midterm #2 Flashcards
relevant subj and obj data that should be collected to determine clinical manifestations of pts w/ CKD
age-related changed in the urinary system
the number of functioning nephrons decreases with age
describe CKD
involves the progressive, irreversible loss of kidney function
5 stages of CKD based on GFR
Normal GFR = 125 mL/minute
Stage 1: GFR > 90
Stage 2: GFR = 60-89
Stage 3: GFR = 30-59
Stage 4: GFR = 15-29
Stage 5 ESRD occurs when GFR < 15 mL/minute
select risk factors that contribute to the development of CKD
DM, HTN, obesity, renal vascular disease
summarize the significance of CV disease in pts w/ CKD
hypertension
multi-system clinical manifestations in pts w/ uremia
Syndrome that incorporates all signs and symptoms seen in various systems throughout the body due to the build-up of waste products and excess fluid associated with kidney failure.
CKD
– collaborative care
Detect and tx any reversable causes
Goals of CKD care:
- delay progression of renal disease
- preserve existing renal function
- treat clinical manifestations
- prevent complication
- educate pt and family regarding kidney disease and options for care
- prepare pts for renal replacement therapy or transplantation
Care must be tailored to pts stage
hemodialysis vs peritoneal dialysis
hemodialysis:
- blood leaves the body
peritoneal dialysis:
- cleaning fluid enters the body and filters the waste
- via osmosis and diffusion
describe composition of the major body fluid compartments
intracellular: 2/3
extracellular: 1/3
- plasma, interstitial fluid
transcellular:
- CSF, joints
- pleural/cardiac lubricants
fluid & electrolytes
– diffusion, osmosis,
diffusion:
[high] to [low] through a semipermeable membrane
osmosis:
movement of water between two compartments by a membrane permeable to H2O but not to solute
- moves from low [solute] to high [solute]
- requires no energy
hydrostatic pressure, oncotic pressure, and osmotic pressure
if oncotic pressure drops and you don’t have the pull pressure (12mmHg)
- the fluid is going to stay in the tissues = edema
- in a case of low albumin we can give it supplementally or synthetic intravascular bulking agents that ↑ the oncotic pull pressure
- ↑ interstitial hydrostatic push pressure (30mmHg)
- a counter pressure (compression) to overcome hydrostatic pressure
2nd and 3rd spacing + examples
2nd spacing:
- fluid moved into the interstitial space
- not useful to the body
- w/ therapy push or pull it where it can be useful
3rd spacing:
- in a cavity where we cant draw it back or push it back
- needs to be removed
- ascites
- fluid no longer available to the body
list and summarize the ways in which the body regulates water balance
- hypothalamic regulation - thirst, stimulates pituitary
- pituitary regulation
- ADH , less urine output - Adrenal Cortical Regulation
- RAAS system; renin aldosterone (Sodium retention (therefore H2O) acts on kidneys - Renal regulation
- release Na, vasodilation - Cardiac regulation
- ANF - GI regulation
- LI, H2O absorption (c-diff, viral infections, cholera, Crohn’s,) - Insensible H2O loss
- What happens with body (900mL lost)
regulation of H2O balance
– hypothalamus
1 ) senses thirst
2 ) stimulates posterior pituitary to release ADH
3 ) ADH makes the kidneys permeable to reabsorb H2O
4 ) aldosterone released from adrenal gland makes kidneys reabsorb H20 + Na and excrete K+
regulation of H2O balance
– kidney
renin-angiotensin system
regulation of H2O balance
– cardiac
ANF/ANP released when volume and pressure ↑
- ANF causes vasodilation and ↑ urinary excretion of Na and H2O
- blood volume ↓
the impact of normal aging on fluid and electrolyte balance
structural change to kidney
loss of SUBQ
> loss of moisture
↓ thirst mechanism
isotonic solution
to ↑ intervascular fluid
NS 0.9% > not if hyponatremic
Lactated Ringers
D5W > not w/ pts who are DM or those with ↑ICP
hypotonic solution
NS 0.45%
Dextrose 5% in H2O
tx of cellular dehydration
- don’t give for ↑ICP, trauma, burns or hypovolemia
hypertonic solution
5% in 0.45/0.9% Dextrose
- cerebral edema
- hyponatremia
- don’t give if HF/ CKD
collab care
– Hyperkalemia
C big K drop
C- Calcium gluconate- stabilize myocardium
B- β2-adrenergic agonists such as salbutamol to shift potassium into the cells
I- IV insulin (shift K+ into cells), and
G- IV Glucose to manage hypoglycemia
K- Kayexalate
D- diuretics or Dialysis
the process of acid-base regulation
buffer system:
- reacts imediately
resp system:
- responds in min
- max effectiveness reached within hrs
renal system:
- 2-3 days to reach max response
- maintain balance for a long period of time
biochemistry and physiology involved with acid-base balance in the body
buffer system:
- K+ exchanged w/ H+
- alkalosis > hypokalemia
- acidosis > hyperkalemia
lungs
- rapid resps > ↓ CO2 > ↓ acidity
slow resps > ↑CO2 > ↑ acidity
kidneys
- excretion and/or retention of acids and bicarb
- ↓ H+ and ↑HCO3 > ↓ acidity
ABG normal values
pH = 7.35 - 7.45
paCO2 = 35-45
HCO3 = 22-26
paO2 = 80 - 100mmHg
metabolic acidosis
Accumulation of acid:
- DKA, septic shock (lactic acid accumulation), starvation
loss of bicarbonate:
- diarrhea, renal failure
metabolic alkalosis
Loss of acid:
- NG suctioning
- prolonged vomiting
- loss of K+ due to diuretic therapy
Gain in bicarbonate:
- ingestion of baking soda
respiratory acidosis
Anything that causes hypoventilation:
- COPD
- barbituate or sedative overdose
- severe pneumonia
- Atelectasis
- Respiratory muscle weakness
