Acute Biologic Acute Biologic CrisisCrisis
Congestive Heart FailureCongestive Heart Failure
Congestive Heart FailureCongestive Heart Failure
Left Side Heart FailureLeft Side Heart Failure
Left Side Left Side Heart Heart
FailureFailure
Right Right Side Side Heart Heart
FailureFailure
AnasarcaAnasarca
Right Right Side Side Heart Heart
FailureFailure
AscitesAscites
Right Right Side Side Heart Heart
FailureFailure
AscitesAscites
Right Side Right Side Heart Heart
FailureFailure
Peripheral edema
Right Side Heart FailureRight Side Heart FailureJugular vein distention
DysrhythmiasDysrhythmias
DysrhythmiasDysrhythmias
Respiratory FailureRespiratory Failure
Respiratory FailureRespiratory FailureWhen The client can’t When The client can’t eliminate CO2 fr. Alveolieliminate CO2 fr. Alveoli
CO2 retentionCO2 retention
Respiratory FailureRespiratory Failure
O2 is not absorbed by O2 is not absorbed by alveolialveoli
O2 level dropsO2 level dropsCO2 > 45 mm HgCO2 > 45 mm Hg
Acute respiratory distress syndrome
Causes Resp failureCauses Resp failure
Mechanical abnormality Mechanical abnormality in lungs or chest wall in lungs or chest wall
Defect Resp control Defect Resp control center of braincenter of brain
Severe Resp InfectionSevere Resp Infection
ASSESSMENTASSESSMENTAlteration in breath soundsAlteration in breath soundsDyspneaDyspneaHAHARestlessness / confusionRestlessness / confusionTachycardiaTachycardiaCyanosisCyanosis
ASSESSMENTASSESSMENT LOCLOC
DysrhythmiasDysrhythmias
INTERVENTIONSINTERVENTIONS
Identify Identify causecause
Administer Administer O2O2
Mechanical Mechanical ventilatorventilator
Renal FailureRenal FailureAcute Renal FailureAcute Renal Failure
Chronic Renal FailureChronic Renal Failure
Acute Renal FailureAcute Renal Failure
Rapid onset of oliguria Rapid onset of oliguria (<400 ml /day) , with (<400 ml /day) , with severe rise in BUN & severe rise in BUN &
creatinine creatinine (Azotemia – (Azotemia –
accumulation of nitrogen accumulation of nitrogen in blood )in blood )
Causes of Acute Renal FailureCauses of Acute Renal Failure
Pre-Renal Causes- Pre-Renal Causes- factors outside of factors outside of the kidneythe kidney
Causes of Acute Renal FailureCauses of Acute Renal Failure
Pre-Renal CausesPre-Renal CausesShockShockCirculatory collapseCirculatory collapseCVDCVDHemorrhageHemorrhageSevere vasoconstriction Severe vasoconstriction
Causes of Acute Renal FailureCauses of Acute Renal Failure
Intra-Renal Causes: Intra-Renal Causes: kidney diseaseskidney diseases
Damage to kidneyDamage to kidneyPoisoningPoisoningIron overload (BT)Iron overload (BT)Acute pyelonephritisAcute pyelonephritis
Causes of Acute Renal FailureCauses of Acute Renal Failure
Post-Renal Causes: Post-Renal Causes: Obstruction in the Obstruction in the Urinary tractUrinary tract
Renal calculiRenal calculiProstatic tumorProstatic tumorReproductive diseasesReproductive diseases
Complications ARFComplications ARF
Hyperkalemia – most Hyperkalemia – most dangerous dangerous complication, may lead complication, may lead to cardiac arrest if rise to cardiac arrest if rise in K+ is too fastin K+ is too fast
Nursing Care ARFNursing Care ARFDaily WeightDaily WeightCVP monitoringCVP monitoringDiuretic as prescribedDiuretic as prescribedLow protein, K,Na & Low protein, K,Na & high carbohydrate diethigh carbohydrate diet
Nursing Care ARFNursing Care ARFEmergency mgt of Emergency mgt of Hyper K : insulin & Hyper K : insulin & dextrose , Kayexalate dextrose , Kayexalate enemaenema
Chronic Renal failureChronic Renal failure
Chronic Chronic irreversible irreversible progressive progressive reduction of reduction of
functioning renal functioning renal tissuetissue
