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sav nur 334 exam 3 week 4 > week 4 content > Flashcards

week 4 content Flashcards

1
Q

BUN vs Cr

Most reliable indicator of renal function

A

Cr - specific to kidneys

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2
Q

_________- is breakdown/metabolism of muscle and protein, and released at a consistent rate
- Low ________= muscle atrophy/wasting, or maybe not significant
- High ________ = kidney damage

A

Cr

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3
Q

________ Cr = muscle atrophy/wasting, or maybe not significant
________ Cr = kidney damage

A

low
high

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4
Q

which electrolyte lab could be affected by

o nitrogen
o protein
o GI bleed
o Hydration status
o kidney function

A

BUN

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5
Q

if BUN is high what are 5 reasons could be causing it?

A
  1. High nitrogen (maybe from tube feeds)
  2. High protein (dietary)
  3. GI bleed (blood is rich in protein)
  4. Hydration status (false high/dehydrated or false low/overhydrated) = High or low BUN
  5. poor kidney function
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6
Q

If pt has
High BUN and WNL Cr =

if pt has
high BUN and high Cr =

A

explore other factors outside of kidneys
- GI bleed? Check H&H
- hydration status? FVE/FVD

kidney thing

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7
Q

one of the first electrolytes to become abnormal if kidney damage

A

potassium

  • kidneys excrete most potassium
  • kidney disease = kidneys aren’t excreting properly
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8
Q

high K = __________ and __________

A

cardiac dysrhythmias and muscle weakness

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9
Q

Po and Ca are _______ related

A

inversely

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10
Q

CKD/kidney disease =
Ca is ___ = Po is ____
kidneys aren’t excreting properly = Po is ___

A

ca is low = po is high

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11
Q

CKD/kidney disease = calcium reabsorption is ____creased = renal osteodystrophy (bone break risk)

A

decreased
low ca

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12
Q

with CKD, kidneys aren’t excreting properly = Mg is ______

A

high

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13
Q

urinalysis
best time to collect?
analyze within ___hr of void

A

morning first void
1 hr

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14
Q

urinalysis
includes (with expected findings)
- bilirubin =
- color =
- glucose =
- ketones =
- odor =
- pH =
- protein =
- RBCs =
- Specific gravity =
- WBCs =

A

includes (with expected findings)
- bilirubin = none
- color = amber yellow
- glucose = none
- ketones = none
- odor = aromatic
- pH = 4.6 – 6
- protein = zero – trace
- RBCs = 0 – 4
- Specific gravity = 1.010 – 1.030 (shows concentration so hydrated = low, dehydrated = high)
- WBCs = 0 – 5

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15
Q
  • Specific gravity = 1.010 – 1.030
    shows concentration of urine so
    hydrated = low/high?
    dehydrated = low/high?
A

hydrated = low
dehydrated = high

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16
Q

what type of urinary diagnostic study?

gives Glomerular Filtration Rate (GFR) - a measure of how well your kidneys are filtering waste products from your blood, amount of blood filtered per minute by glomeruli.

(The higher/lower the GFR, the worse your kidney function is?)

A

Creatinine clearance

for GFR, lower = worse

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17
Q

what type of urinary diagnostic study

  • Done at bedside
  • Calculates presence of residual urine
A

bladder scanner

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18
Q

what type of urinary diagnostic study

  • Confirms suspected UTI
  • Identifies causative agents of UTI
  • Sterile container used
  • Meatus must be cleaned prior to urine collection
  • Collect specimen 1-2 seconds after voiding starts
A

Clean catch urine

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19
Q

what type of urinary diagnostic study

Xray of abdomen and pelvis
- Bowel prep may be ordered (cleans out the intestines)
- Delineates organs (outline or define something clearly and precisely)

A

Kidneys, ureters, bladder (KUB)

  • size, shape, and position of kidneys
  • Radiopaque stones are gallbladder, kidney, etc. stones that can be seen on X-rays
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20
Q

what type of urinary diagnostic study

  • Main goal = inspect interior of bladder wall
  • Position = lithotomy
  • Consent form required
  • Post procedure
    o Expected – burning, pink tinged urine, frequency
    o Unexpected – bright red blood
A

Cystoscopy

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21
Q

Cystoscopy

  • Main goal = inspect interior of bladder wall
  • Position = __________
  • Consent form required
  • Post procedure
    o Expected or unexpected – burning, pink tinged urine, frequency?
    o Expected or unexpected – bright red blood?
A

Cystoscopy

  • Main goal = inspect interior of bladder wall
  • Position = lithotomy
  • Consent form required
  • Post procedure
    o Expected – burning, pink tinged urine, frequency
    o Unexpected – bright red blood
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22
Q

what type of urinary diagnostic study

This is a type of X-ray that may be performed during a cystoscopy. A contrast dye is injected directly into the ureters, opposite direction of normal flow, allowing doctors to visualize the upper urinary tract, including the kidneys and ureters.

