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NRSE-3540 Adult Care 1 > Module 3 Blueprint > Flashcards

Module 3 Blueprint Flashcards

1
Q

the kidneys are responsible for

A

filtering water and wastes from the blood stream

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2
Q

what are the functions of the kidney

A

maintaining body fluid volume, creating urine, regulating blood pressure, acid-base balance, produce erythropoietin, and convert vitamin D

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3
Q

what is renal agenesis

A

person born with only one kidney

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4
Q

what is kidney dysplasia

A

born with two kidneys but only one yes

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5
Q

What is the functional unit of the kidney

A

the nephron

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6
Q

What does the nephron do

A

forms urine by filtering waste products and water from the blood

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7
Q

what do juxtaglomerular and macula densa cells do

A

macula densa: detects changes in blood volume and pressure
juxtaglomerular: produce renin

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8
Q

what does renin regulate

A

blood flow, glomerular filtration rate, and blood pressure

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9
Q

when is renin produced by the juxtaglomerular cells

A

blood volume, blood pressure, or sodium levels are low

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10
Q

explain the RAAS system

A

renin –> angiotensinogen –> angiotensin 1 –> angiotensin 2 –> aldosterone

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11
Q

what does aldosterone do

A

increase kidney reabsorption of sodium and water, promotes excretion of potassium

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12
Q

explain blood supply through the nephron

A

afferent arteriole -> glomerulus (water and small particles filtered to make urine) –> proximal convulated tubule–> descending loop of henle –> ascending loop of henle –> distal convoluted tubule –> collecting duct

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13
Q

the remaining blood not filtered in the glomerulus leaves through the

A

efferent arteriole

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14
Q

the regulatory function of the kidney controls

A

fluid and electrolyte, acid and base balance

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15
Q

the hormonal functions of the kidney control

A

RBC formation, blood pressure, and vitamin D activation

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16
Q

the kidneys can manage regulatory functions through urine elimination. What are the processes involved in urine elimination

A

glomerular filtration, tubular reabsorption, tubular secretion

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17
Q

what particles are allowed to be filtered across the glomerular membrane to form glomerular filtrate?

A

water, electrolytes, other small particles (creatinine, urea nitrogen, glucose)

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18
Q

What particles are too large to be filtered through glomerular capillary walls and are not commonly found in urine

A

blood cells, albumin, other proteins

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19
Q

Normal glomerular filtration rate

A

125 mL/min

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20
Q

How many L/day do we excrete in urine and why?

A

1-3L/day to prevent dehydration, much of waste produced by glomerulus is reabsorbed

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21
Q

GFR is controlled by

A

blood pressure and blood flow (the kidneys regulate their own blood pressure to keep GFR constant)

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22
Q

How do the kidneys control their own blood pressure

A

dilating and constricting the afferent and efferent arteriole

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23
Q

“when the systolic blood pressure drops below 65-70 mmhg”

A

“self regulation processes do not maintain GFR”

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24
Q

What is the second process in urine formation

A

tubular reabsorption

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25
Q

What does tubular reabsorption prevent

A

dehydration

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26
Q

How does tubular reabsorption work

A

as filtrate passes through tubular parts of nephron, water and electrolytes are reabsorbed in the capillaries (99%)

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27
Q

What is the renal glucose threshold

A

tubular reabsorption can reabsorb glucose until it gets above 180, then it spills into urine and we have glycosuria

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28
Q

When aldosterone is present, it promotes what to happen to sodium

A

sodium reabsorption in the distal convoluted tubule (water then follows)

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29
Q

how does tubular reabsorption control acid-base balance

A

bicarbonate absorption (along with calcium and phosphate)

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30
Q

what should the nurse do in the presence of glucose or proteins in the blood

A

report to provider as this is an abnormal finding

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31
Q

What is the third process of urine formation

A

tubular secretion

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32
Q

What does tubular secretion do

A

allows substances to move from the blood to the urine

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33
Q

What substances are moved into the urine through tubular secretion and why

A

potassium and hydrogen ions to maintain fluid and electrolyte balance/acid-base balance

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34
Q

the RAAS system is activated by the kidneys to raise

A

blood sodium levels –> in turn raises blood volume levels and blood pressure

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35
Q

What do the prostaglandins of the kidneys do

A

regulate glomerular filtration by dilation and constricting vessels,

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36
Q

what does erythropoietin do

A

produced and released in response to decreased oxygen –> triggers RBC production in bone marrow

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37
Q

What disease process could occur if erythropoietin is decreased

A

anemia

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38
Q

The kidney converts vitamin D into its

A

active form

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39
Q

What is the function of activated vitamin D

A

increase absorption of calcium in GI tract

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40
Q

What two structures do the ureters connect

A

kidneys to the urinary bladder

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41
Q

What is continence

A

the ability to voluntarily control bladder emptying

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42
Q

during micturition, does the external sphincter relax or contract

A

relax

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43
Q

what is the urethra

A

tube that allows excretion of urine from the bladder

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44
Q

how long is the urethra in males

A

6-8 inches

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45
Q

how long is the urethra in females

A

1-1.5

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46
Q

a sudden onset of hypertension in patients older than 50 years can indicate

A

kidney disease

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47
Q

in men older than 50 years, altered urine patterns are typically caused by

A

prostate disease

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48
Q

Why are UTIs and cystitis more common in women

A

the shorter urethra

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49
Q

ingestion of how much fluid / day is recommended

A

2L

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50
Q

a high intake of protein can affect our kidneys how?

A

increase risk for stones

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51
Q

What is nocturia

A

frequent voiding at night

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52
Q

Types of UA?

A

early morning, 24 hour, random, c/s, clean catch

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53
Q

pain that radiates into the perineal area, groin, scrotu,, or labia is known as

A

renal colic

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54
Q

Why do we do early morning?

A

urine is more concentrated.

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55
Q

renal colic pain may be intermittent or continuous, and the patient can present with other symptoms such as

A

pallor/ash gray skin, diaphoresis, hypotension

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56
Q

What does a UA do?

A

identifies the color, clarity, concentration or dilution, specific gravity, acid/alkaline, and presence of drug metabolites, glucose, ketones and proteins.

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57
Q

What should not be present in the urine?

A

glucose, ketones, nitrites, protein and leukocyte esterase.

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58
Q

Signs and symptoms of a UTI

A

cloudy, foul smelling urine, burning, urgency.
LABS: positive leukocyte esterase, nitrites, rbc, sediment.

