N425 - EXAM 2

CRRT

Indications; Assessment (fluid overload, fluid deficit, hemodynamic stability); Interventions for above clinical changes

CRRT > Indications

• Continuous flow of blood through the hemofilter to remove fluid and solute AKI when PT is hemodynamically unstable

CRRT > Assessment (fluid overload, fluid deficit, hemodynamic stability)

Fluid overload; Fluid deficit; Hemodynamic stability

CRRT > Assessment (fluid overload, fluid deficit, hemodynamic stability) > Fluid overload

• I's and O's

• Daily weights

• Hemodynamic monitoring

• Edema

• Rising BP

• Adventitious lung sounds

CRRT > Assessment (fluid overload, fluid deficit, hemodynamic stability) > Fluid deficit

• ECF depletion

• Decreased intravascular volume

• Hemodynamic instability

• hypotension

CRRT > Assessment > Hemodynamic stability

• Continuous VS monitoring

• Watch for HYPOTENSION

CRRT > Assessment (fluid overload, fluid deficit, hemodynamic stability) > Hemodynamic stability > Watch for HYPOTENSION

r/t

CRRT > Assessment > Hemodynamic stability > Watch for HYPOTENSION > r/t

• Increased ultrafiltration rate

• Blood leaks

• disconnection

CRRT > Interventions for above clinical changes

Fluid overload; Fluid deficit; Hemodynamic stability

AKI

Expected assessment findings; Interventions (for fluid balance and abnormal electrolytes); Prioritization of emergent interventions

AKI > Expected assessment findings

Signs of fluid balance (overload, deficit); Lab values

AKI > Expected assessment findings > Signs of fluid balance (overload, deficit)

Overload; Deficit

AKI > Expected assessment findings > Signs of fluid balance (overload, deficit) > Overload

Edema; Increased volume; Rising weight; Hemodynamic changes

AKI > Expected assessment findings > Signs of fluid balance (overload, deficit) > Deficit

ECF depletion; Decreased intravascular volume; Decreased u/o

AKI > Expected assessment findings > Signs of fluid balance (overload, deficit) > Deficit > Decreased u/o

Oliguria; anuria

AKI > Expected assessment findings > Lab values

Serum creatinine; Creatinine clearance; BUN; Serum electrolytes; Urine electrolytes; Fractional excretion of sodium

AKI > Interventions (for fluid balance and abnormal electrolytes)

Obtain IV access; Manage fluid balance

AKI > Interventions (for fluid balance and abnormal electrolytes) > Manage fluid balance

Admin IV fluids based on etiology; Restricted fluid intake based on etiology; Monitor; Fluid balance; Electrolyte imbalance

AKI > Interventions (for fluid balance and abnormal electrolytes) > Manage fluid balance > Admin IV fluids based on etiology

Crystalloids; Colloids; IVFV

AKI > Interventions (for fluid balance and abnormal electrolytes) > Manage fluid balance > Admin IV fluids based on etiology > Crystalloids

NS

AKI > Interventions (for fluid balance and abnormal electrolytes) > Manage fluid balance > Admin IV fluids based on etiology > Colloids

Albumin

AKI > Interventions (for fluid balance and abnormal electrolytes) > Manage fluid balance > Admin IV fluids based on etiology > IVFV

Fluid restriction; Fluid removal

AKI > Interventions (for fluid balance and abnormal electrolytes) > Manage fluid balance > Monitor

Potassium; Sodium; Calcium; Phosphorus

AKI > Interventions (for fluid balance and abnormal electrolytes) > Manage fluid balance > Monitor > Calcium

Hypocalcemia; Replacement; non calcium based meds

AKI > Interventions (for fluid balance and abnormal electrolytes) > Manage fluid balance > Monitor > Phosphorus

Hypophosphoremia; Dietary phos binding meds; Non aluminum based; Acidosis

AKI > Interventions (for fluid balance and abnormal electrolytes) > Manage fluid balance > Fluid balance

Hemodynamic values; Daily weights; I's and Os

AKI > Interventions (for fluid balance and abnormal electrolytes) > Manage fluid balance > Electrolyte imbalance

Hyperkalemia; Hypocalcemia; Hyponatermia; Hyperphosphatemia; Acid base imbalances

AKI > Prioritization of emergent interventions

Avoid nephrotoxic medications; Electrolytes balance

AKI > Prioritization of emergent interventions > Electrolytes balance

Potassium; Sodium

AKI > Prioritization of emergent interventions > Electrolytes balance > Potassium

Hyperkalemia; Ecg changes

AKI > Prioritization of emergent interventions > Electrolytes balance > Sodium

hypoNA; hyperNA

Hyperkalemia management

EKG changes; Interventions based on priority

Heparin induced thrombocytopenia (HIT)

Etiology; signs/symptoms; Lab values; Treatment/management

Heparin induced thrombocytopenia (HIT) > signs/symptoms

s/s

Heparin induced thrombocytopenia (HIT) > signs/symptoms > s/s

Neuro s/s; CV s/s; Pulmonary s/s

Heparin induced thrombocytopenia (HIT) > signs/symptoms > s/s > Neuro s/s

Confusion; Headache\ Impaired speech patterns; Hemiparesis or hemiplegia; Vision disturbances; Dysarthia; Aphasia; Ataxia; Vertigo; Nystagmus; Sudden decrease in consciousness

