Final Exam - New material Flashcards
What is the most common clinical manifestation of acute renal failure?
Oliguria
(Low Urine output)
Complications of AKI
Hyperkalemia *
Chronic Kidney Disease may result from
Diabetes
Hypertension
Glomerulonephritis
polycystic disease
A1C Normal range
4-7%
What range for A1C has the highest risk for diabates
5.7% - 6.4%
Actions of insulin
Promotes glucose uptake
inhibits gluconeogenesis
Promotes fat and glycogen breakdown
Increased protein synthesis
How does insulin effect Potassium?
Lowers K by driving K into the cell
Type 1 diabetics
Always insulin dependent
Three P’s of Diabetes
Polyuria
Polydipsia
Polyphagia
Insulin Aspart, glulisine, lispro (Short Acting)
Onset, Peak, Duration
5-15 mins
peak: 1-2 hours
Duration of action: 4-6 hours
Human Regular Insulin
Humulin R
Humulin R
onset, peak, duration
30-60 mins
2-4hours
6-8 hours
Human NPH
Humulin N
Novolin N
onset, peak, duration
2-4 hours
4-10hours
12-16 hours
Detemir
onset, peak, duration
1-2 hours
peak: flat
duration 24 hours
Glargine
(Lantus)
onset, peak, duration
2-4 hours
flat
24 hours
Hyperglycemia S/S
Hot and Dry
3 Ps
polyuria
polydipsia
polyphagua
Hypoglycemia S/S
Cool, Pallor, sweaty
Headache, irritability, weakness, anxious, sweaty, shaly, hungry
What is diabetic ketoacidosis
Life-threatening problem that occurs when the body starts to breakdown fats at a higher rate than carbohydrates
DKA S/S
Dry and High Sugar
Ketones and Kussmaul Respirations
Abdominal Pain
Acidosis
Hypovolemic
Hyperosmolar Hyperglycemic State
Happens slowly and to type 2 diabetics caused by illness, infections, older age
Should patients stop taking their insulin or oral agents when they’re sick
NO!
HHS S/S
Highest sugar - 600+
Extreme fluid loss
Change in LOC
No Ketones
Slower onset
Kussmaul Respirations (DKA)
Deep/Rapid/Regular Respirations
Onset of DKA
Happens Suddenly
Medical Management of DKA
Correct insulin deficiency
Insulin First
Avoid hyperglycemia by switching fluids to dextrose
Nursing priorities of DKA
Insulin drip until ketoacidosis is reversed
HHS Management
Hydration status
Neurologic status
HHS Priorities
Fluids First
Insulin Second
Diabetes Insipidus
Insufficiency or hypofunction of antidiuretic hormone (ADH)
Not enough ADH
Diabetes Insipidus results in
Extracellular dehydration
Hypernatremia
Hypotension and Hypovolemia
Assessment and Diagnosis of DI
Urine output over >300ml/hr or more
Specific Gravity <1.005
Medical Management of DI
Hourly urine output
vasopressin for BP
DDAVP-synthetic ADH
Syndrome of inappropriate Antidiuretic Hormone
(SIADH)
Opposite of DI
TOO MUCH ADH
SIADH Assessment and Diagnosis
Dilutional Hyponatremia
Lethargy and confusion
Anorexia
Seizures, coma, and death
Lab Results Na <120
Urine output below normal
Medical Management SIADH
Fluid Restriction
Na Replacement
Nursing Management SIADH
Hydration Status
Neurological Status
Seizures precautions due to low Na
Cushing Syndrome
Hyper-secretion of CORTISOL
Cushing Syndrome
Caused by an outside cause or medical treatment such as glucocorticoid therapy
Cushing Disease
Caused from inside source due to the pituitary gland producing too much ACTH which causes adrenal cortex to release too much cortisol
Cushings Disease S/S
Skin fragile
Truncal Obesity
Rounded (MOON) face
Ecchymosis
Stria
Sugar (Hyperglycemia)
Excessive body hair
Dorsocervical fat pad (buffalo hump)
Cushings Disease Treatment
Removal of pituitary tumor
or
Adrenalectomy
Addisons Disease
Hyposecretion of Aldosterone and Cortisol
What can cause Addisons Disease?
