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Med Surg 3 (theory class) > NURS 444 week 11 > Flashcards

NURS 444 week 11 Flashcards

1
Q

CKD

A
  • kidney damage:
    ` pathologic abnormalities
    ` markers of damage
    blood urine, imaging test
  • OR glomerular filtration rate (GFR) < 60 mL/min for >3 months.
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2
Q

5 stages of CKD based on GFR

A
  • normal GFR 125 mL/min
    `urine creatinine clearance test (24 hr urine)***
  • end-stage renal disease (ESRD) occurs when GFR <15 mL/min
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3
Q

Gold standard for CKD

A

24 hr urine test

  • creatinine < 100 not normal for anyone
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4
Q

Leading causes and CKD risk facors

A

HTN and DIABETES

risk factors:
- age> 60
- cardiovascular disease
- ethnicity
- exposure to nephrotoxic drugs
- family hx

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5
Q

Clinical Manifestations of CKD

A

itching
mental status change (main reason for dialysis) irritability
trouble sleeping

  • alterations in potassium, phosphate and calcium, sodium, MG
  • metabolic acidosis
  • anemia
  • bleeding tendencies
  • infections
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6
Q

Clinical manifestations of CKD: urine

A

Polyuria:
- due to inability of kidneys to concentrate urine
- most often at night
- specific gravity fixed around 1.010

Oliguria:
- occurs as CKD worsens (<400 mL/24 hr)

Anuria:
- urine output <40 mL/24 hr

Uremia:
- syndrome in which kidney function declines to the point that symptoms develop in multiple body systems
- occurs when GFR < or equal to 10mL/min

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7
Q

Metabolic Acidosis

A
  • headache
  • decreased BP
  • hyperkalemia
  • muscle twitching
  • warm, flushed skin (vasodilation)
  • nausea, vomiting, diarrhea
  • changes in LOC (^drowsiness)
  • ## Kussmaul’s
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8
Q

CKD diag. studies

A

> H&P
dipstick evaluation/ UA
albumin-creatinine ratio (first morning void)
GFR/ creatinine clearance (preferred measure of kidney function)
renal US
renal scan
CT scan
renal biopsy

** rule out tumor or congenital problem

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9
Q

CKD nursing management & Health promotion

A
  • prevention and early identification
  • reg. checkups
  • report changes in urinary appearance, frequency, and volume
  • identify individuals at risk
    history htn
    ` DM
    ` repeated UTI
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10
Q

CKD goals

A
  • preserve existing kidney function

> Treat CV disease
prevent complications
provide patient control

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11
Q

Conservative management CKD

A
  • extracellular fluid correction
  • nutritional therapy
  • erythropoietin
  • calcium supp., phosphate binders**
  • antihypertensive therapy
  • lower potassium
  • adjustment of drug doses
  • ambulatory and home care

phosphate binders to rid body of phosphate

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12
Q

restrictions for CKD

A

^ protein
^ water
^ sodium
^ potassium
^ phosphate

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13
Q

ACUTE care: nursing management for CKD

A

daily weight

daily BP

identify s&s of fluid overload

identify s&s of hyperkalemia

strict dietary adherence

med. education

motivate in patients management of their disease

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14
Q

Dialysis

A
  • initiated when GFR (or creatinine clearance) < 15 mL/min
  • used to correct fluid and electrolyte imbalances
  • remove waste products
  • treat drug overdose
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15
Q

Principles of Dialysis

A

Diffusion: greater to lesser

Osmosis: lesser to greater solute

Ultrafiltration: water and fluid removal. results when an osmotic gradient occurs across a membrane

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16
Q

Peritoneal dialysis:
solutions and cycles

A
  • Dialysate
  • available in 1-2 L plastic bags
  • glucose concentrations of 1.5%, 2.5%, 4.25%
  • electrolyte composition similar to plasma
  • solution warmed to body temp.
  • three phases of PD cycle:
    called an exchange
    1. inflow
    2. dwell
    3. drain
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17
Q

