COMPLETE

CRITICAL CARE
STUDY GUIDE

JDMA NURSING SCHOOL

 INDEX
Category Topics Included
Stroke Neuromuscular Disorders

Seizures Sedation and Analgesia

Neurologic Traumatic Brain Injury Intracranial Hypertension

Glasgow Coma Scale

Neurological Infections

Angina Left- vs. Right-Heart Failure

Heart Blocks Hemodynamic Parameters

Cardiac Cardiac Arrhythmias

Acute Coronary Syndromes

Acute Valvular Heart Disease

Asthma Respiratory Infections

Chest tubes Pulmonary Embolism (PE)
Respiratory Airway Management Oxygen Therapy
Acute Kidney Injury (AKI)

Chronic Kidney Disease Sepsis Associated AKI

Renal Complications Renal Pharmacotherapy

Renal Renal Replacement Therapy

Acid Base and Electrolyte Disorder

Sepsis Disaster Triage

Burns Trauma & Emergency Care
Shock Drug Overdose & Poisoning
Others Organ Donation
Burn Care Phases & Fluid Resuscitation
 COMPLETE

NEUROLOGIC
STUDY GUIDE

JDMA NURSING SCHOOL

 Stroke
A stroke is your brain’s equivalent of a heart attack, happening when
there’s an issue with blood flow to part of your brain. This can happen
when blood vessels are blocked or because of bleeding in your brain.
Strokes are a life-threatening emergency, and immediate medical attention
is critical to prevent permanent damage or death.

A stroke is a life-threatening condition

that happens when part of your brain
doesn’t have enough blood flow. This
most commonly happens because of a
blocked artery or bleeding in your
brain. Without a steady supply of
blood, the brain cells in that area start
to die from a lack of oxygen.

IMPORTANT: A stroke is a life-threatening emergency condition where

every second counts. If you or someone with you has symptoms of a stroke,
IMMEDIATELY call 911 (or your local emergency services number). The
quicker stroke is treated, the more likely you’ll recover without disability.
To recognize the warning signs of a stroke, remember to think FAST:
F. Ask the person to smile. Look for a droop on one or both sides of their
face, which is a sign of muscle weakness or paralysis.
A. A person having a stroke often has muscle weakness on one side. Ask
them to raise their arms. If they have one-sided weakness (and didn’t
have it before), one arm will stay higher while the other will sag and
drop downward.
S. Strokes often cause a person to lose their ability to speak. They might
slur their speech or have trouble choosing the right words.
T. Time is critical, so don’t wait to get help! If possible, look at your
watch or a clock and remember when symptoms start. Telling a
healthcare provider when symptoms started can help the provider
know what treatment options are best for you.
 Stroke Symptoms

The symptoms of stroke can involve one or more of the following:

One-sided weakness or paralysis.

Aphasia (difficulty with or loss of speaking ability).
Slurred or garbled speaking (dysarthria).
Loss of muscle control on one side of your face.
Sudden loss — either partial or total — of one or more senses (vision,
hearing, smell, taste and touch).
Blurred or double vision (diplopia).
Loss of coordination or clumsiness (ataxia).
Dizziness or vertigo.
Nausea and vomiting.
Neck stiffness.
Emotional instability and personality changes.
Confusion or agitation.
Seizures.
Memory loss (amnesia).
Headaches (usually sudden and severe).
Passing out or fainting.
Coma.
 What causes a stroke?
Ischemic strokes and hemorrhagic strokes can happen for many reasons.
Ischemic strokes usually happen because of blood clots.
These can happen for various reasons, such as:
Atherosclerosis.
Clotting disorders.
Atrial fibrillation (especially when it happens due to sleep apnea).
Heart defects (atrial septal defect or ventricular septal defect).
Microvascular ischemic disease (which can block smaller blood
vessels in your brain).
Hemorrhagic strokes can happen for several reasons also, including:
High blood pressure, especially when you have it for a long time,
when it’s very high, or both.
Brain aneurysms can sometimes lead to hemorrhagic strokes.
Brain tumors (including cancer).
Diseases that weaken or cause unusual changes in blood vessels in
your brain, such as moyamoya disease.

RELATED CONDITIONS

Several other conditions and factors can contribute to a person’s

stroke risk. These include:
Alcohol use disorder.
High blood pressure (this can play a role in all types of strokes, not
just hemorrhagic ones because it can contribute to blood vessel
damage that makes a stroke more likely).
High cholesterol (hyperlipidemia).
Migraine headaches (they can have symptoms similar to a stroke, and
people with migraines — especially migraines with auras — also have
a higher risk of stroke at some point in their life).
Type 2 diabetes.
Smoking and other forms of tobacco use (including vaping and
smokeless tobacco).
Drug misuse (including prescription and non-prescription drugs).
 Types of Brain Stroke
Brain stroke is mainly two types.
Ischemic stroke: It is the most common type and contributes to 80%
of brain strokes.
Hemorrhagic stroke: It contributes to 20% of brain strokes.
Ischemic stroke can be either thrombotic or embolic.
Thrombotic stroke is the most common type of ischemic stroke. A
blood clot forms inside a diseased or damaged artery in the brain
resulting from atherosclerosis (cholesterol containing deposits called
plaque), blocking blood flow.
Embolic stroke is caused when a clot or small piece of plaque formed
in one of the arteries leading to the brain or in the heart, is pushed
through the blood stream and lodges in narrower brain arteries. The
blood supply is cut off from the brain due to the clogged vessel.
Haemorrhagic stroke can be due to Intracerebral haemorrhage or
Subarachnoid haemorrhage.
Intracerebral haemorrhage is the bleeding that occurs within the
brain tissue, most common cause is due to changes in the arteries
caused by long-term Hypertension.
Subarachnoid haemorrhage is bleeding that occurs between the
surface of the brain and skull. Common causes being cerebral
aneurysm or arteriovenous malformation (AVM).
 Seizures
Seizures are changes in the brain’s electrical activity. These changes can
cause dramatic, noticeable symptoms or no symptoms at all.
The symptoms of a severe seizure include violent shaking and a loss of
control. Because some seizures can lead to injury or be a sign of an
underlying medical condition, it’s important to seek treatment if you
experience them.

Types of seizures
The three Trusted Source major types are focal onset seizures,
generalized onset seizures, and unknown onset seizures.

Focal onset seizures Focal aware seizure

Focal onset seizures occur in only During a focal aware seizure, you’ll
one areaTrusted Source of the brain. remain fully conscious and be aware
People may also refer to these as that something is happening, even if
partial seizures. you do not recognize it as a seizure.
Focal onset seizures can start in The symptoms of a focal aware
small areas of the brain, such as a seizure will depend on which part of
single lobe, but can affect large the brain the seizure starts.
areas. Focal aware seizures may be
Medical professionals typically split singular events but can also develop
focal onset seizures into two types: into other types of seizures. For this
focal aware seizures and focal reason, people often refer to them
awareness-impaired seizures. as warnings or auras.

Focal impaired-awareness seizure

This type of seizure affects your consciousness. During a focal impaired-
awareness seizure, you may not be able to move, talk, or hear as you did
before. You may also not be able to remember the event.
Focal impaired-awareness seizures can last for up to 2 minutesTrusted
Source. This type of seizure typically affects a larger portion of the brain
than focal aware seizures.
 Generalized onset seizures
These seizures start in both sides of the brain simultaneously. Among the
more common types of generalized onset seizures are:
Tonic.
Tonic seizures will result in your muscles stiffening up.
Clonic.
The convulsions in clonic seizures may cause abnormal, jerky movements
of your limbs. You will likely lose consciousness during these seizures that
can last for a few minutes.
Tonic-clonic.
Tonic-clonic seizures include a combination of both tonic and clonic
symptoms.
Myoclonic.
During a myoclonic seizure you may experience sudden muscle spasms.
These are typically too short lived to affect consciousness and pass quickly.
Myoclonic seizures may be of generalized onset as well as focal onset.
Absence.
People may also refer to these as petit mal seizures. Absence seizures last
for only a few seconds. They can cause you to blink repeatedly or stare into
space. Other people may mistakenly think you’re daydreaming.
Atonic.
During atonic seizures your muscles suddenly go limp. Your head may nod,
or your entire body could fall to the ground. Atonic seizures are brief,
lasting about 15 seconds. People may refer to these seizures as drop attacks.

Generalized onset seizures

Sometimes no one witnesses the beginning of a seizure.

For example, someone may wake up in the middle of the night and observe
their partner having a seizure.
This often means there’s insufficient evidenceTrusted Source for medical
professionals to diagnose the root cause of a seizure. In these instances,
they will define the seizure as an unknown onset seizure.
 Symptoms of a Seizure
You can experience both focal and generalized seizures simultaneously, or
one can happen before the other. The symptoms can last anywhere from a
few seconds to several minutesTrusted Source per episode.
Sometimes symptoms occur before the seizure takes place. These can
include:
a sudden feeling of fear or anxiousness
a feeling of being sick to your stomach
dizziness
a change in vision
a jerky movement of the arms and legs that may cause you to drop
things
an out-of-body sensation
a headache
deja vu
Signs that indicate a seizure is in progress include:
losing consciousness, followed by confusion
having uncontrollable muscle spasms
drooling or frothing at the mouth
falling
having a strange taste in your mouth
 Glasgow Coma Scale
The Glasgow Coma Scale (GCS) is used to describe the level of
consciousness in an individual.
It is often used to gauge the severity of an acute brain injury due to
trauma or medical cause. The test is simple, reliable, and correlates
well with outcomes following brain injury. It is composed of 3
domains which are assessed separately and given numerical scores.
The sum of these scores is the Glasgow Coma Score.
The three areas are

1. Eye Opening,
2. Verbal Response, and
3. Motor Activity.

EYE VERBAL MOTOR

OPENING RESPONSE RESPONSE

Obeys commands 6
Spontaneous 4 Oriented 5
Localising 5
To sound 3 Confused 4
Withdrawl 4
Words 3
To pressure 2 Abnormal flexion 3
1 Sounds 2 Extension 2
None
None 1 None 1

Glasgow Coma Scale Scoring

Mild Moderate Severe

13-15 9-12 3-8
 EYE-OPENING (1-4 Points)

1. Does not open eyes in response to anything.

2. Opens eyes in response to painful stimuli.
3. Opens eyes in response to voice.
4. Opens eyes spontaneously.

VERBAL RESPONSE (1-5 Points)

1. Makes no sounds.
2. Incomprehensible sounds.
3. Utters incoherent words.
4. Confused, disoriented.
5. Oriented, converses normally.

MOTOR ACTIVITY (1-6 Points)

1. Makes no movements.
2. Decerebrate (extensor) posture (an abnormal posture that can include
rigidity, arms and legs held straight out, toes pointed downward, head
and neck arched backward).
3. Decorticate (flexor) posture (an abnormal posture that can include
rigidity, clenched fists, legs held straight out, and arms bent inward
toward the body with the wrists and fingers bend and held on the
chest).
4. Withdrawal from painful stimuli.
5. Localizes to painful stimuli.
6. Obeys commands.
 EXAMPLE

So a patient who has scores of Eye = 3, Verbal = 4 and Motor = 5 is said to

have a GCS of 12.
You would express this as a GCS 12 = E3, V4, M5.
There are some GCS scores that are significant and must be memorized:
3: The lowest possible GCS; this indicates a patient is wholly
unresponsive.
8: The point of intubation; any patient with an 8 or lower is strongly
considered for intubation, as they are unlikely to maintain a patent
airway.
15: The highest GCS score; a patient who opens their eyes
spontaneously, is oriented and alert, and obeys commands has a GCS of
15.

MODIFIERS

Modifiers are used to eliminate misleading scores--it's all about accuracy,

especially as it pertains to outcomes. For example:
You can communicate that the patient is intubated with modifiers like
V1t where it indicates that the patient makes no verbal sounds but it's
secondary to an (endotracheal) tube.
Other common modifiers are E1c where "c" stands for closed due to
swelling or damage. Sometimes, the "1" is omitted, and instead of using
V1t, you could just see Vt since, in that case, the 1 is seen as a
redundancy.
 Traumatic Brain Injury
Traumatic brain injury (TBI) happens when a sudden, external, physical
assault damages the brain. It is one of the most common causes of
disability and death in adults. TBI is a broad term that describes a vast
array of injuries that happen to the brain. The damage can be focal
(confined to one area of the brain) or diffuse (happens in more than one
area of the brain). The severity of a brain injury can range from a mild
concussion to a severe injury that results in coma or even death.

What are the different types of TBI?

Brain injury may happen in one of two ways:

Closed brain injury.

Closed brain injuries happen when there is a nonpenetrating injury to
the brain with no break in the skull. A closed brain injury is caused by
a rapid forward or backward movement and shaking of the brain
inside the bony skull that results in bruising and tearing of brain tissue
and blood vessels. Closed brain injuries are usually caused by car
accidents, falls, and increasingly, in sports. Shaking a baby can also
result in this type of injury (called shaken baby syndrome).
Penetrating brain injury.
Penetrating, or open head injuries happen when there is a break in the
skull, such as when a bullet pierces the brain.

What is diffuse axonal injury (DAI)?

Diffuse axonal injury is the shearing (tearing) of the brain's long

connecting nerve fibers (axons) that happens when the brain is injured as
it shifts and rotates inside the bony skull. DAI usually causes coma and
injury to many different parts of the brain. The changes in the brain are
often microscopic and may not be evident on computed tomography (CT
scan) or magnetic resonance imaging (MRI) scans.
 Primary Brain Injury Secondary Brain Injury
Primary brain injury refers to Secondary brain injury refers to the
the sudden and profound changes that evolve over a period of
injury to the brain that is hours to days after the primary brain
considered to be more or less injury. It includes an entire series of
complete at the time of steps or stages of cellular, chemical,
impact. This happens at the tissue, or blood vessel changes in the
time of the car accident, brain that contribute to further
gunshot wound, or fall. destruction of brain tissue.

What causes a head injury?

There are many causes of head injury in children and adults. The most
common injuries are from motor vehicle accidents (where the person is
either riding in the car or is struck as a pedestrian), violence, falls, or as a
result of shaking a child (as seen in cases of child abuse).
 Distributive shock
Conditions that cause your blood vessels to lose their tone can cause
distributive shock. When your blood vessels lose their tone, they can
become so open and floppy that not enough blood pressure supplies your
organs. Distributive shock can result in symptoms including:
flushing
low blood pressure
loss of consciousness
There are a number of types of distributive shock, including the
following:
Anaphylactic shock
is a complication of a severe allergic reaction known as anaphylaxis.
Allergic reactions occur when your body mistakenly treats a harmless
substance as harmful. This triggers a dangerous immune response.
Anaphylaxis is usually caused by allergic reactions to food, insect venom,
medications, or latex.
Septic shock
is another form of distributive shock. Sepsis, also known as blood
poisoning, is a condition caused by infections that lead to bacteria
entering your bloodstream. Septic shock occurs when bacteria and their
toxins cause serious damage to tissues or organs in your body.
Neurogenic shock
is caused by damage to the central nervous system, usually a spinal cord
injury. This causes blood vessels to dilate, and the skin may feel warm and
flushed. The heart rate slows, and blood pressure drops very low.
Drug toxicities and brain injuries can also lead to distributive shock.

Hypovolemic shock
Hypovolemic shock happens when there isn’t enough blood in your
blood vessels to carry oxygen to your organs. This can be caused by
severe blood loss, for example, from injuries.
Your blood delivers oxygen and vital nutrients to your organs. If
you lose too much blood, your organs can’t function properly.
Serious dehydration can also cause this type of shock.
 Neurological Infections
Neurological infections, also known as central
nervous system (CNS) infections, refer to infections
that affect the brain, spinal cord, and surrounding
tissues. These infections can be caused by various
pathogens, including bacteria, viruses, fungi, and
parasites. As a nurse, understanding neurological
infections is crucial because early recognition and
appropriate management are essential to prevent
serious complications and improve patient outcomes.

