Sepsis and Septic Shock Management Flashcards
7 cards from real Acute Care Nurse Practitioner practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Sepsis and Septic Shock Management flashcards as text
Serial serum lactate measurement is recommended to guide resuscitation in sepsis. An initial lactate > 2 mmol/L should prompt which action?
Answer: Repeat lactate measurement within 2 hours and optimize perfusion targeting lactate normalization
Elevated lactate triggers repeat measurement within 2 hours and resuscitation efforts targeting perfusion; lactate clearance ≥10% per hour correlates with improved survival.
Which hemodynamic pattern best characterizes the pathophysiology of distributive shock in early septic shock?
Answer: Massive vasodilation with decreased SVR, relative hypovolemia, and often high or normal cardiac output
Distributive/septic shock is characterized by profound vasodilation (low SVR) creating relative hypovolemia, with cardiac output typically normal or elevated early due to catecholamine surge.
Procalcitonin (PCT) is used as a biomarker in sepsis management. For which clinical application is PCT most supported by evidence?
Answer: Guiding antibiotic de-escalation and earlier discontinuation when PCT levels significantly decline
While PCT aids early sepsis diagnosis, its strongest evidence-based application is guiding antibiotic de-escalation — a declining PCT trajectory supports earlier discontinuation of antibiotics.
In sepsis management, 'source control' refers to which intervention?
Answer: Identifying and physically eliminating or controlling the anatomical infection source through drainage, debridement, or device removal
Source control involves procedural interventions — such as abscess drainage, infected tissue debridement, or removal of infected catheters/devices — to physically eliminate the infection nidus.
An arterial blood gas from a patient in septic shock shows: pH 7.15, PaCO₂ 28 mmHg, HCO₃ 10 mEq/L, lactate 6 mmol/L. What is the correct interpretation?
Answer: High anion gap metabolic acidosis with appropriate respiratory compensation
The low pH, markedly low bicarbonate, and compensatory hypocapnia with elevated lactate confirm high anion gap metabolic acidosis (lactic acidosis) with an appropriate respiratory compensation.
If a patient with sepsis-associated acute respiratory failure requires intubation and mechanical ventilation, which ventilator strategy is preferred?
Answer: Low tidal volume ventilation (6 mL/kg IBW) with plateau pressure < 30 cmH₂O and permissive hypercapnia
Lung-protective ventilation with low tidal volumes (6 mL/kg ideal body weight) and limited plateau pressures reduces ventilator-induced lung injury, validated by the ARDSNet trial.
When is antibiotic de-escalation most appropriate in a patient recovering from sepsis?
Answer: When culture and sensitivity results identify a specific pathogen and clinical improvement allows narrowing to the most targeted effective agent
Antibiotic de-escalation should occur promptly once pathogen identification and susceptibilities allow narrowing to targeted therapy combined with clinical improvement, reducing resistance selection and adverse effects.