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59
Q

What does a culture and sensitivity do?

A

Identifies the type of bacteria and what antibiotic will kill it

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60
Q

What is important when taking care of a patient with a UTI?

A

get urine sample first, then admin broad spectrum abx

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61
Q

Why do we send patients home on broad spectrum abx?

A

C/S takes 24-72 hours to get back and want them to start on a medication before leaving. Once results come back, we can change to a specific abx.

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62
Q

What does a 24 hour urine collection measure?

A

creatinine, urea nitrogen, sodium, chloride, calcium, catecholamines and proteins.

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63
Q

A 24 hour collection for creatinine clearance measures what?

A

gfr for clients who have impaired kidney function

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64
Q

Client education for 24 hour collection

A

void before timer starts
every drop needs to enter the collection container
Start over if a drop does not enter

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65
Q

clean catch urine collection, client education?

A

do not touch inside of the cup.
Wipe, void, then void into cup.

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66
Q

A renal ultrasound is used to?

A

assess kidney size, assess ureters, bladder, massess, cysts, calculi, and obstructions in the lower urinary tract.

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67
Q

Nursing actions for ultrasound

A

preform skin care by removing gel after the procedure

Complications? minimal risk for client

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68
Q

CT scan is used for?

A

3D imaging of the renal/urinary system to assess for kidney size and obstruction, cysts or masses.

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69
Q

Ct scan can use what?

A

contrast media to enhance images

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70
Q

Nursing actions for CT scan

A

Does not use bowel prep. Same as KUB, but with the use of contrast media

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71
Q

Complications for CT

A

Media can cause acute kidney injury.
risk for complications increases for clients who are: older, dehydrated, history of previous renal insufficiency, and taking nephrotoxic drugs.

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72
Q

Nursing actions for patients taking metformin getting a ct with contrast

A

stop before procedure, and start back after kidney function returns to normal

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73
Q

MRI is used for?

A

staging cancer, similar to CT

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74
Q

MRI nursing actions

A

clients lay down and need to remain still throughout the test
Metal implants are not allowed in the machine

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75
Q

MRI complications

A

poor imaging if client is unable to lie still

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76
Q

X-ray KUB looks at what?

A

kidney, ureters and bladder: visualizes the structures of these areas and detects calculi, strictures, calcium deposits, and obstructions.

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77
Q

Cystoscopy/ Cystourethroscopy does?

A

discovers abnormalities of bladder wall and or occlusions of ureter or urethrea.

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78
Q

Cystoscopy/ Cystourethroscopy pre procedure?

A

NPO after midnight
admin laxative or enema night before for bowel prep.

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79
Q

Cystoscopy/ Cystourethroscopy post

A

monitor vs and urine output
document color (can be pink tinged).
Irrigate cath with normal saline
irrigation if blood clots are present or urine is absent/ decreased.
encourage fluids to increase urine output to reduce burning sensation

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80
Q

Cystoscopy/ Cystourethroscopy complications

A

UTI: cloudy, foul odor, urgency, frequency, burning.

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81
Q

IV Pyelogram does what?

A

identifies obstruction or strucutural disorders of the ureters and renal pelvis of kidneys through instilling contrast media.

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82
Q

Iv pyelogram identfies what?

A

fistulas, diverticula, and tumors in the bladder and urethra, during a cystoscopy.

obstruction in the renal pelvis or ureter

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83
Q

Pre and post/ complications for iv pyelogram

A

same as cystoscopy

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84
Q

Renal scan assess what?

A

renal blood flow and estimates gfr after iv injection of radioactive material to produce scanned image of kidneys

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85
Q

Renal scan pre/post procedure

A

-Assess bp frequently during and after if patient received captorpril (changes blood flow to kidneys).
-Increase fluids if hypotension occurs to promote excretion of the radioactive materials.
alert clients of orthostatic hypotension

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86
Q

Complications of renal scan

A

Radioactive material does not cause nephrotoxicity and are not at risk from the material they excrete in the urine.

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87
Q

Kidney biopsy is done for what?

A

removing a sample of tissue from the kidney for examination

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88
Q

Kidney biopsy pre

A

Review coagulation studies
Ensure client has been NPO 4-6 hrs before

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89
Q

Kidney biopsy post

A

Monitor vs following sedation
Assess dressings and urinary output(hematuria)
Review hgb, hct values
Admin analgesics prn

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90
Q

Kidney biopsy complications

A

Hemmorrhage, and UTI

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91
Q

Hemorrhage signs and symptoms

A

SOB, tachycardia, tachypnea, pallor, cool skin,

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92
Q

Lithotripsy is used for what?

A

to break up stones

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93
Q

Lithotripsy pre/post

A

pre: obtain consent, flat position, anasethetic 45 mins prior, assess for gross hematuria
Post: strain urine, monitor site

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94
Q

Lithotripsy complications

A

bruising and flank pain at side procedure was done atand dysrhythmias.

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95
Q

Ureterolithotomy and Nephrolithotomy is used when?

A

surgery to remove kidney stones depending on the location of the stone. These are open surgeries

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96
Q

Ureterolithotomy and Nephrolithotomy pre procedure

A

NPO. bowel prep,

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97
Q

Ureterolithotomy and Nephrolithotomy post procedure

A

monitor for bleeding,
maintain fluids
initiate infection control measures
monitor for the passages of stone fragments.

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98
Q
A
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99
Q

symptoms/ assessment findings for UTI

A

lower back/ abdominal pain
urinrary frequency, urgency
dysuria, fever, nocturia, hematuria. Feeling of incomplete emptying

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100
Q

Diagnostics/tx and medications for UTI

A

Cystoscopy: complicated UTI
CT for pyleonphritis.

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101
Q

What will be ordered when a patient is suspected to have a UTI?

A

UA. C/S.
WBC count and differential: ureosepsis is suspected.

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102
Q

Patient education for UTI

A

3L of fluid a day
empty bladder every 3-4 hour
bathe daily to promote good hygiene
drink cranberry juice
urinate before and after intercourse.

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103
Q

What conditions are included in UTI?

A

cystitis, urethritis, prostatitis

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104
Q

What bacteria usually causes a UTI?

A

e.coli
staph can also lead to it, but most common is e.coli

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105
Q

Why are women more at risk for getting a UTI?

A

urethra being closer to the anus

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106
Q

What can happen if a UTI is left untreated?

