Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
renal meds
usm son renal meds
| Question | Answer |
|---|---|
| When Infusing ammonium chloride | slowly to avoid ammonium toxicity and decrease irritation to veins |
| mom of 4 year old asthma patien calls you to the room because the child is having some diff. breathing when you enter the room you not that the patient has audible inspiratiry and expiratory wheezing and is listless the child's rr=32 and pluse ox=85% whic | administer the prn duoneb (albuterol + atrovent) nebulizer treatment. |
| Nursing assesment of a patient receiving normal serum albumin for treatment of show should include : | assessing breath sounds |
| Your patient admitted for acute exacerbation of chf is receiving dig and fursemide lasix. Which of the following lab levels should you carefully monitor? | – potassium |
| your patient with newly diagnosed HTN will be started on spironolactone (aldactonne) which of the following drug groups should not be used or used with extreeme caution in patients taking this medication? | ace inhibitors |
| Your pt complains of muscle cramping in the calves, paresthesia of the toes and the sensation of the heart skipping a beat. These symptoms make indticated which of the following im balances? | hyperkalemia |
| Your patient will be sent home on duretic therapy and will need to increase the amount of potassium in the diet. What food choices would you suggest to the patient | banans, tomatoes, beans fresh meats |
| Inadequate blood flow to meet body’s needs | shock |
| Considered medical emergency | shock |
| Can lead to irreversible organ damage and death (kidney’s-fail-starts here) | shock |
| Shock Treatment | : narrow the pipes because what little blood that we have will seem like a lot |
| What is the quickest indicator of shock | Urine output is the quickest indicator, because if kidneys are not getting enough blood flow they wont be putting out urine should be 30 ml/ hour |
| Types of Shock | Cardiogenic, hypovolemic, neurogenic, septic, and anaphylactic |
| The types of shock are Classified by | Underlying pathological condition; Organ system causing the disease |
| Cardiogenic shock means ? | : from failure of heart to pump sufficient blood |
| Most fatal type because it doesn’t repsond well to treatment | cardiogenic shock |
| Hypovolemc shock is what: | from loss of blood volume |
| Neurogenic shock is what: | from vasodilatation due to changes in autonomic nervous system |
| Septic shock is what | Multiple-organ dysfunction; Result of pathogenic organisms in blood ; starts with an infection that gets into the blood stream |
| Causes vasodilation and changes in permeability of capillaries | septic shock |
| Often precursor to acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC) | septic shock |
| During septic shock 1st thing to treat: | stop the immune system, because of the massive overaction of the immune system, massive vasodilation-> a lot of blood to that area. |
| Anaphylactic shock: acute allergic reaction | Not by a bacteria, but same process as septic shock; Inflammation without infection |
| symptoms of shock are | Pale, cold, clammy skin; Feeling of sickness and weakness; Restlessness, anxiety, confusion, depression, apathy – decreased oxygen going to brain; Unconsciousness; Thirst (1st compensatory mech) |
| what is the first compensatory mech of shock | thirst |
| what happens to the cardiovas. System during shock | Cardiovascular system fails to send enough blood to vital organs(407) |
| Effects seen in the cardiovascular system | -Heart and brain affected early - Low BP and diminished cardiac output- Heart rate is rapid and weak- Breathing is shallow and rapid (Going into a metabolic acidosis state ) |
| Pharmacotherapy Goals | Restore normal fluid volume and composition, Maintain adequate blood pressure – maintian adequate tissure perfusion |
| For anaphylaxis the pharmacotherapy : | |
