Acute Kidney Injury
Three categories of acute kidney injury.
Prerenal
Intrarenal
Postrenal
First line intervention for septic shock
Fluid resuscitation with normal saline
30ml/kg immediately
Guide for primary survey in prioritizing care.
ABCDE
(Airway, Breathing, Circulation, Disability, Exposure)
Priorities for managing clients with seizure disorders.
Suction set up at the bedside
IV access
Most common cause of upper gastrointestinal bleeding
Peptic ulcer
Adrenergic blocking agent used in the management of thyrotoxic crisis
Propranolol
Dietary considerations for clients with kidney injury
Adequate fat
Restrict sodium
Priorities of care for all shock states
Oxygenation and ventilation
Adequate tissue and organ perfusion
Fluid resuscitation for a 75 kg client with third degree burns over 40% if the body
Parkland formula
4ml Lactated Ringers x % TBSA x kg
1/2 over 8 hrs
1/2 over 16 hours
Early sign of increased intracranial pressure
Altered level of consciousness
Restlessness
Medications common in the management of hepatic encephalopathy secondary to cirrhosis
lactulose (Cephulac)
rifaximin (Xifaxan)
Signs of adrenocortical insufficiency
Hypoglycemia
Hyperkalemia
Hyponatremia
Hypovolemia
Metabolic acidosis
NSAIDS, Contrast, Aminoglycocydes
Put clients at risk for developing intrarenal acute kidney injury.
Pharmacological management of cardiogenic shock
Dobutamine (positive inotrope)
Nitroglycerine (afterload reducer)
Furosemide (preload reducer)
Signs of compartment syndrome
Paresthesia
Pallor
Signs of autonomic dysreflexia
Hypertension
Bradycardia
Sweating above the level of injury
Pounding headache
Priorities of care in managing a client with ruptured esophageal varices
Maintenance of airway
Assessment of blood loss (vital signs)
Collaborative management of DKA & HHS
Establish IV access with fluid resuscitation with sodium chloride (0.9% or 0.45%)
Continuous regular insulin drip
Add 5% or 10% dextrose (blood glucose ~250mg/dL)
Potential complications during the diuretic phase of AKI
Hypovolemia
Hypokalemia
Hyponatremia
Signs of shock
Restlessness, confusion Decreased urine output
Cool and clammy skin Weak peripheral pulses
Hypotension Sluggish capillary refill
Confusion & agitation
Tachypnea, tachycardia & chest pain
Dyspnea & hypoxia
Petechial rash
Signs of possible fat embolism
First tier treatment for managing increased intracranial pressure.
Osmotic diuretic (Mannitol)
External ventricular drain (EVD)
Brief period of permissive hyperventilation
Dietary considerations for end-stage liver disease
High protein
High calories
High fat
Low Sodium
Management of Addisonian Crisis
Correct underlying cause
Shock management
High dose hydrocortisone replacement
Normal saline and dextrose solutions
Primary lab findings during the oliguric phase of acute kidney injury.
Hyperkalemia
Azotemia (increased creatinine and BUN)
Metabolic Acidosis
Etiology of obstructive shock
Superior vena cava syndrome / compression
Cardiac tamponade
Abdominal compartment syndrome
Tension pneumothorax
Pulmonary embolism
Focus of care for heatstroke
Provide 100% oxygen
Administer fluids
Cool, wet sheets / ice packs
Priorities of care for clients with spinal cord injuries
ABC, ABC, ABC
Spinal precautions
Corticosteroids
Monitor for complications
Pharmacological agents for managing clients with risk for (or actual) gastrointestinal bleeding.
Antacids
Reducing gastric acid secretion
Mucosal barrier enhancer
Pharmacological agents to manage Myxedema Coma
Intravenous levothyroxine
Intravenous corticosteroids
Intravenous glucose