Peds Renal
Describe symptoms of glomerulonephritis, and determine the first presenting symptom.
What is: cola colored urine, periorbital edema (often first), hypertension, reduced urine output, hematuria, fatigue, recent strep infection.
Key difference in clinical management of post operative asymptomatic hypotension versus symptomatic hypotension.
What is: in asymptomatic, no immediate management required. May be residual anesthetic effect->vasodilation. Monitor closely for change.
In symptomatic, immediate intervention indicated.
Pediatric specific complications related to musculoskeletal trauma.
What is: Growth plate deformity causing permanent growth restriction, developmental regression r/t lost milestones and trauma in hospitalization, compartment syndrome, abuse concerns with multiple injuries in various states of healing/inconsistent stories on how injury was acquired.
Key difference in V/S between autonomic dysreflexia and neurogenic shock.
What is: Autonomic dysreflexia has HYPERtension and bradycardia, Neurogenic shock as HYPOtension and bradycardia.
Special consideration for femoral shaft fracture
Blood loss--watch for shock. Fat embolism--watch for sudden dyspnea, decreased LOC, petechiae, chest pain, cyanosis, fever, jaundice.
Suspected diagnosis?
Case A:
- Periorbital edema progressing to anasarca (generalized swelling)
- Frothy urine, ↓ urine output
- Labs: hypoalbuminemia, hyperlipidemia
Case B:
- Cola-colored urine, ↓ urine output
- Mild periorbital edema
-BP: 130/85, HR:78
What is:
A: Nephrotic Syndrome
B: Glomerulonephritis
Describe nursing considerations for the following agents: Midazolam, rocuronium, succinylcholine
Midozolam: hypotension, respiratory depression. Monitor BP, SpO2
Rocuronium: may have longer paralytic action. Monitor breathing for hypoventilation, return of sensation
Succinylcholine: Adverse effect MH, contraindicated with hyperkalemia, burns, neuromuscular disease. Monitor ETCO2, E-
Name the 6 P's of the CMS check.
What is:
Pallor, poikilothermia, paralysis, pulselessness, paraesthesia, pain.
What should the nurse do if any of the 6 Ps are found during a CMS check?
The maximum catheter volume for an SCI patient, to avoid bladder distention.
What is 500 mL?
Positions contraindicated for hip fracture post surgical recovery--both posterior and anterior approach.
Posterior: Hip bent more than 90 degrees, toes pointed inwards, crossed legs.
Use stability pillow and logroll to turn.
Describe pathophysiology of Nephrotic Syndrome.
What is: leaky glomeruli > loss of albumin > loss of oncotic pressure > edema > loss of vascular volume > RAAS activation > retention of water, Na+ > liver compensation > hyperlipidemia
Post operative discharge criteria from SSU, ambulatory surgical clinic
No IV opiates for at least 30 min, PACU criteria met (phase 1 discharge), ambulatory if not contraindicated, voided if indicated, responsible adult for d/c instructions and monitoring at home.
What practice for treating phantom limb pain after amputation has the strongest evidence based practice?
Mirror therapy, medications: Pregabalin, gabapentin, amitriptyline.
Symptoms of pulmonary embolism, and expected treatment plan.
Sx: sudden dyspnea, tachypnea, chest pain, tachycardia, anxiety, decreased SpO2
Nursing considerations for mandibular fracture, post operative.
AIRWAY: Keep airway patent, have trach kit in the room. Have wirecutters in the room. Dental wax for sharp wires.
Describe Rx treatment of
Glomerulonephritis
Hemolytic Uremic Syndrome
Nephrotic Syndrome
GN: Diuretics, antihypertensives, Abx if active strep infection, NO NSAIDs
HUS: supportive--antihypertensives, blood transfusion. Eculizumab for atypical HUS (genetic, autoimmune cause). No Abx.
NS: steroids, diuretics, albumin, immunosuppressants, NO NSAIDs
Describe the 6 Ws in relationship to post-operative fever assessment timeline.
Wave (D0), wind (D1), water (D3), walking (D5), wound (D7), wonder drugs (any day)
What is:
Wave: ECG assessment--r/o MI, dysrhythmias
Wind: breath sounds--r/o pneumonia
Water: urine--r/o UTI
Walking: immobility--r/o VTE
Wound: surgical site--r/o SSI
Wonder drug: anesthesia and other Rx--r/o ADR
Name the components of the acronym: TRACTION, regarding care of traction patients.
What is:
T-Temp (monitor for infection at pin site)
R-Ropes free
A-alignment
C-Circulation (6 P's, CMS)
T-Type of fracture (know proper alignment for traction)
I-Intake (fluids)
O-Overhead trapeze
N-No weights on the floor or bed.
Expected MAP, BP, HR for SCI patients.
If hypotensive, what Rx?
MAP=85-90 (for perfusion)
BP= SBP above 90, below 160
HR=above 60, below 120
Use vasopressors--NE
Heparin is initiated for treatment of DVT. How often is the aPTT checked, from achievement of desired therapeutic level and beyond?
DD: what should the aPTT be for therapeutic range to be met in heparin therapy?
Every 6 hours until therapeutic level 2x, then daily.
DD: 1.5-2.5x normal aPTT, about 45-90 seconds
aPTT of 100 seconds or above may trigger spontaneous bleeding
Expected urine output for pediatric patients and adolescents.
Peds: More than 0.5-2 mL/kg/hr
Adol (same as adult): more than 0.5-1 mL/kg/hr
Clinical red flags after surgical intervention of fractured bone.
Clinical Red Flags
Increasing pain not relieved by medication
Numbness, tingling, pale or cool extremity
Severe swelling or tightness in a limb
Post Operative management: Amputation
What is:
Monitor dressing for bleeding, drainage. Pain management. Compression bandage on stump. Avoid leg elevation (contractures). Prone position for 30 minutes, 3x/day. ROM.
Parent of child after T5 SCI is concerned by the child's inability to move their arms and legs 3 days after injury. They ask the nurse: "Will he be paralyzed forever?". Education?
Spinal shock manifests in days to weeks after injury, masking true neurological function. Sx: flaccid muscles, loss of deep tendon reflexes/sphincters, loss of sensation.
Injuries below T2 typically are paraplegic, with use of upper extremities. True neurological function in the future cannot be ascertained at this time.
Nursing considerations when starting or changing heparin therapy, drawing aPTT.
Initiate fall and bleeding precautions. Double verify with another nurse when changing rate/dose. Draw aPTT from opposite arm of heparin infusion.