ATI MEDSURG REVISION THOROUGHLY DISCUSSED AND CORRECTLY VERIFIED

ATI MEDSURG REVISION THOROUGHLY DISCUSSED AND CORRECTLY VERIFIED - Adverse effects of Furosemide. Furosemide (Lasix) is a potassium wasting loop diuretic that can also be classified as an antihypertensive drug. Some adverse effects can include hypokalemia and hypotension. It is important for the nurse to monitor potassium levels and blood pressure when administering this medication. 2. Balleza - Nursing interventions for a client with SIADH. RUFUS: Main nursing interventions for SIADH are to restrict fluids to less than 1000 mL or 500 for severe SIADH. You should also monitor Is and Os and report decreased urine output. Provide comfort for the patient such as ice chips. Daily weights and monitoring sodium are also important (LEWIS, 1194) In the acute care setting restrict the patient's total fluid intake to no more than 1000 mL/day (including that taken with medications) and obtain daily weights. Position the head of the bed flat or elevated no more than 10 degrees to enhance venous return to the heart and increase left atrial filling pressure, thereby reducing the release of ADH. Frequent turning, positioning, and range-of-motion exercise (if patient is bedridden) are important to maintain skin integrity and joint mobility. Protect the patient from injury (e.g., assist with ambulation, bed alarm) because of the potential for alterations in mental status. Implement seizure precautions. Provide the patient with frequent oral care and distractions to decrease discomfort related to thirst from the fluid restrictions. 3. Balleza - Aspirin as a treatment for MI. Aspirin is an anti-platelet: prevent platelet aggregation (reduce damage to heart muscle) and can essentially prevent an MI. If the nitro did not work for the chest pain, the patient should then take the aspirin and call 911 immediately. If it is being taken to prevent an MI, it can be the 81mg (baby aspirin) or the 325mg tablet. Some studies show that the baby aspirin works better than the higher dose. 4. Balleza - Purpose of cardiac enzymes/what do they determine? Cardiac enzymes (such as troponin) are used to help determine muscle damage to the myocardium RUFUS: The degree of elevation reflects the degree of damage... Troponin-proteins/cardiac enzymes released into blood after a MI/heart ischemia. These enzymes are specific markers in diagnosing a MI. Troponin T & I are detectable within 4-6 hrs (Lewis) 2-3 hrs (ATI) of myocardial injury & are detectable for 10-14 days (T) 7-10 days (I) in the blood. The expected range for T is less than 0.1ng/mL & for I is less than 0.03ng/mL-anything above those levels indicate myocardial injury. (Lewis: anything above 2.5 is positive for injury) 5. Balleza - Stimulation that can precipitate autonomic dysreflexia and priority intervention for it. Autonomic dysreflexia is usually caused when a painful stimulus occurs below the level of spinal cord injury. The stimulus is then mediated through the central nervous system (CNS) and the peripheral nervous system (PNS). Most of these patients have injuries that are occuring above T6. S/S are ELEVATED blood pressure, pounding headache and flushing( I think Bradycardia is one of the signs too no). This can be caused by a DISTENDED BLADDER and a common intervention would be to STRAIGHT CATH the patient. THUMBS UP FROM RUFUS 6. Castillo - Priority intervention to determine MI. Priority intervention to determine MI -Chest pain not relieved with nitro (radiating pain can be present as well) -cardiac enzymes troponin & CKMB elevated/detected in blood specimen -ECG ST elevation OR depression (STEMI or NSTEMI), pathologic Q waves THUMBS UP FROM RUFUS 7. Castillo - manifestations of cardiac tamponade, especially ones requiring immediate intervention. MUFFLED HEART SOUNDS - from fluid in pericaridal sac. (pt. Will need pericardicentesis) • Hyotension • JVD • Paradoxical pulse (variance of 10mmg Hg or more in SBP between expiration and inspiration). ATI 201 THUMBS UP FROM RUFUS 8. Castillo - Priority interventions for anaphylaxis following a bee sting. If a patient has experienced a bee sting and is also experiencing hives, redness and a lump in their throat the priority intervention is to administer EPINEPHRINE STAT THUMBS UP FROM RUFUS 9. Castillo - Signs of pacemaker and ICD malfunction and contraindications for clients with pacemakers and ICD’s. Pacemaker contraindications: • don't raise arm above shoulder on pacemaker side for 1-2 wks (or until cardiologist