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NUR 405 (Med Surg II) > Exam 1 Review pt.3 > Flashcards

Exam 1 Review pt.3 Flashcards

(85 cards)

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1
Q

What is the most reliable indicator of renal function

A

Creatine

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2
Q

Creatine is

A

breakdown of muscle and protein metabolism and is released at a consistent rate

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3
Q

Non renal factors that affect BUN

A

High nitrogen tube feedings / high protein

GI bleed

Hydration status

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4
Q

Your patient has an high BUN. What is the next best nursing action?

A

Check creatine

If creatine is normal check H&H

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5
Q

What are the two electrolytes that are lower in renal disease

A

Calcium

Sodium

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6
Q

In kidney disease, decrease reabsorption of calcium leads to

A

Renal Osteodystrophy

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7
Q

Urinalysis procedure

A

Taken first morning and sent to lab ASAP

Analyze within one hour

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8
Q

Low specific gravity

A

<1.010 very well hydrated

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9
Q

High specific gravity

A

> 1.030 dehydrated

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10
Q

Creatinine Clearance

A

Approximates GFR

24 hour collection

Patient urinate at end of 24 hours

Keep refrigerated

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11
Q

GFR

A

Amount of blood filtered per minute by glomeruli

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12
Q

Estimated GFR calculation takes into consideration the patients

A

Age
Sex
Weight
Ethnicity

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13
Q

Clean catch urine confirms

A

suspected UTI and identities causative agents

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14
Q

Goal of cystoscopy

A

Inspect interior of bladder wall

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15
Q

Post procedure cystoscopy

A

Bruning
Pick tinged urine
Increase frequency

(Bright red blood not normal)

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16
Q

Intravenous Pyelogram

A

Check iodine sensitivity (contrast)

Expected flushed feeling

Force fluid afterwards

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17
Q

Retropylogram is done when

A

IVP does not visualize adequately

Pt allergic to contrast medium

Pt has decreased renal function

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18
Q

Renal Biopsy

A

Conset

Assess coags

NO ASA or warfarin

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19
Q

Renal Biopsy Post Procedure

A

Apply pressure dsg

Keep on affected side for 30-60 min

Best rest 24 hours

VS q 5-10 mins x 1 hr

No heavy lifting for 7 days

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20
Q

What is the gold standard exam for renal colic pain?

A

Non-contrast spiral CT

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21
Q

Upper UTI involves

A

parenchyma - pelvis - ureters

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22
Q

Upper UTI: Manifestations

A

Fever
Chills
Flank pain
(CVA tenderness)

(systemic)

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23
Q

Lower UTI clinical manifestations

A

Bladder emptying symptoms

Bladder storage symptoms

(not systemic)

