U1 ER/Renal Flashcards Preview

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Flashcards in U1 ER/Renal Deck (86):
1

Incidents that require reporting

Suspected abuse
Assaults
Car accidents
Communicable diseases (STDs, hepatitis, meningitis)
Food poisoning
Seizures
Death
Animal bites

2

Emergent (life-threatening) Tier

Respiratory distress
Chest pain with diaphoresis
Active hemorrhage
Unstable vital signs

3

Urgent (needs quick treatment, but not immediately life-threatening) Tier

Severe abdominal pain
Renal colic
Displaced or multiple fractures
Complex or multiple soft tissue injuries
New-onset respiratory infection, esp. pneumonia

4

Nonurgent (could wait several hours if needed without fear of deterioration) Tier

Skin rash
Strains & sprains
Colds
Simple fracture

5

Primary Survey
ABCDE

Airway/cervical spine
Breathing
Circulation
Disability
Exposure

6

Primary Survey
CPR

Compressions
Airway
Breathing

7

BP Indicator
Radial pulse

At least 80 mmHg

8

BP indicator
Femoral pulse

At least 70 mmHg

9

BP indicator
Carotid pulse

At least 60 mmHg

10

Disability
AVPU

Alert
Responds to voice
Responds to pain
Unresponsive

11

Heat exhaustion

Symptoms resemble the flu
Dehydration r/t heavy perspiration & inadequate fluid

12

Heat stroke

Body temp exceeds 104 degrees
Mental status changes
Hypotension, tachycardia, tachypnea

13

Exertional heat stroke

Sudden onset
Strenuous physical activity in hot, humid conditions

14

Classic heat stroke

Occurs over a period of time
Chronic exposure to a hot, humid environment

15

Heat stroke intervention

Cool the body
DO NOT give food or water
Call an ambulance

16

Heat stroke treatment

O2 therapy
0.9% saline
Foley
Aggressive cooling methods
Thorazine for shivering
Valium for seizures

17

Minimal envenomation

Fang marks
Local swelling & pain
No systemic reactions

18

Moderate envenomation

Fang marks
Swelling progressing beyond the site of the bite
Systemic S/S--NV, paresthesias, hypotension

19

Severe envenomation

Fang marks
Marked swelling of the extremity
Subcutaneous ecchymosis
Coagulopathy

20

Effects of pit viper envenomation

Local tissue necrosis
Massive tissue swelling
Hypovolemic shock
Pulmonary edema
Renal failure
Hemorrhagic complications

21

Snakebite first aid

Remove jewelry & restrictive clothing
**Immobilize affected extremity
Maintain at level of the heart
Keep pt warm & calm
NO stimulants

22

Snakebite treatment

O2 therapy
2 large-bore IV lines
Cardiac & BP monitoring
Tetanus prophylaxis
Opioids for pain
Wound care
Antibiotics

23

Rattlesnake Antivenom
Antivenin (Crotalidae)

Hyper-immune horse serum assoc w/ serum sickness

24

Rattlesnake Antivenom
Crotalidae polyvalen immune fab (CroFab)

Don't give to pts with allergies to papya
Caution w/ pts allergic to bromelain (pineapple derivative)
4-6 vials over 60 min
2 vials every 6 hrs for total of 18 hrs

25

Coral snake venom

Nerve toxin
Muscle toxin

26

Coral snakebite S/S

NV, headache, pallor, abominal pain
Ascending paralysis
Reduced perception of pain
Respiratory paralysis
Effects may not be seen for 12-18 hrs

27

Coral snake Antivenom

Micrurus fulvius from horse serum
3-6 vials given slowly over 2 hrs

28

Brown recluse bite first aid

Ice intermittently for 4 days
DO NOT use heat
Elevate affected extremity
Local wound care

29

Brown recluse bite treatment

Topical antiseptic; sterile dressing
Antibiotics
Tetanus prophylaxis

30

Black widow bite S/S

Latrodectism
Severe abdominal pain
Muscle rigidity
NV, weakness
Facial edema
Increased respiratory difficulty
Paresthesias

