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97 Cards in this Set
- Front
- Back
How much should hematocrit rise with each unit of PRBCs?
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3%
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How does chronic alcohol use affect the stomach lining?
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Causes a type of gastritis, can lead to ulcers
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How does smoking affect the stomach lining?
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Decreases blood flow, can lead to ulcers
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Where do peptic ulcers occur?
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Gastric
Duodenal |
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Relative risk of malignancy, gastric vs. duodenal ulcers:
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Higher risk with gastric
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Relative risk of reoccurance, gastric vs. duodenal:
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High risk of reoccurance with both
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At what point after initiation of H. pylori therapy should retesting occur?
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10-14 days
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What do we want stomach pH to be in treating ulcers?
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Above 5
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What pH activates gastrin in the stomach?
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5 or less
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When should antacids be taken in relation to meals?
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2 hours after
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Diarrhea pattern with Crohn's disease:
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Nighttime
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UC vs. CD: which is curable?
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UC, via colectomy
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Extent of CD:
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Entire GI tract
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Extent of UC:
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Limited to colon
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UC vs. CD: which has bloody diarrhea?
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UC
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Define tenesmus:
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Painful urge to defecate
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First-line therapy for UC:
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5-ASA drugs, i.e. mesalamine
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Determining if a CD/UC patient is in remission:
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Clinical presentation is improved/normal
Endoscopy shows improvement in lesions |
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How soon does CRP reflect inflammation?
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6-8 hours
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What is the most serious complication of UC/CD?
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Toxic megacolon
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What is the definitive diagnostic test for UC/CD?
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Colonoscopy with biopsy
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What is the extent of CD in the intestinal wall?
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Transmural
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What is the extent of UC in the intestinal wall?
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Only in the mucosa
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Complications of severe/fulminant disease:
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Hemorrhage
Peritonitis ** |
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Surgical indications for UC:
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Refractory to medical tx
IV steroids not helping Deterioration/acute negative changes |
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Likely site for fistulas in UC:
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Anorectal
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Potential complications of J-pouch (etc) surgery healing:
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Pouchitis
Dehiscence Poor healing due to steroids |
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**UC medications
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*
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**Complications of severe UC
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*
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Define nephrolithiasis:
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Kidney stones
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Where are kidney stones found?
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Anywhere from kidney to urethra
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Problems associated with kidney stones:
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Pain
Hydronephrosis Bleeding Pyelonephritis |
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When are kidney stones most likely to occur in the year?
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July
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What is the biggest risk for kidney stones?
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Dehydration
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What categories of workers are likely to get kidney stones?
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People who work outdoors or very active and not hydrated
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Where, geographically, are kidney stones most likely to occur?
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In warmer regions
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What are the most common type of kidney stone?
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Calcium
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Four types of kidney stone:
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Uric acid
Struvite Cystine Calcium stones |
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Who is prone to uric acid stones?
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Men more than women
People with gout or chemo |
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Who is most prone to struvite stones?
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Women with UTIs
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Who is most prone to cystine stones?
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Men and women alike
Esp. with family history |
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Who is most prone to calcium stones?
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Men more than women
20's-30's |
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What does calcium bind with in kidney stones?
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Oxalate most commonly
Phosphate Carbonate |
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What are good sources of oxalate in food?
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Strawberry and rhubarb!
Berries Spinach and many greens Tea, cocoa, chocolate Wheat bran/germ, quinoa Soy |
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What's the most common manifestation of a kidney stone?
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Unilateral back pain
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What are the s/s of kidney stones?
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Severe pain
Hematuria Chills/fever N/V |
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Describe kidney stone pain:
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Sudden onset
Severe Belly or side of the back Groin or testicular pain |
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Diagnostic tests for kidney stones:
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UA
IV pyelogram |
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What do we look for in a UA for kidney stones?
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Crystals in the urine
Blood in the urine Pyuria or WBCs (maybe) |
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Goal of tx for a kidney stone pt:
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Relieve symptoms and promote passage
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What drugs are used for kidney stones?
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Opioids
Maybe NSAIDs |
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Techniques for easing spontaneous (at home) kidney stone passage:
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High fluid intake
Strain all urine Hot compress on the back PRN opioid Rx |
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Medical tx for kidney stones:
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Profoundly overhydrate (IV and po fluids) and give Lasix to dump all the fluids rapidly
Morphine or other opioid Potentially allopurinol or abx |
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When would you give allopurinol for kidney stones?
