Nursing : Module III, Unit B Flashcards

Terms Definitions
Crystalloid
fluids that are clear
Intramuscular
involving administration of medication into the muscle layer beneath the dermis and subcutaneous tissue
Intradermal
involving administration of a medication into the dermis located just beneath the skin surface
Botanicals
plant species with medicinal purposes
Medication
drug given for its therapeutic effect
What are clinical manifestations that indicate decreased excretion of fluids?
-edema
-SOB
Antagonism
interaction of chemicals by which drug effects decrease
Colloid
fluids that contain proteins or starch molecules
Unit Dose
a prescribed amount of medicine dispensed at a specific time
Metabolism
chemical reaction in the cells that produce heat as a byproduct or the breakdown of a drug(usually in the liver to an inactive form)
Subcutaneous
pertaining to the layer of tissue under the dermis
What is the medical management of accelerated atherosceloris in the pt with CKD?
antihyperlipidemics
What is medical managment of impaired platlet function d/t metabolic toxins in the pt with CKD?
dialysis
Controlled Substance
drugs that are considered to have either limited medicinal use or high potential for drug abuse or addiction
Adverse Effect
any effect other than the therapeutic effect
What is hetastarch?
a synthetic colloid derived from cornstarch with a molecular weight similiar to that of albumin
What is ultrafiltration?
movement of fluid across a semi-permeable membrane as the result of an artificially induced pressure gradient
What is ISF?
- interstitial fluid
- fluid that fills spaces b/t cells of body
What is medical managment for the pt with increased uric acid?
allopurinal
What is medical management of impairment to the reproductive system in the pt with CKD?
- dialysis
- transplant
What is the effect of increased renin production in the pt with CKD?
hypertension
What is the nursing managment of accelerated atherosceloris in the pt with CKD
assess labs
Air Embolus
air bubble in the vascular space that may obstruct circulation
What are the principles of dialysis?
- diffusion
- osmosis
- ultrafiltration
What are the clinical manifestations of an impaired immune system in the pt with CKD?
- s&sx of infection
What is medical managment of irritation to the integumentary system in the pt with cKD?
- dialysis
- antipruritics: Benadryl
What is medical managment of an impaired immune system in the pt with CKD?
antibiotics as needed
What are contraindications for perioneal dialysis?
- multiple surgieres (adhesions)
- recurrent hernias
- advance peripheral arterty disease (won't work)
- very obese
- chronic back problems
- COPD/breathing issues
- intrabdominal pathologies
What are possible complications of hemodialysis?
- disequilibrium syndrome
- cardiobascular: arrhythmias, hypotension, blood loss, air embolus, hemorrhage, steal syndrome
- muscle cramps
- infectious disease
- sepsis
What is albumin?
a sterile solution of serum albumin prepared from pooled blood, plasma serum, or placentas obtained from healthy human donors (pasteurized to destroy any contanimants)
What are the disadvantages of peritoneal dialysis?
- bacterial or chemical peritontitis
- hyperglycemia
- contraindications in pt with ab surgery
-longer
At what point does the level of serum protein create a situation in which the plasma COP becomes less than the plasma HP and fluid shifts from the vascular space into the tissues?
5.3 g/dl
What is nursing managment for the pt with altered sodium balance?
assess for FVE/FVD
What are the effects of accelerated atherosceloris in the pt with CKD?
- MI
- CVA
- CAD
How is decreased erythopoetin production in the pt with CKD medically managed?
- erythropoetin (Epogen, Procrit) IV or SQ may cause bone paint
- darpopoetin (Aranesp), long acting form of erythropoetin
- iron preps: po- Niferex, IV-Infed, Venofer
- Folic acid, B12, multivitamins
Describe urine volume and concentration in the case of fluid volume excess and fluid volume deficit.
FVE: decreased specific gravity, urine pale
 
FVD: increased specific gravity, urine darker color
What characterizes acute renal failure?
- decline in glomerular filtration
- accumulation of waste products: azolemia
What is dextran?
a solution of glucose available in two concentrations, has a molecular weight similiar to that of albumin
What lab values indicate decrease in activation of Vit D and decreased excretion of phosphate?
- blood calcium decreased (hypocalcemia)
- blood phosphate increased (hyperpohsphatemia)
What is nursing managment of the psychosocial impact in hte pt with CKD?
- coping strategies
- support systems
What are blood and serum diagnostic findings in nephrosis?
- decreased protein
- increased lipids
- increased or wnl creatinine
- increased H&H
What is nursing managment irritation to the integumentary system in the pt with cKD?
- assess skin color, integrity
- assess hair and nails
- keep nails short to prevent scratching
- skin care with cool to tepid water, using creams or oils
How does nephrosis threaten immune system?
immunoglobulins are lost urine, posing a increased risk of infection
What is intervention during oliguric phase of ARF with regard to control acid base disorders?
- monitor ABGs
- give NAHCO3
- dialysis
Describe skin/tongue turgor and oral mucoso moisture in the case of fluid volume excess and fluid volume deficit.
FVE: edema, tears, salivation, no tenting
 
