Nur 265 Exam 1 Questions And Answers
Updated Solution
Med Math
• The MD orders drug X at 6mcg/kg/min. Your pt weighs 175 pounds. Pharmacy sends the medication to the unit with a
concentration of 500mg in 250mL. What is your mL/hr?
ml/hr = 250 ml/500 mg X 1 mg/1000mcg X 6 mcg/kg/min X 1 kg/2.2 lb X 175 lb X 60 min/ 1 hr = 15750000/1100000
= 14.31 = 14.3 ml/hr
Labs
• Hbg 12-18
• Hct 37-52%
• WBC 5-10
• RBC 4.2-6.1
• PLT 150-400
• PT 11-12.5 sec (1.5-2.5x normal on Coumadin = 16.5-31.25 sec)
• INR 0.9-1.2 sec (Therapeutic level 2-3x normal = 1.8-3.6 sec)
• PTT 60-70 sec (1.5-2.5x normal on Heparin = 90-175)
• Na 135-145
• K+ 3.5-5
• Creatinine 0.5-1.2
• BUN 10-20
• Total Protein 6.4-8.3
• Albumin 3.5-5
• Mg 1.5-2.5
• Ca 9-10.5
• Cl 98-106
• Phosphorus 2-4.5
• GFR 90-120
• T1 0-0.1
• TT 0-0.2
• BNP >100 = HF
• Specific Gravity 1.005-1.030
Nephrotic Syndrome
• Increased glomerular permeability that allows larger molecules to pass through membrane.
• Signs & Symptoms
o Find in urine
▪ *Massive protein loss, severe proteinuria (> 3.5 g of protein in 24 urine sample)
▪ Lipiduria (Lipids in the urine)
o Find in Blood
▪ Hypoalbuminemia < 3 g/dl (low serum albumin[protein])
• Facial/periorbital edema (w/o albumin in cells, fluids leak out of vessels)
▪ Hyperlipidemia (high serum lipid levels) – due to low albumin
▪ Increased coagulation
• Treatment
o Depends on what the cause is, if immune give steroids
o Maintain fluid and electrolyte balance; daily weights, strict I&Os & abd girth measuring
▪ BP measures if enough fluid in cells
o Furosemide & bumetadine w/ albumin, plasma, dextran
o Sodium and Potassium restriction if labs warrant
o Anticoagulation to prevent renal vein thrombosis – Enoxaparin
o ACE inhibitors to decrease protein loss in urine
, o Cholesterol-lowering drugs
o Restrict protein intake to 1-1.5 g/kg/day w/ high caloric diet to prevent further protein breakdown, but give
enough to maintain muscle health.
• Increased r/f infection and slowed wound healing d/t protein deficit.
• Osteomalacia (body takes Ca from bones) – Ca is bound to albumin, so it is decreased too.
• key Features:
, o Sudden onset of:
▪ Massive proteinuria
▪ Hypoalbumiemia
▪ Edema (especially in the face)
▪ Lipiduria
▪ Hyperlipidemia
▪ Increased coagulation
▪ Reduced kidney function
Acute Kidney Injury (AKI)
• Rapid reduction in kidney function resulting in failure to maintain Fluid & Electrolyte & Acid Base Balance.
• Causes
o Pre-renal (most common cause) – Decreased blood flow to kidney w/ decreased GFR
▪ Hypovolemia, AMI, Hypotension, Vasodilation, Renal Artery Obstruction (clot)
o Intra-renal – Direct kidney damage, usually the tubules from nephrotoxic substances
▪ Antibiotics, heavy metals, poisons, contrast dye (CT scan), some analgesics, NSAIDS, Chemo
▪ Car accident, infection in kidney (pyelonephritis), Lupus, Cancer
▪ Damaged muscle can release heme & myoglobin, can cause tubule damage (rhabdomyolysis)
• Urine turns brown after traumatic kidney injury
o Post-renal – Backward pressure on kidney from obstruction somewhere in lower urinary system
▪ Bladder, Cervical, Colon or Prostate Cancer; Enlarged Prostate (hypertrophy); Kidney Stones;
blood clots in urinary tract.
