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Med Surg 3 > Exam 6 review > Flashcards

Exam 6 review Flashcards

1
Q

BUN/creatinine: normal value- what does increased/ decreased mean

A

BUN (6-24) / creatinine(0.7-1.3)- if both increased indicated kidney damage
if only BUN is increased indicated Dehydration

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2
Q

s/s of increased BUN/ Cretinine

A

Fatigue, confusion, nausea

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3
Q

Normal Potassium Level

A

3.5-5.2

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4
Q

s/s of hyperkalemia

A

Muscle weakness, cardiac arrhythmias, peaked T wave

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5
Q

Normal Sodium lab value

A

135-145

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6
Q

S/s of hyponatremia

A

Confusion, headache, lethargy

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7
Q

S/s of Metabolic Acidosis

A

Kussmaula respirations, confusion, fatigue

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7
Q

Treatment for Pericarditis (complication of ARF)

A

Dialysis/ anti-inflammatory meds

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8
Q

Treatment for Anemia (complication of ARF)

A

Erythropoietin injections and iron supplements- kidneys play a large part of filtration and production of blood/ RBC- when it is damaged your RBC is impacted

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9
Q

Treatment for Fluid/ electrolyte imbalance (complication of ARF)

A

Restrict fluid/ salt- dialysis in severe cases

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10
Q

How do you figure out weight loss/ gain on a dialysis patient

A

1kg= 1000cc (1L) of fluid; helps assess fluid gain/loss

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11
Q

Prerenal injury s/s- who is at the greatest risk

A

Happens d/t decreased blood flow to the kidneys (typicaly hypovolemia)
s/s: Vomiting, thirst, bleeding hypotension, tachycardia, decreased skin turgor
Greatest risk: dehydration, sepsis, HF

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12
Q

Intrarenal injury s/s- who is at the greatest risk

A

d/t structural damage within the kidneys ie nephrotoxic drugs or glumerulonephritis
s/s: Puriritic rash, SQ nodules
greatest risk: glumerulonephritis, antibiotics

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13
Q

Postrenal injury s/s- who is at the greatest risk

A

Caused by blockage in the Urinary tract preventing urine from draining
S/S: flank pain, nocturia, frequency and hesitency\
Greastest Risk: neurogenic bladded, narrowing of urethra, kidney stones, bladded cancer

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14
Q

Initiation phase of Acute renal failure

A

Injury to kidney occurs- happens over a period of hours to days
Causes
Prevention
Treatment

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15
Q

Oliguric phase of Acute renal failure

A

Urine output decreased d/t damage to renal tubules- daily output: 50-500mL/day
Causes
Prevention
Treatment

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16
Q

Recovery phase of ARF

A

Kidney function improves- tubular edema resolves- takes weeks to months to filly recover
Causes
Prevention
Treatment

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17
Q

Diuretic phase of ARF

A

Urine output increased- tubural scaring and damage may occur
Causes
Prevention
Treatment

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18
Q

Vascular access cares

A

o Assess for infection
o Listen for Bruit
o Avoid taking BP on access arms or any blood draws, tight clothes etc.
o Feel for the thrill

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19
Q

Peritoneal dialysis advantages

A

Done at home, less restrictive diet;
put it in- let it set for a bit- then do outflow.
The outflow should be more than in flow

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20
Q

Peritoneal dialysis disadvantages

A

r/4 peritonitis hemorrhage, improper placement of caterer, poor return(blockage), hyperglycemia(sugar is in some of the solutions) , fluid and electrolyte imbalance

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21
Q

Hemodialysis advantages

A

More effective waste removal, stricter diet

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22
Q

Hemodialysis disadvantages

A

risk of infection and access complications.
Hypotension, muscle cramps, infection

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23
Q

Prorites of peritoneal dialysis

A

PREVENT INFECTION (aseptic technique) monitor fluid balance and electrolytes

24
Q

CRRT why used

A

for critically ill patients needing slow, continuous fluid removal. Watch for hypotension, electrolyte imbalances.

25
Q

CRRT potential complication

A

clots, hypotension, pink tingled urine(anything other than yellow, really), dysrhythmias, confusion, not enough fluid coming off

26
Q

Nursing responsibilites for CRRT

A

Hourly output checks, watch BP, watch for clots

27
Q

whats to prevent contract dye injury

A

Pre-hydrate, avoid nephrotoxins, use low-osmolar contrast

28
Q

how to prevent renal failure with use of nephrotoxic drugs

A

adjust the doses, monitor kidney functon, avoid NSAIDs and some antibiotics(-mycin’s)

29
Q

med administration with hemodialysis

A

generally do not give meds via dialysis post- however right after water-soluable meds can be given

30
Q

What meds are given before disalysis

A

Fat soluable

31
Q

what meds are withheld until after dialysis

A

water soluable and blood pressure meds- Dialysis will excrete water soluable meds. pt bp may change during dialysis therefore you dont want to give until after- as we take fluid off their blood pressure will decrease

32
Q

Time and schedule of med admin

A

give long acting meds during non dialysis days when possible (dialysis will excrete them)

33
Q

Drug clearence by dialysis

A

Any medication that are easily dialyzable should be held till after to ensure they reach therapeutic levels

34
Q

what is dialysis diseequilibrum syndrome

A

Rapid removal of urea causes CNS symptoms; headache, confusion N/V, hypertension, seizure— reduction of urea from the vascular system- cells are pulling fluid in, causing brain cells to swell, resulting in symptoms of ICP

35
Q

how do you fix/ prevent Dialysis disequilibrium syndrome

A

Slow dialysis or reduce flow rates.- most common for first-time dialysis and or 1-2 hrs of starting dialysis

36
Q

how is organ retrival/ transplant done?

