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NRSG 200: Med Surg 3 > [Exam 3] Chapters 53, 54, 55 > Flashcards

[Exam 3] Chapters 53, 54, 55 Flashcards

1
Q

Functions of the Kidney: What is the acronym to remember the functions?

A

A Wet Bed

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2
Q

Functions of the Kidney: 3-step process for urine formation?

A

Filtration, Reabsorption, Secretion

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3
Q

Functions of the Kidney: Blood pressure regulated through what?

A

RAAS System

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4
Q

Chronic Kidney Disease: What does this mean?

A

Umbrella term that describes a decreased function of the kidney that has lasted 3 or more months

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5
Q

Chronic Kidney Disease: If untreated, this will turn into what?

A

End-stage kidney disease

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6
Q

Chronic Kidney Disease - RFs: This includes what Heart issues?

A

Cardiovascular Disease, Hypertension, Decreased Perfusion to Kidneys, Obesity, Diabetes,

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7
Q

Chronic Kidney Disease - RFs: Why is Hypertension a problem?

A

This is causing damage to kidney and they are not noticing

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8
Q

Chronic Kidney Disease - Stages: What determines the stages?

A

They are five stages, and they are determined by GFR

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9
Q

Chronic Kidney Disease - Stages: Normal GFR?

A

> 125

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10
Q

Chronic Kidney Disease - Stages: At what level GFR to we determine its end-stage kdiney disease and they need dialysis?

A

When their GFR is < 15. Kidneys can no longer remove bodies waste.

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11
Q

Chronic Kidney Disease - CMs: What levels will we see in their lab results?

A

Increased creatinine levels
Decreased RBC levels
Metabolic Acidosis
Electrolyte Imbalance

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12
Q

Chronic Kidney Disease - CMs: What is creatinine, what is happening when its increased?

A

This is serum creatine in blood. End product of muscle energy of metabolic muscule breakdown. Measures effectiveness of renal function.

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13
Q

Chronic Kidney Disease - CMs: Creatinine shows us what?

A

How effectively are kidneys are doing

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14
Q

Chronic Kidney Disease - CMs: Decreased RBC production affects the body how?

A

Anemia.

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15
Q

Chronic Kidney Disease - CMs: What signs of Anemia will patient experience

A

Fatigue, potentially impaired gas exchange,

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16
Q

Chronic Kidney Disease - CMs: Why does MEtabolic Acidosis occur?

A

Because they lose the acid-base balance regulator relationship. Can’t regulate hydrogen ion

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17
Q

Chronic Kidney Disease - CMs: Hydrogen ion is what?

A

Acidic, and kidneys can’t get rid of it.

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18
Q

Chronic Kidney Disease - CMs: What electrolyte imbalance may occur

A

Hyperkalemia

Abnormal Calcium/Phosphorus

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19
Q

Chronic Kidney Disease - CMs: What to know about calcium and phosphorus?

A

They are inversely related to one another.

Phosphorus goes up and Calcium goes down. And reverse as well .

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20
Q

Chronic Kidney Disease - CMs: What must we continue to monitor?

A

GFR, Patients retaining fluid and being edematous.

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21
Q

Chronic Kidney Disease - Nursing MX: What are the things we can do?

A

Treat underlying cause
Monitor Labs (GFR)
BP and Weight

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22
Q

Chronic Kidney Disease - Types: What are the types that lead to this kdiney disease?

A

Nephrosclerosis

Primary Glomerular Disease

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23
Q

Chronic Kidney Disease - Types: What is Nephrosclerosis?

A

This is the hardening of the renal arteires that is caused by hypertension and diabetes

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24
Q

Chronic Kidney Disease - Types: What is Primary Glomerular Disease?

A

That is disease that destroys glomerulus of the kidney related to infection.lupus, diabetes.

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25
Q

Renal Cancer - RFs: What does this include?

A 
Gender (Males)
Tobacco
Occupation Exposure
Obesity
Polycystic Kidney Disease
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26
Q

Renal Cancer - RFs: Which one is an abnormal RF for this?

