Renal and GI

Question 1

What are some associated symptoms of ascites?

Answer 1

Portal hypertension increases capillary pressure/obstructs blood flow, vasodilation to splanchnic ciruculation (abdominal organs), hormones increase fluid retention, albumin decreases which decreases osmotic pressure, albumin moves into abdominal cavity

Question 2

What are the best ways to manage diverticular disease at home?

Answer 2

2L fluids/day, cooked veggies, fruit, exercise, bulk laxitives (psyllium fiber/stool softeners)

Question 3

What is the GFR for stage 1 CKD?

Answer 3

> 90

Question 4

What is the GFR for stage 2 CKD?

Answer 4

60-89

Question 5

What is the GFR for stage 3 CKD?

Answer 5

30-59

Question 6

What is the GFR for stage 4 CKD?

Answer 6

15-29

Question 7

What is the GFR for stage 5 CKD?

Answer 7

<15

Question 8

With peritoneal dialysis, how is dialysate moved into and out of the abdominal cavity?

Answer 8

By raising and lowering the bag of dialysate

Question 9

What is “felt and heard” in a fistula?

Answer 9

A “thrill” is felt and a “bruits” is heard. A result would be “positive thrill and bruits”

Question 10

How often do you change an ostomy appliance?

Answer 10

Every 3-7 days

Question 11

When replacing an ileostomy appliance, how big do you cut the hole?

Answer 11

1/8 inch bigger than the stoma

Question 12

What dietary restrictions are usually required for dialysis patients?

Answer 12

Fluids restricted to 500-600 mL more than output, sodium 2 g or less, reduce protein and potassium

Question 13

How often is dialysis done, and how does it affect drug level?

Answer 13

3-4X/week is usually necessary. Water soluble drugs are readily filtered by dialysate, but fat soluble are not

Question 14

What serious complications are monitored for in cirrhosis?

Answer 14

Jaundice, portal hypertension (which causes ascites and varices), hepatic encephalopathy/coma

Question 15

What is it important to monitor for with Crohn’s?

Answer 15

Electrolytes, dysrhythmias, GI bleed, perforation of bowel

Question 16

What are some important nursing actions for ulcerative colitis?

Answer 16

High protein/low residue diet, I&O, daily weight, symptoms of dehydration, oral fluids, address diarrhea.

Question 17

What are the symptoms of portal hypertension?

Answer 17

Ascites (straie, distended veins, umbilical hernia), varices (hematemesis, melana, deterioration, shock)

Question 18

What is the etiology and prevention of chronic gastritis?

Answer 18

Etiology = ulcers, H. Pylori, autoimmune, diet, meds, alcohol, smoking, reflux) Prevention = Diet, rest, reduce stress, avoid alcohol/NSAIDs

Question 19

What are the risk factors for CKD?

Answer 19

DM, HTN, chronic glomerulonephritis, pyelonephritis/infections, tract obstruction, hereditary lesions, vascular disorders, meds/toxins

Question 20

What is defined as “progressive irreversible loss of renal function”?

Answer 20

Chronic kidney disease?

Question 21

Acute kidney disease is _____.

Answer 21

Reversible (usually)

Question 22

What is the normal rate for GFR?

Answer 22

125 mL/hr

Question 23

At what stage of CKD would a patient probably have some dialysis? Full dialysis? Transplant list?

Answer 23

Some = stage 3. Full = stage 4. Transplant = stage 5

Question 24

Name the 8 causes of CKD listed.

Answer 24

DM, HTN, obstruction of tract, hereditary lesions, vascular disorders, meds/toxins, chronic glomerulonephritis, pyelonephritis/other infections

Question 25

What med is particularly hard on the kidneys and what med is given to aid the kidneys in its removal?

Answer 25

Radioactive dye from the cath lab. Mucomyst.

Question 26

What are some s/s of CKD?

Answer 26

Decreased urine output, weight gain, joint pain, elevated BP, rapid/irregular heartbeat, dry/fragile skin, itching, uremic frost, RBC low and imbalance of electrolytes

Question 27

What lab results indicate CKD?

Answer 27

Hypocalcemia, hyperkalemia, hyperphosphatemia, decreased RBCs/urine protein/urine creatinine, metabolic acidosis, elevated BUN/serum creatinine

Question 28

What are some complications of CKD?

Answer 28

Uremia (nitrogenous wastes in blood), HF, anemia, HTN, electrolyte imbalances, pathologic fractures, mental changes, seizures

Question 29

What kind of dietary changes are made for CKD?

Answer 29

Low protein/potassium, fluids 500-600 mL more than previous days output

Question 30

What is given to increase RBC production?

Answer 30

Erythropoietin

Question 31

What other meds will increase RBC production besides erythropoietin?

Answer 31

Calcium and phosphorous binders, anti-hypertensives, anti-seizure meds

Question 32

What is a common way to access vein/artery for dialysis?

Answer 32

An AV fistula

Question 33

Which type of gastritis leads to ulcers?

