Exam 3 renal/GI blueprint

Question 1

What do you need to know about fistula assessment?

Answer 1

Identify the fistula tract

Maintaining fluid and electrolyte balance

Controlling infection

Protecting the surrounding skin

Manage output

Providing nutritional support

Most fistulas heal spontaneously. Surgery may be needed to treat the complications.

Question 2

S/S of ascites (book)

Answer 2

Ascites is manifested by abdominal distention with weight gain. If the ascites is severe, the increase in abdominal pressure from the fluid accumulation may cause eversion of the umbilicus. Abdominal striae with distended abdominal wall veins may be present. Patients may have signs of dehydration (e.g., dry tongue and skin, sunken eyeballs, muscle weakness) and a decrease in urine output. Hypokalemia is common. It is due to an excessive loss of potassium caused by hyperaldosteronism. Low potassium levels can also result from diuretic therapy used to treat the ascites.

Question 3

is an auto digestion of the pancreases by its own digestive enzymes released too early in the pancreas.

Answer 3

pancreatitis

Question 4

what are the pancreatitis labs?

Answer 4

Increased amylase
Increased lipase
Increased WBC
Increased bilirubin
Increased glucose
Decreased platelets
Decreased Ca and Mg

Question 5

what do you need to know about the pancreatitis digestive enzymes?

Answer 5

Digestive enzymes (exocrine): amylase (breaks down the carbs to glucose), protease (breaks down the proteins), and lipase (breaks down the fats).

Question 6

what are the S/S of liver failure?

Answer 6

Asterixis (liver flap)

Jaundice (yellow discoloration in the eyes and skin)

Ascites

Edema

Abdominal pain

Chronic dyspepsia (GI upset)

Itchy skin

Increased bilirubin and ammonia

Decreased platelets (risk for bleeding)

Decreased WBCs (risk for infection)

Question 7

AV fistula assessment?

Answer 7

assess for a thrill and bruit and remind the care team of the location of the fistula to prevent risk to site

Question 8

what are common symptom in liver failure/ cirrhosis?

Answer 8

has the appearance of a pregnant abd. you should measure abd girth at the same time each day and monitor I&Os.

Question 9

S/S of liver failure?

Answer 9

cirrhosis - hardening/fibrosis of liver tissue > liver can’t filter > toxins buildup

ammonia - Bi products of protein that builds up > mental status change/lethargy and involuntary hand movement (asterixis - liver flap) > hepatic encephalopathy

portal HTN > esophageal varices jaundice, ascites, chronic dyspepsia, itchy skin, petechiae

Question 10

Liver failure meds?

Answer 10

lactulose: pulls off ammonia via poop
diuretics if you have ascites

Question 11

interventions for ascites?

Answer 11

paracentesis to pull off fluid and monitor for hypovolemic shock. measure girth at the same time each day and measure I&O, use diuretics, and limit sodium.

Question 12

Upper & lower GI bleeds?

Answer 12

Upper - black, tarry, coffee ground blood

Lower- bright red blood

Question 13

GI bleed priorities?

Answer 13

fragile swollen vessels in the esophagus (esophageal varices) which can come from portal HTN in cirrhosis or liver failure and can rupture and cause esophageal bleed and most common cause of upper GI bleed. you want to detect changes in VS and prevent hypovolemic shock.
hemodynamics should be priority and watch for hypovolemic shock.

Question 14

NG tube/suction risks?

Answer 14

be careful with esophageal varices to prevent GI bleed, aspiration pneumonia, NG suction can cause metabolic alkalosis, and continuous suction can interfere with K+ causing hypokalemia (which flat T waves, cardiac function impairment, and dysrhythmias and low BP.