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Classification Systems for Acute Kidney Injury

Classification Systems for Acute Kidney Injury Background:- Acute kidney injury (AKI), formerly called acute renal failure (ARF), is commonly defined as an abrupt decline in renal function, clinically manifesting as a reversible acute increase in nitrogen waste products—measured by blood urea nitrogen (BUN) and serum creatinine levels—over the course of hours to weeks. The vague nature of this definition has historically made it difficult to compare between scholarly works and to generalize findings on epidemiologic studies of AKI to patient populations. Several classification systems have been developed to streamline research and clinical practice with respect to AKI.   Acute Kidney Injury Network:- In September 2004, the Acute Kidney Injury Network (AKIN) was formed. AKIN advised that the term acute kidney injury (AKI) be used to represent the full spectrum of renal injury, from mild to severe, with the latter having incre
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HOW TO PERFORM OPEN TRACHEAL SUCTION VIA AN ENDOTRACHEAL TUBE

HOW TO PERFORM OPEN TRACHEAL SUCTION VIA AN ENDOTRACHEAL TUBE  [ Credland N (2016) How to perform open tracheal suction via an endotracheal tube. Nursing Standard. 30, 35, 36-38. [Date of submission]: January 11 2016; [date of acceptance]: February 25 2016 ] RATIONALE AND KEY POINTS:- Tracheal suctioning involves the removal of pulmonary secretions from the respiratory tract using negative pressure under sterile conditions. Nurses should be aware of the risks associated with open tracheal suction via an endotracheal tube and recognise appropriate indications for tracheal suction. They should have the knowledge and competence to perform tracheal suction effectively and an understanding of the patient experience of the procedure. Ø   Respiratory assessment of the patient should be carried out to identify when tracheal suction is required. Ø   A suction pressure of 80-120mmHg is recommended, and suction should last no longer than 15 seconds. Ø   Reassurance and support
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SSC Guidelines -Updated Bundles in Response to New Evidence

                                  Updated Bundles in Response to New Evidence The leadership of the Surviving Sepsis Campaign (SSC) has believed since its inception that both the SSC Guidelines and the SSC performance improvement indicators (1) will evolve as new evidence that improves our understanding of how best to care for patients with severe sepsis and septic shock becomes available. With publication of 3 trials (2,3,4) that do not demonstrate superiority of required  use of a central venous catheter (CVC) to monitor central venous pressure (CVP) and central venous oxygen saturation (ScvO2) in all patients with septic shock who have received timely antibiotics and fluid resuscitation compared with controls or  in all patients with lactate >4 mmol/L, the SSC Executive Committee has revised the improvement bundles as follows: TO BE COMPLETED WITHIN 3 HOURS OF TIME OF PRESENTATION*: 1. Measure lactate level 2. Obtain blood cultures prior to administration of antibiotics
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Asthma Guideline

Royal Children’s Hospital, Melbourne Australia Asthma Guideline Assessment and management Children with respiratory distress should have    minimal handling .   SaO2:   Oxygen may be required for low saturations, DO NOT give for wheeze or increased work of breathing.  The arterial oxygen saturation (SaO2) may be reduced in the absence of significant airway obstruction due to factors such as atelectasis and mucous plugging of airways. SaO2 is purely a measure of oxygenation, which may be preserved in the presence of deteriorating ventilation (with CO2 retention). Tachycardia can be a sign of severity - but is also a side effect of beta agonists such as salbutamol.   Severity    Signs of Severity    Management   Mild Normal mental state Subtle or no increased work of breathing accessory muscle use/recession. Able to talk normally Salbutamol by MDI/spacer (dose below table) - give once and review after 20
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GASTRIC RESIDUAL VOLUME

GASTRIC RESIDUAL VOLUME NUTRITION SUPPORTS IN CRITICALLY ILL PATIENTS MONITORING:- Patients on tube feeding are at risk for fluid imbalance, gut dysfunction,and electrolyte imbalance.Refeeding syndrome is often seen in chronically under nourished patients,especially  those with electrolyte losses such as diarrhea,vomiting or renal wasting. It has long been standard clinical practice to check the patients gastric residual volume[GRV] at regular intervals and / or prior to increasing the infusion rate of gastric tube feeding. This was done based on the theory that the risk of pneumonia would be minimized by recognizing gastric fluid accumulation and therefore predicting and reducing vomiting. However, this practice has now been shown to lack benefit, and is no longer recommended .If GRV is measured, volumes of less than 500ml should not result in the holding of the feeds unless other signs of intolerance, such as distension, nau
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Gastrointestinal Infections in the ICU

Gastrointestinal Infections in the ICU    Intra-abdominal infections are a major cause of morbidity, mortality and antibiotic expenditure in the ICU [21]. Accurate and timely diagnosis can have a major impact on clinical outcome, antimicrobial selection, healthcare cost and need for surgical intervention. Spontaneous bacterial peritonitis in the ICU is commonly seen in decompensated cirrhotic patients, likely due to the translocation of overgrowing enteric bacteria (usually gram negative organisms, although MRSA has been commonly described in ICU patients) across an anatomically intact gastrointestinal tract. Gastrointestinal wall perforation or ulceration can result in polymicrobial seeding into neighboring areas, resulting in signs of acute abdomen. Localized pain suggests the infection is walled-off in the area directly associated with the area of seeding, whereas diffuse pain suggests generalized peritonitis. Intra-abdominal abscesses, bowel perforation, cholecystitis, and ascend
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Thinking About Plan B? - Nurses in Business

Thinking About Plan B? - Nurses in Business It is an exciting time to be a nurse! There are so many options for nurses including owning a business. Although most nurses do not see themselves as entrepreneurs, nurses are educated in a scientific method of problem solving and resolution that equips them for a successful transition into an entrepreneurial role. It is an exciting time to be a nurse! There are so many options for today’s nurse and one area that is growing is nurses interested in becoming business owners. What is creating this need for  Plan   B usiness? Well one thing is that the number of nurses employed by hospitals is decreasing from what it has been for decades. Today, about 58% of nurses are employed by hospitals compared to 68% in 1980. Many nurses, over 30%, report being burned out and highly dissatisfied with their jobs. The dissatisfaction relates to feelings of frustration, being overwhelmed with new technology (equipment and EMRs) and overworked due to high
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