AKI
What are some Prerenal causes of AKI?
HF, dehydration, decreased cardiac output
Name some risk factors of CKD
over 60 yo, heart disease, DM, family hx
What are some clinical manifestations of Hypothyroidism?
tired or lethargic, personality changes, impaired memory, slowed speech, depression, weight gain, intolerance to cold, myxedema
This is considered the “master gland”
Pituitary gland; base of your brain, below the hypothalamus
Category of burn that extends into the dermis
deep partial thickness (2nd degree)
Explain the most common cause of AKI
Acute tubular necrosis; lack of oxygen to the tubules of the kidneys, often caused by stroke, MI, certain medications, sepsis, trauma, prolonged hypotension
What is some important teaching for a patient with a GFR of 10 who states, "I will just need to be on dialysis until I'm feeling better".
In ESRD this patient will need a kidney transplant or ongoing dialysis to maintain life
DI
polyuria, polydypsia
Patient teaching for SIADH
Diet supplement Sodium + Potassium; good oral hygiene; daily weights, watch for s/s of electrolyte imbalances
A patient has suffered a partial thickness chemical burn to his entire left leg and the posterior of his left arm. Using the rules of nines, what percent of his body has been affected? AND is this patient appropriate to be kept at BMC?
22.5%
No-- partial thickness of greater than 10% is criteria for a burn center transfer
Name some clinical manifestations of AKI
fluid volume deficits, metabolic acidosis, increased serum sodium and potassium, increased BUN + creatinine
Describe anemia associated with CKD
normochromic, normocytic anemia; associated with decreased erythropoietin
Considerations with using propranolol in an asthmatic patient
should be avoided, alert PCP if noted
What are some of the hormones produced by the pituitary gland and the function of these hormones?
ACTH: stimulates the production of cortisol; maintained BP and blood sugar
FSH: (follicle-stimulating hormone) → promotes sperm production and stimulates ovaries to produce estrogen
LH: luteinizing hormone → stimulates ovulation in women and testosterone production in men
GH: helps maintain healthy muscles and bones
Prolactin: causes breast milk to be produced
TSH: stimulates the thyroid gland, which regulates metabolism, energy
Oxytocin: helps the labor to progress
ADH: anti-diuretic hormone (vasopressin) regulates water balance and sodium levels
This can be a life threatening emergency of a patient with a major burn
Hypovolemic shock; caused by massive shift of fluids out of the blood vessels d/t increased capillary permeability
What are some of the expected therapies initiated to lower high potassium?
insulin IV (+glucose), sodium bicarb, kayexalate, dietary modifications
Nursing management of preoperative care for kidney transplant
emotional and physical care
possible need for ongoing dialysis/pre procedure dialysis
EKG, chest x-ray, labss
Tx of SIADH
Fluid restriction (800-1000 ml/day) IV hypertonic saline, loop diuretics, vasopressor receptor antagonists (Vaprisol, Samsca)
What adverse effects of PTU should a patient be aware of?
s/s of infection (e.g. fever, chills) + s/s of liver injury (pruritus, RUQ pain, anorexia)
Three major organ systems most susceptible to complications
cardiovascular, urinary, respiratory
Name some common nephrotoxic drugs
Contrast dye, amnioglycosides (gentamicin), NSAIDs, statins
Complications of a kidney transplant
Rejection, infection, CVD, CA, recurrence of the original kidney disease, long-term steriod therapy
Drug therapy for hyperthyroidism
antithyroid-> tapazole, PTU; inhibit thyroid hormone synthesis
RAI: damages or destroys thyroid tissue which limits thyroid hormone secreation
surgical therapy
Name some causes of SIADH
CA; CNS disorders (stroke, infection); medications (SSRIs, chemo drugs); HIV
Nursing care in the acute phase of burn injury
wound care, fluid replacement, pain and anxiety management