Final exam test 2 :)\ Flashcards
(99 cards)
1
Q
What labs are increased in CKD?
A
-BUN, Cr, potassium, phosphate, urine protein
2
Q
What labs are decreased in CKD?
A
- Calcium, H&H, Cr clearance, GFR
3
Q
Normal level Cr
A
0.5-1.2
4
Q
Normal BUN level
A
10-20
5
Q
Normal sodium level
A
135-145
6
Q
normal potassium level
A
3.5-5.0
7
Q
Normal phosphate level
A
2.4-4.5
8
Q
Normal calcium level
A
8.2-10.2
9
Q
normal pH
A
7.35-7.45
10
Q
Normal HgB in women vs men
A
women : 12-16
males: 14-18
11
Q
Normal HCt in women vs men
A
women: 38-44
men: 43-49
12
Q
Normal urine protein
A
6-8
13
Q
Normal Cr clearance
A
88-137
14
Q
Normal GFR
A
125
15
Q
What are foods high in potassium?
A
oranges bananas, melons, tomatoes, deep green veggies, beans, etc.
16
Q
What drugs can we give in hyperkalemia?
A
- IV Ca gluconate
-Kayexalate - IV glucose/insulin
17
Q
What are some foods high in phosphorus?
A
-milk, cheese, ice cream, yogurt
18
Q
What can be given to decrease phosphurus? and what do you educate the pt about these?
A
- calcium acetate and calcium carbonate (phosphate binders)
-Administer with each meal, watch for constipation!
19
Q
What drug can we give for hyperparathyroidism?
A
-calcimimetic agents
20
Q
What can we give to help with pt anemia in CKD?
A
- erythropoietin
- folic acid supplementation
21
Q
What vitamin can we also give for hyperphosphatemia to increase phosphate binding?
A
-Vitamin D
22
Q
What drugs should you not give in CKD?
A
-digoxin
-Demerol
-NSAIDS
-watch for nephrotoxic meds
like aminoglycosides
penicillin
tetracyclines
23
Q
What may you need to hold prior to dialysis?
A
- antihypertensives, water soluble meds
24
Q
What are ways to treat CKD?
A
-kidney transplant
-Renal replacement therapies
hemodialysis
peritoneal dialysis
continuous renal replacement therapy (CRRT)
25
What do we assess for pre-op kidney transplant?
- assess for ureteral reflux
to make sure there is no issues of urine backflow
26
What should we educate our patients who just had a kidney transplant??
- Immunosuppressive meds 4 life = cyclosporine
27
Hyperacute stage of kidney transplant rejection occurs how long after transplant?
- min-hours after transplant
-requires graft removal
28
Accelerated kidney transplant rejection occurs how long after transplantation.?
-2-4 days
-requires graft removal
29
Acute kidney transplant occurs how long after transplant?
- 1st 3 months after transplant
-manage with increased dose of immunosuppressants
30
What are s/s of kidney rejection?
-fever, swelling, tenderness, pain of transplanted kidney
-oliguria,edema, weight gain, fever, HTN
31
Chronic rejection s/s of kidney transplant include?
-progressive azotemia, proteinuria, and HTN
32
What is a fistula?
- surgical connection of an artery and a vein (nothing artificial!)
- must mature before beginning use for dialysis/ can take weeks/months
33
What is a graft?
-PROSTHEITC graft inserted between an artery and vein.
- can be used more quickly, doesn't last as long, prone to infection
34
A person is having restlessness, twitching, n/v, some confusion during dialysis what do we ?think is going on and what do we do?
- Disequilibrium syndrome
-stop/slow dialysis, infuse HYPERTONIC saline, albumin or mannitol to draw fluid from the brain.
35
What is our goal weight gaining between dialysis
- no more than 3 llbs
36
What are some contraindications for peritoneal dialysis?
- hx of abd surgery, diverticulitis, pancreatitis
- recurrent abdominal wall/inguinal hernias
- obesity
-pre-exsiting back problems/vertebral disease
-COPD
37
What do you do if peritoneal dialysis is not flowing well?