A

Retrograde pyelogram

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23
Q

Retrograde pyelogram

T/F

  1. Indicated if IVP doesn’t visualize adequately
  2. Indicated if Allergy to contrast/iodine
  3. Indicated if Decreased renal function
  4. Uses cystoscope and ureteral catheter
  5. Bowel prep not required
  6. Post procedure unexpected – burning, pink tinged urine, frequency, bright red blood
  7. allergic reactions or systemic responses may be possible
A
  1. T
  2. T
  3. T
  4. T
  5. F - required
  6. F
    Expected – burning, pink tinged urine, frequency
    Unexpected – bright red blood
  7. F - Contrast dye is not in blood stream – no allergic reactions or systemic responses
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24
Q

what type of urinary diagnostic study

type of X-ray imaging technique used to visualize the kidneys, ureters, and bladder (KUB).
It provides detailed cross-sectional images of these organs without the use of contrast dye.
- Gold standard exam for diagnosing renal colic symptoms
- Quick
- Noninvasive
- No IV contrast

A

Non-contrast Spiral CT (CT/KUB)

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25
Q

what type of urinary diagnostic study

This is an X-ray examination of the urinary tract that uses contrast dye. The dye is injected into a vein, and it travels through the bloodstream to the kidneys, ureters, and bladder. The X-rays allow doctors to visualize the urinary tract and identify any abnormalities.

A

Intravenous pyelogram (IVP)

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26
Q

Intravenous pyelogram (IVP)

T/F

  1. Bowel prep required?
  2. Uses contrast dye?
  3. check for _______ sensitivity, if anaphylaxis reaction AVOID
  4. unexpected – flushed feeling with injection
  5. Kidneys must be functional –
  6. contrast is taken up by kidneys and excreted by kidneys
  7. contrast is nephrotoxic
  8. requires force fluids afterwards to flush contrast out of system
  9. if creatinine is high = consider alternative test
  10. The dye is injected into a vein, and it travels through the bloodstream to the kidneys, ureters, and bladder
  11. local reaction expected, not systemic
A
  1. T
  2. T
  3. iodine
  4. F - expected
  5. T
  6. T
  7. T
  8. T
  9. T
  10. T
  11. F - in the blood stream is systemic, this is why allergic reaction is very serious, could cause systemic s/e
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27
Q

what type of urinary diagnostic study?

uses calculation that takes patient’s age, sex, weight, and ethnicity into consideration

A

eGFR

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28
Q

creatinine clearance is checked with a 24 hour urine collection
- Discard first urine, then 24 hour collection window begins
- Save all urine for 24 hours
- During this 24 hour window, we will also test serum creatinine
- The 24 hour urine container should be kept ______
- At end of 24 hour collection window, pt voids one last time and that last void is added to the collection

A

cold

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29
Q

creatine clearance is checked with a _______________

A

24 hour urine collection

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30
Q

Renal biopsy
T/F
1. Indications – suspicious for kidney cancer
2. Consent form required
3. Assess coagulation history
4. No ASA
5. No warfarin

A

all true

  1. kidneys are very vascular, bleed risk if coagulation is not adequate
  2. and 5. antiplatelet, thins blood
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31
Q

renal biopsy Post procedure
T/F
1. Apply pressure dressing
2. Keep on unaffected side for 30-60 mins
3. Bedrest 24 hours
4. Vitals q 5-10 mins for 1 hour
5. high BP and low Hr may indicate bleed
6. Assess for chest pain and signs of bleeding
7. No heavy lifting for 7 days

A
  1. T
  2. F - Keep on affected side for 30-60 mins
  3. T
  4. T
  5. F - low BP and high HR
  6. F - Assess for flank pain and signs of bleeding
  7. T
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32
Q

lower vs upper UTI

  • Involves parenchyma (functional tissue of an organ), pelvis or ureters
A

upper UTI

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33
Q

upper UTI Systemic infection s/s
1.
2.
3.

