TBI
4 lobes of brain and functions
Parietal - sensory, Frontal - emotions and speech, Temporal - auditory and Occipital - visual
Elevated Systolic pressure with widening pulse pressure = B/P 180/70, HR - 50 and hyperventilation
Cushing's Triad - late finding of Increased ICP and indicative of Herniation
Major causes of Ascites in Liver Failure
Portal Hypertension and Low Albumin
Treatment for rupture esophageal varices
Ocetreotide, Propranolol, Vasopressin, Blood products and Blakemore tube and possibly TIPS procedure
Signs of Right-sided Heart Failure (RSHF) and possible treatments
+JVD, peripheral edema, CVP>8, hepatomegaly - dopamine, dobutamine, milrinone and digoxin
Key assessment to calculate cerebral perfusion pressure which tells us about cerebral blood flow
What is MAP
Glasgow Coma Scale less than 8
Indicative of Brain injury and less than 8 may need to intubate
Cause of Hepatic Encephalopathy
Elevated Ammonia Levels
Causes of CKD
Diabetes, Hypertension, Glomerulonephritis, Hydronephrosis, Nephrotic Syndrome, Pyelonephritis and Renal Cell Carcinoma
Signs of Left Sided Heart Failure (LSHF) and possible treatments
+crackles, SOB, dyspnea, orthopnea and PND and PAWP>12 - dopamine, dobutamine, milrinone and digoxin
Which is more serious finding Decorticate or Decerebrate posturing
Decerebrate - - rigid extension and indicates brainstem injury
Key treatments for Increased ICP
Mannitol, 3% Hypertonic Saline and Sodium Bicarbonate, Must keep HOB elevated 30 degrees or higher, limited fluids, maintain PaCO2 35mmHg, Keep O2 Sat > 94%, Keep Temp less than 100 degrees Fahrenheit
Cause of Spleenmegaly, Hepatomegaly and esophageal varices
Portal Hypertension
Patients with ESRD are at risk for fluid overload or fluid volume defecit?
Fluid overload evident by crackles in lung fields, SOB/dyspnea/orthopnea +JVD and edema
Hyperventilation will result in what acid-base imbalance where hypoventilation will result in which acid base imbalance
Respiratory alkalosis and respiratory acidosis
Key assessments in patient with brain injury
Airway, LOC using GCS and pupil reaction (CN III)
Goal of medication treatments for Increased ICP
Increase CPP, Decrease ICP, Improve LOC - measure through GCS and Increased UOP
Treatment of ascites
Paracentesis (need repeats not cure and empty bladder before procedure) and spironolactone
Diet restriction for Chronic Kidney disease
Low sodium, low potassium, low phosphorous, decreased protein and fluid restriction
Treatment of ventricular fibrillation and pulseless VTach
CPR, defibrillation and epinephrine
Must assume all patients with TBI have what and therefore must avoid what?
Increased ICP and therefore no D5W, limited fluids less than 50 mL/hr, NO Lunbar Punctures, minimal suctioning, space nursing care/activities, NO neck or hip/knee flexion, no valsalva
Which is more serious - negative babinski, + Doll's eyes or + decerebration
+ Decerebration
Medications given for Hepatic Encephalopathy
Lactulose, rifaximin and neomycin - goal of these meds is to improve LOC
Treatment for SVT
Vagal maneuvers, adenosine, synchronized cardioversion
Causes of Sinus Tachycardia
Hypovolemia, anxiety, pain and fever/infection