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AH
exam 3
| Question | Answer |
|---|---|
| What values support a diagnosis of pyrlonephritis? | WBC, bacteria, pyuria (puss in urine). |
| Abnormal urinalysis values? | Urine ph of 3 (this is caused by bacteria). Normal ph of urine 5 to 7. |
| Pyridium will be prescribed to decrease | pain and frequency of urination. |
| Acute pyelonephritis expected symptoms | Flank pain on the affected said, fever, malaise. |
| Discharge instruction for acute pyelonephritis | increase fluids 2000-3000 ml, treat uti (possible cause of pylo), return for follow-up urine culture. |
| Urolithiasis intervention | strain all urine, 3-4L of fluid, change diet. Common types: calcium, uric acid, will be on pain meds and Flomax |
| Teaching about cyctitis (bladder infection) | no sprays, cotton underwear, urinate before and after sex |
| Who gets cystitis? | Old ppl and preganant ppl. |
| There will be blood nitrates and WBC in urine for ppl with | cystitis. |
| Laboratory values that should be monitored with renal insufficiency patient taking nephrotoxic antibiotics? | Worry about(hyperkalemic), metabolic acidotic, fluid overload, periorbital edema. Give Lasix, they will go into diuretic phase and become hypovolemic so give normal saline. DO NOT give gyntomyicin or vancomicin, no lovanox b/c they are renal toxic |
| • Patient needs dialysis if | GFR less than 15, academia, severe hyperkalemia, overload, hypertension, or uremia patient |
| • Patient at greatest risk for UTI | Post menopausal old ladies |
| • Renal calculi patient need to drink | 16 cups of water |
| • Stop taking phenazopyridine after | painful urination is relieved |
| • UTI female teaching | urinate every 2 to 3 hours |
| • Glomerulonephritis | ask about history of strep |
| • Treatment for glomerulonephritis | diuretics, antibiotics, treat strep, protein restriction (low protein), restrict salt |
| • Who needs high protein? | Peritoneal dialysis |
| • What for hypoglycemia, hypotension, hypoglycemia for | renal failure |
| • CRF increases the patient’s risk for | end stage renal disease, iron deficiency (erythropoietin), hyperkalemia, hyperphosphatemic, hypocalcaemia which leads to osteoporosis. |
| • Biggest worry with any organ transplant is | fever |
| • You can keep the organ if rejection is | acute |
| • Kidney rejection | fever and painful transplant site |
| • Oliguric phase of ARF most important intervention | is controlling the blood pressure, so its limiting fluid intake. |
| • Priority intervention for end stage renal disease | Excess fluid volume |
| • BP meds should be withheld for | hemodialysis patients |
| • The nurse should be alert of which assessment for Chronic renal failure patient laboratory values | hypocalcaemia and hyperphosphatemia |
| • Patient in renal failure in the oliguric phase would have urine output of | less than 400ml |
| • AV fistula in place in the right upper extremity for hemodialysis | make sure he has thrill and bruit, no BP, no blood draw. |
| • Leading cause of ESRD is he patient with a history of | diabetes |
| • HAVE PEE | indications of dialysis |
| • Avoid morphine in | pancreatitis |
| • Antibiotics in pylo are given | iv |
| • Goodpastueur’s questions | blood in urine or blood in lungs (not good), hemoptysis |
| o Which Hep can be vaccinated against | A and B |
| o Which one is a risk factor for hepatocellularcarcinoma | Hep C |
| o Which one becomes chronic | Hep B and hep c |
| o Know hep b markers -what you need to see when person is vaccine | anti-HB) vs. when someone is exposed (surface antigen-HBsAG). |
| • What causes toxic hepatitis | (APAP) |
| o What to monitor for patient with toxic hep | lft (liver function test) |
| o When drawing labs for this person you would draw for | clotting, liver functions, and Tylenol level. |
| • Window for giving charcoal | 4hrs |
| • Autoimmune diseases | hemochromatosis, Wilsons |
| o Hemochromatosis | iron |
| o Wilsons | copper |
| • Fulminant liver failure transplant window | 72hr |
| • Cirrhosis -nonalcoholic fatty liver, what causes it? | Weight, diet |
| o Major complication of cirrhosis | portal hypertension which leads varicies, ascites, hepatic encephalopathy, hepatorenal syndrome, poor clotting, immunosuppression, anemia |
| o Teaching for cirrohosis | diet , NO ALCOHOL, no Tylenol (no hepatotoxins), high carb diet, low sodium diet |
| • Ascites | |
| o Position for paracentesis | they are in high fowlers |
| o Pre-paracentisis | remember to void before the procedure |
| o What are you looking for in the paracential fluid? | Bacteria |
| • Jaundice | if they have this, this doesn’t necessarily mean they have liver failure |
| o Acute care (large bore iv, take over airway, give blood and fluid, ppi, vitamin K) | Know varaciel bleed treatments |