Answer 33

Chronic

Question 34

What are the s/s of Acute Gastritis?

Answer 34

Abdominal discomfort, HA, N/V, lassitude, hiccuping

Question 35

What are the s/s of chronic gastritis?

Answer 35

Epigastric discomfort, anorexia, heartburn after eating, belching, sour taste, N/V, food intolerance

Question 36

What are the treatments for gastritis?

Answer 36

Acute = Avoid alcohol and NSAIDs, if due to acid/alkali avoid emetics/lavage. Chronic = Avoid alcohol/NSAIDs, diet, rest, reduce stress

Question 37

How do you assess for gastritis?

Answer 37

History, presenting s/s, abdomen, 72 hr diary

Question 38

What are the nursing interventions for gastritis?

Answer 38

Acute = nothing oral. Both = avoid alcohol, caffeine, smoking

Question 39

Where is diverticular disease most common?

Answer 39

Sigmoid colon. LLQ

Question 40

What's the difference between diverticulosis and diverticulitis?

Answer 40

Diverticulosis = pouching. Diverticulitis = inflammation/infection

Question 41

What test is done to verify diverticular disease?

Answer 41

Colonoscopy

Question 42

What type of diet causes diverticular disease?

Answer 42

Low fiber

Question 43

What are the s/s of diverticular disease?

Answer 43

Diverticulosis = LLQ pain, chronic constipation precedes it, nausea, anorexia, bloating. Diverticulitis = Severe LLQ pain, N/V, fever, chills, leukocytosis

Question 44

What are the complications of diverticular disease?

Answer 44

Perforation, peritonitis, abscess, bleeding, sepsis

Question 45

What are the 2 types of IBD?

Answer 45

Crohn's disease and ulcerative colitis

Question 46

What are some potential complications of IBD?

Answer 46

Electrolyte imbalance, cardiac dysrhythmias, GI bleed/fluid loss, perforation

Question 47

What kind of diet will these patients be on?

Answer 47

High protein/low ash or TPN

Question 48

How is fluid and nutrient absorption affected with a diversion?

Answer 48

Decreased

Question 49

What's the most common cause of cirrhosis? Other causes?

Answer 49

Malnutrition due to alcoholism. Ifection, anorexia, metabolic disorders, nutritional deficiencies, hypersensitivity

Question 50

What are the s/s of cirrhosis?

Answer 50

Jaundice, portal hypertension, hepatic encephalopathy/coma, nutritional deficiencies

Question 51

What causes portal hypertension?

Answer 51

Restricted blood flow through the liver

Question 52

What does portal hypertension lead to?

Answer 52

Ascites and varices

Question 53

What else can cause ascites?

Answer 53

Vasodilation of splanchnic circulation, aldosterone changes, decreased synthesis of albumin, movement of albumin into the peritoneal cavity

Question 54

What type of scale is best when weighing patients with ascites?

Answer 54

Stand-up scale

Question 55

What is assessed for patients with ascites?

Answer 55

Weight/girth, straie, distended veins, umbilical hernia, fluids in abdominal cavity (dullness/fluid wave), fluid/electrolyte imbalances

Question 56

What is the treatment for ascites?

Answer 56

Low sodium, diuretics, bed rest, paracentesis, salt-poor albumin

Question 57

What does salt-poor albumin do?

Answer 57

Shifts sodium back into the vascular system where it can be excreted

Question 58

How often is endoscopy done for patients with cirrhosis?

Answer 58

q2yrs

Question 59

What are the s/s of varices?

Answer 59

Hematemesis, melana, general deterioration, shock

Question 60

What is the treatment for bleeding varices?

Answer 60

Treat shock, O2, IV electrolytes and volume expanders, blood and blood products, nitro/vasopressin, propranolol and nadolol to reduce portal hypertension. Balloon tamponade.

Question 61

What is acute pancreatitis and what usually causes it?

Answer 61

Blockage of bile duct, usually by a gall stone, backs up pancreatic enzymes and autodigestion and inflammation of the pancreas occur.

Question 62

What usually causes chronic pancreatitis?

Answer 62

Alcoholism

Question 63

What are the s/s of acute pancreatitis?

Answer 63

Abdominal guarding, N/V, fever, jaundice, confusion, agitation, flank/umbilical bruising, respiratory distress, hypoxia, renal failure, hypovolemia, shock

Question 64

What are the s/s of chronic pancreatitis?

Answer 64

Severe upper abdominal/back pain, weight loss, steatorrhea, comes and goes

Question 65

What are the acute assessments for pancreatitis?

Answer 65

Focus on pain/discomfort, fluid/electrolytes, alcohol use, GI, respiratory, anxiety/coping

Question 66

What are the potential complications with pancreatitis?

Answer 66

Electrolyte imbalances, pancreatic necrosis, shock, MODS, DIC

Question 67

What are the treatments for pancreatitis?

Answer 67

Analgesics, low intermittent suction, frequent oral care, bed rest, promote comfort/relieve anxiety