• Phases of AKI
o Onset: Initial event to development of manifestations, immediate to week before sx.
o Oliguric – Anuric: 1-8 weeks, the longer lasts worse prognosis. Up to 2 mon diminished function
▪ Ex: NPO b4 surgery can cause
▪ Urine amounts <400cc/24hrs
▪ Gradual buildup of nitrogenous wastes (azotemia)
▪ Manifestations of fluid overload (Crackles, edema, decreased O2, increased RR, dyspnea)
▪ Elevated
• Serum Creatinine (0.6-1.2)
• BUN (10-20)
• K (3.5-5)
• Phosphorus (phosphate) (2-4.5)
• Magnesium (1.5-2.5)
▪ Decreased
• Na (135-145) – due to dilutional effect
• Ca (9-10.5)
• Metabolic Acidosis (7.35-7.45) - Bicarb to tx short term, dialysis to tx severe.
o Diuretic: Gradual or abrupt return of GFR & leveling of BUN, lose 1-2L a day of urine
▪ Hypovolemia and electrolyte imbalance (balance is key to survival)
o Recovery: Lasts 3-12 months
• Uremic Encephalopathy – Build up in urea and poison brain, decreased LOC
• Assessment is key to prevention and early intervention (restore volume)
o For pts at risk: Hypotensive, surgery, hypovolemic (burns, MVAs, hemorrhaging) or pt w/shock
• Seizure precautions (elevated BUN), infection prevention, High calorie, low protein, low K, Na, Mag, Phos.
• Renal Dialysis or CRRT if pt. can’t tolerate (runs 24 hrs at bedside)
• Meds
o Dopamine – Dilates renal artery and increases blood flow
o Diuretics – furosemide & mannitol for fluid overload but use cautiously
o Hyperkalemia acutely tx w/
▪ 1st – Calcium Gluconate
▪ 2nd – Glucose, insulin & bicarb combo
▪ Forces K intracellularly for a short time to prevent cardiac complications
o ABX to prevent infection (NO Aminoglycosides –mycin, tetracycline, Methicillin, Rifampin, Sulfonamides)
o Calcium Chanel Blockers may be used to tx AKI resulting from nephrotoxins
• Daily weights and strict I&O
Updated Solution
Med Math
• The MD orders drug X at 6mcg/kg/min. Your pt weighs 175 pounds. Pharmacy sends the medication to the unit with a
concentration of 500mg in 250mL. What is your mL/hr?
ml/hr = 250 ml/500 mg X 1 mg/1000mcg X 6 mcg/kg/min X 1 kg/2.2 lb X 175 lb X 60 min/ 1 hr = 15750000/1100000
= 14.31 = 14.3 ml/hr
Labs
• Hbg 12-18
• Hct 37-52%
• WBC 5-10
• RBC 4.2-6.1
• PLT 150-400
• PT 11-12.5 sec (1.5-2.5x normal on Coumadin = 16.5-31.25 sec)
• INR 0.9-1.2 sec (Therapeutic level 2-3x normal = 1.8-3.6 sec)
• PTT 60-70 sec (1.5-2.5x normal on Heparin = 90-175)
• Na 135-145
• K+ 3.5-5
• Creatinine 0.5-1.2
• BUN 10-20
• Total Protein 6.4-8.3
• Albumin 3.5-5
• Mg 1.5-2.5
• Ca 9-10.5
• Cl 98-106
• Phosphorus 2-4.5
• GFR 90-120
• T1 0-0.1
• TT 0-0.2
• BNP >100 = HF
• Specific Gravity 1.005-1.030
Nephrotic Syndrome
• Increased glomerular permeability that allows larger molecules to pass through membrane.
• Signs & Symptoms
o Find in urine
▪ *Massive protein loss, severe proteinuria (> 3.5 g of protein in 24 urine sample)
▪ Lipiduria (Lipids in the urine)
o Find in Blood
▪ Hypoalbuminemia < 3 g/dl (low serum albumin[protein])
• Facial/periorbital edema (w/o albumin in cells, fluids leak out of vessels)
▪ Hyperlipidemia (high serum lipid levels) – due to low albumin
▪ Increased coagulation
• Treatment
o Depends on what the cause is, if immune give steroids
o Maintain fluid and electrolyte balance; daily weights, strict I&Os & abd girth measuring
▪ BP measures if enough fluid in cells
o Furosemide & bumetadine w/ albumin, plasma, dextran
o Sodium and Potassium restriction if labs warrant
o Anticoagulation to prevent renal vein thrombosis – Enoxaparin
o ACE inhibitors to decrease protein loss in urine
, o Cholesterol-lowering drugs
o Restrict protein intake to 1-1.5 g/kg/day w/ high caloric diet to prevent further protein breakdown, but give
enough to maintain muscle health.
