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Critical Care > GU exam 2 > Flashcards

GU exam 2 Flashcards

1
Q

acute glomerulonephritis

A

caused by infection!!
-typically Strep that is untreated
-10 days after infection s/s
-seen in young adult and children

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2
Q

acute glomerulonephritis

A

edema / fluid retention
hematuria
decrease UO
mild HTN

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3
Q

acute glomerulonephritis labs

A

urinalysis : protein , blood , WBC
CMP :
-BUN increase
-Creatinine increase
-GFR decreased
-Albumin decreased
CBC : WBC increase

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4
Q

acute glomerulonephritis dx

A

history
presentation
lab findings

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5
Q

acute glomerulonephritis complications

A

fluid overload
HTN

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6
Q

acute glomerulonephritis potential complication

A

acute or chronic kidney disease with no tx

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7
Q

acute glomerulonephritis tx

A
  1. abx - penicillin
  2. diuretics - HTN
  3. fluid / sodium restrict
  4. low protein
  5. steroids
  6. plasmapheresis
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8
Q

acute glomerulonephritis management

A

monitor vitals
diet intake
meds

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9
Q

acute glomerulonephritis education

A

disease
meds : FINISH ALL ABX!!!
dietary restriction
infection prevention

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10
Q

polycystic kidney disease

A

excessive growth of fluid filled cysts in kidneys

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11
Q

polycystic kidney disease s/s

A

HTN!!!
hematuria
flank / low back pain
HA
UTI!!!
urinary frequency!!!
urinary calculi

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12
Q

polycystic kidney disease labs

A

urinalysis : blood and bacteria
CBC : H and H decrease
CMP :
-BUN increase
-Creatinine increase
-potassium increase
-calcium decrease
-phosphorous increase

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13
Q

polycystic kidney disease tests

A

renal US : shows renal cysts
abd. CT

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14
Q

polycystic kidney disease complications

A

HTN
hematuria

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15
Q

polycystic kidney disease potential complications

A

renal calculi / UTIs
heart valve abnormality
aneurysm
liver / GI cysts
RENAL FAILURE

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16
Q

polycystic kidney disease tx

A

ACE inhibitors / ARBS
non-narcotics - acetaminophen
palliative nephrectomy
UTI abx
RENAL TRANSPLANT

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17
Q

polycystic kidney disease education

A

immediately report INFECTION
diet
medication adherence

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18
Q

acute kidney injury

A

rapid loss of renal function that is reversible when treating underlying cause

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19
Q

azotemia

A

collection of nitrogenous wast products in blood

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20
Q

prerenal AKI

A

caused by decrease blood flow to kidneys
-ex : hypovolemia!!!

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21
Q

intrarenal AKI

A

direct damage to renal tissue impairing nephron functioning
-ex : prolonged ischemia , contrast dye , aminoglycoside antibiotics

***acute glomerulonephritis
**acute tubular necrosis

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22
Q

postrenal AKI

A

caused by obstruction below kidneys
-ex : urinary tract stones , tumors , BPH

**urine is backing up

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23
Q

oliguric phase

A

urine output < 400 mL / day
-does not respond to fluid challenges or diuretics

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24
Q

diuretic phase

A

urine output increases rapidly - up to 5L / day

**dehydration common and electrolyte imbalance

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25
Q

AKI s/s

A

volume overload s/s
-edema
-SOB
-HF
-JVD
-HTN
-chest pain
anorexia / nausea
constipation / diarrhea
confusion
seizure

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26
Q

AKI labs

A

CBC : H and H decreased
CMP :
-increase potassium
-increase phosphorous
-increase phosphate
-increase BUN
-increase creatinine
-decrease calcium
-decrease sodium
ABG : metabolic ACIDOSIS

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27
Q

AKI complications

A

HYPERKALEMIA
fluid overload

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28
Q

hyperkalemia EKG

A

PEAK T WAVES
-worsening = QRS complex is widening and loss of P waves

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29
Q

hyperkalemia protocol

A
  1. Calcium Gluconate
  2. D50 (IV glucose)
  3. insulin
  4. albuterol
  5. bicarb
  6. kayexalate
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30
Q

AKI tx

A

eliminate the cause
diuretics
sodium restriction
potassium restriction
dialysis = short term

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31
Q

AKI management

A

CARDIAC MONITOR
fluid balance
positioning / deep breathing

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32
Q

chronic kidney disease cause

A

diabetes and hypertension
-IRREVERSIBLE

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33
Q

chronic kidney disease s/s

A

HTN
yellow / grey skin color
HF
arrhythmia
n/v
HA
fatigue
amenorrhea
chronic anemia
confusion
seizures

