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Critical Care > Exam #3 > Flashcards

Exam #3 Flashcards

1
Q

what are the types of acute kidney injury?

A

pre renal, intra renal, post renal

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2
Q

what is the function of the kidney?

A

remove waste from blood, produce urine, bp control, metabolize drugs, pH and erythropoietin

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3
Q

what is intra renal AKI?

A

direct injury to the kidney

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4
Q

what causes pre renal aki?

A

decreased kidney perfusion, dehydration, low bp, bleeding out

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4
Q

what is a pre renal acute kidney injury?

A

something occurs before the kidney causing them to fail

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5
Q

what is the cause of intra renal AKI?

A

kidney vasculature problem, clots, ischemia, and inflammation of structures in kidney

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5
Q

what body parts can contribute to post renal AKI?

A

ureter, bladder, urethra, prostate, kidney stones, BPH, obstruction

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5
Q

what are the stages of kidney injury?

A

initiation, oliguria, diuresis, recovery

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6
Q

what is post renal AKI?

A

damage to kidney due to structures after the kidney

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7
Q

what happens during the diuresis stage of KI?

A

the kidneys are correcting and urine output is high

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7
Q

what happens in the initiation stage of kidney injury?

A

the cause of the injury

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8
Q

what happens during the oliguria stage of kidney injury?

A

injury sets in causing low urine output

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8
Q

how many mL per day for oliguria patient in AKI?

A

less than 400 per day

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9
Q

what happen to kidney labs during oliguria stage of AKI?

A

bun and creatinine rise

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10
Q

what happens to fluid volume status during oliguria stage of AKI?

A

fluid volume overload

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11
Q

what is it called when patient over diuresis?

A

rebound dehydratin

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12
Q

what type of respirations can be present in acidotic aki patients?

A

paroxysmal breathing

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12
Q

what happens to BUN and Creatinine during the diuresis of KF?

A

start to head towards normal levels

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13
Q

what happens to electrolytes during diuresis stage?

A

they can deplete due to output being so high

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14
Q

what happens during the recovery stage of KI?

A

complete recovery and normal labs

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14
Q

what happens to electrolytes in aki/kf that can skew labs?

A

hemodilution

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15
Q

what are manifestations for aki/kf

A

fluid overload, metabolic acidosis, hyperventilation to correct acdidity, change in LOC

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15
Q

what are the kidney injury labs?

A
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16
Q

what can happen to mental status during aki/kf?

A

lethargy, coma, uremic encephalopathy

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17
Q

what is the equation for MAP?

A

systolic + 2(diastolic)/3

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18
Q

what map helps perfuse the kidney?

A

65 and up

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18
Q

when is the only time to give fluids to AKI?

A

only during the diuresis phase

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19
Q

what meds are given to aki patients?

A

Furosemide, insulin, and sodium bicarb

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20
Q

what are side effects of furosemide?

A

hypotension, electrolytes, hypokalemia,

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21
Q

what labs are effected by furosemide?

A

Mg, K,

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21
Q

what should patient have on when taking furosemide?

A

tele

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22
Q

why is insulin given to ki/kf patients?

A

combats hyperkalemia

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23
Q

what should be monitored when giving insulin to ki/kf patient?

A

blood sugar and bmp

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24
Q

what might have to be supplemented in patients getting insulin for ki/kf?

A

dextrose

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25
Q

why is bicarb given to ki/kf patients?

A

to help with the metabolic acidosis

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26
Q

what kind of nutrition do aki patients have?

A

restrict K, Na, Mg, phosph, and lower protein

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27
Q

what is an indication for hemodialysis?

A

continued hyperkalemia, metabolic acidosis, and fluid overload

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27
Q

what are the kinds of access types for hemodialysis?

A

av fistula, av graft, quintin

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28
Q

what does a AV fistula look like?

A

its the joining of a artery and vein that makes a big vessel

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29
Q

what doe a av graft look like?

A

a tube is inserted under the skin

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30
Q

what does a quintin look like?

A

cvl like line that has two ports

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31
Q

how many needles are used in av HD?

