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123 Cards in this Set

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What do you monitor with Diuretics?
Monitor blood pressure, pulse, and weight in those receiving
in the geriatric population since orthostatic hypotension a problem with
diuretics.
Lab effects with Diuretics
Decreased Na
Decreased K
Decreased Mg
Decreased HCO3
Three popular Loop Diuretics
Bumetanide (Bumex)
Fumsemide (Lasix)
Torsemide (Demadex)
What allergy cross action with Loop Diuretics to watch for?
sulfa
Thiazide and thiazide-like diuretics
Bendroflumethiazide (Naturetin), lndapamide (Lozol), Benzthiazide (Exna), Methyclothiazide (Enduron, Aquatensen), Chlorothiazide (Diuril), Chlorthalidone (Hygroton, Thalitone), Metolazone (Zaroxlyn, Diulo, Mydrox), Cyclothiazide (Anhydron) • Polythiazide (Renese), Hydrochlorothiazide (HCTZ, Esidrix, HydroDIURIL) Quinethazone (Hydromox), Trichlormethiazide (Metahydrin, Naqua), Hydroflumethiazide (Saluron, Diucardin)
Selective aldosterone blockers (SABs) (Potassium sparing diuretics- Where do they work?
work in the distal tubule of the nephron.
Name the 3 Selective aldosterone blockers (SABs) (Potassium sparing diuretics) Remember Amy Tried to Spy on in the distal tubule with potassium
AMIloride (Midamor), TRIamterine (Dyrenium), SPIronolactone (Aldactone)
Clients on diuretics are frequently on?
potassium supplements to keep their blood levels normal. Do not crush potassium tablets.
Cholinergic agents
Bethanechol chloride (Urecholine)
Cholinergic agents help?
help the bladder to contract when the muscle has lost its tone such as in clients with flaccid neurogenic bladder or some types of incontinence. Usually work within one hour after oral administration
Cholinergic side effects? Remember Sludge
Increased Salvation and Sweating, Increased Lacrimation, Increased Urinary Incontinence, Increased Diarrhea, Increased GI cramps, Increased Emesis
Anticholinergic agents
Propantheline bromide (Pro-Banthine), Atropine (used in cardiac and pre-operative conditions)
What do Anticholinergic agents do?
Cause the bladder to relax and fill. They also help the client to contract the external urethral sphincter on command and regain control of continence.Usually work within one hour after oral administration.
Signs of overdose on an anticholinergic (or an antihistamine)?
Hot as a hare = Increased temperature
Mad as a hatter = Confusion, delirium, pupil dilation
Red as a beet = Flushed face
Dry as a bone = Decreased secretions, dehydration, thirst
Anticholinergic side effects? opposite of cholinergics, remember Sludge as well
Decreased salvation and sweating
Decreased lactrimation
Decreased urinary incontinence
Decreased diarrhea
Decreased GI cramps
Decreased Emesis
Antispasmodics, what do they do?
Prevent bladder spasms which can be very painful and lead to incontinence. The agents should be given one hour before meals
Side effects of Antispasmodics
constipation, dry mouth, and tachycardia.
Antispasmodic Medications
Dicyclomine (Bentyl), Oxybutynin chloride (Ditropan), Flavoxate (Urispas), Tolterodine (Detrol)
Phosphate binders, what do they do?
Used in renal failure to bind phosphate in the gastrointestinal tract so the body cannot absorb it.
Three Phosphate binder agents include
Aluminum hydroxide (Amphogel), Sucralfate (Carafate), Sevelamer hydrochloride (Renagel)
Side effect of aluminum hydroxide (Amphogel)?
Constipation
Side effect of sevelamer hydrochloride (Renagel)?
Diarrhea
Precaution when giving Phosphate Binders?
Do not administer phosphate binders and calcium supplements with other drugs.
Vitamin and mineral supplements for renal and urological, what are they used for?
Used to treat the anemia and electrolyte imbalances which occur with renal failure.
Side effects of Erythropoietin (Epogen, Procrit)
can cause hypertension and tachycardia with recombinant human erythropoietin.
Iron supplements and folic acid are needed for?
the red blood cells to duplicate.
Sodium polystyrene sulfonate (Kayexalate) is given to treat?
the high potassium levels seen in renal failure.
Sultisoxazole (Gantrisin) and phenazopyridine (Pyridium, Urogensic) cause?
the urine to be red-orange in color.
Precautions for Ciprofloxin (Cipro)?
drug is concentrated in the urine and goes through the kidney: Can get crystal formation with the medication. Important to push fiuids to 1-2 quarts per day.
What are Urinary tract infections?
Bacterial infection that affects any part of the urinary tract. Common infection especially in women. Very serious in the elderly and those with chronic disease because they can become septic.
