N444: Test 2

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N444: Test 2 by Mind Map: N444: Test 2

1. Cardiovascular Disease

1.1. Leading COD

1.1.1. Nearly half of all American deaths

1.1.2. Leading COD in both genders

1.1.2.1. Men dominate ages 20-54

1.1.2.2. Women dominate ages 55-75+

1.1.3. Due to lifestyle

1.2. Review of CV system

1.2.1. Two-part circulation

1.2.1.1. Pulmonary (R)

1.2.1.2. Systemic (L)

1.2.2. Heart supply

1.2.2.1. Vena cava (blood in)

1.2.2.2. Pulmonary artery/vein

1.2.2.2.1. Artery: Blood away from heart

1.2.2.2.2. Vein: Blood to heart

1.2.2.3. Aorta (blood out to systemic)

1.2.2.4. Coronary arteries

1.2.3. Movement

1.2.3.1. Systole (contraction) & diastole (relaxation)

1.2.3.2. SA node (RA) controls heart action

1.2.4. Conduction system

1.2.5. Action potential

1.2.5.1. Depolarization

1.2.5.2. Repolarization

1.2.5.3. Refractory periods

1.2.5.3.1. Effective RP

1.2.5.3.2. Relative RP

1.2.6. Cardiac output

1.2.6.1. Stroke volume

1.2.6.2. Cardiac output

1.2.6.3. Preload

1.2.6.4. Contractility

1.2.6.5. Afterload

1.2.6.6. Ejection fraction

1.3. Types of CVD

1.3.1. Atherosclerosis/CAD

1.3.1.1. Deposits accumulate in arterial lumen

1.3.1.2. Plaque buildup >> Damage in artery

1.3.1.3. Various other causes

1.3.1.3.1. High BP surges

1.3.1.3.2. Elevated cholesterol/tri

1.3.1.3.3. Cigarrete smoking

1.3.2. CHD

1.3.3. Angina pectoris

1.3.4. Arrhythmia

1.3.5. CHF

1.3.6. Stroke/CVA

1.4. Risk factors

1.4.1. Inflammatory processes

1.4.2. Abdominal obesity (>40 inches)

1.4.3. Triglycerides >150

1.4.4. Low HDL: <40M-50F

1.4.5. BP >130/85

1.4.6. Fasting glucose >100

1.5. Assessment

1.5.1. Health history

1.5.1.1. Demographic info

1.5.1.2. Genetic history

1.5.1.3. Cultural/social factors

1.5.2. Risk factors

1.5.2.1. Modifiable

1.5.2.2. Non-modifiable

1.5.3. Manifestations

1.5.3.1. Chest pain

1.5.3.2. Dyspnea

1.5.3.3. Peripheral edema

1.5.3.4. Weight gain

1.5.3.5. Fatigue

1.5.3.6. Dizziness

1.5.3.7. Syncope

1.5.3.8. Altered LOC

1.5.4. Other areas

1.5.4.1. Medications

1.5.4.2. Nutrition, elimination

1.5.4.3. Activity, rest

1.5.4.4. Self-concept

1.5.4.5. Roles, relationships

1.5.4.6. Sexuality

1.5.4.7. Coping skills

1.5.4.8. Prevention strategies

1.6. Lab data

1.6.1. Cardiac biomarkers

1.6.2. CK, CK-MB

1.6.3. Myoglobin

1.6.4. Troponin T and I

1.6.5. Lipid profile

