Med Surg II - Test 3

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Author:
TMill
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149422
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Med Surg II - Test 3
Updated:
2012-04-22 22:03:32
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Renal System
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4-24-2012
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  1. Renal threshold for glucose?
    220 mg/dl
  2. How many ml/min do nephrons filter in a healthy kidney (GFR)?
    125 ml/min
  3. What should you suspect of men with recurrent UTIs?
    STDs
  4. What regulates blood flow, GFR & BP?
    Renin
  5. What controls sodium & water reabsorption?
    Prostoglandin
  6. What stimulates RBC production in bone marrow?
    Erythropoietin
  7. If you have poor kidney function what would you suspect your H & H levels to be?
    Low (anemia)
  8. What is the best indicator of overall kidney function?
    Serum Creatinine
  9. Normal Levels of Serum Creatinine in Men & Women?
    • M = .6 - 1.2
    • F = .5 - 1.1
  10. Normal value for BUN?
    10-20
  11. Specific gravity?
    1.005 - 1.030

    (decreased means dilute - increased means concentrated)
  12. If an older adult has a decreased LOC what should you suspect?
    UTI
  13. When is the best time to do an urinalysis?
    First void of the morning
  14. What phosphorus and calcium levels would you suspect to see in a patient with poor kidney function?
    Increased Phosphorus & Low Calcium
  15. Billirubin in a urinalysis would sugest what?
    Liver damage
  16. Leukoesterase & Nitrates in the urine - what should you suspect?
    UTI
  17. Why are older people at an increased risk for UTI?
    They have a tendency to retatin urine
  18. What is a baby's chance of getting PKD if one parent has an Autosomal Dominant gene?
    50%
  19. Which is worse: Autosomal Dominant or Recessive PKD?
    Recessive
  20. What is ACUTE PAIN r/t in PKD?
    Cyst Rupture
  21. What is CHRONIC PAIN r/t in PKD?
    Compression
  22. What is the main manifestation to be concerned about with PKD?
    Hypertension
  23. What type of diet should you adopt if you have PKD?
    High Fiber & 2500 ml/day & Low Sodium Diet
  24. What % of kidney function must be lost before Serum Creatinine increases?
    50%
  25. What are some manifestations of PKD?
    • Hypertension
    • Increased abdomen size
    • Flan pain
    • Constipation
    • Edema
  26. A patient with PKD develops a severe headache.. What should you suspect?
    Berry Aneurism
  27. S/S of a Berry Aneurism r/t PKD?
    • **Headache
    • *Itching
    • Neurologic/Vision chances
  28. What is often the first manifestation of PKD?
    PAIN
  29. Where would you expect to see pain in someone with Hydroureter?
    Low - scrotal pain for men
  30. Where would you expect to see pain in someone with Hydronephritis?
    High - flank pain
  31. Nephrosotomy post-op care?
    -first 12-24 hrs red-tinged blood is normal

    -If drainage decreases and patient has back pain OR leaking urine/blood from site - Notify Physician
  32. Acute Pyelonephritis is related to what?
    Bacterial Infection
  33. Chronis Pyelonephritis is related to what?
    recurrent UTIs (scarring/ inflammation)
  34. S/S of Acute Pyelonephritis?
    • Fever, chills, malaise, fatigue
    • flank pain, abdominal discomfort
    • tachcardia, tachypenea
    • S/S of UTI (urgency, frequency, dysuria)
  35. S/S of Chronis Pyelonephritis?
    S/S of renal failure - hypertension, nocturia, hyperkalemia, acidosis and inability to conserve sodium
  36. Where would you expect to see edema on someone with Acute GN?
    preorbital (face & hands)
  37. Where would you expect to see edema in someone with Chronic GN?
    dependent edema (feet & legs)
  38. S/S of Glomerulonephritis?
    FLUID OVERLOAD

