acute biologic crisis

Acute Biologic Acute Biologic CrisisCrisis

Congestive Heart FailureCongestive Heart Failure

Left Side Heart FailureLeft Side Heart Failure

Left Side Left Side Heart Heart

FailureFailure

Right Right Side Side Heart Heart

FailureFailure

AnasarcaAnasarca

Right Right Side Side Heart Heart

FailureFailure

AscitesAscites

Right Side Right Side Heart Heart

FailureFailure

Peripheral edema

Right Side Heart FailureRight Side Heart FailureJugular vein distention

DysrhythmiasDysrhythmias

Respiratory FailureRespiratory Failure

Respiratory FailureRespiratory FailureWhen The client can’t When The client can’t eliminate CO2 fr. Alveolieliminate CO2 fr. Alveoli

CO2 retentionCO2 retention


O2 is not absorbed by O2 is not absorbed by alveolialveoli

O2 level dropsO2 level dropsCO2 > 45 mm HgCO2 > 45 mm Hg

Acute respiratory distress syndrome

Causes Resp failureCauses Resp failure

Mechanical abnormality Mechanical abnormality in lungs or chest wall in lungs or chest wall

Defect Resp control Defect Resp control center of braincenter of brain

Severe Resp InfectionSevere Resp Infection

ASSESSMENTASSESSMENTAlteration in breath soundsAlteration in breath soundsDyspneaDyspneaHAHARestlessness / confusionRestlessness / confusionTachycardiaTachycardiaCyanosisCyanosis

ASSESSMENTASSESSMENT LOCLOC

DysrhythmiasDysrhythmias

INTERVENTIONSINTERVENTIONS

Identify Identify causecause

Administer Administer O2O2

Mechanical Mechanical ventilatorventilator

Renal FailureRenal FailureAcute Renal FailureAcute Renal Failure

Chronic Renal FailureChronic Renal Failure

Acute Renal FailureAcute Renal Failure

Rapid onset of oliguria Rapid onset of oliguria (<400 ml /day) , with (<400 ml /day) , with severe rise in BUN & severe rise in BUN &

creatinine creatinine (Azotemia – (Azotemia –

accumulation of nitrogen accumulation of nitrogen in blood )in blood )

Causes of Acute Renal FailureCauses of Acute Renal Failure

Pre-Renal Causes- Pre-Renal Causes- factors outside of factors outside of the kidneythe kidney


Pre-Renal CausesPre-Renal CausesShockShockCirculatory collapseCirculatory collapseCVDCVDHemorrhageHemorrhageSevere vasoconstriction Severe vasoconstriction


Intra-Renal Causes: Intra-Renal Causes: kidney diseaseskidney diseases

Damage to kidneyDamage to kidneyPoisoningPoisoningIron overload (BT)Iron overload (BT)Acute pyelonephritisAcute pyelonephritis


Post-Renal Causes: Post-Renal Causes: Obstruction in the Obstruction in the Urinary tractUrinary tract

Renal calculiRenal calculiProstatic tumorProstatic tumorReproductive diseasesReproductive diseases

Complications ARFComplications ARF

Hyperkalemia – most Hyperkalemia – most dangerous dangerous complication, may lead complication, may lead to cardiac arrest if rise to cardiac arrest if rise in K+ is too fastin K+ is too fast

Nursing Care ARFNursing Care ARFDaily WeightDaily WeightCVP monitoringCVP monitoringDiuretic as prescribedDiuretic as prescribedLow protein, K,Na & Low protein, K,Na & high carbohydrate diethigh carbohydrate diet

Nursing Care ARFNursing Care ARFEmergency mgt of Emergency mgt of Hyper K : insulin & Hyper K : insulin & dextrose , Kayexalate dextrose , Kayexalate enemaenema

