Final Exam 😍 test 1 Flashcards
(91 cards)
1
Q
What is the purpose of giving LR?
A
To increase blood volume and increase urine output.
2
Q
What should we monitor for when giving D5NS?
A
hypervolemia (volume overload/pulmonary edema
- D5NS is a hypertonic solution
3
Q
Excessive use of LR can cause what?
A
-Metabolic Alkalosis
4
Q
Avoid giving LR in what type of patients?
A
Pt in renal failure!
5
Q
What type of pt can you not give hypotonic fluids to?
A
- hypotensive pt
-head injuries with increased ICP - pt w/ liver disease, trauma, or burns
6
Q
What is our go-to IV gauge?
A
20!!
- good for IV fluids/UO
7
Q
What gauge is preferred for blood?
A
18!!
8
Q
Tubing should be changed every how many days?
A
4
9
Q
Change IV bag how often?
A
24 hours!
10
Q
Clotting of an IV cath can be do to what things?
A
-kinked IV tubing
-very slow infusion rate
-empty IV bag
-failure to flush line
11
Q
What are s/s of hematoma?
A
- ecchymosis
-immediate swelling at site
-blood leaking from insertion site
12
Q
How do you treat a hematoma?
A
- d/c and apply direct pressure
-apply ice on/off 24 hours
-elevate extremity
13
Q
s/s of phlebitist?
A
- pain
-inflammation
-swelling
-warmth
-tenderness along the vein (Red streak)
14
Q
How do you treat phlebitis?
A
- d/c IV
- Apply warm/moist compress
15
Q
What are s/s of infiltration?
A
- coolness of skin
-edema at or below the site
-blanching/leaking at insertion site
-discomfort at site
-decrease in flow rate
-coolness of skin
16
Q
How do you treat infiltration?
A
- Stop infusion –> d/c IV
- warm compress to site
-elevate extremity
17
Q
What are signs of extravasation??
A
-pain/burning at site
-redness/blistering
-necrosis or sloughing
18
Q
What position do we put pt in with fluid overload?
A
-High fowlers
19
Q
What are s/s of fluid overload?
A
- Increase in Bp/HR
- bounding pulse
-JVD
-cough - weight gain
- edema
-intake >output
20
Q
What position do we put pt who are having an air embolism?
A
- left lateral Trendelenburg position
- to trap in RA!!
21
Q
What type of current is when the body becomes part of the circuit?
A
Alternating
22
Q
What type of current is when the body receives a one directional blast?
A
Direct
23
Q
What type of burn can cause immediate cardiac or pulmonary arrest?
A
Electrical
24
Q
What should we NOT do with a superficial partial burn?
A
– don’t apply ice/submerge in ice water!!
25
What is the main thing you want to watch out for with burn edema?
- compartment syndrome
26
What are the s/s of burn shock?
- hypotension, tachycardia, AMS, decreased urinary output
27
What starts to happen in the post- burn shock phase?
- volume increases, UO increases, BP normalizes
28
What tissue involvement is going on with superficial burn?
Epidermal
29
Wound characteristics for superficial burns?
-Mild erythema
-Dry/no blisters
-Blanches easily (blanchable)
30
What tissue is involved in superficial partial thickness burns?
entire epidermis and minimal damage to the dermis
31
Wound characteristics for superficial partial thickness burns?
-Closed or open/weeping blisters
-Pink/red
-Mild edema
-Blanches easily
32
What is the tissue Involvement with Deep Partial Thickness Burns?
Entire epidermis and deep layers of the dermis
33
What are some wound characteristics of Deep Partial Thickness Burns?
-Waxy appearance/ blisters
-Pink/red edges with white center
-Nonblanchable
-Decreased/absent capillary refill
34
What is the tissue involvement of a full thickness burn?
the entire epidermis and dermis is destroyed
35
What are the wound characteristics of a full thickness burn?
-Dry, leathery (eschar)
-Pale, white, brown, black, or charred
-No blanching
36
What do we suspect if a person has myoglobinuria?
Acute tubular Necrosis!!
Red/tea colored urine!
37
How do you prevent a paralytic ileus d/t a burn?
Enteral feeding!
38
What ulcer is specific to burn pt?
Curling ulcer
39
What is the main goal in the emergent/resuscitative phase?
-airway management
40
what are the fluid and electrolyte changes in the emergent phase of a burn?
-decreased blood volume/UO
-hyperkalemia
-hyponatremia
-metabolic acidosis
- elevated H&H
41
What is the main goal in the acute/intermediate phase?
Wound healing and infection prevention!
42
What are the f/e changes in the acute phase?
-increase UO
-hemodilution
-hyponatremia/hypokalemia
- metabolic acidosis
43
Somone just came in with a burn, and is now having a change in mental status, decreased urinary output, and a decline in respiratory function. What do we suspect?
Sepsis
44
A person is spitting up black sputum what do we suspect and do to treat?
- CO2 poisoning
- Immediate administration of 100% o2 via mask; intubate/ventilation
45
How do you treat an injury above the glottis?
-emergent intubation!!
46
What can an injury above the glottis cause?
-edema
- which then leads to mechanical obstruction
- which then leads to respiratory failure
47
How do we treat an injury below the glottis?