Autoimmune due to the adrenal cortex becoming damaged due to the body attacking itself
Addisons Disease S/S
Sodium and low sugar
Tired and muscle weakness
Electrolyte imbalances
Reproductive changes
Low blood pressure
increased pigmentation
Diarrhea nausea, depression
Addisons Disease Nursing interventions
Watch K levels and glucose levels
Hormone replacement levels of cortisol and aldosterone
Addisons Crisis
Sudden pain
Syncope
Shocl
Super low blood pressure
Sever V/D + headache
Addison Crisis treatment
Need IV cortisol STAT
D5NS fluid to keep blood sugar and sodium levels good
S/S of Thyroid Disorder
Weight loss
heat intolerance
tachycardia
hypertension
Diarrhea
Soft hair
Cardiac dysrhythmias
Thyroid Strom
Life threatening Hyperthyroidism
Clinical presentation of thyroid storm
Thermoregulation: Fever
Heart: Dysrhythmias
CNS: agitation, restlessness
GI: n/v/d
Hypocalcemia
Graves Disease
Autoimmune disorder that produces high amounts of thyroid hormones
Graves’ Disease S/S
Protruding eyeballs, goiters, thin body, jittery
Myxedema Coma
Sever hypothyroidism with hypothermia and coma
Myxedema Coma S/S
Confused, hypothermic, waxy buildup on skin
Pheochromocytoma
Tumor of adrenal medulla secretes catecholamines
Treatment for Pheochromocytomas
Must remove tumor
Causes of Cushings Disease
Steroids long term use
Tumors (pituitary/adrenal)
Small cell lung cancer
Shock Syndrome
(Result of All forms of shock)
All types of shock eventually result in impaired tissue perfusion and the development of acute circulatory failure
Hypovolemic Shock
Inadequate intravascular volume, relative to the vascular space
Cardiogenic Shock
Impairment of myocardial function
Causes of cardiogenic shock may include
After cardiac surgery, drug toxicity, inflammatory heart disease
Distributive Shock
Inappropriate distribution of blood flow, increased capillary permeability
(Septic and anaphylactic shock)
Obstructive Shock
Mechanical obstruction to blood flow into and through the heart and great vessels resulting in low cardiac output
Causes of Obstructive Shock
Cardiac Tamponade, PE, Critical aortic stenosis
Multiple Organ Dysfunction Syndrome
Primary MODS directly results from well-defined insult in which organ dysfunction occurs early and is directly attributed to insult itself (trauma, aspiration, Rhabdo)
Secondary MODS
Consequence of widespread systemic inflammation that results in dysfunction of organs not involved in initial insult
Clinical Manifestations of MODS
Heart rate >90 (TACHY)
RR>20 (Tachypnea)
WBC >12
Bands >10%
Conditions related to MODS
Infection
Ischemia
Trauma
Hemorrhagic Shock
Aspiration
MODS Medical Management
Fluid resuscitation
Identification and treatment of infection
prevent infection
maintenance of tissue oxygenation
comfort and emotional support
MODS Nursing Management
Hand washing for infection prevention
Oxygen delivery
nutritional support
comfort and emotional support
preventing complications
Systemic Inflammatory Response Syndrome (SIRS)
Abnormal response characterized by generalized inflammation in organs that are remote from the initial insult
Nursing Management for Septic Shock
Vasopressors
Fluid administration
blood cultures
antibiotics
emotional support
monitor for complications
Cardiogenic Shock Assessment and diagnosis
Decline in CO
Chest pain
Tachycardia
Respiratory Alkalosis
Hypoxemia
Pulmonary Edema
Becks Triade
Muffled Heart Sounds
JVD
Hypotension
Treatment for Cardiac Tamponade
Needle Aspiration (Emergent)
Pericardial Window (Surgical)
Pulmonary Embolism
Thrombolysis
Antocoagulation
Tension Pneumothorax
Needle Decompression
Chest Tube Placement
Treatment for Anaphylactic shock
Administer Epinephrine
Neurogenic Shock Assessment and Diagnosis
Hypotension
Bradycardia
Warm, Dry skin
Hypothermia
Toxic Epidermal Necrolysis
Caused the skin to peel and blister off
caused by drug reactions
Steven-Johnson Syndrome
Steven Johnson’s Syndrome is a rare and serious disorder of the skin and mucous membranes. It’s usually a reaction to medication that starts with flu-like symptoms, followed by a painful rash that spreads and blisters.
