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MED SURG EXAM 4

Terms in this set (156)

Identify risk factors for oral cavity cancer.
Lifestyle choices (i.e. smoking) and
Early symptoms affects the floor of the mouth and tongue. Can be asymptomatic in early stages.
Identify nursing interventions for patients undergoing IV conscious sedation for GI procedures.
Gag reflex, ABC's (monitor respiration & cardiac), shoulder pain (referred from gas), decrease respiration try to wake patient up (do simple first)
What are the risk factors for Gastroesophageal Reflux Disease (GERD)?
Pregnancy, obesity, hiatal hernia, food trigger (caffeine, spicy, citrus, chocolate) smoking, alcohol, ascites, tight belts/girdles, presence of NG tube, eating large meals, LES hypotension, loss of esophageal motility, increased states of gastric secretion, delayed emptying of gastric contents
What lifestyle changes should a patient with GERD make?
Avoid caffeine, spicy, eat small frequent meals, don't lie down for 1 hour after a meal, elevate HOB 4-8 inches when sleeping, don't eat before going to bed, surgery to tighten sphincter. [other foods & drinks to avoid on slide 29 in the comments]
What causes gastritis?
The onset of INFECTION with Helicobacter pylori can result in acute gastritis; H. pylori is a gram-negative bacterium that penetrates the mucosal gel layer of the gastric epithelium
What teaching do we provide for patients with gastritis?
Eat a well-balanced diet, avoid alcohol, don't take too much aspirin, NSAIDS or corticosteroids, avoid excess coffee (caffeine), avoid contaminated water, manage stress, stop smoking, avoid exposure to toxic substances, GI rest → clear liquids → heavier liquids → solid food, seek medical advice if experiencing reflux.
Identify causes of Peptic Ulcer Disease (PUD).
Causes - gastroduodenal mucosa cannot withstand digestive action of gastric acid and pepsin
Identify complications of Peptic Ulcer Disease (PUD).
Complications - perforations and penetration into attached structures and obstruction
Differentiate the difference between mechanical and obstructive intestinal obstructions
Mechanical - decreased peristalsis, etc.
Obstructive - physical blockage (tumor, strictures)
contrast irritable bowel syndrome (IBS) versus irritable bowel disease
○ IBS [3 types IBS-C (constipation) IBS-D (diarrhea) IBS-M (both)] - GI motility, visceral hypersensitivity, intestinal inflammation, post infectious, bacterial overgrowth, food insensitivity, carbohydrate malabsorption, gluten sensitivity, genetics, psychosocial dysfunction
Inflammatory Bowel Disease = Crohns disease + ulcerative colitis
○ Crohn's - mouth → anus, transmural (all layers), not uniform, strictures, fistulas, diarrhea, pain in RLQ, fever
○ Ulcerative colitis - (only affects rectum & colon, never affects s. intestines) large intestine, mucosa and submucosa, diarrhea, blood, mucus and pus, pain in LLQ, tenesmus (anal spasm), rectal bleeding
What are risk factors, signs and symptoms of hemorrhoids?
○ Risk factors - surgery, weakened muscles, congenital, fat, increased abdominal pressure [Caused by increased abdominal pressure, the condition worsens during pregnancy, constipation with straining, obesity, heart failure, prolonged sitting or standing, and strenuous exercise and weight lifting]
○ S&S - protrusion of abdominal contents through area of weakens muscle, strangulation of the intestine, intestinal obstruction, necrosis of bowel tissue
○ Prevention - of constipation; HYDRATE
What is diverticulitis?
Small, pouchlike protrusion or herniation, often in the GI tract, particularly the colon
How to manage flared diverticulitis?
rest bowels avoid high fiber
Complications of diverticulitis.
Perforation, abscess and fistula formation, bowel obstruction, and bleeding
Inflammation can also result in fistulas to other organs
Colorectal cancer screenings depend on what?
risk factors;
(most early forms of colorectal cancer do not cause symptoms, which makes screening especially important)
What are the RF of colorectal cancer?
Age > 50 yr
Genetic predisposition
Personal/family history of cancer
Familial adenomatous polyposis
What are the complications of liver failure (caused by cirrhosis), including portal hypertension?
