Final Flashcards
Acute renal failure: Pre renal
Decrease in CO
Hemorrhage
Low BP
MI, sepsis
Acute renal failure: Renal
Aminoglycosides NSAIDS Aspirin ACE inhibitors Burns Metformin
Acute renal failure: Post renal
Kidney stone BPH UTI Pylonephritis Stricture secondary to STI
Nursing interventions for pt in acute renal failure
Monitor I/O Limit Na and fluid intake Diet low in K+ Administer HCO3 IV Administer lasix Monitor ABG Cardiac monitor Give Ca+/ decrease P Kayaxelate
How is acute renal failure diagnosed
Increased BUN and creatinine Decreased urinary output Hyperkalemia Hyponatremia Increased specific gravity Hypocalcemia Hyperphosphatemia Edema Altered mental status Increased BP
Causes of chronic renal failure
HTN, DM, chronic urinary obstruction, autoimmune disorder
Phases of renal failure: Oliguric
Lasts 8-15 days, Urine output is less than 400ml/day. Increased BUN/creatinine. Hyperkalemia, HTN, edema, pulmonary edema, N/V, metabolic acidosis, tingling in extremities, drowsiness, uremic breath. Restrict fluid intake and administer diuretics
Phases of renal failure: Diuretic
Urine output rises slowly , excess urine output indicates damaged nephrons are recovering. Decline in BUN, creatinine, hypokalemia, hyponatremia, hypovolemia, tachycardia, dehydration, hypotension. Urine output may be up to 4,000ml/day. Administer IVF
Phases of renal failure: recovery
May take 1-2 years. Urine volume returns to normal. Increased GFR
Anemia occurs during renal failure because
Of decreased secretion of erythropoietin by damaged nephrons
Manifestations of chronic RF
Ataxia, lethargy, slurred speech, HF, HTN, pericardial effusion, edema, crackles, SOB, anemia, anorexia, constipation, hematuria, oliguria, polyuria, proteinuria, dry skin, yellow gray pallor
S/S of hyperkalemia
Bradycardia, muscle weakness, diarrhea
What is used to treat emergency hyperkalemia
Insulin or Calcium gluconate
What is used to treat/prevent polycythemia
Hydroxyurea
Aplastic anemia is when
Bone marrow is replaced by fat, may be idiopathic
What is the treatment for aplastic anemia
Bone marrow transplant
What is the only anemia to give you neuro complications
Vitamin B12 deficiency
S/S of iron deficiency anemia
Smooth sore red tongue, rigid nails, angular cheilosis,
What should not be take with iron because they diminish absorption
Antacid and dairy products
Reactions during blood transfusions occur
Within the first 15 min
Transfusions should be given over ____ hrs to preven circulatory overload
2 hrs
If giving multiple transfusions what medication should be given in between
Lasix (prevents fluid overload)
Most common cause of hypothyroidism
Hashimoto thyroiditis (Thyroid is invaded by WBC causing inflammation. Autoimmune)
S/S of hyporthyroidism
Weight gain Dry skin Constipation Bradycardia Fatigue Lethargy Cold intolerance Slow thinking Amenorrhea
Myxedema coma is treated with
T3, T4 IV
Hyperthyroid is caused by
Graves disease (thyroid is larger than normal)
S/S of hyperthyroidism
Weight loss Diarrhea Tachycardia Increased sweating Nervousness Heat intolerance Exopthalmus Irritable, HTN
Manifestations of myxedema coma
Respiratory failure Hypotension Hyponatremia Hypothermia Hypoglycemia
Interventions for treating myxedema coma
Maintain airway Replace fluids (NS, yperonic saline) IV synthroid IV glucose Corticosteriods Monitor V/S hourly Warm blankets
S/S of Addisons disease
hypoglycemia(sweating, HA, tremors)
hyponatremia
hyperkalemia (cardiac problems)
hyperpigmentation in mouth and lips
Addisons is diagnosed by
Low early serum cortisol, low fasting blood glucose, low sodium, and elevated potassium levels
Manifestations of Addisonian crisis
Cyanosis Pallor, apprehension Rapid, weak pulse Rapid resp Confusion, restlessness Extreme weakness Diarrhea
Addisonian crisis can be caused by
Slight overexertion Exposure to cold Acute infection Decrease in salt intake Dehydration Stress
Management of Addisonian crisis
Encourage fluids IVF and glucose IV electrolytes Diet high in Na+ Florinef or prednisone IV Vasopressors to increase BP Minimize stress
Manifestations of Cushings
Central obesity Diabetes and peptic ulcer Buffalo hump Moon face Thin extremities Thin, fragile skin Bruises Striae Muscle wasting Osteoporosis
Laboratory findings for CUshings
Hypernatremia
Hyperglycemia
Hypokalemia
Cushings is diagnosed by
Overnight Dexamethasone suppression test.
Diet for a pt with Cushings
High protein High calcium High vitamin D Low sodium Low calories
Key manifestations of thyroid storm
Fever
Tachycardia
Systolic hypertension
Temperature increase of 1 degree
Radioactive iodine
May take 4-8 wks for results
Oral dose
Antithyroid meds are stopped 3 days before and started 3 days after
Preop care for thyroidectomy
Administer antithyroid meds and iodine prep to decrease the secretion of thyroid hormones and reduce thryroid size. Ensure HTN and tachycardia are under control. Teach pt to support the neck when coughing or moving by placing both hands behind the neck when moving
Post op care for thyroidectomy
Use sandbags or pillows to support the head and neck. Place pt in Semi Fowlers. Avoid neck extension. Monitor for laryngeal stridor. Keep emergency trach kit in room
After a thyroidectomy the pt may experience
Hypoparathyroidism
Other things to monitor in pt post thyroidectomy
Muscle twitching
Tingling around the mouth or toes
Assess pt voice at 2hr intervals
Management of thyroid storm
Maintain airway Give PTU 300-900mg daily Methimazole up to 60mg daily Administer Na iodide IV Cardiac monitor Central venous pressure cath Glucocorticoids, hydrocirtisone, dexamethasone Antipyretics Cooling blankets NS infusions
