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final exam rnu
nursing renal etc.
| Question | Answer |
|---|---|
| acute vascular access device | av shunt, subclavian, femoral |
| av fistula | 4-6 weeks to mature. long term device - assess thrills/bruits. no venipuncture, BP or IV in arm. assess CSM, hemorrhage |
| struvite stones are made of? | mg and ammonia |
| cystine stones | autosomal recessive disorder can't break down cystine - leads to stones |
| urine osmolality | better test of urine concentrating than specific gravity |
| causes of prerenal failure | chf, hypovolemia, obstructions to renal blood flow (renal artery stenosis, clamp artery during surgery, embolism to artery) |
| average MAP | 100-110 |
| kidney needs minimum map of __. | 60. |
| acute renal failure mgt | protein, K and fluid restrict (previous days u/o + 500cc.) HTN meds (aldomet, ace), diuretics (after fluid bolus challenge), low dose dopamine - trt cause, fluid if rt hypovolemia |
| s/s of acute renal failure | lethargy, twitching, tremors, NV, decrease UO, ^ BUN, creatinine, K (neuro and cardiac changes), anemia, metabolic acidosis, wt gain/loss |
| stages acute renal failure | 1) onset- 2 days UO decrease 20%, BUN creatinine ^ 2) oliguric-anuric - 8-14 days. UO<400cc/day UO 5% normal value, lab values max 3) diuretic - 10 days UO ^ lab values decrease, K and lytes balance 4) recovery- 4-6 months UO and labs stablize |
| causes of postrenal failure | uretral calculi (any calculi with obstruction leads to hydronephrosis), prostatis hypertrophy, bladder tumors, urethral stricture |
| casues of intralrenal failure | acute tubular necrosis (ATN), glomerulonephritis, diabetic neuropathy, HTN, any condition that leads to prolonged ischemia (necrosis to renal tissue) |
| uremia related assessment | confusion, lethargy, sz, anemia, bleeds, skin changes, bone demineralization (renal oesteodystrophy-renal rickets), peripheral neuropathies, peptic ulcers, diarrhea, constipation, pulmonary edema, HTN, cardiac standstill (^ K) |
| 3 stages chronic renal failure | decreased renal reserve-BUN and creatinine WNL renal insufficiency-mild-mod azotemia, some systemic effects (bone loss, htn, retain fluids) trt'd end stage renal disease-uremia, 5% renal fxn remains, irreversible, creatinine reaches 10, need dialysis |
| chronic renal failure etiologies | glomerulonephritis, HTN, diabetic neuropathy, adult polycystic kidney disease (autosomal recessive genetic disorder) |
| CAPD nursing care | weigh after draining, cath patency (heparin), allowed more protein, ambulate |
| capd complication | albumin loss |
| bladder cancer cell types | transitional cell carcinoma or urothelial cancer |
| transurethal resection and cystoscopy | scrape urethra and bladder for superficial cancer - hematuria post-op |
| partial cystectomy` | remove 1/2 bladder - capacity reduced |
| total cystectomy | entire bladder removed -need urostomy |
| radical cystectomy | remove bladder, lymph, muscle, fat |
| pelvic exeneration | remove pelvin organs w/bladder |
| ileal conduit (loop) | permanent urostomy - 1 or both ureters placed into resected ileum (becomes stoma) continually flows - stoma not visible |
| permanent urostomies | ileal conduit (loop), colon conduit, kock's pouch (valve inside, drain w/catheter), indiana pouch, ureterosigmoidoscopy |
| ureterostomy | temporary urostomy - tiny stomas likely to occlude nephrostomy tube |
| uremia mgt | protein (0.6-1g/kg) restirct, K (2g) and Na (2g) restrict, fluid restrict, daily wt, ^ carbs, vit D + calcium, phosphate binders, HTN meds (aldomet, ace) dialysis |
| amphogel - sevelemar HCL, renegal, calcium acetate (phos lo) | phosphate binders for uremia |
| lithotripsy | external sound wave break up stone |
| percutaneous lithotripsy | pulsating device placed inside - closer to stone |
| extracorporeal shock wave lithotripsy | water bath near stone |
| cystostomy | open incision into bladder to remove stones |
| percutaneous nephrolithotomy | scope placed into kidney-pelvis to remove stones |
| nephrolithotomy | open surgical procedure - remove stones |
| ureterlithotomy | remove stones from ureters |
| nephrectemy | remove entire kidney |
| interleukin 2 and interpheron alpha | biologic tx kills renal cancer cells |
| hemolytic uremic syndrome (HUS) | acute renal failure, hemolytic anemia, thrombocytopenia |
| s/s HUS | -proteinuria, hematuria mild-UO changes, anemia, thrombocytopenia, azotemia severe- HTN, sz, stupor |
| DDAV - desmopressin | 2 sprays before bad (or tab) for enuresis high relapse rate |
| hypospadias | urethral opening underside of shaft |
