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Med Surg > GI/GU 13 Q > Flashcards

GI/GU 13 Q Flashcards

1
Q

Chronic progressive disease of the liver. There is extensive degeneration and destruction of the parenchymal cells that leads to irreversible fibrosis and degeneration of the liver.

A

Cirrhosis

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2
Q

2 major risk factors for cirrhosis

A

Alcohol, hepatitis (esp. C)

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3
Q

Early onset of cirrhosis is insidious. When you start seeing signs and symptoms the life expectancy is _ to _ years

A

5-10 years

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4
Q

With cirrhosis, you can see hepatic encephalopathy from increased ammonia. This can lead to asterexis. What is the normal ammonia level?

A

ammonia 15-45

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5
Q

To reduce ammonia, you can give _ PO, NG, or by enema.

A

lactulose

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6
Q

4 things you should teach the cirrhosis patient to avoid

A

Alcohol, aspirin, acetaminophen, NSAIDs

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7
Q

All patients with cirrhosis should have an EGD to screen for

A

varices

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8
Q

Your patient had a paracardiocentisis for ascites. Afterwards yoiu should monitor for signs of bladder _

A

bladder perforation (pain, hematuria)

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9
Q

Enlarged swollen veins secondary to portal hypertension. There is fragile tissue that bleeds easily

A

Esophageal/gastric varices

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10
Q

3 medications that may be used for varices

A

octreotide (Sandostatin), vasopressin, nonselective beta blockers (ex. propranolol)

Note: Vasopressin is used with caution in elderly d/t cardiac effects. It is often given with nitro.

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11
Q

What is a major risk factor for varices?

A

Cirrhosis

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12
Q

3 treatments tha may be used for varices

A

Sclerotherapy, banding, Blakemore tube

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13
Q

Position a patient with varices HOB 30-45. If hypotensive position

A

flat and on their side

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14
Q

What lab shoud you check before and after q 4 units of PRBCs

A

Ionized calcium

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15
Q

Each unit of PRBCs should raise the Hgb by _ to _

A

1-1.5

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16
Q

Within how many hours of thaw should FFP be used?

A

2

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17
Q

If a blood infusion is needed before type can be determined what should be used? (universal donor)

A

O-

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18
Q

Terminal complication of liver disease due to the liver being unable to convert ammonia to urea

A

Hepatic encephalopathy

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19
Q

Is asterixis an early or late sign of hepatic encephalopathy?

A

Early

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20
Q

Important nursing intervention in hepatic encephalopathy is preventing

A

constipation

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21
Q

A rapid onset of severe liver dysfunction in an individual without prior history of liver disease

A

fulminant (acute) hepatic failure

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22
Q

What is the first sign of fulminant hepatic failure

A

change in cognitive function

Note: there will be hour by hour changes in LOC

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23
Q

In fulminant hepatic failure, keep _ from rising

A

ICP

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24
Q

Risk factors for fulminant hepatic failliure (2)

A
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25
Q

2 major complications of fulminant hepatic failure

A

renal failure, brainstem compression

Note: brainstem compression is the most common cause of death due to cerebral edema

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26
Q

Inflammation of the pancreas from activated pancreatic enzymes autodigesting pancreas.

A

Acute pancreatitis

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27
Q

What 2 enzymes will be 3x the normal in acute pancreatitis?

A

Lipase, amylase

Note: lipase is more specific

Note: height of elevation does not correlate with severity

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28
Q

Acute pancreatisis can be sudden with out warning and manifest as a

A

diabetic coma

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29
Q

What type of fluid spacing is seen with acute pancreatitis?

A

major 3rd spacing

Note: watch for hypovolemic shock

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30
Q

The acute pancreatitis patient is at risk for _, this makes assessing lung sounds a priority.

A

Heart failure

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31
Q

3 signs that occur in acute pancreatitis

A

Grey turners, Cullen’s sign, abdominal pain that radiates to the back

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32
Q

It is important to place the acute pancreatitis on _ status to starve the pancreas

A

NPO

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33
Q

What medication should not be administered to a patient with acute pancreatitis?

A

Morphine

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34
Q

In acute pancreatis, _ will be low due to autodigestion. Monitor Chvostek’s and Trousseau signs!

A

Calcium

35
Q

3 things that worsen the pain of acute pancreatitis

A

Fatty foods, alcohol, and supine

36
Q

2 appropriate pain medications for acute pancreatitis

A

demerol, dilaudid

37
Q

3 times enteral nutrition is contraindicated

A

absent bowel sounds, intestinal obstruction, acute pancreatitis

38
Q

Nasal/oral tubes for enteral nutrition should be for short term use (<_)

A

4 weeks

39
Q

2 important concerns for a patient with enteral nutrition

A

Aspiration, dislodged tube

Note: HOB 3-45 (prefer 45) during and for 30-60 minutes after

40
Q

To flush a tube for enteral nutriton it can be done with 30 mL of tap water. If the patient is _ use sterile water

A

Immunocompromised

41
Q

Discard open feeding system after _ hour or a closed system after _ hours

A

Open: 24 h

Closed: 48 h

42
Q

What type of AKI? Insult to kidneys leads to decreased renal perfusion

Ex. Blood loss, hypotension

A

Prerenal

43
Q

In prerenal oliguria is there danage to the kidney tissue (parenchyma)?