FVD: dry skin, decreased tears and salivation, skin tenting, sunken fontanels
Describe blood pressure in the case of fluid volume excess and fluid volume deficit.
FVE: increased
 
FVD: decreased, orthostatic ( drop of 15 mmHg and increased 20 BPM indicate positive orthostatic hypotension)
 
MAP: systolic + 2(diastolic)/3 (60-70)
What is medical managment effect of irritation to the nuerological system in the pt with CKD?
- dialysis
- nuerotontin for peripheral neuropathy
What are the phases of ARF?
- onset
- oliguric phase
- diuretic phase
- recovery phase
What are the mechanisms used for excretory function?
- glomerular filtration
- tubular resabsorption
- tubular secretion
 
125L/day is filtered, 1.5L of urine produced
What are intra-renal causes of acute renal failure?
- prolonged pre-renal disease
- nephrotoxins
- intra-tubular obstruction
- infection
- trauma
- malignent hypertension
- PIH
- systemic disease: lupus
What is osmosis?
movement of fluid from an area of less concentration of solutes to an area of greater concentration of solutes
What is teh effect of impairment to the reproductive system in the pt with CKD?
- decreased estrogen
- decreased testosterone
How is decreased activation of Vit D and decreased excretion of phosphate medically managed?
- aluminum hydoxide antacids: Amphogel; avoid magnesium containing antacids d/t inability of kidneys to excrete
- phosphate binders: Phoslo, Renegal, Forsenol
- calcimimetics: snesipar
- activated vit D: recaltral, calcijex, zemplar
What are requirments for kidney donors?
- good renal function
- no evidence of infection
- no long-standing diabetes
- no hx cancer
- no major systemic health problems
- informed consent w/ psych evaluaion
- family consent for cadaver kidney
What is chronic renal transplant rejection?
- occurs months to years later
- graft is destroyed by ischemia
- s/sx: increaed wt, increased BP, increased creatinine, s/sx of uremia
- nothing can be done
What are nursing measures for IVP?
- NPO after midnight
- bowel prep
- no allergies to seafood or iodine
- after procedure increase fluid intake to flush drugs out of system
- oral mucimist as it is a renal vasoldilator and helps to prevent kidney damage as result of contrast dye (contrast induced nephthropay)
- metformin must be stopped before studies
What is medical managment of decreased hydrogen ion excretion?
sodium bicarb, dialysis if too severe
What is the effect of the psychosocial impact in hte pt with CKD?
- psysiologic changes
- stress r/t chronic illness
- loss/reudction in work
- changes in self concept and body image
What is nursing management for pt with decreased activation of Vit D and decreased excretion of phosphate
- assess for bone tenderness, fractures, weakness
- safety precations: careful handling and fall precautions
- given phosphate binders with meals
- assess and treat constipation caused by phosphate binders and fluid restrictions
What is the nursing managment of decreased potassium excretion?
- assess serum potassium
- EKG
- HR, rhythm
What are TMI for a person with nephrosis in order to faciliate treat hyperlipidemia?
anticoagulants may be prescribed to prevent renal vein thrombosis that results in PE
What are the two types of perineal dialysis?
- automated: cycler controls phase of each cycle, catheter only opened 2x per day
- CAPD: 4-5 exchanges/day with 4-8 hr dwell time at night (mimics normal renal function)
What are radiologic dx studies for ARF and CRF?
- KUB: radiology looking for cysts, size, shape, tumors
- IVP: dye injected goes to kidney looks for stones, tumors, cysts; use with caution
- ultrasound: kidney size, cysts, tumors
- renal scan: nuclear medicine, radioactive dye, gamma camera
- CAT scan: show more subtle differences
What are TNI for a person with nephrosis in regards to medications?
- response usually seen within 7-28 days
- monitor for side effects of steroids
What type of cuffs are used in peritoneal dialysis and what is their purpose?
dancrun cuffs used to secure cath and prevent growth of bacteria
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