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Adult Health 3 > Test 1 - Hemodynamics, Renal, Burns > Flashcards

Test 1 - Hemodynamics, Renal, Burns Flashcards

1
Q

S/S of Sepsis

A
  • Temperature greater than 102.2
  • Progressive tachycardia and tachypnea
  • Low platelets (thrombocytopenia)
  • Hyperglycemia
  • Insulin resistance
  • Large amounts of residual tube feeding
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2
Q

Systemic Effects of Sepsis

A 
-Fluid shifting (third spacing)
     Hyperkalemia
     Hyponatremia
-Hemoconcentration = poor perfusion
    H&H ^^^; blood thickens
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3
Q

Parkland Formula

A

% burn (TBSA) x wt. in kg x 4 mL = fluid to replace

Give 1/2 in the first 8 hrs post-injury, and 1/2 in the next 16 hrs

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4
Q

TBSA calculation

A 
F. Torso: 18%
R. Torso: 18%
RA: 9%
LA: 9%
LLE: 18%
RLE: 18%
Head: 9%
Genitals: 1%
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5
Q

Assess Fluid Adequacy in Burns

A

Assess UOP:

 - Regular Burn: 30 mL/hr
 - Electrical Burn: 70 mL/hr
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6
Q

NGT for burn patient (>20% TBSA)

A
  • Ileus likely, and stomach acid production doesn’t stop and must be removed
  • May remove at return of bowel sounds or passing of gas/stool
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7
Q

TPN - may need for patients with Ileus

A
  • Give through central line
  • Monitor BG
  • If new TPN bag missing, hang D10 while getting new bag
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8
Q

Transfer Prep

A

Dry Gauze only!

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9
Q

Increased Risk of Death in Burn Injury

A
  • Older than 60 yrs. old
  • Burn >40%
  • Inhalation Injury
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10
Q

S/S of CHF

A
  • Crackles
  • SOB
  • Edema
  • Pallor
  • Cold/Clammy
  • Increased cap refill time
  • Decreased renal perfusion
  • JVD
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11
Q

UOP

A

1 ml/kg/hr (~30 ml/hr)

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12
Q

Cardiac Output Equation

A

CO = HR x SV(oreload, afterload, contractility)

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13
Q

Starling Law

A

Greater stretch will produce greater CO –> to a point

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14
Q

Afterload (PVR and SVR)

A

PVR (Pulmonary Vascular Resistance): R. Ventricle

SVR (Systemic Vascular Resistance): L. Ventricle

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15
Q

Cardio Myopathy

A

Overstretched heart

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16
Q

Pulmonary Vascular Resistance (PVR)

A

37 - 250 dynes/sec/cm

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17
Q

Systemic Vascular Resistance (SVR)

A

800 - 1,400 dynes/sec/cm

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18
Q

Afterload (Increase/Decrease)

A

Vasoconstriction/Vasodilation

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19
Q

Factors that affect Preload

A
  • Over-infusion
  • R/L Ventricle fail or poor contractility
  • Hemorrhage
  • Extreme vasodilation
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20
Q

Dobutamine

A

Inotropic (increases contractility)

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21
Q

Atropine

A

Increases HR (and thus CO)

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22
Q

Dopamine

A

Vasopressor/Vasoconstrictor

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23
Q

Nitroglycerin

A

Vasodilator

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24
Q

NorEpinepherine (Levophed)

A

Increases contractility, vasoconstriction, and HR

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25
Q

Factors that raise vascular tone

A

HTN, vasopressors

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26
Q

Factors that lower vascular tone

A

Distributive shock, Nitro

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27
Q

Cardiac Output (value)

A

4-8 L/min

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28
Q

RA/CVP (R. Preload)

A

2-6 mmHg or 2-8 cm H2O

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29
Q

Wedge Pressure (L. Preload)

A

8-12 mmHg

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30
Q

If Wedge unavailable, check???