Ascites, portal hypertension with varices, hepatic encephalopathy, coagulopathy, hepatorenal syndrome, spontaneous bacterial peritonitis, jaundice, malaise, fever, abdominal pain, irritability, pruritus, vomiting, nausea can lead to esophageal varices (really bad).
Identify nursing diagnoses for the patient who has liver failure due to cirrhosis.
ineffective airway, risk for bleeding, disturbed body image, deficient knowledge, ineffective health management
Identify interventions for the patient who has liver failure due to cirrhosis.
administer neomycin sulfate (reduce bacteria), and lactulose (ammonia). Monitor I&O, mental status, ability to swallow, color of stool, abdominal distention, maintain hydration.
What dietary education is needed by the patient who has liver failure?
Decrease protein and fat intake. Avoid alcohol and certain medications
Identify risk for the development of gallstones.
Obstruction of ducts. Diet, sex/age, ethnicity, obesity, genetics, diabetes, estrogen therapy, cholesterol drugs, diet.
What nursing interventions are needed for the patient who has acute pancreatitis?
○ Pain management (opioids, anticholinergics, histamine blockers, pancreatic enzymes, antibiotic therapy), labs, diagnostic imaging.
■ Amylase, lipase, WBC, and glucose are often higher than normal in patients with acute pancreatitis
What teaching do we provide for patients with a family history of colon cancer?
Get a colonoscopy before age 50.
When providing colostomy care, what is the normal appearance of a stoma, what are nursing consideration and what patient teaching will you provide?
○ Beefy red and moist. Measure stoma. Choose appropriate appliance. Avoid foods that cause excess gas. Empty pouch frequently to remove gas.
What teaching do we provide for patients to avoid hepatitis?
○ Deals with the liver, wash hands, feces, viral illness; Get vaccination for A & B. avoid contact with blood/feces ingestion.
pre- & post procedure nursing considerations for patients scheduled for CT scan
○ CT scan: PRE - explain procedure, assess for anxiety, patient IV, allergies to iodine (shellfish/dye), monitor kidney function (excrete contrast) POST - administer IV fluids / increase PO, monitor for allergic reactions
Identify pre- & post procedure nursing considerations for patients scheduled for PET scan
○ PET scan: PRE - explain procedure, NPO 6 to 8 hours prior to test, no caffeine/alcohol/tobacco - 24 hrs, allergies to iodine (shellfish or dyes), monitor kidney function POST - administer IV fluids / increase PO
pre- & post procedure nursing considerations for patients scheduled for MRI
○ MRI: PRE - explain procedure, screen for metal object (ie. Cardiac objects), assess for anxiety POST - administer IV fluids / increase PO
pre- & post procedure nursing considerations for patients scheduled for angiogram
○ Angiogram: PRE - explain procedure - 60 to 120 min., NPO, informed consent obtained, contrast causes warm flushed feeling, complete neuro/peripheral pulses/VS, monitor kidney function, iodine allergy POST - monitor arterial catheter site (femoral area/no bleeding), administer IV fluids or increase PO, monitor for allergic reaction
pre- & post procedure nursing considerations for patients scheduled for lumbar puncture
○ Lumbar puncture: PRE - hold anticoagulants, insure informed consent obtained POST - flat bedrest 4 to 6 hours, administer IV fluids or increase PO, monitor for allergic reaction
Identify three primary headaches
migraine, tension, cluster
Identify four sources of secondary headache
○ infection, neoplasms, vascular abnormalities, medication-induced
Describe the classic symptoms of tension headache (i.e., location, characteristic of pain, and associated symptoms).
○ Dependent upon frequency (>15 days = chronic) LOCATION - pericranial muscles, frontal, temporal CHARACTERISTIC OF PAIN - bilateral pressing & tightening (non pulsating) pain, band-like, mild to moderate pain, pain/tenderness
Describe the classic symptoms of migraine headache (i.e., location, characteristic of pain, and associated symptoms).
○ Chronic episodic disorder LOCATION - hyperexcitation of neurons (cortical spreading depression), vasodilation, inflammation in the brain CHARACTERISTICS OF PAIN - intense throbbing pain, unilateral, photo/phonophobia, N/V
Describe the classic symptoms of cluster headache (i.e., location, characteristic of pain, and associated symptoms).