A

one in and one out

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32
Q

what should you keep in mind when getting labs and vitals on HD patietn?

A

dont do those things if they have a AV fistula

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33
Q

is hypotension normal during HD?

A

yes

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34
Q

what do you do if your HD patient has severe hypotension?

A

stop and call provider

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35
Q

what should be done after completion of HD?

A

check labs to make sure that it was effective

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36
Q

what is the equation for low urine output?

A

0.5ml per kg

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37
Q

where do quinton caths go?

A

into the jugular vein down to the superior vena cava

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38
Q

what are some complications of HD?

A

dialysis disequilibrium syndrome, hypotension, dysrhythmias, and bleeding

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38
Q

what are symptoms of dialysis dysequilibrium syndrome?

A

altered LOC, headache, restless, N/V, seizures, coma

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38
Q

why are HD patients at risk for bleeding?

A

because they are one anti coags

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39
Q

what dysrhythmias are HD patients at risk for?

A

a fib, v fib, v tach

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39
Q

what is the difference between acute and chronic kf?

A

its kidney function that never recovers in the acute stage

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40
Q

what are symptoms of Chronic Kf?

A

hyperkalemia, metabolic acidosis, kussmals breathing, hypertension, fluid overload, RAA activation, lethargy, seizures, coma, yellowing skin, urea crystals on skin

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41
Q

what other disease can chronic KF lead to?

A

HF

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42
Q

what stage is the worst in chronic kf?

A

stage 5

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43
Q

what are the labs for chronic kf?

A

Bun, creatinine, GFR, electrolytes, pH, H and H

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44
Q

what happens to bun and creatinine in chronic kf?

A

high

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45
Q

what happens to GFR in chronic kf?

A

low

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46
Q

what is a good GFR?

A

anything above 90

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47
Q

why is H and H low?

A

decreased erythropetin production

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48
Q

what are interventions for ckf?

A

HD, PD, daily weights, labs, fluid restriction

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49
Q

what meds are ckf patient on?

A

furosemide, insulin, sodium bicarb, Sodium polystyrene sulfate, epoetin alpha

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50
Q

what stages of ckf is Sodium polystyrene sulfate given?

A

chronic stages 1-3

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51
Q

what must the patient be having to get Sodium polystyrene sulfate

A

Bowel movements

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52
Q

how does Sodium polystyrene sulfate work?

A

trades potassium ions for sodium in large intestine

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53
Q

what does epoetin alpha do?

A

stimulates RBC production

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54
Q

what are the risks of taking epoetin alpha?

A

thickening of the blood that can lead to stroke, MI, PE, DVT

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55
Q

what will the patient feel when taking epoetin alpha

A

they will feel better because their anemia is gone but they are not cured

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56
Q

what labs should be monitored when taking epoetin alpha

A

PT/ PTT/ INR/ CBC

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57
Q

how low of fluid restriction can ckf patients be?

A

1000ml

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58
Q

what is commonly paired with Sodium polystyrene sulfate

A

laxative

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59
Q

what a laxative that can be paired with Sodium polystyrene sulfate

A

sorbitol or lactulose

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60
Q

what are complications of CKF?

A

pulmonary edema and drug toxicity

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61
Q

what are symptoms of pulmonary edema?

A

fluid overload, restless, anxiety, tachycardia, sob, crackles, pink frothy sputum,

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62
Q

what meds for pulmonary edema?

A

diuretics and morphine

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63
Q

what meds are hard on kidney and should be adjusted for ckf?

A

digoxin, antibiotics, diuretics, ace inhibitors, NSAIDs, glycosides, ant acids

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64
Q

what do glycosides do?

A

improve cardiac function

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65
Q

what electrolytes should be restricted in kf patients?

A

Na, K, Mg, Phosphorus

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66
Q

what are indications for peritoneal dialysis?

A

fluid overload, acidosis, hyperkalemia, Chronic kf, diffusion/osmosis in peritoneal cavity,

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67
Q

why would a patient want PD over HD?

A

less hazardous, flexibility, can be done at home

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68
Q

what is the access called for PD?

