Blue Print Flashcards by Amanda Hoeler

How to assess whether protein intake is sufficient for patients with CKD?

BUN and serum prealbumin levels
-want low protein before dialysis ~40g/day and increased once dialysis starts

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What are the medications used to prevent renal failure?

ACE inhibitors - slow progression of kidney disease
ARBs - “sartans” treat high BP
BB - help increase cardiac output to avoid HF
CCB- improve GFR & blood flow to the kidneys

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What is the desired outcome for lasix?

Increased urinary output
Decreased urinary retention
No crackles in lungs, reduced SHOB, lowered BP, decrease weight (no fluid overload)

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What are the signs of worsening renal failure?

Kussmaul respirations
Decreased GFR
Creatinine trending up

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What’s the priority assessment for patient with hyperkalemia?

monitor for cardiac issues!!!
Dysrhythmias

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What disorders can lead to pre-renal failure?

Shock/hemorrhage (hypovolemia)
Severe burns
HYPOtension/cardiac damage
atheroscolerosis
Anything that blocks blood flow to kidneys

** reduced or impaired cardiac output which impacts the kidneys

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What does respiratory distress look like in patients with RF?

Crackles, SHOB, suspense, increased RR, Kussmaul breathing

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Why does respiratory distress happen in patients with RF?

Fluid volume overload

or Kussmaul -> metabolic acidosis

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What do you do for RF patient with respiratory distress?

diuretics
raise HOB
O2
monitor

Kussmaul- raise HOB and give O2

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What is epogen?

Used for anemia treatment due to CKD

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Why do patients with CRF need epogen?

Helps the body create more RBCs because damaged kidneys aren’t making erythropoietin

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How to prevent worsening renal failure?

Monitor I’s & O’s
DW & daily BPs
Fluid restrictions
Medications: ACE, ARBs, BB
reduce: potassium, protein, sodium, phosphorus
Dialysis
Supplements
Avoid IV contrast, NSAIDs, other renals meds- metformin

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What is post renal failure?

physical obstruction
-kidney stones
-bladder cancer
-prostate cancer/BPH

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Who is at risk for post renal failure?

women with blood clots in urine
patients with prostate or bladder cancer

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What should be assessed with an AV fistula?

feel the thrill and listen for bruit Q4 hours
assess distal pulses
assess for signs on infection
avoid putting pressure on the site

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What are possible complications of AV fistulas?

thrombosis -> tPA
stricture-> balloon angioplasty
infection-> sterile
ischemia-> new fistula

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What is the relationship between HF and ARF?

poor cardiac output

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What are the goals between HF and ARF

improve cardiac output!
digoxin can do this

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What is CRRT?

continuous renal replacement therapy
only used in emergencies and on unstable patients
used to avoid large volume shifts but provides same results
need a 1:1 ratio in ICU
run over 24 hours

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Priority assessment finding during CRRT?

blood pressure
keep SBP > 90

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Kidney Transplant Education

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What are the priority assessment for patients with thrombocytopenia?

excessive risk for bleeding
look for bruises, petechiae, purpura and mucous membrane bleeding
microclots-> can cause the ischemia to kidney, cardiac, brain

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What are the platelet amount for increased risk of bleeding?

<50,000

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What are the platelet amount for increased spontaneous bleeding?

<20,000

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Relevance of leukemia and high WBCs?

risk for infection -> neutropenic precautions HANDWASHING no roomies aseptic technique pulmonary hygiene skin care no sick people allowed

What is pancytopenia?

Deficiency in all so RBCs, WBCs, platelets

RBC value

4-6 million

WBC value

4,500- 11,000

platelet value

150k to 450k

What is auto-contamination in patients at high risk of infection

overgrowth of normal flora which can lead to sepsis in immunocompromised **change gloves between wound care

What are the priorities in reducing infection in patients at risk for infection?

Handwashing aseptic technique pulmonary hygiene skin care neutropenic precautions

Lymphoma assessment findings

Typically asymptomatic enlarged painless lymph node/s B symptoms =poorer prognosis -night sweats, losing weight, high fever

Lymphoma education

HL- Reed-Sternberg cells -more predictable NHL- no Reed-Sternberg cells -less predictable

What are risk factors for lymphoma?

immune system issues (organ transplant, immunosuppressed, HIV) chronic infection exposure to dust, pesticides & insecticides

What are the priorities for low platelets?

bleeding precautions -> anemia

What is the importance of hydration with MM?

fluid imbalances????? excretion of excessive amounts of antibodies which are proteins too much proteins clog up blood vessels

Normal prealbumin levels

16 to 35

What is the importance of urinary output with burns?

monitor fluid balance- dehydration = increased risk r/t burns tells us if the kidneys are working

Assessment of breathing, airway patency in burns

PROTECT THE AIRWAY!!! ABCs intubate in large burns dehydrate = airway edema may occur after fluid given

Interventions/ priorities for difficulty breathing

protect the airway intubate apply O2, raise HOB, SpO2 monitor

What are the priority lab findings for patients with burns

airway??

Response for low urinary output in burn victims

Flush the foley because stuff gets stuck :(

Risk of burns/ prevention

smoke detectors adjust hot water turn pot handles away from reach safe use oxygen electrical chemical

Calculate TBSA

rule of nines

Calculate fluid administration for patients with burns

2mg x kg x TBSA % /2 then split into how many hours

Name this burn: redness, mild edema, only epidermis

superficial- thickness

Name this burn: blanchable, blisters, pink, moist pain

superificial partial

Name this burn: no blisters, moist, blanchable, wet, painful red

deep partial

Name this burn: dry, leathery, white, black or brown, no blanching, painless

full thickness

Name this burn: bone, tendon and muscle included

4th degree

What are standard orders for DKA?

Name this burn zone: Dead

maybe how you feel but the right answer is zone of coagulation

Name this burn zone: dead vs alive

zone of stasis

Name this burn zone: alive

zone of hyperemia

What is the common chemical used in burn dressings

Silver or Ag

What are the surgical indications for burns?

zone of coagulation so dead full thickness burn 4th degree burn

How to reduce burn convresion

1st 72 hours -proper fluids -good nutrition -early mobilization -avoid hypothermia

Why is it important to reduce the zone of stasis?

once tissue dies - > need surgery so the goal is to have the body heal itself

What are the criteria for ICU admission for burns?

intubation TBSA >20 % fluid resuscitation escharotomies medical comorbidities

Normal creatinine

0.6- 1.2

BUN

7-20

Hemoglobin

12-18

Hct

36-54

Sodium

135-145

Albumin

3.4-5.4

Prealbumin

15-36