Heparin induced thrombocytopenia (HIT) > signs/symptoms > s/s > CV s/s

Chest; Diaphoresis; Pallor; Alterations in BP; dysrhythmias

Heparin induced thrombocytopenia (HIT) > signs/symptoms > s/s > Pulmonary s/s

Dyspnea; Pleuritic pain; Chest pain; Rales; Chest wall tenderness; Erythema; Palpable cord; Pain on passive dorsiflexion of food, spontaneous maintenance of relaxed foot in abnormal plantar (homans sign)

Heparin induced thrombocytopenia (HIT) > Lab values

Platelet count

Heparin induced thrombocytopenia (HIT) > Lab values > Platelet count

Less than 100,000mm^3^; Sudden drop of 50% from pts baseline after initiation of heparin therapy

Heparin induced thrombocytopenia (HIT) > Treatment/management

HIT

Heparin induced thrombocytopenia (HIT) > Treatment/management > HIT

Medical; Nursing

Heparin induced thrombocytopenia (HIT) > Treatment/management > HIT > Medical

Monitor plt count; Discontinue heparin; Test heparin for antibodies; Direct thrombin inhibitors

Heparin induced thrombocytopenia (HIT) > Treatment/management > HIT > Medical > Direct thrombin inhibitors

Argatroban

Heparin induced thrombocytopenia (HIT) > Treatment/management > HIT > Nursing

Decrease heparin exposure; Surveil for complications; Comfort and emotional support; Educate pts and family

Heparin induced thrombocytopenia (HIT) > Treatment/management > HIT > Nursing > Decrease heparin exposure

Flush; Vascular access devices

Heparin induced thrombocytopenia (HIT) > Treatment/management > HIT > Nursing > Surveil for complications

DVT; Pulmonary emboli; Acute limb ischemia; Educate pt and family

DIC (disseminated intravascular coagulation)

Etiology; signs/symptoms; Lab values; treatment/management

DIC (disseminated intravascular coagulation) > Etiology

Always secondary to underlying condition; Gram negative sepsis -- 20%; Neoplasms; Obstetric complications; Massive tissue injury; Other causes

DIC (disseminated intravascular coagulation) > signs/symptoms

r/t hemorrhage; r/t thrombi

DIC (disseminated intravascular coagulation) > signs/symptoms > r/t hemorrhage

Gum bleeding; Venipunctures; Old surgical sites; Epistaxis; Ecchymoses; Hemoptysis; Hematuria; Abdominal distension; Hemorrhage; Subarachnoid hemorrhage

DIC (disseminated intravascular coagulation) > signs/symptoms > r/t thrombi

Peripheral cyanosis; Gangrene; Dysrhythmias; Chest pain; Acute MI; Pulmonary embolus; Resp failure; Oliguria; AKI; Diarrhea; Constipation; Bowel infarct; ALOC; Ischemic stroke

DIC (disseminated intravascular coagulation) > treatment/management

Medical; Nursing

DIC (disseminated intravascular coagulation) > treatment/management > Medical

Prevention; Maintaining organ perfusion; Slowing consumption of coagulation factors; Platelet transfusions

DIC (disseminated intravascular coagulation) > treatment/management > Nursing

Support vital functions; Bleeding precautions; Comfort; Surveil for complications

Distinguish between HIT and DIC

Assessment findings including lab values; Treatment differences based on priority concerns

Distinguish between HIT and DIC > Assessment findings including lab values

HIT; DIC

Distinguish between HIT and DIC > Assessment findings including lab values > HIT

s/s; Labs

Distinguish between HIT and DIC > Assessment findings including lab values > HIT > s/s

Neuro s/s; CV s/s; Pulmonary s/s

Distinguish between HIT and DIC > Assessment findings including lab values > HIT > s/s > Neuro s/s

Confusion; Headache\ Impaired speech patterns; Hemiparesis or hemiplegia; Vision disturbances; Dysarthia; Aphasia; Ataxia; Vertigo; Nystagmus; Sudden decrease in consciousness

Distinguish between HIT and DIC > Assessment findings including lab values > HIT > s/s > CV s/s

Chest; Diaphoresis; Pallor; Alterations in BP; dysrhythmias

Distinguish between HIT and DIC > Assessment findings including lab values > HIT > s/s > Pulmonary s/s

Dyspnea; Pleuritic pain; Chest pain; Rales; Chest wall tenderness; Erythema; Palpable cord; Pain on passive dorsiflexion of food, spontaneous maintenance of relaxed foot in abnormal plantar (homans sign)

Distinguish between HIT and DIC > Assessment findings including lab values > HIT > Labs

Platelet count

Distinguish between HIT and DIC > Assessment findings including lab values > HIT > Labs > Platelet count

Less than 100,000mm^3^; Sudden drop of 50% from pts baseline after initiation of heparin therapy

Distinguish between HIT and DIC > Treatment differences based on priority concerns