A

Polycystic Kidney Disease

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27
Q

Renal Cancer - RFs: What is Polycystic Kidney DiseasE?

A

Fluid filled cysts that can change shape of kidney and can alter kidney tissue and cause tumor to develop

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28
Q

Renal Cancer - CMs: What are these?

A

Often no symptoms
Palpable Mass
Painless Hematuria

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29
Q

Renal Cancer - CMs: How may this be found?

A

On palpation or the painless hematuria

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30
Q

Renal Cancer - CMs: As cancer progresses, what symptoms may you see?

A

Symptoms of metastasis such as weight loss, weakness,

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31
Q

Renal Cancer - Assessment/Diagnostic: What assessments may be performed?

A

May feel the mass on palpation

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32
Q

Renal Cancer - Assessment/Diagnostic: What diagnostic tests may occur?

A

Renal Angiogram, CT, Cystoscope, Urography

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33
Q

Renal Cancer - Assessment/Diagnostic: What is a Renal Angriogram?

A

Imaging test to look at blood vessels in kidney

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34
Q

Renal Cancer - Assessment/Diagnostic: What is cystoscope

A

Procedure that allows doctor to exmine lining of the bladder and urters

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35
Q

Renal Cancer - Assessment/Diagnostic: What is urography (pyelography)

A

X-Ray technique for producing an image of the renal pelvis

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36
Q

Renal Cancer - Med Mx, Surg Mx: What is the preferred method?

A

Surgery, radical nephroectomy. They will go in where they remove the kidney that is cancereous.

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37
Q

Renal Cancer - Med Mx, Surg Mx: Renal artery immobilization may be done, whcih is what?

A

If you have renal artery thats feeding kidney, they will block and immobilzie the blood supply to the kidney. Kidney will not be fed and will kill the tumor.

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38
Q

Renal Cancer - Med Mx, Pharm Mx: What will typically be done?

A

Chemotherapy, Interleukin II.

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39
Q

Renal Cancer - Nursing Mx: What will we have to focus on?

A

Pain Control
Catheter and Drains
Patient Education

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40
Q

Renal Cancer - Nursing Mx: PAtient will be educated on what?

A

The tubes and drains that are connected to them.

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41
Q

Renal Cancer - Nursing Mx: What interventions are typically done after patient has surgery

A

Turns every 2 hours, cough/deep breath, DVT prophylaxis.

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42
Q

Renal Cancer - Nursing Mx: When would radiation be considered?

A

This is typically more for palliative care to keep them comfortable

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43
Q

AKI: What is this?

A

Rapid loss of renal function due to damage to the kidneys. Some event has caused kidneys to malfunction

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44
Q

AKI: What is the other name for this

A

ACute renal failure

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45
Q

AKI: What are some events that may cause this?

A

If patient hypovolemic, hypotensive, kidneys aren’t getting perfused.

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46
Q

AKI: What must you treat first?

A

Whaetever is causing the kidney injury. If dehydrated, give more water.

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47
Q

AKI - Classifications: What are the three classifications of this?

A

Prerenal
Intrinsic
Postrenal

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48
Q

AKI - Classifications: What occurs in prerenal?

A

Marked decrease in renal blood flow

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49
Q

AKI - Classifications: What occurs in intrinsic?

A

Damage to structures within the kidney

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50
Q

AKI - Classifications: What occurs in postrenal ?

A

Obsturction of urine outflow from kidney

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51
Q

AKI - Classifications: What may cause prerenal?

A

Septic, Shock, Vasodilated, Impaired Cardiac Function, Decreased EF.

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52
Q

AKI - Classifications: In prerenal , cause is happening before what?

A

Before the kidney is affected.

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53
Q

AKI - Classifications: What is happening in Intrinsic?

A

Damage to glomeruli or kidney tubules.

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54
Q

AKI - Classifications - Intrinsic: What can cause damage to occur?

A

Antibiotics, Amioglycosides (mycin family)

Contrast for CT.

