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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
What does hemodialysis and peritoneal dialysis do?
-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
26
What are complications from dialysis ?
-hypotension -electrolyte imbalance -anemia -clotting/infection at access site -infectious disease (HIV, Hep B and C)
27
Why use peritoneal dialysis over hemodialysis?
-older adults -pts who are unable to tolerate anticoagulation -difficult vascular access -chronic infection or are unstable -chronic disease -CHF, severe HTN
28
What are complications from peritonitis?
-sepsis -infection -abdominal pain
29
What is the function of the pancreas?
-secretes hormones to regulate blood sugar: Insulin Glucagon Somatostatin Pancreatic polypeptide -Releases enzymes to help with digestion: Lipase amylase Chymotrypsin Protease
30
What does Lipase do?
release from pancreas helps digest fat
31
What does amylase do?
released from the pancreas helps digest carbohydrates
32
What does Chymotrypsin do?
released from the pancreas helps digest protein
33
What does protease do?
released from the pancreas helps break down proteins
34
What is the function of the liver?
-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
35
What is the function of the gallbadder?
-To store and concentrate bile to help with digestion and absorption of fat
36
what are the 3 main functions of the GI sysem?
digestion absorption metabolism
37
Where does most of the absorption take place in the digestive tract?
Small intestine
38
Where is Vitamin B-12 absorbed?
Small intestine
39
What do stools look like with an upper GI bleed?
dark and tarry "coffee grounds)
40
What do stools look like with a lower GI bleed?
Bright red and bloody
41
What is H.Pylori?
Very strong bacterial infection in the mucosal lining of stomach
42
S/S of H. pylori
bad breath N/V Burping Bloating Gas Anorexia burning stomach pain gnawing pain
43
What treatments are used for H. Pylori?
Antibiotic PPI antidiarrheal Therapy support
44
What are risk factors for getting stomach cancer?
-FHX -long-term gastritis (inflammation of the stomach) -smoking -H. Pylori -Poor diet -lac of physical activity -obesity
45
What are S/S of stomach cancer?
-stomach pain -N/V -weight loss -vomiting blood or blood in stool -feeling full after a small mean -anorexia -heartburn
46
How do we diagnose stomach cancer?
-upper endoscopy -Barium swallow -CT scan -Biomarker -Pet scan -MRI
47
What are treatment options for stomach cancer?
-Endoscopic mucosal resection -surgery -Radiation -Chemotherapy -Targeted therapy -Immunotherapy -Hyperthermic intraperitoneal chemo -Clinical trials -Follow up testing
48
What are risk factors that can lead to colon cancer?
Smoking FHX ETOH High fat, high protein, low fiber Hx of IBD DM2 Obesity Ethnic background
49
What are S/S of colon cancer?
-changes in bowls -gas/bloating -N/V -abdominal discomfort -fatigue -anorexia -weight loss
50
What are treatment options for colon cancer?
chemo radiation surgery symptom management palliative care
51
What are the feces like in a sigmoid colostomy
formed
52
What are the feces like in a descending colostomy
semi-formed
53
what are the feces like in a transverse colostomy
uniformed
54
What are the feces like in an ascending colostomy?
fluid
55
What is short gut syndrome?
Shortened or narrowed small intestines (can be congenital or postsurgical) Leads to inadequate absorption of nutrients.
56
What are S/S of short gut syndrome?
Distention diarrhea cramping weight loss anemia (RBC loss or Vit. B12 deficiency)
57
What is dumping syndrome?
Foods (high in sugar) moved from stomach into small bowel too quickly after eating. Most often happens after surgery
58
S/S of dumping syndrome?
abdominal cramps and diarrhea 10-30 minutes after eating (can happen 1-3 hours after eating).
59
What is pancreatitis?
Inflammation of the pancreas
60
What are causes of pancreatitis?
gallstones ETOH high levels of fat in the blood infection genetics high levels of calcium steroids and estrogen abdominal injury
61
What are s/s of pancreatitis?
feeling bloated or too full after eating N/V Cramps diarrhea flushing/fever dizziness, lightheaded tachycardia tachypnea fatty poops anorexia
62
What can chronic pancreatitis lead to?
Scarring of the pancreas tissue (fibrosis) can stop the pancreas from making enzymes and hormones.
63
What are treatment options for pancreatitis?
-PPI -Antibiotic -vitamins -antispasmodics -enzymes mineral water -diet -no ECOH
64
What is a whipple?
"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
What is steatosis?
"Fatty liver" Too much fat is built up in the liver (5%-10% of liver's weight).
66
What are the stages of steatosis / fatty liver?
1) liver is inflamed, which damages tissue (steatopepatitis) 2) scar tissue forms (fibrosis) 3) extensive scar tissue replaces healthy tissue (cirrhosis)
67
What is cirrhosis
When the healthy tissue of the liver is replaced by scar tissue (fibrosis) and the liver can no longer function properly
68
What are the two types of forms of fatty liver disease?
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
What are risk factors for getting fatty liver?
-Hispanic or Asian descent -menopause -obesity -HTN -Hyperlipemia -DM2 -Sleep apnea
70
What are s/s of fatty liver?
-abdominal pain -fullness in RUQ -Nausea -anorexia -Wt loss -Jaundice -Edema -tiredness -confusion -weakness / fatigue
71
What enzymes are elevated in liver diseases
AST ALT
72
How does cirrhosis occur?
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
What are the stages of liver disease?
