 Hi and welcome to nursing school explaining this video on mods or multiple organ dysfunction syndrome. If you haven't already done so I highly recommend watching my other video on sepsis and septic shock so that you understand what occurs physiologically before mods occurs because usually sepsis is what leads to multiple organ dysfunction. So in sepsis we have this widespread inflammation in the body that leads to massive vasodilation and because we have multiple organs that fail mods is defined as two plus organ systems that fail but if three or more organ systems fail the patient has a mortality rate of 80 to 90 percent which is really really high and usually the lungs fail first because of the cytokine release and this massive inflammation leading to ARDS or acute respiratory distress syndrome. What follows is the kidney's liver and GI system fail and if it spreads so far that the cardiovascular as well as the neurologic system are affected it leads to 100 percent mortality. So pathophysiologically quick review here there is widespread damage to the vascular endothelium that leads to increased capillary permeability because of the release of the endotoxins from the bacteria that are causing sepsis and this massive capillary permeability leads to vasodilation and the vasodilation again leads the body to produce more of these inflammatory mediators that then cause the slow blood pressure. When there's low blood pressure the organs don't get perfused and because of the platelet activation microclots occur in the circulation that then leads to a mechanical obstruction of the blood flow so basically now we have an embolus that's floating around in the bloodstream that can't get dislodged anywhere. Now because we have the decreased organ perfusion the body kind of goes into a state of panic and produces more glucose in because of the stress response which leads to increased oxygen demand because the glucose has to come from somewhere and then the cells are unable to use the O2 because it goes into this glucose production into the stress response. Now when the cells are unable to utilize O2 tissue hypoxia occurs body switches from aerobic to anaerobic metabolism leading to metabolic acidosis then what happens as the tissues and organs don't get enough O2 cell death occurs and then if one or two or three more organs are affected it leads to organ failure maybe leading to multiple organ dysfunction if more than two are affected and then over here I have outlined the signs and symptoms per body system and then what can we do in terms of nursing care and how is this treated and most of the time these two are closely related and then in red here I have so called the most of the important lab tests and diagnostic tests that you'll see in evaluating patients who are exhibiting signs of multiple organ dysfunction syndrome. So in terms of the respiratory system because of this tissue hypoxia and the body trying to compensate for the metabolic acidosis it's going to increase the respiratory rate which will be significantly elevated and the patient might show crackles which are evident of ARDS developing and then there will be this ventilation and perfusion mismatch so now the the blood flow and the oxygenation don't match we don't have the gas exchange that will usually occur which leads to also decreased oxygen saturation and then the abnormal arterial blood gases because of this metabolic acidosis. Now in terms of nursing care how we monitor this is if what we do about it is give the patient O2 monitor the respiratory status very carefully check their ABGs and prepare to intubate so patients who are in mods and ARDS they will need to go on a ventilator no questions asked because they are just now not able to regulate their respiratory system efficiently enough to blow off all the acids that the body is producing from this metabolic acidosis. Now cardiovascular system because this massive phase of dilation will decrease the systemic vascular resistance so the blood pressure as well as the central venous pressure which is a good indicator of fluid volume status that will be massive hypertension and mean arterial pressure the heart rate will be elevated in an attempt to compensate for the low blood pressure to try to perfuse the organs and the patient might exhibit signs and symptoms of heart failure so what can we do for the cardiovascular system just like in sepsis we give the patient's IV fluids as the most important part of treating a patient who is dealing with this massive vasodilation and fluid loss in the intravascular space so IV fluids crystalloids as well as colloids maybe in a later phases to pull the fluid back in the intravascular space as well as vasopressors to help maintain the blood pressure so basically constrict the blood vessels to bring the blood pressure up but again like in sepsis IV fluids IV fluids IV fluids in terms of the neural system so decreased level of consciousness as well as the patient might be at risk for seizures not only for the hypoperfusion of the brain but also because electrolyte imbalances might occur specifically sodium imbalances and then we assess certainly the patient's level of consciousness to detect any changes for the renal system so the urine output will be decreased because now we don't produce we don't perfuse the organs such as the kidneys or the patient might be an uric meaning no urine production at all and then that will increase the urine specific gravity if there is urine produced meaning that it's more concentrated and then it will be an elevated kidney function evident in elevations in BUN and creatinine levels now over here we want to assess the urine output and the labs specifically again ABGs as well as we know with kidney function hyperkalemia can occur so we need to specifically assess that as well as our other electrolytes the GI system might be affected because now if the GI system here is not being perfused it is leading to evidence that we can collect and so there will be decreased peristalsis because the bowel is not being perfused it cannot function properly there will be decreased or absent bowel sounds or the patient might be having a paralytic alias or there might be GI bleeding from possibly stress also so the patient is developing because this is a severely sick patient and then nursing care for the GI system we're going to assess their abdomen and the bowel sounds to see if this paralytic alias is occurring we want to administer medications for stress also prophylaxis and those are usually PPIs and H2 blockers we want to monitor their souls for blood because the GI bleed and then we want to give them nutrition early and most likely they will have to be TPN total parenteral nutrition because again the patients will be intubated and the GI system might not be working and this is really really important because if the patient is a multiple organ dysfunction syndrome or multiple organs are on the verge of failing we want to support the body with as much nutrition as we can because the patient is in this hyper metabolic state so the more nutrition we can get into them the more glucose nutrients protein we can give them the better off they'll be in this basically anabolic metabolic state that they're in by suffering this organ failure and basically the body is just breaking down so we want to support them from a nutritional perspective the liver with the liver starts to fail liver function tests will be elevated as well as ammonia which is the byproduct of just cellular metabolism that's usually being cleared by the liver so we might see an increase in that remember that the kidney the liver also has to do with albumin production so the proteins that keep the the fluids in the intravascular space as well as clotting so we might see an elevation in PT and INR here now for nursing measures we want to monitor the patient for bleeding and they might turn jaundice just as slightly as the bilayer will get elevated and for hematologically with these microclots in the circulation and the mechanical obstruction here we might see a decrease in platelet count as well as an elevation in D dimer and fsp which are fibrin split products that are important in the coagulation cascade and the way that we clot and the clot is broken down and then so hematologically we need to make make monitor the patient for bleeding again not only for stools but this could be bleeding at the gums or from ILE sites or just minor scratches that they might have and then DVT prophylaxis because the patient is prone to clotting so we want to prevent DVTs and um emboli getting the slot that could basically settle in any of the blood vessels and cause organ dysfunction even from from a clotting perspective so again this is a very critically ill patient that will need to be taken care of in the intensive care unit will need meticulous nursing care the there are a lot of similarities between this and sepsis because sepsis is the precursor so we need to make sure that we deal that we are very diligent in our nursing care and treatment in our assessment skills to prevent the patient from turning into multiple organ dysfunction syndrome from being septic so thank you for watching this video I hope to see you again soon here on nursing school explain thanks for watching