Podcast
Questions and Answers
Which factor primarily influences the selection of an appropriate anesthetic agent?
Which factor primarily influences the selection of an appropriate anesthetic agent?
- The availability of specific anesthetic agents in the facility.
- The patient's request regardless of medical appropriateness.
- Evaluation of each individual situation in consultation with the patient and surgeon. (correct)
- The surgeon's preference and experience.
A patient in the ICU is receiving multiple stimuli and is unable to prioritize or disregard them. Which condition is the patient experiencing?
A patient in the ICU is receiving multiple stimuli and is unable to prioritize or disregard them. Which condition is the patient experiencing?
- Sensory deficit
- Sensory deprivation
- Sensory overload (correct)
- Sensory adaptation
A patient recovering from anesthesia has lost sensation above the nipple line. What potential complication should the nurse be aware of?
A patient recovering from anesthesia has lost sensation above the nipple line. What potential complication should the nurse be aware of?
- Cardiac arrhythmias.
- Hepatic dysfunction.
- Respiratory difficulties. (correct)
- Renal failure.
What is a key consideration when caring for mechanically ventilated patients receiving neuromuscular blocking agents in the ICU?
What is a key consideration when caring for mechanically ventilated patients receiving neuromuscular blocking agents in the ICU?
Which of the following describes how sensory nerves transmit impulses to the brain?
Which of the following describes how sensory nerves transmit impulses to the brain?
A client reports feeling anxious and restless in the ICU. Which environmental factor most likely contributes to this?
A client reports feeling anxious and restless in the ICU. Which environmental factor most likely contributes to this?
Which of the following best describes the primary goal of administering premedication prior to general anesthesia?
Which of the following best describes the primary goal of administering premedication prior to general anesthesia?
Following the administration of epidural anesthesia, a patient exhibits signs of respiratory depression. What immediate intervention is most appropriate?
Following the administration of epidural anesthesia, a patient exhibits signs of respiratory depression. What immediate intervention is most appropriate?
Which of the following patients is most likely to experience delayed awakening from anesthesia due to prolonged drug metabolism?
Which of the following patients is most likely to experience delayed awakening from anesthesia due to prolonged drug metabolism?
A nurse notices a patient in the PACU is shivering. What is the primary concern related to this?
A nurse notices a patient in the PACU is shivering. What is the primary concern related to this?
A patient is scheduled for a minor surgical procedure requiring local anesthesia. Which nursing intervention is most important?
A patient is scheduled for a minor surgical procedure requiring local anesthesia. Which nursing intervention is most important?
What information should the nurse prioritize when receiving a patient from the operating room?
What information should the nurse prioritize when receiving a patient from the operating room?
A patient with a history of COPD is undergoing a brachial plexus block. Which potential complication requires vigilant monitoring?
A patient with a history of COPD is undergoing a brachial plexus block. Which potential complication requires vigilant monitoring?
In the context of sensory alterations, what might a patient experience if placed in an isolated environment with minimal interaction?
In the context of sensory alterations, what might a patient experience if placed in an isolated environment with minimal interaction?
Following spinal anesthesia, a patient's blood pressure drops significantly. What immediate intervention should the nurse perform?
Following spinal anesthesia, a patient's blood pressure drops significantly. What immediate intervention should the nurse perform?
Which statement best describes the function of the afferent nervous system?
Which statement best describes the function of the afferent nervous system?
What is the primary function of the cerebrospinal fluid (CSF) within the central nervous system?
What is the primary function of the cerebrospinal fluid (CSF) within the central nervous system?
Damage to the cerebellum is most likely to result in which of the following deficits?
Damage to the cerebellum is most likely to result in which of the following deficits?
Which of the following accurately describes the role of the vertebral column in protecting the spinal cord?
Which of the following accurately describes the role of the vertebral column in protecting the spinal cord?
A patient has suffered damage to the medulla oblongata following a stroke. Which of the following functions is most likely to be affected?
A patient has suffered damage to the medulla oblongata following a stroke. Which of the following functions is most likely to be affected?
Which of the following differentiates the somatic nervous system from the autonomic nervous system?
Which of the following differentiates the somatic nervous system from the autonomic nervous system?
What would be the most likely result of damage to the descending motor tracts?
What would be the most likely result of damage to the descending motor tracts?
Spinal cord injury at the level of C4 poses a high risk for respiratory compromise?
Spinal cord injury at the level of C4 poses a high risk for respiratory compromise?
A patient is exhibiting signs of spastic paralysis. Where is the most likely location of the lesion in the nervous system?
A patient is exhibiting signs of spastic paralysis. Where is the most likely location of the lesion in the nervous system?
Which division of the autonomic nervous system is primarily responsible for the 'fight or flight' response?
Which division of the autonomic nervous system is primarily responsible for the 'fight or flight' response?
The postganglionic fibers of the parasympathetic nervous system release which neurotransmitter?
The postganglionic fibers of the parasympathetic nervous system release which neurotransmitter?
How does damage to the frontal lobe primarily manifest?
How does damage to the frontal lobe primarily manifest?
Increased heart rate, bronchodilation, and pupil dilation are effects associated with:
Increased heart rate, bronchodilation, and pupil dilation are effects associated with:
What is the primary function of the spinothalamic tract?
What is the primary function of the spinothalamic tract?
The vagus nerve (CN X) exerts widespread influence in the body with which function?