A

tenckhoff cath

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69
Q

what should be kept in mind when changing caps on PD?

A

its a sterile procedure

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70
Q

what should be kept in mind when looking at I/os for PD ?

A

you want Out to be at least input or more

71
Q

what are the phases of PD?

A

fill, dwell, and drain

72
Q

what is ocuring during the fill phase?

A

sterile solution is going into the tenckhoff by gravity for 10 minutes

73
Q

what is occurring during the dwell phase?

A

fluid is being pulled into the peritoneum

74
Q

how long does the dwell phase last?

A

3-6 hours

75
Q

what happens during the drain phase?

A

the fluid is draining by gravity

76
Q

how long does the drain phase take?

A

10 - 20 minutes

77
Q

what should you do with fluids before PD?

A

warm them

78
Q

what should be done during PD infusion?

A

vitals, temp, weight

79
Q

what ia the complication of PD?

A

peritonitis

80
Q

what are the symptoms of peritonitis?

A

fever, abd pain, tender, N/v, foul smelling drainage, cloudy/effluent drainage,

81
Q

what should be done if patient is experiencing peritonitis

A

stop the infusion and call physician

82
Q

what foods are high in K?

A

citrus, bananas, avocadoes, green, potatoes, watermelon

83
Q

what foods are high in sodium?

A

soups, chips, processed, fried foods

84
Q

what foods are high in Mg?

A

dark chocolate, nuts, beans, legumes

85
Q

what foods are high in phosphorus?

A

dairy, beef liver, sardines, oysters

86
Q

what foods are high in calcium?

A

greens, bones, dairy, nuts

87
Q

what is benign cancer?

A

a slow growing cancer that is not “bad”

88
Q

does benign cancer cause death?

A

not typically unless it stop vital function

89
Q

is benign cancer metastatic?

A

no

90
Q

is benign cancer rapid or slow growing?

A

slow

91
Q

can benign cancer be surigcally removed 100%

A

yes

92
Q

does benign cancer spread to other area?

A

no because its not metastatic

93
Q

is benign cancer differentiated or not undifferentiated

A

differentiated

94
Q

what does differentiated mean?

A

they resemble the cells that they are growing near

95
Q

what does undifferentiated mean?

A

do not resemble the cells that are around them

96
Q

what is the malignant cancer?

A

the bad form of cancer

97
Q

is malignant cancer differentiated or undifferentiated ?

A

undifferentiated

98
Q

is malignant cancer harmful to cells around it?

A

YES

99
Q

can malignant cancer be metastatic?

A

yes

100
Q

how does malignant caner go metastatic?

A

by getting into the lymphatic system

101
Q

does malignant cancer grow at a slow or fast rate?

A

fast

102
Q

what is contact inhibition?

A

the idea that when cells feel other cells touching it will stop reproducing

103
Q

what type of cancer does not have cell contact inhibition?

A

malignant

104
Q

what type of cancer has normal chromosomes?

A

benign

105
Q

what type of cancer does not have normal chromosomes?

A

malignant

106
Q

what are some general symptoms of cancer?

A

anemia, weakness, systemic inflammation, and weight loss

107
Q

what are some preventative measures for cancer?

A

avoiding carcinogens, modifying lifestyle, removal of tissues, chemoprevention, vacccines

108
Q

what can you do to avoid carcinogens?

A

stop smoking/vaping and use sunscreen

109
Q

what lifestyle factors can be done to avoid cancer?

A

diet, fiber, low fat, healthy diet, safe sex, limiting alcohol

110
Q

what does removal of tissue mean for avoiding cancer?

A

removing at risk areas, moles, polyps, breast tissue

111
Q

what does chemoprevention mean in preventing cancer?

A

taking meds that interupt the develoment of cancer….celebrex…aspirin

112
Q

what vaccination help prevent cancer.?

A

the hpv vaccines….gardasil and cervarix

113
Q

ADD SECONDATRRY PREVENTION

A
114
Q

are screenings diagnostic?

A

no

115
Q

what are the diagnostics for cancer?

A

cytology, tissue biopsy, and bone marrow biopsy

116
Q

what are some warning signs of cancer?

