Class notes
NUr265 Exam 1
- Course
- Institution
Nur265 Advanced Medsurg Exam 1
[Show more]
Seller
Follow
anallamosas
Reviews received
Content preview
Galen College of NursingNur265 Advanced Medsurg
Medical Surgical Nursing: Ignatavicius, Workman, Rebar, Heimgarterner 10th edition
Exam 1 (unit 1,ch63, 53, 54, Unit 2/3 31, 32, 33,35 please see page numbers (will be on exam)
Prof Angoma
Know these Labs
Normal Urine per hr= 30mL/hr
-Creatine 0.6-1.2= Best indicator of kidney function
-BUN- 10-20 (if higher effected by stress, dehydration)
-WBC- 5-10,000
-Hemoglobin-
-Albumin-3.5-5.0
-Lipase-0-110
-Potassium- 3.5-5.0...Opposite relationship to NA.......(K=Assess heart EKG)
-Sodium- 135-145.....Opposite relationship to K ….......(Na=Assess LOC Nuero check)
-Calcium- 9-10.5
-Phosphorous- 2-4.5
MAP – 65-100 or more normal (perfusion to vital organs) = 2(Diastolic BP)+ (Systolic BP) /3
GFR- 90 or higher
Remember: Low sodium; high potassium for fluid overload; High sodium; low potassium for dehydration
AKI= Acute kidney injury- rapid loss of kidney function from renal cell damage build up of ammonia
-Onset- abrupt and reversible
-S/S- 1st sign decrease urine output, oliguria less than .5mL/kg/hr , azotomia, w/ progression = fluid overload signs; Bowels=urinary
retention; high Bp, high pulse, bounding;; crackles in lungs. (xray); infiltration; skin= edema, anascara; confusion, low sp02, increased RR;
reduced perfusion signs= MAP below 65, HR up, thready pulse, respiratory alkalosis PH low SpO2 88% ;SOB, REMEMEBR assess for
hypotension and tachycardia= SHOCK);
Assess for fluid overload- low o2 stat, edema, BP up, dyspnea, SOB, tachycardia, JVD, crackles, (Dx Xray:
infiltration); hyperventilating, resp alkalosis (Dx ABG)
-Patho- GFR decrease (filtration); can be hours or days = tell HCP if decrease in urine output (less than 30ml/hr)
-Causes- prerenal (prefusion); dehydration ,blood loss, cardiac output, heart failure, cardiogenic shock, infection, obstruction, NG suctioning,
sepsis, Vomiting/diarrhea, hypertension
intrarenal (in renal): myoglobinuria, BPH, tubular necrosis, renal ischemia, obstruction, nephrotoxicity, intrarenal infection; acute Poly
nephritis, contrast, mycins antibiotics (peak and trough), NSAIDS, naproxen,
post renal (after renal) blockage; bladder neck obstruction, bladder cancer, calculi, post renal infection, tumor
-4 phases=initiation/ onset; oliguric phase, Diuretic phase, recovery phase
1. Onset phase – decrease urine output 1-3 weeks
2. Oliguric phase= 1-3 weeks; less than 400mL/24hrs, High specific gravity; S/S anorexia, N/V, decreased urine output
3. Diuretic phase- 3-6L per day, low specific gravity; output 1000-200mL/day (have foley catheter monitor urine output)
replace fluids monitor electrolytes; may need dialysis ; Polyuria can be sign of recovery
4. recovery phase- 12month or less
Renin- angiotensin 1 and 2 = retention of sodium and retention of water
Labs- Creatine over 1.3, BUN over 20; urine less than 30mL/hr; metabolic acidosis Ph below 7.35; ABG ,high K hyperkalemia; sodium is low;
no anemia related to AKI
Nursing interventions= VS; I&O, daily weights (1 lb per day = fluid retention); labs BUN , creatine, electrolytes; acidosis (treat w/ sodium
bicarb); 2L of fluid per day; avoid/prevent HYPOtension
Assess for fluid overload- low o2 stat, edema, BP up, dyspnea, SOB, tachycardia, JVD, crackles, (Dx Xray: Infiltration);
hyperventilating, resp alkalosis (Dx ABG)
Meds- diuretics
Diet (mod protein, high carb); restrict potassium & sodium; avoid nephrotoxic meds; if poor appetite enteral or parenteral nutrition
Prevent- hydration!!!!; Na and K know levels; Avoid indwelling caths if possible; prevent infection, maintain electrolytes
Teaching- low sodium, low potassium, low phosphorous, high carb diet; only specific moderate proteins,
Complication- Pericarditis- (sac around heart) painful, pleuritic pain, friction rub, tachycardia, fever monitor for bleeding, seizures
Page 1378- physical assessment S/S- “early stages of AKI sp02- 88%” Hypoxemia (tachycardia, low BP= SHOCK) -S/S- decrease urine
output, oliguria less than .5mL/kg/hr , azotomia, w/ progression = fluid overload signs; Bowels=urinary retention; high Bp, high
1
, pulse, bounding;; crackles in lungs. (xray); infiltration; skin= edema, anascara; confusion, low sp02, increased RR; reduced perfusion
signs= MAP below 65, HR up, thready pulse, respiratory alkalosis PH low SpO2 88% ;SOB,
Page 1379 (Labatory profile table) creatine increase 1-2 every 24-48 hrs; increase 1-6 in 1 week or less; elevated potassium and
magnesium; elevated blood osmolarity
