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% of cheat sheets but are needed for some symbol support.
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% Document Info
\author{hibbaas}
\pdfinfo{
  /Title (nursing-sepsis-ax-and-care.pdf)
  /Creator (Cheatography)
  /Author (hibbaas)
  /Subject (Nursing Sepsis Ax \& Care Cheat Sheet)
}

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\fancyhead[L]{
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
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    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Nursing Sepsis Ax \& Care Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{hibbaas} via \textcolor{DarkBackground}{\uline{cheatography.com/73728/cs/18582/}}}
\end{tabulary}
\end{multicols}}

\fancyfoot[L]{ \footnotesize
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
  \SetRowColor{FootBackground}
  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}hibbaas \\
  \uline{cheatography.com/hibbaas} \\
  \end{tabulary}
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\columnbreak
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 19th January, 2019.\\
   Page {\thepage} of \pageref{LastPage}.
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  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\end{multicols}}




\begin{document}
\raggedright
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% Set font size to small. Switch to any value
% from this page to resize cheat sheet text:
% www.emerson.emory.edu/services/latex/latex_169.html
\footnotesize % Small font.

\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Criteria}}  \tn
% Row 0
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\mymulticolumn{1}{x{5.377cm}}{{\bf{SIRS}} (\textgreater{}2):} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{T \textgreater{}100.4/\textless{}95.0   HR \textgreater{}90} \tn 
% Row Count 2 (+ 1)
% Row 2
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\mymulticolumn{1}{x{5.377cm}}{RR \textgreater{}20 or PaCO2 \textless{}32} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{WBC \textgreater{}12/\textless{}4 or Bands \textgreater{}10\%} \tn 
% Row Count 4 (+ 1)
% Row 4
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\mymulticolumn{1}{x{5.377cm}}{{\bf{Sepsis}}: SIRS + Infection} \tn 
% Row Count 5 (+ 1)
% Row 5
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\mymulticolumn{1}{x{5.377cm}}{{\bf{Severe Sepsis}} (\textgreater{}1 org dysf):} \tn 
% Row Count 6 (+ 1)
% Row 6
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\mymulticolumn{1}{x{5.377cm}}{SBP \textless{}90/decrease by \textgreater{}40 or MAP \textless{}65} \tn 
% Row Count 7 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Cr \textgreater{}2.0 or UO \textless{}0.5 mL/kg/hr x2hr} \tn 
% Row Count 8 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Platelets \textless{}100,000} \tn 
% Row Count 9 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{INR \textgreater{}1.5 or PTT \textgreater{}60} \tn 
% Row Count 10 (+ 1)
% Row 10
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\mymulticolumn{1}{x{5.377cm}}{Lactate \textgreater{}2} \tn 
% Row Count 11 (+ 1)
% Row 11
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\mymulticolumn{1}{x{5.377cm}}{{\bf{Septic Shock}}: Severe Sepsis + Refractory Hypotension} \tn 
% Row Count 13 (+ 2)
% Row 12
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\mymulticolumn{1}{x{5.377cm}}{Persistent tiss hypoperfusion after fluid resusc} \tn 
% Row Count 14 (+ 1)
% Row 13
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\mymulticolumn{1}{x{5.377cm}}{SBP \textless{}90/decrease by \textgreater{}40 or MAP \textless{}65} \tn 
% Row Count 15 (+ 1)
% Row 14
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\mymulticolumn{1}{x{5.377cm}}{Lactate \textgreater{}4} \tn 
% Row Count 16 (+ 1)
% Row 15
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{MODS}}: \textgreater{}1 End-organ dysfunction} \tn 
% Row Count 17 (+ 1)
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Phases of Septic Shock}}  \tn
% Row 0
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\mymulticolumn{1}{x{5.377cm}}{{\bf{Early / Hyperdynamic Phase}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{hypotension, tachycardia, tachypnea, Ꝋ/↑ CO, ↓SVR, bounding pulse} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{warm, well perfused extremities but ↓visceral flow} \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{flushed, moist skin} \tn 
% Row Count 6 (+ 1)
% Row 4
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\mymulticolumn{1}{x{5.377cm}}{{\bf{Late / Hypodynamic Phase}}} \tn 
% Row Count 7 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{hypotension, tachycardia, tachypnea, narrow thready pulse, vasoconstriction, CO declines} \tn 
% Row Count 9 (+ 2)
% Row 6
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\mymulticolumn{1}{x{5.377cm}}{cold, poorly perfused extremities} \tn 
% Row Count 10 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{pale, dry skin} \tn 
% Row Count 11 (+ 1)
