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MS2 Exam 1 > "On the Exam" Per Professor Whitton > Flashcards

"On the Exam" Per Professor Whitton Flashcards

1
Q

How to calculate restricted fluids for ARF patient

A

Allow 500mL for insensible losses and add the fluid amount excreted from previous 24 hours.

Example:

Pt with ARF excretes 325mL of urine in 24 hours, allow 825mL for next 24 hrs.

(500mL + 325mL = 825mL)

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2
Q

Maintenance Phase of ARF

A
  • significant fall in GFR
  • oliguria may develop
  • Azotemia
  • fluid retention
  • electrolyte imbalances
  • metabolic acidosis
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3
Q

What to monitor for Hyperkalemia

A
  • BP
  • apical HR
  • serum K+ level
  • continuous cardiac monitoring is highly recommended
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4
Q

What to Administer for Hyperkalemia

A
  • electrolyte binding and electrolyte excreting meds (Kayexalate)
  • 50% dextrose and insulin
  • Calcium gluconate
  • NaHCO3
  • loop diuretics
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5
Q

What to avoid with Hyperkalemia

A
  • High K+ foods

- K+ sparing meds

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6
Q

What would you potentially need to prepare the patient for with Hyperkalema

A

-peritoneal or hemodialysis

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7
Q

Hypermagnesemia Causes

A

Mg is Regulated by the kidneys and necessary for cardiac function

caused by renal patients receiving magnesium supplements

decreased renal excretion of magnesium

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8
Q

Hypermagnesemia clinical manifestations

A
  • depresses CNS

- cardiac dysrhythmias (PVC’s and VF)

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9
Q

What to administer for hypermagnesemia

A
  • loop diuretics

- calcium

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10
Q

What to avoid with hypermagnesemia

A
  • antacids
  • laxatives
  • enemas
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11
Q

Phosphate

A
  • major role in nerve, RBC, and muscle function
  • maintains acid base balance
  • kidneys excrete phosphate
  • inverse relationship with calcium
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12
Q

Phosphate has an inverse relationship with…

A

Calcium

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13
Q

Hyperphosphatemia causes

A

chronic renal failure and/pr excessive Vit D intake

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14
Q

Hyperphosphatemia Effects

A
  • decreased serum calcium levels

- Tetany

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15
Q

Increased phosphorus levels leads to….

A

decreased Ca+ levels which leads to stimulation of parathyroid hormone with leads to bone demineralization

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16
Q

What to administer with Hyperphosphatemia

A
  • TUMS (phosphate binders)
  • calcium acetate (PhosLo)
  • Sevelamer (Renagel) with meals
  • Stool softeners because phosphate binders are constipating
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17
Q

What to avoid with Hyperphosphatemia

A

-aluminum hydroxide preps

18
Q

Hypocalcemia causes

A
  • CRF
  • vit D deficiency
  • loop diuretics (Lasix)
  • increased phosphate levels
19
Q

Hypocalcemia effects

A
  • stimulate PTH to release Ca+ from bone
  • Chovstek’s sign
  • Trousseau’s
  • Tetany/seizures
20
Q

What to administer for Hypocalemia

A

-calcium supplements and activated Vit D

21
Q

Metabolic Acidosis

A

-kidneys unable to excrete hydrogren ions

OR

-manufacture bicarb resulting in acidosis

22
Q

What to administer for Metabolic Acidosis

A

-NaHCO3 (alkalizers)

23
Q

CRF patients adjust to ….

A

low HCO3 levels and do not become acutely ill

24
Q

Rifle Criteria

A

Risk:
-Increased SCreat x1.5 or GFR decrease >25%.

-UO less than .5ml/kg/h for 6 hrs

Injury:
-Increased SCreat x2 or GFR decrease >50%.

