Exam #3

calculating fluid balance in patients

A patients intake and output should be equal if fluid intake is greater than output, the body is in positive fluid balance but if the output is greater than the intake it is in negative fluid balance. Fluid balance= total fluid intake-total fluid output

Arterial blood gas values, assessment and treatments

Arterial blood gas values- Page 508 Iggy Page 441-445 Morton Assessment- Morton pages 554-555 Treatments-

ARDS, assessment and treatments

Assessment- Assessments- Acute respiratory failure may present within a few hours to several days, Vital signs throughout progression vary but the general trend is hypotension, tachycardia, and hyperthermia or hypothermia, respiration initially rapid and labored varies once mechanical ventilation is instituted. Early symptoms- tachypnea, dyspnea, tachycardia, breath sounds are clear in this phase, Table 27-3 Morton page 524 neurological changes, restlessness and agitation, impaired oxygenation, decreased perfusion to brain, accessory respiratory muscle use, as it progresses lung auscultation may reveal crackles secondary to increased secretions, cardiogenic pulmonary edema may be minimal, ability to compensate decreases, dependent lung fields have decreasing breath sounds, as fluid accumulates and alveoli collapse, lung compliance decreases, decreased oxygen saturation, lethargy omnious sign. Iggy- • Persisting hypoxia • Decreased pulmonary compliance • Dyspnea • Noncardiac-associated bilateral pulmonary edema • Dense pulmonary infiltrates seen on x-ray Assess breathing of any patient at risk for ARDS. Determine whether increased work of breathing is present, as indicated by hyperpnea, noisy respiration, cyanosis, pallor and retraction intercostally between ribs or substernal, document sweating respiratory effort, and any changes in mental status,. abnormal lung sounds are not heard on auscultation because edema occurs first in interstitial spaces and not in airways. • Lower Pao2 value on ABG • Refractory hypoxemia • "Whited-out" (ground glass) appearance to chest x-ray • No cardiac involvement on ECG • Low-to-normal PCWP Treatments- Oxygenation and Ventilation • Refractory hypoxemia hallmark of ARDS • Goal to optimize oxygen delivery o Arterial oxygenation o Hemoglobin o Cardiac output • Fluid management • Positive inotropic agents and vasoconstrictors Mechanical Ventilation • Lung-protective ventilation strategies o Limits ventilator-induced lung injury (VILI) • Includes o Low tidal volumes (less than 6 mL/kg predicted body weight) o PEEP o Limit plateau pressures to 30 cm H2O Ventilation Strategies • Permissive hypercapnia o Limits plateau and peak airway pressures o Not used with cardiac or neurological involvement • Pressure-controlled ventilation o Limits the peak inspiratory pressure to a set level o May require sedation to prevent dyssynchrony with the ventilator. Novel Ventilation Strategies • Inverse-ratio ventilation • Airway pressure release ventilation (APRV) • High-frequency oscillatory ventilation (HFOV) • Partial ventilatory modes o A/C, SIMV, PSV, PAV, APRV, BIPAP, and NAVA Extracorporeal lung support • Involves the use of large vascular cannulas to remove blood from the patient. • A pumping device and circuit circulate the blood, and one or two "artificial lungs" remove carbon dioxide and oxygenate the blood o Extracorporeal membrane oxygenation (ECMO) o Extracorporeal carbon dioxide removal (ECCO2R) Positioning • Frequent position changes • HOB elevated >30 degrees to prevent VAP • Prone positioning o Using patient's bed, Stryker frame or Roto-Prone™ therapy system o Improves gas exchange Pharmacologic Therapy • Antibiotics, if indicated • Bronchodilators and mucolytics • IV corticosteroids • Nitric oxide • Sedation • Neuromuscular blocking agents Nutritional Support • Enteral feeding benefits • Balanced caloric, protein, carbohydrate, and fat intake • Usually require 35 to 45 kcal/kg/d • High carbohydrates avoided to prevent excess carbon dioxide production • Antioxidants and omega-3 fatty acids Iggy- • ET intubation, conventional mechanical ventilation with PEEP or CPAP • Drug and fluid therapy • Nutrition therapy • Case management Positioning may be imporant in promoting gas exchange Read Intervention Page 614

Arteriovenous fistula in the forearm for dialysis, assessment and care

Assessment- assess for adequate circulation in the fistual or graft as well as in the lower portion of the arm. Check distal pulses and capillary refil in the arm with the fistula graft. Then check for a bruit or a thrill by auscultation or palpation over the access site. Chart 68-7 Page 1435 Iggy. Look at safety box. assess for thrombosis or stenosis infection, aneurysm formation, ischemia and heart failure. Thrombosis or clotting is the most frequent complication. Observe for clots. Most infections are caused by staph infection, aneurysms can form in the fistula and are caused by repeated loss of fistula function, ischemia occurs in a few patients. Manifestations vary from cold or numb fingers to gangrene. Apply pressure to the needle and puncture sites, prepare skin using best practices before cannulation. Avoid constrictive devices. Rotate needle insertion sites with each hemodialysis treatment, assess for a thrill and bruit. Morton arterial blood flowing into the venous system results in a marked dilation of the vein. Maintaining blood flow through the fistula is the priority of care. excessive bleeding or hematoma of the arteriovenous fistula take care to avoid traumatic venipuncture excessive manipulation of the needles and repeated use of same sites for venipuncture. Assess for a thrill a loud swishing sound termed a bruit plus a palpable thrill indicates a functional fistula. Complications are thrombosis, aneurysm, or pseudoaneurysm or distal hypoperfusion ischemic syndrome known as steal syndrome which occurs when shunting of blood from the artery to the vein produces ischemia of the hand causing pain or coldness in the hand. Care- Chart 68-7 Page 1435 Iggy Morton 561 Box 30-1 and 30-2

CKD basic home care instructions

Because of the complex nature its progressive course and many treatment options a case manager is helpful in coordinating care. As kidney disease progresses a patient is seen by a physician regularly. with a dietitian and social worker evaluate home environment and determine equipment needs before discharge. Once patient is discharged home car nurses direct care and monitor progress. page 1445 Community based care Diet changes Always discuss your diet with your healthcare provider before making any changes. Salt (sodium) in your diet Based on your condition, you may be told to eat 1,500 mg or less of sodium daily Limit processed foods such as: Frozen dinners and packaged meals Canned fish and meats Pickled foods Salted snacks Lunch meats Sauces Most cheeses Fast foods Don't add salt to your food while cooking or before eating at the table. Eat unprocessed foods to lower the sodium, such as: Fresh turkey and chicken Lean beef Unsalted tuna Fresh fish Fresh vegetables and fruits Season foods with fresh herbs, garlic, onions, citrus, flavored vinegar, and sodium-free spice blends instead of salt when cooking. Don't use salt substitutes that are high in potassium. Ask your healthcare provider or a registered dietitian which salt substitutes to use. Don't drink softened water, because of the sodium content. Make sure to read the label on bottled water for sodium content. Don't take over-the-counter medicines that contain sodium bicarbonate or sodium carbonate. Read labels carefully. Potassium in your diet Based on your condition, you may be told to eat less than 1,500 mg to 2,700 mg of potassium daily. Always drain canned foods such as vegetables, fruits, and meats before serving. Don't eat whole-grain breads, wheat bran, and granolas. Don't eat milk, buttermilk, and yogurt. Don't eat nuts, seeds, peanut butter, dried beans, and peas. Don't eat fig cookies, chocolate, and molasses. Don't use salt substitutes that are high in potassium. Ask your healthcare provider or a registered dietitian which salt substitutes to use. Protein in your diet Based on your condition, your healthcare provider will talk with you about why you should limit protein in your diet. Cut back on protein. Eat less meat, milk products, yogurt, eggs, and cheese. Phosphorus in your diet Don't drink beer, cocoa, dark colas, ale, chocolate drinks, and canned ice teas. Don't eat cheese, milk, ice cream, pudding, and yogurt. Don't eat liver (beef, chicken), organ meats, oysters, crayfish, and sardines. Don't eat beans (soy, kidney, black, garbanzo, and northern), peas (chick and split), bran cereals, nuts, and caramels. Eat small meals often that are high in fiber and calories. You may be told to limit how much fluid you drink. Other home care Try not to wear yourself out or get overly fatigued. Get plenty of rest and get more sleep at night. Move around and bend your legs to avoid getting blood clots when you rest for a long period of time. Weigh yourself every day. Do this at the same time of day and in the same kind of clothes. Keep a record of your daily weights. Take your medicines exactly as directed. Keep all medical appointments. Take steps to control high blood pressure or diabetes. Talk with your healthcare provider for advice. Talk with your healthcare provider about dialysis. This procedure may help if your chronic kidney disease is progressing to end stage renal disease. Follow-up care Follow up with your healthcare provider, or as advised. When to call your healthcare provider Call your healthcare provider right away if you have any of the following: Chest pain (call 911) Trouble eating or drinking Weight loss of more than 2 pounds in 24 hours or more than 5 pounds in 7 days Little or no urine output Trouble breathing Muscle aches Fever of 100.4°F (38°C) or higher, or as advised by your healthcare provider Blood in your urine or stool Bloody discharge from your nose, mouth, or ears Severe headache or a seizure Vomiting Swelling of legs or ankles

hemodialysis and medicaitons

Blood clotting can occur during dialysis anti-coagulation with heparin is most often delivered into the blood circuit via a pump. in patient with high risk for bleeding a reduced dose of regional anticoagulation (using citrate rather than helparin for anticoagulation or reversing heparin action by administering protamine before returning blood to patient or no anticoagulation may be used. heparin remain active in the body for 4-6 hours after dialysis increasing the patient's risk for hemorrhage during and immediately after HD treatments. Monitor closely for evidence of bleeding or hemorrhage. Table 68-13 in iggy Page 1436. Heparin is most commonly used because it is easy to administer and it increases clotting time rapidly and is monitored easily monitored easily and its effect may be reveresed with protamine. citrate solutions also may be used for this process.

