got into NP school. start august 23. been busy gettin things in order!

NP school

i am ACTUALLY applying for fall 2018 start in a dual FNP/AGACNP program. here is hoping

caringintensely:
“ No.
Talk about setting an impossible standard. Talk about empty words that set new nurses up for disappointment.
New nurses, hear me.
YOU WILL have days when your compassion runs dry and you take care of your patient simply because...

caringintensely:

No.

Talk about setting an impossible standard. Talk about empty words that set new nurses up for disappointment.

New nurses, hear me.

YOU WILL have days when your compassion runs dry and you take care of your patient simply because it’s your job, and you have to, not because you are some kind of angel.

YOU WILL pull another nurse into the med room to chew out the family member who is driving you insane.

YOU WILL cause your patient pain. With just about everything you go into the room to do. Heparin shots, enemas, dressing changes, repositioning patients in pain, making them get out of bed after surgery when all they want to do is rest. You will do these things because it is for their good, and because recovery is painful and they need someone to lead them through it.

And you will have a day when you drive home from the hospital and cry and come to the conclusion that nursing was a huge mistake, you can’t do it, it’s too hard.

If we don’t tell you to expect it, you may not realize that you are incorrect and that you’re simply coming to grips with the reality of a profession that can push you to your limits in every way.

We have a high calling as nurses, but don’t romanticize it too much in your mind. We’re just people.

(via nursingisinmyblood)

THIS

Pre-renal: decreased perfusion

  • decreased volume
  • decreased albumin
  • restrictive cardiac disease

Intra-renal: tubular or glomerular defect

Post-renal: outflow obstruction

renal nephrology CCRN review

Increased Intracranial Pressure

thefuturern:

(>20 mm Hg) Due to a rigid and fixed skull, there is no room for any additional fluid, blood, or lesions. Additional matter without an expansion of volume, especially, creates increased pressure. Increased intracranial pressure is very serious and could lead to brain herniation and subsequent death.

Causes

  • Brain tumors
  • CNS infections
  • Cerebral edema
  • Intracranial bleeding
  • Excess CSF

Manifestations

  • Changes in level of consciousness (LOC) ***often the first indication***

Glasgow Coma Scale measures LOC via eye, motor, and verbal responses to stimulus from the environment. It scores from 3-15 w/ 8 being the “magic number” - think magic 8 ball. If you shake it up, or stimulate it, and a number < 8 appears a severe coma is present. 9-12 represents a moderate coma. 13-14 represents a mild coma.

  • Blurred vision
  • Coma
  • Decerebrate posture (extension of arms indicative of brain stem involvement)
  • Diplopia
  • Doll’s eye phenomena
  • Headache
  • Projectile vomiting
  • Behavior changes
  • Seizures
  • Cushing’s reflex (as manifested by Cushing’s triad):  increased BP w/ widening PP (peripheral resistance increased to shunt blood towards the oxygen-needy brain), decreased pulse rate (in a vagal-induced response to rising BP), decreased/irregular (Cheyne Stokes) respirations

Indicative of impending herniation - emergent medical response necessary.

Treatment of ICP

  • Keep HOB elevated at 30 degrees
  • Keep patient well hydrated
  • Frequent neuro-checks needed
  • Strict I&O
  • Anticonvulsants for seizure prevention (phenytoin)
  • Mannitol (osmotic diuretic used to reduce cerebral edema)
  • Loop diuretics
  • Avoid aspirin, narcotics, or meds that depress respirations (as they are already at risk for being low)
  • Hyperventilate patient (blow off CO2 [hypocapnia]) to decrease cerebral blood flow (cerebral vasoconstriction in response to low CO2 levels)
  • Decrease environmental stimuli
  • initiate seizure and safety precautions (padded side rails up, call light w/in reach)

ICP intracranial pressure neuro neurology CCRN review nurblr nursing nurse

the Monro-Kellie hypothesis

The Monro-Kellie doctrine states that three things exist within the fixed dimensions of the skull: blood, cerebrospinal fluid, and brain. An increase in any one component must necessarily lead to a decrease in one (or both) of the other components, otherwise intracranial pressure will increase.

Increases in one of the three components can take many different shapes and sizes. For example, abnormal bleeding within the cranium such as in epidural and subdural hematomas are common examples, which typically occur after traumatic events (think car accidents, falls, etc). Bleeding within the brain tissue itself - known as an intraparenchymal or intracerebral hematoma - can also occur, especially in patients with untreated high blood pressure. Brain tumors of any type effectively increase the amount of brain tissue. And last, but not least, the cerebrospinal fluid can back up in a condition known as “hydrocephalus”.

Regardless of the cause, the end result is an abnormal increase in either blood, brain, or cerebrospinal fluid within the confines of the skull.

So what’s the big deal? If the abnormality becomes large enough, the pressure within the skull can increase rapidly. Eventually the pressure can become so great that the brain gets squished, and will pop over rigid boundaries and out the small holes within the skull.

This is known as “herniating” the brain tissue. It can occur in numerous places within the skull depending on where the pressure is greatest. However, the most important herniation clinically occurs at the base of the skull where a hole known as the foramen magnum exists.

When the brain herniates here it really pisses off a vital structure known as the brainstem. The brainstem is responsible for all the stuff we don’t consciously think about (heart rate, breathing, etc.), which ultimately keeps us alive. When herniation of the brainstem through the foramen magnum occurs it stretches all the “wires” that allow our brainstem to function properly. If severe enough, all those autopilot functions (ie: breathing, beating of the heart, etc.) stop working and brain death occurs.

neuro neurology monro-kellie hypothesis monro-kelli doctrine ICP intracranial pressure CCRN review nurblr


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