Test 3 All in Flashcards
Hematopoesis
Blood cell production, occurs in red bone marrow of irregular bones
Hematopoetic stem cell
As the cell matures it differentiates and changes production of several different types of cells depending on the demand of the cells.
Erythropoesis
RBC Production. Stimulated by hypoxia needs protein - high protein diet needed for healing, stimulated by the kidney.
Anemia
Low oxygen in the blood
Reticulocyte
Immature RBC, measures rate at which new RBC’s enter the blood stream. Mature in 48 hours of release into blood stream. No nucleus and slightly larger than mature RBC
Hemolysis
Destruction of RBCs
Normal life span of RBCs
120 days
Leukocytes
WBCs Neutrophils, most common acute inflammatory response, monocytes have a large mononuclear cell
Lymphocytes
bcells- fever, night sweats. t cells - decide what to be.
Thrombocytes
Normal count is 150000 - 400000. Aid in blood clotting. activated when exposed to interstitial collagen from injured blood vessel, form clumps, stickiness is called adhesiveness, clumps formation is called aggultination
Coagulation cascade
Heparin acts on intrinsic factor. Coumadin acts on extrinsic factor
Spleen
Recycling center of the body. Filters out old RBCs, reuses iron from hemoglobin and returns to bone marrow. Sickle cell alters splenic function.
Red Bone Marrow and stem cells
Decrease with age, never completely deplete. medications may interfere with clotting time. chemo attacks all rapidly dividing cells (including hair)
Anemia may be related to
Decreased intake of iron, cobalamin, folic acid, and green leafy vegetables
Anemia questions for patients
Age of menarche, clotting, cramping, and amount of bleeding.
Skin in an anemia patient will look like?
skin may be pale (decreased HGB), flushing (increased HGB), jaundice (excessive hemolysis) cyanosis (low HGB, High deoxyhemoglobin) Pruritis (hodgkins), leg ulcers (sickle cell), Petechia (low platelet or clotting factor), eccymosis, hematoma.
The eyes in an anemia patient will have?
Jaundiced sclera due to accumaltion of bile pigment.
What is responsible for Coagulation of the blood?
Platelets
why does a patient who has undergone Gastric bypass surgery develop anemia?
because they cant absorb Vitamin B12 (Cobalamin)
Neutopenia
low WBC’s >4,000
The basis of cellular and humoral immune response………..
Lymphocytes (B+T cells)
Thrombocytopenia
low platelets and low thrombocytes
If you can feel a patients spleen?
STOP PALPATING SICKO
A chemo pt is at risk for?
bleeding, infection, & anemia
WBC count >11,000
WBC < 4,000
Infection
Leukopenia
Nursing Responsibility for a Bone Marrow Biopsy
Get consent, Pre-emptive medication (Conscious sedation) Versed, & Morphine, Pressure dressing after (hold for 15 min) do frequent site checks, Assess the site for bleeding (underneath them) Possible Complications: Infections and bleeding
Erythropoetin stimulates?
Bone marrow to make RBC when O2 is low. Anticipate administering Epogen SQ for management of anemia secondary to CRF
A client with case of fever, chills, and left costovertebral pain should have what kind of test started?
Clean catch urine test.
IF you have a female client who has given you a urine test, what can you expect?
If they are on their menarche you can expect RBC’s in the urine.
What is ATN?
Acute Tubular Necropsy.
If urine PH is below 4 what is this a sign of?
Respiratory or METABOLIC ACIDOSIS
If your urine sample comes back positive for streptococci, or is contaminated. What probably happened?
You touched the inside of the cup.
Yellow or brown urine sample is usually?
Pyridium. given for urinary pain. burning and urgency.
What blood chemistries should you check for in a urine sample?
BUN, Creatinine. These are expected in a client in suspected Cancer of pancreas. Run this test before chemo.
Normal urine residual should be?
<50 ml
Renal function can be checked with this? It is a better indictor than BUN.
Serum Creatinine. It is not influenced by protein and exercise.
Normal platelet life is?
9-10 days
BUN level is normally?
10-30 mg/dl
Normal Serum Creatinine levels are?
0.5 - 1.5 mg/dl
Most people in renal failure have what kind of HCO3 levels?