○ AKA trigeminal autonomic cephalgia, most severe form of primary headaches LOCATION - unk CHARACTERISTICS OF PAIN - severe, unrelenting, unilateral orbital, supraorbital, temporal pain, ipsilateral (same side), conjunctival injection &/or lacrimation, occur same time for several weeks ASSOCIATED SYMPTOMS - nasal congestion/rhinorrhea, eyelid edema, forehead/facial sweating, miosis, ptosis
What is the primary physiologic process that leads to pain associated with migraine headache?
○ Premonitory (hunger cravings/mood changes prior to headache), aura [change within visual field (i.e. Wavy lines of hot road)], headache, postdromal
Identify nursing interventions for headaches
○ Maintain calm, dark, quiet environment; teaching: headache diary, avoid triggers
● What are and describe the phases of seizure?
○ Preictal, aura, postictal
● Differentiate primary seizures from secondary seizures.
○ Primary (idiopathic) secondary (underlying cause)
● Identify causes of secondary seizures
○ Underlying brain lesion, tumor, or trauma; metabolic disorder; drug/alcohol withdrawal; stroke; electrolyte disturbances
○ Tonic clonic seizures
begin stiffening/rigidity, LOC, rhythmic jerking
○ Absence seizures
brief LOC, blank stare
○ Myoclonic seizures
brief jerking or stiffening of extremities
○ Atonic (akinetic) seizures
sudden loss of muscle tone
○ Complex partial seizures
LOC, automatisms, post ictal amnesia
○ Simple partial seizures
remains conscious, aura (déjà vu, offensive smell or sudden onset of pain, one-sided movement of extremity
● What are five elements of "self-management" of seizure disorder?
○ Understand medications, check w/ provider before taking other medications, medical alert bracelet, help at home, driving laws
● What are the nursing interventions to care for a patient who is having a seizure?
○ Protect from injury, turn on side, maintain airway, nothing in mouth, do not restrain, record duration of seizure, assess vitals after cessation of seizure
● ·What must be documented after a patient has had a seizure?
○ Frequency, description, sequence of seizure, observations during seizure, duration, preictal?, postictal?, time to pre-seizure state
● What is status epilepticus and what are key elements in managing this condition?
○ No recovery time, happen one after another; MANAGEMENT - establish airway, IV access, monitor ABG/metabolic changes, IV push Ativan/Valium, IV phenytoin (Dilantin) loading dose
○ Meningitis
inflammation of the meninges, bacterial/viral/fungal/aseptic
○ Encephalitis
inflammation of the brain
● How is meningitis medically diagnosed and managed?
○ Medical: DIAGNOSIS - lumbar puncture [(CSF analysis) cell count, differential count, protein], CT scan, CBC, serum electrolytes (risk SIADH) MANAGEMENT - pharmacologic therapy (broad septum antibiotics, medications, pain), monitor closely for changes in neurologic assessment, monitor complications
● How is meningitis nursing diagnosed?
○ Nursing: DIAGNOSIS - risk for confusion, activity intolerance, risk for imbalanced fluid volume, impaired comfort
● Identify nursing interventions for patient with meningitis.
○ MANAGEMENT - assess (neuro status, VS, CN, I&O, vascular), actions (prevent pressure ulcers, perform ROM, provide quiet environment, minimize bright light, elevate HOB 30°, administer meds), teaching (complete antibiotics)
● Identify six changes that occur in the aging nervous system.
○ Slower processing time, recent memory loss, decreased touch sensation, change in perception of pain, change in sleep patterns, altered balance and/or decreased coordination
● What neurotransmitter is associated with Parkinson's disease (PD)?
○ Dopamine
● What are key features of PD?
○ Resting tremors, muscle rigidity, movement changes (bradykinesia, akinesia), postural instability, mask-like face
● What are the nursing interventions used to care for the patient with PD?
○ Assess (tremors, rigidity & bradykinesia, mobility, gag/swallowing, bowel/bladder function) Actions (allow patient time, administer medications, facilitate nutritional intake, fall & aspiration precautions, encourage self-care deficiencies, communication, collaborate with interdisciplinary) Teaching (medications, safety, psychosocial support)
● What are key features of Alzheimer's disease?