Common Types of Neurological Infections

1. Meningitis
2. Encephalitis
3. Brain Abscess
4. Neurosyphilis
5. Tuberculous Meningitis

Meningitis

1. Meningitis is the inflammation of the meninges, the protective

membranes covering the brain and spinal cord.
2. Causes: Bacterial (e.g., Streptococcus pneumoniae, Neisseria
meningitidis, Haemophilus influenzae), viral (e.g., enteroviruses),
or fungal (e.g., Cryptococcus neoformans) infections.
3. Clinical Presentation: Symptoms include severe headache, fever,
neck stiffness (nuchal rigidity), photophobia (sensitivity to light),
altered mental status, and sometimes a characteristic rash in
bacterial meningitis.
 Encephalitis

1. Encephalitis is inflammation of the brain tissue

itself.
2. Causes: Most commonly viral, including herpes
simplex virus (HSV), West Nile virus, and Japanese
encephalitis virus.
3. Clinical Presentation: Symptoms can range from
mild to severe and may include fever, headache,
confusion, seizures, focal neurological deficits, and
altered consciousness.

Brain Abscess

1. A brain abscess is a
localized collection of
pus within the brain.
2. Causes: Bacterial (e.g.,
Staphylococcus
aureus,
Streptococcus
species) or fungal
(e.g., Aspergillus
species) infections.
3. Clinical Presentation:
Symptoms depend on
the location and size
of the abscess but
may include
headache, focal
neurological deficits,
fever, and altered
mental status.
 Neurosyphilis

1. Neurosyphilis is a manifestation of the sexually

transmitted infection syphilis that involves the
CNS.
2. Cause: Treponema pallidum bacterium.
3. Clinical Presentation: Different forms may
present, including meningitis,
meningoencephalitis, and general paresis, causing
cognitive and behavioral changes.

Tuberculous Meningitis

1. Tuberculous meningitis is a severe form of tuberculosis (TB) that

affects the meninges and brain.
2. Cause: Mycobacterium tuberculosis.
3. Clinical Presentation: Symptoms include fever, severe headache, neck
stiffness, altered mental status, and focal neurological deficits.
 Nursing Considerations

Assessment and Diagnosis

Early recognition of neurological infections is crucial for prompt
treatment.
Nurses should assess for classic signs and symptoms, including fever,
headache, neck stiffness, altered mental status, and neurological deficits.
Obtain a thorough patient history, including recent illnesses, travel
history, and exposure to infectious agents.
Infection Control and Isolation Precautions
Adhere to strict infection control measures to prevent the spread of
infections to other patients and healthcare workers.
Implement appropriate isolation precautions based on the infectious
agent (e.g., droplet precautions for bacterial meningitis).
Vital Signs Monitoring
Regularly monitor vital signs, paying particular attention to temperature,
as fever is a common symptom of neurological infections.
Neurological Assessment
Perform frequent neurological assessments to detect any changes in
mental status, motor function, and sensory responses.
Document the Glasgow Coma Scale (GCS) score to assess the level of
consciousness.
Fluid and Electrolyte Management
Administer intravenous fluids and electrolyte replacement as prescribed
to maintain hydration and electrolyte balance.
Medication Administration
Administer antimicrobial agents (antibiotics, antivirals, antifungals)
promptly as prescribed.
Monitor for potential adverse reactions and drug interactions.
Prevention and Health Promotion
Promote vaccination to prevent certain viral infections associated with
neurological complications (e.g., meningococcal vaccine).
Educate the community about the importance of infection control
practices and maintaining overall health.
 Neuromuscular Disorders
Neuromuscular disorders refer to a group of conditions that affect the
nerves that control voluntary muscles and the muscles themselves. These
disorders disrupt the communication between the nervous system and the
muscles, leading to weakness, muscle wasting, impaired coordination, and
other motor-related problems. Neuromuscular disorders can have various
underlying causes, and their severity and progression can vary significantly
from one individual to another.

Symptoms of Neuromuscular Disorders:

Muscle weakness or fatigue.
Muscle cramps or spasms.
Difficulty walking or maintaining balance.
Tremors or involuntary muscle movements.
Muscle wasting or atrophy.
Difficulty swallowing or speaking.
Numbness or tingling in the limbs.
Breathing difficulties in severe cases.
 Types of Neuromuscular Disorders

Muscular Dystrophy
A group of genetic disorders characterized by progressive muscle weakness
and wasting. Duchenne muscular dystrophy is the most common and
severe form, typically affecting boys during childhood.
Amyotrophic Lateral Sclerosis (ALS)
Also known as Lou Gehrig's disease, ALS is a progressive neurodegenerative
disorder that affects nerve cells (motor neurons) in the brain and spinal
cord, leading to muscle weakness and loss of control over voluntary
movements.
Myasthenia Gravis
An autoimmune disorder where the immune system attacks the receptors
on muscle cells that receive nerve signals, causing muscle weakness and
fatigue, often affecting the eyes, face, and throat.
Spinal Muscular Atrophy (SMA)
A genetic disorder that affects motor neurons in the spinal cord, leading to
progressive muscle weakness and atrophy.
Charcot-Marie-Tooth Disease (CMT)
A group of inherited peripheral nerve disorders that result in muscle
weakness, particularly in the lower limbs, and sometimes affect sensory
nerves as well.
Guillain-Barré Syndrome (GBS)
An autoimmune disorder that causes temporary inflammation of the
peripheral nerves, leading to muscle weakness, numbness, and in severe
cases, paralysis.
Polymyositis and Dermatomyositis
Inflammatory muscle diseases that cause muscle weakness and
inflammation.
Spinal Cord Injuries
Damage to the spinal cord can result in loss of muscle function and
sensation below the injury site.
Peripheral Neuropathies
A broad category of disorders affecting peripheral nerves, leading to
weakness, numbness, and pain.
 Diagnosis and Treatment

Diagnosing neuromuscular disorders often involves a combination of

medical history, physical examination, neurological testing, imaging studies
(MRI, CT scans), electromyography (EMG), nerve conduction studies, and
genetic testing.
Treatment for neuromuscular disorders varies depending on the specific
condition and its severity. While many neuromuscular disorders are
currently incurable, treatment aims to manage symptoms, slow disease
progression, and improve quality of life. Depending on the disorder,
treatment options may include:
Physical therapy and occupational therapy to maintain muscle strength
and function.
Medications to manage symptoms and reduce inflammation (if
applicable).
Assistive devices such as braces, walkers, or wheelchairs.
Breathing assistance devices for respiratory support.
Speech therapy for those with speech and swallowing difficulties.
Nutritional support to prevent malnutrition and maintain weight.

Research into neuromuscular disorders is ongoing, and

advancements in medical science offer hope for
potential future treatments and therapies. In some
cases, gene therapies and other innovative approaches
show promise in clinical trials.

Managing neuromuscular disorders often involves a

multidisciplinary team of healthcare professionals,
including neurologists, physical therapists,
occupational therapists, speech therapists,
nutritionists, and psychologists. Regular follow-ups
and a comprehensive care plan are essential to address
the specific needs of each individual affected by these
complex conditions.
 Sedation and Analgesia
Sedation
Sedation involves the administration of medications to induce a state of
relaxation and drowsiness, making the patient calmer and less anxious.
There are different levels of sedation, ranging from mild relaxation to deep
sedation, each tailored to the specific needs of the patient and the
procedure being performed. The levels of sedation are as follows:

Minimal Sedation (Anxiolysis): The patient remains conscious,

responsive, and can breathe on their own. This level is often achieved
using drugs like benzodiazepines.
Moderate Sedation (Conscious Sedation): The patient is in a depressed
level of consciousness, but can still respond to verbal commands and
maintain their own airway. This level is often achieved using a
combination of benzodiazepines and opioids.
Deep Sedation: The patient is in a state of depressed consciousness, but
may require assistance with breathing. Deep sedation is often used for
more invasive procedures or surgeries, and it may involve the use of
potent anesthetic agents.
Sedation is commonly used in settings such as:
Dental procedures.
Endoscopies and colonoscopies.
MRI and CT scans.
Minor surgical procedures.
Cardiac catheterizations.
Critical care settings to manage patient comfort and agitation.

Analgesia
Analgesia involves the administration of pain-relieving medications to
reduce or eliminate pain sensations in the body. The goal of analgesia is to
make the patient more comfortable and improve the overall experience
during medical interventions. Analgesic medications can be classified into
various categories, including:
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
These drugs reduce inflammation and pain and are commonly used for mild
to moderate pain relief. Examples include ibuprofen and naproxen.
Opioids
These powerful painkillers are used for moderate to severe pain relief. They
bind to specific receptors in the brain and spinal cord to reduce pain
perception. Common opioids include morphine, fentanyl, oxycodone, and
hydromorphone.
Local Anesthetics
These agents block nerve signals in a specific area, numbing the region and
providing localized pain relief. They are often used for minor procedures or
surgeries.
Regional Anesthesia
Involves injecting anesthetic agents around a cluster of nerves to numb a
larger area, providing pain relief during and after surgery.

Patient-Controlled Analgesia (PCA)

In this approach, patients have control over administering small doses of
opioids to manage their pain within safe limits.
 Combination of Sedation and Analgesia:

In certain situations, sedation and analgesia may be used together to

achieve a balanced approach, such as in major surgeries or critical care
scenarios. The combination aims to provide both pain relief and relaxation,
ensuring patient comfort and cooperation.
It's essential for healthcare providers to carefully monitor patients during
sedation and analgesia administration, as these interventions can affect
vital signs, respiratory function, and consciousness levels. An appropriate
level of monitoring and the presence of trained healthcare personnel are
crucial to ensuring patient safety during these procedures.
Overall, sedation and analgesia play critical roles in improving patient care,
enhancing the effectiveness of medical interventions, and reducing patient
discomfort and anxiety in various healthcare settings.
Sedation refers to the administration of medications to induce a state of
relaxation, calmness, and drowsiness in a patient. The primary goal of
sedation is to reduce anxiety and fear while also providing comfort during
medical procedures that might be unpleasant or painful. It does not
necessarily target pain relief directly but helps to alleviate any emotional
distress or unease associated with the procedure.
Analgesia, on the other hand, is the relief of pain or the reduction of the
perception of pain without causing sedation or loss of consciousness. The
main goal of analgesia is to target and alleviate pain, making it more
tolerable for the patient during medical procedures, surgeries, or in cases
of acute or chronic pain.
Analgesics, also known as painkillers, can be administered through various
routes such as oral, intravenous, intramuscular, or transdermal. There are
different classes of analgesics, including non-opioid medications like
acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), as
well as opioid medications, which are more potent and are used for
moderate to severe pain.
 Intracranial Hypertension
Intracranial Hypertension, also known as intracranial
pressure (ICP) or raised intracranial pressure, is a
medical condition characterized by increased pressure
within the skull and the brain. The skull is a rigid
structure, and any increase in the volume of brain tissue,
blood, or cerebrospinal fluid (CSF) can lead to elevated
pressure inside the cranial cavity. Intracranial
Hypertension is a serious condition that requires
prompt diagnosis and treatment to prevent potential
neurological damage.

Causes Of Intracranial Hypertension

Intracranial Hypertension can be caused by various factors, including:

1. Traumatic Brain Injury (TBI): Severe head injuries can lead to swelling
and increased ICP due to bleeding or edema (fluid accumulation) in the
brain.
2. Brain Tumors: Tumors within the brain or near the skull can exert
pressure on brain tissues and elevate ICP.
3. Brain Infections: Infections such as meningitis or encephalitis can
cause inflammation and increased fluid production, leading to
elevated intracranial pressure.
4. Hydrocephalus: A condition where there is an accumulation of excess
cerebrospinal fluid in the brain, leading to increased pressure.
5. Cerebral Edema: Swelling of brain tissue due to various causes like
stroke, inflammation, or metabolic disturbances can cause raised ICP.
6. Intracranial Hemorrhage: Bleeding within the brain, such as in
subarachnoid or intracerebral hemorrhage, can increase pressure
within the skull.
 Symptoms Of Intracranial Hypertension

The symptoms of Intracranial Hypertension can vary depending on the

severity and underlying cause. Common signs and symptoms include:

1. Severe headache: Typically worse in the morning or upon waking, and

can be associated with nausea and vomiting.
2. Vision problems: Blurred vision, double vision, or vision loss may
occur due to pressure on the optic nerve.
3. Altered mental status: Confusion, irritability, or changes in
consciousness may be present.
4. Seizures: In some cases, elevated ICP can lead to seizures.
5. Focal neurological deficits: Weakness, numbness, or coordination
problems may occur if specific brain areas are affected.
6. Papilledema: Swelling of the optic disc at the back of the eye, visible
during an eye examination.
 Diagnosis

Diagnosing Intracranial Hypertension involves a combination of clinical

assessment, neurological examination, and imaging studies. Common
diagnostic tools and procedures include:

1. Neurological examination: The healthcare provider will assess the

patient's mental status, vision, reflexes, and coordination.
2. Imaging studies: CT (computed tomography) and MRI (magnetic
resonance imaging) scans of the brain can help identify the underlying
cause of elevated ICP, such as tumors, hemorrhages, or
hydrocephalus.
3. Lumbar puncture: In some cases, a lumbar puncture (spinal tap) may
be performed to measure the CSF pressure and rule out other
conditions.

4. Intracranial pressure monitoring: In severe cases, a small device may be

surgically placed inside the skull to directly measure and monitor ICP.
 Treatment

The treatment of Intracranial Hypertension depends on the underlying

cause and the severity of the condition. Some common treatment
measures include:
Medications
Diuretics may be prescribed to reduce brain swelling and lower ICP.
Steroids can be used to control inflammation in certain conditions.
Surgery
If the cause of elevated ICP is a brain tumor, surgical removal or
debulking may be necessary. In cases of hydrocephalus, a shunt can be
inserted to divert excess CSF away from the brain.
Monitoring and Supportive Care
Continuous monitoring of ICP and vital signs is essential in critical care
settings. Supportive care to maintain adequate oxygenation and blood
pressure is also crucial.
Therapeutic Hypothermia
In some cases of traumatic brain injury, controlled cooling (hypothermia)
may be used to reduce ICP and protect the brain.
Positioning
Elevating the head of the bed and maintaining the head
at a neutral position can help reduce ICP.

Intracranial Hypertension is a potentially life-threatening condition that

requires immediate medical attention. If left untreated, it can lead to
brain herniation, which is a medical emergency with a high risk of
morbidity and mortality. Prompt diagnosis, identification, and
management of the underlying cause are vital to improve outcomes and
prevent complications. Patients at risk of elevated ICP, such as those with
severe head injuries or brain tumors, need close monitoring by healthcare
professionals to detect and address any changes in intracranial pressure
early on.
 COMPLETE

CARDIAC
STUDY GUIDE

JDMA NURSING SCHOOL

 Angina

Angina is the medical term for chest pain or discomfort caused by a

temporary disruption in the flow of blood and oxygen to the heart. People
describe angina discomfort as a squeezing, suffocating or burning feeling –
usually in the centre of the chest, behind the breastbone.

Key facts about angina Angina or a heart attack?

It’s your heart telling you that If you are experiencing chest pain
it needs more oxygen. for the first time, seek medical
You need to stop what you’re attention immediately. If you
doing, rest and/or take your have already been diagnosed with
medication. angina and you are experiencing
It’s almost always a sign that unusual symptoms, or if your
you have blocked arteries and medication isn’t working, see a
heart disease. healthcare provider immediately.
It’s usually a short-lived You could be experiencing the
event – lasting for a few emergency signs of a heart attack.
minutes.
It’s a warning that without What does angina feel like?
treatment, you are at risk for
heart attack, irregular Often during physical activity
heartbeat (arrhythmia) and or stress.
cardiac arrest When you are in a very cold
(cardiopulmonary arrest). place.
After a large meal.
 Types of angina
The two most common types of angina are stable and unstable. Stable
angina (angina pectoris) can be managed with medication and lifestyle
changes. Unstable angina may not respond to rest or nitroglycerin. It
needs urgent attention.

