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Adult Exam 3 Midterm

Adult Exam 3 - Midterm

Renal Failure - Manifestations Polyuria, nocturia, fixed low specific gravity <1.010, oliguria (400-500cc/24hr), anuria (<100cc/24hr)
Renal Failure - Labs BUN (varies c meals); Creatinine (inc, GFR) (serum = funct of kidney; clearance = estimates GFR ~ 0.5-1.5); Protein urea screening (screening, dipstick)
Normal Creatinine 0.5 - 1.5
Normal BUN 8-21
Normal GFR >59
Stages of Renal Failure - what to remember dec renal reserve (watch meds); kidney insufficiency (watch diet); kidney failure (further interventions); ESRD (dialysis)
Renal Failure - Medications HTN (CCBs, BBs, ACEs, ARBs); Diuretics (Loop); Kayexalate; Anemia; dec phosphate intake; PhosLo, Renagel, Fosrenal, Calcitrol
Renal Failure - Management Tx CAD, diabetes, HTN; renal diet (dec phosphate intake (dairy, eggs, meat, fish), Na, K, fluid restrictions, inc cal from fat; skin care, medications, dialysis,
Dialysis - Diffusion particles move from an area of greater to lesser concentration across semipermeable membrane
Dialysis - Osmosis fluid moves from an area of lesser to greater conc. of particle across semipermeable membrane
Peritoneal dialysis Cath placement -> dialysate -> dwell time (fluid in ABD from 20min to 8hrs) -> fluid removal
Intermittent peritoneal dialysis several times/day c complete (no dialysate left in ABD) exchanges
CAPD (continuous ambulatory peritoneal dialysis) always leave dialysate in ABD; done at home ~4x/day; may keep tubing in tact or d/c
CCPD (continuous cyclic peritoneal dialysis)/Automated peritoneal dialysis (APD) always leave dialysate in ABD; MACHINE - cycles 3-5 cycles during the night; 1-2L in ABD left in during day
Peritoneal Dialysis Advantages fewer dietary restrictions (typically dbl. protein); inc mobility; insulin can be put in dialysate; fewer fluid shifts
Peritoneal Dialysis Disadvantages Peritonitis (tube in ABD -> risk for infection); not for obese, ABD surgery, hernia; may make back problems worse; may inc serum glucose/Trig levels
Peritoneal Dialysis Complications Peritonitis; obstructions; hypoTN; fluid/electrolyte imbalances; hernia; preforation of stomach/bladder; resp distress; muscle cramps
Hemodialysis Caths (temp); Ateriovenous (AV) fistula (forearm, thrill, 4-6wks to mature); Subq access device; machine (semipermeable membrane, dialysate, 1 unit at a time)
Hemodialysis - Nursing Management Pre-dialysis (assess include BP; hold meds unless checked c dialysis nurse); hypovolemia; DISEQUILIBRIUM SYNDROME (r/t rapid fluid change, cerebral edema (N/V, confusion, HA), slow or stop dialysis); check muscle cramps; post (sepsis, Hep C, bleeding)
Stages of COPD - 1 et 2 1 (mild, min SOB, c/s cough et/or sputum, unrecognized, PFT >80%); 2 (mod, mod-severe SOBE, c/s cough/sputum/dyspnea, med attention, PFT 50-80%)
Stages of COPD - 3 et 4 3 (severe, inc severe SOB, c/s cough/sputum/dyspnea, repeat exacerbations, dec QOL, dec exercise, inc fatigue, PFT 30-50%); 4 (very severe, further dec QOL r/t SOB, exacerbations life threatening, PFT <30% predicted or <50% c chronic resp failure)
PFT (Pulmonary funct test) - Spirometry Tests - SEE BACK!!! FVC (Forced vital capacity); FEV1 (forced expiratory vol in 1 sec); TV (tidal volume); Functional residual vol; Pulmonary diffusion capacity (means ability of gas to diffuse against the alveolar cap membrane)
COPD stages determined by spirometric classification
Dyspnea Scale 0 least restricted -> 1 SOB c exercise -> 2 walk slower or stop for breath -> 3 stops p ~100m/few minutes -> 4 most restricted (too breathless to leave house/breathless during dressing)
COPD - Nursing Care/Teaching teach (meds, correct use, spacer, PO care, shake et prime, hold breath for 10 sec), report (resp infection, depression, sleep difficulties), flu vaccine, pneumovax, smoke cessation
COPD - Medications Anti-inflammatory; bronchodilators; mucolytics (mucomyst); aerosol therapy (albuterol, atrovent); theophylline (caffeine); combo agents
COPD - Medications - Anti-Inflammatory agents Coricosteroids - PO (Prednisone, prob c mod doses long time); IV (Solu-Medrol); Inhaled (Azmacort, Flovent)
COPD - Medications - Brochodilators Beta 2 Agonists (s inc HR, Epinephrine Beta1 inc HR et BP); Short-acting (Albuterol, Levalbuterol); Long-acting (Salmeterol, safety prob c corticosteroids); Anticholinergic (Atrovent - short; Spiriva - dry powder)
Anticholinergic Effects Know the ABCD'S (Anorexia, Blurry vision, Constipation/Confusion, Dry Mouth, Sedation/Stasis of urine)
COPD - Medications - Combo agents Combivent (Albuterol, Atrovent); Advair (Flovent - corticosteroid; serevent (long-acting beta agonist)
COPD - complications spontaneous pneumothorax (fragile lung tissue); Cor pulmonale (heart probs d/t lungs; pulmonary HTN R sided CHF; Low pO2 causes vasoconstriction -> pulmonary HTN; lead to R ventricular hypertrophy leads to cor pulmonale)
Short Duration: Rapid Acting (Humalog, Novolog, Apidra) onset 10-30min; peak 30min - 3hrs; duration 3-6.5hrs
Short Duration: Slow Acting (Humulin) onset 30-60min; peak 1-5hrs; duration 6-10hrs
Intermediate Duration (NPH) onset 1-2hrs; peak 6-14hrs; duration 16-24 hrs
Intermediate Duration (Levemir) onset 6-8min; peak 12-24hrs; duration dose dependent
Long Duration (Lantus) onset 70min; peak none; duration 24hrs
Oral diabetic agents (MORE INFORMATION?) Sulfonylureas; Metformin (Glucophage) (off ~24hrs before test c dye involved)
BBs... end with -lol
ACEs ... end in -pril; can cause a cough
ARBs ... end with -sartan
How do cardiac medications affect CO? Preload (diuretics); afterload (digoxin (pos inotrop, inc), BBs (dec), CCBs (dec)); Contractility (BBs, CCBs (vasodilation), ACEs, ARBs (vasodilation))
Expected c Renal Failure fluid overload (dec Na, Phosphorus; inc K, CR); ABG (met. acid.); fragile bones; erythropoietin made in kidney (anemia, dec Hgb -> epogen); loop diuretics; diet
Novolog 70/30 (IMPLICATIONS FOR MANAGEMENT?) 70 = long acting, 30 = short acting
Split Mix Dosing vs Intensive Therapy of Insulin - SEE BACK!!! advantages et disadvantages of each
Created by: kdrummond08