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Med Surg 3 (theory class) > NURS 444 week 11 > Flashcards

NURS 444 week 11 Flashcards

(55 cards)

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1
Q

CKD

A
  • kidney damage:
    ` pathologic abnormalities
    ` markers of damage
    blood urine, imaging test
  • OR glomerular filtration rate (GFR) < 60 mL/min for >3 months.
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2
Q

5 stages of CKD based on GFR

A
  • normal GFR 125 mL/min
    `urine creatinine clearance test (24 hr urine)***
  • end-stage renal disease (ESRD) occurs when GFR <15 mL/min
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3
Q

Gold standard for CKD

A

24 hr urine test

  • creatinine < 100 not normal for anyone
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4
Q

Leading causes and CKD risk facors

A

HTN and DIABETES

risk factors:
- age> 60
- cardiovascular disease
- ethnicity
- exposure to nephrotoxic drugs
- family hx

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5
Q

Clinical Manifestations of CKD

A

itching
mental status change (main reason for dialysis) irritability
trouble sleeping

  • alterations in potassium, phosphate and calcium, sodium, MG
  • metabolic acidosis
  • anemia
  • bleeding tendencies
  • infections
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6
Q

Clinical manifestations of CKD: urine

A

Polyuria:
- due to inability of kidneys to concentrate urine
- most often at night
- specific gravity fixed around 1.010

Oliguria:
- occurs as CKD worsens (<400 mL/24 hr)

Anuria:
- urine output <40 mL/24 hr

Uremia:
- syndrome in which kidney function declines to the point that symptoms develop in multiple body systems
- occurs when GFR < or equal to 10mL/min

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7
Q

Metabolic Acidosis

A
  • headache
  • decreased BP
  • hyperkalemia
  • muscle twitching
  • warm, flushed skin (vasodilation)
  • nausea, vomiting, diarrhea
  • changes in LOC (^drowsiness)
  • ## Kussmaul’s
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8
Q

CKD diag. studies

A

> H&P
dipstick evaluation/ UA
albumin-creatinine ratio (first morning void)
GFR/ creatinine clearance (preferred measure of kidney function)
renal US
renal scan
CT scan
renal biopsy

** rule out tumor or congenital problem

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9
Q

CKD nursing management & Health promotion

A
  • prevention and early identification
  • reg. checkups
  • report changes in urinary appearance, frequency, and volume
  • identify individuals at risk
    history htn
    ` DM
    ` repeated UTI
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10
Q

CKD goals

A
  • preserve existing kidney function

> Treat CV disease
prevent complications
provide patient control

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11
Q

Conservative management CKD

A
  • extracellular fluid correction
  • nutritional therapy
  • erythropoietin
  • calcium supp., phosphate binders**
  • antihypertensive therapy
  • lower potassium
  • adjustment of drug doses
  • ambulatory and home care

phosphate binders to rid body of phosphate

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12
Q

restrictions for CKD

A

^ protein
^ water
^ sodium
^ potassium
^ phosphate

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13
Q

ACUTE care: nursing management for CKD

A

daily weight

daily BP

identify s&s of fluid overload

identify s&s of hyperkalemia

strict dietary adherence

med. education

motivate in patients management of their disease

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14
Q

Dialysis

A
  • initiated when GFR (or creatinine clearance) < 15 mL/min
  • used to correct fluid and electrolyte imbalances
  • remove waste products
  • treat drug overdose
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15
Q

Principles of Dialysis

A

Diffusion: greater to lesser

Osmosis: lesser to greater solute

Ultrafiltration: water and fluid removal. results when an osmotic gradient occurs across a membrane

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16
Q

Peritoneal dialysis:
solutions and cycles

A
  • Dialysate
  • available in 1-2 L plastic bags
  • glucose concentrations of 1.5%, 2.5%, 4.25%
  • electrolyte composition similar to plasma
  • solution warmed to body temp.
  • three phases of PD cycle:
    called an exchange
    1. inflow
    2. dwell
    3. drain
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17
Q

Peritoneal Dialysis complications

A

!! exit site infection
!! peritonitis
!! hernias
!! lower back problems
!! bleeding
!! pulm. complications
!! protein loss

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18
Q

Types of hemodialysis grafts

A
  • arteriovenous fistulae
  • AV grafts
  • temporary vascular access
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19
Q

Nursing Management:
Before Tx hemodialysis

A
  • complete fluid status assessment
  • condition of access
  • temperature
  • skin condition
  • medications
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20
Q

Nursing management:
During Tx hemodialysis

A

> alert for changes in condition
VS q 30 to 60 min. (or more frequent depending on patients condition)

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21
Q

HD complications

A

!! hypotension
!! muscle cramps
!! loss of blood
!! hepatitis

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22
Q

HD and peritoneal dialysis considerations

A
  • cannot fully replace hormonal and metabolic functions of kidneys
  • can ease many symptoms
  • can prevent certain complications
  • patient/family need clear explanations of dialysis and transplantation
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23
Q

