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U1 ER/Renal Flashcards

1
Q

Incidents that require reporting

A 
Suspected abuse
Assaults
Car accidents
Communicable diseases (STDs, hepatitis, meningitis)
Food poisoning
Seizures
Death 
Animal bites
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2
Q

Emergent (life-threatening) Tier

A

Respiratory distress
Chest pain with diaphoresis
Active hemorrhage
Unstable vital signs

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3
Q

Urgent (needs quick treatment, but not immediately life-threatening) Tier

A 
Severe abdominal pain
Renal colic
Displaced or multiple fractures
Complex or multiple soft tissue injuries
New-onset respiratory infection, esp. pneumonia
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4
Q

Nonurgent (could wait several hours if needed without fear of deterioration) Tier

A

Skin rash
Strains & sprains
Colds
Simple fracture

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5
Q

Primary Survey

ABCDE

A 
Airway/cervical spine
Breathing
Circulation
Disability
Exposure
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6
Q

Primary Survey

CPR

A

Compressions
Airway
Breathing

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7
Q

BP Indicator

Radial pulse

A

At least 80 mmHg

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8
Q

BP indicator

Femoral pulse

A

At least 70 mmHg

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9
Q

BP indicator

Carotid pulse

A

At least 60 mmHg

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10
Q

Disability

AVPU

A

Alert
Responds to voice
Responds to pain
Unresponsive

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11
Q

Heat exhaustion

A

Symptoms resemble the flu

Dehydration r/t heavy perspiration & inadequate fluid

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12
Q

Heat stroke

A

Body temp exceeds 104 degrees
Mental status changes
Hypotension, tachycardia, tachypnea

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13
Q

Exertional heat stroke

A

Sudden onset

Strenuous physical activity in hot, humid conditions

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14
Q

Classic heat stroke

A

Occurs over a period of time

Chronic exposure to a hot, humid environment

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15
Q

Heat stroke intervention

A

Cool the body
DO NOT give food or water
Call an ambulance

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16
Q

Heat stroke treatment

A 
O2 therapy 
0.9% saline
Foley
Aggressive cooling methods
Thorazine for shivering
Valium for seizures
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17
Q

Minimal envenomation

A

Fang marks
Local swelling & pain
No systemic reactions

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18
Q

Moderate envenomation

A

Fang marks
Swelling progressing beyond the site of the bite
Systemic S/S–NV, paresthesias, hypotension

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19
Q

Severe envenomation

A

Fang marks
Marked swelling of the extremity
Subcutaneous ecchymosis
Coagulopathy

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20
Q

Effects of pit viper envenomation

A 
Local tissue necrosis
Massive tissue swelling
Hypovolemic shock
Pulmonary edema
Renal failure
Hemorrhagic complications
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21
Q

Snakebite first aid

A 
Remove jewelry & restrictive clothing
**Immobilize affected extremity
Maintain at level of the heart
Keep pt warm & calm
NO stimulants
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22
Q

Snakebite treatment

A 
O2 therapy
2 large-bore IV lines
Cardiac & BP monitoring
Tetanus prophylaxis
Opioids for pain
Wound care
Antibiotics
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23
Q

Rattlesnake Antivenom

Antivenin (Crotalidae)

A

Hyper-immune horse serum assoc w/ serum sickness

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24
Q

Rattlesnake Antivenom

Crotalidae polyvalen immune fab (CroFab)

A

Don’t give to pts with allergies to papya
Caution w/ pts allergic to bromelain (pineapple derivative)
4-6 vials over 60 min
2 vials every 6 hrs for total of 18 hrs