A

can lead to pyelonphritis and ureosepsis which can lead to death.

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107
Q

Older adults manifestations of UTI

A

confusion, incontinence, loss of appetite, nocturia, dysuria, hypotension, tachycardia, tachypnea, and fever

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108
Q

Lab values for UTI

A

Bacteria, sediment, wbc, rbc, positive leukocyte esterase and nitrites (68%-88%) positive results indicates UTI.
WBC >10,000 and increased neutrophils

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109
Q

Medications for UTI

A

Fluoroquinolones, nitrofurantoin, trimethoprim, sulfonamides

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110
Q

If admin a sulfa we need to ask client for an allergy to what?

A

sulfa

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111
Q

When clients are taking a flurorquinolones or sulfa, we should explain to them?

A

sunburn is a risk and take with a full glass of water.

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112
Q

Patient medication education

A

take full abx, take with food, monitor and report watery diarrhea that can be c. diff

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113
Q

What is Phenazopyridine and what is important to teach the patient?

A

bladder analgesic used to treat uti.
-turn urine orange, take with food,
DOES NOT TREAT INFECTION, just the symptoms.

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114
Q

How should female clients take care of themselves to decrease risk of UTI?

A

wipe the perinel area from front to back.
avoid bubble baths and perfume feminine products.
avoid sitting in wet bathing suit
avoid tight clothing

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115
Q

Nursing care for UTI

A

warm sitz bath 2-3 times a day to provide comfort
avoid caths
pregnant individuals need to be treated asap as this can turn to pyelonephritis.

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116
Q

Most common type of Renal calculi

A

calcium phosphate or calcium oxalate.

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117
Q

What is the most common cause of kidney stones?

A

dehydration (especially in older adult clients)

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118
Q

Assessment findings and symptoms of kidney stones

A

severe pain. Intensifies as stone moves
flank pain
frequency dysuria, fever,pallor, diaphoresis, nausea and vomitting
hematuria,

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119
Q

Lab test for kidney stones

A

UA

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120
Q

Lab values for kidney stones

A

increased RBC, WBC, bacteria, crystals, increased urine turbidity if infection is present.
Decreased ph: uric acid, cystine stones
Increased ph: calcium or struvite stones

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121
Q

diagnostic procedures for kidney stones

A

x-ray, ct. mri of abdomen and pelvis, renal ultrasound or cystoscopy.

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122
Q

Nursing care for kidney stones

A

strain all urine to check for passage of calculus and save for lab analysis.
3L fluid a day unless contra
Encourage ambulation
Monitor when client is passing stones
monitor for pain, urinary ph, intake and ouput.

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123
Q

Medications for Kidney stones

A

opioids, NSAIDS, Spasmoltyic medications, ABX

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124
Q

Opioid kidney stones

A

watch for respiratory depression. Can be used for the first 24-36 hours with acute onset of calculi.

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125
Q

NSAIDs for kidney stones

A

Ketorolac: moderate pain, fever and inflammation.
risk for decreased renal function and perfusion.
Nursing action: observe for bleeding
Patient: watch for bleeding, Dark stool, blood in stool
notify provider if abd pain occurs (gastric ulceration)

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126
Q

Spasmoltyic medications, Kidney stone

A

Oxybutynin alleviates pain by decreasing bladder spasms.

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127
Q

Nursing action for Oxybutynin

A

assess for history of glaucoma (oxy can increase icp)
monitor for dizziness and tachycardia, and monitor for urinary retention

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128
Q

Client education for Oxybutynin

A

report palpitations, and problems with voiding or constipation
-dizzy, dry mouth are common
Suck on hard candies.

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129
Q

ABX kidney stones

A

-admin with food and monitor for nephrotoxicity and ototoxicity for clients taking gentamyocin.

Client education
-Urine can have foul odor because of this medication
-report loose stool

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130
Q

Diagnostic/ tx for kidney stones

A

lithotripsy, retrograde ureteroscopy, open surgery nonsurgical chemolysis

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131
Q

What is nonsurgical chemolysis?

A

uses chemicals to break the stones up.

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132
Q

What are the types of open surgeries for kidney stones?

A

ureterolithotomy: ureter
Pyelolithotomy:kidney pelvis
Nephrolithotomy: in kidney

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133
Q

Client education for calcium phosphate stones

A

limit intake of food high in animal protein, sodium and reduce calcium intake.

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134
Q

Calcium oxalate

A

avoid oxalate sources: spinich, black tea, rhubarb, cocoa, beets, pecans, strawberries, peanuts, okra, chocolate, wheat germ, lime peel, swiss chard
limit sodium intake

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135
Q

Struvite education

A

avoid high phosphate foods, dairy products, red and organ meats and whole grains.

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136
Q

Uric acid education

A

decrease intake of purine sources, organ meats, poultry, fish, gravies, red wine, sardines

consume lemon or orange juice to alkalize the urine.

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137
Q

cystine education

A

limit animal protein intake

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138
Q

Hydronephrosis occurs when?

A

a calculus has blocked a portion of the urinary tract. The urine backs up and causes distention of kidney leading to permanet kidney damage.

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139
Q

Nursing actions for Hydronephrosis

A

notify provider immediately, prepare client for removal of stones.

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140
Q

Hydronephrosis vs hydroureter

A

obstruction is in the ureter rather than in the kidney

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141
Q

What is hydroureter

A

enlargement of the ureter

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142
Q

common causes of urinary obstruction

A

kidney stones, tumors, fibrosis , structure abnormality

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143
Q

treatment and diagnostic for hydronephrosis

A
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144
Q

Lab findings for someone with hydronephrosis or hydroureter

A

-bacteria or white blood cells
if infection is present
-microscopic examination may show tubular epithelial cells
-blood chemistries normal unless GFR is decreased (which will increase BUN and creatinine)
-elevated K+, potassium, phosphorus, and calcium
-metabolic acidosis

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145
Q

Primary problems associated with hydronephrosis and hydroureter

A

infection and urinary retention

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146
Q

urinary outflow obstruction can be seen with

A

ultrasound or CT

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147
Q

Patient education for hydronephrosis

A
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148
Q

What is polycystic kidney disease?

A

congenital disorder where clusters of fluid filled cysts develop in the nephrons

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149
Q

Is PKD hereditary?

