WEEK TWELVE

Question 1

Special Procedures for Advanced Practice

Answer 1

Rebound tenderness (Blumberg’s sign), choose a site away from tender area, pain on release of pressure
Inspiratory arrest (Murphy’s sign), inflamed gall bladder, pain on deep breath when palpating liver
Iliopsoas muscle test, ? Appendix/leg lift
Obturator test, questionable

Question 2

Causes of abdominal complications?

Answer 2

Infections
Trauma (blunt and Penetrating)
Inflammation
Pre-existing conditions
Cancers
Organ failure

Question 3

Renal failure?

Answer 3

Acute Renal Failure (ACR)
20-25% of Intensive Care patients
High mortality rates 
Poor outcome if RRT required
Chronic Kidney Disease
CKD is more common among women than men.
More than 35% of people aged 20 years or older with diabetes have CKD.
More than 20% of people aged 20 years or older with hypertension have CKD.

Question 4

Pre renal

Answer 4

Pre-renal
Blood supply to the kidneys 
	hypovolemia
	decreased cardiac function
	decreased peripheral vascular disease
	decreased renovascular blood flow

Question 5

Intra renal

Answer 5

Acute Tubular Neurosis (ATN)
Glomerulonephritis
Nephrotoxicity
Vascular insufficiency

Question 6

Acute tubular neurosis (ATN)

Answer 6

Damage to the tubular portion of the nephron may be caused by more than one mechanism.
Most commonly associated with administration of nephrotoxic agents in association with prolonged hypoperfusion or ischemia.
Provoked by Infection , blood transfusion, drugs, ingested toxins and poisons complication of heart failure or cardiovascular surgery.
Term often used in ICU to describe ARF. Accounts for 30% ARF in ICU.

Question 7

Glomerulonephritis

Answer 7

Infective/inflammatory process damaging glomerular membrane or a systematic autoimmune illness attacking the membrane. This allows larger blood components eg plasma proteins and WBC cross the membrane. This causes tubular congestion and nephron failure.

Question 8

Nephrotoxicity

Answer 8

Damage to nephron from causative agent
Drugs
Antibiotics
anti-inflammatory
cancer drugs
radio opaque dies.

Question 9

Vascular Insufficiency

Answer 9

1/3 of pts in ICU have chronic renal dysfunction.
May be undiagnosed related to diabetes, ageing process , hypertension.
These factors create reduction in vasculature of the kidney therefore reduce glomerular filtration.

Question 10

Post renal

Answer 10

Benign prostatic hyperplasia
Bladder cancer
Calculi formation
Neuromuscular disorders
Spinal cord disease
Strictures
Trauma (back, pelvis, perineum)

Question 11

Acute renal failure

Answer 11

Clinical history essential in differentiating between pre-existing renal disease and potential for ARF
Clinical History along with key assessments allow for accurate diagnosis

Question 12

Clinical management of ARF

Answer 12

Reducing further Damage
IV fluid resuscitation
Assessment for renal outflow obstruction
Cease or modify any nephrotoxic drugs or agents  
Treat infection with alternate less toxic antibiotics
Nutrition
Enteral or Parenternal
30-35kcal/kg/day
Protein intake 1-2g/kg/day
Renal replacement Therapy (RRT)

Question 13

Renal therapy options

Answer 13

Peritoneal dialysis
Haemodialysis 
Continuous renal replacement therapy (Acute) 
Haemodialysis Community based (Chronic) 
Access - Catheter 
AV access
AV fistula – (no catheter)
Renal transplant

Question 14

Liver failure

Answer 14

Liver failureis the inability of theliverto perform its normal synthetic and metabolic function as part of normal physiology.
There are two types of liver failure
Acute
Chronic

Question 15

Acute liver failure

Answer 15

Acute Liver Failure is the rapid development of hepatocellular dysfunction, specifically coagulopathy and mental status changes (encephalopathy) in a patient without known prior liver disease

Question 16

Diagnosis of acute liver failure

Answer 16

Diagnosis 
Based on:
physical exam
laboratory findings
patient history
past medical history to establish mental status changes, coagulopathy, rapidity of onset, and absence of known prior liver disease respectivel

Question 17

Chronic liver failure

Answer 17

Usually associated with Cirrhosis & can develop from viral Hep B & C, alcohol, metabolic (Wilson’s disease) or autoimmune.

Question 18

Consequences of liver failure

Answer 18

Hepatic Encephalopathy
Hepatorenal Syndrome
Varices & Variceal Bleeding
Ascites
Respiratory Compromise