1.6.6. Brain (b-type) natriuretic peptide)

1.6.7. C-reactive protein

1.6.8. Homocysteine

1.7. Diagnostic studies

1.7.1. ECG

1.7.1.1. 12-lead

1.7.1.2. Various monitoring styles

1.7.1.3. Cardiac stress test

1.7.2. Radionuclide imaging

1.7.2.1. Myocardial perfusion imaging

1.7.2.2. Ventricular function, wall motion tests

1.7.2.3. CT, PET, MRI

1.8. Treatment

1.8.1. Cardiac cath

1.8.2. Hemodynamic monitoring

1.8.3. Coronary bypass surgery

1.8.4. Balloon angioplasty

2. Cardiovascular Disorders

2.1. Analyzing cardiac rhythm

2.1.1. Rate, rhythm, regularity

2.1.2. Measure ECG intervals

2.1.2.1. P-wave: A. depol.

2.1.2.1.1. PR-wave

2.1.2.1.2. Start of atrial depol to start of ventricular depol

2.1.2.1.3. Time required to send impulse through atria and AV node

2.1.2.1.4. Lasts 0.12-0.20 sec

2.1.2.2. QRS complex: V. depol.

2.1.2.2.1. May not have all 3 waves

2.1.2.2.2. Q - First downward deflection

2.1.2.2.3. R - First upward deflection

2.1.2.2.4. S - Second downward deflection

2.1.2.2.5. Lasts 0.04-0.12 seconds

2.1.2.3. ST segment: Isolectric line

2.1.2.3.1. "At rest point" b/w ventricular depol & repol

2.1.2.3.2. Elevation OR depression >0.5

2.1.2.3.3. Very significant

2.1.2.4. QT interval: Beginning of QRS to end of T

2.1.2.4.1. Ventricular depol & repol

2.1.2.4.2. 0.38-0.42 seconds

2.1.2.4.3. Less than half of R-R interval

2.1.2.5. T wave: Rounded deflection slightly larger than P-wave

2.1.2.5.1. Ventricular repol

2.1.2.6. U-wave: Small, rounded; after T wave

2.1.2.6.1. Late depol of papillary muscle

2.2. Specific alterations

2.2.1. CHD

2.2.1.1. aka CHD or IHD

2.2.1.2. Obstructed blood flow

2.2.1.2.1. Atherosclerosis

2.2.1.2.2. Reduced blood flow to myocardium

2.2.1.2.3. Most prevalant CVD in adults

2.2.1.3. Statistics

2.2.1.3.1. 500K deaths

2.2.1.3.2. 2 M hospitalizations

2.2.1.3.3. $8.5B for meds

2.2.1.3.4. $133.2B total

2.2.1.4. Manifestations

2.2.1.4.1. Chest pain (most common)

2.2.1.4.2. Angina pectoris

2.2.1.4.3. MI

2.2.1.4.4. HF

2.2.1.4.5. Sudden cardiac death

2.2.1.4.6. May be asymptomatic

2.2.1.4.7. May have "atypical" presentation

2.2.1.5. Risk factors

2.2.1.5.1. Hyperlipidemia

2.2.1.5.2. Smoking

2.2.1.5.3. Sedentary lifestyle

2.2.1.5.4. Alcohol

2.2.1.5.5. Hyperhomocystinemia

2.2.1.5.6. Oral contraceptives

2.2.1.5.7. Stress

2.2.1.6. Lab tests

2.2.1.6.1. (see pp. 706)

