AKI
Causes of AKI
Pre renal - Shock, HF, Anaphylaxis, Embolism, Renal artery thrombosis, Burns, dehydration
Intra renal - Allergies (Antibiotics), Infections (Bacterial or viral), Chemical exposure, contrast media, hemolytic blood transfusion reaction, Malignant HTN
Post renal - BPH, bladder cancer, prostate cancer, renal calculi, strictures
Hemodialysis types and responsibilities
types are AV fistulas and grafts
- Fistulas take longer to mature, however, grafts have an increased risk for infection
Responsiilities = Weight pt before and after, have baseline vitals and neuro status
Insulin risk associated with exercise
Exercise normally lowers blood glucose even without insulin, when taking insulin before exercise check BS before administration to prevent hypoglycemia
Parathormone action
This hormone is responsible for calcium secretion and regulating calcium levels
In order to increase calcium, PTH transfers calcium from bone to blood and the kidneys get acted upon by promoting reabsorption of Ca from PTH
GCS (Glasgow coma scale)
Significance of pinpoint and dilated pupils
GCS determines level of consciousness in 3 levels
- 3-8 / 9-12 / 13-15, LOWEST score can get is a 3
Dilated pupils indicate some kind of head injury (Ominous sign) and pinpoint pupils indicate pons damage or drug overdose
Hyperkalemia tx
Insulin = K enters cells when this is given, prophylactic IV glucose is given to prevent hypoglycemia
Sodium Bi carb = Considered to correct acidosis
Kayexalate = Potassium wasting diuretic
Hemodialysis and diet restriction
Disequilibrium syndrome
Caused by fluid shifts during dialysis, this causes cerebral edema and a wide variety of neuro symptoms
Beta blockers and hyperglycemia
When administering beta blockers such as propranolol, these have a tendency to inhibit insulin release which would then lead to BS build up
hypocalcemia s/s
tetany, muscle cramps, seizures, circumoral numbness
Differences between epidural and subdural hematoma
Epidural is between the inner surface of the skull and the dura, arterial or venous origin
Subdural = between dura and the arachnoid layer of the meninges, venous origin
CKD risk factors and Neurologic s/s
Age, CV disease, Diabetes, Ethnic (Black, native american), Nephrotoxic drugs, Family hx of CKD, HTN
Neurologic s/s = HA, fatigue, sleep disturbances, encephalopathy
- due to ammonia increase as urea is not being formed and excreted
When to hold metformin
Needs to be held before IV contrast scan and before a cardiac cath
Somogyi phenomenon
Early morning hyperglycemia occurs due to a rebound effect from late night hypoglycemia
Priority action = check BG at 2-4 in the morning for hypoglycemia
The HCP may increase the dose of insulin
Cushing's syndrome
Chronic exposure to corticosteroids
- changes in physical appearance = wgt gain, buffalo hump, moon face
- stretch marks, muscle weakness, hyperglycemia, hypokalemia, hypertension
Steroids should NEVER be stopped abruptly
Head trauma: concussion education
If child has unequal pupils, increased drowsiness, convulsions, weakness in arms or legs, REPORT
Keep child in dark room, low stim, headache is NORMAL
Acid base changes
Metabolic acidosis = kidneys can't excrete acid from defective reabsorption and regeneration of HCO3.
HCO3 diseases which leads to a weaker buffer for the produced acids
HYPERKALEMIA
Differences between HHS and DKA
DKA = Ketones in urine, acetone breath, severe hyperglycemia, systemic acidosis, develops over hours or 1-2 days, in type 1 diabetes, KUSSMAUL respiration
HHS = Profound hyperglycemia and hyperosmolarity, No significant ketone boyd production or acidosis, develops over days to weeks, in type 2 diabetes, HIGHER MORTALITY
ADH and fluid balance
pts with SIADH have severe fluid overload
- Sodium will be decreased and potassium will be increased (Hyponatremia)
hyponatremia s/s = HA, V, decreased lvl consciousness, seizures
`Addison crisis s/s and F/E imbalances
Hyponatremia and hyperkalemia occur
Anorexia, NV, and fatigue
Hypoclycemia
Skull fracture (Basilar)
At the base of the skull
Halo sign or "Battle sign" a hematoma behind the ear is a sign for this fracture
Ads = Immediate initiation in almost any hospital, less complicated, fewer diet restrictions, home dialysis possible
Dis = Peritonitis, protein is lost, hyperglycemia, surgery for catheter replacement, contraindicated in pt with multiple abd surgeries/trauma
Hyperglycemia vs hypoglycemia
Hyper = blurred vision, dry skin, HA, NV, Progression to DKA or HHS
Hypo = Cold and clammy skin, tachycardia, Nervousness, unsteady gait, seizures, coma, numbness or fingers and toes
Dilutional hyponatremia
Complication of SiADH
Extracellular fluid expands, GFR increases, and sodium levels decline = dilutional hyponatremia
Thyroid storm meds
Iodine, beta blockers, and antithyroid drugs (propylthiouracil and methimazole)
- Inhibit thyroid hormone synthesis
Risk for meningitis and Dx
A CSF leak is a high indicator of meningitis
Brudzinski sign: reflexive flexion of the knees and hips following passive neck flexion
Kernig sign: extension of the knee is painful or limited in extension
Bacterial meningitis is a MEDICAL emergency