👩🏾‍🎓- Renal & Crisis Test Flashcards

Question

People with CKD are more prone to which 3 conditions

Answer 1

Metabolic acidosis , ❤️ problems and bleeding

Answer 2

Hypertension Fluid overload Heart failure (results from htn, hypervolemia, anemia and ultimately causes LV enlargement) Risk for- CAD, pericarditis, pericardial effusion

Answer 3

Dyspnea/tachypnea (watch for kussmauls) Crackles Pulmonary effusions Pulmonary edema Pneumonitis

Answer 4

Severe acidosis | Associated with CKD

Answer 5

Lethargy Decreased alertness/cloudy mentation Poor concentration Neuropathy If untreated can cause seizures, coma

Answer 6

Yellow or darkening of skin Pruritus Uremic frost (uremia seeping from pores)

Answer 7

Initially May appear “normal” Oliguric Anuric (may occur once crrt is initiated)

Answer 8

Anxiety Depression Fear of death Economic status changes Loss of independence Loss of control Role change at home and/or work

Answer 9

Anorexia, n/v Weakness, fatigue Itching Uremic frost Muscle cramps Hiccups Stomatitis Ulcers Bowel changes (diarrhea or constipation)

Answer 10

Moderate protein (to decrease the workload on the kidneys) High carb Low potassium , low phosphorus

Answer 11

Fluid- restricted to 1-1.5 L/day Protein- restricted in early stages because it slows CKD K- restricted to 70 mEq/day Na- typical restriction is 2g/day Ph- restricted to 700 mg/day

Answer 12

Hemodialysis- fluid & waste removal with dialysate and ultrafiltration via machine, generally required 12 hours/week in divided treatments, may be used emergently CRRT- fluid & waste removal by hemofiltration (and sometimes dialysate) via machine, continuous treatment, typically reserved for icu Peritoneal dialysis- fluid & waste removal with dialysate and ultrafiltration in peritoneal cavity

Answer 13

Continuous veno-venous hemofiltration CVVH: filter only, no dialysate Continuous veno-venous hemodiafiltration CVVHD: filter & dialysate Continuous arterio-venous hemofiltration CAVH: filter only, no dialysate Continuous arterio-venous hemodiafiltration CAVHD: filter & dialysate SCUF: slow continuous ultrafiltration

Answer 14

Dialysate, Time (schedule) and ultrafiltration

Answer 15

Regulates blood acidity and electrolytes

Answer 16

Venous catheter (external access) Fistula or graft (internal access)

Answer 17

Inserted in jugular, subclavian or femoral vein Vascath (non tunneled)- temporary Permcath (tunneled)- lasts longer than vascath, but not intended to be permanent

Answer 18

AV fistula- surgical anastomosis of vein and artery AV graft- surgical implantation of artificial graft to connect vein & artery (listen for bruit and thrill)

Answer 19

Venous catheters- infection, embolism (air or thrombus), pneumothorax after insertion AV fistula or graft- infection, clotting, loss of blood flow secondary to hypotension, steal syndrome, aneurysm in access

Answer 20

Ischemia resulting from a vascular access device | Risk associated with fistula or graft hemodialysis access

Answer 21

Occurrence of neurological s&s attributed to cerebral edema during or following shortly after hemodialysis S&S- vomiting, confusion, headache, twitching, seizures Treatment- slow or stop dialysis and give hypertonic saline and mannitol to pull off fluid from brain

Answer 22

Loss of thrill S&S of infection Bulging Pain

Answer 23

- daily weights before and after treatment - know your patients dry weight - medication management around dialysis - protect and assess access continually - assesses the CKD patient appropriately (watch hemodynamics and monitor for complications)

Answer 24

Fluid restriction Less Na Less proteins 8-10 oz/daily Grains/cereal/bread 6-11 servings Milk, cheese, yogurt 1 oz/day (⬆️ phosphorus) Veggies & fruit 2-3 servings each (watch for K)

