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AC 3 Exam 3 Flashcards

1
Q

How does AKI present?

A

Sudden onset
May not progress
Full recovery is possible but may lead to ESRD/ESKD
Usually good prognosis
High mortality if other comorbidities, increased age, need for renal replacement therapy, etc

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2
Q

Why should we avoid HTN and hypotension in AKI patients?

A

HTN damages blood vessels to the kidneys and possibly cause stenosis
Hypotension leads to reduced blood flow to the kidneys

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3
Q

What nursing interventions should be implemented when caring for AKI patients?

A

Strict I&Os
Daily weights
Monitor electrolytes and labs
Monitor drug levels & adjust dose
Avoid nephrotoxic drugs/agents

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4
Q

What’s a fluid challenge and what’s the purpose in AKI patients?

A

Fluid bolus 500-1000 mL over 1 hour to see if the kidneys can handle filtering and putting urine output
Make sure the kidneys can still work

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5
Q

Why do we have to be careful when giving IVF to AKI patients?

A

We want to maintain their fluid status but we don’t want to fluid overload them. If the kidneys are already impaired and can’t make any urine out, giving pt more fluid will make them suffer more

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6
Q

What are some kidney lab changes that can be observed in patients with AKI?

A

Elevated BUN & Creatinine
Decreased creatinine clearance
Decreasing GFR

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7
Q

What’s azotemia?

A

Build up of wastes in the blood (increased blood osmolarity, creatinine, BUN)

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8
Q

Why is it important to get a dietitian involved when caring for AKI patients?

A

There is an increased rate of protein breakdown in muscles in AKI
Fluid/protein/electrolyte intake might be restricted and adjusted
A dietitian will calculate protein & caloric needs

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9
Q

How often should you assess food intake in AKI patients?

A

Q shift

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10
Q

Can you have AKI on CKD?

A

Yes; kind of like exacerbation episode

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11
Q

How is CKD presented?

A

Gradual onset
Progressive & permanent
Treatment & lifestyle changes required to slow progression & delay onset of ESRD
ESRD fatal without renal replacement therapy
Reduced lifespan
Potential for complex medical conditions affecting whole body system even with optimal treatment

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12
Q

Why is ESRD/ESKD fatal and can cause systemic problems even with optimal treatment?

A

When the kidneys are down, the body cannot filter/get rid of waste. Fluid and electrolyte imbalances also happen, which affect the entire system. We can only do so much, and all patients respond differently to treatment

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13
Q

How can any kind of surgery lead to AKI?

A

Anesthetics decrease blood flow to kidneys, which can possibly cause AKI

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14
Q

How many stages are there for CKD?

A

5; 1 being at risk and 5 being at ESRD

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15
Q

How is stage 1 CKD characterized?

A

At risk
Normal kidney function but either abnormal urine findings, structural abnormalities, or genetic traits r/t kidney disease
Reduce exposure to nephrotoxins
Manage HTN, DM, abnormalities

Promote kidney health as much as possible

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16
Q

How is CKD stage 2 characterized?

A

Mild CKD
Slightly reduced kidney function
Proteinuria may be present

Focus on reduction of risk factors

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17
Q

At what CKD stage are we trying to slow disease progression and start restricting fluids, proteins, and electrolytes?

A

Stage 3; moderate CKD

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18
Q

At what CKD stage are we managing complications, jaundice around the eyes may be present, educate about options, prepare for renal replacement therapy, and discuss patient preferences & values?

A

Stage 4; severe CKD

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19
Q

At what CKD stage are we implementing renal replacement therapy or kidney transplant?

A

Stage 5: ESKD

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20
Q

What is the biggest medication difference between AKI and CKD management?

A

Diuretic use
We can use diuretics with AKI but not CKD

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21
Q

Why should we educate CKD patients to avoid antacids?

A

Antacids have high amount of electrolyte in it; some are high in Mg, Na..etc.
We need to restrict electrolytes in CKD

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22
Q

A phosphate binder is prescribed to a CKD patient to take with meals to keep the phosphorus level low. Morning lab results are out, and the phosphorus level came out to be low. Should you give the phosphate binder?

A

Yes

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23
Q

Can you give protein supplement to a CKD patient on HD?

A

Yes, HD needs protein. With the patient already on protein restriction, we should supplement to maintain the protein level

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24
Q

What supplements can/should be given to CKD patients?