○ Progress cognitive impairment; forgetfulness, difficulty w/ language, short-term memory loss, agnosia (inability to process info.), emotional lability, personal changes, loss of cognitive skills
● Identify the seven elements of managing Alzheimer's disease.
○ Cognitive stimulation & memory training, structure the environment, orientation & validation therapy, promoting self-management, promoting bowel & bladder continence, promoting communication, medication
● What nursing interventions are used to manage priority problems (i.e., chronic confusion, risk for injury and caregiver role strain) of Alzheimer's disease?
○ Acute/chronic confusion, caregiver role strain, labile emotional control, ADL self-care deficit
● Identify clinical presentation of myasthenia gravis
(acquired autoimmune) - ocular palsies, ptosis, diplopia, dysphagia, fatigue, progressive muscle weakness
● Identify clinical presentation of Guillain-Barre
acute inflammatory demyelinating) - affects PNS: motor weakness, sensory abnormalities, ascending paralysis
● Identify complications and interventions for Guillain-Barre.
○ Respiratory arrest, complications of immobility (VTE, pressure ulcers, muscle atrophy/contractures, urinary stasis), residual numbness/weakness
trigeminal neuralgia
"Tic douloureux" - CN V; chronic pain syndrome, older than 50 y.o., classic pain (unilateral, excruciating, sharp, shooting, piercing, burning, jabbing) atypical pain (continuous burning sensation of entire face), provoked by minimal stimulation "trigger zone"
facial palsy
"Bells palsy" - acute paralysis of CNVII, in all ages; PRESENTATION - inability to close eye, eye +/- tearing, wrinkle forehead/smile/whistle/grimace, mask like/sag face, taste impaired, tinnitus
● Identify risk factors for hemorrhagic stroke
○ (intracerebral) Sever HTN; (subarachnoid) ruptured aneurysm, arteriovenous malformation
● Identify risk factors for thrombus ischemic strokes
HTN, smoking, hypercholesterolemia, age > 55, men > women, race, HX of MI/migraines, prior stroke, sickle cell
● Identify risk factors for embolic ischemic strokes
a fib, MI, cardiomyopathy, prosthetic valve complication, endocarditis, rheumatic heart disease, ischemic attack; "underlying cardiac problem"
● What visual changes may occur with stroke?
○ Blurred vision, diplopia, blindness in one eye, tunnel vision
● What diagnostic test is priority for the patient who presents with symptoms of stroke?
○ CT - can help determine underlying cause (rule out hemorrhagic to admin t-Pa)
● Identify medical management of ischemic stroke
■ t-PA actively dissolves clots
■ Don't use if active bleeding anywhere in the body, trauma or bleeding precautions
● Identify medical management of hemorrhagic stroke
■ Titanium clip around aneurysm or platinum coil to fill aneurysm
● When caring for a patient who has had a stroke, what are the nursing interventions for the following diagnosis: impaired swallowing, mobility and promoting self-care, effective communication, improving mobility, promoting continence, managing sensory perception loss and unilateral body neglect?
○ Impaired swallowing - aspiration precautions, swallowing study
○ Mobility and promoting self-care - getting them to participate in hygiene, PT
○ Effective communication - knowing what type of speech issue they may have
○ Improving mobility - frequent turning, helping them move
○ Promoting continence - stool & urine. Timed toileting. May be constipated.
○ Managing sensory perception loss - teach to sweep the room if they have lost peripheral vision.
○ Unilateral body neglect - teach to be purposeful with other side of body. Be aware of it. Carry arm.