Stable angina Unstable angina

Usually lasts 5 minutes; rarely Often happens while you are
more than 15 minutes. resting.
Triggered by physical activity, It occurs suddenly. You feel chest
emotional stress, heavy pain you did not have before.
meals, extreme cold or hot Discomfort lasts longer than
weather. stable angina (more than 20
Relieved within 5 minutes by minutes).
rest, nitroglycerin or both. Not relieved by rest or
Pain in the chest that may nitroglycerin.
spread to the jaw, neck, arms, Episodes may get worse over
back or other areas. time.
May feel like the burning What you can do if you experience
sensation of heartburn or an episode of unstable angina:
indigestion. Unstable angina should be
What you can do if you treated as a medical emergency.
experience an episode of stable Your doctor will do tests to find
angina: out if you are experiencing
Track what triggers it. unstable angina.
Record how long it lasts. You may need medical treatment
Note what helped ease the to prevent a heart attack.
pain.

Causes
Angina occurs when there’s not enough blood flow to the heart as a
result of heart disease. Without enough blood, the heart doesn’t
get enough oxygen. This triggers the chest pain.
Angina pain can be triggered by:
physical activity
exercise
emotional stress
extreme temperatures (either hot or cold)
heavy meals
drinking alcohol
smoking

Symptoms
Angina symptoms can vary from person to person, between men and
women (see below), and by the type of angina you have. The main
symptoms of angina are:
Shortness of breath or difficulty breathing
Pain
Tightness, pressure or discomfort in the centre of the chest
Ache or discomfort in areas other than the chest: jaw, shoulder,
arms or back
A burning sensation that feels like indigestion or heartburn
Burning or cramping pain
More common in women – vague pain, pain in the neck or throat
Fatigue
Be aware Women may describe their angina symptoms differently
than men. They are more likely to experience:
vague pain in the centre of the chest
pain in the neck or tightness in the throat
the feeling of a panic attack, anxiety
dizziness, fainting
sweating at night
fatigue
When to call your doctor If you have chest pain that is new,
worsening or constant, seek medical care immediately. You are at
greater risk of:
heart attack
irregular heartbeat (arrhythmia)
cardiac arrest
 Left- vs. Right-Heart Failure
What is heart failure?
Although the term heart failure suggests your heart isn’t able to function
at all, it actually means your heart muscles just aren’t functioning well
enough to support your body’s needs. It develops when your heart muscles
are either too weak or not elastic enough to pump blood properly. About
6.2 million peopleTrusted Source in the United States are living with heart
failure.
Heart failure is usually a chronic and progressive condition, but it can
develop quickly after a heart attack or other conditions that damage your
heart. The most common cause of heart failure is coronary artery disease,
which is a narrowing of the arteries that supply blood to your heart.

Left-sided heart failure

Left-sided heart failure is more commonTrusted Source than right-sided
heart failure and is caused by dysfunction of your left ventricle. It most
oftenTrusted Source occurs due to coronary heart disease, heart attacks,
or long-term high blood pressure. Left-sided heart failure can cause
right-sided heart failure.

Left-sided heart failure causes blood to build up in your pulmonary

veins that carry blood from your lungs to your left atrium. This buildup
of blood can cause breathing symptoms, such as:

trouble breathing
shortness of breath
coughing, especially during exertion
shortness of breath when lying down
sleeping on extra pillows at night
 Right-sided heart failure
Right-sided heart failure most oftenTrusted Source develops from left-
sided heart failure due to a backup of blood around your lungs that puts
more stress on the right side of your heart. According to data from the
European Society of Cardiology registry, right-sided heart failure only
accounts for 2.2 percentTrusted Source of heart failure hospital
admissions.
Right-sided heart failure leads to blood buildup in your veins, which in
turn may lead to fluid retention and swelling. The legs are the most
common area to develop swelling, but it’s also possible to develop it in
your genitals and abdomen.
Common symptoms of right-sided heart failure include:
palpitations
chest discomfort
shortness of breath
fluid retention, especially in your lower body
weight gain
A variety of respiratory conditions can contribute to the development of
right-sided heart failure. These include:
pneumonia
pulmonary embolism
acute respiratory distress syndrome
chronic obstructive pulmonary disease

Connection between left- and right-sided heart failure

Left-sided heart failure is more common, and right-sided heart failure
often results from left-sided heart failure. The European Society of
Cardiology registry reports about 20 percentTrusted Source of cases of
right ventricular failure being secondary to left-sided heart failure.
Risk factors for developing both types of heart failure include:
Age. Your risk of heart failure increases with age.
Ethnicity. In the United States, Black people are more likelyTrusted
Source to have heart failure than people of other ethnic backgrounds.
They’re also more likely to have heart failure at a younger age.
Sex assigned at birth. Men tend to develop heart failure at a younger
ageTrusted Source than women.
Family history. You’re more likely to develop heart failure if a close
family member has also been diagnosed with it.
Lifestyle factors. Consuming excessive alcohol consumption, drug
misuse, smoking, and a poor diet all increase your chances of heart
failure.
Medical conditions. Certain other medical conditions, such obesity,
high blood pressure, and diabetes, increase your likelihood of heart
failure. Some cancer treatments like chemotherapy and radiation also
increase your risk.
 Hemodynamic Parameters
Parameter Equation Normal range

Arterial Blood Systolic (SBP) 90-140 mmHg

Pressure (BP) Diastolic (DBP) 60-90 mmHg

Mean Arterial 70-105 mmHg

[SBP + (2 x DBP)]/3
Pressure (MAP)

Right Atrial Pressure 2-6 mmHg (CVP

(RAP) Central Venous normal range is
Pressure (CVP) equivalent to RAP)

Right Ventricular Systolic (RVSP) 15-25 mmHg 0-8

Pressure (RVP) Diastolic (RVDP) mmHg

Pulmonary Artery Systolic (PASP) 15-25 mmHg 0-8

Pressure (PAP) Diastolic (PADP) mmHg
Mean Pulmonary
Artery Pressure [PASP + (2 x PADP)]/3 10-20 mmHg
(MPAP)
Pulmonary Artery
Occlusion Pressure 6-12 mmHg
(PAOP)
Left Atrial Pressure 6-12 mmHg
(LAP)
Cardiac Output
HR x SV/1000 4-8 L/min
(CO)

Cardiac Index CO/BSA 2.5-4 L/min/m2

(CI)
 Hemodynamic Parameters
Parameter Equation Normal range

Stroke Volume (SV) CO/HR x 1000 60-100 mL/beat

Stroke Volume 33-47 mL/m2

CI/HR x 1000
Index (SVI) /beat
Stroke Volume 100x(SVmax-
<10-15%
Variation (SVV) SVmin)/mean (SV)

Systemic Vascular 800-1200

MAP-RAPx80/CO
Resistance (SVR) dynes/sec/cm–5

Systemic Vascular 1970-2390

MAP-RAPx80/C
Resistance Index dynes/sec/cm–5/m2
(SVRI)

Pulmonary
MPAP- 100-250
Vascular
PAOPx80/CO dynes/sec/cm-5
Resistance (PVR)

Pulmonary MPAP- 255-285

Vascular PAOPx80/CI dynes/sec/cm-5/m2
Resistance Index
(PVRI)
 Heart Blocks

Heart blocks, also known as atrioventricular (AV)

blocks, are a type of cardiac conduction disorder
that affects the electrical signals traveling between
the heart's upper chambers (atria) and lower
chambers (ventricles). These signals coordinate the
heart's pumping action, allowing it to beat
effectively and pump blood to the body.

In a normal heart rhythm, electrical impulses generated in the sinoatrial

(SA) node, the heart's natural pacemaker located in the right atrium, travel
through the atria, causing them to contract. The impulses then pass
through the AV node, which acts as a gatekeeper, slowing the electrical
signals briefly before transmitting them to the ventricles. This delay is
crucial, as it allows the ventricles to fill with blood before contracting and
pumping blood out to the body.

Classification Of Heart Blocks

Heart blocks occur when there is a disruption in the electrical conduction
system, causing the signals to be delayed or blocked in their transmission
from the atria to the ventricles. Heart blocks are classified into three types,
based on their severity:
First-degree heart block
First-degree atrioventricular (AV) block is a condition of abnormally slow
conduction through the AV node. It is defined by ECG changes that include
a PR interval of greater than 0.20 without disruption
of atrial to ventricular conduction. This condition is
generally asymptomatic and discovered only on
routine ECG. This activity illustrates the evaluation
and management of first-degree heart block.
 First-degree AV block is
almost universally
without associated
symptoms. Patients will
frequently be unaware of
the condition until it
appears on routine
electrocardiography.
Upon recognition of the
PR interval prolongation,
a thorough history should
be obtained, with a
specific focus on any
history of congenital or
acquired heart disease,
risk factors for heart disease, family history of cardiac disease, the
presence of neuromuscular disease, or family history of neuromuscular
disease.
Second-degree heart block
This type is characterized by intermittent blockages in the transmission of
electrical signals from the atria to the ventricles. It can be further classified
into two types:
Type I or Mobitz I
The electrical signals are
progressively delayed
until one signal is
completely blocked,
resulting in a missed
heartbeat. This pattern
repeats itself, with the
cycle continuing.
 Type II or Mobitz II
In this case, certain electrical signals
are blocked without warning,
leading to missed heartbeats, but
the pattern may not be as
predictable as in
Type I. On an ECG, Mobitz type
II can be identified by the
presence of intermittent, non-
conducted P waves without
progressive prolongation of the PR
interval.
Third-degree heart block
Also known as complete heart block, this is the most severe form of heart
block. In this condition, there is a complete blockage of electrical signals
between the atria and ventricles, leading to the two chambers beating
independently of each other. The atria and ventricles contract at their own
rates, and the heart's overall rhythm is usually slower than normal. The
condition requires immediate medical attention.
Causes of heart blocks can vary and
may include heart diseases, aging,
certain medications (e.g., beta-
blockers, calcium channel
blockers), myocardial
infarction (heart attack),
infections, and other
underlying heart conditions.

Treatment for heart blocks depends on their severity. Some cases may not
require treatment if they are asymptomatic and not posing a risk to the
patient's health. However, more severe heart blocks may necessitate the
use of pacemakers, which are implanted medical devices that help regulate
the heart's rhythm by sending electrical signals to the heart when needed.
 Acute Valvular Heart Disease

Acute valvular heart disease refers to a sudden and severe

impairment of one or more heart valves. The heart valves
are critical structures that ensure the unidirectional flow
of blood through the heart chambers. They prevent
backflow and allow efficient pumping of blood to different
parts of the body.
Acute valvular heart disease is often life-threatening. The diagnosis of
acute valvular decompensation is made by attention to the physical
assessment and appropriate use of diagnostic techniques. Recent advances
in valvular heart disease have centered around noninvasive diagnostics.
Doppler echo-cardiography can accurately diagnose and quantify stenotic
and regurgitant lesions; its use with M-mode and two-dimensional
echocardiography makes these the noninvasive diagnostic procedures of
choice.

Four Main Valves In The Heart

Mitral valve
Located between the left atrium and the left
ventricle.
Aortic valve
Situated between the left
ventricle and the aorta (the main
artery that carries oxygenated blood to the
body).
Tricuspid valve
Found between the right atrium and the right
ventricle.
Pulmonary valve
Positioned between the right ventricle and the pulmonary artery (the
vessel that carries blood to the lungs for oxygenation).
Acute valvular heart disease can be caused by various factors, including:

1. Infective endocarditis: A bacterial infection affecting the inner lining of

the heart and heart valves. It can lead to valve damage and
dysfunction.
2. Acute rheumatic fever: An inflammatory condition that may result
from inadequately treated strep throat. It can lead to inflammation of
heart valves, especially the mitral valve.
3. Aortic dissection: A life-threatening condition where a tear occurs in
the aortic wall, which may involve the aortic valve and impair its
function.
4. Trauma: Severe chest trauma or injury can damage heart valves.
5. Blood clots: Formation of blood clots on heart valves, known as
valvular thrombosis, can cause acute valve dysfunction.

The symptoms of acute valvular heart disease can vary depending on

which valve is affected, but common signs include:
Sudden onset of shortness of breath.
Chest pain or discomfort.
Palpitations or rapid heartbeat.
Fatigue and weakness.
Dizziness or fainting.
The diagnosis of acute valvular heart disease involves a thorough medical
history, physical examination, and various diagnostic tests, such as
echocardiography, electrocardiogram (ECG/EKG), and sometimes cardiac
catheterization.
Treatment of acute valvular heart disease aims to stabilize the patient,
relieve symptoms, and manage complications. In severe cases, emergency
interventions like valve repair or replacement surgery may be necessary.
Medical management can include medications to reduce symptoms,
manage heart failure if present, and prevent complications such as blood
clots.
Prevention of acute valvular heart disease involves
timely and appropriate management of conditions like
strep throat, infective endocarditis prophylaxis for
high-risk individuals, and lifestyle modifications to
reduce the risk of heart disease.
 Cardiac Arrhythmias

Cardiac arrhythmias, also known as cardiac

dysrhythmias, are abnormal heart rhythms
resulting from disruptions in the electrical signals
that regulate the heart's contraction and relaxation.
These irregular rhythms can cause the heart to beat
too fast (tachycardia), too slow (bradycardia), or
irregularly.
The heart's electrical system is responsible for generating and conducting
electrical impulses, which coordinate the heart's pumping action to
effectively circulate blood throughout the body.

The primary components of the electrical system include:

Sinoatrial (SA) node
Located in the right atrium, the SA node serves as the heart's natural
pacemaker. It initiates electrical impulses that cause the atria to contract.
 Atrioventricular (AV) node
Positioned between the atria and ventricles, the AV node acts as a
gatekeeper, slowing down the electrical signals from the atria before
transmitting them to the ventricles.
Bundle of His and Purkinje fibers
After passing through the AV node, the electrical impulses travel through
specialized pathways called the bundle of His and Purkinje fibers,
stimulating the ventricles to contract.
Cardiac arrhythmias can be classified based on their heart rate and origin:

1. Sinus Arrhythmias: These are irregular heart rhythms that originate

from the SA node, the heart's natural pacemaker.
2. Supraventricular Arrhythmias: These arrhythmias originate above the
ventricles and include conditions like atrial fibrillation (AFib), atrial
flutter, and paroxysmal supraventricular tachycardia (PSVT).
3. Ventricular Arrhythmias: These arrhythmias arise in the ventricles and
can be more serious. Examples include ventricular tachycardia (VT)
and ventricular fibrillation (VF), which can be life-threatening.
Common causes and risk factors for cardiac arrhythmias include:

Heart disease (e.g., coronary artery disease, heart failure,

cardiomyopathy).
Electrolyte imbalances (e.g., potassium, calcium, magnesium).
Structural abnormalities in the heart.
High blood pressure (hypertension).
Thyroid disorders.
Drug or alcohol abuse.
Stimulants (e.g., caffeine, certain medications).
Age and family history.
Stress and anxiety.
Symptoms of cardiac arrhythmias can vary widely, depending on the
type of arrhythmia and its severity. Some individuals may not
experience any symptoms, while others may have.
Diagnosis of cardiac arrhythmias involves various tests,
such as electrocardiogram (ECG/EKG), Holter monitoring
(24-hour ECG recording), event monitoring, stress tests,
echocardiogram, and electrophysiology studies.
Treatment for cardiac arrhythmias depends on the
specific type, severity, and underlying cause. Options
include:
Lifestyle modifications
Reducing stress, avoiding stimulants, and maintaining a healthy diet and
exercise routine.
Medications
Antiarrhythmic drugs may be prescribed to control the heart's rhythm and
rate.
Cardioversion
Electrical shock applied to the chest to restore normal heart rhythm in
certain arrhythmias.
Catheter ablation
A procedure in which the abnormal tissue causing the arrhythmia is
destroyed using radiofrequency or cryoenergy.

Implantable devices:
Pacemakers may be implanted to regulate heart rhythm in bradycardias,
while implantable cardioverter-defibrillators (ICDs) are used to treat life-
threatening ventricular arrhythmias.

