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exam 3

QuestionAnswer
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 Lactulosediarrhea
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