Blue Print Flashcards
How to assess whether protein intake is sufficient for patients with CKD?
BUN and serum prealbumin levels
-want low protein before dialysis ~40g/day and increased once dialysis starts
What are the medications used to prevent renal failure?
ACE inhibitors - slow progression of kidney disease
ARBs - “sartans” treat high BP
BB - help increase cardiac output to avoid HF
CCB- improve GFR & blood flow to the kidneys
What is the desired outcome for lasix?
Increased urinary output
Decreased urinary retention
No crackles in lungs, reduced SHOB, lowered BP, decrease weight (no fluid overload)
What are the signs of worsening renal failure?
Kussmaul respirations
Decreased GFR
Creatinine trending up
What’s the priority assessment for patient with hyperkalemia?
monitor for cardiac issues!!!
Dysrhythmias
What disorders can lead to pre-renal failure?
Shock/hemorrhage (hypovolemia)
Severe burns
HYPOtension/cardiac damage
atheroscolerosis
Anything that blocks blood flow to kidneys
** reduced or impaired cardiac output which impacts the kidneys
What does respiratory distress look like in patients with RF?
Crackles, SHOB, suspense, increased RR, Kussmaul breathing
Why does respiratory distress happen in patients with RF?
Fluid volume overload
or Kussmaul -> metabolic acidosis
What do you do for RF patient with respiratory distress?
diuretics
raise HOB
O2
monitor
Kussmaul- raise HOB and give O2
What is epogen?
Used for anemia treatment due to CKD
Why do patients with CRF need epogen?
Helps the body create more RBCs because damaged kidneys aren’t making erythropoietin
How to prevent worsening renal failure?
Monitor I’s & O’s
DW & daily BPs
Fluid restrictions
Medications: ACE, ARBs, BB
reduce: potassium, protein, sodium, phosphorus
Dialysis
Supplements
Avoid IV contrast, NSAIDs, other renals meds- metformin
What is post renal failure?
physical obstruction
-kidney stones
-bladder cancer
-prostate cancer/BPH
Who is at risk for post renal failure?
women with blood clots in urine
patients with prostate or bladder cancer
What should be assessed with an AV fistula?
feel the thrill and listen for bruit Q4 hours
assess distal pulses
assess for signs on infection
avoid putting pressure on the site
What are possible complications of AV fistulas?
thrombosis -> tPA
stricture-> balloon angioplasty
infection-> sterile
ischemia-> new fistula
What is the relationship between HF and ARF?
poor cardiac output
What are the goals between HF and ARF
improve cardiac output!
digoxin can do this
What is CRRT?
continuous renal replacement therapy
only used in emergencies and on unstable patients
used to avoid large volume shifts but provides same results
need a 1:1 ratio in ICU
run over 24 hours
Priority assessment finding during CRRT?
blood pressure
keep SBP > 90
Kidney Transplant Education
What are the priority assessment for patients with thrombocytopenia?
excessive risk for bleeding
look for bruises, petechiae, purpura and mucous membrane bleeding
microclots-> can cause the ischemia to kidney, cardiac, brain
What are the platelet amount for increased risk of bleeding?
<50,000
What are the platelet amount for increased spontaneous bleeding?
<20,000
Relevance of leukemia and high WBCs?
risk for infection -> neutropenic precautions
HANDWASHING
no roomies
aseptic technique
pulmonary hygiene
skin care
no sick people allowed
What is pancytopenia?
Deficiency in all so RBCs, WBCs, platelets
RBC value
4-6 million
WBC value
4,500- 11,000
platelet value
150k to 450k
What is auto-contamination in patients at high risk of infection
overgrowth of normal flora which can lead to sepsis in immunocompromised
**change gloves between wound care
What are the priorities in reducing infection in patients at risk for infection?
Handwashing
aseptic technique
pulmonary hygiene
skin care
neutropenic precautions
Lymphoma assessment findings
Typically asymptomatic
enlarged painless lymph node/s
B symptoms =poorer prognosis
-night sweats, losing weight, high fever
Lymphoma education
HL- Reed-Sternberg cells
-more predictable
NHL- no Reed-Sternberg cells
-less predictable
What are risk factors for lymphoma?
immune system issues (organ transplant, immunosuppressed, HIV)
chronic infection
exposure to dust, pesticides & insecticides
What are the priorities for low platelets?
bleeding precautions -> anemia
What is the importance of hydration with MM?
fluid imbalances?????
excretion of excessive amounts of antibodies which are proteins
too much proteins clog up blood vessels
Normal prealbumin levels
16 to 35
What is the importance of urinary output with burns?
monitor fluid balance- dehydration = increased risk r/t burns
tells us if the kidneys are working
Assessment of breathing, airway patency in burns
PROTECT THE AIRWAY!!!
ABCs
intubate in large burns
dehydrate = airway edema may occur after fluid given
Interventions/ priorities for difficulty breathing
protect the airway
intubate
apply O2, raise HOB, SpO2 monitor
What are the priority lab findings for patients with burns
airway??
Response for low urinary output in burn victims
Flush the foley because stuff gets stuck :(
Risk of burns/ prevention
smoke detectors
adjust hot water
turn pot handles away from reach
safe use oxygen
electrical
chemical
Calculate TBSA
rule of nines
Calculate fluid administration for patients with burns
2mg x kg x TBSA % /2 then split into how many hours
Name this burn:
redness, mild edema, only epidermis
superficial- thickness
Name this burn:
blanchable, blisters, pink, moist pain
superificial partial
Name this burn:
no blisters, moist, blanchable, wet, painful red
deep partial
Name this burn:
dry, leathery, white, black or brown, no blanching, painless
full thickness
Name this burn:
bone, tendon and muscle included
4th degree
What are standard orders for DKA?
Name this burn zone:
Dead
maybe how you feel but the right answer is zone of coagulation
Name this burn zone:
dead vs alive
zone of stasis
Name this burn zone:
alive
zone of hyperemia
What is the common chemical used in burn dressings
Silver or Ag
What are the surgical indications for burns?
zone of coagulation so dead
full thickness burn
4th degree burn
How to reduce burn convresion
1st 72 hours
-proper fluids
-good nutrition
-early mobilization
-avoid hypothermia
Why is it important to reduce the zone of stasis?
once tissue dies - > need surgery so the goal is to have the body heal itself
What are the criteria for ICU admission for burns?
intubation
TBSA >20 %
fluid resuscitation
escharotomies
medical comorbidities
Normal creatinine
0.6- 1.2
BUN
7-20
Hemoglobin
12-18
Hct
36-54
Sodium
135-145
Albumin
3.4-5.4
Prealbumin
15-36