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34
Q

chronic kidney disease labs

A

CBC : H and H decrease
CMP :
-decrease sodium
-increase potassium
-increase phosphate
-decrease calcium
-decrease CO2
-increase creatinine
-increase BUN
ABG : ACIDIC
urinalysis : protein

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35
Q

chronic kidney disease tests

A

CT and renal US

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36
Q

chronic kidney disease complications

A

fluid overload
electrolyte imbalance
dysrhythmias
anemia
fragile bones

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37
Q

chronic kidney disease tx

A
  1. hyperkalemia protocol
  2. HTN
  3. anemia - erythropoietin IV only when active bleed or symptomatic
  4. dyslipidemia - STATINS
  5. hypocalcemia - Vit D and calcium supplement
  6. renal osteodystrophy - phosphate binders (administer with each meal)
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38
Q

renal replacement therapy

A

hemodialysis
peritoneal dialysis
renal transplant

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39
Q

CKD education

A

disease process
DO NOT miss dialysis
dietary restriction : protein / phosphorous / sodium / potassium
no nephrotic meds

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40
Q

renal transplant

A

improve life function NOT A CURE

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41
Q

renal transplant candidate

A

free of medical problems that increase risk
-cardiac disease
-cancer (metastatic)
-chronic infection
-alcoholism
-chemical dependency
NOT considered

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42
Q

post op renal transplant

A
  1. evaluate function : I / O
  2. immunosuppressive therapy : prevent tissue rejection , increases infection risk
  3. ASSESS URINE OUTPUT hourly for 48 hours
    -abrupt decrease = rejection or acute tubular 4. necrosis
  4. urine color : pink is normal , NOT FRANK RED
  5. monitor fluid status : NO FLUID OVERLOAD
    -weigh daily
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43
Q

acute rejection

A

1 week - 2 years : mainly 2 weeks
-oliguria or anuria
-temp > 100
-increase BP
-enlarged tender kidney
-lethargy
-elevated creatinine, BUN, potassium
-fluid retention

44
Q

acute rejection tx

A

increase immunosuppressant meds

45
Q

acute tubular necrosis

A

hypoxic damage when transplant is delayed after kidneys are harvested
-increase risk longer they wait for transplant

46
Q

thrombosis

A

sudden decrease in UO can signal this

47
Q

renal artery stenosis

A

cause HTN , balloon angioplasty or surgically repaired

48
Q

renal cancer

A

occurs in males, AA more common
-smoking
-tobacco
-first degree relative
-obesity
-HTN

49
Q

renal cancer s/s

A

TRIAD : flank mass , flank pain , hematuria
weight loss
fatigue
HTN
fever
anemia

50
Q

renal cancer tests

A

US
CT scan
MRI

**dx is made from biopsy

51
Q

renal cancer complications

A

pain
reduced circulation
ESRD
metastasis

52
Q

renal cancer chemotherapy…

A

IS NOT EFFECTIVE
-use immunotherapy and radiation

53
Q

renal cancer surgery

A

radical nephrectomy

54
Q

renal cancer post op

A

wound / incisions
foley cath
stent
nephrostomy tubes

55
Q

prostate cancer

A

higher rate in AA
family hx
diet high in red meat / calcium
high BMI

56
Q

prostate local disease

A

weak urinary stream
urinary hesitancy
sensation of incomplete emptying
urgency / frequency
urge incontinence
UTI

57
Q

prostate invasive disease

A

hematuria
dysuria
perineal / suprapubic pain
ED
incontinence
s/s of renal failure
hemospermia
rectal pain

58
Q

prostate cancer labs

A

PSA
CRITICAL CUT OFF POINT is 4

** >4 ng is a concern

59
Q

prostate cancer dx

A

prostate biopsy , screening is controversial

60
Q

prostate management

A

radiation
-external beam
-BRACHYTHERAPY
cryotherapy
ablative hormone therapy : testosterone suppression

61
Q

brachytherapy

A

radioactive seeds in the prostate , MUST obtain from sex for 2 weeks , USE A CONDOM after 2 week period

**keep partner safe from radiation

62
Q

prostate cancer surgery

A

radical prostatectomy : removal of prostate and seminal vesicles

**ALL result in impotence

63
Q

prostate post op

A
  1. aseptic wound care
  2. manage bladder irrigation
  3. meds : pain, stool softener , IV abx
64
Q

prostate cancer education

A

brachytherapy sex safety
signs of infection
prevention

65
Q

testicular cancer causes

A

brother with testicular cancer
cryptorchidism (undescended testes)
down’s syndrome
smoking

