Intracerebral hemorrhage (ICH) is caused by bleeding within the brain tissue itself — a life-threatening type of stroke. A stroke occurs when the brain is deprived of oxygen and blood supply. ICH is most commonly caused by hypertension, arteriovenous malformations, or head trauma. Treatment focuses on stopping the bleeding, removing the blood clot (hematoma), and relieving the pressure on the brain. An ICH can occur close to the surface or in deep areas of the brain. Sometimes deep hemorrhages can expand into the ventricles – the fluid filled spaces in the center of the brain. Blockage of the normal cerebrospinal (CSF) circulation can enlarge the ventricles (hydrocephalus) causing confusion, lethargy, and loss of consciousness.
CCRN Intracerebral Hemorrhage Review - Signs and Symptoms
headache, nausea, and vomiting
lethargy or confusion
sudden weakness or numbness of the face, arm or leg, usually on one side
loss of consciousness
temporary loss of vision
CCRN Intracerebral Hemorrhage Review - Causes
Hypertension: elevated blood pressure may cause tiny arteries to burst inside the brain. Normal pressure is 120/80 mm Hg.
Blood thinners: drugs such as coumadin, heparin, and warfarin used to prevent clots in heart and stroke conditions may cause ICH.
AVM: a tangle of abnormal arteries and veins with no capillaries in between.
Aneurysm: a bulge or weakening of an artery wall.
Head trauma: fractures to the skull and penetrating wounds (gunshot) can damage an artery and cause bleeding.
Tumors: highly vascular tumors such as angiomas and metastatic tumors can bleed into the brain tissue.
Amyloid angiopathy: a buildup of protein within the walls of arteries.
Drug usage: alcohol, cocaine and other illicit drugs can cause ICH.
Spontaneous: ICH by unknown causes.
CCRN Intracerebral Hemorrhage Review - Treatment
Treatment may include lifesaving measures, symptom relief, and complication prevention. Once the cause and location of the bleeding is identified, medical or surgical treatment is performed to stop the bleeding, remove the clot, and relieve the pressure on the brain. If left alone the brain will eventually absorb the clot within a couple of weeks – however the damage to the brain caused by ICP and blood toxins may be irreversible. Generally, patients with small hemorrhages (<10 cm3) and minimal deficits are treated medically. Patients with cerebellar hemorrhages (>3 cm3) who are deteriorating or who have brainstem compression and hydrocephalus are treated surgically to remove the hematoma as soon as possible. Patients with large lobar hemorrhages (50 cm3) who are deteriorating usually undergo surgical removal of the hematoma.
CCRN Intracerebral Hemorrhage Review (2020) - Other CCRN Related Courses
Respiratory failure can happen when your respiratory system is unable to remove enough carbon dioxide from the blood, causing it to build up in your body. The condition can also develop when your respiratory system can’t take in enough oxygen, leading to dangerously low levels of oxygen in your blood. Respiratory failure may be acute or chronic. Acute respiratory failure is a short-term condition. It occurs suddenly and is typically treated as a medical emergency. Chronic respiratory failure, however, is an ongoing condition. It gradually develops over time and requires long-term treatment. Chronic respiratory failure usually happens when the airways that carry air to your lungs become narrow and damaged. This limits air movement through the body, which means that less oxygen gets in and less carbon dioxide gets out. Chronic respiratory failure can also be classified as hypoxemic or hypercapnic respiratory failure. Low blood oxygen levels cause hypoxemic respiratory failure. High carbon dioxide levels cause hypercapnic respiratory failure.
CCRN Chronic Respiratory Failure Review - Signs and Symptoms
Symptoms of chronic respiratory failure may not be noticeable at first. They usually occur slowly over an extended period of time. When symptoms do develop, they may include:
difficulty breathing or shortness of breath, especially when active
coughing up mucous
bluish tint to the skin, lips, or fingernails
CCRN Chronic Respiratory Failure Review - Causes
Diseases and conditions that commonly lead to chronic respiratory failure include:
Although acute respiratory failure is a medical emergency that must be treated in a hospital, chronic respiratory failure may be managed at home, depending on its cause. In severe cases, medical professionals can help you manage the condition in a long-term healthcare center. Treatment options typically include:
treating the underlying cause of respiratory failure
removing excess carbon dioxide from the blood
increasing oxygen levels in the blood
CCRN Chronic Respiratory Failure Review (2020) - Other CCRN Related Courses
Empyema is also called pyothorax or purulent pleuritis. It’s a condition in which pus gathers in the area between the lungs and the inner surface of the chest wall. This area is known as the pleural space. Pus is a fluid that’s filled with immune cells, dead cells, and bacteria. Pus in the pleural space can’t be coughed out. Instead, it needs to be drained by a needle or surgery. Empyema usually develops after pneumonia, which is an infection of the lung tissue.
