Term
| Functions of the renal system |
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Definition
-Fluid and electrolyte balance
-Blood filtration-remove waste products of the body's metabolic processes in the form of urine
-Acid-base balance
-Blood pressure regulation
-Erythropoetin production
-Vit D production |
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Term
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Definition
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Term
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Definition
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Term
| Glomerular filtration rate |
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Definition
Stage 1: kidney damage (90 or more GFR-ml/min)
Stage 2: kidney damage (60-80)
Stage 3: kidney damage (30-59)
Stage 4: kidney damage (15-29)
Stage 5: Kidney failure: ESRD (less than 15) |
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Term
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Definition
-Acute kidney injury (AKI): sudden onset and frequently reversible with supportive care
-Chronic Kidney Disease (CKD): gradual onset over months to years
-End-stage Renal Disease (ESRD) |
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Term
| RIFLE criteria for Acute Kidney Injury |
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Definition
Defines 3 grades of increasing severity of AKI
Risk
Injury
Failure
2 outcome classes
Loss
End-stage kidney disease |
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Term
| Types of Acute renal failure |
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Definition
Prerenal failure – results from conditions that interrupt the renal blood supply; thereby reducing renal perfusion (hypovolemia, shock, hemorrhage, burns impaired cardiac output, diuretic therapy).
Postrenal failure – results from obstruction of urine flow.
Intrarenal failure – results from injury to the kidneys themselves (ischemia, toxins, immunologic processes, systemic and vascular disorders). |
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Term
| Symptomatic treatment for AKI |
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Definition
-Hyperkalemia (urgent)
Kayexalate (binds with K+ for excretion in stool)
IV insulin
IV glucose
-Oxygen
-Medications (Diuretics sometimes)
-Dialysis: Hemodialysis, or continuous renal replacement therapy CRRT-ICU only |
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Term
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Definition
-Special large-volume high-flow catheters
For acute dialysis--temporary uncuffed
For chronic dialysis if patient has lost or is not a candidate for AV or AV shunt
-DO NOT FLUSH! Filled with heparin to avoid clotting |
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Term
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Definition
progressive decline in kidney function that correlates with loss of nephron
-Symptoms occur when overall renal function is less than 20-25% of nephrons remain
-ESRD: 90% nephron loss--uremic syndrome |
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Term
| Dietary restriction for CKD |
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Definition
-Low protein
-Low potassium, sodium, phosphorus |
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Term
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Definition
-Replace urinary output plus 500ml
-methods to manage thirst such as hard candy and ice |
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Term
| Care of the patient on Peritoneal Dialysis |
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Definition
Peritonitis is a major concern (“risk for infection”)—STERILE PROCEDURE
Wear mask and sterile gloves for procedure. Put mask on pt.
Assess drained “effluent” for clarity. Cloudy effluent is sign of peritonitis (like urine).
Assess for abdominal pain, hyperactive BS, diarrhea, unusual abd distention.
