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2807nrs chronic > Renal, GIT and hepatic conditions > Flashcards

Renal, GIT and hepatic conditions Flashcards

1
Q

What is CKD?

A

Kidney damage and/ or reduced kidney function for at least 3 mths

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2
Q

Causes of CKD

A
  • Damaged kidney vessels / impaired circulation due to HTN, DM, CVD
  • Growth of cysts on kidneys (polycystic kidney disease)
  • Attacks on kidney tissue by disease or immune system (glomerulonephritis)
  • Damage due to backward flow of urine into kidneys (reflux nephropathy)
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3
Q

Stages of CKD

A

Early CKD stages:
- HTN
- abnormal urinalysis
- proteinuria
- Increased serum creatinine

Late CKD stages:
- fatigue
- fluid retention
- SOB
- cold intolerance
- pruritis
- leg cramps
- N+V
- anaemia
- albuminuria
- increased serum creatinine

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4
Q

Role of the kidneys

A
  1. Excretion - remove wastes from body fluids
  2. Elimination - eliminate wastes from body
  3. Homeostasis - volume and solute concentration of plasma in the blood
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5
Q

Risk factors for CKD

A
  • Diabetes
  • Hypertension
  • Established CVD
  • Family hx kidney disease
  • Obesity
  • Smoking
  • Age >60 years
  • Aboriginal Torres Strait
    Islander origin
  • History of acute kidney
    injury
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6
Q

Nurses role in health promotion of CKD

A
  • Manage medications (ACE-Inhibitors, ARBs)
  • Avoid nephrotoxic meds (NSAIDS)
  • Manage diet - low in salt, potassium, fluid restrictions
  • Manage symptoms (pruritus, N&V, fluid retention)
  • Manage depression, role strain, emotions that can
    accompany CKD
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7
Q

In late stages of CKD, nurses educate and prepare patients
for ESKD treatment. What are these stages and what do these stages include?

A

Dialysis – waste and extra fluid removed from the blood;
two types of dialysis
Kidney transplantation – live or deceased donor
Non-dialysis supportive care – end of life treatment

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8
Q

What is Haemodialysis

A

filtration of blood using semi-permeable
membrane filter (dialyser) to remove waste and excess fluid

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9
Q

What is Peritoneal Dialysis

A

Uses peritoneal membrane to filter
waste products from blood via diffusion
Peritoneal catheter inserted into abdominal cavity to
access peritoneal membrane

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10
Q

What are the two types of peritoneal dialysis

A

Continuous Ambulatory
Peritoneal Dialysis (CAPD) –
performed manually by person
4-5 X per day
Continuous Cycler Peritoneal
Dialysis (CCPD) – performed
overnight via a machine (cycler)
while person sleeps

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11
Q

Nursing considerations of dialysis

A
  • Emotional and psychological impact of dialysis regime on
    person / carer
  • Financial implications - can person continue working with
    dialysis demands?
  • Best ways to promote patient choice, independence and
    quality of life
  • Person’s living situation – rural (travel), living alone,
    modifications to home for home dialysis (water/electricity
    supply)
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12
Q

What is kidney transplantation

A

Kidney from one person (donor)
is transferred into the body of another person (recipient)

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13
Q

what is supportive care

A

Supportive care - also called conservative care;
management of ESKD without dialysis or transplantation
* May be selected instead of pursuing dialysis/transplant or
may choose to discontinue dialysis
* Involves use of meds and diet to manage symptoms
* Aim to support person to live as independently as possible
until the end of life
* Most people stay well until the last two months

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14
Q

supportive care nursing considerations

A
  • Supportive care is discussed openly as a treatment option
    for each patient with ESKD
  • Assumptions are not made re: who would/ would not like
    supportive care instead of dialysis/transplant
  • Patients/ families realise that supportive care does not
    mean “no care” – they will be actively managed
  • Conversations re: treatment options are revisited regularly
  • Interdisciplinary involvement (GP, social work, PT, etc)
  • A person’s symptoms are attended to promptly
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15
Q

What are chronic GIT conditions

A

long-lasting conditions of the
upper and lower gastrointestinal tract

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16
Q

What are the four GIT disorders?

A
  • Disorders of intestinal motility
  • Chronic inflammatory bowel disorders (IBDs)
  • Malabsorption syndrome
  • Neoplastic disorders
17
Q

Disorders of intestinal motility

A
  • Chronic diarrhoea
  • Constipation
  • Irritable bowel syndrome (IBS)
18
Q

Chronic inflammatory bowel disorders (IBDs)

A
  • Ulcerative colitis
  • Crohn’s disease
19
Q

Malabsorption syndromes

A
  • Coeliac
20
Q

Neoplastic disorders

A
  • Benign polyps
  • Colorectal cancer
21
Q

Chronic diarrhoea

A
  • Increased frequency, volume, fluid content of stool
    persisting longer than 3-4 weeks
  • Water content of faeces increased – from malabsorption
    or water secretion in bowel
  • Potential causes: gastroenteritis, lactose intolerance,
    parasitic infection, antibiotics, impaired absorption
  • Complications: loss of water and electrolytes leading to
    dehydration; vascular collapse; hypovolemic shock,
    hypokalaemia/ hypomagnesium, metabolic acidosis
22
Q

