Module 8 Flashcards
Kidney Function (renal function)
the kidneys filter
nephrologists are physicians that specialize in ?
alter drugs and drug dosage based on
the kdineys metabolize most (some eliminated by?)
waste and excess water from the blood
kidney function
patient’s kidney function
drugs (liver)
Acute kidney failure/renal failure -conditions that result in limited blood flow to the kidneys blood .. in.. M hert ... liver.. use of certain ? -..agents -dyes used in NS... al.. severe severe severe
loss-fluid loss infection MI heart disease lupus liver failure drugs -chemotherapy agents radiographic imaging NSAIDs alcohol burns dehydration allergic reaction (anaphylaxis)
Chronic Kidney failure: diseases that impact on kidney function -... high plyscystic recurrent
Diabetes (DM) -IDDM
type 1 and type 2
blood pressure - hypertensio (HTN)
-kidney disease
kidney infection
Kidney damage in COVID-19
the protein spikes on this virus detect ?
the virus uses the ACE2 receptors to enter the ?
some organ cells have greater expression of ACE2 receptors which put those organs at greater risk from ?
ACE2 receptors found on cells in the host
cells of the host
SARS CoV-2 includes the kidneys
How does COVID damage the Kidneys:
the virus itself infects the ? kidney’s have receptor cells that allow the virus to ? (similar receptors found on?)
too little oxygen causes kidneys to ? (low oxygen levels in blood leads to ?)
the body’s reaction to the infection (…storm)
-body sends out ? that help cells communicate as the immune system tries to fight ?
but this results in severe ? this inflammatory reaction can destroy ? including?
COVID-19 causes tiny ? this can clog the small blood vessels leading to and within ? which impairs ?
repair of kidneys following COVID is ?
kidneys
-attach and invade (lungs and heart)
-malfunction/ kidney damage
cytokine/ cytokines/ an infection / inflammation / healthy tissue including kidney tissue
blood clots to form in blood stream/ kidneys / kidney function
uncertain
Kidney damage in COVID:
reduced kidney function can occur despite no prior history of ?
up to 30% of patients hospitalized in china and ny developed ?
detected through abnormal ?
patients may require ?
kidney issues and the need for dialysis can persist beyond the ?
kidney dysfunction moderate or severe kidney injury lab work findings (BUN and Creatinine) dialysis acute phase of illness
Dialysis: a process to remover ? from the blood of the body when kidneys are not ? typically completed? duration of dialysis is about ? considerations for SLP intervention - - -
waste products and fluid from blood of body / functioning properly
3 times per week
4 hours
- positioning
- fatigue
- cognitive status
Clinical symptoms of renal impairment: xero.. H... shortness of reduced n.. v... dehy... wea... ...cramps f... dry... and possible
xerostomia HTN breath appetite nausea vomiting dehydration weakness muscle cramps fatigue dry,itchy skin changes in cognitive function
Dialysis: hemodialysis and peritoneal dialysis
acute
chronic
renal failure (ARF) renal failure - chronic kidney disease (CKD)
Lab values: renal function
creatinine: a waste product made when your body breaks down ?
increased creatinine may indicate that kidneys are not
protein you eat and when muscles are injured
not working normally
BUN-
urea is a waste product of ?
produced from breakdown of protein already ?
BUN can increase if intake of ?
patients with kidney disease are frequently placed on?
lower in? may also have ?
increased BUN levels can mean kdiney function is ?
BUN levels may also be elevated related to
blood urea nitrogen -metabolism in body and in diet protein increases -renal diet -sodium, phosphorous and protein/ fluid restrictions reduced from normal -other conditiosn
Complete Metabolic panel”
includes
BUN and Creatinine
The gastrointestinal System: GI structures: what receptors includes: - - -
ACE 2
liver
intestine
pancreas
COVID- GI function
impact on GI function
-initial symptoms of infection can include
limited number of ?
for patients with chronic GI issues, monitoring was ?
in patients with COVID injury/disorders of the GI system have been found including liver acute acute feeding
diahrrea, vomiting and abdominal pain
- endoscopic procedures completed
- limited
liver injury acute cholecystitis acute pancreatitis -necrotizing pancreatitis feeding intolerance -medications virus itself
Importance of GI function on decision making for evaluation of swallowing/PO intake
-is digestive tract
are there digestive issues that impact on patient’s ability to ?
sall?
bowel ?