severe anorexia, causes, clinical signs, lab findings, treatment

Definition- Causes- Clinical signs- Lab findings- Treatment-

aspiration pneumonia, causes, assessment and treatments

Causes-Aspiration pneumonia. Aspiration pneumonia occurs when you inhale food, drink, vomit or saliva into your lungs Aspiration pneumonia is a lung infection that develops after you aspirate (inhale) food, liquid, or vomit into your lungs. If you are not able to cough up the aspirated material, bacteria can grow in your lungs and cause an infection. Results form aspiration of food or stomach contents spiration can lead to serious complications such as aspiration pneumonia, an infectious process from aspiration of oropharyngeal contents. Aspiration pneumonitis refers to direct chemical lung injury from the aspirated material and often cannot be distinguished clinically or radiographically from aspiration pneumonia. Assessment- focus is on preventing lung damage and treating infection, aspiration of stomach contents can cause widespread inflammation leading to acute respiratory distress syndrome and permanent lung damage •Inflammatory response to inhaled or aspirated foreign material or the uncontrolled multiplication of microorganisms invading the lower respiratory tract Aspiration occurs frequently in healthy individuals while they are sleeping. the risk for clinically significant aspiration is increased in individuals unable to protect their airways. for example patients with alcohol abuse, depressed level of consciousness, or dysphagia. aspiration of bacteria found in dental plaques is receiving increased attention as a significant source of pneumonia. Treatments- steroids and NSAIDS are used with antibiotics are used to reduce the inflammatory response. antibiotic therapy if needed. Supplementary oxygen to keep O2 sat above 90% should be instituted; management of hypotension, acute respiratory distress syndrome therapy, and septic shock therapy should be considered, because these conditions may ensue if the disease process isn't halted. Clinical presentation of these patients should direct admission and hospitalization levels. Intubation, altered level of consciousness, and hypotension would justify an intensive care unit admission.

dark yellow urine, causes and treatment

Causes-Urine color comes from urochrome pigment. Color variations may result from increased levels of urochrome or other pigments, changes in the concentration or dilution or urine and the presence of drug metabolites in urine. Dark amber indicates concentrated urine. Urine naturally has some yellow pigments called urobilin or urochrome. The darker urine is, the more concentrated it tends to be. Dark urine is most commonly due to dehydration. However, it may be an indicator that excess, unusual, or potentially dangerous waste products are circulating in the body. Dark urine is most commonly due to dehydration. However, it may be an indicator that excess, unusual, or potentially dangerous waste products are circulating in the body. For example, dark brown urine may indicate liver disease due to the presence of bile in the urine. excess exercise. Treatment- Page 157 Chart 11-3

Chronic renal failure, causes and treatment, What are meds that affect this? (? Meds that affect this)

Causes-• Progressive, irreversible disorder; kidney function does not recover • End-stage kidney disease (ESKD) • Azotemia • Uremia Uremic syndrome Table 68-8 Page 1422diabetic nephropathy, hypertensive nephrosclerosis • Fluid overload due to the inability of disease kidneys to maintain body fluid balance • Potential for pulmonary edema due to fluid overload • Decreased cardiac function due to reduced stroke volume, dysrhythmias, fluid overload, and increased peripheral vascular resistance • Weight loss due to inability to ingest, digest, or absorb food and nutrients as a result of physiologic factors • Potential for infection due to skin breakdown, immunity-related kidney dysfunction, or malnutrition • Potential for injury due to effects of kidney disease on bone density, blood clotting, and drug elimination • Fatigue due to kidney disease, anemia, and reduced energy production • Anxiety due to change in health status, economic status, relationships, role function; threat of death; lack of knowledge about diagnostic tests, disease process, treatment; loss of control; or disrupted family life • Potential for depression due to chronic debilitating illness Treatment- Early detection and treatment are important. Morton Page 595 31-6, renal replacement therapies, Peritoneal dialysis, Kidney transplantation, Chart 68-6 Page 1429 • Control diseases that lead to CKD • Dietary adjustments • Weight maintenance • Smoking cessation • Exercise • Limitation of alcohol Planning and Implementation: Responding • Managing fluid volume • Preventing pulmonary edema • Increasing cardiac function • Enhancing nutrition • Preventing infection • Preventing injury • Minimizing fatigue • Reducing anxiety • Recognizing and managing depression Kidney Replacement Therapies • Hemodialysis o Dialysis settings o Procedure o Anticoagulation o Vascular access o Nursing care o Post-dialysis care Peritoneal Dialysis (PD) • Siliconized rubber catheter placed into the abdominal cavity for infusion of dialysate • Types of PD (selection depends on patient's ability and lifestyle) o Continuous ambulatory o Multiple-bag continuous ambulatory o Automated o Intermittent o Continuous-cycle • Management of alterations in drug elimination o Adjust dosages according to GFR • Management of skeletal alteration includes loss of bone density and formation of calcium phosphate crystals. o Regulate phosphate. o Maintain calcium levels. o Treat vitamin D deficiency. o Control metabolic acidosis. • Managing of integumentary alterations include dryness, pruritus, uremic frost, ecchymosis, and purpura. o Meticulous skin care o Prevent skin breakdown • Managing alterations in dietary intake o Restrict fluid, sodium, potassium, and phosphate o High calorie, moderate protein restrictions • Managing alterations in psychosocial functioning Management of Renal Failure • Manage fluid balance changes o Treat hypovolemia o Prevent hypervolemia • Use diuretics o Furosemide, mannitol, thiazide diuretics • Dopamine • Dialysis or ultrafiltration • Manage acid-base alterations o Metabolic acidosis o IV sodium bicarbonate (severe acidosis) • Manage cardiovascular alterations o Hypertension o Hyperkalemia o Pericarditis ECG Changes in Hyperkalemia Management of Renal Failure • Managing pulmonary alterations o Pulmonary edema o Pleural effusions, pneumonitis, pulmonary infections • Managing gastrointestinal alterations o GI bleeding o Gastritis, ulcerative esophagitis, duodenitis o Anorexia, nausea and vomiting, diarrhea, GERD, uremic fetor o Stomatitis o Constipation • Managing neuromuscular alterations o Sleep disturbances, muscle irritability, restless leg and burning feet syndrome o Peripheral neuropathies o Seizures • Managing hematologic alterations o Increased bleeding tendency o Impaired immune syndrome o Anemia Anemia • Causes include o Erythropoietin deficiency o Decreased RBC survival time o Blood loss o Other • Management o Administer iron and human erythropoietin. o Blood products Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Whether they're over-the-counter -- like aspirin, ibuprofen, or naproxen -- or prescribed by your doctor, you shouldn't use them regularly for a long time or take high doses of them. Overuse of pain meds causes up to 5% of chronic kidney failure cases every year Your doctor may tell you to avoid certain pain relievers such as aspirin, ibuprofen, naproxen (Aleve) and celecoxib (Celebrex). These drugs, which doctors call "NSAIDs" (nonsteroidal anti-inflammatory drugs), could play a role in kidney disease. Meds- Table 68-5 Table 1419 table 68-7

Renal Calculi, causes, treatments, and discharge teaching

Definition- Causes- The cause is unknown at least 90% of patients who form stones have a metabolic risk factor Table 66-4 Page 1384 Iggy lists some metabolic risk factors that can casue stone formation. Patiens who are white older obease, or have diabetes our gout have increased risk for stone formation. Other conditions are hyperparathyroid ism Urinary tract obstruction, inflamatory bowel disease, aand a history of GI problems. Diet is NOT considered a risk for stone formation but calcium and vitamin D supplementation as well as high dose ascorbic acid have ben implicated in stone formation. high intake of fluids fruits and vegetables and lowe consumption of rpotien and balanced intake of calcium fats, carbohydrates are perscribed to treat urolythiasis. Treatments- Managing Pain; Drug therapy for pain like poids and Nsaids ketorlac, avoiding over hydrationa dn udnerhydration to help make the passage of stones less painful, diuretics to aid in expulsion. Lithotripsy shock wave litherotripsy. minimially invasive surgical procedures, stenting, ureteroscopy, precutaneous uretolithotomy, pehrolithotomy, preventing infection- give appropriate antibiotics, maintain adequate nutrition and fluid intake, drug therapy using broad spectrum antibiotics, nutrition therapy adequate calorie intake with a balance of all food groups, prevent obstruction high intake of fluids. drug therapy nutrition therapy Discharge Teaching- Chart 66-11 Page 1388 Urolithiasis • Presence of calculi (stones) in urinary tract • Most common associated condition is dehydration • High urine acidity or alkalinity, and drugs, contribute to stone formation • Stone may occlude ureter; hydronephrosis may occur if not addressed • Pain is excruciating; may cause shock Etiology and Genetic Risk • Metabolic risk factors (e.g., dehydration) • Patients who are white, obese, or have diabetes or gout are at higher risk • Certain vitamin supplementation may be connected with stone formation Incidence and Prevalence • Varies with geographic location, race, family history • About 12% of adults will have at least one episode Assessment: Noticing • Ask about history of urologic stones • Obtain dietary and supplementation history • Major symptom is renal colic • Nausea, vomiting, pallor, diaphoresis often accompany pain • Assess urine output • Obtain urinalysis, WBC count; CT or KUB may be indicated Interventions: Responding • Managing pain o Nonsurgical management Drug therapy Lithotripsy o Surgical management MIS procedures Open procedures • Preventing infection • Preventing obstruction causes: slow urine flow, damage to the lining of the urinary tract, decreased amounts of inhibitor substances in the urine, high urine acidity or alkalinity, certain meds treatment: manage pain and allow it to pass on its own, lithotripsy, minimally invasive surgery, ureteroscopy teaching: take antibiotics to prevent UTI, resume normal activity, balance exercise and rest, return to work 2 days-6 weeks, may have diet restriction, drink 3L, monitor urine pH, expect bruising after lithotripsy, may have bloody urine after procedure, pain may be a sign of infection or another stone