Chronic constipation

A
  • Infrequent of difficult passage of stools – organic or
    psychogenic
  • Presentation: reduced frequency BM, frequent flatus,
    abdo discomfort, anorexia, Straining, hard dry stools,
    faecal impaction
  • Potential causes: ageing, lack of exercise, insufficient
    dietary fibre, dehydration, decreased gastric motility due
    to damage to neural pathways or exposure to drugs such
    as narcotics
23
Q

Irritable Bowels Syndrome (IBS)

A
  • AKA spastic bowel / functional colitis
  • Disorder of lower GIT characterised by abdo pain with constipation, diarrhoea or both
  • No identifiable organic cause – but CNS regulation of motor / sensory fx of bowel altered
24
Q

Ulcerative colitis

A
  • Affects colon and rectum’s mucosa and submucosa
  • Course of disease typically intermittent (called chronic
    intermittent colitis), mild-moderate
  • Manifestation: 5-30 stools per day with blood/mucus;
    cramping LLQ relieved with defecation; nutritional deficit
  • Complications: Long-term – colorectal CA; Acute – perforation, toxic megacolon, major haemorrhage
25
Q

Crohn’s disease

A
  • Affects any portion of GIT from mouth to anus – usually
    terminal ileum and ascending colon; affects entire bowel wall
  • Usually slow progression, relapsing
  • Manifestation: persistent diarrhoea – typically no blood; pain RLQ relieved with defecation; palpable RL mass;
    fever; fatigue; significant nutritional deficit
  • Complications: Long-term – colon CA; Acute – obstruction, fistulisation, abscess; malabsorption
26
Q

Malabsorption syndromes

A

intestinal mucosa ineffectively absorbing nutrients

27
Q

Coeliac is an example of what syndrome?

A

Malabsorption Syndrome

28
Q

What is coeliac?
Including its presentations and complications.

A

Chronic immune-mediated malabsorption
characterised by sensitivity to gluten (a cereal protein)
Presentation: abdo bloating/cramps, diarrhoea, steatorrhea; anaemia
Complications: nutrient
deficiency, growth
delay, GI malignancies,
intestinal lymphoma

29
Q

What are neoplastic disorders and what are the two types ?

A

Any abnormal growth, whether
malignant or benign
1. Polyps – tissue mass protruding from bowel wall into
lumen
2. Colorectal cancer – cancer of colon or rectum

30
Q

Explain Polyps

A
  • Can develop in any portion of bowel
  • Can be single or multiple
  • Most are benign but can become malignant
  • Most are asymptomatic and found on routine exam – larger polyps may cause intermittent pain/ bleeding
31
Q

Nurses role of Polyps

A
  • Diagnostic tests (colostomy),
    assessment
  • Education and promotion of self management related to:
    Colonoscopy preparation – cathartics,
    cleansing enemas
    Complications related to
    colonoscopy/polyp removal –
    haemorrhage, fluid/electrolyte imbalance
    Follow up screening
32
Q

Types of colostomies

A

Permanent or temporary

33
Q

What is Temporary colostomies

A

*Preventing stool from entering that section of the bowel and resting it. Short-term (temporary) colostomy is
created.
*May be present from weeks, months, or years.
*Colostomy will be reversed (removed) and the bowel will function as it did pre-colostomy.

34
Q

What is permanent colostomies

A

Long-term (permanent) colostomy made. Diseased part of
the bowel is removed or permanently rested. The
colostomy is not expected to be closed in the future

35
Q

What is chronic hepatic conditions and what are two common conditions

A

Long-lasting conditions of liver
Two conditions: Hepatitis and cirrhosis

36
Q

What is Hepatitis and its symptoms

A

Inflammation of the liver
Symptoms: jaundice, fatigue, anorexia,

37
Q

Nurses role of hepatitis including prevention, diagnostic tests and education

A

Prevention: alcohol, healthy diet, vaccination, safe sex
Diagnostic tests: Biopsy
Education and promotion of self-management related to:
- Risk of infecting others
- Managing medications
- Nutritional needs
- Managing fatigue

38
Q

What is cirrhosis, its causes and symptoms

A
  • End stage of chronic liver disease
  • Functional hepatic tissue gradually replaced by scar tissue
    Causes: chronic OH abuse, HBV/HCV, fat accumulating in liver
    Symptoms: increased bilirubin/ammonia levels, jaundice, nausea
39
Q

Nursing role of cirrhosis including prevention, diagnostic tests and education

A

Prevention: alcohol, healthy diet,
vaccination, safe sex
Diagnostic tests: full blood count
Education and promotion of self-management related to:
- Managing medications
- Nutritional needs

2807nrs chronic (7 decks)

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