NUR 265 Exam 1

- What is nephrotic syndrome? A condition of increased glomerular permeability that allows larger molecules to pass through the membrane into the urine and then be excreted. - What are key features of nephrotic syndrome? - Massive proteinuria -Hypoalbuminemia -Edema (facial and periorbital) -Lipiduria -Hyperlipidemia -Increased coagulation -Reduced kidney function - In nephrotic syndrome, severe protein loss in the urine is greater than what? 3.5g in 24 hours - What is nephrotic syndrome treated with? -immunosuppressant agents (if immunity based). -ACE inhibitors (decreased protein loss in urine) -statins (improve blood lipid levels). -Heparin (used to treat vascular effects and improve kidney function) - Describe Prerenal AKI. Give examples. Decreased perfusion to kidneys. -NSAIDs -Severe dehydration -Renal artery stenosis -MI or HF resulting in low ejection fraction and low cardiac output -Blood/ fluid loss - Describe Intrarenal AKI. Give examples. Tissue damage to the actual kidneys. -Glomerulonephritis or inflammation of the glomeruli -Sepsis -Intrarenal bleeding -Pyelonephritis - Describe Postrenal AKI. Give examples. Obstruction that occurs after the kidney. -Enlarged prostate (BPH) -Bladder Cancer -Kidney stones - How do you determine the mean arterial pressure (MAP)? Systolic + (Diastolic*2) /3 - What is the MAP needed to perfuse the kidneys? 65 mmHg - What are examples of nephrotoxic drugs? -NSAIDS -Metformin -Diuretics -Antibiotics (especially -mycin) -Contrast dye - During the diuretic phase of AKI, what needs to be monitored? Watch for dehydration and make sure output is greater than input - What are the dietary restrictions for an AKI patient? -Low protein -Low sodium -Fluid restriction: mL day (for anything except perfusion problem) - What are the 2 most common causes of CKD? -HTN -Uncontrolled diabetes - What is azotemia? Nitrogenous waste build up - What are manifestations of uremia? •Metallic taste in mouth •Anorexia •Nausea/vomiting •Muscle cramps •Uremic frost on skin •Itching •Fatigue and lethargy •Hiccups •Edema •Dyspnea •Paresthesia's - What effects can CKD have on the cardiac system -HTN -Heart failure (major problem. Call the doctor) -Pericarditis - What effects can CKD have on the Integumentary system -Uremic frost - What are the dietary restrictions on CKD? -Protein (restrict early in disease process to preserve kidney function) -Potassium -Fluid -Sodium - Describe hemodialysis -3x a week- 4-5 hours -At risk for bleeding do to heparin -Extremely fatigued post. -Vitals and weight before and after -Slight fever post is normal. Monitor. - Describe peritoneal dialysis -Sterile procedure at home where catheter is placed into the abdomen -Wear a mask -Solution may be warmed using a heating bag or blanket, not microwave! -Make sure patient turns and repositions to mix solution in the cavity - Describe nursing care for an AV fistula. -Palpate and auscultate- bruit and thrill -Distal pulses -ROM- helps form the fistula -Monitor for infection -No heavy lifting or carrying -No pressure -Aneurysm can form at AV fistula site - Describe dialysis disequilibrium syndrome -Life threatening! (occurs if fluid is pulled off too fast) -S/S: restless, headache, decreased LOC, seizures, coma -Call a rapid immediately -Give barbiturates and anticonvulsants - What is cirrhosis? An extensive, irreversible scarring of the liver. - What are common causes of cirrhosis? -ETOH -Viral hepatitis (HEP C) - Autoimmune hepatitis -Drugs and chemicals (aetaminophen or anything else hepatotoxic) - What are early S/S of cirrhosis? -Enlarged liver -Fatigue -Weight loss -Anorexia -N/V -Abdominal pain -dry skin -brusing -spinder angioma -fector hep (funky breath) - What are end stage S/S of cirrhosis? -Ascites -Small liver -clotting disorder (bruising, GI bleed) -Jaundice -Elevated ammonia levels (give Lactulose) -Hepatic encephalopathy -Decreased bile production - What are the stages of hepatic encephalopathy? -Stage 1: personality changes, subtle things that may not be recognized -Stage 2: Continuing mental changes, mental confusion, disorientation to time, place, and person -Stage 3: Marked mental confusion, progressive deterioration -Stage 4: metabolic acidosis, unresponsiveness leading to death in most patients, unarousable - What causes hepatic encephalopathy? The buildup of ammonia in the body - Describe the physical assessment of an end stage cirrhosis patient. -Ascites -Jaundice -Coagulation problems -Fatigue -Spider angiomas -Petechiae -Liver flaps (asterixis) - What is a Blake-Moore tube used for? Esophageal Varices - Describe a paracentesis. -A procedure that is needed to get rid of the fluid in the abdomen -Have the pt. void before the procedure (ensures the bladder is out of the way and wont get punctured) -Patient is positioned in fowlers position in bed - What are the treatments for cirrhosis? Transplant is the only cure! - Describe