Chronic Obstructive pulmonary disease, causes, s/s, treatments, patient apperance

Definition- Includes emphysema and chronic bronchitis Many patients have both. Emphysema- The two major changes that occur are a loss of lung elasticity and hyperinflation of the lung, dyspnea, air trapping. An increased amount of air is trapped in the lungs. Hyperinflation of the lungs. Chronic Bronchitis- inflammation of the bronchi and bronchioles caused by exposure to irritants. triggers inflammation vasodilation mucosal edema and congestion, and bronchospasm. affects only airways, no alveoli. Thickening of the mucous glands due to chronic irritation can lead to a reduction in the size of the airways. Causes- Cigarette smoking patient with a 20-pack-year-history, Alpha1-antitrypsin deficiency, asthma, chronic exposure to irritants. Signs and Symptoms- respiratory changes occur as a result of obstruction, changes in chest size and fatigue, changes in breathing rate and pattern (rapid shallow respirations, abnormal breathing pattern with the abdominal wall is sucked in during inspiration or use accessory muscles in the abdomen and neck, inspect the chest size, during exacerbation Breaths PM can be 40-50. Resp movement is jerky and appears uncoordinated, Check for chest retractions and asymmetric, chest expansion, limited diaphragmic movement because the diaphragm is flattened and below usual resting state, fremitus, wheezes and other sounds reduced breath sounds, note pitch and location fo sound hyper resonate on percussion because of trapped air. A silent chest may indicate airflow obstruction or pneumothorax, dyspnea, barrel chest, AP diameter is 1:1, chronic bronchitis- blue or cyanotic dusky appearance, excessive sputum production, assess for delayed cap refill, finger clubbing, decreased arterial oxygen levels. cardiac changes assess heart rate and rhythm, check for swelling of the feet and ankles (dependent edema), pallor of cyanosis of nail beds and mucous membranes in the late stage (underweight). Psychosocial-decreased socialization, isolation, embarrassment, economic status may be affected, anxiety. Lab- abnormal gas exchange, oxygenation, ventilation and acid-base status. Hypoxemia, hypercarbia, metabolic alkalosis occurs as compensation by kidney bicarb occurs, elevated HCO3, PH remains lower than normal. polycythemia, central cyanosis, horizonal ribs, protruding abdomen, flattening of hemidiaphragms, purse lip breathing, supraclavicular wasting, nasal flaring, resting muscle activation, reduced breath sounds, wehezing during quiet respiration, inspiratory crackle, displaced heart sounds, evidenc eof right heart failure, jugular vein distension, right ventricular heave, Treatments- Nonsurgical- airway maintenance, monitoring, breathing techniques, positioning, effective coughing, oxygen therapy, exercise conditioning, suctioning, hydration and use of vibratory positive pressure device. Monitor change in respiratory status Drug Therapy- Beta-adrenergic agents, cholinergic antagonists, methylxamthines, corticosteroids, NSAIDS, mucolytics. Surgery- Lung reduction surgery, READ IGGY Pages 562-564 READ Morton Pages 504-508. Patient Appearance- Provides cues about respiratory status and energy level. Observe weight in proportion to height, posture, mobility, muscle mass and overall hygiene. The patient with increasingly severe COPD is thin, with loss of muscle mass in extremities, but neck muscles may be enlarged. Slow moving and slightly stooped. They often sit forward bending posture with arms held forward a position known as the orthopneic or tripod position. When breathing difficulty becomes so difficult the patient may have an activity intolerance they may neglect bathing and grooming.

Proteinuria, causes and treatments

Definition- Causes- increased amounts may indicate stress, infection, recent strenuous exercise, or glomular disorders, polcystic kidney disease, Both diabetes and high blood pressure can cause damage to the kidneys, which leads to proteinuria, Chronic Glomerulonephritis, Nephrotic Syndrome, Diabetes, High blood pressure, Family history of kidney disease, Dehydration Emotional stress Exposure to extreme cold Fever Strenuous exercise Chronic kidney disease acute or chronic renal failure Treatments- Fix the underlying cause of the problemIf you have diabetes or high blood pressure, the first and second most common causes of kidney disease, it is important to make sure these conditions are under control. If you have diabetes, controlling it will mean checking your blood sugar often, taking medicines as your doctor tells you to, and following a healthy eating and exercise plan. If you have high blood pressure, your doctor may tell you to take a medicine to help lower your blood pressure and protect your kidneys from further damage. The types of medicine that can help with blood pressure and proteinuria are called angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs). If you have protein in your urine, but you do not have diabetes or high blood pressure, an ACE inhibitor or an ARB may still help to protect your kidneys from further damage. If you have protein in your urine, talk to your doctor about choosing the best treatment option for you. Sometimes infection or chemicals damage the kidneys, and this makes protein show up in the urine. If your child has an infection, the proteinuria will go away once the infection is treated. ... When a lot of protein is in the urine, the level of protein in the blood may go down Changes in your diet. Medication to control kidney disease symptoms that include swelling and high blood pressure. Cessation of smoking and alcohol consumption. Regular exercise. Weight loss. Protein restriction early in the course of the dsiease prevents some problems and may preserve kidney function.

Glycosuria, causes and treatments

Definition- Causes- reflects hyperglycemia or a decrease in the kidney threshold for glucose. a condition characterized by an excess of sugar in the urine, typically associated with diabetes or kidney disease. This often happens because you have an abnormally high level of glucose in your blood (hyperglycemia) Type 2 diabetes is the most common cause of glycosuria. Diabetes mellitus Treatment-Getting at least 30 minutes of physical activity every day. Developing a diet plan that provides you with enough nutrients while also decreasing sugar or fats intake. This may mean eating more whole grains, vegetables, and fruits. Taking medications to help your body use insulin more effectively. These can include metformin (Glumetza), which allows your body to respond better to insulin, or sulfonylureas (Glyburid), which helps your body make more insulin. Keeping track of your blood sugar levels so that you can better understand how your body reacts to certain foods, activities, or therapies. Glycosuria isn't a cause for concern on its own. No treatment is needed if there isn't an underlying condition that's causing you to pass high amounts of glucose in your urine. Treatment for glycosuria depends on what is causing it, and often the management of the underlying condition is enough to treat it. This includes proper management of diabetes and hyperthyroidism.

Glucosuria, causes, treatments, and patient monitoring

Definition- Causes- reflects hyperglycemia or a decrease in the kidney threshold for glucose. a condition characterized by an excess of sugar in the urine, typically associated with diabetes or kidney disease. This often happens because you have an abnormally high level of glucose in your blood (hyperglycemia) Type 2 diabetes is the most common cause of glycosuria. Diabetes mellitus Treatment-Getting at least 30 minutes of physical activity every day. Developing a diet plan that provides you with enough nutrients while also decreasing sugar or fats intake. This may mean eating more whole grains, vegetables, and fruits. Taking medications to help your body use insulin more effectively. These can include metformin (Glumetza), which allows your body to respond better to insulin, or sulfonylureas (Glyburid), which helps your body make more insulin. Keeping track of your blood sugar levels so that you can better understand how your body reacts to certain foods, activities, or therapies. Glycosuria isn't a cause for concern on its own. No treatment is needed if there isn't an underlying condition that's causing you to pass high amounts of glucose in your urine. Treatment for glycosuria depends on what is causing it, and often the management of the underlying condition is enough to treat it. This includes proper management of diabetes and hyperthyroidism. Patient Monitoring- urine osmolarity and gravity In most affected individuals, renal glycosuria is a benign condition, resulting in no apparent symptoms (asymptomatic). However, in some cases, glycosuria may be pronounced enough to result in excessive urination (polyuria), excessive thirst (polydipsia), and other associated symptoms.

acute renal failure, correlation with labs

Definition- Correlation with labs- Page 1415 Chart 68-1 Morton Page 591 box 31-4 and lab studies section

Acute pneumonia, who is at risk, what medications can increase this riks

Definition- Who is at risk- older adults, has never received the pneumococcal vaccination or received it more than 5 years ago, did not receive flue vaccine in previous year, has chronic health problem or other coexisting condition that reduces immune response, has recently been exposed to respiratory viral or influenza infections, uses tobacco or alcohol or is exposed to high amounts of secondhand smoke, chronic lung disease, has altered level of consciousness, has has a recent respiration event, develops when immune system can not overcome invading organisms Chart 31-3 page 589 and chart 31-2 Morton- Colonization of the oropharynx, previous antibiotic therapy, increased age, dental plaque, smoking, and chronic disease. Aspiration- while healthy individuals sleep, patients unable to protect airways, alcohol abuse, depressed level of consciousness, dysphagia, vocal cord surgery, intubation. Prolonged intubation- organisms can collect on tube. Host factors- spread through blood, pulmonary circulation provides portal of entry, they can migrate from other sites to lungs and causes pneumonia. Meds that can increase risk- Immunosuppressants, drugs that increase gastric PH (histamine (h2 blockers), antacids, proton pump inhibitors or alkaline tube feedings, mechanical ventilation. corticosteroids, PPI oral antipsychotics and antidiabetic agents.

Pulmonary Edema, signs and symptoms

Definition- Increased pressure causes fluid to cross the capillaries into pulmonary tissues happens in chronic kidney disease. Signs and Symptoms- Depending on the cause, pulmonary edema symptoms may appear suddenly or develop over time. Mild to extreme breathing difficulty can occur that worsens with activity and lying down. Cough, chest pain, and fatigue are other symptoms. Pain areas: in the chest Respiratory: shortness of breath on lying down, fast breathing, rapid breathing, shallow breathing, or wheezing Whole body: fatigue or sweating Also common: coughing, water retention, or fast heart rate, crackles. Increased pressure in the left atrium, and pulmonary vessels. Early- Restlessness, anxiety, parid heart rate, shortness of breath, and crackles that begin at the base of the lungs, as it worsens level of fluid in lung rises increased crackles decreased breath sounds. frothy blood tinged sputum and diaphroetic and cyanosis with decrease in pulmonary and respiratory function, electrolyte abnormalities.

