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457 Cards in this Set

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What happens to the kidneys during diabetes mellitus?
The kidneys are damaged by glomerularsclerosis and nephrosclerosis scarring (afferent or efferent arterioles)
What symptoms manifest with diabetes mellitus and kidneys?
Increase of protein in the urine, edema, high blood pressure, and renal failure.
What is the relationship between kidneys and insulin?
The kidneys metabolize insulin, and when they are so damaged, the metabolization of it also declines. This results in a lower insulin requirement.
How can you slow the sclerotic process of the kidney with diabetes?
Control hypertension. Manage blood sugar. Have a low protein diet.
Can you completely remove renal failure from diabetes mellitus?
No. It will develop in 5-10 years regardless.
What occurs when there is a reduction of blood flow through the kidneys?
The renin-angiotension-aldosterone system is activated and increase blood pressure.
Why does renal hypertension occur?
The kidney cannot excrete sodium and water from damage due to disease. This results in renal hypertension and contributes to the systemic blood pressure.
How do you control/halt renal hypertension?
Blood pressure management
What is hypotension or cardiac shock and how does it affect the kidneys?
Pump failure and low volume output...this causes renal vasoconstriction and increases renal blood flow.
Does the GFR function with renal hypotension?
Yes.
How do you reverse vasoconstriction of the renal system due to hypotension?
Return fluid volume.
What occurs after fluid volume is restored after hypotension?
There will be oliguria before it is restored followed by a mobilization of fluids from interstitial to intravascular spaces. This will cause the patient to have polyuria!
What is rhabdomylosis?
Rhabdomylosis is myoglobin being forced out of the muscle cells in relation to strenuous exercise, crush injuries, and any trauma of skeletal muscle.
What are the symptoms of rhabdomylosis?
Fever, malaise, n/v, pain, muscle weakness, swelling,
What do the electrolytes look like with rhabdomylosis?
High potassium, high phosphate, high uric acid and high calcium in the diuretic phase

Low calcium in beginning, and low myoglobin
How do you treat rhabdomylosis?
Bed rest to reduce muscle metabolism, correct acidosis, and electrolyte imbalances.
Name a few nephrotoxic chemicals and what are their affects on the kidney?
acute tubular necrosis
tubular defects
intersitial nephritis
vasculitis
nephrotic syndrome

heavy metals, arsenic, lead, copper, phosphorous, carbon monoxide,snake venom, mushrooms,antibiotics, analgesics
What is pyelonephritis?
Bacterial infection of pelvis and parenchyma
What are most kidney infections stemmed from?
Other infections throughout the urinary tract.
What is the number one organism that causes pyelo?
e.coli
Why does chronic pyelonephritis occur?
chronic obstruction with reflux or chronic disorders, has a slow progression and many acute attacks
What can pyelonephritis ultimately result in?
Scarring of the kidney and decreased function
What are symptoms of acute pyelo?
Big kidneys, focal parenchymal abcess, lymphocyte accumulation, can cause no manifestation, headache, chills, fever, flank pain, muscle pain, cystitis symptoms,
What are some symptoms of chronic pyelonephritis?
high blood pressure
azotemia
pyuria
anemia
acidosis
proteinuria
poor urine-concentrating ability
How do you treat acute pyelo?
AB- sulfamethoxazole and sulfonamides, lots of fluids
How do you manage chronic pyelo?
Control BP, give ABs,be careful with fluids may be contraindicated if renal dysfunction is high, low na diet
What can happen to antimicrobials with fluids?
They can be less effective if diluted significantly.
How much fluid should be pushed for acute pyelo or chronic pyelo if not contraindicated?
3-4 liters
What is hydronephrosis?
Distension of the kidney by an obstruction of normal urine flow. Obstruction could be a stone, tumor, scar tissue, etc. Over time, this causes nephron destruction and urinary stasis increases other chances for problems.
What occurs after removal of an obstruction?
Postobstructive diuresis can occur which may lead to electrolyte imbalances and dehydration.
Are renal tumors always cancerous?
Most of the time, but benign ones cannot be distinguished from malignant ones on x-rays.
What causes kidney cancer?
Smoking and nephrotoxic substances
Where do adenocarcinomas frequently metastisize?
lungs and brain
What is nephroblastoma?
Wilm's tumor in adults. The prognosis is worse for adults.
What are the symptoms of renal cancer?
Mass palpated. Hematuria. Flank pain. fever. weight loss. elevated esr and abnormal liver test.
Why do people frequently put off going to see doctor about renal cancer?
intermittent hematuria
How do you identify a mass?
IVP, US, CT
How good is survival of renal cancer in 1 2 3 4 stages?
1- 65%
2-40%
3 and 4..five year survivals are rare
How do you treat renal cancer?
Radiation, chemo, and surgery. Chemo has yet to prove its effectiveness. Immunotherapy is best.
What is immunotherapy?
Stimulates the immune system to fight against renal cancer.
What is a nephrectomy?
Excision of a kidney due to renal cancer and also with adrenal gland and fat removal. Need dialysis if not a partial.
What are complications of a nephrectomy?
Hemorrhage is very high. Pnuemothorax.
What should urinary output look like if they have a total versus a partial nephrectomy?
Partial..0.5 ml
Total...0.25 ml
What are some discharge instructions for a nephrectomy?
Do not lift anything heavier than ten pounds in the first 6 weeks,
Tubulointerstitial disease or Interstitial disease is what?
Inflammation in the spaces between cells.
How does an acute tubulointerstitial disease present?
Has a rapid onset of an allergic reaction. Fever, rash, eosinophilia, oliguria, hematuria
What are the three outcomes associated with acute tubulointersitial disease?
complete recovery, renal failure to death, or transition to chronic tubulointerstitial disease
What are commonly prescribed for tubulointerstitial disease?
steroids, but still waiting on proof of effectiveness
What is the patho of tubulointerstitial disease?
Inflammation and scarring of intersitial space and influx of inflammatory cells and tubular atrophy. In later stage, hard to tell between pyelo or tubulointerstitial.