A

Obtain consent, match done/ recipient, access compatibility- nurses don’t talk to family; doctor does

37
Q

What is the first requirement in looking at organ transplats?

A

ABO and HLA compatability

38
Q

Generalized rejection signs and symptoms

A

Fever and decreased organ function- generalized discomfort, pain/ swelling

39
Q

Hyperacute rejection

A

within min of transplant- when antigens are incompatable

40
Q

Acute rejection

A

occurs within the first 6 months- immune system attacks the new organ

41
Q

chronic rejection

A

months to years post transplant

42
Q

What are potential complications for patients who are donating organs and how can they be treated

A

-Surgical Complications: Bleeding, infection, clots, organ injury → Treat with antibiotics, anticoagulants, surgical repair.
-Pain/Discomfort: Post-op pain → Manage with analgesics, ice packs, and physical therapy.
-Psychological Impact: Anxiety, depression → Support groups, counseling, medications if needed.
-Organ Function Changes: Reduced organ reserve → Monitor function, lifestyle changes, dietary modifications.
-Long-term Health Risks: Hypertension, proteinuria → Manage with antihypertensives, ACE inhibitors/ARBs.

43
Q

What are the transplant rejection meds- why are they given

A

Cyclosporine: Prevents organ rejection by inhibiting T-cell activation.
Side effects: Nephrotoxicity, hypertension, infection risk.
Requires regular blood level monitoring.
Tacrolimus:More potent calcineurin inhibitor; prevents T-cell activation.
Side effects: Nephrotoxicity, hyperglycemia, neurotoxicity, infection risk.
Requires therapeutic level monitoring.

Purpose: Suppress the immune system to prevent rejection of transplanted organs.
Often combined with other immunosuppressive drugs for better efficacy.

44
Q

DIC symptoms, labs, treatment complications

A

Symptoms:
Bleeding: Petechiae, ecchymoses, Pain/swelling in extremities, organ ischemia
General: Hypotension, tachycardia, fatigue, altered mental status.

Labs:
Prolonged PT/aPTT
Low fibrinogen & platelets
Elevated D-dimer

Treatment: Treat Cause ( infection/ trauma)

Complications:
Severe bleeding →Hypovolemic shock, Organ failure from ischemia.

45
Q

HIT- what is it- lab values

A

Increased platlets
An immune response to heparin causing increased clot risk

46
Q

Liver failure – causes, s/s, treatment, patho, complications

A

Causes: Viral hepatitis, drug toxicity, ischemia, Alcohol abuse, non-alcoholic fatty liver disease, hepatitis B/C.
Signs/Symptoms:
Jaundice, ascites, coagulopathy, hepatic encephalopathy, fatigue.
Elevated liver enzymes, hypo/hyperalbuminemia,
Treatment: Acetylcysteine for acetaminophen toxicity, lactulose for encephalopathy.
Liver dysfunction → Impaired detoxification, protein synthesis, and bile excretion → Accumulation of toxins (ammonia) → Organ failure and encephalopathy.
Complications:
Hepatic encephalopathy, bleeding, infection, renal failure, sepsis, multi-organ failure.

47
Q

Ascites- causes, treatment, s/s

A

Causes Portal hypertension.
S/S: Abdominal distention, SOB.
Treatment: Diuretics, paracentesis.

48
Q

Hepatic encephalopathy (portal-systemic encephalopathy) - potential causes, treatment (why done)

A

Causes: Ammonia buildup.
Treatment: Lactulose to reduce ammonia.

49
Q

Pancreatitis- identifying prognosis, treatment

A

Prognosis Factors: High WBC, amylase, lipase.
Treatment: NPO, IV fluids, pain management.

50
Q

Acetylcysteine: why used, how does it work

A

Why: Prevents contrast-induced nephrotoxicity.
How: Replenishes glutathione, neutralizing free radicals.

51
Q

Aminoglycosides: why used, how does it work

A

Why: Antibiotic for severe infections.
How: Inhibits bacterial protein synthesis; monitor renal function (nephrotoxic).

52
Q

Azithromycin: why used, how does it work

A

Why: Broad-spectrum antibiotic.
How: Inhibits bacterial protein synthesis.

53
Q

Cyclosporine: why used, how does it work

A

Why: Prevents organ rejection.
How: Inhibits calcineurin, suppressing T-cell activation.

54
Q

Kayexalate: why used, how does it work

A

Why: Treats hyperkalemia.
How: Exchanges potassium for sodium in the intestines, excreting potassium.

55
Q

Lactulose: why used, how does it work

A

Why: Treats hepatic encephalopathy.
How: Lowers ammonia by converting it to ammonium and increasing excretion.

56
Q

Methylprednisolone: why used, how does it work

A

Why: Anti-inflammatory for organ rejection or severe inflammation.
How: Suppresses immune response.

57
Q

Neomycin: why used, how does it work

A

Why: Reduces gut bacteria in liver disease.
How: Decreases ammonia production by gut flora.

58
Q

Sodium Bicarbonate: why used, how does it work

A

Why: Treats metabolic acidosis.
How: Neutralizes excess acid, restoring pH balance.

Med Surg 3 (1 decks)

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