NSAIDS

Myoglobinurea

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55
Q

AKI - Classifications - Intrinsic: How to treat if this is happening due to an antibiotic?

A

Take away the antibiotic and give them a different one

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56
Q

AKI - Classifications - Intrinsic: What happens if Creatinine is at 2 and contrast is needed?

A

Contrast induced neuropathy can occur . This is why we premedicate with extra solution and give bicarb and bicarb solution for the kidneys.

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57
Q

AKI - Classifications - Intrinsic: NSAIDS damage what?

A

The kidneys

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58
Q

AKI - Classifications - Intrinsic: Tyelonol damages what?

A

The liver

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59
Q

AKI - Classifications - Intrinsic: Why does Myoglobinurea occur?

A

When there is a crush injury . Patient is found down and developed rhabomylosis (due to muscle injury. Results form death of muscle fibers). Myoglobin gets released from muscle and plug kidneys

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60
Q

AKI - Classifications - PostRenal: What does this deal with?

A

Obstruction of urine outflow from kidney. Urine can’t go to bladder or if prostate tissue, backs up the kidney. Backup of urine into kdiney

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61
Q

AKI - Classifications - PostRenal: What can cause this

A

Kidney stone, BPH, blood clots within ureter,

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62
Q

AKI - Phases: What occurs in first phase?

A

Initiation phase. What causes the original injury

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63
Q

AKI - Phases: What occurs in the second phase

A

Oliguria period. <0.5 mL/kg/hr. Decreased urine output

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64
Q

AKI - Phases - 2nd Stage: Decreased urine output leads to what

A

Increased concentration of potassium, creatinine, uric acid , increase in waste products.

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65
Q

AKI - Phases - 2nd Stage: What issues can occur in patient has high potassium level?

A

Peak T Wave.

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66
Q

AKI - Phases - 2nd Stage: How can high potassium be treated?

A

Kayexelate, works by binding to stool and patient poops out potassium. DEcreases concentration.

Insulin

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67
Q

AKI - Phases - 2nd Stage: What does giving insulin for high potassium do for patient?

A

Forces the potassium back into cell until we can get the potassium down permanently.

Given in emergent siutation.

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68
Q

AKI - Phases - 2nd Stage: What must you do if you give insulin for hyperkalemia?

A

You have got to give dextrose so you don’t bottom patients glucose out.

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69
Q

AKI - Phases - 3rd Stage: What occurs here?

A

Diuresis. Gradual increase of urine output and GFR is increasing

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70
Q

AKI - Phases - 3rd Stage: What must you watch out for here?

A

The patients fluid volume levels

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71
Q

AKI - Phases - 4th Stage: What is this?

A

Recovery period. 3-12 months. Lab values normal. May still have slight reduction in GFR.

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72
Q

AKI - CMs: Where will the signs appear?

A

in every body system of the body

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73
Q

AKI - CMs: What symptoms will they have?

A

Will be critically ill, lethargic, dry mucuous membranes,

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74
Q

AKI - CMs: What CNS effects may we see?

A

Headache, drowsiness, muscle twitching, seizures, due to electroltye imbalances and toxins building up

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75
Q

AKI - CMs: What tests must you look clcosely at?

A

Creatinine, BUN, GFR, Creatinine Clearance

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76
Q

AKI - CMs: What is Creatinine clearane?

A

The most reliable indicator of how the kidneys are functioning.

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77
Q

AKI Tx - Assessment/Diagnostics: Imaging will consist of ?

A

KUB, MRI, Ultrasound

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78
Q

AKI Tx - Prevention: How can this be prevented?

A

If you are going to be giving nephrotoxic medications, monitor the kidney function.

This includes antibiotics and amioglycosides.

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79
Q

AKI Tx - Prevention: What must you watch out for if patient has contrast?

A

Contrast induced nephropathy (damage to small blood vessels or to the units in kidneys that clean blood)

Monitor function before this

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80
Q

AKI Tx - Pharmacological Therapy: This will focus on what?

