Exam 3 Flashcards
what would we look at to tell us if protein intake is sufficient in CRF?
prealbumin
(normal 15-25)
insufficient = low + muscle wasting
medications to prevent renal damage
- antihypertensives (ACE*, CCB)
- BBs
best way to assess for successful lasix therapy
daily weights
(would also have decreased pulmonary congestion and decreased s+s of fluid overload, and decreased confusion by reducing azotemia)
signs renal failure is worsening (6)
- oliguria/anuria
- BUN/creatinine increase
- increased azotemia
- increased electrolytes
- decreased GFR
- metabolic acidosis
scenarios that contribute to pre-renal failure (6)
anything that causes decreased perfusion (hypotension, shock, sepsis, burns, atherosclerosis, dehydration)
priority intervention for dyspnea after burns
- O2
- raise HOB
- monitor breath sounds and breathing effort
if wheezing suddenly stops, prepare for immediate intubation
what lab values would you see with burns? (7)
- hyponatremia
- hyperkalemia
- low albumin
- Hct increased - false high (b/c of fluid loss)
- hyperglycemia
- increased BUN/creatinine
- WBCs increased
what temp should water be at or below for burn safety?
120* farenheit
what is autocontamination + how can we mitigate this as nurses? (re: burns)
when normal flora overgrows and penetrates the internal environment.
we can change gloves in between dressing changes
why does respiratory distress happen in patients with renal failure?
fluid overload from kidneys that aren’t functioning properly as well as metabolic acidosis (can’t excrete acid or produce enough bicarb) –> causes Kussmaul breathing
nursing interventions for respiratory distress secondary to renal failure (4)
- O2
- raise HOB
- resp. assessment q4hr
- diuretics
patients with CKD often have _______ (low number of type of cells), and would be prescribed which medication to help them?
anemia (b/c kidneys cannot produce enough erythropoietin to make RBCs)
rx: epoetin alpha (Epogen)
how can a patient prevent renal failure from worsening? (5)
- control comorbidities
- lifestyle changes (diet, exercise, smoking, drinking)
- medication adherence
- say hydrated (2L/day)
- watch NSAID use
post-renal failure scenarios (7)
obstruction =
1. kidney stones
2. bladder cancer
3. cervical cancer
4. prostate cancer
5. BPH
6. blood clots
7. damaged nerves controlling bladder
AV fistula care (5)
- “feel the thrill”
- listen for the bruit
- don’t take BP, perform venipunctures or anything invasive/heavy pressure on this arm
- pulses in distal extremity
- encourage ROM / elevation
what is most common concern/complication with AV fistula?
thrombosis
how often should AV fistulas be assessed?
q4hr
what is leading cause of death in patients with ESKD?
cardiac disease
how are renal failure and heart failure related? (4 things)
-renal failure –> backflow of fluid onto heart + increases workload
-anemia increases workload on heart
-HTN increases workload on heart
-uremic buildup directly affects heart (cardiomyopathy)
what is CRRT? why do we do it? what patients would we use it for?
continuous renal replacement therapy
to restore acid-base and f+e balance
pt: those that are too unstable to handle highs and lows with BP
duration of CRRT
24 hours
important teaching for kidney transplant (3)
- med adherence
- signs of infection + rejection
- urine can be pink/blood tinged for weeks
how do we calculate fluid replacement for burn patient using parkland formula?
2mL/kg/TBSA% and divide by 2
1st half: given over 8 hours (adjust hours as needed if they’ve gone hours since burn injury without fluids-per messer example)
2nd half: given over 16 hours
what is leukemia? why are they still at risk of infection?
excessive production of immature WBCs –> impaired immunity b/c they are not fully functioning WBCs
creates overcrowding in BM for other cells
what is pancytopenia?
low WBCs, RBCs, platelets
what is lymphoma?
cancer of lymphoid cells
lymphoma assessment findings (4)
(resembles TB)
1. drenching night sweats
2. painless, large swollen lymph nodes
3. perpetuating fever (> 101.5*)
4. weight loss >10%
lymphoma education (3)
- radiation care
- reproductive plans (if they want)
- medication/chemo treatments
what is multiple myeloma?
cancer of mature B-lymphocytes (plasma cells) –> secrete antibodies
why is hydration important with multiple myeloma?
antibodies increase serum protein levels and clog blood vessels in kidneys + other organs (increased blood viscosity → increased risk of thrombosis)
common chemical in wound dressings for burns
Ag (silver ‘cause it Aint Gold - thanks royce)
what stage of burn requires surgery?
full thickness
(excision + grafting required for healing)
ways to reduce burn conversion (6)
- Proper fluid resuscitation
- Early nutrition (protein needs + patients are hypermetabolic)
- Enteral nutrition (within 6 hrs)
- Early mobilization (blood flow, functionality, prevention of PNA, promotes fluid motion + vascular return)
- Avoid hypothermia (vasoconstriction shunts blood away from skin)
- Avoid vasopressors (blood + fluids instead)
why do we want to avoid burn conversion?
to avoid surgery!!! (b/c if gets to full thickness, they will require excision + grafting)
reasons a burn patient would admit to ICU (5)
- Fluid resuscitation
- Intubated patients
- escharotomies: require q1hr neurovascular checks
- Medical co-morbidities
- Electrical injury w/ EKG changes: b/c need telemetry monitoring (If no EKG changes, will be discharged)
- Inhalation injury
type of burn:
Sunburn
Not included in TBSA %
superficial (1st degree)
type of burn:
into top layers of dermis
Superficial partial
type of burn:
deeper into dermis
Deep partial
type of burn:
Moist, blisters, wet, blanches
partial thickness (2nd degree)
type of burn:
Requires grafting
full thickness (3rd degree)
type of burn:
Dry, leathery, no blanching, white, black, brown, thrombosed vessels may be visible
full thickness (3rd degree)
type of burn:
PAINLESS or insensate (“doesn’t feel right,” pt can feel pressure)
full thickness (3rd degree)
type of burn:
Excision + grafting is REQUIRED for healing
full thickness (3rd degree)
type of burn:
extending into bone or muscle
“4th degree”
type of burn:
PAINFUL - b/c nerve endings have been unroofed
partial thickness (2nd degree)
type of burn:
Can heal on own w/wound management
partial thickness (2nd degree)
hi, guess what?
THIS IS YOUR LAST MED SURG TEST EVER!!!
hi
you’re doing great
hello, guess what?
less than 2 months until graduation. u got this. love u.