Common causes CRFCommon causes CRFDiabetic nephropathyDiabetic nephropathyHypertensive Hypertensive nephropathynephropathy
GlomerulonephritisGlomerulonephritisChronic pyelonephritisChronic pyelonephritis
Stages CRFStages CRF1.1. Reduced RenalReduced Renal Reserve Reserve
high BUN no clinical high BUN no clinical symptoms yetsymptoms yet
2.2. Renal insufficiency-Renal insufficiency- mild mild AzotemiaAzotemia – impaired urine – impaired urine concentration , nocturiaconcentration , nocturia
Stages CRFStages CRF3.3. Renal failure –Renal failure – Severe Severe
azotemia, azotemia, acidosis,concentrated acidosis,concentrated urine, severe anemia & urine, severe anemia & electrolyte imbalanceselectrolyte imbalances
Stages CRFStages CRF4.4. ESRD-ESRD- Renal shutdown Renal shutdown
severely decreased renal severely decreased renal function with clusters of function with clusters of systemic symptomssystemic symptoms
CRF systemic SSCRF systemic SSHyper K, Hypernatremia, Hyper K, Hypernatremia, HypocalcemiaHypocalcemia
AnemiaAnemiaAnorexia, nausea & Anorexia, nausea & vomitingvomiting
CRF systemic SSCRF systemic SS
Ammoniacal breathAmmoniacal breathImmunosuppressionImmunosuppressionHTN, CHFHTN, CHFPulmonary edemaPulmonary edemaSevere pruritusSevere pruritusPeripheral neuropathyPeripheral neuropathyUremic amaurosisUremic amaurosis
Nursing Care ESRDNursing Care ESRDLow Protein, Low Na Low Protein, Low Na dietdiet
Prepare client for Prepare client for peritoneal / peritoneal / hemodialysishemodialysis
Monitor AnemiaMonitor Anemia
Nursing Care ESRDNursing Care ESRDAdminister epoietin Administer epoietin alpha (Epogen), alpha (Epogen), diuretics, diuretics, antihypertensives as antihypertensives as prescribedprescribed
Kidney transplantKidney transplant
Peritoneal DialysisPeritoneal Dialysis
Peritoneal DialysisPeritoneal Dialysis
HemodialysisHemodialysis
HEMODIALYSIS: HEMODIALYSIS: Is the Is the diffusion of dissolved diffusion of dissolved particles from the blood particles from the blood into the dialysate bath of into the dialysate bath of the hemodialysis machine the hemodialysis machine across the semipermeable across the semipermeable membrane of the dialyzer.membrane of the dialyzer.
Hemodialysis requires Hemodialysis requires vascular access: vascular access:
Subclavian vein/ Femoral Subclavian vein/ Femoral vein (temporary)vein (temporary)
Arteriovenous fistula, Arteriovenous fistula, arteriovenous shunt,/ arteriovenous shunt,/ arteriovenous graft arteriovenous graft
( Permanent( Permanent))
HemodialysisHemodialysis
HemodialysisHemodialysis
Nursing Management: Nursing Management: Assess the integrity of the Assess the integrity of the hemodialysis access sitehemodialysis access site
Monitor VSMonitor VSAssess client for fluid Assess client for fluid overloadoverload
Nursing Management: Nursing Management: Weigh the client before and Weigh the client before and
after the dialysis treatment after the dialysis treatment ( to determine fluid loss)( to determine fluid loss)
Hold meds that can be Hold meds that can be dialyzed offdialyzed off
Monitor for SS of Shock & Monitor for SS of Shock & Disequilibrium syndromeDisequilibrium syndrome
Complication: Disequilibrium Complication: Disequilibrium Syndrome –Syndrome – is the rapid change is the rapid change in composition of extracellular in composition of extracellular fluid where the solutes of the fluid where the solutes of the blood are removed from the blood are removed from the blood faster than that of the blood faster than that of the CSF, causing osmotic movement CSF, causing osmotic movement of fluid into the CSF causing of fluid into the CSF causing cerebral edema.cerebral edema.