A

yes and is more common in caucasian clients

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150
Q

Expected findings in PKD

A

anxiety, guilt, abd pain, flank pain, headaches, enlarged abd girth, constipation, bloody/cloudy urine, renal lithiasis, progressive kidney failure, nocturia.

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151
Q

lab findings for PKD

A

hyponatremia, increased BUN, Creatinine, creatinine clearance

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152
Q

diagnostic procedures and lab test

A

ua, ultrasound, ct/mri

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153
Q

Nursing care for PKD

A

Hypertension control: highest nursing priority.

pain: analgesics, relaxation, deep breathing, use NSAIDs cautiously.
Infection: admin abx, evaluate blood creatinine levels and urinary output. monitor specific gravity

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154
Q

Client education for PKD

A

monitor bp and weight daily
notify provider if elevated temp
adhere to low sodium diet.

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155
Q
A
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156
Q

What is uremia

A

buildup of nitrogenous waste products in the blood as a result of kidney failure

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157
Q

symptoms of uremia

A

anorexia, N and V, muscle cramps, pruritus, fatigue, lethargy

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158
Q

What should we observe near the costovertebral angle

A

asymmetry or discoloration,

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159
Q

We should auscultate the renal artery for any

A

bruits (swooshing noises)

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160
Q

What can a bruit indicate

A

renal stenosis

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161
Q

When a distended bladder is percussed, it often sounds

A

dull

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162
Q

How to perform bladder percussion

A

percussion the lower abdomen and continue in the direction of the umbilicus until dull sounds are no longer heard

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163
Q

If a patient reports flank pain or tenderness, should we percuss this section first?

A

NO! start with non-tender

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164
Q

How to assess the urethra

A

using a good light source, inspect meatus and area around it

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165
Q

we should teach females to wipe from

A

front to back to decrease risk of infection

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166
Q

when is serum creatinine produced

A

when muscle and other proteins are broken down

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167
Q

Why do males tend to have a slightly higher creatinine level than women

A

have more muscle mass

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168
Q

when the serum creatinine level is doubled, what does this indicate in GFR

A

it’s reduced by 50%

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169
Q

What is the only disease that will increase creatinine

A

kidney disease

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170
Q

a decreased creatinine level can indicate

A

decreased muscle mass

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171
Q

BUN measures the

A

effectiveness of urea nitrogen excretion (byproduct of muscle breakdown in the liver)

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172
Q

does an increase BUN always indicate kidney disease

A

no

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173
Q

what are other diseases that can cause an elevated BUN level

A

rapid cell destruction from infection, cancer treatment, steroid therapy

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174
Q

If liver dysfunction is present, are urea nitrogen levels decreased or increased

A

decreased because the liver failure limits urea production

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175
Q

what is the blood urea nitrogen to serum creatinine ratio

A

comparison of levels of BUN to test other non-kidney related factors

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176
Q

elevations to both serum creatinine and kidney disease indicates

A

kidney dysfunction not related to dehydration or poor perfusion

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177
Q

What does cystatin c measure

A

glomerular filtration rate

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178
Q

What does cystatin-c

A

protein produced by nucleated cells in the body. produced at a constant rate

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179
Q

When glomerular filtration rate decreases, does cystic-c increase or decrease

A

increase

180
Q

Blood osmolarity is a measure of

A

overall concentration of particles in the blood

181
Q

blood osmolarity is a good indicator of

A

hydration status

182
Q

when blood osmolarity is decreased, what occurs with vasopressin

A

its release is inhibited

183
Q

When blood osmolarity increases , vasopressin is

A

released

184
Q

what is microalbumineria

A

presence of albumin in the urine that is not measurable by a urine dipstick or usual urinalysis procedures

185
Q
A
186
Q
A
187
Q

Treatment for hydronephrosis and hydroureter

A

-caused by stone : cystoscopic or retrograde urogram procedures
-caused by stricture (hydronephrosis): nephrostomy is performed

188
Q

with hydronephrosis, we may see damage to kidney tissue, as well as

A

kidney necrosis and fluid + electrolyte imbalances

189
Q

difference between external and internal nephrostomy tube

A

external drains fluid outside of body, internal can drain fluid outside of body or can drain some into the bladder to pee out

190
Q

Patient preparation for nephrostomy

A

NPO 4-6 h b4, PT/INR/PTT should be normal, drugs used to relieve hypertension, moderate sedation

191
Q

Procedure of nephrostomy

A

prone position, soft - tipped guide wire is placed through needle and then a catheter is placed over wire, catheter remains in place to drainage bag

192
Q

Post surgical care for nephrostomy

A

-assess amount of drainage in collection bag h for 24 h
(if drainage decreases and patient has back pain it can indicate the tube is dislodged)
-monitor site for leaking or blood
-drainage may contain blood for 12-24 h, then it should be clear
-irrigate with 5 ml normal saline to check potency and dislodge clots
-diuresis can occur so monitor for s/s of dehydration
-assess for infection

193
Q

When else may a nephrostomy tube be used

A

with renal calculi to prevent stone from passing

194
Q

How often do we drain nephrostomy tube

A

4-5 times / day

195
Q

How often do we change drainage bag

A

3 times week

196
Q

When do we change dressing for nephrostomy tube

A

q other day, 2x/week, when soiled

197
Q

What are reasons we may have zero urine output from nephrostomy tube

A

kinks, stone, pulled out

198
Q

What complications should we monitor patient for after nephrostomy

A

decreased/absent drainage, cloudy or foul smelling drainage, leakage of blood or urine from site, back pain

199
Q

What is pyelonephritis

A

urinary tract infection that spreads from the bladder to the kidneys

200
Q

acute pyelnephritis

A

results from active bacterial infection

201
Q

chronic pyelonephritis

A

occurs from repeated UTIs caused by obstruction, reflux, structural deformities, tumors, spinal cord issues, DM

202
Q

What is reflux

A

back flow of urine toward the kidney… increases risk of pyelonephritis

203
Q

Symptoms of acute pyelonephritis

A

acute tissue inflammation, local edema, tubular cell necrosis, possible abscess

204
Q

What are kidney abscesses, a complication of pyelonephritis

A

pockets of infection

205
Q

Symptoms of chronic pyelonephritis

A

fibrosis and scar tissue –> leading to impaired filtration, reabsorption, and kidney function

