Bonnie's Set - Acute Care - Renal & Neuro

Front 1

In filtering the blood going in the kidney, what is the blood called and what is the path that it takes?

Back 1

Afferent - from Renal Artery-to Kidney-Branched into afferent arteriole-glomerulus-filtered

Front 2

After filtering the blood in the kidney, what is the blood called, leaving the kidney, and what is the path that it takes?

Back 2

Efferent - from Efferent arteriole-leaves Kidney to Renal Vein

Front 3

What is specific gravity?

Back 3

The test that displays the kidney's ability to concentrate urine. The higher the number, the more concentrated it is

Front 4

What is creatinine?

Back 4

A protein that is supposed to be excreted in urine. If it is not excreted, it remains in the blood and should not be very high in the blood

Front 5

What is BUN?

Back 5

Blood urea nitrogen. Affected by dehydration, volume depletion, shock and hypovolemia. Should be excreted in the urine. An increase in BUN means a decrease in renal perfusion or volume.

Front 6

What is the normal ratio between BUN and creatinine?

Back 6

10:1 ie BUN 8-20mg/dL over creatinine .6-1.2

Front 7

What is serum osmolality?

Back 7

Measurement of particles in a solution..Concentration………Equals the concentration of particles in plasma. Increases with dehydration and decreases with overhydration

Front 8

Name some conditions of high serum osmolality.

Back 8

* dehydration

* Diabetes Insipidous

* Hyperglycemia

* Hypernatremia

Front 9

What does a renal angiogram show?

Back 9

Assessing Renal Perfusion of the Renal Artery. Poor renal perfusion over time causes too much production of Renin Hence too much vasoconstriction = HTN and eventually CRF (chronic renal failure) ie DM

Front 10

What's an important way to assess the kidneys?

Back 10

* Compare patient's weight from previous day or shift.

* Assess I's and O's - everything measurable (IV fluids, foods with high water content, drinks, not 3CCs of lovenox)

Front 11

What are the signs and symptoms of dehydration?

Back 11

* Dry

* decreased UO

* low BP

* may have increased (Hemato)Crit

* Serum Osmolality be increased

Front 12

What is osmosis?

Back 12

A fluid (solvent) that will go from an area of low concentration to an area of high concentration.

Front 13

What is diffusion?

Back 13

Particles (solutes) that will go from an area of high concentration to an area of low concentration.

Front 14

What does hemodialysis do?

Back 14

• Removes urea,creatinine, and uric acid

• Removes excess water

• Maintains appropriate levels of electrolytes

Front 15

What are the three different kinds of access for a patient to be dialysized?

Back 15

1 - vascular catheter (done in emergencies at the wrist

2 - A-V fistula (artery & vein are anastomosed - there's a bruit & thrill)

3 - Synthetic vascular graft (man made)

Front 16

What are the blood vessels called leaving the body for dialysis?

Back 16

* Afferent. The blood leaves the body through an artery. (A for afferent and A for artery)

* The dialysis machine takes the place of the kidney, so the vessels in and out are the same as in and out of the kidney.

Front 17

What are the blood vessels called going back to the body from dialysis?

Back 17

Efferent. The blood returns to the body in a vein.

Front 18

When are blood pressure meds given on dialysis days and why?

Back 18

They are given either after or up to 6 hours before because the medication will be cleaned out of the blood during dialysis.

Front 19

What is the role of the dialysis nurse?

Back 19

To closely monitor the electrolytes and the amount of fluid removed or not removed from the blood.

Front 20

What are the causes of acute renal failure?

Back 20

* Prerenal - MI, rhabdomyolysis, any surgery requiring a heart/ lung machine, shock, dehydration

* Intrarenal - Damage to the kidney itself - pyelonephritis, glomerulonephritis, acute tubulor necrosis

* Postrenal - obstruction of flow out of the kidney - tumors, masses, stones, BPH (benign prostatic hypertrophy)

Front 21

What is the assessment of AKI?

Back 21

* Prerenal - has the patient had surgery? Have they had an MI or shock?

* Intrarenal - is the patient on gentamycin? aminoglycosides? Rhabdomyolysis?

* Postrenal - does the patient have a history of kidney stones?

* labs show high K+, high BUN, high creatinine

Front 22

What is a nephrotoxin and give a couple of examples.

Back 22

* Anything toxic to the kidneys.

* Aminoglycosides (Antibiotics ending in 'mycin')

* IV contrast dye

Front 23

What is the management of hyperkalemia and why?

Back 23

* Insulin brings glucose and potassium with it back into the cells (potassium leaves the cells to neutralize blood glucose causing hyperkalemia)

* D50 so the serum glucose does not go too low

* Bicarb helps to neutralize the acidic environment (potassium & glucose are very acidic)

Front 24

Give an example of a condition causing post-renal failure.

Back 24

Hydronephrosis (Kidneyor bladder becomes distended secondary to a stone/renal calculi)

Front 25

Give an example of a condition causing intrarenal failure.

Back 25

* Cystitis (infection of the bladder)

* pyelonephritis (infection of the kidney)

Front 26

What are the functions of the brain stem?

Back 26

* Heart rate

* breathing

* blood pressure

Front 27

What is important information for the neuro exam?

Back 27

1 - Mental status (most critical) - GCS

2 - Motor function - Do they respond to commands? Squeeze hands? withdraw? posturing? inequalities?

3 - Pupillary changes (pinpoints - opiates, brain stem damage, dilated - cocaine, crack & PCP)

4 - Vital Signs (HR, BP & T are late findings - respiratory patterns will be the first VS to change with a head injury)

Front 28

What are the responses to stimuli listed from best to worst?