Home with a peripherally inserted central catheter (PICC), patient teaching

Definition- Long catheter inserted through a vein of the antecubital foss interaspect of the bend of the arm or middle of the upper arm. Patient Teaching- Teach patients to perform usual ADL's however they should avoid excessive physical activity. Muscle contractions in the arm from physical activity like heavy lifting can lead to catheter dislodgement and possible lumen occlusion. May be contraindicated in paraplegic patients who rely on their arms for mobility and in the patients use of crutches that provide support in the axilla. Comonyly performed in patients hospital room an ambulatory care treatmetn facility, or the imaging department. Reguardless of where they are inserted, the same precautions myst be taken with any other central line inssertion using the cather related blood streem infection prevention bundle. Including hand hygiene, maximal barrier precautions upon insertion, chlorhexidine skin anticeptics, opitmal catheter site selection and post placement care with avoidence of the frmor alvein for central venous access in adult patients. Daily review of line necessity with prompt removeal of uneccesarly lines. The INS recomendation for flushing Picc lines not actively used is 5 mL of heparin in a 10 ML syringe at least daily when using a non-valved catheter at least weekly with valved catheter. use 10 ml of sterile saline to flush before and after medicaito administration. and 20 ml after drawing blood. Always use 10 ML barrel syringes to flush any central line because the pressure exerted by smaller barel poses a risk for ruptering the catheter. You may have some bleeding and mild discomfort during the first 24 to 72 hours after your PICC is inserted. If you have any bleeding from the exit site, apply pressure and a cold compress to the area. Call your doctor or nurse if the bleeding and discomfort does not get better after 72 hours, or if it gets worse at any time. Check your exit site each day for: Redness Tenderness Leakage Swelling Bleeding If you have any of these signs or symptoms, call your doctor. You may have an infection. Do not have any of the following on the arm where your PICC was inserted: Needle sticks (such as for blood draws or IV line) Blood pressure measurements Tight clothing or tourniquets Prepare a clean work area by cleaning a solid surface with a disinfectant (such as Lysol® or another brand). Wash your hands well, using one of the following methods: Use an alcohol-based hand sanitizer (Purell® or another brand) according to directions If alcohol-based sanitizer is not available, wash your hands with antibacterial soap for at least 15 seconds, rubbing all surfaces briskly, including between your fingers and under your fingernails. Use a paper towel or clean hand towel to dry your hands, and then use the towel to turn off the faucet. Before each time you flush or put any medicine into the IV tubing, put on non-sterile gloves and scrub the injection cap for 30 seconds with a fresh chlorhexidine wipe, using friction. Let it dry. Do not fan or blow on it. Perform hand washing before caring for your child's PICC line. This includes: administering medication, cap change, dressing change, and any time handling the PICC line.

Acute Pulmonary Disease assessment

Definition- (acute respiratory failure)- can be ventilatory failure, oxygen exchange failure or a combination of both ventilatory and oxygenation failure and is classified by abnormal blood gas values Acute Respiratory Failure • ABG values o Pao2 <60 mm Hg o Sao2 <90%; or Paco2 >50 mm Hg with pH <7.30 • Ventilatory/oxygenation failure • Patient is always hypoxemic Care Coordination and Transition Management • Home care management • Self-management education • Health care resources Ventilatory Failure • Physical problem of lungs or chest wall • Defect in respiratory control center in brain • Poor function of respiratory muscles, especially diaphragm • Extrapulmonary causes • Intrapulmonary causes Oxygenation (Gas Exchange) Failure • Insufficient oxygenation of pulmonary blood at alveolar level • Ventilation normal, lung perfusion decreased • Right to left shunting of blood • V/Q mismatch • Low partial pressure of O2 • Abnormal hemoglobin Combined Ventilatory/Oxygenation Failure • Often occurs in patients with abnormal lungs o Chronic bronchitis o Emphysema o Asthma attack • Diseased bronchioles and alveoli cause oxygenation failure; work of breathing increases; respiratory muscles unable to function effectively The manifestations of ARF are related to dyspnea (perceived difficult breathing) the hallmark of respiratory failure. evaluate dyspnea on the basis of how breathless the patient becomes while performing common tasks. Depending on the nature of the underlying problem the patient may not be aware of the changes in the work of breathing. Dyspnea is more intense when it develops rapidly slowly progressive RF may be first noticed as dyspnea on exertion or when lying down. The patient may have orthopnea, finding it easier to breathe in an upright position. Assess for a change in the patient's respiratory rate or pattern and chages in lung sounds. Pulse oximetry may show decreased oxygen saturation, but end tital CO2 monitoring may be more valuable for monitoring the patient with ARF. His or her puse oximitry may show adequate oxygen saturation but because of increased ETCO2 the aptient may be close to respiratory failure. ABG's are reviewd to most acurately identify the degree of hypoxia and hypercarbia. Manifestations of hypoxic respiratory failure incudes: Restlessness, irritability, agitation, confusion, and tachycardia. Hyperapnic failure includes decreased level of consciousness, headache, drowsiness, lethargy and possible siezures. The effects of acidosis may lead to decreasaed LOC, drowsiness, confusion, hypotension, bradycardia and weak peripheral pulses. Causes MOrton Page 513 Page 514 Morton.

Bronchoscopy, post-procedure monitoring of patient

Definition- A bronchoscopy is the insertion of a tube int he airways usually as far as the secondary bronchi to view airway structures and obtain tissue samples for biopsy or culture. It is used to diagnose pulmonary disease. Post-Procedure Monitoring for Patient- Monitor patient until the effects of the sedation have resolved and gag reflex has returned, continue to monitor vital signs including oxygen saturation and assess for potential complications including bleeding infection or hypoxemia. Careful monitoring of patient is indicated after bronchoscopy the nurse assesses for any evidence of complications whihc may include laryngospasm, fever, hemodynamic changes, cardiac dysrrthmias, and pneumothorax, hemmorage or cardiopulmonary arrest. insertion of a tube in the airways, usually as far as the secondary bronchi, to view structures and obtain samples for biopsy or culture. Assess for return of gag reflex, monitor vitals and O2 sat. assess breath sounds every 15 minutes for the first 2 hours. Assess for infection or bleeding

Spontaneous pneumothroax, who is at greatest risk, treatments and oxygen therapy.

Definition- A pneumothorax occurs when air enters the pleural space between the visceral and parietal pleura producing partial or complete lung collapse. The air or gas enters as a result of a rupture in either the visceral or partial pleural chest wall when this occurs, air in the lung parenchyma enters the pleural cavity during inspiration but is unable to escape during expiration, preventing normal expansion, the pressure rises and causes the lung to collapse, and the mediastinum shifts to the contralateral side which casues compression of the main vessles and contralateral lung if not treated. Spontaneous pneumothorax is any pneumothorax that develops without any trauma. Primary and secondary. This term was designates as primary when the patient die not have any underlying lung disease and secondary when there was evidence of lung disease such as COPD, asthma, marfan syndrom, lung cancer, necrotizing TB or cystic fibrosis Who is at greatest risk- Tall and thin adolescent males are typically at greatest risk, but females can also have this condition. Other risk factors include connective tissue disorders, smoking, and activities such as scuba diving, high altitudes and flying. Treatments & Oxygen therapy- Supplemental oxygen should be administered to all patients with pneumothorax because oxygen accelerates of air reabsorption from the pleural space if it is 15%-20% no medical intervention is required if greater than 20% a chest tube is placed in the apical and anterior aspect of the pleural space to assist air removal. Connecting chest tube to underwater seal drainage alone is usually adequate to resolve pheumothorax. if it persists after 12-24 hours 12-20 cm H2O suction should be applied to facilitate closure.

Acute respiratory failure and ABG results

Definition- Defined as the rapid onset of inadequate gas change demonstrated by hypoxemia in which PaO2 is 55mmHG or less and hypercapnia in which the PaCO2 is 50 mmHg or greater with a PH of 7.35 or less. May occur in individuals with normal respiratory systems wand those with chronic pulmonary diseases. The signs and symptoms are nonspecific and insensitive ABG results are needed to determine the exact level. Acute hypoxemic respiratory failure- Classifed by abnormal oxygen transport, inability to achieve adequate oxygenation PaO2 less than 60 mm hg Acute hypercapnic respiratory failure- inadequate alveolar ventilation, marked the elevation of carbon dioxide with relative preservation of oxygenation. Iggy- Partial pressure of oxygen less thatn 60 mm HG (hypoxemic/oxygenation failure, or partial pressure of arterial carbon dioxide more than 45 mm Hg occuring with acidemia (PH < 7.35 (hypercapnic/ventilatory failure and oxygen saturation less than 90% in both cases

Heart Failure, assessment findings, care and treatment of patients

Definition- Heart failure may occure in CKD because it increases the workload of the heart as a result of anemia hyertension and fluid overload, left bentricular enlargment and heart failure are comen in ESKD, Uremia may cause uremic cardiomyopathy, the uremic txin effect on the myocardium. Heart failure may also occur in these patients becuase of hypertension and coronary artery disease, cardiac disease is a leading cause of death in patients with ESKD. Cardiocascular disease can cause renal failure in this case. assess heart rate and rhythm listen for extra heart sounds (S3) irregular patterns, or pericardial friction rub. Unless dialysis vascular access has been created measure blood pressure in each arm. Assess jugular veins for distension assess for edema of the feet shinks sacrum and around the eye crackles dring ascultation and shortness of breath with exertion and at night suggest fluid overload. Care and Treatment- Drug therapy using diuretics, obtain daily weights, review intake and output, fluid restriction, calcium chanel blockers, angiotension converting enxzyme inhibitors alpha adragenergic blockers beta blockers, vasodilators. nutrition therapy sodium restriction both fluid and sodium retension contribute to heart failrue. potassium restriction may be needed. Heart failure can reduce the blood flow to your kidneys, which can eventually cause kidney failure if left untreated. Kidney damage from heart failure can require dialysis for treatment. Heart valve problems. Treatments can include eating less salt, limiting fluid intake, and taking prescription medications. In some cases a defibrillator or pacemaker may be implanted. Diuretic, Beta blocker, ACE inhibitor, Antihypertensive drug, Dietary supplement, Blood pressure support, Vasodilator, and Heart medication