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Uric acid stones
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What type of kidney stone would get antibiotics?
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Struvite stones
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What is the priority nursing intervention for a kidney stone pt?
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Strain all urine
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First-line surgical intervention for kidney stones:
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Extracorporeal shock wave lithotripsy
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Indications for ESWL:
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Stone 1/2in or smaller
Beyond the minor calyx Calcium-based (very hard) stone |
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Refraining from sexual activity post-ESWL:
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Yes, maybe a week
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Discharge instructions post-ESWL:
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Strain all urine
Drink LOTS of water Followup with physician in 7 days Report a fever (101 or more) or severe pain Bright red bloody urine: go back to ER Take antibiotics through to completion Expect diffuse bruising/pain; apply warm moist heat |
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Priority nursing intervention for post-ESWL inpatient:
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Titrating continual bladder irrigation
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What color should urine be with CBI?
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Pink with no urine
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If clots are seen with CBI, what should you do?
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Increase the rate
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What's a common adverse effect of CBI?
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Bladder spasm
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What is the etiology of glomerulonephritis?
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Untreated strep infection leads to an autoimmune process in the glomeruli
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Common manifestations of GN:
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Edema
Smoky or rust colored urine Hematuria Joint pain/stiffness |
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Where does edema manifest with GN?
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Generalized
Abdominal Face/eyes especially Feet/ankles |
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Specific pre-renal causes of renal failure:
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Hypovolemia
Abruptio placenta Hemorrhage Burns Renal artery stenosis |
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Specific intra-renal causes of renal failure:
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Hemolytic transfusion reaction
DIC Pyelonephritis Interstitial nephritis |
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Specific post-renal causes of renal failure:
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Obstructive uropathy
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Most common sign of a hemolytic transfusion reaction:
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Lower back pain
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Renal complication of Bactrim therapy:
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Interstitial nephritis
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General pre-renal causes of renal failure:
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Volume
Renal flow |
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General intra-renal causes of renal failure:
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Infection
Necrosis Hemolysis Medications |
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General post-renal causes of renal failure:
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Obstructions
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Three stages of renal failure:
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Oliguria
Diuretic Recovery |
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What occurs during the oliguria phase of renal failure?
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Acute decrease in urine production
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Define oliguria in terms of output:
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Less than 400ml in 24 hr
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What happens during the diuretic stage of renal failure?
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Filtration but no concentration
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What happens during the recovery stage of renal failure?
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Creatinine clearance returns to normal
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Where is erythropoietin produced?
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Kidneys
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What are the manifestations of oliguric renal failure?
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Generalized edema
Change in mental status Arrhythmias Hypertension Anorexia Metabolic acidosis Dependent edema |
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What causes arrhythmias in oluguric renal failure?
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Hyperkalemia
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How do we treat hyperkalemia in renal failure?
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D50/insulin/bicarb
Kayexalate Dialysis (emergency) |
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Is anasarca expected in renal failure?
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Yes
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Why does level of consciousness change with oliguric renal failure?
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Fluid retention leads to hyponatremia
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What causes a pericardial friction rub in renal failure?
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Uric acid crystallization
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How do we eliminate nitrogenous wastes in a patient in renal failure?
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Diuretics (if they work)
Dialysis |
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Priority problems in diuretic phase of renal failure:
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Fluid volume deficit
High risk of electrolyte imbalances |
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Patient teaching priority during the recovery phase of renal failure:
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Identifying nephrotoxins and preventing recurrence of underlying cause if possible
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Nephrotoxins:
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Amphoteracin B
NSAIDs Fertilizers, home chemicals Aminogycoside abx |
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Taking a 24 hour urine collection:
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Dump first urine after the order
Indicate start time Collect for 24 hours Send to lab |
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Skin findings in chronic renal failure:
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Yellow-brown skin color (from urea) with ecchymoses
Dry skin with petechiae Decreased sensation Uremic frost |
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Why do chronic renal failure patients get ecchymoses?
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Clotting cascade interrupted
Capillaries are congested and leaky due to fluid overload |
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Medication used in chronic renal failure:
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ACE inhibitors
Procrit |
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Diet for chronic renal failure:
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Moderate in protein (or whatever is appropriate for pt)
High carbohydrate Fluid restriction Low in sodium, potassium, phosphorus Supplement vitamins B, C |
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How often is hemodialysis done and how long does it last?
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4-6 hours
3x/week |