Exam 2 Flashcards
What are interventions for Nephrolithiasis (kidney stones)
What are nursing considerations for Nephrolithiasis (kidney stones)
-pain control
-nausea control
-hydration
-education (drink H2O, reduce Na, No soda)
What medications are used for Nephrolithiasis (kidney stones)
-Opioids
-Alpha 1 blocker
What is pt education regarding Nephrolithiasis (kidney stones)
-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
What are the phases of Nephrolithiasis (kidney stones)
(page 391)
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
What are the stages of acute kidney injury
(page 391)
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
What are the types of acute kidney injury?
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.
What are complications of Prerenal acute kidney injury?
-rental vascular obstruction
-shock
-decreased cardiac output causing decreased renal issues
-sepsis
-liver failure
What are causes of Intranal acute kidney injury?
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
What are causes of Post acute kidney injury?
Stone, tumor, bladder atony
prostate hyperplasia, urethral stricture (narrow)
spinal cord disease or injury
What are expected findings for acute kidney injury?
-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
What are the lab and lab results for someone with kidney failure
-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
What procedures are used to detect someone with kidney failure
-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
What medications are used for someone with kidney failure
What is Rhabdomyolysis
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).
What are causes of Rhabdomyolysis
drugs
dehydration
excessive exercising
heatstroke
burns
What is chronic kidney disease?
-progressive and irreversible kidney failure
-can lead to ESKD or ESRD
What are the stages of chronic kidney disease?
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
What are causes / risk factors to developing chronic rental failure?
Diabetes
HTN
Renal artery stenosis
Autoimmune disease
What is Glomerulonephritis ?
Inflammation in the glomeruli (kidney filter system).
What are risk factors that could lead to Glomerulonephritis
recent infection
travel
recent surgery or illness
Manifestations of Glomerulonephritis
Anorexia
N/V
Dysuria
Oliguria
Fatigue
HTN
Crackles
Weight gain
Redish-brown or cola colored urine
What will lab results show for Glomerulonephritis
-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
What are we going to do for a pt with Glomerulonephritis?
-coordinate care and conserve energy
-restrict fluid?
-administer antibiotics
-teach relaxation exercises
-monitor BP, respirations, fluid and electrolytes
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
What are complications from dialysis ?
-hypotension
-electrolyte imbalance
-anemia
-clotting/infection at access site
-infectious disease (HIV, Hep B and C)
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
What are complications from peritonitis?
-sepsis
-infection
-abdominal pain
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
What does Lipase do?
release from pancreas
helps digest fat
What does amylase do?
released from the pancreas
helps digest carbohydrates
What does Chymotrypsin do?
released from the pancreas
helps digest protein
What does protease do?
released from the pancreas
helps break down proteins
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
What is the function of the gallbadder?
-To store and concentrate bile to help with digestion and absorption of fat
what are the 3 main functions of the GI sysem?
digestion
absorption
metabolism
Where does most of the absorption take place in the digestive tract?
Small intestine
Where is Vitamin B-12 absorbed?
Small intestine
What do stools look like with an upper GI bleed?
dark and tarry “coffee grounds)
What do stools look like with a lower GI bleed?
Bright red and bloody
What is H.Pylori?
Very strong bacterial infection in the mucosal lining of stomach
S/S of H. pylori
bad breath
N/V
Burping
Bloating
Gas
Anorexia
burning
stomach pain
gnawing pain
What treatments are used for H. Pylori?
Antibiotic
PPI
antidiarrheal
Therapy support
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
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
How do we diagnose stomach cancer?
-upper endoscopy
-Barium swallow
-CT scan
-Biomarker
-Pet scan
-MRI
What are treatment options for stomach cancer?
-Endoscopic mucosal resection
-surgery
-Radiation
-Chemotherapy
-Targeted therapy
-Immunotherapy
-Hyperthermic intraperitoneal chemo
-Clinical trials
-Follow up testing
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
What are S/S of colon cancer?
-changes in bowls
-gas/bloating
-N/V
-abdominal discomfort
-fatigue
-anorexia
-weight loss
What are treatment options for colon cancer?
chemo
radiation
surgery
symptom management
palliative care
What are the feces like in a sigmoid colostomy
formed
What are the feces like in a descending colostomy
semi-formed
what are the feces like in a transverse colostomy
uniformed
What are the feces like in an ascending colostomy?
fluid
What is short gut syndrome?
Shortened or narrowed small intestines (can be congenital or postsurgical)
Leads to inadequate absorption of nutrients.
What are S/S of short gut syndrome?
Distention
diarrhea
cramping
weight loss
anemia (RBC loss or Vit. B12 deficiency)
What is dumping syndrome?
