MS2 Exam 1

What diet will we encourage for pt with AKI?

- LOW potassium - LOW sodium - LOW protein diet (pt can only have specific proteins)

How much dialysate is to be infused into peritoneum during peritoneal dialysis?

1-3 L

If a client with CKD reports muscle weakness, diarhhea, and tingling in the hands, what 2 actions should the nurse do first?

1. Check the client's most recent electrolyte levels 2. obtain a blood specimen for ABGs

What findings related to cardiac output, pulse pressure, and HR are consistent with cardiac tamponade?

1. Decreased cardiac output 2. Narrowing pulse pressure! 3. HR goes up to try to increase cardiac output

What are some common causes of pancreatitis?

1. ETOH abuse 2. gallstones (billary disease) 3. abd trauma 4. tumors 5. viral infections

What 2 pt education points for pt with CAD taking clopidogrel/Plavix?

1. Gastric irritation and diarrhea are possible side effects 2. Take WITH a glass of water! Can be taken with OR without food, but make sure they take w glass of water

What are s/s of cirrhosis?

1. Jaundice and icterus (yellow eyes) 2. dark urine 3. altered LOC 4. fetor hepaticus (musty/sweaty breath or odor)

What 2 meds to give for hepatic encephalopathy?

1. Lactulose (pulls excess ammonia out of blood) 2. Abx

What are the 3 pt teaching points for mechanical heart valves?

1. Lasts lifelong (does not need replacement) 2. Pt will be on lifelong anticoagulant 3. has a click

Pt teaching for nitroglycerin including SubL and Patch?

1. Monitor BP and dizziness (causes BP drop) 2. SubL nitro: take 1 tab Q5 min up to 3 times 3. Patch: rotate site to prevent irritation, REMOVE patch before defibrilation; remove after 12-14 hr

What 2 pt education points for pt with CAD taking Aspirin?

1. Monitor for and report and bleeding 2. Ringing in ears=toxicity; report ASAP

What meds will we give for CAD?

1. NITRATES (nitroglycerin and isosorbide dinitrate/Isordil) 2. BETA-BLOCKERS (carvedilol/Coreg and metoprolol/Lopressor) 3. ANTIPLATELETS (Aspirin and clopidogrel/Plavix)

What will we educate pt with CKD to avoid?

1. NSAIDs 2. contrast dye 3. antacids containing Mg- (d/t increased Mg- levels in blood)

What are the 3 pt teaching points for biologic heart valves?

1. Only lasts 8-10 years; needs replacement 2. No anticoagulants needed 3. NO click

What are some s/s of acute pancreatitis?

1. Pain in upper abd 2. N/V 3. weight loss 4. Jaundice 5. Cullens sign 6. Turners sign

What are some complications of cirrhosis?

1. Portal HTN (d/t pressure build-up in portal vein) 2. Esophageal varices (d/t pressure) 3. Splenomegaly (enlarged spleen) 4. Ascites (d/t build-up of fld causing large abd) 5. hepatic encephalopathy (d/t build-up of toxins in blood) 6. hepatorenal syndrome 7. muscle wasting and hair loss

What are two common signs of damaged kidneys?

1. Posterior flank bruising 2. Peritonitis

What are two common dangerous complications of peritoneal dialysis?

1. Respiratory distress (d/t infusing fld too quickly or overfilling and cavity) 2. Peritonitis (infection of peritoneum)

If kidney disease begins due to abx, what two actions will we take?

1. STOP abx 2. take peak and trough

What are four pt teaching points for pt with hepatic encephalopathy?

1. Take meds as directed 2. Drink lots of flds 3. Increase proteins, carbs, and fiber in diet 4. NO ETOH

What are s/s of chronic pancreatitis?

1. Upper abd pain 2. N/V 3. Steatorrhea 4.Weight loss 5. Jaundoce 6. Increased BG 7. poor digestion

What are five considerations regarding peritoneal dialysis that we should observe?

1. Warm dialysate before adm 2. Sterile technique 3. Monitor output color 4. Monitor for infection 5. Daily weights

What are three s/s of hepatic encephalopathy?

1. altered LOC/change in personality 2. abnormal tendon reflex 3. jaundice

What are s/s of CKD?

1. low urine output (kidneys not producing urine) 2. Heart arrythmias (high K+ and Mg- in blood) 3. Decreased GFR (causes uremic frost, pruritis from frost on skin, metabolic acidosis) 4. Hypervolemia (HTN, edema, JVD, crackles) 5. Anemia (decreased production of Epo)

What are some treatments for chronic pancreatitis?

1. manage pain 2. IV hydration and electrolyte replacement 3. Pancreatic enzyme replacement 4. Enteral feedings 5. Monitor and control BG 6. Eat a diet high in protein

What will we do for pt with ascites?

1. measure abd girth 2. parascentesis or meds to remove excess fld

What will we monitor for if we suspect Disequilibrium syndrome?