approves) • don't get pacemaker wet (keep dry) for 4 days after insertion • no contact sports or heavy lifting for 2 months; avoid direct blows to generator site • avoid close proximity to high output electrical generators: don't put anything magnetic directly over the generator (garage door openers, burglar alarms, magnets, stereo speakers) • don't stand near antitheft devices fr prolonged period of time: walk through them normally • no MRI's • tell security at airport you have pacemaker b/c it will set off the alarms: NO handheld security wands directly over pacemaker Pacemaker malfx signs: • on ECG: pacer spikes will NOT be directly before the P or QRS complex; if they are on the T wave=life threat. dysrhythmia • hiccups: can mean the generator is pacing the diaphragm, not the heart • failure to sense: pacemaker fails to recognize spontaneous atrial or vent. activity & it fires inappropriately-fires during excitable period resulting in V-TACH o (v-tach=150-250 bpm; irregular or regular rhythm; pulse present or pulseless-pulseless requires CRP and defib asap followed by EPI and AMIODARONE; hypotension & pulmonary edema present) • failure to capture: electrical charge to myocardium insufficient to produce atrial or vent. contraction resulting in BRADY or ASYSTOLE. ICD contraindications: • don't lift arm on ICD side above shoulder until approved by dr. • don't drive until cleared by dr. • no direct blows • avoid large magnets • no MRI • don't stand near antitheft devices fr prolonged period of time: walk through them normally • cell phone must be at least 6 INCHES away from ICD site-use opposite ear to talk on and do not put in shirt pocket directly over or on same side as ICD; walkie talkie 6 inches away also • ICD malfx signs-I couldn't find a ton of these, please add or correct as I know I must be missing something • inappropriate shocks (if fires once, more than once or you feel sick after a shock, contact EMS/911/tell your dr asap, I think whenever it fires you should contact your Dr) • tachy..? THUMBS UP FROM RUFUS 10. Chesler - Normal EKG tracing and how to quickly assess the heart rate on a 6 second strip. Normal EKG tracing: o 1: P wave (atrial depolarization [contraction]) o 2: PR interval - from beginning of P wave to beginning of QRS complex. Time for impulse to spread through atria, to right before ventricular contraction. 0.12-0.20 sec o 3: QRS complex [Q wave, R wave, S wave]  Q wave: first downward deflection after the P wave. Short and narrow, not present in many leads. 0.03 s  R wave: first upward deflection of QRS complex. Length not usually measured.  S wave: first downward deflection after the R wave. Length not usually measured. • QRS interval: beginning to end of QRS complex. Time for ventricular depolarization (contraction). 0.12 s. o 4: ST segment - from S wave to beginning of the T wave. Time between ventricular depolarization and repolarization. Should be isoelectric (flat), representing the absence of electrical activity in cardiac cells. . Time: 0.12 s. o 5: T wave - time for ventricular repolarization. Should be upright. Time: 0.16 s.  Disturbances are usually caused by electrolyte imbalances, ischemia, or infarction. o 6: QT interval - from beginning of QRS complex to the end of the T wave. Time for entire depolarization and repolarization of ventricles. • Assessing the heart rate on a 6 second strip: count the number of R-R intervals and multiply by 10. Remember, the R wave is the first upward wave of the QRS complex. RUFUS: remember that the P wave comes before every QRS complex. 11. Chesler - Clinical manifestations of left and right-sided heart failure. o Left-sided failure: left ventricle is failing to pump blood from the heart effectively. Blood backs up into pulmonary veins and lungs. o Dyspnea, orthopnea (SOB while lying down), nocturnal dyspnea o Fatigue o Displaced apical pulse (due to hypertrophy) o S3 heart sound (gallop) o Pulmonary congestion (dyspnea, cough, bibasilar crackles) o Frothy sputum (can be blood-tinged) o AMS (Altered Mental Status) o Manifestations of organ failure like oliguria (decreased urine output) o Right-sided failure: right ventricles isn't pumping blood out to the lungs effectively. Therefore blood is backing up into systemic circulation.  