Nursing Management: Nursing Management: Disequilibrium syndrome:Disequilibrium syndrome:
Assess for Nausea & Assess for Nausea & vomitingvomiting
Assess for headacheAssess for headacheRestlessness, agitation & Restlessness, agitation &
or confusionor confusionWatch out for seizuresWatch out for seizures
Nursing Management: Disequilibrium Nursing Management: Disequilibrium syndrome:syndrome:
Notify physician if SS of Notify physician if SS of disequlibrium syndrome disequlibrium syndrome occursoccurs
Reduce environmental Reduce environmental stimulistimuli
Dialyze the patient at a shorter Dialyze the patient at a shorter period and at a slower rateperiod and at a slower rate
Kidney TransplantKidney Transplant
The Nursing The Nursing process starts process starts
with with ASSESSMENTASSESSMENT
Ang pitong Ang pitong katotohanan katotohanan
ukol saukol saCranial Nerves Cranial Nerves
GCS atbp.GCS atbp.AssessmentAssessment
1. Cranial Nerve II1. Cranial Nerve IIOptic Nerve-=Optic Nerve-=
Hindi lahat Hindi lahat nang nakikita nang nakikita
mo ay hindi iyo.mo ay hindi iyo.
2. Upon Inspection2. Upon InspectionHindi mo Hindi mo
kayang kayang bilangin ang bilangin ang buhok mo.buhok mo.
3. Cranial nerve XII3. Cranial nerve XIIHypoglossal nerveHypoglossal nerveHindi lahat nang Hindi lahat nang ngipin mo ay abot ngipin mo ay abot
nang dila monang dila mo..
4.Glasgow Coma Scale4.Glasgow Coma ScaleSubukan nang Subukan nang mga tanga ang mga tanga ang
pangatlong pangatlong assessmentassessment
5. Human Error5. Human ErrorAng pangatlo Ang pangatlo
ay maliay mali
6. Cranial nerve VII6. Cranial nerve VIIFacial nerveFacial nerve
Mapapangiti ka Mapapangiti ka kasi nagmukha kasi nagmukha
kang tangakang tanga
7. Law of Karma7. Law of KarmaIpasa mo ito sa Ipasa mo ito sa
ibang ibang istudyante istudyante
nang OC para nang OC para makaganti ka.makaganti ka.
BurnsBurns
Cell destruction of Cell destruction of the layers of the skin the layers of the skin and resultant and resultant depletion of fluid and depletion of fluid and electrolytes electrolytes
Types of BurnsTypes of BurnsThermal : exposure to flameThermal : exposure to flameChemical: exposure to Chemical: exposure to
strong acids or alkalistrong acids or alkaliElectrical: Caused by Electrical: Caused by
electrical strong electrical electrical strong electrical current results in internal current results in internal tissue injurytissue injury
Burn Depth:Burn Depth:Superficial thickness burn (1st Superficial thickness burn (1st
degree)degree)- mild to severe - mild to severe erythema of skin, blanches erythema of skin, blanches with pressure – heals in 3-7 with pressure – heals in 3-7 daysdays
Partial thickness burn(2nd Partial thickness burn(2nd degree)degree) – large blisters; – large blisters; painful heals 2-3 weeks painful heals 2-3 weeks
Burn Depth:Burn Depth:Full thickness burns (3rd Full thickness burns (3rd
degree) – white yellow deep degree) – white yellow deep red to black (eschar) red to black (eschar) disruption of blood flow, no disruption of blood flow, no pain; scarring and wound pain; scarring and wound contractures will develop. contractures will develop. Grafting is required; Grafting is required; healing healing takes weeks to monthstakes weeks to months
Burn Depth:Burn Depth:Deep full thickness burn(4th Deep full thickness burn(4th