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
What are the S/S of ESLD
-confusion -disorientation -jaundice -pruritus -easy to bruise/bleed -ascites -abd pain -dark urine -anorexia -pale stools -blood in vomit or stool -N/V
75
What is paracentesis?
When they insert a needle into the peritoneal area in the abdomen to drain fluid
76
What is a liver transplant
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
What are anti-rejection medications?
Medications that are taken for life after a person receives a transplant
78
What can anti-rejection meds cause?
bone thinning diabetes diarrhea headache HTN High cholesterol
79
If someone comes in with a GI issue, what are the most common labs drawn?
-CBC -CMP -PT/PTT -Triglycerides -Liver function test (AST & ALT) -Pancreas function tests (amylase and lipase) -CEA -CA (Cancer antigen)
80
What is lactulose
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
What are the lab values when testing for: Liver Pancreas Kidney
Liver: ALT AST Pancreas Amylase Lipase Kidney Creatine BUN
82
What are nursing interventions for GI bleeds
-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
What is a TIPS
Transjugular intrahepatic portosystemic shunt Inserting a stent (tube) to connect the portal begins to adjacent blood vessels to have lower pressure.
84
What is a wedge resection?
removing tumor and tissue surrounding cancerous area
85
What is an anatomical segmental resection?
removes tumor, blood vessels, lymphatics, lung segment where tumor was located *all the segments*
86
What is a lobectomy?
removing the entire lobe for lung including the lymphnodes
87
What is a pneumonectomy?
Removing the entire lung with lymph nodes
88
What is a pleurectomy?
removing the inner lining of the chest cavity
89
What is Acute Respiratory Failure?
ARF Ventilation failure due to mechanical abnormality of the lung or chest wall. This leads to decreased oxygen perfusion (hypoxia)
90
What are VENTILATORY risk factors for ARF
COPD PE Pneumothorax flail chest ARDS Asthma Pulmonary edema Fibrosis Guillain-Barre Syndrome ICP
91
What are Oxygenation risk factors for ARF
-Pneumonia -Hypoventilation -Hypovolemic shock (can occur from pulmonary edema, pulmonary embolism, ards) -low hemoglobin
92
What are s/s of ARF
-dyspnea -orthopnea -cyanosis -pallor -hypoxemia -tachycardia -confusion -irritability or agitation -restlessness -hypercarbia (high CO2)
93
What are nursing interventions for ARFs?
-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
What types of meds are given for ARF?
-Benzo (anxiety and decrease O2 consumption) -Corticosteroids (decrease inflammation) -Opioid (pain) -Neuro blockers (facilitates for vent) -Antibiotics (treat infection)
95
What is Acute Respiratory distress syndrome?
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
What are risk factors for ARDS?
-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
What are manifestations of ARDS?
-Dyspnea -Bilateral pulmonary edema (noncardiac) -reduced lung compliance -dense patchy infiltrates -severe hypoxemia
98
What does hypoxemia look like?
*Low levels of O2 saturation -dyspnea -Tachy -headache -cyanosis -clubbing of fingers
99
What is tuberculosis?
AIRBORNE Bacteria that affects lungs and can spread to other organs Shows up on chest X-ray
100
Manifestations of TB
-couch lasting over 3 weeks -purulent sputum, may be blood streaked -fatigue -lethargy -wt loss -anorexia -night sweats -low grade fever in afternoon
101
Nursing care of pts with TB
-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
What meds are used for TB?
-Isoniazid -Rifampin -Pyrazinamide -Ethambutol -Streptomycin sulfate
103
What is a pulmonary embolism?
When arteries in the lungs become blocked by a blood clot
104
PE prevention
-smoking cessation -wt maintenance -healthy diet -physical activity -prevent DVT (leg exercises, compression stockings, avoid sitting for long periods)
105
What are risk factors for PE
-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
What are manifestations of PE
-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
How do we care for a Pt with a PE
-O2 -High fowlers position -IV access -Medication -Assess resp status -Assess cardiac status -Emotional support -Monitor LOC
107
What tests are done for PE?
ABG CBC D-dimer X-ray -ventilation-perfusion scan -pulmonary angiography (invasive)
107
Causes of pneumothorax
Trauma excess pressure COPD Asthma Cystic fibrosis TB Whooping cough
107
What meds are given for PE?
-Anticoagulant -Direct factor Xa factor -Thrombolytic therapy (alteplase to bust up the clot) -Embolectomy - surgical removal of emboli -Vena Cava filter
107
What is a pneumothorax?
A collection of air outside the lung, but still in the pleural cavity. This compresses the lung and prevents it from expanding .
108
What is a tension pneumothorax
When the pneumothorax causes a mediastinal shift *this is life-threatening and fatal is left untreated
109
What is a hemothorax?
When the chest cavity (pleura space) fills with blood
110
What is a flail chest?
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
What are the manifestations for a pneumothorax / hemothorax?
-s/s of respt distress -tracheal deviation -reduced or absent breath sounds -asymmetrical chest wall movement -hyperresonance on percussion -dull percussion -subcutaneous emphysema
112
What are reasons that someone may need a chest tube?
Pneumothorax Hemothorax Hemopneumothorax Pleural Effusion Empyema
113
When would you place a tube in the superior vs the inferior position?
Superior - air Inferior - fluid
114
What is mediastinal drainage?
Used after cardiac surgery to drain fluid from the pericardial sac

Adult Health 2 (2 decks)

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