Exam #3 Flashcards
what are the types of acute kidney injury?
pre renal, intra renal, post renal
what is the function of the kidney?
remove waste from blood, produce urine, bp control, metabolize drugs, pH and erythropoietin
what is intra renal AKI?
direct injury to the kidney
what causes pre renal aki?
decreased kidney perfusion, dehydration, low bp, bleeding out
what is a pre renal acute kidney injury?
something occurs before the kidney causing them to fail
what is the cause of intra renal AKI?
kidney vasculature problem, clots, ischemia, and inflammation of structures in kidney
what body parts can contribute to post renal AKI?
ureter, bladder, urethra, prostate, kidney stones, BPH, obstruction
what are the stages of kidney injury?
initiation, oliguria, diuresis, recovery
what is post renal AKI?
damage to kidney due to structures after the kidney
what happens during the diuresis stage of KI?
the kidneys are correcting and urine output is high
what happens in the initiation stage of kidney injury?
the cause of the injury
what happens during the oliguria stage of kidney injury?
injury sets in causing low urine output
how many mL per day for oliguria patient in AKI?
less than 400 per day
what happen to kidney labs during oliguria stage of AKI?
bun and creatinine rise
what happens to fluid volume status during oliguria stage of AKI?
fluid volume overload
what is it called when patient over diuresis?
rebound dehydratin
what type of respirations can be present in acidotic aki patients?
Kussmal breathing
what happens to BUN and Creatinine during the diuresis of KF?
start to head towards normal levels
what happens to electrolytes during diuresis stage?
they can deplete due to output being so high
what happens during the recovery stage of KI?
complete recovery and normal labs
what happens to electrolytes in aki/kf that can skew labs?
hemodilution
what are manifestations for aki/kf
fluid overload, metabolic acidosis, hyperventilation to correct acdidity, change in LOC
what are the kidney injury labs?
what can happen to mental status during aki/kf?
lethargy, coma, uremic encephalopathy
what is the equation for MAP?
systolic + 2(diastolic)/3
what map helps perfuse the kidney?
65 and up
when is the only time to give fluids to AKI?
only during the diuresis phase
what meds are given to aki patients?
Furosemide, insulin, and sodium bicarb
what are side effects of furosemide?
hypotension, electrolytes, hypokalemia,
what labs are effected by furosemide?
Mg, K,
what should patient have on when taking furosemide?
tele
why is insulin given to ki/kf patients?
combats hyperkalemia
what should be monitored when giving insulin to ki/kf patient?
blood sugar and bmp
what might have to be supplemented in patients getting insulin for ki/kf?
dextrose
why is bicarb given to ki/kf patients?
to help with the metabolic acidosis
what kind of nutrition do aki patients have?
restrict K, Na, Mg, phosph, and lower protein
what is an indication for hemodialysis?
continued hyperkalemia, metabolic acidosis, and fluid overload
what are the kinds of access types for hemodialysis?
av fistula, av graft, quintin
what does a AV fistula look like?
its the joining of a artery and vein that makes a big vessel
what doe a av graft look like?
a tube is inserted under the skin
what does a quintin look like?
cvl like line that has two ports
how many needles are used in av HD?
one in and one out
what should you keep in mind when getting labs and vitals on HD patietn?
dont do those things if they have a AV fistula
is hypotension normal during HD?
yes
what do you do if your HD patient has severe hypotension?
stop and call provider
what should be done after completion of HD?
check labs to make sure that it was effective
what is the equation for low urine output?
0.5ml per kg
where do quinton caths go?
into the jugular vein down to the superior vena cava
what are some complications of HD?
dialysis disequilibrium syndrome, hypotension, dysrhythmias, and bleeding
what are symptoms of dialysis dysequilibrium syndrome?
altered LOC, headache, restless, N/V, seizures, coma
why are HD patients at risk for bleeding?
because they are one anti coags
what dysrhythmias are HD patients at risk for?
a fib, v fib, v tach
what is the difference between acute and chronic kf?
its kidney function that never recovers in the acute stage
what are symptoms of Chronic Kf?
hyperkalemia, metabolic acidosis, kussmals breathing, hypertension, fluid overload, RAA activation, lethargy, seizures, coma, yellowing skin, urea crystals on skin
what other disease can chronic KF lead to?
HF
what stage is the worst in chronic kf?
stage 5
what are the labs for chronic kf?
Bun, creatinine, GFR, electrolytes, pH, H and H
what happens to bun and creatinine in chronic kf?
high
what happens to GFR in chronic kf?
low
what is a good GFR?
anything above 90
why is H and H low?
decreased erythropetin production
what are interventions for ckf?
