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Female, 47 years old, Subarachnoid Hemorrhage, Medications, Ineffective…

- - - - Goal: Patient will remain free of pressure injuries for the duration of their hospital stay.
        
        Turn or reposition patient every 2 hours while in bed.
        
        Provide frequent changes if patient is incontinent.
        
        Keep patient's skin clean by giving a daily bed bath and changing their gown and linens.
      - Assess patient daily for signs of skin breakdown, including underneath soft restraints.
- - - - Acute Kidney Injury
        
        Etiology/Risk Factors
        
        Dehydration
        
        Infection or septic shock
        
        Medications such as aspirin, ibuprofen, or naproxen
        
        Blood or fluid loss
        
        Hypotension
        
        MI
        
        Liver failure or cirrhosis*
        
        Severe burns
        
        Sever anaphylaxis
        
        Alcohol use*
        
        High cholesterol
        
        Uncontrolled hyperglycemia
        
        Kidney stones
        
        Being hospitalized for a serious condition requiring intensive care*
        
        Hypertension*
        
        Certain cancers
        
        Diagnostic Tests
        
        Cr: 1.53
        
        BUN: 29
        
        GFR: 78
        
        Ultrasound of kidneys
        
        MRI
        
        CT without contrast
        
        Kidney biopsy
        
        Low urine output
        
        Urine osmolality
        
        Electrolyte imbalances: phosphorous 2.0
        
        Pathophysiology:
        -a rapid decline in kidney function that happens within a few hours to within a day
        -causes a buildup of nitrogenous waste products and impairs fluid and electrolyte imbalanace
        -is potentially reversible if the precipitating factors can be corrected or removed prior ro the occurrence of permanent kidney damage
      - Hepatic Encephalopathy
        
        Pathophysiology:
        -refers to central nervous system manifestations of liver failure
        -ealry signs include asterisks, memory loss, speech impairment, and personality changes such as euphoria, irritability, anxiety, and lack of concern with self and personal appearance
        -progression to decerebrate rigidity, coma, and death
        -caused by the accumulation of neurotoxins, such as ammonia, appear in the blood due to the liver having lost its capacity to detoxify
        
        Etiology/Risk Factors
        
        Renal failure*
        
        Gastrointestinal bleeding such as esophageal varices*
        
        Constipation*
        
        Infections
        
        Medication noncompliance*
        
        excessive dietary protein
        
        Dehydration due to factors such as fluid restrictions, diuretics, diarrhea, vomiting, or excessive paracentesis
        
        Electrolyte imbalances*
        
        Alcohol consumption*
        
        Liver failure*
        
        Diagnostic Tests
        
        CT or MRI of brain: scattered small volume SAH bilateral
        
        AST: 108
        
        ALT: 62
        
        Bilirubin: 14.66
        
        Ammonia: 87
        
        Doppler ultrasound of blood flow through the liver
        
        EEG to measure brain activity
        
        Urobilinogen in urine
      - Pathophysiology: -involves a loss of control over the ability to drink moderately resulting in negative consequences that impact relationships, physical health, mental health, and the ability to fulfill role obligations
        -alcohol is used in increasing amounts to achieve the same effect and the absence of alcohol results in withdrawal symptoms
        -patients experience intense cravings for alcohol that drive ongoing consumption
        -alcohol affects reward systems such as the endogenous opioid system, glutamate, serotonin, and dopamine
      - Diagnostic Tests
        
        CIWA scale
        
        DSM-5 criteria
        
        Physical exam including liver enlargement, jaundice, hand tremors, unsteady gait: patient has jaundice skin and sclera, abdominal CT showed enlarged liver
        
        History of drinking: patient has a long history of drinking
        
        ALT: 62
        
        AST: 108
        
        Blood alcohol concentration
      - Etiology/Risk Factors
        
        steady drinking over time (binge drinking regularly)*
        
        family history of alcoholism
        
        history of depression, anxiety, schizophrenia, or bipolar disorder
        
        history of trauma
        
        having bariatric surgery
        
        start consuming alcohol at an early age