Podcast
Questions and Answers
What is the hallmark sign of Cushing's Syndrome?
What is the hallmark sign of Cushing's Syndrome?
- Hyperglycemia (correct)
- Hypokalemia
- Slow wound healing
- Weight gain
Which diagnostic test helps determine if Cushing's Syndrome is due to a pituitary or adrenal cause?
Which diagnostic test helps determine if Cushing's Syndrome is due to a pituitary or adrenal cause?
- 24 hour urine cortisol test
- Midnight salivary cortisol level
- Plasma ACTH levels (correct)
- Low Dose dexamethasone suppression test
What is a common psychological symptom associated with Cushing's Syndrome?
What is a common psychological symptom associated with Cushing's Syndrome?
- Increased libido
- Cognitive clarity
- Emotional lability (correct)
- Improved sleep quality
What treatment option is appropriate for an ACTH-secreting pituitary adenoma in Cushing's Syndrome?
What treatment option is appropriate for an ACTH-secreting pituitary adenoma in Cushing's Syndrome?
Which of the following symptoms is NOT typically associated with Cushing's Syndrome?
Which of the following symptoms is NOT typically associated with Cushing's Syndrome?
What is the normal range for Central Venous Pressure (CVP)?
What is the normal range for Central Venous Pressure (CVP)?
Which catheter is specifically used for administering Total Parenteral Nutrition (TPN)?
Which catheter is specifically used for administering Total Parenteral Nutrition (TPN)?
What is a potential disadvantage of using a Central Venous Catheter (CVC)?
What is a potential disadvantage of using a Central Venous Catheter (CVC)?
What does the PA diastolic pressure (PAD) measure in relation to fluid volume status?
What does the PA diastolic pressure (PAD) measure in relation to fluid volume status?
Where is the most typical site for placing a Central Venous Catheter (CVC)?
Where is the most typical site for placing a Central Venous Catheter (CVC)?
What distinguishes an ICU from a PCU?
What distinguishes an ICU from a PCU?
What is the purpose of triage in emergency care?
What is the purpose of triage in emergency care?
In the Emergency Severity Index (ESI), what does level 1 indicate?
In the Emergency Severity Index (ESI), what does level 1 indicate?
What is included in a primary survey for trauma patients?
What is included in a primary survey for trauma patients?
Which statement is true regarding patients in levels 3, 4, and 5 of the ESI?
Which statement is true regarding patients in levels 3, 4, and 5 of the ESI?
What does 'acuity' refer to in the context of critical care?
What does 'acuity' refer to in the context of critical care?
What would be the likely response for a patient classified under ESI level 2?
What would be the likely response for a patient classified under ESI level 2?
What is typically involved in the detailed assessment performed by emergency nursing after triage?
What is typically involved in the detailed assessment performed by emergency nursing after triage?
What is the purpose of performing a dynamic response test on A-line tubing?
What is the purpose of performing a dynamic response test on A-line tubing?
What might indicate a need for immediate intervention when monitoring A-line and EKG readings?
What might indicate a need for immediate intervention when monitoring A-line and EKG readings?
Which of the following is NOT a risk associated with A-lines?
Which of the following is NOT a risk associated with A-lines?
What does the term phlebostatic axis refer to?
What does the term phlebostatic axis refer to?
Which of the following is a component of the '5 P's' used for neurovascular checks?
Which of the following is a component of the '5 P's' used for neurovascular checks?
What life-long treatment is necessary after adrenal gland surgery?
What life-long treatment is necessary after adrenal gland surgery?
In the Oliguric Phase of AKI, what is a common daily urine output range?
In the Oliguric Phase of AKI, what is a common daily urine output range?
Which classification system is used to assess the severity of AKI?
Which classification system is used to assess the severity of AKI?
What dietary restriction is typically necessary for a patient with kidney disease?
What dietary restriction is typically necessary for a patient with kidney disease?
Which symptom might indicate an imbalance of potassium in AKI patients?