206
Q

What bacteria is the most common cause of UTI

A

e-coli

207
Q

Who most commonly gets acute pyelonephritis

A

young female who is sexually active, women in 2nd-3rd trimester

208
Q

Symptoms of acute pyelonephritis

A

fever, chills, tachycardia, tachypnea, colicky abdominal discomfort, N/V, burning/urgency/frquency with urination, CVA tenderness, flank/back/loin pain, recent UTI

209
Q

Symptoms of chronic pyelonephritis

A

HTN, hyponatremia, nocturia, hyperkalemia, acidosis

210
Q

Assessment of someone with suspected pyelonephritis includes

A

-inspecting the flanks and palpating CVA
-inflammation: enlargement, asymmetry, edema/redness, hyperpigmentation,

211
Q

Why should we do a psychosocial assessment on someone with suspected pyelonephritis q

A

often get embarrassed and upset that it may have to do with sexual activity

212
Q

Laboratory assessment findings with pyelonephritis

A
  • UA: positive leukocyte esterase and presence of WBC and bacteria and RBC and protein
  • CBC with differential, C-reactive protein, ESR
    -BUN and creatinine (increased)
    -GFR
213
Q

Imaging used with pyelonephritis

A

X-ray of kidneys, ureter, bladder (KUB)
CT (abscesses, fluid accumulation, inflammation)
voiding cystourethrogram (reflux)

214
Q

Other diagnostic assessments with pyelonephritis

A

-antibody-coated bacteria (to see if they need long-term antibiotic therapy)
-testing for certain enzymes (kidney tissue deterioration)
-radionuclide renal scans (active pyelonephritis or abscesses)
- kidney biopsy

215
Q

nonsurgical interventions for pyelonephritis

A

acetaminophen (pain), antibiotics (brand then narrow), catheter replacement, nutritional therapy (adequate calories from all food groups and 2L fluid/day)

216
Q

Surgical management of pyelonephritis

A

pyelolithotomy (removal of stone from kidney), nephrectomy (removal of kidney), ureteral diversion, reimplantation of ureters to restore proper drainage, ureteroplasty (ureter repair or revision) , ureteral reimplantation

217
Q

Patient teaching for pyelonephritis

A

importance of finishing ABX therapy, importance of regular follow-up visits, blood pressure control (to slow kidney dysfunction), importance of adequate fluid intake

218
Q

What is glomerulonephritis

A

immune disorder of the kidney (could result from lupus, inflamed glomeruli)

219
Q

Acute glomerulonephritis occurs quickly 10 days after tis kind of infection

A

strep

220
Q

Physical assessment for acute glomerulonephritis

A

-inspect for cuts/lesions (including new jewelry)
-assess for edema
-ask about SOB
-listen to lungs (crackles) and s3 heart sound and distended neck veins
-smoky-reddish/brown urine
-dysuria or oliguria
-weights for fluid retention
-anorexia, N/V, fatigue

221
Q

What will the UA of someone with acute GN show

A

hematuria, proteinuria, red blood cell casts

222
Q

Why is a 24 hour urine sample needed in someone with suspected acute GN

A

assess for presence of protein (may be 3g/ 24h)

223
Q

Will serum albumin levels be increased or decreased in someone with acute GN

A

decreased (its being peed out)

224
Q

will GFR be increased or decreased in a patient with acute GN

A

decreased

225
Q

What diagnostic tool may be used to diagnose acute GN

A

kidney biopsy

226
Q

Nursing interventions for patient with acute GN

A

-manage infection with proper abx (penicillin, erythromycin, azithromycin)
-stress personal hygiene (handwashing)
-corticosteroids (to suppress inflammation)

227
Q

How to prevent complications of acute GN

A

-fluid overload, HTN, edema = diuretics and sodium and water restrictions
-restriction of potassium and protein to prevent hyperkalemia and uremia (as result of elevated BUN)
-anti-hypertensive drugs

228
Q

For a patient with acute GN, when may dialysis be needed

A

-uremia or fluid overload cannot be treated with nutrition therapy and fluid management (symptoms of uremia include N/V/anorexia)

229
Q

How to reduce emotional stress in client with acute GN

A

relaxation techniques, and diversional activities

230
Q

Patient teaching for acute glomerulonephritis

A

-purpose of taking drugs
-diet and fluid restrictions
-daily weights and BP and notify of any sudden increases
-

231
Q

What is rapidly progressive glomerulonephritis (RPGN)

A

presence of crescent-shaped cells in the bowman capsule , often progresses to end-stage kidney disease

232
Q

Symptoms of RPGN

A

fluid volume excess, HTN, oliguria, electrolyte imbalances, uremic symptoms

233
Q

What is chronic glomerulonephritis

A

develops over years or decades

234
Q

What are the symptoms of chronic glomerulonephritis

A

mild proteinuria, hematuria, HTN, fatigue, occasional edema

235
Q

During chronic glomerulonephritis, what happens to the kidney tissue

A

atrophies, functional nephrons greatly reduced, glomerular changes in late stages

236
Q

What occurs from the loss of nephrons in chronic glomerulonephritis

A

reduces glomerular filtration –> proteins enter urine -> ESKD

237
Q

What is a common assessment finding with chronic glomerulonephritis we should assess for

A

nocturia, dyspnea (due to fluid overload), decreased urine output, changes in cognition and memory (due to waste buildup in blood)

238
Q

Physical assessment findings of chronic glomerulonephritis

A

systemic circulatory overload (crackles, SOB, increased weight, HTN, venous distention) uremic symptoms (slurred speech, ataxia, tremors, asterixis) yellow color to skin, bruises, rashes, dryness, itching

239
Q

Diagnostic assessment findings for chronic glomerulonephritis

A

-urine output decrease
-fixed urine specific gravity despite fluid intake
-red blood cells,
-red blood cell casts,
-GFR is low
-elevated serum creatinine
-BUN increased

240
Q

What can happen with sodium levels with chronic glomerulonephritis

A

retention of sodium, but heavily diluted plasma shows abnormally low sodium levels

241
Q

electrolyte imbalances found in chronic glomerulonephritis

A

hyperkalemia hyperphosphatemia
acidosis

242
Q

How do kidneys appear on x-ray or CT with chronic glomerulonephritis

A

small

243
Q

Management of chronic GN

A

diet changes, fluid intake sufficient to prevent reduced blood flow to the kidneys, drug therapy to control problems from uremia

244
Q

Eventually, chronic glomerulonephritis

A

dialysis or transplantation

245
Q

Example of short and long bones

A

short: phalanges
long: femur

246
Q

The red bone marrow makes

A

red blood cells

247
Q

The yellow bone marrow makes

A

fat cells

248
Q

What are the bone forming cells?

