Adult Ii - Exam 3

Front 1

apraxia

Back 1

inability to use objects properly or inability to carry out learned sequential movements or commands

Front 2

8 Functions of the Kidneys

Back 2

1. Regulate volume and composition of ECF
2. Urine, excrete metabolic waste
3. Erythropoietin
4. Renin - BP regulation
5. Prostaglandin - Vasodilation
6. Activates Vitamin D
7. Insulin Breakdown
8. Regulated Na, K, Ca, Mg, Cl, and Bicarb

Front 3

Azotemia

Back 3

Abnormal concentration of nitrogenous wastes in the blood

Front 4

Normal GFR

and

Normal urine output

Back 4

GFR: 125 ml/minute

Urine Output: 1 ml/minute (60 ml/hour, 1-2 L/day)

Front 5

Normal Creatinine

Back 5

0.5-1.5mg/dl

Front 6

Normal Uric acid

Back 6

2.5-5.5mg/dl

Front 7

Normal Sodium

Back 7

135-145 mEg/l

Front 8

Normal Potassium

Back 8

3.5-5.0 mEg/L

Front 9

Normal Calcium

Back 9

4.5-5.2 mEg/L

Front 10

Normal Total Serum Calcium

Back 10

10.5 mEg/L

Front 11

Normal Phosphorus

Back 11

2.8-4.5 mg/dl

Front 12

Normal Bicarb

Back 12

20-30 mEg/l (Most patients in renal failure have metabolic acidosis and low serum HCO3- levels)

Front 13

Formula for Bicarb

Back 13

HCO3-

Front 14

BUN: Full name and definition

Back 14

Blood Urea Nitrogen: Nitrogenous end product of protein metabolism, serves as index of renal function

Front 15

Normal BUN

Back 15

7-18 mg/dL
Patient >60: 8-20 mg/dL

Front 16

What can effect a BUN result?

Back 16

1. Protein intake
2. Tissue breakdown
3. Fluid volume changes

Front 17

24 Hour Urine Test: Normal mL/sec AND Normal mL/min for Men and Women

Back 17

Test Creatinine Clearance. Used to follow progression of renal disease.
Normal: 1.67-2.5 mL/sec
Men: 95-135 mL/min
Women: 85-125 mL/min

Front 18

Normal Creatinine Serum Level

Back 18

0.6-1.2 mg/dL

Front 19

Specific Gravity

Back 19

1.010 - 1.025

Front 20

Risk Factors for ARF

Back 20

1. Age
2. Trauma or surgery
3. Burns
4. Cardiac failure
5. Sepsis
6. Obstetric complications
7. Hypertension
8. Diabetes mellitus.

Front 21

Primary cause of CKD?

Back 21

Diabetes

Front 22

Stages of CKD

Back 22

Stage 1 (GFR >90) - Stage 5 (GFR <15 - ESRD)

Front 23

Clinical Manifestations of CRF

Back 23

1. Elevated serum creatinine
2. Anemia
3. Metabolic acidosis
4. Abnormal calcium and phosphorus
5. Fluid retention (edema and CHF)
6. Hypertension

Front 24

Signs of of Uremic Syndrome

Back 24

High BUN &amp; creatinine level
Fatigue
Anorexia
N/V
Pruritis
Neurological changes
Headache, coma, convulsions

Front 25

Stages of ARF

Back 25

1. Initiation
2. Oliguria
3. Diuresis
4. Recovery

Front 26

Oliguria Period of ARF

Back 26

1. Urinary output <400 mL
2. Increase in serum urea, creatinine, uric acid, organic acids, potassium, and magnesium
3. Decreased Ca++, Na+, pH
4. Fluid volume excess
5. Nausea, vomiting, irritability, drowsiness, confusion, coma
6. Restlessness, twitching, seizures
7. Hematologic disorder: Anemia
8. Hypertension, edema , pulmonary edema, CHF
9. Waste product accumulation: Albuminemia
10. Typically 8-15 days (can last weeks)

Front 27

Diuresis Period

Back 27

1. Urine output 4-5 L/day
2. Large fluid and electrolyte loss – monitor for hyponatremia, hypokalemia, hypovolemia and hypotension : Na+ and K+ loss in urine
3. High urine output r/t osmotic diuresis from high urea concentrate in the glomerular filtrate and the inability of the tubules to concentrate the urine. (dilute : reflected in low specific gravity)
4. Kidneys can excrete wastes, but not concentrate urine.
5. Uremia present (AEB low creatinine clearance, elevated serum creatinine and BUN)
6. Lasts 1 – 3 weeks

Front 28

Recovery Period

Back 28

1. Begins when the GFR increases; s/s could occur within 1-2 weeks of this phase; however renal function may take a year to stabilize.
2. Client begins to return to normal levels of activity (decreased BUN)
3. Residual renal insufficiency may be evident
4. Increased mental and physical activity
5. Renal function may continue to improve for up to 12 months after oliguric ARF began
6. Renal function may never return to pre-illness level of functioning

Front 29

Kayexalate

Back 29

Cation exchange resins: Given oral or retention enema for hyperkalemia

Front 30

Aluminum hydroxide

Back 30

Used for elevated phosphate levels

Front 31

Protein Restrictions for Renal Failure

Back 31

2/3 total protein should be from high-biologic sources such as milk, eggs, meat
Protein requirement varies with dialysis; calculate 1 - 1.5 g/kg IBW
provide adequate nonprotein kcals

Front 32

Sodium Restrictions for Renal Failure

Back 32

2.0 - 3.0 mg/day

Front 33

How often do you assess thrill/bruits in a fistula?

