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Adult Health 2 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What are interventions for Nephrolithiasis (kidney stones)

A
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2
Q

What are nursing considerations for Nephrolithiasis (kidney stones)

A

-pain control
-nausea control
-hydration
-education (drink H2O, reduce Na, No soda)

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3
Q

What medications are used for Nephrolithiasis (kidney stones)

A

-Opioids
-Alpha 1 blocker

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4
Q

What is pt education regarding Nephrolithiasis (kidney stones)

A

-increase fluid (2L)
-Stop smoking
-avoid beverages with tannin (coffee, tea, some wine)
-collect (strain) urine
-maintain healthy weight
-Use NSAIDS cautiously (they filter through kidney)
-Take all antibiotics prescribed for infection
-Control Diabetes and HTN

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5
Q

What are the phases of Nephrolithiasis (kidney stones)

(page 391)

A

Onset: when this started (ends when oliguria develops and lasts for hours and days)
***the event

Oliguria: Low / no urine. Output is 100 to 400 in a 24 hour periods without diuretics and lasts 1-3 weeks
***kidneys stop peeing

Diuresis: Kidney starts to recover, but diuresis of a large amount of fluid occurs lasting 2-6 weeks
***

Recovery: Continue until kidney function is fully restored and can take up to 12 months

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6
Q

What are the stages of acute kidney injury

(page 391)

A

Stage 1: Risk stage. Creatinine is 1.5 times baselined and urine output less than 0.5 for 6 hours

Stage 2: Injury stage. Creatinine is 2 times baselined and urine output less than 0.5 for 12 hours

Stage 3: failure stage. Creatinine is 3 times baselined and urine output less than 0.3 for 12 hours

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7
Q

What are the types of acute kidney injury?

A

Prerenal: Results from volume depletion and prolonged reduction of blood flow to the kidneys

Intrarenal: Results from direct damage to kidney from lack of oxygen (acute tubular necrosis)

Postrenal: Occurs as a result of bilateral obstruction of structures leaving the kidney.

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8
Q

What are complications of Prerenal acute kidney injury?

A

-rental vascular obstruction
-shock
-decreased cardiac output causing decreased renal issues
-sepsis
-liver failure

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9
Q

What are causes of Intranal acute kidney injury?

A

Physical Injury: Trauma

Hypoxic injury: renal artery or vein stenosis or thrombosis

Chemical injury acute nephrotoxins, dye, alcohol (Gentamyasin and vancomyasin)

Immunologic injury: infection, vasculitis, acute glomerulonephritis

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10
Q

What are causes of Post acute kidney injury?

A

Stone, tumor, bladder atony

prostate hyperplasia, urethral stricture (narrow)

spinal cord disease or injury

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11
Q

What are expected findings for acute kidney injury?

A

-Cardiovascular - fluid overload, hyperkalemia

-Respiratory - crackles, decreased oxygenation

-Renal - scant to normal or excessive urine output

-Neurological - lethargy, muscle twitching, seizures

-Integumentary - dry skin and mucous membranes

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12
Q

What are the lab and lab results for someone with kidney failure

A

-Serum Creatine: gradually increases 1 to 2
-blood urea nitrogen : increases 80 - 100
-urine specific gravity: it will be high
-serum electrolytes
-hematocrit: decreased
-Urinalysis; sediment presence
-ABG: Metabolic acidosis

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13
Q

What procedures are used to detect someone with kidney failure

A

-X-ray of pelvis, kidney, urethra, and bladder (KUB)
-Ultrasound detects an obstruction
-CT scan WITHOUT contrast dye, or MRI to detects anatomies
-kidney biopsy
-nuclear medicine tests

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14
Q

What medications are used for someone with kidney failure

A
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15
Q

What is Rhabdomyolysis

A

Rare condition where muscle cells break down. This releases myoglobin into the blood which can lead to kidney failure.

The kidneys cannot filter all the muscle breakdown material (myoglobin).

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16
Q

What are causes of Rhabdomyolysis

A

drugs
dehydration
excessive exercising
heatstroke
burns

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17
Q

What is chronic kidney disease?

A

-progressive and irreversible kidney failure
-can lead to ESKD or ESRD

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18
Q

What are the stages of chronic kidney disease?