Why does tubulointerstitial disease occur?
hypo or hyper calcemia, drug toxicity, metal toxicity, analgesic abuse, septicemia, and pyelo
What are early manifestations of tubulointerstital disease?
unexplained decrease in renal function. Glucose, uric acid, phosphates, amino acids, and bicarb are found in urine because they are not absorbed.
What kind of problem is associated with tubulointerstitial disease?
Metabolic acidosis and severe bicarbnaturia
What is glomerulonephritis?
Proliferative and inflammatory changes in the glomerular structure- acute or chronic- nephrotic or nephritic
A set of clinical manifestations caused by protein wasting secondary to diffuse glomerular damage (abnormal permeability of basement membrane).
nephrotic syndrome
What does albumin and protein value look like with nephrotic syndome?
Hypoalbuminemia and proteinuria
What occurs pathophys in nephrotic syndrome?
The low albumin causes fluid to move into interstital spaces, causing edema. This then triggers the renin-angiotensin system to retain sodium and water that further adds to extracellular fluid.
What is the relationship between lipids and anemia to nephrotic syndrome?
Hyperlipidemia occurs, because of increased liver lipoprotein synthesis in response to decreased albumin
What are other problems associated with nephrotic syndrome?
Hypovolemia, clot, osteomalacia
How does a client with nephrotic syndrome present?
Waxy looking, anorexia, malaise, irritable, menses abnormal or absent, proteinuria severe, cell casts and fat bodies
How do you treat nephrotic syndrome?
Fix the permeability of the basement membrane.Loop diuretics. Albumin to pull water back into vessels.Mild NA restriction. K restricted if levels are high. Make diet palatable, they need the calories! Support skin integrity b/c edema compromises its nutrition
How much protein is suggested to prevent further breakdown in nephrotic syndrome?
1 to 1.5 g/kg/day
What decreases inflammation in nephrotic glomerular damage?
Steroid therapy
What is nephritic syndrome?
Hematuria and one of the following: oliguria <400/day, hypertension, elevated BUN, or decreased GFR
How do you treat nephritic syndrome?
Immunosuppressive drugs, and treatment of blood pressure and uremia.
What accompanies glomerulonephritis?
nephrotic and nephritic syndromes
What is an immunologic disorder that causes inflammation and increased cells in the glomerulus due to antigen-antibody complexes produced by infection get trapped in the glomerulus?
glomerularnephritis
What are manifestations of acute glomerulonephritis?
Rapid onset; hematuria with RBC casts and proteinuria. Fever, chills, weakness, pallor, anorexia, nausea, vomiting, edema,facial swelling. Ascites, pleural effusion,and heart failure.
What is the cardinal sign for glomerularnephritis?
Hypertension
How does urine present itself in glomerularnephritis?
smokey, dark brown urine with a low pH, excessive foam from increased proteinuria, and a mid to high level specific gravity.
How do you treat glomerular nephritis?
Plasmapheresis given with steroids and immunosuppressants. It removes circulating antibodies and the inflammatory response. The client's blood is replaced with fresh frozen plasma.
How does glomerularnephritis cause people to catch opportunistic disease?
The steroids and immunosuppressants and also diminishes the body's defenses, especially to streptoccoccus.
What are signs you can look for that signify trauma to the kidneys?
Hematuria, but can have clear urine. Flank pain or over 11th or 12th rib, shock, and mass,paralytic ileus
When can the renal trauma patient become more active?
When urine runs clear from blood.
How long does a kidney have for surgery with renal vascular surgery?
24 hours
What are the two causes of renal artery disease?
atherscleosis and fibromuscular dysplasia
What is a beading of the renal artery with stenosis and dilation alternations?
fibromuscular dysplasia
How do you treat an atherosclerotic renal artery?
percutaneous transluminal renal angioplasty
What can occur after renal bypass graft surgery?
Hypertension that can last for 48 hours.
What is a congenital disorder called supernumerary kidney/.
an extra kidney
What is the congenital anomaly renal agenesis?
Absence of one or both kidneys
What are aplastic kidneys?
small kidneys that have no functioning tissue
What are renal hypoplasia kidneys?
Small kidneys but have little functionq
What is polycystic kidney disease?
hereditary disorder that has sac-like cysts that contain fluid, blood, or urine all over the kidney
How does polycystic kidney disease differ from other kidney disorders?
polycystic is sodium wasting instead of sodium retaining, therefore, more na is needed
What occurs during acute renal failure with labs and GFR?
GFR decreases
BUN and creatnine increase
What consists of a decreased GFR?
Anything less than 400 cc per day
What is oliguria?
100-400
What is anuria/
< 100
What are the two most common causes of acute renal failure?
prenrenal Hypovolemia and hypotension
Describe the prerenal cause of ARF.
They interfere with kidney perfusion and reduced renal blood flow through the kidneys.
What are intrarenal causes of ARF?
They involve parenchymal changes caused by disease or nephrotoxic substances.
What occurs when lots of myoglobin and hemoglobin are released from traumatized muscle tissue?
They accumulate inside of the kidney and causes damages.
What are postrenal causes of ARF?
They arise from obstruction in the urinary TRACT. Anywhere from the tubules to the urethral meatus.
Electrolyte rebalance is based on urine amounts. What is significant about elevated or decreased potassium?
High levels of potassium arise when it cannot be excreted from the kidney. It increases chances of dysarrhythmias. It also is released from body's cells when acidosis is present, and is further increased by rapid tissue catabolism.
How does magnesium affect the kidneys?
The kidneys usually excrete magnesium, but it can accumulate in renal failure.
What should be avoided if worried about retention of magnesium in the kidneys?
Dark veggies, unrefined grains, nuts, legumes, antacids, and osmotic laxatives
What occurs with the accumulation of acid waste products?
metabolic acidosis..treat with na bicarb or dialysis for severe acidosis
Name five signicant events that call for dialysis in acute renal failure.
