NUR 265 HESI Med Surg
ARF Post Renal - Answer- Renal Calculus: Lithiasis, BPH
Risk for Hyperparathyroidism ^ Calcium
Pathological Fractures
Prevent Volume Depletion
Manif: low urine output, decreased BP / Pulse
Orthostatic Hypotension, thirst
^ Blood Osmolarity
Hemodialysis - Answer- Pharmokenetic excretion adversely affected
Monitor for digtoxicity / hyperkalemia / dillusional hyponatremia
3 requirements: access to blood, semipermeable membrane, dialysate
More Effective/ Shorter time
#1 Complication - Disequilibrium Syndrome causing ICP
Admin Anticonvulsants (Dilantin)
Peritoneal Dialysis - Answer- Monitor Albumin
#1 Complication - Peritonitis leads to septic shock
Ridge Board Like Abdomen
Cloudy Excretion - Infection
Interventions: heparinization required
weigh before / after, acquire baselines
^ protein intake - excreted at dialysis
Teaching: know signs for peritonitis, cloudy excretion, monitor
glucose for hyperglycemia
Dialysis Air Embolism - Answer- clamp catheter
Patient Left Lateral Trendelenburg
Notify Physician
Admin Oxygen
DKA - Answer- Lacks insulin, DMI (insulin dependent), Ketones
Sudden Onset - infection, injury, stress
Uncontrolled hyperglycemia
Met. Acidosis - Kussmaul Respirations
Polyuria / dipsia / phagia
Dehydration, Osmotic Diuresis 6 - 10 L
Glucose >250
Interventions: #1 assess airway, #2 LOC, #3 Hydration (Dextrose)
Admin Insulin
Before Admin IV K+ assure output 30ml +
HHNKS - Answer- DMII, Insulin Resistant, Gradual Onset
Glucose >600
Major factor is obesity
Worse Diuresis / Dehydration
Neurological - coma, seizures, stroke
,Met. Alkalosis
Interventions: #1 Hydration, #2 LOC
Admin Insulin restoring glucose w/I 72hrs
Evaluate Fluid Volume / Daily Weights
Teaching: store unopened insulin vials in refrigerator or room temp
for 28 days
Draw regular insulin into syringe first when mixing insulins
Exercise decreases blood sugar levels
Sick Days: keep taking insulin
monitor glucose more frequently
watch for signs of hyperglycemia
**If in doubt if hyper / hypo glycemic, treat for hypoglycemia
Hypoglycemia - Answer- Glucose <70, rapid decline
Excess Insulin, wrong time / type
Manif: #1 early -Neurogenic (Cholinergic / Adrenergic)
#2 Central Neuroglycopenic: confusion, seizure, coma
Interv: Mild - admin carbs / protein
Severe -admin Glucagon
Teach: avoid exercise / alcohol
New bottle Insulin / more potent
Change injection site
Med Alert Bracelet / Carry carb snack
Drink alcohol with food / after meal
**Taking Beta Blockers: manif less intense
**Does not always experience warning symptoms
DI Pituitary (Hypothalamus) - Answer- Lack ADH - Vasopressin
Fluid Deficit / ^ Output
Causes: Lithium, Trama, Surgical, Tumors, Hemorrhage, Cerebral
Aneurysm, Hypophesectomy (pituitary removal)
Manif: dehydration, polyuria, thirst, hyperthermia, coma, ataxia, hypotension, tachy,
hypovolemia / shock, ^Hct / Hgb / BUN
Interv: Admin Desmopressin (nasal, 10x stronger, long acting)
Admin Vasopressin (oral, short acting, use for upper
respiratory infection)
*Never deprive fluids more than 4 hrs
Accurate I&O, daily weights
Drugs: Lifelong Therapy
SIADH Pituitary (Hypothalamus) - Answer- Excess ADH (vasopressin), fluid overload
Cause: SSRI's, Small Cell Lung Therapy
Manif: Dillusional Hyponatremia (below 115), LOC, seizure, coma,
loss deep tendon reflexes, hypothermia, bounding pulse
Interv: Tolvaptan / Conovaptan - promotes water excretion w/o NA
loss, Admin in Hospital (Black Box)
Diuretics
Hypertonic Saline #% Sodium Chloride
Restrict fluid intake 600mL
#1 monitor lung sounds (ABC's)
, Hyperparathyroidism PTH - Answer- ^ Calcium, 120+, benign tumor
Bone density decreased / pathological fractures
^ Osteoclast activity (destruction)
Post Renal Failure (calcui Stones)
Manif: weight loss, arthritis, waxy pallor
bone deformities, mental confusion > coma,
epigastric pain, constipation, peptic ulcer
Interv: #1 hydration -Saline
Diuretics - Furosemide (Laxis) >calciurea
Oral Phosphates - decrease calcium
Calcitonin - decrease release of skeletal calcium
Enhanced w/Glucocorticosteroids
Use lift sheet, monitor cardiac, I&O
Surgery - parathyroidectomy
Hypocalcemia Crisis (Trousseau / Chvostek)
Hoarseness
Hypoparathyroidism PTH - Answer- Decrease Calcium
Cause: removal of parathyroid / subtotal thyroidectomy
Manif: tingling / numbness @ mouth / hands /feet (mild)
muscle cramps, spasms, seizures (severe)
Interv: Calcium Gluconate
Calcitrol
Magnesium, Sulfate - Magnesemia
Eat ^ calcium - dark green leafy vegs
Avoid milk / yogurt, processed cheese
Drugs: Lifelong Therapy
Addisons (Adrenalcorticol) - Answer- Low Cortisol / Aldosterone
Occurs gradually / quickly due to stress; life threatening
Cortisol - anti inflammatory / histamine
Cause: #1 tumor necrosis / hypophysectomy / radiation
#2 Cessation on glucocorticoid therapy, immunodeficient
(TB / Cancer / Aids / Toxins), hemorrhage, adrenalectomy
Manif: Hypo GNVT - glycemia / natremia / volemia / tension
Hyperkalemia
Salt cravings, GI / menstrual / impotence changes
hyperpigmentation, shock, loss of body hair
Interv: Fludrocortison (Florinef) - maintain K+ / Na, like aldosterone
(Reabsorbs Na / Excrete K+)
Hydrocortison - corrects glucocorticoid deficiency
Prednisone - corticol replacement
#1 Rapid Infusion Normal Saline
#2 Solucortef - glucocorticoid hydrocortisone
Kayexalate - hyperkalemia
Glucose / Glucagone - Hypoglycema
Weigh Daily
Monitor hemoconcentration - Hct / BUN
Diet: ^ sodium / carbs, low potassium