NGT suction of ?
impact of anasthesia on
functional
eat by mouth/ receive non oral nutrition via the gut
small bowel obstruction (SBO)
-bowel sounds (present/absent)
gastric contents
GI function
Aritifical nutrition:
enteral:
utilizes the
delivered by ?
parenteral: bypasses the ? and delivers nutrition to the body via the
GI tract (stomach or intestines) -mouth, via tube, or a combo of two
GI tract/ blood stream (via a vein)
Non Oral means of Nutrition utilizing the GI Tract (enteral nutrition) short term: oral naso -large -small
longer term:
peri…
gas..
jeuji
oral gastric tube (OGT)
Nasogastric tube (NGT)
large bore
small bore
pericutaneous endoscpoic gastrostomy (PEG) Gastric tube (GT) jeujinostomy tube (J-tube)
Nasogastric tube: lare bore ? aka? double ? can also ? -frequently placed in sometimes remains in place after
nasogastric tube (NGT or OGT) salem slump tube lumen/suction gastric contents intubated patients extubation
DHT: smaller ? placed at the bedside by a guide wire is used with tube for ? then? placement is checked by ?
bore/diamter than the NGT
qualified nurse (RN)
placement (stiffness) then removed
X-ray prior to intiaiton of any feedings
Risk of nasal tube placement: patient ... difficulty with ... digestive ? -intolerance o the ? .. syndrome (rapid stomach emptying into? ) gastro.. aspiration of tube feedings due to ?
discomfort placement sinusitis issues -tube feeding formula -dumping syndroe (small intestine) -gastroesophageal reflux -incorrect tube placement or tube displacement
Percutaneous Endoscopic Gastrostomy:
an .. procedure
-
-
-
endoscopic procedure
- gastroenterology
- PEG
radiology procedure
- interventional radiology
- IR-guided percutaneous gastrostomy
G-tube:
Sometimes the term G-tube is used intechangeably with
cand be confused with an
initially it was the sole way of ?
G-tube placement requires ?
a surgical procedure where an incision is placed in
PEG
open g-tube
placing feeding tube
general anasthesia
upper abdomen to expose stomach
Percutaneous Endoscopic Jeujunostomy:
feeding goes directly to
typically administered via
small intestine
pump (slow, constant delivery of nutrition)
Gastro-jejunal (GJ) tube:
placed in the stomach but with a ?
feeds directly into the ?
has a ? as well which can be used to give? drain? vent?
can use the gastric port for? if safe to do so depending on patients
a PEG can be converted to a ?
-often done if patient is not
thin long tube that is threaded into the jejunal portion of the small intestine
jejunum, second part of small intestine
feedings as well/ condiiton
GJ tube
-tolerating tube feedings
Tube Feeding Delivery:
bolus feedings: more in line with ?
can help to mantain
continuous feedings:
completed if body is not tolerating
-… issues
always provide if the feeding tube is ?
typical consumption of 3 meals per day
-circadian rhythms
bolus feeds
-GI tract issues
lower in the GI tract than stomach (within intestine)
Formulations for enteral nutrition: formula: varous ? depending on? who decides? - - - -
brand and types depending on pt needs or tolerance
MD or clinical dietitian
ensure
boost
glucerna
jevity
Things to consider:
the impact of a feeding tube that is in place may?
may see decreased ? due to presence of NGT
risk of ?
Pt’s mental status for compliance to ?
patient/family?
have impact on swallowing function pharyngeal clearance of bolus / decreased epiglottic inversion aspiration with tube feedings leave tube in place wishes
Total Parenteral nutrition: feeding directly into the utilized only when the GI tract is ? through a ? contains: - - - - - - custom prepared by a ? for each individual patient
bloodstream (bypasses GI tract)
-non-functional
vein
lipids dextrose vitamins minerals amino acids water
pharmacist
-
total parenteral nutrition (TPN)
peripheral Parenteral nutrition (PPN)
total parenteral nutrition:
typically administered ? per day
can be completed ?
10-12 hours
during sleep
Resections:
intestine
small intestine/bowel
large intestine/bowel
Nutritional status/nutritional recommendations: NPO NPO except NPO with? oral diet: -clear... -full... ...diet mechanical ? regular **** what initiative
nil per os
meds
non oral means of nutrition
clear liquid (post-surgical)
full liquid (includes liquids not clear)
soft consistency diet (chopped vs. ground meats/veggies)
-regular consistency diet
**international dysphagia diet standardization initiative (IDDSI)
Other diet considerations: other necessary diet alterations, other than texture can include: sodium cardiac ...diet ...diet ...diet fluid ... ...diet
restrictions (Na restiction) cardiac diet/ heart healthy diet diabetic diet (ADA diet) low-residue diet low-fat diet fluid restrictions 1800 calorie diet
Lab Values: nutritional status visceral protein status: ... low albumin levels indicate albumin levels are also linked with ? -consider these levels when determining typically monitored by the ? can become an issue for patients receiving SLP services with regard to ? or poor ? -calorie count by ? elderly patients in hospital with dysphagia only consumed?
non-muscle proteins circulating in the blood
malnourishment
-strength of immune system
pneumonia risk in a pt with aspiration
clinical dietician / prolonged nPO status or poor oral intake on modified diet
clinical dietician
14.5% of their estimated energy requirements
Albumin Levels: albumin: half life of approx. ? -thus not the best indicator of ? does not show albumin levels may be ? if patient is dehydrated
prealbumin: half life of ?