A

o Fever
o Chills
o Flank pain “CVA tenderness” = triangle on each side of back where kidney is
o fatigue
o vomiting

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34
Q

lower UTI Symptoms r/t bladder emptying or storage
o Hesitancy
o Intermittency
o Post void dribbling
o Urinary retention
o Dysuria

A

bladder emptying

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35
Q

lower UTI Symptoms r/t bladder emptying or storage

o Urinary frequency
o Urgency
o Incontinence
o Nocturia
o Nocturnal enuresis – bed wetting

A

storage

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36
Q

diagnostics for Pyelonephritis

1st - _______ done at bedside
2nd _________ confirms results
3rd unique to pyelonephritis
- WBC w/ diff will show =
- image testing
- Blood culture – if we suspect _______

A

dip stick urinalysis

microscopic urinalysis

shift to the left (bands, neutrophils) = infection

if we suspect bacteremia (bacteria in blood)/urosepsis (UTI infection spread to blood) = we think UTI got into blood

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37
Q

Indications for a urine culture/clean catch
SATA
-Complicated UTI
-Nosocomial/hospital acquired UTI
-Frequent UTI
-UTI is unresponsive to therapy
-lower UTI
-Questionable diagnosis – don’t know what it is

A

-Complicated UTI
-Nosocomial/hospital acquired UTI
-Frequent UTI
-UTI is unresponsive to therapy
X-lower UTI
-Questionable diagnosis – don’t know what it is

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38
Q

Cystitis

A

Inflammation of bladder wall

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39
Q

Urosepsis

A

UTI that has spread to blood (systemic circulation)
Life threatening

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40
Q

Nephrolithiasis

A

kidney stones

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41
Q

small tube that is surgically inserted into the renal pelvis/kidney through the back (small flank incision)
- It is used to drain urine when the normal flow of urine is blocked
- Attached to external bag for closed drainage to collect urine
- Temporary option

A

nephrostomy tube

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42
Q

Indications for a nephrostomy tube
1.

A
  1. Ureter is totally obstructed for any reason
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43
Q

If excessive pain or drainage around exit site of nephrostomy tube = possible _____________

If irrigation is ordered
-Use clean or sterile technique
-Gently instill no more than ___ ml of _____

A

If excessive pain or drainage around exit site
- Possible bloackage

If irrigation is ordered
- Use strict aseptic technique – high risk for infection
- Gently instill no more than 5 ml of sterile NS

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44
Q

kidney stones
Diagnostic studies
T/F
- Careful H&P
- Non-contrast spiral CT (CT/KUB) – gold standard exam
- Ultrasound
- IVP
- CBC
- Urinalysis – assess for hematuria, crystalluria, pH
- Retrieval/analysis of stones

A
  • Careful H&P
  • Non-contrast spiral CT (CT/KUB) – gold standard exam
  • Ultrasound
  • IVP
    X- CBC
  • Urinalysis – assess for hematuria, crystalluria, pH
  • Retrieval/analysis of stones
45
Q

Types of kidney stones
(5)

A

Types of kidney stones
1. Calcium oxalate – most common
2. Calcium phosphate
3. Uric acid
4. Cystine
5. Struvite – magnesium ammonium phosphate

46
Q

kidney stones - Care
Acute attack
1. treat
2. treat
3. treat

A
  1. treat symptoms - pain NSAIDS and opioids
  2. treat infection - systemic abx
  3. treat obstruction - pass, stent, surgical removal
47
Q

kidney stones - Care
Acute attack
treat symptoms = Pain
- ______ pain - originates from the internal organs kidneys and ureters
- “renal colic” – constant or waxes and wanes
- Can cause __________ compromise – pain is so bad it starts messing with vitals
- what location of pain is typically especially severe pain?
treat with ___ and _____

A

o Pain
 visceral - originates from the internal organs kidneys and ureters
 “renal colic” – waxes and wanes
 Can cause hemodynamic compromise – pain is so bad it starts messing with vitals (treating pain may be priority so hemodynamic compromise doesn’t occur)
 Flank pain is typically especially severe pain
 treat with NSAIDS and opioids

48
Q

is treating pain with kidney stones priority? Why or why not

A

Can cause hemodynamic compromise – pain is so bad it starts messing with vitals (treating pain may be priority so hemodynamic compromise doesn’t occur)