| Causes of fluid loss include | Hemorrhage; extensive burns; severe dehydration ; Persistent vomiting(metabolic alkalosis) or diarrhea(poop out bases - metabolic acidosis); intensive diuretic therapy |
| Patient vomiting for three days what will you use to treat them | ... |
| In Hypovolemic Shock there is Three categories of fluid-replacement agents used (page 408-example) | Blood-donated from blood bank; Colloids – plasma protiens ; Crystalloids- electrolytes in it |
| Intravenous Fluid Therapy Replaces fluids and electrolytes using | Uses crystalloids and colloids |
| Causes of water and electrolyte loss | Gastrointestinal fluid loss, vomiting, diarrhea, laxatives, suctioning; Perspiration, burns, hemorrhage, excessive diuresis, ketoacidosis |
| Whole Blood is Indicated for treatment of | acute, massive blood loss; 30% or more of total volume |
| Supply depends on donors | whole blood |
| Requires careful cross-matching | whole blood |
| Can transmit infections such as hepatitis or HIV | whole blood |
| More the surface antigens the more likely | they can reject it |
| Cant let blood sit out too much, otherwise it | hemolyizes, check to make sure it’s the right one, hang quickly |
| Colloids do what ? | Expand plasma volume and maintain blood pressure |
| Truly like plasma(oily), glass jar, not a big volume infusion – quick IVPB or IVP, synthetic version of your blood | colloids |
| Used when up to one-third of adult client’s blood volume lost | colloids |
| Stay suspended in blood | colloids |
| Problems : Sometimes establishes a too quick of a fluid shift, often see allergic reactions with it because it is a protein –protein allergies | colloids |
| Draw molecules from body’s cells and tissues into blood vessels | colloids (Oncotic pressure) |
| Examples of colloids | : normal human serum albumin, plasma protein fraction, dextran, hetastarch |
| normal human serum albumin, plasma protein fraction, dextran, hetastarch | Examples of colloids |
| cost of colloids | Expensive |
| Colloids Prototype drug | : normal serum albumin (Albuminar, Albutein) |
| to maintain plasma osmotic pressure and transport substances through blood | colloids |
| Colloids are Used for | : restoration of plasma volume and blood proteins |
| Colloid SEs are | : allergies and protein overload |
| Things to look for in side effects of colloids | : crackles, CHS sym. BP changes HR and RR changes |
| Crystalloids are used to | Replace lost fluids and electrolytes; increase urine output |
| IV solutions cause movement of fluid between | blood and body’s cells. |
| Examples of crystalloids are | Isotonic, hypertonic, hypotonic (p. 432, 433) |
| Normal saline, lactated Ringer’s, hypertonic saline, and 5% dextrose in water | crystalloids |
| Hyptonic solution the fluid will | shifts out |
| Hypertonic fluid is going in which will lead to | : edema |
| D5(hypertonic)NS(isotonic) = | a little hypertonic |
| 3%-hypertonic if ut in too fast can cause | – strong – cerebral edema ( too fast) |
| D5 (hyper) 1/2NS(hypo) = | slightly hypotonic |
| Lactated ringers are what kind of soluntion | : isontonic solution ( IV gatorade) – goto tx for burns |
| Anaphylaxis | Serious hypersensitivity response to allergen |
| Anaphylaxis May be caused by | common drugs |
| Common drugs that may cause anaphylaxis | Penicillins, cephalosporins, Nonsteroidal anti-inflammatory drugs (NSAIDs)ACE inhibitors |
| Signs and Symptoms of Anaphylaxis | Periorbital edema, urticaria, wheezing and difficult breathing |
| Periorbital edema, urticaria, wheezing and difficult breathing | anaphylaxis |
| Some other sings of shock | Palpitations, chest pain, N/V, Sweating, weakness, dizziness, confusion,Sense of impending doomBlurred vision, headache, anxiety, More than likely breathing will only get worse |
| Treatment of Anaphylaxis | sympathomimetics, antihistamines, glucocorticoids used |
| Therapy is symptomatic for anaphylaxis to | To support cardiovascular system, To prevent further hyperreaction of immune system |