Chronic Renal failureChronic Renal failure

Chronic Chronic irreversible irreversible progressive progressive reduction of reduction of

functioning renal functioning renal tissuetissue

Common causes CRFCommon causes CRFDiabetic nephropathyDiabetic nephropathyHypertensive Hypertensive nephropathynephropathy

GlomerulonephritisGlomerulonephritisChronic pyelonephritisChronic pyelonephritis

Stages CRFStages CRF1.1. Reduced RenalReduced Renal Reserve Reserve

high BUN no clinical high BUN no clinical symptoms yetsymptoms yet

2.2. Renal insufficiency-Renal insufficiency- mild mild AzotemiaAzotemia – impaired urine – impaired urine concentration , nocturiaconcentration , nocturia

Stages CRFStages CRF3.3. Renal failure –Renal failure – Severe Severe

azotemia, azotemia, acidosis,concentrated acidosis,concentrated urine, severe anemia & urine, severe anemia & electrolyte imbalanceselectrolyte imbalances

Stages CRFStages CRF4.4. ESRD-ESRD- Renal shutdown Renal shutdown

severely decreased renal severely decreased renal function with clusters of function with clusters of systemic symptomssystemic symptoms

CRF systemic SSCRF systemic SSHyper K, Hypernatremia, Hyper K, Hypernatremia, HypocalcemiaHypocalcemia

AnemiaAnemiaAnorexia, nausea & Anorexia, nausea & vomitingvomiting

CRF systemic SSCRF systemic SS

Ammoniacal breathAmmoniacal breathImmunosuppressionImmunosuppressionHTN, CHFHTN, CHFPulmonary edemaPulmonary edemaSevere pruritusSevere pruritusPeripheral neuropathyPeripheral neuropathyUremic amaurosisUremic amaurosis

Nursing Care ESRDNursing Care ESRDLow Protein, Low Na Low Protein, Low Na dietdiet

Prepare client for Prepare client for peritoneal / peritoneal / hemodialysishemodialysis

Monitor AnemiaMonitor Anemia

Nursing Care ESRDNursing Care ESRDAdminister epoietin Administer epoietin alpha (Epogen), alpha (Epogen), diuretics, diuretics, antihypertensives as antihypertensives as prescribedprescribed

Kidney transplantKidney transplant

Peritoneal DialysisPeritoneal Dialysis

HemodialysisHemodialysis

HEMODIALYSIS: HEMODIALYSIS: Is the Is the diffusion of dissolved diffusion of dissolved particles from the blood particles from the blood into the dialysate bath of into the dialysate bath of the hemodialysis machine the hemodialysis machine across the semipermeable across the semipermeable membrane of the dialyzer.membrane of the dialyzer.

Hemodialysis requires Hemodialysis requires vascular access: vascular access:

Subclavian vein/ Femoral Subclavian vein/ Femoral vein (temporary)vein (temporary)

Arteriovenous fistula, Arteriovenous fistula, arteriovenous shunt,/ arteriovenous shunt,/ arteriovenous graft arteriovenous graft

( Permanent( Permanent))

HemodialysisHemodialysis

Nursing Management: Nursing Management: Assess the integrity of the Assess the integrity of the hemodialysis access sitehemodialysis access site

Monitor VSMonitor VSAssess client for fluid Assess client for fluid overloadoverload

Nursing Management: Nursing Management: Weigh the client before and Weigh the client before and

after the dialysis treatment after the dialysis treatment ( to determine fluid loss)( to determine fluid loss)

Hold meds that can be Hold meds that can be dialyzed offdialyzed off

Monitor for SS of Shock & Monitor for SS of Shock & Disequilibrium syndromeDisequilibrium syndrome

Complication: Disequilibrium Complication: Disequilibrium Syndrome –Syndrome – is the rapid change is the rapid change in composition of extracellular in composition of extracellular fluid where the solutes of the fluid where the solutes of the blood are removed from the blood are removed from the blood faster than that of the blood faster than that of the CSF, causing osmotic movement CSF, causing osmotic movement of fluid into the CSF causing of fluid into the CSF causing cerebral edema.cerebral edema.