JVD  Ascending dependent edema in legs, ankles, sacrum…  Abdominal distention, ascites  Fatigue, weakness  Nausea and anorexia  Polyuria at rest (nocturnal)  Hepatomegaly and tenderness  Weight gain THUMBS UP FROM RUFUS 12. Chesler - Client education regarding multiple sclerosis and pregnancy. o MS will cause an exacerbation of the condition. Need to report S/S of exacerbation: weakness, spasticity, visual changes. o Source: ATI p 55 and Rufus’ lecture Wednesday 3/1 13. Chesler - Etiology of myasthenia gravis and describe myasthenic crisis. o Myasthenia gravis: autoimmune disease of neuromuscular junction characterized by fluctuating weakness of certain skeletal muscle groups. Happens in either gender and people of any ethnicity. o Antibodies attack acetylcholine (ACh) receptors, leading to fewer ACh receptor sites at the NMJ. This is a problem because ACh molecules can't attach and stimulate muscle contractions. o These anti-AChR antibodies are found in 90% of people with generalized MG. In those who don't their muscle weakness might be related to autoantibodies to tyrosine kinase, though others may be involved. o Thymic tumors are found in 15% of MG patients, while most others have abnormal thymus tissue. o Myasthenic crisis: acute worsening of muscle weakness that is triggered by infection, surgery, emotional distress, drug overdose, or inadequate drugs. Muscles most often involved are those for moving the eyes and eyelids, chewing, swallowing, speaking, and breathing. RUFUS: IF MYASTHENIC CRISIS AFFECTS THE MUSCLES NEEDED TO BREATH WHAT WILL THE PATIENT NEED? INTUBATION? 14. Chesler - Contraindications for lumbar puncture. o a. Lumbar puncture is contraindicated with increased intracranial pressure or infection at the site of puncture. (Lewis, p 1349) o Additional from blackboard:  increased ICP or infection at puncture site  pt suspected of having obstruction in foramen magnum or other signs of increased ICP (confusion, irritability, restlessness, dilated pupils, slurred speech , brady, htn, headache,GCS changes/decreasing, etc) because the brain can herniate downward on the brainstem causing pressure on the cardiac and respiratory centers of the brain and can actually lead to death. THUMBS UP FROM RUFUS 15. Cortes - Nursing interventions for the potential use of smallpox as an agent of terrorism. • Smallpox can be prevented or the incidence reduced by vaccination, even when first given after exposure (Lewis, p. 1690) • Treatment for smallpox (eTable 69-2, Elselvier website) • No known cure • cidofovir (Vistide) under testing • Isolation for containment • Vaccine available for those exposed • Vaccinia immune globulin (VIG) available • Smallpox Treatment (ATI: Fundamentals 9.0, p. 77) ●Supportive care (prevent dehydration, provide skin care, medications for pain and fever) ●Antibiotics for secondary infections. RUFUS on BB: You got it! Vaccination is important even after exposure. Thanks. 16. Cortes - Nursing interventions to maintain proper cuff pressure on an ET tube when the patient is on mechanical ventilation. • • Maintaining cuff pressure at 20-25 cm H2O ensures adequate tracheal perfusion. • • Measure and record cuff pressure after intubation and on a routine basis (e.g., every 8 hours) using the minimal occluding volume (MOV) technique or the minimal leak technique (MLT). o Both techniques aim to prevent the risks of tracheal damage from high cuff pressures. The use of continuous cuff measurement is being studied. The steps in the MOV technique for cuff inflation are as follows (Lewis, p. 1616): 1. (1) for the mechanically ventilated patient, place a stethoscope over the trachea and inflate the cuff to MOV by adding air until no air leak is heard at peak inspiratory pressure (end of ventilator inspiration). 2. (2) for the spontaneously breathing patient, inflate until no sound is heard after a deep breath or after inhalation with a BVM. 3. (3) use a manometer to verify that cuff pressure is between 20 and 25 cm H2O. 4. (4) record cuff pressure in the chart. If adequate cuff pressure cannot be maintained or larger volumes of air are needed to keep the cuff inflated, there could be a leak in the cuff or tracheal dilation at the cuff site. In these situations, notify the physician to reposition or change the ET tube. *The procedure for MLT is similar with one exception. Remove a small amount of air from the cuff until a slight air leak is auscultated at peak inflation. (Lewis, p. 1616) Mechanical Ventilation: Considerations/Ongoing care (ATI: Med-Surg 10.0, p. 113) Maintain adequate (but not excessive) volume in the cuff of the ET tube. • • Assess the cuff pressure at least q 8 hr. Maintain the cuff pressure below 20 mm Hg to reduce the risk of tracheal necrosis. • • Assess for an air leak around the