49
Q

kidney stone is < 4 mm =
kidney stone is > 4 mm =

A

o stone is < 4 mm = may pass spontaneously through urine
o stone is > 4 mm = usually doesn’t pass, may need stent placement (makes urethra opening larger)
o removal of stones

50
Q

kidney stone
T/F
1. 3L/day to prevent
2. force fluids not advised while managing obstructed stone
3. any fluid is preferred
4. strain urine in order to collect stone for analysis
5. stand/sit up to void on regular basis helps to prevent stones
6. ambulate/turn helps to treat stones
7. PCA pump may be indicated
8. pain is hard to control

A
  1. T
  2. T
  3. F - water
  4. T
  5. T
  6. F - prevent stones
  7. T
  8. T
51
Q

kidney stones
diet changes may be indicated depending on stone type

  1. diet change for calcium oxalate stones = low oxalate food or low calcium food?
  2. low purine food diet for which stone?
  3. low oxalate foods - SATA
     dark roughage
     spinach
     cocoa
     nuts
     milk
A
  1. low oxalate food, stones don’t come from dietary calcium
  2. o for uric acid stone = low purine food
  3.  dark roughage
     spinach
     cocoa
     nuts
52
Q

Endourologic procedures

example:

A

minimally invasive surgical techniques used to treat conditions of the urinary tract.

Lithotripsy

53
Q

Outpatient procedure used to break up stones into smaller pieces, Disintegrates/pulverizes stones via shock waves, that may be passed naturally through the urinary tract.

A

Lithotripsy

54
Q

There are two main types of lithotripsies:
External lithotripsy (indirect) and Internal lithotripsy (direct)
________________
- Cystoscopy approach or
- percutaneous approach – through skin
- uses laser
_________________
- Stones broken down and washed out
- Major advantage = not invasive
- Possible complications
o Hemorrhage
o Infection
o Retention of stone fragments

A

There are two main types of lithotripsies:
Internal lithotripsy (direct)
- Cystoscopy approach or
- percutaneous approach – through skin
- uses laser

External lithotripsy (indirect)
- Stones broken down and washed out
- Major advantage = not invasive
- Possible complications
o Hemorrhage
o Infection
o Retention of stone fragments

55
Q

which type of lithotripsy is this?
- Cystoscopy approach or
- percutaneous approach – through skin
- uses laser

A

internal/direct

56
Q

which type of lithotripsy is this?
- Stones broken down and washed out
- Major advantage = not invasive

A

external/indirect

57
Q
  • Possible complications of the external lithotripsy?
    1.
    2.
    3.
A

o Hemorrhage
o Infection
o Retention of stone fragments

58
Q

Post op lithotripsy
1. Expected or unexpected finding – hematuria
2. Expected or unexpected finding – low urine output
3. low urine output might imply ___________
4. Stent placement – helps facilitate passage of fragments. Removed after __-__ weeks

A

Post op
- Expected finding – hematuria
- Unexpected finding – low urine output = might imply obstruction
- Stent placement – helps facilitate passage of fragments
o Removed after 1-2 weeks

59
Q

Predisposition to UTI
T/F
1. Anything that causes renal stasis
2. Neurogenic bladder
3. Foreign bodies or anything that obstructs urine from exiting
4. Kidney stones
5. male urethra
6. Anything compromising immune system or response
7. DM
8. Aging
9. diarrhea
10. pregnancy
11. poor hygiene
12. delay in urination

A
  1. Anything that causes renal stasis
  2. Neurogenic bladder
  3. Foreign bodies or anything that obstructs urine from exiting
  4. Kidney stones
    F - 5. female urethra
  5. Anything compromising immune system or response
  6. DM
  7. Aging
    F - 9. constipation - impedes urine outflow
  8. pregnancy
  9. poor hygiene
  10. delay in urination
60
Q

T/F
Older adults with UTI
- will present with classic s/s
- localized abdominal pain
- Cognitive impairment – confusion
- Generalized clinical deterioration

A

F - will not present with classic s/s
F - non- localized abdominal pain
T- Cognitive impairment – confusion
T- Generalized clinical deterioration

61
Q

UTI diagnosis
1st test =
2nd test =

A

Type of Urinalysis – quick dipstick (done at bedside)

confirm with microscopic urinalysis

62
Q

UTI diagnosis
o Positive nitrites = indicates _______
o Increased WBC = indicates _________
o Positive leukocyte esterase (an enzyme present in WBCs) = indicates ______

A

o Positive nitrites = indicates bacteria
o Increased WBC = indicates pyuria
o Positive leukocyte esterase (an enzyme present in WBCs) = indicates pyuria