Nursing Management: Nursing Management: Disequilibrium syndrome:Disequilibrium syndrome:

Assess for Nausea & Assess for Nausea & vomitingvomiting

Assess for headacheAssess for headacheRestlessness, agitation & Restlessness, agitation &

or confusionor confusionWatch out for seizuresWatch out for seizures

Nursing Management: Disequilibrium Nursing Management: Disequilibrium syndrome:syndrome:

Notify physician if SS of Notify physician if SS of disequlibrium syndrome disequlibrium syndrome occursoccurs

Reduce environmental Reduce environmental stimulistimuli

Dialyze the patient at a shorter Dialyze the patient at a shorter period and at a slower rateperiod and at a slower rate

Kidney TransplantKidney Transplant

The Nursing The Nursing process starts process starts

with with ASSESSMENTASSESSMENT

Ang pitong Ang pitong katotohanan katotohanan

ukol saukol saCranial Nerves Cranial Nerves

GCS atbp.GCS atbp.AssessmentAssessment

1. Cranial Nerve II1. Cranial Nerve IIOptic Nerve-=Optic Nerve-=

Hindi lahat Hindi lahat nang nakikita nang nakikita

mo ay hindi iyo.mo ay hindi iyo.

2. Upon Inspection2. Upon InspectionHindi mo Hindi mo

kayang kayang bilangin ang bilangin ang buhok mo.buhok mo.

3. Cranial nerve XII3. Cranial nerve XIIHypoglossal nerveHypoglossal nerveHindi lahat nang Hindi lahat nang ngipin mo ay abot ngipin mo ay abot

nang dila monang dila mo..

4.Glasgow Coma Scale4.Glasgow Coma ScaleSubukan nang Subukan nang mga tanga ang mga tanga ang

pangatlong pangatlong assessmentassessment

5. Human Error5. Human ErrorAng pangatlo Ang pangatlo

ay maliay mali

6. Cranial nerve VII6. Cranial nerve VIIFacial nerveFacial nerve

Mapapangiti ka Mapapangiti ka kasi nagmukha kasi nagmukha

kang tangakang tanga

7. Law of Karma7. Law of KarmaIpasa mo ito sa Ipasa mo ito sa

ibang ibang istudyante istudyante

nang OC para nang OC para makaganti ka.makaganti ka.

BurnsBurns

Cell destruction of Cell destruction of the layers of the skin the layers of the skin and resultant and resultant depletion of fluid and depletion of fluid and electrolytes electrolytes

Types of BurnsTypes of BurnsThermal : exposure to flameThermal : exposure to flameChemical: exposure to Chemical: exposure to

strong acids or alkalistrong acids or alkaliElectrical: Caused by Electrical: Caused by

electrical strong electrical electrical strong electrical current results in internal current results in internal tissue injurytissue injury

Burn Depth:Burn Depth:Superficial thickness burn (1st Superficial thickness burn (1st

degree)degree)- mild to severe - mild to severe erythema of skin, blanches erythema of skin, blanches with pressure – heals in 3-7 with pressure – heals in 3-7 daysdays

Partial thickness burn(2nd Partial thickness burn(2nd degree)degree) – large blisters; – large blisters; painful heals 2-3 weeks painful heals 2-3 weeks

Burn Depth:Burn Depth:Full thickness burns (3rd Full thickness burns (3rd

degree) – white yellow deep degree) – white yellow deep red to black (eschar) red to black (eschar) disruption of blood flow, no disruption of blood flow, no pain; scarring and wound pain; scarring and wound contractures will develop. contractures will develop. Grafting is required; Grafting is required; healing healing takes weeks to monthstakes weeks to months