A

Calcium and vit D
Calcium to bring phosphorus level down (calcium-phosphate channel)

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25
Why should med level be adjusted when pt is on HD?
Many meds dialyze out of the bloodstream during HD
26
Why is it important to give vitamins and minerals after HD instead of before?
Vitamins and minerals dialyze off during HD
27
What are some injury prevention education that we can provide to CKD patients?
Monitor BP Monitor blood glucose Monitor urine output Dietary restrictions (low protein, electrolytes)
28
How is HD done?
Usually through AV fistula or hemodialysis catheter x3 week, each 4-5 hours Fistula cannot be used until 3 months after initial creation
29
Why is neurovascular check important after AV fistula creation?
Fistula can block blood flow to tissues below the site
30
How is peritoneal dialysis better than hemodialysis in terms of patient's quality of life?
PD is better because it's relatively easier to go through and patients can do it themselves at home However, thorough education is required (ex. sterile field) and patient compliance is important Because each sessions are shorter than HD, this needs to be done daily
31
What is dialysis disequilibrium syndrome?
Urea concentration in brain is different than in blood; caused by osmosis. S/S: nausea, headache, muscle cramps, LOC change, tremors, seizures, coma, visual disturbances. etc.
32
Why is large amount of urine expected post kidney transplant?
Pt were not making much urine with their impaired kidneys. Now they got a new one that actually works and filters good, large amount of urine is expected
33
What type of post-transplant rejection has an onset of within 48 hours of surgery?
Hyperacute Increased temp, BP, and pain at transplant site (iliac fosssa)
34
How is hyperacute rejection fixed?
Immediate remove of transplanted kidney May require dialysis
35
What is the onset of acute rejection?
A week to several weeks after surgery
36
What are the s/s of acute rejection?
Flu-like symptoms Oliguria or Anuria Increased temp, BP Enlarged, tender kidney Lethargy Fluid retention Elevated kidney function labs and potassium
37
How is acute rejection treated?
Increase the dose of immunosuppressive drugs
38
What is the onset of chronic rejection?
Occurs gradually over months to years
39
What are the s/s of chronic rejection?
Gradual increase in kidney function labs, fluid retention, electrolyte imbalance, fatigue
40
How is chronic rejection treated?
Conservation management until dialysis is required
41
Why is lifelong immunosuppression required for transplant patients?
There is a very high risk of kidney rejection after transplant. We don't want to lose the kidney again. If not on immunosuppressant, body will attack the new kidney
42
What is the primary cause of kidney transplant failure?
Lack of adherence especially with immunosuppressants. Very strict schedule, cannot miss a dose
43
What are some patient education post-transplant?
Take meds as directed Never stop, start or change your dose without approval from transplant team Check with transplant team before starting any new meds If you miss a dose, do not double next dose; contact the transplant team for instructions Contact transplant team if feeling too ill to take med because of N/V/D Do not run out of meds Do not take any OTC meds or herbal supplements No pregnancy; contact if planning
44
What is multiple sclerosis?
Auto-immune, chronic disease that affects myelin and nerve fibers. Myelin sheath damaged, exposing nerve fibers.
45
In what group is MS common?
Female usually at 30-31
46
How does MS cause increased falls, decreased mobility, and possible confusion?
Myelin is for conduction and transmission of electrical impulses; because myelin is destroyed in MS, there is not good conduction leading to impaired mobility
47
There are 4 common types of MS. Which type is most common and able to return to baseline condition?
Relapsing-Remitting
48
What type of MS has steady & gradual deterioration?
Primary progressive
49
What type of MS has remission & exacerbation but never returns to baseline then steady progressive?
Secondary progressive
50
What is progressing-relapsing MS?
Frequent relapses with partial recovery Never back to baseline Each release progresses more
51
Why is MS hard to and takes long time to diagnose?
Vague symptoms like increased fatigue, dizziness, and unexplained paresthesia Blamed on stress, anxiety, or exhaustion
52
What are some late symptoms of MS?
Changes in cognition including Decreased short-term memory Decreased concentration Inattentiveness Impaired judgement Impaired bowel & bladder Impaired sexual function
53
What kind of medication is given to manage MS?
Immunosuppressants
54
How is MS diagnosed?
No single lab; Abnormal CSF (increased myelin proteins & WBCs) MRI brain & spinal cord (presence of plaques in at least two areas)
55
Why do MS patients have impaired immunity?
Due to disease & drug therapy (immunosuppressant bc autoimmune disease)
56
Muscle spasticity, tremors, and/or fatigue in MS patients puts them at risk for
Fall They have impaired mobility
57
Why is visual acuity and cognition decreased in MS patients?
Due to dysfunctional brain neurons from damaged myelin
58
How is infection & impaired immunity managed in MS patients?
Immunomodulators Anti-inflammatories Corticosteroids Medical marijuana Avoid crowds & sick individuals
59
How can MS patients improve mobility?
PT/OT Meds for muscle spasicity (baclofen, gabapentin) Meds for paresthesias Exercise program Neuro sx for tremors No rigorous activity
60
What are the main patient education points in managing MS?
