Things To Know

Diaphoresis

Excessive sweating

Oliguria

Low urine output

Anuria

No urine output

Rhonchi

Continuous, low pitched, rattling/snoring/gurgling lung sound

Tachypnea

Increased respiration

Dyspnea

Slowed breaths

Hypoxemia

Low oxygen staturation

Hemoptysis

Coughing up blood

Glomerular Filtration Rate (GFR)

Rate of blood flow through the kidneys

• expected range: 90-120 mL/min

• Decrease → kidney dysfunction (chronic kidney disease)

• Increase → pregnancy

Dysuria

Pain while urinating

Nocturia

Excessive urination at night

Hematuria

Bloody urine

Incontinence

Involuntary voiding

Enuresis

Involuntary voiding during sleep

Proteinuria

Abnormal amounts of protein in the urine

Oliguria

Decreased urine output

Anuria

No urine output

Micturition

Voiding

Creatinine

• End product of m. metabolism

• Filtered from the blood via glomerulus

• High levels can indicate impaired kidney function

• 0.6 - 1.2 mg/dL

• Decrease → low m. mass, hyperthyroidism, starvation, liver disease

• Increase → acute or chronic kidney disease, congestive heart failure, dehydration, certain drugs

Blood Urea Nitrogen (BUN)

• Normal waste product resulting from the breakdown of proteins

• High levels can indicate impaired kidney function

• 7 - 20 mg/dL

• Decrease → liver damage, malabsorption, poor diet, low nitrogen diet

• Increase → acute ot chronic kidney disease

Urine Specific Gravity

• A measure of the kidneys ability to excrete or conserve water

• 1.010 - 1.030

• Decrease → adequate or excessive fluid intake, DI (diluted)

• Increase → dehydration, SIADH (concentrated)

Urine Output

• The amount of urine a person excretes from their bladder via the urethra

• 30 mL/hr - 1500 mL/day

• Decrease → shock, hypotension, trauma, infection, CKD

• Increase → DM, DI, too many diuretics

urinalysis

Laboratory tests that evaluates physical, chemical, and microscopic properties

Dysuria

Burning with urination

Pyelonephritis

Kidney infection

Hematuria

Dark / cola colored urine

Fibromuscular Dysplasia

Blood vessel disorder that causes abnormal cell growth in the walls of medium sized arteries

Asterixis

A flapping tremor

Indications for Urgent Dialysis

A → acidosis

E → electrolytes

I → intoxications

O → overload

U → uremia

Monroe-Kellie Doctrine

80% brain, 10% CSF, 10% blood

Cerebral Perfusion Pressure

CPP = MAP - ICP

• Normal ICP → 5-15 mmHg

• Normal CPP → 55-65 mmHg

Bacterial Meningitis

Bacterial infection triggers meningeal inflammation

• inflammation may disrupt the blood brain barrier

• cerebral edema and increased ICP may develop

Aseptic (Viral) Meningitis

Usually caused by viruses, not bacteria

• enteroviruses, mumps, herpesviruses, measles, influenza, west nile virus, lymphocytic choriomeningitis virus

Encephalitis

Inflammation affects the brain parenchyma (neurons and functional brain tissue)

Isotonic Solutions

Fluid is balanced between the extracellular space and the cell

Hypotonic Solutions

Fluid shifts from the extracellular space into the cell

Hypertonic Solutions

Fluid shifts out of the cell into the extracellular space

Spinal Shock

Temporary loss of neurological activity below injury

Neurogenic Shock

Loss of sympathetic vascular tone

Injury Level

High cervical → C1 - C4

Lower cervical → C5 - C8

Thoracic → T1 - T12

Same Threats for the Brain

Increase intracranial volume

Increase ICP

Decrease CPP

Electrical instability

Secondary injury cascade

Brain Ischemia

ICP rises and MAP falls

Ischemic Stroke - Thrombotic

Intermittent or stepwise improvement between episodes of worsening symptoms

Ischemic Stroke - Embolic

Abrupt development of completed stroke

Hemorrhagic Stroke

Usually abrupt onset

Epidural Hematoma

Arterial bleeding into the space between the dura and the inner skull

Subdural Hematoma

Venous bleeding into the space beneath the dura and above the arachnoid

Intracerebral Hemorrhage (ICH)

Accumulation of blood within the brain tissue caused by the tearing of small arteries and veins in the subcortical white matter

Subarachnoid Hemorrhage (SAH)

Ruptured aneurysm

Symptoms of a Stroke

B → loss of balance

E → loss of or blurry vision

F → face dropping

A → arm weakness

S → speech difficulty

T → time to call 911

Multiple Sclerosis (MS)

Affect myelin and nerve fibers of the brain and spinal cord

Types

• clinically isolated syndrome (CIS)

• relapsing remitting

• primary progressive

• secondary progressive

Parkinson’s

Progressive neurodegenerative disorder (tremor, muscle rigidity, bradykinesia or akinesia, postural instability)

Types

• stage 1 → initial stage

• stage 2 → mild stage

• stage 3 → moderate disease

• stage 4 → severe disability

• stage 5 → complete ADL dependence

Alzheimer’s Disease

Chronic, terminal disease that is characterized by formation of neuritic plaques, neurofibrillary tangles, and vascular degeneration in the brain

Vascular Dementia

Impaired blood flow to the brain, causing ischemia or necrosis of brain neurons

Delirium

Abrupt

Dementia

Usually develops slowly and secretly without being noticed right away

• can be abrupt in stroke/trauma

Hyperactive Delirium

Predominantly restless and agitated

Hypoactive Delirium

Predominantly drowsy and inactive

Mixed Motor Types

Evidence of both subtypes of delirium in the previous 24 hours

A-F Bundle

A → assess, prevent, and manage pain

B → both SAT and SBT

C → choice of analgesia and sedation

D → delirium, assess, prevent, and manage

E → early mobility and exercise

F → family engagement and empowerment

Brieft Confusion Assessment Method (bCAM)

Altered mental status or fluctuating course

Inattention

Altered LOC?

Disorganized thinking

• only positive is yes to altered LOC and any errors in disorganized thinking

Confusion Assessment Method for the ICU (CAM-ICU)

Acute change or fluctuating course of mental status

Inattention

Altered LOC (current RASS level)

Disorganized thinking

• positive if RASS other than 0 and more than 1 error in disorganized thinking