Burn Depth:Burn Depth:Deep full thickness burn(4th Deep full thickness burn(4th

degree) – Involves injury degree) – Involves injury to muscle and bone= to muscle and bone= appears black(eschars) – appears black(eschars) – hard and inelastic healing hard and inelastic healing takes weeks to months; takes weeks to months; grafts are requiredgrafts are required

Nursing DiagnosisNursing Diagnosis

Decreased Cardiac Decreased Cardiac output Related to output Related to Fluid shiftsFluid shifts

Rule Of 9Rule Of 9Head and neck 9%Head and neck 9%Anterior trunk 18% ( Anterior trunk 18% ( chest-9 abdomen-9)chest-9 abdomen-9)

Posterior trunk-18%Posterior trunk-18%

Rule Of 9Rule Of 9Arms 9% each Arms 9% each (forearms only or (forearms only or upper arms only upper arms only 4.5%)4.5%)

Legs – 18% each Legs – 18% each Perineum-1%Perineum-1%

Rule of 9Rule of 9

PARKLAND (BAXTER) PARKLAND (BAXTER) FORMULA FOR FLUID FORMULA FOR FLUID REPLACEMENTREPLACEMENT

4ml Lactated Ringer’s 4ml Lactated Ringer’s sol x Kg body mass x sol x Kg body mass x total percentage of body total percentage of body surface burnedsurface burned

PARKLAND (BAXTER)PARKLAND (BAXTER)•1st 8 hours = ½ of total

24 hour fluid replacement•next 8 hours = ¼ of

total•last 8 hours= ¼ of total

A man Suffered from a 3A man Suffered from a 3rdrd degree burn degree burn involving the head and neck, front of involving the head and neck, front of the torso (chest & abdomen), and the torso (chest & abdomen), and whole left arm. Weight is 50 kgwhole left arm. Weight is 50 kg

Calculate the:Calculate the: TBSA burnedTBSA burned

24 hour fluid replacement in ml24 hour fluid replacement in ml11stst 8 hours fluid replacement 8 hours fluid replacement

22ndnd 8 hour 8 hour remaining 8 hourremaining 8 hour

TBSA:TBSA: Head & neck= 9%Head & neck= 9% front of torso = 18% front of torso = 18% Whole left arm = 9% Whole left arm = 9%

TBSA burned 36%TBSA burned 36%

24 hour replacement: 24 hour replacement: Parkland Baxter Parkland Baxter formulaformula

4mlX 50 kgs x (TBSA)36%4mlX 50 kgs x (TBSA)36%

= 7200 ml= 7200 ml

11stst 8 hours : 8 hours :7200 ml7200 ml 22

= 3600 ml = 1= 3600 ml = 1stst 8 hours 8 hours

22ndnd 8 hours & 8 hours & remaining 8 hours remaining 8 hours respectively :respectively :

3600 ml3600 ml 22

= 1800 ml = 2nd 8 hours= 1800 ml = 2nd 8 hours= 1800 ml = last 8 hours= 1800 ml = last 8 hours

MANAGEMENT OF BURNS:MANAGEMENT OF BURNS:Administer fluids as Administer fluids as

prescribedprescribedMaintain a high calorie, high Maintain a high calorie, high

protein dietprotein dietMonitor intake and outputMonitor intake and outputMonitor for infections of Monitor for infections of

burn siteburn site

Burn Medications:Burn Medications:Nitrofurazone ( Furacin)Nitrofurazone ( Furacin) – – broad spectrum antibiotic broad spectrum antibiotic ointment or cream – used ointment or cream – used when bacterial resistance when bacterial resistance to other drugs is a problem to other drugs is a problem : apply 1/16 inch thick film : apply 1/16 inch thick film directly to burndirectly to burn

Burn Medications:Burn Medications:Mafenide ( Sulfamylon)Mafenide ( Sulfamylon) – water – water

soluble cream bacteriostatic gr soluble cream bacteriostatic gr + - bacteria- apply 1/16 inch + - bacteria- apply 1/16 inch directly to burn – notify directly to burn – notify physician if hyperventilation physician if hyperventilation occurs as this drug may ppt. occurs as this drug may ppt. metabolic acidosis.metabolic acidosis.