| Random fact: | Wit blood products : baseline vitals, check vitals every 15 min, check any complaints that they have; if you notice a change ( fever, rash, hr, ) the best thing to do is stop the blood and then try to figure it out |
| Treatment of Anaphylaxis immediately | Give oxygen immediately |
| After oxygen is given for anaphylaxis give patient | Antihistamine—prevents release of histamine IVP-bennadryl ; Bronchodilator—relieves shortness of breath – NEB – skip the puffer ; Corticosteroids—suppresses inflammation – something IV |
| Prototype drug for aympathomimetics | : epinephrine (Adrenalin) |
| Adrenalin | epinephrine, sympathomimetics |
| Sympathomimetics Action: | |
| for use as nonselective adrenergic agonist | sympathomimetics |
| sympathomimetics are used to | treat anaphylaxis, shock, cardiac arrest |
| sympathomimetcs SEs: | hypertension and dysrhythmias (r/t flight or fight, increase BP – too many red bulls |
| hypertension and dysrhythmias (r/t flight or fight, increase BP – too many red bulls | sympathomimetics |
| This is only a quick fix- Code meds | sympathomimetics |
| If there is a Cardiac issue how will you administer sympathomimetics | – IVP, IV infusion |
| Vasoconstrictors/Sympathomimetics Prototype drug: | norepinephrine (Levaterenol, Levophed) |
| Norepinephrine levaterenol levophed | vasoconstrictors / sympathomimetics |
| Sympathomimetics Action: | |
| to act directly on alpha-adrenergic receptors to raise BP; also has positive inotropic effects | sympathomimetics |
| Sympathomimetics Use: | to treat acute shock and cardiac arrest |
| To treat acute shock and cardiac arrest | sympathomimetics |
| Sympathomimetics SEs: | |
| When we use this its when we Tried everything that we can, normally don’t come off of alive, family cant let go… | sympathomimetics |
| Keep upping this drug to raise the BP but in turn keep dropping, only temporary | sympatho |
| Inotropic Agents | Prototype drug: dopamine (Dopastat, Inotropin) |
| dopamine (Dopastat, Inotropin) | inotropic agents |
| Inotropic Action for low dose | : is dose dependent; low doses = dopaminergic effect, |
| Inotropic action for high doses = | high doses beta-adrenergic effect(be careful of this- watch kidneys when you give) |
| Inotropics are Used | : to treat hypervolemic and cardiogenic shock |
| SEs of inotropics are | : dysrhythmias, hypertension, gangrene |
| Little doses are good… of this drug | inotropics |
| Increase cardiac contractility, give to people with low bp | inotropic |
| Nursing Implications for Shock Treatment | ABCs,Monitor urine output and VS,Assess for s/s of hypo/hypervolemia ,Renal Regulation , Kidneys regulate (Fluid volume, electrolytes, acid-base balance) |
| Kidneys secrete | Renin, Erythropoietin, Calcitrol |
| Complications of RF – | anemia, hyperkalemia, hyperphosphatemia, hypervolemia, hypocalcemia, & metabolic acidosis |
| Diuretics do what ? | Increase rate of urine flow (production) not going to help kidneys work when they arent working |
| Excretion of excess fluid used to treat | Hypertension, heart failure, kidney failure, Liver failure or cirrhosis, pulmonary edema |
| Side Effects of Diuretic Therapy | Fluid and electrolyte disturbances (Dehydration, Orthostatic hypotension, Potassium and sodium imbalances ) |
| Loop Diuretics are the… | Most potent, K losing |
| Loop Diuretics | Prototype drug: Fursemide (Lasix) |
| Lasix fursemide | loop diuretics |
| Loop Action: | |
| Increases GFR by renal vasodilatation | lasix, loop |
| Loops are Used to help with: | |
| Loop Diuretics | SEs: hypotension, nocturia, photosensitivity, electrolyte disturbances, muscle weakness |
| When giving loop diuretics Caution | : obstructive urinary elimination pxs, diabetics (increases BS), gout, sulfa allergies, pregnancy |
| Before administering loops | Check K and BP before, will increase GFR, |