66
Q

testicular cancer s/s

A

PAINLESS MASS
pain, swelling, hardness in scrotum

67
Q

testicular cancer labs

A

alpha-fetoprotein
HCG

^^tumor markers

68
Q

testicular cancer tests

A

US: makes sure not infection
CT and x-ray : stage

69
Q

testicular cancer surgery

A

ON ALL TESTICULAR CANCER
radical orchiectomy - removal of affected testicle

70
Q

seminomas

A

post surgery radiation OR chemo

71
Q

nonseminomas

A

chemotherapy after surgery

72
Q

testicular cancer management

A

pain
monitor infection
aseptic wound care

73
Q

testicular cancer teaching

A

infection s/s
sperm storage : sperm bank before tx
self exams
follow ups

74
Q

renal replacement therapy

A

indicated for AKI or ESRD (end stage renal disease)

75
Q

CRRT (continuous renal replacement therapy)

A

indicated for acutely ill AKI or severe fluid overload

**HEMODYNAMICALLY UNSTABLE PTS

76
Q

CRRT access

A

vascular access - central line
-double or single lumen

77
Q

CRRT process

A

uses a filter to move particles and blood is returned to patient

**use anticoagulation to prevent clotting - HEPARIN is used as a bolus

78
Q

CRRT mechanical complication

A

vascular access related
-bleeding , hematuria , AV fistula , thrombosis
-infection
circuit complications
-premature filter clotting
-air embolism

79
Q

CRRT hemodynamic complications

A

hypothermia
hypotension - less risk than w/ hemodialysis

80
Q

CRRT metabolic complications

A

metabolic acidosis / alkalosis
hypernatremia
hypophosphatemia
hypomagnesemia
hypocalcemia
hypokalemia

81
Q

CRRT nursing assessment

A

frequent hour vitals
hourly assessment of volume filtrate

82
Q

hemodialysis

A

can be performed outpatient, inpatient hospital settings

83
Q

hemodialysis access

A
  1. central venous double lumen: short term
  2. AV fistula: surgical, cannot use this immediately
  3. AV graft: do not have to mature , infection prone
84
Q

AV fistula assessment

A

auscultate BRUIT
palpable THRILL

**must mature before use

85
Q

hemodialysis

A

blood pumped, uses a membrane and dialysate solution

86
Q

hemodialysis complication

A

hypotension : rapid removal of fluid
muscle cramp, HA, nausea, dizziness, malaise
bleeding
infection
dialysis associated dementia
dialysis disequalibrium
localized

87
Q

dialysis associated dementia

A

progressive complication , r/t aluminum in dialysis

88
Q

dialysis disequilibrium syndrome

A

due to rapid changes in extracellular fluid causing shift into brain

**cerebral edema

89
Q

hemodialysis infections

A

HIV
hepatitis C / B
cytomegalovirus

90
Q

hemodialysis assessment

A

assess vascular access
AV fistulas need THRILL and BRUIT
neuro assessment

91
Q

peritoneal dialysis

A

indicated for pts who desire more control or had vascular access problems

**CAN be done at home

92
Q

PD contraindications

A
  1. multiple abd surgeries
  2. recurrent hernias
  3. obesity
  4. pre-existing back problems
  5. severe COPD
93
Q

PD access

A

permanent indwelling PD catheter

94
Q

Fill phase

A

room temp steril dialysate instilled

95
Q

dwell phase

A

metabolic waste products and excess electrolytes diffuse dialysate remains in abd

96
Q

drain phase

A

gravity drains dialysate out of cavity into sterile bag

97
Q

continuous ambulatory peritoneal dialysis

A

dialysate infused into abd 4-5 times / day for around 4-6 hours

-pts may be ambulatory , no machines

98
Q

automated peritoneal dialysis

A

used overnight exchanges , dialysis free during day

99
Q

intermittent peritoneal dialysis

A

30-40 exchanges per week
(30-60 minutes each)

100
Q

PD complications

A

peritonitis
catheter infection
hyperglycemia
outflow problems
respiratory compromise
protein loss

101
Q

peritonitis r/t PD

A

fever and abd pain
cloud peritoneal effluent
repeated infection = catheter removal

102
Q

PD catheter infection

A

site redness, tenderness, drainage
-abscess formation

103
Q

PD abdominal pain

A

can be caused by too fast infusion of dialysate

104
Q

PD hyperglycemia

A

glucose in dialysate can be absorbed into blood stream

105
Q

PD nursing assessment

A

abdominal girth
outflow
complications

Critical Care (15 decks)

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