Exam 3 Flashcards
1) Assessing whether protein intake is sufficient for patient with CRF
- Patients with CRF cannot filter protein, thus leading to build up of waste product in body. Protein restrictions are needed for those who have not undergone dialysis.
- Patients on dialysis can increase protein intake to 1.0-1.2g/kg/day.
2) Medications used to prevent renal damage
Diuretics -> for mild- moderate CRF only. Lasix: decrease amount of fluid in body
Anti- hypertensives-> reduce BP
CCBS: improve bf & GFR
Ace inhibitors: slow progression
BBs: help increase CO to avoid HF
3) What outcomes are best way to assess for Lasix therapy
-> Check daily weight
4) Signs of worsening renal failure
- Wt change of > 2 lbs in a day or > 5lbs in a week.
- Azotemia
-Proteinuria - Oliguria
- decreased GFR
- Anemia
- increases BUN/Creatinine, Na, and K+
- increased phosphorus, decreased Ca
- Vascular calcium deposits
- Uremia
- HTN
5) Priority assessment for patient with hyperkalemia
Assess EKG!!!
- At risk of cardiac dysrhythmias
- Watched for peaked T waves, wide QRS, prolonged PR interval
6) Disorders that can lead to pre-renal failure
Any disorder that affects perfusion (from renal artery -> heart)
- Shock, MI, dehydration
7) Importance of urinary output with burns
UOP is important in monitoring kidney fxn and fluid management in burn patients. Burn pts should be at least outputting more than 30mL/ hr, if not then they need to increase fluids.
8) Assessment of breathing, airway patency in burns
Look for:
- hoarse, metallic, barky cough
- edema
- Monitor SPO2, resp status
- look for uneven chest movement
-
9) Intervention/ priority for difficulty breathing after burns
If difficulty presents:
- Intubate before swelling occurs
- monitor resp status, bronchoscopy, suction, making sure they have equal chest movement, give O2
10) Priority lab findings for patient with burns
- Potassium (Hyper then hypo)
- Sodium (Hyponatremia)
- Acidosis (pH is low)
- RBCs are low
- WBCs are high
- Platelets low or could be high
- Hematocrit is high
- Fibrinogen/ albumin/ globulin is low
11) Response for low urinary output in burn victims
For patients with low urinary outputs: increase fluids by 10% or 100 mL per hour, if they still have low output then initiate colloid rescue and decrease fluids
12) Risks of burns/ prevention (water heaters, smoking, oxygen use, etc…)
Risks: ischemia, tissue hypoxia, resp failure
Prevention: Buy smoke detectors, turn pots handles away from reach, adjust water heater, safe use of oxygen (no smoking!)
13) Autocontamination in patients at high risk of infection (burn patients, cancer)
- Do not use wipes that were used on one part of the body on another part of body.
- High risk of infection!
14) Priorities in reducing infection in patients at risk of infection
- Watch for signs of early signs of infection
-Initiate neutropenic precautions - HANDWASHING
- Avoid cross-contaminations
-monitor WBC - isolation
- don PPE
15) Recognizing respiratory distress in patients with renal failure: What does it look like, why does it happen, what do you do
Patients develop rapid, deep breathing known as Kussmaul respirations, happens because lungs are trying to compensate in metabolic acidosis, you want to monitor safety and resp status. Also listen to lung sounds-> for possible pulmonary edema
- Limit fluid intake, O2 monitoring, give O2, listen to lung sounds
16) What it is epogen and why do patients with CRF need it?
Epogen is also known as EPO-A. It’s a medication to stimulate the kidneys to produce erythropoitin in order to increase RBC’s.
17) Prevention of worsening renal failure (education/ lifestyle changes)
Measure BP’s everyday, Daily wts, Fluid restrictions, K restrictions, Na restrictions, monitor albumin, alter protein intake, dialysis, medications
18) What is post-renal failure and who is at risk?
Post renal failure is caused by an obstruction below the kidneys to the bladder. Anyone who has BPH or bladder cancer.
