final exam Flashcards

Question

AKI prevention

Answer 1

AKI early identification Prevent dehydration Avoid hypotension Limit exposure to nephrotoxins Adequate fluid administration:Avoid over diuresis, maintain MAP, caution with nephrotoxic agents & IV contrast Preserve renal function Prevent complications Balance FVE and FVD

Answer 2

High carbohydrate diet (limit fat intake d/t ketone production) So carbs are used for energy, then protein can be used for tissue and muscle needs Protein- very individualized Limited to needed only, then increased when in diuretic phase

Answer 3

* All Types Monitor urine output and total I/O Weigh daily Cardiac monitoring ABG interpretation * Prerenal Administer IVF, blood products * Intrarenal Restrict fluids, renal diet Limit nephrotoxins (NSAIDs, chemo, contrast, aminoglycosides, etc.) * Postrenal Perform bladder scans, administer urine flow medications (tamsulosin, finasteride)

Answer 4

* Toxic syndrome caused by the release of myoglobin from skeletal muscle Causes AKI Can cause intra-renal injury or ATN * Traumatic Crush injuries, burns, electrocution, falls with long down time * Non-traumatic Illicit drugs, heat stroke, medications (i.e. statins), malignant hyperthermia

Answer 5

* Muscle cramps, weakness and dark (tea-colored) urine * Increased serum creatine kinase Indicative of muscle injury or disease * Increased myoglobin * Increased BUN/Creatinine, potassium * AKI

Answer 6

-IVF, dialysis -Monitor lactate Levels, CK, BUN/Creat, potassium -Cardiac monitor, frequent VS, I/O

Answer 7

* Ischemia:Pre-renal causes (shock) * Nephrotoxins: Antibiotics Heavy metals Poisons Anesthetics Radiopaque Contrast Dye Heme pigments: Myoglobin Rhabdomyolysis: Released from muscle tissue caused by damage Hemoglobin Intravascular hemolysis:blood transfusion reactions

Answer 8

* ATN is an AKI caused by damage to the kidney tubules -Damaged cells of epithelial tubules, kidney structures are damaged/ destroyed Tubules=tiny ducts that filter blood Epithelial cells take 7-21 days to regenerate * Most Common intrinsic AKI * ATN impairs release of ADH * U/A- Muddy brown casts present

Answer 9

Same as intrarenal failure -Support, IVF, avoid nephrotoxins, treat complications

Answer 10

Contrast (IV, PO, PR) is used in a wide variety of diagnostic imaging. Contains Iodine or gadolinium (gad) Molecular structure (3 ring) for tissue differentiation Agents higher than blood osmolality (275-299 mOsm/kg) are hyperosmolar and can cause shifts of both solutes and water in a variety of organs – especially the KIDNEYS

Answer 11

Needed when the pathologic changes of stage 4 and 5 CKD are life threatening or pose continuing discomfort to the patient When conservative therapies such as diet, drugs, and fluid restrictions are no longer effective alone Transplantation may be discussed at anytime HD/CRRT or PD

Answer 12

Most common renal replacement therapy used with ESKD & renal failure Dialysis removes excess fluids and waste products and restores chemical and electrolyte balance Passes patient blood through an artificial semipermeable membrane to perform the filtering and excretion functions of the kidney

Answer 13

AV Fistula: An internal anastomosis of an artery to a vein– located in Forearm– needs to mature for 2-4 months or longer AV Graft: Synthetic vessel tubing tunneled beneath the skin, connecting and artery and a vein– Located in forearm, upper arm, inner thigh– needs to mature for 1-2 weeks

Answer 14

* HD Catheter: Dual or Triple Lumen- Inserted in Subclavian, internal jugular, or femoral vein: can be used immediately after insertion- need chest x-ray to confirm placement * Subcutaneous Device: An internal device with two metallic access ports and two catheters inserted into large central veins: Located in Subclavian– Can be used immediately after insertion

Answer 15

Limb alert assessments: Bruit (swish heard) Thrill (vibration felt)

Answer 16

* Medications can be dialyzed out with HD and should not be administered just before or during HD * Vasoactive drugs can cause hypotension during HD (nitroglycerin, nitroprusside, etc.) * Coordinate meds with physician & HD RN * Post HD: * Monitor for s/s of side effects from treatment * Most common problems include: Hypotension h/a N/V Malaise Dizziness Muscle cramps

Answer 17

* Dialysis Disequilibrium Syndrome (fluid volume shifts) -Cerebral edema and increased ICP -Neurological symptoms (h/a, n/v, restlessness, decreased LOC, seizures, coma, or death) -Hypotension (circulatory collapse)