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25
Coral snake venom
Nerve toxin | Muscle toxin
26
Coral snakebite S/S
``` NV, headache, pallor, abominal pain Ascending paralysis Reduced perception of pain Respiratory paralysis Effects may not be seen for 12-18 hrs ```
27
Coral snake Antivenom
Micrurus fulvius from horse serum | 3-6 vials given slowly over 2 hrs
28
Brown recluse bite first aid
Ice intermittently for 4 days DO NOT use heat Elevate affected extremity Local wound care
29
Brown recluse bite treatment
Topical antiseptic; sterile dressing Antibiotics Tetanus prophylaxis
30
Black widow bite S/S
``` Latrodectism Severe abdominal pain Muscle rigidity NV, weakness Facial edema Increased respiratory difficulty Paresthesias ```
31
Black widow bite first aid
Ice pack Support ABCs Monitor for systemic toxicity
32
Black widow bite treatment
Opioids for pain Muscle relaxants Tetanus prophylaxis Antihypertensives
33
Bark scorpion sting confirmation
Gentle tapping at the sting site that greatly increases the pain Sting affects cranial nerves & musculoskeletal
34
Bark scorpion sting interventions
Ice pack for pain Analgesics Treat fever Tetanus prophylaxis
35
Bark scorpion sting S/S
``` High fever Hypertension GI disorders Tachycardia Pulmonary edema Paresthesias ```
36
Lightening injuries S/S
Asystole Amnesia Confusion/disorientation Seizures
37
Long term lightening strike survivors
Chronic fatigue Depression HA Chronic pain
38
Hypothermia
<95 degrees (35C)
39
Mild hypothermia
32-36C; 89.6-96.8F Shivering Muscular incoordination
40
Moderate hypothermia
28-32C; 82.9-89.5F | Obvious motor impairment & weakness
41
Severe hypothermia
<82F Shivering stops Pt may perceive warmth & undress Bradycardia & hypotension
42
1st degree frostbite
Hyperemia (increased blood flow) to involved area | Formation of edema
43
2nd degree frostbite
Large fluid blisters develop | Partial thickness skin necrosis
44
3rd degree frostbite
Small blisters containing dark fluid | Affected body part is cool, numb, blue or red, & nonblanching
45
4th degree frostbite
No blisters or edema Affected body part is numb, cold, & bloodless Full thickness necrosis extends into muscle & bone Gangrene develops
46
Early signs of frostbite
White, waxy appearance of exposed skin
47
Frostbite Treatment
Rewarming in water temp of 104-108 degrees Tetanus prophylaxis Debridement & amputation Severe pain during rewarming (analgesics)
48
Altitude-related Illness
Elevations >5000 ft can produce physiologic responses
49
Acute mountain sickness (AMS)
``` Rapid ascent Throbbing headache Anorexia, NV Irritable, apathetic Acetazolamide (Diamox) to treat ```
50
High altitude cerebral edema (HACE)
Pt can't perform ADLs Apathy Change in mental status, confusion, impaired judgement
51
High altitude pulmonary edema (HAPE)
``` Usually in 1st 1-2 days of rapid ascent Poor exercise tolerance Fatigue, weakness Persistent, dry cough Cyanosis of lips & nail beds Tachycardia & tachypnea at rest ```
52
AKI Prerenal causes
``` Any condition causing decreased blood flow to the kidneys Arrythmias Shock Sepsis Burns Dehydration Trauma ```
53
AKI Prerenal key features
``` Hypotension Tachycardia Decreased cardiac output Decreased urine output Lethargy ```
54
AKI Intrarenal causes
``` Physical, chemical, or immunologic damage directly to the kidney Nephrotoxins Poorly treated prerenal Crush injuries Transfusion reactions Renal artery/vein thrombosis/stenosis Sickle cell disease Lupus ```
55
AKI Intrarenal key features
``` Edema, weight gain Lethargy, confusion Anorexis, NV SOB, crackles, pulmonary edema Hypertension, tachycardia, JVD Oliguria/anuria ```
56
AKI Postrenal causes
Obstruction to the urine collection system Bladder atony Cervical, prostatic, ureter, bladder, or urethral cancer Kidney stones
57
AKI Postrenal key features
Same as Intrarenal
58
AKI Onset Phase
Begins with precipitating event & continues until oliguria develops LASTS HOURS TO DAYS Increased serum creatinine & BUN
59
AKI Oliguric Phase
Urine output 100-400mL/24hrs LASTS 1-3 WKS Increased serum creatinine & BUN Hyperkalemia, hyperphosphatemia, hypermagnesemia, & hypocalcemia
60
