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Adult Health > AH II Test 3 > Flashcards

AH II Test 3 Flashcards

1
Q

Right Brain Damage

A
  • paralyzed left side or hemiplasia
  • left sided neglect
  • spatial-perceptual defecits
  • denies/minimizes problems
  • rapid perfromance, short attention span
  • impulsive, safety problems
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2
Q

Left-Brain Damage

A
  • paralyzed right side, hemiplegia
  • impaired speech/language aphasia
  • impaired right/left discrimination
  • slow performance, cautious
  • aware of defecits, depression, anxiety
  • impaired comprehension
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3
Q

Risk Factors for Stroke

A
  • heredity
  • age
  • gender (males)
  • race (African American)
  • HTN
  • Obesity
  • DM
  • smoking
  • hyperlipidemia
  • heavy ETOH, cocaine
  • inactivity
  • carotid stenosis
  • oral contraceptives
  • atrial fib
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37
Q

Status Epilepticus

A
  • 2+ sz’s between which there is incomplete recovery of consciousness
  • neurological emergency-high mortality rate due to hypoxia, hypoglycemia, systemic acidosis, hyperthermia, exhaustion
  • precipitated by-abrupt stopping of AEDs, fever, acute ETOH withdrawal, head trauma, metabolic disturbances, infection
  • Tx=AEDs (IV Dilantin), IV valium, ativan, O2, cool, protect, treat underlying cause
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38
Q

TIA

A
  • cerebral ischemia without infarction
  • symptoms resolve after an hour (usually)
  • temporary loss of vision, hemiparesis, numbness, aphasia (disturbance of the comprehension and formulation of language caused by dysfunction in specific brain regions), tinitus, vertigo, ataxia
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39
Q

Symptoms of Stroke

A
  • sudden weakness in face, arm, leg
  • diff understanding of speech, loss of speech
  • dizziness
  • visual distrubances
  • unexplained, severe HA
  • change in personality or mental status–confusion
  • sudden loss of consciousness or syncope

(older adults can have atypical presentation–falls, failing to eat/drink, functional decline, memory loss, urinary incontinence)

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40
Q

Time is Brain!

A
  • penumbra=compromised area–has an ischemic core
  • penumbra will necrose in 3-6 minutes
  • inflammatory process outside of necrosis
  • cellular death in 4-6 minutes
  • average time bt onset of stroke and beginning of medical care = 24 hours
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41
Q

Ischemic Stroke

A
  • 85% of strokes
  • Thromolytic or Embolytic
  • thrombolytic=usually where athreosclerotic plaques have narrowed blood vessel
  • embolytic–most common=A Fib, can also be fat (long bone fx), air, tumor, bacteria)
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42
Q

Hemorrhagic Strokes

A
  • bleeding into the brain (intracerebral) or into the subarachnoid space or ventricular space
  • due to ruptured vessel
  • 30-50 mls is a hemorrhage
  • causes: HTN (esp during activity), aneurysms, AV malformation, coag disorders, anticoag drugs, trauma, bleeding, brain tumor
  • sudden onset, severe HA
  • complications=hydrocephalus, Sz, vasospasm, rebleeding (1,2,14d post stroke)
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43
Q

Dx Stroke

A
  • CT scan to determine hemorrhagic/ischemic
  • cerebral angiogram
  • carotid ultrasound or doppler (use if carotid stenosis is believed to be cause of ischemia)
  • LP for RBCs in CSF
  • ECG (dysrhyth) or Echocardiogram (clots)
  • coag studies-PT/INR, PTT, plts
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44
Q

Tx Stroke

A
  • O2 for sats >92
  • VS’s-MAP <130 to maintain CPP
  • assess neuro status (GCS, pupils, motor/sensory function)
  • IV with NS
  • Labs (hyponatremia, hyper/hypoglycemia can cause more brain damage)
  • sz control/precautions
  • assess gag reflex
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45
Q

Tx for

Ischemic Strokes

A
  • after CT scan—
  • tPA-activates plasminogen which > fibrolytic process
  • within 3.5-4 hr of stoke
  • adverse effect=bleeding
  • contraindications=taking anticoags, abn PTT, plts, BP > 185/110, recent GI bleed, stroke or head trauma within 14d, PG
  • post tPA (or those ineligible)-anticoags, ASA, Plavix, Pradaxa
  • take BP down slowly over time
  • mechanical embolius removal in cerebral ischemia (MERCI)–done in interventional radiology-arteriorgram
  • Sx-carotid endarterectomy (90% occlusion or more)
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46
Q

