Term
| Mortality rate increases as time increases without care. |
|
Definition
|
|
Term
|
Definition
Airway maintenance
Control of external bleeding & shock
Immobilization
Immediate transport |
|
|
Term
| What has helped the golden hour? |
|
Definition
|
|
Term
| Primary survey ABCDE in ER |
|
Definition
Airway
Breathing
Circulation
Disability
Exposure |
|
|
Term
Palpable radial pulse Sys=___
Palp brachial Sys=___
Palp central pulse Sys= ___ |
|
Definition
|
|
Term
|
Definition
Allergies
Medications
Past illness/Pregnant
Last meal
Events/environment r/t injury |
|
|
Term
| Third leading cause of taumatic injury |
|
Definition
|
|
Term
| Bluish discoloration of umbilicus |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Referred pain to left shoulder |
|
Definition
|
|
Term
| Signs indicating some type of internal hemorrhaging |
|
Definition
Cullen's
Gray-Turner's
Kehr's |
|
|
Term
| You can watch for this critical issue by monitoring bladder pressure. |
|
Definition
| Abdominal compartment syndrome |
|
|
Term
| Danger of abdominal compartment syndrome. |
|
Definition
| Ischemia - obviously can't amputate |
|
|
Term
| Insert needle through abdomen and draw back fluid. If clear, no hemorrhage in abd cavity. (negative) |
|
Definition
| Diagnostic peritoneal lavage (DPL) |
|
|
Term
| With these injuries we worry about life-threatening hemorrhage, hemodynamic instability, coagulopathies, acidosis and hyperthermia. |
|
Definition
|
|
Term
| With this type of injury we worry about life-threatening hemorrhage and sepsis. |
|
Definition
|
|
Term
| This type of injury has risk for sepsis and abscess or fistula formation. |
|
Definition
| Intestinal injuries (see more b/c seatbelts) |
|
|
Term
| Perianal ecchymosis, pain on palpation, rocking of iliac crests, loweer limb persis or hypoesthesia, hematuria |
|
Definition
|
|
Term
| Perianal ecchymosis, pain on palpation, rocking of iliac crests, loweer limb persis or hypoesthesia, hematuria |
|
Definition
|
|
Term
|
Definition
| Control hemorrhage, stabilize, immediate surgey |
|
|
Term
| What can triple lumen monitor? |
|
Definition
|
|
Term
| You patient has a pelvic fracture and has no longer has palpable pulses in feet, what do you do? |
|
Definition
|
|
Term
| Platelets activated by arrival of thrombin at site of injury. Platelets become sticky and beging to aggregate. Activated platelets undergo degranulation, releasing factors to assist clot formation. |
|
Definition
| DIC (Disseminated Intravascular Clotting) |
|
|
Term
| Involved in platelet aggregation |
|
Definition
Thromboxane A2 (TxA2)
Adenosine diphosphate (ADP) |
|
|
Term
| DIC depletion of ____ _____, _______ and _______; may result in multiple organ failure and death. |
|
Definition
Clotting factors
Platelets
RBCs |
|
|
Term
| Damage to endothelium resulting in activation of the coagulation mechanism. |
|
Definition
|
|
Term
|
Definition
Bleeding everywhere
Hemoptysis
Hematuria
Subarachnoid hemorrhage |
|
|
Term
|
Definition
PT inc
aPTT inc
D-Dimer inc
Inc. fibrinolytic activity, fibrin degradation product & fibrinogen |
|
|
Term
| Primary intervention DIC is ________. |
|
Definition
|
|
Term
|
Definition
| Maintain organ perfusion (prevents MODS) |
|
|
Term
|
Definition
IVF
Inotropes
RBCs/Platelets |
|
|
Term
|
Definition
|
|
Term
|
Definition
Recombinant human protein C
Antithrombin III |
|
|
Term
| Why frequently assess neuro status of DIC pt? |
|
Definition
|
|
Term
| What VS do you watch for subtle trends in for potential shock? |
|
Definition
|
|
Term
| Why can RN write orders for organ transplant? |
|
Definition
|
|
Term
| Organ transplant Tx guidelines usually under direction of ____. |
|
Definition
|
|
Term
| Why do we do oral care on donors? |
|
Definition
|
|
Term
| Your donor pt has IICP, what do you do? |
|
Definition
| Nothing, not going to donate brain ! |
|
|
Term
|
Definition
|
|
Term
| These organs last 4-6 hrs |
|
Definition
|
|
Term
| Longest organ for donation 24-72 hrs |
|
Definition
|
|
Term
| Liver lasts how many hrs for donation? |
|
Definition
|
|
Term
| Longer it takes to transplant organ better chance of _________. |
|
Definition
|
|
Term
| Relatively new term to describe spectrum of acute-onset kidney disorders. |
|
Definition
| Acute Kidney Injury (AKI) |
|
|
Term
| Characterized by sudden decline in GFR, retention of products in blood normally excreted by kidney, disruption of electrolyte balance, acid-base homeostasis and fluid volume equilibrium |