HIT; DIC

Distinguish between HIT and DIC > Treatment differences based on priority concerns > HIT

Medical; Nursing

Distinguish between HIT and DIC > Treatment differences based on priority concerns > HIT > Medical

Monitor plt count; Discontinue heparin; Test heparin for antibodies; Direct thrombin inhibitors

Distinguish between HIT and DIC > Treatment differences based on priority concerns > HIT > Medical > Direct thrombin inhibitors

Argatroban

Distinguish between HIT and DIC > Treatment differences based on priority concerns > HIT > Nursing

Decrease heparin exposure; Surveil for complications; Comfort and emotional support; Educate pts and family

Distinguish between HIT and DIC > Treatment differences based on priority concerns > HIT > Nursing > Decrease heparin exposure

Flush; Vascular access devices

Distinguish between HIT and DIC > Treatment differences based on priority concerns > HIT > Nursing > Surveil for complications

DVT; Pulmonary emboli; Acute limb ischemia; Educate pt and family

Distinguish between HIT and DIC > Treatment differences based on priority concerns > DIC

Medical; Nursing

Distinguish between HIT and DIC > Treatment differences based on priority concerns > DIC > Medical

Prevention; Maintaining organ perfusion; Slowing consumption of coagulation factors; Platelet transfusions

Distinguish between HIT and DIC > Treatment differences based on priority concerns > DIC > Nursing

Support vital functions; Bleeding precautions; Comfort; Surveil for complications

Sickle cell anemia

Signs and symptoms; Pathophysiology; treatment/management

Sickle cell anemia > Signs and symptoms

Low grade fever; Bone or joint pain

Sickle cell anemia > Pathophysiology

RBCs form an abnormal sickle or crescent shape; Unable to carry adequate oxygen to tissues; Trapped in vasculature

Sickle cell anemia > treatment/management

Medical; Nursing

Sickle cell anemia > treatment/management > Medical

Bone marrow transplant; Pain management; Prevent infection; Transfusion therapy; Admin of hydroxyurea

Sickle cell anemia > treatment/management > Nursing

Support vital functions; Comfort and emotional support; Surveil for complications; Educate pt and family

Sickle cell anemia > treatment/management > Nursing > Support vital functions

Vital signs; Hemodynamic parameters; I&Os; Lab values; Mental status; Skin

Hip and Pelvic Traumas: Complications, Management, identification

https://nursing.unboundmedicine.com/nursingcentral/view/Diseases-and-Disorders/73680/all/Pelvic%20Fractures?refer=true; Complications; Management; Identification

Hip and Pelvic Traumas: Complications, Management, identification > Complications

Hemorrhage; Exsanguination; Gait disturbances; Erectile dysfunction; GI tract trauma; His dislocation; Thromboembolic phenomena; Hypovolemic shock; Immobility; Infection

Hip and Pelvic Traumas: Complications, Management, identification > Complications > Thromboembolic phenomena

Including fat emboli

Hip and Pelvic Traumas: Complications, Management, identification > Management

ABCs; Fluid volume status; CNS parameters; Notify

Hip and Pelvic Traumas: Complications, Management, identification > Management > ABCs

HIGHEST PRIORITY; Can cause hypovolemic shock

Hip and Pelvic Traumas: Complications, Management, identification > Management > Fluid volume status

Body weights

Hip and Pelvic Traumas: Complications, Management, identification > Management > Notify

Delayed cap refill; Tachycardia; U/Oless than .5mL/kg/hr; Alterations in LOC

Hip and Pelvic Traumas: Complications, Management, identification > Identification

History; Physical

Hip and Pelvic Traumas: Complications, Management, identification > Identification > History

Injury; MVA; Sit in jury description & location; Fall; Pain; Underlying medical disorders; Med history

Hip and Pelvic Traumas: Complications, Management, identification > Identification > History > MVA

Safety restraint; Driver or passenger

Hip and Pelvic Traumas: Complications, Management, identification > Identification > History > Fall

Impact; Distance; Type of landing surface

Hip and Pelvic Traumas: Complications, Management, identification > Identification > History > Pain

Tenderness; Inability to void; Pain

Hip and Pelvic Traumas: Complications, Management, identification > Identification > History > Underlying medical disorders

Polycysic kidney disease; Frequent UTIs; Osteoporosis; Rheumatoid arthritis

Hip and Pelvic Traumas: Complications, Management, identification > Identification > History > Med history

Corticosteroids; Tetanus immunization

Hip and Pelvic Traumas: Complications, Management, identification > Identification > Physical

Airway; Breathing; Circulation; Disability; Exposure; Ensure C spine is IMMOBILIZED; Inspect

Hip and Pelvic Traumas: Complications, Management, identification > Identification > Physical > Disability

Neuro

Hip and Pelvic Traumas: Complications, Management, identification > Identification > Physical > Exposure

Underlying disease

Hip and Pelvic Traumas: Complications, Management, identification > Identification > Physical > Inspect

Abrasions; Pain and tenderness; Ecchymosis; Contusions; Lacerations; Groin; Genetalia; Suprapubic area; Frog leg positioning; instability

FAST Ultrasound

Bed US