1

Neurologic Monitoring• Neurologic dysfunction is difficult to recognize in sedated patient.

• Obtain history, from family if not from patient

• Neurologic examination– Mental status – Pupillary response and eye movement– Corneal and gag reflex– Respiratory rate and pattern– ICP monitoring (10 to 15 mm Hg normal)– Glasgow Coma Scale (see Table 46-6)

2

Monitoring Renal Function• Kidney functions

– Filtering and excretion of wastes– Regulates fluid and electrolyte composition

• Renal failure is noted by– BUN increases of 10 to 15 mg/dl/day – Creatinine increases of 1 to 2.5 mg/dl/day – Urine volume reflects renal perfusion

• Oliguria <400 ml/day in average-sized adult• Anuria occurs with <50 ml/day

3

Monitoring Nutritional Status• Adequate nutrition key for healing

• Assessment for malnutrition important– Including organ function and muscle wasting– Serum albumin concentration most common

• <2.2 g/dl reflects severe malnutrition; shows chronic, not acute, change• Also altered by sepsis, dehydration, trauma

4

Estimating Nutritional Needs• First step is estimating caloric need.

• That is to estimate the basal energy expenditure, or BEE.

• Harris-Bennedict equation estimates BEE– Men = 66 + (13.7) (wt) + 5 (ht) – 6.8 (age)– Women = 65 + (9.6) (wt) + 1.8 (ht) – 4.7 (age)– For ill patients, often multiply the result by a stress factor of 0.5 to 2.5.