What is Cystitis?
Inflammation of the bladder resulting in urinary incontinence, hematuria, low back or suprapubic pain, buming on urination, fever, nausea and vomiting. May be Acute or Chronic.
What is Pyelonephritis?
Ascending urinary tract infection that reaches the pelvis of the kidney. May affect one or both kidneys. Pain on percussion at the costovertebral angle. Other symptoms are the same as cystitis. May be Acute or Chronic.
Lab effects of Urinary tract infections?
Increased WBC in urine (>4), + leukocyte esterase, + Nitrites
Encourage Client to?
Take all of antibiotics. Do follow up cultures to make sure it is gone.
What is the Diet Recommended with UTI?
Acid ash diet recommended. These foods leave an acid residue to be excreted in the urine.
Recommended foods for UTI
Meat or fish, Eggs, Cereals. Minimal milk, fruits and vegetables excegt for: C = Cranberries P = Prunes P = Plums. Drink cranberry juice to decrease the pH of the urine to prevent UTIs (Only helps prevents UTI, will not fight UTI). Avoid urinary tract irritants especially when being treated for a bladder infection such as: Coffee, Tea, Citrus juices, Colas, Alcohol.
How much fluid with UTI?
3000ml/day
Hygiene care with UTI?
Void Every 2-3hours and wipe front to back! (ask Kim), Take showers instead of tub baths and wear clothes that can breathe such as cotton panty liners.
Why estrogen creams are used with UTI’s?
To restore the vaginal pH
Renal calculi
Solid, dissolved minerals in the urine which form inside the kidneys or bladder.
Nephrolithiasis
Stones in the calyxes ofthe kidneys.
Urolithiasis
Stones in the urinary tract.
What is severe, spastic type pain caused by calculli called?
Colic
Signs and Treatment of Renal calculi
Flank pain: stone in the kidney or upper ureter. Radiation to the abdomen or scrotum: the stone in the ureter or bladder. Give pain medications on schedule to decrease spasms and control pain. lf the calculi are in the calyxes of the kidney, may have a small incision made into the flank area. Measure uric acid levels.
What is Renal insufficiency?
A decline of 75% to 90% of renal function. Those with renal insufficiency do not require dialysis but they do have laboratory abnormalities and cannot excrete drugs as well due to a loss of functioning nephrons. HTN= decreased renal funchtion and failure.
Which two groups have the highest risk of developing renal insufliciency and failure pecause of compromised blood flow to the kidneys?
Those with HTN and Elderly
Will be put on what medications to try to preserved renal function?
ACE inhibitors, May develop nephrotic syndrome as an adverse effect. Monitor urine for protein every month for nine months and then periodically thereafter to detect nephrotic syndrome.
What is Acute renal failure (ARF)?
A sudden and almost complete loss of the function of the kidneys over a short period of time.
What are the three phases of ARF?
Oliguric, Diuretic, then Recovery
What Lab effects are seen in ARF?
Increased BUN, Creatinine and Potassium
Diet Restrictions with ARF?
Protein intake is restricted until blood chemistry shows ability to handle the protein catabolites, urea, and creatinine. Need high quality proteins to prevent muscle wasting. Ensure high calorie intake with carbohydrates so protein is spared for its own work. Give hard candy, jelly beans, flavored carbohydrate powders, and rice.
What is important to watch for in ARF?
Infections have a high mortality rate in clients with acute renal failure due to decreased phagocytosis associated with renal failure.
What is Chronic renal failure (CRF)?
A chronic and progressive condition where renal function is lost and less than 10% of function remains. Those with end stage renal failure require dialysis to live.
What is Uremia or azotemia?
High BUN and creatinine levels from protein metabolism. Must restrict protein in these clients. GFR is the most reliable indicator of the level of protein consumption. Will be seen in end stage renal failure.
Lab Values associated with CRF?
Increased potassium, phophorus, magnesium, PT, PTT, sodium, blood sugar, and uric acid, Decreased calcium, RBC, pH and HCO3, and albumin levels.
What are complications of CRF?
Anemia, Renal osteodystrophy, Severe resistant hypertension, Infection, Metabolic acidosis.
What is Spastic bladder?
Bladder empties on its own due to spasms.
What is Neurogenic bladder?
Difficulty or inability to pass urine without the use of a catheter or other method. The condition is associated with neurological disorders, major pelvic surgery, diabetes and strokes.
What are exercises that may be beneficial to reduce incontinence?
Kegal exercises.
What group has the most difficulty with bladder control?
Elderly
What is Glomerulonephritis?
Inflammation of the glomerulus of the kidney. Usually follows a beta hemolytic strep infection of the respiratory or integumentary systems.
What are clinical manifestations of Glomerulonephritis?