-significant fluid overload
-uncontrolled hyperkalemia or acidosis
-progressive uremia as evidenced by elevated creatnine and bun
-altered CNS function
-pericarditis
What are some special considerations to implement before starting a client on CRRT?
Lower heparin to decrease chances of bleeding and give fluids if hypovolemic
How does dialysis work?
Plasma is filtered across a membrane and solutes as well. This occurs because of diffusion.
Why is CRRT better than other dialysis methods?
It is slow and continuous removal. Others may be short and efficient though. Less traumatic.
Why are catheters carefully placed when a patient is in ARF?
They are at high risk of infection, and if one has to be placed, meticulous care must be partaken in.
Pericarditis is a common complication associated with ARF. Describe how it presents.
pleuritic pain that may subside when patient is upright, pericardial friction rubs, tachy, fever
How do you treat an ARF patient with pericarditis?
Steroids and NSAIDs
-periocardiocentesis
-pericardiectomy
What does increased BUN do?
Decreases the seizure threshold.
How do you relieve a seizure patient with elevated BUN?
Phentoin or phenobarbital
How should renal patients eat?
High calorie,low protein diets. Good quality protein.
What kind of dialysis allows for fluid removal and is it's main focus?
Slow continuous ultrafiltration
What method of dialysis works by convection, and how does it work?
Blood is removed and returned through venous access. This extra fluid added helps to pull out waste from the blood.
What method of dialysis is slow and involves removal of blood and the return of blood through a venous access?
Contiunuous venovenous hemodialysis
What method of dialysis uses both convection and diffusion to remove waste?
It has the best clearance. Continuous venovenous hemodiafiltration...diasylate runs and electrolyte solution are both ran to convect and diffuse waste. VERY expensive
What is the removal of fluid by artery?
continuous arteriovenous ultrafiltration
What can you do to help out fluid restricted clients who are thirsty?
Ice chips, spray bottles
Name the two biggest causes of CRF.
Diabetes M. and Hypertension
What are two conditions that may progress to chronic renal failure besides doing everything you can to prevent it?
lupus and diabetes mellitus
Why do serum urea nitrogen and creatnine levels decrease with kidney failure?
The kidney cannot filter as it once could and the GFR is reduced and clearance as well. This results in an excess that enters the blood instead of being excreted.
What occurs with surviving nephrons in chronic renal failure?
They remaining nephrons hypertrophy from so much added stress from solutes and the kidneys cannot concentrate urine adequately.
Why do some clients suffer from fluid depletion with chronic kidney failure?
They can't concentrate their urine, so a large amount of fluid is passed to try to help excrete the solutes.
What is wrong with the tubules in chronic renal failure?
They lose their ability to reabsorb electrolytes..usually sodium...which makes it numerous in urine. As time progresses, the body loses lots of fluid as well, and renal damage increases. The number of nephrons decline, and the kidneys cannot get rid of excess water salt and other waste products.
When do you see effects of uremic toxins on the body?
A GFR of less than 10 to 20 ml/min.
Describe the clinical course of ESRD and uremic syndrome. 4 stages.
1. reduced renal reserve
2. renal insufficiency
3. renal failure
4. ESRD and no maintenance of homeostasis
What is the reduced renal reserve stage of ESRD?
The BUN is high-normal, and the client is not experiencing any manifestations.
What is the renal insufficiency stage of ESRD?
Involves mild azotemia with impaired urine concentration, nocturia,mild anemia
What is azotemia?
Elevation of BUN and Creatnine
What is the renal failure stage of ESRD?
SEVERE azotemia, acidosis, impaired urine dilution,severe anemia,and a number of electrolyte imbalances
Why does anemia occur with renal failure?
The kidney is responsible for producing erythropoetin, a substance that stimultes RBC proliferation in the bone marrow.The kidney cannot produce it if it is not functioning normally.
What two groups characterized ESRD (of manifestations)?
Deranged excretory and regulatory mechanisms along with gastroin,cardio,neuro,hematologic,integu,skeletal,and hormonal manifestations. The kidneys can no longer maintain homeostasis.
Name the five functions of the kidney that are messed up with end stage.
1. inability to make erythropoetin
2. cant maintain acid base balance
3. cant regulate blood pressure
4.cannot degrade insulin
5. and cannot synthesize prostaglandins
How does CRF end in acidosis metabolic?
The kidney cannot excrete hydrogen as well...so results in acidosis.
What occurs with decreased phosphate excretion?
Hyperphosphatemia (more in blood because not being excreted)...
What does hyperphosphatemia lead to?
Decreased calcium absorption and hypocalcemia
Hyperphosphatemia leads to decreased calcium absorption that leads to hypocalcemia..that leads to?
hyperthyroidism
Name four symptoms of uremia?
1. increased BUN
2. increased creatnine
3. proteinuria
4. and increased uric acid
Act that says that people who show up the ER, regardless of their financial situation, must be treated
COBRA
Act that combats discrimination practice of hospitals
Emtala
What are the five things given to treat chest pain?
IV, o2,morphine,pain medicine, and ECG
What can o2 do to an ekg reading?
It can mask EKG changes.
Why is oxygen a priority when treating chest pain?
Time is muscle! Put it on right away...EKG changes tell you if there is damage to the heart muscle
Name the two goals of the EMS system.
1. provide emergency care as quickly as possible
2. get the right patient to the right hospital in the least amount of time
Who are often not taken to the correct level of trauma related to ambulance transfer?
the elderly
What is the goal of nursing in a disaster situation?
the greatest good for the greatest number of people
What level of acuity related to trauma includes seizure,shock,labor,major burns,chest pain,anaphylaxis?
emergent
What is the goal time for the emergent phase of the 3 level acuity system?
immediately
What acuity level includes kidney stones, closed fractures, and lacerations?
urgent
How long should the urgent phase of acuity take?
15-120 minutes
What level of acuity in trauma includes rashes, sore throats, earaches, sprains and strains?
nonurgent
what is the goal time for the nonurgent phase of acuity levels?