19) Care of AV fistula: Assess what is normal, when to be concerned
No BP or sticks on fistula arm
- feel for a thrill and listen for bruit Q4hr
-Assess distal pulses
- signs of infection - stay sterile
- avoid pressure
- If ischemia occurs, obtain new fistula
- watch for thrombosis, strictures
20) Heart failure and acute renal failure: What is the relationship and what are goals when a person with HF develops ARF related to the HF?
In heart failure there is decreased CO which in turns leads to decreased perfusion to the kidneys causing AKI.
Goals: Improve Blood flow to kidneys by increase cardiac output by giving BBs, antihypertensives, CCBs
21) What is CRRT?
-CRRT is dialysis for the unstable patient!
- must be done in ICU
-1:1 setting
-24 hours a day
- no hemodynamic shifts
- done with vasopressors
- uses afilter
22) Kidney transplant education
Education surrounding med adherence is very important to avoid rejection.
- Also warn of signs of thrombus (occurs within 2-3 days after surgery, look for decreased UOP)
- Signs of infection ( fever, pain, confusion)
- Signs of rejection (decreased UOP, look at catheter)
23) DKA standard orders
DKA -> 1 L of NS over 1 hour and start insulin
When CBG < 250 -> switch to D5 1/2 NS and add KCL if hypokalemic, seize insulin use
24) Calculate fluid for a patient with burn using Parkland Formula
2cc/kg/TBSA= total amount / 2
1st half in 8 hours
2nd half in 16 hours
25) Priority assessment findings for patient with thrombocytopenia
- observe for signs of bleeding
- monitor platelet count
26) Relevance of leukemia and high WBC’s (but still at high risk of infection)
Leukemia -> proliferation of immature WBCs leading to decreased immunity.
27) What is pancytopenia?
Low platelets, low WBCs, Low RBCs
28) Lymphoma assessment findings
- enlarged lymph nodes
- Presence of Reed-Steinberg cells in Hodgkins
- Night sweats
- Fever
-Wt loss of 10% or more in 6 months
29) Lymphoma education
Managing risk associated with pancytopenia
- Also have patients manage condition as they are at greater risk of developing secondary cancers
30) Low platelet priorities
- Advise patient to not use abrasive toothbrushes, use electric razors only, minimize venipunctures, no floss, watch for bleeding, platelet transfusion,
31) Importance of hydration with multiple myeloma
Hydration is important in MM because MM results in proliferation of IG antibodies that are abnormal. Antibodies are proteins that collect in the kidneys and decrease its function. This causes renal failure and leads to decreased retention of water. This results in increased thirst.
32) Priority assessment finding during CRRT management
- Adequate Perfusion over 90 SBP
- BP ( no hyptension )
33) Calculate TBSA
Rule of nines
34) Calculate fluid administration for a patient with burns
Use parkland formula
35) Identify depth of burns based on description
1st degree-> only epidermis is affected
2nd degree-> partial thickness
only part of dermis is destroyed
3rd degree-> Whole entire dermis and epidermis is destroyed
4th degree-> Damages to the bone, tendon, muscle
Circumferential -> around the chest
36) Common chemical in wound dressing for burns
Silver based
37) Surgical indications for burns
- Severity of burns-> if so deep that it can not heal on own
- if conversion occurs
38) How to reduce burn conversion
Proper fluid resuscitation
- early nutrition
- early mobilization
- avoid hypothermia
39) Why is it important to reduce the zone of stasis (and prevent burn conversion
Zone of stasis is when burnt skin is on the border of being alive or dead. Burn conversion can happen up to 72 hours after burn and once it is in zone of coagulation, it is dead. Must be excised or surgically removed.
40) Indications for ICU admission for burns
- Depends on TBSA, co-morbidities, MOI
- Burns that are 20% more in TBSA
- Escharotomies due to q1hr neuro checks
- Complex medical history/ comorbidities
- Ventilation required
