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Critical Care > GU exam 2 > Flashcards

GU exam 2 Flashcards

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1
Q

acute glomerulonephritis

A

caused by infection!!
-typically Strep that is untreated
-10 days after infection s/s
-seen in young adult and children

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2
Q

acute glomerulonephritis

A

edema / fluid retention
hematuria
decrease UO
mild HTN

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3
Q

acute glomerulonephritis labs

A

urinalysis : protein , blood , WBC
CMP :
-BUN increase
-Creatinine increase
-GFR decreased
-Albumin decreased
CBC : WBC increase

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4
Q

acute glomerulonephritis dx

A

history
presentation
lab findings

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5
Q

acute glomerulonephritis complications

A

fluid overload
HTN

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6
Q

acute glomerulonephritis potential complication

A

acute or chronic kidney disease with no tx

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7
Q

acute glomerulonephritis tx

A
  1. abx - penicillin
  2. diuretics - HTN
  3. fluid / sodium restrict
  4. low protein
  5. steroids
  6. plasmapheresis
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8
Q

acute glomerulonephritis management

A

monitor vitals
diet intake
meds

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9
Q

acute glomerulonephritis education

A

disease
meds : FINISH ALL ABX!!!
dietary restriction
infection prevention

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10
Q

polycystic kidney disease

A

excessive growth of fluid filled cysts in kidneys

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11
Q

polycystic kidney disease s/s

A

HTN!!!
hematuria
flank / low back pain
HA
UTI!!!
urinary frequency!!!
urinary calculi

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12
Q

polycystic kidney disease labs

A

urinalysis : blood and bacteria
CBC : H and H decrease
CMP :
-BUN increase
-Creatinine increase
-potassium increase
-calcium decrease
-phosphorous increase

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13
Q

polycystic kidney disease tests

A

renal US : shows renal cysts
abd. CT

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14
Q

polycystic kidney disease complications

A

HTN
hematuria

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15
Q

polycystic kidney disease potential complications

A

renal calculi / UTIs
heart valve abnormality
aneurysm
liver / GI cysts
RENAL FAILURE

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16
Q

polycystic kidney disease tx

A

ACE inhibitors / ARBS
non-narcotics - acetaminophen
palliative nephrectomy
UTI abx
RENAL TRANSPLANT

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17
Q

polycystic kidney disease education

A

immediately report INFECTION
diet
medication adherence

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18
Q

acute kidney injury

A

rapid loss of renal function that is reversible when treating underlying cause

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19
Q

azotemia

A

collection of nitrogenous wast products in blood

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20
Q

prerenal AKI

A

caused by decrease blood flow to kidneys
-ex : hypovolemia!!!

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21
Q

intrarenal AKI

A

direct damage to renal tissue impairing nephron functioning
-ex : prolonged ischemia , contrast dye , aminoglycoside antibiotics

