Nur 265 Test 1 Study Guide (Answered) Complete Solution
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Nur 265
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Nur 265
Nur 265 Test 1 Study Guide (Answered) Complete Solution
Med Math
● The MD orders drug X at 6mcg/kg/min. Your pt weighs 175 pounds. Pharmacy sends the medication to the unit with a concentration of 500mg in 250mL. What is your mL/hr?
ml/hr = 250 ml/500 mg X 1 mg/1000mcg X 6 mcg/kg/min X 1 kg...
nur 265 test 1 study guide answered complete solution med math ● the md orders drug x at 6mcgkgmin your pt weighs 175 pounds pharmacy sends the medication to the unit with a concentration of 500
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Nur 265 Test 1 Study Guide (Answered) Complete Solution
Med Math
● The MD orders drug X at 6mcg/kg/min. Your pt weighs 175 pounds. Pharmacy sends the medication
to the unit with a concentration of 500mg in 250mL. What is your mL/hr?
ml/hr = 250 ml/500 mg X 1 mg/1000mcg X 6 mcg/kg/min X 1 kg/2.2 lb X 175 lb X 60 min/ 1 hr =
15750000/1100000 = 14.31 = 14.3 ml/hr
Labs
● Hbg 12-18
● Hct 37-52%
● WBC 5-10
● RBC 4.2-6.1
● PLT 150-400
● PT 11-12.5 sec (1.5-2.5x normal on Coumadin = 16.5-31.25 sec)
● INR 0.9-1.2 sec (Therapeutic level 2-3x normal = 1.8-3.6 sec)
● PTT 60-70 sec (1.5-2.5x normal on Heparin = 90-175)
● Na 135-145
● K+ 3.5-5
● Creatinine 0.5-1.2
● BUN 10-20
● Total Protein 6.4-8.3
● Albumin 3.5-5
● Mg 1.5-2.5
● Ca 9-10.5
● Cl 98-106
● Phosphorus 2-4.5
● GFR 90-120
● T1 0-0.1
● TT 0-0.2
● BNP >100 = HF
● Specific Gravity 1.005-1.030
Nephrotic Syndrome
● Increased glomerular permeability that allows larger molecules to pass through membrane.
● Signs & Symptoms
o Find in urine
▪ *Massive protein loss, severe proteinuria (> 3.5 g of protein in 24 urine sample)
▪ Lipiduria (Lipids in the urine)
o Find in Blood
▪ Hypoalbuminemia < 3 g/dl (low serum albumin[protein])
● Facial/periorbital edema (w/o albumin in cells, fluids leak out of vessels)
▪ Hyperlipidemia (high serum lipid levels) – due to low albumin
▪ Increased coagulation
● Treatment
o Depends on what the cause is, if immune give steroids
o Maintain fluid and electrolyte balance; daily weights, strict I&Os & abd girth measuring
▪ BP measures if enough fluid in cells
o Furosemide & bumetadine w/ albumin, plasma, dextran
o Sodium and Potassium restriction if labs warrant
o Anticoagulation to prevent renal vein thrombosis – Enoxaparin
o ACE inhibitors to decrease protein loss in urine
, o Cholesterol-lowering drugs
o Restrict protein intake to 1-1.5 g/kg/day w/ high caloric diet to prevent further protein breakdown,
but give enough to maintain muscle health.
● Increased r/f infection and slowed wound healing d/t protein deficit.
● Osteomalacia (body takes Ca from bones) – Ca is bound to albumin, so it is decreased too.
Acute Kidney Injury (AKI)
● Rapid reduction in kidney function resulting in failure to maintain Fluid & Electrolyte & Acid Base Balance.
● Causes
o Pre-renal (most common cause) – Decreased blood flow to kidney w/ decreased GFR
▪ Hypovolemia, AMI, Hypotension, Vasodilation, Renal Artery Obstruction (clot)
o Intra-renal – Direct kidney damage, usually the tubules from nephrotoxic substances
▪ Antibiotics, heavy metals, poisons, contrast dye (CT scan), some analgesics, NSAIDS, Chemo
▪ Car accident, infection in kidney (pyelonephritis), Lupus, Cancer
▪ Damaged muscle can release heme & myoglobin, can cause tubule damage (rhabdomyolysis)
● Urine turns brown after traumatic kidney injury
o Post-renal – Backward pressure on kidney from obstruction somewhere in lower urinary system
▪ Bladder, Cervical, Colon or Prostate Cancer; Enlarged Prostate (hypertrophy); Kidney
Stones; blood clots in urinary tract.
