Treatment Flashcards
AKI
Underlying cause
Fluid balance
Sodium polystyrene sulfonate, sorbitol, IV insulin/D50 for hyperkalemia
IV bicarbonate
Dialysis
AKI and CKD
Fluid balance (prevent excess)
Adequate nutrition (increase protein and calcium and vitamin D)
Education
Activity with rest
Prevent complications
FVE
I/O, weights
Limit fluid
Oral hygiene
ESKD
RRT
Dialysis
Kidney transplant
ESRD diet
4-5 small meals
Low salt
Low potassium
Low phosphorus
High protein
Limit fluids
Types of RRT
HD, CRRT, PD, Hemofiltration, hemodiafiltration
Kidney transplant contraindications for living donor
HTN and DM
Kidney transplant requirements
No infection
Anti rejection meds
Psychosocial evaluation
Sinus Brady
Change meds
Pacemaker
Atropine
Sinus tachy
Vagal maneuver
Meds: BB, CCB, adenosine
A fib drugs and devices
BB
Warfarin
Amiodarone
Cardioversion, ablation, watchman
Adjunct with meds for arrhythmias
Pacemakers
Cardioversion
Defibrillation
6 minute walk test
Prevention CAD
Lower cholesterol with diet and meds
Exercise
Stop smoke
Manage HTN
Control DM
Angina goal
Decrease oxygen demand and increase the supply
Reduce and control risk factors
Angina meds
Nitro
BB, CCB
Antiplatelet/anticoagulants- aspirin, clopidogrel and ticlopidine, heparin, glycoprotein inhibitors
May also need PPI, H2 for GI upset
MI
MOAN: morphine, oxygen, aspirin (ASA), nitro (NTG)
BB, heparin
PCI for STEMI
Thrombolytic (“plase”) if no PCI
Inpatient: cardiac monitor, meds, ASA and clopidogrel, BB, ACE ARB
Goals include: improve respiratory and perfusion
Nursing: oxygen, elevate head, IO, pain, frequent assessment and evaluation
Mitral regurgitation
HF treatment (BB, ACE, ARB)
Mitral stenosis
Anticoagulant, BB, CCB, digoxin
Aortic regurgitation
ACE, CCB
Valvuloplasty, valve replacement
Aortic stenosis procedures
TAVR (valve replacement), percutaneous valvuloplasty
Nursing for valvular heart disorders
Daily weights, activity with rest
(Along with typical monitor and med stuff)
Nursing for valve surgery (plasty or replacement)
Monitor for HF and emboli
(Along with typical perioperative stuff like VS, anesthesia recovery, stability)
Anticoagulant, prevent endocarditis, echoes
Cardiomyopathy nursing
Low Na, fluid restriction
Meds
Exercise, pacemaker
Rest with legs down, O2
Heart infection prevention
Abx and oral hygiene
Immunization
Lower UTI prevention
Shower, hygiene, fluids, pee, vitamin C or cranberry juice
Lower UTI treatment
Fluids
Avoid coffee, tea, citrus, cola, alcohol
Abx and analgesics
Heat
UTI hospital protocol
If no void 4-6 hrs/symptomatic, scan
If scan >300 ml do straight cath
Repeat if not fix
Foley if still problem
Pyelonephritis
Usually outpatient
Abx and fluids
If chronic: strict IO and temp
Urolithiasis
Pain and infection control
ID location and type
Increase fluid - we want 2 L UOP
Strain all UOP
Urolithiasis surgical procedures
Ureteroscopy, ESWL (shockwave lithotripsy), percutaneous nephrolithotomy, chemolysis with percutaneous nephrostomy
Bladder cancer
Radiation, chemo
Surgery: transurethral resection “TURBT”, cystectomy with diversion
Non invasive: TURBT then IVT then surveillance; lifestyle
Neobadder nursing
F and lytes and nutrition
Prevent acidosis
Catheter care, bladder retraining
Cutaneous diversion nursing
Monitor urine volume hourly
Stoma and skin care
Fluids
Self care
BPH drugs and nursing
Alpha block (alfuzosin, tamsulosin, terazosin)
Anti androgen (finasteride, dutasteride)
Pain and spasm control
Catheter for acute/unable to void
BPH surgical procedures
TUMT (transurethral microwave)
TUNA (transurethral ablation)
Resections: TURP, suprapubic, retropubic, transurethral incision
BPH post TURP care
CBI (continuous bladder irrigation)
Pain control
Monitor for hemorrhage and infection
Early ambulating
Prostate cancer
ADT hormonal therapy
Therapeutic vaccine
Radiation and chemo
Resection
Post prostate surgery mgmt
Treat if transurethral resection syndrome
F and lyte
Manage complications: hemorrhage, infection, VTE, catheter
CBI
CBI mgmt
Titration high when red til clear then slow
CBI infused - foley OP = UOP
Bring in a back up bag
HF nursing and surgical options
Meds, lifestyle, O2
Surg: ICD (defibrillator device), valve repair, heart transplant
HF meds
Diuretics
ACE, ARB, BB
Ivabradine
Hydralazine and isosorbide dinitrate
Digoxin
Special considerations with treating HF older patient
Diuretics with BPH
Drugs with decreased renal
Atypical ss: fatigue, weak, somnolence