    (SOA, crackles, edema, S3 Gallop)
  39. What causes fluid overload in GN?
    Sodium & Water retention
  40. What is Chronic GN due to?
    Disease processes such as LUPUS or diabetes
  41. What is Acute GN usualy due to?
    Infection - ask about recent infections, tattoo, piercings
  42. Treatment of Acute GN?
    • Antibiotics
    • Personal Hygeine
  43. What determines the extent of kidney damage?
    Renal Biopsy
  44. How do you collect Creatinine Clearance?
    • -Discard first specimen & note time
    • -Collect for 24 hrs.
    • -Void at end of 24 hrs. and save specimen
    • -keep on ice or in refrigerator
    • -tell everyone
  45. Renal Scan patient instructions?
    • -obtain informed consent & weight
    • -drink 2-3 glasses of water prior to procedure
    • -void before procedure
    • -increase fluids after procedure
  46. Post Procedure Renal Biopsy?
    • check pressure dressing
    • supine postion & strict bed rest
    • monitor for bleeding!!!!
    • report complications (abdominal pain, decreased bowel sounds, guarding)
    • No heavy lifting or activity for 1-2 weeks
  47. What is the first manifestation of Diabetic Nephropathy?
    Albuminuria (.3 g/dl)
  48. Other patient care for Diabetic Nephropathy?
    • Avoid nephrotoxic agents & dehydration
    • assess need for insulin
  49. What is a common manifestation of Renal Cell Carcinoma due to the parathyroid hormone produced by tumor cells?
    Hypercalcemia
  50. What is hypertension due to in Renal Cell Carcinoma?
    increased blood levels of RENIN
  51. What does increased HCG levels cause in Renal Cell Carcinoma?
    decreased libido (sex drive) :'(
  52. Post-Op care following Renal Cell Carcinoma Surgery?
    Assess for signs of bleeding in bed linens, H&H, BP, distended abdomen, hypotension, etc.
  53. BUN level is directly related to what?
    Protein
  54. What are the 4 main causes of CRF?
    • Hypertension
    • Diabetes
    • Infection
    • Kidney Disease
  55. What are EARLY signs of CRF?
    • Proteinuria
    • Hematuria
    • Decreased ability to concentrate urine (polyuria & nocturia)
    • Elevated Cr & BUN
  56. Metabolic Changes you would expect to see with CRF?
    • Hyperkalemia
    • Hyperphosphatemia
    • Hypermagnesemia
    • Hypocalcemia
    • Metabolic Acidosis (kussmaul respirtations)
  57. CRF Cardiac Changes:

    Excess volume, excess sodium, renin-angiotensin-aldosterone
    Hypertension
  58. CRF Cardiac Changes:

    Anemia, hypertension, fluid overload, uremic toxins
    Heart Failure
  59. CRF Cardiac Changes:

    Chest pain, pericardial friction rub, increased HR, fever
    Pericarditis
  60. CRF Cardiac Changes:

    Bradycardia, decreased pulse pressure, muffled heart sounds
    Cardiac Tamponade
  61. Hematologic changes with CRF?
    • Anemia (decreased erythropoietin)
    • Bleeding (impaired platelet function)
  62. GI changes with CRF?
    • Halitosis (increased ammonia)
    • PUD
    • uremic colitis
    • GI bleed
  63. Integumentary changes with CRF?
    Uremic Frost (crystallized urea on the skin)
  64. Normal Phosphorus level?
    3-4.5
  65. Normal potassium level?
    3.5 - 5
  66. Normal Calcium level?
    9 - 10.5
  67. Normal Hemoglobin levels?
    • F: 12 - 16
    • M: 14 - 18
  68. Normal Hematocrit levels?
    • F: 37 - 47
    • M: 42 - 52
  69. Fluid restriction in pt. with CRF?
    Urine output + 500-700 ml/day
  70. Diet restrictions/additions in a patient with CRF?
    Decrease potassium, sodium & phosphorus

    Increase Calcium & Iron
  71. How much weight gain over 2 days should be reported in a patient with CRF?
    5 pounds over 2 days
  72. Do you give diuretics to ssomeone with ESKF?
    No
  73. After undergoing Hemodialysis what must the patient be aware of?
    Risk for bleeding r/t Heparin


    Be cautious for 4-6 hours afterwards!
  74. What is the antidote for Heparin in Hemodialysis?
    Protamine Sulfate
  75. Care of AV Fistulas & Grafts?
    • Avoid venipunctures and taking BP in that extremity
    • Feel for Thrill
    • Auscultate for Bruit
    • Assess distal pulses
    • Asses bleeding & infection
    • Never use site to administer IV fluids

    Do not sleep on or do any heavy lifting with affected arm!
  76. Hemodyalisis: Which port is blood drawn through?
    Proximal Lumen
  77. Hemodyalisis: Which port is blood returned through?
    Distal Lumen
  78. What should you asses for during Hemodialysis?
    Dialysis Disequilibrium Syndrome
  79. Dialysis Disequilibrium Syndrome S/S?
    • Decreased LOC
    • Headache
    • Hypotension
    • Nausea & Vomitting
    • Cerebral Edema r/t decreased blood volume & BUN
  80. Treatment of Dialysis Disequilibrium Syndrome?
    Anticonvulsants due to the risk of seizures
  81. How does Peritoneal Dialysis work?
    Gravity
  82. Peritoneal Dialysis: Sanguinous drainage?
    Bleeding - stop infusion & call MD
  83. Peritoneal Dialysis: Brown Drainage?
    Bowel Perforation - stop infusion & call MD
  84. Peritoneal Dialysis: Urine colored drainage?
    Bladder Perforation - stop infusion & call MD
  85. Peritoneal Dialysis: Cloudy drainage?
    Infection - collect a sample
  86. Peritoneal Dialysis: Pre-dialysis care?
    • Measure abdominal girth
    • Assess VS & lung sounds
    • Record weight
    • Monitor BUN, Cr, electrolytes, H&H
    • Empty Bladder
  87. Peritoneal Dialysis: Post Dialysis Care?
    • Time meals with outflow!!
    • weight
    • monitor BUN, Cr, electrolytes, H&H

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