Foods (high in sugar) moved from stomach into small bowel too quickly after eating.
Most often happens after surgery
S/S of dumping syndrome?
abdominal cramps and diarrhea 10-30 minutes after eating
(can happen 1-3 hours after eating).
What is pancreatitis?
Inflammation of the pancreas
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
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
What can chronic pancreatitis lead to?
Scarring of the pancreas tissue (fibrosis) can stop the pancreas from making enzymes and hormones.
What are treatment options for pancreatitis?
-PPI
-Antibiotic
-vitamins
-antispasmodics
-enzymes
mineral water
-diet
-no ECOH
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.
What is steatosis?
“Fatty liver”
Too much fat is built up in the liver (5%-10% of liver’s weight).
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)
What is cirrhosis
When the healthy tissue of the liver is replaced by scar tissue (fibrosis) and the liver can no longer function properly
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
What are risk factors for getting fatty liver?
-Hispanic or Asian descent
-menopause
-obesity
-HTN
-Hyperlipemia
-DM2
-Sleep apnea
What are s/s of fatty liver?
-abdominal pain
-fullness in RUQ
-Nausea
-anorexia
-Wt loss
-Jaundice
-Edema
-tiredness
-confusion
-weakness / fatigue
What enzymes are elevated in liver diseases
AST
ALT
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.
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)
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
What is paracentesis?
When they insert a needle into the peritoneal area in the abdomen to drain fluid
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.
What are anti-rejection medications?
Medications that are taken for life after a person receives a transplant
What can anti-rejection meds cause?
bone thinning
diabetes
diarrhea
headache
HTN
High cholesterol
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)
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
What are the lab values when testing for:
Liver
Pancreas
Kidney
Liver:
ALT
AST
Pancreas
Amylase
Lipase
Kidney
Creatine
BUN
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
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.
What is a wedge resection?
removing tumor and tissue surrounding cancerous area
What is an anatomical segmental resection?
removes tumor, blood vessels, lymphatics, lung segment where tumor was located
all the segments
What is a lobectomy?
removing the entire lobe for lung including the lymphnodes
What is a pneumonectomy?
Removing the entire lung with lymph nodes
What is a pleurectomy?
removing the inner lining of the chest cavity
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)
What are VENTILATORY risk factors for ARF
COPD
PE
Pneumothorax
flail chest
ARDS
Asthma
Pulmonary edema
Fibrosis
Guillain-Barre Syndrome
ICP
What are Oxygenation risk factors for ARF
-Pneumonia
-Hypoventilation
-Hypovolemic shock (can occur from pulmonary edema, pulmonary embolism, ards)
-low hemoglobin
What are s/s of ARF
-dyspnea
-orthopnea
-cyanosis
-pallor
-hypoxemia
-tachycardia
-confusion
-irritability or agitation
-restlessness
-hypercarbia (high CO2)
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
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)
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
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
What are manifestations of ARDS?
-Dyspnea
-Bilateral pulmonary edema (noncardiac)
-reduced lung compliance
-dense patchy infiltrates
-severe hypoxemia
What does hypoxemia look like?
*Low levels of O2 saturation
-dyspnea
-Tachy
-headache
-cyanosis
-clubbing of fingers
What is tuberculosis?
AIRBORNE
Bacteria that affects lungs and can spread to other organs
Shows up on chest X-ray
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
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
What meds are used for TB?
-Isoniazid
-Rifampin
-Pyrazinamide
-Ethambutol
-Streptomycin sulfate
What is a pulmonary embolism?
When arteries in the lungs become blocked by a blood clot
PE prevention
-smoking cessation
-wt maintenance
-healthy diet
-physical activity
-prevent DVT (leg exercises, compression stockings, avoid sitting for long periods)
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
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
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
What tests are done for PE?
ABG
CBC
D-dimer
X-ray
-ventilation-perfusion scan
-pulmonary angiography (invasive)
Causes of pneumothorax
Trauma
excess pressure
COPD
Asthma
Cystic fibrosis
TB
Whooping cough
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
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 .
What is a tension pneumothorax
When the pneumothorax causes a mediastinal shift
*this is life-threatening and fatal is left untreated
What is a hemothorax?
When the chest cavity (pleura space) fills with blood
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
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
What are reasons that someone may need a chest tube?
Pneumothorax
Hemothorax
Hemopneumothorax
Pleural Effusion
Empyema
When would you place a tube in the superior vs the inferior position?
Superior - air
Inferior - fluid
What is mediastinal drainage?
Used after cardiac surgery to drain fluid from the pericardial sac