Myopia
nearsightedness; can't see things far away (images fall in front of retina)
Hyperopia
farsightedness; can't see things up close (images fall behind retina)
Presbyopia
gradually age related loss of lens accommodation (inability to focus on close objects)
Astigmatism
misshapen cornea, causes uneven bending of light (near/distant blurry)
(sub)Conjunctival hemorrhage
benign hemorrhage under conjunctiva; no pain, no visual impairment; can be caused by forceful pushing, will resolve on own
Conjunctivitis
inflammation or infection of conjunctiva "pink eye"; caused by pathogens of things that get into eye
Bacterial conjunctivitis s/s
thicker discharge, "cant open my eyes" ; typically start in one eye then infects the other
Corneal abrasions
scrape or scratch on cornea, painful & can lead to infection
mostly caused by contact wearers, windy, & abrasive eye injury
s/s & complications of corneal abrasions
s/s: unilateral eye pain, photophobia, spasms occur leading to --- squinting, tearing, blurred vision, sensation of object in eye
complications: corneal ulcer
Cataracts
lens opacity, blurred vision;
s/s: clouded, blurred, or dimmed vision, sensitivity to light & glare, halo vision, fading/yellowing colors, diplopia
Phacoemulsification
used to treat cataracts; cloudy part is taken out and a new lens is put on top; very successful procedure
Glaucoma & risk factors
increased ocular pressure;
AA > 40 y.o., > 60 y.o., myopia, corticosteroids
Open-angle glaucoma
most common; aqueous fluid doesn't drain well out of eye
asymptomatic; progression lead to loss of peripheral vision (symptomatic)
Closed-angle glaucoma
OPHTHALMOLOGY EMERGENCY; pressure builds up unable to drain;
excruciating eye pain, eye pain, N/V, rainbows around light, blurred vision, VISION IS LOST QUICKLY!
Normal tension glaucoma
damage to optic nerve despite not high IOP
Macular degenerative disease
age related degeneration of macula-loss of central vision
straight lines distorted, absent/distorted central vision
● Identify five interventions used for the patient who has reduced vision.
1. Treating meal times like clock- "sandwich is at 3, peas are at 9"
2. "I can help you walk up the hall-I have my arm out"
3. Clear their walkways
4. Ask them "what is the best way for me to assist you"-no awkwardness
5. Community resources-coping with others with similar experiences can be helpful
External otitis
"swimmers ear"; inflammation/infection of skin of external ear
s/s of external otitis
itching/pain (movement of tragus/pinna), drainage, hearing loss
management/TX of external otitis
apply heat & topical antibiotics
(earwick - to apply antibiotic, irrigation - to help loosed cerumen)
Otitis media
inflammation of middle ear (tympanic membrane) common in children
adult onset of otitis media
sinusitis, allergies, cigarette smoke exposure, native americans
s/s of otitis media
ear pain, trouble sleeping flat, fluid/blood drainage, hearing loss
severe can lead to chronic, facial palsy, labyrinthitis, mastoiditis
Age related changes of hearing
dryness of cerumen (conductive hearing loss), stiffening of TM, calcification of ossicles, prebyscusis
Meniere's Disease
chronic unilateral sensorieural loss, tinnitus, vertigo, recurrent "attacks"
s/s of Meniere's Disease
vertigo, N/V, tinnitus, sweating, increase in symptoms w/ sudden movements, unilateral sometimes bilateral hearing loss, diarrhea, headaches, abdominal pain, uncontrollable eye movement (nystagmus)
Conductive hearing loss
problem conducting sound waves anywhere along the route through the outer ear, tympanic membrane (eardrum), or middle ear (ossicles).
