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fourth semester notes[1]

fourth semester notes[1]



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Published by mara5140

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Published by: mara5140 on Dec 23, 2008
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Renal Failure-Chronic (CRF)
Inability of the kidneys to perform vital functions including excretion of toxins,
electrolytes, fluids, and hydrogen ions.

Affects more than 2 out of a 1000 people in the U.S. annually.
Gradual, over many years.

Diabetes and HTN are the primary causes of CRF, accounting for 40% and 25%,
respectively, of all cases. Other causes include trauma, autoimmune disorders, birth
defects, drug OD, and genetic diseases.

Clinical Findings:
Edema throughout the body, shortness of breath, fatigue, flank pain, oliguria (progressing
to anuria), elevated BP, and pale skin.

Nursing Focus

\u2022 Never take a BP or perform a venipuncture on an arm with a dialysis shunt.
\u2022 Help minimize discomfort from frustrations with fluid restrictions by offering ice
chips, frozen lemon swabs, diversional activities, and hard candies.
\u2022 Provide routine skin care; uremia causes itching and dryness of skin.
\u2022 Monitor blood urea nitrogen (BUN) and serum creatinine levels.
\u2022 Monitor strict fluid intake and output; fluids are typically restricted to an amount equal
to the previous day's urine output plus 500-600 mL.
\u2022 Perform frequent turning and ROM exercises to minimize skin breakdown.

Patient Teaching

\u2022 Provide Pt and family with literature on CRF and/or dialysis.
\u2022 Restrict sodium, water, potassium, phosphate, and protein intake as ordered.
\u2022 Encourage compliance with secondary preventive measures.
\u2022 Explain the actions, dosages, side effects, and adverse reactions of meds.

Lab Conventional SI Units
BUN 6-23 mg/dL 2.5-7.5 mmol/L
Creatinine 15-25 mg/kg of body weight/day 0.13-0.22 mmol kg-1/day
Uric acid Male: 4.0-9.0 mg/dL 238-535 \u00b5mol/L
Female: 3.0-6.5 mg/dL 178-387 \u00b5mol/L

Glasgow Coma Score

Eyes Open \u2022 Spontaneously: 4
\u2022 To command: 3
\u2022 To pain: 2

\u2022 Unresponsive: 1
Best Verbal Response \u2022 Oriented: 5

\u2022 Confused: 4
\u2022 Inappropriate: 3
\u2022 Incomprehensible: 2
\u2022 Unresponsive: 1

Best Motor Response \u2022 Obeys commands: 6
\u2022 Localizes pain: 5
\u2022 Withdraws from pain: 4
\u2022 Abnormal flexion: 3
\u2022 Abnormal extension: 2

\u2022 Unresponsive: 1
Total .....................
Burn Assessment
\u2022 Depth of burn (1st; epidermis, 2nd; epidermis and partial dermis, or 3rd; penetrating
the dermis and underlying tissues).
\u2022 Percentage of TBSA involved.

\u2022 Age of the Pt (age + TBSA = % probability of mortality).
\u2022 Pulmonary injury (smoke inhalation, toxic fumes).
\u2022 Associated injuries (airway burns and other trauma).
\u2022 Special considerations (chemical/electrical burns, CO poisoning).
\u2022 Preexisting diseases (potential for exacerbation).

Emergency Management (May Need MD Order)

\u2022 Establish and manage ABCs and intubate if indicated. Use c-spine precautions if
traumatic injury is suspected.
\u2022 Administer 100% oxygen via NRB mask or use BVM if indicated.
\u2022 Obtain IV access and titrate to hemodynamic status.
\u2022 Attach ECG monitor and manage dysrhythmias per ACLS.
\u2022 Order and review labs (glucose, BUN, creatinine, CBC, electrolytes, PT, and PTT).

Fluid Replacement-First 24 hr (Start From Time of Injury)
\u2022 4 mL \u00d7 percentage of BSA \u00d7 weight (kg).
\u2022 Infuse half over 1st 8 hrs, a fourth over 2nd 8 hrs, and a fourth over last 8 hrs.
Rule of Nines

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