Kidney and Urinary Tract Function

● Dysuria: Difficulty or painful urination

● Hematuria: change in color or volume of urine
● Anuria: Greatly decreased urine production of < 50mL/24 hrs
● Nocturia: Frequent urination at night
● Renal Calculi: Kidney stones
● Oliguria: Urine output less than 400mL in 24 hrs
● Enuresis: Involuntary urination
● pH for urine should be acidic
● Pyuria: White blood cells
● Urinary Casts: Proteins secreted by damaged kidney tubules
● Kidney issues: Pay attention to blood pressure (HTN)
● Creatinine clearance differs between men and women
● Q1: B
● Q2: B

Endocrine Assessment and Management

● Diabetes insipidus: lack of Vasopressin also known as ADH: excessive loss of fluid
● Rapid insulin: works within 15 minutes: give 10-15 minutes before a meal
● Regular insulin: the only insulin you can give by IV
● Lantus insulin: no peak

Care of Patients with Cancer

Exam review
● Reusing questions
● Dehydration: elderly: who is at greatest risk
○ Older adults: those with impaired cognition
● If someone who needs to take in less sodium: what does that look like, what is a low
sodium option
○ Less processed foods, fresh foods, no deli meats/canned options,
● Hypocalcemia: what does it look like: what assessment criteria
○ Decreased production PTH, Positive trousseaus or chvosteks sign
○ Laryngeal stridor, dysphagia, tingling, cardiac dysrhythmias, tetany
● Dehydrated patient: presenting signs and symptoms
○ Acute: low BP
○ Chronic: high BP
● Potassium: normal levels: 3.5-5.0, high or low: what do you do if they have an issue,
what system does it affect
○ Affects the cardiovascular system
● Central line in patient how to know it is good to use
○ Chest x-ray to confirm placement
● If have a patient with a central/picc what does infiltration look like, what is going to be
most worrisome if found
○ Redness, pain, stop the IV,
● Do older adults always spike a temperature when they get an infection
○ No
● Osteoarthritis, rheumatoid: nodules/node, how to assess, name of them
○ OA: Degeneration of the joints, Articular cartilage breakdown, joint space
narrows, morning stiffness usually improves by 30 minutes, aggravated by
movement
■ Bouchard’s nodules: proximal
■ Heberden’s nodes: distal
○ RA: An autoimmune disease, RA synovium breaks down, destroys cartilage and
erodes bone, joint stiffness lasts longer than 1 hr, redness, boggy joints
■ Fever, weight loss, lymph node enlargement
■ NSAIDs, DMARDs, weight reduction
■ Inflammation, autoimmunity, degeneration
○ SLE: Autoimmune disorder: fever, weight loss, malaise, butterfly-shaped rash,
Stiff in the morning
● Cardiac meds: Beta blockers, Ace inhibitors, goals of beta blockers, MOA
○ ACE inhibitors: Disrupt renin-angiotensin 2 pathway by reducing amount of ACE
produced: leads to less vasoconstriction and reduced peripheral resistance, more
water and sodium excreted in the urine, lowers BP
○ Beta blockers: slow the HR
● Assessing pts who is at greatest risk for cardiovascular disease, nationalities,
comorbidities,
○ African Americans
○ Hyperlipidemia, HTN, metabolic syndrome, obesity, type 2 diabetes, smoking,
physical inactivity
● If assessing pt and want to know if HF symptoms returning what do you ask
○ Activity tolerance, diet, Ability to perform ADLs
● Don’t send pt to MRI with pacer
○ Yes
● If you have a pt angina vs. acute coronary syndrome
○ Angina: Pain or pressure in the anterior chest, caused by insufficient blood flow
leading to decreased oxygen when there is an increased need from the heart for
it. Resides with rest or nitroglycerin
○ Acute coronary syndrome: Emergent situation characterized by acute onset of
myocardial ischemia (lack of O2 to the heart), if no intervention occurs, MI, Not
relieved with rest and medications
● Pt with afib: what meds are they on
○ Beta blockers: to slow the HR
○ Blood thinners to prevent clots
○ Calcium channel blockers to slow the HR and control the rhythm
● Obstructive sleep apnea who is at greatest risk for developing:
 ○ large neck
● PVCs: are they all bad, if they subside without tx avoid what
○ Nicotine, alcohol, caffeine, stress, infection, surgery, trauma
● Rhythm strips: past
○
● Tx of rhythms
○ Sinus bradycardia: treat underlying cause
○ Sinus tachycardia: Treat underlying cause
○ PAC: Treat underlying cause
○ Atrial Fibrillation: Slow ventricular rate, treat underlying cause
○ Atrial flutter: Slow ventricular rate: terminate arrhythmia, treat underlying cause
○ Reentry (Paroxysmal) SVT: Vagal maneuvers, adenosine, synchronized
cardioversion
○ Monomorphic Ventricular tachycardia: Antiarrhythmic agent, cardioversion,