A

Decreasing potassium levels

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81
Q

AKI Tx - Pharmacological Therapy: What can be given to decrease potassium?

A

Kayexelate (reduces potassium content and exchanges sodium ions for potassium in GI tract and patients poop out potassium)

Insulin if unstable (potassium shifted into cell)

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82
Q

AKI Tx - Pharmacological Therapy: Important to montior what here?

A

Potassium levels

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83
Q

AKI Tx - Nutritional Therapy: What will their diet consist of?

A

High calories(help body recover), high carbs

84
Q

AKI Tx - Nutritional Therapy: What will be restricted in their diet?

A

Potassium and Phosphorus (because kidneys recoveryign and may still have high phosphorus and potassium)

85
Q

AKI Tx - Nutritional Therapy: What foods are avoided with potassium?

A

Bananas, Citrus Fruits, Coffee

86
Q

AKI Tx - Nutritional Therapy: Once patient starts to recover, what can they increasE?

A

Their protein levels ,

87
Q

AKI Tx - Nutritional Therapy: Why do you not want to give high protein diets?

A

It is hard of the kidney and cnanot filter out as well. May cause more damage to kidney.

88
Q

AKI Tx - Nursing Mx: What nursing management should we do?

A 
Monitor FLuid/Electrolytes
REduce Metabolic Rate
Promote Pulmonary Function
PRevent Infection
sKin Care
Psychosocial Support
89
Q

AKI Tx - Nursing Mx: We want to promote pulmonary function to prevent what?

A

Atelectasis (Complete or partial collapse of entire lung) and Pneumonia (infection that inflames air sacS)

90
Q

AKI Tx - Nursing Mx: What change will they have on their EKG?

A

Peaked T Wave

91
Q

ESKD: What stage does this occur in?

A

5th stage of CKD

92
Q

ESKD: GFR level here?

A

< 15 ml/min

93
Q

ESKD: This will require permanent what?

A

Renal replacement therapy (RRT)

94
Q

ESKD: What is RRT?

A

This is dialysis

95
Q

ESKD: WHat body systems are affected>?

A

All of the system s

96
Q

ESKD: Neurological changes?

A

Weakness/FAtigue/Confusion

97
Q

ESKD: Cardiovascular Changes?

A 
Increased BP
Pitting Edema
Periorbital Edema
Increased CVP (normal 2-6)
Pericarditis

Because fluid is overloading

98
Q

ESKD: Pulmonary Changes?

A

SOB, DEpressed COugh, Thick Sputum

99
Q

ESKD: GI Chagnes?

A 
Ammonia Odor to breath
Metallic taste
Mouth/gum ulcerations
Anorexia
N/V
100
Q

ESKD: Psychological Changes?

A

Withdrawn
Behavior Changes
Depression

101
Q

ESKD: Hematoligcal Changes?

A

Anemia
Bleeding Tendencies
Increased Potassium Serum

102
Q

ESKD: Skin changes?

A 
Dry, FLaky
Pruirtus (itchy skin bc ur)
Ecchymosis
Purpura 
Yellow-gray skin color
103
Q

ESKD: Musculoskeletal changes?

A

Cramps
Renal Osteodystrophy
Bone Pain

104
Q

ESKD: What must you assess for if someone is on hemodialysis

A

Thrill and Bruit. Evalaute access site fo rpatency.

105
Q

ESKD: What must you not do for hemodialysis site

A

Take blood pressure or blood samples from the extremity with fistula/graft.

106
Q

ESKD - Assessment: What changes will we assess for?

A 
GFR
Na / H2O Retention
Acidosis
Anemia
Ca/Phos Imbalance
107
Q

ESKD - Diagnostics: What diagnostic tests can be performed?

A

Kidney ultrasound

108
Q

ESKD - Complications: What complications may occur?

A 
Anemia
Ca/Phos Imbalance
Bone Disease
Hyperkalemia
HTN
Pericarditis
Percardial Effusion/Tamponade
109
Q

ESKD - Medical Mx: Waht is the overall goal?