63
Q

Reducing risk factors for Nosocomial/hospital acquired UTI
T/F
- Urinary catheters are bad!
o Avoid use if possible
o Remove as soon as possible
- Careful aseptic technique with urinary tract instrumentation
o Sterile technique
o what do you do If you put cath in vagina first?
- Hand washing and glove wearing when giving peri care
- Avoid incontinence episodes
o Clean up asap
o Toilet regularly

A

all true

o If you put cath in vagina first, leave it
o Never pull it out and try again

64
Q

UTI acute interventions
Avoid bladder irritants
SATA
 Caffeine
 Alcohol
 ruff-age foods
 Citrus juice
 Chocolate
 Spicy foods
 cranberry juice

A

 Caffeine
 Alcohol
X ruff-age foods
 Citrus juice
 Chocolate
 Spicy foods
X cranberry juice

65
Q

why are Urinary diversion devices indicated?

A

Patient has lost bladder and no longer has a urine reservoir

66
Q

Types of urinary diversion devices?
1. Ileal conduit – _____ diversion to ______
2. Cutaneous reservoir – _______ diversion to ______
3. Orthotopic neobladder – _____ diversion to _______

A

Types:
- Ileal conduit – incontinent diversion to skin
- Cutaneous reservoir – continent diversion to skin
- Orthotopic neobladder – continent diversion to urethra

67
Q

Ileal conduit
incontinent diversion to skin
T/F
1. Indicated if pt has significant comorbidities or shorter life expectancy
2. Stoma is visible
3. no external collecting bag
4. Skin integrity concerns
5. Body image concerns
6. Unexpected finding – mucus in urine
7. Ileal conduit = urine
8. Ileostomy = urine and stool
9.most closely mimics normal voiding

A
  1. T
  2. T
  3. F - - Permanent external collecting bag required
  4. T
  5. T
  6. F - - Expected finding – mucus in urine (part of ileum/small intestine used so urine will have mucus in it from that)
  7. T
  8. F - - Ileostomy = stool
  9. F
68
Q

Cutaneous reservoir
continent diversion to skin
T/F
1. Names – Indiana, Kock, Miami
2. Intermittent
3. Life-long
4. sterile technique self catheterization required
5. external bag
6. most closely mimics normal voiding

A
  1. T
  2. T
  3. T
  4. F- clean technique
  5. F - - no external bag
  6. F
69
Q

Orthotopic neobladder
continent diversion to urethra
T/F
1. internal reservoirs (fake bladder) connected to native/natural urethra
2. internal reservoir constructed from a segment of intestine (ileum) that is separated from bowel and anastomosed to the native urethra
3. most closely mimics normal voiding
4. procedure of choice after cystectomy (bladder removal)
5. requires temporary external bag

A
  1. T
  2. T
  3. T
  4. T
  5. F
70
Q

rank which urinary diversion device you would want if you had to have one, 1 being best - 3 being worst

Orthotopic neobladder
Ileal conduit
Cutaneous reservoir

A
  1. Orthotopic neobladder
    continent diversion to urethra
    no bag, most closely mimics natural pee
  2. Cutaneous reservoir
    continent diversion to skin
    no external bag, down side is the self cath required
  3. Ileal conduit
    incontinent diversion to skin
    stoma, external bag, body image,
71
Q

what kidney problem is likely to follow severe and prolonged
- hypotension
- hypovolemia
- exposure to nephrotoxic agent

and why?

A

AKI

r/t decreased perfusion to kidneys

72
Q

what levels would you expect with AKI -
GFR?
UOP?
BUN?
Cr?

A
  • decreased GFR = < 90 ml/min
  • decreased UOP = < 30 ml/hr (with or without decrease in UO)
  • increased BUN = > 20
  • increased Cr = > 1.2
73
Q
  • most common
  • related to decreased CO = low BP, hypovolemia, decreased perfusion

AKI - prerenal, intrarenal, or postrenal?

A

prerenal

74
Q
  • issue is with actual kidney
  • ex: acute tubular necrosis (ATN)

AKI - prerenal, intrarenal, or postrenal?

A

intrarenal

75
Q
  • issue is below kidney
  • ex: prostate issue

AKI - prerenal, intrarenal, or postrenal?

