renal
what dx tests can be used for acute kidney injury (aki) (name 2)?
history-physical exam
serum creatinine & BUN levels
serum electrolytes
UA
Renal US
Renal scan
CT scan
what is the moa for h2 r/c blockers?
decreases histamine, decreases acid
what is the moa of dobutamine?
inc myocardial contractility
dec ventricular filling pressures
dec svr & pawp
inc co & sv & cvp
what is a thermal burn and give an example.
caused by flame, flash, scald, or contact with hot object.
severity of injury depends of the temp of the burning agent and duration of contact time.
name 1 similarity and 1 difference between bph and prostate CA.
similar: dec urine force, dribbling, difficulty start/stop urine stream, frequency, urgency, urinary retention, dysuria
differences:
bph: noctura, us shows enlarged prostate with elevated psa, dre enlarged smooth prostate
prostate CA: mets- lunbosacral pain in hips/legs, wt loss; us with biopsy confirms elevated psa, pap is a biomarker that elevates with prostate CA, alk phos suggests mets to bone; dre shows fixed firm nodular mass.
expected outcomes for the pt with ckd include (name 1)
fluid & electrolyte levels within normal limits
acceptable weight with no more than a 10% wt loss
what does serum albumin/prealbumin levels indicate?
nutritional status of pt
what is the moa of nitroglycerin?
venous dilation
dilates coronary arteries
dec preload
glass bottle for infusion
s/e= possible headache
what is a chemical burn and give an example.
what is the purpose of continuous bladder irrigation?
keeps uretha/bladder patent, removes bloody clots; will see pinkish colored urine with clots - eventually become clear urine
chronic kidney disease (ckd) has 5 stages. describe the differences between stage 1 vs stage 5.
stage 5: kidney failure; GFR <15 (for dialysis)
what kind of questions might you ask a pt with suspected upper gi bleed?
diet?
alcohol?
smoker
stools, vomit? if yes what color? looking for blood
nsaid or corticosteroid use
stress level
what is the moa of norepinephrine (levophed)?
B1 adrenergic agonist (cardiac stimulation)
Alpha adrenergic agonist (peripheral vasoconstriction)
renal vasoconstriction
inc bp & map & cvp & pawp & svr
first drug of choice for septic shock after mi
what is a smoke/inhalation injury?
results from breathing noxious chemicals or hot air that damages respiratory tract: upper airway injury, lower airway injury, metabolic asphyxiation.
airway compromise and pulmonary edema can develop within hours of injury.
what is dysmenorrhea and how can we manage it?
painful menses
tx- non pharm = heat, exercise, distraction, acupuncture, TENs
drugs = nsaids, oral contraceptive therapy (helps to suppress ovulation)
the most common cause of death in pts with ckd is cardiovascular related. name 2 causes.
mi
ischemic heart disease
pad
hf
cardiomyopathy
stroke
what is the main manifestation of acute pancreatitis and where is it located?
abd pain due to the distention of the pancreas, peritoneal irritation, and obstruction of the biliary tract. pain is usually in the LUQ, but it may be mid epigastric. often rads to back. eating worsens the pain. pain has a sudden onset, described as severe deep piercing continuous steady
what is the moa of sodium nitroprusside?
arterial & venous vasodilation
dec preload & afterload
dec cvp & pawp
dec bp
protect solution from light
monitor for cyanide toxicity
what is an electrical burn and given an example.
results from intense heat generated from an electrical current. direct damage to nerves and vessels causes tissue anoxia/death. severity of injury depends on the amount of voltage, tissue resistance, current pathway, surface area in contact with current, and length of time that the current flow was sustained.
watch for cardiac dysrhythmias/cardiac arrest, severe metabolic acidosis, and myoglobinuria.
name 1 pro and 1 con of hormone replacement therapy
pro= tx menopausal sx, dec risk for osteoprosis, dec risk for colon CA
con= inc risk for breast/endometrial CA, inc risk for emboli/stroke
nursing management considerations for aki (name 2)?
treat cause
fluid restriction
optimize nutrition
lower K if high: give Ca gluconate (raises the threshold for cardiac excitation), regular insulin IV (moves K into cell), Sodium bicarb (helps correct acidosis and shifts K into cell), Kayexalate (produces osmotic diarrhea to help remove K)
dialysis if necessary
what are the classifications of jaundice (name 1)?
hemolytic jaundice: caused from blood transfusions reactions, hemolytic anemia, sickle cell crisis
hepatocellular jaundice: caused by cirrhosis, hepatitis, liver CA
obstructive jaundice: caused by cirrhosis, hepatitis, liver CA, common bile duct obstruction from stone, biliary strictures, pancreatic CA
what is the moa for dopamine?
positive inotropic effects: inc cardiac contractility, inc av conduction, inc hr, inc co, inc bp, inc map
can cause progressive vasoconstriction at high doses
what is the emergent phase of a major burn? and why is hypovolemic shock the greatest initial threat to a pt with a major burn?
emergent phase- lasts up to 72 hrs from time of burn injury. this phase ends when fluid mobilization and diuresis begins.
massive shifts of fluids OUT of blood vessels because of capillary permeability, begins as early as 20 min after injury. water, na,& plasma proteins (albumin) move into the interstitial spaces and other surrounding tissues = intravascular volume depletion...
hypovolemic shock: will see dec bp, inc hr
rbc are destroyed, will see high hct, high K, high na levels in interstitial space during this time period.
at the end of the emergent phase, capillary membrane permeability is restored if fluid resuscitation is adequate; interstitial fluid returns to the vascular space; diuresis occurs, and urine will have a low specific gravity.
name 2 risk factors for cervical CA
infection with high risk strains of hpv 16 & 18, immunosupression, using oral contraceptive therapy for a long time, being exposed to the drug diethylstilbestrol (DES- synthetic estrogen), giving birth to many children, smoking