A

To maintain hemostasis and acid base balance within the body

110
Q

ESKD - Pharmacological Therapay: What will be given?

A

Calcium and Phosphate Binders to regulate the levels,

111
Q

ESKD - Pharmacological Therapay: What meds are given for phosphorus?

A

PhosLo , Renvela

This bind to phosphorus and get it down .

112
Q

ESKD - Pharmacological Therapay: What ot know for PhosLo and Renvela?

A

They must be given with a meal which may raise calcium.

113
Q

ESKD - Pharmacological Therapay: What meds may be given for calcium?

A

Tums. Will bring up calcium and decrease phosphorus

114
Q

ESKD - Pharmacological Therapay: What meds cna be given ccardio wise?

A

Antihypertensives to control blood pressure

115
Q

ESKD - Nutritional Therapay: How can this be monitored?

A

With albumin levels (3.5-5).

116
Q

ESKD - Nutritional Therapay: What happens if albumin is in the 2s?

A

That will show that they are malnourished. Want to make sure that are taking in large biologic protein

117
Q

ESKD - Nutritional Therapay: They can’t take a large amount of protein?

A

it is hard on the kidney

118
Q

ESKD - Nutritional Therapay: What must we be sure of for protein they are taking in?

A

We have to make sure its good quality like dairy and meat.

119
Q

ESKD - Nutritional Therapy: What restriction will they be placed on?

A

Fluid restriction.

120
Q

ESKD - Nutritional Therapy: How much fluid can they have?

A

500-600 mL intake + whatever output they had the previous day.

121
Q

ESKD - Nutritional Therapy: How much fluid can they have if they had 50 mL of fluid output yesterday

122
Q

ESKD - Nutritional Therapy: How will their kidneys be fitlered?

A

Through dialysis

123
Q

ESKD - Nursing Mx for Education: this includes what?

A

How much fluid they can take in, when to take their meds, when to go to dialysis

124
Q

ESKD - Nursing Care Plan: This will include what?

A 
Based on problems patient has. 
Excess Fluid Volume
Imbalance Nutrition
Deficient Knowledge
Activity Intolerance
125
Q

ESKD - Nursing Care Plan: How will excess fluid volume be fixed?

A

Can’t give lasix. Must be done through dialysis and must monitor weight. Great indicator to help manage fluid volume.

126
Q

ESKD - Nursing Care Plan: Every pound of weight is how much water?

127
Q

Renal Replacement Therapies: What is this>

A

Dialysis , because they cannot regulate it anymore.

128
Q

Renal Replacement Therapies: Hemodialysis can be used for patients other than ESKD, like who?

A

Those with AKI who are acidotic. Can correct it quickly by putting them on this.

129
Q

Renal Replacement Therapies: What does dialysis do?

A

Removes excess fluids, electrolytes, solutes, toxins, from the blood in people who have kidney failure

130
Q

Renal Replacement Therapies: In what scenario can dialysis be run?

A

Emergent, if patient comes in and are very acidic and potassium 7 . Flash pulmonary edema.

Scheduled, 3x per week.

131
Q

Renal Replacement Therapies - Hemodiaylsis: What are dialyzers?

A

The dialyzr machine

132
Q

Renal Replacement Therapies - Hemodiaylsis: What is dialysate?

A

Important because it matches the ideal ECF to pull toxins off the blood. Works off of diffusion, osmosis, toxins move from area of low concentration to high to follow diaylsate.

133
Q

Renal Replacement Therapies - Hemodiaylsis: What is the red thing that hangs off of dialysis machine?

A

This is the filter, the artificial kidney . They pull out the toxins and excess fluids and return clean blood into patient.

134
Q

Vascular Access - Hemodialysis: Temporary access can be in the form of what?

A

Permacath that are placed where central line is placed. Can be in IJ, subclavian, femoral vein.

135
Q

Vascular Access - Hemodialysis: If a permacath is cuffed, what does it mean?

A

There is a cuff further along and tissue will adhere. Places at less risk for infection

136
Q

Vascular Access - Hemodialysis: If going on long term, permacath may be an option way?

