MULTIPLE ORGAN DYSFUNCTION

SYNDROME (MODS)

is altered organ function in acutely

ill patients that requires medical
intervention to support continued
organ functions.
The actual incidence of MODS is
difficult to determine because it
develops with acutely illnesses
that compromise tissue perfusion.
PATHOPHYSIOLOGY
MODS can be classified as
PRIMARY
SECONDARY

PRIMARY – is the result of direct tissue

impaired perfusion or ischemia
SECONDARY – is often the complication
of SIRS and sepsis
SIRS- systemic inflammatory response
syndrome
- overwhelming inflammatory
response in the absence of
infection causing relative
hypovolemic and decreased
tissue perfusion.
MODS can be a complication of any
form of shock because of inadequate
tissue perfusion.

SHOCK- all organ systems suffer damage

from lack of adequate perfusion
that result in organ failure
VARIOUS CAUSE OF MODS
*dead or injured tissue
*infection
*perfusion deficits

The organ failure usually begin

*lungs
*liver
*gastrointestinal system
*kidney
CLINICAL MANIFESTATIONS

*both in primary and secondary MODS

low blood pressure is the first
manifestation but after treatment the
patient appears to respond.
*in case of primary MODS when the lungs
is being affected/injure the patient
experiences respiratory compromise
that necessitates intubation .
 CLINICAL MANIFESTION

*usually occur with in 72 hours after

the initiating event, respiratory failure
failure leads rapidly to MODS.
* secondary MODS which occurs most
often in patient with septic shock
*the pattern is more insidious and
progressively unfolds over about one
month.
*the patient also experience respiratory
failure and require intubation.
*they remain hemodynamically stable for
about 14 days
*despite apparent stability they exhibit a
hyper metabolic state that is
characterized by hyperglycemic-
-elevated blood sugar
Hyperlacticacidemia-excess of lactic
acid in the blood.
POLYURIA-excessive urine output.
 *infection is usually present and skin
breakdown begins.
*during this stage there is sever loss
of skeletal muscle mass.
*if the hyper metabolic phase can be
reversed the patient can be survive
with some damage to affected organ.
*if the hyper metabolic process cannot
be halted and cells do not receive
adequate oxygen and nutrients the
patient has irreversible organ failure
and dies.
*if hyper metabolic phase cannot be
reversed, MOSD progresses it is
characterized by jaundice
hyuperbilirubinemia
(liver failure)
oliguria progressing to anuria
(renal failure) that require dialysis.
*Patients become less hemodynamic ally
stable and begin to require vasoactive
medication and fluid support.

*the onset of organ dysfunction is an

ominous progressive sign, the more
organs that fail, the worse the
outcome.
MEDICAL MANGEMENT
*Prevention remains the top priority to
in managing MODS.
*elderly patients are at risk for MODS
- aging
- degenerative process
- immune compromise
- chronic illness
- malnutrition
-immunosuppression
-surgical / traumatic wounds
*if prevention measure fail, treatment
measure's to reverse MODS are aimed

* controlling the initiating events

*promoting adequate organ perfusion
* providing nutritional support
NURSING MANAGEMENT
*supporting the patient
*monitoring organ perfusion
*providing information
*support to the family members
*address end-of-life decisions to
ensure supportive therapy
*all invasive procedure must be carried
out with aseptic techniques after
careful hand hygiene.
*IV lines, arterial and venous punctures
sites, surgical incisions, traumatic
wound, urinary catheter and pressure
ulcer must be monitored for signs of
infections
NURSING MANAGEMET
*identification and elimination of the
cause of infection
*any routes of infection must be
eliminated like IV lines are removed
and reinserted at other body sites,
urinary catheter must be removed,
any abscess are drained and necrotic
area are debrided.
*nurses must know how to identify
patient who are at risk for sepsis –
elderly, immunosuppressed, extensive
traumas, burn
*Specimen for culture and sensitivity
are often obtained
*fever is one body’s natural mechanism
for fighting infections.
*nurses must monitor blood levels like
BUN, Creatinine, WBC, hemoglobin,
hematocrit, platelet level