Nurs 480 Exam 1 – 3 With Satisfied Solutions

NURS 480 EXAM 1 – 3 WITH SATISFIED SOLUTIONS Where does MODS occur first? - Organ failure begins in lungs - progrssive dypnea, resp failure, ARDS Pt presentation of MODS - IV fluids/vasoactive meds needed to support BP/CO Hyperglycemic/hyperlactic acidemia -----severe loss of skeletal muscle Elevated bilirubin and LFTs Decreased bowl sounds and translocation of gut flora Elevtaed creatinine, BUN, anuria Coma or unresponsive DIC - Sign of underlying disorder Inflammatory response initiates clotting cascade Platelets will be decreased on CBC do to use during clots Pt presentation of DIC - Eccymosis Petechiae Hematoma Dypsnea Tachypnea Hemoptysis Pul Embolism Hypotension Chest Pain Hematemesis Rectal bleeding Melena Lab test - Low platelet (150,000) Fibrinogen (170) Prolonged PT (12.5sec) aPTT(35 sec) Thrombin (11) D-dimer = check for clots, "leftovers" liek sawdust = clot breakdown RN considerations of DIC - Sepsis and leukemias are comon causes of DIC Monitor trends over time ATN in kidneys Alveolar compromise in lungs Headache, visual changes, LOC Avoid activities that would increase introcranial pressure A high cardiac output and low CVP suggest septic shock, and massive fluid replacement is indicated. - Increased PAWP indicates that the patient has excessive fluid volume (and suggests cardiogenic shock), and diuresis is indicated. Bradycardia and a low systemic vascular resistance (SVR) suggest neurogenic shock, and fluids should be infused cautiously. - The renal hypoperfusion that accompanies cardiogenic shock results in increased BUN and creatinine levels. What are the 3 functions of renal? - Urine formation Regulatory Function(acidBase/electrolytes) Hormonal Functions Hormonal functions of the kidney - -renin to help regulate or control BP, potassium and sodium - erythropoietin: stimulates RBC production -regulation of calcium/phosphorus balance through activation of Vitamin D - bradykinins/prostaglandins