the diet for a patient with cirrhosis. -Small frequent meals -High carbs -High protein -Moderate fats -Moderate vitamins - What medications are given to patients with cirrhosis? -Diuretics -PPI or H blockers -Broad spectrum antibiotics -FFP-coags -Platelets thrombocytopenia -lactulose - Describe acute pancreatitis. A serious and at times life threatening inflammation of the pancreas. It is caused by premature ativation of excessive pancreatic enzymes that destroy tissues and pancreatic cells (basically the pancreas starts digesting itself) - What are causes of acute pancreatitis? -Choleylithiasis -Trauma to pancreas -Chronic ETOH consumption -Toxic drugs - What are signs and symptoms of acute pancreatitis? -Middle epigastric/left upper quadrant -Boring pain that doesn't radiate, but rather goes through their body -Sudden onset -Radiates to back, left shoulder, and flank area -Jaundice- due to bilirubin increase -Nausea and vomiting - How is acute pancreatits diagnosed? -Cat scan first -#1 diagnostic is amylase and lipase labs - Describe the physical assessment of a patient with acute pancreatitis -Jaundice skin: due to bile duct obstruction -Gray-blue skin on abdomen/flank areas (2 essential assessments- call PHCP) (cullens & turners) -Guarding and rigidity -Ascites -Fetal position -Palpable mass - How is acute pancreatitis treated? -Rest the gut: insert an NG tube -Opioids for pain management - Describe chronic pancreatitis. Progressive,destructive disease of the pancreas that has remissions and exacerbation. Pain is not described as "boring" pain - What are the signs and symptoms of chronic pancreatitis? -LUQ pain (described as burning and gnawing) -abd tenderness -ascites -luq mass -wt loss -jaundice -dark urine -steatorrhea -3 diabetic Ps -muscle wasting - What needs to be taught about enzyme replacement? -Take enzymes with meals and snacks and follow with a glass of water -Administer enzymes after H2 blockers or PPI -Swallow without chewing to avoid irritation in the mouth -If can't swallow, place in gelatin casing and eat with apple sauce -Don't mix enzymes in protein-rich food! -Wipe your lips after taking enzymes -Don't crush enteric coated preparations -Follow up all labs - What type of diet is a pt with chronic pancreatitis on? Bland...all the time small meals increase protein avoid fatty - What is thrombocytopenia? Platelet numbers are below what is needed for blood clotting. Pt. will start bleeding spontaneously when the platelets fall below 20,000 - Describe bleeding precautions -Soft toothbrush -Electric razor -Fall precautions - What medication is administered in thrombocytopenia? Platelets if needed - What will a patient with thrombocytopenia look like They will have petichae and ecchymosis - What is Heparin induced thrombocytopenia (HIT)? Occurs as a paradocical/rebound effect of heparin, therefore the opposite action of heparin occurs (cloting). At risk for PE or DVT - What med is given to treat HIT? Argatroban (anti-coag) - What is Disseminated intravascular coagulation (DIC) caused by? A problem with the blood clotting process. Patients at risk= sepsis, placenta abruptio, blood transfusions - What medications are given for DIC? Heparin in the early stage and then clotting factors are given when hemorrhage is the primary problem - What is the normal range for Central venous pressure (CVP)? 4-12 - What is the normal range for pulmonary artery wedge pressure (PAWP)? 4-12 - What does it mean when the PAWP is increased/decreased? Increased= LSHF or hypervolemia Decreased= Hypovolemia or decrease in afterload - What is the formula and the normal for cardiac output? HR * SV (4-7) - What is normal for Cardiac index? 2-4 - What needs to be done when assessing chest pain? PQRST P-provoking? at rest or activity? Q-quality. What type of pain? R-radiating? S-severity? rate from 1-10 T-timing. How long? -What type of pain? sharp, dull, squeezing -Take a deep breath, does pain get better or worse with breathing? -Does pain feel better if you reposition? - Describe the difference between respiratory and cardiac pain. MI: Describes pain as dull or pressure ("elephant on chest"), big breath or repositioning doesn't change the pain Resp.: Sharp intermittent pain with SOB. Changing positions helps the pain - Describe MONA Morphine, Oxygen, Nitro, Aspirin Administer based on ABC's - What is the pre-cath procedure? -labs (check for prerenal disease) -consents -12 lead EKG -Shave prep -ALLERGIES and Medications - What is a normal troponin lab value? 