Diabetes Insipidus
How do you know your patient with DI is improving?
They will have a normal urine output, urine specific gravity, electrolytes, and vital signs
What are the signs of a barotrauma?
increased cough and high pressure alarms
What are the donor management goals?
Maintain homeostasis (HR and systolic BP > 100), keep core temp between 97 to 100 F, correct any electrolyte imbalances
What are the symptoms of DIC?
Hypotension, hypoxemia, respiratory distress, and metabolic acidosis
What are the clinical manifestations of DI?
Polyuria, polydipsia, and polynocturia; increased serum sodium and hematocrit seen on labs
What are good patient positioning techniques?
Good lung down, elevate HOB, prone (why?)
Cataract formation, new onset diabetes, infection, tumors, malignancies, organ dysfunction, GI ulcers, weight gain
What are the signs of organ injury for MODS?
Metabolic acidosis, the lungs will have ARDS< failure in renal, hepatic, and GI systems
What would you provide education for with this patient?
Take meds as prescribed, daily weights, signs of DI and fluid overload
What is needed for the post intubation assessment?
Assess for symmetrical chest rise/fall, equal lung sounds, no breath sounds over abdomen, confirm placement with portable CXR, end tidal CO2 device (negative result means it is misplaced)
Describe the three type of graft rejection.
Hyperacute: occurs minutes/hours post transplant, graft will need to be removed
Acute: most common, days to month post transplant, can be aided by increasing immunosuppressant drugs
Chronic: can occur anytime, even years after transplant, may present with end-stage organ failure, can treat with increased immunosuppressants and target organ support
Describe the patho of DIC.
Blood disorder caused by sepsis, too many procoagulant factors released because of sepsis inflammation, excess thrombin released, clots form and lodge in vasculature
What would the labs look like in a patient who has DI?
Increased sodium and H&H; urine osmolality less than 200, and urine specific gravity of less 1.005
Describe VAP prevention.
Oral care with chlorhexidine, elevate the HOB, minimize sedation and SBTs, early exercise and ambulation, use an ETT tube as it has a port to drain secretions, and only change the vent circuit when it malfunctions or is soiled
What is the apnea test?
Tests for brain death, preoxygenate for 10 minutes, take them off the vent for 10 minutes, observe for signs of respiratory effort, if none are present it's a POSITIVE result and they are brain dead
What are the interventions for MODS?
May need specific organ support, control the infection, maximize oxygenation, restore/maintain intravascular volume
What are symptoms of CO poisoning, and what would you do about it?
Headache, NV, dizziness, confusion, dyspnea; check carboxyhemoglobin level
Clinical diagnosis of brain death
Correct acid-base imbalances, absent reflexes, positive apnea test, core temp is above 90 F, negative tox screen, patient exhibits decerebrate posturing