A

PAP Diastolic pressure

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31
Q

Measuring Hemodynamics, requires patient to be

A

HOB @ 45 degress or less (Phlebostatic axis parallel to transducer)

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32
Q

Air Embolism S/S & Treatment

A

S/S: angina

Treatment: Trendelenburg, roll onto left side

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33
Q

Cardiac Tamponade

A

Fluid b/w layers of the heart

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34
Q

Cardiac Tamponade S/S and Treatment

A

S/S:

  • Muffled S1 & S2
  • Decreased CO & BP
  • Incresed HR

Treatment: ask pt. to move, cough, or RN may remove PA cath

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35
Q

Lasix (Furosemide)

A
  • Diuretic

- Give in CHF to remove excess fluids

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36
Q

Ejection Fracture (value)

A

60-70%

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37
Q

MAP equation

A

MAP = [ (2 x diastolic) + Systolic] / 3

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38
Q

Arterial Line Implications

A
  • Allens Test: 7-10 seconds
  • DO NOT PUSH IV DRUGS
  • Observe waveform to determine placement
  • MAP should be >65 mmHg (should be within 10 mmHg of manual MAP)
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39
Q

Kidney Functions

A

-Maintain fluid & e-lyte balance
-Regulate BP
-Produce HCO3 (bicarb)
-Filter waste
-Produce erythropoietin (stimulate RBC production)
-Hormone for Ca absorption
-Creates Urine (1500-2000 mL/day)
Minimum UOP: 30 mL/hr

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40
Q

Glomerular Filtration Rate (value)

A

Normal: >60

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41
Q

Sodium (value)

A

135 - 145

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42
Q

Potassium (value)

A

3.5 - 5.0

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43
Q

Specfic Gravity (value)

A

1.010 - 1.025

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44
Q

Specific Gravity HIGH/LOW

A

HIGH: Hypovolemia/dehydration, Elevated ADH/SIADH
LOW: Hypervolemia, Diabetes, Glomerulonephritis
Renal failure

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45
Q

Renal Biopsy (Implications)

A

Pre: Prone, NPO
Post: Supine, watch for bleeding, localized pain expected, hematuria up to 72 hrs

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46
Q

Polycystic Kidney Disease

A

Genetic disorder resulting in cysts

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47
Q

Autosomal Dominant PKD (one parent)

A
  • Most common
  • Cysts by age 30
  • 50% pass to child
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48
Q

Autosomal Recessive PKD (both parents)

A
  • RARE

- Cysts by birth/in womb

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49
Q

PKD S/S

A
  • Abd/flank pain
  • Increased abdominal birth
  • HTN r/t renal ischemia
  • Hematuria
  • Constipation

Cysts can grow in liver, pancreas, and blood vessels

*High incidence of cerebral aneurysm, heart valve issues, kidney stones

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50
Q

PKD Implications

A
  • Family history
  • Abx
  • Pain control
  • Avoid constipation
  • Control HTN (ACE inhibitors -angioedema risk)
  • Notify HCP if HA doesn’t go away
  • Dyialysis or transplant
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51
Q

Glomerularnephritis/GN (Acute Nephritic Sydrome)

A

Inflammation of glomerulus = decreased filtration of blood

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52
Q

GN Causes

A

Primary: genetic or immune
Most commonly: Upper Resp. Strep. Infection
Secondary

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53
Q

Types of GN:

A

Acute (AGN)

Chronic (CGN)

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54
Q

Acute Glomerulanephritis (AGN)

A
  • Occurs 10 days after recent infection

- Ages 3 to 14

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55
Q

AGN Assessment Findings

A 
-Fluid retention
     Facial/peripheral edema
-HTN
-Dysuria/Oliguria
-Fatigue, N/V from high uremia
56
Q

AGN Diagnostic Tests

A
  • UA positive for: blood, protein, WBC
  • Serum CR elevated
  • Decreased GFR
  • Renal biopsy
57
Q