1. restlessness 2. confusion 3. N/V 4. Headache

What is the expected GFR for pt in stage 4 CKD?

15-29; severe loss of kidney fxn

What surface area of the aortic valve requires URGENT surgery?

1cm or less

Normal value for cardiac output?

3-6L/min

Normal value for central venous pressure (CVP)?

3-8 mm/Hg

What is the expected GFR for pt in stage 3 CKD?

30-59; moderate loss of kidney fxn

What is the expected range for Mean Arterial Pressure (MAP)?

60-65 or greater

What is a normal ejection fraction from the heart?

60-75%

What is the expected GFR for pt in stage 2 CKD?

60-89; mild loss of kidney fxn

Normal value for MAP?

60-90 mm/Hg

When can peritoneal dialysis be performed?

7 days a week @ home

What is the expected GFR for pt in stage 5 CKD?

<15; end stage renal disease, dialysis needed

What ejection fraction value would indicate heart failure and the need for a heart transplant?

<40%

What amount of urine output is considered oliguria?

<400 mL/day

What is the expected GFR for pt in stage 1 CKD?

>90; kidney damage with normal renal fxn

What is Mitral Valve Stenosis?

A condition where the mitral valve in the heart narrows (blood flow from the left atrium to the left ventricle is obstructed)

What is Cullen's sign?

A gray-blue discoloration around the umbilicus caused by acute pancreatitis

What is Turner's sign?

A gray-blue discoloration on the posterior flank and peritoneal cavity caused by acute pancreatitis

What is metabolic syndrome and which disease process is it a risk factor for?

A group of conditions that increases your risk for heart disease, stroke, and type2 DM (assoc. with CAD)

What is a biologic heart valve?

A heart valve made of living mammal tissue; Porcine= pig, Bovine= cow

What is hepatorenal syndrome?

A life-threatening complication of cirrhosis where there is rapid deterioration of kidney function

What is acute pancreatitis?

A serious and life-threatening inflammation of the pancreas

If pt has splenomegaly, what will we monitor for?

Anemia (d/t decreased RBC production from the spleen)

Pt presents with these symptoms; what cardiac disorder would you suspect? - JVD - Clear lung sounds - Muffled heart sounds - Decreased cardiac output

Cardiac tamponade! - If JVD is present, you would suspect crackles in lungs too because of fluid overload. However, if JVD is present with CLEAR lung sounds, suspect cardiac tamponade. This is because the pressure on the heart is causing the JVD, not fluid overload

What is angina?

Chest pain caused by ischemia

What is the greatest risk for a pt with a mechanical heart valve?

Clots!

What is cardiac tamponade?

Compression of the heart due to pericarditis; medical EMERGENCY!

What is myocardial ischemia?

Decreased blood flow to the heart caused by plaque occlusion in the vessels; causes ischemia and tissue death

What is cirrhosis?

Diffuse destruction of the liver with scar tissue

What is a dangerous complication of hemodialysis?

Disequilibrium syndrome

If you hear worsening heart murmurs such as a change in the tone or the murmur gets louder, what cardiac disorder would you expect?

ENDOcarditis

What cardiac disease is nail bed splintering associated with?

Endocarditis (also Oster nodes= brown spot on thumb that is painful, Janeway lesion= spot on palm that is not painful, and Roth spots= spots in eyes) ALL R/T BLOOD VESSEL HEMORRHAGE

If K+ is dangerously high, what do we give?

FIRST: calcium gluconate to stabilize cardiac membranes SECOND: insulin with D50

If a client receiving hemodialysis states that they will limit their intake of sodium to 5G/day, what should the nurse do?

Follow up with the pt; this is too much Na intake for a pt in renal failure

Which test is the best overall indicator of kidney fxn?

GFR

What special consideration about a pt's medications should we observe when they are about to go to dialysis?

HOLD MEDS; NO meds that lower BP (ex diuretics or anti-hypertensives) - this is b/c there is a risk for hypotension during dialysis

What is the treatment for endocarditis?

IV abx (penicillin PLUS cefitriaxione and gent/vanc) for 4-6 weeks

What is the greatest risk for a pt with a biologic heart valve?

Infection!

What is the expected urine output for someone with oliguria?

Less than 400 mL/day

Expected urinalysis results for pt with Acute Tubular Necrosis?

Muddy brown color; sediment

For a pt with an AKI who is having tall, peaked T-waves on their cardiac monitor strip, what will we do?

NOTIFY MD ASAP! (indicates a STEMI, "tombstone" after QRS complex)

What is Aortic Stenosis?

Narrowing of the aortic valve caused from wear and tear

If bruit and/or thrill are absent when assessing for AV patency for hemodialysis, what will we do?

Notify MD ASAP

For a client receiving IV gentamicin who has developed oliguria and an increased BP, what action would the nurse take first?