degree) – Involves injury degree) – Involves injury to muscle and bone= to muscle and bone= appears black(eschars) – appears black(eschars) – hard and inelastic healing hard and inelastic healing takes weeks to months; takes weeks to months; grafts are requiredgrafts are required
Nursing DiagnosisNursing Diagnosis
Decreased Cardiac Decreased Cardiac output Related to output Related to Fluid shiftsFluid shifts
Rule Of 9Rule Of 9Head and neck 9%Head and neck 9%Anterior trunk 18% ( Anterior trunk 18% ( chest-9 abdomen-9)chest-9 abdomen-9)
Posterior trunk-18%Posterior trunk-18%
Rule Of 9Rule Of 9Arms 9% each Arms 9% each (forearms only or (forearms only or upper arms only upper arms only 4.5%)4.5%)
Legs – 18% each Legs – 18% each Perineum-1%Perineum-1%
Rule of 9Rule of 9
PARKLAND (BAXTER) PARKLAND (BAXTER) FORMULA FOR FLUID FORMULA FOR FLUID REPLACEMENTREPLACEMENT
4ml Lactated Ringer’s 4ml Lactated Ringer’s sol x Kg body mass x sol x Kg body mass x total percentage of body total percentage of body surface burnedsurface burned
PARKLAND (BAXTER)PARKLAND (BAXTER)•1st 8 hours = ½ of total
24 hour fluid replacement•next 8 hours = ¼ of
total•last 8 hours= ¼ of total
A man Suffered from a 3A man Suffered from a 3rdrd degree burn degree burn involving the head and neck, front of involving the head and neck, front of the torso (chest & abdomen), and the torso (chest & abdomen), and whole left arm. Weight is 50 kgwhole left arm. Weight is 50 kg
Calculate the:Calculate the: TBSA burnedTBSA burned
24 hour fluid replacement in ml24 hour fluid replacement in ml11stst 8 hours fluid replacement 8 hours fluid replacement
22ndnd 8 hour 8 hour remaining 8 hourremaining 8 hour
TBSA:TBSA: Head & neck= 9%Head & neck= 9% front of torso = 18% front of torso = 18% Whole left arm = 9% Whole left arm = 9%
TBSA burned 36%TBSA burned 36%
24 hour replacement: 24 hour replacement: Parkland Baxter Parkland Baxter formulaformula
4mlX 50 kgs x (TBSA)36%4mlX 50 kgs x (TBSA)36%
= 7200 ml= 7200 ml
11stst 8 hours : 8 hours :7200 ml7200 ml 22
= 3600 ml = 1= 3600 ml = 1stst 8 hours 8 hours
22ndnd 8 hours & 8 hours & remaining 8 hours remaining 8 hours respectively :respectively :
3600 ml3600 ml 22
= 1800 ml = 2nd 8 hours= 1800 ml = 2nd 8 hours= 1800 ml = last 8 hours= 1800 ml = last 8 hours
MANAGEMENT OF BURNS:MANAGEMENT OF BURNS:Administer fluids as Administer fluids as
prescribedprescribedMaintain a high calorie, high Maintain a high calorie, high
protein dietprotein dietMonitor intake and outputMonitor intake and outputMonitor for infections of Monitor for infections of
burn siteburn site
Burn Medications:Burn Medications:Nitrofurazone ( Furacin)Nitrofurazone ( Furacin) – – broad spectrum antibiotic broad spectrum antibiotic ointment or cream – used ointment or cream – used when bacterial resistance when bacterial resistance to other drugs is a problem to other drugs is a problem : apply 1/16 inch thick film : apply 1/16 inch thick film directly to burndirectly to burn
Burn Medications:Burn Medications:Mafenide ( Sulfamylon)Mafenide ( Sulfamylon) – water – water
soluble cream bacteriostatic gr soluble cream bacteriostatic gr + - bacteria- apply 1/16 inch + - bacteria- apply 1/16 inch directly to burn – notify directly to burn – notify physician if hyperventilation physician if hyperventilation occurs as this drug may ppt. occurs as this drug may ppt. metabolic acidosis.metabolic acidosis.