Tx for Hemorrhagic Strokes

A
  • depending on cause–may require craniotomy to clip aneurysm or remove blood from brain
  • serial CTs to monitor re-bleeding
  • clipping, wrapping, coagulation, resecting, coiling
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47
Q

Stroke Deficits

A
  • apraxia-inability to carry out learned movements (dressing, combing hair)
  • agnosia-inability to use an item correctly
  • aphasia-difficulty with language (expressive and/or receptive) *left brain damage
  • dysphagia-difficulty swallowing

(wernicke=receptive, broca=expressive)

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48
Q

Stroke Dysphagia Screening

A
  • GCS (cut off at <13)
  • facial symmetry
  • tongue symmetry
  • palatal symmetry
  • water test
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49
Q

Levels of SCI

A
  • Quadriplegia-C1 through C8 (bowel and bladder)
  • Paraplegia-T1 through L4 (bowel and bladder)
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50
Q

Muscles of Respiration

A

C2-C8: Accessory rib muscles
C2-C5: diaphragm-phrenic nerve
T1-T7: Intercostal muscles
T6-T12: Abdominal muscles
(for deep breathing and coughing)

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51
Q

Incomplete Cord Injuries

A
  • Anterior Cord Syndrome–often flexion injury-motor function, pain, temp sensation lost below injury, no loss of reflexes (touch, position, vibration and motion remain in tact)
  • Posterior Cord Syndrome-motor function, pain and temperature sensation in tact (loss of vibr, crude touch, and position sensation)

-Central Cord Syndrome-lesion in central cord; motor weakness and sensory loss in upper and lower extremities, more pronounced in upper

-Brown-Sequard Syndrome-penetrating injury that causes hemisection of cord-affects half of cord; characterized by ipsilateral loss of motor function and contralateral loss of sensory function.

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52
Q

Neurogenic Shock

A
  • during acute phase
  • complication of SCI
  • hypotension
  • brady
  • warm, dry extremities
  • inability to reg temp
  • areflexia below injury
  • no sensation, movement (flaccid)

Tx=dopamine for hypotension

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53
Q

Complications of SCI

A

Acute (30 minutes-6 weeks)

Neurogenic Shock=hypotension, brady, warm, dry extremities, Tx=dopamine

Hyperkalemia (due to muscle loss)–Kayexylate, diuretics, insulin

Chronic

autonomic dysreflexia (above T5-6, disconnect bt parasympathetic/sympathetic)=HA, HTN, brady, diaphoresis

hazards of immobility

bowel/bladder mgt

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54
Q

Autonomic Dysreflexia/Hyperreflexia

A
  • complication of SCI
  • more likely above T5-6
  • disconnect bt parasympathetic and sympathetic
  • intact lower motor neurons sense painful stimuli below level of injury (full bladder, bowel), trasmit message up cord, at SCI, pain signal stops
  • ascending info reaches splenic sympathetic outflow (T5-6) and sitmulates sympathetic response
  • S/S=sudden, severe HTN, pounding HA, brady, arterial dilation, flushed skin, sweating above T6, nasal congestion, cool skin and goose bumps below injury
  • Tx-raise HOB, monitor BP, determine cause, vasodilators (apresoline, procardia, NTG)
  • Complications=stroke, MI, Sz, renal hemorrhage, retinal hemorrhage
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55
Q

HNP

(herniated nucleus pulposus)

A
  • Herniated discs
  • L4-S1 most common (sciatica)
  • C5-C7=second most common

Risk Factors: age >40, prolonged sitting, obesity, smoking, trauma, genetic predisposition

S/S=change in posture/gait, position change, muscle spasm, DTR loss, effect on ADLs, bowel/bladder status, lower extremity radiculopathy-sciatica (if orig L4-S1)

Tx-2 d bed rest, PT, ice/heat/massage, traction, NSAIDs, opioids, muscle relaxants, steroids. Sx-discectomy (removal of soft, gel stuff), laminectomy (removal of entire lamina)–log roll, do not ambulate w/o an order, do not raise HOB, draw sheet, neuro checks (motor loss, urinary retention, sensory loss), stool softener, wound check, TCDB q2, ATB, TLSO (vest), CSF leak, retroperitoneal hemorrhage, meningitis

Spinal fusion- for multiple laminectomies, chiropractic, acupuncture, spinal injections (steroids), chemonucleolysis therapy (enzyme injected to east herniated disk)-SE=anaphylaxis and paralysis