CCRN Empyema Review - Signs and Symptoms
having a case of pneumonia that does not improve
pus in mucus
a crackling sound from the chest
decreased breathing sounds
dullness when tapping chest
fluid in the lungs (visible with a chest X-ray)
CCRN Empyema Review - Causes
Pneumonia is the most common cause of empyema. People who have undergone thoracotomies, or chest surgeries, might also be at risk of developing empyema if bacteria get into the wound.
CCRN Empyema Review - Risk Factors
being older than 70
having been in the hospital recently
having had chest surgery or trauma
chronic obstructive pulmonary disorder (COPD)
intravenous drug use (in simple empyema cases)
CCRN Empyema Review - Treatment
Treatment is aimed at removing the pus and fluid from the pleura and treating the infection. Antibiotics are used to treat the underlying infection. The specific type of antibiotic depends on what type of bacteria is causing the infection. The method used to drain the pus depends on the stage of the empyema. In simple cases, a needle can be inserted into the pleural space to drain the fluid. This is called percutaneous thoracentesis. In the later stages, or complex empyema, a drainage tube must be used to drain the pus. This procedure is usually performed under anesthesia in an operating room. There are different types of surgery for this:
CCRN Empyema Review (2020) - Other CCRN Related Courses
Pleural effusion, sometimes referred to as “water on the lungs,” is the build-up of excess fluid between the layers of the pleura outside the lungs. The pleura are thin membranes that line the lungs and the inside of the chest cavity and act to lubricate and facilitate breathing. Normally, a small amount of fluid is present in the pleura.
CCRN Pleural Effusion Review - Signs and Symptoms
Dry, nonproductive cough
Dyspnea (shortness of breath, or difficult, labored breathing)
Orthopnea (the inability to breathe easily unless the person is sitting up straight or standing erect)
CCRN Pleural Effusion Review - Causes
The most common causes of transudative (watery fluid) pleural effusions include:
Post open heart surgery
Exudative (protein-rich fluid) pleural effusions are most commonly caused by:
Other less common causes of pleural effusion include:
Bleeding (due to chest trauma)
Chylothorax (due to trauma)
Rare chest and abdominal infections
Asbestos pleural effusion (due to exposure to asbestos)
Meig’s syndrome (due to a benign ovarian tumor)
Ovarian hyperstimulation syndrome
CCRN Pleural Effusion Review - Treatments
Treatment of pleural effusion is based on the underlying condition and whether the effusion is causing severe respiratory symptoms, such as shortness of breath or difficulty breathing.
Diuretics and other heart failure medications are used to treat pleural effusion caused by congestive heart failure or other medical causes. A malignant effusion may also require treatment with chemotherapy, radiation therapy or a medication infusion within the chest.
A pleural effusion that is causing respiratory symptoms may be drained using therapeutic thoracentesis or through a chest tube (called tube thoracostomy).
For patients with pleural effusions that are uncontrollable or recur due to a malignancy despite drainage, a sclerosing agent (a type of drug that deliberately induces scarring) occasionally may be instilled into the pleural cavity through a tube thoracostomy to create a fibrosis (excessive fibrous tissue) of the pleura (pleural sclerosis).
Pleural sclerosis performed with sclerosing agents (such as talc, doxycycline, and tetracycline) is 50 percent successful in preventing the recurrence of pleural effusions.
CCRN Pleural Effusion Review (2020) - Other CCRN Related Courses
Hepatitis A is a highly contagious liver infection caused by the hepatitis A virus. The virus is one of several types of hepatitis viruses that cause inflammation and affect your liver's ability to function. You're most likely to get hepatitis A from contaminated food or water or from close contact with a person or object that's infected. Mild cases of hepatitis A don't require treatment. Most people who are infected recover completely with no permanent liver damage. Practicing good hygiene, including washing hands frequently, is one of the best ways to protect against hepatitis A. Vaccines are available for people most at risk.