2-4 hours
Disaster situation: Tornado...patient has massive head injury..the outcome does not look good---what should yor actions be?
let patient go
What does a green tag signify?
minor
What does a yellow tag signify?
delayed
What does a red tag signify?
immediate care
How does radioactive injury effect the body?
Slow tissue death and new birth defects...could occur over years
How do you differentiate biochemical attacks versus the flu?
Skin manifestations with flu like symptoms
How are viral hemmorhagic fevers spread?
aerosol
How do you treat viral hemmorhagic fever?
support cannot treat
What is important about the incubation period?
It is critical and each disease has its own length.
What is the time for START triage and rapid tx?
less than 60 seconds per patient
Should you complete CPR on a black tag?
no
If a person is wearing a c-collar, what should you tag them as?
Yellow, even if walking around
What is RPM for Trauma?
Respirations, Pulse, and Mental Status
What kind of tag is applied to a person that is breathing at a rate of greater than 30 respirations?
RED tag
What can you tell about blood pressure when you are able to feel a pulse?
That the systolic pressure is at least 80.
What are the two main objectives for trauma care?
No CPR.
-open the airway
-control the bleeding
When is a legal psychiatric restraining order implemented?
When a patient cannot feed themselves or are a safety threat to themselves or others.
What occurs when a person has a psychiatric episode and a legal psych restraining order is implemented?
72 hour lockdown at a psych facility with a psychiatrist evaluation of whether or not they can be released
What should you collect hair evidence in?
paper envelope
What should you put swabs from a wound, membrane, orifice that is evidence in to preserve it?
let it air dry and then in an envelope
Where should you contain glass, bullets, nails, paint chips, fiber, and soil?
PAPER ENVELOPE
Where should you put wet clothingif it is evidence?
paper bags
What should you do for wounds before caring for them?
take pictures
Name the three stages of trauma urgency in the ED.
1.emergent
2.urgent
3.nonurgent
This stage of ED trauma is immediate treatment with threat to life/limb/and vision?
emergent
This stage needs to be treated, but life limb and vision are not threatened unless they are not txed in 1-2 hours.
urgent
What requires evaluation and possible treatment, but time is not a critical factor in the ED rating?
nonurgent
What are primary and secondary assessments in emergency nursing?
1. ABCs-threat
2.Non-threat problems
How do you evaluate neuro in a child?
AVPU- awake and alert? verbal stimulus to ge response? painful stimulus to evoke a response? unresponsive to any stimulus
What pain level is considered high risk?
> 7
If you have ineffective airway clearance related to an obstruction, what should you do?
If cervical neck injury- jaw thrust, do a chin lift if not.
After opening the airway with a chin lift or jaw thrust, what should you do?
Maintain airway with nasopharynx or oral airway
If you fail to remove obstruction with jaw thrust and chin lift..what should you do?
Heimlich, suction, intubate, laryngeal mask airway or crichthyroidostomy
What occurs in impaired gas exchange that is related to obstruction,infection,or injury?
pulmonary edema occurs and inflicts acute damage to the alveolar capillary membrane
How does alveolar collapse occur with impaired gas exchange related to obstruction,infection,or injurt?
Fluid collects, surfactant decreases, and then they collapse
A patient presents with sounds diminished or absent on the left lung. He also has asymmetrical chest wall movement sustained from chest wall blunt trauma?
He is experiencing a pnuemothorax and a flail chest
What should you do in the event of a pnuemothorax with flail chest?
Give o2 via cannula and mask from 2-10 liters per minute.
What meds should you give with a pnuemothorax?
Aerosol bronchodilators (metaprozenol and albuterol)

Epinephrine to decrease inflammation of bronchi

Steroids

IV fibrolytics for emboli

Hepa mask for infectious people
This type of pnuemothorax has air escaping into the pleuralcavity and it decreases lung expansion capacity?
simple related to penetration or blunt injury
What type of pnuemothorax has a traumatic opening that moves air in and out during breathing?
open related to penetrative trauma
What type of pnuemothorax has air trapped in the pleural cavity with no escape during exhalation?
Tension
Which pnuemothorax is the most emergent?
tension
A patient presents with pain with breathing, unequal breath sounds, and less than 94% on the pulse ox..what is occuring?
Simple pnuemothorax
A patient presents with a sucking sound, pain, tachypnea, and either no or diminished breath sounds or unequal?
Open pnuemothorax
A patient presents with extreme respiratory distress, distended jugular veins, mediastinal heart shift along with the trachea and vessels too. Vital signs show a low blood pressure and decrease cardiac output
Tension pnuemothorax
How do you DX tension pnuemothorax?
chest film
How do you treat a pnuemothorax?
Give o2 through hi flow mask
Cover open chest wall wound with gauze.
Release trapped air with a needle.
Insert chest tube to reinflate lung.
What is flail chest?
A serious rib fracture that consists of particles moving during breathing.
A patient comes in with respiratory distress, pallor, cyanosis, and paradoxical chest movements..what is occuring?
Flail chest
How do you treat flail chest?
Intubate, Ventilate and PEEP.
What should you monitor for with flail chest?
edema and ARDS
A patient presents will dull percussion over chest, and blood collecting under the thorax with shoulder pain...what are they experiencing?
Hemothorax
What test is performed on an abdominal injury that involves infusing saline into a catheter and allowing it to drain via gravity and then evaluated?
Diagnostic peritoneal lavage
What is blood collecting underneath the thorax?
kehr's sign
What things should be done when an emergency thoractomy is performed?
Watch for fluid loss and keep the patient warm
If a patient is experiencing excess fluid volume, how should you intervene?
