Medsurg 3 part 8 Flashcards
central line dressing change: pt may need to wear
a mask (if he’s unable to turn his head away during the change)
central line dressing change: before you remove the old dressing, put on your mask and use __ gloves
non-sterile (non sterile is when removing the dressing)
central line dressing change: when do you set up the sterile field
after you removed the dressing and thrown out your soiled gloves
central line dressing change: after you clean the site with clorhexidine/alcohol, let it dry but don’t
fan it
central line dressing change: after you let the alcohol dry, apply a
transparent dressing
SLE patients on steroid therapy should limit how much ___ they eat
limit how much salt they eat because steroids cause fluid retention
steroids: monitor for 3 complications
fluid retention
HTN
kidney problems
steroids: caution about the tx schedule
don’t stop taking abruptly
RA medication that’s only given short term
steroids
instructions for taking steroids
take with food
___ disease is the only condition that increases serum creatinine level
kidney
3 things that you test for in the urine because they’re not normally present
Glucose, ketone bodies, and protein
kidney dx test: Allows for visualization of structures and to detection of renal calculi, strictures, calcium deposits, or obstructions
x ray
CT scan complication
dye can cause kidney damage
kidney dx test: Used to assess size of kidney, image the ureters, bladder, masses, cysts, calculi, and obstructions of the lower urinary tract
ultrasound
kidney biopsy: must be NPO for
4 to 6 hours
Which hepatitis’ make kidney transplant contraindicated
B and C
an immunosuppressant medication to prevent rejection of the donor kidney.
Cyclosporine
kidney transplant: within 24 hours of the surgery the client is usually
dialyzed
post kidney transplant intervention: lifelong
immunosuppression
oliguria is evidenced by urine output of 100 to ___ mL in 24 hr.
400
azotemia
high BUN
Renal artery ___ is due to scarring of surgical anastomosis.
stenosis
Monitor for and report hypertension, bruit over artery anastomosis site, and decreased kidney function, such as oliguria and elevated BUN and creatinine.
Renal artery stenosis
the most common cause of first-kidney-transplant-year morbidity and mortality.
Infection
Glomerulonephritis usually follows a ___ infection
streptococcal
Insoluble immune complexes develop and become trapped in the glomerular tissue producing swelling and capillary cell death
Acute glomerulonephritis
Acute glomerulonephritis: Insoluble ___ ___ develop and become trapped in the glomerular tissue
immune complexes
Glomerulonephritis: Consume a diet low in ___ and restrict ___ intake
sodium
fluid intake
Glomerulonephritis urine appearence
Smoky or coffee-colored urine (hematuria)
Glomerulonephritis urine lab finding
protein
Fluid volume excess: you might hear crackles or ___
rales
Normal BUN range
10 to 20
Normal creatinine range
.5 to 1.2
normal urine output level
90 ml
Glomerulonephritis: Observe the client’s skin for ____.
pruritus
Glomerulonephritis: exercise
none. put on bedrest to decrease metabolic demand
4 Glomerulonephritis drugs
diuretic (to reduce edema)
vasodilator (to reduce BP)
abx (for infection)
steroids (immunosupress)
Glomerulonephritis: procedure that filters antibodies out of circulating blood volume by removing the plasma
Plasmapheresis
Glomerulonephritis: Plasmapheresis: Monitor for signs of ___ if too much calcium is removed with the plasma
tetany
2 complications of Glomerulonephritis
uremia and anemia
For uremia, offer foods high in
carbs
pre-renal AKI: administer a ___ to prevent the movement of calcium into the kidney cells, maintain cell integrity, and increase (GFR)
CCB
which kind of AKI: Monitor for ECG dysrhythmias and changes (tall T waves)
Intrarenal
AKI: you need a diet high in
protein to replace protein being lost in the urine
Disease Prevention of AKI: Encourage clients to drink at least
2 to 3 L daily
Disease Prevention of AKI: cautious use of
NSAIDs
Chronic kidney disease (CKD) is a progressive, ___ kidney disease.
irreversible
CKD: Urinalysis: Hematuria, proteinuria, and ___ in specific gravity.