Answer 18

Allows exchange of wastes, fluids, and electrolytes to occur in the peritoneal cavity Slower than HD Less hazardous CKD patients can select HD or PD PD is great for patients who are difficult to obtain vascular access on, can’t tolerate anticoagulation, who are unstable, and those with a chronic infection **Not a treatment for AKI**

Answer 19

Sterile dialysate (1-2L) is introduced into the peritoneal cavity via an abdominal catheter and waste ducts are cleared by diffusion and osmosis

Answer 20

peritoneal adhesions extensive intra-abdominal surgery

Answer 21

Peritonitis (inflammation of peritoneum)- most common 60-80% of long-term pts Cloudy dialysate drainage, diffuse abdominal pain, and rebound tenderness Tx: antibiotics, heparin, maybe removal of catheter

Answer 22

Duodenum, jejunum, ileum

Answer 23

cecum, ascending colon, transverse colon, sigmoid

Answer 24

Large Intestine

Answer 25

life threatening

Answer 26

bowel obstruction (large or small) appendicitis diverticulitis

Answer 27

peritonitis sepsis and septic shock

Answer 28

spontaneous bacterial peritonitis (ie PD catheter)

Answer 29

perforated organs that leak contents (ie diverticulitis, trauma, infection. ingestion of sharp object)

Answer 30

immunocompromised infection (chemo/aids/hiv)

Answer 31

Immediate hypermotility followed by paralytic ileus (consider bowel sounds) * Peristalsis slows or stops in response to the inflammation * Toxins and wastes enter the Abdominal cavity and can enter the blood stream * Causing Sepsis and SEPTIC SHOCK * Fluid backs up in the small intestine causing dilation and can leak into the abdominal cavity * Air and Fluid collect in the Bowel

Answer 32

Bacteria or chemicals entering the abdominal cavity causing widespread inflammation * Fluid shifts from intestinal ECF to abdominal cavity, causing hypovolemia -HYPOVOLEMIC SHOCK (consider risks r/t FVD) * Bowel or appendix perforation, peritoneal dialysis contamination, leaked pancreatic enzymes

Answer 33

Pain * Mimics disorder causing the problem * Begins as diffuse abdominal pain that transitions to constant, localized and increasing intensity * Rebound tenderness and extremely distended abdomen * Very Rigid, board like abdomen * Anorexia, nausea and vomiting * Increased abdominal pressure causing vena cava flattening, gut ischemia, ARF/anuria, worsening acidosis, difficulty ventilating * Normal 0-5mmHg * Diminished peristalsis with eventual Ileus * Decreased or absent bowel sounds and absence of flatus and feces * Tachycardia * Hypotension (decreased CO) * Fever * Sepsis, hypovolemia, shock

Answer 34

Radiology: Abdominal Xray and CT Scan showing free air, bowel dilation and distension, bowel inflammation or edema/fluid in the abdomen, abscesses * Labs: Increased WBCs, disturbances in potassium, sodium and chloride

Answer 35

* NPO * Isotonic IVF-many LITERS * Pain management * Opioids * Electrolyte replacement * r/t AKI from decreased CO * Antibiotics * E.Coli, Klebsiella, Pseudomonas, Streptococcus * Broad spectrum until causative agent determined * Semi- Fowlers position * NG/OG tube to decompress the abdomen * Surgery: REPAIR CAUSE * Laparotomy * Pre/intra/post-op care needed * Drains and wound care

Answer 36

Inflamed and edematous appendix * Occlusion caused by stool, foreign body or infectious material * Causes ischemia and bacterial impedance * Gangrene * Perforation * Appendix ruptures and contents can center peritoneum * Occurs with 6 to 24 hours of appendicitis * Most common complication: peritonitis

Answer 37

Constant pain that progresses to RLQ pain (McBurney’s Point) * Rebound tenderness * Rovsing’s Sign- push on LLQ & pain occurs in RLQ * n/v * Anorexia * Fever

Answer 38

increased WBC, increased C-Reactive Protein (released from liver in response to inflammation) * Ultrasound showing enlarged appendix, CT scan * Surgical Intervention (exploratory) * Drainage of abscess * Removal of appendix (appendectomy)

Answer 39

Intensive and complete nutrition supplement * Hypertonic Solution with dextrose, minerals, electrolytes, protein * Given via a central line * Monitor I/O, monitor blood glucose

final exam Flashcards

(66 cards)