A

They may have poor vascular disease because of the heart problems which would not allow for a fistula or graft

137
Q

Vascular Access - Hemodialysis: Patients with permacath are at big risk for what?

A

infection, because its big and goes into heart

138
Q

Vascular Access - Hemodialysis: Permanent types include what

A

fistula and graft

139
Q

Vascular Access - Hemodialysis: What is fistula

A

they take an artery and vein and join it together. Helps vein get much bigger. Will take 2-3 months to mature. May use permacath in mean time.

140
Q

Vascular Access - Hemodialysis: What is a graft?

A

Synthetic tubing that is placed between artery and vein.

141
Q

Vascular Access - Hemodialysis: With a fistula and graft, what must you assess for ?

A

Feel for the thrill (vibrating, swishing, turbulent blood flow) and hear for the bruit. (will ehar for the flow of blood)

142
Q

Vascular Access - Hemodialysis: What does it mean if you can’t hear thrill or bruit?

A

They may not be able to run on dialysis on that day and may negatively impact patient.

143
Q

Hemodialysis - Complications: What complciations can occur before they start?

A

SOB because fluid that has accumulated. May become hypotensive during dialysis because we are pulling all this fluid out.

144
Q

Hemodialysis - Complications: Why complciations may they experience

A

Muscle cramping bc electrolyte shift
Dysrhythmias bc electrolyte imabalce
Air embolism (rare)
Dialysis Equilibrium (within brain, have rapid osmotic shift that causes disequilbrium)

145
Q

Hemodialysis - Nursing Mx: How can you promote pharmacologic therapy for these patients?

A

If its 8am for dialysis , you don’t want to rush to get meds in because they’ll be dialyzed off.

Best thing to do if call pharamcist to see if meds appropriate to give

146
Q

Hemodialysis - Nursing Mx: How do you promtoe fluid and nutritional therapy?

A 
Protein Restriction
Low Potassium (salt substitues)
147
Q

Hemodialysis - Nursing Mx: How can you help meet psychosocial needs?

A

Running 3x a week for hours can be draining. Make sure to support them emotioanlly

148
Q

Hemodialysis - Nursing Mx: How can you promote home and community based care?

A

Hemodialysis can be ran at home.

149
Q

Continuous Renal Replacement Therapies: What is Continuous Venovenous Hemofiltration (CVVH)

A

This is basically just pulling fluid off. This is continuous because they are critically ill.

150
Q

Continuous Renal Replacement Therapies: What is Continuous Venovenous Hemodialysis (CVVHD)

A

This is doing the full dialysis. This will be used for patients who are very critically ill and continuous.

151
Q

Peritoneal Dialysis (PD): This is the treatment of choice for which patient?

A

The patient who doesn’t want hemodialysis or they don’t want to end up with kidney transplant.

152
Q

Peritoneal Dialysis (PD): How do waste products move here?

A

From an area of higher concentration to an area of lower concentration

153
Q

Peritoneal Dialysis (PD): Where does this occur?

A

The periotneal membrane that covers the abdominal organs and covers the wall. SErves as semipermeable membrane.

154
Q

Peritoneal Dialysis (PD): How does this work?

A

Dialysate fluid goes into the peritoneal membrane and gravity takes it down. Uric acids are cleared from blood through diffusion and osmosis.

It dwells and dialysate flows out into drainage bag

155
Q

Peritoneal Dialysis (PD) - Procedure: how can you prepare patient for this?

A

Patients will get peritoneal catheter inserted. Explained the procedure to patient and encourage patient to empty bowel and bladder. REduces risk of internal puncture.

156
Q

Peritoneal Dialysis (PD) - Procedure: What are they put on before the catheter is placeD?

A

An antibiotic just to make sure infections are prevented.

157
Q

Peritoneal Dialysis (PD) - Procedure: Once catheter is inserted and theyre ready to go, nurse will do what?

A

Set up equipment and seet up dialysate that will dwell within peritoneum.

158
Q

Peritoneal Dialysis (PD) - Procedure: Temperature for dialysate?