A

5 stages

1: minimal damage GFR greater than 90
2: mild kidney damaged with mildly decreased GFR 60-89)
3: moderate kidney damage (GFR 30-59)
4: Severe - GFR 15-29
5: End stage - GFR is Less than 15

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19
Q

What are causes / risk factors to developing chronic rental failure?

A

Diabetes
HTN
Renal artery stenosis
Autoimmune disease

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20
Q

What is Glomerulonephritis ?

A

Inflammation in the glomeruli (kidney filter system).

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21
Q

What are risk factors that could lead to Glomerulonephritis

A

recent infection
travel
recent surgery or illness

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22
Q

Manifestations of Glomerulonephritis

A

Anorexia
N/V
Dysuria
Oliguria
Fatigue
HTN
Crackles
Weight gain
Redish-brown or cola colored urine

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23
Q

What will lab results show for Glomerulonephritis

A

-UA will show red blood cells and protein
-GFR will decrease
-Blood, skin, throat cultures
-24 hr Urine collection for protein
-Serum blood urea nitrogen and creatine will increase
-anti-nuclear antibody presence

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24
Q

What are we going to do for a pt with Glomerulonephritis?

A

-coordinate care and conserve energy
-restrict fluid?
-administer antibiotics
-teach relaxation exercises
-monitor BP, respirations, fluid and electrolytes

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25
Q

What does hemodialysis and peritoneal dialysis do?

A

-helps filter out the blood to rid the body of extra flid and electrolytes.

-helps the body achieve acid-base balance

-helps to restore internal homeostasis by osmosis, diffusion, and ultrafiltration

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26
Q

What are complications from dialysis ?

A

-hypotension
-electrolyte imbalance
-anemia
-clotting/infection at access site
-infectious disease (HIV, Hep B and C)

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27
Q

Why use peritoneal dialysis over hemodialysis?

A

-older adults
-pts who are unable to tolerate anticoagulation
-difficult vascular access
-chronic infection or are unstable
-chronic disease
-CHF, severe HTN

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28
Q

What are complications from peritonitis?

A

-sepsis
-infection
-abdominal pain

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29
Q

What is the function of the pancreas?

A

-secretes hormones to regulate blood sugar:
Insulin
Glucagon
Somatostatin
Pancreatic polypeptide

-Releases enzymes to help with digestion:
Lipase
amylase
Chymotrypsin
Protease

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30
Q

What does Lipase do?

A

release from pancreas

helps digest fat

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31
Q

What does amylase do?

A

released from the pancreas

helps digest carbohydrates

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32
Q

What does Chymotrypsin do?

A

released from the pancreas

helps digest protein

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33
Q

What does protease do?

A

released from the pancreas

helps break down proteins

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34
Q

What is the function of the liver?

A

-produces bile
-carries away waste and breaks down fasts
-produces proteins for blood plasma
-produces cholesterol to carry fat through the body
-stores extra glucose as glycogen
-regulates blood levels of amino acids
-regulates blood clotting
-clears blood from drugs and other poisonous substances
-Helps resist infections by making immune factors
-removes bacteria from blood stream
-clears bilirubin

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35
Q

What is the function of the gallbadder?

A

-To store and concentrate bile to help with digestion and absorption of fat

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36
Q

what are the 3 main functions of the GI sysem?

A

digestion
absorption
metabolism

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37
Q

Where does most of the absorption take place in the digestive tract?

A

Small intestine

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38
Q

Where is Vitamin B-12 absorbed?

A

Small intestine

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39
Q

What do stools look like with an upper GI bleed?

A

dark and tarry “coffee grounds)

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40
Q

What do stools look like with a lower GI bleed?

A

Bright red and bloody

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41
Q

What is H.Pylori?

A

Very strong bacterial infection in the mucosal lining of stomach

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42
Q

S/S of H. pylori

A

bad breath
N/V
Burping
Bloating
Gas
Anorexia
burning
stomach pain
gnawing pain

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43
Q

What treatments are used for H. Pylori?

A

Antibiotic
PPI
antidiarrheal
Therapy support

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44
Q

What are risk factors for getting stomach cancer?

A

-FHX
-long-term gastritis (inflammation of the stomach)
-smoking
-H. Pylori
-Poor diet
-lac of physical activity
-obesity

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45
Q

What are S/S of stomach cancer?

A

-stomach pain
-N/V
-weight loss
-vomiting blood or blood in stool
-feeling full after a small mean
-anorexia
-heartburn

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46
Q

How do we diagnose stomach cancer?

