Acute Kidney Injury Notes

Acute kidney injury Serum creatine level 0.6-1.2 Urine creatine most specific and most accurate to measuring kidney function BUN- 8-20 Serum osmolaity – good fluid of balance 275-290 Urine output- 0.5ml/kg/hr Diet - Low potassium diet Hyeperkalemia- dysrthemia Recovery stage – HIGH PROTEIN DIET Chornic kindey injury - Fluid volume overload - Jvd, weight gain 1 l = 1KG , sob , edema+ 3 + 4 bp goes up - Backward flow of fluid - Pulmonmary edema and lower extremites crackles - Diet: low potassium, low salt, low protein ( biological protein) - High calcium- monitor phosphors levels, high iron for the anemia - High protein when they are on peritoneal or hemodilsys 9 albmin increases ) MOP Delegation you cant do this - Evaluation - Assessment - Teaching - Planding education, assessment , discharge teaching Autonomy – choose the treatment Beneficence- quality of doing good Fideility- loyal Jutice- equal Non malificen- no harm Veracity saying the truth Pt safety advocate - Joint commission is responsible for this - 1- identify the pt - Communication - Use medication safely – medication reconsilation at discharge to - Prevent infection in the health care - Ideify pt at risk for sucicde Improve healthcare equqity Prevent mistake in surgery Nervous system - Increase intracranial pressure Prioritiziation- cervical injury – venitalitor support c1-c5 Gcs 8 or less comatose - Increase intracranial pressure - Interventions - Elevate the bed HOB 30% promote venous drainage - Stool softeners, no suction, limit stimulation no coughing, give them meds, use log roll position to move - Cushings triade - increased BP with a widend pulse pressure ( dialstolice decreases and systolic increases ) , bradycardia, bradypnea- Cheyne strokes ( periods of apnea) risk for brain hernation Autonomic shock - Low BP and Hr - - give epei Spinal shock - Up to 12 months after injury - Flacind, no redlexes, no sensation - Monitor bowel sounds - Distenstion possible ng Neurogenic dysreflexia - After spinal shock has resolved - Life long above t6 - Sever increase in BP - Bradycardcia - Distenedn bladder - Skin - Constipation - Something that is stimulating the pt Reproductivee - Risk factors – at a young age 15-35 - Undistended testicles – cryptorchidism’s - Family hx - Personal hx from one testical to another - Race and enthnicty - Hiv positive men Breaset cancer - Breast exam – monthly - macarena - Biopsy- to collect cells and diagnose cancer - Intervention for biopsy- bleeding precaution no vit e, no garlic supplements, blood thinners, no aspirin, supportive bra, avoid jarring movements like moving, possible nerve injury Integumentary - Mole map - Abcde- asymmetry, borders, color, diameter greater than 6mm, evolving - Basal cell carcinoma- pearly borders - Squamous- scaly and patchy - MelanomaBurns - Priority ( airway, breathing, circulation, disability exposure 100% humitdified oxygen Parkland formula – for circulation large boren cath 16 or 18 g 4ml x tbsa x kg lactaed ringers Dyability use glaucoma Exposure – where the burns have occurred Inflammatory bowel disease Crohns disease - Cobble storm appears - Patchy - Slow - Mouth to ansus - Right lower qudrent - 5 loose stools - Steatorrhea - Esr increased - Wbc increased - Folic decreased - Antiglygen increased - Ct barium x ray – string sighn - colectomy ulcerative coltis - Cuntinous - Colon and rectum - Colin to rectum - Left lower quadrent pain - 15-20 stools - laporscopic Nursing - Bowel elimination - Small frequne meals - Fluid balnce - Replace elcrtyolytes - The foods - Antiinflamotry meds Intestinal obstruction - Mechanical – adhesion or tumor, hernia, - Labs, hemoglobon, abgs, Colon and gastric cancer - Smoking and alch biggest risk factors - Gastric- h plyori , gastritis, genetics - Mainfestaiions - Colorectal – left sides lesion and righ sides worst lesion - Blood in the stool Gastrics – pain relived by antacid Advance- dyspepsia Gastric- caroembgetics Cirrhosis - Peticahe - Hepatic- needle, fine needle Pancreatitis - Auto digestion - Gall stones, ethnol, trauma - Amylase and lipase Immune system - HIV- race is more prone b;ack African American hispanice - Risk factors to HIV – - The viral rna is is converted into viral through process called - ELISA – DETECTS ANTIBODIES - Western blot confirms - Ejects all organs - Karposis sarcoma and candidiasis - Nuerological: - Chronic or latent phase: c4 count is between 200- 499 - Less than 200= aids be safe for oprtunitsic infection - Meds – art viral load - Guillian barre – peripheral nerve myline - Respitrory failure – ventilation Myasthenia gravies- myoneural junction - thymectomy - rhumatic dirorders joints mucles and soft tissues of the body inflammation – inflmatory process PAIN AND JOINT SWELLING , ERYTHEMA, WEAKNESS, FAITFUE DECREASE JOINT PAIN AND SWELLING AND ACHIVE RESMISSION Systemic lupus - Riskfactors pregnancy and stress - Pregnancy and race - Butterfly Photosentsivyt Pericardiattis - Dressler syndrome can taek time - Acute, chronic, reaoccurent - Tx: pericardioectomy - Manifestaions: can be asymptomatic - Paradoxical Bp- drop of bp more than qo mm during inspiration - Pericardial friction rub 4th intercostal space on left side - Cardiac tamponade is an emergency - Valve disorders – related to valevs located on the left side increase pulmonary areteyr - LVH, - Tx: replacement of valves - Tissues valves: no anticoagulation less risk for clot formation - Mechanical valve: clot meds - Dental procedure let the dentist know they need to take antibiotics for Arrythmias Atrical fibrillation - Most irregular rythem - Risk for emolbic events such as stroke - Need to be on anticouggluents - Rapid irrgeugark rythem - Uncontrolled a fib hr is fast – rapid ventricular response Pacemakers - Ideal tx for pts who have blocks on the av node - Pacemaker is for the brady cardia - Icd – accelerated hr - Report hiccups - No MRI - PHONE ON RIGHT SIDE CADERIAC catherizION Stay in a flat postion for at least 6 hours w hob no more than 30 degress RADIAL – rist bands Check for otrthostacic hypotension Endoncrie system Cushings disease ( endogemnous) – Syndrome ( increased cortisol) - Secondary to something - Long term used of glucorticosteroids - Muscle atrophy- increase glucose- Pts can have palpitations prone to heart arrythmias – low postassium – a fib notificy hcp - high protein diet muscle wasting proximal hydro - Fall precautions ( bone fx - Might or might not have fever Adisions disease - Hypo glycedmia - Treatment- iv cortisione and fluids - Hyper kalemia Diabetes insipidus - Decrease adh - Low specific gravity lower 1.005 – diluted - Dehydrated - Tx desmopressin – decrease urine outpute and improve urine specific gravity - Concentrate the urine , decreased urine and increased specific gravity - Causes vaso contrcition Siadh - Lung cancer increase secretion of adh - High specific gravity Musckulo skeletal Osteomalacia - Replace vit d - Side ejects Hypocalcemia- fatigue headace, - Take torniquent oj can cause false result false high Pagets disease - Bone remodeling , skull malformation, lower extremites - Elevated alkaline phosphate – bone pain Gout - High purine diet, red meat, beefs, lamb, pork organ meet, chicken liver, - Alchol consumption - Tx: dietd, limit alch, pain Bone cancer - Pain management full pain assemsnet - Emotional support and education on post op care -