• Increased r/f infection and slowed wound healing d/t protein deficit.
• Osteomalacia (body takes Ca from bones) – Ca is bound to albumin, so it is decreased too.
• key Features:
, o Sudden onset of:
▪ Massive proteinuria
▪ Hypoalbumiemia
▪ Edema (especially in the face)
▪ Lipiduria
▪ Hyperlipidemia
▪ Increased coagulation
▪ Reduced kidney function
Acute Kidney Injury (AKI)
• Rapid reduction in kidney function resulting in failure to maintain Fluid & Electrolyte & Acid Base Balance.
• Causes
o Pre-renal (most common cause) – Decreased blood flow to kidney w/ decreased GFR
▪ Hypovolemia, AMI, Hypotension, Vasodilation, Renal Artery Obstruction (clot)
o Intra-renal – Direct kidney damage, usually the tubules from nephrotoxic substances
▪ Antibiotics, heavy metals, poisons, contrast dye (CT scan), some analgesics, NSAIDS, Chemo
▪ Car accident, infection in kidney (pyelonephritis), Lupus, Cancer
▪ Damaged muscle can release heme & myoglobin, can cause tubule damage (rhabdomyolysis)
• Urine turns brown after traumatic kidney injury
o Post-renal – Backward pressure on kidney from obstruction somewhere in lower urinary system
▪ Bladder, Cervical, Colon or Prostate Cancer; Enlarged Prostate (hypertrophy); Kidney Stones;
blood clots in urinary tract.
• Phases of AKI
o Onset: Initial event to development of manifestations, immediate to week before sx.
o Oliguric – Anuric: 1-8 weeks, the longer lasts worse prognosis. Up to 2 mon diminished function
▪ Ex: NPO b4 surgery can cause
▪ Urine amounts <400cc/24hrs
▪ Gradual buildup of nitrogenous wastes (azotemia)
▪ Manifestations of fluid overload (Crackles, edema, decreased O2, increased RR, dyspnea)
▪ Elevated
• Serum Creatinine (0.6-1.2)
• BUN (10-20)
• K (3.5-5)
• Phosphorus (phosphate) (2-4.5)
• Magnesium (1.5-2.5)
▪ Decreased
• Na (135-145) – due to dilutional effect
• Ca (9-10.5)
• Metabolic Acidosis (7.35-7.45) - Bicarb to tx short term, dialysis to tx severe.
o Diuretic: Gradual or abrupt return of GFR & leveling of BUN, lose 1-2L a day of urine
▪ Hypovolemia and electrolyte imbalance (balance is key to survival)
o Recovery: Lasts 3-12 months
• Uremic Encephalopathy – Build up in urea and poison brain, decreased LOC
• Assessment is key to prevention and early intervention (restore volume)
o For pts at risk: Hypotensive, surgery, hypovolemic (burns, MVAs, hemorrhaging) or pt w/shock
• Seizure precautions (elevated BUN), infection prevention, High calorie, low protein, low K, Na, Mag, Phos.
• Renal Dialysis or CRRT if pt. can’t tolerate (runs 24 hrs at bedside)
• Meds
o Dopamine – Dilates renal artery and increases blood flow
o Diuretics – furosemide & mannitol for fluid overload but use cautiously
o Hyperkalemia acutely tx w/
▪ 1st – Calcium Gluconate
▪ 2nd – Glucose, insulin & bicarb combo
▪ Forces K intracellularly for a short time to prevent cardiac complications
o ABX to prevent infection (NO Aminoglycosides –mycin, tetracycline, Methicillin, Rifampin, Sulfonamides)
o Calcium Chanel Blockers may be used to tx AKI resulting from nephrotoxins
• Daily weights and strict I&O