Peritoneal Dialysis complications

A

!! exit site infection
!! peritonitis
!! hernias
!! lower back problems
!! bleeding
!! pulm. complications
!! protein loss

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18
Q

Types of hemodialysis grafts

A
  • arteriovenous fistulae
  • AV grafts
  • temporary vascular access
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19
Q

Nursing Management:
Before Tx hemodialysis

A
  • complete fluid status assessment
  • condition of access
  • temperature
  • skin condition
  • medications
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20
Q

Nursing management:
During Tx hemodialysis

A

> alert for changes in condition
VS q 30 to 60 min. (or more frequent depending on patients condition)

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21
Q

HD complications

A

!! hypotension
!! muscle cramps
!! loss of blood
!! hepatitis

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22
Q

HD and peritoneal dialysis considerations

A
  • cannot fully replace hormonal and metabolic functions of kidneys
  • can ease many symptoms
  • can prevent certain complications
  • patient/family need clear explanations of dialysis and transplantation
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23
Q

Kidney transplantation

A

B and O types have the longest waiting times

24
Q

Types of Renal Transplants

A
  • Cadaver
    ` need heart beating
    ` HLA and ABO matched
    ` national ntwrk UNOS
  • living-related
  • living-unrelated
    preferred to be ABO compatible but not necessary (paired organ donation) preferable to have HLS match
    ` careful emotional and physical eval. of donor
25
Q

Contraindications for kidney transplant

A

^ advanced malignancies
^ untreated cardiac disease
^ chronic resp. failure
^ extensive vasc. disease
^ chronic infection
^ unresolved psychosocial disorders

26
Q

Nursing management: preoperative kidney transplant

A

kidney transplant recipient

  • emotional and physical preparation
  • immunosuppressive drugs
  • ECG
  • CXR
  • lab studies
27
Q

nursing management: before incision in kidney transplant

A
  • urinary cath placed
  • antibiotic solution instilled
    distends the bladder decreases risk of infection
  • crescent-shaped incision
  • surgery 3-4 hours
28
Q

nursing management”
post-op kidney transplant

A

liver donor:
- care is similar to laparoscopic nephrectomy

  • close monitoring of renal function
  • close monitoring of hematocrit
  • pain management Post-op care
29
Q

nursing management: post-op care
Recipient

A
  • maintenance of fluid and electrolyte balance is first priority*** ex. output is 200 mL so we replace with 200
  • large vol. of urine soon after transplant
  • urine output replaced with fluids mL by mL hourly
    200mL out > 200 in
  • acute tubular necrosis (ATN) can occur
    (may need dialysis)
  • maintain catheter patency

**we maintain graft of fistula just in case.

30
Q

Hyperacute kidney transplant rejection

A

occurs minutes to hours after.
- first 24-48h

!! temp. >100
!! nausea
!! headache
!! pain
!! no BUN/ creat. improvement

** take kidney out

31
Q

Acute
kidney transplant rejection

A

occurs days to months after transplant

** we increase amount of immunosuppressant drug which will usually resolve the problem

32
Q

chronic
kidney transplant rejection

A

process that occurs over months or years
- irreversible

  • immunosuppressants won’t work
  • go back to conservative care
33
Q

Goals of immunosuppressive therapy for kidney transplant

A
  • adequately suppress immune response
  • maintain sufficient immunity to prevent infection
34
Q

Immunosuppressive med classes

A

+ cyclosporine
+ corticosteroid
+ monoclonal antibodies

35
Q

Most common infection complications in the first month:
Kidney transplant

A

~ pneumonia
~ wound infection
~ IV line and drain infections

36
Q

Fungal infections with kidney transplant

A

~ Candida***
~ cryptococcus
~ aspergillus
~ pneumocystis jiroveci

37
Q

Viral infections with kidney transplants

A

~ CMV*** (one of most common)
~ Epstein-barr virus
~ herpes simplex virus

38
Q

Kidney transplant: Complications

A

!! cardiovascular disease
!! malignancies
!! recurrence of original renal disease
!! dyslipidemias are also something to manage
!! regular screening is important**

