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Role Transition > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Proteinuria due to
Chronic renal failure can cause
Normal BUN
Creatinine
GFR

A
  • glomerulus defect
  • chronic anemia due to decreased erythropoietin
  • 8 to 25
  • 0.6 to 1.3
  • 90
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2
Q

Urinalysis interventions
WBC in urine indicate

A
  • clean front to back & collect midstream
  • UTI
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3
Q

Intravenous pyelogram IVP
Preprocedure
Cytoscopy & bladder biopsy pre
Post procedure
Renal biopsy preprocedure
Post biopsy

A
  • used for someone with recurrent infections
  • Dye allergies, NPO, expect flushing & salty taste
  • NPO night before, enemas
  • pink-tinged urine is common, bright red urine & blood clots not common
  • clotting studies (PT, PTT, INR)
  • supine bedrest 8Hrs, pressure to site for 30min, avoid lifting 2 weeks
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4
Q

Disorders to push fluids
Disorders to hold fluids

A
  • infections, kidney stones, cystitis, pyelonephritis
  • chronic renal failure, glomuleronephritis, nephrotic syndrome
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5
Q

UTI is
Manifestations
Interventions
Preventing UTI

A

Inflammation of bladder also known as cystitis
- dysuria, cloudy, urgency, frequency, foul odor, Suprapubic pressure
- urine culture is gold standard test, increase fluid intake 3L per day
- void 2-3hrs, perineal care wipe front to back, no bubble baths, void after intercourse, cotton pants, vaginal creams in menopause

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6
Q

Urosepsis most common organism
Manifestations
Interventions

Urethritis assessment
Interventions

A
  • E. coli
  • Fever, altered mental status
  • Give IV antibiotics & send urine culture
  • burning with urination, frequency & urgency
  • test for STDs (no symptoms w chlamydia)
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7
Q

Pyelonephritis common cause
Manifestations
Interventions

A
  • ascending infection from a previous untreated UTI
  • UTI symptoms + high fever, flank pain, CVA TENDERNESS
  • fluids, antibiotics, pain meds, antiemetic
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8
Q

Glomerulonephritis is
Complications
Clinical manifestations
Interventions

A
  • destruction & inflammation of glomeruli caused by untreated strep (pharyngitis or tonsillitis 2-3weeks prior)
  • low urine output, fluid overload, High BP
  • Hematuria (main ID), proteinuria, crackles, Low GFR, high BUN & Cr
  • fluid restriction, I&Os, daily weight, avoid NSAIDS & vancomycin
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9
Q

Nephrotic syndrome assessment
Interventions

Hydronephrosis can lead to
Assessment
Interventions

A
  • proteinuria, hypoalbuminemia, Hyperlipidemia, anemia, edema
  • bedrest, low protein diet, fluid restriction
  • renal failure due to obstruction of urine flow
  • HTN, headache, flank pain
  • monitor for diuresis, push fluid to flush stone out
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10
Q

Polysistic kidney disease leads to
Interventions

A
  • renal failure
  • cyst rupture, drain abscesses, prepare for dialysis or transplant
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11
Q

Urolithiasis & nephrolithiasis is
Manifestations
Complications of obstruction
Best test
Causes
Interventions

A
  • formation of calculi or stones
  • sudden onset of severe flank pain, dysuria, nausea
  • hydronephrosis, renal failure, infection
  • computed tomography CT, size & location of stone
  • family Hx, purine rich diet, calcium diet, dehydration, uric acid
  • pain meds, flomax to dilate ureters, strain all urine, do not massage flank area
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12
Q

Prostatitis manifestations
Interventions
BPH after age 50
BPH can cause
Surgical procedure for BPH
Post op & return quality

A
  • fever, chills, dysuria, boggy prostate, hematuria
  • antibiotics, analgesics, masturbation, prostate massage
  • pt should be screened for prostate cancer
  • Postrenal failure due to obstruction
  • Transurethral resection of the prostate (TURP)
  • continuous bladder irrigation to prevent clot formation, returns should be red to pink; report bright red clots STAT
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13
Q

