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Nursing > U1 ER/Renal > Flashcards

U1 ER/Renal Flashcards

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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
Q

Coral snake venom

A

Nerve toxin

Muscle toxin

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26
Q

Coral snakebite S/S

A 
NV, headache, pallor, abominal pain
Ascending paralysis 
Reduced perception of pain
Respiratory paralysis
Effects may not be seen for 12-18 hrs
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27
Q

Coral snake Antivenom

A

Micrurus fulvius from horse serum

3-6 vials given slowly over 2 hrs

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28
Q

Brown recluse bite first aid

A

Ice intermittently for 4 days
DO NOT use heat
Elevate affected extremity
Local wound care

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29
Q

Brown recluse bite treatment

A

Topical antiseptic; sterile dressing
Antibiotics
Tetanus prophylaxis

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30
Q

Black widow bite S/S

A 
Latrodectism
Severe abdominal pain
Muscle rigidity
NV, weakness
Facial edema
Increased respiratory difficulty
Paresthesias
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31
Q

Black widow bite first aid

A

Ice pack
Support ABCs
Monitor for systemic toxicity

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32
Q

Black widow bite treatment

A

Opioids for pain
Muscle relaxants
Tetanus prophylaxis
Antihypertensives

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33
Q

Bark scorpion sting confirmation

A

Gentle tapping at the sting site that greatly increases the pain
Sting affects cranial nerves & musculoskeletal

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34
Q

Bark scorpion sting interventions

A

Ice pack for pain
Analgesics
Treat fever
Tetanus prophylaxis

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35
Q

Bark scorpion sting S/S

A 
High fever
Hypertension
GI disorders
Tachycardia
Pulmonary edema
Paresthesias
36
Q

Lightening injuries S/S

A

Asystole
Amnesia
Confusion/disorientation
Seizures

37
Q

Long term lightening strike survivors

A

Chronic fatigue
Depression
HA
Chronic pain

38
Q

Hypothermia

A

<95 degrees (35C)

39
Q

Mild hypothermia

A

32-36C; 89.6-96.8F
Shivering
Muscular incoordination

40
Q

Moderate hypothermia

A

28-32C; 82.9-89.5F

Obvious motor impairment & weakness

41
Q

Severe hypothermia

A

<82F
Shivering stops
Pt may perceive warmth & undress
Bradycardia & hypotension

42
Q

1st degree frostbite

A

Hyperemia (increased blood flow) to involved area

Formation of edema

43
Q

2nd degree frostbite

A

Large fluid blisters develop

Partial thickness skin necrosis

44
Q

3rd degree frostbite

A

Small blisters containing dark fluid

Affected body part is cool, numb, blue or red, & nonblanching

45
Q

4th degree frostbite

A

No blisters or edema
Affected body part is numb, cold, & bloodless
Full thickness necrosis extends into muscle & bone
Gangrene develops

46
Q

Early signs of frostbite

A

White, waxy appearance of exposed skin

47
Q

Frostbite Treatment

A

Rewarming in water temp of 104-108 degrees
Tetanus prophylaxis
Debridement & amputation
Severe pain during rewarming (analgesics)

48
Q

Altitude-related Illness

A

Elevations >5000 ft can produce physiologic responses

49
Q

Acute mountain sickness (AMS)

A 
Rapid ascent
Throbbing headache 
Anorexia, NV
Irritable, apathetic
Acetazolamide (Diamox) to treat
50
Q

High altitude cerebral edema (HACE)

A

Pt can’t perform ADLs
Apathy
Change in mental status, confusion, impaired judgement

51
Q

High altitude pulmonary edema (HAPE)

A 
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
Q

AKI Prerenal causes

A 
Any condition causing decreased blood flow to the kidneys
Arrythmias
Shock
Sepsis
Burns
Dehydration
Trauma
53
Q

AKI Prerenal key features

A 
Hypotension
Tachycardia
Decreased cardiac output
Decreased urine output
Lethargy
54
Q

AKI Intrarenal causes

A 
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
Q

AKI Intrarenal key features

A 
Edema, weight gain
Lethargy, confusion
Anorexis, NV
SOB, crackles, pulmonary edema
Hypertension, tachycardia, JVD
Oliguria/anuria
56
Q