Burn Medications:Burn Medications:Silver SulfadiazeneSilver Sulfadiazene( Silvadene)( Silvadene) – cream Broad – cream Broad
spectrum to gr+ - ; does not spectrum to gr+ - ; does not cause metabolic acidosis – keep cause metabolic acidosis – keep burn covered at all times with burn covered at all times with Sulfadiazine – (1/16 inch thick);Sulfadiazine – (1/16 inch thick);
Monitor CBC – causes leukopeniaMonitor CBC – causes leukopenia
Burn Medications:Burn Medications:Silver Nitrate – Antiseptic Silver Nitrate – Antiseptic
solution against gr-, dressings solution against gr-, dressings are applied to the burn and are applied to the burn and then kept moist with Silver then kept moist with Silver nitrate ; used on extensive nitrate ; used on extensive burns that may precipitate burns that may precipitate fluid and electrolyte fluid and electrolyte imbalance.imbalance.
LIVER CIRRHOSIS - LIVER CIRRHOSIS - A A chronic progressive chronic progressive disease of the liver disease of the liver characterized by characterized by diffused damage to cells. diffused damage to cells. ( Fibrosis & Nodule ( Fibrosis & Nodule formation) .formation) .
Types:Types:Laennec’s cirrhosis – Laennec’s cirrhosis –
Alcohol inducedAlcohol inducedPostnecrotic c – massive Postnecrotic c – massive
liver necrosis as a result of liver necrosis as a result of viral hepatitisviral hepatitis
LIVER BIOPSY – LIVER BIOPSY – Removal of a living Removal of a living tissue sample for tissue sample for analysis.analysis.
Open biopsy- With Open biopsy- With Abdominal Incision under Abdominal Incision under GAGA
Closed biopsy – Needle Closed biopsy – Needle aspiration for histologic aspiration for histologic study = performed under study = performed under local anesth.local anesth.
Preprocedure care Preprocedure care closed / needle biopsy closed / needle biopsy – teach client to – teach client to refrain from taking refrain from taking aspirin or NSAIDS aspirin or NSAIDS
Post procedure needle Post procedure needle biopsy – position on right biopsy – position on right sidelying during initial 1-sidelying during initial 1-2 hours to prevent 2 hours to prevent hemorrhage and bile hemorrhage and bile leakage, give vit. K if leakage, give vit. K if prescribed. prescribed.
Complications of Cirrhosis – Complications of Cirrhosis –
Portal HTN Portal HTN – as a result of – as a result of obstruction /hardening of liver obstruction /hardening of liver tissue inc in pressure in portal tissue inc in pressure in portal veinvein
AscitesAscites – as a result of portal – as a result of portal HTN – fluid accumulates in HTN – fluid accumulates in abdomenabdomen
Complications of Cirrhosis – Complications of Cirrhosis – Esophageal varices – Esophageal varices –
Fragile thin walled Fragile thin walled distended veins in the distended veins in the esophagus that is prone to esophagus that is prone to rupture rupture
Coagulation defectsCoagulation defects – – decreased synthesis of bile decreased synthesis of bile Dec. absorption of fat sol Dec. absorption of fat sol vitamins ex. Vit.K vitamins ex. Vit.K
Nursing Diagnosis: Nursing Diagnosis: Fluid Volume Deficit rel to Fluid Volume Deficit rel to hemorrhage ( bleeding hemorrhage ( bleeding esophageal varices)esophageal varices)
Risk of Injury rel to Risk of Injury rel to change in level of change in level of consciousness’ consciousness’
Liver Failure –Liver Failure – ESLD- ESLD- inability of liver to inability of liver to function – rise in function – rise in ammonia blood level, ammonia blood level, leading to Hepatic leading to Hepatic Coma.Coma.