|
Definition
|
|
Term
| Who has greater incidence of AKI? |
|
Definition
| Older pts, those with pre-existing chronic kidney disease |
|
|
Term
| This is 1% of acute hospital admits, complicates 7% of episodes, inc. mortality rate of critical patients. |
|
Definition
|
|
Term
|
Definition
gentamiacin
amphotericin B
IV dye
Ibuprofen
Aminoglycosides |
|
|
Term
| Type of AKI with hypoperfusion |
|
Definition
|
|
Term
| Classic finding prerenal AKI. |
|
Definition
|
|
Term
| Any condition that produces an ischemic or toxic insult directly at the site of the nephron. |
|
Definition
|
|
Term
| When internal filtering structures are affected by ischemia. |
|
Definition
| Acute Tubular Necrosis (ATN) |
|
|
Term
| Any obstruction that hinders the flow of urine from beyond the kidney through the remainder of the urinary tract. |
|
Definition
|
|
Term
| Which type of AKI is not commonly a cause of AKI in critically ill? |
|
Definition
|
|
Term
| Sudden development of anuria should prompt nurse to check what? |
|
Definition
|
|
Term
| Acute rise in BUN (two names) |
|
Definition
|
|
Term
| Nephrotoxic or ischemic injury c damage to kidney tubular epithelium. In severe cases extends to basement membrane. If require dialysis. |
|
Definition
| Acute Tubular Necrosis (ATN) |
|
|
Term
| This damage prevents normal concentration of urine, waste filtration and regulation of acid-base, electrolyte and H20 balance. |
|
Definition
|
|
Term
| Accounts for 76% of AKI in critically ill. |
|
Definition
|
|
Term
| Cellular debris collects in the tubules |
|
Definition
|
|
Term
| What happens when tubular hydrostatis pressure increases to match GFR? |
|
Definition
|
|
Term
|
Definition
Onset
Oliguric/Anuric
Diuretic (Recovery) |
|
|
Term
| Period from insult until cell injury occurs. Lasts hrs to days. |
|
Definition
|
|
Term
| In which stage of ATN may you be able to stop irreversible damage? |
|
Definition
|
|
Term
| Why don't we stop ATN in onset phase? |
|
Definition
|
|
Term
Lasts 5-8 d in nonoliguric
Lasts 10-16 d in oliguric patient |
|
Definition
| Oliguric/Anuric phase ATN |
|
|
Term
| Accumulation of necrotic cellular debris in tubular space blocks the flow of urine and causes damage to cell wall and basement membrane |
|
Definition
|
|
Term
| Oliguria is more often seen with ______ damage and is sign that damage is extensive and severe. |
|
Definition
|
|
Term
| Lab change in oliguric phase ATN that will kill pt fastest |
|
Definition
|
|
Term
| Lab changes in Oliguric phase ATN |
|
Definition
Azotemia
Elev. Cr
Hyperkalemia
Hyperphosphatemia
Hypocalcemia |
|
|
Term
| What ABG change may occur with oliguric phase ATN? |
|
Definition
|
|
Term
| Phase ATN lasts 7-14 d and has inc. in GFR and polyuria. |
|
Definition
|
|
Term
| Diuretic phase ATN: Tubular obstruction has passed but _____ and ______ remain. |
|
Definition
|
|
Term
| ____ returns before tubules are able to function normally (ATN) |
|
Definition
|
|
Term
| In diuretic phase kidneys can clear _______ but not _______. |
|
Definition
|
|
Term
| Kidney tubular cells that have survived proliferate. |
|
Definition
|
|
Term
| GFR returns to 70-80% of normal within __-__ yrs. (ATN) |
|
Definition
|
|
Term
| If serious kidney damage was done the _____ and _____ levels may never return to normal and some may require what? |
|
Definition
|
|
Term
| Accumulation of unexcreted waste products |
|
Definition
|
|
Term
| can be influenced by hydration, catabolism, GI bleed, infection, fever and steroids. |
|
Definition
|
|
Term
| MOST RELIABLE INDICATOR OF RENAL FUNCTION; byproduct of muscle metabolism (values vary by age and gender) |
|
Definition
|
|
Term
| Most reliable estimation of GFR. Need 24 hr urine collect. |
|
Definition
|
|
Term
| Most common causes of AKI in critically ill. (7) |
|
Definition
Inflammation
Hypotension
Vasopressin
Trauma
Rhabdomyolysis
Crush/Burn injuries
Iatrogenic |
|
|
Term
| Why can vasopressin cause AKI? |
|
Definition
|
|
Term
| Breakdown of muscle tissue |
|
Definition
|
|
Term
| What can you give to help protect kidneys from dye; smells & tastes bad. |
|
Definition
| N-Acetylcysteine (Mucomyst) |
|
|
Term
| What fluid changes can happen with AKI? |
|
Definition
| 3rd spacing, hypotension; monitor preload (CVP) |
|
|
Term
