3 rehabilitative phase getting pt back to baseline or

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(helps reduce infection). 3. Rehabilitative Phase : getting pt back to baseline or as close to baseline as possible. PT, OT, psychological counseling Can last months
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Critical Care Test 3 (11) Acute Kidney Injury 3 causes : Prerenal, Renal, Postrenal. Prerenal : think PERFUSION. Anything that affects ability of kidneys to get perfused will case Prerenal injury. HF, shock, burns Intrarenal : direct damage to kidney itself. Usually caused by acute tubular necrosis (tubules of kidneys have been damaged). IV contrast dye, diuretics (Lasix, bumex), antibiotics Prerenal kidney injury that goes untreated can turn to Intrarenal injury Postrenal: less common. Caused by obstruction after the kidneys. Kidney stone. Enlarged prostate. 3 phases of Kidney Injury: Initiation: from time of injury to when you see change in urine output. When pts has normal urine output and turns to oliguria Maintenance: urine output is at lowest point. Ex. Pt admitted with burn and decrased urine output (initiation). 24 hrs later, you are lucky if 5 ml/hr (maintenance) Recovery: tissue begins to recover. Not everyone’s tissues will recover. Some pts go from AKI to chronic kidney failure. Assessment: VS: altered based on cause. Prerenal pts will have low BP, high HR (due to shock or burn). Hyperventilation for compensation. Physical Assessment: depends on causes depending on what is going on with pt. crackles due to fluid overload. Changes in LOC bc kidney fail to filter blood appropriately. Lab values: elevated BUN/creatinine. Elevated magnesium and potassium. Decreased sodium levels. Decreased in RBC & hgb (bc erythropoietin is produced in kidneys). Treatment: Monitor I/Os. Monitor weight. Monitor labs. Treat cause = why are kidneys failing? Is it because of shock, lets treat shock to increase perfusion. Is it bc of burns, lets treat burns to increase perfusion to kidneys. It is diuretics, lets stop diuretics. Pharmacological: diuretics are controversial. Dopamine is controversial (physician has been doctor for a while, it is because old research shows low amts of dopamine increase perfusion to kidneys. However, recent research shows that it doesn’t). N -Acetylcysteine (Mucomyst) give before IV contrast dye and after IV contrast dye. Protects kidneys from IV contrast dye. Really smelly!! Hyperkalemia: big concern for AKI!!! Kidneys to great job at regulating potassium levels. Restrict potassium. Give them kayexelate (binds to potassium and poops out. Given PO or enema. Problem with PO, takes longer to work. Give enema, works quickly. Give insuli n = pushes potassium back into cells. Give glucose so insulin doesn’t drop sugar so much. Albuterol and sodium bicarbonate pushes potassium back into cells. Calcium gluconate does nothing for potassium, you give to protect heart from effects of potassium bc potassium is associated with relaxation of heart; higher my potassium is, the more my heart will be at rest (risk for Vtach Vfib).
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  • Fall '18
  • Traumatic brain injury

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