Final Exam 😍 test 1 Flashcards
What is the purpose of giving LR?
To increase blood volume and increase urine output.
What should we monitor for when giving D5NS?
hypervolemia (volume overload/pulmonary edema
- D5NS is a hypertonic solution
Excessive use of LR can cause what?
-Metabolic Alkalosis
Avoid giving LR in what type of patients?
Pt in renal failure!
What type of pt can you not give hypotonic fluids to?
- hypotensive pt
-head injuries with increased ICP - pt w/ liver disease, trauma, or burns
What is our go-to IV gauge?
20!!
- good for IV fluids/UO
What gauge is preferred for blood?
18!!
Tubing should be changed every how many days?
4
Change IV bag how often?
24 hours!
Clotting of an IV cath can be do to what things?
-kinked IV tubing
-very slow infusion rate
-empty IV bag
-failure to flush line
What are s/s of hematoma?
- ecchymosis
-immediate swelling at site
-blood leaking from insertion site
How do you treat a hematoma?
- d/c and apply direct pressure
-apply ice on/off 24 hours
-elevate extremity
s/s of phlebitist?
- pain
-inflammation
-swelling
-warmth
-tenderness along the vein (Red streak)
How do you treat phlebitis?
- d/c IV
- Apply warm/moist compress
What are s/s of infiltration?
- coolness of skin
-edema at or below the site
-blanching/leaking at insertion site
-discomfort at site
-decrease in flow rate
-coolness of skin
How do you treat infiltration?
- Stop infusion –> d/c IV
- warm compress to site
-elevate extremity
What are signs of extravasation??
-pain/burning at site
-redness/blistering
-necrosis or sloughing
What position do we put pt in with fluid overload?
-High fowlers
What are s/s of fluid overload?
- Increase in Bp/HR
- bounding pulse
-JVD
-cough - weight gain
- edema
-intake >output
What position do we put pt who are having an air embolism?
- left lateral Trendelenburg position
- to trap in RA!!
What type of current is when the body becomes part of the circuit?
Alternating
What type of current is when the body receives a one directional blast?
Direct
What type of burn can cause immediate cardiac or pulmonary arrest?
Electrical
What should we NOT do with a superficial partial burn?
– don’t apply ice/submerge in ice water!!
What is the main thing you want to watch out for with burn edema?
- compartment syndrome
What are the s/s of burn shock?
- hypotension, tachycardia, AMS, decreased urinary output
What starts to happen in the post- burn shock phase?
- volume increases, UO increases, BP normalizes
What tissue involvement is going on with superficial burn?
Epidermal
Wound characteristics for superficial burns?
-Mild erythema
-Dry/no blisters
-Blanches easily (blanchable)
What tissue is involved in superficial partial thickness burns?
entire epidermis and minimal damage to the dermis
Wound characteristics for superficial partial thickness burns?
-Closed or open/weeping blisters
-Pink/red
-Mild edema
-Blanches easily
What is the tissue Involvement with Deep Partial Thickness Burns?
Entire epidermis and deep layers of the dermis
What are some wound characteristics of Deep Partial Thickness Burns?
-Waxy appearance/ blisters
-Pink/red edges with white center
-Nonblanchable
-Decreased/absent capillary refill
What is the tissue involvement of a full thickness burn?
the entire epidermis and dermis is destroyed
What are the wound characteristics of a full thickness burn?
-Dry, leathery (eschar)
-Pale, white, brown, black, or charred
-No blanching
What do we suspect if a person has myoglobinuria?
Acute tubular Necrosis!!
Red/tea colored urine!
How do you prevent a paralytic ileus d/t a burn?
Enteral feeding!
What ulcer is specific to burn pt?
Curling ulcer
What is the main goal in the emergent/resuscitative phase?
-airway management
what are the fluid and electrolyte changes in the emergent phase of a burn?
-decreased blood volume/UO
-hyperkalemia
-hyponatremia
-metabolic acidosis
- elevated H&H
What is the main goal in the acute/intermediate phase?
Wound healing and infection prevention!
What are the f/e changes in the acute phase?
-increase UO
-hemodilution
-hyponatremia/hypokalemia
- metabolic acidosis
Somone just came in with a burn, and is now having a change in mental status, decreased urinary output, and a decline in respiratory function. What do we suspect?
Sepsis
A person is spitting up black sputum what do we suspect and do to treat?
- CO2 poisoning
- Immediate administration of 100% o2 via mask; intubate/ventilation
How do you treat an injury above the glottis?
-emergent intubation!!
What can an injury above the glottis cause?
-edema
- which then leads to mechanical obstruction
- which then leads to respiratory failure
How do we treat an injury below the glottis?
- intubation/vent/O2
What type of diet do we want burn pt to be on orally?
-High protein/high calorie
Before we perform a dressing change on a burn pt, what do we need to do first?