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56
Q

Cauda Equina Syndrome

A
  • complete bilateral compression of lower lumbar and sacral roots (below conus medullaris)
  • sensory and motor loss below lesion: flaccid LE; < DTRs, urinary/fecal incontinence or retention, surgical emergency
57
Q

Peripheral Nervous System

A
  • 31 pairs of spinal nerves
  • 12 pairs of cranial nerves

Autonomic NS-parasympathetic, sympathetic

Disorders:

  • peripheral neuropathy
  • trigeminal neuropathy
  • bell’s palsy
  • botulism
  • tetnus
58
Q

peripheral neuropathy

A

due to:

-DM, vascular abnormalities, renal/liver failure, B12 deficiency, AIDS, drug toxicity, infection, toxic subs (heavy metals), trauma

S/S-muscle weakness, stabbing, cutting, searing, tingling, burning, numbness, loss of sensation, impaired reflexes

8P’s-pain, pallor, paresthesia, pulselessness, paralysis, polar, perception, pressure

Tx-underlying cause, antiepileptic meds (gabapentin), antidepressants (nortriptyline), opioids

smoking makes it worse

caution with extremity care-may not feel wounds

elastic stockings to facilitate venous return

59
Q

Myelogram

A
  • Lumbar puncture below L3, inj contrast
  • can show bony overgrowth, spinal cord tumors, spinal abcesses, HNP or pinched nerve
  • contrast (assess allergies)
  • kidney/thyroid/liver problems that may effect excretion (BUN/Creatinine)
  • NPO 4-8h

d/c drugs that cause blood thinning, lower sz threshold (antidepressants, phenergan, TCA, CNS stimulants), metformin, glucophage

-post procedure-force fluids, assess urine output, LE movement, spinal HA

60
Q

Trigeminal Neuralgia

tic douloureux

A
  • unilateral face pain—CN V
  • burning, knifelike or lightning shock in 1-3 branches on trigeminal nerve
  • intense paroxysms that last seconds to minutes, unpredictable
  • causes: dental, trauma, virus, compression of nerve above ear by cerbellar artery
  • meds=AEDs (tegretol, oxcarbazepine), antidepressants (amitryptiline), muscle relaxants (Baclofen)
  • Sx-glycerolrhizotomy (chemical ablation), percutaneous rhizotomy (radiofrequency ablation), microvascular decompression, gamma knife radiosurgery
  • post-op–prone to injury (can’t feel on that side)
61
Q

Bell’s Palsy

A
  • 7th cranial nerve
  • facial weakness, paralysis–unilateral
  • etiology unknown, linked to HSV, lyme’s
  • full recovery in 6 wks if treated
  • may have blisters above ear along nerve
  • fever, tinnitus, hearing defecit, flaccidity of affected side, inability to close eye, loss of taste, excessive tearing
  • Tx-prednisone, Acyclovir, Valtrex, Famvir, doxycycline (for lyme’s dz)
  • moist heat, massage, electrical stim of nerves, exercise, pain mgt, nutritional status
  • risk for corneal abrasion
62
Q

Botulism

A
  • destroys or inhibits transmission of acetylcholine at myoneural junction
  • reportable
  • s/s-n/v, abd cramping, dif convergance of eyes, photophobia, ptosis, paralysis of extraocular muscles, blurred vision, double vision, dry mouth, sore throat, swallowing difficulty, paralytic ileus, muscle weakness, sz, resp arrest
  • Tx=antitoxin, (do NOT induce vomit bc of neuro issues-may aspirate), GI tract purges, ventilary support
63
Q

Tetanus

A
  • severe polyradiculitis and polyneuritis affecting spinal and cranial nerves
  • Clostridium tetani
  • entry via deep wound, dental infection, heroin injection, human/animal bites, open fx
  • can be fatal
  • s/s-stiff jaw (trismus) and neck, fever, tonic convulsions, opisthotonos, laryngeal and respiratory spasm (apnea-death), diaphoresis, labile HTN, tachy, arhythmias, hyperthermia
  • tetnus booster, TIG (immunoglobs), control spasms with deep sedation (valium, barbituates, neuromuscular blocking agents-vecuronium), penicillin or other ABT, quiet, dk room, mechanical ventilation
64
Q

Parkinson’s Dz

A
  • progressive disorder of CNS
  • genetically linked with environmental trigger
  • degeneration of neurons of substantia nigra (dopamine producing)
  • affects voluntary coordinated movements
  • imbalance bt dopa and ACh (too much)

