Galen Advanced Medsurg Nur265 EXAM 1 With 100% correct answers 2025-2026 already graded A+

AKI S/S

oliguria;decreased urine output; azotomia;

fluid overload signs- crackles, edema, confusion, low spO2 (88), tachycardia; Map below 65

AKI in xray dx

infiltration (fluid in lungs)

AKI ABG results may read

respiratory alkalosis (spao2 below 88%)

example of pre renal AKI

dehydration, blood loss, decreased cardiac output, heart failure; infection; NG suction, sepsis, V/D

Example of intra renal AKI

myoglobinuria,BPH, tubular necrosis, nephrotoxocity; acute polynephtiits, contrast

Example of post renal AKI

bladder neck obstruction, bladder cancer; calculi; tumor

Duiretic phase (3rd phase) of AKI

Nurse should give 3L-6L per day; place Foley

Asses I and O (output=1000-2000mL/day)

replace fluids and monitor electrolyes

dialysis may be required

Best Lab indicator of Kindey function (AKI and CKD)

creatine (Normal 0.6-1.2)

AKI increased 1-2 every 24-48hrs

Normal urine output per hour

30 mL/hr

normal potassium levels

3.5-5.0 mEq/L

Normal Sodium levels

135-145 mEq/L

Diet for AKI patients

mod protein

high carb

Complication of AKI

Preicarditis

Nephrotoxic agents include

contrast

mycin antibitics (peak and trough)

NSAIDS (celecoxib, ibuprophen, ketorolac, napraxon)

Diet : AKI patient w/ dialysis

protein 40 g/day

diet:AKI patient without dialysis

protein 1-1.5g/kg

Na 60-90 mEq/kg

K restriction 60-70 mEq/kg

Define oliguria

decreased urine production

400mL/day or less

How many stages of Kidney failure are there?

5 stages ( defined by GFR)

stage 1 (GFR 90 and up)

Stage 5 (GFR 15 or less)

signs of Chronic Kidney Disease

oliguria, anemia, azotomia, hyperkalemia

Diet for Chronic kidney disease

restrict K, restrict NA, low protein

best food apples

treatment for chronic kidney disease

hemodialysis and peritoneal dialysis

complication during hemodialysis

Disequilibruim syndrome

S/S of disequilibium syndrome

medical emergency tell hcp

headache

restless

confused

N/V

seizure

fatigue

complication of peritoneal dialysis

peritonitis (board like abdomen)

hemodialysis contraindicated for

severe cardiac disease, vascular disease, bleeding disorders

peritoneal dialysis contraindicated for

fibrosis, active inflammatory GI disease, diverticulitis, ascites, central obesity, peritoneal adhesions, recent abd surgery

Arteriovenous Fistula care

Do not sleep on arm

feel thrill & hear bruit every 4 hours

NO bp on av access arm

no venipuncture on av access arm

assess distal pulses

patient undergoing hemodialysis

weight before and after

assess meds (meds to be held)

VS = HR, BP,RR,temp

assess site, skin, LOC, electrolytes

Caring for peritoneal dialysis patient

patient and nurse must be masked

sterile gloves

remove old dressing

remove contaminated gloves

use Aseptic technique (sterile field 2 4x4 gauze, 3 cotton swab w/ iodine

sterile gloves

circular motion use swabs clean (insertion site to abd) repeat 3x

precut gauze over site

tape only EDGES

Cirhosis causes

drugs, toxins,too much tylenol, Hep c

Cirrhosis description

scarred tissue, irreversible

high ammonia (changes in LOC, confusion)

S/S of Cirrhosis

asterixis, fetor hepaticus (fruity breath), splenomegaly, weight loss, anorexia, jaundice fatigue

Cirrhosis labs

high ammonia, low albumin, low platelet,high ALT, highAST

complication of cirrhosis

hepatic encephalopathy, thrombocytopenia,

spenomegaly, DIC

Ascites, esophageal varices

Prepare for paracentesis

1. explain procedure

2. weigh before and after

3. Patient MUST void BEFORE

4.HOB elevated

5. VS during

6, measure, document characteristics of drainage

7.Send specimen to lab

8. remove cath & apply dressing

9. bedrest

10. weigh again (expected weight loss due to removal of fluid)

Hepatic encephalopathy causes

cirrhosis,

liver failure

s/s of hepatic encephalopathy

high ammonia, LOC changes

confusion, personality changes, mood changes

late sign jaundice, bad breath or fruity breath,

sleep and mood disturbance

treatment of cirrhosis (least invasive)

Lactulose PO

(have bedside commode nearby..expect alot of poop)

treatment for cirrhosis

neomycins, flagyl (antibiotics)

cathartics (inhibit ammonia production)

Acute/chronic pancreatitis causes

alcohol, gallstones, ESRP,

hyperparathyroid, hyperlipedimia, hypercalcemia

acute pancreatitis S/S

mid epigastric pain

LUQ pain radiates to back

juandice,fever

turners sign (blue flanks)

cullen sign (periumbilicus)

hypotension

acute panreatitis labs

elevated lipase

low calcium

low magnesium

elevated WBC

elevated bilirubin

acute pancreatitis nursing interventions

NPO 24hrs

iv hydration

pain management hydromorphone

NO Morphine

may need insulin momentarily

Diet acute pancreatitis

low protein, low fat, low sugar, mod carb,

take pancreatic enzyme with food

examples of acceptable food for acute pancreatitis

grilled chicken w/ baked potato

reduced fat cheese, whole wheat cracker

complications of pancreatitis

hypervolemic shock

s/s of chronic pancreatitis

abd pain, LUQ mass

steatorrhea,

muscle wasting

jaundice as cites

dyspnea, adventitious breath sounds

diet for chronic pancreatitis

low fat, mod carb, high protein

take pancreatic enzyme w/meal

eat small meals w/ high calorie snack

no fat soluable meds,

avoid caffeine, alcohol, spicy food,

Treatment for sinus bradycardia

Atropine sulfate

Treatment for A fib

w/ pulse= 180 joules cardio version

without pulse=CPR defibrillation

Atrial flutter (EKG appearance)

