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Med Surg II > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

what would we look at to tell us if protein intake is sufficient in CRF?

A

prealbumin
(normal 15-25)

insufficient = low + muscle wasting

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2
Q

medications to prevent renal damage

A
  1. antihypertensives (ACE*, CCB)
  2. BBs
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3
Q

best way to assess for successful lasix therapy

A

daily weights

(would also have decreased pulmonary congestion and decreased s+s of fluid overload, and decreased confusion by reducing azotemia)

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4
Q

signs renal failure is worsening (6)

A
  1. oliguria/anuria
  2. BUN/creatinine increase
  3. increased azotemia
  4. increased electrolytes
  5. decreased GFR
  6. metabolic acidosis
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5
Q

scenarios that contribute to pre-renal failure (6)

A

anything that causes decreased perfusion (hypotension, shock, sepsis, burns, atherosclerosis, dehydration)

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6
Q

priority intervention for dyspnea after burns

A
  1. O2
  2. raise HOB
  3. monitor breath sounds and breathing effort

if wheezing suddenly stops, prepare for immediate intubation

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7
Q

what lab values would you see with burns? (7)

A
  1. hyponatremia
  2. hyperkalemia
  3. low albumin
  4. Hct increased - false high (b/c of fluid loss)
  5. hyperglycemia
  6. increased BUN/creatinine
  7. WBCs increased
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8
Q

what temp should water be at or below for burn safety?

A

120* farenheit

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9
Q

what is autocontamination + how can we mitigate this as nurses? (re: burns)

A

when normal flora overgrows and penetrates the internal environment.

we can change gloves in between dressing changes

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10
Q

why does respiratory distress happen in patients with renal failure?

A

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

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11
Q

nursing interventions for respiratory distress secondary to renal failure (4)

A
  1. O2
  2. raise HOB
  3. resp. assessment q4hr
  4. diuretics
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12
Q

patients with CKD often have _______ (low number of type of cells), and would be prescribed which medication to help them?

A

anemia (b/c kidneys cannot produce enough erythropoietin to make RBCs)

rx: epoetin alpha (Epogen)

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13
Q

how can a patient prevent renal failure from worsening? (5)

A
  1. control comorbidities
  2. lifestyle changes (diet, exercise, smoking, drinking)
  3. medication adherence
  4. say hydrated (2L/day)
  5. watch NSAID use
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14
Q

post-renal failure scenarios (7)

A

obstruction =
1. kidney stones
2. bladder cancer
3. cervical cancer
4. prostate cancer
5. BPH
6. blood clots
7. damaged nerves controlling bladder

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15
Q

AV fistula care (5)

A
  1. “feel the thrill”
  2. listen for the bruit
  3. don’t take BP, perform venipunctures or anything invasive/heavy pressure on this arm
  4. pulses in distal extremity
  5. encourage ROM / elevation
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16
Q

what is most common concern/complication with AV fistula?

A

thrombosis

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17
Q

how often should AV fistulas be assessed?

A

q4hr

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18
Q

what is leading cause of death in patients with ESKD?

A

cardiac disease

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19
Q

how are renal failure and heart failure related? (4 things)

A

-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)

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20
Q

what is CRRT? why do we do it? what patients would we use it for?

A

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

21
Q

duration of CRRT

A

24 hours

22
Q

important teaching for kidney transplant (3)

A
  1. med adherence
  2. signs of infection + rejection
  3. urine can be pink/blood tinged for weeks
23
Q

how do we calculate fluid replacement for burn patient using parkland formula?

A

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

24
Q

what is leukemia? why are they still at risk of infection?

A

excessive production of immature WBCs –> impaired immunity b/c they are not fully functioning WBCs

creates overcrowding in BM for other cells

25
Q

what is pancytopenia?

A

low WBCs, RBCs, platelets

26
Q

what is lymphoma?

A

cancer of lymphoid cells

27
Q

lymphoma assessment findings (4)

A

(resembles TB)
1. drenching night sweats
2. painless, large swollen lymph nodes
3. perpetuating fever (> 101.5*)
4. weight loss >10%

28
Q

lymphoma education (3)

A
  1. radiation care
  2. reproductive plans (if they want)
  3. medication/chemo treatments
29
Q

what is multiple myeloma?

A

cancer of mature B-lymphocytes (plasma cells) –> secrete antibodies

30
Q

why is hydration important with multiple myeloma?

A

antibodies increase serum protein levels and clog blood vessels in kidneys + other organs (increased blood viscosity → increased risk of thrombosis)

31
Q

common chemical in wound dressings for burns

A

Ag (silver ‘cause it Aint Gold - thanks royce)

32
Q

what stage of burn requires surgery?

A

full thickness
(excision + grafting required for healing)

33
Q

ways to reduce burn conversion (6)

A
  1. Proper fluid resuscitation
  2. Early nutrition (protein needs + patients are hypermetabolic)
  3. Enteral nutrition (within 6 hrs)
  4. Early mobilization (blood flow, functionality, prevention of PNA, promotes fluid motion + vascular return)
  5. Avoid hypothermia (vasoconstriction shunts blood away from skin)
  6. Avoid vasopressors (blood + fluids instead)
34
Q

why do we want to avoid burn conversion?

A

to avoid surgery!!! (b/c if gets to full thickness, they will require excision + grafting)

35
Q

reasons a burn patient would admit to ICU (5)

A
  1. Fluid resuscitation
  2. Intubated patients
  3. escharotomies: require q1hr neurovascular checks
  4. Medical co-morbidities
  5. Electrical injury w/ EKG changes: b/c need telemetry monitoring (If no EKG changes, will be discharged)
  6. Inhalation injury
36
Q

type of burn:

Sunburn
Not included in TBSA %

A

superficial (1st degree)

37
Q

type of burn:

into top layers of dermis

A

Superficial partial

38
Q

type of burn:

deeper into dermis

A

Deep partial

39
Q

type of burn:

Moist, blisters, wet, blanches

A

partial thickness (2nd degree)

40
Q

type of burn:

Requires grafting

A

full thickness (3rd degree)

41
Q

type of burn:

Dry, leathery, no blanching, white, black, brown, thrombosed vessels may be visible

A

full thickness (3rd degree)

42
Q

type of burn:

PAINLESS or insensate (“doesn’t feel right,” pt can feel pressure)

A

full thickness (3rd degree)

43
Q

type of burn:

Excision + grafting is REQUIRED for healing

A

full thickness (3rd degree)

44
Q

type of burn:

extending into bone or muscle

A

“4th degree”

45
Q

type of burn:

PAINFUL - b/c nerve endings have been unroofed

A

partial thickness (2nd degree)

46
Q

type of burn:

Can heal on own w/wound management

A

partial thickness (2nd degree)

47
Q

hi, guess what?

A

THIS IS YOUR LAST MED SURG TEST EVER!!!

48
Q

hi

A

you’re doing great

49
Q

hello, guess what?

A

less than 2 months until graduation. u got this. love u.

Med Surg II (6 decks)

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