CCRN Hepatitis Review (2020) - Signs and Symptoms
Sudden nausea and vomiting
Abdominal pain or discomfort, especially on the upper right side beneath your lower ribs (by your liver)
Clay-colored bowel movements
Loss of appetite
Yellowing of the skin and the whites of your eyes (jaundice)
CCRN Hepatitis Review (2020) - Causes
The virus most commonly spreads when you eat or drink something contaminated with fecal matter, even just tiny amounts. It does not spread through sneezing or coughing.
CCRN Hepatitis Review (2020) - Treatment
No specific treatment exists for hepatitis A. Your body will clear the hepatitis A virus on its own. In most cases of hepatitis A, the liver heals within six months with no lasting damage.
CCRN Hepatitis Review (2020) - Other CCRN Related Courses
Hepatic encephalopathy is a decline in brain function that occurs as a result of severe liver disease. In this condition, your liver can’t adequately remove toxins from your blood. This causes a buildup of toxins in your bloodstream, which can lead to brain damage. Hepatic encephalopathy can be acute (short-term) or chronic (long-term). In some cases, a person with hepatic encephalopathy may become unresponsive and slip into a coma.
CCRN Hepatic Encephalopathy Review - Signs and Symptoms
Symptoms of hepatic encephalopathy differ depending on the underlying cause of the liver damage.
Symptoms and signs of moderate hepatic encephalopathy may include:
Problems with handwriting or loss of other small hand movements
A musty or sweet breath odor
Symptoms of severe hepatic encephalopathy are:
Drowsiness or lethargy
Severe personality changes
CCRN Hepatic Encephalopathy Review - Causes
The exact cause of hepatic encephalopathy is unknown. However, it’s usually triggered by a buildup of toxins in the bloodstream. This occurs when your liver fails to break down toxins properly. Your liver removes toxic chemicals such as ammonia from your body. These toxins are left over when proteins are metabolized or broken down for use by various organs in your body. Your kidneys change these toxins into safer substances that are then removed through urination. When your liver is damaged, it’s unable to filter out all the toxins. Toxins can then build up in your bloodstream and potentially get into your brain. Toxic buildup can also damage other organs and nerves.
CCRN Hepatic Encephalopathy Review - Treatment
Treatment options for hepatic encephalopathy depend on the severity and underlying cause of the condition. You’ll likely need to eat less protein if eating too much protein caused the condition. Since protein is necessary for your body to function properly, a dietician or doctor can create a diet that’ll allow you to get enough protein without making your symptoms worse. Medications can also help slow the rate at which your blood absorbs toxins. Your doctor may prescribe antibiotics and lactulose (Enulose), a synthetic sugar. These medications can draw ammonia, created by intestinal bacteria from your blood, into your colon. Your body will then remove the blood from your colon.
CCRN Hepatic Encephalopathy Review (2020) - Other CCRN Related Courses
Metabolic encephalopathy is defined as a potentially reversible abnormality of brain function caused by processes of extra cerebral origin. These processes usually involve some metabolic upset (electrolytes, serum osmolarity, renal function or hepatic dysfunction); some deficiency (metabolic substrates, thyroid hormone, vitamin B12, etc.); some toxic exposure (drugs, alcohol, medicines, etc.) or systemic toxic states (sepsis, for example). Therefore, in metabolic encephalopathy, there is diffuse cerebral dysfunction. Of course, the degenerative diseases of the brain that result in dementia also produce diffuse dysfunction of the brain.
CCRN Metabolic Encephalopathy Review - Signs and Symptoms
Muscle weakness in one area
Poor decision-making or concentration
Difficulty speaking or swallowing
Muscle twitching and myalgia
Cheyne-Stokes respirations (an altered breathing pattern seen with brain damage and coma)
CCRN Metabolic Encephalopathy Review - Causes
Causes of metabolic encephalopathy include carbon monoxide or cyanide poisoning; which prevents hemoglobin from carrying oxygen in the bloodstream and results in tissue anoxia. In addition to liver and kidney waste products; it may include abnormally high or low blood sugar, thyroid problems, and high or low sodium levels in the blood.