Surgery
In some cases, surgical interventions may be necessary, especially if
arrhythmias are related to structural heart problems.
 Acute Coronary Syndromes (ACS)

Acute Coronary Syndromes (ACS) is a term used to describe a group of

cardiovascular conditions that result from reduced blood flow to the heart
muscle due to the obstruction of coronary arteries. ACS includes unstable
angina, non-ST-segment elevation myocardial infarction (NSTEMI), and
ST-segment elevation myocardial infarction (STEMI). These conditions are
considered medical emergencies and require immediate attention and
treatment to prevent serious complications, including heart attack and
even death.
ACS is primarily caused by atherosclerosis,
a condition characterized by the buildup
of fatty plaques within the coronary
arteries, which supply oxygen and
nutrients to the heart muscle. Over time,
these plaques can rupture or cause the
formation of blood clots, leading to partial
or complete blockage of the artery. The
reduction in blood flow to the heart can
cause chest pain (angina) or lead to a heart
attack (myocardial infarction) if not
promptly treated.
Symptoms:
The typical symptoms of ACS include:
Chest pain or discomfort (angina),
which may radiate to the arms, back,
neck, jaw, or stomach.
Shortness of breath.
Nausea and vomiting.
Cold sweats.
Lightheadedness or dizziness.
Palpitations (irregular heartbeats).
 Types of ACS

Unstable Angina
Unstable angina is characterized by chest pain or discomfort that occurs at
rest or with minimal exertion. The pain may be more severe, frequent, or
prolonged compared to stable angina. Unstable angina is considered a
warning sign that a heart attack (STEMI or NSTEMI) may occur soon if left
untreated.

Non-ST-Segment Elevation Myocardial Infarction (NSTEMI)

In NSTEMI, there is a partial blockage of a coronary artery, causing a
reduction in blood flow to the heart muscle. This leads to damage to the
heart muscle, as evidenced by elevated cardiac enzymes (biomarkers) in
blood tests. However, there is no persistent ST-segment elevation on the
electrocardiogram (ECG).
 ST-Segment Elevation Myocardial Infarction (STEMI)
STEMI occurs when there is a complete blockage of a coronary artery,
causing a significant reduction or cessation of blood flow to a specific area
of the heart. This leads to more extensive damage to the heart muscle. On
the ECG, there is persistent ST-segment elevation, indicating the location
and extent of the heart muscle involved.

Treatment
The management of ACS aims to restore blood flow to the affected
coronary artery promptly and minimize heart muscle damage. Treatment
options include:
Medications
Antiplatelet agents, anticoagulants, nitroglycerin, and pain relievers are
often administered to reduce blood clotting, alleviate pain, and stabilize
the condition.
Percutaneous Coronary Intervention (PCI)
Also known as coronary angioplasty, this procedure involves inserting a
catheter with a balloon at its tip into the blocked artery to widen it and
restore blood flow. Sometimes, a stent (a small mesh tube) is placed to keep
the artery open.
Thrombolytic Therapy
In cases where PCI is not immediately available or feasible, clot-dissolving
medications (thrombolytics) may be used to break down the blood clot
causing the blockage.

Coronary Artery Bypass Grafting (CABG)

In certain situations, CABG surgery may be required to bypass the blocked
coronary artery with a healthy blood vessel from another part of the body.
 COMPLETE

RESPIRATORY
STUDY GUIDE

JDMA NURSING SCHOOL

 Asthma
Asthma is a long-term disease of the lungs. It
causes your airways to get inflamed and
narrow, and it makes it hard to breathe. Severe
asthma can cause trouble talking or being
active. You might hear your doctor call it a
chronic respiratory disease. Some people refer
to asthma as "bronchial asthma."

Asthma is a serious disease that affects about

25 million Americans and causes nearly 1.6
million emergency room visits every year.
With treatment, you can live well. Without it,
you might have to go to the ER often or stay at
the hospital, which can affect your daily life

Causes of Asthma
No one really knows what causes asthma. What we do know is that asthma
is a chronic inflammatory disease of the airways. The causes can vary from
person to person. Still, one thing is consistent: When airways come into
contact with a trigger, they become inflamed, narrow, and fill with mucus.

How Asthma Attacks Happen?

When you have an asthma attack, your airways narrow and it gets hard to
breathe. This can result from spasms of the muscles around the airways,
inflammation and swelling of the mucosal membrane that lines them,
or high amounts of mucus inside them. You might have shortness of
breath, wheeze or cough as your body tries to get rid of mucus.
Why do you have asthma and your friend doesn't? No one knows for sure.
Allergies play a role for many people, as do genetics.

Asthma Triggers
Some known triggers of asthma attacks include:
Allergies
Food and food additives
Exercise
Heartburn
Smoking
Sinusitis
Medications
Weather
Smoke

symptoms of an asthma attack

Severe wheezing when breathing both in and out
Coughing that won't stop
Very rapid breathing
Chest pain or pressure
Tightened neck and chest muscles, called retractions
Difficulty talking
Feelings of anxiety or panic
Pale, sweaty face
Blue lips or fingernails

Classification of asthma

Mild intermittent asthma.

Mild symptoms less than twice a week. Nighttime symptoms less than
twice a month. Few asthma attacks.
 Mild persistent asthma.
Symptoms three to six times a week. Nighttime symptoms three to four
times a month. Asthma attacks might affect activities.
Moderate persistent asthma.
Daily asthma symptoms. Nighttime attacks five or more times a month.
Symptoms may affect activities.
Severe persistent asthma.
Ongoing symptoms both day and night. You have to limit your activities.
Your asthma may be getting worse if:
You have symptoms more often and they interfere more with your
daily life.
You have a hard time breathing. You can measure this with a device
called a peak flow meter.
You need to use a quick-relief inhaler more often.

Types of Asthma
There are several:
Adult-onset asthma.
Asthma can start at any age, but it's more common in people younger than
40.
Status asthmaticus.
These long-lasting asthma attacks don’t go away when you use
bronchodilators. They’re a medical emergency that needs treatment right
away.
Asthma in children.
Symptoms can vary from episode to episode in the same child. Watch for
problems like:
Coughing often, especially during play, at night, or while laughing. This
may be the only symptom.
Less energy or pausing to catch their breath while they play
Fast or shallow breathing
Saying their chest hurts or feels tight
A whistling sound when they breathe in or out
Seesaw motions in their chest because of trouble breathing
Shortness of breath
 Exercise-induced bronchoconstriction.
You might hear this called exercise-induced asthma. It happens during
physical activity, when you breathe in air that’s drier than what’s in your
body, and your airways narrow. It can affect people who don’t have
asthma, too. You’ll notice symptoms within a few minutes after you start
to exercise, and they might last 10 to 15 minutes after you stop.
Allergic asthma.
Things that trigger allergies, like dust, pollen and pet dander, can also
cause asthma attacks.
Nonallergic asthma.
This type flares in extreme weather. It could be the heat of summer or the
cold of winter. It could also show up when you’re stressed or have a cold.
Occupational asthma.
This usually affects people who work around chemical fumes, dust, or
other irritating things in the air.
Eosinophilic asthma.
This severe form is marked by high levels of white blood cells called
eosinophils. It usually affects adults between 35 and 50 years old.
Nocturnal asthma.
Your asthma symptoms get worse at night.
Aspirin-induced asthma.
You have asthma symptoms when you take aspirin, along with a runny
nose, sneezing, sinus pressure, and a cough.
Cough-variant asthma.
Unlike with other types, the only symptom of this kind of asthma is a long-
term cough.
 Chest Tubes
Chest tubes are placed to drain air, blood, or fluid from the pleural
cavity (the space between the chest wall and the lungs).
In addition to being used for drainage, a chest tube, a thin plastic tube,
can also be used to administer medications. The tip of the tube (which
has drainage holes) is inserted through the skin, usually on the side of
the chest, into the pleural cavity. The tubing and the other end of the
tube exits from the chest and is attached to a drainage system. The size
and type of chest tube and drainage system depends on the reason that a
patient needs a chest tube.
 Reasons for Chest Tube Insertion
Reasons for chest tube insertion include but are not limited to

Pneumothorax:
air leakage into the pleural cavity, which causes the lung to collapse
Hemothorax:
blood in the pleural cavity, which may be from injury to the chest
Pleural effusion:
fluid in the pleural cavity, which includes simple fluid (an uninfected
collection of fluid around the lung due to inflammation from underlying
pneumonia), pus (empyema), or lymph (chylothorax)
Pleurodesis:
a procedure that involves placing medications into the pleural cavity
and that may be used for pneumothorax that does not respond to usual
treatment or pleural effusions
Postoperative care:
Patients who have surgery on the chest may have a chest tube placed
after the surgery.
 Acute Kidney Injury (AKI)
Acute kidney injury (AKI), also
known as acute renal failure (ARF), is
a sudden episode of kidney failure or
kidney damage that happens within a
few hours or a few days. AKI causes a
build-up of waste products in your
blood and makes it hard for your
kidneys to keep the right balance of
fluid in your body. AKI can also affect
other organs such as the brain, heart,
and lungs. Acute kidney injury is
common in patients who are in the
hospital, in intensive care units, and
especially in older adults.

Acute kidney injury also known as acute kidney failure is the condition
in which the kidneys lose their functioning ability suddenly. This
condition may take place in a couple of days or sometimes less. It is a
severe kidney disorder that requires immediate treatment.
With the help of
Ayurvedic treatment,
the condition can be
reversed if proper
treatment is taken
immediately.
The reason is, in this
condition, the
kidneys get failed
within a very
short time and
hence the condition
can be reversed
with early detection
and proper treatment.
 sign and symptoms

Some of the major symptoms of acute kidney injury are listed below:

Nausea
Abnormal urine output (mostly low but sometimes may high)
Swollen legs, ankles or feet
Feeling lethargic
Trouble catching your breath
Feeling confused
Loss of hunger
Pain or pressure in your chest
Seizure or coma
These above signs indicate that you are affected with acute kidney injury
and the condition needs immediate treatment not only to prevent this
condition from getting worse but also to cure it permanently.
 Risk factors: Acute Kidney Injury Treatment
AKI does not discriminate so anyone can get this kidney disease. But some
people are more likely to get this kidney disorder who possess any of the
below-listed condition:
Having age 65 or above
Having any underlying kidney disease
High blood pressure
Having any chronic disease such as heart disease, liver, and diabetes

Risk factors: Acute Kidney Injury Treatment

Several factors may be responsible for the occurrence of this kidney
disorder. Some of the major causes of acute kidney injury are as below:
Diabetes–
It is the most common cause of kidney disorders as high blood sugar levels
can damage the vessels that connect kidneys to other body organs also the
kidney filters.
Uncontrolled high blood pressure–
Persistently high blood pressure can broaden the veins or vessels in the
body including kidney vessels as well. If the condition lasts longer, it can
damage kidney vessels seriously.
Reduced blood flow through your kidneys–
Kidneys require sufficient blood for their proper functioning so if they get
a low rate of blood to them, they can get damaged.
Direct injury to your kidneys–
Any direct injury to the kidneys can cause AKI to occur.
Obstruction or blockage in the ureters–
If there comes any obstruction in the ureters and the condition goes
untreated, it can lead to AKI.
Heart disease or heart attack–
Any serious heart disorder can also be responsible for causing acute
kidney failure.
Severe infection–
Infection in the urinary tract or kidneys can be causative for acute kidney
failure.
 Respiratory Infections
Respiratory infections are a group of infections
that primarily affect the respiratory system,
which includes the nose, throat, sinuses, airways,
and lungs. These infections can be caused by
various pathogens, including viruses, bacteria,
fungi, and sometimes even parasites.
Respiratory infections are widespread and can
range from mild, self-limiting illnesses to severe,
life-threatening conditions.

Types Of Respiratory Infections

Upper Respiratory Infections (URIs) and Lower Respiratory Infections

(LRIs) are two categories of respiratory infections that affect different
parts of the respiratory system. They are characterized by specific
symptoms and affect different areas within the airways.
Upper Respiratory Infections (URIs)
URIs primarily involve the upper part of the respiratory system, including
the nose, throat, sinuses, and sometimes the middle ear. They are typically
caused by viruses, and while they are generally not severe, they can be
quite common and uncomfortable. Some common types of upper
respiratory infections include:
Common Cold
The most prevalent type of URI caused by various viruses, particularly
rhinoviruses. Symptoms include a runny or stuffy nose, sneezing, sore
throat, cough, mild body aches, and sometimes low-grade fever.
Sinusitis
Inflammation of the sinuses, often occurring as a complication of the
common cold or other viral infections. Symptoms include facial pain or
pressure, nasal congestion, headache, and thick nasal discharge.
 Pharyngitis (Sore Throat)
Infection and inflammation of the throat, often caused by viruses (such as
adenovirus, influenza virus) or bacteria (such as Streptococcus pyogenes in
strep throat). Symptoms include a sore and scratchy throat, difficulty
swallowing, and swollen tonsils.
Otitis Media
An infection of the middle ear, usually seen in children. It may follow a
cold or sinus infection and can cause ear pain, ear drainage, hearing
difficulties, and fever.

Lower Respiratory Infections (LRIs)

LRIs involve the lower part of the respiratory system, which includes the
trachea, bronchi, and lungs. They can be caused by a variety of pathogens,
including viruses, bacteria, and fungi. Unlike URIs, LRIs can be more
severe and have a higher risk of complications, particularly in vulnerable
individuals with pre-existing respiratory conditions or weakened immune
systems.
LRIs can be more serious and require medical attention, especially in high-
risk individuals. Treatment for LRIs may involve antibiotics for bacterial
infections, antiviral medications for certain viral infections, and
supportive care such as oxygen therapy and respiratory treatments for
severe cases. Some common types of lower respiratory infections include:
 Pneumonia
Infection and inflammation of the lung tissue, caused by bacteria (e.g.,
Streptococcus pneumoniae), viruses (e.g., influenza virus, respiratory
syncytial virus), fungi (e.g., Pneumocystis jirovecii in
immunocompromised individuals), or other organisms. Symptoms include
high fever, productive cough with yellow or green sputum, chest pain, and
difficulty breathing.
Bronchitis
Inflammation of the bronchial tubes, which carry air to the lungs. Acute
bronchitis is usually caused by viruses and leads to a persistent cough,
often accompanied by mucus production. Chronic bronchitis, often seen in
individuals with smoking history, is a long-term condition associated with
a persistent cough and increased sputum production.
Bronchiolitis
Primarily affecting infants and young children, bronchiolitis is an
infection that causes inflammation and obstruction of the small airways in
the lungs, typically caused by respiratory syncytial virus (RSV). Symptoms
include wheezing, coughing, rapid breathing, and difficulty feeding.
 Prevention and Management

Preventing respiratory infections involves several key measures:

Vaccination
Vaccines are available for some respiratory infections like influenza and
pneumococcal pneumonia. Getting vaccinated can reduce the risk of
infection and its complications.
Hand Hygiene
Regularly washing hands with soap and water or using alcohol-based hand
sanitizers can help prevent the spread of respiratory viruses.
Respiratory Etiquette
Covering the mouth and nose with a tissue or elbow when coughing or
sneezing can prevent the release of infectious droplets into the air.
Avoiding Close Contact
Staying away from individuals who are sick and avoiding crowded places
during outbreaks can reduce the risk of exposure.
Healthy Lifestyle
Maintaining good overall health, including a balanced diet, regular
exercise, adequate sleep, and stress reduction, can support the immune
system's function.