2.2.1.6.2. Cardiac enzymes, biomarkers

2.2.1.6.3. Lipid profile

2.2.1.6.4. Electrolytes

2.2.1.6.5. CRP

2.2.1.6.6. Coag studies

2.2.1.6.7. ABGs

2.2.1.6.8. Thyroid studies

2.2.1.6.9. Urine protein

2.2.1.7. Diagnostic tests

2.2.1.7.1. ECG

2.2.1.7.2. Cardiac cath

2.2.1.7.3. Myocardial imaging

2.2.1.7.4. Stress test

2.2.1.7.5. X-Ray

2.2.1.7.6. EKG

2.2.2. Angina

2.2.2.1. Episodes or paroxysmal pain

2.2.2.1.1. Tightness, choking, heavy sensation

2.2.2.1.2. Retrosternal pain that may radiate

2.2.2.1.3. Often accompanied by anxiety

2.2.2.1.4. Usually subsides with rest or nitroglycerin

2.2.2.2. Caused by insufficient coronary blood flow

2.2.2.3. Triggered by physical or emotional stress

2.2.2.4. Associated symptoms

2.2.2.4.1. Dyspnea/SOB

2.2.2.4.2. Dizziness

2.2.2.4.3. N/V

2.2.2.5. Treatment

2.2.2.5.1. Decrease myocardial oxygen demand

2.2.2.5.2. Increase oxygen supply

2.2.2.5.3. Medications

2.2.2.5.4. Oxygen therapy

2.2.2.5.5. Address risk factors

2.2.2.5.6. Reperfusion therapy

2.2.2.6. Nursing care

2.2.2.6.1. Assessment

2.2.2.6.2. Diagnoses

2.2.2.6.3. Collaborative problems

2.2.2.6.4. Planning

2.2.2.6.5. Treatment

2.2.3. MI

2.2.3.1. Permanent destruction of a part of myocardium

2.2.3.2. Caused by rupture of plaque >> thrombus >> obstruction

2.2.3.3. Same disease process as unstable angina but at different stages

2.2.3.4. ACS = MI + UA

2.2.3.5. Manifestations

2.2.3.5.1. Chest pain

2.2.3.5.2. Other symptoms

2.2.3.6. Diagnosis

2.2.3.6.1. ECG

2.2.3.6.2. Lab tests

2.2.3.7. Treatment

2.2.3.7.1. Diagnostic studies w/i 10 min of admission

2.2.3.7.2. Oxygen, medications

2.2.3.7.3. Bed rest!

2.2.3.7.4. Need for percutaneous coronary intervention

2.2.3.7.5. Need for thrombolytic therapy

2.2.3.7.6. Give IV heparin or LMWH, clopidogrel/ticlopidine, glycoprotein 2B/3A inhibitors

2.2.4. ACS

2.2.4.1. Assessment

2.2.4.1.1. Vital component

2.2.4.1.2. Review all symptoms

2.2.4.1.3. Compare to baseline and recent data

2.2.4.1.4. Watch the ECG

2.2.4.2. Diagnoses

2.2.4.3. Collaborative problems

2.2.4.3.1. Acute pulm. edema

2.2.4.3.2. HF

2.2.4.3.3. Cardiogenic shock

2.2.4.3.4. Dysrhythmias, cardiac arrest

2.2.4.3.5. Pericardial effusion

2.2.4.3.6. Cardiac tamponade

2.2.4.4. Planning

2.2.4.4.1. Relieve pain, ischemic signs

2.2.4.4.2. Limit damage

2.2.4.4.3. Reduce anxiety

2.2.4.4.4. Maintain tissue perfusion and good RR

2.2.4.4.5. Adherence/compliance

2.2.4.4.6. Recognize complications early

2.2.5. HF

2.2.5.1. Overview

2.2.5.1.1. Inability of heart to meet perfusion needs

2.2.5.1.2. Fluid overload OR inadequate tissue perfusion

2.2.5.1.3. Indicates a myocardial disease

2.2.5.1.4. Either systolic (contraction) or diastolic (filling)

2.2.5.1.5. May be reversible, but usually progressive

2.2.5.2. Manifestations

2.2.5.2.1. R. side

2.2.5.2.2. L. side

2.2.5.2.3. Chronic HF = biventricular

2.2.5.3. Classification

2.2.5.3.1. NYHA

2.2.5.3.2. ACC/AHA

2.2.5.3.3. Type = treatment

2.2.5.4. Medical management

2.2.5.4.1. Address the cause

2.2.5.4.2. Reduce AL/PL >> Reduce workload

2.2.5.4.3. Optimize therapy

2.2.5.4.4. Prevent exacerbations

2.2.5.4.5. Utilize medications

2.2.5.5. Nursing care

2.2.5.5.1. Health history

2.2.5.5.2. Personal patterns

2.2.5.5.3. Physical exam

2.2.5.5.4. Diagnoses

2.2.5.5.5. Collaborative problems

2.2.5.5.6. Planning

2.3. Cardiac rehab

2.3.1. Phase 1

2.3.1.1. Inpatient

2.3.1.2. Soon after stable

2.3.1.3. Recognize emergency

2.3.1.4. Rest-activity balance

2.3.2. Phase 2

2.3.2.1. Outpatient for 2-6 weeks

2.3.2.2. Individualized exercise plan

2.3.2.3. Support, teaching

2.3.3. Phase 3

2.3.3.1. Outpatient

2.3.3.2. For life

3. Genitourinary Dysfunction

3.1. BPH

3.1.1. Normal prostate characteristics

3.1.1.1. Large walnut to kiwi size