Nursing InterventionsNursing Interventions
AssessmentAssessmentMain problem is Main problem is
decreasing LOC bec of decreasing LOC bec of accumulation of ammoniaaccumulation of ammonia
JaundiceJaundiceAbdominal painAbdominal pain
AscitesAscitesSpider angioma on nose Spider angioma on nose
cheeks upper thorax and cheeks upper thorax and shouldersshoulders
HepatomegalyHepatomegalyFetor hepaticusFetor hepaticus (fruity (fruity
breath)breath)
Asterixis (flapping Asterixis (flapping tremors)- wrist & tremors)- wrist & fingersfingers
Laboratories:Laboratories: inc in inc in Ammonia Level N= Ammonia Level N= ammonia 15-110 ug/dlammonia 15-110 ug/dl
Asterixis (flapping Asterixis (flapping tremors)- wrist & tremors)- wrist & fingersfingers
Laboratories:Laboratories: inc in inc in Ammonia Level N= Ammonia Level N= ammonia 15-110 ug/dlammonia 15-110 ug/dl
Nursing InterventionsNursing InterventionsElevate Head of bed to min Elevate Head of bed to min
DOBDOBProvide vitamins B Provide vitamins B
complex, A,DEK & Ccomplex, A,DEK & CLow protein diet as Low protein diet as
prescribed to dec ammonia prescribed to dec ammonia productionproduction
Nursing InterventionsNursing InterventionsWeigh & measure Weigh & measure abdominal girth dailyabdominal girth daily
If IM drugs are If IM drugs are needed= use only needed= use only small gauge needles small gauge needles & inject only when & inject only when neededneeded
Nursing InterventionsNursing InterventionsEsophageal varices - Esophageal varices - Sengstaken – Sengstaken – Blakemore tubeBlakemore tube is is applied to stop applied to stop bleeding E varices) bleeding E varices) – – have scissors at the have scissors at the bedsidebedside
Nursing InterventionsNursing InterventionsAdminister Administer LactuloseLactulose as as
prescribed ( dec. pH w/c dec prescribed ( dec. pH w/c dec production of ammonia by the production of ammonia by the bacteria & facilitates the bacteria & facilitates the excretion of ammoniaexcretion of ammonia
Administer Administer NeomycinNeomycin(Mycifradin)- inhibit (Mycifradin)- inhibit bacteria = dec production of bacteria = dec production of ammoniaammonia
Nursing InterventionsNursing Interventions
Teach client to Teach client to avoid hepatotoxic avoid hepatotoxic drugsdrugs
DKA( DiabeticDKA( Diabetic Ketoacidosis) Ketoacidosis)
/ HHNS / HHNS ( Hyperglycemic( Hyperglycemic
Hyperosmolar Hyperosmolar nonketotic Syndrome)nonketotic Syndrome)
DKADKA- Is a life - Is a life threatening threatening complication of DM complication of DM type 1 = develops type 1 = develops bec of severe bec of severe insulin deficiency insulin deficiency
MANIFESTATATIONS = MANIFESTATATIONS = Hyperglycemia, Hyperglycemia, dehydration, electrolyte dehydration, electrolyte loss and acidosisloss and acidosis
CAUSE; Missed insulin CAUSE; Missed insulin dose, or infectiondose, or infection
HHNS- HHNS- SIMILAR TO SIMILAR TO dka WITH EXTTREME dka WITH EXTTREME hyperglycemia except hyperglycemia except that in HHNS there is that in HHNS there is no acidosis. This is for no acidosis. This is for DM type 2DM type 2
ASSESSMENT: ASSESSMENT: Blood glucose – 300 – Blood glucose – 300 – 800 mg/dl800 mg/dl
Low bicarbonate & Low bicarbonate & low pHlow pH
DehydrationDehydration
ASSESSMENT: ASSESSMENT: Mental status Mental status changeschanges
Neurological deficitsNeurological deficitsSeizuresSeizures
NURSING DX: NURSING DX: Fluid Volume deficit Rt Fluid Volume deficit Rt hyperosmolar diuresishyperosmolar diuresis
Risk for injury RT Risk for injury RT Mental status Mental status
changeschanges
NURSING INTERVENTION:NURSING INTERVENTION:Administer Insulin IV Administer Insulin IV push 5-10 units 1st push 5-10 units 1st then IV infusionthen IV infusion
NURSING INTERVENTION:NURSING INTERVENTION:Restore Fluids ( administer Restore Fluids ( administer