Notify MD immediately for any abnormal findings. Send specimen of effluent for C&S, WBCs |
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Term
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Definition
-Natural acquired immunity
-Artificial acquired immunity: mild if any symptomatic response but still immunogenic
-Natural passive immunity
-Artifical passive immunity: short-term (IVIG, RhoGam) |
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Term
| Drugs that affect the immune system |
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Definition
-Allergies: Corticosteroids, antihistamines, epinephrine
-Immunosuppressants: corticosteroids, cyclosporins, tacrolimus
-Boosting the immune system: Interferons, neupogen, IVIG
-Vaccinations |
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Term
| 3 types of live vaccinations |
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Definition
1. Varicella
2. Zoster
3. Measles, mumps, rubella |
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Term
| Characteristics of metastatic neoplasms |
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Definition
-Rapid and uncontrolled growht
-No contact inhibition; loose adherence; and migration
-Non-functional |
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Term
| 7 early warning signals of cancer (CAUTION) |
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Definition
1. Change in bowel or bladder habits
2. A sore that does not heal
3. Unusual bleeding or discharge
4. Thickening or a lump in the breasts, testicles, or elsewhere
5. Indigestion or difficulty in swallowing
6. Obvious change in the size, color, shape, or thickness of a wart, mole or mouth sore
7. Nagging cough or hoarseness |
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Term
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Definition
Strict aseptic technique for all invasive procedures, avoid unnecessary lines and tubes
Limit visitors (healthy adults only)
Private room and supplies—do not bring in common supplies (ie, BP machine)
Call for temp >100.5 , monitor for early s/s infection
Monitor WBC and ANC daily
No fresh flowers in room
Diet: “neutropenic diet” (no fresh fruits or veggies, or undercooked food)
Pt & family education |
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Term
| Biologics, including immunotherapy for cancer treatment |
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Definition
Cytokines
-Interferons—improve immune response, decrease rate of cancer cell growth
-Interleukins—improve immune response against cancer cells
-Hematopoietic growth factors
Thalidomine—decrease angiogenesis
Monoclonal antibodies—target specific antigens (CLL, non-Hodgkins, melanoma)
Vaccines
BCG therapy—bladder cancer only
Side effects— flu-like symptoms, severe allergic reactions |
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Term
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Definition
Done in special units or on oncology floor
For hematopoietic cancers
High dose chemo or radiation to destroy pt’s own bone marrow— pts are extremely ill
New stem cells are infused after matching HLA antigens
-Autologous
-Allogenic
New WBCs, RBCs, platelets within 2-4 weeks
Immunosuppression takes months to 1-2 years to resolve. |
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Term
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Definition
Infection: sepsis, DIC
Procoagulant: DVT & PE
F/E imbalance: SIADH, hypercalcemia
Compression by tumor:
-Spinal cord compression
-SVC syndrome
Response to therapy: tumor lysis syndrome |
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Term
| DNR, DNAR, AND, Comfort Care |
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Definition
DNR: Do Not Resuscitate
DNAR: Do Not Attempt Resuscitation
AND: Allow Natural Death
Comfort Care: must also have DNR/AND
POLST– Physician Orders for Life-Sustaining Treatment |
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Term
| Physician's Orders for Life-Sustaining Treatment (POLST) |
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Definition
Orders that specifically address different treatments that patients can have.
Covers CPR as well as ACLS orders
Also give providers information about patient’s GOAL :
-From aggressive curative care to comfort care only
-Directs specific ACTIONS to be taken or held (see example POLST orders) |
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Term
| Physician's Orders for Life-Sustaining Treatment (POLST) |
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Definition
Orders that specifically address different treatments that patients can have.
Covers CPR as well as ACLS orders
Also give providers information about patient’s GOAL :
-From aggressive curative care to comfort care only
-Directs specific ACTIONS to be taken or held (see example POLST orders) |
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Term
| Pain meds for palliative care |
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Definition
Opioids: scheduled and PRN for breakthrough pain
Neuroleptics for neuropathic pain
Multiple routes may be utilized (po, IV, SC, buccal, dermal) |
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Term
| Dyspnea in palliative care |
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Definition
Goal is relief of subjective dyspnea, not physical signs of respiratory effort
Treat cause when possible:
-Radiation to shrink obstructive tumors
-Dexamethasone to treat inflammatory lung conditions
-Pleural drainage for effusion
-Bronchodilators for asthma
-Paracentesis for abdominal pressure on lung expansion
Symptomatic treatment:
-Oxygen
-Opioids |
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Term
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Definition
| Oropharyngeal relation and upper airway secretions--very distressing to families. Treat with anit-cholinergics (scopolamine, hyoscyamine, glycopyrrolate, and atropine) and positioning |
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Term
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Definition
Requires physician certification that patient has less than six months to live
-Barrier to patients receiving hospice care with both physicians and patients/families
-Uncertainty of remaining length of life
Palliative care in an EOL context: addresses quality of life (QOL) issues but also emotional, social, spiritual, and financial preparation for death. |
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