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89 Cards in this Set
- Front
- Back
Name the 3 meninges in order of closest to skull to closest to brain
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- Dura mater
- Arachnoid - Pia mater |
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List the order of layers and spaces from skull to brain
Hint: ED'S A Super Person |
Epidural Space
Dura Mater Subdural Space Arachnoid Subarachnoid space Pia Mater |
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True or False
CSF circulates in the subarachnoid space |
True
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True or False
Intracerebral bleed is above the level of the pia mater |
False, it is below the pia mater
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Name the 3 kinds of blunt head injury
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- Deformation
- Acceleration- deceleration - Rotation |
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What is a coup-contracoup head injury?
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Injury on the side of the head that was hit and the opposite side secondary to the brain moving around in the skull
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What does PERRLA stand for?
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Pupils equal round reactive to light and accommodation
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What is the difference between perforating and penetrating injury?
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-Perforating enters and exits
- Penetrating enters but does not exit |
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Why do head wounds bleed profusely?
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Vessels can not vasoconstrict
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Generally what meds do patients get with a head injury to stop bleeding and help with pain?
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Epi and Lidocane
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What are the four types of skull fractures?
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- Linear
- Comminuted - Depressed - Basilar skull fracture |
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Linear skull fractures are described as? what do you normally see with them?
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- crack in the skull
- hematomas |
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Comminuted skull fractures are?
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Multiple linear fractures, "egg shell fracture"
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Depressed skull fracture is described as?
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"step off" where skull fragment is resting on brain below
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Depressed skull fractures can be closed or open, explain the difference and needs of both
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- Closed: dura is intact, if depression is greater than thickness of the skull surgery is needed
- Open: dura is torn, focal brain injury and seizures common, infection can get into wound |
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True or False
Basilar skull fractures are linear and usually heal themselves but are serious bc of proximity to brain stem. |
True
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What are the 2 kinds of basilar skull fracture?
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- Anterior fossa
- Posterior fossa |
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What are the s/s of an anterior fossa fracture?
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- Raccoon eyes
- Rhinorrhea |
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If a patient with a head injury has clear liquid and/or blood coming from their nose, what would we want to test for? how?
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CSF
If clear, test for glucose If bloody, test for halo sign |
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What are the s/s of a posterior fossa fracture?
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- Battle's sign
- Otorrhea - may have hearing loss, nausea, vertigo, nystagmus |
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Would you put an NG tube in a patient with a head injury?
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NO
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Decreased Na and Ca, increases the risk for?
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Seizures
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What is the difference between primary and secondary head injury?
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- Primary is the mechanical injury to the brain
- Secondary is caused by oxygen and nutrient supply/demand mismatch |
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What is the difference between concussion and contusion?
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- Concussion is transient, temporary neurogenic dysfunction caused by mechanical force on the brain
- Contusion is bruising of the surface of the brain |
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What are the characteristics of a mild concussion?
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- No loss of consciousness
- Sensation of having "bell rung", dazed thinking |
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What are the characteristics of a moderate concussion?
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- May have brief loss of consciousness and neuro deficits that clear quickly
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What are the usually D/C instructions for a patient with a moderate concussion?
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- Wake patient every 3-4 hrs for first 12 hrs
- Look for difficulty to arouse, change in behavior, vomiting, problems hearing, speaking, or seeing |
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Any loss of consciousness requires what?
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ED evaluation
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What are the characteristics of a severe concussion?
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- Prolonged loss of consciousness and/ or neuro deficits that last minutes to hours
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True or False
A severe concussion requires admission to hospital for observation and evaluation. |
True
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Describe post concussion syndrome
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- Usually happens after several concussions but can occur after only one
- Behavioral changes: forgetful, confusion, loses temper easily, acts w/out thinking - Visual and hearing disturbances - May continue for months or years |
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What are some teaching points for patient and family with a head injury?
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- Notify MD if: increased drowsiness, N/V, worsening headache, stiff neck, seizures, blurring vision, behavior changes, heart rate below 60
- abstain from alcohol - avoid driving, playing contact sports, and taking hot baths |
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Is a contusion worst than a concussion?
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YES
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What is the main problem with a contusion? how long can the coma last?
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- Increased ICP
- days to weeks |
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Epidural hematoma is where? what kind of bleed?
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- Between the skull and the dura
- Arterial bleed |
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What is worst an epidural or subdural hematoma?
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Epidural
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What is the classic presentation of an epidural hematoma?
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- Momentary loss of cosciousness followed by a lucid period lasting mins to few hours, then rapid deterioration
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What are the s/s of an epidural hematoma?
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- decreased LOC
- ipsilateral sluggish, dilated, fixed pupils - possible seizures - hemiparesis or hemiplegia - posturing |
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Where is a subdural hematoma? what kind of bleed?
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- Between the dura and arachnoid
- Venous bleed |
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True or False
Subdural hematomas are slower to develop than epidural hematomas. |
True
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What are the s/s of an acute subdural hematoma?
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- s/s occur within 48 hrs
- gradual LOC changes - hemiparesis or hemiplegia |
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How long does it take for s/s of a sub acute subdural hematoma to show? what is it usually associated with?
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- s/s occur between 3 days to 3 weeks after injury
- associated with less severe underlying contusions |
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How long does it take a chronic subdural hematoma to present itself? why?