-REPOSITION PT
38
What diet to people with peritoneal dialysis want to be on?
- high protein
-increase fiber
- limit carbs if gaining weight
39
What foods do you want to limit with oxalate stones?
-chocolate, tea, peanuts , spinach, strawberries
40
What can you give for uric acid stones?
allopurinol
41
How do you manage calcium stones?
-restrict Ca
- restrict protein and sodium
- thiazide diuretics
42
What should you expect after an ESWL?
-hematuria
43
What type of education would we give to pt that have stones?
- TRIAL OF PASSAGE
-low sodium, low oxalate, high citrus diet
44
First sign you see with bladder cancer?
PAINLESS HEMATURIA
45
What are some general s/s of prostatitis?
-pain with/after ejaculating
-burning/urgency/frequency
46
What drug should a pt with prostatitis be on?
-flomax
47
What do you need to educate pt with prostatitis ab?
-avoid alc,coffee,tea,chocolate, caffeine
-avoid intercourse
-avoid sitting for long periods of time
48
Clinical manifestations of BPH
-dribble,urinary frequency, nocturia, decreased volume/force of stream.
49
How do we diagnose BPH
DRE- recommended for older men around 50
50
What are some risk factors for prostate cancer?
-age >50
-diet high in red meat, dairy, or fat
-family hx
-africans
51
Clinical manifestations of prostate cancer?
- blood in urine/semen
-painful ejaculation
52
How do you diagnose prostate cancer?
-DRE
-PSA
53
What should educate the pt on if they are on brachytherapy?
-avoid infants and pregnant women for 2 months
-strain urine -lost beads
-condom for 2 weeks
-may cause inflammation of the rectum, bowel, and bladder
54
What do we want to educate our pt who just had prostate surgery?
-avoid straining/heavy lifitng
-avoid long trips/strenous exercise
-avoid spicy foods, alc, and coffee
55
Clinical manifestations of testicular cancer?
- painless enlargement
- backache, abdominal pain, weight loss, weakness
55
Clinical manifestations of testicular cancer?
- painless enlargement
- backache, abdominal pain, weight loss, weakness
56
How do we diagnose testicular cancer?
- TSE
-TUMOR MARKERS
57
A person just got a suprapubic cath and is complaining of yellow crusty buildup what do we tell them to do?
-increase fluid intake.
58
What do we use for catheter care for a suprapubic cath?
soap and water BID
59
How long does the pt have to void after d/c suprapubic cath?
6 hours
60
Can we clamp a nephrostomy tube?
NO
61
What do we want to assess for after getting a nephrostomy tube?
-bleeding!
62
Pet scan pre-op care=?
-NPO 6-12 hours
-no caffeine, alc, or tobacco 24 hours before
63
Pre-procedure things for cerebral angiography = ?
- NPO @ MN, CONSENT
-assess for allergies to iodine, contrast dye, seafood
- assess for anticoagulant use = HOLD!!
64
Post-procedures for cerebral angiography?
-pulses distal to cath site q 15 min for first hour then hourly
-bedrest 6-12 hours/legs straight
-pressure on site for 15-20 min
65
EEG pt education prior to procedure?
- no caffeine 8-12 hours
-wash hair the night before and the morning of the test
- don't use hair products the day of the test to help with electrode attachment.
66
Lumbar puncture pre-procedure :
Post-procedure:
- anticoagulant/antiplatelet med are being help
-dont hold BP med!!
-obtain consent
-check pt,inr platelets
postprocedure: lay flat 4-6 hours
67
Decerebrate = what?
- extension, externally rotated
68
What are things to avoid in transsphenoidal surgery?
- vigorous coughing
-blowing the nose
-Sucking through a straw
-sneezing
69
What are some post op education for transsphenoidal surgery?
