Exam 5 Flashcards
What are the criteria for an infant to undergo therapeutic hypothermia?
HIE
Pt should meet all three criteria (at any point w/n first 6 hrs of life):
one or more of the following: APGAR less than or equal to 5 at 10 mins, prolonged resucitation at birth, pH less than 7 from cord or baby w/n 1 hr of birth, abnormal base excess w/n 1 hr
one or more of the following: lethargy, stupor or coma, abnormal tone, abnormal reflexes, oculomotor or pupillary abnormalities, absent or weak suck, autonomic instability, abnormal EEG
What are the criteria for adults to undergo therapeutic hypothermia?
MI
less than 12 hours since ROSC
motor component of glasgow coma scale is less than or equal to 5 (no purposeful movement)
sepsis did not cause the arrest
core body temp is greater than 30
What occurs during the induction of cooling for therapeutic hypothermia?
CT scan to r/o head bleed
intubated and mechanically ventilated
baseline labs
ekg to determine cardiac event
start cooling ASAP
target temp (varies but can be 32 to 36)
fever prophylaxis
two sources of temp monitoring (not oral)
What occurs during the rewarming phase of therapeutic hypothermia?
done slowly to prevent cerebral edema (should take 12 to 16 hrs, 0.25 to 0.5 degrees an hour)
begins 12 to 24 hours after initiation of cooling
at risk for hypotension, hyperkalemia, hypoglycemia
What are risk factors for acute liver failure?
drugs (acetaminophen), hep B, alcohol, “real water” alkaline water
What are risk factors for cirrhosis?
alcohol, chronic hep B or C, autoimmune, wilson’s disease, hemochromatosis, primary biliary cholangitis, primary sclerosing cholangitis, nonalcoholic fatty liver disease, non alcoholic steatohepatitis
Which types of medications are given for chronic hep B?
nucleoside and neculotide analogs
Which types of medications are used for chronic hep c?
direct acting antivirals
What is the treatment of choice for acute hepatitis?
liver transmplant
What is the treatment and management for ascites?
diuretics, paracentesis, sodium restriction, albumin, TIPS
What medication is used for hepatic encephalopathy?
lactulose (binds ammonia and excretes through bowels)
What happens to the hepatocytes during liver disease? What does it cause?
decreased
bile production: jaundice, hyperbilirubinemia
coagulation: thrombocytopenia, easy bruising, prolonged clotting time, anemia
glucose and protein metabolism: ascites
detoxiification and processing of drugs, hormones, and metabolites: hepatic encephalopathy (confusion, agitation, difficulty concentration d/t ammonia buildup in brain), asterixis (tremor of hand - similar to flapping of bird wing d/t ammonia buildup in brain), spider angiomas (vasodilation, red center and little veins that branch out (like spider legs) d/t impaired estrogen metabolism)
What are the assessment data for DKA?
BS>250
pH<7.3
anion gap>12
ketones in urine
symptoms: kussmaul respirations, n/v, lethargy, loss of consciousness
How is hypoglycemia prevented in DKA?
tight control of insulin drips, dosages based on weight
once BS is at the facility determined number (typically 200-250) insulin dosage is cut in half
if on continuous IV insulin need to also have basal SQ insulin a few hours before d/c drip to get back into regimen
How are the interventions for DKA prioritized?
- fluids to avoid hypovolemic shock: one of most serious complications, once pt reaches a certain BS add dextrose to fluid
- electrolytes (K): especially concered about K d/t diuresis and insulin deficiency, do not correct hyperkalemia b/c it will naturally go down w/ fluids and insulin, if K<3.3 then supplement K before starting insulin
- insulin
- bicarb (if pH<6.9): does not necessarily lead to better outcomes
- ID and management of precipitating event