AGN Implications

A
  • Daily weight
  • Limit protein
  • Strict I&O (output plus 500mL insensible loss)
  • Limit potassium
58
Q

Chronic Glomerularnephritis (CGN)

A
  • Slow progression, occurs over 20-30 yr
  • Symptomatic only in late stage
  • Idiopathic
  • Similar tests to AGN
59
Q

GN S/S

A
  • Anemia
  • Fluid and e-lyte imbalance
  • Hyperkalemia
  • Hyopcalcemia
  • Acidosis
60
Q

Nephr-o-tic Syndrome

A

-High levels of Proteinuria (>3.5 in 24 hr)
Low oncotic pressure
-Idiopathic
-Most common in ages 32-7
-Liver is triggered to produce “bad” protein (protein & cholesterol)

61
Q

Edema

A

Treat with: ACE, statins, diet per GFR (low sodium and cholesterol)

62
Q

Diabetic Nephropathy

A

More than 1/2 of diabetics develop this

-Caused by progressive microvascular deterioration

63
Q

Early indication of Diabetic Nephropathy

A

Persistent microalbuminuria (> 0.3 g/dL)

64
Q

Implications for Diabetic Nephropathy

A

-Aggressive diabetic control: check A1C (less than 6.5)
-ACE Inhibitors (-pril)
BP control, protect kidneys, suppress inflammation,
control BP
-Avoid pregnancy
-Hypoglycemic episodes as kidney declines r/t increased free insulin

65
Q

Renal Failure (2 types)

A
  • Acute Kidney Injury (AKI)

- Chronic Kidney Disease (CKD)

66
Q

Acute kidney Injury (AKI)

A

Rapid onset, reversible

Risk category for AKI: serum CR 1.5 x normal, or UOP <0.5 mL/kg/hr for more than 6 hr

67
Q

Chronic Kidney Disease (CKD)/Chronic Renal Failure (CRF)

A

Slow onset, permanent damage

GFR <60

68
Q

Types of AKI

A

3 Types:
Pre-renal: hypoperfusion volume
Intra-renal: intrinsic damage
Post-renal: obstruction

69
Q

Phases of AKI

A

3 Phases:
Oliguric: UOP 100-400 mL/day, Increased BUn/CR, fluid overload, LOW sodium r/t dilution, HIGH potassium r/t no removal
Diuretic: UOP up to 5-10 L/day, Potassium and Sodium BOTH LOW
Recovery: output returns to normal 1-2 L/day

70
Q

AKI Implications

A
  • Monitor signs of fluid depletion/excess
  • Daily weight
  • Be aware of nephrotoxic substances (NSAIDs)
71
Q

CRF

A

1 risk factor is diabetes

Progressive, irreversible
CKD becomes End Stage Renal Disease (ESRD)

Azotemia: accumulation of wastes in blood
Uremia: symptomatic azotemia

72
Q

CRF Causes

A 
Diabetes
HTN
Chronic urinary obstruction
Autoimmune disorders
Glomerular diseases
73
Q

Changes in CRF/CKD

A
  • HTN, HF
  • Hyperkalemia
  • Metabolic acidosis
  • Uremic halitosis, N/V, anorexia, GI bleed
  • Pericarditis, angina, pericardial friction rub
  • Pleural friction rub
  • Low erythropoietin, iron, and folic acid -> anemia
  • Uremic frost
  • Hypocalcemia
74
Q

Implications of CRF/CKD

A

Fluid volume management
Stable Weight
PO fluids: 500 mL plus previous output
NA restriction
Monitor for S/S of HF: edema, crackles, SOB, tachycardia, anxiety
Diuretics, Morphine sulfate (for pain and
vasodilation)
Diet depends on type of dialysis and degree of kidney damage

75
Q

Control BP for CRF/CKD

A

Caclium Blockers “pine”
ACE Inhibitors “pril”
Beta blockers “lol”
Alpha blockers “zosin”