Kidney transplantation watch out for
Interventions for rejection
Education

A
  • gross hematuria, blood clots, graft rejection; fever, malaise, WBC count, deteriorating renal fxn, anemia
  • removal of kidney, high doses of corticosteroids, immunosuppressive meds
  • avoid contact sports, avoid exposure to people with infections, immunosuppressive therapy for life
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14
Q

Prerenal failure causes
Intrarenal causes
Postrenal causes

A
  • decreased perfusion, vascular failure, Hypovolemia
  • tubular necrosis, nephrotoxicity
  • obstruction of outflow
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15
Q

Acute renal failure is
Causes
Oliguric phase
Diuretic phase
Recovery phase

A
  • sudden loss of kidney function, reversible
  • infection, obstruction, dehydration, ischemia, toxic substances
  • 8-15 days, GFR decreases, oliguria, HTN, elevated BUN & Cr
  • GFR increases, urine output rises & then diuresis, loss of electrolytes, decline in BUN & Cr
  • 1-2 years, normal urine volume, increase in strength, BUN stable, can develop chronic renal failure
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16
Q

Chronic renal failure is
Stage 1: diminished renal reserve
Stage 2: renal insufficiency
Stage 3: end stage
Causes
Manifestations

A
  • irreversible damage & results in end stage renal disease
  • reduced renal fxn, healthier kidney compensates, nocturia & polyuria, no accumulation of metabolic waste
  • metabolic wastes accumulate, oliguria & edema occur
  • excessive accumulation of metabolic wastes, kidneys can’t maintain homeostasis, dialysis is required
  • ARF, chronic obstruction, recurrent infections, HTN, metabolic disorders
  • kussmaul respirations, muscle twitching, anorexia, confusion & lethargy, oliguria, proteinuria, azotemia, uremic frost, fluid overload
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17
Q

Special problems in renal failure

A

Hypocalcemia
Hyperkalemia (peaked T, wide QRS)
HTN
Hyper or Hypovolemia
Metabolic acidosis
Neuro changes
Muscle cramps
Anemia

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18
Q

Hypocalcemia in renal failure leads to
Treating anemia
Hemodialysis preferred access
Hemodialysis interventions

A
  • secondary hyperparathyroidism due to compensation
  • always hang blood with NS, if adverse rxn - stop infusion, change tubing & send to lab
  • AV fistula ; auscultate for bruit & palpate for thrill to assess patency
  • weigh before & after, hold BP drugs day of dialysis
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19
Q

Disequilibrium syndrome is
Manifestations
Interventions

A
  • common in 1st dialysis: removing too much fluid too fast causes altered LOC; decrease rate of dialysis
  • restlessness, confusion, seizure, HTN, headache
  • decrease rate of dialysis, notify physician,
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20
Q

AV shunt advantages
Disadvantages
AV fistula advantages
Disadvantages
Interventions for fistula & graft

A
  • can be used immediately, no venipuncture
  • external danger of dislodging, risk for infection or hemorrhage
  • access of choice, less danger of clotting or hemorrhage, used indefinitely, decreased infection
  • takes 4-6 weeks before use, arterial steal syndrome (hand discolored & decreased capillary refill), needle insertion required
  • don’t measure BP or place IV on affected arm, monitor for infection & steal syndrome, palpate pulses, thrill & bruits,
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21
Q

Peritoneal dialysis if outflow is insufficient
Inflow, dwell time, outflow
Peritonitis signs
Characteristics of outflow

A
  • change position of patient (side to side, or sit upright)
  • warmed dialysate, inflow bag higher than abdomen, hang 4-8hrs, outflow bag lower than abdomen lvl
  • fever, board like rigid abdomen, guarding, tenderness
  • during 1st exchanges may be bloody, should be clear after (brown = bowel perforation) (urine color = bladder perforation) (cloudy = peritonitis)
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22
Q

Hypopituitarism is
Interventions
Hyperpituitarism is
Interventions
What is hypophysectomy & complications
Post-op