Low HCO3 because they are in metabolic acidosis. Normal levels are 20-30
Some chemotherapies are nephrotoxic. what needs to be monitored when patients are on chemo?
BUN, Creatanine, & Urine output
A potassium level >6 can lead to what?
MM Weakness & cardiac arrythmias. Normal levels are 3.5-5.0
Phosphorus is inversely related to?
Calcium
Nephrotic drugs alter?
Urine function. Advil and Ibuprofin are nephrotoxic.
Azotemia is?
High levels of Nitrogenous waste products in urine. Kidneys are not filtering correctly.
Who is prone for renal disorders?
Smokers, Textile workers, PAinters,
Dehydration can lead to?
UTI, Calculi, Renal failure.
Before using IVP what does the nurse need to asses for?
Seafood allergies. SHRIMP
ARF stands for?
Acute Renal Failure
The most common bacterium in UTI’s is?
E. Coli
MRI’s visualize what?
Soft tissues
Bactrim must be administered how?
On an empty stomach. 1 hour before or two hours after a meal. With a full glass of water.
Bactrim is taken for how long?
3 - 5 days. Taken on an empty stomach
If stone is present should fluids be increased to dilute?
No when stones are present, just hydrate do once stone is gone you can super hydrate to help keep new stones from forming.
While you have a UTI, you should avoid what kind of food or juice?
Citrus. It irritates the bladder.
One of the clinical manifestations of Cystitis is?
Suprapubic pain. Relieved by voiding and frequency.
The most common symptom of early bladder cancer is?
Gross painless hematuria. Either chronic or intermittent.
What is created in a radical cystectomy?
An ileal conduit
Which of the following is not a likely cause of CRF?
A. diabetes
B. HTN
C. Aplastic anermia
D. Glomerulonephritis
C. Aplastic anemia
All others cause permanent damage to the nephrons–CRF
Aplastic anemia, a life-threatening blood disorder, has no effect on the nephrons. It is characterized by pancytopenia, not renal failure
In CRF, the GFR usually is affected when how many nephrons are damaged?
A. less then 25%
B. 40-50%
C. 60-70%
D. more than 75%
D. more then 75%, damage of 25-75% = renal insufficiency
Which GI effect is not likely to occur in a client with CRF?
A. Nausea
B. anorexia
C. oral muscousal ulcerations
D. Increase Ca+ absorption
D. Increase Ca+ absorption, it is decrease r/t lack of activation of Vit D
Uremic toxins accumlate and inflame the GI mucosa–> nausea, anorexia and oral mucosal ulcerations.
CRF causes electrolye imbalnces including?
A. hypokalemia
B.hypocalcemia
C.hypomagnesemia
C.hypophosphatemia
B. Hypocalemia r/t kindey inablitity to activate vit D (needed for Ca+ absorption
All others occur r/t kidney ability to excrete them into the urine. They then accumlate in the blood
Dietary limitations to prevent complications from CRF should limit all of the following nutrients.. except??
A. sodium
B. Calcium
C. Potassium
D. Phosporous
B.Calcium, CRF patients don’t need to restrict Ca+ because hypocalcemia may occur.
Limit all others too prevent hyperkalemia, hypernatremia, and hyperphosphatemia
When assessing for CRF, you should not find?
A. lethargy and weakness
B. Ruddy skin from increased RBCs
C. HTN from Na+ and water retention
D. Adventitious breath sounds from uremic toxins
B. Ruddy skin from increased RBCs, CRF pts have anemia from decreased erythropoitin production.
They are likely to have pallor. All other s/s are typical for CRF.
Which is the appropriate question to as a 52 y/o male with post renal failure
A. Do you have and heart problems?
B. Do you have an enlarged prostate?
C. Do you have high blood pressure?
D. Have you recently had a diagnostic exam that utlized dye?
B. Do you have an enlarged prostate?
Post renal failure results from obstruction of urine from the kindey
Ask about disorders that can lead to obstruction (renal calculi, blood clots, tumors)
Heart problems = prerenal failure
HTN & dye reactions = intrarenal failure
Which hormone triggers the conversion of angiotensin I to angiotensin II
A. renin
B. aldosterone
C. antidiuretic hormone
D. adrenocorticotropic hormone
A. Renin –> HTN increases blood flow to the kindey
Aldosterone is secreted by the adrenal cortex in response to renin.