A

changes in bowel/bladder, sores, bleeding, lumps, indigestions, diffculty swallowing, changes in warts/moles, cough, hoarse, anemia, weight loss

117
Q

whats the worst stage of cancer?

A

4

118
Q

classification?

A

q

119
Q

what are the different kinds of cancer surgery?

A

controlling, debulking, curative, diagnostic, prophylaxis, palliation, and reconstructive

119
Q

what does a controlling/debulking surgery for?

A

removing part of the tumor when complete removal is not possible…..can help with symptoms and make radiation more effective

120
Q

what is a curative surgery?

A

removes all of the cancer

121
Q

what is a diagnostic surgery?

A

removal of tissue to test

122
Q

what is prophylaxis surgery?

A

removal of at risk tissue

123
Q

what is a palliation surgery?

A

performed to relieve symptoms only not to cure

124
Q

what is reconstructive surgery?

A

increases function or appearance of the part

125
Q

what is radiation treatment for cancer?

A

using radiation waves on the tumor to kill the cells

126
Q

what is brachytherapy

A

a type of cancer treatment where seeds, capsules, caths, or ribbons release small amounts of radiation over time

127
Q

what is radiation toxicity?

A

occurs when a certain area of the body that received radiation has a reaction

128
Q

what is the time frame for radiation toxicity to set in?

A

within 2 weeks

129
Q

what are symptoms of radiation toxicity?

A

redness, stomatitis, marrow depression

130
Q

what is stomatitis?

A

painful red sores in mouth

131
Q

what labs are effected by radiation toxicity?

A

low rbc, wbc and plateletes

132
Q

what precautions are people ingested radioactive isotopes on?

A

xxx

133
Q

what are best practices for patient that has received radiation?

A

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

134
Q

what are some general side effects of radiation?

A

alopecia, fatigue, flaky skin, mucosasitis, anorexia, n/v, diarrhea, bone marrow suppression, altered taste, fever, atrophy, dysphagia, incontinence, cognitive dysfunction

135
Q

what should be avoided in radiation patients for the patient?

A

dont wash off ink marks, no alcohol lotions, mild soap, no hard scrubbing

136
Q

what are the kinds of chemo N/V

A

anticipatory, acute, delayed, and breakthrough

137
Q

what is anticipatory n/v

A

thoughts trigger the n/v

138
Q

what is acute n/v?

A

within the first 24 hours of chemo

139
Q

what is delayed n/v

A

after the first 24 hours

140
Q

what is breakthrough n/v?

A

occurs intermittnetly

141
Q

what should you do for n/v prior to infusing chemo?

A

give meds before the infusion

142
Q

what meds maybe given prior to chemo to preven n/v

A

ondasteron, lorazepam and metoclopramide

143
Q

what meal education is given to n/v chemo patient

A

small frequent meals opened away from patients face

144
Q

what route is used to give patients meds that have n/v>

A

iv or IM

145
Q

what type of conditions follow bone marrow suppresion?

A

neutropenia, anemia, thrombocytopenia

146
Q

what is neutropenia?

A

decreased wbc

147
Q

what should be reported with a neutropenic patietn?

A

temp, cough, phlegm, fatigue

148
Q

what should be limited for neutropenic patient?

A

visitors

149
Q

what should be eliminated in neutropenic patient

A

no fruit, flower, raw food

150
Q

what is anemia?

A

decreased RBC and hemoglobin

151
Q

what is given to anemic patients?

A

epoetin

152
Q

how will anemic patients feel?

A

tired and sob

153
Q

what is thrombocytopenia?

A

increased risk of bleeding

154
Q

what are you watching for in thrombocytopenia patients?

A

LOC, stroke, bruising, urine, bowel

155
Q

what is extravasation?

A

occurs when chemo leaks outside of vein into tissue

156
Q

how can you prevent extravasation?

A

by checking for blood return from IV frequently

157
Q

what is mucositis?

A

sores and irritation of the mouth

158
Q

what meds are used for mucositis?

A

lidocaine, Benadryl, dexamethasone, and nystatin

159
Q

what should be avoided with mucositis?