A

Needs to be at body temperature. If too cold, will cause vasoconstriction and cramping. Won’t pull toxins out.

159
Q

Peritoneal Dialysis (PD) - Procedure: What technique is used when accessing cathers?

A

Septic technique. To prevent infection.

160
Q

Peritoneal Dialysis (PD) - Procedure: What happens as the dialysate is infused?

A

It dwells in the cavity for a set amount of before you drain the dialysate and pull out all the fluid that was in there into the drainage bag

161
Q

Peritoneal Dialysis (PD) Old School - Procedure: COmplications:?

A

Peritonitis
Leakage
Bleeding

162
Q

Peritoneal Dialysis (PD) - Procedure: How can you monitor for peritonitis?

A

Board-Like Abdomen
Abdomen Distention
Abdominal Guarding
Fever

163
Q

Peritoneal Dialysis (PD) - Procedure: What color should drainge be?

A

Clear or straw colored. If cloudy, indicates infection. If brown, indicates perforation

164
Q

Peritoneal Dialysis (PD) - Procedure: Diagnostic for Peritonitis?

A

CBC, Xray
Peritoneal Aspiration
Peritoneoscopy
Ultrasound

165
Q

Peritoneal Dialysis (PD) - Procedure: How can you fix peritonitis?

A 
Identify Cause
Antibiotics
IV Fluids
Decreased Abd Distention
Surgery to Close Perforation
166
Q

Peritoneal Dialysis (PD) - Procedure: If peritonitis not fixed, what will happen to patient?

A

They will go septic

167
Q

PD Approaches - Types: What is Acute Intermittent PD?

A

This has to do with fill, dwell, drain method

168
Q

PD Approaches - Types: What is Continuous Ambulatory PD?

A

Exchanges occur 4-5x per day. 24 hours a day. 7 days a week

169
Q

PD Approaches - Types: What is Continuous Cyclic PD?

A

Uses a machine called cycler and it can be run at night

170
Q

PD Approaches - Nursing Consideration: How to prevent constipation?

A

Don’t want that because it’ll slow the flow of diasylate to peritoneum. Need to be on high fiber and stool softeneres.

171
Q

PD Approaches - Nursing Consideration: What kind of diet do they have

A

High protein diet because they lose a lot of protein

172
Q

PD Approaches - Nursing Consideration: Why to give Emotional Support?

A

They have catheters in them. Need the support because its a lot.

173
Q

Special Considerations for Hospitalized Dialysis Patients: What change can occur on the patients skin?

A

Uremic Frost, which is why they itch.

174
Q

Special Considerations for Hospitalized Dialysis Patients: What is Uremic Frost?

A

Toxins come onto the surface of the skin and appears as white spots on their skin. usually in metabolic acidosis.

175
Q

Special Considerations for Hospitalized Dialysis Patients: When patients in hospital, what must you do everyday?

A

Get daily weights. Greatest indicator of their fluid status

176
Q

Special Considerations for Hospitalized Dialysis Patients: What should you do for those with dialysi to protect them?

A

Protect vascular access (thrill/bruit/no bp/no sticks/) and be careful with iv therapy .

Provide catheter site care

177
Q

Special Considerations for Hospitalized Dialysis Patients: What do you monitor cardiac wise?

A

Cardiac/respiratory complciations

monitor blood pressure

178
Q

Special Considerations for Hospitalized Dialysis Patients: What other care cna you provide for their overall body?

A

Fluid/Eclectrolyte levels
Manage discomfort
PRevent infection
Provide support / give meds

179
Q

Kidney Surgery - PreOp Considerations: What should be done nrusing wise?

A

Give them fluids, promote excretion of waste products if they can handle it.

Also treat infections beforehand

180
Q

Kidney Surgery - Perioperative Concerns: : What position may they be in?

A

Flank (On right side, left arm up over head)
Lumbar (leaning more on stomach, right arm over head)
Thoracoabdomianal approach (on right side but leaning more back)

Depends on where on kidney they are trying to get to.