Antidiuretic hormone, screted by the hypothalmus, decrease urine production.
Adrenocortiocotropic hormone, from the anterior pititary gland, stimulates corticosteroid secretion
Which statement is INaccurate?
A. Each kindey contains millions of nephrons
B. The loop of henle is the main kindey filter
C. The kindeys receive more than 1L of blood from the heart/min
D. The afferent arterioles carry unfiltered blood from the renal artery to the glomerular capillaries
B. The loop of henle is the main kindey filter
The glomerulus is the main filtration system in the nephrons
Together with the convoluted tubules, the loop of henley concentrates(rather than filters) the urine
The kindeys (each of which contain millions of nephrons) receives1.25 liters of unfiltered blood/min
The blood is transported from the renal artery to the glomerular capillaires by the afferent arterioles.
Which findings are indictive of flid volume overload?
A. palpitations, weakness. leg cramps
B. Pericardial friction rub
C. Pleural friction rub, fever, DIB(SOB)
D. S3 <3 sounds, pulmonaary crackles and JVD
D. S3 <3 sounds, pulmonary crackles and JVD
palpitations, weakness, leg cramps = electrolyte imblance
Pericardial friction rub = pericarditis
Pleural friction rub, fever, and DIB = uremic toxins inflame the visceral and parietal pleura of the lung
The risk for developing prerenal failure is greatest in pts with?
A. <3 failure
B. Acute pyelonephritis
C. Acute glomerulonephritis
D. SLE
A. \<3 failure Disorders that decrease cardiac outout (\<3 failure), decrease he blood flow to the kindeys. If the kindeys cant compensate=prerenal failure. Renal infections ( pyelonephritits and glomerulonephritis) and SLE = intrarenal failure
In ARF - Kussmauls respirations occur due to the body trying to?
A. Decrease the blood pH
B. Exhale excess CO2
C. Increase H+ ion excretion
D. Increase the CO2 level
B. Exhale the excess CO2
This prcess beings when damged tubules prevent the syntheis of ammonia. The H+ accumulates in the blood since it can’t combine with ammonia. This decrease the blood pH. At first the body compensates by combing the H+ with bicarbs. This forms carbonic acis, which breaks down into water and CO2.
During the oliguric phase of ARF, neurological s/s result from?
A.Hypokalemia
B. hyponatremia
C. Decreased H+ ions in the blood
D.Urea and creatinine buildup in the blood
D. Urea and creatinine build up in the blood.
Unexcreated urea and creatinine build up in the blood = toxic effects on the CNS = neurological effects (lethargy/confusion)
In the diuretic phase of ARF, which of the following is true?
A.Urine output decreases
B. Glomerular filtration of blood stops
C. THe body retains K+ and Na+
D. The renal tubules cant concentrate urine
D. The renal tubules can’t concentrate urine.
During the diuretic phase, the urine output increases, the glomeruli filter the blood and the body excretes (rather then retains) K+ and Na+
Which lab test reflects the oliguric phase of ARF?
A. BUN = 34 mg/dL
B. Creatinine = 1mg/dL
C. Na+ = 158 mEq/L
D. K+ = 3.4 mEq/L
A. BUN of 34
The BUN level exceeds 20 mg/dL
The creatinine levels exceeds 1.2 mg/dL
The Na+ drops below 135
The K+ exceeds 4.5
Preneal (ARF) before the kindey, causes consists of factors outside of kindey, some of them are:
Decreased renovascular blood flow = HTN, decreased urine output, BUN 70, creatinine >2.9, specific gravity >1.040
Hypovolemia
Decreased cardica output
Decreased peripheral vascular resistance
Intrarenal (ARF) results from conditions that cause direct damage to the renal tissue, some causes are:
Infection, Drugs (mutiple nephrotoxic antibotics: genotamcyin, all mycins), infiltrating tumors, IVP contrast, prolonged prerenal ischemia, nephrotoxic injury, acute glomerulonephritis, toxemia of pregnancy, malignant HTN, systemic lupus erthematosus, interstitial nephrtits, Acute Tubular Necrosis (ATN)
Postrenal (ARF) involve mechancial obstruction of urinary outflow, some causes are:
Benign prostatic hypertrophy (BPH), bladder cancer, calculi formation (nephrolithiasis), neurmuscular disorders, prostate cancer, spinal cord disease, trauma, adhesions from surgery.