3.1.1.2. Round, rubbery, free of nodules or masses

3.1.1.3. Two lateral lobes separated by palpable groves

3.1.1.4. 3 zones

3.1.1.4.1. Peripheral

3.1.1.4.2. Central (EJD)

3.1.1.4.3. Transitional

3.1.2. Disease overview

3.1.2.1. Non-malignant

3.1.2.2. Increases with age

3.1.2.3. 50% of men by age 60

3.1.2.4. 90% of men by age 85

3.1.3. Risk factors

3.1.3.1. Gender, age, family history, race

3.1.3.2. Smoking, heavy alcohol use

3.1.3.3. Obesity, inactivity

3.1.3.4. HTN

3.1.3.5. Western diet

3.1.3.6. Heart disease

3.1.3.7. Diabetes

3.1.3.8. Marital status

3.1.4. Prevention

3.1.4.1. No smoking

3.1.4.2. Moderate alcohol consumption

3.1.4.3. Healthy, balanced diet

3.1.4.4. Treat and control other dx

3.1.4.5. Weight loss or maintenance

3.1.4.6. Exercise

3.1.5. Pathophysiology

3.1.5.1. Tissue closest to urethra starts to grow

3.1.5.2. >> Pressure on urethra >> Restricted flow

3.1.5.3. >> More effort by bladder >> Thickened wall

3.1.5.4. >> Decreased storing capacity

3.1.6. Manifestations

3.1.6.1. Hesitancy

3.1.6.2. Abdominal straining

3.1.6.3. Weak stream of urine

3.1.6.4. Interrupted steam

3.1.6.5. Dribbling

3.1.6.6. Urinary retention

3.1.6.7. F/U/N

3.1.6.8. Incomplete emptying

3.1.7. Complications

3.1.7.1. Recurrent UTIs

3.1.7.2. Azotemia

3.1.7.3. Bladder stones

3.1.7.4. RF

3.1.8. Assessment

3.1.8.1. Health history

3.1.8.1.1. UT problems

3.1.8.1.2. Family history

3.1.8.2. DRE

3.1.8.3. Patient-voiding diary

3.1.9. Diagnostics

3.1.9.1. Urinalysis, urine culture

3.1.9.2. PSA >4.0 ng/mL

3.1.9.3. Urinary flow-rate recording

3.1.9.4. Cytoscopy

3.1.9.5. Ultrasound

3.1.9.6. AUA Symptom Index

3.1.10. "Look Alike" problems

3.1.10.1. Urethral stricture

3.1.10.2. Prostate or bladder cancer

3.1.10.3. Neurogenic bladder

3.1.10.4. Urinary bladder stones

3.1.11. Medical management

3.1.11.1. Goals

3.1.11.1.1. QOL

3.1.11.1.2. Urine flow

3.1.11.1.3. Obstruction

3.1.11.1.4. Progression

3.1.11.1.5. Complications

3.1.11.2. Types

3.1.11.2.1. Watchful waiting

3.1.11.2.2. Pharm therapy

3.1.11.2.3. Minimally invasive procedures

3.1.11.2.4. Surgical resection

3.1.11.3. Treatment

3.1.11.3.1. Medications

3.1.11.3.2. MITs

3.1.11.3.3. Surgery

3.2. Prostate cancer

3.2.1. 2nd most common cancer in men

3.2.2. 2nd most common COD in American men

3.2.3. High risk group: AA men (2x more likely)

3.2.4. Age = primary risk factors

3.2.5. Survival rates

3.2.5.1. 98% five years

3.2.5.2. 84% ten years

3.2.5.3. 56% fifteen years

3.2.6. Risk factors

3.2.6.1. Diet, hormones

3.2.6.2. Gender, age, race, family history

3.2.6.2.1. HPC1

3.2.6.2.2. BRCA1 and 2

3.2.7. Prevention

3.2.7.1. Avoid excessive red meat and high-fat dairy

3.2.7.2. 5-alpha reductase inhibitors can lower risk

3.2.8. Pathophysiology

3.2.8.1. Starts in peripheral zone near the rectum

3.2.8.2. Uncontrolled tumor growth >> mutations >> progression

3.2.8.3. Usually adenocarcinomas

3.2.8.4. Slow-growing

3.2.8.5. 47% asymptomatic until advanced

3.2.8.5.1. Urinary problems

3.2.8.5.2. Sexual dysfunction

3.2.8.5.3. Hematuria or blood in semen

3.2.8.5.4. Frequent pain in lower back, hips, upper thighs

3.2.9. Assessment

3.2.9.1. Health history

3.2.9.2. DRE

3.2.9.3. PSA >4

3.2.9.4. TRUS with biopsy

3.2.10. Diagnostics

3.2.10.1. Gleason score 2-10

3.2.10.1.1. Lower: Less aggressive

3.2.10.1.2. Higher: More aggressive

3.2.10.2. Staging

3.2.10.2.1. 1-2 localized

3.2.10.2.2. 3: Advanced, outside gland

3.2.10.2.3. 4: Metastasis to lymph nodes or organs

3.3. Prostate surgery

3.3.1. Treatment

3.3.1.1. Highly variable

3.3.1.1.1. Watchful waiting

3.3.1.1.2. Surgery

3.3.1.1.3. Radiation therapy

3.3.1.1.4. Hormonal therapy

3.3.1.1.5. Chemotherapy

3.3.1.1.6. Other therapy

3.3.1.1.7. (see pp. 1522)