A

osteoblasts

249
Q

What are the bone destroying cells

A

osteoclasts

250
Q

How many bones do we have

A

206

251
Q

What are the functions of the musculoskeletal system

A

protect vital organs, store calcium

252
Q

Calcium and phosphorus have an ______ relationship

A

inverse

253
Q

What does PTH hormone do

A

stimulate the release of calcium from the bone to raise serum calcium levels (stimulates bone resorption)

254
Q

What does calcitonin do

A

decrease serum calcium by decreasing bone resorption

255
Q

A body’s decrease in vitamin D level can result in ______ in the adult

A

osteomalacia (softening of bone)

256
Q

Estrogens stimulate ____ activity and inhibit ______.

A

osteoblastic ; PTH

257
Q

When estrogen levels decline at menopause , women are susceptible to

A

osteoporosis

258
Q

What is arthritis

A

joint inflammation

259
Q

what is synovitis

A

synovial inflammation

260
Q

When does muscle atrophy occur

A

prolonged immobility, not regular exercise, aging

261
Q

tendons attach

A

muscle to bone

262
Q

ligaments attach

A

bone to bone

263
Q

older adults, especially women, have bone density loss known as

A

osteopenia

264
Q

osteoporosis can cause

A

kyphosis and gait changes (these changes predispose the person to fractures)

265
Q

What are things that can result from prolonged immobility

A

risk for bed sores, skin breakdown, blood clots, pneumonia, muscle atrophy , decrease ROM, contractures

266
Q

Can contractures be permanent?

A

yes

267
Q

CT is very useful for detecting musculoskeletal conditions in which places

A

vertebral column and joints

268
Q

Before CT, the nurse should asses the client for which allergies

A

iodine- based contrast

269
Q

Why is MRI used for most musculoskeletal disorders

A

more accurate than CT for spinal and knee problems, most appropriate for viewing joints and small tissues

270
Q

What is an magnetic resonance athrography (MRA)

A

MRI with contrast injected into the joint

271
Q

What is an arthroscopy

A

tube inserted into joints for direct visualization; may be used as a diagnostic or a surgical procedure

272
Q

Patient prep for arthroscopy

A

-pt must have mobility
- ROM exercises may be taught

273
Q

Nursing safety priority for arthroscopic procedure

A

neurovascular status: distal pulses, warmth, color, capillary refill, pain, movement, sensation of affected extremity

274
Q

Follow-up care for arthroscopy

A

-encourage client to perform exercises
-mild analgesic (acetaminophen) for diagnostic
-opioid analgesic for surgery
- ice for 24 hours
- elevate extremity 12-24 hours

275
Q

Complications of arthroscopic procedure

A

swelling, severe joint or limb pain, thrombophlebitis, infection

276
Q

What is carpal tunnel syndrome

A

disease where we have compression of the median nerve, causing pain and numbness

277
Q

What are causes of carpal tunnel syndrome

A

typing, repetitive movements, cell phone use

278
Q

Symptoms of carpal tunnel syndrome

A

‘pins and needles’ sensation in first three fingers and thumb side of ring finger

279
Q

Assessment findings of carpal tunnel syndrome

A

positive Phalen’s maneuver test, atrophy, swelling, skin discoloration, brittle nails, increased/decreased hand sweating

280
Q

Treatment for carpal tunnel syndrome

A

Nonsurgical: NSAIDs, corticosteroid injection, immobilization, yoga
Surgical: CTR surgery

281
Q

Nursing care following surgery for CTS

A

-neurovascular health assessments
-dressing checks
-exremity elevation
-analgesics
-hand movements restricted 4-6 weeks

282
Q

Patient education for CTS

A

-chair height, wrist rest devices, short breaks from repeotive activities, stretch fingers and wrists
-chronic and will likely need surgery again

283
Q

Nurses should recognize that those with CTS are at risk of

A

injury, and decreased ability to perform ADL’s

284
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319
Q

What is important to review in a history of a women?

A

Menopause

320
Q

Why should we pay attention to menapause?

A

Decreased estrogen can increase risk for fractures and the development of osteoporosis.

321
Q

In older adults who have kyphosis what do we worry about?

A

Falls because they are off center.

322
Q

What can kyphosis impaire?

A

Breathing, leading to decreased profusion, gas exchange and pooling of secretions

323
Q

Kyphosis puts patients at risk for?

A

Pneumonia because of the pooling of secretions

324
Q

Diabetics are at risk for foot ulcers because?

A

they have decreased sensory perception deficit.

325
Q

What kind of lifestyle impairs the musculoskeletal system?

A

Seditary lifestyle can increase blood clts, muscle atrophy because of immobility.

326
Q

what profession is at risk for getting injured?

A

construction workers or individuals who work around chemicals.

327
Q

Why would an allergy to dairy cause issues with the musculoskeletal system?

A

If they are not consuming enough calcium they can have hypocalcemia.

328
Q

Can steroids affect calcium level?

A

yes

329
Q

Should an injury ever effect your pulse?

A

NO

330
Q

What is involved in a musculoskeletal assessment?

A

Review of patients history, age, pain, assess skin, and muscle strength, assess gait and general mobility, assess pulses

331
Q

What is a complete fracture?

A

Fracture through the entire width of the bone

332
Q

What is an incomplete fracture?

A

bone does not divide

333
Q

What is a closed fracture?

A

no visible wound, does not break the skin

334
Q

What is a open or compound fracture?

A

fracture that breaks through the skin surface

335
Q

What is a simple fracture?

A

One fracture line

336
Q

What is a comminuted fracture?

A

Multiple fracture lines, bone in multiple pieces

337
Q

What is a displaced fracture?

A

Bone fragments not in alignment

338
Q

What is a non-displaced fracture?

A

Bone fragments remain in alignment

339
Q

What is a pathologic (spontaneous) fracture?

A

fracture that occurs due to underlying disease

340
Q

What is a fatigue or stress fracture?

A

Excessive strain to that area of the body. Most commonly occurs in the foot from running or jumping. Also known as a hairline fracture

341
Q

What is a compression fracture?

A

Fractures that occur in older adults with osteoporosis.