Complications of Anemia
Erythrocyte (RBC) disorders lead to hypoxia
Hypoxia accounts for and is the underlying cause of the s/s of anemia:
-DIB
-palpitations
-confusion and tachycardia in severe cases
MCV =
Mean corpusular volume (size of cell)
- microcytosis (small cells)
- macrocytosis (big cells)
MCH=
Mean corpuscular hemoglobin (color of cell)
- low is hypochromia (pale)
- high is macrocytosis (dark)
Mild symptoms of Anemia
Hgb 10-14, palpitations, dyspnea, diaphoresis
Moderate symptoms of Anemia
HgB 6-10, same symptoms as mild but at rest, dyspnea on exertion, pallor
Sever Anemia symptoms
HgB <6, irritation of oral mucosa, impaired thought processess, tachycardia, chest pain, blurred vision, pallor, depression, theres more but only the bold ones were highlighted.
Nursing diagnosis for Anemia
Ineffectivwe therapeutic regimen management r/t lack of knowledge of meds and nutrition AEB: asking about diet, meds and RX.
- Teach to take Fe+ before meals with Vit C
- inform client that Fe+ will cause dark stools and constipation
- avoid taking with hot coffee/tea
- take enteric coated
Nutrition for Anemic patients
Foods high in iron: red meat, spinach, raisins, green-leafy veggies, dried fruits.
Eat small frequent meals with snacks.
Iron deficiency Anemia (malabsorption)
Gastric surgery may remove or bypass duodenum, Vit B12 isnt absorbed due to decreased intrinsic factor (cant take B12 oral, must be IM)
Megaloblastic (pernicious) Anemia
Chronic condition r/t impaired DNA synthesis, deficiency of folic acid and/or cobalamin (B12), may cause degenerative changes in the nervous system AEB: numbness and tingling in extermities.
Schilling Test
Used to diagnosis Pernicious Anemia and malabosption syndromes, postitive for pernicious anemia when radioactive B12 is not found in the 1st 24 hr urine.
Aplastic Anemia (pancytopenia)
Decrease of all blood cell types- especially WBCs
Sickle Cell patho
When exposed to decreased O2 (being hig up in an airplane) – RBCs sickle, become rigid, fragile and sticky.
Sickle cell crisis
Severe. S/S= pain first ( aching and swelling in joints of hands and feet - priority nursing intervention is to adminster dilaudid IVP during crisis, get blood cultures for temp > 101.0 = infection!
Complications of Sickle cell crisis
Prone to infection r/t spleen fails to phagocytize foregin substances (pneumonia), chronic leg ulcers.
Treatment of sicke cell disease
Broad-spectrum antibotics, folic acid, exchance blood transfusions(in aplastic crisis), chelation therapy to decrease transfusion-induced iron overload, Oxygen.
Erythropoietin (procrit)
Used in pts not responding to hydroxyurea, can be self administer at home ( teach self injections)
someone with leukemia cant take this.
Preventions of Sickle cell
Flu and pneumonia vaccines since they are at risk for injection and to help prevent crisis, avoid hypoxia ( high altitudes, dehydration)
Assessment findings for sickle cell
Increased bilirubin (client scratches skin), DIB (SOB), pale mucous membranes, C/O painful swelling of hands and feet, CHF, hepatomegaly, pneumonia on x-ray
Nursing interventions for sickle cell
Manage pain (PRIORITY), bedrest during exacerbation, increase fluids, IV fluids, O2, teach to avoid: overexertion, high altitudes(moutains), dehydration (drink at least 8-10 glasses of water daily.
Blood administration
Assess the clients lungs before and after, check for allergies, obtain a signed consent, 19 gauage or larger needle, isotonic solution(NS) in one and blood via the other spike, positively ID the donor blood and recipeient ( 2 RNs), check for storage lesions (old blood, temp of blood), takes 2-4 hours.
Adminstration of blood
Remain with patient for first 15 minutes or 50 ml of blood (reactions occur at this time), infuse at rate of no more than 2 ml/min, take no more than 4 hours to administer, may use blood warmer to avoid chills.
