NUR 265 Exam 1 Study Guide
AKI - stages and interventions
s/s: anuria, low output, systolic BP, PP, orthostatic hypotension, thirst, blood
osmolarity; change in fluid balance, new sediment in urine (smoke or red color),
foul smelling. Report OP < 30 mL/hr for 2 hrs or dark amber urine.
Stage 1:
Serum Creatinine: 1.5-1.9 x baseline or 0.3 mg/dL over 48 hrs
Urine OP: <0.5 mL/kg/hr for 6-12 hrs
Stage 2:
Serum creatinine: 2.0-2.9 x baseline
Urine OP: <0.5 mL/kg/hr for 12 hr
Stage 3:
Serum creatinine: 1.0 x baseline or in crea. To 4.0 mg/dL
Or initiation of renal replacement therapy
Or in patients <18 yrs, in eGFR to <35 mL/min/1.73mm
Urine OP: anuria lasting for 12 HR
Or <0.3 mL/kg/hr for > 24 hrs
Phases:
1. Onset – trauma/injury
2. Oliguria – min. urine
3. Diuretics – a lot of urine
Measure I/O
Fluid electrolyte shift
Continue to perfuse kidneys
4. Recovery - 6 months – 1 yr
Azotemia: retention of nitrogenous waste in blood
Arterial blood gas; indications for obtaining an ABG; normal values for CO2,
Pa02, and Bicarb:
Indications for ABG: AMS/ Respiratory status
Normal ABG values:
, pH 7.35 – 7.45 (acid – base)
C02 35 – 45 (base – acid)
HC03 22 – 26 (acid – base)
Pa02 80 – 100 (problem = < 80)
Drugs that damage the kidneys Dietary guidelines for CKD patients:
Abx (mycins- vancomycin, gentamycin, etc. PEAK & TROUGH)
NSAIDS, acetaminophen, Metformin, Contrast Dye
(hold Metformin 48 hrs before giving contrast dye) need to pre/post fluid bolus
patient
Lowest dose of contrast medium
Metformin + Contrast dye = NO
CKD diet:
low protein, mod carb, fluid restriction, Na restriction (2G daily); K
restriction
add phosphate binder to every meal/snack;
iron supplement; iron rich foods; vitamins & water soluble vits.
Ca (careful about what kind of Ca they take in), Vit D supplement
monitor all serum levels; depends on wt. gain & BP
How do CKD patients look and smell?
Musty, edematous, uremia (uremic frost); pruritus
Hemodialysis: process, expected outcomes, patient signs/symptoms to expect
after dialysis, concerning signs/symptoms after dialysis:
Weigh patient before/after
Feel the thrill, hear the bruit – monitor AV Fistula (do nothing to it)
Serum electrolytes
On heparin during dialysis
Elevated temp after dialysis – dialysate warms blood
Risk for bleeding
BP low during dialysis – slow down/Trendelenburg patient
Disequilibrium syndrome – AMS, h/a, n/v; low BP; P
, Peritoneal dialysis patient:
aseptic technique, protein; prevent peritonitis
Warm dialysate (not in microwave)
1. Instill – 1-3 L; clamp
2. Fill -
3. Dwell – semi fowler/supine position
4. Drain – look for cloudiness, monitor for peritonitis (cloudy drainage, rigid,
call dr) *rigid abd = priority patient
**going slow in, going slow out – reposition patient
Pancreatitis: dietary guidelines, labs, expected signs/symptoms, concerning
signs/symptoms
Pancreatic enzymes activating prematurely
Diet – mod-high carb, avoid caffeine/alcohol/spicy foods ;
Pancreatic enzymes replacement therapy (PERT) w/
meals
amylase, lipase, trypsin; ALT/AST, BGL, WBC, Bili
Hypocalcemia – trousseau, chvostek’s sign
S/S: abd pain, RUQ, sudden onset pain, decrease/absent bowel sounds(Possible
ileus) Cullen’s sign/Turners sign; generalized jaundice; rigidity
hypotensive, tachycardia = pancreatic hemorrhage TX: NPO, IV fluid;
medications – dilaudid – IV ABX
Paracentesis:
V/S, Void, height, weight, HOB elevated
Measure drainage, record, document characteristics
If they lost weight = GOOD
Apply dressing to site; look for leakage
Cirrhosis: dietary guidelines, emergency complications, expected
signs/symptoms of hepatic encephalopathy, medications for management of
the condition:
PT/aPTT = prolonged
AST/ALT & ammonia
Bilirubin – total; conjugated(direct); unconjugated (indirect)
AKI - stages and interventions
s/s: anuria, low output, systolic BP, PP, orthostatic hypotension, thirst, blood
osmolarity; change in fluid balance, new sediment in urine (smoke or red color),
foul smelling. Report OP < 30 mL/hr for 2 hrs or dark amber urine.