Metabolic alkalosis, causes and treatment

Definition- Metabolic alkalosis is a bicarbonate level of greater than 26 mEq/L and a ph of greater than 7.45. Characterized b excessive loss of nonvolatile acids or excessive production of bicarbonate. Causes- excess use of bicarbonate, lactate administration in dyalysis, excess ingestion of antacids, (loss of acids) vomiting, NG sucitoning, hypokalemia, hypochloremia, adminstration of diuretics, increased levels of aldosterone. Hypercortisolism, hyperaldosteronism, thiazide diuretics, blood transfusions, total parentral nutrtion. Treatment- Intervnetions implimented to prevent further losses of hydrogen potassium calcium and chlorie ions, resore fluid balance to monitor changes and to proved for patient safety. treatments that may have cuased it are stopped drug therapy is perscribed to resolve cuases of alkalosis such as diuretics antienemics are perscribed for vomiting. • Prevent further losses of hydrogen, potassium, calcium, chloride ions • Restore fluid balance • Monitor changes, provide safety • Modify or stop gastric suctioning, IV solutions with base, drugs that promote hydrogen ion excretion

Respiratory acidosis, causes and treatments

Definition- PH < 7.35, PAo2 Low, PCo2 High, Bicarb variable, serum potassium elevated if acute, low or normal if renal compensation. Causes- Retention of CO2 which causes increased free hydrogen ion production(respiratory depression (depressed function of the brainstem neurons that trigger breathing movements, anesthetic agents, opioids, poisons, damaged or destroyed neurons (physical), cerebral edema and respiratory depression- brain tumors, cerebral aneurysm, stroke, overhydration), inadequate chest expansion (skeletal trauma, deformities, respiratory muscle weakness or external obstruction, respiratory muscle weakness caused by electrolyte imbalances, fatigue, muscular dystrophy muscle damage, or muscle breakdown, external- casts, tight scar tissue, obesity ascites), airway obstruction ( coughing, neck edema and local lymph node enlargement (external) (internal aspiration of foreign objects, bronchoconstriction, mucus and edema), reduced alveolar capillary defusion(pneumonia, pneumonitis, TB, emphysema, acute respiratory distress syndrome, chest trauma, pulmonary emboli, pulmonary edema, downing, respiratory function is impaired, causing problems with O2 and CO2 exchange is reduced, mechanical ventelation, chronic metabolic alkalosis, chronic bronchitis, excessive pheumonia, large pheumothorax, pulmonary edema, asthma, COPD, Drugs, cardiac arrest, CNS trauma, Neuromuscular disease. Treatments-Improving ventilation and oxygenation, maintaining a patent airway. Drug therapy- improving ventilation and oxygenation rather than altering PH, bronchodilators, anti-inflammatories, and mucolytics Oxygen therapy-promotes gas exchange for patients with respiratory acidosis, use the lowest flow that prevents hypoxemia to avoid oxygen-induced tissue damage. Ventilation support- mechanical cant keep oxygen above 90% Preventing complications- nursing priority. Monitor breathing status hourly and interventions when changes occur are critical in preventing complications, listen to breath sounds, assess ease of air move into lungs, check for retractions use of accessory muscles like neck, whether breathing produces grunt or wheeze that can be heard without a stethoscope. assess nail beds and oral membranes for cyanosis (late finding).

Chest physiotherapy, which type of patient, procedure and benefits to patients

Definition- Postural drainage, positioning, and chest percussion and vibration are methods of CPT used to improve pulmonary function. Positioning changes from supine to upright affect gas exchange and positioning the lateral position may improve gas exchange. Positioning patient with the good lung down improve oxygenation this improvement occurs because shunting is decreased when the good lung is in the dependent position. Type of Patient- The is therapy is beneficial for the patient with cystic fibrosis. the removal of obstructive, thick sticky secretions is important in preventing infections and helps ease breathing. Procedure- This uses chest percussion chest vibration and dependent drainage to loosen secretions and promote drainage. AN inflatable vest can be used by rapidly filling and deflating and gently compressing and releasing the chest wall. Read Process on Page 450-451 Morton Chest physiotherapy process. Benefits to patients- the removal of obstructive, thick sticky secretions is important in preventing infections and helps ease breathing. Dislodges secretions. Facilitates gravitational drainage of secretions

Mediastinal shift, causes and implications

Definition- a shift of central thoracic structes toward one side.Mediastinal shift (upper and lower) is a clinical and radiological marker of significant importance, which at times helps to determine the aetiological cause of the underlying pathology. Mediastinal shift is the deviation of the mediastinal structures (great arteries, trachea, heart) towards one side of the chest cavity, usually seen on chest radiograph. It indicates a severe asymmetry of intrathoracic pressures Causes-pneumothorax ( collapsed lung after thoracentesis); tension pneumothorax (high pressure_ This pull, caused by the collapsed lung, is so great that it 'overcomes' the push caused by the underlying fluid, resulting in a net shift of the mediastinum to the same side as the fluid (effusion) (trachea slanted more to the unaffected side instead of being in the center of the neck). Hence, in these cases, the trachea and heart either remain central or get shifted to the same side as the effusion, tumor. the accumulation of air in the pleural cavity with eventually cause an interruption int he normal physiology between the lung and chest wall and prevent the normal expansion of the lung. When the pressure rises the elasticity of the lung causes it to collapse and the mediastinum shifts to the contralateral side which can cause a compression of the major arteries and eventually compression of the contralateral lung if not treated. Implications (Conclusion that can be drawn)- The patient's lung has collapsed, which can result in a decreased ability to take in the air and decreases gas exchange this also causes a change in pressure of the lung. This pull, caused by the collapsed lung, is so great that it 'overcomes' the push caused by the underlying fluid, resulting in a net shift of the mediastinum to the same side as the fluid (effusion). (Image)

Definition of ARDS

Definition- complex clinical syndrome it is accute respiratory failure with these features, hypoxemia that persists even when 100% oxygen given (refractory hypoxemia, a cardinal feature), Decreased pulmonary compliance, dyspnea, noncardiac associated bilateral pulmonary edema, dense pulmonary infiltrates on X-ray Acute respiratory distress syndrome (ARDS) is a life-threatening lung condition that prevents enough oxygen from getting to the lungs and into the blood.

Thoracentesis, reasons, procedure, pre-procedure, assessment of patient post-procedure

Definition-A needle is inserted into the pleural space to remove air fluid or both. obtain specimines for diagnostic evaluation or instil medications. Some patients requrie medication before to reduce anxiety requires the cooperation of patient so a local anestetic is used to minimize pain and scomfort taht accompanies the procedure, during the procedure the patient is placed in a char or in the edge of a bed in an upright position with arms and shoulders raised so that the ribs lift and separate allowing easier needle insertion, if patient is unable to lift arm sitting on the bed with arms placed above the head on a table is an alternative position. During the nurses primary function is to provide comfort for the patient, perform ongoing assessment of the patietns respiratory system dress the woulnd with sterile dressing on completion of procedure and sent labeled specimins to the lab as ordered. Assess for complications including pneumothorax, pain hypotension, and pulmonary edema. Reasons-needal aspiration of pleural fluid or air from the pleural space for diagnositc or managment purposes helps make diagnoses, pleural fluid may be drained to relieve blood vessle or lung compression and the respiratory distress caused by cancer empyema pleuisy or tuberculosis. Drugs can be instilled into the pleural space during thoracentesis. Procedure- IGgy Page 511 Pre-procedure- Assessment of patient post procedure-

Absent breath sounds, cause, treatment, assessment of

Definition-A pneumothorax occurs when air enters the pleural space between the visceral and parietal pleura producing partial or complete lung collapse. The air or gas enters as a result of a rupture in either the visceral or partial pleural chest wall when this occurs, air in the lung parenchyma enters the pleural cavity during inspiration but is unable to escape during expiration, preventing normal expansion, the pressure rises and causes the lung to collapse, and the mediastinum shifts to the contralateral side which casues compression of the main vessles and contralateral lung if not treated. Causes- Pneumothorax; Hemothorax; Using a stethoscope, the doctor may hear normal breathing sounds, decreased or absent breath sounds, and abnormal breath sounds. Absent or decreased sounds can mean: Air or fluid in or around the lungs (such as pneumonia, heart failure, and pleural effusion) Increased thickness of the chest wall. Absent breath sounds can be caused by a lack of breathing (apnea) or by lung disorders that block the transmission of the sounds to the surface of the chest, e.g., pneumothorax, pleural effusion. When auscultating the lungs, the nurse will identify decreased or absent breath sounds on the affected side. Air or fluid in or around the lungs (such as pneumonia, heart failure, and pleural effusion) Increased thickness of the chest wall Over-inflation of a part of the lungs (emphysema can cause this) Reduced airflow to part of the lungs Sudden onset of pleuritic chest pain o Shortness of breath, dyspnea, increased work of breathing o Uneven chest wall movement o Distant or absent breath sounds o Hyperresonant to percussion o Tachycardia Treatment- Treat the underlying cause Assessment of- Chest radiograph, CT. Patient complains of sudden onset of acute pleuretic chest pain localized to the affected lung. The pleuritic chest pain is usually accompanied by shortness of breath, increased work of breathing, and dyspnea. chest wall movement may be uneven because the affected side does not expand as much, breath sounds may be distant or absent. Tachycardia occurs frequently.