Page 1380-Interventions Nephrotoxic agents- Assess kidney function before contrast; NO /low contrast hydrate before (1mL/kg/
12hr)& after (3mLkg/1hr), Mycins antibiotic (peak and trough) avoid NSAIDS (Celecoxib, Ibuprophen, ketorolac, naproxen)
Page 1380- “monitor fluid and electrolytes in diuretic phase” Diuretic phase- 3-6L per day, low specific gravity; output 1000-
200mL/day (have foley catheter monitor urine output) replace fluids monitor electrolytes; may need dialysis ; Polyuria can be sign
of recovery
Page 1381 (Nutrional therapy) Assess food intake every shift; input equal to output + 500mL; low sodium, low potassium, low
phosphorous, high carb diet; only specific Proteins, MODERATE PROTEIN; HIGH CARB
-No dialysis protein 40g/day; Dialysis protein 1-1.5g/kg; Sodium 60-90mEq/kg; potassium restrict 60/70 mEq/kg
CKD-Chronic Kidney disease-slow progressive, irreversible loss in kidney function GFR less than or= 60mL per min for 3month or
longer
S/S= oliguria, less than 400mL/day; Anemia, metabolic acidosis ( Ph less than 7.35); azotomia ( skin breakdown), Kussmaul respirations,
potassium elevated;
Complications hypertensive crisis (headache, N/v, change in LOC) Report to Hcp; high K over 5* (Peaked t waves and st elevation
Creatine clearance test- 24hrs collect all urine, discard 1st urine
5 Stages- stage 1 (GFR 90+); stage 2 (GFR 89-60); stage 3 (GFR 59-60); stage 4 (GFR 29-15); stage 5 (GFR 15 or less) kidney transplant/
dialysis.......NORMAL GFR is 90ml/hr; stage 4 and 5 dialysis hyperkalemia
Causes- after AKI, uncontrolled DM, uncontrolled HTN, Chronic urinary obstruction, infections, renal artery occlusion, autoimmune disorders;
polycystic kidney disease
Nursing interventions= VS; I&O, daily weights (1 lb per day = fluid retention Report to HCP); labs BUN , creatine, electrolytes; acidosis
(treat w/ sodium bicarb); hear thrill feel buit
Teaching- activity rest periods, Avoid aspirin, NSAIDS, avoid spironolactone(k sparing), no antacids( mg); Avoid Mycin, Avoid Ct contrast dye,
Restrict fluid, Restrict NA, Restrict K
Diet- restrict K, Restrict NA (less than 2grams/day , low phosphorus (no dairy), low protein ( no processed meats, no canned foods); NO salt
substitutes, no leafy veggies, no carrots, no tomatoes, no avocadoes, no strawberry, organs or bananas.......BEST FOOD APPLES
Labs- *creatine – over 1.3; low h&h (anemia); NA high over145; phos high over 4.5, and low calcium; high K over 5* (Peaked t waves and st
elevation; Na high ( 135-145 ); low BUN
High K treatment= IV calcium gluconate (prevent dysthymias); Iv 50% dextrose+ reg insulin (lower K); Kayexalate
(polystyrene sulfonate); dialysis
Treatments- epoetin alfa, folic acid, iron supplement, loop diuretics (excrete Mg), Dialysis, …...hemodialysis (3-4 hrs 3x a week), peritoneal
dialysis;
Teaching- fistula; no BP on that arm, feel thrill and bruit hear; no iv infusion on that site; hold hypertensive after dialysis
Complication in hemodialysis- Disequilibrium syndrome =headache, restless, N/V confused, seizure; runs of PVC Tell HCP!!!
Table 16.3 look
-Peritoneal dialysis - ( complication: Peritonitis EMERGENCY board like abdomen, feel,rigid) the process = 1-3L of abdomen; sit in high
Fowlers position; can be done in patient home; once week; give stool softener; clear fluid ( cloudy bad = peritonitis), no machine, no partner
Page 1379- creatine increase 0.5-1mg/dL every 1-2 years; potassium up; phosphorus up; blood osmolarity up ; ABG down Metabolic
acidosis; hemocrit down
Page 1392 Table 63.8 Dietary Restrictions=
a. W/ chronic uremia= Protein=.55-1.5/kg/day; Fluid=1500mL-3000mL, Potassium= 60-70mEq daily; Sodium= 1-3g/day
phosphorous= 700mg per day
b. W/ Hemodialysis = Protein=1-1.5g/kg/day; fluid=500-700mL/day plus amt of urine; Potassium=70mEq daily; Sodium 2-
4g/day; Phosphorous= 700mg/day
c. W/ peritoneal dialysis= protein=1.2-1.5g/kg/day; fluid= restricted; potassium= no restriction; Sodium=restriction;
phosphorous=800mg/day
Page 1395- Table 63.9 Hemodialysis vs Peritoneal Dialysis
a. Hemodialysis – PROS-efficient ; treatment short time Complications = disequilibrium syndrome, muscle cramps, headache,
itchy, infection, anemia; dyrthmias, hypotension, contraindicated= severe cardiac disease; severe vascular disease; bleeding
disorders; Access= AV fistula, AV graft, CV cath; Procedure= complex; special trained person; home or dialysis center
2
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller anallamosas. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $7.99. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
67096 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now