| o Octreotide- somatostatin, vasopressin- reduces blood flow | Know varaciel bleed treatments |
| o TIPS (shunting) | Know varaciel bleed treatments |
| If someone had a tips procedure what could be a complication after their bleed (post bleed)? | Hepatic encephalopathy |
| Blakemore tube | |
| o Hepatic encephalopathy Triggers | complication of cirrhosis, post tips, hyopoK, hypovolemia, opiods, metabolic alkalosis, paracentesis, uremia, |
| o Hepatic encephalopathy Side effect | Asterixis (hand flapping when both arms are extended), fetor hepaticus (corpse breath) |
| o Hepatic encephalopathy Drug given | Lactulosediarrhea |
| o Hepatic encephalopathy Lab monitored | ammonia-NH3- (which will increase) |
| • Having hepatitis and autoimmune disease are big risk | for liver cancer (complication) |
| • Folminant liver | have to have a transplant |
| • Acute pancreatitis treatment | NPO, pain medication, AVOID MORPHINE give dilaudid |
| o Pancreatitis Triggers | I GET SMASHED |
| o Pancreatitis big worry | low calcium (hypocalcemia) and respiratory compromise in acute phase, lipase will be high |
| • Lab values | ast & alt (show inflammation), albumin(late change) bilirubin, amylase & lipase (associated with pancreatitis)?????????? |
| • Pancreatic cancer starts out painless then | very painful, super fatal |
| • Give pancreatic enzyme for | chronic pancreatitis |
| • Gallbladder | fat, female, forty and fertile |
| • Kidney | urophathy-UTI- |
| o Know the difference between upper and lower UTI | upper has systemic symptoms, lower doesn’t |
| o Know what you will see in urine in UTI | pyuria (white pus) |
| o Know what the number one bacterial cause is for UTI ? | ecoli |
| o Know the teaching for UTI | lifestyle- cotton underwear, no spraying, no douching, urinate before and after sex, wiping, bathes |
| o Treatment for uti | pyridium, need to be on antibiotics |
| o Pyelo How it presents | CVA tenderness, chills, malaise, vomit, fever |
| o Pyelo must have | systemic symptoms, got to have IV antibiotics, PO will not work |
| o Pyelo Why ppl get it? | It is an ascending UTI infection (urosepsis) |
| o Men with pylo think | std- chlamydia or gonorrhea. |
| o Glomerular nephritis | know acute (post strep) vs. the other ones (like lupus which is treated by steroids) |
| o GN- they will have | protein and blood in urine and look super poofy (periorbital edema), patient is hypertensive |
| o GN Control | salt, water, and potassium |
| • Nephrotic syndrome | you lose albumin (all we need to know about nephrotic syndrome), significantly low oncotic pressure-hypotensive |
| • Kidney stones | (nephrolithiasis)- |
| o Kidney stones(nephrolithiasis)-Know teaching | flowmax, pain control |
| o Magic number for kidney stone is | 4- if it is more than 4mm they cannot pass it. |
| o Kidney stones(nephrolithiasis)- If they pee it out they have to | strain their urine, no treatment or diet recommendation until you know what stone is made of, |
| o Kidney stones(nephrolithiasis)-How it presents | (like pylo but NO systemic symptoms-no fever), have increase water, flank pain |
| • Normal after lithotripsy | low bowel bleed (blood tinged urine) |
| • Renal vascular disease- RAS (renal arteriole sclerosis)causes | systemic hypertension |
| • PCKD- talk about | reproducing for a 20-30 year old, genetic counseling, need a kidney transplant |
| • Smoking= | Bladder cancer |
| • Stress(treatment: kegals) vs overflow = | (Flomax) vs urge (detropan/detrol)- |
| • Retentions | medical emergency, |
| o What you do for retentions? | Use diuretic, then fluid replacement |
| o Who will get it (retention)? | Men, bph, sudden anuria |
| • Turbit | pink urine |
| o Pre kidney injury is anything that causes | low cardiac out, anything low volume |
| o Intrinsic kidney injury is caused by | big nephrotoxins (gyntomicin, NSAIDS, vancomycin, APAP) |
| o Post renal kidney injury is caused by | stones or bph (cancer tumors) |
| • Oliguric (fluid overload, hypertension, hyperkalemic) vs diuretic | (hypotensive) |
| • Magic number in creatinine | above 1.2 you got renal failure |
| • CKD 125 | (normal), 15 (end stage renal) |
| o Diabetes is #1 risk factor for | CKD, hypertension # 2 risk factor for CKD |
| o Ace inhibitors is the drug of choice for | CKD patients |
| • End stage renal | need dialysis |
| o Hemodialysis | takes a long time, but a little better, not as big of a risk |
| o Peritoneal | big risk, can do at home, high protein diet |
| • Know how we do hemodialysis | need fistula or graft |
| o Graft | benefit is time |
| o Fistula is | by far superior |
| • Indication for dialysis | AEIOU (Acidemia, Electrolyte (K!), Intox, Overlaod (fluid), Uremia |
Created by:
lalad13
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