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79 Cards in this Set
- Front
- Back
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What phase is oliguric type of renal failure?
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Second Phase
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Symptoms of oliguric (2nd) phase of renal failure.
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low urine output
BUN/ creatine increased < 400cc out in 24 hours |
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How will urine appear after kidney biopsy?
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May have blood in urine for about 24 hours.
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Why does dialysate solution have glucose?
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Glucose is lost during dialysis, the levels in bag are prescribed by physician. Different percentage means amount of glucose.
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ARF Prerenal
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decreased blood flow to kidneys leads to ischemia.
Increasing blood flow reverses it usually. |
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ARF Renal (intrarenal) phase
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Damage to kidneys or neurons of the kidney itself. May be from immune or inflammatory process.
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Post renal
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From obstruction anywhere in urinary system. Stones, strictures, Calculi
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Treatment for oliguric phase
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Normal saline, then high dose diuretic such as Mannitol or Lasix. Small dose of Dopamine 2.5-5 mic/kg/min to increase renal perfusion.
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Disequilibrium Syndrome
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urea is removed from blood but not brain or CSF, causes fluid shift and edema,N/V, low BP,HA, confusion. Start dialysis slowly at first to prevent.
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Diet for CRF
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fluid restriction (1000cc day)
low sodium low potassium low protein beware of sodium substitutes because they are high in potassium |
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Labs on renal patient will be
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increased BUN
increased creatine increased triglycerides because of high lipids |
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Normal Potassium
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3.5 - 4.5
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Normal sodium
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135 - 145
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Normal calcium
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8.5- 10.5
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Normal phosphorus
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1.7- 2.5
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calcium and phosphorus have inverse relationship
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elevated phosphourus means low calcium,parathyroid kicks in getting calcium frombones which inturn means pt is high risk for fractures.
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To Raise calcium levels
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Give Aluminum Hydroxide gel which will bind with phosphourus to excrete in stool = higher calcium levels
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Arteriovenous Fistula
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used primarily for CRF
aseptic technique must be used for insertionand drsg change |
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Arteriovenous Fistula Complications
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Thrombolisis
Infection |
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Nurses POC for CRF
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fluid restriction
diuretics Na,K,protein restrictions Aluminum Hydroxide gel w/ meals sodium bicarb to treat acidosis (IV or PO) calcitrol (activates Vit D in calcium for absorption) calium, water sol vitamins, iron ( not given w/ antacids) blood transfusion topical ointment (uremic itch) watch meds,especially narcotics because of longer excretion time. |
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Nrsg diagnosis for CRf with calcium and vit d problem
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High risk for injury R/T low calcium levels AEB brittle bones
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Kidney transplant donor must not have:
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COPD,liver disease, active infection, extensivevascular disease, must be histocompatible (family best fit).
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Person recieving organ will be on what for the rest of their lives:
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immunsupressive therapy
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Normal BUN
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8 - 23 mg/dl
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Normal creatinine
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0.6 - 1.2 mg/dl
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Drugs given fo renal failure
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ace inhibitors (Dopamine)
diuretics (mannitol, lasix) |
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Lab values that mean kidney failure
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BUN < 100
Creatinine < 10 |
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sensitive and accurate indicator forrenal failure
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BUN Creatinine levels
urine output |
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What lab would you check for bleeding esophageal varicies?
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Amonia because blood is protein and digesting it causes increase in amonia
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Cirrhosis
decreased LOC |
high amonia levels
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Biliary Cirrhosis
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dark urine,cly colored stool, jaundice, weakness, fatigue, ascites,spider angiomas
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Cirrhosis labs
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high AST
SGOT SGPT |
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alcoholic cirhossis
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Laennec's
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hepatic encephalopathy
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manifested by neuro
checkhandwriting Q Shift (decreased LOC, impaired thinking, neuro disturbances) |
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labs for cirrhosis
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biliruben
early stages 3-10 mg/100ml late more than 50 mg/100 ml |
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Normal albumin
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3.4 - 5.4 g / dl
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Normal amonia
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15 - 45
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Why does pt with cirhossis have ascites?