76
Q

S/S of abnormal bleeding

A
  • Lethargy
  • Hyoptension
  • Pallor
  • Tachycardia
  • Tarry stool (use hemocult test)
77
Q

CRF/CKD drug

A 
Eopgen (Procrit)
     stimulates RBC production
     lifelong treatment
     takes 2-6 weeks to have an effect
     can cause HTN, bone pain, and increases clot risk
-may need multivitamins
78
Q

Hyperkalemia

A

Normal: 3.5-5.0
S/S:
Neuro- decreased reflexes and sensation
Resp- resp muscle paralysis
GI - N/V, diarrhea
CV: Peaked T waves, bradycardia, wide QRS, V-fib

79
Q

Hyperkalemia options - mild

A

Dietary changes, avoid high potassium foods

-potatoes, oranges, broccoli, raisins, banana, salt substitute, avocado

80
Q

Hyperkalemia options - severe

A

-Furosemide (lasix) - ototoxicity risk
-Kayexalate (sodium polstyrene sulfonate) - rectal
Beware of digoxin interaction, and ileus
-10 units IV regular insulin in D50 or use Albuterol (lowers potassium)
-Calcium gluconate: monitor for EKG changes (tall PT wave)
-Treat acidosis: sodium bicarb
-Dialysis

81
Q

Phosphate Level (value)

A

2.5 - 4.5 mg/dL

82
Q

Hyperphosphatemia

A

Level > 4.5

Renal failure retains phophorus and doesn’t have enough hormone to absorb calcium

83
Q

Hyperphosphatemia management

A
  • Avoid high phosphorus foods (processed meats, organs, avoado, peas)
  • Administer phophate binders (calcium gluconate/Tums, sevelamer/Renagel)
  • Meds with meals
  • S/S of hypophosphatemia (weakness, anorexia, confusion)
  • Avoid other meds
  • Stool softner
84
Q

To combat constipation

A
  • Increase activity and add fiber
  • No OTC w/o approval
  • Avoid fleets enema (high phosphate)
  • Avoid Milk of Magnesia, Maalox Mylanta
  • Stool softner if ordered
85
Q

Calcium Levels

A

8.5 - 10.5 mg/dL

86
Q

Hypocalcemia Signs to check

A

Levels <8.5 mg/dL
Trousseau’s Sign: wrist spasm w/ BP cuff
Chvostek’s Sign: facial twitch when touched

87
Q

Hypocalcemia S/S

A

Respiratory: larygneal spasm
Cardiovascular: dysrhythmias
Musculoskeletal: osteodystrophy, calcifications

88
Q

To increase Calcium levels

A

Calcitrol (rocaltrol) - activated vitamin D to trigger Ca absorption in GI
Calcium supplements
Phosphate binders

89
Q

Goals of Dialysis

A
  • Remove excess end products of protein metabolism (BUN/CR)
  • Ensure safe levels of e-lytes
  • Remove excess fluids
  • Restore acid/base balance (remove acids, replace bicarb)
90
Q

3 Types of dialysis

A

Hemodialysis (access fistula in arm), Peritoneal Dialysis (access peritoneal cavity), Continuous Renal Replacement Therapy (very slow for unstable patients)

91
Q

Hemodialysis

A

2-3 sessions/wk for 3-4 hrs

  • Need long term access on non-dominant hand(fistula or graft)
  • Vas cath for temp use if needed immediately
92
Q

HD contraindications

A
  • Low BP (MAP <70), hemodynamically unstable

- Bleeding tendency/history

93
Q

Nursing Care for HD

A
  • wt b4/after dialysis (dry weight after should be lower)
  • V/S
  • Avoid invasive procedures post dialysis 4-6 hrs
  • Dialysis removes meds except insulin, give them after
94
Q

Disequilibrium Syndrome

A
  • Rare, happens with first time HD pts
  • Prolonged HD can cause cerebral edema
  • S/S:
    • Alt. LOC
    • Seizure
    • N/V
    • Muscle cramps
  • Monitor for depression
  • Consider continuity of care
95
Q