For respiratory infections, treatment may vary depending on the specific

pathogen and the severity of the illness. Mild cases can often be managed
with rest, hydration, and over-the-counter medications for symptom
relief. However, severe or bacterial infections may require specific
antimicrobial medications, and in some cases, hospitalization for
supportive care and monitoring.
It's important to consult a healthcare professional if symptoms of a
respiratory infection are severe, persistent, or accompanied by other
concerning signs, especially in vulnerable populations such as young
children, the elderly, or individuals with underlying health conditions.
Early diagnosis and appropriate management can help prevent
complications and promote a faster recovery.
 Oxygen Therapy

Oxygen therapy is a medical treatment that involves administering

supplemental oxygen to individuals who have difficulty getting enough
oxygen into their bloodstream. It is used to treat a variety of medical
conditions where the body's natural ability to breathe in sufficient oxygen
is compromised.
The primary goal of oxygen therapy is to
increase the oxygen concentration in the
blood, thereby improving tissue oxygenation
and supporting various bodily functions. It is
commonly used in hospitals and healthcare
settings, but it can also be administered at
home under medical supervision.
Conditions that may require oxygen therapy include:

1. Chronic Obstructive Pulmonary Disease (COPD): COPD, including

emphysema and chronic bronchitis, is a lung disease that obstructs
airflow and makes it difficult to breathe.
2. Pneumonia: An infection that causes inflammation in the lungs,
making it harder for oxygen to pass into the bloodstream.
3. Asthma: A chronic respiratory condition that causes airway
inflammation and constriction, leading to breathing difficulties.
4. Heart Failure: A condition where the heart cannot pump blood
effectively, resulting in reduced oxygen supply to tissues.
5. Respiratory Distress Syndrome: Often seen in premature infants, it is
a condition where the lungs are not fully developed, and the baby
struggles to breathe.
6. Sleep Apnea: A sleep disorder where breathing repeatedly stops and
starts during sleep, leading to lowered blood oxygen levels.
 types of oxygen therapy

There are several types of oxygen therapy that can be used to deliver
supplemental oxygen to individuals who require it. The choice of oxygen
therapy depends on the patient's condition, needs, and the prescribed
oxygen flow rate. Here are the most common types of oxygen therapy:

Nasal Cannula
This is one of the most common and least intrusive methods. It consists of
a small tube with two prongs that fit into the patient's nostrils. The tube is
connected to an oxygen source, and the oxygen is delivered directly into
the nose. Nasal cannulas are lightweight and allow patients to talk, eat,
and drink while receiving oxygen.
Oxygen Masks
Oxygen masks cover the patient's nose and mouth and are available in
various types, such as:
 Simple Face Mask: Covers the nose and mouth and delivers a fixed
concentration of oxygen.
Partial Rebreather Mask: Reservoir bag attached to the mask allows
patients to rebreathe some of the exhaled air, which helps conserve
oxygen.
Non-Rebreather Mask: Similar to the partial rebreather mask, but it
has a one-way valve to prevent the patient from inhaling exhaled air,
ensuring a higher oxygen concentration.
Reservoir Mask
A reservoir mask, also known as a partial rebreather mask, is a type of
oxygen mask used in oxygen therapy to deliver a higher concentration of
oxygen to the patient. It is designed to allow the patient to inhale a
mixture of oxygen and some of the exhaled air, which helps conserve
oxygen and maintain a higher fraction of inspired oxygen (FiO2).
CPAP
A CPAP machine delivers a constant flow of air through a mask that the
patient wears over their nose or both their nose and mouth while sleeping.
The air pressure generated by the CPAP machine is higher than the
surrounding air pressure, and this continuous positive pressure helps
keep the airway open, preventing it from collapsing or becoming blocked
during sleep.
Nasal High Flow (NHF)
Nasal High Flow (NHF) therapy, also known as High-Flow
Nasal Cannula (HFNC) therapy, is a type of respiratory
support used in medical settings to deliver a heated and
humidified flow of oxygen and air mixture to patients with
respiratory insufficiency or distress. It provides a higher
flow of gas than conventional oxygen therapy methods like
nasal cannulas or oxygen masks.
Ventilator
Ventilators are essential life-support devices commonly used in
intensive care units (ICUs) and other healthcare settings to support
patients with respiratory failure or other conditions that compromise
their ability to breathe.
 Pulmonary Embolism (PE)

Pulmonary Embolism (PE) is a serious and potentially life-

threatening medical condition that occurs when a blood
clot, usually originating from the deep veins of the legs
(deep vein thrombosis or DVT), travels through the
bloodstream and lodges in one of the arteries in the lungs,
blocking blood flow. This blockage can lead to impaired
oxygen exchange, reduced blood flow to the lung tissues,
and sometimes damage to the lung parenchyma.

riskpart
A blood clot that travels to another factors
of your body is called an embolus.
When an embolus blocks a blood vessel it's called an embolism. When a
pulmonary embolus blocks blood flow to your lungs, it's called a
pulmonary embolism.
 risk factors

Several risk factors increase the likelihood of developing Pulmonary

Embolism:
1. Venous Thromboembolism (VTE) Risk Factors: These include a history
of deep vein thrombosis (DVT) or previous pulmonary embolism,
recent surgery (especially orthopedic surgeries or major abdominal
surgeries), prolonged immobility (bed rest or long flights), and trauma.
2. Medical Conditions: Certain medical conditions like cancer, heart
failure, chronic obstructive pulmonary disease (COPD), inflammatory
disorders, and inherited or acquired clotting disorders can increase
the risk of PE.
3. Hormonal Factors: Hormonal medications, such as birth control pills
or hormone replacement therapy, can elevate the risk of clot
formation.
4. Obesity: Being overweight or obese is associated with an increased
risk of PE.
5. Smoking: Smoking damages the blood vessels and promotes blood clot
formation.

symptoms

The symptoms of Pulmonary Embolism can vary in severity and can

sometimes be nonspecific or mistaken for other medical conditions.
Common symptoms include:

Sudden onset of shortness of breath, which may worsen with activity.

Chest pain, often described as sharp and intensified by deep breathing
or coughing.
Rapid or irregular heartbeat (tachycardia or arrhythmia).
Cough, sometimes with blood-tinged sputum (hemoptysis).
Lightheadedness, dizziness, or fainting (syncope).
 Diagnosis

The diagnosis of Pulmonary Embolism involves a combination of clinical

assessment, imaging studies, and laboratory tests. The following methods
are commonly used:

1. CT Pulmonary Angiogram (CTPA): This is the preferred imaging test to

visualize blood clots in the pulmonary arteries.
2. V/Q (Ventilation-Perfusion) Scan: This test evaluates the lung's
ventilation and perfusion to detect areas with impaired blood flow due
to clots.
3. Doppler Ultrasound: This test is used to detect deep vein thrombosis
(DVT) in the legs.
4. Blood Tests: Measurement of D-dimer levels can help rule out PE in
low-risk individuals.

treatment

The goals of treating Pulmonary Embolism are to stabilize the patient,

prevent the clot from growing, and prevent new clots from forming. The
main treatment approach includes:
1. Anticoagulant Medications: Blood thinners, such as heparin and
warfarin, are prescribed to prevent further clot formation and to allow
the body's natural mechanisms to dissolve the existing clot.
2. Thrombolytic Therapy: In severe cases of PE, clot-dissolving
medications (thrombolytics) may be administered to rapidly dissolve
the clot.
3. Inferior Vena Cava (IVC) Filters: In some situations where
anticoagulants are contraindicated or ineffective, a filter may be
inserted into the inferior vena cava (the large vein that carries blood
from the lower body to the heart) to prevent clots from reaching the
lungs.
 Airway Management

Airway management is a critical component of patient care that involves

establishing and maintaining a clear and open airway to ensure proper
breathing and oxygenation. It is a fundamental skill used in various
medical settings, including emergency medicine, anesthesia, intensive
care units (ICUs), and during surgeries. Proper airway management is
essential to support patients who are unable to maintain their airway
independently due to various medical conditions or procedures.

types of artificial airways

Artificial airways are medical devices used to establish and maintain an

open airway in patients who are unable to maintain proper breathing on
their own. They are commonly used during anesthesia, in intensive care
units (ICUs), and for patients requiring respiratory support.

There are several types of artificial airways, each designed for specific
situations and patient needs. The main types of artificial airways include:
Oropharyngeal Airway (OPA)
Nasopharyngeal Airway (NPA)
Endotracheal Tube (ETT)
 Oropharyngeal Airway (OPA)
Inserted through the mouth into the back of the throat to keep the
tongue away from the posterior pharynx.
Typically used for unconscious or deeply sedated patients during
resuscitation or when maintaining an open airway is necessary.
Not suitable for conscious or semi-conscious patients due to the risk
of gagging or airway obstruction.

Nasopharyngeal Airway (NPA)

Inserted through one nostril into the nasopharynx to maintain an
open airway and facilitate breathing.
Often used for patients with intact gag reflexes, those with facial
trauma, or for short-term airway management in conscious or semi-
conscious patients.
Endotracheal Tube (ETT)
A tube inserted through the mouth or nose and advanced into the
trachea to establish a secure airway.
Used for patients who require long-term mechanical ventilation,
general anesthesia during surgery, or for airway protection in patients
at risk of aspiration.
Connected to a ventilator or a breathing circuit to provide mechanical
ventilation.
Laryngeal Mask Airway (LMA):
A supraglottic airway device that sits in the pharynx, forming a seal
over the larynx without passing through the vocal cords.
Used as an alternative to endotracheal intubation for short surgeries,
anesthesia induction, or during emergencies.
Available in various sizes to accommodate different patient
populations.
Each type of artificial airway has its advantages, limitations, and specific
indications for use. The choice of the appropriate artificial airway depends
on the patient's condition, the level of consciousness, the need for
mechanical ventilation, and the healthcare provider's expertise.
 COMPLETE

RENAL/URINARY
STUDY GUIDE

JDMA NURSING SCHOOL

 Chronic Kidney Disease
Kidney disease means your kidneys aren’t working properly and are
beginning to lose their function. Chronic kidney disease (CKD) worsens
over time. High blood pressure and diabetes are two common causes of
CKD. There’s no cure for CKD, but you can take steps to preserve
function for as long as possible. Late-stage kidney disease requires
dialysis or a kidney transplant.
Chronic kidney disease (CKD and chronic renal disease) means that
there’s damage to your kidneys and they aren’t working as well as they
should. Your kidneys are like a filter in your body — filtering out wastes,
toxins and extra water from your blood. They also help with other
functions like bone and red blood cell health. When your kidneys begin
to lose their function, they can’t filter waste, which means the waste
builds up in your blood.
 Stages Of Chronic Kidney Disease

Chronic kidney disease (CKD) is a progressive condition characterized by

the gradual loss of kidney function over time. There are five stages of CKD,
which are classified based on the level of kidney function. These stages are
determined by the glomerular filtration rate (GFR), a measure of how
effectively the kidneys filter waste and excess fluid from the blood.
The stages range from very mild (stage 1) to kidney failure (stage 5).
Healthcare providers determine the stage of your kidney function
according to the glomerular filtration rate (GFR). Your GFR is a number
based on the amount of creatinine, a waste product, found in your blood.
Here are the five stages of chronic kidney disease:
Stage 1:
Kidney damage with normal or increased GFR
In this stage, there is evidence of kidney damage, such as abnormal urine
tests or imaging results, but the GFR is still normal or higher than 90
mL/min. Kidney function is generally preserved, and symptoms may not be
present at this stage.
Stage 2:
Mildly decreased GFR
In stage 2, the GFR is slightly reduced, ranging from 60 to 89 mL/min.
Kidney damage is still present, but it may start to cause mild symptoms,
such as increased urination or blood in the urine. However, many
individuals in this stage may still not experience noticeable symptoms.
Stage 3:
Moderately decreased GFR
Stage 3 is divided into two sub-stages:
Stage 3A: GFR ranging from 45 to 59 mL/min
Stage 3B: GFR ranging from 30 to 44 mL/min In stage 3, kidney function
is significantly reduced, and symptoms become more apparent.
Common symptoms include fatigue, fluid retention, increased blood
pressure, and changes in urination patterns. Treatment and lifestyle
modifications are often necessary to slow down the progression of the
disease.
 Stage 4:
Severely decreased GFR
Stage 4 is divided into two sub-stages:
Stage 4A: GFR ranging from 15 to 29 mL/min
Stage 4B: GFR less than 15 mL/min (kidney failure) In stage 4, kidney
function is severely impaired, and individuals may experience
symptoms such as severe fatigue, persistent fluid retention, nausea,
decreased appetite, and a buildup of waste products in the blood. At this
stage, patients may require more intensive medical interventions, such
as dialysis or a kidney transplant.

Stage 5:
Kidney failure (End-stage renal disease)
In stage 5, the kidneys have lost nearly all their function, with a GFR less
than 15 mL/min. Kidney failure is also referred to as end-stage renal disease
(ESRD). At this point, the kidneys are unable to maintain the body's internal
balance, and dialysis or a kidney transplant becomes necessary for survival.
It's important to note that the progression of CKD can vary from person to
person, and early detection and appropriate management can help slow
down the progression and minimize complications. Regular monitoring and
medical supervision are crucial for individuals with chronic kidney disease.
 Symptoms Of Chronic Kidney Disease
In the early stages of kidney disease, you usually don’t have noticeable
symptoms. As the disease worsens, symptoms may include:
A need to pee more often.
Tiredness, weakness, low energy level.
Loss of appetite.
Swelling of your hands, feet and ankles.
Shortness of breath.
Foamy or bubbly pee.
Puffy eyes.
Dry and itchy skin.
Trouble concentrating.
Trouble sleeping.
Numbness.
Nausea or vomiting.
Muscle cramps.
High blood pressure.
Darkening of your skin.
Keep in mind that it can take years for waste to build up in your blood and
cause symptoms.

Causes Of Chronic Kidney Disease

Kidney diseases happen when your kidneys are damaged and can’t filter
your blood. With chronic kidney disease, the damage tends to happen over
the course of several years.
High blood pressure (hypertension) and diabetes are the two most common
causes of chronic kidney disease. Other causes and conditions that affect
kidney function and can cause chronic kidney disease include:
Glomerulonephritis: This type of kidney disease involves damage to the
glomeruli, which are the filtering units inside your kidneys.
Polycystic kidney disease: This is a genetic disorder that causes many
fluid-filled cysts to grow in your kidneys, reducing the ability of your
kidneys to function.
 Membranous nephropathy: This is a disorder where your body’s
immune system attacks the waste-filtering membranes in your kidney.
Obstructions of the urinary tract from kidney stones, an enlarged
prostate or cancer.
Vesicoureteral reflux: This is a condition in which pee flows backward
back up your ureters to your kidneys.
Nephrotic syndrome: This is a collection of symptoms that indicate
kidney damage.
Recurrent kidney infection (pyelonephritis).
Diabetes-related nephropathy: This is damage or dysfunction of one or
more nerves, caused by diabetes.
Lupus and other immune system diseases that cause kidney problems,
including polyarteritis nodosa, sarcoidosis, Goodpasture syndrome and
Henoch-Schönlein purpura.

CKD is a prevalent condition, affecting a significant portion of the global

population. Its prevalence is increasing due to factors such as an aging
population, rising rates of diabetes and hypertension, and lifestyle changes.
CKD poses a substantial healthcare burden, necessitating timely detection,
management, and preventive strategies.
 Renal Replacement Therapy (RRT)
Renal Replacement Therapy (RRT) is a medical
treatment used to provide artificial support for
patients with severe kidney failure or acute
kidney injury (AKI) when their kidneys are
unable to adequately filter waste products and
maintain fluid and electrolyte balance. RRT is a
life-saving intervention that helps to remove
toxins and excess fluids from the body,
maintaining overall health and preventing life-
threatening complications associated with
kidney dysfunction.