0-0.1 - Describe post cath care. -Put them on tele monitor -Keep affected leg straight- keep clot in place -Keep HOB less than 30 degrees -Don't want to kink @ leg -Hematoma will burst and bleed! -Pulse check of affected extremity -IV fluids - Describe contraindications for thrombolytic therapy Absolute -Any prior intracranial hemorrhage -Cerebral vascular lesion -Known malignant intracranial neoplasm -Ischemic stroke within 3 months -Suspected aortic dissection -Active bleeding -Closed head or facial trauma with in 3 months Relative -Hx of poorly controlled HTN -BP greater than 180/110 -Pregnancy -Dementia, or other intracranial pathology -CPR (10 minutes+) or major surgery within 3 wks -Recent internal bleeding (2-4 weeks) -Noncompressible vascular punctures -Streptokinase 5 days ago or allergy to them -Active peptic ulcer -Anticoag use: Higher INR, higher bleeding risk - Describe an MI S/S of a female indigestion, chronic fatigue, inability to "catch their breath", aching, choking, strangling - Describe a CABG A Vein is taken out of the leg or artery out of an arm. It is attached at the root of the aorta, and beyond the blockage to have blood flow to the heart - Describe a post op CABG -rewarm slowly: if too quick- vasodilatation will occur and BP will drop -q15 min urinary output for 24 hrs -patient must be sitting up!! -maintain blood pressure and vitals -Monitor hemodynamics -Monitor for drainage!: If more than 150 mL/hour call rapid!!!! - PVC - - - VTACH - - VFIB - - - ASYSTOLE - AFIB - What is the #1 complication with a CABG? Sternal infection. Use antibiotics and assess REEDA - What is cardiac tamponade? It occurs when fluid quickly accumulates in the pericardium and causes a sudden decrease in cardiac output - What are nursing consideration for a cardiac tamponade? -Check chest tubes for acute decrease in drainage -They will have JVD with clear lung sounds -Muffled heart tones -Hypotension -Pulsus paradoxus -HOB 30-45 Emergent and must be fixed ASAP - What are the two types of surgeries to repair a broken valve? Bilogical: From pigs. Lasts 5-7 years. Body does not reject it Prosthetic: Man made, lasts up to 20+ years. Body will reject so coumadin is needed - In which type of cardiomyopathy is Digoxin contraindicated? Hypertrophic - Describe dilated cardiomyopathy The walls are very thin and everything is dilated - Describe hypertrophic cardiomyopathy the thickening of the heart muscle - How can cardiomyopathy be treated? Medically or surgically -Heart transplant -Rest -Medications to increase cardiac output -Diuretics -mitral val rep - What is pericarditis? Inflammation/ infection of the periardial sac - What are S/S of pericarditis? Chest pain -Sharp, stabbing -Behind breast bone -Left side of chest -Elevated with tripod position -SOB-oxygen -Low grade temp -Relieved with positioning -worse on inspiration -pericardial friction rub - What are S/S of endocarditis? -Fever- night sweats, malaise, chills, fatigue -Anorexia and weight loss -Cardiac murmur -Heart failure development -Petechiae -Osler's nodes -Splinter haemorrhage: black longitudinal lines on nails - What is endocarditis caused by? A bacterial infection: normally staph or strep - What long term antibiotic is the patient with endocarditis on? Usually Vanco for 6 weeks - What are the S/S of abdominal aortic aneurysm (AAA)? gnawing pain in abdomen, flank, or back lasting for hours, pulsating in upper abdomen. Listen for bruit NEVER PALPATE PULSATING ABDOMEN!!!- RUPTURE If pain worsens and moves down the leg it is an emergency!!! - What medication is given if the patient is in sinus bradycardia? Atropine. Give IV fluids and oxygen pacing - What is the treatment for sinus tachycardia? treat the underlying cause. Valsalva maneuver, stress management, beta blocker, diltiazem, dig - What medications are given if the pt is in atrial fibrillation? Amiodarone, diltiazem, metoprolol, digoxin - What is the normal range for H&H? Hemoglobin: M: 14-18 g/dL F: 12-16 g/dL Hematocrit: M: 42%-52% F: 37%-47% - What is the normal range for BUN? 10-20 mg/dL - What is the normal range for creatnine? M: .06-1.2 mg/dL F: 0.5-1.1 mg/dL - What is the normal PT range? 11-12.5 sec **1.5-2.5 times the normal on Coumadin - What is the normal INR range? 0.9-1.2 sec - What is the normal PTT range? 60-70 sec **1.5-2.5 times the normal on Heparin - What is the normal APTT range? 30-40 sec **1.5-2.5 times the normal on Heparin - What is the normal range for specific gravity? 1.005-1.030 - What is the therapeutic Digoxin range? 0.5-2 ng/mL - What is the normal platelet range? 150-400 m^3 - What is the normal albumin range? 50-80mg / 24 hrs at rest - What is the normal triglyceride range? M: 40-60 mg/dL F: 35-135 mg/dL - What is the normal glucose range? 70-110 mg/dL - After thrombolytic are administered, what needs to be watched? Watch for signs of bleeding - What is the treatment for angina pectoris? "NBC" Nitro, Beta Blockers, Calcium Channel Blockeprs - What are s/s of bacteria peritonitis? new fever & abd pain - What are s/s of DIC? petechiae ecchymosis prolonged bleeding severe uncontrolled hemorrhage everywhere black tips on fingers, toes, ears, nose - What is the cause of hemophilia? genetic disorder - What are s/s of hemophilia? prolonged bleeding bruising hematuria splenic rupture ICP Hemarthrosis