Exam 3 based on blueprint Flashcards
weight gain goals for CKD
overnight
in a week
between dialsyis
gain no more than:
2 lb overnight
5 lb / week
3 lb b/w dialysis
what stage should we start ACE inbitiors for CKD?
stage 1!
how do BB help CKD?
Help increase cardiac output/ avoid heart failure (reduced perfusion of kidneys –> Accelerated kidney disease)
protein intake for CKD : regular vs dialysis
regular = 0.55-0.6 g/kg/day
dialysis = 1-1.2 g/kg/day
how do we know if lasix working?
-daily weight!
clear lung sounds
signs of worsening renal failure:
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
priority assessment for hyperkalemia
EKG
disorders that can lead to pre-renal failure
Reduced perfusion = PRERENAL
Shock
Hypotension
Anything that blocks blood flow to kidneys (Atherosclerosis)
Importance of urinary output with burns
determines if fluid replacement is adequate
Assessment of breathing, airway patency in burns
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
Intervention/ priority for difficulty breathing after burns
intubate
Priority lab findings for patient with burns
ABG
Kidney function/perfusion labs
Electrolytes
H&H
Response for low urinary output in burn victims
flush foley to make sure it is patent
increase IVF
Risks of burns/ prevention
Smoke Detectors
Adjust hot water heater
Turn Pot handles away from reach
Safe use of Oxygen (no open flames)
Autocontamination in patients at high risk of infection (burn patients, cancer)
change gloves frequently and between dressing change sites
Priorities in reducing infection in patients at risk of infection
hand hygeine
lines clean/removed
limit exposure to crowds/sick people
Recognizing respiratory distress in patients with renal failure: What does it look like, why does it happen, what do you do
fluid overload!
JVD, edema, crackles, increased O2 demand, increase RR, dypnea
-diuretics, dialysis, O2
What it is epogen and why do patients with CRF need it?
Epoetin alfa
-kidneys can’t make EPO so they are anemic and at riskfor bleeding
-epogen increase your RBC
Prevention of worsening renal failure (education/ lifestyle changes)
- 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
Prevention of worsening renal failure (education/ lifestyle changes)
- 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
What is post-renal failure and who is at risk?
Obstruction = POSTRENAL
* Bladder Cancer
* Kidney Stones
* Prostate cancer or BPH
Care of AV fistula: Assess what is normal, when to be concerned
-no BP/sticks in that arm
-feel the thrill, listen to the bruit
concerned if no distal pulse, infection, ischemia
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?
-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
What is CRRT?
- “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