342
Q

Stages of bone healing

A

1- hematoma forms
2-granulation tissue –> fibrocartilage (foundation for bone healing)
3- vascular and cellular proliferation (callus)
4- callus transformed into bone
5- consolidation and bone remodeling

342
Q

What nutrients are needed for production of new bone

A

calcium, phosphorus, vitamin D, protein

343
Q

What are complications of fractures?

A

VTE, Dvt, pe formation
Infection
Compartment syndrome
Fat embolism

344
Q

If a patient has a open fracture, what can this increase their chance for?

A

infection

345
Q

What is compartment syndrome?

A

Increase pressure within a closed compartment that results in impaired circulation

346
Q

Compartment syndrome is considered what?

A

a medical emergency

347
Q

What is the procedure used to fix compartment syndrome?

A

Fasciotomy.

348
Q

Symptoms of compartment syndrome?

A

pain, paleness, pulselessness, parasthesia, paralyzed.

349
Q

What is the first sign of compartment syndrome?

A

Parasthesia (numbness and tingling). The other 4 will follow after this sign

350
Q

When assessing a patient with an injury, it is important to assess them how?

A

above and below the injury location. Assess skin for warm and pinkness with no impaired pulse. Bilaterally.

351
Q

If a patient has a dressing and develops compartment syndrome what is the nursing intervention we should do?

A

cut the dressing off and notify provider.

352
Q

When assessing pain, what should we try first?

A

non pharmacological interventions. Deep breathing, guided imagery, distraction, positioning, breathing, ambulation

353
Q

What is avascular necrosis?

A

causes bone death, most common in hip fractures

354
Q

Chronic pain can only be assessed by?

A

subjective data

355
Q

Infection (osteomyelitis) happens when?

A

Osteomyelitis is a severe and difficult infection to treat. It is an infection in the bone most often caused by bacteria.

356
Q

Pathophysiology of Osteomyelitis

A

Inflammatory response is initiated that allows for capillary leakage and swelling in that area. This can lead to drainage from the actual wound or puss depending on the type of wound.
Bone becomes ischemic and leads to bone death.

357
Q

What can happen during osteomyelitis?

A

bone will regnerate before treatment is complete, laying new bone on top of the infected bone causing a prolonged infection and making it harder to treat.

358
Q

Osteomyelitis can be

A

acute or chronic

359
Q

What is the difference between acute and chronic Osteomyelitis

A

With acute, it is treated and is resolved.
With chronic: treatment is not long enough lasting in an infection of 3 months or longer.

360
Q

Most common ways osteomyelitis occurs?

A

Break in the skin, stabbing, open fracture, ANIMAL BITE., or if diabetics get a foot ulcer and bacteria enter the bone.

361
Q

What is the difference between acute and chronic osteomyelitis symptom wise?

A

acute: fever swelling, heat, bone pain, erythmia
Chronic: no fever and localized pain.

362
Q

Which bacteria most likely is the cause of osteomyelitis?

A

staph

363
Q

What is the most common cause of MRSA infection?

A

Surgical infections. (external fixator and open reduction)

364
Q

Education for patients with open wounds

A

infection prevention
understanding how to maintain any open wounds
monitor for signs and symptoms of infection.
know how to do iv abx at home.

365
Q

Patients on ABX for MRSA and osteomyelitis should be educated on what when taking ABX?

A

Because of the prolonged period of time taking ABX, patient should be educated that they may develop a superinfection (C.DIFF).

366
Q

How many stools a day should a patient report for suspicion of c.diff?

A

10-15 a day and describe as explosive

diarrhea is common but if having 10-15 a day alert provider

367
Q

Medications used to treat MRSA?

A

Vancomycin, daptomycin, linezolid.

368
Q

Opioids and NSAIDs can be used in conjunction to?

A

reduce pain and promote wound healing

369
Q

Fat embolism

A

Fat globules released from yellow bone marrow 12-48 hours after the injury has occured.

370
Q

Pathophysiology of Fat embolism

A

Clog small vessels that supply blood to our organs. The lungs are mostly effected.

371
Q

Nursing interventions for fat embolism

A

Supportive care, o2 management, and monitor symptoms.

372
Q

Early indication of fat embolism

A

hypoxemia, sob, increased rr

373
Q

Progressed symptoms of Fat embolism

A

changes in LOC

374
Q

What is distinctive in fat embolism

A

Petechiae found over the trunk, last symptom to develop in fat embolisms.

375
Q

How to diagnose a fat embolism?

A

chest x-ray, ct, mri

376
Q

Fractures can cause fat embolisms how

A

yellow bone marrow contains fat and when it breaks it can cause bits of fatty tissue from inside of the bone to enter the blood stream which can travel to respiratory system.

377
Q

Treatment for fat embolism

A

immobilize the fracture, bed rest, o2, fluids.

378
Q

Are dvt/pe and fat embolisms the same?

A

yes, the difference is the petechiae seen in fat embolisms.

379
Q

two types of casts

A

fiberglass and plater

380
Q

Plaster casts take how long to form?

A

24 hours to dry before they become rigid.

381
Q

Education for patient with placement of plaster cast?

A

as the cast is forming it will have musty smell, but once it drys it will be odorless.
be careful not to damage the plaster while its drying because it is not rigid.

382
Q

Fiberglass forms how?

A

becomes rigid quickly to immobilize a joint or bone.

383
Q

assessment for the types of casts

A

check above and below the cast
assess skin for warmth, dry, pink skin and intact
Check thumbsite for fiberglass cast.
capilarry refill
wiggle fingers and toes
assess pulses.
check places that irritation may occur.

384
Q

If there is an odor after 24-48 hours after a plaster cast as been placed, what does this indicate?

A

infection.

385
Q

Patient education for fiberglass cast?

A

do not stick stuff under your cast, as this can tear the skin and cause an infection where it can not be seen.

386
Q

Cast removal patient education

A

do not scrub the area, allow it to soak
gradual exercise
weakness may be present

387
Q

if a patient has a wound under cast, what can we do?

A

cut a section in the cast to preform wound care.

388
Q

Nursing interventions for prevention of musculoskeletal problems with aging?

A

weight bearing exercises/ how to prevent falls/adequate intake of calcium and vitamin d (decreased bone density)
body mechanics, assistive walking devices, supportive shoes (kyphosis)
regular physical examinations
apply warmth (osteoarthritis)
decreased ROM (assess ADL’s)

389
Q

What is important to remember with bucks?

A

skin integrity can become impaired because of the pulling of the skin from weights.

