AAA
How is an aneurysm diagnosed?
CT/US imaging
Manifestations of left-sided heart failure
- dyspnea
- pulmonary edema
- pink and frothy sputum
- tachypnea
- decreased O2 sat
- orthopnea
- cyanosis
- dizziness
- activity intolerance
- fatigue
(Left = Lungs)
Clinical manifestations of refractory shock
- severe hypotension
- circulatory collapse
- severe tachycardia
- dysrhythmia d/t hypoxia, acidosis, hyperK
- profound cellular hypoxia
- prepare for celestial discharge
Clinical manifestations of early sepsis
- BP: normal to hypotensive
- HR: increased, thready
- RR: rapid, deep
- skin: warm, flushed
- mental status: alert, oriented, anxious
- urine output: normal
- other: febrile, chills, weakness, diarrhea
Diagnostics for AKI
- creatinine, BUN (increased)
- electrolytes
- urinalysis
- CBC
- renal ultrasound
- CT/MRI
- KUB
- renal biopsy
- ABGs (metabolic acidosis)
Signs and symptoms of aortic aneurysm rupture
- Hypotension
- Pulsatile mass
- Sudden, severe chest, back or abdominal pain
Manifestations of right-sided heart failure
- edema
- weight gain
- anorexia, nausea
- RUQ pain
- JVD
Clinical manifestations of early shock
- nonspecific
- restlessness
- normal BP
- slightly tachycardic
Clinical manifestations of late sepsis
- HR: tachycardic, dysrhythmic
- RR: rapid, shallow, dyspneic
- skin: pale, cool, edematous
- mental status: lethargic to comatose
- urine output: oliguric to anuric
- other: normal to decreased temperature
Causes of prerenal AKI
Reduced perfusion:
- blood or fluid loss
- hypovolemic shock
- severe dehydration
- burns/wounds
Low CO:
- MI
- dysrhythmia
- HF
Altered vascular resistance:
- infection (sepsis/septic shock)
- blood pressure medications
- liver failure
- renal artery stenosis
- atherosclerosis blocking blood flow to kidneys
If symptomatic, what is the most common symptom of intact abdominal aortic aneurysm?
Mild to moderate back pain
Diagnostics for HF
- BNP
- electrolytes
- BUN/creatinine
- LFT
- thyroid function
- ABG
- CXR
- ECG
- echo
Clinical manifestations of compensatory shock
- tachycardia
- increased respiratory rate and effort
- cool, pale skin
- diaphoresis
- decreased urine output
- restlessness, anxiety
Diagnostics for sepsis
- CBC
- lactate
- cultures
- renal function
- liver function
- ABGs
- procalcitonin
- CRP
- electrolytes
- imaging if related to root cause
Causes of intrarenal AKI
- acute tubular necrosis
- glomerulonephritis, pyelonephritis
- kidney hemorrhage
- DIC
- nephrotoxins (contrast dye, NSAIDs, etc.)
- allergic disorders
- SLE
- hemolysis
- rhabdomyolysis
What are the primary medications used to pharmacologically treat aortic aneurysms?
- Beta blockers
- Statins
- Angiotensin II blockers
- Calcium channel blockers
Medications for HF
- ARBs
- Beta blockers
- Diuretics
- Vasodilators
- Dig
- Antidysrhythmics
Clinical manifestations of decompensated shock
- significant tachycardia
- severe hypotension
- narrowed pulse pressure
- rapid, weak, thready pulse
- acidosis
- hyperkalemia
- ALOC
Hour-1 bundle
- measure lactate
- obtain blood cultures
- broad-spectrum antibiotics
- rapid fluid administration
- vasopressors if MAP <65 mmHg
- hour begins at the time of triage or when sepsis is suspected
Causes of postrenal AKI
- tumors, kidney stones, strictures
- any kind of pelvic/lower abdominal cancer
- nerve damage to nerves that control bladder
- blood clots
The three pathophysiological steps of an aortic aneurysm
- Plaque erosion
- Inflammation
- Weakened vasculature
- daily weight monitoring
- low sodium diet
- medication compliance
- fluid restrictions
- lifestyle changes (smoking cessation, etc.)
- daily cardiovascular exercise as tolerated
- PT/OT
- call the provider or go to ER for dyspnea, dizziness, persistent cough, rapid weight gain, etc.
Nursing care for shock
- treat underlying cause
- increase arterial oxygenation
- improve tissue perfusion (shock position)
- fluid replacement
- pressors
- inotropes (dopamine, dobutamine, etc.)
- vasodilators (nitro - depends on cause)
- colloid solutions (albumin)
- diuretics, antibiotics, epi, etc. depending on cause
- monitor labs
- assess urine output
- assess mental status
- alert rapid response
SIRS criteria
- temperature >100.9 or <96.8
- RR > 20
- WBC >12,000, <4,000 or >10% bands
- HR >90
- PCO2 <32 mmHg
Nursing assessment for AKI
History taking:
- change in urine appearance, frequency or volume
- factors that lead to reduced kidney perfusion
- drug history
- comorbidities
- acute illnesses
- volume depletion
Physical assessment:
- assess urine output and quality (new floaties, hematuria, foul odor, etc.)
- assess urinary symptoms (hesitancy, frequency, etc.)
- monitor for pain (suprapubic or flank)
- assess for fluid overload
- evaluate signs for hypoxemia, hypoperfusion
- monitor labs (especially creatinine, GFR, BUN, electrolytes)