CCRN Metabolic Encephalopathy Review - Treatment
Metabolic encephalopathy treatment is directed toward reversal or control of the underlying process, supportive care, and prevention of complications such as infection, electrolyte imbalance, and cerebral edema. Successful treatment of metabolic encephalopathy depends upon early recognition of the symptoms and intervention to reverse the conditions that could lead to hypoxia or accumulation of toxins in the bloodstream. Delayed treatment could result in permanent or residual damage to the brain. Patients are maintained on a low-protein diet to lower blood ammonia levels since ammonia is a by-product of protein metabolism. Comatose patients may require special tube feedings and life support systems. Liver transplantation may be considered in patients with chronic liver cirrhosis.
CCRN Metabolic Encephalopathy Review (2020) - Other CCRN Related Courses
Encephalopathy means damage or disease that affects the brain. It happens when there’s been a change in the way your brain works or a change in your body that affects your brain. Those changes lead to an altered mental state, leaving you confused and not acting like you usually do. Encephalopathy is not a single disease but a group of disorders with several causes. It’s a serious health problem that, without treatment, can cause temporary or permanent brain damage. It’s easy to confuse encephalopathy with encephalitis. The words sound similar, but they are different conditions. In encephalitis, the brain itself is swollen or inflamed. Encephalopathy, on the other hand, refers to the mental state that can happen because of several types of health problems. But encephalitis can cause encephalopathy.
CCRN Infectious Encephalopathy Review - Signs and Symptoms
The symptoms you have depend on the type and cause of your encephalopathy, but some of the most common ones are:
Trouble thinking clearly or focusing
Muscle weakness or twitches they can’t control
Eye movements they can’t control
CCRN Infectious Encephalopathy Review - Causes
When encephalopathy results from repeated trauma, it is called chronic traumatic encephalopathy.
Trauma to the head may lead to nerve damage that affects brain function. Chronic traumatic encephalopathy can develop following multiple brain traumas or injuries over time. These may result from a series of accidents or blows to the head.
People in the military or who play contact sports may have a higher risk of chronic traumatic encephalopathy.
If toxins build up in the blood and reach the brain, they can cause damage. This may result from an underlying condition, infection, or exposure to toxic chemicals.
If a person does not receive treatment for high blood pressure, it can lead to swelling in the brain. When this results in a brain injury, it is called hypertensive encephalopathy.
Lack of Oxygen
If the brain does not get enough oxygen, a person may experience brain damage. Encephalopathy caused in this way is called hypoxic ischemic encephalopathy.
Vitamin B-1 Deficiency
When a person has a vitamin B-1 deficiency, they can develop a type of brain disease called Wernicke encephalopathy.
CCRN Infectious Encephalopathy Review - Treatment
Medications to stop seizures or reduce ammonia levels
Stopping a medication you’ve been taking
Changing the foods you eat
Dialysis or an organ transplant if liver or kidney problems are causing your condition
CCRN Infectious Encephalopathy Review (2020) - Other CCRN Related Courses
Portal hypertension is an increase in the pressure within the portal vein (the vein that carries blood from the digestive organs to the liver). The increase in pressure is caused by a blockage in the blood flow through the liver.
Increased pressure in the portal vein causes large veins (varices) to develop across the esophagus and stomach to get around the blockage. The varices become fragile and can bleed easily.
CCRN Portal Hypertension Review - Signs and Symptoms
The onset of portal hypertension may not always be associated with specific symptoms that identify what is happening in the liver. But if you have liver disease that leads to cirrhosis, the chance of developing portal hypertension is high.
The main symptoms and complications of portal hypertension include:
Gastrointestinal bleeding: Black, tarry stools or blood in the stools; or vomiting of blood due to the spontaneous rupture and bleeding from varices.
Ascites: An accumulation of fluid in the abdomen.
Encephalopathy: Confusion and forgetfulness caused by poor liver function and the diversion of blood flow away from your liver.
Reduced levels of platelets or decreased white blood cell count.
CCRN Portal Hypertension Review - Causes
The most common cause of portal hypertension is cirrhosis, or scarring of the liver. Cirrhosis results from the healing of a liver injury caused by hepatitis, alcohol abuse or other causes of liver damage. In cirrhosis, the scar tissue blocks the flow of blood through the liver and slows its processing functions.