390
Q

Weight amount for bucks

A

5-10 lbs

391
Q

Nursing reminders for tractions?

A

do not manually lift the weights unless ordered too
ALWAYS NEED TO BE FREE HANGING
Document: skin integurity, profusion and color.

392
Q

Skeletal differs from Bucks how?

A

allows for more weight, pins go through the bone and weight pulls on the bone.
15-30lbs weights

393
Q

Bucks is used for?

A

femur and hip fractures

394
Q

Skeletal puts the patient at risk for?

A

infection

395
Q

Nursing intervention and care for skeletal?

A

pin care is now added with skin assessment and care.

396
Q

What does free hanging mean?

A

they are not resting on the floor, bed, or bed frames.

397
Q

What is ORIF

A

open reduction with internal fixation.
surgical placement of pins and rods inside the patient
at risk for infection now

398
Q

What is OREF

A

surgically placed

399
Q

OREF requires?

A

pin care for infection prevention

400
Q

pre-op considerations for fixators?

A

obtain consent, npo, anasthesia

401
Q

Post op education for patients with surgically placed fixators

A

Understand how to do pin care at home and monitor for signs and symptoms of infection and infection prevention.

402
Q

Difference between strain and a sprain

A

Strain is muscle or tendon; falls, lifting, and exercise
sprain is ligament ; twisting from falls, sports activity

403
Q

management of strains

A

Cold and heat, anti-inflammatories, muscle relaxants, surgical repair if needed (3rd degree), activity limitations

403
Q

m

A
404
Q

management of sprains

A

RICE, immobilization, surgery if severe

405
Q

Emergency care for an extremity fracture?

A

immbolize, pressure,, call 911.

406
Q

Decreased pth leads to

A

hypocalcemia.

407
Q

Hypercalcemia puts patients at risk for

A

fracutres

408
Q

Phosphorus is low

A

calcium can be high, at risk for fractures

409
Q

Calcitonin high

A

calcium is low

410
Q

Vitamin d activation

A

activated in kidneys, absorbed in the intestines

411
Q

Vitamin d and calcium

A

vitamin d makes it possible for intestines to absorb calcium.

412
Q

If we can not find a pulse and assess it correctly what should we do?

A

obtain a doplar to assess the pulse

413
Q

Amputations can be either

A

elective or traumatic

414
Q

What is an example of an elective amputation

A

a diabetic patient choosing to remove toe after infection

415
Q

Traumatic amputations are more likely to be seen

A

in the community

416
Q

What should you do if you witness a traumatic amputation in the community

A
  1. call 911 2. ABC’s 3. find dry (preferably sterile) gauze or clean cloth and put on limb, elevate above heart level and hold pressure
417
Q

Should you remove the the cloth to check for bleeding during a traumatic amputaion?

A

no

418
Q

What should we do to preserve the body part after amputation

A

preserve the limb by wrapping in gauze and placing it in a bag, put digit in ice water solution, keep dry but cold

419
Q

what is phantom limb pain

A

pain that occurs where a limb is absent

420
Q

For phantom limb pain, what psychosocial needs should be met

A

validating and acting on their pain, “Where is your pain located at”

421
Q

What treatments options can be used for phantom limb pain?

A

-IV calcitonin
-Beta-blockers (dull burning)
-Gabapentin (knife, sharp nerve pain)
-TENS unit
-Antispasmodics (spasms)

422
Q

Why do we give IV calcitonin during first few weeks after amputation

A

can reduce occurrence

423
Q

How long do we elevate limb following amputation

A

24 h

424
Q

Nursing interventions following amputation

A

-compression dressing
-observe for bleeding/infection
-assess pulses
-assess skin breakdown
-prevent contractures

425
Q

What assessments should we perform on clients with amputation

A

neurovascular, cap refill, psychosocial (amputee and caregiver/family grieving)

426
Q

What is a neuroma

A

complication of amputation; tumor at end of nerve cells, most often in upper extremities amputation

427
Q

Treatment for neuroma

A

removal (may come back afterwards and present with more pain), peripheral nerve blocks, steroid injectors

428
Q

What is a flexion contracture

A

-biggest complication of hip or knee amputation
-these patients are not a candidate of prosthetic device

429
Q

Nursing interventions for preventing flexion contractures

A

ROM exercise, turn q 2 hours and independently, firm mattress, do not elevate after 24 Horus , push residual limb down into the bed

430
Q

How often should our amputee patients lay prone to prevent flexion contracture?

A

20-30 min q 3-4 h

431
Q

what wrapping method do we use with prosthesis to help shape stump?

A

figure 8

432
Q

What is an arthroplasty

A

surgical removal of a diseased joint due to osteoarthritis, osteonecrosis, ra, trauma, or prosthetics.

433
Q

Pre procedure for Arthroplasty

A

CBC, urinalaysis, electrolytes, bun, creatinine. Assess for surgical readiness and rule out anemia, infection and organ failure.

chest x-ray and ecg.

434
Q

Post procedure for arthroplasty

A

extensive physical therapy
monitor for incisional infection
care for the incision
monitor for dvt and pe

435
Q

Complications from arthroplasty?

A

Vte, dvt. pe, joint discoloration, infection, anemia, neurovascular compromise.

436
Q

What can an arthroplasty put the patient at risk for?

A

DVT, and incision infection.

437
Q

What is a total joint arthroplasty?

A

Total joint replacement, involves replacement of all components of an articulating joint

438
Q

What is a total knee arthroplasty?

A

Involves replacement of the distal femoral component, tibia plate, patellar button.
This is a surgical option when conservative measures fail

439
Q

What can be perscribed weeks before an arthroplasty to raise the hemoglobin level to prevent anemia?

A

epoetin alfa

440
Q

What is a contraindication to arthroscopy?

A

uti, arterial impairment, uncontrolled diabetes, hypertension, cardiac disorders (dysrhythmia)

441
Q

Client education for a Arthroscopy

A

scrub the surgical site the night before surgery to decrease bacteria count on skin which helps lower the chance of infection

442
Q

why are older adult clients at higher risk of developing dvt and pe after arthroplasty?

A

compromised circulation and their age

443
Q

Nursing actions for post arthroplasty?

A

monitor for bleeding
maintain aseptic technique
monitor incision site for infections
follow prescriptions monitoring mobility, and positioning to protect joints and prosthetics
assess neurovascular status of operative extremity.

NRSE-3540 Adult Care 1 (5 decks)

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