cuff (client speaking, air hissing, or decreasing SaO2). Inadequate cuff pressure can result in inadequate oxygenation and/or accidental extubation. • **RUFUS (during the final review) said: To maintain proper cuff pressure inject air until you hear a slight leak. 17. Cortes - Hemodynamic monitoring to determine effectiveness of treatment for MI. (ATI: Med-Surg 10.0, p 162-163 and Lewis p, ) • • Indwelling catheters that provide info about blood vol. and perfusion, fluid status, and how well the heart is pumping. • • Assessment parameters w/ normal ranges: CVP (2-6 mm Hg), PAP (systolic: 15-28 mm Hg/diastolic: 5-16 mm Hg), PAWP (6-15 mm Hg), CO (3-6 L/min), SVO2: (60%-80%) • • Pulmonary Artery (PA) catheter: measures mixed SvO2; inserted into large vein (jugular/femoral) and threaded to R atrium and ventricle; multiple lumens, ports, components for hemodynamic measurements, blood sampling, IV infusions. • • Arterial lines (A-lines): placed in radial, brachial, femoral arteries; provide continuous info about BP and allow arterial blood sampling; assess circulation (cap refill, temperature, color) in limb with A-line; not used for IV fluids; assess integrity of arterial waveform to verify accuracy of BP readings. • • Indications: serious/critical illness, HF, post CABG, ARDS, AKI, burn/trauma injury. • • Nursing Considerations: o Pre-procedure: ensure client understanding/obtain consent; place in supine or Trendelenburg position (per ATI); level transducer at 4th ICS, mid axillary line (phlebostatic axis); zero system with atmospheric pressure. o Post procedure: obtain chest X-ray to verify placement; continuous cardiac and respiratory monitoring (VS, compare NIBP to arterial BP); document/report waveforms (indicate migrated/displaced catheter); document catheter placement each shift or as needed (after movement or transfer). o Obtaining readings: place client in supine position and HOB can be elevated 15-30 degrees before recording; level transducer/zero system; compare findings to physical assessment; monitor trends. • • Manifestations of altered hemodynamics: o Preload: CVP measures R heart; PAWP measures L heart; Elevated preload manifested by crackles in lungs, JVD, hepatomegaly, peripheral edema, taut skin turgor; Decreased preload manifested by poor skin turgor, dry mucous membranes. o Afterload: R heart measured by pulmonary pressure; L heart measure by systemic pressure; Elevated afterload manifested by cool extremities, weak peripheral pulses; Decreased afterload manifested by warm extremities, bounding peripheral pulses. *Important to note that intravascular volume in older adults is often reduced; nurse should anticipate lower values, especially if dehydration is present. • • Complications and nursing actions: o Infection/Sepsis: change dressings per protocol and as needed; use aseptic technique w/ dressing changes; monitor for infection; thorough hand hygiene; specimen collection; antibiotic therapy; IV fluids; vasopressors for vasodilation secondary to sepsis. o Embolism: use 0.9 NS for flushing system; avoid introduction of air into flushing system; recognize the risk of pneumothorax; recognize risk of dysrhythmia During the final review: Patient has large anterior wall MI. What is most important for the nurse to obtain? A hemodynamic concerned with the heart? RUFUS: pulmonary artery wedge pressure (PAWP) will tell us about ventricular and diastolic pressure or preload of the heart. If tx. is effective, there will be a decrease in CVP, PAP, and PAWP, and an increase in cardiac out and SvO2. 18. Cortes - Clinical manifestations of mitral valve regurgitation. (Lewis, p. 821-823) • Acute: poorly tolerated; new systolic murmur w/ PE and cardiogenic shock developing rapidly; thread peripheral pulses, cool, clammy extremities • Chronic: weakness, fatigue, exertional dyspnea, palpitations, s2 gallop, holosystolic murmur, orthopnea, peripheral edema • There is nothing in the ATI book listing MVR manifestations. RUFUS (during review) said: report s/s of pulmonary edema. She specifically said crackles. 