Portal hypertension may also be caused by thrombosis, or a blood clot that develops in the portal vein.
CCRN Portal Hypertension Review - Treatment
The effects of portal hypertension can be managed through diet, medications, endoscopic therapy, surgery, or radiology. Once the bleeding episode has been stabilized, treatment options are prescribed based on the severity of the symptoms and on how well your liver is functioning. First level of treatment When you are first diagnosed with variceal bleeding, you may be treated with endoscopic therapy or medications. Dietary and lifestyle changes are also important. Endoscopic therapy consists of either sclerotherapy or banding. Sclerotherapy is a procedure performed by a gastroenterologist in which a solution is injected into the bleeding varices to stop or control the risk of bleeding. Banding is a procedure in which a gastroenterologist uses rubber bands to block the blood supply to each varix (enlarged vein). Medications such as beta blockers or nitrates may be prescribed alone or in combination with endoscopic therapy to reduce the pressure in your varices and further reduce the risk of recurrent bleeding. The drug lactulose can help treat confusion and other mental changes associated with encephalopathy. This medication has the ability to increase the amount of bowel movements you will have per day. Dietary and lifestyle changes Maintaining good nutritional habits and keeping a healthy lifestyle will help your liver function properly. Some of the things you can do to improve the function of your liver include the following: Do not use alcohol or street drugs. Do not take any over-the-counter or prescription drugs without first consulting with your physician or nurse. Some medications may make liver disease worse, and they may interfere with the positive effects of your other prescription medications. Follow the dietary guidelines given to you by your physician or nurse. Follow a low-sodium (salt) diet. You will probably be required to consume no more than 2 grams of sodium per day. Reduced protein intake is required only if confusion is a symptom. Your dietitian will help you create a meal plan that helps you follow these dietary guidelines
CCRN Portal Hypertension Review (2020) - Other CCRN Related Courses
Obstructive sleep apnea is a potentially serious sleep disorder. It causes breathing to repeatedly stop and start during sleep. There are several types of sleep apnea, but the most common is obstructive sleep apnea. This type of apnea occurs when your throat muscles intermittently relax and block your airway during sleep. A noticeable sign of obstructive sleep apnea is snoring. Treatments for obstructive sleep apnea are available. One treatment involves using a device that uses positive pressure to keep your airway open while you sleep. Another option is a mouthpiece to thrust your lower jaw forward during sleep. In some cases, surgery may be an option too.
CCRN Obstructive Sleep Apnea Review - Signs and Symptoms
Excessive daytime sleepiness
Observed episodes of stopped breathing during sleep
Abrupt awakenings accompanied by gasping or choking
Awakening with a dry mouth or sore throat
Difficulty concentrating during the day
Experiencing mood changes, such as depression or irritability
High blood pressure
CCRN Obstructive Sleep Apnea Review - Causes
Obstructive sleep apnea occurs when the muscles in the back of your throat relax too much to allow normal breathing. These muscles support structures including the back of the roof of your mouth (soft palate), the triangular piece of tissue hanging from the soft palate (uvula), the tonsils and the tongue. When the muscles relax, your airway narrows or closes as you breathe in and breathing may be inadequate for 10 seconds or longer. This may lower the level of oxygen in your blood and cause a buildup of carbon dioxide. Your brain senses this impaired breathing and briefly rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don't remember it. You can awaken with shortness of breath that corrects itself quickly, within one or two deep breaths. You may make a snorting, choking or gasping sound. This pattern can repeat itself five to 30 times or more each hour, all night long. These disruptions impair your ability to reach the desired deep, restful phases of sleep, and you'll probably feel sleepy during your waking hours. People with obstructive sleep apnea may not be aware that their sleep was interrupted. In fact, many people with this type of sleep apnea think they slept well all night.
During this sleep study, you're hooked up to equipment that monitors your heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while you sleep.
Home sleep apnea testing
Under certain circumstances, your doctor may provide you with an at-home version of polysomnography to diagnose obstructive sleep apnea. This test usually involves measurement of airflow, breathing patterns and blood oxygen levels, and possibly limb movements and snoring intensity.
CCRN Obstructive Sleep Apnea Review (2020) - Other CCRN Related Courses