Burn Medications:Burn Medications:Silver SulfadiazeneSilver Sulfadiazene( Silvadene)( Silvadene) – cream Broad – cream Broad

spectrum to gr+ - ; does not spectrum to gr+ - ; does not cause metabolic acidosis – keep cause metabolic acidosis – keep burn covered at all times with burn covered at all times with Sulfadiazine – (1/16 inch thick);Sulfadiazine – (1/16 inch thick);

Monitor CBC – causes leukopeniaMonitor CBC – causes leukopenia

Burn Medications:Burn Medications:Silver Nitrate – Antiseptic Silver Nitrate – Antiseptic

solution against gr-, dressings solution against gr-, dressings are applied to the burn and are applied to the burn and then kept moist with Silver then kept moist with Silver nitrate ; used on extensive nitrate ; used on extensive burns that may precipitate burns that may precipitate fluid and electrolyte fluid and electrolyte imbalance.imbalance.

LIVER CIRRHOSIS - LIVER CIRRHOSIS - A A chronic progressive chronic progressive disease of the liver disease of the liver characterized by characterized by diffused damage to cells. diffused damage to cells. ( Fibrosis & Nodule ( Fibrosis & Nodule formation) .formation) .

Types:Types:Laennec’s cirrhosis – Laennec’s cirrhosis –

Alcohol inducedAlcohol inducedPostnecrotic c – massive Postnecrotic c – massive

liver necrosis as a result of liver necrosis as a result of viral hepatitisviral hepatitis

LIVER BIOPSY – LIVER BIOPSY – Removal of a living Removal of a living tissue sample for tissue sample for analysis.analysis.

Open biopsy- With Open biopsy- With Abdominal Incision under Abdominal Incision under GAGA

Closed biopsy – Needle Closed biopsy – Needle aspiration for histologic aspiration for histologic study = performed under study = performed under local anesth.local anesth.

Preprocedure care Preprocedure care closed / needle biopsy closed / needle biopsy – teach client to – teach client to refrain from taking refrain from taking aspirin or NSAIDS aspirin or NSAIDS

Post procedure needle Post procedure needle biopsy – position on right biopsy – position on right sidelying during initial 1-sidelying during initial 1-2 hours to prevent 2 hours to prevent hemorrhage and bile hemorrhage and bile leakage, give vit. K if leakage, give vit. K if prescribed. prescribed.

Complications of Cirrhosis – Complications of Cirrhosis –

Portal HTN Portal HTN – as a result of – as a result of obstruction /hardening of liver obstruction /hardening of liver tissue inc in pressure in portal tissue inc in pressure in portal veinvein

AscitesAscites – as a result of portal – as a result of portal HTN – fluid accumulates in HTN – fluid accumulates in abdomenabdomen

Complications of Cirrhosis – Complications of Cirrhosis – Esophageal varices – Esophageal varices –

Fragile thin walled Fragile thin walled distended veins in the distended veins in the esophagus that is prone to esophagus that is prone to rupture rupture

Coagulation defectsCoagulation defects – – decreased synthesis of bile decreased synthesis of bile Dec. absorption of fat sol Dec. absorption of fat sol vitamins ex. Vit.K vitamins ex. Vit.K

Nursing Diagnosis: Nursing Diagnosis: Fluid Volume Deficit rel to Fluid Volume Deficit rel to hemorrhage ( bleeding hemorrhage ( bleeding esophageal varices)esophageal varices)

Risk of Injury rel to Risk of Injury rel to change in level of change in level of consciousness’ consciousness’

Liver Failure –Liver Failure – ESLD- ESLD- inability of liver to inability of liver to function – rise in function – rise in ammonia blood level, ammonia blood level, leading to Hepatic leading to Hepatic Coma.Coma.

