Permplasma leakage fluidelect imbalance hypovolemia

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Complications- increased cap. perm/plasma leakage/ fluid/elect. imbalance, hypovolemia, in severe cases shock, acid/base imbalance, metabolic alkalosis/ acidosis(end stages), bowel perf, peritonitis, sepsisEtiologyIntussusception- telescoping of bowelVolvulus- twisting of bowelAssessmentObstipation(not passing stool/flatus), question GI history, abdom. distention, peristaltic waves, hiccups, fever(above 101), tachycardia, boardlike abd., pain (if localized-strangluation and more concerning), N/V,fluid/elect. Imbalance, bobborygmi(high pitch bowel sound)Diagnosis- CAT scan and possible blood draw (elevated WBC, hemoconcentration as result of dehydration, elevated hemogl/crit), serum NA/K decreased)Reduce potential for injury (peritonitis, AKI)Acute pain management (sometimes pain meds are held for diagnostic purposes)TreatmentNG tubes (assess Q4)IV fluid replacement (NPO)Exploratory laparotomy (for mechanical cases)
Fiber intake, adequate fluids when dischargedExtra Notes; no vomitting in Large bowel obstruction, Semi Fowlers position is best, SBO at high risk for fluid/elect. And acid/base imbalancesStroke Video NotesIschemic (thrombotic*slower onset or embolic*faster onset)Thrombotic= atherosclerosis in carotid arteryDiminished bloodflowEmbolic=thrombi or clot gets stuck in cerebral artery split or veterbrovascular system *A fib can cause/ ischemiaHemmorhagic (brain bleed, aneurysm, hypertension → arteriovenous malformation)ICH=bleeding from sustained HTN (cocaine use)SAH*more common=bleeding in subarachnoid space (trauma)AVM=tangled malformation of vessels without capillary network“Worst headache of my life”Occur most often during activitysymptoms= N/V, photophobia, cranial neuropathy, stiff neck, LOCMost strokes are ischemicVasospasm= sudden periodic constriction of cerebral artery, often followed by SAH or AVM rupture→ leads to secondary ischmia and infarction and further damageStroke SymptomsSudden confusion/trouble speaking, numbness in face/arms/legs, vision problems, dizziness, headacheRight sided stroke= disoriented with time/space, proprioception, patient might be unaware of their defecitsDifficulty performing ADL’s, OTLeft sided stroke= aphasia, agraphia, alexia(dyslexia), acalculiaDifficulty carrying out simple tasksNeed reorientation, schedule/routine, PTHemiplegia=paralysis on one side of bodyhemiparesis=weakness on one side of bodyataxia=gait disturbancehypotonia/flaccid paralysis=unable to overcome gravityhypertonia/spastic paralysis= fixed positions Unilateral body neglet syndrome= common with right sided stroke, patients are unaware of paralysis(one-sided leaning), hemianopsiaAt risk for fallsptosis= eyelid droopingAmaurosis fugax=blindness in one eye, briefhemianopsia= blindness in half of visual field *common in MCA strokeEmbolic assessmentHeart murmurs, dysrhythmias(a-fib), HTN (150/100 or higher may lead to anotherstroke)CBC, metabolic panel, cardiac anzymesPT, INR, PTT (in the case of anticoag therapy)CT scan without contrast is gold standard for diagnosing bleeds

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