● Phases of AKI
o Onset: Initial event to development of manifestations, immediate to week before sx.
o Oliguric – Anuric: 1-8 weeks, the longer lasts worse prognosis. Up to 2 mon diminished function
▪ Ex: NPO b4 surgery can cause
▪ Urine amounts <400cc/24hrs
▪ Gradual buildup of nitrogenous wastes (azotemia)
▪ Manifestations of fluid overload (Crackles, edema, decreased O2, increased RR, dyspnea)
▪ Elevated
● Serum Creatinine (0.6-1.2)
● BUN (10-20)
● K (3.5-5)
● Phosphorus (phosphate) (2-4.5)
● Magnesium (1.5-2.5)
▪ Decreased
● Na (135-145) – due to dilutional effect
● Ca (9-10.5)
● Metabolic Acidosis (7.35-7.45) - Bicarb to tx short term, dialysis to tx severe.
o Diuretic: Gradual or abrupt return of GFR & leveling of BUN, lose 1-2L a day of urine
▪ Hypovolemia and electrolyte imbalance (balance is key to survival)
o Recovery: Lasts 3-12 months
● Uremic Encephalopathy – Build up in urea and poison brain, decreased LOC
● Assessment is key to prevention and early intervention (restore volume)
o For pts at risk: Hypotensive, surgery, hypovolemic (burns, MVAs, hemorrhaging) or pt w/shock
● Seizure precautions (elevated BUN), infection prevention, High calorie, low protein, low K, Na, Mag, Phos.
● Renal Dialysis or CRRT if pt. can’t tolerate (runs 24 hrs at bedside)
● Meds
o Dopamine – Dilates renal artery and increases blood flow
o Diuretics – furosemide & mannitol for fluid overload but use cautiously
o Hyperkalemia acutely tx w/
▪ 1st – Calcium Gluconate
▪ 2nd – Glucose, insulin & bicarb combo
▪ Forces K intracellularly for a short time to prevent cardiac complications
o ABX to prevent infection (NO Aminoglycosides –mycin, tetracycline, Methicillin, Rifampin, Sulfonamides)
, o Calcium Chanel Blockers may be used to tx AKI resulting from nephrotoxins
● Daily weights and strict I&O
● Decreased Urine Specific Gravity (1.005-1.030) is earliest sign of AKI
Hemodialysis
● Hypotension is major issue with hemodialysis and up to 30% of pts can’t tolerate.
● 2-3x a week for 2-3 hours
● Pt needs large vascular access – AV Fistula, shiley catheter (jugular, subclavian, femoral)
● Disequilibrium Syndrome
o Caused by rapid changes in fluid volume and electrolytes
o S/S – H, malaise, grumpy, exhausted, n/v, restlessness, decreased LOC, seizures, coma, death
o CRITICAL! – Early tx w/ anticonvulsants (ethosuximide, gabapentin) & barbiturates (phenobarbital)
● Anticoagulation needed
● Weigh pt b4 and after, know pt. dry weight, certain drugs withheld b4 (BP drugs, vitamins, etc), Assess VS
● AV Fistula
o Surgical connection of artery to vein, up to 4 months to mature
o Need temporary vascular access (AV shunt or HD catheter)
o No BP or sticks
o Palpate thrills & auscultate bruit q4 hrs and assess pulses
o Elevate postoperatively
o Check for bleeding and assess for manifestations of infection
o No carry heavy objects or sleep on extremity, no pressure on it
o Chlorhexidine before access
o Teach pt to wash area w/antibacterial soap & h2o between sessions
● HD Catheter
o Subclavian, jugular, femoral
o Aseptic technique
o Heparin dwell solution after dialysis tx, DO NOT USE FOR ANYTHING BUT DIALYSIS TX.
o If used in emergency make sure to waste 10cc from catheter before use.
o More time needed for dialysis tx (4-8 hrs) because smaller than AV fistula
CRRT (Continuous Renal Replacement Therapy)
● Dialysis slowly over 24 hrs at bedside by trained RN
● Safer for brain injury, Cardiovascular DOs, and pts who can’t tolerate hemodialysis
● Clots easy! Must be anticoagulated (Heparin)
Peritoneal Dialysis (PD)
● Repeated cycles of 1-3L of fluid instilled into abd, allowed to dwell for a period of time then drained
● Can be done at home and effective for years
● Good for those who can’t handle anticoagulation
● Can be complicated by scars and infection
● Warm fluid to prevent pain form cramping, NOT in microwave!
● R/f hypoalbuminemia due to albumin crossing peritoneal membrane especially if pt infected.
● Peritonitis major complication (fluid coming out should be color of urine, not cloudy or fowl smelling)
o Cloudy or opaque effluent is earliest sign of peritonitis.
o Sterile technique - mask
● Respiratory Distress w/ large fluid volumes
Chronic Renal Failure
● Irreversible & progressive reduction of functioning renal tissue.
● ESRD – Stage 5
o Diabetes is leading cause, >30% of pts who receive dialysis.
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