AKI Diuretic Phase
Sudden onset 2-6 wks after oliguric stage Urine flow increases rapidly over a period of several days Urine output up to 10L/day dilute urine BUN level falls Normal kidney tubular function reestablished
61
AKI Recovery Phase
Return to normal level of activity Complete recovery can take up to 12 months Lower energy level; less stamina Kidney function may never return to pre-illness levels
62
AKI Imaging Assessment
Abdominal x-ray to check kidney size Ultrasonography CT scan WITHOUT contrast--identify obstruction or tumor Renal scan--determine blood flow
63
AKI Interventions
``` Lasix to promote kidney flow 500-1,000mL NS infused over 1 hr Calcium channel blockers Kayexelate to reverse hypokalemia High calorie diet--low in protein, sodium, & potassium Fluid restriction Dialysis ```
64
Chronic kidney disease
Progressive kidney injury Kidney function DOES NOT recover Azotemia--nitrogen-based wastes in blood Uremia
65
CKD causes
``` Glomerular disease Tubular disease Urinary tract disease Infection Metabolic kidney disease ```
66
CKD | Reduced renal reserve
Unaffected nephrons overwork to compensate No manifestations of kidney dysfunction Kidney function is reduced if pt is stressed with infection, fluid overload, pregnancy, or dehydration
67
CKD | Reduced GFR
Kidney nephron damage Reduced GFR--BEST measure Increased output of DILUTE urine Can cause severe dehydration if untreated
68
CKD | ESKD
Urea & creatinine build up in the blood Kidneys can't maintain homeostasis Severe F/E & A/B imbalances
69
CKD kidney changes
Abnormal urine production Poor water excretion Electrolyte imbalances GFR is effective until 3/4 kidney function is lost
70
CKD metabolic changes
Decreased kidney function leads to increased creatinine levels
71
CKD electrolyte changes
Early CKD--hyponatremia | Later CKD--Na excretion is decreased, hypernatremia; ANY increase in K+ leads to hyperkalemia
72
CKD A/B balance
Early CKD--blood pH changes are small | Later CKD--respiratory alkalosis
73
Hemodialysis pt selection
Depends on symptoms, NOT GFR Pts with fluid overload that doesn't respond to diuretics Uncontrolled hypertension Uremic signs--NV, decreased attention span, worsening anemia, pruritis
74
Complication of vascular access devices
Thrombosis (most common) Stenosis Infection--staph aureus Aneurysm--repeated needle puncture at same site Ischemia--decreased blood flow below the fistula Heart failure (rare)
75
Postdialysis assessment
``` Hypotension Headache NV Malaise, dizziness Muscle cramps or bleeding ```
76
Complications of dialysis
Dialysis disequilibrium syndrome Infectious disease Hepatitis B & C HIV
77
Dialysis disequilibrium syndrome
Rapid decrease in fluid volume & BUN | Headache, NV, restlessness, decreased LOC, seizures
78
Continuous ambularoty peritoneal dialysis (CAPD)
Infusion of 4 2L exchanges Dwell time 4-8 hrs No machine necessary Resembles kidney action
79
Automated peritoneal dialysis
In-home dialysis while pt sleeps | Delivers large volumes of dialysis solution
80
Peritoneal dialysis complications
``` Peritonitis--cloudy effluent 1st sign Pain--when 1st starting & with cold dialysate Exit site infections Poor dialysate flow--r/t constipation Dialysate leakage Bleeding Bowel perforation ```
81
Kidney transplant candidate selection
<70 yrs; after 70, individual basis | Unsuitable--advanced cardiac disease, metastatic cancer, chronic infection, alcoholism, chemical dependency
82
Kidney transplant operation
4-5 hrs | Recipient keeps old kidney unless infection or polycystic kidney disease
83
Kidney transplant complications
``` Rejection Acute tubular necrosis Thrombosis--2-3 days after transplant Renal artery stenosis Hematoma Abscess ```
84
Kidney transplant | Acute rejection S/S
``` 1 wk to 2 yrs postop Oliguria, anuria Increased temp Increased BP Flank tenderness Fluid retention ```
85
Kidney transplant | Chronic rejection S/S
Gradual over months to yrs Increased BUN, creatinine Electrolyte imbalances Fatigue
86
Uremia S/S
``` Metallic taste Anorexia, NV Muscle cramps Itching Fatigue Edema Paresthesias ```

Nursing (9 decks)

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