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Kol- 410 Med Surg II > Exam 3 based on blueprint > Flashcards

Exam 3 based on blueprint Flashcards

1
Q

weight gain goals for CKD
overnight
in a week
between dialsyis

A

gain no more than:
2 lb overnight
5 lb / week
3 lb b/w dialysis

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2
Q

what stage should we start ACE inbitiors for CKD?

A

stage 1!

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3
Q

how do BB help CKD?

A

Help increase cardiac output/ avoid heart failure (reduced perfusion of kidneys –> Accelerated kidney disease)

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4
Q

protein intake for CKD : regular vs dialysis

A

regular = 0.55-0.6 g/kg/day
dialysis = 1-1.2 g/kg/day

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5
Q

how do we know if lasix working?

A

-daily weight!
clear lung sounds

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6
Q

signs of worsening renal failure:

A

oliguria
azotemia
unable to compensate/kussmaul
need more dialysis
HF
labs worse
fluid overload
bleeding issues/anemia
skin changes (uremic frost/pruritis)
weight gain -Gain (or lose) more than
2 lbs overnight
5 lbs in a week

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7
Q

priority assessment for hyperkalemia

A

EKG

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8
Q

disorders that can lead to pre-renal failure

A

Reduced perfusion = PRERENAL
Shock
Hypotension
Anything that blocks blood flow to kidneys (Atherosclerosis)

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9
Q

Importance of urinary output with burns

A

determines if fluid replacement is adequate

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10
Q

Assessment of breathing, airway patency in burns

A

excess fluid shifting into lungs – decreased lung compliance, pressure on bronchioles, V/Q mismatch, crackles

intubate before swelling occurs

swellung can occur 8-12 hours after burn once rescusitaiton has begun

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11
Q

Intervention/ priority for difficulty breathing after burns

A

intubate

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12
Q

Priority lab findings for patient with burns

A

ABG
Kidney function/perfusion labs
Electrolytes
H&H

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13
Q

Response for low urinary output in burn victims

A

flush foley to make sure it is patent

increase IVF

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14
Q

Risks of burns/ prevention

A

Smoke Detectors
Adjust hot water heater
Turn Pot handles away from reach
Safe use of Oxygen (no open flames)

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15
Q

Autocontamination in patients at high risk of infection (burn patients, cancer)

A

change gloves frequently and between dressing change sites

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16
Q

Priorities in reducing infection in patients at risk of infection

A

hand hygeine
lines clean/removed
limit exposure to crowds/sick people

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17
Q

Recognizing respiratory distress in patients with renal failure: What does it look like, why does it happen, what do you do

A

fluid overload!
JVD, edema, crackles, increased O2 demand, increase RR, dypnea

-diuretics, dialysis, O2

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18
Q

What it is epogen and why do patients with CRF need it?

A

Epoetin alfa
-kidneys can’t make EPO so they are anemic and at riskfor bleeding
-epogen increase your RBC

19
Q

Prevention of worsening renal failure (education/ lifestyle changes)

A
  • Infection prevention
  • Injury prevention
  • Be aware of medications that are cleared by the kidneys
  • May need dose adjustment/ May have increased effects
  • High risk of fatigue- rest and activity balance
  • Anxiety reducing techniques
  • 60-70 meq potassium / day
  • Na 1-3g (post dialysis 2-4g)
  • daily weights
  • fluid restrictions
20
Q

Prevention of worsening renal failure (education/ lifestyle changes)

A
  • Infection prevention
  • Injury prevention
  • Be aware of medications that are cleared by the kidneys
  • May need dose adjustment/ May have increased effects
  • High risk of fatigue- rest and activity balance
  • Anxiety reducing techniques
  • 60-70 meq potassium / day
  • Na 1-3g (post dialysis 2-4g)
  • daily weights
  • fluid restrictions
21
Q

What is post-renal failure and who is at risk?

