Exam 3 Flashcards
glomerulonephritis CM
Chills, fever, leukocytosis, bacteriuria, pyuria, low back pain, flank pain, N, V, malaise, dysuria
Difference between acute and chronic glomerulonephritis
Acute: temporary and reversible kidney damage. Chronic: irreversible CKD
Risk factors for glomerulonephritis
Strep infection, endocarditis, HIV/Hep B or C, good pasture syndrome, Lupus, diabetic nephropathy, hypertension.
Describe how you get glomerulonephritis after strep
about 2-3 weeks after a strep infection, the antigens form a complex with the bodies antigens, these complexes trigger inflammation the glomerulus and prevent adequate filtering. `
specific CM of strep GN
periorbital edema, cola-colored urine, sodium retention, HTN
complication of strep GN
rapidly progressing GN (rapid loss of kidney function over a course of days or weeks)
`Teatment for rapidly progressing GN
correct fluid overload, manage BP, corticosteroids, cytotoxic drugs, plasmapheresis, dialysis
what is good pasture syndrome
autoimmune disease occurring in young male smokers, antibodies attack lungs and kidneys. presents as flu-like symptoms
treatment options for good pasture syndrome
corticosteroids, immunosuppressants, plasmapheresis, dialysis, transplant.
what is pyelonephritis
inflammation of renal tissue caused by infection or obstruction
what is important to remember about CT scans with kidney patients
no contrast dye
goals for Pyelonephritis
treat infection (culture and antibiotics) prevent dehydration (antiemetics and hydration)
what causes kidney stones
too much calcium/vitamins in the diet, immobility, hydronephrosis, infection
lithotripsy
shockwave therapy: be sure to strain all urine for stones, bleeding is normal but it should go away after a couple days
Medication for kidney stones
Flowmax - relaxes smooth muscles
cause of Prerenal AKI
reduced systemic cirrculation
cause of Intrarenal AKI
direct kidney damage
cause of post-renal AKI
obstruction
phases of AKI
oliguric, diuretic, recovery
what do we need to monitor in patients with renal issues
I&O, daily weight, fluid/ electrolyte levels (Na and K esp.)
cause of chronic kidney disease
diabetes and hypertension
creatinine normal values
0.6-1.3
normal BUN values
6-20
when do you start needing dialysis
with a GFR of 29 or lower, or acutely if fluid/electrolyte levels are imbalanced
ways to decrease your risk for CKD
control your blood sugar, control blood pressure, good diet, healthy weight, exercise, no tobacco use
best medications for CKD
ACE inhibitors and ARBs (they are renal protective)
CM for CKD
edema, back pain, oliguria, HTN
Complications of CKD
Anemia, Hyperkalemia, HF, and Mineral Bone Disorders
What level of K requires immediate intervention
> 6.5
What are treatment options for hyperkalemia
- Kayexalate (BS x4 and give with food, constipation as a S/E)
- Insulin and dextrose (shift K into the cells)
- IV gluconate (prevent V tach)
- dialysis
What causes bone issues in CKD
a decrease in Vitamin D in the body decreases calcium that is absorbed, the body then produces PTH to break down the bones for calcium.
Meds for bone disorders of CKD
Activated vitamin D, Phosphate binder (sevelamer, Calcium acetate - can cause CV issues and hypercalcemia, give with food)
what causes anemia in CKD
decreased erythropoetin
meds for anemia in CKD
hematopoietics (Epogen - S/E: HTN and thromboembolism)
Iron supplement (give between meals, S/E GI upset, constipation and
dark tarry stools)
folic acid
What should we teach CKD patients
take daily weight and monitor I&O, Watch the signs of fluid overload and electrolyte imbalance. avoid NSAIDs, decongestants, or laxatives
Complications of Hemodialysis
dysrhythmias, infection, disequilibrium syndrome
types of vascular access
temporary JV catheter, fistula, graft. (DO NOT ACCESS)
how often do you do hemodyalysis
3-4 hours, 3 days a week
complications of Peritoneal dialysis
loss of protein, hyperglycemia, peritonitis
risk factors for bladder cancer
cigarette smoking!
chemical exposure, radiation, chemo, chronic urinary irritation
CM for bladder cancer
Hematuria!
irritable bladder
types of urinary diversion device
incontinent type: ileal ostomy (constant output)
continent type: urinary “pouch”, still an ostomy, empties Q4-6
orthotopic type: new “bladder” formed from intestinal tissue, no urge
present
treatment for bladder cancer
Chemo inserted with a catheter. pt should hold it for 2 hours and then urinate it out. (there a no systemic effects)
Risk for Renal cancer
Cigarrette smoking!
obesity, chemical exposure, HTN, genetic predisposition or mutation
CM for renal cancer
starts asymptomatic, hematuria, flank pain, palpable mass, vague sickness symptoms.
