Adult Exam 3 - Midterm
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| Renal Failure - Manifestations | Polyuria, nocturia, fixed low specific gravity <1.010, oliguria (400-500cc/24hr), anuria (<100cc/24hr)
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| 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)
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| Normal Creatinine | 0.5 - 1.5
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| Normal BUN | 8-21
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| Normal GFR | >59
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| Stages of Renal Failure - what to remember | dec renal reserve (watch meds); kidney insufficiency (watch diet); kidney failure (further interventions); ESRD (dialysis)
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| Renal Failure - Medications | HTN (CCBs, BBs, ACEs, ARBs); Diuretics (Loop); Kayexalate; Anemia; dec phosphate intake; PhosLo, Renagel, Fosrenal, Calcitrol
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| 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,
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| Dialysis - Diffusion | particles move from an area of greater to lesser concentration across semipermeable membrane
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| Dialysis - Osmosis | fluid moves from an area of lesser to greater conc. of particle across semipermeable membrane
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| Peritoneal dialysis | Cath placement -> dialysate -> dwell time (fluid in ABD from 20min to 8hrs) -> fluid removal
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| Intermittent peritoneal dialysis | several times/day c complete (no dialysate left in ABD) exchanges
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| CAPD (continuous ambulatory peritoneal dialysis) | always leave dialysate in ABD; done at home ~4x/day; may keep tubing in tact or d/c
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| 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
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| Peritoneal Dialysis Advantages | fewer dietary restrictions (typically dbl. protein); inc mobility; insulin can be put in dialysate; fewer fluid shifts
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| 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
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| Peritoneal Dialysis Complications | Peritonitis; obstructions; hypoTN; fluid/electrolyte imbalances; hernia; preforation of stomach/bladder; resp distress; muscle cramps
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| Hemodialysis | Caths (temp); Ateriovenous (AV) fistula (forearm, thrill, 4-6wks to mature); Subq access device; machine (semipermeable membrane, dialysate, 1 unit at a time)
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| 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)
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| 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%)
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| 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)
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| 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)
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| COPD stages determined by | spirometric classification
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| 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)
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| 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
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| COPD - Medications | Anti-inflammatory; bronchodilators; mucolytics (mucomyst); aerosol therapy (albuterol, atrovent); theophylline (caffeine); combo agents
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| COPD - Medications - Anti-Inflammatory agents | Coricosteroids - PO (Prednisone, prob c mod doses long time); IV (Solu-Medrol); Inhaled (Azmacort, Flovent)
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| 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)
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| Anticholinergic Effects | Know the ABCD'S (Anorexia, Blurry vision, Constipation/Confusion, Dry Mouth, Sedation/Stasis of urine)
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| COPD - Medications - Combo agents | Combivent (Albuterol, Atrovent); Advair (Flovent - corticosteroid; serevent (long-acting beta agonist)
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| 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)
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| Short Duration: Rapid Acting (Humalog, Novolog, Apidra) | onset 10-30min; peak 30min - 3hrs; duration 3-6.5hrs
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| Short Duration: Slow Acting (Humulin) | onset 30-60min; peak 1-5hrs; duration 6-10hrs
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| Intermediate Duration (NPH) | onset 1-2hrs; peak 6-14hrs; duration 16-24 hrs
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| Intermediate Duration (Levemir) | onset 6-8min; peak 12-24hrs; duration dose dependent
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| Long Duration (Lantus) | onset 70min; peak none; duration 24hrs
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| Oral diabetic agents (MORE INFORMATION?) | Sulfonylureas; Metformin (Glucophage) (off ~24hrs before test c dye involved)
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| BBs... | end with -lol
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| ACEs ... | end in -pril; can cause a cough
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| ARBs ... | end with -sartan
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| How do cardiac medications affect CO? | Preload (diuretics); afterload (digoxin (pos inotrop, inc), BBs (dec), CCBs (dec)); Contractility (BBs, CCBs (vasodilation), ACEs, ARBs (vasodilation))
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| 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
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| Novolog 70/30 (IMPLICATIONS FOR MANAGEMENT?) | 70 = long acting, 30 = short acting
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| Split Mix Dosing vs Intensive Therapy of Insulin - SEE BACK!!! | advantages et disadvantages of each
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