Stage 1:
Serum Creatinine: 1.5-1.9 x baseline or 0.3 mg/dL over 48 hrs
Urine OP: <0.5 mL/kg/hr for 6-12 hrs
Stage 2:
Serum creatinine: 2.0-2.9 x baseline
Urine OP: <0.5 mL/kg/hr for 12 hr
Stage 3:
Serum creatinine: 1.0 x baseline or in crea. To 4.0 mg/dL
Or initiation of renal replacement therapy
Or in patients <18 yrs, in eGFR to <35 mL/min/1.73mm
Urine OP: anuria lasting for 12 HR
Or <0.3 mL/kg/hr for > 24 hrs
Phases:
1. Onset – trauma/injury
2. Oliguria – min. urine
3. Diuretics – a lot of urine
Measure I/O
Fluid electrolyte shift
Continue to perfuse kidneys
4. Recovery - 6 months – 1 yr
Azotemia: retention of nitrogenous waste in blood
Arterial blood gas; indications for obtaining an ABG; normal values for CO2,
Pa02, and Bicarb:
Indications for ABG: AMS/ Respiratory status
Normal ABG values:
, pH 7.35 – 7.45 (acid – base)
C02 35 – 45 (base – acid)
HC03 22 – 26 (acid – base)
Pa02 80 – 100 (problem = < 80)
Drugs that damage the kidneys Dietary guidelines for CKD patients:
Abx (mycins- vancomycin, gentamycin, etc. PEAK & TROUGH)
NSAIDS, acetaminophen, Metformin, Contrast Dye
(hold Metformin 48 hrs before giving contrast dye) need to pre/post fluid bolus
patient
Lowest dose of contrast medium
Metformin + Contrast dye = NO
CKD diet:
low protein, mod carb, fluid restriction, Na restriction (2G daily); K
restriction
add phosphate binder to every meal/snack;
iron supplement; iron rich foods; vitamins & water soluble vits.
Ca (careful about what kind of Ca they take in), Vit D supplement
monitor all serum levels; depends on wt. gain & BP
How do CKD patients look and smell?
Musty, edematous, uremia (uremic frost); pruritus
Hemodialysis: process, expected outcomes, patient signs/symptoms to expect
after dialysis, concerning signs/symptoms after dialysis:
Weigh patient before/after
Feel the thrill, hear the bruit – monitor AV Fistula (do nothing to it)
Serum electrolytes
On heparin during dialysis
Elevated temp after dialysis – dialysate warms blood
Risk for bleeding
BP low during dialysis – slow down/Trendelenburg patient
Disequilibrium syndrome – AMS, h/a, n/v; low BP; P
, Peritoneal dialysis patient:
aseptic technique, protein; prevent peritonitis
Warm dialysate (not in microwave)
1. Instill – 1-3 L; clamp
2. Fill -
3. Dwell – semi fowler/supine position
4. Drain – look for cloudiness, monitor for peritonitis (cloudy drainage, rigid,
call dr) *rigid abd = priority patient
**going slow in, going slow out – reposition patient
Pancreatitis: dietary guidelines, labs, expected signs/symptoms, concerning
signs/symptoms
Pancreatic enzymes activating prematurely
Diet – mod-high carb, avoid caffeine/alcohol/spicy foods ;
Pancreatic enzymes replacement therapy (PERT) w/
meals
amylase, lipase, trypsin; ALT/AST, BGL, WBC, Bili
Hypocalcemia – trousseau, chvostek’s sign
S/S: abd pain, RUQ, sudden onset pain, decrease/absent bowel sounds(Possible
ileus) Cullen’s sign/Turners sign; generalized jaundice; rigidity
hypotensive, tachycardia = pancreatic hemorrhage TX: NPO, IV fluid;
medications – dilaudid – IV ABX
Paracentesis:
V/S, Void, height, weight, HOB elevated
Measure drainage, record, document characteristics
If they lost weight = GOOD
Apply dressing to site; look for leakage
Cirrhosis: dietary guidelines, emergency complications, expected
signs/symptoms of hepatic encephalopathy, medications for management of
the condition:
PT/aPTT = prolonged
AST/ALT & ammonia
Bilirubin – total; conjugated(direct); unconjugated (indirect)