AKI Postrenal causes

A

Obstruction to the urine collection system
Bladder atony
Cervical, prostatic, ureter, bladder, or urethral cancer
Kidney stones

57
Q

AKI Postrenal key features

A

Same as Intrarenal

58
Q

AKI Onset Phase

A

Begins with precipitating event & continues until oliguria develops
LASTS HOURS TO DAYS
Increased serum creatinine & BUN

59
Q

AKI Oliguric Phase

A

Urine output 100-400mL/24hrs
LASTS 1-3 WKS
Increased serum creatinine & BUN
Hyperkalemia, hyperphosphatemia, hypermagnesemia, & hypocalcemia

60
Q

AKI Diuretic Phase

A

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
Q

AKI Recovery Phase

A

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
Q

AKI Imaging Assessment

A

Abdominal x-ray to check kidney size
Ultrasonography
CT scan WITHOUT contrast–identify obstruction or tumor
Renal scan–determine blood flow

63
Q

AKI Interventions

A 
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
Q

Chronic kidney disease

A

Progressive kidney injury
Kidney function DOES NOT recover
Azotemia–nitrogen-based wastes in blood
Uremia

65
Q

CKD causes

A 
Glomerular disease
Tubular disease
Urinary tract disease
Infection 
Metabolic kidney disease
66
Q

CKD

Reduced renal reserve

A

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
Q

CKD

Reduced GFR

A

Kidney nephron damage
Reduced GFR–BEST measure
Increased output of DILUTE urine
Can cause severe dehydration if untreated

68
Q

CKD

ESKD

A

Urea & creatinine build up in the blood
Kidneys can’t maintain homeostasis
Severe F/E & A/B imbalances

69
Q

CKD kidney changes

A

Abnormal urine production
Poor water excretion
Electrolyte imbalances
GFR is effective until 3/4 kidney function is lost

70
Q

CKD metabolic changes

A

Decreased kidney function leads to increased creatinine levels

71
Q

CKD electrolyte changes

A

Early CKD–hyponatremia

Later CKD–Na excretion is decreased, hypernatremia; ANY increase in K+ leads to hyperkalemia

72
Q

CKD A/B balance

A

Early CKD–blood pH changes are small

Later CKD–respiratory alkalosis

73
Q

Hemodialysis pt selection

A

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
Q

Complication of vascular access devices

A

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
Q

Postdialysis assessment

A 
Hypotension
Headache
NV
Malaise, dizziness
Muscle cramps or bleeding
76
Q

Complications of dialysis

A

Dialysis disequilibrium syndrome
Infectious disease
Hepatitis B & C
HIV

77
Q

Dialysis disequilibrium syndrome

A

Rapid decrease in fluid volume & BUN

Headache, NV, restlessness, decreased LOC, seizures

78
Q

Continuous ambularoty peritoneal dialysis (CAPD)

A

Infusion of 4 2L exchanges
Dwell time 4-8 hrs
No machine necessary
Resembles kidney action

79
Q

Automated peritoneal dialysis

A

In-home dialysis while pt sleeps

Delivers large volumes of dialysis solution

80
Q

Peritoneal dialysis complications

A 
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
Q

Kidney transplant candidate selection

A

<70 yrs; after 70, individual basis

Unsuitable–advanced cardiac disease, metastatic cancer, chronic infection, alcoholism, chemical dependency

82
Q

Kidney transplant operation

A

4-5 hrs

Recipient keeps old kidney unless infection or polycystic kidney disease

83
Q

Kidney transplant complications

A 
Rejection
Acute tubular necrosis
Thrombosis--2-3 days after transplant
Renal artery stenosis
Hematoma
Abscess
84
Q

Kidney transplant

Acute rejection S/S

A 
1 wk to 2 yrs postop
Oliguria, anuria
Increased temp
Increased BP
Flank tenderness
Fluid retention
85
Q

Kidney transplant

Chronic rejection S/S

A

Gradual over months to yrs
Increased BUN, creatinine
Electrolyte imbalances
Fatigue

86
Q

Uremia S/S

A 
Metallic taste
Anorexia, NV
Muscle cramps
Itching
Fatigue
Edema
Paresthesias

Nursing (9 decks)

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