decrease
CKD: CBC:
decreased H/H secondary to the loss of erythropoietin
CKD: diet should be high in
carbs
CKD: exercise
must have a balance activity and rest
CKD: avoid which meds
NSAIDS
antimocrobials
ACE inhibitors
Angiotension blockers
CKD: Instruct the client to avoid antacids containing ___
magnesium
A urinary tract infection (UTI) refers to any portion of the
lower urinary tract (ureters, bladder, urethra, prostate)
Cystitis Urethritis Prostatiti are all
UTIs
An upper UTI refers to conditions such as
pyelonephritis
pyelonephritis
inflammation of the kidney
most common bacteria of a UTI
e coli
Untreated UTIs may lead to ___ and ___
pyelonephritis and urosepsis
Pyuria
pus in urine
pyelonephritis dx test
CT scan
UTI: how much fluid should they drink
3 liters
UTI: Recommend warm __ bath two or three times a day to provide comfort
sitz
UTI: Encourage clients to ___ daily to promote good body hygiene.
bathe
one example of an abx used for UTI
Fluoroquinolones
UTI abx: client teaching
take with food
UTI: Advise the client to urinate before and after ___.
intercourse
Clients who have chronic ___ should avoid cranberry juice, which irritates the bladder.
cystitis
Pyelonephritis: the infection usually begins
in the lower tract and moves up
Pyelonephritis: ___ is elevated during exacerbating inflammatory processes of the kidneys
CRP
Pyelonephritis: a nuclear medicine test that uses injectable radioactive dye to visualize organs, glands, bones, and blood vessels that have infection and inflammation
Gallium scan
the removal of a large stone from the kidney that causes infections and blocks the flow of urine from the kidney
Pyelolithotomy
Administer ____ for pain associated with pyelonephritis and following procedures.
opioids
the presence of calculi (stones) in the urinary tract.
Urolithiasis
The majority of stones (75%) are composed of
calcium
is not believed to increase the risk of stone formation unless there is a preexisting metabolic disorder or renal tubular defect
diet high in calcium
There is an increased incidence of urolithiasis in
males
kidney stones are aka
nephrolithiasis
Flank pain that radiates to the abdomen, scrotum, testes, or vulva is suggestive of stones in the
ureter or bladder
urinary tract obstruction is a medical ___ and needs to be treated to preserve kidney function
emergency
smoky-looking urine
Hematuria
Renal Calculi Urinalysis: ___ noted on microscopic exam
Crystals
__ or __ are used to confirm the presence and location of stones
KUB or IVP
IVP is contraindicated if there is a ___ ___
urinary obstruction
A CT or MRI is used to identify __ or __ __ stones, which
cannot be seen on standard x-rays.
cystine or uric-acid
Renal Calculi: Encourage ambulation to promote
passage of the stone
drug that alleviates pain with a neurogenic or overactive bladder
Oxybutynin
Monitor for nephrotoxicity and ___ for clients taking gentamicin for UTI
ototoxicity
patient is on abx for UTI: teach them that the urine might
smell bad bc of the abx
Extracorporeal shock wave lithotripsy (ESWL) requires ___ sedation
moderate
Extracorporeal shock wave lithotripsy (ESWL) normal finding
bruising at the site and hematuria
Renal Calculi: ____ diuretics (hydrochlorothiazide) are used to increase calcium reabsorption
Thiazide
Renal Calculi: avoid dairy products, red and organ meats, whole grains because they contain
phosphate
occurs when a stone has blocked a portion of the urinary tract. The urine backs up and causes distention of the kidney
Hydronephrosis
Pancreatitis is an ____ of the pancreas by pancreatic digestive enzymes that activate prematurely before reaching the intestines
autodigestion
Epigastric pain, radiating to back, left flank, or left shoulder
pancreatitis
pancreatitis pain is worse when ___ ___ or ___
lying down or eating (specifically after alcohol or fatty food)
pancreatitis pain is not relieved with
vomiting
pancreatitis bowel sounds
absent or gone
pancreatitis breath
fruity (hyperglycemia)
pancreatitis may have a sign related to calcium…
tetany (Trousseau’s and Chevos)
reliabe diagnostic test of acute pancreatitis
CT scan
pancreatitis: you should be NPO until
pain goes away
pancreatitis: TPN may be indicated because there’s less risk for
hyperglycemia
When diet is resumed: bland, low-fat diet with no stimulants (caffeine); small, frequent meals
pancreatitis
medication used to decrease intestinal motility and the flow of pancreatic enzymes.
Anticholinergics
Pancreatic enzymes can be given as a medication to help digest food. The patient should
sprinkle contents of capsules on nonprotein foods.
drink a full glass of water following pancrelipase.
wipe lips and rinse mouth after taking (to prevent skin breakdown or irritation).
pancreatitis fluid imbalance problem
hypovolemia
pancreatitis can cause Type __ diabetes mellitus
one
