Author Question: The patient is a gravida 6, para 1. She is admitted after a cesarean section after an amniotic ... (Read 164 times)

bb · **on:** Jun 25, 2018

The patient is a gravida 6, para 1. She is admitted after a cesarean section after an amniotic embolus. Her heart rate (HR) is more than 150 beats/min with a systolic BP less than 80 mm Hg.

Her temperature is 38 C, and her condition has caused her to develop prerenal azotemia. The patient was fluid resuscitated through a double-lumen catheter, which was placed into her right femoral access, and started on vasopressors with a fair response (BP, 80/50 mm Hg; HR, 122 beats/min). Because of her diagnosis and a concern regarding fulminating sepsis, the patient was begun on CVVH. Which of the statements best describes CVVH?

a. Complete renal replacement therapy requiring large volumes of ultrafiltrate and filter replacement
b. Complete renal replacement therapy that allows removal of solutes and modification of the volume and composition of extracellular fluid to occur evenly over time
c. Involves the introduction of sterile dialyzing fluid through an implanted catheter into the abdominal cavity, which relies on osmosis, diffusion, and active transport to help remove waste from the body
d. Complete renal replacement therapy that allows an exchange of fluid, solutes, and solvents across a semipermeable membrane at 100 to 300 mL/hr

Question 2

A patient is admitted to the critical care unit with a subdural hematom

a. The GCS is used to assess his level of consciousness. Which statement is true concerning the GCS?

a. It provides data about level of consciousness only.
b. It is considered equivalent to a complete neurologic examination.
c. It is a sensitive tool for evaluation of an altered sensorium.
d. It is the most critical assessment parameter to account for possible aphasia.

Eunice618 · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

B
Continuous venovenous hemodialysis is indicated when the patient's clinical condition warrants removal of significant volumes of fluid and solutes. Fluid is removed by ultrafiltration in volumes of 5 to 20 mL/min or up to 7 to 30 L/24 hr. Removal of solutes such as urea, creatinine, and other small non-protein-bound toxins is accomplished by convection. The replacement fluid rate of flow through the continuous renal replacement therapy circuit can be altered to achieve desired fluid and solute removal without causing hemodynamic instability.

Answer to Question 2

A
Several points should be kept in mind when the Glasgow Coma Scale is used for serial assessment. It provides data about level of consciousness only, and it should never be considered a complete neurologic examination. Additionally, it is not a sensitive tool for evaluation of an altered sensorium, and it does not account for possible aphasia or mechanical intubation. It is also a poor indicator of lateralization of neurologic deterioration.