What to do for blood transfusion reactions
Stop the infusion immediately (clamp everything off and get another IV), maintain NS IV line (seperate line), monitor vitals and urine output, recheck ID tags and numbers, notify blood bank immediately, send blood bag, tubing and UA to blood bank.
Acute blood transfusion reactions
Antibodies in the recipient’s serum react with anitgens on the donors RBCs
-casued by ABO-incompatible blood tye (adminstering to wrong patient)
Anaphylactic/severe allergic reactions to blood transfusions
Wheezing, cyanosis, cardiac arrest, initiate CPR if indicated, epinephrine SQ or IV as ordered, do not restart transfusion, Call Code !
Delayed hemolytic reactions
Occurs 2-14 days after transfusion or as early as 3 days and as late as several months.
Polycythemia- manifestations and major problems.
Thick blood, enhanced blood viscosity and volume, congestion of organs and tissues and splenomegaly.
Manifestations- headache, dizziness, vertigo- all due to HTN secondary to hyperviscosity and hypervolemia (fluid volume overload)
Major problems- thrombosis(stroke), institute active or passive leg exercises and ambulate to prevent DVT.
Patho of Hodgkin’s disease
Presence of Reed-Sternberg cells in the biopsy speciem ( GIANT, MALIGNANT, MULTINUCLEATED LYMPHOTCYTE)
Hodgkin B symptoms
Worse prognonsis=fever, night sweats, weight loss
Neupogen
Increases WBCs
Erythropeietin (EPO), procrit, Epogen
increases RBCs
Thrombocytopenia
Decreased platelets- teach to avoid injurt (avoid dental floss, hard tooth brushes, question orders in rectum)
Ibritumomab tiuxetan (Zevalin)
A monoclonal antibody that tagets the CD20 antigen on the B cell and B cell tumor, allowing delivery of radiation directly to the malignany cells. (mouse urine)
Multiple myeloma
Slow insidious nature, causes mental changes, series of involuntary muscular contractions, Ca+ is lost from bone, high levels of protein-acute tubular necrosis, bone pain (get help turning patient, give norco, vicodin, loritab, give two tabs if pain is 8, see what they usually take)
Chronic Pyelonephritis s/s
fever, chills, flank pain, and dysuria
Risk factors for pylenephritis
past medical Hx of chronic renal calculi (kidney stones)
Nursing diagnosis for UTI
Acute pain r/t inflammation of mucosal tissue of urinary tract AEB: pain on urination, flank pain, suprapubic pain, lower back pain or bladder spasms.
Urinary tract calculi (nephrolithiasis)
Post-renal disease, Tx for UTI cause by pseudomonas predisposes client to renal calculi further down the road.
Stones are reccurent in..
50% of patients, and more common in summer.
Etiology and patho of stones
Crystals, when in concentrated form, untie to form stones. Keeping urine dilute and free-flowing prevents this!
Lifestyle factors related to kindey stones
prolonged bedrest, prolonged hospitalization, immobility, sedentary occupation.
Types of stones
Calsium oxalate, calcium phosphate, struvite (acidify urine with cran juice), Uric acid (give allupurinol [prevents] ), crystine -genetic defect.
Calcium phosphate dietry suggestion
Diet high in Ca+ may actually lower the risk by decreasing urinary excretion of oxalate (a commone factor in many stones)
what to teach client when going for cystoscopy
They may experience burning and frequency for several hours after.
Pyridium may be used after to decrease bladder irritability.
Clinical manifestations of kindey stones
Abdominal flank** pain (severe) r/t stone irritation, **hematura & renal colic, nausea and vomiting, mild shock (when passing stone)
Pain management for kindey stones
Load em up! opoid analgesics, tamsulosin (flomax) [vasodilates], keep adequately hydrated -overhydration=spams.
What to report with a lithotripsy
WBCs >14,000
Nutrirional therapy before stone removal
Avoid forcing fluids ( Does Not facilitate stone passage, may exacerbate colic.
nutritonal therapy after stone removal
increase fluids to 3,000 ml/d
Most common symptom in early bladder cancer
Gross, painless hematuria (chronic or intermittent). Confirmed by BIOPSY.
