Exam 2 Flashcards
Proteinuria due to
Chronic renal failure can cause
Normal BUN
Creatinine
GFR
- glomerulus defect
- chronic anemia due to decreased erythropoietin
- 8 to 25
- 0.6 to 1.3
- 90
Urinalysis interventions
WBC in urine indicate
- clean front to back & collect midstream
- UTI
Intravenous pyelogram IVP
Preprocedure
Cytoscopy & bladder biopsy pre
Post procedure
Renal biopsy preprocedure
Post biopsy
- 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
Disorders to push fluids
Disorders to hold fluids
- infections, kidney stones, cystitis, pyelonephritis
- chronic renal failure, glomuleronephritis, nephrotic syndrome
UTI is
Manifestations
Interventions
Preventing UTI
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
Urosepsis most common organism
Manifestations
Interventions
Urethritis assessment
Interventions
- E. coli
- Fever, altered mental status
- Give IV antibiotics & send urine culture
- burning with urination, frequency & urgency
- test for STDs (no symptoms w chlamydia)
Pyelonephritis common cause
Manifestations
Interventions
- ascending infection from a previous untreated UTI
- UTI symptoms + high fever, flank pain, CVA TENDERNESS
- fluids, antibiotics, pain meds, antiemetic
Glomerulonephritis is
Complications
Clinical manifestations
Interventions
- 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
Nephrotic syndrome assessment
Interventions
Hydronephrosis can lead to
Assessment
Interventions
- 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
Polysistic kidney disease leads to
Interventions
- renal failure
- cyst rupture, drain abscesses, prepare for dialysis or transplant
Urolithiasis & nephrolithiasis is
Manifestations
Complications of obstruction
Best test
Causes
Interventions
- 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
Prostatitis manifestations
Interventions
BPH after age 50
BPH can cause
Surgical procedure for BPH
Post op & return quality
- 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
Kidney transplantation watch out for
Interventions for rejection
Education
- 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
Prerenal failure causes
Intrarenal causes
Postrenal causes
- decreased perfusion, vascular failure, Hypovolemia
- tubular necrosis, nephrotoxicity
- obstruction of outflow
Acute renal failure is
Causes
Oliguric phase
Diuretic phase
Recovery phase
- 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
Chronic renal failure is
Stage 1: diminished renal reserve
Stage 2: renal insufficiency
Stage 3: end stage
Causes
Manifestations
- 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
Special problems in renal failure
Hypocalcemia
Hyperkalemia (peaked T, wide QRS)
HTN
Hyper or Hypovolemia
Metabolic acidosis
Neuro changes
Muscle cramps
Anemia
Hypocalcemia in renal failure leads to
Treating anemia
Hemodialysis preferred access
Hemodialysis interventions
- 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
Disequilibrium syndrome is
Manifestations
Interventions
- 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,
AV shunt advantages
Disadvantages
AV fistula advantages
Disadvantages
Interventions for fistula & graft
- 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,
Peritoneal dialysis if outflow is insufficient
Inflow, dwell time, outflow
Peritonitis signs
Characteristics of outflow
- 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)
Hypopituitarism is
Interventions
Hyperpituitarism is
Interventions
What is hypophysectomy & complications
Post-op
- 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
Posterior pituitary hypofunction
Signs
Interventions
Hyperfunction
Signs
Interventions
- 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
Thyroid gland hormones
TSH levels
Hashimoto is
Graves’ disease is
Manifestations
- 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
Hyperthyroidism treatment
Thyroid storm causes
Manifestations
Thyroidectomy post op
- 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
Hypothyroidism signs
Interventions
Myxedema coma is
Interventions
- 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
Hypoparathyroidism assessment
Interventions
Hyperparathyroidism assessment
Interventions
What leads to secondary Hyperparathyroidism
- 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
Adrenal cortex produces
Aldosterone
Cortisol
Medulla produces
- cortisol & aldosterone
- retain sodium & water, excrete potassium
- minor retention of sodium & water, decrease potassium
- epi & norepinephrine ; vessel construction & increased HR (severe HTN in Pheochromocytoma)
