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Advanced Med Surg > Final > Flashcards

Final Flashcards

1
Q

Acute renal failure: Pre renal

A

Decrease in CO
Hemorrhage
Low BP
MI, sepsis

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2
Q

Acute renal failure: Renal

A 
Aminoglycosides
NSAIDS
Aspirin 
ACE inhibitors
Burns
Metformin
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3
Q

Acute renal failure: Post renal

A 
Kidney stone
BPH
UTI
Pylonephritis
Stricture secondary to STI
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4
Q

Nursing interventions for pt in acute renal failure

A 
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
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5
Q

How is acute renal failure diagnosed

A 
Increased BUN and creatinine 
Decreased urinary output 
Hyperkalemia 
Hyponatremia 
Increased specific gravity 
Hypocalcemia 
Hyperphosphatemia 
Edema
Altered mental status
Increased BP
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6
Q

Causes of chronic renal failure

A

HTN, DM, chronic urinary obstruction, autoimmune disorder

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7
Q

Phases of renal failure: Oliguric

A

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

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8
Q

Phases of renal failure: Diuretic

A

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

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9
Q

Phases of renal failure: recovery

A

May take 1-2 years. Urine volume returns to normal. Increased GFR

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10
Q

Anemia occurs during renal failure because

A

Of decreased secretion of erythropoietin by damaged nephrons

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11
Q

Manifestations of chronic RF

A

Ataxia, lethargy, slurred speech, HF, HTN, pericardial effusion, edema, crackles, SOB, anemia, anorexia, constipation, hematuria, oliguria, polyuria, proteinuria, dry skin, yellow gray pallor

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12
Q

S/S of hyperkalemia

A

Bradycardia, muscle weakness, diarrhea

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13
Q

What is used to treat emergency hyperkalemia

A

Insulin or Calcium gluconate

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14
Q

What is used to treat/prevent polycythemia

A

Hydroxyurea

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15
Q

Aplastic anemia is when

A

Bone marrow is replaced by fat, may be idiopathic

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16
Q

What is the treatment for aplastic anemia

A

Bone marrow transplant

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17
Q

What is the only anemia to give you neuro complications

A

Vitamin B12 deficiency

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18
Q

S/S of iron deficiency anemia

A

Smooth sore red tongue, rigid nails, angular cheilosis,

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19
Q

What should not be take with iron because they diminish absorption

A

Antacid and dairy products

20
Q

Reactions during blood transfusions occur

A

Within the first 15 min

21
Q

Transfusions should be given over ____ hrs to preven circulatory overload

A

2 hrs

22
Q

If giving multiple transfusions what medication should be given in between

A

Lasix (prevents fluid overload)

23
Q

Most common cause of hypothyroidism

A

Hashimoto thyroiditis (Thyroid is invaded by WBC causing inflammation. Autoimmune)

24
Q

S/S of hyporthyroidism

A 
Weight gain
Dry skin
Constipation
Bradycardia
Fatigue
Lethargy
Cold intolerance
Slow thinking
Amenorrhea
25
Q

Myxedema coma is treated with

A

T3, T4 IV

26
Q

Hyperthyroid is caused by

A

Graves disease (thyroid is larger than normal)

27
Q

S/S of hyperthyroidism

A 
Weight loss
Diarrhea
Tachycardia
Increased sweating
Nervousness
Heat intolerance
Exopthalmus
Irritable, HTN
28
Q

Manifestations of myxedema coma

A 
Respiratory failure
Hypotension
Hyponatremia
Hypothermia
Hypoglycemia
29
Q

Interventions for treating myxedema coma

A 
Maintain airway 
Replace fluids (NS, yperonic saline)
IV synthroid 
IV glucose 
Corticosteriods
Monitor V/S hourly 
Warm blankets
30
Q

S/S of Addisons disease

A

hypoglycemia(sweating, HA, tremors)
hyponatremia
hyperkalemia (cardiac problems)
hyperpigmentation in mouth and lips

31
Q

Addisons is diagnosed by

A

Low early serum cortisol, low fasting blood glucose, low sodium, and elevated potassium levels

32
Q

Manifestations of Addisonian crisis

A 
Cyanosis
Pallor, apprehension
Rapid, weak pulse
Rapid resp
Confusion, restlessness
Extreme weakness
Diarrhea
33
Q

Addisonian crisis can be caused by

A 
Slight overexertion
Exposure to cold 
Acute infection
Decrease in salt intake 
Dehydration
Stress
34
Q

Management of Addisonian crisis

A 
Encourage fluids
IVF and glucose
IV electrolytes
Diet high in Na+
Florinef or prednisone IV
Vasopressors to increase BP
Minimize stress
35
Q

Manifestations of Cushings

A 
Central obesity
Diabetes and peptic ulcer
Buffalo hump
Moon face 
Thin extremities
Thin, fragile skin
Bruises
Striae 
Muscle wasting 
Osteoporosis
36
Q

Laboratory findings for CUshings

A

Hypernatremia
Hyperglycemia
Hypokalemia

37
Q

Cushings is diagnosed by

A

Overnight Dexamethasone suppression test.

38
Q

Diet for a pt with Cushings

A 
High protein
High calcium
High vitamin D
Low sodium 
Low calories
39
Q

Key manifestations of thyroid storm

A

Fever
Tachycardia
Systolic hypertension
Temperature increase of 1 degree

40
Q

Radioactive iodine

A

May take 4-8 wks for results
Oral dose
Antithyroid meds are stopped 3 days before and started 3 days after

41
Q

Preop care for thyroidectomy

A

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

42
Q

Post op care for thyroidectomy

A

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

43
Q

After a thyroidectomy the pt may experience

A

Hypoparathyroidism

44
Q

Other things to monitor in pt post thyroidectomy

A

Muscle twitching
Tingling around the mouth or toes
Assess pt voice at 2hr intervals

45
Q

Management of thyroid storm

A 
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

Advanced Med Surg (4 decks)

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