Hi fowlers, hi flow mask, bipap, RSI sometimes,
Name five types of drugs that can be given for excess fluid volume.
b-type natripeptide
lasix
morphine
bb
ace inhibitors
Name five types of drugs that can be given for excess fluid volume.
b-type natripeptide
lasix
morphine
bb
ace inhibitors
Name five types of drugs that can be given for excess fluid volume.
b-type natripeptide
lasix
morphine
bb
ace inhibitors
A patient presents with distended jugular veins, muffled heart sounds and decreased cardiac output..
tamponade
A patient presents with distended jugular veins, muffled heart sounds and decreased cardiac output..
tamponade
How do you treat tamponade? 4
PTCA, fibrolytics, nitro and aspirin and a periocardiocentesis
How do you treat tamponade? 4
PTCA, fibrolytics, nitro and aspirin and a periocardiocentesis
A patient presents with distended jugular veins, muffled heart sounds and decreased cardiac output..
tamponade
What is the pnuemonic for confusion assessment?
Vowels and tipss
alcohol,epilepsy,encephalopathy,endocrine,insulin,overdose,underdose or uremia, trauma, infection, psych, stroke/shock........controlled by reticular activating system
What is the pnuemonic for confusion assessment?
Vowels and tipss
alcohol,epilepsy,encephalopathy,endocrine,insulin,overdose,underdose or uremia, trauma, infection, psych, stroke/shock........controlled by reticular activating system
How do you treat tamponade? 4
PTCA, fibrolytics, nitro and aspirin and a periocardiocentesis
What is the significance of tongue lacerations?
seizure activity
What is the pnuemonic for confusion assessment?
Vowels and tipss
alcohol,epilepsy,encephalopathy,endocrine,insulin,overdose,underdose or uremia, trauma, infection, psych, stroke/shock........controlled by reticular activating system
What is the significance of tongue lacerations?
seizure activity
What is significance of confusion with petechial rash?
lethal bacterial meningitis
What is significance of confusion with petechial rash?
lethal bacterial meningitis
How do you test for rhabdomylosis?
Urine for myoglobin
What is the significance of tongue lacerations?
seizure activity
How do you test for rhabdomylosis?
Urine for myoglobin
When would you give 50% dextrose IV fluids?
A blood sugar less than 45
When would you give 50% dextrose IV fluids?
A blood sugar less than 45
What is significance of confusion with petechial rash?
lethal bacterial meningitis
How should you treat stroke?
Give TPA in 6 hours
How do you test for rhabdomylosis?
Urine for myoglobin
How should you treat stroke?
Give TPA in 6 hours
What should you give for tonic/clonic seizures?
diazapam,lorazepam
When would you give 50% dextrose IV fluids?
A blood sugar less than 45
What should you give for tonic/clonic seizures?
diazapam,lorazepam
How should you treat stroke?
Give TPA in 6 hours
What should you give for tonic/clonic seizures?
diazapam,lorazepam
The Concussion Classes
1- No LOC, Tiny bit of confusion, they return to normal, there is no amnesia
2- Brief LOC, mild confusion, some anterograde amnesia
3- Loc <6 hours, confusion and anterograde and retrograde amnesia
4-LOC >6 hours, confusion, and aneterograde and retrograde amnesia
What is the abscence of memory after and during a trauma?
anterograde amnesia
What is the abscence of memory before trauma?
retrograde amnesia
If there is a head injury, what medication can be given to decrease the chances of cerebral edema/
diuretics such as mannitol or a corticosteroid
What is a ring of inflammation around the cornea of the eye?
ciliary flush
If there is a spinal cord injury where would the deficit occur?
Below the level of injury
If there is a spinal cord injury, what should be done?
Immobilize and intubate
What should you do in the event of an amputation?
Clean it with normal saline.
Wrap it in sterile saline soaked gauze, and place in plastic bag. Ice.
In the event of a traumatic wound injury, what should emergency care entail?
High irrigation and normal saline. Suture over joints. Do not give lidocaine in mucous membranes.
If epinephrine is in a medication you are giving for a wound injury, what parts of the body should you avoid?
digits, penis, ear, nose
If a patient is suspected of having poison in their system and they are unconcious, what should you do?
Give them a gastric lavage of activated charcoal and a cathartic.
If a patient is suspected of poisoning and they are concious, what should you do?
Give liquid activated charcoal becacuse is absorbs the fastest within the first hour.
When should you use ipecac and when should you not use it?
Use if the ingested substance is not alkaline and in the first thirty minutes.
How do you treat chemicals on the skin?
Dust off then rinse
What should you be aware of and how should you treat a snake bite?
Be aware of chances of DIC and do not put any ice on the bite. Cleanse the area.
What occurs with hyperthermia in regards to NA?
its depleted because of sweat
A patient presents comatose with a decreased blood presure and tachycardia. He has a fever of 106.0 fah..what is he experiencing and what should you do?
Heat stroke.
Reduce his fever to 101 at least. Give chloropromazine and diazapam to decrease shivering.
What is classified as hypothermia?
< 94 degrees
A patient presents with a temperature of 93-95, shivers has a racing and bradycardic heart, is lethargic and confused?
mild hypothermia
A patient has a temp of 86-93, and has a decreased loc, bradycardic, experiencing a fibrillation, no shivering, and is hypovolemic and hypoventilating?
moderate hypothermia
A patient is in a coma with a temperature of less than 86 degrees, has fixed and dilated pupils, apnea, a decreased blood pressure, and his heart is in v fib and asystole...
Severe Hypothermia
What do you need to do in regards to warming of hypothermic patients?
Warm slowly! Can cause v fib and cardiac collapse if too rapid.
How do you treat frostbite?
105-115 degree bath and give pain medication
Name the ABCDE of primary assessment in the regards of emergency nursing.
a-airway and includes cervical spine
b-breathing
c-circulation and bleeding
d-disability-neuro
e-exposure and environment
What is secondary assessment with emergency nursing and when should you return to primary?
Secondary assessment is when you do a thorough head to toe when the patient is thought to be stable with primary assessment. If the patient becomes hemodynamically unstable, you must return to primary.
What is the pnuemonic of pain PQRST?
provokes
quality
region/radiation
severy
timing
What is three tier triage?
urgent, nonurgent,emergent
What are the four triage catergories with START?
decreased, immediate, delayed, and minor
What are the three things assessed during START?