3.3.1.2. Radical prostatectomy

3.3.1.2.1. Standard

3.3.1.2.2. First-line therapy

3.3.1.2.3. Localized tumor

3.3.1.3. Post-op complications

3.3.1.3.1. Bleeding

3.3.1.3.2. Clots/DVT

3.3.1.3.3. Cath obstruction

3.3.1.3.4. Sexual dysfunction, incontinence

3.3.1.3.5. Infection

3.3.1.3.6. Transurethral resection syndrome

3.3.2. Nursing care

3.3.2.1. Activity tolerance, ADLs

3.3.2.2. HPI, specific symptoms, FH

3.3.2.3. Anxiety

3.3.2.4. Knowledge deficit

3.3.2.5. Pain, discomfort

3.3.2.6. Maintain FVB

3.3.2.7. Stop complications from occuring

3.3.2.8. Patient education

3.3.2.8.1. Expectations

3.3.2.8.2. Equipment

3.3.2.8.3. Wound care

3.3.2.8.4. Monitoring for complications

3.3.2.8.5. What to report to MD

3.3.2.8.6. Perineal exercises

3.3.2.8.7. Activity limitations post-op

3.3.2.8.8. Prevent dehydration

3.3.2.8.9. Ambulation

3.4. Testicular cancer

3.4.1. Great survival rate if localized

3.4.2. Most common cancer in young men

3.4.3. Modifiable risk factors

3.4.3.1. Cryptochoridism

3.4.3.2. Occupational exposure to chems

3.4.4. Prevention

3.4.4.1. Treat undescended testis

3.4.4.2. Avoid occupational exposure

3.4.5. Classification

3.4.5.1. Germinal

3.4.5.1.1. 90% of cases

3.4.5.1.2. In sperm-producing tissues

3.4.5.1.3. Seminomas

3.4.5.1.4. Non-seminomas

3.4.5.2. Nongerminal

3.4.5.2.1. Supportive and hormonal tissues

3.4.6. Manifestations

3.4.6.1. Mass, swelling, enlargement

3.4.6.2. Usually painless

3.4.6.3. Heaviness or ache in lower areas

3.4.7. Assessment

3.4.7.1. History, phys exam

3.4.7.2. Elevated tumor markers

3.4.7.2.1. AFP

3.4.7.2.2. Beta-hCG

3.4.7.3. Inguinal orchiectomy required to diagnosis

3.4.8. Treatment

3.4.8.1. Remove testis via orchiectomy through inguinal incision

3.4.8.2. Can bank sperm BEFORE treatment (not after)

3.4.8.3. Radiation is usually for sperminomas (can preserve fertility in unafffected testis)

3.4.8.4. Chemo is for all types

3.4.8.5. Combo therapy is best

4. Chronic Renal Dysfunction

4.1. Normal kidney functions

4.1.1. Body water regulation

4.1.1.1. Urinary output

4.1.1.2. Blood pressure

4.1.2. Excretory regulation

4.1.2.1. Nitrogenous wastes

4.1.2.2. Drug metabolites

4.1.2.3. Other wastes

4.1.2.4. Uric acid

4.1.3. Metabolic/endocrine regulation

4.1.3.1. E-poietin

4.1.3.2. RAA

4.1.3.3. Vitamin D

4.1.4. Acid-base balance

4.1.4.1. Metabolic compensation

4.1.5. Electrolyte balance

4.2. Renal dysfunctions

4.2.1. Chronic kidney disease (CKD)

4.2.1.1. Umbrella term

4.2.1.1.1. Kidney damage

4.2.1.1.2. Decreased GFR over >3 months

4.2.1.1.3. Decreased QOL; increased $$$

4.2.1.1.4. Premature death

4.2.1.1.5. Can progress to ESRD >> dialysis/transplant

4.2.1.2. Risk factors

4.2.1.2.1. Diabetes**

4.2.1.2.2. CVD

4.2.1.2.3. HTN

4.2.1.2.4. Obesity

4.2.1.2.5. Family history

4.2.1.2.6. Cancer

4.2.1.3. Stages

4.2.1.3.1. 1) GFR = 90

4.2.1.3.2. 2) GFR = 60-89