Avoid overexertion Avoid stress Avoid extreme temperatures Avoid extreme humidity Avoid sick people Always balance rest with activity
61
What are some concerns for spinal cord injury?
Airway, impaired motor function (mobility), sensory perception, bowel/bladder control
62
From where up is the patient at risk for autonomic dysreflexia and neurogenic shock?
T6 and above
63
Why is it important to keep SBP > 90 in spinal injury patients?
Lower BP = decreased perfusion to injured area = worsens injury
64
What is autonomic dysreflexia?
Massive sympathetic system discharge; potentially life threatening Generally related to a full bladder or constipation
65
What are some s/s of autonomic dysreflexia?
Sudden rise in BP Sweating above level of lesion/injury Blurred vision Flushing Congestion Severe sudden headache stroke risk
66
How is autonomic dysreflexia treated?
Prevent full bladder (straight cath 2-3x daily) Constipation regimen Don't be in too warm of an environment No tight clothing Nitrates & nifedipine (calcium channel blocker) to vasodilate
67
A patient with spinal cord injury reports sudden headache. The nurse notes increased BP. What should you do next?
Bladder scan
68
What's spinal shock?
Immediate body response to the injury Complete loss of sensation but temporary Usually lasts less than 48 hours but can continue to several weeks Usually resolve on its own Normotensive
69
What's neurogenic shock?
Same as other shock with hypotension but with bradycardia Injuries above T6
70
How is neurogenic shock treated?
Fluid resuscitation; goal MAP 80-90. We need lots of pressure to perfuse spinal cord Vasopressors Atropine for bradycardia
71
How long does acute back pain last?
3 months
72
Sciatic nerve-burning, stabbing pain down leg or foot indicates
Pain from lower back
73
What kind of imaging can be done for back pain?
X-ray, CT/MRI, Bone scan, Nerve conduction studies X-ray first usually because it's least invasive and quickest
74
What are some surgical interventions for back pain?
Spinal fusion with back brace Diskectomy Laminectomy Interbody case fusion ACDF (anterior cervical diskectomy & fusion) - most common
75
What are some post-op pain meds for back pain?
Pain pump via spinal infusion Morphine or Demerol Ziconotide (this can cause psychosis with mental health pt)
76
What are some post-op care for spinal patients?
Monitor for CSF leak Place pt flat & besdrest Report sudden & severe headache immediately Report bulging at incision site immediately Monitor for FVD, paralytic ileus, fat emboli
77
Where is gallbladder pain at?
RUQ
78
Where is pancreatic pain at?
Epigastric, LUQ radiating to back
79
How does cholecystitis develop?
Trapped bile -> bile irritates tissue causing edema, distention -> ciculation becomes impaired -> ischemia, infection, necrosis, and gangrene can occur, which then pt can go septic
80
What are the 4 big risk factors for cholecystitis?
Female Fat Forty Fertile
81
How does prolonged TPN use can play a role in cholecystitis?
The lipids in TPN doesn't get digested as same as food. That lipid also is going straight into the bloodstream
82
What are some s/s of cholecystitis?
Abd pain R. shoulder or scapula pain Anorexia, N/V Dyspepsia Belching Nutrition problem
83
What's biliary colic?
Spasms as stone moves or gets stuck in tract Goes away once stone passes
84
How is cholecystitis diagnosed?
Labs: elevated WBC, AST/LDH, bilirubin, amylase/lipase Ultrasound of RUQ X-ray can show calcified stones HIDA (hepatobiliary scan)
85
What are some dietary education that can be provided to cholecystitis patients?
Avoid food that causes abd pain, N/V High fiber and low fat diet Avoid foods that causes gas Small, frequent meals Routine labs
86
How is cholecystitis managed once in the hospital?
NPO (may need sx, bowel rest) and IVF (avoid dehydration) Opioids for pain Ketorolac/toradol Antiemetics
87
Why should we keep HOB elevated for post lap chole?
Flat = abd stretched out
88
Why is acute pancreatitis common on holidays & vacations?
Because people be drinking a lot
89
Can gallstones be formed while going through acute pancreatitis?
Yes, because as the pancreas swells, bile can be blocked
90
Why is an abdominal ultrasound second choice to a CT with contrast for diagnosis of pancreatitis?
Pancreas is hard to visualize with US
91
How is pancreatitis managed in the hospital?
NPO & IVF IV replacement of electrolytes (N/V & decreased PO intake) NG tube (decompress) PCA opioids Decrease gastric acid Prophylactic abx can be used
92
What dietary patient education can be done for pancreatitis?
J-tube may be needed to bypass pancreas Daily weights Small, frequent, mod-high carbs, protein low fat bland meal No caffeine or alcohol Contact PCP for N/V/D
93
Why does pancreatic cancer have limited tx?
Because it's diagnosed late & metastasizes fast
94
What are some s/s of pancreatic cancer?
Glucose intolerance Splenomegaly Severe ascites leg/calf pain Severe weakness & fatigue LUQ mass
95
How is pancreatic cancer diagnosed?
Elevated CEA (cancer elevated antibodies) Confirmation of tumor (and US & CT with contrast) Endoscope
96
What's the goal of pancreatic cancer management?
Prevent spread & decrease pain
97
What are 2 surgical managements for pancreatic cancer?
If tumor is < 3cm, resection If tumor large, consider Whipple; big risk for obstruction, bleeding, and infection
98
For post-op pancreatic cancer, expect to have these three things in the patient:
NG tube (decompress) Biliary drains Foley NG and foley can be put in but they will come out with some kind of drain post op
99
How should you position the patient post-op pancreatic cancer?
Dependent position; sit them up Semi fowlers
100

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