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24
Q

Pyelonephritis

A

Inflammation (r/t infection) of renal parenchyma and collecting system

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25
Factors that predispose someone to UTI's
Neurogenic bladder Kidney stones Female urethra Aging DM Constipation Pregnancy Delay in urination
26
UTI in Older Adults
Non localized abdominal discomfort Cognitive impairment Generalized clinical deterioration
27
Pyelonephritis Diagnosis
Mild fatigue to sudden onset of chills - fever - vomiting CVA tenderness Urinalysis WBC w/ diff Blood culture
28
Nephrolithiasis
Kidney stone
29
When a ureter is totally obstructed for any reason, what is indicated?
Nephrostomy tubes
30
Pain or drainage around nephrostomy tube exit site indicates
possible blockage
31
Internal lithotripsy
(direct) Cystoscopy Percutaneous Laser
32
External lithotripsy
(indirect) Stones broken down and washed out Non invasive
33
Lithotripsy possible complication
Hemorrhage Infection Retention of stone
34
Kidney Stone Nursing Implementation
Adequate fluid intake Turn q 2 Stand/sit to void Ambulate often Monitor passing of stones
35
Ileal conduit
Procedure of choice if significant comorbidities Incontinent Stoma visible and need collecting device Mucus secretion is normal
36
Cutaneous Diversions
Continent Kock Pouch Catheterization required
37
Orthotopic Neobladder
Continent procedure of choice Internal reservoir connected to native urethra Most closely approximates normal voiding
38
Post Opp Urinary Diversion Surgery
NPO and NG to LWS ileal conduit: -Properly fitting appliance and meticulous skin care -Expect mucus in urine Stoma assessments Continent diversion: -Cather every few hours at first than 4-6 hours Neobladder: -Void be relaxing sphincter and bearing down every 2-4 hours -Will not feel urge
39
AKI: GFR UOP BUN Cr
GFR <90 ml/min UOP <30 ml/hr BUN >20 mg/dL Cr >1.2 mg/dL
40
Causes of AKI
Pre renal -Decrease perfusion -Hypotension Intra renal -HTN -Toxin -DM -Drugs Post renal -Blockage past renal pelvis
41
AKI Clinical Manifestations
Oliguria Begins 1 day after hypotensive event FVE Metabolic acidosis Hyponatremia Hyperkalemia Waste product accumulation Neurologic disorders
42
CKD Clinical manifestations
Edema Hyperkalemia Hyperphosphatemia Hypermagnesemia Metabolic acidosis Anorexia Malnutrition Itching CNS changes Anemia (decrease erythropoietin) Renal osteodystrophy
43
Two major causes of CKD
Hypertension Diabetes
44
Collaborative Care CKD
Monitor fluid and electroylte levels I&O Daily weights Treat symptoms
45
Symptoms of CKD
Volume overload Hyperkalemia Metabolic acidosis Mineral and bone disorders HTN Anemia Dyslipidemia Malnutrition
46
Renal diet pre dialysis
Decrease protein Decrease potassium Decrease sodium Fluid restriction (when oliguric)
47
Teach patient with CKD that it is important to report
Weight gain > 4hrs Increasing BP SOA Edema Increasing fatigue / weakness Confusion/lethargy
48
HD VS PD review slides
48
diffusion
The movement of particles from an area of higher to lower concentration
49
osmosis
The movement of water from an area of lower to higher concentrations
49
Nursing management of FC imbalances
Dairly weights I&O Monitor: Lab Na Hct Urine serum osmolality
50
Fluid Volume Deficit (FVD)
Insensible water loss or perspiration Diabete insipidus Hemorrhage GI losses Overuse of diuretics Inadequate fluid intake Third spacing
50
Causes of FVE
Excess isotonic or hypotonic fluids Heart failure Renal failure Primary polydipsia SIADH Cushing syndrome Long term use of steroids
51
Lab finding that are impacted by FV status
BUN Na Hct Urine / serum osmolality
52
Hypernatremia causes
Excess sodium intake Inadequate water intake Excess water loss Diseases: -DI -Cushing -DM
53
Hyponatremia causes
Excess sodium loss -GI and Skin Inadequate sodium intake Disease: -SIADH -Heart failure -Kidney failure -Cirrohsis
54
Hypernatremia Manifestations
Change in mental status HA Irritability Difficulty concentarting
55
Hypernatremia Nursing Care
If water loss cause add water If sodium excess is cause, remove sodium Gradually achieve normal sodium level over 48 hours to avoid edema of cerebral cells
56
Hyponatremia Clinical Manifestations
Change in mental status Drowsy Restless Lethargy
57
Hyponatremia Nursing Care
If mild restrict fluids and loop diuretics If acute, small amount of IV hypertonic NS Avoid rapid correction
58
What precautions should someone with hyponatremia be in?
Seizure
59
Hyperkalemia Causes
Excess potassium intake -kcl+renal insufficiency Shift of potassium out of cell -acidosis -tissue catbolism Failure to eliminate potassium
60
Hypokalemia Causes
Excess potassium loss Shift of potassium into cells -insulin -alkalosis Lack of potassium intake -starving -No K+ in IVF if NPO
61
Hyperkalemia: Manifestations
EKG changes Muscle weakness Paresthesia Confusion
62
Hyperkalemia Nursing care
Stop intake Increase K excretion Force K back into cell EKG monitoring
63
Hypokalemia Manifestations
EKG changes Muscle weakness Paresthesia
64
Hypokalemia Nursing Care
Increase med intake Increase PO intake IV KCL
65
IV KCL safety alert
Always dilute never push Should not exceed 10 mEq/hr unless ICU Infiltration causes necrosis
66
Hypercalcemia Causes
Hyperparathyroidism Hematologic cancer
67
Hypocalcemia causes
Renal failure Parathyroid deficiency or removed Multiple blood transfusions
68
Hypercalcemia Manifestations
Sedative Confusion Seizures Coma
69
Hypercalcemia Nursing Care
Mild: Stop calcium meds/intake and maintain adequate hydration Severe: pamidronate = gold standard for cancer calcitonin injection which rapids increases renal excretion
70
Hypocalcemia Manifestations
Tetany Chvostek's Trousseaus EKG
71
Hypocalcemia Nursing Care
Mild: Diet with calcium rich foods and vitamin D Symptomatic: IV calcium gluconate
72
Hypermagnesemia Causes
Renal failure + increase mag IV mag in pregnant
73
Hypomagnesemia Causes
GI Loss Malnourishment Alcohol abuse
74
Hypermagnesemia Manifestations
Nerves and Muscles Slow down Lethargy Muscle weakness Decrease DTR
75
Hypermagnesemia Nursing Care
Avoid foods high in mag Promote FF if renal is okay Dialysis if CKD IV calcium gluconate
76
Hypomagnesemia Manifestations
Nerves and muscles revved UP Confusion Cramps Tremors Hyperactive C/T signs
77
Hypomagnesemia Nursing Care
Oral: Mylanta Magnesium sulfate IV: Mag sulfate Replace over several days
78
IV push mag sulfate can cause
severe hypotension
79
Hyperphosphatemia causes
Renal failure Laxatives Hypoparathyroidism
80
Hypophosphatemia causes
Malnutrition Chronic alcohol use Severe diarrhea
81
Hyperphosphatemia Manifestations
Hypocalcemia
82
Hypophosphatemia Manifestations
Hypercalcemia

NUR 405 (Med Surg II) (66 decks)

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