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accumulation of "free fluid" (ALBUMEN and plasma) in peritoneal cavity. It happens because of osmosis.
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Why give IV albumen in ascites?
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To restore serum levels which should cause fluid to shift from peritoneal cavity back to blood stream (osmosis)
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Primary Survey Of Trauma PT
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A,B,C,D's
airway, breathing, circulation, then disability (neuro) |
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Primary Survey In Trauma
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LOC and AVPU
alert, verbal, pain,unresponsive |
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Priority Assessment with C 4 fracture?
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Respiratory Status
Usually fatal, involves diaphram, pt needs vent |
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Spinal Shock (neuro shock)
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Complete loss of muscle function, loss of bowel and bladder, sexual function, and autonomic reflexes.
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Indications that shock is resolving
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Return of reflexes (hyperrefelxia)
Use of bowel and bladder |
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hypovolemic shock
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lethargy and restlessness are early signs
late signs Cushing's Triad |
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Interventions with ICP
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head at midline
HOB 15-30 degrees pressure off neckfor adequate flow maintain normothermia treat pain NGT w/ IVPB Zantac |
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Major complication of ICP
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Herniation Syndrome
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Hiv infects
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T helper cells, T4 lymphocytes, macrophages, and B cells.
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Polikulothermia
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pt body takes on environmental temperature.
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Complications of thrombolytic therapy
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bleed
allergic reaction stroke |
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decreased RST
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ischemia
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elevated T
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trauma / injury
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Pt with MI had high PCWP
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pulmonary capillary wedge pressure- ideal range is 20 mm. If to much fluid then then pcwp can increase, watch when giving fluids. Pt may need diuretics rather than fluids b/c at risk for developing pulmonary edema.
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Flail chest is pneumothorax usually from crushing injury.
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Air in pleural space, decreased lung expansion, open wound from stab or pulling tube out. Cover with only 3 sides taped.
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Hemothorax is blood in chest cavity
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16 guage needle to aspirate lung
CT at 4th or 5th intercostal space |
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Hemothorax and Pneumo thorax
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need CT to reinflate lung
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Risk factor for ARD's
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aspiration
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Trauma score of 14 what is assessed
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respiratory rate
respiratory effort systolic blood pressure capillary refill Glascow Coma Scale |
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Glascow Coma Scale
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eyes
motor verbal |
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Decerbrate
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extension of everything
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decorticate
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arms flexed
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decerbrete
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extension of everything
flaccid |
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abnormal posturing of poorest prognosis
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bilateral flaccid
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acute tubular necrosis
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caused by ischemia of kidneys or
exposure to nephrotoxic agents |
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ATN s/s
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decreased urine output
edema/swelling drowsy/lethargic hard to arrise N/V delerium confusion |
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Breathing pattern in CRF
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Kuss Mals
acidosis |
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Secondary prevention for HIV
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safe sex
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Potential for injury with cirrhosis
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high risk for injury R/T decreased prothrombin production and synthesis of substance used in blood coagulation. Or fluid volume deficit.
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routine orders pancreatitis
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assessment- location, severity, character,onset, duration,precipitating factors.
Positioning- fetal position to relieve pain. |
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endoscopic retrograde cholangiopancreatography for pancreatitis
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NPO after midnight and for 2-4 hours after procedure
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subdural hematoma
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steady decline in LOC
oftenin elderly & drunks |
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epidureal hematoma
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rapid decline in LOC
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intracerebral hematoma
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occur less often, bleeding directly into the brain tissue. Cause problems with increased ICP, hemapalegia and hemaparesis common.
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subarachnoid hemmorhage SAH
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bleeding into subarracnoid space, most often from trauma and anerysm. May lose concious immediately or become confused and lethargic and gradually comatose.
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A Fib
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No P Wave present
Indesernable ST waves |
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A Flutter
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No P wave
No definable ST waves saw tooth, picket fence |
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Pulseless Electrical Activity
PEA |
Has a pulse but patient dead
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3rd degree heart block
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No association with P and QRS
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V Tac
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No pulse,no BP
no P wave,no PR interval not well defined QRS complexes |