high-energy shock
○ Polymorphic VT: Unsynchronized shock, magnesium
○ Ventricular fibrillation: Immediate shocks
○ Asystole: CPR, vasopressor, atropine
○ PEA: Identify and treat underlying cause, CPR, vasopressor, atropine
● Risks factors for rheumatoid arthritis
○ Cigarette smoking, environmental pollution, family history, illness
● If walk into pts room and hr 220: asking them to bear down to lower, dont want someone
with low hr to bear down
○
● Anemia: acute vs. chronic: who is more symptomatic
○ Acute
● Pt with HF, why do we tell them to weigh themselves everyday
○ It is the most accurate measure of how much fluid is being retained or loss. 1 kg
of weight is equal to 1 L of water
● Understand ACE inhibitors, what to educate
○
● Trying to teach pt. Iron def anemia: what in diet
○ Iron, vitamin c
○ Avoid tea and coffee, milk and some dairy products, tannin containing foods
(grapes, corn, sorghum), phytates (brown rice and whole-grain wheat), oxalic
acid (peanuts, parsley, chocolate)
● High cholesterol: elevated lipid panel: how to know if they are eating properly: what do
they choose
○ High soluble fiber, low saturated fat
● Is HTN always symptomatic
○ No
● Educate to keep taking meds
○ Symptoms can occur if not: such as rebound HTN if beta blockers are stopped
suddenly, can cause antibiotic resistance
● Understand giving chemo: what PPE
○ Gown, double gloves, Eye protection, masks
● Prioritization questions
○
● Long acting vs. short acting beta 2 agonists: what to use in acute episode
○ Quick acting meds: SABAs (albuterol), anticholinergics (ipratropium)
○ Long acting meds: Corticosteroids, Cromolyn sodium, LABA
● Pt with COPD: assess how well they are doing: questions to ask
○ Activity tolerance, movement ability, diet, breathing problems
● 4 copd pts, who to see first
○ The one bent over in a chair struggling to breath: ABCs
● Parkinsons: aspiration as dx progresses, how to help someone at risk for aspiration
○ Elevate hob, maintain environment free from too much activity to avoid
distraction, use stronger side of body
● What to do for someone with migraine what to avoid
○ Dark, quiet, elevate HOB 30 degrees, avoid triggers such as lights and smells
● Pt with parkinsons: what muscle descriptor
○ Leadpipe: stuck in one position
○ Cogwheel: catch in muscle or click
○ Rigidity
● Someone with ulcerative colitis: associate complications
○ Limited to large intestine, ulcers penetrate the inner lining of the abdomen
○ Toxic megacolon (Fever, abd. Pain, distension, vomiting)
○ Perforation
○ Bleeding is common during bowel movements
○ Bone fractures
● Pernicious anemia; what are you missing
○ You’re missing B12
● Something when leg swollen, inflamed pressure: worried about what
○
● Metabolic syndrome: diagnostic criteria
○
● Pts with ESKD what do they most frequently die of
○ Cardiac events such as an MI or HF
● What does GFR mean
○ The amount of plasma filtered through the glomeruli per unit of time
● Review endocrine: cushings, addisons, hypo/hyperthyroid,
○ Addisons: Insufficient steroid production: too little cortisol and aldosterone
■ Fatigue, hypotension, N/V/diarrhea, weight loss, salt cravings, abdominal
pain, depression, hyperpigmentation, hypoglycemia, muscle/joint pain,
body hair loss
○ Cushings: Too much cortisol
 ■ Fatty hump, rounded moon face, pink/purple stretch marks, HTN, bone
loss, T2DM, bruise easily, excess hair growth, absent menstrual periods,
frequent/unusual infections
○ Hypothyroidism: Hashimoto’s:
■ Lethargy, slow mentation, weight gain, constipation, cold intolerance,
generalized slowing of functions
■ Starts with hyperthyroidism then treatment can cause hypothyroidism
■ Myxedema: Severe deficiency, Coma, hypothermia, unconsciousness,
depressed respirations, bradycardia, hypoglycemia, hyponatremia,
hypotension
■ Levothyroxine
○ Hyperthyroidism: Thyrotoxicosis
■ Increased metabolic rate, increased circulation of catecholamines, goiter,
anxious, restless, fine tremors, tachycardia, fine hair, exophthalmos,
weight loss, osteoporosis in women
○ Hyperparathyroidism:
■ Bone decalcification, renal calculi, increased serum calcium
■ Sometimes no symptoms, apathy, anorexia, fatigue, muscle weakness,
N/V/constipation, HTN, cardiac arrhythmias
○ Hypoparathyroidism:
■ Hyperphosphatemia & Hypoglycemia
■ Tetany, spasmodic contractions, stiff hands and feet, bronchospasm,
laryngeal spasm, dysphagia, seizures, dysrhythmias
■ Positive Chvostek sign: Tap on facial nerve: spasm
■ Positive Trousseau sign: Carpopedal spasm with BP cuff
■ Tx: calcium and magnesium