The vagus nerve (CN X) exerts widespread influence in the body with which function?
What is the primary rationale for maintaining spinal cord precautions on a patient with a potential spinal injury?
What is the primary rationale for maintaining spinal cord precautions on a patient with a potential spinal injury?
A patient with a known spinal cord injury is being logrolled. Why is this technique preferred over other methods of repositioning?
A patient with a known spinal cord injury is being logrolled. Why is this technique preferred over other methods of repositioning?
After a motor vehicle accident, a patient is suspected of having a spinal cord injury. What is the MOST important immediate intervention at the accident scene?
After a motor vehicle accident, a patient is suspected of having a spinal cord injury. What is the MOST important immediate intervention at the accident scene?
Which statement accurately differentiates between primary and secondary spinal cord injury mechanisms?
Which statement accurately differentiates between primary and secondary spinal cord injury mechanisms?
A patient with a cervical spinal cord injury is at risk for secondary injury. What physiological response contributes MOST significantly to this risk?
A patient with a cervical spinal cord injury is at risk for secondary injury. What physiological response contributes MOST significantly to this risk?
How does swelling following a spinal cord injury potentially worsen neurological deficits?
How does swelling following a spinal cord injury potentially worsen neurological deficits?
What is the MOST common mechanism of injury in spinal cord injuries resulting from motor vehicle accidents?
What is the MOST common mechanism of injury in spinal cord injuries resulting from motor vehicle accidents?
A patient presents with subluxation at C4-C5 revealed by X-ray. Which type of injury mechanism is MOST likely the cause?
A patient presents with subluxation at C4-C5 revealed by X-ray. Which type of injury mechanism is MOST likely the cause?
What is the MOST important indicator of a complete spinal cord injury based on functional assessment?
What is the MOST important indicator of a complete spinal cord injury based on functional assessment?
How does spinal shock differ from neurogenic shock in the context of spinal cord injuries?
How does spinal shock differ from neurogenic shock in the context of spinal cord injuries?
A patient in neurogenic shock presents with hypotension and bradycardia. Which intervention is MOST appropriate?
A patient in neurogenic shock presents with hypotension and bradycardia. Which intervention is MOST appropriate?
What assessment finding is MOST indicative of autonomic dysreflexia in a patient with a high-level spinal cord injury?
What assessment finding is MOST indicative of autonomic dysreflexia in a patient with a high-level spinal cord injury?
A patient with a T4 spinal cord injury suddenly develops a severe headache, hypertension, and bradycardia. What is the MOST appropriate immediate nursing action?
A patient with a T4 spinal cord injury suddenly develops a severe headache, hypertension, and bradycardia. What is the MOST appropriate immediate nursing action?
Following initial stabilization, which diagnostic study is MOST effective in visualizing soft tissue damage and potential nerve root avulsion in a patient with an incomplete spinal cord injury?
Following initial stabilization, which diagnostic study is MOST effective in visualizing soft tissue damage and potential nerve root avulsion in a patient with an incomplete spinal cord injury?
When caring for an immobilized patient with a spinal cord injury, why is it critical to check the pressure points under the cervical collar regularly? (every 2 hours)
When caring for an immobilized patient with a spinal cord injury, why is it critical to check the pressure points under the cervical collar regularly? (every 2 hours)
According to the modified Munro-Kellie doctrine, which components primarily influence intracranial dynamics?
According to the modified Munro-Kellie doctrine, which components primarily influence intracranial dynamics?
What is the significance of the cerebral perfusion pressure (CPP) in the context of intracranial regulation?
What is the significance of the cerebral perfusion pressure (CPP) in the context of intracranial regulation?
Which of the following is considered a serious elevation of intracranial pressure (ICP) that requires active treatment?
Which of the following is considered a serious elevation of intracranial pressure (ICP) that requires active treatment?
How does the displacement of CSF into the spinal canal and basal cisterns contribute to maintaining intracranial equilibrium?
How does the displacement of CSF into the spinal canal and basal cisterns contribute to maintaining intracranial equilibrium?
What is the primary role of cerebral autoregulation in maintaining adequate brain function?
What is the primary role of cerebral autoregulation in maintaining adequate brain function?
What is the potential consequence of Mean Arterial Pressure (MAP) falling below the autoregulatory threshold of 50/60 mmHg?
What is the potential consequence of Mean Arterial Pressure (MAP) falling below the autoregulatory threshold of 50/60 mmHg?
How does acidosis (e.g., hypoxia, hypercapnia, ischemia) affect cerebral blood flow (CBF)?
How does acidosis (e.g., hypoxia, hypercapnia, ischemia) affect cerebral blood flow (CBF)?
What is the rationale for closely monitoring both ICP and CPP in patients with intracranial hypertension?
What is the rationale for closely monitoring both ICP and CPP in patients with intracranial hypertension?
Which condition is NOT typically associated with increasing brain volume and thus potentially elevating ICP:
Which condition is NOT typically associated with increasing brain volume and thus potentially elevating ICP:
How do brain tumors lead to increased intracranial pressure?
How do brain tumors lead to increased intracranial pressure?
What is the typical timeframe for cerebral edema to reach its maximum following an insult to the brain?
What is the typical timeframe for cerebral edema to reach its maximum following an insult to the brain?
Which mechanism is NOT a typical cause of increased CSF volume leading to intracranial hypertension?