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- symptoms take 3 weeks to several months to develop and the injury may not be recalled
- s/s develop slowly bc bleed is so slow the brain can accommodate it to a point |
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Why does chronic sudural hematoma occur more in elderly and alcoholics?
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Brain atrophy
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What is the treatment for subdural hematomas?
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Craniotomy to evacuate the hematoma
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If there is a bleed in the arachnoid or pia mater would the lumbar and ventricle puncture show blood? Why or why not?
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Yes, bc CSF flows in the spinal column and the subarachnoid space
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What are the s/s of subarachnoid hemorrhage?
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- Nuchal rigidity
- decreased LOC - headache - hemiparesis or hemiplegia - ipsilateral dilated pupil |
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With an aneurysm and/or subarachnoid hemmorrhage, what do the patients usually state?
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"The worst headache I've ever had"
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What is a sentinel leak?
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A warning leak that usually manifests by one or two headaches with vomiting
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Can a lumbar puncture be done if there is increased ICP?
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NO
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If a LP is done and there is a bloodly apperance to the CSF that is dark amber in color, what does that tell us?
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Bleed happened about 5 days ago
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When does the highest incidence of rebleeding occur on a patient with an aneurysm?
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1st day after intial hemorrhage and again in 7 days if no surgery has been done
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What are the s/s of rebleeding?
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- increased headache
- n/v - changes in BP and respirations |
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What are two surgeries done for rebleeding?
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- Aneurysm clipping
- AVM excision, depending on size and location |
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What are two complications of a bleed?
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- Rebleeding
- Vasospasm |
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Vasospasm does not occur when what procedure is done?
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AVM
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When is the highest incidence for vasospasm?
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3-5 days post bleed and continues for up to 3-4 weeks
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What are the s/s of vasospasm? how is it dx?
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- change in LOC and pupils
- Dx by doppler and/or angiogram |
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What is the treatment/prevention for vasospasm?
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- HHH therapy
- Nimotop |
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What is Nimotop? why is it used for vasospasm?
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- Calicum channel blocker
- has an affinity for cerebral arteries |
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What is HHH therapy? why is it used for vasospasm?
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- Hypertensive, Hypervolemic, Hemodilution
- Keeps blood vessel walls tense so they can't spasm and keeps blood flowing |
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What is used in HHH therapy to get the results needed? give examples of each
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- Vasopressors (Neo-synephrine, Dopamine, Levaphed)
- Volume expanders (albumin, dextran) - Reducing the Hct to 30% |
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In HHH therapy, why is the Hct reduced?
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gets increased oxygen delivery related to increased blood flow
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What do vasopressors do?
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- Increase HR, BP, urinary output
- dilated pupils |
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What is the Fisher Scale?
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Grades SAH based on size and location
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What is the Hunt and Hess Scale?
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Grades SAH on client symptoms, 1 being the best and 5 being the worst
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What are the s/s of meningitis?
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- fever, headache, n/v, nuchal rigidity, photophobia
- Kernig's sign - Brudzinski's sign |
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What is Kernig's sign?
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Painful spasm in hamstring when hip is flexed and leg straightened at knee
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What is Brudzinski's sign?
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Flexes at hip and knees in response to passive flexion of neck
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What does the nurse do for a patient with bacteria meningitis?
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- Start antibiotics after LP
- Assess for increased ICP - Give codeine bc its less sedating - Patient should go in isolation - Temp management - Seizure control/ management |
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What does the nurse do for viral meningitis?
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Treat symptoms
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True or False
Meningitis can be caused by bacteria, virus, chemical, or fungus. |
True
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In bacterial meningitis the CSF would look cloudy or clear?
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Cloudy
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Encephalitis is usually caused by virus or bactieria?
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Virus
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S/S of encephalitis are similar to meningitis but more _______ onset
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Gradual
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How does a person get encephalitis?
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- Ticks, mosquitos (West Nile)
- complications of measles, chickenpox or mumps - common in AIDS patients |
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What is the treatment for encephalitis?
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- Supportive care
- Mannitol - Lasix - Antivirals: Acyclovir |
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What kind of needle do you need for Mannitol?
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Filtered
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Do you want to give D5W to a patient with encephalitis?
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No
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What are the s/s for a brain tumor?
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- Headache
- papilledema - vomiting - seizures |
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What does the prognosis of a brain tumor depend on?
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- Location
- Cell involvement - Size |
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Why is general IV chemotherapy not successful for brain tumors?
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Doesn't cross blood/brain barrier
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What is done to treat brain tumors?
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- Radiation
- Polymer wafers inserted into tumor - Ommaya reservoir - Surgery |
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What happens in Diabetes Insipidus?
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Decrease in ADH leading to dehydration and seizures
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How is Diabetes Insipidus treated?
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- IV fluids adjusted to output
- DDAVP admin intranasally |
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What is a warning sign for Diabetes Insipidus?
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Urinary output of greater than 200 mL/hr for 2 hrs
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What happens in SIADH?
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Increased production of ADH leading to overhydration and coma
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How is SIADH treated?
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- Strict fluid restriction
- 3% saline, very hypertonic - Monitor Na levels carefully |
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What is a warning sign for SIADH?
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Output less than 30 mL/hr for 2 hrs
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