4.2.1.3.3. 3) GFR = 30-59

4.2.1.3.4. 4) GFR = 15-29

4.2.1.3.5. 5) GFR = <15

4.2.1.4. Clinical appearance

4.2.1.4.1. Elevated serum creatinine

4.2.1.4.2. Anemia

4.2.1.4.3. Metabolic acidosis

4.2.1.4.4. Electrolyte abnormalities

4.2.1.4.5. Fluid retention

4.2.1.4.6. HTN

4.2.1.5. Diagnostic findings

4.2.1.5.1. GFR

4.2.1.5.2. Creatinine

4.2.1.6. Medical management

4.2.1.6.1. Treat cause

4.2.1.6.2. Routine visits

4.2.1.6.3. Prevention

4.2.1.6.4. Control risk factors

4.2.1.7. Gerontological considerations

4.2.1.7.1. Increased kidney dysfunction and renal failure

4.2.1.7.2. Predisposed b/c of systemic diseases

4.2.1.7.3. Medication precautions

4.2.2. End-stage renal disease (ESRD)

4.2.2.1. 5th and final stage of CKD

4.2.2.2. Needs permanent replacement therapy

4.2.2.3. Uremia >> Decline in function + progression of ESRD

4.2.2.3.1. Underlying disorder

4.2.2.3.2. Urinary excretion of protein

4.2.2.3.3. HTN

4.2.2.4. Clinical manifestations

4.2.2.4.1. Variable

4.2.2.4.2. HTN, edema

4.2.2.4.3. Crackles

4.2.2.4.4. Anemia

4.2.2.4.5. Cramps, weakness

4.2.2.4.6. Gray-bronze skin color

4.2.2.4.7. Dry, flaky skin

4.2.2.4.8. Repro/neuro alterations

4.2.2.4.9. Ammonia breath

4.2.2.4.10. Metallic taste

4.2.2.5. Diagnosed by GFR, C, BUN

4.2.2.6. Complications

4.2.2.6.1. Hyperkalemia

4.2.2.6.2. Pericardial alterations

4.2.2.6.3. HTN

4.2.2.6.4. Anemia

4.2.2.6.5. Bone disease

4.2.2.6.6. Metastatic, vascular calcifications

4.2.2.7. Treatment

4.2.2.7.1. Maintain function

4.2.2.7.2. Treat reversible factors

4.2.2.7.3. Meds, diet

4.2.2.7.4. Dialysis

4.2.2.8. Nursing care

4.2.2.8.1. Fluid status

4.2.2.8.2. Diet education

4.2.2.8.3. Self-care

4.2.2.8.4. Emotional support

4.2.2.8.5. Patient knowledge

4.2.2.9. Collaborative problems

4.2.2.9.1. Hyperkalemia

4.2.2.9.2. Percarditis, pericardial effusion

4.2.2.9.3. Pericardial tamponade

4.2.2.9.4. HTN

4.2.2.9.5. Anemia

4.2.2.9.6. Bone disease, metastatic calcifications

4.3. Goals

4.3.1. Maintain IBW w/o excess fluid

4.3.2. Good nutritional intake

4.3.3. Increased knowledge

4.3.4. Participation in activity w/i tolerance

4.3.5. Improved self-esteem

4.3.6. Abscence of complications

4.4. Renal replacement therapies

4.4.1. Hemodialysis

4.4.1.1. Most common (80%)

4.4.1.2. Acute illness

4.4.1.3. Intermittent (2-3x per week)

4.4.1.4. Two main purposes

4.4.1.5. Removes toxins/wastes by...

4.4.1.6. Complications

4.4.1.6.1. HF, CHD, angina, stroke, PVI

4.4.1.6.2. HTN, vascular calcifications

4.4.1.6.3. Itching r/t phosphorous deposits

4.4.1.6.4. Sleep disturbances (very common)

4.4.1.6.5. SOB, hTN, muscle cramps

4.4.1.6.6. Dysrhythmias, air embolus (rare)

4.4.1.6.7. Dialysis disequilibrium

4.4.1.6.8. Leading COD = ???

4.4.1.6.9. Malnutrition

4.4.1.6.10. Bone pain, fractures

4.4.2. Continuous RRT

4.4.2.1. Certain groups

4.4.2.1.1. Too unstable for HD