Hematuria, Proteinuria, Low urinary output, Third spacing, Fluid volume excess, Fatigue, Hypertension, Headache, Potential for seizures
What are complications of Glomerulonephritis?
Acute intrinsic or intra-renal failure, Chronic renal failure, Nephrotic syndrome.
What are treatments of Glomerulonephritis?
Fluid restrictions with intake and output and daily weights, Offer hard candy due to dry mouth, High calorie (carbohydrates), low protein, and low sodium diet, Rest for 4-10 days.
What are lab effect of Glomerulonephritis?
+ ASO titer, Increased BUN, creatinine
What is Nephrotic syndrome?
Disorder of the basement membrane of the glomerulus which becomes permeable to plasma proteins. lt is usually idiopathic and occurs over a 2-3 year period with exacerbations and remissions seen.
Lab effects seen in Nephrotic syndrome?
Decreased albumin and calcium, Increas in cholesterol and triglycerides
Nephrotic Syndrome and Swelling?
See swelling because of decrease onootic pressure due to low albumin levels. Increase protein in the diet unless glomerular Hltration rate is impaired. IV albumin followed by diuretic as needed.
Nephrotic Syndrome and Ascites and fluid retention?
Limit sodium but not fluids unless they are hyponatremic. Asses Acities daily.
What do you measure daily to assess ascites?
Abdominal Girth and Weight.
Hyperlipidemia in Nephrotic Syndrome?
this is seen because the liver cannot synthesis proteins due to low albumin levels.
Diarrhea in Nephrotic Syndrome?
this is seen from all the fluid retention that can occur.
Medications for Nephrotic Syndrome?
Steroids and cholenergics.
What is Polycystic kidney disease?
Progressive, genetic disorder of the kidneys which is characterized by the presence of multiple cysts in both kidneys. The disease can also damage the liver, pancreas, and rarely the heart and brain. This is a renal disorder.
What will the BP reading be in PKD?
High
Bladder Injury?
Could occur due to blunt trauma with a bladder that is full. If a Iaceration, it may need to be repaired.
What is a Ileal conduit?
This is the urinary diversion for a cystectomy due to bladder cancer.
S/S of Fluid volume deficit?
Urinary output of 30 mL per hour indicates adequate tissue perfusion. Tenting of the skin is more accurate to assess fluid volume deficit than dry mucous membranes and cracking of the lips. Replace fluids orally whenever possible. CVP readings will be low in fluid volume deficit.
Lab effects with fluid volume deficit?
Increased BUN, creatinine, Na+, specific gravity, Hct
What to remember with Fluid volume overload?
Monitor weight since it is the most accurate way to measure fluid balance and nutrition.
Important thing to remember with intake and output questions?
When given an intake and output question, don’t forget about insensible losses such as stool, perspiration, and respiration.
What are the universal symptoms of electrolyte imbalances?
Muscle weakness and paresthesia
What are the Extracellular electrolytes?
Sodium and ChIoride
What are the Intracellular electrolytes?
Potassium, Magnesium and Phosphate
What are the Clinical manifestations of Hyperkalemia?
Decreased urine output which increases K+, decreased HR, decreased muscle function= paralysis, Increased GI with diarrhea and nausea, Tall peaked T waves, Low voltage P wave and loss of the P wave, Prolonged QRS, Dysrhythmias, Death by cardiac arrest
What are the Causes of Hyperkalemia?
Acidosis, Addison’s disease, Oliguria and renal failure, Multiple blood transfusions
What are the Treatments of Hyperkalemia?
Insulin and Dextrose, Sodium Bicarbonate, Kayexalate and Calcium
What are the Clinical manifestations of Hypokalemia?
Increased urine ouput = decreased K+, Increased HR, Decreased muscle function, Decreased GI with constipation, anorexia, nausea, and vomiting, Dysrhythmias arid increased sensitivity to digitalis (Lanoxin), Flat T waves, ST segment depression, U waves, Death by cardiac arrest
What are the causes of Hypokalemia?
Diuretics, Diarrhea, Vomiting, Gastric suction, Steroid administration, Hyperaldosteronism, Cushing’s syndrome
What are the Treatmemt of Hypokalemia?
Potassium rich foods, Oral supplements, Intravenous supplements
Can you push potassium?
No
How much potassium can you put in a bag of IV fluid?
40mEq
What are the Clinical manifestations of Hypercalcemia?
Decreased Reflexes, Decreased Mental function and lethargy, Decreased Muscle function = Weakness and incoordination, Decreased Gl with constipation, anorexia, nausea, vomiting, Decreased Calcium in the bone = Deep bone pain, Increased Urine output and dehydration
What are the Causes of Hypercalcemia?
Hyperparathyroidlsm, Bone cancer, Bedrest, Excess calcium supplements
What are the Treatments of Hypercalcemia?