31

Black widow bite first aid

Ice pack
Support ABCs
Monitor for systemic toxicity

32

Black widow bite treatment

Opioids for pain
Muscle relaxants
Tetanus prophylaxis
Antihypertensives

33

Bark scorpion sting confirmation

Gentle tapping at the sting site that greatly increases the pain
Sting affects cranial nerves & musculoskeletal

34

Bark scorpion sting interventions

Ice pack for pain
Analgesics
Treat fever
Tetanus prophylaxis

35

Bark scorpion sting S/S

High fever
Hypertension
GI disorders
Tachycardia
Pulmonary edema
Paresthesias

36

Lightening injuries S/S

Asystole
Amnesia
Confusion/disorientation
Seizures

37

Long term lightening strike survivors

Chronic fatigue
Depression
HA
Chronic pain

38

Hypothermia

<95 degrees (35C)

39

Mild hypothermia

32-36C; 89.6-96.8F
Shivering
Muscular incoordination

40

Moderate hypothermia

28-32C; 82.9-89.5F
Obvious motor impairment & weakness

41

Severe hypothermia

<82F
Shivering stops
Pt may perceive warmth & undress
Bradycardia & hypotension

42

1st degree frostbite

Hyperemia (increased blood flow) to involved area
Formation of edema

43

2nd degree frostbite

Large fluid blisters develop
Partial thickness skin necrosis

44

3rd degree frostbite

Small blisters containing dark fluid
Affected body part is cool, numb, blue or red, & nonblanching

45

4th degree frostbite

No blisters or edema
Affected body part is numb, cold, & bloodless
Full thickness necrosis extends into muscle & bone
Gangrene develops

46

Early signs of frostbite

White, waxy appearance of exposed skin

47

Frostbite Treatment

Rewarming in water temp of 104-108 degrees
Tetanus prophylaxis
Debridement & amputation
Severe pain during rewarming (analgesics)

48

Altitude-related Illness

Elevations >5000 ft can produce physiologic responses

49

Acute mountain sickness (AMS)

Rapid ascent
Throbbing headache
Anorexia, NV
Irritable, apathetic
Acetazolamide (Diamox) to treat

50

High altitude cerebral edema (HACE)

Pt can't perform ADLs
Apathy
Change in mental status, confusion, impaired judgement

51

High altitude pulmonary edema (HAPE)

Usually in 1st 1-2 days of rapid ascent
Poor exercise tolerance
Fatigue, weakness
Persistent, dry cough
Cyanosis of lips & nail beds
Tachycardia & tachypnea at rest

52

AKI Prerenal causes

Any condition causing decreased blood flow to the kidneys
Arrythmias
Shock
Sepsis
Burns
Dehydration
Trauma

53

AKI Prerenal key features

Hypotension
Tachycardia
Decreased cardiac output
Decreased urine output
Lethargy

54

AKI Intrarenal causes

Physical, chemical, or immunologic damage directly to the kidney
Nephrotoxins
Poorly treated prerenal
Crush injuries
Transfusion reactions
Renal artery/vein thrombosis/stenosis
Sickle cell disease
Lupus

55

AKI Intrarenal key features

Edema, weight gain
Lethargy, confusion
Anorexis, NV
SOB, crackles, pulmonary edema
Hypertension, tachycardia, JVD
Oliguria/anuria

56

AKI Postrenal causes

Obstruction to the urine collection system
Bladder atony
Cervical, prostatic, ureter, bladder, or urethral cancer
Kidney stones

57

AKI Postrenal key features

Same as Intrarenal

58

AKI Onset Phase

Begins with precipitating event & continues until oliguria develops
LASTS HOURS TO DAYS
Increased serum creatinine & BUN

59

AKI Oliguric Phase

Urine output 100-400mL/24hrs
LASTS 1-3 WKS
Increased serum creatinine & BUN
Hyperkalemia, hyperphosphatemia, hypermagnesemia, & hypocalcemia

60

AKI Diuretic Phase

Sudden onset 2-6 wks after oliguric stage
Urine flow increases rapidly over a period of several days
Urine output up to 10L/day dilute urine
BUN level falls
Normal kidney tubular function reestablished

61

AKI Recovery Phase

Return to normal level of activity
Complete recovery can take up to 12 months
Lower energy level; less stamina
Kidney function may never return to pre-illness levels

