FINAL EXAM

risk factors for AKI and chronic kidney disease

older age → stiffening of blood vessels

diabetes ½ → high blood sugars cause dmg to small blood vessels, causing kidney damage making and inability to filter

hypertension → kidneys aren’t able to function effectively

hyperlipidemia → causes stenosis, damages vasculature, unable to filter

s/s of respiratory failure

hypoxemic respiratory failure: not enough oxygenation

• PaO2: less than 60 and PaCO2: normal/low

• dyspnea (sob), tachypnea

• irritability, confusion

• cyanosis

• tachycardia, arrythmia

• somnolence (drowsiness, excessive sleepiness)

hypercapnic respiratory failure: increase in carbon dioxide, typically more mental-related changes

• PaCO2: greater than 50

• headache

• change of behavior

• coma

• asterixis (eyeballs shake back and forth), tremors

• papilledema/blurred vision

• warm extremities

smoke inhalation injury: assessments and tx

1. inhalation injury assessment → singed hairs, burns, swollen neck, black soot, itchy/difficult vision, runny nose, abd. pain, nausea, stidor, chest tightness

2. treatment → bronchoscopy (scope in airway to evaluate burns in enclosed spaces where injury is likely), intubate

pancreatitis s/s

acute:

• deliberating pain located in epigastric/L. upper abd. region, abrupt onset

• pain after eating (especially fatty meals or drinking alcohol), can radiate to back (observe for guarding)

• swelling in the abdomen

• nausea, vomiting, dehydration

• fever, chills, tachycardia (due to extreme pain), diaphoresis, tachypnea

• jaundice

• hyperglycemia (insulin is not being released properly)

• steatorrhea (pale, loose, foul-smelling, floating, bulky stool)

• internal bleeding

  • cullen’s and grey-tuners’s sign: c-shaped ecchymosis around or w/in pancreas; ecchymosis occuring on the side/flank, rare and dangerous condition in hemorrhagic pancreatitis

• psuedocysts: necrotic/calcified tissue walls off fluid in pancreas, can rupture → peritonitis

chronic:

• also epigastric pain that radiates to the back

  • will be fearful of eating → recurrent challenges affect quality of life and contributed to increased disability, absences from social/work events, cognitive disruptions, anxiety, and depression

• osteoporosis

• malabsorption

• nausea and vomiting

• weight loss

• steatorrhea

• pseudocysts

pancreatitis lab work

• amylase and lipase levels → increased as it leaks out into the bloodstream when not used for digestion

• triglyceride levels → increased, used to see if contributing to gallstone creation

• blood glucose → see severity of disease

• complete blood count, metabolic panel

• abdominal ultrasound or CT → if gallstones are suspected

• c-reactive protien → produced by liver in response to inflammation

• endoscopic retrograde cholangiopancreatography → uses endoscope and x-rays to diagnose

discharge education for pancreatitis patients

• strategies for maintaining low-fat, nutritent-dense diet

  • rich in vegetables, fruits, and whole grains

• cessation of alcohol and smoking, high-cholesterol

• maintaing adequate hydration

• monitoring if fatty stools improved → prescribed pancrelipase (pancreatic enzyme supplement)

• monitoring blood sugar levels depending on severity

priority tx for DKA/HHS patients

DKA:

• provide NS fluid to improve hypovolemia → switch to IV fluids and electrolyte replacement

  • DO NOT bolus back-to-back as it can cause fluid overload and cerebral edema → neuro changes or seizures

• give insulin gtt to improve glucose levels

  • Q15mins BS check, 1:1 w/ patient

  • monitor potassium level → starting insulin will make potassium go back into the cell so potassium levels should NOT be low when starting

    • provide insulin drip and potassium replacement levels as it is not indicated to not give insulin due to glucose levels

• strict I and Os → DO NOT WANT PATIENT EATING, will need to be NPO then on clear liquids as they will spike glucose levels and impacts insulin drip rate

• monitoring potassium levels (for both hyper and hypo)

• provide patient education on checking blood glucose levels

  • Q4hrs when sick

  • if fasting or NPO, check w/ MD on insulin dosing

HHS:

• provide IV fluid replacement (replace first 12hrs with specific amount then 24hrs later do different amount due to electrolyte levels and kg)

• frequent blood pressure checks due to hypovolemia

• insulin gtt

  • monitoring potassium levels during → monitor arrythmias

• strict intake and output

• discharge education on managing blood sugar at home

signs of cushing’s triad

recognizing common ECGs and tx

discharge goals for TBI patients

clinical presentations for the stages of shock

s/s of DIC and treatments

cirrhosis treatment

s/s of increasing ICP

treatments for septic shock

s/s of MI and treatments

common MI medications and their functions