Pt teaching for access

A

Assess fistula for thrill and bruit

96
Q

Continuous Renal Replacement Therapy (CRRT)

A

-Very slow dialysis
-Use for hemodynamically unstable pts
-Implications:
V/S
I&O
Labs
Hypothermia
S/S of infection

97
Q

Peritoneal Dialysis (PD)

A

PD catheter into the abdominal cavity
1-2 L fluid infused by gravity over 10-20 minutes
4-8 hrs dwell time, then drain

98
Q

Contraindications for PD

A
  • Recent abd surgery -> adhesions, scars
  • Peritonitis
  • Excessive abd obesity
  • COPD
99
Q

Nursing care for PD (inflow)

A

-Monitor for peritonitis
Rigid abd, high fever, N/V -> stop infusion, call HCP
-Monitor V/S and wt
-Mild pain during inflow is normal
avoid cold dialysate
use heating pad to warm fluid (no microwave)
Elevate HOB

100
Q

Nursing care for PD (outflow)

A

-Output must equal intake
-Poor/slow outflow
avoid constipation (enema prior)
reposition pt from side to side
milk tubing gently if clotted
continuous leakage (may need HD)

101
Q

PD - RED FLAG

A

if cardiac arrest occurs during PD, drain immediately to allow best chest compression

102
Q

Renal Transplant

A

Recipients (2-70 yr)- free from medical or psych problems that would increase complication risk
Donor (18-60 yr)- meet criteria, living related = “best”

103
Q

Additional donor requirements

A 
Type match
Antibody screen
Kideny function test
Psych eval
Able to be unpaid for 12 weeks for recovery
104
Q

Renal transplant nursing care

A
  • Daily wt, V/S (BP)
  • Monitor output (foley)
  • Diuresis normal at first (monitor e-lytes)
  • Monitor for low fever, pain, increase BUN/CR, swelling, alt. mental status
105
Q

Transplant patient education

A
  • Immunosuppressants for life
  • Keep daily record of wt, V/S, and UOP to monitor for rejection (report change immediately)
  • Increased infection risk (avoid crowds, wear a mask, prophylactic abx)
  • Pregnancy can cause complications
  • Oral contraceptives work less
  • No NSAIDs w/o approval
106
Q

Increased BUN/CR

A

S/S of concentration r/t low volume

107
Q

Increaed Wedge pressure (or diastolic PAP)

A

Left sided HF (CHF)

108
Q

Basic Knowledge r/t burn

A 
Skin is the largest organ
Skin functions:
     sensory
     protective barrier
     maintain fluid/e-lyte balance
     vitamin-D production
109
Q

Burn Etiology

A

Skin can regrow if parts of dermis remain

Burns may cause alterations in anatomy and function

110
Q

Superficial Burn

A

Only epidermal layer
Sunburn is most common superficial burn
No need for IVF or burn center

111
Q

Skin layers

A

epidermis > dermis > fatty tissue

112
Q

Superficial partial thickness burn

A

Epidermis and top layer of dermis burned

  • Pain r/t exposed nerve endings
  • wet, weeping blisters
  • heals in 1-2 weeks
113
Q

Deep partial thickness burn

A

Epidermis to bottom layer of dermis

  • varying levels of pain and decreased sensation
  • soft/dry eschar
  • heals in 2-6 weeks
114
Q

Full thickness burn

A

Entire epidermis and majority of dermis

  • Cherry red color
  • Decreased or absent cap refill
  • Hard, non-elastic eschar
  • May involve bone & muscle
  • Heals in weeks to months
115
Q

Deep Partial and Full Thickness Burn - Eschar

A

Eschar must be removed to allow healing to begin

116
Q

Circumfrential burn

A

Full thickness burn all the way around digit, limb, or torso
Affects circulation distal to injury (touriquet effect*)
DO NOT ELEVATE until escharotomy -> may worsen condition