Addison’s disease is
Manifestations
Treatment
How should you stop steroids
Addisonian crisis signs
- 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
Cushing syndrome is
Signs
Treatment
- increased levels of cortisol
- hyperglycemia, moon face & Buffalo humps, mood swings, bruising & petechiae, thin & wasted muscles, osteoporosis
- removal of tumors, manage diabetes & HTN
Hyperaldosteronism is & known as
Assessment
Treatment
Pheochromocytoma is
Signs
Interventions
Post op adrenalectomy
- 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
Type 1 diabetes
Type 2 diabetes
Exercise
Diagnostic criteria for diabetes
- 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%
Metformin (biguanides)
Main adverse rxn
Glipizide (sulfonylurea)
Precaution & adverse
Onset & peak
- 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
Rapid acting: onset & peak
Regular insulin
Insulin lispro
Insulin aspart
Intermediate acting
Long acting
- 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
Dawn phenomenon / treatment
Somogyi phenomenon / treatment
- Hyperglycemia in middle of night & AM hyperglycemia / evening dose of intermediate acting insulin
- hypoglycemia in middle of night & AM hyperglycemia / bedtime snack
Hypoglycemia treatment unconscious
If patient can swallow
DKA
Manifestation
Interventions
- 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
HHNKS is
Diabetic nephropathy
Interventions
- 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
Normal cells
Cancer cells
- 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
Breast cancer metastasized to
Lung cancer
Colorectal
Prostate
- bone, lung, brain, liver
- brain, liver
- liver
- bone, spine, lung, liver, kidneys
Risk factors for cancer
Chemicals & drugs
Obesity
Nutrition
High alcohol intake
Radiation (UV also)
Smoking
Viruses & bacteria
Warning signs of cancer
C
A
U
T
I
O
N
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
Side effects of chemo
Nursing interventions
- immunosuppresion, anemia & thrombocytopenia
- monitor CBCs, platelets & WBCs, bleeding precautions, high calorie diet, no raw foods or flowers, avoid crowds
Radiation therapy is
External is
Education
Internal is
Sealed
If radiation implant dislodges
- 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
Leukemia manifestations
Patient precautions
- anemia, leukopenia, thrombocytopenia (bleeding), anorexia & fatigue, bone pain, immunosuppression
- bleeding precautions & protective isolation precautions
Hodgkin’s lymphoma
Non-Hodgkin’s
- involves single chain of lymph nodes & Reed-sternberg cells are present
- effects more widespread lymph nodes (worse prognosis)
Multiple myeloma is
Monitor for
- malignancy of bone marrow with presence of bence Jones protein & includes increased uric acid & calcium
- renal failure due to increased uric acid
Ovarian cancer has
Pancreatic cancer manifestations
Risk factors for colorectal cancer
- 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
Frontal lobe
Parietal lobe
Temporal
Occipital
- intellectual functions (Broca’s area for speech)
- sensory
- auditory (wernicke’s area got reception)
- vision
Normal ICP & causes of Increased
What is CPP
Signs of increased ICP
What is Cushing’s triad
Interventions
- 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
Spinal shock occurs / signs
Autonomic dysreflexia manifestation
Triggered by
Interventions
- 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
Myasthenia gravis is
Signs
Ice test
Myasthenic crisis
Cholinergic crisis
- 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)
Parkinson’s disease due to
Signs
Medication
- deficient dopamine
- Tremor, Rigidity, Akinesia, Postural instability
- levodopa-Carbidopa (MUST be given at same time everyday to prevent on/off phenomena)
Meningitis caused by
Signs
Kernigs
Brudzinskis
CSF in bacterial
CSF in viral
- 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
Ischemic stroke
Risk factors
Hemorrhagic stroke causes
Thrombotic (atherosclerosis plaque) or embolic (embolus)
- A fib, MI, valve replacement, HTN, atherosclerosis, smoking
- HTN & weakening of vessels, ruptured aneurysm, head trauma
Left side stroke effects
Right side
- aphasia, Alexia, agraphia, slow cautious behavior, depression, right side defects
- no depth perception, disorientation, impulsiveness, poor judgement, left side defects
Hypokalemia in
Hyperkalemia in
Acidosis in
Alkalosis
- Hyperaldosteronism, DKA, HHNKS
- renal failure
- DKA, HHNKS, Metformin, hyperthyroidism, renal failure
- Hyperaldosteronism