HD, PD, daily weights, labs, fluid restriction
what meds are ckf patient on?
furosemide, insulin, sodium bicarb, Sodium polystyrene sulfate, epoetin alpha
what stages of ckf is Sodium polystyrene sulfate given?
chronic stages 1-3
what must the patient be having to get Sodium polystyrene sulfate
Bowel movements
how does Sodium polystyrene sulfate work?
trades potassium ions for sodium in large intestine
what does epoetin alpha do?
stimulates RBC production
what are the risks of taking epoetin alpha?
thickening of the blood that can lead to stroke, MI, PE, DVT
what will the patient feel when taking epoetin alpha
they will feel better because their anemia is gone but they are not cured
what labs should be monitored when taking epoetin alpha
PT/ PTT/ INR/ CBC
how low of fluid restriction can ckf patients be?
1000ml
what is commonly paired with Sodium polystyrene sulfate
laxative
what a laxative that can be paired with Sodium polystyrene sulfate
sorbitol or lactulose
what are complications of CKF?
pulmonary edema and drug toxicity
what are symptoms of pulmonary edema?
fluid overload, restless, anxiety, tachycardia, sob, crackles, pink frothy sputum,
what meds for pulmonary edema in KF
diuretics and morphine
what meds are hard on kidney and should be adjusted for ckf?
digoxin, antibiotics, diuretics, ace inhibitors, NSAIDs, glycosides, ant acids
what do glycosides do?
improve cardiac function
what electrolytes should be restricted in kf patients?
Na, K, Mg, Phosphorus
what are indications for peritoneal dialysis?
fluid overload, acidosis, hyperkalemia, Chronic kf, diffusion/osmosis in peritoneal cavity,
why would a patient want PD over HD?
less hazardous, flexibility, can be done at home
what is the access called for PD?
tenckhoff cath
what should be kept in mind when changing caps on PD?
its a sterile procedure
what should be kept in mind when looking at I/os for PD ?
you want Out to be at least input or more
what are the phases of PD?
fill, dwell, and drain
what is ocuring during the fill phase?
sterile solution is going into the tenckhoff by gravity for 10 minutes
what is occurring during the dwell phase?
fluid is being pulled into the peritoneum
how long does the dwell phase last?
3-6 hours
what happens during the drain phase?
the fluid is draining by gravity
how long does the drain phase take?
10 - 20 minutes
what should you do with fluids before PD?
warm them
what should be done during PD infusion?
vitals, temp, weight
what ia the complication of PD?
peritonitis
what are the symptoms of peritonitis?
fever, abd pain, tender, N/v, foul smelling drainage, cloudy/effluent drainage,
what should be done if patient is experiencing peritonitis
stop the infusion and call physician
what foods are high in K?
citrus, bananas, avocadoes, green, potatoes, watermelon
what foods are high in sodium?
soups, chips, processed, fried foods
what foods are high in Mg?
dark chocolate, nuts, beans, legumes
what foods are high in phosphorus?
dairy, beef liver, sardines, oysters
what foods are high in calcium?
greens, bones, dairy, nuts
what is benign cancer?
a slow growing cancer that is not “bad”
does benign cancer cause death?
not typically unless it stop vital function
is benign cancer metastatic?
no
is benign cancer rapid or slow growing?
slow
can benign cancer be surigcally removed 100%
yes
does benign cancer spread to other area?
no because its not metastatic
is benign cancer differentiated or not undifferentiated
differentiated
what does differentiated mean?
they resemble the cells that they are growing near
what does undifferentiated mean?
do not resemble the cells that are around them
what is the malignant cancer?
the bad form of cancer
is malignant cancer differentiated or undifferentiated ?
undifferentiated
is malignant cancer harmful to cells around it?
YES
can malignant cancer be metastatic?
yes
how does malignant caner go metastatic?
by getting into the lymphatic system
does malignant cancer grow at a slow or fast rate?
fast
what is contact inhibition?
the idea that when cells feel other cells touching it will stop reproducing
what type of cancer does not have cell contact inhibition?
malignant
what type of cancer has normal chromosomes?
benign
what type of cancer does not have normal chromosomes?
malignant
what are some general symptoms of cancer?
anemia, weakness, systemic inflammation, and weight loss
what are some preventative measures for cancer?
avoiding carcinogens, modifying lifestyle, removal of tissues, chemoprevention, vacccines
what can you do to avoid carcinogens?
stop smoking/vaping and use sunscreen
what lifestyle factors can be done to avoid cancer?
diet, fiber, low fat, healthy diet, safe sex, limiting alcohol
what does removal of tissue mean for avoiding cancer?
removing at risk areas, moles, polyps, breast tissue
what does chemoprevention mean in preventing cancer?
taking meds that interupt the develoment of cancer….celebrex…aspirin
what vaccination help prevent cancer.?
the hpv vaccines….gardasil and cervarix
what are secondary preventions for cancer?
