1. 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. 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. 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. 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.