19. Curbis - Complications of acute pericarditis and clinical manifestations requiring immediate intervention. Two major complications that may result from acute pericarditis are pericardial effusion and cardiac tamponade. Pericardial effusion (buildup of fluid in the pericardium) • Occurs rapidly or slowly • Large effusion can compress nearby structures • Pul¬monary tissue compression can cause cough, dyspnea, and tachypnea. • Phrenic nerve compression can induce hiccups • Compression of the laryngeal nerve may result in hoarseness. • Heart sounds are generally distant and muffled • Blood pressure (BP) usually is maintained Cardiac tamponade (develops asd the pericardial effusion increases in volume) • Results in compression of heart • Speed of fluid accumulation affects the severity of clinical manifestations • Manifestations: o Chest pain o Confusion, anxiety & restlessness o Decreased CO o Muffled heart sounds o Narrowed pulse pressure o Tachypnea & tachycardia o Pulsus paradoxus o (Slow onset clinical manifestation may only be) dyspnea o JUGULAR VEIN DISTENTION (per RUFUS final review) BECK’s TRIAD: The signs are low arterial BP, distended neck veins, and distant, muffled heart sounds. Clinical Manifestations include: • Progressive, frequently severe, sharp chest pain • Worsening pain with deep inspirations or when lying supine • Pain is relieved when sitting up or leaning forward • Radiating pain to neck, arms, or left shoulder (often mistaken for angina) • Trapezius muscle pain (phrenic nerve innervates that region) • Dyspnea r/t shallow rapid breaths to avoid chest pain • Hallmark finding is pericardial friction rub (scratching, grating, high-pitched sound (ask patient to hold breath, still heard? Cardiac (Lewis 815) 20. Curbis - Describe ventricular tachycardia and what it looks like on a 6 second strip. Rate & Rhythm: 150-250 bpm and regular or irregular P Wave: Not usually visible PR Interval: Not measurable QRS Complex: Wide and distorted (Lewis 794) FIG. 36-18 Ventricular tachycardia. A, Monomorphic. B, Torsades de pointes (polymorphic). (Lewis 799) 21. Curbis - Diagnosis of heart failure. Diagnosing HF is often difficult, since neither patient signs nor symptoms are highly specific, and both may mimic those associated with many other medical conditions (e.g., anemia, lung disease). A primary goal in diagnosis is to find the underlying cause of HF. • An endomyocardial biopsy (EMB) may be done in patients who develop unexplained, new-onset HF that is unresponsive to usual care. • Ejection fraction is used to differentiate systolic and diastolic HF. This distinction is important to make in the early treatment of HF. EF is measured using echocardiography and/or nuclear imaging studies. • Other useful diagnostic tests include electrocardiogram (ECG), chest x-ray, and heart catheterization. Laboratory studies also aid in the diagnosis of HF. In general, BNP levels correlate positively with the degree of left ventricular failure. Many laboratories routinely measure the N-terminal prohormone of BNP (NT-proBNP). This is a more precise assay to aid in the diagnosis of HF. Levels are temporarily higher in patients receiving nesiritide (Natrecor) and may be high in patients with chronic, stable HF. Increases in BNP or NT-proBNP levels can be caused by conditions other than HF. These conditions include pulmonary embolism, renal failure, and acute coronary syndrome. (Lewis 772) RUFUS (from BB) thumbs up for: Elevated hBNP (100pg/mL +) confirms dx. of HF 22. Curbis - Cushing’s triad. • NEUROLOGICAL EMERGENCY (sign of brainstem compression and impending death)!!! • Indicates severely increased ICP. • Manifestations: o DIPLOPIA (double vision) (per RUFUS final review) o Headache o Nausea/vomiting o Systolic hypertension with a widening pulse pressure o Bradycardia with a full and bounding pulse o Altered respirations (Lewis 1360 & 1366) THUMBS UP FROM RUFUS ON BB: cushings triad-from increased ICP with loss of autoregulation. lewis says systolic htn with widening pulse pressure, brady with full & bounding pulse & altered respirations 23. Curbis - Ventriculostomy system used for ICP monitoring. RUFUS: Ventriculostomy measures ICP. • Ventriculostomy if the gold standard for monitoring ICP. o Specialized catheter is inserted into the lateral ventricle and coupled to an external transducer. o Directly measures the pressure within the ventricles. o Facilitates removal and/or sampling of CSF. o Allows for intraventricular drug administration. • The transducer is external. • It is important to ensure that the transducer of the ventriculostomy is level with the foramen of Monro (interventricular foramen). • The ventriculostomy system must also be at the ideal height (a reference point for this foramen is the tragus of the ear). • Every time the patient is repositioned, the system needs assessed to ensure it is level. (Lewis ) 24. Delgado - Functions of the posterior temporal lobe and describe how to assess for