Nursing InterventionsNursing Interventions

AssessmentAssessmentMain problem is Main problem is

decreasing LOC bec of decreasing LOC bec of accumulation of ammoniaaccumulation of ammonia

JaundiceJaundiceAbdominal painAbdominal pain

AscitesAscitesSpider angioma on nose Spider angioma on nose

cheeks upper thorax and cheeks upper thorax and shouldersshoulders

HepatomegalyHepatomegalyFetor hepaticusFetor hepaticus (fruity (fruity

breath)breath)

Asterixis (flapping Asterixis (flapping tremors)- wrist & tremors)- wrist & fingersfingers

Laboratories:Laboratories: inc in inc in Ammonia Level N= Ammonia Level N= ammonia 15-110 ug/dlammonia 15-110 ug/dl

Nursing InterventionsNursing InterventionsElevate Head of bed to min Elevate Head of bed to min

DOBDOBProvide vitamins B Provide vitamins B

complex, A,DEK & Ccomplex, A,DEK & CLow protein diet as Low protein diet as

prescribed to dec ammonia prescribed to dec ammonia productionproduction

Nursing InterventionsNursing InterventionsWeigh & measure Weigh & measure abdominal girth dailyabdominal girth daily

If IM drugs are If IM drugs are needed= use only needed= use only small gauge needles small gauge needles & inject only when & inject only when neededneeded

Nursing InterventionsNursing InterventionsEsophageal varices - Esophageal varices - Sengstaken – Sengstaken – Blakemore tubeBlakemore tube is is applied to stop applied to stop bleeding E varices) bleeding E varices) – – have scissors at the have scissors at the bedsidebedside

Nursing InterventionsNursing InterventionsAdminister Administer LactuloseLactulose as as

prescribed ( dec. pH w/c dec prescribed ( dec. pH w/c dec production of ammonia by the production of ammonia by the bacteria & facilitates the bacteria & facilitates the excretion of ammoniaexcretion of ammonia

Administer Administer NeomycinNeomycin(Mycifradin)- inhibit (Mycifradin)- inhibit bacteria = dec production of bacteria = dec production of ammoniaammonia

Nursing InterventionsNursing Interventions

Teach client to Teach client to avoid hepatotoxic avoid hepatotoxic drugsdrugs

DKA( DiabeticDKA( Diabetic Ketoacidosis) Ketoacidosis)

/ HHNS / HHNS ( Hyperglycemic( Hyperglycemic

Hyperosmolar Hyperosmolar nonketotic Syndrome)nonketotic Syndrome)

DKADKA- Is a life - Is a life threatening threatening complication of DM complication of DM type 1 = develops type 1 = develops bec of severe bec of severe insulin deficiency insulin deficiency

MANIFESTATATIONS = MANIFESTATATIONS = Hyperglycemia, Hyperglycemia, dehydration, electrolyte dehydration, electrolyte loss and acidosisloss and acidosis

CAUSE; Missed insulin CAUSE; Missed insulin dose, or infectiondose, or infection

HHNS- HHNS- SIMILAR TO SIMILAR TO dka WITH EXTTREME dka WITH EXTTREME hyperglycemia except hyperglycemia except that in HHNS there is that in HHNS there is no acidosis. This is for no acidosis. This is for DM type 2DM type 2

ASSESSMENT: ASSESSMENT: Blood glucose – 300 – Blood glucose – 300 – 800 mg/dl800 mg/dl

Low bicarbonate & Low bicarbonate & low pHlow pH

DehydrationDehydration

ASSESSMENT: ASSESSMENT: Mental status Mental status changeschanges

Neurological deficitsNeurological deficitsSeizuresSeizures

NURSING DX: NURSING DX: Fluid Volume deficit Rt Fluid Volume deficit Rt hyperosmolar diuresishyperosmolar diuresis