| Loop Diuretics Nursing Implications | ototoxic, creatinine (renal function ) daily weights, increase k, watch dehydration, and DIG TOX (HALOS around LIGHT ) |
| Thiazide Diuretics are | K losing-but not as much , Increasing dietary intake may be sufficient to cover |
| Often used with loops | thiazide |
| Thiazide | Prototype drug: Hydrochlorathiazide (HCTZ) |
| Not for immediate diuresis | thiazide |
| Thiazide Action: | Inhibits Na reabsorption in the cortical diluting tubule |
| Thiazide is Used: | |
| When giving Thiazide Diuretics Caution: | obstructive urinary elimination pxs, diabetics (increases BS & decreases effectiveness of oral antidiabetics), hx of gout, high chol, sulfa allergies, pregnancy |
| When giving thiazide worry about | Worry about lithium tox. – will kill you quickly, quickest way is through water imbalances. |
| Thiazide SEs: | |
| Side effects of what hypotension, nocturia, photosensitivity, electrolyte disturbances, muscle weakness | thiazide d |
| Drug interactions when taking Thiazide | increases lithium, decreases hyperuricemic agents and DM meds |
| Thiazide Diuretics Nursing Implications | take up to 4 weeks for maximum HTN effects, Check BP and K levels, watch BS and chol , daily weights, dehydration, DIG TOX |
| K Sparing Diuretics are | Weak diuretics |
| K sparing | Prototype drug: Spironolactone (Aldactone) |
| Spironolactone (Aldactone) | k sparing |
| K sparing Actions: | increases Na excretion and decreases K excretion in the distal convoluted tubules |
| K sparing is Used | : HTN, edema, primary, hypokalemia hyperaldolsteronism, hirsutism, PMS, precocious puberty, myasthenia gravis |
| HTN, edema, primary, hypokalemia hyperaldolsteronism, hirsutism, PMS, precocious puberty, myasthenia gravis use what ? | k sparing |
| When giving a k sparing use Cautions: | Renal insufficiency, hyperkalemia, pregnancy, gout, renal calculi, pregnancy |
| K was 5.1 are you going to give the next dose ? | – don’t give, a little bit is a big deal |
| If it was k was 4.8 – | yes would give but monitor closely |
| K Sparing Diuretics SEs: | previous SE HTN, edema, primary, hypokalemia hyperaldolsteronism, hirsutism, PMS, precocious puberty, myasthenia gravis + agranulocytosis |
| Agranulocytosis side effect | k sparing |
| Nursing Implications for k | May take up to 2 weeks to reach maximum HTN effect, Check BP and K level (but you are watching for high levels), Watch for agranulocytosis (WBC, fever, sore throat) Dly wts and I & O |
| Angranulocytosis include | WBC up fever and sore throat |
| Avoid K in diet and Na substitutes | k sparing |
| Take with food or milk | k sparing |
| Control of Water Balance is essential | Essential to homeostasis |
| Frequent indications for IV therapy include imbalances of | Body fluids,Electrolytes, Acid-base |
| Osmolality | Concentration of osmotic solution |
| Osmolality isDependent on | number of dissolved solutes in a body fluid (Usually sodium, glucose, or urea) |
| Normal osmolality is | 275–295 mOsm/kg |
| Changes in osmolality can cause | water to move to different compartments, Greatest contributor is sodium |
| Sodium controlled by | hormone aldosterone |
| Tonicity is | relative concentration of intravenous fluid, General term, not precise measurement |
| Osmosis is when | Water moves from areas of low osmolality to areas of high osmolality |
| Hypertonic intravenous fluid | Water moves from interstitial space to plasma. |
| Hypotonic intravenous fluid | Water moves from plasma to interstitial space. |
| I sotonic intravenous fluid | No fluid shift |
| Fluid BalanceAchieved through | complex mechanisms |
| Most important regulator of fluid intake is | thirst |
| Primary regulators of fluid output: | kidneys |
| Primary regulators of fluid output is kidneys including : | |
| Renin-angiotensin mechanism – | vasoconstriction , makes worse |
| Aldosterone – | holds in Na and holds in water |
| Antidiuretic hormone (ADH)- | prevents release of water |
| Fluid-Balance Disorders | deficit or excess |