RPM
respirations > 30
pulse- radial...have bp 80 sysy
mental stat: command following
If someone is breathing fast just because they are having an anxiety attack, should you still consider them as immediate?
YES. No time to wonder why the patient is breathing like that!
When should CPR be initiated in a mass casualty incident?
After EVERY patient has been assessed with START triage and that on-scene resources exceed the patients' needs and that no one else's life is in danger.
If the event of a patient status change that is upgraded, what should you do?
Remove old tag and put on new one.
In the even of a patient status change that is downgraded, what should you do?
Put a new tag over the old one.
A patient is not breathing, he is drooling, has stridor, retractions, cyanosis, agitation and a decreased loc..what is he experiencing?
ineffective airway related to obstruction
How do you treat obstruction?
Remove and intubate. Immobilize spine.
A patient presents with a high rr, resp alkalosis, numbness and tingling in distal extremities or lips, spasms of carpal of pedal...
Hyperventilation
A patient presents with a rr decreased, decreased loc, pallor, cyanosis, and an o2 sat of less than 96%...
hypoventilation
Heat related disorder with muscle spasms of arms and legs...
heat cramp
Heat related depletion of na due to excess sweating which causes dehydration. Headache, dizzy, nausea, weakness, mild hypotension, and cool, clammy skin..
heat exhaustion
Heat related comatose, low bp, tachy, hot and flushed, and core temp is greater than 105
heat stroke
How do you passively warm a patient?
Remove wet clothes. Warm room, and give warm blankets
How do you actively warm a patient?
Give them a warm bath of 104 degrees, heat lamps, and blankets.
How do you actively warm a patient?
Warm iv fluid, heated oxygen warm lavage, and CAVR
What step of triage process relates to the incident command system. This coordinates efforts among all that respond.
Response plan
What is post disaster planning?
CISD...critical incident stress debrief
What is the preplan phase of disaster management?
Eval the resources, communications and supplies
What is immediate triage?
Life threat injury and could be saved
What is delayed traige?
Not immediate but within one hour..life is threatened
What are class A biochemical warfare agents?
They pose a risk to national security because they can be easily disseminated or transmitted, cause lots of death, panic, and action for health preparedness.
A person presents with sudden onset of fever and circulatory compromise and hypovolemia. There are signs of petechial hemmorhage, NVD and potential shock/renal failure....
viral hem fever
What is the highest transmission person to person during a viral hem fever?
later stages of disease
What kind of ppe should you used with viral hem fever?
negative pressure room, respirator, shield, etc.
What is a late trauma mortality?
A death that occurs days to weeks after the injury usually due to sepsis or multiple organ failure.
What is a trauma center classification that includes a regional resource center that is capable of providing all care for 24/7 and they prevent through rehab?
level 1
What is a trauma center classification that is community based and have many level 1 attributes, but may have to transfer in some situations?
level 2
What is a level trauma center that serves as a link for communities without level 1 or level 2 centers, they just provide stabilization before transfer.
level 3
What is a trauma level center than is an initial entry point for rural or remote areas?
level 4
What kind of loss occurs with burns?
plasma
WHat kind of shock results from vasodilation d/t histamine release?
anaphalactic
If hypotension persists with crystalloid infusion...
..give blood
What is leading cause of death in 1-14 year olds?
injury
What is leading cause of death in children?
MVC
What is the most common severe injury in infants and toddlers?
falls
what kind of trach should you use in kids less than 8?
uncuffed
When are RR abnormal for any kid?
greater than 60
A person presents with tea colored urine following being run over with a steam roller. His labs say that he has an increase in creatnine levels...what does he have and how should we treat it?
myoglobinuria...crush injury...bicarb and mannitol
What kind of test minimizes specific immunity responses to the transplanted organ?
histocompatibility testing
What therapy supresses reactions but the patient does not develop complications? What happens if it is long term?
immunosuppression
long term complications
A patient presents with shortness of breath,fatigue, graft tenderness, abnormally elevated labs, irregular heart beats, anda fever...what could be occuring?
organ transplant rejection
What is a transplant between two different genetically diff people...
allografts
What type of rejection occurs in minutes to hours and antibodies are formed along with tissue necrosis?
hyperacute
What type of reject occurs in the first three months with a cellular immune response?
acute
What type of rejection occurs greater than three months and results from frequent episodes of acute rejection, increased ischemia, and cytomegalovirus?
chronic
What is the leading cause of death in transplanted patients?
infection
How do you treat acute rejection?
hi dose steroids
How do you treat chronic rejection?
retransplantation
How can the spleen mask a hemorrhage?
It can wall off the hemorhagge and also dislodge clots.
What do you assume about a trauma patient when you first get them?
that they have a cervical spine injury until proven otherwise
When may they use a trach?
Head injury for trauma
When should you bag them?
When they are not breathing
If you hear distant heart sounds, what should you suspect?
tamponade
Where are sites for the intraosseous needle if peripheral one cannot be placed?
sternum or the tibia
What happens with air in a tension pnuemothorax?
The air cannot get out so it pushes heart to the side!
Should you give pain medication to a client with a head injury and decreased blood pressure?
Hm..depends...be very careful
What kind of fluids should you give to begin with? If that doesn't work..what should be given?
crystalloids
give blood (plasma and cells)
When should you give colloid fluids?
Crush injuries with a loss of protein..progress to transfusion if no changes
What drug is good to use with compartment syndrome..and how does it work?
Mannitol. It promotes excretion of salt and water which decreases extracellular fluids.
Why would you want to look at amylase and lipase enzyme results?
looking for pancreatic dysfunction
How can you counteract an allergy to shellfish or iodine with a contrast study?
Benadryl, solumedrol, decadron IV
How can you protect kidneys from contrast dye?
Mix mucomyst with coke.
Should you see free air on an abdominal film?
No
What should you do prior to getting a CT scan?
Pregnancy test
If you want to see soft tissues on a CT scan, what is added?
contrast dye
If you want to see stones on a CT scan, should you add contrast?