Breast exam, colonoscolp, Endoscopy, DRE, Mammogram
are screenings diagnostic?
no
what are the diagnostics for cancer?
cytology, tissue biopsy, and bone marrow biopsy
what are some warning signs of cancer?
changes in bowel/bladder, sores, bleeding, lumps, indigestions, diffculty swallowing, changes in warts/moles, cough, hoarse, anemia, weight loss
whats the worst stage of cancer?
4
classification?
q
what are the different kinds of cancer surgery?
controlling, debulking, curative, diagnostic, prophylaxis, palliation, and reconstructive
what does a controlling/debulking surgery for?
removing part of the tumor when complete removal is not possible…..can help with symptoms and make radiation more effective
what is a curative surgery?
removes all of the cancer
what is a diagnostic surgery?
removal of tissue to test
what is prophylaxis surgery?
removal of at risk tissue
what is a palliation surgery?
performed to relieve symptoms only not to cure
what is reconstructive surgery?
increases function or appearance of the part
what is radiation treatment for cancer?
using radiation waves on the tumor to kill the cells
what is brachytherapy
a type of cancer treatment where seeds, capsules, caths, or ribbons release small amounts of radiation over time
what is radiation toxicity?
occurs when a certain area of the body that received radiation has a reaction
what is the time frame for radiation toxicity to set in?
within 2 weeks
what are symptoms of radiation toxicity?
redness, stomatitis, marrow depression
what is stomatitis?
painful red sores in mouth
what labs are effected by radiation toxicity?
low rbc, wbc and plateletes
what precautions are people ingested radioactive isotopes on?
xxx
what are best practices for patient that has received radiation?
private room, door closed, dosimeter, lead apron during care, no pregnant women, no children, visotors limited to 30 minutes and 6 feeet, never touch radioactive source with bare hands
what are some general side effects of radiation?
alopecia, fatigue, flaky skin, mucosasitis, anorexia, n/v, diarrhea, bone marrow suppression, altered taste, fever, atrophy, dysphagia, incontinence, cognitive dysfunction
what should be avoided in radiation patients for the patient?
dont wash off ink marks, no alcohol lotions, mild soap, no hard scrubbing
what are the kinds of chemo N/V
anticipatory, acute, delayed, and breakthrough
what is anticipatory n/v
thoughts trigger the n/v
what is acute n/v?
within the first 24 hours of chemo
what is delayed n/v
after the first 24 hours
what is breakthrough n/v?
occurs intermittnetly
what should you do for n/v prior to infusing chemo?
give meds before the infusion
what meds maybe given prior to chemo to preven n/v
ondasteron, lorazepam and metoclopramide
what meal education is given to n/v chemo patient
small frequent meals opened away from patients face
what route is used to give patients meds that have n/v>
iv or IM
what type of conditions follow bone marrow suppresion?
neutropenia, anemia, thrombocytopenia
what is neutropenia?
decreased wbc
what should be reported with a neutropenic patietn?
temp, cough, phlegm, fatigue
what should be limited for neutropenic patient?
visitors
what should be eliminated in neutropenic patient
no fruit, flower, raw food
what is anemia?
decreased RBC and hemoglobin
what is given to anemic cancer patients?
epoetin
how will anemic patients feel?
tired and sob
what is thrombocytopenia?
increased risk of bleeding
what are you watching for in thrombocytopenia patients?
LOC, stroke, bruising, urine, bowel
what is extravasation?
occurs when chemo leaks outside of vein into tissue
how can you prevent extravasation?
by checking for blood return from IV frequently
what is mucositis?
sores and irritation of the mouth
what meds are used for mucositis?
lidocaine, Benadryl, dexamethasone, and nystatin
what should be avoided with mucositis?
no alcohol,smoking, spicy, and citrus should be avoided
what is chemo brain?
decrease speech, decreased coordination and forgetful
what can chemo do to your nerves/
can give oyu periphreal neuropahty
where do you feel peripheral neuropathy?
numb feet/hands, impaired gate, ED, neuropathic pain, lose of taste, orthostatic hypotension, constipatino
what are peripheral neuropathy at risk for?
falls
what are the chemo side effects?
Alopecia, chemo brain, pain, peripheral neuropathy, extravasation, mucositis/stomatitis
what are the symptoms of sepsis in cancer patients?
fever, eryhthema, swelling, and warmth
what is given for hyperuricemia?
allupirnol
what is happening during a grade 0 cancer?
??
what is happening during grade 1 cancer?
well differentiated
what does well differentiated mean?
it is similar to cells growing around it
what does grade 2 cancer mean?
moderate differentiated
what does grade 3 cancer mean?
poorly differentiated with few normal cells
what does grade 4 cancer mean?
undifferentiated or poorly differentiated with no normal cells