fluids as prescribed)fluids as prescribed)–Treat dehydration w/ rapid Treat dehydration w/ rapid infusion of NSS or .45% infusion of NSS or .45% salinesaline
–when blood glucose reaches when blood glucose reaches 250-300 mg/dl D5NS, or 250-300 mg/dl D5NS, or D5 .45%Saline is usedD5 .45%Saline is used
NURSING INTERVENTION:NURSING INTERVENTION:Always use infusion pump Always use infusion pump
for IV insulinfor IV insulinMonitor serum potassium ( Monitor serum potassium (
initially as a result of initially as a result of acidosis Hyperkalemia is acidosis Hyperkalemia is present upon admin of present upon admin of insulin K+ level drops)insulin K+ level drops)
NURSING INTERVENTION:NURSING INTERVENTION:Monitor LOC= too Monitor LOC= too rapid decrease in rapid decrease in blood glucose may blood glucose may cause cerebral edemacause cerebral edema
ADDISON’S DISEASE ADDISON’S DISEASE – – Is the hyposecretion Is the hyposecretion of adrenal cortex of adrenal cortex hormoneshormones
ADDISONIAN CRISIS/ Acute ADDISONIAN CRISIS/ Acute Adrenal Insufficiency-Adrenal Insufficiency- Is a Is a life threatening disorder life threatening disorder caused by acute adrenal caused by acute adrenal insufficiency precipitated by insufficiency precipitated by stress, infection, trauma or stress, infection, trauma or surgery. Without appropriate surgery. Without appropriate hormonal replacement it may hormonal replacement it may lead to shock.lead to shock.
ASSESSMENT:ASSESSMENT:Severe headacheSevere headacheSudden Severe lower leg Sudden Severe lower leg & lower back pain& lower back pain
Generalized weaknessGeneralized weaknessShockShock
NURSING INTERVENTION addisonian NURSING INTERVENTION addisonian crisis:crisis:
Correct hypoglycemia Correct hypoglycemia IV D5 glucose pushIV D5 glucose push
Prepare to administer Prepare to administer glucocorticoid IV glucocorticoid IV (Solucortef)(Solucortef)
NURSING INTERVENTION addisonian NURSING INTERVENTION addisonian crisis:crisis:
Following crisis – Following crisis – glucocorticoids orallyglucocorticoids orally
Monitor blood Monitor blood pressure to assess for pressure to assess for shockshock
NURSING INTERVENTION addisonian NURSING INTERVENTION addisonian crisis:crisis:
Monitor LOCMonitor LOCProtect client from Protect client from infectioninfection
Monitor electrolyte Monitor electrolyte imbalancesimbalances
THYROID CRISIS – (THROID THYROID CRISIS – (THROID STORM/ Thyrotoxicosis)STORM/ Thyrotoxicosis)- - Acute life threatening condition Acute life threatening condition that occurs in a client with that occurs in a client with uncontrollable hyperthyroidism uncontrollable hyperthyroidism – maybe a result of – maybe a result of manipulation of thyroid gland manipulation of thyroid gland during surgery(release of during surgery(release of thyroid hormones to thyroid hormones to bloodstream) bloodstream)
THYROID CRISIS – THYROID CRISIS – (THROID STORM/ (THROID STORM/ Thyrotoxicosis)Thyrotoxicosis)- -
Causes: Undiagnosed , Causes: Undiagnosed , untreated untreated hyperthyroidism, hyperthyroidism, infection, trauma infection, trauma
Medical management:Medical management:Antithyroid Antithyroid medications; beta medications; beta blockers; blockers; glucocorticoids & glucocorticoids & iodides are given iodides are given before surgery to before surgery to prevent thyroid crisisprevent thyroid crisis
Medical management:Medical management:Antithyroid medsAntithyroid meds: : Iodide, Propylthiouracil, Iodide, Propylthiouracil, MethimazoleMethimazole
Iodides/ Iodine = Reduce Iodides/ Iodine = Reduce the vascularity of the the vascularity of the thyroid gland before thyroid gland before thyroidectomy,thyroidectomy,
Medical management:Medical management:Iodides= used in the Iodides= used in the treatment of thyroid treatment of thyroid storm because it enables storm because it enables the storage of TH in the the storage of TH in the thyroid gland.thyroid gland.