Which mechanism is NOT a typical cause of increased CSF volume leading to intracranial hypertension?
How does obstruction of venous outflow from the brain contribute to increased ICP?
How does obstruction of venous outflow from the brain contribute to increased ICP?
Why is PaCO2 considered the 'most potent and powerful autoregulatory mechanism' in the context of cerebral blood flow?
Why is PaCO2 considered the 'most potent and powerful autoregulatory mechanism' in the context of cerebral blood flow?
Which of the following is typically the EARLIEST and most sensitive indicator of rising ICP?
Which of the following is typically the EARLIEST and most sensitive indicator of rising ICP?
What is the likely cause of motor dysfunction, such as weakness on one side of the body, associated with increased ICP?
What is the likely cause of motor dysfunction, such as weakness on one side of the body, associated with increased ICP?
How does pressure on the oculomotor nerve (CN III) typically manifest in patients with increased ICP?
How does pressure on the oculomotor nerve (CN III) typically manifest in patients with increased ICP?
Cushing's triad, a sign of severely increased ICP, is characterized by which set of vital sign changes?
Cushing's triad, a sign of severely increased ICP, is characterized by which set of vital sign changes?
What does Cheyne-Stokes breathing pattern, observed in patients with increased ICP, suggest about the location of brain compression?
What does Cheyne-Stokes breathing pattern, observed in patients with increased ICP, suggest about the location of brain compression?
For a patient with increased ICP, what PaCO2 range is generally recommended to optimize cerebral blood flow and minimize secondary injury?
For a patient with increased ICP, what PaCO2 range is generally recommended to optimize cerebral blood flow and minimize secondary injury?
Which of the following cerebrovascular disorders is MOST likely to result in cerebral ischemia?
Which of the following cerebrovascular disorders is MOST likely to result in cerebral ischemia?
Which artery is MOST commonly involved in thrombotic strokes due to its contribution to cerebral blood flow?
Which artery is MOST commonly involved in thrombotic strokes due to its contribution to cerebral blood flow?
What is the PRIMARY mechanism by which hemorrhagic strokes cause secondary damage to cerebral tissue?
What is the PRIMARY mechanism by which hemorrhagic strokes cause secondary damage to cerebral tissue?
A patient with a subarachnoid hemorrhage (SAH) is at risk for cerebral vasospasm. What is the PRIMARY concern related to this complication?
A patient with a subarachnoid hemorrhage (SAH) is at risk for cerebral vasospasm. What is the PRIMARY concern related to this complication?
What is the MOST common cause of subarachnoid hemorrhage?
What is the MOST common cause of subarachnoid hemorrhage?
Which of the following assessment findings is MOST indicative of meningeal irritation in a patient with a subarachnoid hemorrhage?
Which of the following assessment findings is MOST indicative of meningeal irritation in a patient with a subarachnoid hemorrhage?
During the acute phase of a subarachnoid hemorrhage, what cardiovascular changes are MOST concerning as indicators of increased intracranial pressure?
During the acute phase of a subarachnoid hemorrhage, what cardiovascular changes are MOST concerning as indicators of increased intracranial pressure?
Which of the following interventions is MOST important for preserving viable brain tissue in a patient with subarachnoid hemorrhage?
Which of the following interventions is MOST important for preserving viable brain tissue in a patient with subarachnoid hemorrhage?
A patient with a subarachnoid hemorrhage is at risk for rebleeding. What intervention is MOST important to minimize this risk?
A patient with a subarachnoid hemorrhage is at risk for rebleeding. What intervention is MOST important to minimize this risk?
A patient post aneurysmal clipping develops dysphasia and increased left-sided weakness. What complication is MOST likely occurring?
A patient post aneurysmal clipping develops dysphasia and increased left-sided weakness. What complication is MOST likely occurring?
Which of the following is a PRIMARY component in the collaborative management of a patient with intracerebral hemorrhage?
Which of the following is a PRIMARY component in the collaborative management of a patient with intracerebral hemorrhage?
A patient with a stroke develops hyponatremia. Which condition should be suspected if treatment with fluid restriction could be fatal?
A patient with a stroke develops hyponatremia. Which condition should be suspected if treatment with fluid restriction could be fatal?
A patient with a traumatic brain injury develops a rapid elevation in blood pressure and heart rate. What physiological response is MOST likely causing these vital sign changes?
A patient with a traumatic brain injury develops a rapid elevation in blood pressure and heart rate. What physiological response is MOST likely causing these vital sign changes?
Following a head injury, a patient's blood pressure drops precipitously. What is the MOST likely explanation for this change?
Following a head injury, a patient's blood pressure drops precipitously. What is the MOST likely explanation for this change?
Which of the following core temperature readings would be considered a confounding factor that could mimic brain death?
Which of the following core temperature readings would be considered a confounding factor that could mimic brain death?
What is the PRIMARY focus when caring for a multi-organ donor patient?
What is the PRIMARY focus when caring for a multi-organ donor patient?
Why is it important to maintain normothermia in a potential organ donor?
Why is it important to maintain normothermia in a potential organ donor?
In the context of neurological determination of death, what clinical finding is essential to confirm the absence of brainstem function?
In the context of neurological determination of death, what clinical finding is essential to confirm the absence of brainstem function?
Following a severe traumatic brain injury, a patient develops diabetes insipidus. What finding is MOST indicative of this complication?