A

No

44
Q

What type of AKI? Insult that affects thhe insides of the kidneys

ex. prolonged ischemia

A

Intrarenal

45
Q

AKI: Suspect _ causes if the pateint has had nephrotoxic agents or contrast media

A

Intrarenal

46
Q

AKI: which type is caused by a mechnical obstruction of outflow of urine

ex. stone, BPH, prostate cancer

A

Post renal

47
Q

3 stages of AKI

A

Oliguric –> diuretic –> recovery

48
Q

In the oliguric phase (1st) of AKI the UOP will be <

A

<400 mL/day

49
Q

Which one for oliguric phase of AKI?

Resp. acidosis

Resp. alkalosis

Metabolic acidosis

Metabolic alkalosis

A

Metabolic acidosis

Note: there is accumulation of waste products (watch neuro)

50
Q

Patient in oliguric phase of AKI will have hyper_ and hypo_

A

hyperkalemia, hyponatremia

51
Q

During the diuretic phase (2nd) of AKI UOP increases to _ to _ L/day

A

1-3 liters/day

52
Q

2 problems that can occur during the diuretic phase of AKI

A

hypotension, hypotension

Note: Monitor for hyponatremia, hypokalemia, dehydration

Note: Diuretic phase usually lasts 1-3 weeks

53
Q

The recovery stage of AKI (3rd) begins when _ increases allowing BUN and Creatinine to decrease

A

GFR increases

54
Q

Usually the first test or AKI

A

Kidney ultrasound

55
Q

Normal GFR

A

120-125

Note

<100 renal insufficiency

<20 renal failure

<10 life threatening

56
Q

Gain or loss of 1 kg is equal to _ mL of fluid

A

1000 mL

57
Q

General rule for fluid restriction is to add all losses for previous 24 hrs plus _ mL for insensible losses. This total becomes their fluid allocation for the next day

A

Losses + 600 mL = fluid allocation for next day

58
Q

Most common risk factor for AKI

A

ATN

59
Q

Treatments for hyperkalemia

A

Calcium gluconate, bicarb, insulin, dexstrose, kayexelate, dialysis

60
Q

What is the primary cause of deah in AKI?

A

Infection

61
Q

Progressive and irreversible. presence of kidney damage or decreased GFR <60 for >3 months

A

Chronic Kidney disease

62
Q

Primary cause of death in CKD

A

Cardiovascular disease

63
Q

Most common cause of CKD

A

Diabetes

64
Q

Hyperkalemia can occur in CKD. At what levels can it be fatal?

A

7-8

65
Q

Controlling _ is one of the most important therapeutic goals for CKD

A

Controlling BP

66
Q

For CKD how should you take BP

A

Supine, sitting, standing

67
Q

GFR < _ is ESRD

A

GFR <15=ESRD

68
Q

For CKD you may administer erythropoietin. What do you need to remember about this?

A

Give iron supplements. Give folic acid. Avoid blood transfusions.

69
Q

CKD usually need 2 or more _

A

antihypertensives

70
Q

In CKD, a depressed _ occurs in stage 5

A

CNS

71
Q

What is the target BP for dialysis?

A

< 130/80

Note: <125/75 if significant proteinuria

72
Q

What GFR usually warrants dialysis?

A

GFR <15

73
Q

3 complications from hemodialysis

A

Hypotension, muscle cramps, loss of blood when not fully rinsed from dialyzer/holding pressure on sites

74
Q

What is added to the blood during dialysis?

A

Heparin

75
Q

3 things to assess before dialysis

A

Fluid status (weight), condition of vascular access, and temp

76
Q

Difference between last post dialysis weight and present pre dialysis weight determines

A

amount of fluid to remove

77
Q

First priotity for a postop renal transplant

A

Fluid and electrolyte balance

78
Q

What will these cause? Resp. acidosis or resp. alkalosis?

CNS depression, asphyxia, hypoventilation

A

Resp. acidosis

79
Q

Resp. acidosis or resp. alkalosis?

Hyperventilation, hypoxia, gram negative bacteria

A

Resp. alkalosis

80
Q

pH

A

7.35-7.45

81
Q

CO2

A

35-45

82
Q

PO2

A

80-100

83
Q

hCO3

A

22-26

Med Surg (19 decks)

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