A

-upper endoscopy
-Barium swallow
-CT scan
-Biomarker
-Pet scan
-MRI

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47
Q

What are treatment options for stomach cancer?

A

-Endoscopic mucosal resection
-surgery
-Radiation
-Chemotherapy
-Targeted therapy
-Immunotherapy
-Hyperthermic intraperitoneal chemo
-Clinical trials
-Follow up testing

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48
Q

What are risk factors that can lead to colon cancer?

A

Smoking
FHX
ETOH
High fat, high protein, low fiber
Hx of IBD
DM2
Obesity
Ethnic background

49
Q

What are S/S of colon cancer?

A

-changes in bowls
-gas/bloating
-N/V
-abdominal discomfort
-fatigue
-anorexia
-weight loss

50
Q

What are treatment options for colon cancer?

A

chemo
radiation
surgery
symptom management
palliative care

51
Q

What are the feces like in a sigmoid colostomy

A

formed

52
Q

What are the feces like in a descending colostomy

A

semi-formed

53
Q

what are the feces like in a transverse colostomy

A

uniformed

54
Q

What are the feces like in an ascending colostomy?

A

fluid

55
Q

What is short gut syndrome?

A

Shortened or narrowed small intestines (can be congenital or postsurgical)

Leads to inadequate absorption of nutrients.

56
Q

What are S/S of short gut syndrome?

A

Distention
diarrhea
cramping
weight loss
anemia (RBC loss or Vit. B12 deficiency)

57
Q

What is dumping syndrome?

A

Foods (high in sugar) moved from stomach into small bowel too quickly after eating.

Most often happens after surgery

58
Q

S/S of dumping syndrome?

A

abdominal cramps and diarrhea 10-30 minutes after eating
(can happen 1-3 hours after eating).

59
Q

What is pancreatitis?

A

Inflammation of the pancreas

60
Q

What are causes of pancreatitis?

A

gallstones
ETOH
high levels of fat in the blood
infection
genetics
high levels of calcium
steroids and estrogen
abdominal injury

61
Q

What are s/s of pancreatitis?

A

feeling bloated or too full after eating

N/V
Cramps
diarrhea
flushing/fever
dizziness, lightheaded
tachycardia
tachypnea
fatty poops
anorexia

62
Q

What can chronic pancreatitis lead to?

A

Scarring of the pancreas tissue (fibrosis) can stop the pancreas from making enzymes and hormones.

63
Q

What are treatment options for pancreatitis?

A

-PPI
-Antibiotic
-vitamins
-antispasmodics
-enzymes
mineral water
-diet
-no ECOH

64
Q

What is a whipple?

A

“Pancreaticonduodenectomy”

Treat pancreatic cancer that has spread beyond the pancreas.

Removal of the head of the pancreas, first part of the small intestine, and gallbladder.

65
Q

What is steatosis?

A

“Fatty liver”

Too much fat is built up in the liver (5%-10% of liver’s weight).

66
Q

What are the stages of steatosis / fatty liver?

A

1) liver is inflamed, which damages tissue (steatopepatitis)

2) scar tissue forms (fibrosis)

3) extensive scar tissue replaces healthy tissue (cirrhosis)

67
Q

What is cirrhosis

A

When the healthy tissue of the liver is replaced by scar tissue (fibrosis) and the liver can no longer function properly

68
Q

What are the two types of forms of fatty liver disease?

A

1) alcohol-induced (5% of ppl in US have this)

2) non-alcohol related fatty liver disease (NAFLD) 1 in 3 adults and 1 in 10 children in US, case is unknown but obesity and diabetes can increase risk

69
Q

What are risk factors for getting fatty liver?

A

-Hispanic or Asian descent
-menopause
-obesity
-HTN
-Hyperlipemia
-DM2
-Sleep apnea

70
Q

What are s/s of fatty liver?

A

-abdominal pain
-fullness in RUQ
-Nausea
-anorexia
-Wt loss
-Jaundice
-Edema
-tiredness
-confusion
-weakness / fatigue

71
Q

What enzymes are elevated in liver diseases

A

AST
ALT

72
Q

How does cirrhosis occur?

A

Each time the liver is damaged - it tries to repair itself and scar tissues form. The more times this happens, the more and more scar tissue builds up. the scar tissue cannot be undone.