-UO less than .5ml/kg/h for 12 hrs

Failure:
-Increased SCreat x3 or GFR decrease >75%. OR SCreat greater than or equal to 4mg/dL

-UO less than .3ml/kg/h for 24 hrs or Anuria for 12 hrs

Loss:
-Persistent ARF= complete loss of kidney function more than 4 weeks

ESKD:
more than 3 months

**RIF= High Sensitiity

**LE= High Specificity

25
Q

Glomerulonephritis

A
  • immunological disorder
  • 3rd leading cause of renal failure
  • multiple types and classifications

“something happens and then you get it…”

26
Q

How to care for biopsy patient

A

The patient must lie on his or her back for 8 to 24 hours. Some nephrologists advocate a 24-hour recovery in the hospital, where the patient can be observed for complications.
The kidney contains many blood vessels and bleeds as a result of the biopsy. Bright red (arterial) blood in the urine (hematuria) may be seen for the first 24 hours. If blood is seen in the urine after 24 hours, further care may be required to stop the bleeding. Many people experience muscle aches and general soreness during recovery.

27
Q

IVF administration after AKI

A
  • Guaranteeing adequate renal perfusion and intravascular volume is important for prevention and therapy of AKI
  • Maintenance of volume homeostasis and correction of biochemical abnormalities remain the primary goals of tx and may include
  • correction of fluid overload with furosemide
  • correct acidosis with bicarb
  • correct hyperkalemia
  • correct hematologic abnormalities (anemia, etc..)
28
Q

Peritonitis

A

Inflammation of the membrane lining the abdominal wall and covering the abdominal organs.

-Contraindicated for PD

29
Q

Clinical Manifestations for Peritonitis

A
  • fever
  • cloudy outflow
  • rebound abdominal tenderness
  • abdominal pain
  • malaise
  • N/V
30
Q

Tx of Peritonitis

A
  • Antibiotics can be added to dialysate solution to prevent peritonitis
  • Admin antibiotics post infection
  • obtain sample of outflow for C and S
31
Q

Prevention of Peritonitis

A
  • Antibiotics can be added to dialysate solution to prevent peritonitis
  • **maintain meticulous sterile technique
  • prevent catheter insertion site from becoming wet
  • follow institutional policy for connecting and disconnecting PD solution bags
32
Q

Corticosteroids Side Effects given orally for short-term therapy

A
  • glaucoma (elevated pressure in eyes)
  • fluid retention, which causes swelling in lower legs
  • HTN
  • mood swings
  • weight gain (fat deposits in the abdomen, face, and the back of the neck)
33
Q

Corticosteroids Side Effects given orally for long-term therapy

A
  • cataracts
  • hyperglycemia
  • increased risk of infections
  • osteoporosis
  • increased risk of fractures
  • suppression of adrenal gland hormone production
  • bruising, thin skin
  • delayed wound healing
  • growth suppression in children
34
Q

Corticosteroids Side Effects for inhaled/nebulized corticosteroids

A
  • oral thrush
  • hoarseness
  • can be easily avoided by rinsing and gurgling with water following medication administered
35
Q

Instructions for MDI Inhaler

A
  1. firmly insert a charged MDI canister into the mouthpiece unit or spacer
  2. Remove mouthpiece cap. Shake canister vigorously for 3-5 seconds
  3. exhale slowly and completely
  4. holding the canister upside down, place the mouthpiece in the mouth, closing lips around it if a space is being used. When no spacer is being used, hold the mouthpiece directly in front of mouth
  5. press and hold canister down while inhaling deeply and slowly for 3-5 seconds
  6. hold breath for 10 seconds, release pressure on the container, remove from mouth and exhale. Wait20-30 seconds before repeating the procedure for a second puff
  7. rinse mouth after using the inhaler to minimize systemic absorption and drying the mucous membrane
  8. Rinse the inhaler mouthpiece and spacer after use, store in clean location
36
Q

Corticosteroids Action

A

block the late response to inhaled allergens and reduce edema and bronchial hyperresponsiveness.

-preferred route is MDI or DPI to minimize systemic absorption and reduce the many ADRs of prolonged steroid use.

37
Q

Rescue inhalers/meds

A

SABAs

  • albuterol
  • bitolterol
  • pributerol
  • terbutaline

admin MDI/DPI

4-6 hr duration

38
Q

Quick Relief Meds for Asthma Exacerbation

A
  • SABAs
  • Anticholinergics
  • Methyxanthines
39
Q

SABA administration

A

-up to 3 tx at 20 min intervals OR a single nebulizer tx

40
Q

When is it advised to step up therapy…

A

use of a SABA >2 days/week which indicates inadequate control

41
Q

Treatment of choice for quick relief of an asthma exacerbation

A

inhaled SABA

MS2 Exam 1 (13 decks)

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