Answer 25

Peritoneal dialysis- 1923 Hemodialysis- 1937 at the university of Lund, Sweden

Answer 26

Dialysate is constantly in peritoneal cavity 4-5 manual exchanges during day Low concentration dialysate swells over night

Answer 27

Dialysis dwells primarily overnight 4-5 machine/cycler exchanges overnight Low concentration dialysate dwells during day

Answer 28

Dialysate, dwell time and additives

Answer 29

1. 5% glucose 2. 5% glucose 4. 25% glucose * higher concentration of glucose, removes more fluid & solutes*

Answer 30

1. Fill peritoneum with 1-2 L dialysate (takes about 20 mins) 2. Dwell dialysate (3-5 hrs) 3. Drain effluent (takes about 20mins)

Answer 31

``` Sodium Bicarbonate Acetate Chloride Calcium Potassium Magnesium (Treated) tap water ```

Answer 32

``` Glucose Lactate Sodium Potassium Chloride Calcium Magnesium Hydrochloric acid (prevents caramelization) ```

Answer 33

- peritonitis - leakage - bleeding Long term: hypertriglyceridemia, abdominal hernia or exacerbation of hemorrhoids and hiatal hernia

Answer 34

Cloudy drainage Abdominal pain Rebound tenderness Hypotension

Answer 35

Protein requirements increase (protein is pulled across the peritoneal membrane Fruits and vegetables aren’t restricted b/c PD patients don’t have issues with K regulation No fluid or sodium restriction Restricted phosphorus and carbs

Answer 36

-maturational crisis Predictable, transitional points Ex: getting married in a few weeks -situational crisis Unexpected, unpredictable, common Ex: going through a divorce -adventitious crisis Unexpected, unpredictable, uncommon Ex: big and devastating

Answer 37

Crisis- upset in a previously steady state = poor problem solving Disaster- overwhelming event that leads to temporary disruption of function

Answer 38

Mass casualty- 100 or more affected Multi casualty- 2 but less than 100

Answer 39

``` Internal External Predictable Unpredictable Natural Frequent Rare Manmade ```

Answer 40

Violence against persons or property in violation of the crimson laws of the U.S Ex- assassinations, kidnapping, hijacking, bombings, imputed based attacks, chemical/biological/nuclear/radiological weapons

Answer 41

Mitigation- lessen the impact of a disaster before it strikes Preparedness- activities undertaken to handle a disaster when it strikes Response- search and rescues, clearing debris and feeding and sheltering victims Recovery- getting a community back to its pre-disaster status

Answer 42

Heroic- need to help Honeymoon- survivors reminisce Disillusionment- delay in receiving help Reconstruction- sense of normalcy PTSD- 1 to 3 months later

Answer 43

Governor has to declare a state of emergency

Answer 44

``` Oliguria Edema Fever Increasing BP Weight gain Swelling or tenderness over transplant site ```

Answer 45

``` Flank pain Renal colic Hematuria Flank mass/swelling Ecchymosis Abdominal wounds ```

Answer 46

Five level triage algorithm 1 (most urgent) to 5 (least urgent)

Answer 47

Calculates fluid requirements for burn patients in a 24hr period 4ml/kg x %TBSA

Answer 48

- Exhaustion symptoms: faint or dizzy, excessive sweating, cool, pale, clammy skin, n/v, rapid weak pulse, muscle cramps Treatment: move to cooler location, drink water, take a cool shower or use cold compress -stroke Symptoms: throbbing headache, no sweating, body temp above 103, red, hot, dry skin, n/v, rapid strong pulse, may lose consciousness Treatment: get emergency help, keep cool until treated

Answer 49

Coagulopathy, metabolic acidosis, hypothermia

Answer 50

Flumazenil

Answer 51

Convection- heat is loss by being exposed to cool air or water Conduction- loss of heat to cold object Evaporation- loss of heat through sweating

Answer 52

Myocardial irritability (arrhythmias), bradycardia and altered mental status