A
  • insufficient growth hormone, resulting in delayed growth & development
  • administer human growth hormone replacement
  • excess growth hormone : gigantism (before epiphyseal plates close) or acromegaly (after closure of epiphyseal plates)
  • skin care, help with ambulation, hypophysectomy
  • removal of pituitary ; increased ICP, bleeding, meningitis
  • elevate HOB, neuro exams, monitor post-nasal drip (halo ring & glucose in CSF), glucocorticoids
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23
Q

Posterior pituitary hypofunction
Signs
Interventions

Hyperfunction
Signs
Interventions

A
  • deficiency of ADH leads to diabetes insipidus
  • fluid volume deficit, high osmolality, low specific gravity, polyuria, thirst, poor turgor, weight loss
  • hypotonic fluids, check Na, Desmopressin & vasopressin
  • oversecretion of ADH results in SIADH
  • fluid volume excess, Hyponatremia, HTN
  • fluid restriction, daily weight, diuretics, hypertonic fluids, seizure precautions
24
Q

Thyroid gland hormones
TSH levels
Hashimoto is
Graves’ disease is
Manifestations

A
  • T3 & T4 elevated in hyperthyroidism & decreased in hypothyroidism
  • increased in hypothyroidism & decreased in hyperthyroidism
  • autoimmune disease & common cause of hypothyroidism
  • common cause of hyperthyroidism
  • exopthalmus, goiter (enlarged thyroid), HTN, palpitations, weight loss, heat intolerance
25
Q

Hyperthyroidism treatment
Thyroid storm causes
Manifestations
Thyroidectomy post op

A
  • radioactive iodine, thyroidectomy
  • untreated hyperthyroidism; precipitated by stress, infection,
    trauma
  • high fever, tachycardia, angina, agitation, restlessness, high mortality rate
  • patent airway, laryngeal spasms (calcium gluconate at bedside), semi-Fowler
26
Q

Hypothyroidism signs
Interventions
Myxedema coma is
Interventions

A
  • fatigue, lethargy, weight gain, constipation, edema
  • hormone replacement (levothyroxine), low carb & protein meals
  • life threatening hypothyroidism (coma, hypothermia, CV collapse, hypoglycemia, lactic acidosis)
  • patent airway, give IV fluids glucose & synthroid, monitor for AMS
27
Q

Hypoparathyroidism assessment
Interventions
Hyperparathyroidism assessment
Interventions
What leads to secondary Hyperparathyroidism

A
  • hypocalcemia & hyperphosphatemia; tetany, hypotension, laryngeal spasm, trousseaus & chvosteks
  • seizure precautions, IV calcium gluconate, Vitamin D, phosphate binders
  • hypercalcemia & low phosphate; pathological fractures, anorexia, weight loss, HTN, kidney stones
  • don’t give thiazide diuretics give furosemide, give calcitonin to prevent bone breakdown, encourage fluids
  • end stage renal failure
28
Q

Adrenal cortex produces
Aldosterone
Cortisol
Medulla produces

A
  • cortisol & aldosterone
  • retain sodium & water, excrete potassium
  • minor retention of sodium & water, decrease potassium
  • epi & norepinephrine ; vessel construction & increased HR (severe HTN in Pheochromocytoma)
29
Q

Addison’s disease is
Manifestations
Treatment
How should you stop steroids
Addisonian crisis signs

A
  • decreased levels of cortisol (hypocorticolism)
  • orthostatic hypo, confusion, weakness, lethargy, arrhythmias
  • cortisone replacement, high carb & protein diet
  • gradual withdraw of steroids
  • severe headache & abdominal pain, shock, severe hypotension
30
Q

Cushing syndrome is
Signs
Treatment

A
  • increased levels of cortisol
  • hyperglycemia, moon face & Buffalo humps, mood swings, bruising & petechiae, thin & wasted muscles, osteoporosis
  • removal of tumors, manage diabetes & HTN
31
Q

Hyperaldosteronism is & known as
Assessment
Treatment
Pheochromocytoma is
Signs
Interventions
Post op adrenalectomy

A
  • excessive secretion of aldosterone; known as Conn’s syndrome
  • fluid volume excess, hypokalemia, metabolic alkalosis (paresthesia)
  • reduce BP, correct hypokalemia, adrenalectomy, spironolactone
  • catecholamime producing tumor
  • exaggerated fight or flight, severe HTN, tremors
  • control BP, remove tumor
  • reverse isolation: protect patient from others, administer glucocorticoids
32
Q