- a better indicator of current ?
18-21 days (current status)
immediate changes
elevated
1-2 days
-current status
Tube Feeding in Dementia:
34% of 186,835 nursing home patients with dementia were ?
no evidence of?
no evidence of?
tube feeding may actually increase the risk of ?
tube fed
increased QOL
improved nutritional status
developing pneumonia
Tube feeding in severe dementia:
main results:
there was no evidence of increased ? in patients receiving enteral tube feeding
none of the studies examined ? and there was no evidence of benefit in terms of ?
authors conclusions: despite the very large number of patients receiving this intervention there is insufficient evidence to suggest that enteral tube feeding is ?
data are lacking on the ? of this intervention
survival
QoL / nutritional status or prevalence of ulcers
beneficial to patients with advanced dementia / adverse effects
Slp Involvemetn in non-oral nutrition / end of life discussions
patient and family education regarding ?
where are we now - what are the options moving forward
-SLP
family
coordinate with ?
.. care team
swallowing function and or comm. function
-treatment management options
family wishes
clinical dietitian and physicians
palliative care team
SLP end of life discussion
can involve methods to facilitate? when possible to determine ?
… on ventilator
cna involve teaching regarding ? for the least restrictive ?
document??!!!
can involve discussion with MD/care team regarding ? and will the findings have a role in ?
are the patient and family wishes ?
communication/ patient wishes
-minimal leak speech
swallowing precautions for least restrictive PO diet
-understood risk
what will results of this evaluation demonstrate / moving forward with care for this patient
already known?
Surgical intervention in GI:
…
-resection of
… surgery
esophagectomy : removal of esophagus typically due to cancer
small or large intestine
bariatric surgery
anastomosis:
a surgical connection between ?
potential for
stricture ?
between two tubular structures
leak
narrowing of lumen
Bariatric surgeries:
roux en Y ?
creates a small pouch from the ? connecting this newly created pouch to ?
sleeve gastrectomy
- typically a laparoscopic procedure meaning ?
approx. 80% of stomach is ? leaving a … about the size and shape of a banana
-
gastric bypass
-stomach/ small intestine
small instruments inserted through multiple small incisions in upper abdomen
removed/ tube shaped stomach
esophageal
potential for oral/pharyngeal dysphagia
The esophagus:
about .. long
primary role: move ?
passes behind the ? through the ?
barrett’s esophagus:
acid coming up into the ? results in ?
these cellular changes… can result in ?
25 cm long (from incisors to stomach)
food/liquid from throat to stomach (peristalsis)
heart/diaphragm
esophagus from stomach (gastroesophageal reflux)/ cellular changes
dysplasia/ cancer
Esophagectomy:
removal of a portion of the ?
rebuilding a structure to ?
various
entire esophagus to remove disease
replace esophagus
surgeries
The immune system: recognizes ? destroys ? made up of ? - - -
cytokine storm in COVID:
an over response to the body’s ? that leads to ? which destorys?
pathogens invaded the body pathogens and clear them from the bod white blood cells (WBC) (Leukocytes) -lymphocytes (B&T cells) phagocytes granulocytes -neutrophils (largest number of WBC found within the body)
immune system inflammation/ healthy tissue
Immune system, lab values:
elevated WBC counts indicate that there is an immune system ?
an elevated ANC can indicate ?
neutrophils are present in the oral cavity and work to ?
changes to the immune response can occur after ?
-this can result in a reduction in ?
in this case, secretion of salive is?
-leads to an increase in the number of ? which if aspirated presents a greater risk of
response taking place
bacterial infection present
trap bacteria and remove debris
stroke or TBI (reduced WBC)
- changes in oral protection from bacteria
- diminished
- bacteria/ infection
Immune system - lab values: WBC levels: low levels -indicate risk for -neutropenia can be caused by ? -risk for changes in ? high levels ? can indicate ?
also called neutropenia
-developing infection
systemic stress
-oropharyngeal bacteria control can result in pneumonia
neutrophilia
acute infection
COVID testing: antigen testing: detects certain ... swab can be completed as a ? false negatives are ? patient is positive for COVID 19 but the test shows a? if COVID is highly suspected and results are negative an ?
molecular testing-polymerase chair reaction (PCR)
detects
… how collected
can be completed as a ? or with ?
very ? with some reduction in accuracy when completed as a ?
proteins found in the virus
nasal swab
rapid test/ or results sent off to the lab
possible with rapid test
- negative result
- MD may order PCR test
genetic material of virus
nasal swab, throat swab, saliva sample
-rapid test or results sent to lab
accurate/ rapid test
COVID antibody testing
utilized to determine whether someone has ?
not proven to detect ?
but it is all that is available for testing patients who have ?
timing of administration of this test is important for ?
HAD the virus
antibodies following vaccination
-immunocompromise
accuracy in detecting antibodies