Back 33

Every 8 Hours

Front 34

When do you monitor for hemorrhage with dialysis?

Back 34

During dialysis and for 1 hour afterwards

Front 35

Two leading causes of kidney failure?

Back 35

Diabetes and Hypertension

Front 36

Ways to save remaining kidney function

Back 36

Controlling your blood glucose
Controlling your blood pressure
Low-protein diet
Healthy levels of cholesterol
Quitting smoking

Front 37

What is the leading cause of serious, long-term disability?

Back 37

Stroke

Front 38

Risk factors for CVA

Back 38

1. Age (>55)
2. Sex (Male)
3. Race (African Americans)
4. Heredity
5. Hypertension
6. Atrial Fibrillation
7. Hyperlipidemia
8. Obesity
9. Smoking
10. Diabetes
11. Heavy Alcohol Use

Front 39

Most common kind of stroke?

Back 39

Ischemic (85%)

Front 40

Ischemic vs. Hemorrhagic Stroke

Thrombotic vs Embolic Stroke

Back 40

Ischemic Strokes =
Thrombotic: Narrowing from plaque, clot forms
Embolic: Blood clot or other debris lodge in small vessels of the brain

Hemorrhagic: Blood vessel burst and leaking blood causes tissue damage

Front 41

TIA

Back 41

Transient Ischemic Stroke - mini-stroke; warning sign of major stroke

Front 42

Clinical manifestation: "Worst headache of my life"

Back 42

Hemorrhagic Stroke, typically occurs during periods of activity, hypertension is the most important cause

Front 43

What is the primary diagnostic test after a stroke?

Back 43

CT (Without contrast until a hemorrhagic stroke is ruled out)

Front 44

What can mimic a stroke?

Back 44

Hypoglycemia and MI

Front 45

Treatment for people who have TIAs

Back 45

Anti-platelet Agents = Aspirin

Front 46

Surgical treatments for carotid disease

Back 46

Carotid endarterectomy
Transluminal angioplasty
Stenting
Extracranial-intracranial bypass

Front 47

When is tPA used with strokes?

Back 47

Within 3 hours

Front 48

GCS

Back 48

Glasgow Coma Scale: Range 3-15

Front 49

3 Criteria in the Glasgow Coma Scale

Back 49

Motor Response
Verbal Response
Eye Opening

Front 50

4 Stages of a Seizure

Back 50

Prodromal
Aura
Ictal
Postictal

Front 51

Simple vs Complex Seizure
Partial vs Generalized Seizure

Back 51

Simple: no loss of consciousness
Complex: loss of consciousness

Partial: one part of the brain
Generalized: whole braine

Front 52

Akinetic, atonic, and astatic AKA...

Back 52

Tonic Seizure: dropsy

Front 53

Seizure Meds

Back 53

Older: Dilantin, Tegretol, phenobarbital, and Depakote

Newer: Neurontin, Lamictal, Topamax, Gabitril, Keppra, and Zonegram

Front 54

Phenytoin: Brand Name and Side Effect

Back 54

Dilantin - gingival hyperplasia

Front 55

What meds are used to treat status epilepticus?

Back 55

IV Ativan
Valium

Front 56

Possible precipitating factors for MS

Back 56

Infection
Physical injury
Emotional stress
Excessive fatigue
Pregnancy
Poor state of health

Front 57

4 Clinical Courses of MS

Back 57

Relapsing-remitting
Primary-progressive
Secondary-progressive
Progressive-relapsing

Front 58

Clinical Manifestations of MS

Back 58

Motor: Weakness or paralysis of limbs, trunk, and head; Diplopia; Scanning speech; Spasticity of muscles

Sensory: Numbness and tingling; Blurred vision; Vertigo and tinnitus; Decreased hearing; Chronic neuropathic pain

Cerebral: Nystagmus; Ataxia; Dysarthria; Dysphagia

Emotional: Anger; Depression; Euphoria

Front 59

Spastic Bladder

Back 59

Spastic bladder: small capacity for urine results in incontinence

Front 60

Flaccid Bladder

Back 60

Flaccid bladder: large capacity for urine and no sensation to urinate

Front 61

Diagnosis of MS

Back 61

Based primarily on history, clinical manifestations, and presence of multiple lesions over time measured by MRI

Certain tests are used as adjuncts to clinical exam
CSF analysis
Evoked responses
MRI/MRS

Front 62

Drug Therapy for MS

Back 62

Corticosteroids
Immunosuppressants
Immunomodulators
Antispasmotics
CNS stimulants
Anticholinergics
Tricyclic antidepressants and antiseizure drugs

Front 63

3 Chambers in a Pleurevac

Back 63

Collection Chamber
Water Seal Chamber
Suction Control Chamber

Front 64

Toxic Side Effects of Anti-Seizure Meds

Back 64

diplopia, drowsiness, ataxia, and mental slowing