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Adult Care 1 > Exam 3 > Flashcards

Exam 3 Flashcards

(85 cards)

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1
Q

What are the functions of the kidney?

A

Controls fluid and electrolyte balance, RBC formation, maintains BP, vitamin D activation, excretes fluid and waste

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2
Q

Why does the kidney activate vitamin D?

A

Needed to regulate calcium levels

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3
Q

How do the kidneys control fluid and electrolyte balance?

A

Secretion of aldosterone to promote absorption of water and sodium and excretion of potassium

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4
Q

What processes are included for the kidney’s regulatory function?

A

Glomerular filtration, tubular reabsorption, and tubular secretion

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5
Q

What is glomerular filtration?

A

Blood is passed through the efferent arteriole into the glomerulus and filtrate is collected within the bowman’s capsule. RBCs and albumin are not able to pass the glomerular membrane; not usually in urine. Filtered blood leaves the efferent arteriole leaving glomerulus

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6
Q

What is tubular reabsorption?

A

Water and electrolytes are absorbed into tubules into bloodstream

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7
Q

What is tubular secretion?

A

Substances move from the blood into the urine

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8
Q

How does the RAAs system work?

A

drop in BP/Blood volume—>kidney releases renin—>liver releases angiotensinogen —> renin acts on angiotensinogen=angiotensin 1–>ACE on angiotensin 1-> angiotensin 2->vasoconstriction and stimulates adrenal gland to release aldosterone->stimulates kidneys to absorb water and sodium into bloodstream—> increase Blood volume and BP

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9
Q

What are the main parts of the adrenal gland?

A

adrenal medulla and adrenal cortex

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10
Q

The adrenal medulla is…

A

The inner portion of the adrenal gland sitting on top of the kidney

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11
Q

The adrenal cortex is…

A

The outer portion of the adrenal gland sitting on top of the kidney

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12
Q

The adrenal medulla produces

A

Catecholamines such as epinephrine and norepinephrine

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13
Q

The adrenal cortex produces

A

Mineralcorticoids,glucocorticoids, and sex hormones like aldosterone, cortisol, and androgens and estrogen

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14
Q

What labs will be abnormal for a client with renal dysfunction?

A

BUN (10-20mg/dL) Creatinine(0.5-1.2mg/dL)
Specific Gravity (1.010-1.025)
Sodium (135-145 mEq/L)
Potassium (3.5-5mEq/L)
Calcium (9-10.5mg/dL)

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15
Q

What is BPH?

A

Benign prostatic hypertrophy; obstruction of urethra in males causing incontinence and urinary retention

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16
Q

What are the types of urinary dysfunction?

A

enuresis, stress incontinence,overactive bladder, reflex incontinence, mixedincontinence, overflow incontinence, functional incontinence, transient incontinence, gross total incontinence

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17
Q

UA test/procedure, education, interventions

A

UA looks at clarity, color, specific gravity, bacteria, ketones, glucose, pH,protein (leukocyte esterase and nitrites).
Educate 24 hour collection:Discard first voided specimen and note the time as the 24 hour collection start time. Refrigerate urine collection or store on ice. Void every drop into container.
Clean catch: wipe thoroughly side, side ,middle with clean wipe or circular for men inside to outside, void, stop then void into cup
Interventions: label with pt name, date, time, and initial

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18
Q

Ultrasound pre and post op interventions, education, complications

A

Assesses size of kidneys, image of ureters bladder, massses, cysts,calculi, and lower UT obstructions
Intervention: cleanse skin from gel post procedure.
Complications: minimal risk for client

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19
Q

CT pre and post op interventions, education, complications

A

Three-dimensional imaging of renal/urinary system to assess kidney size and obstruction, cysts, masses. IV contrast enhances images(iodine based)
Interventions: encourage fluid intake during day, stop metformin for IV contrast 24 hrs before, NPO after midnight, allergies?(iodine, seafood, eggs, milk, chocolate, asthma?), pregnant?
Post-oral fluids encouraged, KF labs before resuming metformin
Complications: media can cause AKI, risk of complication greater for older adults, dehydrated, Hx of renal insufficiency, nephrotoxic drugs

