CKD
Pathophysiology of CKD
- gradual scarring and destruction of entire nephron units
- progressive, irreversible
- usually caused by diabetes, HTN
Risk factors for DIC
- hemolytic rx to blood transfusion
- bacterial/fungal blood infections
- large hemangiomas
- certain types of leukemia, pancreatitis, liver disease
- recent surgery
- severe tissue damage (burns, head injuries)
- pregnancy complications
- stasis of venous blood flow
- vessel wall damage
- altered blood coagulation
- inherited thrombophilia
- cancer
- smoking
- prolonged immobility
- trauma
- surgery
- MI/HF
- obesity
- advanced age
- family hx
- oral contraceptives, estrogen replacement therapy
- pregnancy
- central lines
What is the most common trigger of autonomic dysreflexia?
Diagnostic tests for cirrhosis
- LFTs
- CBC
- coags
- electrolytes
- bilirubin
- albumin
- ammonia
- glucose
- cholesterol
- ultrasound
- liver biopsy
How do you know an AV fistula is working properly?
It has a palpable thrill and audible bruit
Diagnostic tests for DIC
- CBC
- platelet count
- coag studies
- fibrin degradation products
- fibrin split products
- fibrinogen
- D-dimer
Clinical manifestations of PE
- symptoms typically develop suddenly
- dyspnea
- pleuritic chest pain
- anxiety
- feeling of impending doom
- cough, hemoptysis
- tachypnea, tachycardia, S3/S4 heart sounds
- crackles, rubs
- low fever
- diaphoresis
- petechiae over chest and axillae
- decreased O2
- cyanosis
- syncope
Incomplete vs complete spinal cord injury
incomplete: SCI with some preserved motor or sensory function below level of injury
complete: no motor or sensory function below level of injury
Nutritional guidelines for cirrhosis
- sodium restriction (<2g daily)
- fluid restriction (<1500 mL)
- small, frequent meals and snacks
- prioritize plant over animal protein; only restricted if ammonia high
- high calorie, moderate fat
- vitamin and mineral supplements
What are the two A-words Christina told us we have to know?
- azotemia: excessive urea and nitrogenous substances in the blood
- asterixis: involuntary flapping movements of the hands, can be due to severe uremia
Treatment for DIC
- treat underlying cause!
- prevent organ damage, maintain perfusion
- administer FFP, cryoprecipitate, platelets
- institute bleeding precautions
- O2
- mechanical ventilation
- heparin to prevent further clotting (may be long term for chronic DIC)
Diagnostics for PE
- ABGs
- pulse oximetry
- D-dimer
- *pulmonary angiogrpahy (CTPA)*
- VQ scan
- CT
- ECG
- EtCO2
- coags
- abrupt onset of severe hypertension due to overactive ANS
- happens in injuries above T5
- flushing
- diaphoresis
- headache
- bradycardia
- vision changes
- goosebumps
Cirrhosis medications
- diuretics
- lactulose, neomycin
- beta blockers
- ferrous sulfate
- folic acid
- antacids
- oxazepam (serax)
Nutrition and fluid management for CKD
- restrict dietary protein (slows progression)
- high carb, moderate fat
- sodium restriction (<2g daily)
- K+ and phosphate restrictions in ESRD
- I&Os, daily weight
- fluid restriction
Assessment findings in DIC
- petechiae
- ecchymosis
- oozing IV sites
- blood in stool/urine
- decreased cap refill, peripheral pulses
- VS (tachycardia, tachypnea, hypotension, etc)
- ALOC
- hypoxia
- acidosis
Medications to prevent blood clots (specific drugs)
- antiplatelets: aspirin, clopidogrel (plavix)
- anticoagulants: apixaban (eliquis), heparin, rivaroxaban (xarelto), warfarin (coumadin), enoxaparin (lovenox)
- thrombolytic agents: alteplase (activase), urokinase (abbokinase)
Nursing interventions for AD
- sit patient upright immediately
- loosen restrictive clothing or devices
- assess bowel and bladder - treat accordingly
- monitor BP closely
- administer antihypertensives
Major complication of TIPS procedure
hepatic encephalopathy
Common medications given for CKD
- diuretics
- antihypertensives
- phosphate binders
- sodium polystyrene
- vitamin D
- erythropoietin
- ferrous sulfate
Nursing interventions for DIC
- assess peripheral pulses, warmth and cap refill
- monitor LOC and mental status
- carefully reposition q2 hours minimum
- discourage leg crossing, do not elevate knees
- minimize use of tape
- bleeding precautions
- maintain airway patency
- continuously monitor SpO2
- maintain bedrest
- encourage deep breathing and effective coughing
- administer anxiolytics as Rxed
- support nutrition
- treat pain
Reversal agents for blood thinners (3)
heparin: protamine sulfate
warfarin: prothrombin complex concentrate
anticoagulant-induced prothrombin deficiency: vitamin K
Priority of nursing care for SCI
Prevent further injury
...maintain airway
Nursing interventions for cirrhosis
- vital signs
- daily weight
- monitor I&O
- assess peripheral edema and abdominal girth
- assess neuro status, LOC
- avoid hepatotoxic meds
- assess bowel elimination
- monitor for impaired renal function
- institute bleeding precautions
- maintain skin integrity