4.4.2.1.2. Oliguric RF >> Fluid overload

4.4.2.1.3. Kidneys can't handle needs

4.4.2.2. No rapid fluid shifts, arterial access, machinery

4.4.3. Peritoneal dialysis (PD)

4.4.3.1. Goals

4.4.3.1.1. Remove wastes

4.4.3.1.2. Fluid, electrolyte balance

4.4.3.2. For those who cannot have HD or transplant

4.4.3.3. Slower rate of exchange >> fewer comlications

4.4.3.4. Utilizes the peritoneal membrane

4.4.3.5. Complications

4.4.3.5.1. Acute

4.4.3.5.2. Long-term

4.4.4. Nursing management

4.4.4.1. Home HD

4.4.4.1.1. Usually an outpatient procedure

4.4.4.1.2. Highly motivated and adaptable

4.4.4.1.3. Caregiver committment

4.4.4.2. Medications

4.4.4.2.1. Timing is important

4.4.4.2.2. Water-soluble meds removed by HD

4.4.4.2.3. Avoid toxicity

4.4.4.2.4. Patient education to dosing, timing

4.4.4.2.5. Use volumetric IV pump

4.4.4.3. Protecting vascular access

4.4.4.3.1. No BP or sticks on that side

4.4.4.3.2. Assess bruit or thrill q8hr

4.4.4.3.3. Assess site for infection and dressing

4.4.4.4. Hospitalized patients

4.4.4.4.1. S/S uremia

4.4.4.4.2. Fluid overload, HF, PE, pericarditis

4.4.4.4.3. Discomfort

4.4.4.4.4. Pain management

4.4.4.4.5. Site care

4.4.4.4.6. Preventing infection

4.4.4.4.7. Avoid K or Mg supplements

5. Fluid & Electrolyte Balance

5.1. Fluids

5.1.1. 60% of adult body is fluid

5.1.1.1. Variable

5.1.1.2. ICF

5.1.1.3. ECF

5.1.1.3.1. Intravascular

5.1.1.3.2. Interstitial

5.1.1.3.3. Transcellular

5.1.2. Regulation

5.1.2.1. Movement depends on pressure

5.1.2.1.1. HP: Exerted on walls on BVs

5.1.2.1.2. OP: Exerted by protein in plasma

5.1.2.2. Types of movement

5.1.2.2.1. Osmosis: Low to high

5.1.2.2.2. Diffusion: High to low

5.1.2.2.3. Filtration: High HP to low HP

5.1.2.2.4. Active transport: Pump from low to high

5.1.3. Gerontological considerations

5.1.3.1. Reduced homeostatic mechanisms

5.1.3.2. Decreased body fluid percentage

5.1.3.3. Medication use

5.1.3.4. May appear differently

5.1.3.5. Easily overloaded

5.1.3.6. Dehydration

5.1.4. Imbalances

5.1.4.1. FVD

5.1.4.1.1. Loss of ECF exceeds water intake

5.1.4.1.2. Causes

5.1.4.1.3. Risk factors

5.1.4.1.4. Manifestations

5.1.4.1.5. Lab data

5.1.4.1.6. Nursing care

5.1.4.2. FVE

5.1.4.2.1. R/T fluid overload or diminished mechanisms

5.1.4.2.2. Risk factors

5.1.4.2.3. Contributing factors

5.1.4.2.4. Manifestations

5.1.4.2.5. Nursing care

5.2. Electrolytes

5.2.1. Carry a charge

5.2.2. Variable concentration by compartment

5.2.3. Imbalances by electrolyte

5.2.3.1. Na

5.2.3.1.1. Hyponatremia

5.2.3.1.2. Hypernatremia

5.2.3.2. K

5.2.3.2.1. Hypokalemia

5.2.3.2.2. Hyperkalemia

5.2.3.3. Ca

5.2.3.3.1. Hypocalcemia

5.2.3.3.2. Hypercalcemia

5.2.3.4. Mg

5.2.3.4.1. Hypomagnesmia

5.2.3.4.2. Hypermagnesmia

5.2.3.5. P

5.2.3.5.1. Hypophosphatemia

5.2.3.5.2. Hyperphosphatemia

5.2.3.6. Cl

5.2.3.6.1. Hypochloremia

5.2.3.6.2. Hyperchloremia