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20
Q

MRI
pre and post op interventions, education, complications

A

Useful for staging cancer, similar to CT
Interventions pre- client lay down and remain still for entire test, remove all metal (jewelry, accessories, those with implants/hardware MUST have an MRI safe card!!)
Education- must report implants and metal objects from surgeries and accessories- MRI=giant magnet!
Complications= poor imaging and more time if client is not still

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21
Q

Cystoscopy and cystourethroscopy pre and post op intervention, education, potential complications

A

Used to discover abnormalities of bladder wall (cystoscopy) and/or occlusions fourteen and urethra (cystourethreoscopy)
Pre interventions- pt receives anesthesia, check for s/s bleeding and infection, NPO after midnight, bowel prep
Intraprocedure: lithotomy position, monitor VS
Post- monitor VS and output, document color of urine (can be pink-tinged),encourage fluids to avoid infection and increase urine output
Irrigate catheter with NS if blood clots present or output is decreased/absent
Complications:possible UTI
Cloudy,foul-smelling urine
Urgency
Urine positive for leukocyte esterase, nitrites, sediment, and RBC’s

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22
Q

X-ray-KUB pre and post op interventions, education, potential complications

A

X-rayof kidney, ureters, and bladder
Visualization of structures, obstructions,renal calculi, strictures, calcium deposits
Interventions: ask client if pregnant, remove all jewelry and metal objects, clothes over area
no known complications

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23
Q

IV pyleogram pre and post op interventions, education, and potential complications

A

Identifies obstruction or structural disorders of the ureters and renal pelvis by instilling contrast media during a cystoscopy
Interventions-anesthesia , check for findings of bleeding and infection, NPO after midnight, bowel prep, monitor VS and output post, urine color, encourage oral fluids
Complications: UTI

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24
Q

Renal scan pre and post op intervention, education, potential complications

A

Assess renal blood flow and estimates GFR after Iv injection of radioactive material to produce scanned image of kidneys
Post-assess BP frequently during and after procedure if Client receives captopril during procedure to change blood flow to kidneys
-alert clients abt possible ortho hypotension following procedure if captopril given
-increase fluid intake if hypotension occurs and also to promote excretion of radioisotope
Complications:radioactive material does not cause nephrotoxicity
-clients are not at risk from radioactive material they excrete in urine

