in the ICU who has been
Dysfunction Syndrome and may result in septic shock.
• Adult patients who are hypotensive, administer an isotonic, diagnosed with multiple organ dysfunction Syndrome (MODS
In the absence of infection, is termed systemic • Respiratory failure: Hypoxemia, require mechanical ventilation crystalloid solution( as Ringer lactate , sodium chloride 0.9%) Promoting communication with the patient and family along
inflammatory response syndrome (SIRS). Both SIRS
• Cardiovascular failure: Hypotension that is unresponsive to in boluses of 500 mL (10 mL/kg in children), with repeat with addressing end-of-life issues
and sepsis could ultimately progress to multiple organ
clinical assessments after each bolus. Complications
dysfunction syndrome. adequate fluid resuscitation and requires vasopressors. • Administer repeat boluses until signs of adequate perfusion • Acute respiratory distress syndrome (ARDS
Almost any disease that results in tissue injury may are restored. • Disseminated Intravascular Coagulation DIC
• Renal dysfunction: Diminished urine output, increased serum
result in MODS Intravascular volume resuscitation • Acute Renal failure (ARF)
creatinine, • Monitor patients for signs of volume overload, such as • Intestinal bleeding
• Pancreatitis dyspnea, pulmonary crackles, and pulmonary edema, on • Liver failure
• Hematologic failure Anemia, thrombocytopenia, and
• Aspiration syndromes chest radiograph. Improvement and normalization of the • Central Nervous System dysfunction
disseminated intravascular coagulation. patient's mental status, heart rate, BP, capillary refill, • Heart failure
• Extracorporeal circulation (e.g. cardiac bypass) and urine output indicate adequate volume resuscitation. • Death
• Signs of shock : In the compensatory stage of shock, the body
• Multiple blood transfusion • Administer antibiotics parenterally in doses adequate Prevention
shunts blood from the organs, such as the skin and kidneys, to to achieve bactericidal serum levels • Lung : Pressure or volume limited ventilation to minimize
• Ischaemia–reperfusion injury Vasopressor supportive therapy barotrauma and volutrauma
the brain and heart to ensure adequate blood supply. As a result,
• Autoimmune disease When proper fluid resuscitation fails to restore • Cardiovascular : Restrict transfusion of packed red cells when
the patients skin is cool and clammy. Also in this compensatory hemodynamic stability and tissue perfusion, initiate hemoglobin is > 70
• Heat-induced illness therapy with vasopressor agents. These agents are • Renal : Avoidance of nephrotoxins
stage, blood vessels vasoconstriction, the heart rate increases,
• Eclampsia dopamine, norepinephrine and epinephrine • Gastrointestinal : Stress ulcer prophylaxis with H2 blockers rather
bowel sounds are hypoactive, and the urine output decreases than sucralfate // Enteral nutrition
• Poisoning/toxicity
• Hematologic : DVT prophylaxis
Pathophysiology