Cardinal Symptoms=tremors, rigidity, bradykinesia

  • s/s usually start unilaterally
  • also pill rolling, no arm swinging, < eye blinking, dysphagia, micrographia, cogwheel, shuffling gait, stooped posture, fall risk, head bowed, trunk bent forward, shoulders drooped, arms flexed, generalized weakness, slowed, monotonous speech, masked faces, decreased QOL, depression, confusion, dementia, psychosis, sleep problems, < cognition and memory
  • DX-r/o other dz, CSF analysis for decreased dopamine
  • Tx-increase dopamine, decrease ACh, increase QOL

meds-Sinemet (=levadopa and carbidopa=dopamine precursors); SE=dyskinesia, dystonia (stiffening/tightning of muscles), on-off phenomenon, wearing off phenomenon. other meds-dopamine agonists (symmetrel, parlodel), MAO-B inhibitors-Eldepryl, anticholinergics (cogentin, artane)

  • Surgery-stereotactic=thalamotomy, pallidotomy (high beam radiation to break abnormal neural pathways), deep brain stimulation (electrical currents to interfere with tremors), neurotransplantation (experimental-fetal substantia nigra tissue from human or pig)
  • Nursing-meds on schedule (30 min bf meals), monitor SE’s of meds, nutritional intake, constipation, maintain ADLs, fall precautions, small frequent meals, ensure, water ATC, aspiration precautions (auscultate bf and after meals), speech therapy (swallow)
65
Q

Drugs linked to Parkinsonianism

A
  • antipsychotics (haldol, lithium, etc)
  • antiemetics (compazine)
  • reglan
  • antihypertensives (reserpine, aldomet)
  • methamphetamines
66
Q

Too much ACh

A

-constipation (<peristalsis>secretions)</peristalsis>

67
Q

Symptoms of BPH

A

All voiding symptoms:

  • initiating stream
  • reduced stream
  • intermittency
  • dribbling urine
  • incomplete emptying
  • frequency
  • urgency
68
Q

Dx of BPH vs Prostate CA

A
  • DRE-BPH=uniform, elastic, non-tender enlargement. CA= stony,hard nodule
  • PSA-elevated for both (normal is 4-10 ng/ml)
  • creatinine and BUN (0.6-1.3, 6-20)
69
Q

Tx for BPH

A

Conservative:

  • watch and wait
  • dietary: avoid ETOH, caffeine, large amts of fluid, fluid bf bed, meds that cause retention (anticholinergics (atropine, scopalmine), decongestants)
  • meds=5 alpha reductase inhibitors (finasteride)-shrinks prostate, lowers testicular andrgoens that stim growth, SE=libido, ED. alpha andrenergic receptor blockers (terazosin, doxazosin, tamsulosin=Flomax)-promote smooth muscle relax, SE=postural hypoTN, dizziness
  • herbal=saw palmetto
70
Q

TURP

(transuretheral resection of the prostate)

A
  • tissue is removed
  • irrigation soln carries out debris
  • BLEEDING!–continous bladder irrigation (CBI)
  • pre-op=assess clotting factors
  • post-op=clots normal for 24-36h, hematuria, antispasmotics to prevent bladder spasm (ditropan), increase fluids, watch for UTI, avoid lifting
71
Q

Prostate CA

A
  • androgen dependent adenocarcinoma
  • metastasis can be direct or through lymph system to bones, liver, lungs
  • risk factors=age, family hx, STD hx, heavy metal exposure
  • s/s-same as BPH, hematuria, pain in lumbosacral area radiating to hips and legs
  • hormonal tx=estrogens to inhibit release of LH from pituitary, meds-Megace or depo-provera
72
Q

Functions of the Kidneys

A
  • maintain body fluid volume and composition
  • filter waste products for elimination
  • acid/base regulation
  • regulate BP (renin)
  • erythropoietin
  • metabolize vitamin D to active form
73
Q

Renal Terminology

A
  • GFR-125 ml/min
  • 1200 ml/min = blood flow through kidneys
  • Normal urine output = 1500 mL/day
  • minimum = 30 ml/hr (720 ml/24hr) (less = lack of profusion, ischemia)
  • oliguria = 100-400 ml/24 hr
  • anuria = no output or less than 100 ml
  • dysuria = painful
  • nocturia
  • polyuria = > 2000 ml/24 hr (DI)
  • uremia = full blown renal failure
74
Q