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25
Kidney biopsy pre and post interventions, education, and potential complications
Sample of tissue is taken from kidney either by needle aspiration or excision and sent for cytologic examination Pre-sedation and ongoing monitoring , review coagulation studies, ensure client has been NPO 4-6 hrs Post- monitor VS following sedation, assess dressings and output (hematuria),Hgb and Hct values, admin analgesia PRN Complications:hemorrhage,infection, cloudy/foul smelling urine, urgency, positive for leukocyte esterase and nitrites, sediment, and RBCs
26
Lithotripsy pre and post op interventions, education, and potential complications
“Shock wave therapy”, breaks stone into small pieces. Pre-local anesthesia/conscious sedation—>airway management Continuous monitoring of output and VS, bruising on affected side flank, occasional stents, educate pt that hematuria should subside in 24 hrs, some discomfort as fragments pass, NPO after midnight, increases fluid intake
27
Ureterolithotomy and nephrolithotomy pre and post interventions, education, and potential complications
28
Care and nursing interventions for nephrostomy tube
It prevents stones from passing through the rest of the tract -empty bag 4-5 times a day -change bag 3X a week -site dressing 2x a week and when soiled
29
UTI labs, S/S diagnostics, TX, care, education, meds
-UA - frequency,urgency, dysuria, oliguria, flank pain, suprapubic pain, hematuria -Bladder scan -Antibiotics, increased fluid intake, pain management -urinate after sex, maintain fluid intake, proper peri-care/hygiene -trimethoprim, sulfamethoxazole, nitrofurantoin
30
Renal calculi labs, S/S diagnostics, TX, care, education, meds
-Renal colic, flank pain(may radiate to abd, sportsmen, testes, vulva), dysuria and frequency, diaphoresis, pallor, N/V, tachycardia,oliguria/anuria -UA, KUB, IV pyelogram (contraindicated if urinary obstruction), CT/MRI(if cysteine or Uris acid calculi, cannot be seen on X-RAY), renal ultrasound/cystoscopy -strain urine and save for lab,increase oral intake 3L/day,encourage ambulating and hot baths, monitor/assess pain, I&O,urinary pH -opioids, NSAIDs, spasmolytics, abx -adhere to diet and meds
31
Polycystic kidney disease labs, S/S diagnostics, TX, care, education, meds
Clusters of fluid filled cysts in nephrons -UA; hematuria, proteinuria, bacteria=infection; gradual increase of creatinine, BUN, and creatinine clearance -fam Hx, anxiety/guilt,abd/flank pain, HA, HTN, abd girth, bloody/cloudy urine, constipation, renal lithiasis, hyponatremia, nocturia , progressive kidney failure -imaging(US, MRI, CT -HTN control, pain mngmt, infection prevention, constipation prevention; needle aspiration and drainage of cysts -monitor BP and weight daily; notify if elevated temp; adhere to low sodium diet; inform if changes in urine and BM
32
Hydronephrosis labs, S/S diagnostics, TX, care, education, meds
33
Hydroureter labs, S/S diagnostics, TX, care, education, meds
34
Pyelonephritis labs, S/S diagnostics, TX, care, education, meds
Infection and inflammation of kidney pelvis, calyces, medulla. E.coli=most common -UA and C&S; serum creatinine and BUN elevated;c-reactive protein elevated and ESR elevated -KUB, US, Gallium scan,IV pyelogram -pyelolithotomy, nephrectomy, urteroplasty, abx, pain analgesics -assess nutrition, I&O, pain, increase fluid intake 2L/day unless contraindicated , antipyretic
35
Glomerulonephritis (acute) labs, S/S diagnostics, TX, care, education, meds
Can lead to end-stage kidney disease, acute follows an infection -UA-RBCs and protein; GFR=low; cultures; 24 urine(protein assay); BUN and creatinine=inc; hyperkalemia, hyperphosphatemia, hypocalcemia -anorexia, N, dysuria, oliguria, fatigue, HTN, DB, crackles, wight gain, cola-colored urine, older adults=CHF S/S, S3 sound -kidney biopsy -fluid restriction? Abx, monitor BP and resp status, fluid and electrolytes, antihypertensives -complete full abx tx, monitor weight daily and report, adhere dietary and fluid restrictions
36
Glomerulonephritis (chronic)
Develops over period of 20-30 years, decreased protein assay in 24 hour collection urine
37
Bone healing process post fracture
Hematoma forms, necrosis of broken bone, fibroblasts invade clot and secrete collagen fibers=mass of cells and fibers (callus), callus bridges inside and outside together (2-6 weeks), osteoblasts invade callus and slowly convert bone
38
How many bones in human body?
206
39
Assessment techniques of musculoskeletal pt
Neurovascular assessment- 5P’s Respiratory and cardiac assessment, mobility/ROM assessment, imaging, pain
