Chronic Renal Failure
DM, uncontrolled HTN, damage to kidney tissue, stones, hypovolemia
What are the risk factors of developing a PE?
What are symptoms?
Risk Factors: DVT, fat embolus, air bubble from entry into veins (CVL), broken tips
Symptoms: Dyspnea, chest pain, apprehension, anxiety, restlessness, feeling of doom, cough, hemoptysis, decreased O2 saturation, tachycardia, decreased BP, crackles, pleural friction rub, S3/S4, diaphoresis, petechiae
What are the three types of Pleural Effusion?
1. Transudate (clear)
2. Exudate (cloudy)
3. Hemothorax (blood)
What is the purpose and function of a chest tube?
use gravity and or suctioning to restore negative pressure in pleural cavity be removing air/blood/fluids from pleural space
What is the normal range for pH, CO2, and HCO3?
pH = 7.35-7.45
CO2 = 35-45
HCO3 = 22-26
What is the stage name, GFR, and a potential complication of Stage 4 chronic kidney disease?
Severe, 15-29 mL/min, the presence of anemia needs to be controlled
What diagnostic tests would be used to identify a PE?
Pulmonary Angiography, CT, CXR, labs (d-dimer), ABG
What treatment is needed for Pneumothorax?
small bore needle, chest tube, thoracentesis
When should you call an MD concerning a chest tube?
increased crepitus, new air leak, drainage, >150 mL per hour x2 hours, a change in drainage color, clots, decreased drainage, respiratory distress
pH - 7.91
CO2 - 49
HCO3 - 25
Metabolic Alkalosis
What are some nutritional therapy considerations for chronic kidney disease?
limit protein intake, fluid intake, sodium, potassium, phosphorus, take mineral/vitamin supplements, eat enough calories to meet the metabolic need
O2, VS, heart monitor, lung sounds, fibrinolytic / thrombolytic therapy, anticoagulants such as heparin & warfarin, surgery (embolectomy)
What is the primary cause of Pneumothorax? Who is at the greatest risk?
Causes: chest trauma, CPR, lung disease, smoking, mechanical ventilation, altitude changes
Risk: JAKE TUCKER
Why should you Vaseline gauze when removed?
It forms an occlusive dressing
pH - 7.28
CO2 - 27
HCO3 - 25
Metabolic Acidosis
What is the stage name, GFR, and a potential complication of Stage 2 chronic kidney disease?
Mild, 60-89 mL/min, nephron damage has occured and there is a slight elevation of metabolic wastes in the urine
What measures should be included in "injury prevention" for patients with a PE?
monitor bleeding in stool, urine, drainage, vomit, ABD girth, back pain, skin
What is the main difference between Pneumothorax and Pleural Effusion?
Pleural Effusion - the buildup of pleural fluid in the pleural cavity.
Pneumothorax - the presence of air or gas in the pleural cavity.
What should you do if CT accidentally removed?
cover with gauze and tape on 3 sides to allow air to still escape
pH - 7.29
CO2 - 47
HCO3 - 25
Respiratory Acidosis
What are the different types of vascular access used for hemodialysis (long term and temporary)?
Temporary access - Hemodialysis catheter, may use a temporary subclavian catheter until the AV fistula matures
What are some key nursing care points of treating a patient with a PE?
Genetic counseling, education for post-op families and patients on signs and symptoms of PE & DVT, monitor all injuries for signs of DVT
What are the primary causes of Pleural Effusion?
manifestation of underlying disease changes in capillary pressure/permeability, imbalance of oncotic and hydrostatic pressure, decreased lymphatic clearance of fluids, CHF, infections
What is involved in nursing care for a patient with a chest tube?
secure tubing to patient, keep unit below level of insertion site, assure suction connected as ordered, keep 2 chest tube clamps at bedside
check for [crepitus, signs of infection, drainage at site, intactness of tube] every 12 hours
pH - 7.52
CO2 - 32
HCO3 - 24
Respiratory Alkalosis