Exam 3 stuff Flashcards
(121 cards)
1
Q
how quickly does AKI happen?
A
hours to days
2
Q
what happens when kidneys lose fxn?
A
inability to maintain F&E and A+B balance
3
Q
what are the three causes of AKI
A
prerenal
intrarenal
postrenal
4
Q
examples of prerenal injury
A
shock, hypo, anything that blocks blood flow to the kidneys
5
Q
examples of intrarenal injury
A
glomerulonephritis, lupus, drugs that damage the kidneys, toxins, ischemia
6
Q
examples of postrenal injury
A
bladder cancer, kidney stones, prostate cancer/BPH
7
Q
how do kidneys compensate when its pre + post injury? (3)
A
activating RAAS
constricting kidney blood vessels to raise the BP in kidneys
releasing ADH: less pee, more volume.
8
Q
what does kidney compensation for AKI lead to (that also causes issues?)
A
oliguria
azotemia
9
Q
assessment findings for AKI
A
oliguria (less than 400 mL/24 hrs)
FVO
crackles
increased O2 demand/RR/dyspnea
edema
N/V: r/t azotemia
confusion
10
Q
dx for AKI
A
serum Cr, BUN
abnormal e- (esp K)
urine Na levels
Metabolic acidosis
Urine SG (dilute or conc.)
US
CT scans- no IV contrast though!!
MRI
X ray/KUB
11
Q
interventions for AKI
A
INTERVENE EARLY!
maintain MAP
monitor Is & Os
fluid replacement or restriction
meds… diuretics
Venous monitoring
nutrition
RRT
12
Q
what sort of nutrition is appropriate for someone with AKI
A
get a dietician on board!
40 g/day of protein (more if on dialysis)
K restrictions…
Fluid restrictions
13
Q
how many stages are there of CKD?
A
5 stages! based on GFR fxn
14
Q
what does stage 1 on CKD look like?
A
normal kidney fxn/GFR but increased risk for damage
15
Q
what does stage 2 of CKD look like?
A
mild disease/decrease in fxn. decrease in GFR 60-80%
16
Q
what does stage 3 of CKD look like?
A
moderate disease/azotemia present.
restriction fluids
GFR 30-59%
17
Q
what does stage 4 of CKD look like?
A
severe disease
can’t maintain F&E, A&B
dialysis maybe
GFR 15-29
18
Q
what does stage 5 of CKD look like?
A
GFR <15
dialysis def.
death or transplant
19
Q
what does CKD do to the CV system?
A
HTN, malfxn of RAAS, HLD, HF, Pericarditis, cardiomyopathies
20
Q
what does CKD do hematologically?
A
causes anemia r/t reduced EPO. can also cause reduced platelets
21
Q
CKD and GI
A
stomatitis, colitis, anorexia, N/V, hiccups, PUD
22
Q
CKD assessment findings r/t azotemia
A
anorexia, N/V, fatigue
23
Q
what is the metallic taste during CKD r/t?
A
build up of uremic acid! can also have uremic halitosis
24
Q
skin changes r/t CKD
A
pruritis, bronzed color, uremic frost, bruises
25
What are other assessment findings of CKD?
urinary changes, wt loss, drowsiness, confusion, neuropathies, FVO, dysrhythmias, HTN, s/s of anemia
26
goals (wt wise) for CKD
pts will not:
gain or lose 2 lbs overnight, 5 lbs in a week or 3 bw dialysis
27
what kind of meds for CKD
Diuretics!
28
when should we not use diuretics?
after dialysis has started
29
what are other meds for CKD?
anti-HTN, CCB, ACE inhibitors, BB
30
what can CCB do for CKD?
improve GFR and blood flow to kidneys
31
what do ACE inhibitors do for CKD
slow the progression of CKD
32
what are two other things r/t to CV and CKD that patients should do?
daily wts! and measure BP daily!
33
nutrition requirements for CKD
altered protein intake
fluid restrictions
K restrictions
Na restrictions
Phosphorus restrictions
34
what does altering protein intake do for CKD
uremia is the build up of protein waste. reducing protein intake can preserve kidney fxn! monitor albumin
35
when should a CKD pt increase protein intake?
after dialysis has started!
36
what are the forms of RRT? (3)
peritoneal dialysis
hemodialysis
CRRT
37
what are the different types of RR access?