Medical management:Medical management:However it is given However it is given only for 10-14 days only for 10-14 days Because eventually it Because eventually it looses its effect on looses its effect on the thyroid gland.the thyroid gland.
NURSING INTERVENTION:NURSING INTERVENTION:ASSESSMENT : elevated ASSESSMENT : elevated Temp ( high fever); Temp ( high fever); tachycardia; agitation; tachycardia; agitation; tremorstremors
Maintain a patent airway Maintain a patent airway
NURSING INTERVENTION:NURSING INTERVENTION:Administer Administer antithyroid meds as antithyroid meds as prescribed ( sodium prescribed ( sodium iodide solution)iodide solution)
Monitor VSMonitor VS
MULTI ORGAN DYSFUNCTION SYNDROME
(MODS)SEPSIS, DEAD TISSUE,
PNEUMONITIS, PANCREATITIS
RESPIRATORY FAILURE
INTUBATION (maybe stable for 7-14 days)
MALFUNCTION of GI
SEEDING OF BACTERIA FR. GI TO OTHER ORGANS
HYPERMETABOLIC STATE
HYPERMETABOLIC STATE (hyperglycemia, hyperlactacidemia, ulceration in GI-seeding of bacteria from GI to other organs)(skin breakdown, loss of muscle mass, delayed healing of surgical wounds)(mortality rate 60%)
LIVER FAILURE(jaundice),
RENAL FAILURE(mortality rate 90-100%)
Criteria for Dx of Criteria for Dx of MODSMODS
Cardiovascular Failure Cardiovascular Failure presence of 1 or more of the ff:presence of 1 or more of the ff:<54 bpm<54 bpmSystolic < 60 mm HgSystolic < 60 mm HgVtach/ V fibVtach/ V fibpH < 7.24pH < 7.24
Respiratory FailureRespiratory Failure
RR < 5/min RR < 5/min RR> 49/minRR> 49/min
Renal Failure presence of 1 or Renal Failure presence of 1 or more of the ff:more of the ff:
Output < 479 ml/24 hrOutput < 479 ml/24 hr or < 159 ml/ 8 hror < 159 ml/ 8 hrBUN > 100mg/dlBUN > 100mg/dlCrea > 3.5mg/dlCrea > 3.5mg/dl
Hematologic Failure presence Hematologic Failure presence of 1 or more of the ff:of 1 or more of the ff:
WBC < 1000 uLWBC < 1000 uLPlatelets < 20,000Platelets < 20,000HCT < 20%HCT < 20%
Hepatic failure presence of both Hepatic failure presence of both of the FF:of the FF:
Bilirubin > 6 mg %Bilirubin > 6 mg %PT > 4 sec over PT > 4 sec over control in absence of control in absence of anticoagulationanticoagulation
(normal PT – 11-12sec)(normal PT – 11-12sec)
Neurologic FailureNeurologic Failure
GCS < 6 in GCS < 6 in absence of absence of sedationsedation
Med MGT: Med MGT: Control of infection w/ Control of infection w/
antibiotics ( common MRSA antibiotics ( common MRSA & Vancomycin resistant& Vancomycin resistant
Aggressive pulmonary Aggressive pulmonary care mech vent & O2 care mech vent & O2 (intubation)(intubation)
Enteral (NGT) feedingEnteral (NGT) feeding
NRSNG MGT: Limited NRSNG MGT: Limited : effective client & : effective client &
family copingfamily coping
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