Following a severe traumatic brain injury, a patient develops diabetes insipidus. What finding is MOST indicative of this complication?
When managing a patient undergoing withdrawal of life support for Declaration of Cardiocirculatory Death (DCD), what is a key consideration for organ donation eligibility?
When managing a patient undergoing withdrawal of life support for Declaration of Cardiocirculatory Death (DCD), what is a key consideration for organ donation eligibility?
In a patient with cirrhosis and portal hypertension, which assessment finding indicates the development of collateral circulation?
In a patient with cirrhosis and portal hypertension, which assessment finding indicates the development of collateral circulation?
A patient with liver cirrhosis develops ascites. Which pathophysiological mechanism primarily contributes to this condition?
A patient with liver cirrhosis develops ascites. Which pathophysiological mechanism primarily contributes to this condition?
A patient with end-stage liver disease has increasing confusion and asterixis. Which lab value would the nurse correlate with these findings?
A patient with end-stage liver disease has increasing confusion and asterixis. Which lab value would the nurse correlate with these findings?
A patient with liver failure is at increased risk of bleeding. Which alteration contributes MOST significantly to this increased risk?
A patient with liver failure is at increased risk of bleeding. Which alteration contributes MOST significantly to this increased risk?
Which of the following is the primary goal of administering direct-acting antivirals (DAAs) in a patient with Hepatitis C?
Which of the following is the primary goal of administering direct-acting antivirals (DAAs) in a patient with Hepatitis C?
Which intervention is MOST important in preventing the transmission of Hepatitis A?
Which intervention is MOST important in preventing the transmission of Hepatitis A?
A patient with acute liver failure is being assessed for hepatic encephalopathy. Which clinical finding is MOST indicative of this complication?
A patient with acute liver failure is being assessed for hepatic encephalopathy. Which clinical finding is MOST indicative of this complication?
A patient with cirrhosis develops splenomegaly. Which complication is the patient MOST at risk for due to this condition?
A patient with cirrhosis develops splenomegaly. Which complication is the patient MOST at risk for due to this condition?
A patient with acute liver failure is at risk for spontaneous bacterial peritonitis (SBP). What physiological factor contributes MOST to this risk?
A patient with acute liver failure is at risk for spontaneous bacterial peritonitis (SBP). What physiological factor contributes MOST to this risk?
A patient with cirrhosis is undergoing paracentesis for ascites. Which intervention is MOST important to prevent circulatory dysfunction following the procedure?
A patient with cirrhosis is undergoing paracentesis for ascites. Which intervention is MOST important to prevent circulatory dysfunction following the procedure?
A patient with acute liver failure requires sedation. Which agent should be avoided, if possible, due to the risk of masking neurological changes and further potentiating hepatic encephalopathy?
A patient with acute liver failure requires sedation. Which agent should be avoided, if possible, due to the risk of masking neurological changes and further potentiating hepatic encephalopathy?
Laboratory results that are indicative of hepatocellular liver disease include:
Laboratory results that are indicative of hepatocellular liver disease include:
A patient with liver failure is admitted to the ICU with gastrointestinal bleeding due to esophageal varices. Which intervention is MOST likely to be included in the initial management of this patient?
A patient with liver failure is admitted to the ICU with gastrointestinal bleeding due to esophageal varices. Which intervention is MOST likely to be included in the initial management of this patient?
During the assessment of a patient with liver cirrhosis, the nurse notes an enlarged liver upon palpation. What is the significance of this finding?
During the assessment of a patient with liver cirrhosis, the nurse notes an enlarged liver upon palpation. What is the significance of this finding?
A patient with chronic hepatitis B is at risk for developing cirrhosis. What pathophysiological change contributes to the development of cirrhosis?
A patient with chronic hepatitis B is at risk for developing cirrhosis. What pathophysiological change contributes to the development of cirrhosis?
The nurse is caring for a patient with acute liver failure. Which electrolyte imbalance is MOST likely to be present, requiring close monitoring?
The nurse is caring for a patient with acute liver failure. Which electrolyte imbalance is MOST likely to be present, requiring close monitoring?
A patient is suspected of having acute hepatitis. Which blood test would be MOST useful in determining the liver's synthetic ability?
A patient is suspected of having acute hepatitis. Which blood test would be MOST useful in determining the liver's synthetic ability?
Which instruction should be included in the discharge teaching for a patient recovering from hepatitis A?
Which instruction should be included in the discharge teaching for a patient recovering from hepatitis A?
Which statement accurately describes the relationship between alcohol consumption and liver disease?
Which statement accurately describes the relationship between alcohol consumption and liver disease?
In differentiating between hepatocellular and cholestatic liver disease using laboratory results, what pattern is expected?
In differentiating between hepatocellular and cholestatic liver disease using laboratory results, what pattern is expected?
Flashcards
What can affect Consciousness?
What can affect Consciousness?
Alterations can stem from fatigue to comas, injuries, substances, medications, and diseases.
What is Reception regarding Senses?
What is Reception regarding Senses?
Involves sensory nerve activation by stimuli like light, touch, or sound, sending impulses to the brain.
What is Perception regarding Senses?
What is Perception regarding Senses?
Brain interprets stimuli based on quality, nature, and past experiences; consciousness affects this.
What is Reaction regarding Senses?