Back 28

1 - reach toward stimulus

2 - withdraw from painful stimulus

3 - decorticate posturing (flexion)

4 - decerebrate posturing (extension)

5 - no response

Front 29

What is Cushing's Triad?

Back 29

Avital sign trend that may be a sign of impending herniation and increased ICP.

* Rising systolic BP

* Decreasing diastolyc BP (widening pulse pressure)

* Bradycardia

* Irregular respirations

Front 30

What is fasciculation?

Back 30

Involuntary twitching of the feet or toes after succinylcholine is administered. Could indicate a spinal cord lesion

Front 31

What is tonic-clonic movements?

Back 31

•Jerking muscularactivity seen in seizing patients.

Front 32

What are some signs of trauma or infection in the neuro exam?

Back 32

* Battle sign

* Raccoon sign

* CSF from nose or ear

* Meningitis

* Increased ICP

Front 33

What is a Battle Sign?

Back 33

A bruise behind the ear may have resulted from a basilar skull fracture

Front 34

What is a raccoon sign?

Back 34

Periorbital edema and bruising may have resulted from a zygomatic (or orbital) fracture

Front 35

If a patient is seen in the ER for head trauma and they have a runny nose, what should be done and why?

Back 35

The nasal mucus should be tested for glucose because it may be cerebral spinal fluid

Front 36

What happens to the LOC in IICP?

Back 36

The LOC goes down as the ICP goes up.

Front 37

What are the levels of consciousness?

Back 37

Alert (normal)

Awake (may sleep more but otherwise normal)

Lethargic (drowsy but follows commands)

Obtunded (follows simple commands but drowsy)

Stuporous (hard to arouse, inconsistent with commands)

Semicomatose (does not follow commands or speak coherently)

Comatose (may respond with reflexive posturing or may not respond at all)

Front 38

If a patient is behaving as though he's had an ischemic event (CVA or stoke), how long of a window is there to administer t-PA?

Back 38

3 hours from onset of symptoms. If woke up with them, may not be a candidate.

Front 39

What are the three 3 parts that make up the brain in the skull?

Back 39

1 Blood

2 CSF

3 Brain tissue

Front 40

What is the Monroe Kelly doctrine?

Back 40

A compensatory system of auto regulation. If there is too much CSF in the brain, it will compensate by absorbing more fluid or reducing blood flow. If there is swelling, it will reduce CSF. Happens in other systems as well

Front 41

What is the goal of auto-regulation?

Back 41

Maintain perfusion and keep down Increased ICP.

Front 42

What is normal ICP?

Back 42

0-15mm Hg

Front 43

What is normal cerebral perfusion pressure (CPP)?

Back 43

NR 60-100mm Hg (at least 60 is needed for brain injured patients)

Front 44

Why is ICP monitoring important?

Back 44

Intraventricular catheters are important to monitor ICP to help predict outcomes by closely tracking pressure trends because they tell us what therapies are working.

Front 45

What is the first tier therapy for head injury?

Back 45

1. Mannitol administration

2. Respiratory Support

3. Analgesia, sedation & paralytics

4. Control and decrease external stimuli

Front 46

What does mannitol do for ICP?

Back 46

It is a diuretic to reduce the fluid in ICP. Very thick and hypertonic.

Front 47

When suctioning a person with a head injury, need to hyper-oxygenate first. Why?

Back 47

Suctioning out O2 as well. Need to use PEEP sparingly because pulmonary pressures can cause IICP.

Front 48

Why is sedation necessary for a patient with a head injury?

Back 48

Need to keep the patient calm. Agitation can increase all the pressures in the body.

Front 49

Why is it necessary to decrease stimuli for a patient with a head injury?

Back 49

Loud noises and stimuli can increase pressures in the body.

Front 50

What do seizures lead to?

Back 50

* Hypercapnia

* Hypoxia

Front 51

What is hypercapnia?

Back 51

Excessive CO2 in the bloodstream caused by inadequate respiration (hypoventilation).

Front 52

How do you stop acute tonic-clonic activity?

Back 52

* Ativan/ Lorazapam

* Valium/ Diazepam

Front 53

What is postictal?

Back 53

The state after a seizure. Patient may be tired, confused, disoriented, HA

Front 54

What is the most common neurologic issue?

Back 54

Stroke

Front 55

What are some medications are given for seizures?

Back 55

* Tegretol

* Klonipin

* Neurontin

* Lamictal

* Depakote

* Topomax

Front 56

What is the difference between primary and secondary brain injury?

Back 56

* Primary is the mechanism that caused the injury

* Secondary the results such as IICP, seizing, herniation, etc.

Front 57

What are the different kinds of head injuries?

Back 57

* Acceleration (something fast hits the head)

* Acceleration - Deceleration (moving head hits a non-moving surface

* Coup-contre coup (Head it struck and bounces back)

* Rotational injury (anything that causes you to flip and roll - shearing injury for the brain)

Front 58

What is the most sensitive indicator of IICP?

Back 58

Level of consciousness

Front 59

A patient is brought in to the ED and the nurse is informed that the patient is under the influence of PCP. What will the nurse observe in the patient's pupils? What else will cause this?

Back 59

The patient's pupils will be dilated. Crack or cocaine will also cause this.

Front 60

A patient is brought in to the ED and the nurse is informed that the patient is under the influence of heroin. What will the nurse observe in the patient's pupils? What else will cause this?

Back 60

The patient's pupils will be pinpoints. Heroin is an opiate and opiates cause this. Brain stem damage can also cause this.