Dehydration induced confusion, causes and treatments

Definition-Dehydration most frequently leads to poor cerebral perfusion and cerebral hypoxia, causing confusion. Applying oxygen can reduce confusion, even if perfusion is still less than optimum. Increasing the IV flow rate would increase perfusion. However, depending on the degree of dehydration, rehydrating the person too rapidly with IV fluids can lead to cerebral edema. Causes- dehydration causes a change in mental status and temperature with reduced blood flow to the brain this confusion is more common among older adults, and may be the first indication f fluid imbalance, The patient Treatments- replace fluids, oral rehydrating solutions, drug therapy (IV fluids),

Prerenal acute renal failure, causes and treatment

Definition-Pre renal acute renal kidney failure is characterized by any physiological event that results in renal hypoperfusion. Causes- hypovolemia, and cardiovascular failure, See Page 596 Box 31-1 Morton Iggy Page 1413 Prerenal section in table 68-4 • Any physiologic event that results in renal hypoperfusion o Hypovolemia o Cardiovascular failure o Any other event that leads to an acute decrease in "effective renal perfusion" The goal of treatment is to improve of kidney perfusion (blood circulation). This usually involves treating the underlying condition (e.g., infection, heart failure, liver failure). Intravenous (IV) fluids are administered to most patients to treat dehydration Treatment-resolving what is causing the issue The ability to reverse prerenal AKI is the key to its diagnosis. ex: drugs can be used to correct hypotension, The goal of treatment is to improve of kidney perfusion (blood circulation). This usually involves treating the underlying condition (e.g., infection, heart failure, liver failure). Intravenous (IV) fluids are administered to most patients to treat dehydration Treatment focuses on correcting the cause of the prerenal acute kidney injury. Depending on the cause, the condition often reverses itself within a couple of days after normal blood flow to the kidneys has been restored. But if it is not reversed or treated successfully and quickly, prerenal acute kidney injury can cause tissue death in the kidneys and lead to intrinsic (intrarenal) acute kidney injury.

Use a room humidifier after a laryngectomy, patient teaching

Definition/reason behind it- Patient teaching- Let's talk about your 'air conditioning' system. Before your laryngectomy you were breathing through your mouth and more importantly through your nose. Your inspired air was being filtered and humidified by your upper respiratory tract. Inspired air was taken from the relative humidity of your ambient air and moisturized up to 100% by the time it reached the gas exchange units in your lungs, called alveoli. At the same time, particulate matter was removed by the mucous blanket, which coats the lining of the nose and throat. After your laryngectomy, you are left without this normal filtration/humidifying system. Your lungs respond in a very normal and protective manner by producing an increased amount of mucous to filter and humidify the air that is coming in. Bloody sputum can result when you cough excessively to clear this increased amount of mucous. You also may be more susceptible to bronchitis (an infection and inflammation of the lining tissues of the tracheo-bronchial tree) because you are breathing unfiltered, dehumidified air. So, what to do? Everything possible to increase the amount of moisture in the air you inhale. Irrigate your stoma with sterile water or saline solution four times a day and it will help your breathing. You will be taught how to do this in the hospital, but it is very simple. Fill a syringe with two to three cc's of saline, take a deep breath and squirt some into your stoma. You will cough and you are supposed to. If you cough before you get much saline into the stoma, repeat immediately. You are softening any bits of hardened mucous or blood and coughing it out. This is extremely important. A cool mist humidifier in your bedroom will help you to breathe moist air while sleeping. Put fresh water in daily, and every week or two, to prevent bacteria, clean and soak the tank with a solution of one teaspoon of bleach in one gallon of water. Rinse thoroughly before refilling. Some tricks for retaining warmth and humidity in your trachea and lungs include wearing a stoma bib, but you can also wear a scarf, a turtle neck shirt or sweater. Foam stoma protectors are also available. Covering your stoma allows you to conserve the moisture that is trying to leave your lungs as you exhale. You might also wear a soft stoma vent (see your MD for the proper size). A small plastic spray bottle filled with clean saline water can be used to create a mist to dampen your stoma bib. It becomes a portable humidifier. Incision and stoma care Check your incision site daily for 1 week after discharge. Change the dressing according to the directions you were given. Bathe in shallow water. If any water enters your stoma, it will make you cough. Use a waterproof bib to cover your stoma when you shower. Don't swim. Learn to care for your stoma. This includes cleaning and suctioning. Wear a stoma cover to keep moisture from being lost when you breathe. Use a cool-mist humidifier by your bedside. Be sure to clean the humidifier regularly. Avoid swimming and use care wehn showering or shaving, lean slightly forward and cover the stoma when coughing or sneexing,, wear stoma guard with mild soap and water. lubricate stoma with no oil based ointment as needed. increase himidity by using saline in stoma as instructed a bed side humidifier, house plants, and pans of water, obain and wear a medical alert bracelet and emergency care card for life threatening situaitons

Dialysate is formulated with varying concentrations of what? What does this do?

Dialysate (dialyzing solution) flow in opposite directions across an enclosed semipermeable membrane the dialysate contains a balanced mix of electrolytes and water that closely resembles human plasma. on the other side of the membrane is the patietn's blood which contians nitrogen waste products excess water and excess electrolytes. during hemodyalysis the waste products move from the blood into the dialysate because of the different in their concentrations (diffusion). SOme water is also removed from the blood into the dialysate by osmosis. electrolytes can move in either direction as needed and take some fluid with them. Potassium and sodium typically move out of the plasma into the dialysate. Bicarbonate and calcium generally move formt he dialysate into the plasma. This circulating process continues for a length of time removeing nitrogenous wasts and reestablishing fluid and electrolyte balance as well as restoring acid base balance. Water volume may be removed from the plasma by applying positive or negative pressure to the system.

Complication of oxygen therapy

Discomfort, skin breakdown, and other complications. Long term oxygen by nasal canula even with humidification can cause dry mucous membranes, epistaxis and infection of the sinuses, skin breakdown along the face, bridge of nose back of neck and behind ears. can fail if tube gets disconnected from the wall leading to hypoxemia with dysrrythmias or increased dyspnea. Contamination can occur with copious secretions coughed onto a tracheotomy collar. No smoking to prevent fire related oxygen therapy. Masks may cause anxiety with feelings of suffocation. Infection due to not changing the disposable humidification systems, Patients who are ventilated with high oxygen concentrations for prolong periods are at risk for oxygen toxicity which occur at the alveolar level and may progress from capillary leaking to pulmonary edema and possibly to ALI if high Fio2 continues for several days. could be an impairment of pulmonary function due to cell destruction. Carbon dioxide necrosis is a risk for patients with COPD who are sensitive to oxygen. An increased FiO2 may result in elevated PaCo2 hypo-ventilation and respiratory depression or arrest. absorptive atelectasis, alveolar collapse due to nitrogen not being absorbed and less being administered in in the gas mixture. When the nitrogen is not absorbed and oxygen is replacing it can causes alveolar collapse. Respiratory arrest, respiratory failure from fatigue caused by increased work of breathing, risk of aspiration of food or gastric contents can occur in hospitalized patients with food or gastric secretion in patients with dysphagia. Combustion, oxygen induced hypoventilation, hypercarbia (retention of CO2 CO2 narcosis- loss of sensitivity to high levels of CO2 (Page 515 Iggy Box 28-1),Oxygen toxicity, absorptive atelectiasis (new onset crackles and decreased breath sounds), drying of mucous membranes, infection.

Importance of coughing and deep breathing postoperatively

Effective coughing is necessary for the patient to clear secretions. Objectives are to mobilize secretion, promote lung expansion, and prevent the side effects of retain secretions (atelectesis and pneumonia). Should be encouraged every hour even if secretions are not heard. Purpose is to expel secretions, keep the lungs clear and allow full aeration and prevent pneumonia and atelectiasis. Helps improve gas exchange by helping increase airflow in the larger airways, helpful in removing excessive mucous

Early Polycystic kidney disease (PKD) and nutritional therapy

Limit intake of salt to help control blood pressure Preventing constipation- maintain adequate fluid intakem increase dieatry fiber wehnf luid intake is more than 2500 Ml/24 hours and ecerise regularly. Blood pressure control- when kidney impairment results in decreased urine concentration with nocturia and low urine specific gravit urge the patient to drink at least 2 L of fluid per day to prevent dehydration. Restric sodium may help control blood pressure. many patienst have salt wasting and should not follow a salt restricted diet as the disase progresses protein intake may be limited to slow the development of ESKD. Currently no specific diet has been proven to make your polycystic kidneys better or keep them from getting worse. It is, however, ideal to eat a balanced and healthy diet to maintain optimal body conditions. A healthy body is able to fight infection better, and bounce back faster. Accumulation of waste products filtered by your kidneys will build up in your blood as kidney function declines. At the more advanced stages of kidney failure (i.e. GFR <30-40 percent), significant accumulation of these waste products in your blood can cause symptoms of kidney failure. Studies also suggest that some treatments may slow the rate of kidney disease in PKD, but further research is needed before these treatments can be used in patients. In the meantime, many supportive treatments can be done to control symptoms, help slow the growth of cysts, and help prevent or slow down the loss of kidney function in people with PKD. These include: careful control of blood pressure prompt treatment with antibiotics of a bladder or kidney infection lots of fluid when blood in the urine is first noted medication to control pain (talk to your doctor about which over-the-counter medicines are safe to take if you have kidney disease) a healthy lifestyle with regard to smoking cessation, exercise, weight control and reduced salt intake drinking lots of plain water throughout the day avoiding caffeine in all beverages At present, no specific diet is known to prevent cysts from developing in patients with PKD. Reducing salt intake helps control blood pressure in PKD patients who have high blood pressure. A diet low in fat and moderate in calories is recommended to maintain a healthy weight. Speak to your doctor or a dietitian about other changes to your diet, such as avoiding caffeine. nocturia is a symptom early in the disease. Early in the disease pt's lose a lot of water and sodium. Control hypertension

serum potassium, hypo and hyper causes, implications to patients, treatment

Page 163-166 Table 29-5 Page 552

Oliguric renal failure in relationship to diuretics

Relationship to diuretics- duuretics is perscribed to increase urinary elimination of lfuid. The increase in urine output rduced helps to reduce fluid overload and hypertension in patients hwo still avhe some urine output. Because oliguria is a bad prognostic sign in patients with acute renal failure (ARF), diuretics are often used to increase urine output in patients with or at risk of ARF. ... However, clinical trials on the prophylactic use of loop diuretics rather point to a deleterious effect on parameters of kidney function. Used to increase urinary flow and thereby help eleviate ocnditions of fluid overload to prevent tubular obstruction. Furosemide a loop diuretic and mannitol and osmotoc diuretic are often used with hydration to prevent tumular obbstruction in certain obstructive causes of obstructive problems Oliguric (anuric) phase: Urine output decreases from renal tubule damage.

