Chronic Kidney Disease/Acute Kidney Disease
Precautions to take when you have a AV Graft:
no constricting clothes
do not carry heavy objects
no BP in arm
Assess thrill and bruit
do not sleep on arm
assess for bleeding
assess not be used for other meds
Respiratory Acidosis:
Depress:
Drugs
Edema
Pneumonia
Respiratory center
Emboli
Spasms
Sac elasticity
S+S of IICP?
- changes in LOC
- Puplairy abnoramalites
- Imparied Eye movement
- Vomiting
- Cushing Traid
- Headache
Warning Signs of Head Injury?
-Change in LOC
- Seizures
- Otherra
- Visual Problem
- Pupil Issues
- Slurred Speech
- Projectile Vomitting
Complete Transection of Cord?
total loss of sensation and movement, of reflexes below injury. Para or quadriplegic. Tx as immobile.
Phases of AKI:
initiation: begins with event.
Maintain: days to weeks
may be anuric, oliguric, non oilguric. S+S:- urinary chagnes, FVE, electrolye imbalance.
Oliguric:10-14days
400ml/24hrs
does not respond to diruteics
Recovery: return of BUN, Creatine and GFR. May result in fluid abnormalities.
Diuretic Phase: 1-3 weeks
1-3 L/day
hypovolima, hypotension, hyponatremia, hypokalemia, dehydration.
Respiratory Alkalosis:
Tachypnea:
Temp increased
aspirin toxicity
controlled mechanical ventilation
hyperventilation
hysteria
pain, pregnancy
neuro injuries
embolism
asthma
IICP defintion:
immediate shifting to CSF, cerebral BF shifted extracranically through vasoconstriction.
What is a Basilar Skull Frature?
Results from Extension of linear fracture. Temporal Bone and Frontal lobe. Crosses sinus, therefore drain of CSF.
S+S:
Raccon eyes, battle signs, orrhea
S+S of SCI
decreased bladder and bowel function
paralysis
sweating decreased
comprised respiratory function
DVT/PE
Pressure/ stress ulcers
Poiliotheremia
Chronic Kidney Disease S+S:
Confusion
edema
hypertension
thick sputum
mouth ulceration
behvioural changes
anemia
pruitus
bone pain
Acidotic:
Asprin
Carbs
Insuffiency of Kidney
Diarrhea
Osmoty
Fistulas
Intake of increased fat
Carbonic amylase Inhibitors
Ventriculomsty:
cathedar intersered into left ventricle and connected to transduer placed under bone flap. Closed system, decreased CSF by gravit, prevent infection.
Complications of: ventricle collapse, infection, herniation, hematoma.
Tx for Basilar Skull Fracture:
- HOB 30
- test with destrox and tes - tape for glucose
- monitor for Halo signs
- watch for resp + cardiac arrrest due to cererbral edema.
- No suctionng, blowing nose
- Antibodics
- Neuro assessment
Spinal Shock:
temp neuro syndrome, sudden loss of continuity between spinal cord and higher nerve canter. characterized by decreased reflexes, sensation, flaccid paralysis. Paralyzed without sensation.
Dx for CKD:
dipstick urine
albulium-creatine blood work
GFR- only way to stage
Renal U/S
Metabolic alkalosis causes:
Alkali:
Aldosterone
Loop Diuretic
Alkali ingestion
Anticoagulant
loss of fluids
increased sodium bicarb
Manitol- osmotic diecutic, works in 15 mins for 8 hrs. Eatch fro F&E abnoramlites, can use lasix in combo. Not used for anuric or cerebral hemmorage pt.
Lasix- loop diruectic
Dexmathasone- decreased cerebral edema, only for tumour and IICP. increase neuro function, gradual weaning required, decrease inflammation.
Epidural Hematoma Tx:
CT Scan
Burr holes to remove clots and bleeding
Craniotomy with drain intserted
Causes of seizures:
severe birth injury
idopathic
alchol withdrawl
vasular disease
infection
trauma
tumour
error of metabolism
Nutritional therapy for CKD:
protein restricion
water, K,Na,Phoslate restriction
Intrarenal AKI Cause:
direct damage to kineys
inflammation
toxins
drugs
infection
reduced BF
Interventions for IICP?
surgical removal of mass
craniotomy- decrompressive surgery
Prevent hypercapnia and hypoxia
Antivconvasants, stool softners, hypertonic saline, antipyretic
patent airways
suctioning, give O2 before and after
- Neuro Assessment
- Incident Report
- Watch for detoration
-GCS
- Craniplasty
-Prevent secondary dx
Tx of seizures:
note time and duration
assess behaviour
protect body
do not retrain or put things in mouth
side postion
seizure precaution
loosen clothing
Ativan, valium, dilatain, anesthia
monitor IV sites
lobectomy