What is Reaction regarding Senses?
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What are Sensory Deficits?
What are Sensory Deficits?
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What is Sensory Deprivation?
What is Sensory Deprivation?
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What is Sensory Overload?
What is Sensory Overload?
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What is Regional Anesthesia?
What is Regional Anesthesia?
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Epidural Anesthesia
Epidural Anesthesia
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What are Peripheral Nerve Blocks?
What are Peripheral Nerve Blocks?
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What is Intrathecal (Spinal) Anesthesia?
What is Intrathecal (Spinal) Anesthesia?
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What is General Anesthesia?
What is General Anesthesia?
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What are Neuromuscular Blockade agents?
What are Neuromuscular Blockade agents?
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What are Abnormal Physiologic Responses Associated With Anesthesia?
What are Abnormal Physiologic Responses Associated With Anesthesia?
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What is Local Anesthesia?
What is Local Anesthesia?
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Critical care nurses require:
Critical care nurses require:
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Central Nervous System (CNS)
Central Nervous System (CNS)
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Peripheral Nervous System (PNS) includes:
Peripheral Nervous System (PNS) includes:
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Afferent System (Sensory)
Afferent System (Sensory)
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Efferent System (Motor)
Efferent System (Motor)
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Somatic Motor System
Somatic Motor System
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Autonomic Motor System
Autonomic Motor System
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Autonomic nervous system includes:
Autonomic nervous system includes:
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Brain's Major Divisions
Brain's Major Divisions
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Ascending Sensory Tracts (spinothalamic)
Ascending Sensory Tracts (spinothalamic)
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Descending Motor Tracts (corticospinal)
Descending Motor Tracts (corticospinal)
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Somatic Division (motor pathways)
Somatic Division (motor pathways)
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Autonomic Division (motor pathways)
Autonomic Division (motor pathways)
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Lower Motor Neuron
Lower Motor Neuron
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Upper Motor Neuron
Upper Motor Neuron
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Spinal Cord Injury Etiology
Spinal Cord Injury Etiology
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Spinal Cord Injury Prevention
Spinal Cord Injury Prevention
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Primary and Secondary Spinal Cord Injury
Primary and Secondary Spinal Cord Injury
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Spinal Cord Injury Precautions
Spinal Cord Injury Precautions
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Common Mechanisms of Spinal Cord Injury
Common Mechanisms of Spinal Cord Injury
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Functional Injury (Spinal Cord)
Functional Injury (Spinal Cord)
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Complete Spinal Cord Injury
Complete Spinal Cord Injury
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Incomplete Spinal Cord Injury
Incomplete Spinal Cord Injury
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Spinal Shock, Neurogenic Shock, Autonomic Dysreflexia
Spinal Shock, Neurogenic Shock, Autonomic Dysreflexia
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Assessment Findings in Spinal Shock, Neurogenic Shock, Autonomic Dysreflexia
Assessment Findings in Spinal Shock, Neurogenic Shock, Autonomic Dysreflexia
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Treatments for Spinal Shock, Neurogenic Shock, Autonomic Dysreflexia
Treatments for Spinal Shock, Neurogenic Shock, Autonomic Dysreflexia
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Prognosis and Risks of Spinal Shock, Neurogenic Shock, Autonomic Dysreflexia
Prognosis and Risks of Spinal Shock, Neurogenic Shock, Autonomic Dysreflexia
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Principles of Care: Spinal Cord Injury
Principles of Care: Spinal Cord Injury
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Diagnostic Evaluation of Spinal Trauma
Diagnostic Evaluation of Spinal Trauma
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Neurological Assessment
Neurological Assessment
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Intracranial Pressure (ICP)
Intracranial Pressure (ICP)
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Adaptive Mechanisms for Increased ICP
Adaptive Mechanisms for Increased ICP
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Autoregulation of Cerebral Blood Flow (CBF)
Autoregulation of Cerebral Blood Flow (CBF)
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Normal MAP Range for Autoregulation
Normal MAP Range for Autoregulation
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Cerebral Perfusion Pressure (CPP)
Cerebral Perfusion Pressure (CPP)
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Normal CPP Range
Normal CPP Range
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Conditions Increasing Brain Volume
Conditions Increasing Brain Volume
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Causes of Brain Abscesses
Causes of Brain Abscesses
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Cerebral Edema
Cerebral Edema
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Conditions Increasing CSF
Conditions Increasing CSF
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Conditions That Increase Blood Volume
Conditions That Increase Blood Volume
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Hyperemia
Hyperemia
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Potent Autoregulatory Mechanism
Potent Autoregulatory Mechanism
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Earliest Sign of Increased ICP
Earliest Sign of Increased ICP
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Motor Dysfunction with Increased ICP
Motor Dysfunction with Increased ICP
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Cause of Pupil Dysfunction
Cause of Pupil Dysfunction
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Why Headaches Worsen in Morning with Increased ICP
Why Headaches Worsen in Morning with Increased ICP
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Late Findings of Increased ICP
Late Findings of Increased ICP
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Cushing's Triad
Cushing's Triad
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Cause of Herniation
Cause of Herniation
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Cerebrovascular Disorders