- intubation/vent/O2
48
What type of diet do we want burn pt to be on orally?
-High protein/high calorie
49
Before we perform a dressing change on a burn pt, what do we need to do first?
- premedicate at least 20 min prior to starting!
50
Tell me all you know about that silvadene! :)
- broad spectrum antibiotic
-easily penetrates eschar
-NOT FOR FACE
51
Which topical antibiotic therapy is best for the face, but it has minimal eschar penetration?
-bacitracin
52
How can we prevent hypertrophic scars?
- ace wraps
-pressure garments
-hydrate, massage, and protect healing skin
53
What does aldosterone do?
- increases Na resorption
-increases K excretion
54
What is the most accurate indicator to determine F&E imbalances?
WEIGHT
55
What does erythropoietin do?
-Stimulates/regulates RBC production
56
What does pain at the CVA indicate?
- kidney inflammation/infection
57
What is the first sign you see with PKD? and then what follows??
- HTN
-Hematuria
-lower back/flank
58
What type of medicines do you give for PKD?
- antihypertensives, antibiotics, pain medicines
59
What causes pyelonephritis?
- upwards spread of bacteria from bladder (untreated UTI!!/ Most common)
-increased risk incompetent valve/obstruction to flow
-hormonal changes and urinary retention associated w/ pregnancy
-long-term use of an indwelling catheter
60
How do we medically manage acute pyelonephritis?
- antibiotics for 2 weeks (Ciprofloxacin, gentamicin)
- FOLLOW UP 2 WEEKS LATER AND DO C/S!!
61
What is the main symptom with pyelonephritis?
- low back/flank pain
62
What labs do we see with chronic pyelonephritis?
- Low Cr clearance
- High BUN, Cr
63
What are some complications you can see with chronic pyelonephritis??
-ESRD
-HTN
-Renal Calculi
64
How do you treat Chronic pyelonephritis?
LT antibiotics!
65
Why does acute glomerulonephritis usually occur?
Secondary to strep infection
66
What are some clinical manifestations of acute glomerulonephritis?
-hematuria/proteinuria
-hypoalbuminemia
- Cola colored urine
-periorbital/generalized edema
-HTN
-elevated BUN and Cr
67
What kind of diet do we follow for acute glomerulonephritis?
- low protein, low Na, restrict fluids
68
What clinical manifestations do you see with chronic glomerulonephritis?
- feet swelling at night
-retinal change
-yellow/grey skin
-pericarditis
-s/s of HF
69
How do you diagnosis chronic glomerulonephritis?
- UA- specific gravity fixed at 1.010
-proteinuria
GFR < 50
- increased K
-metabolic acidosis
-anemia
-hypoalbuminemia
- increased phosphorus/ low calcium
70
How do we medically manage chronic glomerulonephritis?
- antihypertensives
-na and water restriction
- Diuretics
-adequate calories; high value protein diet
71
What are clinical manifestations of nephrotic syndrome?
- MASSIVE proteinuria
- frothy/foamy/ dark yellow urine
- hypoalbuminemia
- edema, soft-pitting
-hyperlipidemia
72
How do we diagnose nephrotic syndrom
- proteinuria >3.5 g
-WBC in urine
-kidney biopsy
73
What meds/diet do we want to be on for nephrotic syndrome?
- loop diuretics, ACE inhibitors, Albumin
-low sodium, protein, and fat diet
74
What is nephrosclerosis often caused by?
-HTN AND DM
75
What can cause pre-renal failure?
MI!!!
76
What do we see in the initiation phase of ARF?
- decrease in UO
- high urine specific gravity
- low urine Na
77
What phase typically doesn't respond to diuretics?
- Oliguric
78
What do you see in the oliguric phase?
- Urine output falls below 400 ml/day
- specific gravity fixed at 1.010
- reduced GFR
79
What happens in the diuresis phase?
- occurs when cause has been corrected
-gradual increase in UO, then high output
80
What are you at risk for in the diuresis phase?
-DEHYDRATION
81
What happens in the recovery stage?
- labs return to normal --> GFR may permanently be reduced.
82
What labs do you see with ARF?
-low sodium, calcium
- high phosphorus, potassium, elevated BUN, Cr.
-metabolic acidosis
83
What clinical manifestations do you see with ARF?
- Fluid volume overload (edema, pulmonary edema, JVD, SOB, HF, HTN)
84
What drugs can you give for ARF?
-kayexalate
-50% dextrose, insulin IV
Loop diuretics - lasix, bumex
osmotic diuretics (mannitol)
Bicarb replacement (metabolic acidosis)
85
What are the triad of symptoms for renal cancer?
-painless hematuria
-dull pain around kidney
-mass in flank area
86
What drug can we give for renal cancer?
-interleukin-2
87
What are we concerned about after kidney surgey?
- hemorrhage/abdominal distention
-monitor all drains seperatly!!!
paralytic ileus
infection
88
What are some nursing interventions for kidney surgery?
-educate pt to splint incision with hands or pillow when coughing
- encourage cough and deep breathing q1 hour
89
What is the normal Cr level?
-0.5-1.2
90
NORMAL HAMBURGER BUN LEVEL?
10-20
91
normal specific gravity level?
1.005-1.030
