TEST 1 (Gentiourinary Disorders Hepatobiliary disorders) PDF

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LAB VALUES LIVER & KIDNEY FOCUSED 1. ABG VALUES ● ● ● ●

PH: 7.35-7.45 PaO2: 75-100 mmHg (Partial pressure of oxygen) PaCO2: 35-45 mmHg (Partial pressure of Carb diox) HCO3-: 22-26 mEq/L (Bicarbonate)

2. RENAL VALUES / ELECTROLYTES ● ● ● ● ● ●

BUN: 8-21 mg/dL Creatinine : 0.5-1.2 mg/dL Potassium : 3.5-5 mEq/L Sodium : 135-145 Magnesium : 1.3-2.1 Calcium : 8.6-10.3

S/S of HYPO ●

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HYPOnatremia (Na+): confusion, seizures, muscle weakness, nausea/vomiting, headaches, loss of energy, fatigue, and restlessness and irritability. HYPOkalemia (K+): muscular weakness, muscular spasms, tingling, numbness, fatigue, lightheadedness, palpitations, constipation, bradycardia, and, in severe cases, cardiac arrest can occur. HYPOcalcemia (Ca): muscular aches & pain, bronchospasm which can cause respiratory problems, seizures, tetany, life threatening cardiac arrhythmias & tingling of the feet, fingers, tongue and lips. Test for Hypocalcemia (Chvostek’s sign is contraction of facial muscles in response to a light tap over facial nerve in front of the ear HYPOmagnesemia (Mg): numbness and tingling, muscular weakness, convulsions, muscle spasms, cramps, fatigue, and nystagmus

BLOOD FOCUSED I. II. III. IV. ● V. ● ●

Glucose : 70-100 mg/dL HgbA1c : Less or Equal to 6.5% Cholesterol : Less or Equal to 35 mg/dL Albumin 3.4 - 5.4 g/dL Hematocrit Males : 42-52% Females : 36-48%

VI. ● ●

Hemoglobin Males : 14-17.3 g/dL Females : 11-15.5 g/dL

VII. VIII. IX.

INR : 0.9-1.1 Platelets : 150,000-450,000 WBC : 4,500 - 11,000

X. XI. XII.

PT : 10-13 sec PTT : 25-35 sec aPTT : 25-35 sec

S/S of HYPER ●

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HYPERnatremia (Na+): agitation,  thirst, restlessness, dry mucous membranes, edema, confusion and, in more severe cases, seizures and coma. HYPERkalemia (K+): muscular weakness, paralysis weakness, nausea and possible life threatening cardiac dysrhythmias. Peaked T waves HYPERcalcemia (Ca): thirst, renal stones, anorexia, paresthesia, urinary frequency, bone pain, muscular weakness, confusion, abdominal pain, depression, fatigue, lethargy, constipation, nausea and vomiting HYPERmagnesemia (Mg): nausea, vomiting, respiratory disturbances, overall and muscular weakness, cardiac arrhythmias, respiratory paralysis central nervous system depression and hypotension.

AKI / CKD (EVERYTHING) ACUTE KIDNEY INJURY I.

Causes of AKI (Pre/Intra/Post) / Treatment

● Pre-renal: the most common cause, results of external factors -

Cardiac failure, MI, sepsis, blood loss, dehydration, & vascular occlusion

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Hypovolemia, Peripheral Vascular Resistance

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Use of aspirin, ibuprofen, or NSAIDs, Shock

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Sepsis & Liver failure

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Decreased cardiac output

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Hypotension, which causes a decreased blood supply to the kidney -

Fluid Replacement (Treatment)

● Intrarenal: direct damage to the renal tissues and impaired nephron function *Glomerulonephritis / Small-Vessel vasculitis *Acute tubular necrosis -

Tubular obstruction by myoglobin

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Drugs, toxins, prolonged hypertension

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Surgery that required a blood transfusion

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Acute nephrotoxins (Antibiotics, contrast dye,

CHRONIC KIDNEY DISEASE I.

