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Med Surg 2 Final
| Question | Answer |
|---|---|
| end product of protein metabolism | urea |
| what electrolyte imbalance is a major issue with renal failure? | hyperkalemia |
| what does BUN stand for, and what is the normal range? | BUN=blood, urea, nitrogen; normal range 10-20 |
| normal creatinine range? | 0.6-1.3 |
| what does erythropoietin do? | stimulates production of RBCs |
| a condition in which the kidneys are unable to remove accumulated metabolites from the blood, resulting in altered fluid, electrolyte, and acid/base balance; results from many different causes | renal failure |
| a progressive, irreversible deterioration of renal function that results in azotemia; occur for 3 months or longer | chronic renal failure |
| rapid loss of renal function d/t damage to the kidneys; depending on the duration and severity, a wide range of potentially life-threatening metabolic complications can occur, including metabolic acidosis as well as fluid and electrolyte imbalances | acute renal failure |
| some contributing factors of ____ are: -hypovolemia -hypotension -reduced cardiac output and heart failure -obstruction of kidney or lower urinary tract by tumor, blood clot, or kidney stone -bilateral obstruction of the renal arteries or veins | AKI |
| occurs in 60-70% of cases; result of impaired blood flow that leads to hypoperfusion of the kidney | Prerenal AKI |
| commonly caused by volume depletion (burns, hemorrhage, GI losses), hypotension (sepsis, shock), and renal artery stenosis, ultimately leading to a decrease in the GFR | Prerenal AKI |
| result of actual parenchymal damage to the glomeruli or kidney tubules; commonly caused by prolonged renal ischemia, nephrotoxic agents, infectious processes | Intrarenal AKI |
| most common type of intrinsic AKI; results from the destruction of tubular epithelial cells w/abrupt decline in renal function; CKD, DM, heart failure, HTN and cirrhosis can lead to this | Acute tubular necrosis (ATN), or AKI in which there is damage to the kidney tubules |
| intratubular obstruction, tubular back leak (abnormal reabsorption of filtrate and decreased urine flow through tubule), vasoconstriction, and changes in glomerular permeability--> decreased GFR, progressive azotemia, & fluid/electrolyte imbalances | Acute tubular necrosis (ATN) |
| usually results from obstruction distal to the kidney by conditions such as renal calculi, strictures, blood clots, BPH, malignancies, and pregnancy; pressure rises in the kidney tubules, and eventually the GFR decreases | Postrenal AKI |
| phase of AKI: begins with the initial insult and ends when oliguria develops | initiation period |
| phase of AKI: increase in serum concentration of substances usually excreted by the kidneys (urea, creatinine, uric acid, organic acids, and intracellular cations [K+ and Mg]; uremic Sx first appear and life-threatening conditions (hyperkalemia) develop | oliguria period |
| phase of AKI: marked by a gradual increase in urine output, which signals that glomerular filtration has started to recover; lab values stabilize and eventually decrease; watch for a decrease in Na, K, and dehydration (Prerenal AKI can occur) | diuresis period |
| phase of AKI: signals the improvement of renal function and may take 3-12 months; lab values return to pt’s normal level; although a permanent 1-3% reduction in the GFR may occur, it is not clinically significant | recovery period |
| The minimum amount of urine needed to rid the body of normal metabolic waste products is? | 0.5 mL/kg/hr |
| hypoperfusion; elevated BUN, creatinine, urine specific gravity; decreased urine output, urine sodium; urine sediment normal to few casts | Prerenal AKI |
| parenchymal damage; elevated BUN, creatinine, urine sodium; urine output varies (often low); increased urine sodium; abnormal casts and debris; urine specific gravity low normal | Intrarenal AKI |
| obstruction; elevated BUN, creatinine; urine output varies (may be low or sudden anuria); urine sodium varies; usually normal sediment; urine specific gravity varies | Postrenal AKI |
| diagnosing AKI: labs? radiology? | -Labs: UA, serum BUN and creatinine, serum electrolytes, CBC -Diagnostic: ***renal US***, CT of kidneys, IV pyelogram, renal biopsy |
| Tx: prevention (maintain adequate hydration and diuresis); perform rapid interventions and and correct the cause; dialysis; manage systemic problems (infection, electrolyte imbalances); diet: high calorie, low protein/potassium/phosphorus) | AKI |