| orchipexy | tests brought into scrotum and secured. surgical repair before 2nd bday. |
| anorchia | absence of testes |
| acute post-streptococcal glomerulonephritis (APSGN) trt | trt HTN, fluid balance, BP Q4-6 hrs, AB only if persistent strept, no added salt, daily wt, avoid fatigue |
| acute post-streptococcal glomerulonephritis (APSGN) s/s | decreased GFR, hematuria, proteinuria, high specific gravity, high BUN, ASO for strep, acute edema phase, dark urine, decreased UO |
| primary nephrotic syndrome | restricted to glomerular injury |
| secondary nephrotic syndrome | part of systemic illness |
| minimal change nephrotic syndrome | type of primary nephrotic syndrome. obscure non-specific illness |
| congenital nephrotic syndrome | hereditary dt recessive gene on autosome |
| wilm's tumor (nephroblastoma) staging/prognosis | swelling mass in abd- firm, nontender, one side, HTN, anemia, hematuria, wt loss, fever, mets 1- high survival rates 2-tumor ltd to kidney + resected 3-tumor confined to abd 4-mets 5-bilateral renal involvement |
| primary reflux | dt congenital anomaly - familial pattern - screen children thru 72 months |
| secondary reflux | acquired |
| pyelonephritis | inflamm of upper urinary tract. ^ fever, chills, flank pain, abd pain, leukocytosis. suspected children admitted to hospital and AB for 2 days. common cause- reflux w/infection |
| Vesicoureteral reflux (VUR) | retrograde flow of bladder into ureters. siblings screened. spontaneous resolution FU Critical, VCUG (voiding cystouretrography)yrs after, low dose AB, freq urine culture, renal US 1 month post-if no obst-stop AB. renal US and VCUG 6 mo and 1-2 yrs later |
| HUS mgt | fluid repl WITH CARE, correct acidosis/lyte issue. trt early- hemodialysis, PD, cont hemofiltration, transfuse w/PRBC for anemia |
| wilm's tumor (nephroblastoma) mgt | chemo for all stages- VINCRISTINE - surgery 24-48 hrs, nephrectomy. advanced=DOXORUBICIN, post op radiation if lg tumor, if both preop radiation. DONT PALPATE TUMOR, chemo/radiation right after surgery monitor BP (renin excess->HTN) avoid contact sports |
| nephrotic syndrome mgt | salt restrict in edema phase, bed rest, AB, corticosteroids (PREDNISONE 2mg/kg UNTIL NO PROTEINURIA), relapsers=steroid dependent, lasix, immunosupp tx, plasma expander (SPA) I+O daily wt,can go to school |
| Salt poor human albumin | SPA - plasma expander - for nephrotic syndrome |
| acute glomerulonephritis (AGN) | hematuria, proteinuria, oliguria, edema, HTN, circulatory congestion |
| chronic/progressive glomerulonephritis (CGN) | decreased renal fxn, nephrotic syndrome, renal insuff can last 5-15 yrs, rapid can become ESRD, symptomatic=dialysis, transplant |
| nephrotic syndrome s/s | massive proteinuria, hypoalbuminemia, hyperlipidemia, edema, puffy eyes in AM, decrease UO, dark frothy pee, pallor, wt loss, poor appetite |
| medulloblastoma (primitive neuroectodermal tumor) | fast growing- very malignant. HA upon wakening, pressure on pain sens areas, vomit, ataxia, Gold std=MRI. surgery, chemo, radiatioan safe >3 yrs, corticosteroids for brain edema, |
| lumbar puncture | dangerous with ICP (medulloblastoma) |
| neuroblastoma | silent tumor-usually abd-firm nontender, irregular, crosses midline, compress KUB, S/S depend on location. stage 1-2 surgery, stage 3-4 biopsy and radiation |
| acute myelogenous leukemia (AML) | poorer prognosis, high WBC >10k, each relapse=poorer prognosis. BMT poorer results but may be used w/1st remission |
| acute lymphoid leukemia (ALL) | WBC <5k CALLA + early b cell, BMT not for first remission but may with others |
| HIV children classification | mild-lymphadenopathy, recurrent sinus/ear infection, hepatosplenomegaly, parotitis mod-lymphoid interstitial pnuemonia (LIP), organ dysfxn severe- AIDS defining illness except LIP |
| orchiectomy | surgical castration for prostate cancer - remove testosterone source |
| estrogen DES | medical castration |
| leuporide (luproN) | leutinizing-hormone agonist |
| TURP - transurethral resection of prostate | remove some of prostate tissue. 3 way foley. bloody urine. continuous bladder irrig w/NS |
| TUIP | incision made into prostate by laser - no tissue removed. flow should improve |
| suprapubic incision | for prostate cancer-need tube post-op |
| perineal incision | for prostate cancer - lg tumors |
| retropubic incision | preferred for prostate cancer |
| PSA | greater than 2.5 = annual testing for prostate cancer |
| finasteride (proscar) | decrease testosterone formation for BPH. 5-alpha reductase inhibitors |
| saw palmetto | herb for BPH - don't use with proscar |
| methlydopa (aldomet) | htn - |
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