Emergency Operations Plan
(Trauma)
Activation response
Internal and external communication plan
security plans
identification of external resources
Triage
The sorting of patients to determine priority health care needs and the proper site of treatment
North Atlantic Treaty Organization for Triage
(NATO)
Red
Yellow
Green
Black
Phases of Trauma Care
Prehospital resuscitation
Golden Hour*
ABCDEs of Trauma = Primary survey
ABCDEs
Airway
Breathing
Circulation
Disability
Exposure
Phases of Trauma Care
ED and Hospital resuscitation
Damage control resuscitation
massive transfusion protocols
Secondary Survey of Trauma Care
Allergies
Med list
past history
last meal
events related to injury
Biggest sign of increased ICP
Change in LOC
Quadriplegia with total loss of respiratory function occurs at what part of the spine
C1 - C4
Quadriplegia with possible loss of respiratory function due to edema
Spasticity may occur
C4 - C5
C5 - C6 Injury
Quadriplegia with gross arm movements; sparing the diaphragm
C6 - C7 injuries
Biceps intact
diaphragmatic breathing
feeding and grooming independent
C7 - C8 injuries
Triceps and biceps intact
no intrinsic hand muscles
T1 - L2 injuries
Paraplegia with loss of varying amounts of intercostal and abdominal muscles
(In and out of wheelchair independently)
Flail Chest
Fracture of two or more sites on three or more adjacent robs are no longer attached to thoracic cage
Flail Chest results in
Ineffective ventilation
pulmonary contusion
lacerated parenchyma
Flail Chest S/S
Dyspnea
Chest wall pain
Paradoxical chest wall movement
Pneumothorax S/S
Dyspnea
tachypnea
tachycardia
hyperresonance on injured side
Tension pneumothorax
Air enters pleural space on inspiration, but the hair cannot escape on expiration
Tension Pneumothorax S/S
Severe respiratory distress
hypotension
distended neck veins
tracheal deviation
Hemothorax
Accumulation of blood in the pleural space
Hemothorax S/S
Dyspnea
tachypnea
chest pain
signs of shock
dullness to percussion
Kehr’s sign
Sharp epigastric or chest pain radiating to the left shoulder
Becks Triad
Distended neck veins
Muffled heart sounds
hypotension
Pericardial/Cardiac Tamponade
Dyspnea
Becks triad
Discomfort that is relieved by sitting or leaning forward
Cardiac Tamponade
Increase in intrapericardial pressure caused by accumulation of fluid or blood in pericardial sac; trauma, cardiac surgery, cancer, uremia, cardiac rupture
Compartment Syndrome
Tissue compromise from pressure in the muscle compartment
Hallmark sign of Compartment Syndrome
Pain out of proportion to the original injury
What are the 5 P’s of Compartment Syndrome
Paresthesia, pallor, proprioception, pain, pulse
Fat Embolism Syndrome
Fat droplets in small blood vessels of lung or other organs after a long bone fracture or other major trauma. Released from bone marrow or adipose tissue at fracture site into venous system; rare
Complications of Fat Embolism
Respiratory failure, cerebral dysfunction and skin petechiae (does not blanch); symptoms within a few hours to 3-4 days. Initial findings subtle change in behavior and disorientation
Meeting the Needs of Family
Incorporate family into all aspects of care
Grey-Turner’s sign
Purplish discoloration on the flanks or near 11th/12th rib
Acute Renal Failure
rapid decline (over hours to days) in glomerular filtration rate (GFR).