dysfunction. • Posterior temporal lobe function: Integrates visual and auditory input for language comprehension (lewis p.1339) • To asses for dysfunction: Asses for aphasia, inability to recognize words or comprehend speech. Visual agnosia, difficulty recognizing objects. Prosopagnosia, inability to recognize people, faces etc. THUMBS UP FROM RUFUS 25. Delgado - Procedure for obtaining a health history from a client with an acute head injury. • In most patients, history can be self-evident. Family members or bystanders can be a good source of information for the incident details. • Elicit the type or mechanism of the injury. • Asses for the presence of prior head injury. • Asses for remote or active alcohol use or drugs • Asses for sports activities. THUMBS UP FROM RUFUS 26. Delgado - Treatment for lung cancer (chemotherapy vs. surgery). • Chemotherapy: primary choice of treatment . Often used in combination with radiation for small cell lung cancer and nonresectable tumors. • Surgery: treatment of choice for non-small cell lung cancer. The goal of the surgery is to remove all tumor cells. Involves removal of lung( pneumonectomy), lobectomy, segmentectomy, and wedge resection. RUFUS comment from class: Chemo is not very effective with non small cell lung cancer. 27. Delgado - Nursing interventions for a client who smokes and is at risk for lung cancer. • Promote and encourage smoking cessation. • Modeling healthy behaviors by not smoking, promoting smoking cessation programs. • Encourage healthy diet and exercise. 28. Delgado - MI: clinical manifestations, common medications used to treat and prevent, and diagnostic tests. • Clinical manifestations: Chest pain, anxiety, Nausea, dizziness, pallor, cold and clammy skin, tachycardia, tachypnea, diaphoresis, and decreased level of consciousness. • Common medications: Nitroglycerin, morphine, aspirin, metoprolol, alteplase, heparin. • Diagnostic test: Cardiac enzymes levels (troponin, myoglobin, creatine kinase-MB). ECG, Stress test, thallium scan, and cardiac catheterization. RUFUS: WHAT IS IMPORTANT ABOUT CHEST PAIN THAT IS INDICATIVE OF MI? 29. Gabriel - CAD modifiable risk factors. Modifiable risk factor for CAD are: Serum Lipids: Total Cholesterol 200mg/dL Triglycerides 150 mg/dL LDL cholesterol ?160 mg/dL HDL cholesterol 40 mg/dL in men o 50 mg/dL in women Blood pressure 140/90 mm Hg Diabetes mellitus *Tobacco Use *Physical inactivity *Obesity: Waist circumference 102 cm ( greater than 40 in) in men and 88 cm ( greater than 35 in) in women Fasting Blood Glucose 100 mg/dL Psychosocial risk factor ( depression, hostility, anger, stress) *Elevated homocysteine levels Lewis pg 732 Table 34-1 RUFUS: Yes, the diet will definitely help with the cholesterol and reduce the risk for CAD. 30. Gabriel - Nursing interventions for Brown-Sequard syndrome. One side has lost motor the other lost sensoy, so i guess protection of skin and patient from injury. Brown-Séquard syndrome (BSS), also known as hemisection of the spinal cord or partial spinal sensory syndrome, is a rare condition caused by an incomplete lesion of the spinal cord. This damage, most often from physical trauma, results in a contralateral (opposite side of the body) loss of sensation and temperature and ipsilateral (same side of the body) paralysis or extreme weakness Physical Therapy starts in the acute care phase treatment More answers from BB: help reposition patient on ipsilateral side of the lesion ( so if the lesion is on left side the patient will need help repositioning the left leg because of the paralysis, for the contralateral side (opposite side of lesion ex. rt side will not feel pain or temp sensation below the level for the lesion) 31. Gabriel - Clinical manifestations of neurogenic shock. Hypotension Increase/decrease Temp. Inability to regulate temperature which promotes heat loss Bradycardia Decrease venous return, stroke volume, and cardiac output Venous and arterial vasodilation Bladder dysfunction Decreased skin perfusion , cool or warm skin and dry skin Flaccid paralysis below the level of the lesion Loss of the reflex activity Bowel dysfunction Lewis pg figure 67-4 Thumbs up from Rufus in BB: Hypotension ( from the vasodilatation) Bradycardia (from unopposed parasympathetic stimulation) Skin dry, (cool or warm ) Poikilothermi .....................................................................................................................................................DOWNLOAD FOR MORE DISCUSSIONS TO THAT DREAM GRADE............