AV fistula, AV graft, VasCath, PermCath, ABD cath
38
characteristics of an AV fistula
surgical connection of artery and vein!
increases venous blood flow
requires harvesting and maturation-- 6 months!
vessel walls have to thicken before it can be accessed
39
characteristics of an AV graft
utilizes synthetic material
used as an alternative to a fistula
40
what are some care points for a fistula?
NO BP!! hang a sign over bed. feel for thrill and listen for a bruit Q4. assess distal pulses, s/s of infection.
41
what is the most common fistula complication?
thrombosis!
tPa can be used
42
what are other complications of a fistula?
strictures, infection, and ischemia
43
how is vascular access used?
SHORT TERM
44
what are the two types of vascular access points for RRT?
VasCath and PermCath
45
what are some complications of vascular access?
INFECTION! misplacement and dislodgement
only use femoral site if absolutely necessary
do not use for ANYTHING OTHER THAN DIALYSIS
bleeding
46
what is peritoneal dialysis?
utilizes the peritoneal cavity for the exchange of fluids, waste and e-.
47
how do they do peritoneal dialysis?
they infuse fluid into the peritoneal cavity and let it do its thang
48
what are some complications of PD?
infection
peritonitis
discomfort
bowel perforation
49
what do RBCs do?
deliver O2
50
what do platelets do?
form platelet plugs! important for clotting
51
what do WBCs do?
provide protection through immunity and inflammation
52
normal level for RBCs
4-6 million
53
normal level WBC
4,500-11,000
54
normal level platelets
150K-450K
55
what is the patho of leukemia?
excessive overgrowth of immature leukocytes!
which means.... that we have an abundance of WBCs that can't fxn--> reduced immunity!
56
three types of leukemia
lymphocytic
myelocytic
biphenotypic
57
characteristics of acute leukemia
sudden onset
rapidly growing
severe symptoms
58
characteristics of chronic leukemia
slow onset, many persist for months to years
slow growing
usually milder symptoms
may not require immediate tx
59
what are some risk factors for leukemia?
radiation, viral infection, exposure to chemicals and drugs, genetic factors, immunity factors
60
CV assessment findings with leukemia
tachy (r/t anemia)
hypo (r/t anemia)
slow cap refill (r/t anemia)
murmurs (r/t thickness of the blood)
bruits (r/t thickness of the blood)
61
respiratory assessment findings with leukemia
tachypnea
infiltrates
respiratory infection: cough, dyspnea, abnormal breath sounds
62
integumentary assessment findings with leukemia
pallor
cool
petechiae
skin infections
poor healing wounds
bleeding gums
63
GI/GU assessment findings with leukemia
wt loss, N, GI bleeds, hematuria, liver enlargement and spleen enlargement
64
CNS assessment findings with leukemia
HA, seizures, fever, fatigue, behavior changes, somnolence
65
MS assessment findings with leuk
bone pain, joint swelling and pain, muscle weakness
66
what will be low H&H wise with leuk?
H&H, platelets
67
what can WBCs levels be with leuk?
they can be low, normal or high!
patients with high immature WBC count @ dx have poorer prog
68
how do we dx leukemia?
bone marrow aspiration and biopsy
chromosome analysis
imaging
xray
69
interventions for leuk
INFECTION PREVENTION!!!!
drug therapy
70
for leuk patients, what should we watch for with temp?
a 1 degree increase is cause for concern!
71
what is another super important piece of infection prevention for leuk patients?
maintain skin integrity!!
72
what are the 3 phases of acute leuk tx?
induction
consolidation
maintenance
73
what is the induction phase?
combination chemo (7 + 3)
prolonged hospitalization
infection related deaths are common during this time
74
what is the consolidation phase?
another round of chemo
occurs early in remission
75
what is the maintenance
months to years after induction and consolidation
76
what is the first line drug for chronic leuk?
Gleevac (imatinib mesylate)
induces remission in early stages of CML
77
what are some other chronic leuk drugs?
MABs, Targeted therapy, allogenic hematopoietic stem cell transplant
78
complications of leuk
INFECTION
poor clotting
79
what is Nadir?
period of greatest bone marrow suppression
80
what is multiple myeloma?