Risk for injury RT Risk for injury RT Mental status Mental status

changeschanges

NURSING INTERVENTION:NURSING INTERVENTION:Administer Insulin IV Administer Insulin IV push 5-10 units 1st push 5-10 units 1st then IV infusionthen IV infusion

NURSING INTERVENTION:NURSING INTERVENTION:Restore Fluids ( administer Restore Fluids ( administer

fluids as prescribed)fluids as prescribed)–Treat dehydration w/ rapid Treat dehydration w/ rapid infusion of NSS or .45% infusion of NSS or .45% salinesaline

–when blood glucose reaches when blood glucose reaches 250-300 mg/dl D5NS, or 250-300 mg/dl D5NS, or D5 .45%Saline is usedD5 .45%Saline is used

NURSING INTERVENTION:NURSING INTERVENTION:Always use infusion pump Always use infusion pump

for IV insulinfor IV insulinMonitor serum potassium ( Monitor serum potassium (

initially as a result of initially as a result of acidosis Hyperkalemia is acidosis Hyperkalemia is present upon admin of present upon admin of insulin K+ level drops)insulin K+ level drops)

NURSING INTERVENTION:NURSING INTERVENTION:Monitor LOC= too Monitor LOC= too rapid decrease in rapid decrease in blood glucose may blood glucose may cause cerebral edemacause cerebral edema

ADDISON’S DISEASE ADDISON’S DISEASE – – Is the hyposecretion Is the hyposecretion of adrenal cortex of adrenal cortex hormoneshormones

ADDISONIAN CRISIS/ Acute ADDISONIAN CRISIS/ Acute Adrenal Insufficiency-Adrenal Insufficiency- Is a Is a life threatening disorder life threatening disorder caused by acute adrenal caused by acute adrenal insufficiency precipitated by insufficiency precipitated by stress, infection, trauma or stress, infection, trauma or surgery. Without appropriate surgery. Without appropriate hormonal replacement it may hormonal replacement it may lead to shock.lead to shock.

ASSESSMENT:ASSESSMENT:Severe headacheSevere headacheSudden Severe lower leg Sudden Severe lower leg & lower back pain& lower back pain

Generalized weaknessGeneralized weaknessShockShock

NURSING INTERVENTION addisonian NURSING INTERVENTION addisonian crisis:crisis:

Correct hypoglycemia Correct hypoglycemia IV D5 glucose pushIV D5 glucose push

Prepare to administer Prepare to administer glucocorticoid IV glucocorticoid IV (Solucortef)(Solucortef)


Following crisis – Following crisis – glucocorticoids orallyglucocorticoids orally

Monitor blood Monitor blood pressure to assess for pressure to assess for shockshock


Monitor LOCMonitor LOCProtect client from Protect client from infectioninfection

Monitor electrolyte Monitor electrolyte imbalancesimbalances

THYROID CRISIS – (THROID THYROID CRISIS – (THROID STORM/ Thyrotoxicosis)STORM/ Thyrotoxicosis)- - Acute life threatening condition Acute life threatening condition that occurs in a client with that occurs in a client with uncontrollable hyperthyroidism uncontrollable hyperthyroidism – maybe a result of – maybe a result of manipulation of thyroid gland manipulation of thyroid gland during surgery(release of during surgery(release of thyroid hormones to thyroid hormones to bloodstream) bloodstream)

THYROID CRISIS – THYROID CRISIS – (THROID STORM/ (THROID STORM/ Thyrotoxicosis)Thyrotoxicosis)- -

Causes: Undiagnosed , Causes: Undiagnosed , untreated untreated hyperthyroidism, hyperthyroidism, infection, trauma infection, trauma

Medical management:Medical management:Antithyroid Antithyroid medications; beta medications; beta blockers; blockers; glucocorticoids & glucocorticoids & iodides are given iodides are given before surgery to before surgery to prevent thyroid crisisprevent thyroid crisis

Medical management:Medical management:Antithyroid medsAntithyroid meds: : Iodide, Propylthiouracil, Iodide, Propylthiouracil, MethimazoleMethimazole

Iodides/ Iodine = Reduce Iodides/ Iodine = Reduce the vascularity of the the vascularity of the thyroid gland before thyroid gland before thyroidectomy,thyroidectomy,

Medical management:Medical management:Iodides= used in the Iodides= used in the treatment of thyroid treatment of thyroid storm because it enables storm because it enables the storage of TH in the the storage of TH in the thyroid gland.thyroid gland.