A

no alcohol,smoking, spicy, and citrus should be avoided

160
Q

what is chemo brain?

A

decrease speech, decreased coordination and forgetful

161
Q

what can chemo do to your nerves/

A

can give oyu periphreal neuropahty

162
Q

where do you feel peripheral neuropathy?

A

numb feet/hands, impaired gate, ED, neuropathic pain, lose of taste, orthostatic hypotension, constipatino

163
Q

what are peripheral neuropathy at risk for?

A

falls

164
Q

what are the chemo side effects?

A

Alopecia, chemo brain, pain, peripheral neuropathy, extravasation, mucositis/stomatitis

165
Q

what are the oncology emergecies?

A

sepsis, DIC, SIADH, spinal cord compression, Hypercalcemia, SVC syndrome, Tumor Lysis sydrome

166
Q

what is sepsis?

A

infection entering the blood stream

167
Q

why are cancer patients at risk for sepsis?

A

neutropenic

168
Q

what are the symptoms of sepsis in cancer patients?

A

fever, eryhthema, swelling, and warmth

169
Q

what is the intervention for sepsis?

A

antibiotics

170
Q

what is DIC?

A

excessive clotting typically caused by sepsis in caner patietns

171
Q

what happens to clotting factor in DIC?

A

it gets used up by all of the clotting and can lead to bleeding out

172
Q

what are symptoms of DIC?

A

pain, ischemia, stroke like symptoms, dyspnea, necrosis, bleeding, lack of blood flow to organs

173
Q

what is the intervention for DIC?

A

heparin

174
Q

what is SIADH?

A

too much antidiuretic hormone is produced leading to hemodilution

175
Q

what are symptoms of SIADH?

A

fluid overload, JVD, crackles, edema, decreased urine output, weakness, seizures, coma, death, personality changes, confusion

176
Q

what happens to Na with SIADH?

A

it gets diluted causing neuro symptoms

177
Q

how often should you monitor SIADH patient?

A

every 2 hours

178
Q

what is spinal cord compression?

A

occurs when a tumor enter spinal column or bone collapses

179
Q

what are symptoms of spinal cord compression?

A

back pain, weak, loss of sensation, unsteady, urinary retention, constipation

180
Q

where is a spinal cord compression most common?

A

thoracic

181
Q

what is done for spinal cord compression?

A

MIR, high dose steroids, radiation, surgery

182
Q

what causes hypercalcemia in caner patients?

A

bone breakdown releases calcium into the blood stream

183
Q

what are symptoms of hypercalcemia?

A

fatigue, loss of appetite, n/v, constipatino, bone pain, kidney stones, abd pain, altered cognition, urine???

184
Q

what is the treatment for hypercalcemia in cancer patients?

A

iv hydration, loop diuretics, biphosphates, calcitonin

185
Q

what is svc syndrome?

A

compression or obstruction of superior vena cave that prevents blood from returning from body

186
Q

what are symptoms of svc syndrome?

A

edema, head fullness, engorged blood vessles, erythema of the upper body, edema arms/hands, dyspnea, hemmorhage, cyanosis, LOC, decreased cardiac output, hypotension

187
Q

what is the intervention for SVC?

A

radiation, angioplasty, and rare surgery

188
Q

what is tumor lysis syndrome in cancer patients?

A

occurs when large number of tumor cells are destroyed leading to hyperkalemia, hyperuricemia, and hypherphosphateemia

189
Q

what does hyperkalemia causes?

A

cardiac problems

190
Q

what does hyperuricemia lead to?

A

kidney injury

191
Q

what are symptoms of tumor lysis syndrome/

A

lethargy, n/v, anorexia, flank pain, weak, cramps, seizures, altered loc

192
Q

what is the intervention for tumor lysis syndrome?

A

hydration of 3000ml daily, antiemetic, daily weights, BMP,

193
Q

what is given for hyperkalemia?

A

sodium polystrene, glucose, insulin drip

194
Q

what is given for hyperuricemia?

A

allupirnol

Critical Care (3 decks)

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