***acute glomerulonephritis
**acute tubular necrosis

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22
Q

postrenal AKI

A

caused by obstruction below kidneys
-ex : urinary tract stones , tumors , BPH

**urine is backing up

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23
Q

oliguric phase

A

urine output < 400 mL / day
-does not respond to fluid challenges or diuretics

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24
Q

diuretic phase

A

urine output increases rapidly - up to 5L / day

**dehydration common and electrolyte imbalance

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25
AKI s/s
volume overload s/s -edema -SOB -HF -JVD -HTN -chest pain anorexia / nausea constipation / diarrhea confusion seizure
26
AKI labs
CBC : H and H decreased CMP : -increase potassium -increase phosphorous -increase phosphate -increase BUN -increase creatinine -decrease calcium -decrease sodium ABG : metabolic ACIDOSIS
27
AKI complications
HYPERKALEMIA fluid overload
28
hyperkalemia EKG
PEAK T WAVES -worsening = QRS complex is widening and loss of P waves
29
hyperkalemia protocol
1. Calcium Gluconate 2. D50 (IV glucose) 3. insulin 4. albuterol 5. bicarb 6. kayexalate
30
AKI tx
eliminate the cause diuretics sodium restriction potassium restriction dialysis = short term
31
AKI management
CARDIAC MONITOR fluid balance positioning / deep breathing
32
chronic kidney disease cause
diabetes and hypertension -IRREVERSIBLE
33
chronic kidney disease s/s
HTN yellow / grey skin color HF arrhythmia n/v HA fatigue amenorrhea chronic anemia confusion seizures
34
chronic kidney disease labs
CBC : H and H decrease CMP : -decrease sodium -increase potassium -increase phosphate -decrease calcium -decrease CO2 -increase creatinine -increase BUN ABG : ACIDIC urinalysis : protein
35
chronic kidney disease tests
CT and renal US
36
chronic kidney disease complications
fluid overload electrolyte imbalance dysrhythmias anemia fragile bones
37
chronic kidney disease tx
1. hyperkalemia protocol 2. HTN 3. anemia - erythropoietin IV only when active bleed or symptomatic 4. dyslipidemia - STATINS 5. hypocalcemia - Vit D and calcium supplement 6. renal osteodystrophy - phosphate binders (administer with each meal)
38
renal replacement therapy
hemodialysis peritoneal dialysis renal transplant
39
CKD education
disease process DO NOT miss dialysis dietary restriction : protein / phosphorous / sodium / potassium no nephrotic meds
40
renal transplant
improve life function NOT A CURE
41
renal transplant candidate
free of medical problems that increase risk -cardiac disease -cancer (metastatic) -chronic infection -alcoholism -chemical dependency NOT considered
42
post op renal transplant
1. evaluate function : I / O 2. immunosuppressive therapy : prevent tissue rejection , increases infection risk 3. ASSESS URINE OUTPUT hourly for 48 hours -abrupt decrease = rejection or acute tubular 4. necrosis 4. urine color : pink is normal , NOT FRANK RED 5. monitor fluid status : NO FLUID OVERLOAD -weigh daily
43
acute rejection
1 week - 2 years : mainly 2 weeks -oliguria or anuria -temp > 100 -increase BP -enlarged tender kidney -lethargy -elevated creatinine, BUN, potassium -fluid retention
44
acute rejection tx
increase immunosuppressant meds
45
acute tubular necrosis
hypoxic damage when transplant is delayed after kidneys are harvested -increase risk longer they wait for transplant
46
thrombosis
sudden decrease in UO can signal this
47
renal artery stenosis
cause HTN , balloon angioplasty or surgically repaired
48
renal cancer
occurs in males, AA more common -smoking -tobacco -first degree relative -obesity -HTN
49
renal cancer s/s
TRIAD : flank mass , flank pain , hematuria weight loss fatigue HTN fever anemia
50
renal cancer tests
US CT scan MRI **dx is made from biopsy
51
renal cancer complications
pain reduced circulation ESRD metastasis
52
renal cancer chemotherapy...
IS NOT EFFECTIVE -use immunotherapy and radiation
53
renal cancer surgery
radical nephrectomy
54
renal cancer post op
wound / incisions foley cath stent nephrostomy tubes
55
prostate cancer
higher rate in AA family hx diet high in red meat / calcium high BMI
56
prostate local disease
weak urinary stream urinary hesitancy sensation of incomplete emptying urgency / frequency urge incontinence UTI
57
prostate invasive disease
hematuria dysuria perineal / suprapubic pain ED incontinence s/s of renal failure hemospermia rectal pain
58
prostate cancer labs
PSA CRITICAL CUT OFF POINT is 4 ** >4 ng is a concern
59
prostate cancer dx
prostate biopsy , screening is controversial
60