A

postrenal

76
Q

manifestations AKI
1. UOP?
2. begins __ day after hypotensive event and lasts __-__ weeks
3. FVE or FVD?
4. Metabolic acidosis or alkalosis?
5. waste product accumulation?
6. Hypo or hyper natremia
7. Hypo or hyper kalemia
8. Neurologic disorders are r/t _____
9. AKI can develop into CKD if pt doesn’t recover?

A
  1. oliguria = < 400 ml/day or < 30 ml/hour
  2. begins 1 day after hypotensive event and lasts 1-3 weeks
  3. Metabolic acidosis
  4. waste product accumulation – no excretion, build up of waste
  5. Hyponatremia – no excretion, dilution issue
  6. Hyperkalemia – no excretion, accumulation issue
  7. Neurologic disorders – r/t hyponataremia
  8. AKI can develop into CKD if pt doesn’t recover
77
Q

treatment for AKI
T/F
Treatment
1. Find cause
2. Correct F&E imbalances
3. treat Hypokalemia – can be deadly
4. do FVD assessments
5. Fluid restriction
6. check Dilution lab values
7. Daily weights
8. Diuretics
9. Manage BP
10. Prevent/treat infections
11. Maintain nutrition
12. Give IV fluids
13. Avoid nephrotoxic drugs
14. high potassium diet
15. Patiromer (Veltassa)
16. Sodium zirconium cyclosilicate (Lokelma)
17. Sodium polystyrene sulfonate (Kayexalate)
18. Calcium gluconate IV
19. Dextrose and insulin
20. Sodium bicarbonate
21. Hemodialysis

A
  1. F - Hyperkalemia
  2. F - FVE assessments
  3. F
  4. F - Hyperkalemia restrict dietary potassium

15, 16, 17 - - Potassium binders in the GI tract
18 - treats hypocalcemia
19 - treats hypokalemia
20 - treats acidosis and hypokalemia
21 - only permanent way to treat hypokalemia

78
Q

End stage CKD s/s
- No longer maintains F&E balance=
1.
2.
3.
4.
5.
- No longer rids the body or wastes via urine =
1.
2.
3.
4.
5.
- Decreased production of erythropoietin =
1.
- Decreased activation of vitamin D =
1.

A

No longer maintains F&E balance =
- Edema
- Hyperkalemia
- Hyperphosphatemia
- Hypermagnesemia
- Metabolic acidosis – accumulate acidic waste products

No longer rids the body or wastes via urine =
- Anorexia
- Malnutrition
- Itching
- CNS changes
- Metabolic acidosis – accumulate acidic waste products

Decreased production of erythropoietin =
- Anemia

Decreased activation of vitamin D =
- Renal osteodystrophy, weakened bones from low Calcium

79
Q

CKD prevention
- Diagnosis and control of underlying problem causing CKD
1.
2.
- Early detection and treatment of CKD

A

HTN and DM

80
Q

CKD nursing problems
1.
2.
3.
4.
5.
6.

A

EFV = kidneys can’t excrete fluid
- Monitor for FVE
- Daily weights
- Fluid restriction

Malnourishment = restricted intake of nutrients
- Monitor for n/v
- Weight trends
- Serum protein levels
- H&H
- Provide desirable foods

Risk for injury = decreased bone structure, 2ndary to renal osteodystrophy (low Ca)
- Monitor electrolyte levels
- Admin ordered supplements – calcium, vitamin D

Grieving = loss of kidney function, dialysis life long treatment
- Listen
- Support resources
- Encourage family involvement

Infection = suppressed immune system
- Monitor for s/s infection
- Screen and limit visitors
- Aseptic technique of dialysis line care

Activity intolerance = low RBC 2ndary to low erythropoietin production
- Rest periods
- Admin anti-anemic agents
- H&H

81
Q

CKD s/s
SATA
- FVD
- Hypokalemia
- Metabolic acidosis
- Mineral and bone disorder
- HTN
- Anemia
- Hyperlipidemia
- Malnutrition

A

X- FVE
X- Hyperkalemia
- Metabolic acidosis
- Mineral and bone disorder
- HTN
- Anemia
- Hyperlipidemia
- Malnutrition

82
Q

CKD care
o Keep HTN and DM controlled
o Be mindful of nephrotoxicity drugs
1.
2.
o Be mindful of nephrotoxicity Contrast dye
 Admin _________ – prior to contrast to lower risks
 Force fluids – prior to and after

A
  • Prevention
    o Keep HTN and DM controlled
    o Be mindful of nephrotoxicity drugs
     NSAIDS and aminoglycosides
    o Be mindful of nephrotoxicity Contrast dye
     Admin acetylcysteine – prior to contrast to lower risks
     Force fluids – prior to and after
83
Q

CKD diet
o High/Low calorie
o High/Low protein
o what type of CHO
o High/Low K
o High/Low PO
o High/Low Na
o High/Low Mg
o fluid rules?

