Critical Care HESI Remediation

Basilar skull fracture: A halo-sign which is blood surrounded by a yellow colored stain, is likely to appear on the gauze if the client experienced a CSF leak as a result of a basilar skull fracture. o Other signs of a basilar skull fracture: hemorrhage from the nose, pharynx, ears, or blood under the conjunctiva, Battle sign (bruising over the mastoid process) may be seen after 24 hours o CSF leak: when cerebrospinal fluid escapes from the ear or nose and the halo sign is visible on bed linens or head dressing, it is a blood stain surrounded by a yellowish stain o CSF leak is a serious problem because organisms can access the cranial contents through the nose, ear, sinus, or tear in the dura and create problems such as meningitis, abscess formation, or osteomyelitis  Dopamine drip-POC: Dopamine is used as a first choice vasopressor for a client who is hypotensive because it increases systemic vascular resistance and MAP, which determines renal blood flow, GFR, and urine production. Urine output must be monitored at least hourly to evaluate systemic pressure and renal perfusion. o Dopamine is a Vasopressor (causes vasoconstriction). When a person is hypotensive they have low systemic vascular resistance, low cardiac output, and reduced perfusion. Therefore we need to constrict the vessels to raise vascular resistance and ultimately cardiac output, perfusion, and MAP. o It would only make sense that if the patient having trouble with perfusion due to low blood pressure then renal blood flow, GFR, and urine production would slow along with it. Therefore after the administration of dopamine, which is attempting to fix these problems we should monitor urine output for the effectiveness of the drug. o Some reasons why the patient may be hypotensive include shock, trauma, or sepsis.  Hypertensive crisis: Nitropress is a potent vasodilator that acts directly on smooth muscle, and is the drug of choice for immediate reduction of the blood pressure during a hypertensive crisis. o Although nitroprusside is the drug of choice it should be used cautiously because of the risk of thiocyanate toxicity, erratic responses, and a risk for severe hypotension o Hypertensive crisis: diastolic BP higher than 180/120  Hypertensive emergency: diastolic BP greater than 120 and must be lowered quickly to avoid damage to target organs (pt. will complain of headache, confusion, blurred vision, seizures, pulmonary edema, oliguria, hypertensive retinopathy)  Hypertensive urgency: when BP is severely elevated but there is no evidence of target organ damage (severe headache, epistaxis, and anxiety) This study source was downloaded by from CourseH