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Purpose of mechanical ventilation and risks
Purpose-improve gas exchange and decrease the work needed for effective breathing; used to support the patient until lung function is adequate or until acute episode has passed; Risks-cardiac problems (hypotension and fluid retention), lung trauma, GI (stress ulcers), infections, muscle deconditioning
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Interventions for low pressure alarms
disconnection, loss of tidal volume, leaks, extubation
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Interventions for high pressure alarms
decreased compliance, secretions (suction), pneumothorax (alert physician, auscultate breath sounds), ARDS/pulmonary edema, bronchospasm (auscultate breath sounds), ETT in right main bronchi (assess for unequal breath sounds, get chest xray, tape securely in place), pt biting on tube (insert oral airway to prevent biting on ET tube), tube kinked, H2O in tubing, coughing, bucking
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% nursing interventions that promote airway clearance
TCDB, raise HOB, position changes, maintain thin secretions, assist with administration of mucolytics, teach no smoking, enhance mobility, meds
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Fistula education
avoid taking BP, IVs or blood draw in that arm; wear loose fitting clothing, do not lie, sleep or sit in a position that restricts the fistula; loose watch, check thrill 3-4 times a day
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Hemodialysis complications
clotting of AV access, muscle cramps, air embolus, infections, sleep disturbances, hemodynamic changes (hypotension, cardiac dysrhythmias, anemia, PVD)
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Peritoneal dialysis
acute-peritonitits, leakage, bleeding, pain; chronic-ABD hernias, hemorrhoids, low back pain, clots in peritoneal catheter, constipation
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S/S of PE and nursing interventions and meds
Sudden dyspnea, tachypnea, pleuritic chest pain, impending doom, cough, hemoptysis; meds-anticoagulation, fibrinolytics, cardio meds when appropriate; Nursing-minimize risk, prevention, assess, monitor meds, manage pain, manage O2, relieve anxiety, monitor for complications
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Risk factors for ARDS and S/S
Acute lung injury, systemic inflammatory response; Tachycardia, fast R, low O2, pale or cyanotic skin, anxious, deer in headlights, restless, use accessory muscles to help breathe, hypoxia; early signs-restless, anxiety, tachycardia/tachypnea; late-bradycardia, extreme restlessness, dyspnea
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Clinical manifestations of chronic renal failure and diet
Headaches, decreased ability to concentrate urine, polyuria changes to oliguria, increased BUN and serum creatinine, edema, GFR progressively decreases from 90 to 30, mild anemia, increased BP, weakness and fatigue; Diet-limit protein, get calories from simple carbs, fats like olive oil are OK, limit sodium, Phosphorous and calcium
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Continent and incontinent urinary diversion
Ureterostomies-divert urine directly to skin surface through stoma; Conduits-collect urine in a portion of the intestine when is then opened onto the skin as a stoma; Ileal reservoirs-pouch, need to self cath; Sigmoidostomies-pee with poop; may have bowel incontinence; Stoma care-infection, dehiscence, leakage, encourage fluids
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S/S of pneumothorax and interventions
Deviated trachea Sudden pain, air hunger, SOB, anxiety, expansion of chest decreased, accessory muscles for breathing, decreased or absent breath sounds, cyanosis; Chest tube to suction, provide oxygen
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Allen test
23-25 gauge safety needle and 3 ml heparinized syringe; Needle bevel up at 45 degree angle directly where artery is palpable; Quick stick, slow advance; 2-3 ml of blood; Put it into ice to slow; metabolism; Hold pressure gauze for 5 min regular/15 minutes if on blood thinner; Expel air bubbles; Place cap on syringe, gently rotate to mix
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Patho of pulmonary HTN and education and treatments
Occurs when the mean pulmonary arterial pressure exceeds 25 with a pulmonary capillary wedge less than 15; Pressure measured during right sided heart catheterization; Two forms-idiopathic (uncommon) or PA HTN due to known cause
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Impairment of pulmonary vascular bed to handle volume from the rt ventricle, increased blood flow increases PA pressure, increased pressure in PA results in increased workload of RV leading to failure of RV; Medical treatments-manage underlying cause, oxygen with exercise, meds (Coumadin, Cal Channel Blockers, phosp 5 inhibitors, diuretics and lanoxin, Bosentan, prostanoids), close assessment, surgery (transplant, atrial septostomy)
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AKI