A

o High calorie
o Low protein, High protein (after starting dialysis)
o Slow-release CHO
o Low K
o Low PO
low Na
low Mg
fluid restriction

84
Q

with CKD fluid restrictions – alternate ways to reduce thirst
(3)

A

o sucking on ice cubes, lemons, hard candy

85
Q

CKD teaching
importance of reporting
o weight gain > 4 lbs
o increasing BP
o SOA
o Edema
o thirst
o Increasing fatigue/weakness
o Confusion/lethargy

A

o weight gain > 4 lbs
o increasing BP
o SOA
o Edema
Xo thirst
o Increasing fatigue/weakness
o Confusion/lethargy

86
Q

At stage ____ CKD = kidney transplant or dialysis

A

5

87
Q

____________ – medical procedure used to filter waste products and excess fluids from the blood when the kidneys can no longer do it.
- substances move from______ through a semi-permeable membrane and into __________
- ___________concentrations are unique to each person and is selected based on what we want the movement to do

A

Dialysis

blood, a dialysis solution (dialysate)

dialysate

88
Q

_________ – movement of particles from higher to lower
_________– movement of water from lower to higher concentration
Goal = _________

A

Diffusion
Osmosis
equalize concentrations

89
Q

Types of dialysis
____________ – uses semi-permeable membrane (dialyzer) outside of the body
___________ – uses peritoneum (inside body) as semi-permeable membrane

A

Hemodialysis
Peritoneal dialysis

90
Q

which dialysis?
- uses semi-permeable membrane (dialyzer) outside of the body
- required 4 hours/3 days a week
- needs an access
o AV fistula - permanent
o AV graft – permanent
o Right IJ – temporary
o Femoral – temporary

A

hemodialysis

91
Q

4 hemodialysis access points
________- permanent
_______ – permanent
_______– temporary
________ – temporary

A

o AV fistula - permanent
o AV graft – permanent
o Right IJ – temporary
o Femoral – temporary

92
Q

AV fistula or AV graft?

  • permanent
  • artery and vein sewn together
  • most common – forearm anastomosis (surgical procedure that involves connecting two hollow structures, such as blood vessels) of own artery and vein
  • after procedure you have to wait ____ weeks for it to “mature” before you can use it for dialysis
A

AV fistula

6

93
Q

AV fistula care
T/F
1. avoid BP and IV sticks in arm with AV fistula
2. assess for peripheral perfusion distal to site
o pain
o cap refill
o numbness
o tingling
o pulse – radial and ulnar
3. assess for thrill q shift
o “feel the thrill”
o Palpate for turbulent blood flow
4. asses for bruit q shift
o sounds like wooshing
5. thrill and bruit are unexpected findings with AV fistula
6. notify HCP if you feel thrill or hear bruit

A
  1. T
  2. T
  3. T
  4. T
  5. F - expected findings with AV fistula = patency of AV fistula
  6. F - - notify HCP if you can no longer feel thrill or hear bruit
94
Q

AV fistula or AV graft?
- Looped graft under skin connecting vein and artery

A

AV graft

95
Q

AV fistula or graft?

  • adv = can be used quicker
  • disadv = body often recognizes it as foreign and it gets infected
A

AV graft

96
Q

AV fistula temp access
_________
Temporary access used until AV fistula has matured
- tunneled, cuffed cath
- 1-3 weeks
____________
Temporary access used until AV fistula has matured
- Up to 1 week
- Not ideal but used if they cant get anywhere else
- Minimal movement, bed rest likely

A

Right Intra Jugular (IJ)

Femoral

97
Q

which type of dialysis?
- uses peritoneum (inside body) as semi-permeable membrane
- need a catheter – tenckhoff most common
- required 4x every day, but can do it anywhere, don’t have to go to dialysis clinic

A

Peritoneal dialysis

98
Q

dialysis cycle or complete exchange
___________
- 2 L of dialysate is introduced into abdomen – bag is elevated
- 10 mins
____________
- Diffusion and osmosis taking place via semiperm membrane (peritoneum)
- time varies
_____________
- Emptying out of used dialysate by gravity flow – bag is on ground
- 15 – 30 mins

Phase 2: dwell
Phase 3: drain
phase 1: inflow “fill”

A

phase 1: inflow “fill”
- 2 L of dialysate is introduced into abdomen – bag is elevated
- 10 mins
Phase 2: dwell
- Diffusion and osmosis taking place via semiperm membrane (peritoneum)
- Dwell time varies
Phase 3: drain
- Emptying out of used dialysate by gravity flow – bag is on ground
- 15 – 30 mins

99
Q

how many types of hemodialysis?

how many types of peritoneal dialysis?