- mechanical hypoventilation
respiratory alkalosis
Anything causing hyperventilation:
- sepsis, anxiety attack
- 2o to hypoxia, fear, fever
- stimulated respiratory center
- CNS disorders, brain injury, salicylate poisoning
- mechanical overventilation
biological processes involved in cancer
defects in cellular proliferation
- normal cellular function vs. cancer cell
- stem cell theory
- loss of contact inhibition
defects in cellular differentiation:
- proto-oncogenes
> can be altered by mutations
> An oncogene is like a gas pedal that is stuck down causing out of control growth
- tumor-suppressor genes
> rendered inactive by mutations
* BRCA1 and BRCA2 –> mutation makes a high risk for breast and ovary cancer
differentiate the 3 phases of cancer development
1 ) initiation
- genetic or carcinogen mutations
2 ) promotion
- latency period
- cells only become tumors only when they establish the ability to self-replicate and grow
3 ) progression
- growth, invasiveness and metastasis
describe the role of the immune system in relation to cancer
immunological surveillance
- response to tumor-associated antigens
- lymphocytes continually check cell surface antigens and detect/destroy abnormal cells
- involves cytotoxic T cells, natural killer cells, macrophages, and B lymphocytes
describe the use of the classification systems for cancer
– TNM table
tumor (T)
- T0 = no tumor
- Tis = evidence of tumor in situ
- T1, T2, T2 etc.. = progressive ↑in tumor size and involvement
- tx = unable to assess
nodes (N)
- N0 = no lymph node metastasis
- N1, N2, N3= ↑involvement of regional nodes
- Nx = cannot be assessed
Metastasis (M)
- M0 = no evidence
- M1, M2, M3 = metastatic involvement
- Mx = cannot be assessed
explain the role of the nurse in the prevention and detection of cancer
Change in bowel or bladder habits
A sore that doesn’t heal
Unusual bleeding or discharge
Thickening or lump I the breast or else where
Indigestion or difficulty swallowing
Obvious change in a wart or a mole
Nagging cough or hoarseness
Cancer cachexia
explain the use of surgery, radiation therapy, chemo, and biological therapy in tx of cancer
surgery:
- diagnostic, preventative, eliminative, reconstructive, or palliative
chemo:
- exerts chemical influence on cellular division (rapid producing cells)
radiation:
- local destruction of cancer cells
- adjuvant > supplements surgery
- palliative
biotherapy:
- uses the body’s immune system to kill cancer cells
describe the 3 goals of cancer tx
– cure, control, palliative
cure:
- usual life-span
control
- usual or reduced lifespan
palliative
- comfort measures
- reduced lifespan
describe the effects of radiation and chemo on normal tissues
chemo attacks all fast growing cells (systemic)
- hair follicles > alopecia
- GI issues > lining
- bone marrow > pain, ↓WBC, RBC,
radiation
- worksby making small breaks in the DNA inside cells
nursing management of pts receiving rad. therapy and chemo
– adverse rxns
chemo
- labs; WBC, platelets, RBC, Hmg
- G-CSF
- reverse precautions for infection
- transfusion of RBC or platelets
- GI: N/V, constipation
- Intg: skin
-
radiation
general side effects:
- skin problems and fatigue
- other side effects reflect the location of the XRT
complications that can occur in advanced cancer
– assessments and collab intervention for each
common indications for bone marrow transplant and nursing considerations for pts after transplant
stem cells to produce new blood cells
infection control
> reverse precautions
identify S/S of inadequate oxygenation and the implications of these findings
pathophysiology and types
– pneumonia
- acute inflammation of lung parenchyma caused by an agent
- ↑interstitial fluid & alveolar fluid
types:
lobar: - consolidation of 1 lobe of 1 lung
lobular/bronchopneumonia - patchy consolidation throughout
clinical manifestations and collab care
– pneumonia
manifestations:
- chest pain, SOB, cough
- OA > confused
collab care:
- antibiotics
- support measures
- vaccines
- nutrition > 3L of fluid/day
> (IV -> cautious of OA, renal failure and HF)
- fluid/electrolyte management
pathophysiology and types
– COPD
chronic inflammation found in airways & lung parenchyma
> bronchioles & alveoli
Inability to expire air is main characteristic of COPD
types:
chronic bronchitis
- chronic productive cough
emphysema
- abnormal & permanent enlargement of alveoli due to rupture and damage reducing the surface area for gas exchange
clinical manifestations
– COPD
- cough, sputum production, dyspnea, ↑WOB, barrel chest…
collab care
– COPD
smoking cessation
improved ventilation
- bronchodilators
remove bronchial secretions
reduce complications
- DVT prophylaxis
- pneumococcal vaccines
promote exercise in moderation
improve general health
surgical theraphy
nursing management of the client w/ COPD
1 ) Prevent disease progression
2 ) Reduce the frequency and severity of exacerbations
3 ) Alleviate breathlessness and other respiratory symptoms
4 ) Improve exercise tolerance and daily activity
5 ) Treat exacerbations and complications
6 ) Improve health status and QOL
7 ) Promote client comfort and participation in care
8 ) Reduce risk of mortality
nursing management of the client w/ pneumonia
Subj.: focused, questions, meds, hx of smoking/lung diseases, how long have they been sick, sx,
Obj.: breath sounds, RR, accessory muscles, SpO2, productive vs. nonproductive cough
indicators for O2 therapy, methods of delivery, and the complications of O2 administration
