Wednesday, November 5, 2008

Day Two

Second day at the ICU of MSH was more intense in the matter of my participation and active learning. My new preceptor "J. encouraged my participation in performing nursing interventions. I discovered even more about patient assessment and maintenance of the IV pumps, particularly setting up the time for the infusion and using a "total volume setting" for the insulin drip as a reminder to do the Accu-Chek. What a smart way of the time management and using a critical thinking in Nursing!
Just another new thing that I have learned today is that Acetazolamide, besides it usage in glaucoma patients is a potent carbonic anhydrase inhibitor, effective in promotion of diuresis in instances of abnormal fluid retention (e.g., cardiac edema).
Inhibition of carbonic anhydrase in this area appears to retard abnormal, paroxysmal, excessive discharge from central nervous system neurons. The diuretic effect of Acetazolamide is due to its action in the kidney on the reversible reaction involving hydration of carbon dioxide and dehydration of carbonic acid.
The result is renal loss of HCO3 ion, which carries out Sodium, Water, and Potassium. Alkalinization of the urine and promotion of diuresis are thus effected. Alteration in ammonia metabolism occurs due to increased reabsorption of ammonia by the renal tubules as a result of urinary alkalinization.

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