Push fluids to prevent renal calculi. How much? 3000ml, Furosemide (Lasix)
What are the Clinical manifestations of Hypocalcemia?
Increased Muscle twitching, tetany, seizures, Increased Neuromuscular symptoms, Increased Respiratory difliculty and laryngospasm, Increased irritability and memory impairment, Increased Calcium moving out of the bone = bone pain, + Chvostek’s and Trousseau’s signs, Prolonged QT interval and QRS complex. ST segment depression, Dysrhythmias
What are the Causes of Hypocalcemia?
Renal failure, Hypoparathyrcldism, Malabsorption, Pancreatitis, Alkalosis
What are the Treatments of Hypocalcemia?
Calcium rich foods, Oral supplements, Intravenous supplements
Can you give calcium IM?
No
What to remember with Hypermagnesemia?
Everything slows down like hypercalcemia.
What to remember with Hypomagnesemia?
Everything speeds up like hypocalcemia. When magnesium is low, the client is at risk for cardiac dysrhythmias.
What to remember with Hypernatremia?
Primary cause is dehydration. S=Skln flushed and swollen red tongue, A=Agitatl0n, restlessness, and convulsions, L=Low grade fever, T=Thirst and dry mucous membranes
What to remember with Hyponatremia?
Primary causes include fluid overload and renal insufficiency. Will see confusion with hyponatremia. Chloride imbalances usually follow sodium. Correct with intravenous fluids.
Intravenous pyelogram (IVP)
Contrast medium is used. Laxative may be ordered the night before the procedure.
Voiding cystourethrogram
Contrast material is inserted into the bladder by a catheter. The client then needs to void during the test.
What are the need-to-knows of a Foley catheter?
Always advance the catheter one to two inches after urine appears, Rapid emptying of the bladder may cause engorgement of pelvic blood vessels and hypovolemic shock, Encourage men to not urinate with the catheter in place, lf leakage around the foley, obstruction may be present.
Who needs dialysis?
A = Acid base problems, E = Electrolyte imbalances, I = Intoxications and poisonings, O = Overload of fluid, U = Uremic symptoms
What temp shoud peritoneal fluids be?
warm to increase the remeval of toxins.
What happens when Peritoneal fluids are instilled too fast?
pain in the left shoulder occurs during administration,
What color should return peritoneal fluids?
Clear
What postion should the client be in for Peritoneal dialysis?
Semi-fowler’s position
In peritoneal dialysis, lf there is a reduced outflow of fluid:
ask if a recent history of constipation and tum from side to side to try to enhance drainage.
In peritoneal dialysis, lf acute dyspnea occurs with instillation:
drain the fluid to relieve the intra- abdominal pressure.
In peritoneal dialysis, Dialysate solution for peritoneal is much higher what?
Glucose than hemodialysis. Monitor for hyperglycemia if the dwell time is too long.
Hemodialysis Catheter is a?
catheter with two lumens is inserted into the vena cava via the internal jugular or femoral veins. Allows blood to be withdrawn, cleansed, and then returned. Extemal device.
Hemodialysis AV fistula is a?
joining of an artery and a vein. Two needles are inserted during a treatment. Preferred method of long term dialysis. "Feel the thrill and hear the brult" of the fistula.
Hemodialysis AV graft is?
much like a fistula except that an artificial vessel is used to join the artery and vein.
What to know about Hemodialysis?
Sodium and waste products are passed during an exchange.Typical schedule is 3 days a week for 3-4 hours a treatment. Need to protect the site. Teach clients signs and symptoms of gastrointestinal bleed. Disequilibrlum syndrome can occur during an exchange and manifests as headache, hypotension, and confusion. Limit weight gain to 1-1.5 kg between treatments.
What are important things to know about Kidney Transplants?
Donor must have matching leukocyte antigen complexes. Must be ABO compatible but not the same blood type. Combination drug therapy after the transplant. Prednisone, tacrolimus (Prograf), and mycophenolate (CellCept) may be used. The transplant may not work immediately.
What are the Signs of rejection for a Kidney transplant?
Hypertension, Temperature elevation, Decreased urine output, Weight gain
What to know about Lithotripsy?
Crush the stones in the kidneys with lithotripsy. Done under regional or general anesthesia. Client will be NPO and an IV line will be in place.
What to know about Percutanecus nephrostdmy?
A needle or catheter is inserted through the skin into the calyx of the kidney. Any stones may be dissolved by percutaneous irrigation with a liquid that dissolves the stone or by ultrasonic sound waves that can be directed through the needle or catheter to break up the stone, which then can be eliminated through the urinary tract. A nephrostomy tube may be in place in the back. It is essential to keep the tube draining freely.
What is a major problem for end stage renal disease?
Puritis