40
Types of fractures
Greenstick, compound, spiral, oblique, simple, open, closed, comminuted, compression, displaced, non displaced, complete, incomplete, spontaneous/pathologic, stress/fatigue, impacted
41
Open fx
Bone comes through the skin
42
Closed fx
Bone does not protrude through the skin
43
Comminuted fx
Multiple fractures resulting in multiple fragments/pieces
44
Greenstick fx
Incomplete, “hairline” fracture with a bend on the opposing side of the splinter
45
Compound fx
Open fx
46
Spiral fx
Corkscrew like break, results from twisting/spiral motion; most common in abuse cases
47
Simple fx
Single break with bone ends maintaining their alignment
48
Oblique fx
Fracture line is not horizontal or vertical, diagonal
49
Complete fx
Clean break all the way through the bone
50
Incomplete fx
Bone is not completely separated into two pieces
51
Displaced fx
Bone fragments are unaligned
52
Non displaced fx
Bone fragments are aligned
53
Spontaneous fx
Pathologic in nature, caused by a disease process
54
Pathlogic fx
I.e. osteoporosis fx, disease process causes it
55
Fatigue/stress fx
Continuous stress/use of the bone- “shin splints”.
56
Impacted fx
Trauma related
57
How are fx classified?
By the extent of soft tissue damage or the cause of the fx
58
Indications for traction and/or an external fixator
Manual “reset” is not successful and will not hold. This decreases pain, discomfort, and swelling in pt extremity while waiting for permanent surgery solution. External fixation Aligns and treats the break and holds it in place while bone heals-resetting the bone did not work.
59
Nursing interventions for pts with traction and/or external fixation
Monitor skin integrity, wound care, pin care, S/S infection, verity order for weight and confirm correct weight placement, do not allow weight to be on bed or floor-must be free floating, monitor circulation/cap refill, 5P’s above and below site
60
Fractures S/S, assessment, diagnostics, tx,care, education, labs, meds
S/S- obvious deformity, pain, redness, swelling, inability to move extremity/difficulty with great pain Diagnostics-X-ray,CT Tx- manual reset, surgery, casting/splinting, immobilizing, external/internal fixation Education- do not stick things inside cast(infection/skin integrity), strengthening may be needed, med education, S/S infection, RICE Labs- inc WBC, calcium, dec phosphorus
61
Carpal tunnel syndrome S/S, assessment, diagnostics, tx,care, education, labs, meds
62
What are the complications of fractures?
VTE(PE and DVT), infection, compartment syndrome, fat embolisms
63
What is the difference between a DVT and a fat embolism?
DVT- blood clot within the deep veins of the leg, can break off of vessel wall and travel in bloodstream to vital organs Fat embolism- cluster of fat globules that travel in the bloodstream
64
What is a fat embolus?
Cluster of fat traveling in the bloodstream
65
What is compartment syndrome?
Increased pressure within closed compartments, pressing/constricting the neurovascular complexes around the compartments
66
Compartment syndrome Nursing interventions and assessment
Assess-5P’s Pain,pallor, pulse, paresthesia, paralysis Cap refill Skin integrity, temp, texture Pain level Interventions-pain management
67
DVT/PE Nursing interventions and assessment
68
Fat embolism Nursing interventions and assessment
69
Infection (osteomyelitis) Nursing interventions and assessment
70
What are the two common types of casts?
Plaster and fiberglass
71
What are the 5 P’s used for?
Neurovascular assessment mnemonic
72
What are the NV 5 P’s?
Pain, pallor, pulse, paresthesia, paralysis
73
What vitamins and minerals are important for bone structure?
Phosphorus, calcium, Vitmin C
74
What hormones are pertinent to bones?
PTH and Calcitonin
75
Function of PTH
Increases serum calcium level by stimulating osteoclast activity
76
Function of calcitonin
Decrease serum calcium level by inhibiting bone reabsorption and promotes excretion
77
Thyroid hormones are…
Responsible for metabolism and growth hormone
78
What gland produces calcitonin
Thyroid
79
What gland produces PTH
Parathyroid gland
80
Emergency care for an extremity fx
Call 911! Apply pressure to stop bleeding, splint if able
81
Pt education and/or intervention for arthroscopic procedure
82
Carpal tunnel syndrome S/S, assessment, tx, nursing care,pt education, meds, prevention
83
Strain
A tear, or stress upon a tendon
84
Sprain
Tear or stress upon a ligament
85
Interventions and tx for sprains and strains
RICE Rest, ice, compression, elevation

Adult Care 1 (6 decks)

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