Medical management:Medical management:However it is given However it is given only for 10-14 days only for 10-14 days Because eventually it Because eventually it looses its effect on looses its effect on the thyroid gland.the thyroid gland.

NURSING INTERVENTION:NURSING INTERVENTION:ASSESSMENT : elevated ASSESSMENT : elevated Temp ( high fever); Temp ( high fever); tachycardia; agitation; tachycardia; agitation; tremorstremors

Maintain a patent airway Maintain a patent airway

NURSING INTERVENTION:NURSING INTERVENTION:Administer Administer antithyroid meds as antithyroid meds as prescribed ( sodium prescribed ( sodium iodide solution)iodide solution)

Monitor VSMonitor VS

MULTI ORGAN DYSFUNCTION SYNDROME

(MODS)SEPSIS, DEAD TISSUE,

PNEUMONITIS, PANCREATITIS

RESPIRATORY FAILURE

INTUBATION (maybe stable for 7-14 days)

MALFUNCTION of GI

SEEDING OF BACTERIA FR. GI TO OTHER ORGANS

HYPERMETABOLIC STATE

HYPERMETABOLIC STATE (hyperglycemia, hyperlactacidemia, ulceration in GI-seeding of bacteria from GI to other organs)(skin breakdown, loss of muscle mass, delayed healing of surgical wounds)(mortality rate 60%)

LIVER FAILURE(jaundice),

RENAL FAILURE(mortality rate 90-100%)

Criteria for Dx of Criteria for Dx of MODSMODS

Cardiovascular Failure Cardiovascular Failure presence of 1 or more of the ff:presence of 1 or more of the ff:<54 bpm<54 bpmSystolic < 60 mm HgSystolic < 60 mm HgVtach/ V fibVtach/ V fibpH < 7.24pH < 7.24


RR < 5/min RR < 5/min RR> 49/minRR> 49/min

Renal Failure presence of 1 or Renal Failure presence of 1 or more of the ff:more of the ff:

Output < 479 ml/24 hrOutput < 479 ml/24 hr or < 159 ml/ 8 hror < 159 ml/ 8 hrBUN > 100mg/dlBUN > 100mg/dlCrea > 3.5mg/dlCrea > 3.5mg/dl

Hematologic Failure presence Hematologic Failure presence of 1 or more of the ff:of 1 or more of the ff:

WBC < 1000 uLWBC < 1000 uLPlatelets < 20,000Platelets < 20,000HCT < 20%HCT < 20%

Hepatic failure presence of both Hepatic failure presence of both of the FF:of the FF:

Bilirubin > 6 mg %Bilirubin > 6 mg %PT > 4 sec over PT > 4 sec over control in absence of control in absence of anticoagulationanticoagulation

(normal PT – 11-12sec)(normal PT – 11-12sec)

Neurologic FailureNeurologic Failure

GCS < 6 in GCS < 6 in absence of absence of sedationsedation

Med MGT: Med MGT: Control of infection w/ Control of infection w/

antibiotics ( common MRSA antibiotics ( common MRSA & Vancomycin resistant& Vancomycin resistant

Aggressive pulmonary Aggressive pulmonary care mech vent & O2 care mech vent & O2 (intubation)(intubation)

Enteral (NGT) feedingEnteral (NGT) feeding

NRSNG MGT: Limited NRSNG MGT: Limited : effective client & : effective client &

family copingfamily coping

acute biologic crisis

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