| pharmacology in AKI | -IV fluids -diuretics (loop or osmotic) -antihypertensives -Tx of increased serum potassium (Kayexalate) -electrolyte replacement -phosphorus-binding agent (calcium); give with meals |
| hyperkalemia EKG changes | tall, tented, or peaked T waves |
| Sx: irritability, abd cramping, diarrhea, paresthesia, and generalized muscle weakness (may present as slurred speech, difficulty breathing, paresthesia, and paralysis), both cardiac and other muscular function declines-->medical emergency | hyperkalemia |
| Many meds are eliminated through the kidneys; therefore, dosages must be reduced when a patient has AKI. Examples of commonly used agents that require adjustment? | -ATBs (especially aminoglycosides) -digoxin (Lanoxin) -phenytoin (Dilantin) -ACE inhibitors -magnesium-containing agents |
| nursing management of AKI | -fluid balance (daily weights, strict I&Os) -electrolyte imbalance -activity intolerance -skin care -pt knowledge of disease and managment -nutritional status -psychological support -prevention of infection and other complications |
| an umbrella term that describes kidney damage or a decrease in the GFR lasting for 3 or more months; associated with decreased quality of life, increased health care expenditures, and premature death | Chronic Kidney Disease (CKD) |
| stage of CKD: kidney damage with normal or increased GFR (≥90 mL/min/1.73 m2) | stage 1 |
| stage of CKD: mild decrease in GFR (60–89 mL/min/1.73 m2) | stage 2 |
| stage of CKD: moderate decrease in GFR (30–59 mL/min/1.73 m2) | stage 3 |
| stage of CKD: severe decrease in GFR (15–29 mL/min/1.73 m2) | stage 4 |
| stage of CKD: end-stage kidney disease or chronic kidney disease (GFR <15 mL/min/1.73 m2) | stage 5 |
| causes: DM (primary cause) HTN (second leading cause) chronic glomerulonephritis pyelonephritis or other infections obstruction of urinary tract hereditary lesions vascular disorders nephrotoxic meds or other toxic agents | CKD |
| Patients with CKD are at increased risk for? | cardiovascular disease---leading cause of morbidity and mortality |
| Treatment of HTN, anemia, and hyperglycemia and detection of proteinuria all help to slow disease progression and improve patient outcomes | CKD |
| elevated serum creatinine levels (indicate underlying kidney disease); anemia (d/t decreased erythropoietin production by kidney); metabolic acidosis; abnormalities in Ca and P; fluid retention | CKD |
| normal GFR? | 90 |
| urine lab tests (specific gravity, protein, blood, casts); urine culture (infection); urine creatinine clearance (evaluates GFR & renal function); serum BUN (identifies severity of azotemia); serum creatinine level (identifies renal impairment) | CKD |
| neurologic effects of ESRD | Asterixis Behavior changes Burning of soles of feet Confusion Disorientation Inability to concentrate Restlessness of legs Seizures Tremors Weakness and fatigue |
| integumentary effects of ESRD | Coarse, thinning hair Dry, flaky skin Ecchymosis Gray-bronze skin color Pruritus Purpura Thin, brittle nails |
| CV effects of ESRD | Engorged neck veins Hyperkalemia Hyperlipidemia Hypertension Pericardial effusion Pericardial friction rub Pericardial tamponade Pericarditis Periorbital edema Pitting edema (feet, hands, sacrum) |
| pulmonary effects of ESRD | Crackles Depressed cough reflex Kussmaul-type respirations Pleuritic pain Shortness of breath Tachypnea Thick, tenacious sputum Uremic pneumonitis |
| GI effects of ESRD | Ammonia odor to breath (“uremic fetor”) Anorexia, nausea, and vomiting Bleeding from gastrointestinal tract Constipation or diarrhea Hiccups Metallic taste Mouth ulcerations and bleeding |
| hematologic effects of ESRD | Anemia Thrombocytopenia |
| reproductive effects of ESRD | Amenorrhea Decreased libido Infertility Testicular atrophy |
| musculoskeletal effects of ESRD | Bone fractures Bone pain Footdrop Loss of muscle strength Muscle cramps Renal osteodystrophy |
| occurs in ESKD b/c kidneys are unable to excrete increased loads of acid; decreased acid secretion results from inability of kidney tubules to excrete ammonia and to reabsorb sodium bicarb; also decreased excretion of phosphates and other organic acids | metabolic acidosis |
| medication precautions of ESRD | -meds excreted by kidneys will increase half life and plasma levels -caution w/giving protein-bound meds (low plasma protein levels can result in toxicity) -avoid/use extreme caution w/nephrotoxic meds -if on hemodialysis--will med be dialyzed? |
| Is it ok to give cardiac meds right before dialysis? | no |
| pharmacologic management in ESRD | -calcium supplements -phosphorus binders -antihypertensives and CV agents -erythropoietin -anticonvulsants (if necessary) |