Cerebrovascular Disorders
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Cerebral Ischemia
Cerebral Ischemia
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Cerebrovascular accident (CVA)
Cerebrovascular accident (CVA)
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Ischemic Stroke
Ischemic Stroke
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Hemorrhagic Stroke
Hemorrhagic Stroke
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Cerebral Vasospasm
Cerebral Vasospasm
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Subarachnoid Hemorrhage
Subarachnoid Hemorrhage
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Neurologic changes: Sudden Loss of Consciousness
Neurologic changes: Sudden Loss of Consciousness
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Hunt & Hess Scale
Hunt & Hess Scale
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Brain Herniation
Brain Herniation
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Neurologically Determined Death
Neurologically Determined Death
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Clinical Criteria for Neurological Determination of Death
Clinical Criteria for Neurological Determination of Death
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Subarachnoid Hemorrhage Treatment Priority
Subarachnoid Hemorrhage Treatment Priority
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Goal of Oxygen and Carbon Dioxide Elimination
Goal of Oxygen and Carbon Dioxide Elimination
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Normothermia
Normothermia
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Managing Hemodynamic Instability
Managing Hemodynamic Instability
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Goal of Multi Organ Donor Care
Goal of Multi Organ Donor Care
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Good Death
Good Death
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Neurologically Deceased Donor (NDD)
Neurologically Deceased Donor (NDD)
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Declaration of Cardiocirculatory Death (DCD)
Declaration of Cardiocirculatory Death (DCD)
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Metabolic Processes
Metabolic Processes
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Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar State (HHS)
Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar State (HHS)
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Critical Care Nurse Role
Critical Care Nurse Role
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Cerebral Edema Risk
Cerebral Edema Risk
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Hepatic Encephalopathy
Hepatic Encephalopathy
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Hepatic Encephalopathy Symptoms
Hepatic Encephalopathy Symptoms
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Liver Functions
Liver Functions
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Impaired Coagulation
Impaired Coagulation
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Liver Diseases
Liver Diseases
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Hepatitis
Hepatitis
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Hepatitis A (HAV)
Hepatitis A (HAV)
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Hepatitis B (HBV)
Hepatitis B (HBV)
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Hepatitis C (HCV)
Hepatitis C (HCV)
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Acute Fatty Liver
Acute Fatty Liver
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Cirrhosis
Cirrhosis
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Laennec's Cirrhosis
Laennec's Cirrhosis
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Post Necrotic Cirrhosis
Post Necrotic Cirrhosis
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Biliary Cirrhosis
Biliary Cirrhosis
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Portal Hypertension
Portal Hypertension
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Study Notes
Introduction
- Critical care patients can experience severe alterations in metabolic processes that can alter consciousness.
- Profound dehydration in patients with Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar State (HHS) can progress to shock, coma, and death if untreated.
- Critical care nurses play a vital role in reversing severe dehydration, replacing insulin deficiencies, reversing fluid and electrolyte imbalances, and promoting acid-base balance.
- Patients are at risk for cerebral edema with fluctuating glucose levels and cerebral fluid shifts.
- Frequent neurological assessment is crucial to detect subtle changes in the level of consciousness, which can indicate cerebral edema and impaired intracranial regulation.
- Patients with severe hepatic disease can have alterations in consciousness related to impaired metabolic processes
- End-stage liver disease means the liver can no longer detoxify and cleanse the blood, leading to hepatic encephalopathy, with symptoms ranging from drowsiness to coma.
- The liver is a complex organ that maintains normal body functioning through digestive metabolism, nutrient storage and secretion, detoxification, and coagulation homeostasis.
- Impaired coagulation related to liver disease can lead to intracerebral bleed.
- Liver diseases are caused by bile flow obstruction or malfunctioning liver cells.
- Topics include liver anatomy and physiology, disorders causing liver disease (cirrhosis), nursing implications, and hepatic failure treatment strategies.
Anatomy and Physiology of the Liver
- A solid understanding of liver anatomy and physiology is essential.
- The liver is the largest organ in the body.
- It is surrounded by connective tissue known as Glisson's capsule.
- The right lobe of the liver is larger than the left lobe.
- The liver receives blood from the portal vein (75% of supply) and the hepatic artery (25% of supply).
- The liver's functioning unit is called a lobule.
- Liver cells are also known as hepatocytes.
- Kupffer cells, phagocytic in nature, help destroy worn RBCs and detoxify drugs.
- Functions of the liver include digestive metabolism, storage and secretion of nutrients, detoxification, coagulation homeostasis, and bile production.
- The liver stores glycogen, broken down into glucose to maintain blood glucose levels; liver failure patients are at risk for hypoglycemia.
- The liver produces bile, which emulsifies fats and helps absorb fat-soluble vitamins, and is stored in the gall bladder.
- High levels of unconjugated bilirubin suggest hepatocellular dysfunction, while high levels of conjugated bilirubin suggest biliary tract obstruction.
Liver Diseases
- Liver diseases can result in hepatic failure, with a focus on Hepatitis A, B, and C, acute fatty liver, and cirrhosis.
- Fulminant hepatic failure is the most acute and serious liver disease.
Hepatitis
- Hepatitis involves inflammation leading to widespread necrosis of liver cells, caused by viruses, alcohol, drugs, chemicals, and blood transfusions.
- Simultaneous processes occur: inflammation destroys hepatic cells, but new cells are generated.
- New hepatic cells are not arranged in same previous chains, impeding blood flow through sinusoids and increasing pressure in the portal system, leading to portal hypertension.