Renal Diagnostics

A
  • urinalysis (first AM void)
  • specific gravity = 1.003-1.030
  • nitrites, WBCs or leukoesterase in urine = UTI
  • urine culture/sensitivity
  • bilirubin = brown urine
  • rifampin, pyridium = orange urine
  • serum creatinine (end product of muscle/protein metab)
  • BUN-may increase when rapid cell destruction (trauma, lots of exercise, fever, steriods, bleeding), affected by dehydration
  • BUN/creatinine normal ratio is 12:1, if ratio goes up–indicates problem
  • creatinine clearance (NL is 70-135 ml/min)
  • 24 h urine-NaCl, calcium, electrolytes, osmolality
  • KUB (kidneys, ureter, bladder) Xray
  • Bladder scan
  • cystoscopy=lighted scope to detect tubmors, inflammation, prostate strictures, structural irregularities (CI for acute UTI, severely enlarged prostate) Post-procedure= urine pink (blood), increase fluids
  • renal ultrasound
75
Q

Urinarty Tract Infections

A
  • cystitis (inflm or infection of bladder) older adult s/s-anorexia, n/v, abd pain, mental status changes; ATB=ciprofloxacin, sulfamethoxazole/trimethoprim (Bactrim), anlagesics (pyridium-orange pee), antispasmodics (anaspaz)
  • pyelonephritis (infection of kidneys)-may be ascending or descending, may be due to vesicoureteral urine reflex; ATB=cipro, Bactrim (longer time). Sx to repair anomalies/obstruction, ureteroplasty (ureteral repair), ureterolithotomy (stone removal)
76
Q

Renal Diet

A
  • limit fluids
  • low protein
  • Restrict salt, potassium, phosphorous, and other electrolytes
  • adequate calories
77
Q

Glomerulonephritis

A

NOT infection (just inflammation)-due to depositon of immune complexes within glomeruli leads to ineffective filtration (strep, SLE-nephrotic syndrome).

s/s=proteinuria, hematuria, generalized edema, fluid overload, HTN, elevated BUN and creatinine.

Dx=assess for previous (strep) infection, urinalysis, BUN, creatinine, ANA, IgG, C3 complement levels, renal biopsy (needle);

Tx=ATB for strep infection, manage fluid overload with Na restriction, water restriction, diuretics, restrict protein, antihypertensive meds, may need kayexalate, plasmapheresis to filter blood of attacking antibodies

78
Q

Renal CA

A

s/s-may be asymptomatic, early sign is painless hematuria, palpable mass, dull flank pain, wt loss anemia, fatigue (sx of malignancy)

-Dx-urinalysis to r/o, CT, MRI, ultrasound, biopsy

-Tx-nephrectomy (kidney, adrenal gland, fat, lymph nodes), radiation, chemo (if mets), immunotherapy (biological response modifiers)

79
Q

Bladder CA

A
  • s/s-painless hematuria, dysuria, frequency, urgency
  • Dx-urinalysis to r/o infection and examine neoplastic cells, tumor marker=carcinoembryonic antigen (CEA)
  • Tx=surgery, chemo, radiation
  • cystectomy-partial, radial with urinary diversion (ileal conduit, pouch procedures) post-op-may see mucous in urine
  • cutaneous diversions=ileal conduit, ureterostomy, vesicostomy, nephrostomy
80
Q

Renal Calculi

A
  • nephrolithiasis-stones in kidney
  • family Hx
  • 50% contain Ca, others are Mg, uric acid, cystine
  • metabolic risk factors
  • s/s-severe flank or abd pain = “renal colic”, n/v, pallor, diaphoresis
  • urinalysis-hematuria, crystals
  • Dx-KUB, CT, US
  • Tx-pain meds, hydrate to flush stone, strain urine to analyze composition of stone, lithotripsy=sound waves to break stone into small fragments, ureteroscopy = scope in ureter, removal with forceps, stenting via ureteroscope, percutaneous ureterolithotomy under fluroscopy (needle, may place nephrostomy for stone passage)
81
Q

Incontinence

A
  1. Stress incontinence=loss of urine while coughing, sneezing, lifting due to loss of abiity to tighten urethral opening (physiological). tx=meds, bladder retraining, kegels
  2. Urge incontinence=brain signals urination and person can’t suppress signal until appropriate time. tx=ditropan, detrol, toviaz, avoid caffeine and ETOH, limit fluids. more difficult to treat.
82
Q