73
Q

What are the stages of liver disease?

A

1- normal liver
2- fatty liver (can be undone)
3-liver fibrosis (can’t be undone, but can be halted here)
4- cirrhosis (need a liver transplant)

74
Q

What are the S/S of ESLD

A

-confusion
-disorientation
-jaundice
-pruritus
-easy to bruise/bleed
-ascites
-abd pain
-dark urine
-anorexia
-pale stools
-blood in vomit or stool
-N/V

75
Q

What is paracentesis?

A

When they insert a needle into the peritoneal area in the abdomen to drain fluid

76
Q

What is a liver transplant

A

A treatment option for ppl with ESLD

Sometimes a portion of a liver is an alternative to waiting for a deceased donor’s liver.

77
Q

What are anti-rejection medications?

A

Medications that are taken for life after a person receives a transplant

78
Q

What can anti-rejection meds cause?

A

bone thinning
diabetes
diarrhea
headache
HTN
High cholesterol

79
Q

If someone comes in with a GI issue, what are the most common labs drawn?

A

-CBC
-CMP
-PT/PTT
-Triglycerides
-Liver function test (AST & ALT)
-Pancreas function tests (amylase and lipase)
-CEA
-CA (Cancer antigen)

80
Q

What is lactulose

A

a colonic acidifier that works by decreasing the amount of ammonia in the blood (man made sugar solution).

used to treat hepatic encephalopathy in pts with liver disease

81
Q

What are the lab values when testing for:

Liver
Pancreas
Kidney

A

Liver:
ALT
AST

Pancreas
Amylase
Lipase

Kidney
Creatine
BUN

82
Q

What are nursing interventions for GI bleeds

A

-Assess VS frequently
-Monitor for s/s of bleedings (hematemesis or melena *dark sticky feces)
-monitor lab values for hemoglobin and hematocrit levels
-PT/PPT
-Report pain, dizziness, or the presence of blood
-anticipate upper endoscopy, colonoscopy, CT angiography

83
Q

What is a TIPS

A

Transjugular intrahepatic portosystemic shunt

Inserting a stent (tube) to connect the portal begins to adjacent blood vessels to have lower pressure.

84
Q

What is a wedge resection?

A

removing tumor and tissue surrounding cancerous area

85
Q

What is an anatomical segmental resection?

A

removes tumor, blood vessels, lymphatics, lung segment where tumor was located

all the segments

86
Q

What is a lobectomy?

A

removing the entire lobe for lung including the lymphnodes

87
Q

What is a pneumonectomy?

A

Removing the entire lung with lymph nodes

88
Q

What is a pleurectomy?

A

removing the inner lining of the chest cavity

89
Q

What is Acute Respiratory Failure?

A

ARF
Ventilation failure due to mechanical abnormality of the lung or chest wall. This leads to decreased oxygen perfusion (hypoxia)

90
Q

What are VENTILATORY risk factors for ARF

A

COPD
PE
Pneumothorax
flail chest
ARDS
Asthma
Pulmonary edema
Fibrosis
Guillain-Barre Syndrome
ICP

91
Q

What are Oxygenation risk factors for ARF

A

-Pneumonia
-Hypoventilation
-Hypovolemic shock (can occur from pulmonary edema, pulmonary embolism, ards)
-low hemoglobin

92
Q

What are s/s of ARF

A

-dyspnea
-orthopnea
-cyanosis
-pallor
-hypoxemia
-tachycardia
-confusion
-irritability or agitation
-restlessness
-hypercarbia (high CO2)

93
Q

What are nursing interventions for ARFs?

A

-maintain patent airway
-monitor resp status
-mechanical vent
-O2 before suctioning
-suction as needed
-assess and document sputum (color, amount, consistency)
-monitor for pneumothorax
-ABG
-EKG
-VS
-Prevent infection
-Promote nutrition
-Provide emotional support

94
Q

What types of meds are given for ARF?

A

-Benzo (anxiety and decrease O2 consumption)
-Corticosteroids (decrease inflammation)
-Opioid (pain)
-Neuro blockers (facilitates for vent)
-Antibiotics (treat infection)

95
Q

What is Acute Respiratory distress syndrome?

A

ARDS

Inflammatory response injuries the alveolar membrane. This makes the lung space fill with fluid.

Reduction in surfactant weakens the alveoli causing collapse or filling of fluid -> increase edema

96
Q

What are risk factors for ARDS?