Sensorineural hearing loss
due to problems with inner ear; also known as nerve-related hearing loss
● Identify changes in the renal system of an aging individual
○ Decreased glomerular filtration rate
○ Nocturia
○ Decreased bladder capacity
○ Weakened urinary sphincter muscles
○ Tendency to retain urine
Benign prostatic hyperplasia, BPH
enlargement of prostate gland
s/s of BPH
■ Hyperirritable bladder
■ Urgency and frequency
■ Hypertrophied bladder wall muscles
■ Cellules and diverticula
■ Hydroureter
■ Hydronephrosis
■ Overflow urinary incontinence
Nursing diagnosis & management of BPH
impaired urinary elimination, disturbed sleep pattern, risk for infection
Assess - urinary symptoms, bladder scanner, UA
Actions
Catheterization (less infection w/ in/out catherization)
Medications
Teaching
Medical treatment plan
Fluid reduction at night
Cystitis
inflammation of the bladder
s/s of cystitis
frequency, dysuria, urgency, gross/micro hematuria, supra-pubic pain, [in older adults] confusion, falls, incontinence, anorexia, nocturia, urosepsis
Pyelonephritis
infection of the kidneys
s/s of pyelonephritis
[systemic] fever, N/V, general malaise, flank/back pain, CVA tenderness
UTI prevention
breathable cotton clothing, irritants (bubble baths, detergents), front to back perineal care, adequate fluid, urinate after sex
Pyelonephritis prevention
[UTI]
CAUTI prevention
catheter association UTI;
avoid long term use, foley strap, bag in dependent position, avoid reverse trendelenburg position, date bag
s/s of urolithiasis
severe pain "colicky", hematuria, obstructed urinary flow
management of urolithiasis
■ Assess - (pain, VS, N&V)
■ Actions - (pain meds, antiemetics, alpha blocker, fluids, strain urine)
■ Teach - prevention (hydrate, low Na, avoid oxalate)
● How do nephrolithiasis and ureterolithiasis cause hydronephrosis and hydroureter?
○ Urine outflow is obstructed from the stones
hydroureter lithiasis
stone obstruction lies within ureters in the middle, ureters suffer from edema
hydronephrosis
stone obstruction lies closer to the kidneys, edema occurs in kidney (renal)
Types of urinary incontinence
stress, urge, reflex, overflow, functional
Stress urinary incontinence
common; Cannot tighten urethra against contraction of detrusor muscle (usually seen in women who have given birth)
Loss of urine with coughing, sneezing, jogging or lifting
Urge urinary incontinence
Often unknown cause; Perception of urgent need to urinate regardless of urine volume
Reflex urinary incontinence
Stroke, multiple sclerosis, parasacral spinal cord lesions, local irritation;
Abnormal detrusor contractions result from neurologic abnormalities
Overflow urinary incontinence
Diabetic neuropathy, SE medication, intrinsic urethral defect, enlarged prostate, woman with genital prolapsed;
Loss of urine associated with over distention of bladder; obstruction (uncontrolled leakage)
Functional urinary incontinence
Physical, intellectual or environmental issue;
Leakage of urine by factors other than disease of urinary tract
Nonpharmacological Tx stress incontinence
Diary - times of leakage, activities & foods
Pelvic floor (Kegel) exercises
Pessaries (device that's inserted into vagina for support)
Nonpharmacological Tx of urge incontinence
Avoid/eliminate irritants such as nicotine or coffee
Prompted voiding
Fluid control
Clean intermittent catheterization (CIC)
Biofeedback
Nonpharmacological of reflex incontinence
CIC
Reflex voiding
Nonpharmacological of overflow incontinence
CIC
Indwelling catheter
Double voiding "void-rest-void"
Fluid control
[CORRECT UNDERLYING CAUSE]
Nonpharmacological of functional incontinence
Timed toileting
Mobility devices
Polycystic kidney disease, PKD
genetic disorder (autosomomal recessive/dominant) excessive growth of fluid filled cysts
recessive - severe, fatal, seen in babies (usually don't survive)
dominant - seen in adults (asymptomatic until 30/40s)
manifestations of PKD
systemic;
Hypertension initial manifestation (BP not well controlled)
Hematuria
Flank or abdominal pain
Increased abdominal girth due to enlargement
Constipation
Complications of PKD
Severe hypertension
Renal calculi
Recurrent UTI
Aneurysms
Cysts - liver & GI tract
End stage renal disease - loss of kidney function due to increase production of cysts
management of PKD
Limited NSAID in acute. None for chronic pain;