prostate management
radiation -external beam -BRACHYTHERAPY cryotherapy ablative hormone therapy : testosterone suppression
61
brachytherapy
radioactive seeds in the prostate , MUST obtain from sex for 2 weeks , USE A CONDOM after 2 week period **keep partner safe from radiation
62
prostate cancer surgery
radical prostatectomy : removal of prostate and seminal vesicles **ALL result in impotence
63
prostate post op
1. aseptic wound care 2. manage bladder irrigation 3. meds : pain, stool softener , IV abx
64
prostate cancer education
brachytherapy sex safety signs of infection prevention
65
testicular cancer causes
brother with testicular cancer cryptorchidism (undescended testes) down's syndrome smoking
66
testicular cancer s/s
PAINLESS MASS pain, swelling, hardness in scrotum
67
testicular cancer labs
alpha-fetoprotein HCG ^^tumor markers
68
testicular cancer tests
US: makes sure not infection CT and x-ray : stage
69
testicular cancer surgery
ON ALL TESTICULAR CANCER radical orchiectomy - removal of affected testicle
70
seminomas
post surgery radiation OR chemo
71
nonseminomas
chemotherapy after surgery
72
testicular cancer management
pain monitor infection aseptic wound care
73
testicular cancer teaching
infection s/s sperm storage : sperm bank before tx self exams follow ups
74
renal replacement therapy
indicated for AKI or ESRD (end stage renal disease)
75
CRRT (continuous renal replacement therapy)
indicated for acutely ill AKI or severe fluid overload **HEMODYNAMICALLY UNSTABLE PTS
76
CRRT access
vascular access - central line -double or single lumen
77
CRRT process
uses a filter to move particles and blood is returned to patient **use anticoagulation to prevent clotting - HEPARIN is used as a bolus
78
CRRT mechanical complication
vascular access related -bleeding , hematuria , AV fistula , thrombosis -infection circuit complications -premature filter clotting -air embolism
79
CRRT hemodynamic complications
hypothermia hypotension - less risk than w/ hemodialysis
80
CRRT metabolic complications
metabolic acidosis / alkalosis hypernatremia hypophosphatemia hypomagnesemia hypocalcemia hypokalemia
81
CRRT nursing assessment
frequent hour vitals hourly assessment of volume filtrate
82
hemodialysis
can be performed outpatient, inpatient hospital settings
83
hemodialysis access
1. central venous double lumen: short term 2. AV fistula: surgical, cannot use this immediately 3. AV graft: do not have to mature , infection prone
84
AV fistula assessment
auscultate BRUIT palpable THRILL **must mature before use
85
hemodialysis
blood pumped, uses a membrane and dialysate solution
86
hemodialysis complication
hypotension : rapid removal of fluid muscle cramp, HA, nausea, dizziness, malaise bleeding infection dialysis associated dementia dialysis disequalibrium localized
87
dialysis associated dementia
progressive complication , r/t aluminum in dialysis
88
dialysis disequilibrium syndrome
due to rapid changes in extracellular fluid causing shift into brain **cerebral edema
89
hemodialysis infections
HIV hepatitis C / B cytomegalovirus
90
hemodialysis assessment
assess vascular access AV fistulas need THRILL and BRUIT neuro assessment
91
peritoneal dialysis
indicated for pts who desire more control or had vascular access problems **CAN be done at home
92
PD contraindications
1. multiple abd surgeries 2. recurrent hernias 3. obesity 4. pre-existing back problems 5. severe COPD
93
PD access
permanent indwelling PD catheter
94
Fill phase
room temp steril dialysate instilled
95
dwell phase
metabolic waste products and excess electrolytes diffuse dialysate remains in abd
96
drain phase
gravity drains dialysate out of cavity into sterile bag
97
continuous ambulatory peritoneal dialysis
dialysate infused into abd 4-5 times / day for around 4-6 hours -pts may be ambulatory , no machines
98
automated peritoneal dialysis
used overnight exchanges , dialysis free during day
99
intermittent peritoneal dialysis
30-40 exchanges per week (30-60 minutes each)
100
PD complications
peritonitis catheter infection hyperglycemia outflow problems respiratory compromise protein loss
101
peritonitis r/t PD
fever and abd pain cloud peritoneal effluent repeated infection = catheter removal
102
PD catheter infection
site redness, tenderness, drainage -abscess formation
103
PD abdominal pain
can be caused by too fast infusion of dialysate
104
PD hyperglycemia
glucose in dialysate can be absorbed into blood stream
105
PD nursing assessment
abdominal girth outflow complications

Critical Care (15 decks)

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