39
Q

Kidney transplant complications: Cardiovascular disease

A
  • immunosuppression can worsen htn and hyperlipidemia
  • adhere to antihypertensive regimen
40
Q

main cause for malignancies in kidney transplant

A

immunosuppressive therapy

41
Q

Risks for BPH

A
  • family hx
  • obesity
  • physical activity level
  • alcohol consumption
  • smoking
  • DM
42
Q

BPH: obstructive symptoms

A

> due to urinary retention
decrease in calliber of force in urinary stream
difficulty initiating
intermittency
dribbling at end of voiding

43
Q

BPH: irritative symptoms

A

associated w/ infection/ inflammation

< urinary frequency/ urgency
< dysuria
< bladder pain
< incontinence

44
Q

BPH: Diagnostic studies

A
  • H&P
  • dig. rectal exam DRE
  • UA w/ culture
  • PSA levels
  • serum creatinine
  • TRUS scan
  • uroflometry
  • cystoscopy
45
Q

BPH: goals

A

restore bladder drainage

relieve symptoms

prevent/ treat complications

46
Q

BPH: collaborative care

A
  • goals
  • watchful waiting
  • dietary changes
  • timed voiding schedule
47
Q

BPH: invasive therapy indications

A

+ decrease in urine flow sufficient to cause discomfort
+ persistent residual urine
+ acute urinary retention
+ intermittent cath. can reduce symptoms and bypass obstruction

48
Q

Transurethral microwave therapy (TUMT)

A

+ outpatient procedure
+ microwaves directly to prostate through trans.urethral probe
+ heat causes death of tissue

  • post-op urinary retention is common
  • sent home w/ cath 2 to 7 days
  • antibiotics, pain meds, and bladder antipasmodics
    ***NOT APPROPRIATE WHEN RECTAL PROBLEMS EXIST
  • SE: bladder spasms, hematuria, dysuria, retention
49
Q

BPH: Transurethral needle ablation (TUNA)

A

> ^temp . of tissue for necrosis
low-wave frequency used
affects only tissue in contact with needle
majority show improvement of symp.
outpatient: local anasth. and sedation
lasts 30 min w/ little pain and quick recovery
some require cath
hematuria up to a week

COMPLICATIONS: urinary retention, UTI, irritative voiding symptoms

50
Q

BPH: laser prostatectomy

A
  • laser transurethrally to cut or destroy parts of the prostate
  • visual laser ablation (VLAP)
    ` takes several weeks for results
    ` urinary cath. inserted
  • contact laser techniques
    minimal bleeding during and after fast recovery time
    ` patients may take anticoags.
  • photovaporization of the prostate
51
Q

transurethral resection (TURP)

A

resectoscope through urethra to remove prostate

80 - 90% excellence

relatively low risk

hospital stay: spinal or general anesthesia

bladder irrigated first 24 hr to prevent mucous and blood clots

patients must stop anticoagulants before therapy

52
Q

TURP complications

A

!! bleeding
!! clot retention
!! dilutional hyponatremia
!! retrograde ejaculation

53
Q

TURP: nursing pre-op care

A

+ use aseptic technique when using urinary cath.
+ administer antibiotics preoperatively
+ provide opportunity to discuss sexual dysfunction problems
+ inform of possible compications

54
Q

TURP: nursing post-op care

A

+ bladder irrigation to remove clots and ensure drainage
+ admin. antipasmodics
+ teach Kegel
+ observe for infection signs
+ dietary intervention
+ stool softeners

55
Q

Discharge instructions after TURP

A

~ cath. care
~ managing incontinence
~ 2-3 L fluid intake
~ s&s of UTI, wound infection
~ prevent constipation
~ avoid heavy lifting
~ refrain from driving, sex as directed

Med Surg 3 (theory class) (13 decks)

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