- Hepatitis is categorized based on transmission, occurrence, symptom management, and prognosis, with three common types discussed.
Hepatitis A
- Hepatitis A is common among food and beverage industry workers.
- It is transmitted via oral-anal sex, unsanitary water and food, and fecal contamination.
- The incubation period ranges from 15-50 days, during which the disease is highly infectious.
- Many people are asymptomatic during the incubation period.
- Symptoms include nausea, fatigue, anorexia, diarrhea, and jaundice.
- About 90% of patients with Hepatitis A (HAV) fully recover without treatment.
- Prevention includes vaccination and proper hand washing.
Hepatitis B
- Hepatitis B (HBV) is transmitted through blood, semen, or saliva.
- It is commonly associated with intravenous drug users, blood transfusions, and unprotected sex.
- The incubation period is from 6 days to 6 months; individuals are contagious as long as HBg is present in the blood.
- Symptoms include nausea, diarrhea, jaundice, abdominal pain, joint pain, enlarged liver, and loss of appetite.
- Approximately 90% of those infected with HBV develop antibodies and recover, while 10% develop chronic hepatitis and remain infectious, potentially leading to cirrhosis.
- Prevention includes vaccination, education about unprotected sex, and careful handling of needles.
Hepatitis C
- Hepatitis C (HCV) is transmitted through blood and body contact, similar to HBV, via blood transfusions, IV drug use, and sexual contact with an infected partner.
- The incubation period if from 2 weeks to 6 months.
- Most patients infected with HCV are asymptomatic, but symptoms include jaundice, amber-colored urine, fatigue, and loss of appetite.
- Over 85% of individuals with HCV develop chronic liver disease, and it is the leading cause for liver transplantation.
- There is currently no effective vaccination for HCV.
- Treatment aims for sustained virological response (SVR), indicating the absence of detectable Hepatitis C virus RNA by treatment's end.
- Direct-acting antivirals (DAA) are highly effective, attaining SVR after 12 weeks of treatment
Acute Fatty Liver
- Acute fatty liver is caused by excessive lipid deposition in hepatic cells due to impaired fat metabolism.
- It is associated with pregnancy, obesity, diabetes, malnutrition, cystic fibrosis, and alcohol abuse.
- Fatty livers are often difficult to diagnose due to rare symptoms.
- An enlarged liver might be discovered during a routine physical assessment.
- Blood tests may show elevated liver enzymes if inflammation is present.
- Diagnosis is confirmed by liver biopsy, and treatment depends on the underlying cause, such as weight loss and diet control for obesity.
- Fatty livers can be reversed, but if it progresses to hepatic failure, liver transplantation is an option.
Cirrhosis
- Cirrhosis results from diffuse inflammation of hepatic cells, causing fibrosis or scarring within the liver.
- Three main types exist: Laennec's cirrhosis (primarily alcohol-related, liver becomes enlarged and firm due to fatty deposits), post-necrotic cirrhosis (associated with acute viral hepatitis, gallstones, or toxins), and biliary cirrhosis (secondary to biliary tree obstruction, with jaundice as a hallmark).
- During inflammation, hepatocytes are destroyed and regenerated, resulting in structural changes that impede blood flow through the sinusoids, leading to increased pressure in the portal system.
- Cirrhosis progresses slowly, with no initial symptoms.
- Diagnosis often occurs via palpation of the enlarged liver during a routine physical exam; liver function tests may or may not be elevated.
- As cirrhosis advances, complications like portal hypertension and liver dysfunction may occur, along with esophageal varices, ascites, and splenomegaly.
- There is no cure; treatment focuses on slowing disease progression, managing symptoms, and minimizing complications.
Portal Hypertension
- Normal pressure in the portal system is low (5-10 mmHg).
- Inflammation or scarring causes a dramatic pressure increase. Organs accessing the portal system are affected.
- Obstruction from scarring forces blood to find an alternative route, known as collateral circulation.
- Abdominal, esophogastric, and rectal veins dilate to compensate for congestion.
- Common physical assessment findings include hemorrhoids, palpable spleen (splenomegaly), esophageal varices, visible raised abdominal veins (caput medusae), and ascites.
Ascites
- Ascites is a consequence of portal hypertension, with plasma spilling from the liver into the peritoneal cavity.
- Plasma contains albumin.
- The liver is unable to generate albumin, which results from changes from cirrhosis and portal hypertension.
- Loss of plasma proteins decreases oncotic pressure, hindering the body's ability to hold fluid in chambers.
- Protein-filled fluid leaks into the abdomen.
- Circulating blood volume loss stimulates the kidneys to activate the renin-aldosterone system.
- The damaged liver cannot respond, leading to sodium and water retention, increasing ascites and edema.
- Ascites is diagnosed based on abdominal assessment; fluid can be confirmed via CT scan, ultrasound, or paracentesis.
- Treatment includes strict monitoring of intake and output, dietary sodium restriction, and albumin replacement if a paracentesis is performed.
Splenomegaly
- Portal hypertension causes blood to back up into the spleen.
- The spleen becomes engorged, impairing its function, leading to the destruction of healthy platelets.
- Complications from splenomegaly include thrombocytopenia, epistaxis, and petechiae.
- Treatment focuses on reducing portal hypertension and monitoring platelet levels; platelet transfusions may be required.