ventilator bundle of care

Page 526 Morton Box 27-2: Elevate head of bed 30-45 degrees, daily weaning assessment (spontaneous breathing trials), daily sedation withholding, weening protocol, DVT prophylaxis, peptic ulcer prophylaxis. Iggy Page 621- To prevent VAP implementation of the ventilator bundle order sets typically include keeping the head of the bed elevated at least 30 degrees, performing oral care per agency policy (usually brushing teeth every 8 hours and antimicrobial rinse (chlorihexidine)every 2 hours), ulcer prophylaxis preventing aspiration, pulmonary hygiene include chest physiotherapy, postural drainage and turning and positioning. Using the ventilator bundle has greatly reduced the overally incidence of VAP vigilant oral care is key component of the VAP prevention strategie although there is a considerable variation in actual practice for timing products used and specific applicaiton methods page 621 evidence based practice box. The ventilator-associated pneumonia (VAP) reduction care bundle is a grouping of evidence-based, high-impact interventions. In its original form, it was an early example of the Institute for Healthcare Improvement (IHI) care bundle methodology in the US (what is a bundle?). The Ventilator Bundle Checklist helps track an organization's compliance with implementing each element of the Ventilator Bundle. The Ventilator Bundle is a series of interventions related to ventilator care that, when implemented together, will achieve significantly better outcomes than when implemented individually.

Pulmonary embolism (PE), young healthy patients causes and treatments

Pulmonary Embolus - Risk Factors • Prolonged immobilization • Central venous catheters • Surgery • Obesity • Advancing age • Conditions that increase blood clotting • History of thromboembolism Health Promotion and Maintenance • Smoking cessation • Weight reduction • Increased physical activity • If traveling or sitting for long periods, get up frequently and drink plenty of fluids • Refrain from massaging/compressing leg muscles Young healthy patients causes- Most often occurs when inappropriate blood clotting forms a VTE in a vein in the legs or the pelvis and a clot breaks off and travels through the vena cava then it lodges in the pulmonary artery and the platelests collect on the embolous and release substance release that cuases blood vessle constriction, wide spread constriciton and hypertension impair gas exchagne and tissue perfusion. • Thrombus migrates to pulmonary arteries. • Venous thromboembolism includes pulmonary embolism and deep vein thrombosis • Virchow's triad (venous stasis, hypercoagulability, vein wall damage) • Immobility, heart failure, dehydration, and varicose veins contribute to decreased venous return, increased retrograde pressure in the venous system, and stasis of blood with resultant thrombus formation. It can occur in healthy people without warning. smoking, pregnancy, estrogen therapy, heart failure stroke cancer (lung or prostate) and trauma increase risk. Treatments-Prevention 32-1 Page 604 iggy Managing hypoxemia Page 606 Chart 32-3 care of patient with this. Drug therapy begins immediately begins with antiboagulatns to prevent enlargment and prevent more clotting. Unfractioned heparin enoxaparin, Drug therapy example 32-4 page 607 embolectomy, infrerior vena cava filtration, managing hypotension, minimizing anxiety, • Oxygen therapy (nasal cannula, mask) • Continuous patient monitoring • Obtain adequate venous access • Continuous monitoring of pulse oximetry • Drug therapy o Anticoagulants o Fibrinolytics • Assess for bleeding every 2 hour • Examine all stool, urine, drainage, vomitus for gross blood; test for occult blood • Measure abdominal girth every 8 hour • Monitor laboratory values • Surgical management o Embolectomy o Inferior vena cava filtration • Heparin and thrombolytics • Subcutaneous LMWH, unfractionated heparin IV, subcutaneous fondaparinux and adjusted-dose heparin • LMWH should be continued for at least 5 days. • Continue oral anticoagulants for 3 to 6 months. • Prevention o Prophylactic measures are based on the patient's specific risk factors Page 496-498 MOrton If time read pages 603-610 Iggy

Suggestions to help improve COPD

Pulmonary rehabilitation (helps patient optimize functional status of the lungs), structured exercise program, Nutritional counseling (malnutrition is a common issue in patients with COPD and presents in more than 50 % of patients decreases weight loss, allows for the respiratory muscles to function normally and inhibits the further wasting of them. Smoking cessation- single most effective method of reducing the risk for developing may slow progression of disease, counseling may be needed to quit, Pharmacalogic therapy (bronchodilators, corticosteroids, pharmacologic agents,Oxygen therapy is one of the principle nonpharmacologic treatments for patients with severe COPD, improves the quality of life and cognitive performance and the long term survival of patients in hypoxic state, 88% o2 sat at rest and sleep, surgical therapy, lung volume reduction surgery, bullecetomy, lung transplantation. The incidence of COPD and the severity of it would be greatly reduced with smoking cessation, avoid other inhalation irritants. Monitor respiratory status, breathing techniques diaphragmic abdominal and pursed lip breathing, positioning, upright elevate head of bed, effective coughing, drug therapy, oxygen therapy, exercise conditioning, hydration, suctioning, vibratory positive pressure devices surgical management, prevent infection. Explain to the patient and family that they may have periods of anxiety, depression, and ineffective coping. Patients need to know as much about the disease as possible so they can better manage it themselves, identify stressors that can worsen disease, discuss drug therapy, manifestations of infection, breathing position, relaxing therapy, energy conservation, and coughing and deep breathing, nutrition therapy regimen, relaxation therapy, avoid respiratory irritants. get anual vaccines Learn pursed-lip breathing. ... Drink plenty of water. ... Get informed. ... Sit well when COPD symptoms flare. ... Exercise. ... Know and avoid your triggers. ... Get your ZZZs. ... Eat well. Patient should be able to Attain and maintain gas exchange at a level within his or her chronic baseline values, Achieve an effective breathing pattern that decreases the work of breathing, maintain patient airway, Achieve and maintain a body weight within 10% of his or her ideal weight, have decreased anxiety, increase activity level to acceptable for him or her, avoid serious respiratory infections..

Acute respiratory distress, assessments and treatments

Read Entire Section in Morton Assessments- Acute respiratory failure may present within a few hours to several days, Vital signs throughout progression vary but the general trend is hypotension, tachycardia, and hyperthermia or hypothermia, respiration initially rapid and labored varies once mechanical ventilation is instituted. Early symptoms- tachypnea, dyspnea, tachycardia, breath sounds are clear in this phase, Table 27-3 Morton page 524 neurological changes, restlessness and agitation, impaired oxygenation, decreased perfusion to brain, accessory respiratory muscle use, as it progresses lung auscultation may reveal crackles secondary to increased secretions, cardiogenic pulmonary edema may be minimal, ability to compensate decreases, dependent lung fields have decreasing breath sounds, as fluid accumulates and alveoli collapse, lung compliance decreases, decreased oxygen saturation, lethargy omnious sign. Arterial Gas Analysis • Refractory hypoxemia • Persistently low SaO2 • Early—decreased PaCO2 o Respiratory alkalosis • Hypercarbia develops later. o Respiratory acidosis Treatments- Read Morton Pages 525-530 Oxygenation,ventilation- optimize oxygen delivery, arterial oxygenation, hemoglobin, cardiac output,

Pulmonary disease and reasons for dyspnea

Reasons for dyspnea- The manifestations of ARF are related to dyspnea (perceived difficult breathing) the hallmark of respiratory failure. evaluate dyspnea on the basis of how breathless the patient becomes while performing common tasks. Depending on the nature of the underlying problem the patient may not be aware of the changes in the work of breathing. Dyspnea is more intense when it develops rapidly slowly progressive RF may be first noticed as dyspnea on exertion or when lying down. The patient may have orthopnea, finding it easier to breathe in an upright position. dyspnea (difficulty in breathing or breathlessness) is a subjective perception that varies among patients a patient's feelings may not be consistent with the severity of the problem determine the type of onset (slow or abrupt); the duration; relieving factors (position changes, drug use activity cessation; and whether wheezing or stridor occurs with dyspnea. Try to quantify it by asking whether this manifestation interferes with ADL's and if so how severely. in COPD Dyspnea and mucous production often result in poor food intake and adequate nutrition. Can also be a symptom of heart failure. can occur as a result of both cardiac and pulmonary disease. Dyspnea is commonly seen in patients with pulmonary or cardiac compromise. Information about the onset of symptoms gives clues about the source and duration of the problem. Does the dyspnea occur when the patient is lying flat, requiring the patient to sit up, as seen more commonly in heart failure? Does the dyspnea awaken the patient at night, does the dyspnea occur only with exertion, Paryoxsmal nocturnal dyspnea or orthopnea often signifiy heart failure but may occur in a variety of pulmonary disorders. Description of the entire course of dyspnea including exacerbating factors, length of episodes, and any relief measures attempted is warrented. Dyspnea is the medical term for shortness of breath, sometimes described as "air hunger." It is an uncomfortable feeling. Shortness of breath can range from mild and temporary to serious and long-lasting. It is sometimes difficult to diagnose and treat dyspnea because there can be many different causes. Breathing problems from overexertion Breathing problems can result from overexertion in otherwise healthy people. Dyspnea can happen as a result of overexertion, spending time at high altitude, or as a symptom of a range of conditions. Signs that a person is experiencing dyspnea include: shortness of breath after exertion or due to a medical condition feeling smothered or suffocated as a result of breathing difficulties labored breathing tightness in the chest rapid, shallow breathing heart palpitations wheezing coughing If dyspnea occurs suddenly or if symptoms are severe, it may be a sign of a serious medical condition. the most common causes of dyspnea are asthma, heart failure, chronic obstructive pulmonary disease (COPD), interstitial lung disease, pneumonia, and psychogenic problems that are usually linked to anxiety. If shortness of breath starts suddenly, it is called an acute case of dyspnea. Acute dyspnea could be due to: asthma anxiety pneumonia choking on or inhaling something that blocks breathing passageways allergic reactions anemia serious loss of blood, resulting in anemia exposure to dangerous levels of carbon monoxide heart failure hypotension, which is low blood pressure pulmonary embolism, which is a blood clot in an artery to the lung collapsed lung hiatal hernia Dyspnea is also common among people with a terminal illness. If a person experiences shortness of breath for over a month, the condition is called chronic dyspnea. Chronic dyspnea could be due to: asthma COPD heart problems obesity interstitial pulmonary fibrosis, a disease that causes scarring of the lung tissue Dyspnea can be associated with hypoxia or hypoxemia, which is a low blood oxygen levels. This can lead to a decreased level of consciousness and other severe symptoms. If dyspnea is severe and continues for some time, there is a risk of either temporary or permanent cognitive impairment. It can also be a sign of an onset or worsening of other medical problems.