117
Q

Escharotomy

A

Cuts made in eschar to release pressure

Not painful, but may need sedation

118
Q

Fasiotomy

A

Incision into the fascia surround the muscle to improve circulation

  • Deeper than escharotomy
  • Painful
119
Q

Inhalation injury

A

S/S:

  • Facial burns
  • Singed nasal and facial hairs
  • Soot (carbonaceous) sputum
  • Naso or orpharyncerythema
  • Excessive agitation (r/t hypoxia)
  • Tachypnea
  • Inability to swallow (r/t airway edema)
  • Dyspena (r/t airway edema)
120
Q

Carbon Monoxide Poisoning

A 
CO is odorless, colorless, tasteless
S/S:
-cherry red skin (40% or higher)
-HA, confusion, hypotension, tinnitus, vertigo, Nausea
>50%: coma, seizure, death

Pulse ox will give false high

121
Q

Systemic effects of burns

A

CV: hypotension, tachycardia, absent cap refill and pulse
Renal: decreased perfusion, little to no UOP, proteinuria/myoglobinuria

122
Q

Metabolic effect of burns

A
  • Increased metabolism up to 3 yrs post injury
  • Double normal resting energy use and nutrition need
  • Supplemental nutrition needed
  • Based on TBSA and other factors
123
Q

Immunological effect of burns

A

-Loss of skin integrity and release of inflammatory factors
-High risk for infection and sepsis
If pt. survives 1st 24 hrs, sepsis is #1 COD

124
Q

S/S of Sepsis

A 
Temperature >102.2 F (39 C)
Progressive tachycardia and tachypnea
Low platelets
Hyperglycemia
Insulin Resistance
Large amounts of tube feed residual
125
Q

Fluid Shift (third spacing)

A

Plasma moves to interstitial space
Hyperkalemia/Hyponatremia r/t release of K from damaged cells
Hemoconcentration: causes poor perfusion
H&H increases; blood thickens w/o plasma

126
Q

Factors to consider with burns

A

Chemical: protect self
Radiation: transfer to decontamination to protect self
Electric: EKG, no TBSA to measure

127
Q

Burn implications

A

Airway: need NGT w/ >20% TBSA
may need TPN for nutrition
Fluid replacement: needs 2 large bore IV or central line, calculate with Parkland Formula

128
Q

Fluid adequacy evaluation for burns

A 
UOP:
     70 ml/hr for electrical burn
     30 ml/hr for all other burns
BP: >100
HR: <120
CVP: 5-10 mmHg
129
Q

Fluid remobilization

A
  • After first 48-72, edema is reabsorbed
  • Hypokalemia and Hyponatremia
  • Met. acidosis r/t HCO3 excretion in urine
  • Hemodilution (transfusion needed if HCT <20)
130
Q

Conditions for graft survival

A

Constant contact
Constant immobilization
Adequate vascularization
Meticulous skin care

NO HEATING PADS

131
Q

Implications for infection control

A 
Hand washing #1
S/S of infection
IV abx
Cough, deep breathe, ICS
HBO therapy
132
Q

Implications for pain control

A

-Routinely and frequently
-Pain is what patient says
-No PO, SQ, IM meds (body is damaged and can’t absorb, tetanus shot still IM)
-S/E: respiratory depression, ileus (20% burn need NGT to prevent ileus and remove excess stomach acid if occurs)
BS or BM to know removal time of NGT

133
Q

TPN

A

If new bag missing, hang D10 until new bag is found to prevent hypoglycemia

134
Q

Burn Transfer Prep

A

DRY GAUZE ONLY

135
Q

Inotropic Drug

A

Dobutamine: given to increase contractility w/ good BP

136
Q

Vasopressors

A

Nor-Epi and Dopamine: given to vause vasoconstriction

137
Q

Diuretics

A

Lasix and Bumex: given to reduce BP and get rid of excess fluid

Adult Health 3 (12 decks)

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