treatment for renal cancer
partial nephrectomy, simple total nephrectomy, radical nephrectomy
how to screen for prostate cancer
Annual digital rectal exam starting at age 50
biopsy, US, prostate antigen test
how to treat someone with prostate cancer
radical prostatectomy
hormone therapy
internal radiation
screening for BPH
annual digital rectal exam starting at age 50
treatment for BPH
lifestyle changes (non-irritating diet, scheduled voiding, avoid anticholinergics/decongestants)
Medications (Proscar, Flowmax)
Surgery (either a laser, or TURP: transurethral resection of the prostate,
bleeding common, need continuous catheter irrigation)
Medications for BPH
Proscar to shrink the prostate ( takes 6mo. to take effect, evaluate with post-void residual)
Flowmax - (smooth muscle relaxer - S/E hypotension, dizziness)
CM of testicular cancer
firm lump in the scrotum, scrotal swelling, dull abdominal ache
long term side effects of testicular cancer
infertility, ejaculatory dysfunction
risk factors for skin cancer
Light colored skin and eyes
prevention of skin cancer
always wear sunscreen, try to be in the shade during the most sunny times of the day 10-4
3 side effects of Leukemia
anemia, thrombocytopenia, immunosuppresion
most common type of leukemia
Chronic lymphocytic leukemia
Doxorubicin
common drug for Acute Myelogenous Leukemia. can cause cardiac dysfunction!
CM of lymphoma
B symptoms
swollen lymph nodes
fatigue
What are B symptoms
unexplained weight loss, fever, night sweats
Hodgkins vs Non hodgkins lymphoma
H: displays B symptoms and is localized
NH: no/less B symptoms, spread throughout body
what is multiple myeloma
cancer of the plasma cells. decrease production of antibodies, results in production of dysfunctional proteins. these proteins infiltrate the bone marrow.
CM of multiple myelomas
anemia, neutropenia, thrombocytopenia, weakened bones, bone pain, bone pain, fractures, hypercalcemia.
how to prevent hypercalcemia complications of multiple myeloma
weight bearing exercises, continuous IV hydration, monitor I&O, lasix
Important factors to know about external radiation
causes skin damage.
protect skin by cleansing it daily, and avoiding extreme temperatures or other irritants. Dry radiation burns (keep clean and lubricated with aloe) Wet desquamation (keep clean and covered with a dressing)
important factors to know about internal radiation
the patient is radioactive - so limit time at the bedside. 3’ away, cluster care, wear lead apron, wear a badge to measure exposure.
administration concerns for chemo
if a port of venous access is broken the chemo can leak into surrounding tissues leading to extravasation (stop the infusion and aspirate all of the chemo from the catheter)
what to do for nausea and vomiting from chemo
take antiemetic(ondansetron) before chemo and scheduled for 24-48 hours after
what is tumor lysis syndrome
a rapid release of cells d/t destruction from chemo (24-48 hours later)
causes hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia
how to best prevent Tumor Lysis syndrome
take Allopurinol daily(bind to uric acid), increase fluid intake, take sodium bicarb acutely
Superior Vena Cava Syndrome
obstruction of the SVC by tumor or thrombosis
CM of Superior Vena Cava Syndrome
periorbital edema, Distended Neck veins, headaches, seizures, mediastinal mass
Why would someone have a side effect of Anemia during cancer
chemo destroying proliferative cells, malnutrition, or bleeding
medication for Anemia (and S/E)
Sub-Q Erythropoietin. can cause HTN, thrombosis, or headache
Risk of thrombocytopenia, what precautions will we take?
high bleeding risk, need to be on fall precautions.
hold blood thinners and any other drugs that promote bleeding. careful of bruising and cuts (BP cuff, soft tooth brush, electric razor)
What platelet levels quantify thrombocytopenia, prolonged bleeding, and spontaneous bleeding
<150,000 =thrombocytopenia
<50,000 = prolonged bleeding
<20,000 = spontaneous bleeding
at what level is someone under neutropenic precautions, and will we perform chemo with this patient
<1000 ANC (no chemo performed)
What is a neutropenic fever
a fever >100.4 and an ANC <500. requires immediate hospitalization
What does a Neutropenic precaution entail?
no raw or uncooked food, no live plants, strict hand washing, close infection monitoring, screen all visitors
what is Pegfilgrastim
it is a 1-dose, long-lasting colony-stimulating factor for neutropenia. Used to keep dialysis on schedule
What is Vincristine
this is a specific chemotherapy agent. It is a very powerful vesicant so you need to constantly monitor for extravasation. also causes neuropathy
what is Cisplatin
this is a nonspecific chemotherapy agent. causes terrible vomiting, and is nephrotoxic, myelosuppression, ototoxicity, peripheral neuropathy
What is finasteride
a BPH medication used to shrink the prostate, it may take up to 6 months to be effective, and will be evaluated by post-void residual