Liver Dysfunction Requiring ICU Admission
- ICU admissions for liver disease complications include hepatic encephalopathy, variceal bleeding, and infection.
Hepatic Encephalopathy
- Hepatic encephalopathy (HE) affects about 40% of patients with liver cirrhosis, impacting quality of life and prognosis.
- The pathogenesis of involves the liver's inability to remove nitrogenous waste products (ammonia and glutamine) from the blood.
- This accumulation results in neuropsychiatric symptoms.
- Clinical features range depending on disease progression and toxin levels, including confusion, personality changes, asterixis (flapping tremor), decreased consciousness, and coma.
- Hepatic encephalopathy can impair the ability to protect the airway, leading to ICU admission.
- Treatment options reduce ammonia levels as outlined in textbooks.
Variceal Bleeding
- Up to 50% of patients with cirrhosis develop variceal bleeding.
- Review gastrointestinal bleeding etiology, assessment, diagnosis, treatment, and management in required readings.
Infection
- The failed liver means Kupffer cells can no longer rid bacteria from the intestinal tract.
- Liver disease patients are at increased risk of infection and sepsis.
- Poor nutrition and hypoalbuminemia heighten the spontaneous bowel peritonitis (SBP) risk due to bacterial translocation.
- Cirrhosis is also referred to as scarring from fibrosis formed secondary to inflammation.
- Normal pressure in the portal system is low (5-10 mmHg); complications from portal hypertension include ascites, splenomegaly, and esophageal varices.
- Hepatic encephalopathy is thought to be caused by a buildup of circulating toxins like ammonia, endogenous benzodiazepines, exogenous benzodiazepines, neurotransmitters. Asterixis is the sign.
- Treatment of hepatic encephalopathy focuses on decreased ammonia.
- Endoscopy can be performed if esophageal varices rupture. bleeding is controlled via banding or sclerosing visible varices.
- Other treatments for esophageal variceal bleeding include TIPS as in transjugular intrahepatic portosystemic shunt, mechanical tamponade, or a Minnesota or Sennstake-Blakemore tube.
- Due to impaired Kupffer cell function and malnourishment, patients with end-stage liver disease are infection-prone; spontaneous bacterial peritonitis (SBP) develops secondary to bacterial translocation from the intestinal tract for up to 30% of patients with ascites.
Acute Liver Failure
- Acute liver failure is a medical emergency from massive necrosis of liver cells.
- The liver is unable to maintain its role, leading to multi-organ failure.
- The onset of symptoms is unpredictable, rapid, and with a high mortality rate.
Lab value tests
- "Liver Function Tests" (LFTs) are measures of hepatic enzymes and provide clinicians with insight into the origin of liver injury more so than providing a measure of true liver function.
- Aspartate Aminotransferase (AST)
- Alanine Aminotransferase (ALT)
- Alkaline Phosphatase (ALP)
- Gamma-Glutamyl Transpeptidase (GGT)
- Increases in AST and ALT in acute and chronic liver diseases indicate injury or cellular death of hepatocytes. Serum elevation of AST and ALT occurs prior to any physical signs (i.e. jaundice) of liver disease
- Serum ALP, found on the epithelial cells which line the bile ducts and is synthesised and released into the serum during cholestasis
- A measure of GGT can be performed to differentiate a liver origin of ALP
- A true measure of liver synthetic function is revealed through serum measure of prothrombin time (PT) and serum bilirubin.
Fluid and Electrolyte Imbalances Associated with Impaired Intracranial Regulation
- Decreased albumin indicates decreased ability to synthesize
- Increased alkaline phosphatase shows reduced excretion in bile and cholestasis.
- Increased ammonia is the result of decreased conversion to urea
- Increased bilirubin is caused by the impaired ability to convert unconjugated to conjugated bilirubin for excretion.
- Increased direct bilirubin can be attributed to elevated jaundice, hepatitis, liver cell damage and bile duct problems.
- Prolonged INR indicates decreased production of Vitamin K.
- Decreased platelets is attributed to splenomegaly or heightened consumption by the body.
- Decreased hemoglobin means RBC destruction.
- Increased BUN indicates hypoperfusion to kidneys.
- Increased AST and ATL means hepatic cell destruction.
- Increased GGT can be attributed to cholestasis or alcohol abuse.
- Increased creatinine points to renal hypoperfusion.
- Decreased potassium means diarrhea, diuretics, and aldosterone secretion.
- Decreased calcium indicates decreased dietary intake and absorption of vitamin D.
- Magnesium Decreased can not be stored in the liver
- HbsAg (surface antigen) Positive HBV contagious
- HBeAg (antigen) means HBV infectious
Considerations for acute liver failure patients
- Because of the increased risk of gastrointestinal bleeding, patients with acute liver failure should receive stress ulcer prophyllaxis.
- Before an invasive procedure, recently tested INR/PTT and platelet should be tested. Supplement and Vitamin K blood if needed.
- Benzodiazipines should be avoided because they may mask pertinent neurological changes and further potentiate hepatic encephalopathy.
- List five possible causes of acute liver failure: Any from Box 30-13 on page 773 in Urden.
- Name one of the few definitive treatments for acute liver failure: liver transplantation.
Conclusion
- Patients with liver disease and acute liver failure are extremely complex and involves having a sound understanding of the functions and role of the liver.
- Nurses should also have the ability to anticipate, recognize and respond to any complications including impaired consciousness.
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