- premedicate at least 20 min prior to starting!
Tell me all you know about that silvadene! :)
- broad spectrum antibiotic
-easily penetrates eschar
-NOT FOR FACE
Which topical antibiotic therapy is best for the face, but it has minimal eschar penetration?
-bacitracin
How can we prevent hypertrophic scars?
- ace wraps
-pressure garments
-hydrate, massage, and protect healing skin
What does aldosterone do?
- increases Na resorption
-increases K excretion
What is the most accurate indicator to determine F&E imbalances?
WEIGHT
What does erythropoietin do?
-Stimulates/regulates RBC production
What does pain at the CVA indicate?
- kidney inflammation/infection
What is the first sign you see with PKD? and then what follows??
- HTN
-Hematuria
-lower back/flank
What type of medicines do you give for PKD?
- antihypertensives, antibiotics, pain medicines
What causes pyelonephritis?
- upwards spread of bacteria from bladder (untreated UTI!!/ Most common)
-increased risk incompetent valve/obstruction to flow
-hormonal changes and urinary retention associated w/ pregnancy
-long-term use of an indwelling catheter
How do we medically manage acute pyelonephritis?
- antibiotics for 2 weeks (Ciprofloxacin, gentamicin)
- FOLLOW UP 2 WEEKS LATER AND DO C/S!!
What is the main symptom with pyelonephritis?
- low back/flank pain
What labs do we see with chronic pyelonephritis?
- Low Cr clearance
- High BUN, Cr
What are some complications you can see with chronic pyelonephritis??
-ESRD
-HTN
-Renal Calculi
How do you treat Chronic pyelonephritis?
LT antibiotics!
Why does acute glomerulonephritis usually occur?
Secondary to strep infection
What are some clinical manifestations of acute glomerulonephritis?
-hematuria/proteinuria
-hypoalbuminemia
- Cola colored urine
-periorbital/generalized edema
-HTN
-elevated BUN and Cr
What kind of diet do we follow for acute glomerulonephritis?
- low protein, low Na, restrict fluids
What clinical manifestations do you see with chronic glomerulonephritis?
- feet swelling at night
-retinal change
-yellow/grey skin
-pericarditis
-s/s of HF
How do you diagnosis chronic glomerulonephritis?
- UA- specific gravity fixed at 1.010
-proteinuria
GFR < 50 - increased K
-metabolic acidosis
-anemia
-hypoalbuminemia - increased phosphorus/ low calcium
How do we medically manage chronic glomerulonephritis?
- antihypertensives
-na and water restriction - Diuretics
-adequate calories; high value protein diet
What are clinical manifestations of nephrotic syndrome?
- MASSIVE proteinuria
- frothy/foamy/ dark yellow urine
- hypoalbuminemia
- edema, soft-pitting
-hyperlipidemia
How do we diagnose nephrotic syndrom
- proteinuria >3.5 g
-WBC in urine
-kidney biopsy
What meds/diet do we want to be on for nephrotic syndrome?
- loop diuretics, ACE inhibitors, Albumin
-low sodium, protein, and fat diet
What is nephrosclerosis often caused by?
-HTN AND DM
What can cause pre-renal failure?
MI!!!
What do we see in the initiation phase of ARF?
- decrease in UO
- high urine specific gravity
- low urine Na
What phase typically doesn’t respond to diuretics?
- Oliguric
What do you see in the oliguric phase?
- Urine output falls below 400 ml/day
- specific gravity fixed at 1.010
- reduced GFR
What happens in the diuresis phase?
- occurs when cause has been corrected
-gradual increase in UO, then high output
What are you at risk for in the diuresis phase?
-DEHYDRATION
What happens in the recovery stage?
- labs return to normal –> GFR may permanently be reduced.
What labs do you see with ARF?
-low sodium, calcium
- high phosphorus, potassium, elevated BUN, Cr.
-metabolic acidosis
What clinical manifestations do you see with ARF?
- Fluid volume overload (edema, pulmonary edema, JVD, SOB, HF, HTN)
What drugs can you give for ARF?
-kayexalate
-50% dextrose, insulin IV
Loop diuretics - lasix, bumex
osmotic diuretics (mannitol)
Bicarb replacement (metabolic acidosis)
What are the triad of symptoms for renal cancer?
-painless hematuria
-dull pain around kidney
-mass in flank area
What drug can we give for renal cancer?
-interleukin-2
What are we concerned about after kidney surgey?
- hemorrhage/abdominal distention
-monitor all drains seperatly!!!
paralytic ileus
infection
What are some nursing interventions for kidney surgery?
-educate pt to splint incision with hands or pillow when coughing
- encourage cough and deep breathing q1 hour
What is the normal Cr level?
-0.5-1.2
NORMAL HAMBURGER BUN LEVEL?
10-20
normal specific gravity level?
1.005-1.030
