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04-04-2024 MS

Oct 03, 20244 min read

SIADH

Most commonly caused by ICP, this is a disorder of excessive ADH, where fluid retention (fluid volume excess) occurs and dilutional hyponatremia occurs. Seizures may occur. Priority for the nurse is safety.

DI

Most commonly caused by ICP, this is a disorder of inadequate ADH, where fluid loss (fluid volume deficit) occurs and dehydration occurs.

DM

Characterized by inadequate or ineffective insulin in the body. An important complication is DKA, where a fluid volume deficit occurs. Intervention is through fluid replacement (Plain NSS, LR; assess lungs regularly for fluid overload) and insulin.

Diagnostic Examination

  1. Fasting Blood Sugar of >126 mg/dL and Random Blood Sugar of >200 mg/dL

Management

  1. Insulin
    • IV: regular, SQ: all insulin forms

Complications

  1. Macrovascular Complications: stroke, heart attack, heart failure

Cushing’s Syndrome

Elevated steroid hormones in the blood. Blood pressure, sodium, and glucose are elevated, and potassium is low (U-wave become abnormal)

Addison’s Disease

AKA Adrenal Crisis, Adrenal Insufficiency where steroid hormones are deficient. Blood pressure, sodium, and glucose are low, and potassium is high. Fluid volume deficit is present.

Arrythmias

  1. Absent P-Wave, Atrial Fibrillation: may lead to a cardioembolic stroke.
  2. Rapid P-Wave, Atrial Flutter: rapid P-wave
  3. Missing QRS-Wave, 2nd Degree Atrioventricular Block: characterized by bradycardia (prepare atropine).
  4. Prolonged PR Interval, 1st Degree Atrioventricular Block
  5. Complete Heart Block, 3rd Degree Atrioventricular Block
    • All heart blocks result in bradycardia. Prepare atropine. If ineffective, prepare for a pacemaker insertion.
  6. Narrow QRS Complex, Supraventricular Tachycardia: prepare adenosine
  7. Wide QRS Complex, Ventricular Tachycardia, Ventricular Fibrillation, Tachyarrhythmias
    • VT with pulse: check pulse. If present, administer Amniodarone. If absent
    • VT, VF with no pulse: defibrillation
  8. Cardiac Arrest, Asystole: epinephrine, CPR
    • Place the patient on hemodynamic monitoring: CVP monitors the right side of the heart and fluid volume, and PAC checks pressure in the left side of the heart.

CHF

May be caused by MI, Valvular Diseases, and Coronary Artery Diseases. Right: hepatomegaly, jaundice, distended jugular veins, ascites, edema Left: pulmonary edema

Left-Sided Heart Failure

MI

  • Drug of choice: morphine (antidote for morphine: naloxone Narcan)
  • Anticoagulants: prevent blood clotting. Heparin (antidote: protanine), warfarin (antidone: Vitamin K)
  • Novel Anticoagulants: rivaroxaban, apixaban
    • Side effects: bleeding
  • Antiplatelets: prevention of platelet aggregation

Angina

  1. Stable: pain occurs with exertion, relieved by rest
  2. Unstable: pain occurs with exertion, not relieved by rest
  3. Variant/Prinz-Metal: pain occurs at rest, relieved by rest.

Reading Simple ABGs

  1. pH: 7.35 - 7.45. Lower than normal is acidosis, higher is alkalosis.
  2. CO2: 35 - 45. Lower than normal is alkalosis, higher is acidosis.
  3. HCO3: 22 - 26. Lower than normal is acidosis, higher is alkalosis.
  4. Whichever of the CO2 (respiratory) and HCO3 (metabolic) readings agree with the pH is the result. If both agree, it is combined or mixed.

Reading ABG Compensations

  1. Fully Compensated
    • Read the pH. If it is normal, full compensation is achieved. Identify which region the pH is closer to even in the normal range. Determine the match from CO2 or HCO3 to differentiate respiratory from metabolic pH imbalance.
      • pH 7.44, CO2 12, HCO3 3: Fully Compensated Respiratory Alkalosis
  2. Partially Compensated
    • Read the pH. If none of the values are normal, compensation is partial. Same rules as before are observed.
  3. Uncompensated
    • If one of CO2 or HCO3 is normal, but the pH is abnormal, no compensation has been achieved.

DKA

Features Kussmaul’s Breathing, metabolic acidosis, dehydration, and kidney failure

Renal Failure

Signs and Symptoms

  1. Acidosis (metabolic), Anemia, Azotemia (increased creatine; avoid meat and too many fruits that elevate potassium and phosphorus).
  2. Blood Pressure is Elevated
  3. Calcium is decreased
  4. DUK
  5. Edema

Acute Renal Failure

Split between a diuretic and oliguric phase, respectively featuring fluid volume deficit and excess and their associated signs and symptoms.

  1. Pre-Renal ARF: often develops from shock (cardiogenic, septic, hypovolemic, hemorrhagic, anaphylactic, etc).
  2. Intra-renal failure: may develop from any damage to the kidney e.g. nephrotoxic drugs, kidney disease (stones, pyelonephritis, etc.), contrast dyes
  3. Post-Renal ARF: ureter stones, bladder stones, prostate cancer

Signs and Symptoms

Chronic Renal Failure

The main cause of CRF is diabetes mellitus.

Pneumonia

  1. CAP: most commonly streptococcus pneumoniae in adults, and haemophiluz influenzae type b (HiB) in children.
  2. DOC: amoxicillin
  3. DX: CXR (confirmatory)

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