treatment

looks like sharp saw teeth

cardioversion (must have pulse)

ventricular fibrillation (EKG appearance)

treatment

looks like tombstones

defibrilate 360 joules

med epinephrine/ amiodarone

PVC (EKG appearance)

wide and bizarre "DIP"

if run of this .....can be vtach let Dr. Know asap

Pulmonary Edema

Medical emergency

dx xray = infiltration

LV fails to eject blood meaning pressure in lungs

"White lungs"

S/S of pulmonary edema

crackles @ base, SOB,

Dyspnea @rest

skin cold clammy

reduced urine output, lethargy

confusion, disoriented

Severe S/S productive frothy bood tinge sputum

Nursing interventions for Pulmonary edema

high Fowler

give 02 ( simple mask or non-rebreather)

remove fluid ( diuretics, thoracentesis,)

fluid restriction

Valvular heart disease education to patient

Notify HCP and dentist of heart valve

antibiotic prophylaxis before and after procedures (oral /resp )

clean all wound w/ antibiotic ointment

Tell HCP right away if these symptoms of valvular heart disease occur

fever

petichae

SOB

define Cardiac tamponade

pericardium around heart fills w/blood fluid/pus and stop heart from filling

medical emergency!!!

S/S of a Cardiac tamponade

restless

o2 stat low

pulses thready, low bp

muffled heart sounds

JVD

clear lung sounds

pulse paradoxous

Dx of cardiac tamponade

chest x-ray,

echocardiogram (effusion)

treatment of cardiac tamponade

med dobutamine

pericardiocenesis

if chest tube drainage more than ........mL report to hcp

150mL

complication after treatment of cardiac tamponade

Stroke

Blood was pooling now moving= clots may travel

Define dilated cardiomyopathy

chronic disorder no cure

chambers of heart large/ weak pump

= decreased cardiac output

causes of dilated cardiomyopathy

alcohol

cocaine

infection

dilated cardiomyopathy is usually dx in what age group

40 year old

s/s of dilated cardiomyopathy

fatigue

dyspnea

s3, s4 gallop

jvd

crackles

weakness

Like Left side heart failure

Treatment of dilated cardiomyopathy

like heart failure treatment

duiretics

vasodilators

heart transplant (if not done in 5 years patient will die)

dilated myocardiopathy dx anticipate

counseling

grieving

define endocarditis

inflammation of the inner lining of the heart

Endocarditis is caused by

staphylococus aureus,

streptoccoci viridians

(untreated strep, needles, dental procedures)

S/S of endocardititis

pain w/ deep breathing, fever, anorexia

murmurs, upper body petechiae

splinter hemoragaes (nail bed)

roth spots (eye)

osler nodes (red lesions on pads of finger and toes)

janeaway lesions (burn like on finger, toes)

clubbing

treatment for endocarditis

IV antibiotic thru cental/picc line

teaching to endocarditis patient

prophy antibiotic before dental and resp procedures

daily temp 6 weeks

antibiotic on skin lacerations

define pericarditis

inflammation of the pericardium

can be acute or chronic

complications of pericarditis

cardiac tamponade

S/S of pericarditis

pain relieved in tripod ( leaning forward)

pericardial friction rub

low urine output

dyphasia

chest pain radiates to left side

treat meds for pericarditis

Nsaids, NO aspirin

acute coronary syndrome S/S

unstable angina, acute myocardial infarction

cause of acute coronary syndrome

atherosclerosis

define Unstable angina

chest pain at rest ; more than 15mins

not relieved by nitroglycerin

Nitrate teaching

3 dose 5mins apart (total15mins); take while seated; after 1st dose call 911

NO "fils' Sildenafil within 24-48hrs of giving nitrate

Define myocardial infarction

MI heart muscle infarct (die)

ST elevation

T inversion

intervention needed right away

Dx for myocardial infartion

Troponin elevated (over 0.5)

EKG= ST elevation

s/s of myocardial infarction

pain radiates to jaw, left arm, shoulder

N/V, diaphoresis

heartburn

SOB

chest pain

Treatment for MI

1. 1st 10 mins of chest pain EKG (12 lead)

2. o2= SPO@ greater than 90%

3. aspirin 1st 24hrs

4. nitro

5, morphine iv

6, beta blocker

take to cath lab or give thrombolytic "ASE"

Sign of reperfusion after MI treatment

urine output normal 30mL/hr

VS stable, EKG normal, no chest pain

if patient has nonstemi

take to cath lab for cabbage/ stent /

T wave inversion

if patient has stemi

give thrombolytics (ASE_)

" ST elevation"

pre cardiac cath

assess allergy to iodine

blood thinners

stop metformin 48hrs before

baseline bilateral pulse

post cardiac cath

bed rest 6hrs

bedpan 6hrs

no lifting heavy objects

only showers

bilateral distal pulses below site

HOB 30 degrees or more

CABG

if chest tube drainage more than 150 tell HCP

Prosthetic mechanical heart valve teaching

good for 20 years

coagulation meds for life

click sound

Prosthetic biological heart valve teaching

good for 10 years

prophy antibiotics before procedures

no click sound