A

Obstruction = POSTRENAL
* Bladder Cancer
* Kidney Stones
* Prostate cancer or BPH

22
Q

Care of AV fistula: Assess what is normal, when to be concerned

A

-no BP/sticks in that arm
-feel the thrill, listen to the bruit

concerned if no distal pulse, infection, ischemia

23
Q

Heart failure and acute renal failure: What is the relationship and what are goals when a person with HF develops ARF related to the HF?

A

-prerenal –> lack of perfusion to kidney’s or too much fluid for kidney’s to filter out (? i made this up but it sounds right)
avoid weight changes:
2 lbs overnight
5 lbs in a week
Gain 3 lbs between dialysis

24
Q

What is CRRT?

A
  • “Dialysis for the unstable patient”
  • Uses a filter with fine pores (unlike HD’s diffusion process)
  • Runs continuously for 24 hours a day and slowly runs a small amount of blood thru
    • ICU/1:1 nurse ratio
25
Q

Kidney transplant education

A

infection
rejection: low UOP

26
Q

DKA standard orders

A

-airway
-VS q 15
- fluids
- insulin
- bicarb
- frequent cbg checks
- hypotonic fluid CBG >250, D51/2 NS CBG <250

27
Q

Calculate fluid for a patient with burn using Parkland Formula

A

2ml * kg * TBSA % =

1/2 in first 8 hours
1/2 in 16 hours

28
Q

Priority assessment findings for patient with thrombocytopenia

A
  • risk for bleeding/prevention
  • pe/VT from microclots with TTP and HIT
  • platelet transfusion is <10,000
29
Q

Relevance of leukemia and high WBC’s (but still at high risk of infection)

A

Leukiemia is high level of* immature *WBC’s
-unable to fight off infections
-decrease prdxn of other blood cells

30
Q

What is pancytopenia?

A

all the blood cells be low

31
Q

Lymphoma assessment findings

A

-large painless lymph node
-b symptoms: night sweats, weight loss w/o trying, perpetuating fever

32
Q

Lymphoma assessment findings

A

-large painless lymph node
-b symptoms: night sweats, weight loss w/o trying, perpetuating fever

33
Q

Lymphoma education

A

-chemo/radition care: infections, skin care, sterilty, N/V, constipation/diarrhead
-hodgkins = good pronosis
-non-hohgkins = bad prognosis

34
Q

Low platelet priorities

A

BLEEDING, fall/injury prevention

platelet:
<50,000 = bleeding
<20,000 = sponatenous bleeding

35
Q

Importance of hydration with multiple myeloma

A

I think its because all the protein from MM will piss off your kidney’s to keep hydrated to protect that glomerulus

36
Q

Priority assessment finding during CRRT management

A

not sure but its prolly breathing or electrolytes

37
Q

Calculate TBSA- arms? torso? head? legs? genitals?

A

each arm = 9%(4.5 for front and 4.5 for back)
each leg = 18%
torso = 18%
back = 18%
front of head = 4%
back of head = 4%
crotchling = 1%

38
Q

Identify depth of burns based on description

partial (superficial vs deep) vs full thickness

A

partial superficial = blanchable, moist, blister
partial deep= red, dry, white patches , no blister
full = no blanching, dry, leathery (brown, black, yellow, white, deep red)

39
Q

which has pain?
partial (superficial vs deep) vs full thickness

A

partial super = pain
partial deep = less pain
full = no pain

40
Q

Common chemical in wound dressing for burns

A

silver aka Ag

41
Q

Surgical indications for burns

A

full thickness

scar revision/debridement

42
Q

How to reduce burn conversion

A

TBD

43
Q

Why is it important to reduce the zone of stasis (and prevent burn conversion)

A

so patient can heal on their own and not need surgery

44
Q

Indications for ICU admission for burns

A

> 20 % of body
co morbidities
specialized area
? there was one other i think but i cant remember

Kol- 410 Med Surg II (27 decks)

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