No
What should you monitor for after a liver biopsy?
Increased bleeding due to the vascularity of the liver.
What is a vomitus that looks like coffee grounds and what test should be perfomed?
Hematamesis and hemoglobin check
What is bloody stool that is frank and is either on it or it clouds the water?
hematochezia
What are black, tarry stools?
melena
What is a common cause of a GI bleed?
peptic ulcer disease
How does PUD work?
The lining of the stomach fails to protect it from the acid, and the acid eats the lining.
What should be taken with NSAIDS if have pud problems?
milk!
What should be given in replacement of NSAIDS for patients worried or at risk for PUD?
Vioxx cox 1 and cox 2
What is a disorder that occurs in a critically ill patient that presents with a decreased stomach acid ph and has a very irritable lining?
stress related erosive syndrome
How do you treat stress related erosive syndrome?
protonix,zoles,azoles
What are enlarged vessels in the esophagus that result from the hepatic portal vein?
varices
What does a complete metabolic panel include?
lytes and livers-alk-phos
What kind of lab values with you find with pancreatitis?
increased amylase and lipase
What occurs with a tylenol overdose?
liver failure
What occurs with an ibuprofen overdoes?
kidney failure
A patient presents with decreased clotting factors, hypoglycemia, a low ph and low bicarb...hyperventilation, red palms, swelling, spider nevi, and edema?
liver failure
What results with high ammonia levels in liver failure?
confusion
What can you give to decrease ammonia levels?
neomyosin and lacromose
What should you watch for with liver failure?
Neuro deterioration and ARDS.
How do we treat GI bleeds?
protonix-proton pump inhibitors for prophylaxis...for actuality..vitamin k,cryo precipitate, and FFP
What cardiac change can cause a bowel infarction?
A fib can throw a clot down to the bowel.
A patient presents with decreased blood flow to the bowel, has spasms, and the bowel is not absorbing anything..what is going on?
bowel infarct
What treatment should be used first with bowel infarct?
CT/barium testing
What is a bad result for a fecal occult blood test?
blue result BAD! indicates bleeding in gi tract
What kind of nutrition should be given to a bowel infarcted client/
TPN..rests gut...
What is endoscopic ligation and injection used for and how?
GI Bleeds...sclerosing agent..burns down bleeding...sealant agent...fibrinogen glue..and clip off bleed...want to make a scar to stop bleed
What is TIPS surgery?
A shunt between the portal and hepatic vein that treats portal hypotension.
What do antacids do to acid and ph?
Decreases amount of acid and increases ph
What do h2 agonists do?
The decrease volume and concentration of gastric secretions.
What are tagement, somatidine, and ine dines?
h2 agonists that decrease volume and concentration of gastric secretions
What does sucralfate do/
coats stomach and protects it
What does vassopressin do?
increases blood pressure and is given for V FIB
How should you give zofran,phenergan,and reglan?
slow...antiemetics
What should you give when ammonia levels are high and acidosis occurs?
Ammonia detoxicant such as neomyocin and lactilus
What are the functions of somastatin?
Decreases portal veinous pressure by inhibiting vasodilation hormones
A patient presents with elevated liver enzymes, a change in bile drainage from t-tube?
liver rejection confirmed by biopsy
What is a potentially dangerous voltage for electrical burns?
40 v
What is an extremely dangerous electrical voltage with extensive tissue damage?
1000 v
What is a sunburn considered?
radiation burn
A burn with redness,pain,edema,nausea and vomiting, diarrhea, fatigue, a headache, fever, blood problems, and gi later...
radiation
What are the two factors from an inhalation injury due to fire?
hypoxia and co poisoning
What is the number one cause of burns in toddlers?
scalding liquids
What is bad about synthetic fabrics?
highly flammable
What is the greatest cause of fires?
cigarettes
What percentage of TBSA of a burn causes systemic response?
> 25%
What is the normal glomerular filtration rate?
125 ml/min
What determines the movement of blood through the kidney?
Hydrostatic and oncotic pressures
What is the pressure that is fluid pressure exertion?
hydrostatic pressure
What is the pressure exerted by proteins,primarily albumin?
oncotic pressure
What part of the renal system reflects pressures?
the afferent and efferent arterioles
What do the proximal and distal tubules reabsorb? 7
water,na,k,cl,glucose,amino acids,small peptides,
What kind of a response to kidneys have over acid base balance?
a slow one, could take days
What is the minimum flow of plasma required to deliver a substance to the kidney?
clearance
What is a noninvasive measurement of GFR?
creatnine clearance
What is normal values for women for creatnine clearance?
88-128
What are normal values for males for creatnine clearance?
97-137
If you have a creatnine clearance less than sixty, what should you do in regards to medications?
Decrease them!
Why is the failing kidney in metabolic acidosis?
Bicarbonate is leaking out and hydrogen ions are being retained.
What assists the regional distibution of renal blood flow?
intrarenal prostaglandins
Which blood pressure medicine causes a cough?
ACE inhibitor
Which blood pressure medicine causes angiodema?
ARB
Name seven types of neurotoxins.
metals,antibiotics,ibuprofen,anestheia,diuretic,contrast agent,and medications
If someone is born with a ureteral abnormalty, what are they at risk for?
urinary stasis with stones and infection
What is the normal BUN for males and females?
10-20
What is the normal creatnine for females?
0.5-1.1
What is the normal creatnine for men?
0.6-1.2
Sustained temperatures of 104-111.2 degrees on tissue entails what?
enzyme and cell failure that results in the failure of na-k pump which in turn, causes cell edema
What occurs with temperatures greater than 111 degrees on tissues?
necrosis and free radicals
A person presents with an injury related to grabbing onto an electrical line..how should they appear?
Cannot see electric burns, there is an entry and exit area
What can electrical burns ultimately result in?
They can cause a fib, pulmonary arrest, tetany,compression fractures, and obstruction of the renal system. They can also cause cataracts.
How does a fluid shift occur in burns?