| ESRD diet | -restriction of protein, fluids, sodium, food high in potassium and phosphorus -high calorie (carbs and fats) -vitamin supplication -(high protein if on dialysis) |
| nursing interventions for assessing fluid status | -daily weight -I&O balance -skin turgor and presence of edema -JVD -B/P, pulse rate and rhythm -respiratory rate and effort |
| potential sources of fluid | -meds and fluids used to take or administer medications: oral and IV -foods |
| problems/complications of ESRD | -hyperkalemia -pericarditis, pericardial effusion, pericardial tamponade -HTN -anemia -bone disease and metastatic calcifications |
| About 30–50% of patients with CKD develop _____ due to uremia; fever, chest pain, and a pericardial friction rub are classic signs. | pericarditis |
| prevents death but does not cure kidney disease and does not compensate for the loss of endocrine or metabolic activities of the kidneys | hemodialysis |
| how long do you have to wait to use a long-term access catheter for hemodialysis? | 2-3 months; needs time to "mature" |
| access catheter for hemodialysis: assess fistula for audible ____ and palpate for ____ | (audible) bruit, (palpate) thrill |
| two big complications of hemodialysis | infection (local or systemic), injury to fistula site |
| goals are to remove toxic substances and metabolic wastes and to reestablish normal fluid and electrolyte balance | peritoneal dialysis |
| monitor/assess what when patient on dialysis? | -vascular access site -S/Sx of infection -fluid balance -S/Sx of uremia and electrolyte balance (check labs--BUN, creatinine, BMP/CMP) -cardiac/resp status |
| a type of kidney disease with glomerular inflammation; S/Sx: hematuria, edema, azotemia, proteinuria, HTN; may be mild or may progress to AKI or death; Tx: supportive care, diet, ATBs, steroids, immunosuppressants | acute nephritic syndrome |
| prolonged exposure to an environmental temperature >39.2°C (102.5°F); as seen in elderly being outside too long or children/pets in hot cars | nonexertional heat stroke |
| caused by strenuous activity that occurs in hot environments; as seen in farmers or marathon runners | exertional heat stroke |
| people not acclimated to heat, older or very young people, ill or debilitated people, and persons taking some medications are at high risk | heat stroke (aka hyperthermia) |
| manifestations: CNS dysfunction, elevated temp of 40.6°C (105°F) or higher, hot dry skin, anhidrosis (no sweating), tachypnea, hypotension, and tachycardia | heat stroke (aka hyperthermia) |
| tachypnea, hypotension, and tachycardia can indicate what? | shock |
| -ABCs; reduce temp to 39.2°C (102°F) as quickly as possible -cooling methods -monitor temp, VS, ECG, CVP, LOC, I&O -IVs--replace fluid losses -meds: anticonvulsant, K+, Na bicarb, benzos | management of a pt with heat stroke (hyperthermia) |
| -trauma from exposure to freezing temp and freezing of fluid in the intracellular/intercellular spaces -S/Sx: hard, cold, and insensitive to touch; may appear white or mottled, may turn red and painful as rewarmed | frostbite |
| -extent of injury is not always initially known -controlled but rapid rewarming; 37° to 40°C circulating bath for 30- to 40-minute intervals -analgesics for pain -do not massage or handle; if feet are involved, do not walk | frostbite |
| -internal core temp is 35°C or less -older adults, infants, persons with concurrent illness, homeless people, and trauma victims are at risk -ETOH ingestion increases susceptibility -physiologic changes in all organ systems -monitor continuously | hypothermia |
| -use ABCs, remove wet clothing, rewarm, supportive care -active core rewarming (cardiopulmonary bypass, warm fluid administration, warm humidified O2, warm peritoneal lavage) -passive external rewarming (warm blankets and over the bed heaters) | management of a pt with hypothermia |
| cold blood returning from the extremities has high levels of ___ ___ and can cause potential cardiac dysrhythmias and electrolyte disturbances | lactic acid |
| -comprehensive symptom management, psychosocial care, and spiritual support needed to **enhance the quality of life** for any person with advanced illness -interdisciplinary collaboration -settings: hospitals, SNFs, outpatient | palliative care |
| coordinated program of interdisciplinary services provided by professional caregivers and trained volunteers to patients with **serious, progressive illnesses that are not responsive to cure** | hospice care |
| area where breast cancer usually found | upper outer quadrant |