Labs

Table 62.4 pg.1458 or Virtual book pg.3226Lab Values (Specifically for patients W/ CKD) ● ● ●

Creatinine 0.5-1.2 increased Key indicator for kidney damage Gradual increase 1-2 mg/dL every 24-48 Hr BUN 8-21 increased Can increase to 80-100 mg/dL in 1 week or less Sodium 135-145 normal or decreased

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Potassium 3.5-5 increased ECG Changes Peaked T Waves

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Phosphate 2.5-4.5 increased Calcium 8.2-10.2 decreased

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HCO3 22-26 decreased (Bicarb) pH 7.35-7.45 decreased PaCO2 : 35-45 decreased Pt w/ CKD or AKI = Metabolic acidosis

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Hgb Male 14-17 decreased Female 11-15 decreased Hct Male 42-52% decreased Female 36-48% decreased Urine protein 6-8g/dl increased Creatinine clearance 88-137 decreased

heavy metals, blood transfusion reaction, alcohol, & cocaine) *Interstitial nephritis -

Drugs, toxins, Inflammatory disease, infection

● Post-renal: mechanical obstruction of the lower

II. ● ● ●

urinary tract -

Urinary calculi, Retroperitoneal fibrosis

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GFR (Normal Range 90-120 ml/min) Preferred (Checks progression of kidney functions Decreases as Kidney disease progresses Early stages pt will be asymptomatic Stage 1 kidney damage with normal renal function GFR>90ml/min but with proteinuria Stage 2 kidney damage with 60-89ml/min GFR with proteinuria Stage 3 kidney damage mild to severe 30-59ml/min GFR

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Benign prostatic enlargement, prostate cancer

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Cervical cancer, Urethral stricture/valves Meatal stenosis/phimosis (Narrowing of urethra)

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Renal stones & bladder cancer

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Spinal cord disease or injury

II.

Phases ● -

Initiation or Onset (Begins with onset of event, ends when oliguria dev, & lasts hours to days)

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Oliguric (Urine output below 400mL/day) / Fixed urine gravity between 1.007 & 1.010 During this phase Increases in : BUN/creatinine, electrolyte abnormalities, acidosis, & fluid overload as a result of reduced GFR. Normal Urine gravity : 1.005-1.030 Metabolic acidosis = Impairment of ammonia synthesis S/S = Hypertension, ECG changes, hyponatremia, & pulmonary edema Restrict fluid intake : if hypertension is present Administer medications, such as diuretics, as prescribed to increase renal blood flow and diuresis of retained fluid & electrolytes

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Diuresis : AKI has been corrected. This may lead to high amounts of urine output resulting in severe fluid loss. Electrolytes low, urine specific gravity low, dehydrated/ BUN, creatinine and GFR abnormal but bettering Dehydration, hypovolemia, hypotension, & tachy may occur Administer IV fluids as prescribed, which may contain electrolyte to replace losses During the end of this phase everything begins to normalize Check on pt for : Hypokalemia & Hyponatremia

● ● III. ● -

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Stage 4 kidney damage severe loss 15-29ml/min GFR Stage 5 Kidney damage ESRD less than 15ml/min DIALYSIS/KIDNEY TRANSPLANT CKD, treatments options for anemia in renal pts Anemia Cause by the decreased production of erythropoietin hgb 11-12 and hct 32%-36% for pts with CKD. HTN can emerge if erythropoietin (EPO injection, may also be used to aide in anemia) is admins due to the increased blood viscosity) HTN after Erythropoietin administration should be reported to HCP (Pt w/ antihypertensive meds need to be adjusted) - EPO injection contraindicated in uncontrolled HTN

END-STAGE RENAL DISEASE (ESRD) I. ● ● ● ● ● ● ● ● -

S/S (ESRD) Nausea, fatigue, lethargy, involuntary movement of legs, depression, intractable hiccups Neurologic : Lethargy, low attention span, slurred speech Tremors, or jerky movements, ataxia, seizures, coma Cardiovascular Fluid overload (Jugular distension/Peripheral edema) Hyperlipidemia, HTN, dysrhythmias, HF, Orthostatic Hypotension Peaked T waves ECG (Hyperkalemia) Longer QRS interval (HyperK) Respiratory SOB, tachypnea, hyperpnea Kussmaul respirations, crackles, Frothy pink sputum Hematologic Anemia (Pallor, weakness, dizziness) ecchymoses, petechiae, melena GI N/V, anorexia, constipation Foul breath, ulcers in mouth & throat, blood in stools Muscle Skeletal Osteodystrophy (thin fragile bones) / bone pain Renal Urine contains protein (Proteinuria), blood, particles; Change in the amount, color, concentration Polyuria, Nocturia (Early), Hematuria Oliguria, anuria (Late) Skin Decreased skin turgor, yellow cast to skin, dry

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III. ● ●

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IV. ● ● ● ● ● ● ●

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Recovery (Fluid & Electrolytes balance normalize) Complete recovery might take 1 to 2 years Increase GFR, BUN & Creatinine decrease back to normal range Expected findings (AKI) Metabolic acidosis : Low pH : 7.30 & will have Kussmaul respirations (Rapid, deep respirations) Low Bicarb (HCO3) :...