Vasoactive substances are released from tissues. Plasma seeps into tissues. Capillary permeability increases and sodium enters while potassium exits. This increases intracellular and interstitial fluid and decreases intravascular fluid. The body then shunts blood to brain and heart and other organs are deprived. The kidneys do not get enough blood and begin to fail.
What are three pulmonary affects that are associated with burns?
Lung compliance decreases.
Hyperventilation may occur.
Pulmonary vascular resistance may occur.
What can smoke poisoning result in and what can it cause?
Edema,sloughing, tracheobronchitis, and inflammation..ARDS
This thickness burn includes the epidermis and the dermis.
partial thickness
This thickness goes completely through the dermis and maybe down to bone.
full thickness
This partial thickness burn is painful and red. It heals on its own in 3-7 days.
1st degree partial thickness
This partial thickness burn is wet, blistered,painful,and does heal in 3-7 days.
2nd degree partial thickness burn
This full thickness burn has damage throughout the dermis and has eschar which is painless. The surrounding skin hurts.
3rd degree full thickness
This full thickness burn includes skin,fat,muscle,and bone. It appears charred.
4th degree full thickness
How do you treat large 3rd degree burns?
skin grafts
How do you treat 4th degree burns?
Debride,graft,and amputate
What occurs with electrolytes during a burn?
Sodium levels fall and then increase. Then potassium levels increases. Hematocrit also increases in relation to fluid loss.
How are the kidneys affected by burns/
Decreased output <.5 ml and an increased BUN
When is the capillary membrane restored after a burn?
18-36 hours postinjury
A burn patient comes to the clinic for care two days after his injury. He presents with wheezes and bronchorrhea and decreased lung compliance..what is he experiencing?
tracheobronchitis
This level of psychology after a burn includes immediae, shock and disbelief. They are overwhelmed.
impact
This level of psychology following a burn injury includes a client who represses, withdraws, denies, and suppresses themselves.
Retreat
A burn patient accepts themselves and body changes.
Acknowledgement phase
A burn patient and his family accept his limitations and plan for the future.
reconstructive
During this phase, a burn patient would benefit from meeting with other burn patients.
Acknowledgement
During this phase, a burn patient would benefit from getting information from the nurses.
impact phase
This is the time of injury up to 48 hours. Airway and breathing are the number one concern. Hypovolemia exists, and this phase ends with fluid resuscitation.
Emergent burn phase
What burn is more likely to become infected, have contractures, and have more systemic effects?
deep partial and full
What should you give to a burn patient exhibiting inhalation injury?
100% o2 by mask and may need a bilateral escharectomy to increase lung compliance
What kind of fluids should be given with burns, and what should not in the emergent phase?
Give LR not colloids.
What should be given 24 hours after the burn as far as fluids?
colloids and dextrose
When should you anchor a nasogastric tube regarding burns?
20-25% TBSA
What is the choice pain med for burns?
IV morphine
What if there is a gastric dysfunction such as an illeus early on in the burn injury?
Restrict oral fluids
What burns should you submerge and which ones should you not submerge?
Submerge flame and scald burns, but not major burns.
How do you cleanse a wet chemical burn?
Irrigate for 20 mins but not with a neutralizing agent!
How do you treat an eye splashed with chemicals?
NS irrigate and flush to inner canthus outward
A patient presents to you with asphalt and burns from a car injury..what should you do in terms of immediate care?
Cover with sterile towels and clean linens. Debride and give antibiotics. Wash with soap and water. Remove asphalt with medisol citrus-petroleum. Elevate burnt extremities about the heart and doppler the arteries.
If an escharotomy fails to correct a burn. what should be used?
fasciotomy that occurs in the or and under anesthesia.
What are signs of inadequate renal perfusion in regards to burns?
Myoglobin and hemoglobin from damaged cells appears and cause cellular tubal necrosis. Dark red or brown urine.
What kind of antibiotics should be given with burns?
topical only
What phase of burn injury is when the client is hemodynamically stable and is in first 48-72 post injury and cap integrity is good and they are diuresing? This ends with wound closure.
Acute phase
When is hydrotherapy contraindicated?
Hemodynamically unstable and skin grafts
WHat are contraindications to enzymatic wound debridement?
open nerve, body cavity or nervous tissue
What is surgical debridement when layers are shaved?
tangenital
What is surgical debridement when they remove and burn fat down to the fascia?
fascial
What is a topical AM treatment for burns? (deep partial and full)
sulfus sulfdiazine
How do you prevent contractures early with burn patients?
Do not allow them to sit comfortably. Don't give them pillows. ROM, splint, and position!
What is not a replacement for exercise for burn patients, but this can be used when they are immobile?
static splinting
What splint method exercises the joint?
Dynamic splinting
What is the longest period of adjustment with a burn patient?
Acute phase-provide prep education to decrease pain and stress
What is the temp range to aim for in burn patients?
99-101
A burn patient presents with headache, nausea, and change in vitals, high blood sugar, and confusiob..what should you expect?
sepsis
Why are h2 blockers and antacids given for burn patients?
They may have a gastric ph of less than 5...to prevent stress ulcers.
What should you do to assess new skin grafts?
Watch for bleeding. Remove accumulated serum beneath sheet grafts and prevent unwanted movent and shearing of autograph sites.
When is cultured epitheleal autografting used?
To close massive burn wounds
Can scarring be predicted with burns?
No, takes a full year for it to complete.
When can patients begin to walk after having grafts on lower legs?
7 days
How do you postop care for grafts?
-Immobilize graft sites
-Remove serum blebs with small needle
-Elevate to prevent edema
What is important about getting excision of burnt tissue early?
Minimizes functional loss
What should you do to rehab new healed graft sites?
They are not as elastic as skin, so exercise, splint, and position.
How can you minimize hypertrophic scarring in burns?
Massage and pressure therapy
What should you put on donor sites before putting them in dependent position?
ace bandages
How long should pressure garments be worn?
23 hours
What are precautions to the sun for new skin grafts?
No direct sunlight for one year