Obtain an order for gent peak and trough levels

If you hear muffled heart sounds, what type of cardiac disorder would you suspect?

PERIcarditis (d/t fld around heart silencing the sounds)

If a pt has pain relief when they lean forward, which cardiac disorder would be suspected?

Pericarditis

What is coronary artery disease (CAD)?

Plaque accumulation in coronary arteries that decreases the diameter of vessels; this causes a block in blood flow increases pressure in the vessels

What is chronic pancreatitis?

Progressive degeneration of the pancreas caused by repeated flares of acute pancreatitis; causes cirrhosis and is irreversible

Expected urinalysis results for pt with Globinuria?

Red-brown color; RBCs in urine

How is chronic stable angina relieved?

Rest and medication (nitroglycerin)

What is typically the cause of Mitral Valve Stenosis?

Rheumatic fever

What is the treatment for esophageal varices?

Sengstaken-Blakemore tube (applies pressure on esophageal bleed in emergencies)

Which lab is most commonly used to identify AKI?

Serum creatinine

What two bacteria are most likely the cause of endocarditis?

Strep. Viridians and Staph. auerus

T/F: The build-up of nitrogen/urea in the blood causes pericarditis.

TRUE

T/F: You must TURN a patient to see TURNers sign?

TRUE

T/F: A client in late stage CKD should report to their doctor if they develop fatigue or weakness

TRUE; patient reported fatigue is associated with death, pt should start dialysis if this occurs

How is unstable angina relieved?

Unrelieved with meds/rest; CALL 911 ASAP! RISK FOR MI

How does peritoneal dialysis work?

Uses the lining of the stomach as a dialyzing membrane to filter the blood

Expected urinalysis results for pt with pyelonephritis?

WBCs in urine

What is Disequilibrium syndrome?

When solutes are removed too quickly in dialysis, causing increased ICP

What is aortic regurgitation?

When the aortic valve doesn't close properly; causes blood to flow irregularly into the left ventricle

What is Mitral Valve Regurgitation?

When the mitral (bicuspid) valve does not close properly; causes blood to backflow from the left ventricle to the left atrium.

What is pericarditis?

When the sac around the heart fills with fluid and impedes the hearts ability to fill and beat properly; friction rub present

A client has renal colic due to renal lithiasis. What is the nurse's priority in managing care for this client? a. Administer an opioid analgesic as prescribed. b. Encourage the client to drink at least 17 oz (500 mL) of water each hour. c. Do not allow the client to ingest fluids. d. Request the central supply department to send supplies for straining urine.

a. Administer an opioid analgesic as prescribed.

A client underwent a transurethral resection of the prostate (TURP) gland 24 hours ago and is prescribed continuous bladder irrigation. What nursing intervention is appropriate? a. Use sterile technique if manual irrigation of the catheter is required. b. Prepare to remove the catheter when urine appears amber in color. c. Restrict fluids to prevent the client's bladder from becoming distended. d. Decrease the rate of irrigation when output is increasingly red in color.

a. Use sterile technique if manual irrigation of the catheter is required.

The nurse is caring for a client who has returned from receiving hemodialysis treatment. It requires immediate follow up by the nurse if the client has a. a BP of 90/58 b. developed a temp of 99.1*F c. K+ levels that decreased from 6.1 to 5.1 d. reports of feeling tired with no desire to eat

a. a BP of 90/58

A client presents to the emergency department reporting of a dull, constant ache along the right costovertebral angle along with nausea and vomiting. The most likely cause of the client's symptoms is a. renal calculi. b. acute prostatitis. c. interstitial cystitis. d. overdistended bladder.

a. renal calculi.

The nurse collects a urine specimen from a client for a culture and sensitivity analysis. What should the nurse do to preserve the specimen? a. Ask a CNA to collect the specimen and run it to the lab. b. Place the specimen in a fridge until it can be delivered to the labrartory. c. Send it to the laboratory immediately. d. a. Collect the specimen during the last episode of urination in the day.

c. Send it to the laboratory immediately.

A nurse is caring for a client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission? a. ice chips only b. increased dairy products c. nothing by mouth d. iron-rich diet

c. nothing by mouth

What s/s might you see if a pt on peritoneal dialysis goes into respiratory distress?

crackles, dyspnea, tachypnea

A client who had an open appendectomy for a perforated appendix has an incision secured with adhesive strips. What instruction should the nurse give the client about caring for the incision? a. Cover the adhesive strips with a dressing to protect the area. b. Remove the adhesive strips to cleanse the area. c. Place plastic wrap over the incision when taking a bath. d. Leave the adhesive strips in place until they fall off.

d. Leave the adhesive strips in place until they fall off.

What is azotemia?

elevated waste products in the blood (nitrogen)

What s/s might you see if a pt on peritoneal dialysis has suspected peritonitis?

fever, tachycardia, cloudy drainage