| 1 kg wt gain over 24 hrs = _______ mL |
|
Definition
|
|
Term
| Hyperkalemia diet restriction |
|
Definition
| No summer fruits, spinach |
|
|
Term
| tall peaked t-waves; widening QRS leading to Vtach |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Rx forces K+ intracellularly |
|
Definition
|
|
Term
| Way to lose k+ if diuresin? |
|
Definition
|
|
Term
| Due to dilutional effect from fluid overload in ATN |
|
Definition
|
|
Term
| Tap on facial nerve & facial & eyelid muscles contract |
|
Definition
|
|
Term
| Carpopedal spasm when applying BP cuff |
|
Definition
|
|
Term
| Not being reabsorbed back into the bloodstream at proximal tubule and distal nephron; Causes chvostek's & trousseau's |
|
Definition
|
|
Term
|
Definition
| Calcium; Phosphorus binding drugs |
|
|
Term
| Diet change hyperphosphatemia |
|
Definition
| No dairy, processed meats, carbonated beverages, meat, nuts |
|
|
Term
|
Definition
| Calcium salts or non-aluminum non-calcium based medication eg RenaGel or Fosrenol (bind c phosphorus) |
|
|
Term
| Rx given for RBC changes in AKI |
|
Definition
|
|
Term
| What do you monitor when given Epogen? |
|
Definition
| H/H; back off when hit 11 |
|
|
Term
| Separates and removes from the blood excess electrolytes, fluids & toxins. |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Used for anticoag in dialysis (2) |
|
Definition
|
|
Term
Monitor ___ with Heparin;
Monitor ____ with Trisodium citrate |
|
Definition
|
|
Term
| What must you have infusing with trisodium citrate b/c citrate binds with calcium in dialyzer to prevent clotting. |
|
Definition
|
|
Term
| Dialysis fluid removal principles (3) |
|
Definition
ultrafiltration
osmosis
hydrostatic pressure |
|
|
Term
| Solute removal properties dialysis |
|
Definition
|
|
Term
| Temporary (large venous access) hemodialysis options (2) |
|
Definition
|
|
Term
| Long term dialysis access |
|
Definition
|
|
Term
|
Definition
Feel the thrill
Hear the bruit (auscultate c bell) |
|
|
Term
| Traditional hemodialysis length |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Why do CRRT instead of hemodialysis? |
|
Definition
| Critical pts may not be able to tolerate rapid fluid shift |
|
|
Term
| Able to do at home, longer than hemodialysis, no exsanguination issue |
|
Definition
|
|
Term
Abdominal pain/rigidity
Cloudly return drainage (effluent) |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
Connected c sterile technique
Nurse & pt masked when cath open to air |
|
|
Term
| What can insertion site infection in PD turn into? |
|
Definition
|
|
Term
| 2 most common causes acute pancreatitis |
|
Definition
Alcoholism (men)
Gall stones (women) |
|
|
Term
| Normally inactive digestive enzymes become prematurely activated within pancreas itself leading to autodigestion of pancreatic tissue |
|
Definition
|
|
Term
| Pain, vomiting, nausea, fever, abd distention & guarding, hypovolemic shock |
|
Definition
|
|
Term
| Dx tests acute pancreatitis |
|
Definition
|
|
Term
| Labs affected by acute pancreatitis |
|
Definition
Elevated Glucose
Decreased: Ca++, Mg++, K+ |
|
|
Term
| Occurs from bleeding in upper or lower GI |
|
Definition
|
|
Term
| Leading cause of upper GI bleeds |
|
Definition
|
|
Term
| Superficial mucosal erosion to deep focal lesions in upper GI; due to inc. gastric acid production & dec. mucosal blood flow. |
|
Definition
| Stress-related mucosal disease |
|
|
Term
| Engorged & distended blood vessels of esophagus & proximal stomach develop as result of portal HTN |
|
Definition
|
|
Term
|
Definition
Visualization blood in vomit/stool
+guaiac emesis/stool
Serial H/H
Scope |
|
|
Term
| They can use a tube and balloon to stop this kind of bleeding. |
|
Definition
|
|
Term
| What must you keep at bedside if you use a balloon to stop esophageal bleed. |
|
Definition
| Scissors; if airway distress |
|
|
Term
| Used to remove blood or toxic substances from stomach |
|
Definition
|
|
Term
| When is gastric lavage not effective? |
|
Definition
| If contents have passed into intestines |
|
|
Term
| What do you use for gastric lavage? |
|
Definition
| NG tube large bore (enough to get pil fragments out) |
|
|
Term
Insert tube
Attempt to aspirate
flush c H20
Re-aspirate
Continue until no contents in flush
Connect to Low intermittent suction |
|
Definition
|
|
Term
| why might gastric lavage be bad idea for pt with bleed? |
|
Definition
|
|