A

1
2 - automated and continuous ambulatory

100
Q

___________ peritoneal dialysis (APD)
- Uses cycler
- Automatically cycles times
- controls fill, dwell and drain phases
- used at night while sleeping
- does ~4 cycles/exchanges per night, about 1 hour per cycle

______________ peritoneal dialysis (CAPD)
- manual exchanges
- at least 4x/day
- dwell times vary
- may be able to disconnect from bag during dwell period

A

Automated
continuous ambulatory

101
Q
  1. _____________ catheter - A type of peritoneal dialysis catheter, used for continuous ambulatory peritoneal dialysis (CAPD).
  2. Healing period?.
  3. when can you shower?
  4. Daily or weekly catheter care required?
  5. use what to clean the catheter and exit site?
  6. when is dressing required?
  7. exam site for what?
A
  1. tenckhoff catheter
  2. Healing period: Requires 1-2 weeks for the exit site to heal.
  3. Hygiene: Once healed, showering and patting the area dry are allowed.
  4. Daily catheter care: Essential to prevent infections.
  5. Antiseptic solution: Use an antiseptic solution to clean the catheter and exit site.
  6. Dressing: During the healing period, a clean dressing should be applied. After healing, a dressing is not typically required.
  7. Site examination: Examine the exit site daily for signs and symptoms of infection, such as redness, swelling, tenderness, or drainage.
102
Q

hemodialysis, peritoneal, or complications of both?

  1. drastic and hard on body – difficulty adjusting, esp first few times
  2. infection
  3. decreased CO
  4. cardiac dysrhythmias
  5. disequilibrium syndrome - esp first few times
    o disorientation
    o seizures
    o H/s
    o Agitation
    o n/v
  6. air embolism
  7. FVE
  8. Respiratory insufficiency
  9. Abdominal pain
  10. Peritonitis
A
  1. H
  2. B
  3. B
  4. H
  5. H
  6. H
  7. P
  8. P
  9. P
  10. P
103
Q

pts first time getting hemodialysis and they c/o
o disorientation
o seizures
o H/s
o Agitat
suspect what?

A

disequilibrium syndrome - esp first few times

104
Q

___________
inflammation of the peritoneum
- major complication of PD or HD?
- caused by not aseptic technique

A

peritonitis
PD

105
Q

Adv –
- rapid removal of fluid, urea/Cr, K
Disadv –
- requires vascular access/may require heparin
- dietary/fluid restriction more stringent
- hypotension during dialysis

HD or PD?

A

HD

106
Q

Adv –
- less complicated
- home dialysis possible
- increased mobility
- fewer dietary restrictions
- less CV stress
- mimics normal urine routine more
Disadv
- risk for peritonitis
- requires high motivation
- body image issues – catheter

HD or PD?

A

PD

107
Q

dialysis care - HD, PD, or both?
1. monitor vitals
2. i&o
3. daily weight
4. monitor s/s complications
5. monitor lab values
6. daily cath/fistula care
7. no BP, injections, IV insertions on affected limb
8. do not use that IV access for anything except dialysis
9. turn side to side to facilitate drainage PRN
10. observe color of dialysate = dark, cloudy = Implies peritonitis

A

1 - 6 = Both
7. HD
8. HD
9. PD
10. PD

108
Q

drug therapy and HD
1. drug level build up = __________ possible
2. why is this assocaited with HD and not PD?
3. ________ may need to be altered to reduce chance of toxicity
4. some drugs cross semiperm membrane and are lost during dialysis = _________
5. be aware of which drugs are dialyzed out and admin when?

A

toxic levels
2. o since we only do it 3 days a week, drugs cant be excrete from body regularly, can circulate in active forms for prolonged periods = toxic
3. drug dose
4. subtherapeutic
5. after dialysis

sav nur 334 exam 3 week 4 (7 decks)

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