Causes of ARF

A
  • inadequate perfusion(shock, PE, anaphylaxis) (pre-renal 50-75%), damage to glomeruli (intrarenal 25%), obstruction of urine flow (post-renal 10%)
  • critically ill
  • trauma
  • blood transfusion rxn
  • sepsis
  • decreased CO (MI-cardiogenic shock, hypervolemia)
  • nephrotoxic drugs-ATBs, IV contrast, NSAIDs
83
Q

CRF and ESRD

A

Risk:

  • DM, HTN, glomerulonephritis, polycystic kidney dz, systemic dz (SLE), ARF that does not resolve
  • diet=
84
Q

Symptoms of Renal Insufficiency and ESRD

A

Symptoms:

  • reduced renal reserve (40-75% of nephrons gone)-asymptomatic unless stressed, serum BUN/creatinine WNL–seen only with creatinine clearance
  • renal insufficiency (75-90% nephrons gone)-BUN & creatinine increasing, kidneys can’t concentrate, poly and nocturia
  • ESDR (<10% of nephrons)-high BUN/creatinine, sp grav fixed at 1.010m, oliguric, dialysis necessary

CRF leads to uremia (clinical symptoms)-uremic syndrome

85
Q

Labs for ARF and CRF

A
  • creatinine (may get as high as 6)
  • BUN may reach 80-100
  • Serum K, P, Mg increase
  • serum Ca decrease
  • specific gravity fixed at 1.010 (same as serum)
  • creatinine clearance (normal is 85-135) mild RF 50-84, moderate RF 30-50, severe RF < 30
  • ABGs-pH < 7.35, pCO2 < 35, HCO3 (normal 22-26) < 22

CRF:

-H&H, Na, K, Mg, Ca, P, Bicarb, urine proteins present

86
Q

ARF

A

-abrupt deterioration leading to build up of metabolic wastes; can be reversible

pre-renal-hypoTN, tachy, decreased urine output, lethargy, decreased CO, decreased CVP

intra-renal-(acute tubular necrosis)-decreased urine output, edema, hypoTN, tachy, SOB, distended neck veins, wt gain, crackles,too much fluid!

post-renal-oliguria, intermittant anuria, difficulty starting urination

Phases:

onset=precipitating event until oliguria, elev BUN, creatinine

oliguric=u/o < 400 that doesnt respond to fluids challenges or diuretics, elev BUN/creatinine, hyperkalemia, hyperphosphatemia, magnesemia, hypocalcemia, decr bicarb (acidotic)

diuretic=high output after correction of percipitating event, BUN normalizes, 2-6 wks post onset

recovery=renal function improves but may never reach pre-illness levels

Treatment:

  • correct cause, fluid challenge, diuretics (lasix, bumex), dopamine drip (vasoconstricts, increase BP to improve perfusion), CCBs, promote renal blood flow
  • diet: restrict protien, sodium, potassium, fluids
  • hemodialysis
  • peritoneal dialysis
87
Q

AV Fistula & Graft

A
  • fistula=more permanent access-anastamose artery and vein
  • graft=biological or artificial graft between art and vein, used for pts with compromised circulation

audible bruit, adequate circulation distal to shunt

88
Q

Nursing Care for

Peritoneal Dialysis

A
  • used for early RF
  • dextrose in dialysate–osmotic pressure
  • meds added=heparin, KCl, ATBs
  • sterile procedure
  • dwells for 30-90 minutes
  • daily wts
  • monitor I&O
  • assess color, consistency of flow (decreasing: raise HOB, turn), cloudy fibrinous clots-notify doc, assess catheter site, assess pain
  • complications-peritonitis, site infection, low back pain, pulmonary complications=pneumonia, atelectasis, protein loss
89
Q

Drugs and Dialysis

A

avoid dialysable drugs and drugs that cause hypotension prior to dialysis

dialysable: tylenol, ASA, captopril, mannitol, methyldopa, protamine sulfate, pyridoxine (B6), theophylline, some ATBs

not dialyzed: albumin, diazepam (valium), digoxin, furosemide, heparin, hydralizine, iron, propanolol, verapamil

90
Q

Kidney Transplant

A

Exclusions = >70, malignancies, active infection, HIV+, cirrohosis/hepatitis, substance abuse, COPD, LVEF <20%, BMI >35, psych dx

Symptoms of Rejection = acute (1 wk-2y)=oliguria, anuria, fever, elevated BP, flank tenderness, decreased specific gravity, fluid retention. chronic=gradual over months, increased BUN/creatinine, fatigue

immunosupressive drugs=imuran, prednisone, neoral (cyclosporine)

Adult Health (9 decks)

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