| Deficit-fluid-balance disorders Can cause | dehydration or shock |
| Treated with oral or intravenous fluids | deficit |
| Excess-fluid-balance disorders Treated with | diuretics |
| Electrolytes Essential to | Nerve conduction, membrane permeability, Water balance, other critical body functions |
| Sodium is Essential for | maintaining osmolality, water balance, acid-base balance |
| Major electrolyte in extracellular fluid | sodium |
| Sodium and Water Regulation | Water travels with or toward sodium |
| Sodium movement is link between | water retention, blood volume, and blood pressure |
| Sodium is Regulated by | kidneys and aldosterone |
| Sodium level above 145 mEq/L | Hypernatremia |
| Most commonly caused by kidney disease | Hypernatremia |
| Sodium accumulates because of | Decreased excretion, High, net-water loss (watery diarrhea, fever, burns), High doses of glucocorticoids or estrogens |
| Physiology of Hypernatremia | Elevated sodium increases osmolality of the plasma, Draws fluid from interstitial spaces and cells, Causes cellular dehydration |
| Cells are dehydrated in | Hypernatremia |
| Hypernatremia ---Signs and symptoms | Thirst, fatigue, weakness, muscle twitching ; Convulsions, altered mental status, decreased level of consciousness NEURO |
| Treatment of Hypernatremia | low-salt diet |
| Acute hypernatremia treated with | hypotonic intravenous fluids or diuretics |
| Hyponatremia | Sodium level below 135 mEq/L |
| Caused by excessive dilution of plasma | hyponatremia |
| Hyponatremia is caused by | Excessive antidiuretic hormone (ADH) secretion, Excess administration of hypotonic intravenous solution Vomiting, diarrhea, gastrointestinal suctioning, diuretic use |
| Hyponatremia Early Symptoms | Nausea, vomiting, anorexia, abdominal cramping |
| Later signs of hyponatremia | Altered neurologic function such as confusion, lethargy, convulsions, coma, muscle twitching, tremors |
| Treatment of Hyponatremia caused by excessive dilution | Treat with loop diuretics to cause an isotonic dieresis; (balance the concentration out) |
| Treatment of Hyponatremia caused by sodium loss | Treat with oral sodium chloride or intravenous fluids containing salt. (Normal saline, Lactated Ringers, Not hypertonic saline – not tolerated well |
| Sodium Supplements Prototype drug: | sodium chloride |
| Action of sodium supplements : | |
| Sodium supplements are Used: | to treat hyponatremia when serum levels fall below 130 mEq/L |
| Adverse effects of sodium chloride | hypernatremia and pulmonary edema |
| Potassium Balance Essential for | Proper nerve and muscle function,Maintaining acid-base balance |
| Major electrolyte of intracellular fluid | K |
| Influenced by aldosterone | k |
| For each sodium ion reabsorbed, | one potassium ion secreted into renal tubules |
| Hyperkalemia level | Potassium level above 5 mEq/L |
| Hyperkalemia Caused by | high consumption of potassium-rich food, dietary supplements |
| Risk with client taking potassium-sparing diuretics | Hyperkalemia |
| K Accumulates when | renal disease causes decreased excretion – pvc – beats out of turn, vtach (problem) |
| Hyperkalemia Symptoms Most serious | are dysrhythmias TWAVE UP |
| Hyperkalemia symptoms | Muscle twitching, fatigue, paresthesias, dyspnea, cramping, and diarrhea |
| Treatment of Hyperkalemia | Restrict dietary sources; hidden sources , Decrease dose of potassium-sparing diuretics, Administer glucose and insulin, Administer calcium to counteract potassium toxicity on heart, Administer polystyrene sulfonate (Kayexalate)& sorbitol to dec k levels |
| Administer glucose and insulin for | Hyperkalemia |
| If there is a k tox on the heart admin | calcium to counteract it |
| To decrease k levels admin | polystyrene sulfonate and sorbitol |
| Lifethreatening side of Hyperkalemia run them on | insuline soultion & D5 solution: take potassium inside of cell where its not harmful, and doenst cause problems |