Arterial blood gas results, respiratory or metabolic acidosis or alkalosis

Results- Normal PH 7.35- 7.45 PaCO2 35-45 mm HG HCO3 22-26 mEQ/L Respiratory Acidosis- PaCO2 greater than 45mm Hg and PH less than 7.35 Metabolic Acidosis- HCO3 less than 22 mEq/L and PH less than 7.35 Metabolic Alkalosis- HCO3 Greater than 26 mEq/L and PH greater than 7.45 Respiratory alkalosis- Paco2 less than 35 mm HG and PH greater than 7.45 See Box 24-9 and 24-8 on page 445 for details in Morton

Respiratory illness and sepsis, assessment and treatment

Sepsis- The patient with pneumonia has a potential for sepsis related to the present of microorganisms in a very vascular area. Assessment- Many patients with pneumonia have flushed cheeks and an anxious expression may have chest pain or discomfort myalgia headache chills fever cough tachycardia, dyspnea, tachypnea, hemoptysis and sputum prudcction, severe chest muscle weakness also may be present from sustained coughing. Pneumonia is a frequent causes of sepsis, use sepsis screening tool to monitor always check O2 sat and vital signs. Observe breathing pattern position and use of accessory muscles, the hypoxic patient may be uncormfortable in a lying position and may be in a tripod position. assess cough and amount color and consistency of sputum produced. listen for crackles and wheezing, fremitous, evaluate vital signs and compare them with baseline for the patient, may be hypotensive with orthostatic changes as a result of vasodilation and dehydration especially an older adult.. A rapid weak pulse may indicate hypoxemia dehydration or impending sepsis and shock, cardiac dysrythmias may occur as a result of tissue hypoxia. Patient may have fever, pathogen presence in blood and sputum cultures, and the WBC and diffriental may not be within normal limits. Treatment- The key to effective treatment is eradication of the infecting organisms. Death risk is high when sepsis occurs with pneumonia . Antiinfectives are given for all types of pneumonias except the ones caused by viruses, The course of anitinfective therapy veries with drugs and organizm involved. Typically 5-7 days but can be 21 days if immunocopromized. Drug therapy ensure that the patient does not have an issue with drug resistance, Prevention of sepsis. Due to aspiration of food contentnts- interventions focus on preventing lung damage and treating the infection, the aspiration of acidic stomach contents can cause widespread inflammation leading to ARDS steroids and NSAIDS are used with antibiotics to reduce the inflammatory response.

What is the role of the alveoli in respiration?

The alveolus is the end point of the respiratory tract and it is here where gas exchange takes place. The adult lung has a total surface area of 85 m squared. They contain macrophages that move from alveolus to alveolus and sterilize the alveoli. Type 1 comprises approximately 90% of the total surface area where gas exchange takes place. Type two create surfactant which is a lipoprotein that decreases surface tension in alveoli. This prevents the collapse of the smaller airways during inspiration. Alveolar ducts branch from the respiratory bronchioles and resemble grapes, the sacs arise from these ducts and contain groups of alveoli which are the basic units of gas exchange. A pair of healthy adult lungs has 290 million of these and are surrounded by lung capillaries. The numerous alveoli make a large surface area for gas exchange. Ancinus is a term for the structural unit consisting of a respiratory bronchiole, an alveolar duct and an alveolar sac. Type two surcrete surfactant and without it atelectasis or alveolar colapse occurs reducing gas exchange. Alveoli are tiny sacs within our lungs that allow oxygen and carbon dioxide to move between the lungs and bloodstream. We get oxygen and get rid of CO2 Alveolar ventilation is the volume of fresh gas entering the respiratory zone each minute. It represents the amount of fresh air inspired and available for gas exchange. Inversely proportional to PaCO2.

Hyperkalemia and diet

The patient with hyperkalemia should aboid foods that contain potassium. such as salt substitutes, stop potassium containing infusions and keep iv access open withold oral potassium suppliments and provede a potassium restricted diet. Increasing potassium excetion helps reduce hyperkalemia if kidney function is mornaml. Health teaching is important to prevent hperkalemia dietary plan includes foods to avoid such as in chart 11-6 Page 167 Iggy

How the kidneys work

They maintain body fluid volume and composition and filter waste products for elimination Most important! The kidneys remove wastes and extra water from the blood to form urine. Urine flows from the kidneys to the bladder through the ureters. The wastes in your blood come from the normal breakdown of active muscle and from the food you eat. Your body uses the food for energy and self-repair. The kidneys are two bean-shaped organs in the renal system. They help the body pass waste as urine. They also help filter blood before sending it back to the heart. The kidneys perform many crucial functions, including: ... regulating and filtering minerals from blood • Renal clearance o Clearance of metabolic end products o About 60 mL of plasma "cleared" of urea/minute • Regulation o Electrolyte concentrations and pH of the ECF • Fluid balance • Secretion of hormones o Calcitrol and erythropoietin Read Pages 1346-1350

Maximum recommended administration rate for IV potassium

Using a controller for solution delivery a dilution no greater than 1 mEq of potassium to 10 mL of solution is recommended for IV administration. The maximum recommended infusion rate is 5-10 mEq/ hour; this rate is never to exceed 20 mEq/hr under any circumstances in accordance to national patient safety goals. it is never given by IV push to avoid causing cardiac arrest. I Morton for mild to moderate hypokalemia rates of 10-20 mEq/h are recommended. Rates exceeding 40 mEq/h are not recommended.

Venturi mask, use and oxygen settings

Venturi Mask- It is a high flow system that deliveres the most acurate oxygen concentration without intubation it works by pulling in proportional amounts of room air for each liter of low of oxygen an adaptor is located betweeen the bottom of the mask and the source. Adaptors with holes of different sizes allow specific amounts of air to mix with the oxygen, resulting in more precise delivery of oxygen. Each edaptor requires a different flow rate for example to deliver 24% of oxygen the flow rate must be at 4 L/Minute. 24-50% with flow rates as recomended by the manufacturer usually 4-10 L/min. Perform constant surveillance to ensure an accurate flow rate for the specific FiO2: an accurate flow rate ensures Fio2 delivery. Keep the orface for the venturi adaptor open and uncovered:If the venturi orface is covered, the adator does not function and oxygen delivery varies, Prove a mask that fits snugly and tubing that is free of kinks: FIO2 is altered if kinking occurs os or if the mas fits poorly. Assess the patient for dry mucous membranes: confort measures may be indicated. Change to a nasal cannula duirng meal time: oxygen is a drug that needs to be given continuously If the oxygen concetration myst be constant venturi systems are used. The venturi mask delivers an exact percentage of oxygen reguardless of the patietn's tidal volume patients with COPD may require oxygen delivery by the venturi system. These patients are sensitive to oxygen and a small increase in the percentage may resuc in an elivated PaCO2 Page 454 Morton Chart. Venturi Mask • Adaptor located between bottom of mask and O2 sources • Delivers precise O2 concentration—best device for chronic lung disease • Switch to nasal cannula during mealtimes

Bronchiodilator medication, what disease and what benefit

What disease- Asthma- Cause the bronchiolar smooth muscles to relax and they have no effect on inflammation, thy causes bronchodilation through relaxing bronchiolar smooth muscle by binding and activating pulmonary beta two precepts. Primary use is fast acting reliever either to be used during an asthma attack or just before engaging in the activity. Control therapy used daily reliever drugs used to stop an attack. Read Chart 30-6 Page 554 COPD- Bronchodilators primarily B-2 agonists improve dyspnea by stimulating the B-2 adrenergic receptors and by causing relaxation of the airway smooth muscles. offer long-term improvement in symptoms exercise capacity and quality of life Acute respiratory distress syndrome used with mucuoytics to help keep airway pateitn and reduce inflamatory reaction adn accumulation of secretions in airways improves dyspnea by relaxing the airway smooth muscles. Goals relax airway, mobilize secretions, reduce mucosal edema

renal disease, nursing priorities

helping the patient managing fluid volume, Preventing pulmonary edema, Increasing cardiac output, enhancing patient nutrition, Preventing patient injury, Preventing patient infection, Minimizing patient fatigue, minimizing patient anxiety. Nursing Priorities- Morton 31-7 Page 597