Risk factors of getting Bladder cancer
Cigarette smoking (ewwy), exposure to dyes used in some rubbber and cable industries, pt with a PMH of chronic renal lithiasis (recurrent stones), chronic UTIs and chronic cystitis.
Surgical tx for bladder cancer
Radical cystectomy
-ileal conduit is created
normal urine color for post op bladder surgery
Pink during 1st several days (should not be bright red)
Nursing intervention post-nephrectomy
meaure urinary output every 1-2 hours to ensure that the remaining KK is functional
Ileal conduit (urinary diversion)
Uretters are anastamosed to a segment of the ileum for urinary drainage.
Common to have mucous shreds in urine post op r/t attachment to bowel to maintain blood supply.
Make sure ther is drainage in thr bag post-op
Urinary diversion pre-op management
Body image distubrance r/t change in body function
Urinary diversion post op managment
Meticulous skin care around stoma.
Acute Tubular Necrosis (ATN)
Intrarenal, Results when tubular cells do not get enough oxygen (ischemic ATN). These tubules are very metabolically active, they are very dependent on the oxygen that supplies the tubular cells.
Med that can cause ATN
aminoglycosides (mycins), amphotericin B (antifungal), Cisplatin (chemo), radioisotopic contract media (IVP dye)
ATN manifestations
Fluid overload (S3, JVD), decrease urine output or not at all, hyperkalemia, cardiac dysrythmias (life threatening)-abnormally wide QRS complex
Nursing interventions for ATN
diet: increase CHO, decrease protein, decrease Na+, decrease K+
Fluid restrictions, kayexalate to decrease K+ levels (hyperkalemia is life-threatening)
4 phases of ARF
Initiating, oliguric, diuretic, recovery
Oliguric phase of ARF
decrease production of urine ( remember 30 ml/hr is normal), Azotemia (increase accumulation or urea and creatinine), fluid retention (JVD, bounding pluse, pitting edema, S3)
Nursing interventions for pulmonary Edema
Adminster O2, place in semi-fowlers position, DONT cough and deep breath
Sodium balance of oliguric phase
Low Na+!! Avoid excessive intake of sodium, damaged tubules can conserve Na+
K+ excess in oliguric phase
Cardiac muscle is inolerant or acute increase in K+, hyperkalemia creates an elevated T wave, hypokalemia creates and elevated U wave.
Priority of care for hyperkalemia
Management! K+ (3.5-5.0), IV sodium bicarb to decrease blood ph, causing movement of K+ for the extracellular fluid into the cells in exchange for hydrogen ions.
Hematologic disorders of oliguric phase of ARF
Anemia due to impaired erythropoietin production, WBC alteration- infection is the major cause of death with ARF, encourage cough and deep breathing to prevent pneumonia.
Diuretic phase (big urine)
Gradual increase in urine output to 1-3 liters a day, may reach 3-5 liters (>400 ml/hr), nephrons are still not fully functional, monitor for Na+, K+ levelrs for dehyradtion.
Recovery phase
GFR increase, so BUN and creatinine levels start to stabilize then decrease.
Hemodialysis
Method of choice when rapid changes are requred in a short amount of time.
-pt complains of fatigue and is sleeping (azotemia) - emergency situation, SEE PT FIRST !
ISNT sterile
peritoneal dialysis
more simple, but carries the risk of peritonitis
Sterile
Nutritional therapy ARF
Decrease protein intake 1.2 to 1.3 g/kg
Acute interventions for ARF
I & O, daily weights, encourage cough and deep breathing, insentive spirometer
Chronic renal failure CRF
Progessive, irreversible, leading causes: HTN and Diabetes
Stages of CRF
1- kindey damage with normal or increased GFR (at or above 90)
2-kindey damage with wild decrease in GFR (60-89)
3- moderate decrease in GFR(30-59)
4- severe decrease in GFR (15-29)
5- kindey failure GFR <15(normal GFR is 80-135 ml/mi)
Manifestations of CRF
Decrease urinary output with Azotemia(increase in bun and creatinine), arrythmias from hyperkalemia, drug toxicity, renal osteodystrophy (pidgeon chest)- as GFR decreased, phos and Ca+ are impaired, hypocalemia and hyperphosphatemia (trousseau’s, cardiac arrthymias, prolonged clotting time, fracures), pH decreases.