62

AKI Imaging Assessment

Abdominal x-ray to check kidney size
Ultrasonography
CT scan WITHOUT contrast--identify obstruction or tumor
Renal scan--determine blood flow

63

AKI Interventions

Lasix to promote kidney flow
500-1,000mL NS infused over 1 hr
Calcium channel blockers
Kayexelate to reverse hypokalemia
High calorie diet--low in protein, sodium, & potassium
Fluid restriction
Dialysis

64

Chronic kidney disease

Progressive kidney injury
Kidney function DOES NOT recover
Azotemia--nitrogen-based wastes in blood
Uremia

65

CKD causes

Glomerular disease
Tubular disease
Urinary tract disease
Infection
Metabolic kidney disease

66

CKD
Reduced renal reserve

Unaffected nephrons overwork to compensate
No manifestations of kidney dysfunction
Kidney function is reduced if pt is stressed with infection, fluid overload, pregnancy, or dehydration

67

CKD
Reduced GFR

Kidney nephron damage
Reduced GFR--BEST measure
Increased output of DILUTE urine
Can cause severe dehydration if untreated

68

CKD
ESKD

Urea & creatinine build up in the blood
Kidneys can't maintain homeostasis
Severe F/E & A/B imbalances

69

CKD kidney changes

Abnormal urine production
Poor water excretion
Electrolyte imbalances
GFR is effective until 3/4 kidney function is lost

70

CKD metabolic changes

Decreased kidney function leads to increased creatinine levels

71

CKD electrolyte changes

Early CKD--hyponatremia
Later CKD--Na excretion is decreased, hypernatremia; ANY increase in K+ leads to hyperkalemia

72

CKD A/B balance

Early CKD--blood pH changes are small
Later CKD--respiratory alkalosis

73

Hemodialysis pt selection

Depends on symptoms, NOT GFR
Pts with fluid overload that doesn't respond to diuretics
Uncontrolled hypertension
Uremic signs--NV, decreased attention span, worsening anemia, pruritis

74

Complication of vascular access devices

Thrombosis (most common)
Stenosis
Infection--staph aureus
Aneurysm--repeated needle puncture at same site
Ischemia--decreased blood flow below the fistula
Heart failure (rare)

75

Postdialysis assessment

Hypotension
Headache
NV
Malaise, dizziness
Muscle cramps or bleeding

76

Complications of dialysis

Dialysis disequilibrium syndrome
Infectious disease
Hepatitis B & C
HIV

77

Dialysis disequilibrium syndrome

Rapid decrease in fluid volume & BUN
Headache, NV, restlessness, decreased LOC, seizures

78

Continuous ambularoty peritoneal dialysis (CAPD)

Infusion of 4 2L exchanges
Dwell time 4-8 hrs
No machine necessary
Resembles kidney action

79

Automated peritoneal dialysis

In-home dialysis while pt sleeps
Delivers large volumes of dialysis solution

80

Peritoneal dialysis complications

Peritonitis--cloudy effluent 1st sign
Pain--when 1st starting & with cold dialysate
Exit site infections
Poor dialysate flow--r/t constipation
Dialysate leakage
Bleeding
Bowel perforation

81

Kidney transplant candidate selection

<70 yrs; after 70, individual basis
Unsuitable--advanced cardiac disease, metastatic cancer, chronic infection, alcoholism, chemical dependency

82

Kidney transplant operation

4-5 hrs
Recipient keeps old kidney unless infection or polycystic kidney disease

83

Kidney transplant complications

Rejection
Acute tubular necrosis
Thrombosis--2-3 days after transplant
Renal artery stenosis
Hematoma
Abscess

84

Kidney transplant
Acute rejection S/S

1 wk to 2 yrs postop
Oliguria, anuria
Increased temp
Increased BP
Flank tenderness
Fluid retention

85

Kidney transplant
Chronic rejection S/S

Gradual over months to yrs
Increased BUN, creatinine
Electrolyte imbalances
Fatigue

86

Uremia S/S

Metallic taste
Anorexia, NV
Muscle cramps
Itching
Fatigue
Edema
Paresthesias