181
Q

Kidney Surgery - Postoperative Mx: What must you monitor for

A 
Hemorrhage (very vascular kidneys), 
VS
CVP
Urine Output, may not be making urine. 
Blood Clot/DVT/Pneumonia
182
Q

Kidney Surgery - Postoperative Mx: What does abdominal distention show may be happening?

A

Paralytic ileus may be forming

183
Q

Kidney Surgery - Postoperative Mx: How may their fluid status be?

A

They may be hypervolemic or hypovolemia

184
Q

Kidney Surgery - Postoperative Mx - Assessment: This includes all parts of the body, meaning what should be focused on?

A

Monitoring drainage from incision, drainage tubes, assess skin color, Output, VS,

185
Q

Kidney Surgery - Postoperative Mx - Diagnosis: This incldues what

A 
Ineffective Airway Cleanrace
Ineffective Breathing Pattern
Acute Pain
Fever/Axeity
Imapired urinary elimination
186
Q

Kidney Surgery - Postoperative Mx - Diagnosis: What compliations can occur?

A

Bleeding, pneumonia, infection, DVT

187
Q

Kidney Surgery - Postoperative Mx - Interventions: How to do pain relief measures?

A

Analgesic medications

188
Q

Kidney Surgery - Postoperative Mx - Interventions:How to promote airway clearance and effective breathing pattern?

A

With appropriate pain relief, deep-breathing, coughing, and incentive spirometer

189
Q

Kidney Surgery - Postoperative Mx - Interventions: What to do when handling catheter?

A

Strict asepsis with catheter

190
Q

Kidney Surgery - Postoperative Mx - Interventions: Encourage patient to do what early on?

A

Leg exercises, early ambulation, and monitor for signs of DVT

191
Q

Kidney Surgery - Postoperative Mx, Patient Txing: What should patient be taught since they are going home with drains?

A

Instruct family
How to care for drainage system, prevent complications

Signs of infection (redness, drainage)

Follow fluid intake

Health promote/health screening

192
Q

Renal Transplant: Most sucessful when?

A

If we transplant before dialysis

193
Q

Renal Transplant: This is the treamtent of choice for what?

194
Q

Renal Transplant: How to tell if this was successful?

A

If there is urine production

195
Q

Renal Transplant: Where is the kidney usually placed?

A

Cradled in the ilium in the pelvis. Renal artery sutured to iliac artery.

196
Q

Renal Transplant: What happens to the native kidney?

A

It is usually just kept in place.

197
Q

Renal Transplant: Management for this after surgery?

A

Monitor for rejection (anti-rejection meds for life with steroids)

198
Q

Bladder Cancer - RFs: This includes what?

A

Smoking and bladder stones

199
Q

Bladder Cancer - CMs: This incldues what?

A

Painless hematuria (presence of blood in urine), may see pelvic back pain , more frequent UTIs,

200
Q

Bladder Cancer - Diagnosed how?

A

Ureteroscopy (a Scope of the urethra and bladder , can visualzie tumor and get biopsy)

201
Q

Bladder Cancer - Surgical Mx: Why will they have surgery?

A

To remove the tumor

202
Q

Bladder Cancer - Surgical Mx: What may occur during surgery?

A

urinary diversion

203
Q

Bladder Cancer - Surgical Mx: What will occur with a urinary diversion?

A

They will make a stoma , make an ostomy site within bladder will and divert urine.

204
Q

Bladder Cancer - Pharmacological Mx: What will be done here?

A

Chemotherapy. They can do a topical version and can also do BCG Live. Is the most common treatment

205
Q

Bladder Cancer - Radiation: This is done why?

A

To help shrink the tumor

206
Q

Bladder Cancer - Investigational: This includes what?

A

Photodynamic Therapy

207
Q

Bladder Cancer - Investigational: How does photodynamic therapy work?

A

Photosensitizing material injected into the cancer cell. Cells pick it up and is toxic to them and will kill them.

NRSG 200: Med Surg 3 (46 decks)

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