WBC cancer of mature B-lymphocytes
81
what happens when cancer cells excrete excess antibodies?
increase protein levels, "clog up" blood vessels to kidneys and other organs
82
what doe myeloma cells do?
produce excess cytokines
excess cytokines increase cancer cell growth and bone destruction
83
what else can excessive myeloma cells lead to?
reduction in the production of platelets, RBCs and WBCs leading to pancytopenia
84
what are some assessment findings of MM?
elevated protein levels
elevated paraprotein levels
fatigue
bone pain
bruising
anemia
fractures
bacterial infections
kidney problems
85
what are some prognosis factors for MM?
age, performance status, serum Cr, serum albumin, serum Ca, H&H levels
86
how do we dx MM?
x-ray, high levels of IgG and plasma proteins
Bence jones protein in pee
bone marrow biopsy
87
what do we look for on an x-ray for MM?
bone thinning and bone loss... swiss cheese appearance
88
what are Bence Jones proteins?
protein composed of incomplete antibodies
89
what are some interventions for MM?
pain mgmt!
tx options vary based on disease progression
Stem cell transplant
90
what are the standard drug tx options for MM?
proteasome inhibitors
immunomodulating drugs
possible steroids
91
intervention complications for mm?
myelosuppression!
toxicities
thromboembolic event...
neuropathy
N/V
92
what is lymphoma?
cancer of the lymphoid cells and tissue
93
what happens with lymphoma?
uncontrolled growth of T cells and B cells
94
what are the two major forms of lymphoma? and what distinguishes them?
Hodgkin's: reed sternberg cells
NHL: no reed sternberg cells
95
what are some characteristics of hodgkin's
reed sternberg
predictable progression
96
what are some possible causes of hodgkin's?
epstein barr virus
HIV
human T cell leukemia/lymphoma virus
exposure to chemicals
97
characteristics of NHL
no reed sternberg
unpredictable progression!
98
what are some risk factors of NHL?
immune system issues (transplants, HIV), chronic infections, exposure to harmful dust, pesticides and insecticides
99
what is a major assessment finding for any lymphoma?
large, painless lymph nodes
100
how do we dx lymphoma?
biopsy!
101
what is another important step of dx with lymphoma?
staging! must be accurate and is a very detailed process
102
what other findings are important dx factors for lymph?
history, LABS, bone marrow aspiration, and imaging.
103
what is a little different about dx with NHL?
look at lactate dehydrogenase levels, beta 2-microglobulin levels, also look at CSF
104
interventions with hodgkin's
responds well to aggressive therapy!
radiation + chemo
105
interventions with NHL
tx varies based on subtype of tumor.
chemo
MABs
radiation
CAR T cells
targeted therapies
106
what are some intervention complications of hodgkin's
CV disease, secondary malignancies, restrictive lung disease, endocrine dysfunction, hypothyroidism, infertility
107
what are intervention complications of NHL?
cytokine storm!!
MAB reactions
108
what is a cytokine storm?
comes from CAR T-cell therapy--> enhances patients own immune system to kill cancer cells. this charges up the immune system and releases a lot of inflammatory cytokines
109
what are symptoms of a cytokine storm?
flu like
fever, fatigue, body aches, hypotension, edema, decreased UOP
110
what is thrombocytopenia?
decrease in platelets
111
what are some causes of thrombocytopenia?
increased destruction via spleen
decreased production of platelets
inherited
acquired
drug induced
112
what is autoimmune thrombocytopenia purpura?
an autoimmune disease that involves the formation of antiplatelet antibody
113
what is thrombotic thrombocytopenia purpura?
also an autoimmune disorder but one that causes abnormal platelet clumping leading to too few platelets in circulation
114
what does TTP lead to/
inappropriate clotting --> ischemic events and no platelets left for when clotting is needed
115
what are the first signs of thrombocytopenia seen?
skin and mucous membranes!
116
in addition to excessive bleeding with thrombo, what else do we see that causes issues
microclots which block the capillaries of organs and tissues leading to ischemia
117
what are interventions for thrombo?
blood transfusion, platelet transfusion, minimize injury risk
118
what are drugs for thrombo?
drugs that suppress immune fxn like steroids
119
what drugs do we use for ATP?
low dose chemo
IV IgG
IV anti-rho (helps prevent destruction of antibody coated platelets)
120
what about drugs for TTP? + 1 intervention that is not a drug :)
platelet inhibitors
also not a drug but tx: plasma exchange
121
what are surgical interventions for ATP?
splenectomy! only for pts who do not respond to drug therapy
give vax beforehand!!