| In general, the lesions are nontender, fixed rather than mobile, and hard with irregular borders. | breast cancer |
| advanced signs of breast cancer | skin dimpling nipple retraction skin ulceration |
| removal of the breast tissue, nipple–areola complex, and a portion of the axillary lymph nodes (ALND); used for invasive breast cancer | modified radical mastectomy |
| removal of the breast and nipple–areola complex but does not include ALND; used for non-invasive breast cancer | total mastectomy |
| surgery/Tx to remove a breast tumor and a margin of tissue around the tumor without removing any other part of the breast; may or may not include lymph node removal and radiation therapy | breast conservation treatment |
| biopsy of first node (or nodes) in the lymphatic basin that receives drainage from the primary tumor in the breast; less invasive alternative to ALND and is considered a standard of care for the treatment of early-stage breast cancer | sentinel lymph node biopsy |
| chronic swelling of an extremity due to interrupted lymphatic circulation, typically from an axillary lymph node dissection | lymphedema |
| a solid swelling of clotted blood within the tissues | hematoma |
| a pocket of clear serous fluid that sometimes develops in the body after surgery | seroma |
| method of breast reconstruction in which a flap of skin, fat, and muscle from the lower abdomen, with its attached blood supply, is rotated to the mastectomy site | transverse rectus abdominal myocutaneous (TRAM) flap |
| -well-differentiated cells resemble normal cells of the tissue from which the tumor originated -tumor grows by expansion and does not infiltrate surrounding tissues; usually encapsulated -rate of growth is usually slow -does not spread by metastasis | benign |
| -cells undifferentiated and may bear little resemblance to cells of original tissue -grows at periphery and overcomes contact inhibition to invade and infiltrate surrounding tissues -rate of growth variable and depends on level of differentiation | malignant |
| spread of cancer cells from the primary tumor to distant sites; abnormal cells that have invasive characteristics; infiltrate other tissues; spreads 3 ways: lymphatic, hemotogenous, angiogenesis | metastasis |
| performed to obtain a tissue sample for histologic analysis of cells suspected to be malignant | diagnostic surgery, or biopsy |
| used for small, easily accessible tumors of the skin, upper or lower gastrointestinal and upper respiratory tracts | excisional biopsy |
| performed if tumor mass is too large to be removed; a wedge of tissue from tumor is removed for analysis | incisional biopsy |
| performed to sample suspicious masses that are easily and safely accessible, such as some masses in the breasts, thyroid, lung, liver, and kidney | needle biopsy |
| often performed on an outpatient basis; is warranted when the mass is small; includes removal of the mass and a small margin of normal tissue that is easily accessible | local excision |
| removal of the primary tumor, lymph nodes, adjacent involved structures, and surrounding tissues that may be at high risk for tumor spread | wide (or radical) excision |
| removing non-vital tissues or organs that are at increased risk of developing cancer; ex-getting a mastectomy d/t family history of breast cancer | prophylactic (or risk reduction) surgery |
| performed in an attempt to relieve symptoms, such as ulceration, obstruction, hemorrhage, pain, and malignant effusions; ex-PEG tube insertion for enteral nutrition, colostomy for bowel obstruction | palliative surgery |
| may follow curative or extensive surgery in an attempt to improve function or obtain a more desirable cosmetic effect | reconstructive surgery |
| most common type of radiation therapy used for cancer treatment; a machine is used to aim high-energy rays from outside the body into the tumor | external beam radiation therapy (ERBT); aka teletherapy |
| radiation therapy in which a small container of radioactive material is implanted in the body, in or near the cancerous tumor | internal radiation (aka brachytherapy) |
| agents used to destroy tumor cells by interfering with cellular function, including replication and DNA repair | chemotherapy |
| 1-inflammation/irritation of the mucous membranes in the mouth (gums, tongue, lips); 2-a complication of some cancer therapies in which the lining of the digestive system becomes inflamed (often seen as sores in the mouth) | 1-stomatitis, 2-mucositis |