Low potassium diet for CRF
APPLES, pasta, bread, spinachm, cucumber, coffee, peaches, eggs and chicken.
An ounce contains how many mLs?
30 ml !
Uremic frost
Dermatologic manifestations or profound azotemia that occurs when urea and other nitrogenous waste prodcuts accumulate and are excreated via sweat glands–crystallize after evaporation forming crystals on the skin, giving a frosted appearance (usually end stage)
Hematologic manifestions of CRF
Anemia r//t the decreased prodcution by the kidney of the hormone erythropoietin (decrease erythropoesis)
- teach self-injections of procrit (erythropoetin) SQ
- know ready to d/c when can properly give injection.
CRF labs
K+ increased, phosphate increased, Ca+ decreased, pH decreased !
Treatment of renal osteodystrophy
Calcium acetate (PhosLo) Lowers phosphate -to reat defective done development due to decreased serum Ca+
Fluid restriction for CRF
Restrict Na+ and fluids, includes all PO, IV
spread over 24 hrs, 550ml during the day, 300 afternoon, 200 at night.
Nutritional threrapy for CRF
Restrict protein (40gm/day)
low protein det is deficient in vitamins- replace water soluble vitamins lost in dialysis, all but ADEK (fat soluble)
Vascular Access sites for dialysis
Internal Arteriovenous Fistula (AVF)
-decreased complication rate, no dressing, allows freedom
Internal Arteriovenous Graft (AVG)
-decreased risk fo bleeding/clothing, no dressing, allows freedom
AVF/AVG complications
Clotting/thrombosis, Steal syndrome: cold hands/fingers, numbness/tingling of giners, may resolve after 6 weeks.
AVF/AVG nursing interventions
Do not measure BP, draw blood, place an IV, or adminster injections in the extermity its in, do not life heavy objects or do anything that compresses extremity. Teach to carry stuff with opposite arm.
Hemodialysis complications
HTN (hold diuretics and antihypertensives), disequillbrium syndrome (causes nausea, confusion, restlessness, and headache, cerebral edema (confusions, alter LOC,jerking, headache), dialysis encephalopathy ( assess mental status and treat with aluminum-chelating agents)
hemodialysis nursing interventions
Assess BP, lung and heart sounds before and after, weigh beofre and after, hold meds that effect BP, hold meds that be dialyzed off (anitbiotics, water soluble vitamins). Ausculate for bruit, palpate for fistula.
Renal diet for hemodiaylsis
low protein, low Na+ ( Toast, Applecause, Rice, Greenbeans ) TARG? lol
Peritoneal dialysis-procedure
1-2 L dialysis instilled (gravity fill) over 10-20 minutes, fluid dwells, drains.
Aseptic technigue at all times !
Peritoneal dialysis diet
Allowed more protein in the diet because urea and protein are lost in the peritoneal bath.
S/S of Acute rejection of Kindey transplant
Swelling, tenderness at graft site
Immunosuppressive therapy drugs used:
Cyclosporine, corticosteriods, antibodies.
Infections common with immunsupressive therapy
Cytomegalovirus(most troublesome, may result in graft loss and client deth)
Herpes virus-treat with acyclovir (Zovirax)
What client should be aware of post-transplant
They will be on immunosuppressants for the rest of their life!!
Clinical manifestations of BPH (benign prostatic hypertrophy)
Feeling of incomplete bladder emptying after urination, may not be noticed for a long while.
Drug therapy for BPH
5a reductase inhibitors (Proscar) -decrease prostate size, decrease level of dihydrotestosterone, 6 months for relief of symptoms, supression of adrogens(hot flashes)
A-Adrenergic blockers = Tamsulosin (Flomax) - s/e: Hypotension, dizziness, fatigue (Priority nursing intervention is to assess for those s/e !
Post-op for TURP
high potential for hemorrage, continous bladder irrigation (CBI) used to keep catheter from becoming occluded by blood clots, monitor Hgb and Hct, assess for hematuria in continous drainage bad, decrease irrigation rate of flow in clotting occurs, contact DR to udate any complications.