Decreased GFR and oliguria
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Problems-fluid overload, elevated wastes such as urea, creatinine, potassium; changes in hormone levels controlling BP, making RBC and uptake of Calcium
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Cause-1.) prerenal (sudden/severe drop in BP or interruption of blood flow to the kidneys due to severe injury or illness 2.) Intrarenal-direct damage by inflammation, toxins, drugs, infection or reduced blood supply 3.) Postrenal-Sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor or injury
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Phases-RIFLE1.) Risk 2.) Injury 3.) Failure 4.) Loss 5.) ESKD
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Initiation-begins at initial insult and ends when oliguria develops
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Oliguria-<400 ml in 24 hr, increase in metabolic waste in blood, uremic symptoms present
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Diuresis-urine output increases, uremic symptoms still evident
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Recovery-Improvement of renal function, may take up to 12 months for complete recovery, reduced GFR of 1-3%
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Assessment-Fluid status, nutritional status, patient knowledge, activity tolerance, self-esteem, potential complications
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Treatment-Monitor I/O, daily wt, complications of electrolyte imbalances, lab results, administer meds and IV therapy, pt education on case and problems
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DX of TB
DX: NAAT, TB skin test, CXR, acid-fast bacillus, sputum, QuantiFERON-TB Gold (QFT-6) test (results within 24 hours)
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Isoniazid
empty stomach, no booze, liver damage
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Rimfampin
stain skin, reddish/orange secretions, women need other BC, no booze, live damage
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Pyrazinamide
cant have had gout, drink 8 oz water, no sun
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Ethambutol
no booze, may have vision changes-report immediately; no gout, drink water
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GFR
calculation that determines how well the blood is filtered by the kidneys which is one way to measure kidney function
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GFR ranges
60-100 normal, 15-60 kidney disease, 0-15-kidney failure
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Complications of kidney transplant
organ rejection, infection, bleeding, DVT, thrombosis
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Drug therapy for transplant
glucocorticoids, cyclosporine, tacrolimus (Prograf) 100 X more potent than cyclosporine, sirolimus (Rapamune)
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Stages of transplant
Hyperacute-within 48 hours after surgery, increased BP, Increased T, Pain at transplant site; immediate removal of the transplanted kidney; Acute-1 wk-2 yr; oliguria or anuria; temp over 100; increased BP, enlarged tender kidney; lethargy; elevated serum creatinine, BUN, K; fluid retention; treat with increased doses of immunosuppressive drugs; Chronic-Occurs gradually during a period of months to years; gradual increase in BUN and serum creatinine; fluid retention; changes in serum electrolytes; fatigue; conservative mgmt. until dialysis is required; Teach hand hygiene and dont be around live viruses
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Breathing pattern for chronic kidney disease
Kussmal
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Two clinical manifestations of pyelonephritis
anemic, pregnant women get this, caused by staph
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What is glomerulonephritis
acute inflammation of the kidney usually caused by an immune response; strep
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S/S of glomerulonephritis
look for recent incisions, piercings where infections could have happened, edema, fluid volume overload, crackles, maybe fever or not, recent changes in urination and urine color, uremia (vomiting, nausea and anorexia)
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Major clinical manifestation of nephrotic syndrome
protein
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Muscle spasms, tingling and cramping
hypocalcemia
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Bounding pulse, HTN, edema
fluid retention
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Blood clot formation
failure for early ambulation
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Hypotension, decreased urine output, flank pain
hemorrhage post biopsy
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Reduced breath sounds, deviation of trachea
pneumothorax
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Restlessness, anxious, tripod breathing
hypoxia
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