NR 341 EXAM 3 STUDY NOTES
Adrenal Crisis “Addisonian Crisis” p. 1178-1179
- A condition in which the pituitary gland doesn’t make enough
... [Show More] adrenocorticotropic hormone or ACTH
- A medical emergency and potentially life-threatening situation and require immediate emergency treatment
- Causes of Adrenal Crisis
• When the body cannot produce sufficient amounts of cortisol
• Caused by either previously undiagnosed or untreated Addison’s disease
• Suddenly stopping intake of glucocorticoids
- Signs and Symptoms of Adrenal Crisis
• Weakness
• Mental confusion – loss of consciousness
• Dizziness
• N/V
• Extreme low BP
• Chills
• Rash
• Sweating
• High HR
- Diagnosis and Treatment of Adrenal Crisis
• Cosyntropin stimulation test
• Cortisol level test
• Immediate injection of hydrocortisone
- Kidneys filter blood and regulate blood pressure
Acute Kidney Injury p. 1070-1074
- Acute kidney injury (acute renal failure – ARF)
• Sudden deterioration of renal function
• Changes in the vital signs
• Signs of hypo- or hypervolemia
• Patient history
o Predisposing factors
• Disease states
o HTN
o DM
o Immunologic disease
o Hereditary disorders
• Hypotensive episodes
• Exposure to nephrotoxic agents
- Clinical Presentation of AKI
• Vital signs may be altered
o BP changes depending on etiology
o Hyperventilation to compensate for metabolic acidosis
o Body temperature may be altered
• Assess for volume depletion and volume overload
- Laboratory Test of AKI
• Serum creatinine
• Serum BUN
o Affected by catabolism, bleeding, and dehydration
• BUN: Creatinine ration
o Normal 10:1 to 20:1
o More than 20:1, suspect non-renal causes of laboratory abnormalities
• Urine creatinine clearance
o Estimate of GFR
o 24-hour urine; specific collection protocol
o Normal 84-138 mL/min
o Can calculate an estimated value with serum lab values (Cockroft and Gault formula)
• Urine electrolytes
• Urine specific gravity
• Urine osmolarity
- Hyperkalemia
• Due to decreased GFR
• Reduced content
o Kayexalate
o Mineralocorticoids
o Diuretics
• Shift intracellularly
o Glucose and insulin
o Alkali (sodium bicarbonate)
• Antagonize cellular membrane effect
o Calcium gluconate
- Hyponatremia
• Related to fluid overload
• Salt wasting can occur as nephron are damaged
• Treatment – fluid and sodium restriction
- AKI – Acid Base Imbalances
• Metabolic acidosis
o Treatment based on severity of imbalance
o May need IV bicarbonate
o Monitor ionized calcium as hypocalcemia can occur as pH is corrected
- Fluid and Electrolyte Imbalances
• Hyperkalemia
o Low excretion
• Hyponatremia
o Fluid retention
• Hypocalcemia
o Low excretion of phosphorus
o Decreased level of vitamin D
• Hyperphosphatemia
o Low excretion
• Hypermagnesium
o Low excretion
- AKI – Diagnostic Studies
• Non-invasive tests
o X-ray of kidneys, ureter, and bladder (KUB)
• Size, shape, and position of kidneys
• Calculi, cysts, and tumors
o Renal ultrasound
• Size of kidneys
• Obstruction
• Invasive tests
o IV pyelogram
o Computed tomography
• Structures, accumulation of fluid
o Renal angiography
• Abnormalities in blood flow; infarction, masses
o Renal scan
• Renal uptake of isotopes
o Renal biopsy
• Histologic changes
- AKI Course (slide 12 – didn’t talk about)
• Initiation Phase
o Time from event to signs of decreased renal perfusion
• Few hours to 2 days
o Potentially reversible
• Maintenance Phase (oliguric / anuric)
• Recovery Phase
- AKI – Diuretic Therapy
• Controversial
o Convert oliguria to non-oliguric state [Show Less]