exam 2 study guide

how do you collect a 24 hour urine specimen?

1. All urine voided during the 24-hour period is collected in the designated container and stored in the refrigerator or on ice. 2. Dispose of the first urination 3. Save every specimen thereafter for the full 24 hours

BUN range

10-20

hemoglobin normal range

12-18 oxygen in the blood

Sodium normal range

135-145

Platelet normal range

150,000-400,000

Potassium normal range

3.5-5.0

WBC normal range

5,000-10,000

3 cardinal signs of peritonitis

abdominal pain, tenderness, and distention

What will T3/T4 do in hypothyroidism?

decrease

antidiarrheals

diphenoxylate, hydrochloride, atropine sulfate (lomotil), loperamide (Imodium), available

What is the GFR rate when a client is diagnosed with end stage kidney disease.

increased BUN and creatinine?

When administering (TPN) the nurse should:

-check each bag for accuracy -monitor IV pump for accuracy -if TPN solution is unavailable, have HCP order normal saline until it is available -if TPN is not on time, do not speed up the rate -monitor daily weight -monitor electrolytes -monitor I/O -assess IV for infection/infiltration -change IV tubing every 24 hours -change gresseing every 48-72 hours -have 2nd nurse check prescription solution

Signs and symptoms of hypothyroidism

-fatigue-lethargy-personality changes-impaired memory-slow speech-cold intolerance-bradycardia-dyspnea-myxedema: long term-cretinism: if untreated, congenital deficiency, leads to stunted physical/mental growth

Signs and symptoms of hyperthyroidism

-goiter-bruit-exophthalmos (protrusion of eyeballs)-HTN-tachypnea/dyspnea-rapid bounding pulse-dysrhythmias-increased body temp-increased appetite/thirst-N/V-weight loss-fatigue/weakness-insomnia, restlessness, tremor

Medications used to decrease serum potassium slide 34

-insulin and sodium bicarbonate -calcium gluconate -dialysis -sodium polystyrene sulfonate

treatment of myxedema

-maintain patent airway -replace fluids with IV normal or hypertonic saline -give levothyroxine sodium IV -give corticosteroids -check pts temp hourly -monitor BP hourly -cover pt with warm blankets -monitor for change in mental status -turn every 2 hours -institute aspiration precautions

Creatinine range

0.6-1.35

Medications that are harmful to kidneys

antibiotics, diuretics, NSAIDS, PPIs, supplements, laxatives,

immunosuppresants

azathiprine, methotrexate, cyclosporine supress immune response monitor CBC

what broad spectrum antibiotics are prescribed for peritonitis?

cephalosporins: ceftriaxone, cefotaxime, or ampicillin with an aminoglycoside

what dilution is recommended for IV Potassium? What is the recommended rate?

dilution no greater than 1 mEq of potassium to 10 mL of solution maximum recommended rate is 5-10mEq, and is to NEVER exceed 20 mEq under any circumstances. NEVER PUSH IV POTASSIUM

what is metronidazole in conjunction with trimethoprim/sulfamethoxazole or ciprofloxacin prescribed for?

diverticulitis; they are antimicrobials

What does it mean when protein is found in the urine

early kidney damage

what will T3/T4 do in hyperthyroidism?

excess in T3/T4

functions of the kidney

fluid and electrolyte balance, and creating urine for elimination of waste

Slide 13 for medications for glomerulonephritis and nephrotic syndrome

glomerulonephritis: penicillin, erythromycin for strep, modify immunity, F&E balance, may need dialysis

hormonal functions of the kidney

help adjust blood pressure, control RBC's by producing erythropoietin for red blood cell synthesis, convert vitamin d to an active form.

biologic response modifiers

infliximab, adalimumab, (-MAB drugs) inhibits tumor necrosis, prevents leukocytes from going to inflammed tissue

what drugs impair thyroid hormone production?

levothyroxine/synthroid

Medications used for treatment of AKI slide 33

loop diuretics: furosemide/budenomide, and osmotic diuretics

respiratory acidosis

low pH, high CO2 hyperventilate, fatigue, SOB, sweating, confusion, exhaustion, drowsiness

metabolic acidosis

low pH, low HCO3 fast HR, nausea, vomiting, long and deep breaths, weakness, loss of appetite

antimicrobials

metronidazole, ciprofloxacin, clarithromycin prevents or treats infection, helpful for fistulas monitor for GI upset

Which laboratory test provides evidence consistent with a client having renal impairment?

monitor creatinine, BUN, sodium, potassium, calcium, phosphorus, bicarbonate, hemoglobin, and hematocrit. urinalysis showing protein, RBCs, WBCs, decreased specific gravity. GFR increased BUN and creatinine

Which action would the nurse take when a client has returned from surgery with a nephrostomy tube?

monitor tube for drainage for first 24-48 hours after placement. provide tube care, sterile dressing changes, and tube flushing if prescribed

drug therapy for fractures

narcotics, morphine for severe pain, hydrocodone. oxycodone and codeine for moderate/severe pain, NSAIDS: advil, ketorolac, toradol, muscle relaxants: cyclobenzaprine, carisoprodol. blood thinners: heparin, enoxaparin, apixaban, rivaraxiban

GFR

normal GFR: 125 increased means your kidney is good, or increased renal arterial pressure decreased GFR means the kidney has weakened function

A client with acute kidney injury is moved into the diuretic phase after 1 week of therapy. During this phase, which clinical indicators would the nurse assess?

polyuria. monitor for fluid loss, mental status changes, and ECG changes.

which finding would the nurse expect when assessing a child with acute poststreptococcal glomerulonephritis?

skin lesions, edema in the face eyelids or hands, fluid overload, SOB, crackles in the lung fields, S3 heart sound, neck vein distention, redish brown smokey urine, HTN, fatigue. N/V/anorexia if anemic

aminosalicylates

sulfasalazine, mesalamine, olsalazine, balsalazine decreases inflammation by suppressing cytokines avoid exposure to sunlight

Which instruction does the nurse include when teaching safety measures to a patient with rheumatoid arthritis who is receiving methotrexate therapy?

these drugs put the pt at risk for infection bc of decreased immunity. tell pts to avoid alcoholic drinks to prevent liver toxicity, and to watch for mouth sores and dyspnea from pneumonitis. teach about lymph node tumor. folic acid is given to decrease drug side effects.

what assessment data would be a major concern for the nurse when caring for a patient admitted to the ED with pelvic fractures?

vital signs, skin color, and level of consciousness for indications of possible hypovolemic shock from internal blood loss. check the urine for blood.