Indications for Renal Replacement Therapy

Chronic Kidney Disease (CKD) Stage 5

RRT is indicated for patients with end-stage kidney disease (ESKD) or
CKD stage 5 when kidney function has declined to less than 15% of
normal.
Acute Kidney Injury (AKI)
RRT is used in cases of severe AKI when the kidneys suddenly and acutely
lose their ability to function properly, leading to a rapid accumulation of
toxins and fluid in the body.
Fluid Overload
In conditions where there is excessive fluid retention and diuretics are
ineffective, RRT can help remove the excess fluid.
Electrolyte Imbalance
RRT is utilized to correct abnormal levels of electrolytes
(e.g., potassium, sodium, calcium) in the blood that can be
life-threatening.
 Methods of Renal Replacement Therapy
There are three main methods of RRT, each with its advantages and
indications:
1. Hemodialysis (HD): Hemodialysis involves using a machine (dialyzer)
to filter the patient's blood outside the body, removing waste products
and excess fluids. Blood is circulated through the dialyzer, where it is
cleaned and then returned to the patient's body.
2. Peritoneal Dialysis (PD): Peritoneal dialysis is performed internally by
introducing a special fluid (dialysate) into the patient's abdominal
cavity through a catheter. The peritoneal membrane acts as a natural
filter, allowing waste and excess fluid to move from the blood vessels
into the dialysate. After a set dwell time, the fluid is drained out,
carrying the waste with it.
3. Continuous Renal Replacement Therapy (CRRT): CRRT is used
primarily in critically ill patients with AKI. It is a slow and continuous
form of dialysis that more closely mimics the function of the natural
kidneys. CRRT is often used in intensive care units and is well-
tolerated by hemodynamically unstable patients.
 Benefits of Renal Replacement Therapy
Renal Replacement Therapy (RRT) offers several significant benefits for
patients with severe kidney failure or acute kidney injury (AKI). It plays a
vital role in maintaining overall health, preventing life-threatening
complications, and improving the quality of life for individuals with
kidney dysfunction. Some of the key benefits of RRT include:
RRT helps remove waste products and excess fluids from the body,
leading to a reduction in symptoms associated with kidney failure.
Patients often experience improved appetite, reduced nausea, and
increased energy levels, enhancing their overall quality of life.
RRT helps regulate fluid and electrolyte levels in the body. It can
effectively remove excess fluid in patients with fluid overload and
correct imbalances of electrolytes such as potassium, sodium, and
calcium. Maintaining proper fluid and electrolyte balance is crucial for
the normal functioning of organs and preventing life-threatening
complications.
RRT allows better management of dietary restrictions and fluid
intake. Patients on RRT can work with dietitians to optimize their
nutritional intake and meet their individual dietary needs.
For patients with end-stage kidney disease (ESKD) or severe AKI, RRT
is a life-saving intervention. Without RRT, these patients would face
life-threatening complications and a significantly reduced life
expectancy.
RRT can serve as a bridge to kidney transplantation for patients who
are eligible for a kidney transplant. It helps stabilize their condition
and improves their chances of successful transplantation.
Continuous Renal Replacement Therapy (CRRT) is commonly used in
critically ill patients with AKI in intensive care units. CRRT provides
gentle and continuous support, making it suitable for
hemodynamically unstable patients.
RRT can be tailored to meet the individual needs of each patient. The
choice of RRT method and treatment frequency can be adjusted based
on the patient's condition, medical history, and response to therapy.
 Acid-Base and Electrolyte Disorders
Acid-base and electrolyte disorders are medical conditions that result
from imbalances in the body's pH level and concentrations of various
electrolytes. These imbalances can disrupt normal physiological processes
and lead to a wide range of symptoms and complications. Proper
regulation of acid-base balance and electrolyte concentrations is essential
for maintaining normal cellular function and overall health.

Acid-Base Disorders
The body's acid-base balance is maintained through a delicate equilibrium
between acids and bases. The pH scale measures the acidity or alkalinity
of a solution, with a pH of 7 considered neutral. Deviations from the
normal pH range (7.35 to 7.45) can result in the following acid-base
disorders:
Respiratory Acidosis
This occurs when there is an excess of carbon dioxide (CO2) in the blood
due to impaired lung function, leading to decreased ventilation. It results
in an accumulation of carbonic acid, lowering the blood pH.
Respiratory Alkalosis
Respiratory alkalosis is characterized by a decrease in blood carbon
dioxide levels due to hyperventilation or rapid breathing. This leads to a
decrease in carbonic acid concentration and an increase in blood pH.
Metabolic Acidosis
Metabolic acidosis occurs when there is an accumulation of acidic
substances, such as lactic acid or ketones, in the blood. This can result
from conditions such as diabetic ketoacidosis, lactic acidosis, or severe
kidney dysfunction.
Metabolic Alkalosis
Metabolic alkalosis is characterized by an increase in blood bicarbonate
levels, leading to a higher pH. It can be caused by conditions such as
vomiting, excessive use of bicarbonate-containing medications, or excess
aldosterone production.
 Electrolyte Disorders
Electrolytes are electrically charged minerals that play essential roles in
various physiological processes, including nerve function, muscle
contractions, and fluid balance. The main electrolytes in the body include
sodium, potassium, calcium, magnesium, chloride, bicarbonate, and
phosphate. Electrolyte disorders can arise from various factors, including
kidney dysfunction, hormonal imbalances, medication use,
and fluid imbalances. Some common electrolyte disorders
include:

Hyponatremia
Hyponatremia is a condition characterized by low blood sodium levels. It
can result from excessive fluid intake, kidney disorders, hormonal
imbalances, or certain medications. Severe hyponatremia can lead to
neurological symptoms and complications.

Hypernatremia
Hypernatremia refers to high blood sodium levels and is often caused by
dehydration or impaired thirst mechanisms. It can lead to
symptoms such as confusion, seizures, and coma.

Hypokalemia
Hypokalemia is a deficiency of potassium in the blood, commonly caused
by diuretic use, gastrointestinal losses, or kidney dysfunction. It can lead
to muscle weakness, cardiac arrhythmias, and other complications.

Hyperkalemia
Hyperkalemia is an excess of potassium in the blood and
can be life-threatening. It can occur due to kidney dysfunction,
certain medications, or conditions that cause cells to release
potassium into the bloodstream. Severe hyperkalemia
can lead to cardiac arrhythmias and cardiac arrest.
 Hypocalcemia
Hypocalcemia is low blood calcium levels and can result from conditions
such as hypoparathyroidism, vitamin D deficiency, or kidney dysfunction.
It can lead to neuromuscular irritability and cardiac abnormalities.

Hypercalcemia
Hypercalcemia is elevated blood calcium levels and can be caused by
conditions such as hyperparathyroidism, malignancies, or excess vitamin
D intake. It can lead to symptoms such as fatigue, bone pain, and kidney
stones.
Hypomagnesemia
Hypomagnesemia is low blood magnesium levels and can be caused by
alcoholism, malnutrition, or kidney dysfunction. It can lead to muscle
cramps, tremors, and cardiac arrhythmias.

Hypermagnesemia
Hypermagnesemia is elevated blood magnesium levels and is most
commonly seen in patients with kidney dysfunction. It can lead to muscle
weakness, confusion, and cardiac arrhythmias.

The management of acid-base and electrolyte disorders involves

identifying and addressing the underlying cause. Treatment may include
fluid resuscitation, medications to correct imbalances, adjustments to
diet and medication regimens, and addressing any underlying medical
conditions contributing to the disorder. In severe cases, patients may
require hospitalization and specialized care to restore normal acid-base
balance and electrolyte levels.
Acid-base and electrolyte disorders are important considerations in
medical practice as they can have significant effects on patient health and
well-being. Maintaining proper acid-base balance and
electrolyte concentrations is essential for normal cellular
function and overall physiological stability. Proper
evaluation, diagnosis, and management of these disorders
are crucial in optimizing patient outcomes and preventing
complications.
 Fluid Management
Fluid management is a critical aspect of medical care that involves
maintaining a proper balance of fluids in the body to support normal
physiological functions and prevent complications. Fluids play a vital role
in transporting nutrients, removing waste products, regulating body
temperature, and supporting cellular function. Effective fluid management
is essential in various medical settings, including hospitals, clinics, and
critical care units.

Key Components of Fluid Management

Assessment
The first step in fluid management is a thorough assessment of the
patient's fluid status. This includes evaluating the patient's medical history,
current clinical condition, vital signs, urine output, and laboratory values.
It also involves monitoring trends in fluid balance over time.

Fluid Balance Monitoring

Monitoring fluid intake and output is crucial to assess the patient's fluid
status accurately. This includes tracking oral and intravenous (IV) fluid
intake as well as urine output. In critically ill patients, more advanced
monitoring techniques may be used, such as central venous pressure (CVP)
measurement and pulmonary artery catheterization.

Fluid Replacement
In situations of fluid loss, such as dehydration or blood loss, appropriate
fluid replacement is necessary to restore fluid balance and maintain
adequate perfusion of organs and tissues. Different types of fluids may be
used, including crystalloids (e.g., normal saline, lactated Ringer's) and
colloids (e.g., albumin) based on the patient's condition.
 Fluid Restriction
In certain medical conditions like congestive heart failure or kidney
dysfunction, fluid restriction may be necessary to prevent fluid overload
and its associated complications. Fluid restriction is often prescribed based
on the patient's fluid balance and specific medical needs.

Electrolyte Management
Fluid management also includes maintaining proper electrolyte balance
(sodium, potassium, calcium, magnesium, etc.) within the body. Electrolyte
imbalances can lead to significant health issues and need to be addressed
through appropriate fluid and medication adjustments.

Intravenous Therapy
Intravenous (IV) fluid therapy is commonly used to deliver fluids and
medications directly into the bloodstream. IV therapy is valuable in
patients who cannot take oral fluids or require rapid fluid resuscitation.

Fluid Removal
In conditions where there is fluid overload, such as in congestive heart
failure or acute kidney injury, fluid removal techniques like diuretics or
renal replacement therapy (e.g., hemodialysis or continuous renal
replacement therapy) may be used to alleviate symptoms and restore fluid
balance.

Fluid management is a fundamental aspect of medical care that directly

impacts patient outcomes. It involves assessing, monitoring, and adjusting
fluid intake and output to maintain a proper fluid balance in the body.
Proper fluid management is essential for supporting normal physiological
functions, preventing complications, and optimizing the overall well-being
of patients. Individualized and evidence-based fluid management
strategies are crucial to providing the best possible care to patients in
various medical settings.
 Sepsis-Associated AKI
Sepsis-associated acute kidney injury (SA-AKI) is a severe and potentially
life-threatening condition that occurs when a patient develops acute
kidney injury (AKI) as a complication of sepsis. Sepsis is a severe immune
response to an infection, which can lead to widespread inflammation and
organ dysfunction, including the kidneys. SA-AKI is a serious medical
emergency that requires prompt recognition and aggressive management
to improve patient outcomes.

Pathophysiology of SA-AKI

The pathophysiology of SA-AKI is complex and involves several

interconnected mechanisms:

1. Inflammatory Response: Sepsis triggers a dysregulated immune

response, leading to the release of pro-inflammatory cytokines and
other mediators. This systemic inflammation can damage blood vessels
and impair blood flow to the kidneys, contributing to AKI.
2. Hypoperfusion and Hypotension: Sepsis can cause low blood pressure
(hypotension) and reduced blood flow to the kidneys (hypoperfusion).
This decreases oxygen and nutrient supply to renal cells, leading to
their injury and dysfunction.
3. Endothelial Dysfunction: Sepsis-associated inflammation and
microvascular injury can lead to endothelial dysfunction in the
kidneys, affecting their ability to filter and regulate fluids and
electrolytes properly.
4. Intrarenal Microvascular Thrombosis: Microvascular clot formation
within the kidneys can occur during sepsis, further compromising
renal blood flow and function.
5. Apoptosis and Cell Death: Sepsis-induced AKI can result in
programmed cell death (apoptosis) of renal cells, further contributing
to kidney injury.
 Clinical Presentation
Patients with SA-AKI typically present with signs and symptoms of sepsis,
such as fever, rapid heart rate, low blood pressure, altered mental status,
and evidence of infection (e.g., pneumonia, urinary tract infection, or
bloodstream infection). The development of AKI is indicated by a rapid
increase in serum creatinine levels and a decrease in urine output.

Management
The management of SA-AKI is focused on treating the underlying sepsis
and providing supportive care for renal function. Key aspects of
management include:
1. Early Recognition and Treatment of Sepsis: Prompt recognition and
early treatment of sepsis with antibiotics and fluid resuscitation are
vital to prevent further kidney injury.
2. Hemodynamic Support: Maintaining adequate blood pressure and
perfusion to the kidneys through intravenous fluids and, if necessary,
vasopressor medications is crucial to support renal function.
3. Renal Replacement Therapy (RRT): In severe cases of SA-AKI, when
there is inadequate response to fluid resuscitation and vasopressors, or
when life-threatening complications arise (e.g., fluid overload, severe
acidosis), renal replacement therapy (dialysis) may be necessary to
support kidney function.
4. Avoidance of Nephrotoxic Medications: Nephrotoxic medications, such
as certain antibiotics or contrast agents, should be avoided or used
cautiously in patients with SA-AKI.
5. Monitoring and Supportive Care: Close monitoring of renal function,
fluid status, electrolyte levels, and vital signs is essential to guide
treatment and identify any worsening of the condition. Supportive
care, including nutritional support and management of complications,
is also critical in improving patient outcomes.
 Renal Complications of Systemic Diseases
Renal complications of systemic diseases refer to kidney-
related problems that arise as a result of underlying
conditions affecting multiple organs or systems in the
body. The kidneys play a crucial role in filtering waste
products and excess fluids from the bloodstream,
maintaining electrolyte balance, and regulating blood
pressure. When systemic diseases affect the kidneys,
their normal functions can be impaired, leading to
various renal manifestations. Understanding these
complications is essential for early detection, appropriate
management, and improved outcomes for patients.
Here are some of the common systemic diseases with renal complications:
Diabetes Mellitus
Diabetes is a leading cause of chronic kidney disease (CKD). Prolonged
high blood sugar levels in diabetes can damage the small blood vessels
and nephrons (functional units) of the kidneys, leading to diabetic
nephropathy.
Diabetic nephropathy is characterized by proteinuria (presence of
excess protein in the urine), hypertension, and a decline in kidney
function. It can progress to CKD and, in severe cases, result in end-
stage renal disease (ESRD) requiring dialysis or kidney transplantation.

HIV/AIDS
Human immunodeficiency virus (HIV) infection and acquired
immunodeficiency syndrome (AIDS) can cause HIV-associated
nephropathy (HIVAN). HIVAN is a type of kidney disease that primarily
affects individuals of African descent and can lead to ESRD if not
managed effectively.
Additionally, HIV-related immune dysfunction can predispose patients
to other kidney-related infections and complications.
 Hypertension (High Blood Pressure)
Uncontrolled hypertension can cause chronic kidney disease
(hypertensive nephropathy). Prolonged high blood pressure can
damage the blood vessels in the kidneys and impair their ability to
filter waste products and maintain fluid and electrolyte balance.
Hypertensive nephropathy is a common cause of CKD and can lead to
kidney failure if not managed effectively.
Systemic Lupus Erythematosus (SLE)
Lupus is an autoimmune disease that can affect various organs,
including the kidneys. Lupus nephritis is a common complication,
characterized by inflammation in the kidneys.
Lupus nephritis can lead to proteinuria, hematuria (blood in the urine),
and impaired kidney function. If left untreated, it can cause
irreversible kidney damage and progress to CKD.

Rheumatoid Arthritis (RA)

RA is an autoimmune inflammatory disorder that can lead to
secondary amyloidosis. In this condition, abnormal proteins called
amyloids are deposited in the kidneys, causing kidney dysfunction and
damage.
Amyloidosis can impair kidney function and lead to proteinuria,
nephrotic syndrome, and progressive CKD.

Vasculitis
Vasculitis refers to inflammation of blood vessels, which can affect the
kidneys and cause glomerulonephritis. Different types of vasculitis,
such as granulomatosis with polyangiitis (GPA) and microscopic
polyangiitis (MPA), can involve the kidneys.
Vasculitic glomerulonephritis can lead to rapidly progressive kidney
failure if not promptly diagnosed and treated.

Multiple Myeloma
Myeloma kidney can result in kidney dysfunction, proteinuria, and
kidney failure.
 Amyloidosis
Amyloidosis is a group of conditions where abnormal proteins
(amyloids) build up in various organs, including the kidneys. The
amyloid deposits can impair kidney function and lead to proteinuria
and kidney damage.
Amyloidosis can be primary (idiopathic) or secondary to other
conditions, such as multiple myeloma or chronic infections.
Liver Disease
Certain liver diseases, such as cirrhosis and hepatorenal syndrome, can
cause kidney dysfunction. In cirrhosis, there is reduced blood flow to
the kidneys due to portal hypertension, leading to hepatorenal
syndrome.
Accumulation of toxins in the blood due to impaired liver function can
also directly affect kidney health.

