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Med Surg 2 > Blue Print > Flashcards

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1
Q

How to assess whether protein intake is sufficient for patients with CKD?

A

BUN and serum prealbumin levels
-want low protein before dialysis ~40g/day and increased once dialysis starts

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2
Q

What are the medications used to prevent renal failure?

A

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

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3
Q

What is the desired outcome for lasix?

A

Increased urinary output
Decreased urinary retention
No crackles in lungs, reduced SHOB, lowered BP, decrease weight (no fluid overload)

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4
Q

What are the signs of worsening renal failure?

A

Kussmaul respirations
Decreased GFR
Creatinine trending up

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5
Q

What’s the priority assessment for patient with hyperkalemia?

A

monitor for cardiac issues!!!
Dysrhythmias

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6
Q

What disorders can lead to pre-renal failure?

A

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

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7
Q

What does respiratory distress look like in patients with RF?

A

Crackles, SHOB, suspense, increased RR, Kussmaul breathing

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8
Q

Why does respiratory distress happen in patients with RF?

A

Fluid volume overload

or Kussmaul -> metabolic acidosis

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9
Q

What do you do for RF patient with respiratory distress?

A

diuretics
raise HOB
O2
monitor

Kussmaul- raise HOB and give O2

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10
Q

What is epogen?

A

Used for anemia treatment due to CKD

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11
Q

Why do patients with CRF need epogen?

A

Helps the body create more RBCs because damaged kidneys aren’t making erythropoietin

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12
Q

How to prevent worsening renal failure?

A

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

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13
Q

What is post renal failure?

A

physical obstruction
-kidney stones
-bladder cancer
-prostate cancer/BPH

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14
Q

Who is at risk for post renal failure?

A

women with blood clots in urine
patients with prostate or bladder cancer

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15
Q

What should be assessed with an AV fistula?

A

feel the thrill and listen for bruit Q4 hours
assess distal pulses
assess for signs on infection
avoid putting pressure on the site

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16
Q

What are possible complications of AV fistulas?

A

thrombosis -> tPA
stricture-> balloon angioplasty
infection-> sterile
ischemia-> new fistula

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17
Q

What is the relationship between HF and ARF?

A

poor cardiac output

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18
Q

What are the goals between HF and ARF

A

improve cardiac output!
digoxin can do this

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19
Q

What is CRRT?

A

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

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20
Q

Priority assessment finding during CRRT?

A

blood pressure
keep SBP > 90

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21
Q

Kidney Transplant Education

A
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22
Q

What are the priority assessment for patients with thrombocytopenia?

A

excessive risk for bleeding
look for bruises, petechiae, purpura and mucous membrane bleeding
microclots-> can cause the ischemia to kidney, cardiac, brain

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23
Q

What are the platelet amount for increased risk of bleeding?

A

<50,000

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24
Q

What are the platelet amount for increased spontaneous bleeding?

A

<20,000

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25
Q

Relevance of leukemia and high WBCs?

A

risk for infection -> neutropenic precautions
HANDWASHING
no roomies
aseptic technique
pulmonary hygiene
skin care
no sick people allowed

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26
Q

What is pancytopenia?

A

Deficiency in all so RBCs, WBCs, platelets

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27
Q

RBC value

A

4-6 million

28
Q

WBC value

A

4,500- 11,000

29
Q

platelet value

A

150k to 450k

30
Q

What is auto-contamination in patients at high risk of infection

A

overgrowth of normal flora which can lead to sepsis in immunocompromised
**change gloves between wound care

31
Q

What are the priorities in reducing infection in patients at risk for infection?

A

Handwashing
aseptic technique
pulmonary hygiene
skin care
neutropenic precautions

32
Q

Lymphoma assessment findings

A

Typically asymptomatic
enlarged painless lymph node/s
B symptoms =poorer prognosis
-night sweats, losing weight, high fever

33
Q

Lymphoma education

A

HL- Reed-Sternberg cells
-more predictable

NHL- no Reed-Sternberg cells
-less predictable

34
Q

What are risk factors for lymphoma?

A

immune system issues (organ transplant, immunosuppressed, HIV)
chronic infection
exposure to dust, pesticides & insecticides

35
Q

What are the priorities for low platelets?

A

bleeding precautions -> anemia

36
Q

What is the importance of hydration with MM?

A

fluid imbalances?????
excretion of excessive amounts of antibodies which are proteins
too much proteins clog up blood vessels

37
Q

Normal prealbumin levels

A

16 to 35

38
Q

What is the importance of urinary output with burns?

A

monitor fluid balance- dehydration = increased risk r/t burns
tells us if the kidneys are working

39
Q

Assessment of breathing, airway patency in burns

A

PROTECT THE AIRWAY!!!
ABCs
intubate in large burns
dehydrate = airway edema may occur after fluid given

40
Q

Interventions/ priorities for difficulty breathing

A

protect the airway
intubate
apply O2, raise HOB, SpO2 monitor

41
Q

What are the priority lab findings for patients with burns

A

airway??

42
Q

Response for low urinary output in burn victims

A

Flush the foley because stuff gets stuck :(

43
Q

Risk of burns/ prevention

A

smoke detectors
adjust hot water
turn pot handles away from reach
safe use oxygen
electrical
chemical

44
Q

Calculate TBSA

A

rule of nines

45
Q

Calculate fluid administration for patients with burns

A

2mg x kg x TBSA % /2 then split into how many hours

46
Q

Name this burn:
redness, mild edema, only epidermis

A

superficial- thickness

47
Q

Name this burn:
blanchable, blisters, pink, moist pain

A

superificial partial

48
Q

Name this burn:
no blisters, moist, blanchable, wet, painful red

A

deep partial

49
Q

Name this burn:
dry, leathery, white, black or brown, no blanching, painless

A

full thickness

50
Q

Name this burn:
bone, tendon and muscle included

A

4th degree

51
Q

What are standard orders for DKA?

A
52
Q

Name this burn zone:
Dead

A

maybe how you feel but the right answer is zone of coagulation

53
Q

Name this burn zone:
dead vs alive

A

zone of stasis

54
Q

Name this burn zone:
alive

A

zone of hyperemia

55
Q

What is the common chemical used in burn dressings

A

Silver or Ag

56
Q

What are the surgical indications for burns?

A

zone of coagulation so dead
full thickness burn
4th degree burn

57
Q

How to reduce burn convresion

A

1st 72 hours
-proper fluids
-good nutrition
-early mobilization
-avoid hypothermia

58
Q

Why is it important to reduce the zone of stasis?

A

once tissue dies - > need surgery so the goal is to have the body heal itself

59
Q

What are the criteria for ICU admission for burns?

A

intubation
TBSA >20 %
fluid resuscitation
escharotomies
medical comorbidities

60
Q

Normal creatinine

A

0.6- 1.2

61
Q

BUN

A

7-20

62
Q

Hemoglobin

A

12-18

63
Q

Hct

A

36-54

64
Q

Sodium

A

135-145

65
Q

Albumin

A

3.4-5.4

66
Q

Prealbumin

A

15-36

Med Surg 2 (10 decks)

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