Kidney transplantation

Study These Flashcards
A

B and O types have the longest waiting times

24
Q

Types of Renal Transplants

Study These Flashcards
A
  • Cadaver
    ` need heart beating
    ` HLA and ABO matched
    ` national ntwrk UNOS
  • living-related
  • living-unrelated
    preferred to be ABO compatible but not necessary (paired organ donation) preferable to have HLS match
    ` careful emotional and physical eval. of donor
25
Contraindications for kidney transplant
^ advanced malignancies ^ untreated cardiac disease ^ chronic resp. failure ^ extensive vasc. disease ^ chronic infection ^ unresolved psychosocial disorders
26
Nursing management: preoperative kidney transplant
kidney transplant recipient - emotional and physical preparation - immunosuppressive drugs - ECG - CXR - lab studies
27
nursing management: before incision in kidney transplant
- urinary cath placed - antibiotic solution instilled `distends the bladder ` decreases risk of infection - crescent-shaped incision - surgery 3-4 hours
28
nursing management" post-op kidney transplant
liver donor: - care is similar to laparoscopic nephrectomy - close monitoring of renal function - close monitoring of hematocrit - pain management Post-op care
29
nursing management: post-op care Recipient
- maintenance of fluid and electrolyte balance is first priority*** ex. output is 200 mL so we replace with 200 - large vol. of urine soon after transplant - urine output replaced with fluids mL by mL hourly 200mL out > 200 in - acute tubular necrosis (ATN) can occur (may need dialysis) - maintain catheter patency **we maintain graft of fistula just in case.
30
Hyperacute kidney transplant rejection
occurs minutes to hours after. - first 24-48h !! temp. >100 !! nausea !! headache !! pain !! no BUN/ creat. improvement ** take kidney out
31
Acute kidney transplant rejection
occurs days to months after transplant ** we increase amount of immunosuppressant drug which will usually resolve the problem
32
chronic kidney transplant rejection
process that occurs over months or years - irreversible - immunosuppressants won't work - go back to conservative care
33
Goals of immunosuppressive therapy for kidney transplant
- adequately suppress immune response - maintain sufficient immunity to prevent infection
34
Immunosuppressive med classes
+ cyclosporine + corticosteroid + monoclonal antibodies
35
Most common infection complications in the first month: Kidney transplant
~ pneumonia ~ wound infection ~ IV line and drain infections
36
Fungal infections with kidney transplant
~ Candida*** ~ cryptococcus ~ aspergillus ~ pneumocystis jiroveci
37
Viral infections with kidney transplants
~ CMV*** (one of most common) ~ Epstein-barr virus ~ herpes simplex virus
38
Kidney transplant: Complications
!! cardiovascular disease !! malignancies !! recurrence of original renal disease !! dyslipidemias are also something to manage !! regular screening is important**
39
Kidney transplant complications: Cardiovascular disease
- immunosuppression can worsen htn and hyperlipidemia - adhere to antihypertensive regimen
40
main cause for malignancies in kidney transplant
immunosuppressive therapy
41
Risks for BPH
- family hx - obesity - physical activity level - alcohol consumption - smoking - DM
42
BPH: obstructive symptoms
> due to urinary retention > decrease in calliber of force in urinary stream > difficulty initiating > intermittency > dribbling at end of voiding
43
BPH: irritative symptoms
associated w/ infection/ inflammation < urinary frequency/ urgency < dysuria < bladder pain < incontinence
44
BPH: Diagnostic studies
- H&P - dig. rectal exam DRE - UA w/ culture - PSA levels - serum creatinine - TRUS scan - uroflometry - cystoscopy
45
BPH: goals
restore bladder drainage relieve symptoms prevent/ treat complications
46
BPH: collaborative care
- goals - watchful waiting - dietary changes - timed voiding schedule
47
BPH: invasive therapy indications
+ decrease in urine flow sufficient to cause discomfort + persistent residual urine + acute urinary retention + intermittent cath. can reduce symptoms and bypass obstruction
48
Transurethral microwave therapy (TUMT)
+ outpatient procedure + microwaves directly to prostate through trans.urethral probe + heat causes death of tissue - post-op urinary retention is common - sent home w/ cath 2 to 7 days - antibiotics, pain meds, and bladder antipasmodics ***NOT APPROPRIATE WHEN RECTAL PROBLEMS EXIST - SE: bladder spasms, hematuria, dysuria, retention
49
BPH: Transurethral needle ablation (TUNA)
> ^temp . of tissue for necrosis > low-wave frequency used > affects only tissue in contact with needle > majority show improvement of symp. > outpatient: local anasth. and sedation > lasts 30 min w/ little pain and quick recovery > some require cath > hematuria up to a week COMPLICATIONS: urinary retention, UTI, irritative voiding symptoms
50
BPH: laser prostatectomy
- laser transurethrally to cut or destroy parts of the prostate - visual laser ablation (VLAP) ` takes several weeks for results ` urinary cath. inserted - contact laser techniques `minimal bleeding during and after ` fast recovery time ` patients may take anticoags. - photovaporization of the prostate
51
transurethral resection (TURP)
resectoscope through urethra to remove prostate 80 - 90% excellence relatively low risk hospital stay: spinal or general anesthesia bladder irrigated first 24 hr to prevent mucous and blood clots patients must stop anticoagulants before therapy
52
TURP complications
!! bleeding !! clot retention !! dilutional hyponatremia !! retrograde ejaculation
53
TURP: nursing pre-op care
+ use aseptic technique when using urinary cath. + administer antibiotics preoperatively + provide opportunity to discuss sexual dysfunction problems + inform of possible compications
54
TURP: nursing post-op care
+ bladder irrigation to remove clots and ensure drainage + admin. antipasmodics + teach Kegel + observe for infection signs + dietary intervention + stool softeners
55
Discharge instructions after TURP
~ cath. care ~ managing incontinence ~ 2-3 L fluid intake ~ s&s of UTI, wound infection ~ prevent constipation ~ avoid heavy lifting ~ refrain from driving, sex as directed

Med Surg 3 (theory class) (13 decks)

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