anticholinergics

 - Avoiding benzos/anticholinergics. Keppra d/c'ed by neuro due to possibility this worsens agitation.

frontal lobe atrophy

  Ongoing issues with severe agitated delirium due to hx of severe TBI in the past with severe b/l frontal lobe atrophy

Intraparenchymal Hemorrhage- IPH -Study

 Intraparenchymal Hemorrhage

In the context of medical terminology, IPH stands for Intraparenchymal Hemorrhage. This condition refers to bleeding that occurs within the brain's tissue, often resulting from trauma or high blood pressure. It is a serious medical condition that can lead to neurological deficits and requires prompt treatment 

Temporal lobe IPH Left 

 concerning for underlying cerebral amyloid vs mass 

Because of cochlear implant artifact. (MRI cannot do)

UA and WBC elevation c/w urosepsis

 UA and WBC elevation c/w urosepsis

Urosepsis is a critical condition that can arise from a urinary tract infection (UTI) and requires prompt medical attention. 

Elevated white blood cell counts (WBC) and leukocyte esterase levels in urine are key indicators of urosepsis.

 These markers suggest an infection in the urinary tract, which can lead to sepsis if not treated promptly.

The presence of WBC in urine, known as pyuria, indicates inflammation in the urinary tract, possibly due to an infection. 

A leukocyte esterase test is a screening test that detects substances suggesting white blood cells in urine, which may indicate an infection. If the test is positive, further examination under a microscope may reveal white blood cells and other signs of infection.

Urosepsis can be a medical emergency and requires immediate treatment to prevent tissue damage, organ failure, or death. 

Early diagnosis and effective treatment are crucial for improving patient outcomes.

Fluid accumulation in the interstitial spaces

 

1. Fluid accumulation in the interstitial spaces

• Normally, a small amount of fluid leaks out of blood capillaries into the interstitial spaces (the tiny gaps between cells) to deliver nutrients and remove waste.

• This fluid is usually reabsorbed into the bloodstream or drained by the lymphatic system.

• Edema occurs when more fluid leaves the capillaries than is removed — this leads to excess fluid buildup in the tissues.

What does it mean for a virus to be an obligate intracellular parasite?

 A virus being an obligate intracellular parasite means that:

1. A virus can only reproduce inside a living host cell.
2. It cannot carry out metabolism, growth, or reproduction on its own.
3. Outside a host cell, a virus is inactive.

In simple terms

Viruses must hijack a host cell’s machinery to survive and make more viruses.

They use the host’s:

1. Ribosomes (to make viral proteins)
2. Enzymes
3. Energy (ATP)
4. Nucleotides

Without a host cell, a virus cannot replicate.

 Skin weeps from edema due to fluid accumulation in the tissues,

Obesity

 

1) How we define obesity (by BMI)

• Underweight: <18.5
• Normal: 18.5–24.9
• Overweight: 25–29.9
• Class I obesity: 30–34.9
• Class II obesity: 35–39.9
• Class III (severe) obesity: ≥40 → often needs specialty care

2) Health risks to remember

• High blood pressure
• High risk of stroke
• Fatty liver / metabolic disease
• Type 2 diabetes

3) Common causes / contributors

• Genetics
• Medications (e.g., steroids)
• Social & economic factors (food access, stress)
• Age / hormone imbalance
• Stress & lack of sleep
• Gut health (diet, possible role of probiotics)

GLP-1: not a cause—this is a treatment class (e.g., semaglutide). It lowers appetite, slows stomach emptying, and helps with weight loss.

4) Stigma & access

• Weight stigma is common.
• Many patients have limited resources (healthy food, time, support).
• Be supportive and non-judgmental.

5) Bariatric surgery types (simple)

A) Restrictive only

• Laparoscopic Vertical Sleeve Gastrectomy (VSG)
  
• Makes a small stomach “sleeve” (~4 oz).
• Limits how much a patient can eat.
• 
  

B) Restrictive + some malabsorption

• Roux-en-Y Gastric Bypass (RYGB)
  
• Small pouch + rerouted intestine → less absorption of calories/sugar.
• 
  

6) Immediate post-op nursing care (first 24 hrs)

1. Airway & breathing: continuous pulse oximeter to watch for respiratory depression (anesthesia, opioids, OSA risk).
2. Positioning: head of bed up / sit in chair early.
3. Early ambulation: start within ~2–4 hours after arrival to unit; then frequent walking → prevents DVT/PE, promotes bowel function.
4. Oral intake: usually 1 oz (30 mL) every ~15 minutes if surgeon allows → prevents nausea and overfilling.
5. Pain & anti-nausea meds as ordered.
6. Incision & drain checks, vitals, I&O.

7) Diet progression (typical path—follow the surgeon’s orders)

1. Clear liquids (sips)
2. Full liquids (often ~2 weeks)
3. Pureed/soft foods
4. Regular protein-focused small meals

8) What to avoid & WHY

• No straws → swallow air → pain/gas in small pouch.
• No soda / carbonation → gas expands the pouch, discomfort.
• No caffeine (early) → increases acid and irritation, worsens reflux, can dehydrate.
• Avoid high sugar (especially after bypass) → dumping syndrome
  
• s/s: cramping, diarrhea, flushing, palpitations, dizziness.
• (It doesn’t “cause a heart attack,” but it can feel scary—teach patients the symptoms.)
• 
  

9) Teaching & psychosocial support

• Use the RESPECT model with patients:
  
• Rapport – warm, respectful connection
• Empathy – reflect feelings, validate struggles
• Support – affirm strengths, offer help
• Partnership – set goals together
• Explanations – use clear, simple language
• Cultural competence – honor beliefs & food culture
• Trust – be consistent and non-judgmental
• 
  
• Screen for depression and social rejection.
• Encourage family/support persons.
• Use gentle, respectful touch/approach (e.g., shoulder tap) and person-first language.

10) Quick test points (memory triggers)

• VSG = restricts volume; RYGB = restricts + reduces absorption.
• 1 oz q15 min, early ambulation, pulse-ox.
• No straws, soda, early caffeine.
• Dumping = high sugar → GI + vasomotor symptoms.
• GLP-1 = treatment, not a cause.