Type 1 diabetes
Type 2 diabetes
Exercise
Diagnostic criteria for diabetes

A
  • autoimmune destruction of B cells in pancreas (younger & lean)
  • insufficient production of insulin, insensitivity to insulin, excessive production of glucose by liver (older & obese)
  • if glucose is >250 & ketones present; do not exercise
  • 3P’s & casual glucose > 200 / fasting glucose > 126 / A1C > 6.5%
33
Q

Metformin (biguanides)
Main adverse rxn
Glipizide (sulfonylurea)
Precaution & adverse
Onset & peak

A
  • decreases production of glucose, does not increase insulin secretion (no hypoglycemia)
  • lactic acidosis
  • stimulates insulin secretion from beta cells (hypoglycemic effect)
  • precaution in pregnancy, hypoglycemia & weight gain
  • 1-2 hours
34
Q

Rapid acting: onset & peak
Regular insulin
Insulin lispro
Insulin aspart

Intermediate acting
Long acting

A
  • onset 0.5-1hr / peak 2.5-5 hrs
  • onset 0.25-0.5hr / peak 0.5-1.5 hrs
  • onset 0.17-0.33 hr / peak 1-3 hrs
  • NPH onset 1-1.5 hr / peak 6-14hrs
  • insulin glargine: onset 1.1 Hr
35
Q

Dawn phenomenon / treatment
Somogyi phenomenon / treatment

A
  • Hyperglycemia in middle of night & AM hyperglycemia / evening dose of intermediate acting insulin
  • hypoglycemia in middle of night & AM hyperglycemia / bedtime snack
36
Q

Hypoglycemia treatment unconscious
If patient can swallow
DKA
Manifestation
Interventions

A
  • give a glucagon injection
  • give orange juice or candy
  • life threatening complication in severe insulin deficiency, glucose of 300 - 800
  • acidosis, ketosis, kussmaul respirations, polyuria, dehydration, hypokalemia
  • rapid IV infusion for dehydration, IV regular insulin, correct potassium level
37
Q

HHNKS is
Diabetic nephropathy
Interventions

A
  • extreme hyperglycemia without ketosis & acidosis
  • decrease in kidney function; weight loss, fatigue, anemia, neurogenic bladder
  • control HTN, restrict protein sodium & potassium, prepare for dialysis or kidney transplant
38
Q

Normal cells
Cancer cells

A
  • regulates growth, designated appearance, small nucleus, specific function, don’t migrate, tightly bound
  • poorly controlled growth, lose designated appearance, large or multiple nuclei, lose function, migrate
39
Q

Breast cancer metastasized to
Lung cancer
Colorectal
Prostate

A
  • bone, lung, brain, liver
  • brain, liver
  • liver
  • bone, spine, lung, liver, kidneys
40
Q

Risk factors for cancer

A

Chemicals & drugs
Obesity
Nutrition
High alcohol intake
Radiation (UV also)
Smoking
Viruses & bacteria

41
Q

Warning signs of cancer
C
A
U
T
I
O
N

A

Change in bowel or bladder habits
Any sore that doesn’t heal
Unusual bleeding or discharge
Thickening or lumps
Indigestion
Obvious change of wart or mole
Nagging cough or hoarseness

42
Q

Side effects of chemo
Nursing interventions

A
  • immunosuppresion, anemia & thrombocytopenia
  • monitor CBCs, platelets & WBCs, bleeding precautions, high calorie diet, no raw foods or flowers, avoid crowds
43
Q

Radiation therapy is
External is
Education
Internal is
Sealed
If radiation implant dislodges

A
  • destruction of cancer cells directly in path of radiation beam
  • teletherapy ; client does not emit radiation or pose risk to others
  • wash area with soap & water, don’t use lotion or cream, wear soft clothing, avoid sun & heat
  • brachytherapy
  • radiation source implanted; private room, minimize nurses exposure to radiation (wear lead shield)
  • don’t touch dislodged radiation (use forceps & place in lead container
44
Q