Systemic Infections
Some systemic infections, such as bacterial endocarditis or sepsis, can
lead to acute kidney injury (AKI) due to decreased blood flow to the
kidneys, inflammation, or direct infection of the kidneys.
Sepsis-induced AKI is a severe and life-threatening condition that
requires immediate medical attention.

Management
Management of renal complications of systemic diseases involves several
key aspects:
Early Detection: Routine screening and timely diagnosis are essential
for identifying kidney involvement in systemic diseases. Monitoring
kidney function through blood tests and urine analysis can help detect
early signs of kidney damage.

Blood Pressure Control: Maintaining optimal blood pressure is vital to

protect the kidneys from further damage in conditions like diabetes
and hypertension.
 Control of Underlying Condition: Effectively managing the underlying
systemic disease, such as diabetes, hypertension, or autoimmune
disorders, is crucial to prevent or slow down kidney damage.
Immunosuppressive Therapy: In autoimmune diseases like lupus and
vasculitis, immunosuppressive medications may be used to reduce
inflammation and preserve kidney function.
Dialysis and Kidney Transplantation: In cases of advanced kidney
failure (ESRD), renal replacement therapy, including dialysis or kidney
transplantation, may be necessary to sustain life.
Multidisciplinary Approach: Managing renal complications of systemic
diseases often requires a multidisciplinary approach involving
nephrologists, rheumatologists, endocrinologists, and other specialists
to provide comprehensive care.
Patient Education: Educating patients about their condition,
medications, lifestyle modifications, and the importance of adherence
to treatment is crucial in optimizing outcomes and empowering
patients to actively participate in their care.
Renal complications of systemic diseases encompass a wide range of
kidney-related problems that arise due to underlying conditions affecting
multiple organs. Early detection, effective management of the underlying
systemic disease, and timely intervention are essential in preserving
kidney function and improving patient outcomes.
A comprehensive approach involving close monitoring, collaboration
between specialists, and patient education is vital in addressing renal
complications and minimizing their impact on overall health.
With advancements in medical research and innovative treatment
modalities, the management of renal complications of systemic diseases
continues to evolve, offering hope for better outcomes and improved
quality of life for affected individuals.
 Renal Pharmacotherapy
Renal pharmacotherapy refers to the use of medications to treat various
kidney-related conditions and manage renal function. The kidneys play
a crucial role in filtering and eliminating drugs and their metabolites
from the body. However, in patients with kidney dysfunction, the
clearance and metabolism of drugs can be altered, leading to potential
drug accumulation and adverse effects.
Renal pharmacotherapy encompasses various aspects, including:
Drug Dosing Adjustments: In patients with impaired kidney function,
drug dosages may need to be adjusted to prevent drug accumulation and
toxicity.
Nephrotoxicity Monitoring: Some medications have the potential to
cause kidney damage (nephrotoxicity) if not properly managed. Renal
function should be monitored regularly when patients are on
nephrotoxic drugs.
Diabetes Management: For patients with diabetes and kidney disease,
medications such as metformin and sodium-glucose cotransporter 2
(SGLT2) inhibitors may be used to manage blood glucose levels while
considering their renal safety.
Phosphate Binders: Patients with advanced kidney disease may develop
hyperphosphatemia (high blood phosphate levels), requiring the use of
phosphate binders to reduce phosphate absorption from the diet.
Calcium and Vitamin D Supplementation: Patients with CKD may
require calcium and vitamin D supplementation to manage bone health
and prevent complications like secondary hyperparathyroidism.
It is essential for healthcare providers to be well-versed in renal
pharmacotherapy to ensure safe and effective treatment for patients
with kidney disease. Close monitoring of renal function, drug
interactions, and adverse effects is crucial to optimize drug therapy and
improve patient outcomes. Collaborative care involving nephrologists,
pharmacists, and other healthcare professionals is valuable in managing
medication regimens for patients with kidney-related conditions.
 COMPLETE

OTHERS
STUDY GUIDE

JDMA NURSING SCHOOL

 Sepsis
Sepsis is the body’s extreme response to an infection. It is a life-
threatening medical emergency. Sepsis happens when an infection you
already have triggers a chain reaction throughout your body. Infections
that lead to sepsis most often start in the lung, urinary tract, skin, or
gastrointestinal tract. Without timely treatment, sepsis can rapidly lead to
tissue damage, organ failure, and death.

Anyone can get an infection, and almost any infection, including COVID-19,
can lead to sepsis. In a typical year:

At least 1.7 million adults in America develop sepsis.

At least 350,000 adults who develop sepsis die during their hospitalization
or are discharged to hospice.
1 in 3 people who dies in a hospital had sepsis during that hospitalization
Sepsis, or the infection causing sepsis, starts before a patient goes to the
hospital in nearly 87% of cases.

Is sepsis contagious?
You can’t spread sepsis to other people. However, an infection can
lead to sepsis, and you can spread some infections to other people.

What causes sepsis?

Infections can put you or your loved one at risk for sepsis. When
germs get into a person’s body, they can cause an infection. If you
don’t stop that infection, it can cause sepsis. Bacterial infections
cause most cases of sepsis. Sepsis can also be a result of other
infections, including viral infections, such as COVID-19 or
influenza, or fungal infections.
 Who is at risk?
Anyone can develop sepsis, but some people are at higher risk for
sepsis

People with weakened

Adults 65 or older
immune systems

People with chronic People with recent severe

medical conditions, such as illness or hospitalization
diabetes, lung disease,
cancer, and kidney disease

People who survived sepsis Children younger than one

 signs & symptoms
A person with sepsis might have one or more of the following
signs or symptoms:

High heart rate or Fever, shivering, or

weak pulse feeling very cold

Confusion or
Shortness of breath
disorientation

Extreme pain or discomfort Clammy or sweaty skin

 Trauma Medications
There are several medications that can be used in the treatment of
trauma and its associated symptoms. These may include:

Benzodiazepines (SSRIs)
These medications, such as These medications, such as
diazepam or lorazepam, can be fluoxetine or sertraline, are
used to manage anxiety, agitation, commonly used to treat depression
and insomnia associated with and anxiety disorders, but they can
trauma. They work by increasing also be effective in the treatment of
the activity of a neurotransmitter trauma-related disorders like post-
called GABA, which helps to calm traumatic stress disorder (PTSD).
the brain and reduce SSRIs work by increasing the
hyperarousal. amount of the neurotransmitter
serotonin in the brain, which can
Antipsychotics help regulate mood and reduce
anxiety.
hese medications, such as
risperidone or olanzapine, are Beta-blockers
sometimes used in the treatment
of trauma-related disorders when These medications, such as
the individual experiences propranolol, can be used to reduce
symptoms like paranoia or the physical symptoms of trauma,
dissociation. Antipsychotics work such as increased heart rate and
by blocking the activity of blood pressure. Beta-blockers work
dopamine in the brain, which can by blocking the effects of
help reduce symptoms of adrenaline, which can help reduce
psychosis. the physiological response to stress.

It's important to note that medication should only be used as part of a

comprehensive treatment plan that includes therapy, self-care, and social
support. If you are experiencing trauma-related symptoms, it's important
to speak with a mental health professional to develop a personalized
treatment plan that meets your unique needs.
 Burns
Burns, also known as thermal injuries, are injuries that occur when the
skin or other tissues of the body come into contact with heat, electricity,
radiation, or chemicals. Burns can vary in severity, ranging from minor
skin irritation to life-threatening injuries.

classifications of burns
There are different classifications of burns, based on the depth and extent
of the injury. The most common classification system is the one based on
the depth of the burn:
First-degree burns
These are the mildest burns and only affect the top layer of the skin
(epidermis). They are characterized by redness, pain, and swelling, and
usually heal within a few days without scarring.
Second-degree burns
These burns affect the second layer of the skin (dermis), and are
characterized by blistering, severe pain, and swelling. Healing time varies
depending on the extent of the injury, but can take weeks or months.
Third-degree burns
These are the most severe burns and affect all layers of the skin, as well as
underlying tissues. They can be painless due to nerve damage and can
cause scarring, disfigurement, and even death. Third-degree burns require
immediate medical attention.

Burns can be caused by various sources, including fire, hot liquids, steam,
chemicals, electricity, and radiation. Treatment for burns depends on the
severity of the injury, but may involve pain management, wound care,
and, in some cases, surgery.
Prevention of burns involves taking safety precautions, such as using
protective gear when working with heat or chemicals, keeping hot liquids
away from children, and being cautious around open flames or hot
surfaces.
 Causes of burns
Thermal burns
These are the most common type of burns and are caused by exposure to
heat, such as fire, hot liquids, steam, or hot surfaces.
Chemical burns
These burns occur when the skin comes into contact with strong acids,
alkalis, or other harmful chemicals.
Electrical burns
These burns are caused by exposure to electrical currents and can be very
serious, as they can damage internal organs and tissues.
Radiation burns
These burns are caused by exposure to high-energy radiation, such as x-
rays, and can be caused by accidental exposure or radiation therapy.
Friction burns
These occur when the skin rubs against a rough surface, such as road rash.

Treatment for burns

The treatment for burns depends on the severity of the injury. For
minor burns, such as first-degree burns, treatment may include:
Running cool (not cold) water over the affected area for several
minutes to reduce pain and swelling.
Applying a sterile, non-adhesive bandage to protect the burn and
promote healing.
Taking over-the-counter pain medication, such as acetaminophen
or ibuprofen, to manage pain.
For more severe burns, such as second-degree and third-degree burns,
treatment may involve:
IV fluids and medication to manage pain and prevent infection.
Wound care, such as cleaning the burn and applying dressings to
promote healing.
Skin grafts or other surgical procedures to repair the damage and
reduce scarring.
 THREAT FROM BURNS
Burns can be life-threatening and require critical care in severe cases.
Here are some important notes regarding critical care for burns:
Airway management
Burn injuries to the face, neck, and chest can cause swelling and block
the airway. If the patient is having difficulty breathing, they may require
intubation to ensure proper oxygenation.
Fluid resuscitation
Severe burns can cause fluid loss and shock, which can be life-
threatening. Patients with significant burns may require IV fluids and
electrolytes to replace lost fluids and maintain proper hydration.
Pain management
Burns can be extremely painful, and pain management is an essential
part of critical care. Medications such as opioids or non-opioids may be
used to manage pain.
Wound care
Proper wound care is crucial in preventing infection and promoting
healing. Patients with severe burns may require debridement, a process
in which dead or damaged tissue is removed to prevent infection.
Nutritional support
Burn injuries can cause metabolic changes that increase the patient's
nutritional needs. Patients may require enteral or parenteral nutrition to
ensure proper nutrition and promote healing.
Infection control
Burn injuries increase the risk of infection, so strict infection control
measures must be taken to prevent the spread of bacteria. This includes
using sterile equipment and dressing changes, as well as administering
antibiotics as needed.
Psychological support
Burn injuries can be traumatic, and patients may experience depression,
anxiety, or other psychological issues. Critical care teams may include
social workers or psychologists to provide emotional support and
counseling.
 burns rule of 9
The "rule of nines" is a method used to estimate the percentage of body
surface area (BSA) that has been burned in an adult. This method is
commonly used in the initial assessment of burn patients to help
determine the severity of the injury and guide treatment decisions.
The rule of nines divides the body into regions that represent
approximately 9% or multiples of 9% of the total body surface area. The
regions used in the rule of nines are:
Head and neck: 9%
Each arm: 9%
Chest and abdomen: 18%
Upper back and lower back: 18%
Each leg: 18%
Genital area: 1%
By using the rule of nines, the extent of the burn injury can be estimated.
For example, if a patient has burns on both legs and their abdomen, the
estimated BSA burned would be approximately 36% (18% for each leg,
and 18% for the abdomen).
It's important to note that the rule of nines is just an estimation and is
not always accurate. It should be used in conjunction with other
assessment tools and clinical judgment to guide treatment decisions.
Additionally, the rule of nines is not recommended for use in children, as
their body surface area proportions differ from adults. In pediatric
patients, the Lund and Browder chart is typically used to estimate the
percentage of body surface area burned.
The rule of nines is a quick and easy way to estimate the percentage of
body surface area affected by burns. It can be used by healthcare
professionals in the field or in emergency situations to quickly assess the
extent of the burn and provide initial treatment.
In addition to estimating the percentage of body surface area burned,
the rule of nines can also be used to estimate the amount of fluid
resuscitation that may be required. For example, if a patient has burns
affecting 30% of their body surface area, they may require 3 liters of fluid
in the first 24 hours after the injury.
 Shock
The term “shock” may refer to a psychologic or a physiologic type of shock.
Psychologic shock is caused by a traumatic event and is also known as
acute stress disorder. This type of shock causes a strong emotional
response and may cause physical responses as well.
The focus of this article is on the multiple causes of physiologic shock.
Your body experiences shock when you don’t have enough blood
circulating through your system to keep organs and tissues functioning
properly.
It can be caused by any injury or condition that affects the flow of blood
through your body. Shock can lead to multiple organ failure as well as life-
threatening complications.
There are many types of shock. They fall under four main categories, based
on what has affected the flow of blood. The four major types are:

1. Obstructive shock
2. Cardiogenic shock
3. Distributive shock
4. Hypovolemic shock
All forms of shock are life-threatening.

Signs and Symptoms

rapid, weak, or absent pulse confusion
irregular heartbeat anxiety
rapid, shallow breathing decrease in urine
lightheadedness thirst and dry mouth
cool, clammy skin low blood sugar
dilated pupils loss of consciousness
lackluster eyes
chest pain
nausea
 Causes of shock
Anything that affects the flow of blood through your body can cause shock.
Some causes of shock include:
severe allergic reaction blood infections
significant blood loss dehydration
heart failure poisoning
burns

Types of shock
1. There are four major types of shock, each of which can be caused by a
number of different events.
2. Obstructive shock 3. Distributive shock
3. Cardiogenic shock 4. Hypovolemic shock

Obstructive shock Cardiogenic shock

Obstructive shock occurs when Damage to your heart can
blood can’t get where it needs to decrease the blood flow to your
go. A pulmonary embolism is one body, leading to cardiogenic
condition that may cause an shock. Common causes of
interruption to blood flow. cardiogenic shock include:
Conditions that can cause a
buildup of air or fluid in the damage to your heart muscle
chest cavity can also lead to irregular heart rhythm
obstructive shock. These include: very slow heart rhythm
pneumothorax (collapsed
lung)
hemothorax (blood collects
in the space between the
chest wall and lung)
cardiac tamponade (blood or
fluids fill the space between
the sac that surrounds the
heart and the heart muscle)
 How is shock diagnosed?
First responders and doctors often recognize shock by its external
symptoms. They may also check for:
low blood pressure
weak pulse
rapid heartbeat
Once they’ve diagnosed shock, their first priority is to provide lifesaving
treatment to get blood circulating through the body as quickly as
possible. This can be done by giving fluid, drugs, blood products, and
supportive care. It won’t resolve unless they can find and treat the
cause.
Once you’re stable, your doctor can try to diagnose the cause of shock.
To do so, they may order one or more tests, such as imaging or blood
tests.

Imaging tests
Your doctor may order imaging tests to check for injuries or damage to
your internal tissues and organs, such as:
bone fractures
organ ruptures
muscle or tendon tears
abnormal growths
Such tests include:
ultrasound
X-ray
CT scan
MRI scan

Blood tests
Your doctor may use blood tests to look for signs of:
significant blood loss
infection in your blood
drug or medication overdose
 Burn Care Phases & Fluid Resuscitation
Burn Care Phases

The management of burn injuries involves several phases of care, each

with its specific goals and interventions. The three main phases of burn
care are:
Emergency Phase (Resuscitative Phase)
This phase begins immediately after the burn injury occurs and
continues until the patient's condition stabilizes.
The primary focus is on ensuring the patient's ABCs (airway,
breathing, and circulation) are addressed promptly.
For severe burns, rapid fluid resuscitation may be initiated to
prevent hypovolemic shock and maintain adequate tissue perfusion.
Pain management and wound care, such as cooling the burn area and
covering it with a clean, dry dressing, are also important in the initial
phase.
The patient may require transfer to a specialized burn center for
further evaluation and treatment.