Assess - VS, kidney function & electrolyte imbalances via labs, daily weight
Actions
Renal diet - low sodium, low protein
Fluid restrictions
Medications - HTN & pain
Teaching
S&S infection, diet, disease process
Glomerulonephritis (GN)
third leading cause of renal failure; inflammation of the glumeruli
caused by Autoimmune - SLE (lupus), Vasculitis, Infection (Group A beta-hemolytic streptococcus AKA strep throat)
manifestation of glomerulonephritis
***Proteinuria
Hematuria
Casts
HTN
Edema
Elevated Cr & BUN
Acute Kidney Injury, AKI
rapid & progressive azotemia (elevation of urea nitrogen, Cr, K)
phases of AKI
Initiating
Oliguric (UOP < 400ml/day) - how it differentiates from chronic kidney injury
Diuretic
Recovery
Prerenal AKI
Most common
External factors reduce renal blood flow
Blood or fluid loss
Hypotension
Sepsis
Liver failure
Use of ASA & other NSAIDS
Heart attack or heart failure with low EF ejection factor & low CO
Severe burns
Severe dehydration
Intrarenal AKI
Direct damage to renal (kidney) system
Ischemia (ie, from emboli)
Bleeding in the kidney
Glomerulonephritis or inflammation
Systemic infection (sepsis)
Pyelonephritis
Toxins (ETOH, heavy metals, cocaine)
Medications (NSAIDs, antibiotics, chemotherapy)
Lupus
Scleroderma
Postrenal AKI
Mechanical obstruction of lower urinary tract (dec urine output)
Benign Prostatic hypertrophy (BPH)
Tumors
Kidney stone
Neurogenic bladder
Blood clots in the urinary system
s/s of manifestations
Oliguria
< 0.5 mg/kg/hr (wt in kg/2)
< 400 ml/24 hr
Proteinuria
Fluid retention
Increased serum potassium
Increased creatinine
Decreased serum bicarb - patient becoming more acidotic
Edema
complications of AKI
Life-threatening cardiac arrhythmias
Multisystem complications
Pulmonary edema
HF
Neuro changes
GI disturbance
Chronic kidney disease
What are the three most common causes of chronic kidney disease, CKD?
HTN, DM, & glomurulonephritis
Identify s/s of CKD
○ NA & fluid balance → HTN, HF, pulmonary edema
○ Metabolic waste elimination → GI & neuro symptoms
○ Altered Ca and phosphorus → bone breakdown & osteodystrophies
○ Decreased acid clearance & HCO3 → metabolic acidosis
○ Endo & repro → infertility, amenorrhea, hyperparathyroidism, thyroid abnormality
○ Decreased erythropoietin → chronic anemia
● What are the cardiac and pulmonary complications of CKD?
○ Decompensated HF, pulmonary edema, pericarditis, pleural effusion, arrhythmias
● What metabolic, hematologic and nutritional complications occur with CKD?
○ Metabolic acidosis, anemia, malnutrition
● Identify nursing interventions used to manage CKD
○ Renal replacement therapies, support remaining functions of kidneys, treat signs and symptoms, teach dietary restrictions (low protein, K, Na, P), fluid restrictions, avoid OTC meds
● Name the three renal replacement therapies.
○ Hemodialysis (HD)
○ Continuous renal replacement therapies (CRRT)
○ Peritoneal dialysis (PD)
○ Hemodialysis
■ 2-4 hours, 3x/week
■ Blood is removed from the arm or chest and cleaned in a machine, then put back into the patient
○ Peritoneal dialysis
■ 4-6 hours "dwelling"
■ 4-5 exchanges a day
■ Can be done at home by patient or family as no machinery is required
■ Diffusion and filtration across the membrane of the peritoneal cavity
● What issues does the nurse need to consider when caring for the patient on hemodialysis?
○ Hypotension, muscle cramps, headache, nausea, dizziness, malaise, bleeding, systemic infections, dialysis dementia, disequilibrium syndrome, localized access issues
○ AV fistula
■ Surgical anastomosis of artery and vein
■ Preferred access because it last longer and there are less complications
■ Must "mature" for 2-3 months to be large and strong
○ AV graft
■ Synthetic self-sealing graft
■ Used with porr vessels (diabetics, IV drug abusers)
■ Increased clotting & infection
■ Heal 2-3 weeks before use
○ Hemodialysis catheters
■ Special large-volume high-flow catheters
■ Complications → site infection, septicemia
■ Do not flush
■ Do not access (only dialysis nurse)
● Identify benefits and complications of peritoneal dialysis.
○ Benefits
■ Continuous process
■ No machinery
■ At home by patient/family
■ Less risk for hemodynamic instability
■ More freedom (diet, ability to travel)
○ Complications
■ Infection, peritonitis, F&E imbalance
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