| Hypokalemia level | Potassium level below 3.5 mEq/L |
| Hypokalemia Caused by | High doses of loop diuretics, Strenuous muscle activity, Severe vomiting or diarrhea |
| Strenuous muscle activity | hypokalemia |
| Hypokalemia Symptoms , | Neurons and muscle fibers most sensitive to potassium loss,Muscle weakness, lethargy, anorexia, dysrhythmias, cardiac arrest, |
| If you have someone with Muscle weakness, lethargy, anorexia, dysrhythmias, cardiac arrest what will you do | give k supplements |
| Treatment of Hypokalemia Mild— | increase dietary intake |
| Severe hypokalemia treatment | —give oral or parenteral potassium supplements |
| Low T wave! In what electrolyte disturbance | hypokalemia |
| Potassium Supplements | Prototype Drug-potassium chloride (KDur) |
| Action of k supplements | maintain intracellular tonicity, maintain balance with Na, transmit nerve impulses, & maintain cellular metabolism |
| K supplements are used to | : prevent and tx hypokalemia |
| Contraindications in giving k supplements | : renal impairment, Addison’s disease |
| SEs of k supplements | parasthesia, restlessness, weakness, hypotension, EKG changes, N/V/D, hyperkalemia, cardiac arrest ( look like hyperkalemia) make sure that you arent over correcting it |
| Potassium Supplements --- Nursing Implications | take with full glass of water with meals, monitor k levels, don’t crush chew or suck, not IVP |
| Acidosis is excess acid (pH below | 7.35) |
| Alkalosis is excess base (pH above | 7.45) |
| If pateint is vomiting – give them an | atemetic (know atemetics) |
| Resp. acidosis = we want to | speed up the breathing, copd patients will have this |
| Resp. alklosis = we want to | slow them down, give antianxiety, adivan. |
| Acidosis May be respiratory, caused by | hypoventilation |
| Acidosis May be metabolic Causes: | diarrhea, kidney failure, diabetes, excess alcohol, starvation |
| Pharmacotherapy of Acidosis | Administration of sodium bicarbonate is appropriate pharmacotherapy |
| Bicarb Symptoms affect central nervous system by | Lethargy, confusion, coma Deep, rapid respirations in attempt to blow off excess acid |
| Lethargy, confusion, coma Deep, rapid respirations in attempt to blow off excess acid | acidosis |
| Sodium Bicarbonate Therapy Action: | to raise pH of body fluids |
| Sodium Bicarbonate Use: | to correct metabolic acidosis |
| Adverse effects of Sodium Bicarbonate | : metabolic alkalosis caused by receiving too much bicarbonate ion & hypokalemia |
| Nursing Implications when giving sodium bicarb | Usually given IV either bolus or in IVF, Monitor ABGs |
| Sodium Bicarbonate Use cautiously in clients with | cardiac disease or renal impairment, Clients should use alternative OTC antacids |
| Alkalosis May be respiratory Cause: | hyperventilation due to asthma, anxiety, high altitude |
| Alkalosis May be metabolic Causes | Prolonged constipation, excess sodium bicarbonate, diuretics that cause potassium depletion, severe vomiting |
| Prolonged constipation, excess sodium bicarbonate, diuretics that cause potassium depletion, severe vomiting – | |
| hyperventilation due to asthma, anxiety, high altitude | resp alk |
| Symptoms of ammonium chloride are due to central-nervous-system stimulation such as | Nervousness, hyperactive reflexes, convulsions, Slow, shallow respirations in attempt to retain acid |
| Treatment of alk administer | Administration of ammonium chloride (severe cases) ; Administration of sodium chloride with potassium chloride (mild cases) |
| AmMonium Chloride Therapy Action: | to decrease pH of body fluids |
| Ammonium chloride Used: | to reverse severe metabolic alkalosis |
| Adverse effect of ammon. Chloride | : acidosis |
| Nursing Implications when giving ammon. Chloride | IV, ABGS, |
| Ammonium chloride is Contraindicated in | presence of liver disease |
| When Infusing ammonium chloride | slowly to avoid ammonium toxicity and decrease irritation to veins |
Created by:
ameliarae
Popular Nursing sets