Assessment

HISTORY. The patient with MODS has a history of infection, tissue injury, or a perfusion deficit to an organ or body part. Often, this injury or insult is not life-threatening but exposes the person to bacterial contamination. Question the patient (or, if the patient is too ill, the family) to identify the events in the initial insult and any history of preexisting organ dysfunction, such as chronic lung disease, congestive heart failure, and diabetes mellitus. Elicit a complete medication history and the patient's compliance with medications, and ask if the patient has experienced recent weight loss. Determine the patient's dietary patterns to assess the patient's nutritional status. Take a history of the patient's use of cigarettes, alcohol, and other drugs of abuse.

PHYSICAL EXAMINATION. The physical examination of the patient with MODS varies, depending on the organ systems involved and the severity of their dysfunction (Table 3). Expect the patient to develop signs of pulmonary failure first and then hepatic failure and GI bleeding. Renal failure follows. Note that failures of the central nervous system (CNS) and the cardiovascular system are late signs of MODS.

• TABLE 3 Organ System Involvement In MODS
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