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Sepsis Bundles}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Within first 3 hours:}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{O2 support. IV access x2 (large bore).} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Measure lactate level} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Obtain blood cultures x2 prior to abx adm} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Adm broad spectrum abx (w/in 3 hr of ER adm or w/in 1 hr of adm to hospital unit)} \tn 
% Row Count 6 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Adm 30 mL/kg crystalloid for hypotension or lactate \textgreater{}4} \tn 
% Row Count 8 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Within first 6 hours:}}} \tn 
% Row Count 9 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Draw 2nd lactate level if initial lactate \textgreater{}2} \tn 
% Row Count 10 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Measure CVP or ScvO2 for refractory art hypotension or initial lactate \textgreater{}4. Maintain CVP \textgreater{}8 \& Scvo2 \textgreater{}70.} \tn 
% Row Count 13 (+ 3)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Add vasopressors for persistent hypotension following fluid resusc. Maintain MAP \textgreater{}65.} \tn 
% Row Count 15 (+ 2)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Persistent shock- Consider adding Vasopressin 0.04 units/min.} \tn 
% Row Count 17 (+ 2)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Within 24 hours}} from severe sepsis dx:} \tn 
% Row Count 18 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Lung protective ventilation- Maintain insp plateau pressures \textless{}300 cmH2O for vent pts. Avoid tidal volume \textgreater{}6 mL/kg for ARDS pts.} \tn 
% Row Count 21 (+ 3)
% Row 13
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Steroids - Adm low dose steroids for septic shock (hydrocortisone)} \tn 
% Row Count 23 (+ 2)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Glucose control/Insulin therapy} \tn 
% Row Count 24 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Nursing DiagnosesAlt}}  \tn
% Row 0
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\mymulticolumn{1}{x{5.377cm}}{R/F infection: superinfection} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{R/F fluid volume deficit} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Altered tissue perfusion} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Hyperthermia} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Impaired gas exchange} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Fear/anxiety} \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Knowledge deficit} \tn 
% Row Count 7 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Medications}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Glycemic control - IV regular insulin to maintain blood glucose \textless{}180 (goal \textless{}150)} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{VTE prophylaxis - Adm low-dose UFH/LMWH} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Stress ulcer prophylaxis - PPI or H2 rec antag} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Vasoactive Meds:}}} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Norepinephrine 2-20 mcg/min; titrate q5min} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Dopamine 5-20 mcg/kg/min} \tn 
% Row Count 7 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Dobutamine 2.5-20 mcg/kg/min} \tn 
% Row Count 8 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Vasopressin 0.4 units/min} \tn 
% Row Count 9 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Vent Meds:}}} \tn 
% Row Count 10 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Propofol 5-10 mcg/kg/min; max 50 mcg} \tn 
% Row Count 11 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Midazolam 1-2 mg/h; max 0.3 mg/kg/hr} \tn 
% Row Count 12 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Lorazepam 1-2 mg/h; max 10 mg/hr} \tn 
% Row Count 13 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Morphine 1-2 mg/h; max 0.3 mg/kg/hr} \tn 
% Row Count 14 (+ 1)
% Row 13
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Fentanyl 50-100 mcg/hr; max 3 mcg/k/min} \tn 
% Row Count 15 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Nursing Care}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Client-family education} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Enteral feeding} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Urinary catheter} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Strict aseptic technique} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Consider ECHO, EKG, Troponin levels} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Assess fluid \& perfusion status frequently.} \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Monitor coagulation studies (PT, PTT, INR, fibrinogen, FDP, platelets). Adm platelets if counts \textless{}5.} \tn 
% Row Count 8 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Monitor H/H. Assess for signs of bleeding. Adm PRBCs if Hgb \textless{}7.} \tn 
% Row Count 10 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Monitor VS, hemodynamics, EKG closely. Adm anti-arrhythmic as needed. VS q5m during titration.} \tn 
% Row Count 12 (+ 2)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Monitor temp. Fever reduction as needed. Assess \& maintain skin integrity.} \tn 
% Row Count 14 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}