HF nursing
Activity with rest - 30 minutes, wait 2 hours after eating, avoid extremes
Elevate head of bed
Relieve fluid overload - weight, IO, diuretics, fluid and sodium restriction
Treat comorbidities
Education- include teachings on vaccines and infection prevention
Pulmonary edema
O2, NRB, CPAP, BiPAP
Diuretics, dilators (nitro)
Upright with dangly legs
IO
Pericardial effusion and cardiac tamponade
Pericardiocentesis
Pericardiotomy
Drugs for PAD
Phosphodiesterase inhibitor: cilostazol
Antiplatelets
Statins
Surg for PAD
Balloon angioplasty
Stent
Atherectomy
Bypass graft
PAD nursing
Monitor pulses frequently
ABI
Exercise and SET program
Aneurysm management
Control HTN with BB, hydralazine, sodium nitroprusside for emergency
Surgery
Abdominal aortic aneurysm
BB, CCB, ACE, ARB, diuretic
Stent, removal with graft
DVT prevention
Early ambulation and leg exercises
TED hose and SCDs
Heparin, LMWH
Lifestyle: weight, smoke, exercise
Pulmonary embolism drugs and surg
Unstable: thrombolytics, bypass surgery (rare)
Stable: heparin gtt, LMWH, apixaban
Pulmonary embolism nursing
Monitor SpO2
Manage pain
Monitor complications
Leg ulcers
Abx and analgesics
Compression therapy
Debridement
Silver dressing
Avoid heat
Gradually progress activity
Nutrition for healing- protein, vitamins A and C, iron, zinc
Cardiomyopathy surgery
Assist devices (VAD, LVAD)
IAP (balloon pump)
Total artificial heart as last resort
Anti rejection drugs
Angina surgical options
Reperfusion therapy (PCI, stents, CABG)
Angina nursing
Rest, semi Fowler, assessment, meds, 2 L NC
Angina teaching
Stop smoking, low fat high fiber, carry nitro always, maintain good BP and blood sugar
Cholesterol drugs
Statins
Bile acid sequestrants
Nicotinic acids
Cholesterol absorption inhibitors
Omega 3 acid ethyl esters
DM
Nutrition
Exercise
Monitor
Pharm
Education
DM diet
50-60% carbs
20-30% fats
<10% saturated
<300 mg cholesterol
Non animal proteins
Increase fiber
Lower glycemic index
Combined with fats or proteins
Raw or whole
Somogyi
Insulin adjustment
Bedtime snack
Dawn phenomenon
No carbs before bed
Insulin at bedtime
HHS
Rehydrate with iso or hypo
Insulin with D5
Monitor f and lyte
Tele
Diabetic nephropathy - drugs, diet, other
ACE, prevent UTI, low salt low protein diet, dialysis
Insulin drip protocol
100 units/ 100 mL
140-180 glucose
Check glucose q1h
D5W driver
Hypoglycemic mgmt
15-20 gram fast carb, 4-6 oz juice or soda, 3-4 glucose tabs
Recheck 15 minutes later
Retreat if necessary
Snack with carb and protein unless meal in 30-60 minutes
Intranasal glucagon
Emergency hypoglycemia treatment
<55
IM or SC 1 mg glucagon
Fast carb and snack
25 to 50 mL D50 IV
Ketone and glucose test strip education
SIADH
Furosemide, hypertonic IV if severe hyponatremia
IO, weights, monitor labs, neuro
Hypothyroidism
Levothyroxine 75 to 150 mcg/day to start, then raise til labs are normal
Activity intolerance, monitor for myxedema and constipation and chest pain (angina)
Blankets but no heating pads
Infection prevention (can lead to myxedema)
Hyperthyroidism
Small frequent
Cool environment
Monitor for storm, CV, resp, temp
Calcium foods
Dairy
Seeds
Leafy greens
Almonds
Hypercalcemic crisis
Rapid high vol iso 100-150 ml/hr
Calcitonin and mithramycin
Hyperparathyroidism
Avoid high calcium diet, increase fluid to avoid stones
Monitor ss: stones, Ca crisis, apathy, fatigue, NVC, weak, HTN, arrhythmias
Education on fracture prevention
Increase exercise to move calcium into them bones
Hypoparathyroidism
Diet: high Ca low phosph (no spinach or dairy)
Meds
If giving Ca with dig monitor arrhythmia
Monitor post neck surg for tetany, seizure, resp
Seizure precautions
Thyroidectomy
Pre op: no caffeine, decrease stress to avoid storm
Post op: airway/breathing, tracheostomy tray, drains for OP, ss bleeding, ice chips then soft/liquid, monitor Ca and phosph
Addison
Lifelong steroids
Restore circulation/increase BP via 3-4 L NS or D5, hydrocortisone + vasopressors, abx for chronic immune suppression
F and lytes, ortho hypo, fluids, IO
Addison crisis
IVF, glucose, lytes (Na), steroids, vasopressors
Cushing
Avoid injury, falls, infection, skin damage
Cardiac
Hypophysectomy/monitor Addison, radiation, taper steroids, insulin for hyperG
Potassium foods
Fruits and vegetables
Legumes and whole grains
Milk and meat
Phosphorus foods
Meat, dairy, beans
Post PCI assessment
We want…
No chest pain
Normal VS
Normal neuro
Normal heart
Normal lung
