Medsurg 3 part 8 Flashcards by Richard smith

central line dressing change: pt may need to wear

a mask (if he’s unable to turn his head away during the change)

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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)

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central line dressing change: when do you set up the sterile field

after you removed the dressing and thrown out your soiled gloves

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central line dressing change: after you clean the site with clorhexidine/alcohol, let it dry but don’t

fan it

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central line dressing change: after you let the alcohol dry, apply a

transparent dressing

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SLE patients on steroid therapy should limit how much ___ they eat

limit how much salt they eat because steroids cause fluid retention

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steroids: monitor for 3 complications

fluid retention
HTN
kidney problems

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steroids: caution about the tx schedule

don’t stop taking abruptly

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RA medication that’s only given short term

steroids

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instructions for taking steroids

take with food

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___ disease is the only condition that increases serum creatinine level

kidney

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3 things that you test for in the urine because they’re not normally present

Glucose, ketone bodies, and protein

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kidney dx test: Allows for visualization of structures and to detection of renal calculi, strictures, calcium deposits, or obstructions

x ray

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CT scan complication

dye can cause kidney damage

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kidney dx test: Used to assess size of kidney, image the ureters, bladder, masses, cysts, calculi, and obstructions of the lower urinary tract

ultrasound

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kidney biopsy: must be NPO for

4 to 6 hours

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Which hepatitis’ make kidney transplant contraindicated

B and C

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an immunosuppressant medication to prevent rejection of the donor kidney.

Cyclosporine

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kidney transplant: within 24 hours of the surgery the client is usually

dialyzed

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post kidney transplant intervention: lifelong

immunosuppression

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oliguria is evidenced by urine output of 100 to ___ mL in 24 hr.

400

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azotemia

high BUN

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Renal artery ___ is due to scarring of surgical anastomosis.

stenosis

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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

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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

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