A

-localized lung damage
-aspiration
-PE
-Pneumonia
-Sepsis
-Near-drowning accident
-Trauma
-Transfusion
-Damage to central nervous system
-smoke or toxic gas
-drug ingestion/ OD

97
Q

What are manifestations of ARDS?

A

-Dyspnea
-Bilateral pulmonary edema (noncardiac)
-reduced lung compliance
-dense patchy infiltrates
-severe hypoxemia

98
Q

What does hypoxemia look like?

A

*Low levels of O2 saturation

-dyspnea
-Tachy
-headache
-cyanosis
-clubbing of fingers

99
Q

What is tuberculosis?

A

AIRBORNE

Bacteria that affects lungs and can spread to other organs

Shows up on chest X-ray

100
Q

Manifestations of TB

A

-couch lasting over 3 weeks
-purulent sputum, may be blood streaked
-fatigue
-lethargy
-wt loss
-anorexia
-night sweats
-low grade fever in afternoon

101
Q

Nursing care of pts with TB

A

-humidified O2
-N95 mask
-Negative pressure room
-barrier protection
-pt wear surgical mask during transport
-couch secretions out
-administer meds
-promote nutrition
-provide emotional support

102
Q

What meds are used for TB?

A

-Isoniazid
-Rifampin
-Pyrazinamide
-Ethambutol
-Streptomycin sulfate

103
Q

What is a pulmonary embolism?

A

When arteries in the lungs become blocked by a blood clot

104
Q

PE prevention

A

-smoking cessation
-wt maintenance
-healthy diet
-physical activity
-prevent DVT (leg exercises, compression stockings, avoid sitting for long periods)

105
Q

What are risk factors for PE

A

-long-term immobility
-birth control/estrogen therapy
-pregnancy
-tobacco use
-obesity
-surgery
-Central venous catheters
-heart failure
-chronic A-fib
-long bone fractures
-cancer
-trauma
-advanced age

106
Q

What are manifestations of PE

A

-Pleurisy (inflammation of pleura of lungs *sharp pain when breathing deeply)
-pleural friction rub
-tachycardia
-hypotension
-tachypnea
-crackles
-cough
-diaphoresis
-low grade fever
-decreased O2 stat
-pleural effusion (fluid buildup between lung and chest)
-syncope (fainting or passing out)
-cyanosis

107
Q

How do we care for a Pt with a PE

A

-O2
-High fowlers position
-IV access
-Medication
-Assess resp status
-Assess cardiac status
-Emotional support
-Monitor LOC

107
Q

What tests are done for PE?

A

ABG
CBC
D-dimer
X-ray
-ventilation-perfusion scan
-pulmonary angiography (invasive)

107
Q

Causes of pneumothorax

A

Trauma
excess pressure
COPD
Asthma
Cystic fibrosis
TB
Whooping cough

107
Q

What meds are given for PE?

A

-Anticoagulant
-Direct factor Xa factor
-Thrombolytic therapy (alteplase to bust up the clot)

-Embolectomy - surgical removal of emboli
-Vena Cava filter

107
Q

What is a pneumothorax?

A

A collection of air outside the lung, but still in the pleural cavity.

This compresses the lung and prevents it from expanding .

108
Q

What is a tension pneumothorax

A

When the pneumothorax causes a mediastinal shift

*this is life-threatening and fatal is left untreated

109
Q

What is a hemothorax?

A

When the chest cavity (pleura space) fills with blood

110
Q

What is a flail chest?

A

When multiple fractures cause instability of the chest wall and paradoxical chest wall movements. It limits chest wall movements

2 or more rib fractures

111
Q

What are the manifestations for a pneumothorax / hemothorax?

A

-s/s of respt distress
-tracheal deviation
-reduced or absent breath sounds
-asymmetrical chest wall movement
-hyperresonance on percussion
-dull percussion
-subcutaneous emphysema

112
Q

What are reasons that someone may need a chest tube?

A

Pneumothorax
Hemothorax
Hemopneumothorax
Pleural Effusion
Empyema

113
Q

When would you place a tube in the superior vs the inferior position?

A

Superior - air
Inferior - fluid

114
Q

What is mediastinal drainage?

A

Used after cardiac surgery to drain fluid from the pericardial sac

Adult Health 2 (2 decks)

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