Leukemia manifestations
Patient precautions

A
  • anemia, leukopenia, thrombocytopenia (bleeding), anorexia & fatigue, bone pain, immunosuppression
  • bleeding precautions & protective isolation precautions
45
Q

Hodgkin’s lymphoma
Non-Hodgkin’s

A
  • involves single chain of lymph nodes & Reed-sternberg cells are present
  • effects more widespread lymph nodes (worse prognosis)
46
Q

Multiple myeloma is
Monitor for

A
  • malignancy of bone marrow with presence of bence Jones protein & includes increased uric acid & calcium
  • renal failure due to increased uric acid
47
Q

Ovarian cancer has
Pancreatic cancer manifestations
Risk factors for colorectal cancer

A
  • poor prognosis due to late detection
  • jaundice, clay colored stools, abdominal pain, glucose intolerance ; symptoms are late
  • older than 50, colorectal polyps, Hx of bowel disease, ovarian & breast cancer
48
Q

Frontal lobe
Parietal lobe
Temporal
Occipital

A
  • intellectual functions (Broca’s area for speech)
  • sensory
  • auditory (wernicke’s area got reception)
  • vision
49
Q

Normal ICP & causes of Increased
What is CPP
Signs of increased ICP
What is Cushing’s triad
Interventions

A
  • 5-15 / hematoma, coughing, suctioning, edema, seizures, PEEP
  • pressure needed to perfuse brain cells / MAP - ICP = CPP
  • change in LOC, dilated pupils, posturing, severe headache, Cushing’s triad
  • Increased BP, bradycardia, decreased respiration (Cheyenne stokes)
  • elevate HOB, avoid coughing & straining, mannitol or 3% NS, VP shunt
50
Q

Spinal shock occurs / signs
Autonomic dysreflexia manifestation
Triggered by
Interventions

A
  • immediately after injury / hypotension, bradycardia, flaccid paralysis, urinary retention
  • above T6; flushing & diaphoresis, severe HTN, bradycardia, pupil dilation
  • urinary retention or constipation
  • elevate HOB, monitor HTN, assess urine output
51
Q

Myasthenia gravis is
Signs
Ice test
Myasthenic crisis
Cholinergic crisis

A
  • destruction of acetylcholine receptors leading to muscle weakness
  • ptosis, dysarthria, drooling, resp depression
  • put ice on face, if ptosis improved it is positive
  • muscle weakness, SOB, difficulty swallowing, risk for respiratory arrest
  • SLUDGE, pt looks wet, salivation, lacrimation, diarrhea, urination, sweating (due to ach drug toxicity)
52
Q

Parkinson’s disease due to
Signs
Medication

A
  • deficient dopamine
  • Tremor, Rigidity, Akinesia, Postural instability
  • levodopa-Carbidopa (MUST be given at same time everyday to prevent on/off phenomena)
53
Q

Meningitis caused by
Signs
Kernigs
Brudzinskis
CSF in bacterial
CSF in viral

A
  • infections or toxins
  • neck stiffness, photophobia, fever, headache, petechiae rash, change LOC
  • can’t extend knee w hip flexed
  • neck flexion causes knee flexion

Bacterial : cloudy fluid, with decreased glucose & elevated CSF pressure

Viral: clear fluid, with normal glucose & normal CSF pressure

54
Q

Ischemic stroke
Risk factors
Hemorrhagic stroke causes

A

Thrombotic (atherosclerosis plaque) or embolic (embolus)
- A fib, MI, valve replacement, HTN, atherosclerosis, smoking
- HTN & weakening of vessels, ruptured aneurysm, head trauma

55
Q

Left side stroke effects
Right side

A
  • aphasia, Alexia, agraphia, slow cautious behavior, depression, right side defects
  • no depth perception, disorientation, impulsiveness, poor judgement, left side defects
56
Q

Hypokalemia in
Hyperkalemia in
Acidosis in
Alkalosis

A
  • Hyperaldosteronism, DKA, HHNKS
  • renal failure
  • DKA, HHNKS, Metformin, hyperthyroidism, renal failure
  • Hyperaldosteronism

Role Transition (3 decks)

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