- elevate HOB 30-45 degrees 2 weeks after surgery
-avoid tooth brushing until incision healed
-room humidifier PRN
- Monitor nasal packing for blood or CSF drainage (Halo effect)
70
What signs do you see with meningitis?
+Kernig's sign: with thigh flexed, leg can't completely extend.
+Brudzinski's: as the neck is flexed, the knees flex involuntarily.
71
What are clinical manifestations of parkinsons?
-resting temor/pillrolling
- rigidity
-Bradykinesia
-postural instability
72
CSF of meningitis include
- increase WBC/protein
-decrease glucose
cloudy CSF
73
What are some clinical manifestations of cholecystitis?
- Pain (RUQ) = onset 30-1 hours after eating
- + murphy sign = pain on palpation of RUQ
-Steatorrhea= clay colored, oily stools
74
What are the risk factors for cholelithiasis??
-5 f's = fair, fat, over 40, fertile, female
75
Which stones can dissolve?
Cholesterol
PIGMENT STONES WILL NOT DISSOLVE
76
What happens in a cholecystography?
-pt takes PO dye 12 hours prior tot he study.
-ASK AB ALLERGIES!
77
What happens in an ERCP?
-diagnostic and treatment option
- NPO the night before
-take cardiac/HTN meds
78
What do we want to monitor for in a percutaneous transhepatic cholangiography?
-peritonitis
79
UDCA/CDCA does what?
- decreases large CHOLESTEROL STONES, DISSOLVES SMALL ONES, PREVENTS NEW STONES
-not for pt with frequent symptoms, duct obstruction, or PIGMENT STONES
80
How does MTBE work?
it is infused via a catheter directly into the gallbladder
-DISSOLVES CHOLESTEROL STONES
81
What are some clinical manifestations of acute pancreatitis?
-LUQ pain that can radiate to the back/shoulder blades
- deep and very sharp that is more intense after a meal high in fat/ETOH consumption
-N/V, cullens/grey turners sign= retroperitoneal bleeding
- fever, tachycardia, hypotension
82
What lab changes are we going to see with acute pancreatitis?
-amylase, lipase elevated
-increase ast/alt
-elevated glucose, urinary amylase, stool fat content
-DECREASED CALCIUM
83
A pt with acute pancreatitis should be __________.
TOTAL NPO!!!!
84
What medication are people going to be on that have chronic pancreatitis and what do we educate them about it?
Creon- take with every meal!
85
What risk factors are associated with pancreatatic cancer?
-smoking
-diet high in fat/red meats
- chronic pancreatitis
86
What is the most common cause of barium studies?
constipation = encourage fluids, laxatives, and/or enemas.
87
What does small bowel follow through show??
small bowel obstructions = chron's
88
What do we never do if we suspect a perforated colon?
-barium enema
89
Nursing considerations for barium enemas?
-NPO for 8 hours prior
-encourage fluids after & consider taking a laxative
-expect chalky stool for 24-72 hours posy exam
- pt may be on clear liquids the day before the test and have bowel prep ordered
90
What are some nursing considerations for endoscopy?
-NPO 8-10 hours
-NPO until gag reflex has recovered!
-may need to hold ASA and anticoagulation.
91
A person just had an ERCP and is vomiting severe abdominal pain and a fever what do we suspect?
-pancreatitis
92
A person just had an ERCP and is vomiting severe abdominal pain and a fever what do we suspect?
-pancreatitis
93
Which diagnostic test must pt be cooperative and assist with multiple position changes?
ERCP
94
Colonoscopy nursing considerations...
- NPO 6-8 hours prior to study - BOWEL PREP
- HOLD ASA / anticoagulation
- instruct pt to expect fullness, cramping/farting for several hours after procedure
95
#1 cause of stomatitis is what?
THRUSH
96
What is important to educate your pt on when they are using viscous lidocaine for stomatitis?
- aspiration if swallowed!!!
97
What should you NEVER do with neck dissection?
-NO ORAL TEMP
98
What is the gold standard surgery for hiatal hernia?
- nissen fundoplication