Acute Phase
The acute phase starts once the patient's condition has stabilized,
and it continues until the wound heals or is ready for definitive
surgical treatment.
During this phase, the focus is on wound care, infection prevention,
and maintaining fluid and electrolyte balance.
The wound is cleaned and debrided to remove dead tissue and
reduce the risk of infection.
Dressings are used to protect the wound and promote healing.
Pain management, nutrition support, and physical therapy are
essential components of care during this phase.
In some cases, surgical interventions, such as skin grafting or
debridement, may be necessary to improve wound healing and
functional outcomes.
 Rehabilitation Phase
The rehabilitation phase begins once the burn wound has healed or
stabilized.
The primary goal is to restore function, mobility, and independence.
Physical and occupational therapy play a crucial role in helping
patients regain strength, range of motion, and functional abilities.
Psychological support and counseling are also essential for patients
dealing with the physical and emotional impacts of burn injuries.

Fluid Resuscitation in Burn Injuries

Fluid resuscitation is a crucial aspect of burn care, especially for moderate

to severe burns. Burn injuries can lead to significant fluid loss through
damaged skin, resulting in hypovolemic shock and compromised tissue
perfusion. The Parkland Formula is commonly used to calculate the initial
fluid resuscitation volume for burn patients within the first 24 hours:

Parkland Formula
4 mL of lactated Ringer's solution per kilogram of body weight per
percent of total body surface area (TBSA) burned.
Half of the calculated volume is administered in the first 8 hours, and
the remaining half is given over the next 16 hours.
It's important to note that the Parkland Formula provides only a starting
point for fluid resuscitation, and adjustments are made based on the
patient's response and ongoing assessment of fluid needs. Vital signs, urine
output, and other indicators of tissue perfusion are closely monitored to
ensure adequate resuscitation.
The appropriate fluid type and rate of administration may vary based on
the patient's age, comorbidities, burn depth, and other factors. Burn
resuscitation requires close monitoring and continuous reassessment to
avoid complications like fluid overload or inadequate tissue perfusion.
Burn patients with extensive or deep burns may require transfer to a
specialized burn center for comprehensive care and management.
 Trauma & Emergency Care
Trauma and emergency care involve the immediate assessment,
stabilization, and treatment of patients with acute injuries or life-
threatening medical conditions. These specialized medical services are
provided by healthcare professionals in emergency departments,
trauma centers, and pre-hospital settings like ambulances and first
responder teams. The main goals of trauma and emergency care are to
save lives, prevent further injury, and initiate appropriate medical
interventions promptly.

Key Components of Trauma and Emergency Care

1. Primary Assessment: The initial assessment of the patient's ABCs
(airway, breathing, and circulation) is conducted to identify and
address any life-threatening conditions. This includes ensuring the
patient has a patent airway, is breathing adequately, and has a stable
circulation.
2. Resuscitation: For severely injured or critically ill patients,
immediate resuscitation measures are initiated. This may involve
cardiopulmonary resuscitation (CPR) for cardiac arrest, fluid
resuscitation for hypovolemia, and interventions to manage severe
bleeding or shock.
3. Secondary Assessment: Once the patient is stabilized, a more
detailed assessment is performed to identify all injuries or medical
conditions. This includes a head-to-toe examination, obtaining a
medical history (if possible), and conducting diagnostic tests, such as
X-rays, CT scans, or blood tests.
4. Treatment and Interventions: Based on the assessment findings,
appropriate medical interventions are initiated. This may involve
wound care, fracture immobilization, pain management,
administration of medications, and other medical treatments.
5. Triage: In situations with multiple patients or mass casualties, triage
systems are used to prioritize the level of care based on the severity
of injuries and the likelihood of survival.
 Types of Trauma and Emergencies:

Trauma
Trauma refers to injuries caused by accidents, falls, assaults, or other
external forces. Common types of trauma include head injuries,
fractures, burns, penetrating injuries, and injuries to internal organs.
Cardiac Emergencies
These include cardiac arrest, heart attacks (myocardial infarction), and
arrhythmias (irregular heart rhythms).
Respiratory Emergencies
Conditions like acute asthma attacks, respiratory failure, and
pneumothorax require immediate medical attention.
Neurological Emergencies
Stroke, seizures, and traumatic brain injuries are examples of
neurological emergencies.
Surgical Emergencies
Conditions like appendicitis, bowel obstruction, and acute abdomen
may require emergency surgery.
Toxicological Emergencies
Poisonings or drug overdoses necessitate rapid assessment and
appropriate interventions.

In many cases, emergency care begins at the scene of the incident. Pre-
hospital care provided by first responders, emergency medical
technicians (EMTs), and paramedics can significantly impact patient
outcomes. This may involve basic life support, administration of
medications, immobilization of fractures, and transportation to
appropriate medical facilities.

Trauma and emergency care are essential components of healthcare that

require rapid assessment, decisive action, and effective coordination
among healthcare providers. Early and appropriate interventions can
significantly improve patient outcomes in critical and life-threatening
situations.
 Disaster Triage
Disaster triage is a system used in emergency response situations to
quickly and effectively prioritize the allocation of limited medical
resources to the greatest number of victims during a mass casualty
incident or disaster. The primary goal of disaster triage is to identify and
treat those patients who require immediate medical attention and
intervention while ensuring that available resources are utilized
efficiently.

Key Principles of Disaster Triage

Rapid Assessment: Triage personnel, such as first responders,
paramedics, or healthcare providers, quickly assess the victims'
injuries or medical conditions. The assessment focuses on
identifying life-threatening or time-sensitive conditions that require
immediate intervention.

Simple Triage Categories: Disaster triage systems use simple and

easily identifiable categories to categorize patients based on the
severity of their injuries or medical conditions. The most common
triage categories are:

1. Immediate (Red): Patients with life-threatening injuries or

conditions requiring immediate medical attention to survive.
2. Delayed (Yellow): Patients with injuries that are serious but not
immediately life-threatening and can wait for medical care.
3. Minor (Green): Patients with minor injuries or medical issues that do
not require urgent attention and can be managed later.
4. Expectant (Black): Patients with injuries so severe that survival is
unlikely even with medical intervention. These patients are given
comfort care to make them as comfortable as possible.
Treatment Prioritization: Triage personnel prioritize the treatment
and evacuation of patients based on their assigned triage categories.
Immediate patients are treated and transported first, followed by
those in the delayed and minor categories.

Reassessments: In dynamic disaster situations, the conditions of

patients can change rapidly. Regular reassessments of patients are
essential to ensure that their triage category remains accurate and to
identify any changes in their medical condition.

Resource Allocation: The goal of disaster triage is to make the best

use of available resources to provide the greatest benefit to the
largest number of victims. In situations with limited resources, such
as personnel, equipment, or medical supplies, tough decisions may
need to be made to maximize the overall survivability.

Challenges in Disaster Triage

In a disaster, the number of casualties can quickly overwhelm the
available healthcare resources and personnel. The sheer volume of
patients can make it difficult to assess and categorize them promptly
and accurately.
Disasters often lead to a scarcity of medical supplies, equipment, and
personnel. Triage teams may need to make difficult decisions about
how to allocate limited resources to maximize the overall impact on
patient outcomes.
In a disaster, there is likely to be a wide range of injuries, from minor
to life-threatening. Triage personnel must be skilled at quickly
identifying and prioritizing the most severe cases while ensuring that
less critical patients are not overlooked.
Disaster scenes are often chaotic and rapidly changing, making it
challenging to maintain organization and communication among
triage personnel. The noise, debris, and unpredictability of the
environment can hinder the triage process.
 Triage personnel may face emotional and psychological challenges
while dealing with a large number of injured and distressed
individuals. The stress and trauma of the situation can affect decision-
making and the ability to cope effectively.
Triage decisions can involve ethical dilemmas, such as determining
who receives care first when resources are scarce. Healthcare
providers may face moral distress when forced to make difficult
choices based on patient triage categories.
Effective communication among triage teams, medical facilities, and
other responding agencies is critical during a disaster. Ensuring that
all relevant parties have accurate and up-to-date information can be
challenging, especially in rapidly evolving situations.
Different disaster triage systems may be used, and personnel must be
familiar with the specific protocols to ensure consistent and
appropriate patient categorization. In high-stress situations, adhering
to protocols may become more difficult.
Triage teams may face safety risks while operating in disaster zones.
They need to be mindful of their own safety while carrying out their
duties.
Disasters may affect vulnerable populations differently, such as
children, elderly individuals, pregnant women, and individuals with
pre-existing medical conditions. Triage teams must consider the
unique needs of these populations during the triage process.

Despite these challenges, disaster triage remains a critical process for

effective emergency response. Training, preparation, and simulation
exercises can help healthcare providers develop the skills and resilience
needed to navigate these challenges and provide the best possible care to
those affected by disasters. Interagency collaboration, clear
communication, and ongoing education are key components in
overcoming the complexities of disaster triage.
Disaster triage is a vital component of emergency response in mass
casualty incidents or disasters. By quickly assessing and categorizing
patients based on the severity of their injuries or medical conditions.
 Drug Overdose & Poisoning
Drug overdose and poisoning are medical
emergencies that occur when an individual
ingests, inhales, or absorbs an excessive
amount of a drug or toxic substance. These
incidents can lead to serious health
complications and, in severe cases, can be life-
threatening. Prompt recognition and
appropriate management are essential in
managing drug overdoses and poisonings
effectively.

Causes of Drug Overdose and Poisoning

Accidental Overdose
Accidental overdoses occur when individuals take more medication than
prescribed or recommended unintentionally. This may happen due to
misunderstandings about dosing instructions or interactions with other
medications.
Intentional Overdose
Intentional overdoses involve individuals taking a larger amount of a
drug or toxic substance with the purpose of harming themselves or as a
suicide attempt.
Substance Abuse
Drug overdoses can occur in individuals who misuse or abuse drugs,
such as opioids, benzodiazepines, stimulants, or illicit substances.
Exposure to Toxic Substances
Poisonings can result from accidental or deliberate exposure to toxic
substances found in household products, chemicals, pesticides, plants,
or industrial materials.
 Management of Drug Overdose and Poisoning
Activate Emergency Services
If you suspect a drug overdose or poisoning, call emergency services
immediately for professional medical help.
Assessment and Stabilization
The patient's ABCs (airway, breathing, and circulation) are assessed and
stabilized as necessary. For patients with impaired airway or breathing,
intubation and assisted ventilation may be required.
Decontamination
In some cases, decontamination may be necessary to remove the toxic
substance from the patient's system. Decontamination methods include
gastric lavage (stomach pumping), activated charcoal administration, or
whole bowel irrigation.

Administration of Antidotes
For specific drug overdoses or poisonings, antidotes may be given to
counteract the effects of the toxic substance. Examples include naloxone
for opioid overdoses and antidotes for specific types of poisonings.
Supportive Care
Supportive care is provided to address the patient's symptoms and
maintain vital functions. This may include intravenous fluids,
medications to control seizures or agitation, and treatment for
complications like electrolyte imbalances.
 Monitoring and Observation
Patients are closely monitored for changes in their condition and for any
delayed effects of the toxic substance.
Psychosocial Support
For intentional overdose cases, psychosocial support, including
psychiatric evaluation and counseling, is crucial to address underlying
mental health issues and reduce the risk of future attempts.

Signs and Symptoms

The signs and symptoms of drug overdose and poisoning can vary
depending on the specific substance involved. Common signs include:
Altered mental status (confusion, agitation, or coma)
Difficulty breathing or respiratory distress
Irregular or slowed heartbeat
Nausea and vomiting
Seizures
Abdominal pain
Dilated pupils (mydriasis) or pinpoint pupils (miosis)
Sweating or fever
Hallucinations or delirium

Prevention
Prevention of drug overdose and poisoning involves various strategies,
such as:
Educating patients about proper medication use and potential side
effects.
Safe storage and disposal of medications and toxic substances to
prevent accidental exposures.
Increasing awareness of the risks associated with substance abuse and
providing access to addiction treatment programs.
 Organ Donation
Organ donation is the voluntary act of giving one's organs or tissues to
help save or improve the lives of individuals in need of organ
transplantation. Organ transplantation is a life-saving medical procedure
used to replace a failing organ with a healthy one from a deceased or
living donor. Organ donation is a critical aspect of modern medicine and
provides hope and a second chance at life for thousands of patients
worldwide.

Organ donation is the process of surgically removing an organ or tissue

from one person (the organ donor) and placing it into another person (the
recipient). Transplantation is necessary because the recipient’s organ has
failed or has been damaged by disease or injury.
Organ transplantation is one of the great advances in
modern medicine. Unfortunately, the need for organ
donors is much greater than the number of people who
actually donate. Every day in the United States, 21 people
die waiting for an organ and more than 107,380 men,
women and children await life-saving organ
transplants.
 Types of Organ Donation

Deceased Organ Donation

This occurs when organs are retrieved from individuals who have been
declared brain dead or have suffered cardiac death. Brain death is the
irreversible loss of all brain functions, including brainstem functions,
while the heart continues to beat with the help of life support. In some
cases, organs can also be retrieved after cardiac death, where the heart
stops beating, but circulation is maintained artificially for a short time
after death.
Living Organ Donation
In living organ donation, healthy individuals voluntarily donate organs
while they are alive. Living donors typically donate organs such as a
kidney or a part of the liver or lung. Living donation allows for shorter
waiting times and better outcomes for recipients compared to deceased
donation.

Benefits and Impact of Organ Donation

Organ donation saves lives: Transplanted organs can significantly
extend and improve the quality of life for recipients.
Reduces the organ transplant waiting list: Organ donation helps
address the shortage of available organs and reduces the waiting time
for recipients.
Enhances medical research: Donated organs that are not suitable for
transplantation contribute to medical research, leading to
advancements in organ transplantation and related fields.

Organ donation is a selfless act that has a profound impact on the lives of
both donors and recipients. It offers hope, healing, and a renewed chance
at life for those facing organ failure. By raising awareness about organ
donation and its positive impact, we can encourage more individuals to
become donors and contribute to the advancement of medical science and
the improvement of healthcare outcomes for patients in need.
Organs and tissues that can be transplanted include:
Liver. Intestine.
Kidney. Corneas.
Pancreas. Middle ear.
Heart. Skin.
Lung. Bone marrow.
Bone. Heart valves.

Vascularized composite allografts (transplant of several structures

that may include skin, uterus, bone, muscles, blood vessels, nerves
and connective tissue).
 The Organ Donation Process

Registration or Consent
Potential organ donors often register as donors during their lifetime
through government organ donor registries or by expressing their
consent on a driver's license or identification card. Family members may
also give consent for organ donation on behalf of a deceased individual if
the individual's wishes were not documented.

Identification of Potential Donors

In hospitals, potential organ donors are identified based on specific
medical criteria, such as brain death or meeting cardiac death criteria.
Specialized medical teams, separate from the transplant teams, are
responsible for determining the suitability of potential donors.

Consent and Evaluation

The family of the potential donor is approached, and consent for organ
donation is obtained if the individual did not explicitly register as an
organ donor. Living donors undergo thorough medical and psychological
evaluations to ensure that they are healthy and suitable candidates for
donation.
Matching and Allocation
For deceased donation, the donated organs are allocated to recipients
based on several factors, including medical urgency, tissue compatibility,
and waiting time. Organ allocation is managed by national or regional
transplant organizations, following established allocation policies.

Organ Retrieval and Transplantation

For deceased donation, organs are surgically retrieved in an operating
room. For living donation, the donor undergoes surgery to remove the
organ. Transplantation surgery is then performed on the recipient to
implant the donated organ.