Which symptom might indicate an imbalance of potassium in AKI patients?
What is the expected urine output in the Diuretic Phase of AKI?
What is the expected urine output in the Diuretic Phase of AKI?
In the context of CKD, when might patients first begin to show symptoms?
In the context of CKD, when might patients first begin to show symptoms?
Which diagnostic test is contraindicated in patients with renal impairment?
Which diagnostic test is contraindicated in patients with renal impairment?
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Study Notes
Critical Care Overview
- ICU (Intensive Care Unit) cares for critically ill patients, with staffing ratios of 2:1, while PCU (Progressive Care Unit) handles less acute cases at 3:1.
- Triage categorizes patients based on acuity, ranging from life-threatening (Level 1) to stable conditions (Level 5) using the Emergency Severity Index (ESI).
Triage Levels
- Level 1: Most critical, life-threatening conditions, unstable vital signs (e.g., unresponsive trauma).
- Level 2: High-risk patients requiring immediate attention (e.g., strokes, myocardial infarction).
- Levels 3, 4, 5: Less critical stability; apt for diagnostic tests or simple examinations.
Patient Assessment
- Conduct systematic head-to-toe assessments following triage.
- Use primary and secondary surveys for trauma patients, focused assessment for non-trauma.
- Life-threatening findings during assessment should be addressed immediately.
Hemodynamic Monitoring
- Phlebostatic axis is at the 4th intercostal space for accurate transducer referencing.
- Zero balancing ensures the pressure system reads accurately, requiring flatlining during the setup.
Dynamic Response Test
- Observed via a square wave on monitoring equipment during a fast flush of arterial lines.
- Ensures that arterial lines are optimally dampened for accurate blood pressure readings.
Alarm Systems and Risks
- Set parameters for high-low pressure alarms (e.g., alarms for pressures below 90 mmHg).
- Risks associated with arterial lines include hemorrhage, infection, thrombus formation, neurovascular impairment, and potential loss of limb.
Central Venous Pressure Monitoring (CVP)
- Normal CVP range is 2-6 mmHg; reflects right ventricle preload and fluid volume.
- Central Catheter types include CVCs, Swan Ganz Catheters, PICC lines, and midline catheters.
- CVC indications: needed for vesicants, continuous or rapid medication administration, and monitoring CVP.
Pulmonary Artery Catheter (Swan Ganz)
- Measures pulmonary arterial pressures (normal ranges: PAD 5-16 mmHg; systolic 15-28 mmHg; PAWP 16 mmHg).
- Valuable for assessing heart function and fluid volume status in conditions like heart failure or shock.
Endocrine System Overview
- Cushing's Syndrome linked to excess corticosteroids, manifesting as weight gain, purple stretch marks, and hyperglycemia.
Cushing's Syndrome Diagnosis and Treatment
- Diagnosed with elevated cortisol levels and may require surgical intervention to address tumors or adenomas.
- Nursing considerations include monitoring vital signs, managing stress, and lifelong medication adjustment post-surgery.
Renal Health: AKI vs. CKD
- CKD may be asymptomatic until 50% nephron damage occurs, while AKI develops quickly due to prerenal, intrarenal, or postrenal issues.
Acute Kidney Injury (AKI) Phases
- Oliguric Phase: Output < 400 mL/day; may last up to 2 weeks.
- Diuretic Phase: Urine output increases significantly; risk of dehydration and electrolyte imbalances.
- Recovery Phase: May take up to 12 months for stabilization.
AKI Diagnosis and Treatment
- Diagnosed via renal scans, ultrasounds, or biopsies; contraindications include MRI with contrast.
- Treatment may require hemodialysis for critical electrolyte imbalances or elevated BUN.
Nutritional Considerations for Renal Patients
- Renal diets restrict phosphorus and protein while ensuring caloric intake is met with healthy fats.
- TPN or enteral feeding may be necessary for patients with poor appetite.
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