Home care post op
oral fluids 2-3 quarts a day, avoid heavy lifting ( >10lbs), refrain from driving or intercourse, continue annual rectal exams, use a leg bad during the day if sent home with catheter.
Prostate-specific antigen (PSA)
normal is 0-4, variations can be utilized to determine between BPH and prostate CA, baseline can be utilized to determine cancer Tx, PSA may be normal in some men with prostate CA
Lab results for CKD (Chronic Kidney Disease)
Increased Potassium (K+) Decreased pH, Decreased Calcium (Ca+) Increased Creatinine Increased Phosphorus
Assesment findings during Oliguric stage of ARF?
Acidosis, Kyperkalemia, Hypertension
Most common EARLY complaint of Bladder Cancer?
Gross painless hematuria
Person has Bladder CA, theyve undergone a cystectomy,What is created, and what is expected for the first 2 days?
an Illeal Conduit is created, and mucous shreds in the Urine is expected for the first 2 days
What is the most common complaint of a male with BPH (Benign Prostatic Hyperplasia)
Frequent urination due to a feeling of incomplete bladder emptying
A male has an enlarged prostate, and a PSA level is ordered, if the PSA is increased does this guy have Prostate Cancer?
NO! PSA levels are increased due to prostate pathology but not Cancer. The only way to determine cancer is a BIOPSY
A client is being sent home with an indwelling catheter, what are some things to teach him?
Use a leg bag at night, Clean the Urethral meatus (hole) qday, try to avoid frequent movement
What test is a better indicator of renal fx (BUN or CREATININE)? and why?
Creatinine, and because urea levels are influenced by infections and fluid intake. Normal levels are 0.5-1.5!
Someone is getting an IVP (Intravenous Pyelogram) what is of most concern before the procedure?
Check for iodine sensitivity (allergy) Shellfish, shrimp, seafood, etc.
Client is to begin taking Bactrim for a UTI, how to tell him to take it?
With a full glass of H20, on an empty stomach which is an hour before or 2 hours after a meal. Oh and be sure to take the full prescription to get rid of the UTI ya nasty filthball
What is an expected finding upon assessment of someone with interstitial cystitis?
Suprapubic pain relieved by voiding (PEEIN’ their little hearts out)
Most common nsg diagnosis of renal calculi (Kidney stones)
Pain related to irritation of the stone
Most threatening complication of ATN? and WHY
Hyperkalemia (K+ above 5) and because this causes Cardiac arrythmias and this is serious
Someone taking nephrotoxic drugs to treat a previous condition develops ARF (Acute renal failure) what stage is this?
Intrarenal stage
Someone has nephrolithiasis (Kidney stones) what stage is this in ARF?
postrenal
The kidney can’t excrete ammonia, what will the pH be?
This is ARF, and person will have Metabolic acidosis, so a pH below 7.35 (low) and low HCO3 (Bi-carb)
Why is sodium bicarb the solution of choice to be given to a client with ARF?
To increase the pH of the blood, thus shifting potassium into the cells
Someone with CKD (Chronic kidney disease) how do their Calcium and Phosphorus levels look? What should the nurse exect?
Calcium and Phosphorus levels are inversely realted, so they will have a high phosphorus level and a low calcium level, nurse should watch for Chvoteks, Trousseaus, Bleeding, Arrythmias, and fractures due to the low Calcium
A client is undergoing dialysis, what drugs should be expected to avoid while being on dialysis?
Diuretics and Heart meds, theyre already losing enough fluid and electrolytes due to the dialysis
What exercise should a nurse instruct a patient to do if pt c/o incontinence?
Kegel excercises (it’ll help their sex life too)
Someone with thrombocytopenia should be instructed to avoid?
INJURY!!!!!!!!!!!
Someone with severe anemia will present with what?
confusion and tachycardia
A patient with severe anemia will have what?
Pancytopenia (EVERYTHING LOW)!!!
Someone has amenia they need to consume foods high in iron what are some examples?
Spinach and Raisins!
When administering a blood tranfusion, person develops a blood transfusion rxn, what does the nurse do?
STOP the transfusion, get another line with normal saline, call doc!
what are some nursing interventions for a patient with sickle cell anemia?
Medicate their pain, give 02, encourage fluids, encourage activity but not too much