| nursing interventions for maintaining fluid and electrolytes | -Intake and output, daily weights -Assess for dehydration and overload -Laboratory studies including electrolytes, blood urea nitrogen, creatinine, and hematocrit -Replacement as necessary |
| nursing interventions for mucositis | -Frequent, gentle oral hygiene, before and after meals -Soft toothbrush or if counts are low, sponge-tipped applicators -Rinse only with NS, NS and baking soda, or prescribed solutions -Perineal and rectal care |
| two most common side effects of chemotherapy | nausea and vomiting |
| Many chemotherapy agents cause some degree of ____ (depression of bone marrow function), resulting in decreased WBCs (leukopenia), granulocytes (neutropenia), RBCs (anemia), and platelets (thrombocytopenia) and increased risk of infection and bleeding. | myelosuppression |
| Decreased RBCs can lead to ____? What are treatments to correct this? | anemia; folic acid, iron, transfusion |
| small waxy nodule with rolled, translucent, pearly borders; may appear shiny, flat, gray, yellow; most common type and recurrence is also common (rarely metastasizes); locally invasive malignancy arising from epidermal basal cells | basal cell carcinoma |
| generally appears in sun exposed areas of the body (i.e. face, neck, hands, and scalp); localized tumor---therefore prognosis is good; least deadly---rarely causes morbidity or death | basal cell carcinoma |
| rough, thickened, scaly tumor; may be asymptomatic or bleed; border is wide, more infiltrated, more inflammatory; arises from epidermis, sun damaged skin; commonly found on upper extremities/face/lower lip/ears/nose/forehead | squamous cell carcinoma |
| prognosis depends on metastasis, type, level and depth of invasion; 4-8% metastasize by blood and lymphatic system; less aggressive than melanoma, can cause death | squamous cell carcinoma |
| medical management: eradicate tumor, Tx depends on location/type/depth; alternatives: radiation, photodynamic therapy, topical chemotherapeutic creams; surgical: surgical incision, Mohs micrographic surgery, electrosurgery, cryosurgery | basal cell carcinoma and squamous cell carcinoma |
| manifests as a change in nevus or a new growth on the skin; color is dark, red, blue colored or a mix; irregular shape; itching, rapid growth, ulceration, bleeding; cancerous neoplasm preset in dermis and epidermis | melanoma |
| 2x more common in men then women; found anywhere on the body (lower extremities – women; head, neck, trunk – men); Tx: surgical excision, chemotherapy | melanoma |
| frequently r/t sun exposure; sun damage is cumulative and can manifest after a 20-50 year latency period | skin cancer |
| blood flow to region or organ may be reduced; reduced blood flow leads to ischemia or infarction; ischemia/infarction may cause pain, swelling, and fever; crises are intermittent-aggravated by cold causing vasoconstriction and increased blood viscosity | sickle cell anemia |
| entrapment of erythrocytes/leukocytes in microcirulation->tissue hypoxia, inflammation, necrosis d/t inadequate blood flow->perfusion resumes, substances are released causing oxidative damage to vessel->damage to the epithelium and vasculopathy develops | acute vaso-occlussive crisis |
| from infection with the human parvovirus, hemoglobin drops rapidly and the marrow cannot compensate, leading to an absence of reticulocytes | aplastic crisis |
| results when organs pool the sickled cells; spleen is often effected in children (splenic infarction happens often by 10 years of age, leaving spleen non-functional); liver and lungs are effected in the adult population | sequestration crisis |
| IBD diet | -low-residue, low-fat, high-protein, high-calorie diet -supplemental vitamin therapy and iron replacement -avoid cold foods -possible parenteral nutrition |
| dietary management for cholelithiasis | -NPO, NG suctioning then soft, low-fat, high-carb diet (potatoes, bread, plain pasta) -avoid: eggs, cream, pork, fried foods, cheese, rich dressings, gas-forming veggies, alcohol |
| pancreatitis diet | -enteral or parenteral nutrition may be needed -as acute Sx subside, oral feedings gradually reintroduced---high carb, low protein, low fat -b/w acute attacks--low-fat, high-protein -avoid heavy meals, alcohol, and excessive coffee and spicy foods |
| dietary management of peptic ulcer disease | -avoid: extremes of food/drink temp, ETOH, coffee (including decaf), caffeinated beverages -eat three regular meals/day---small/frequent meals not necessary as long as antacid or H2 blocker is taken |
| post prostatectomy diet | -encourage fluids -avoid coffee, alcohol, spicy foods |
Created by:
nurse savage
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