Week 4 - F&E and GI Flashcards
1
Q
what is chrons?
A
- inflammation in the entire GI system from gum to bum
- affects all layers
2
Q
what is colitis?
A
- inflammation in the large intestine
- affects inner mucosa
3
Q
what is diverticulitis ?
A
- inflammation/ infection causes lining pouches
4
Q
where is diverticulitis normally found?
A
lower part of large intestine
5
Q
what GI issues result in diarrhea?
A
- IBS
- Crohn’s
- colitis
- bacteria
- flu/norovirus
- malabsorption
- dumping snydrome
6
Q
what medications cause diarrhea?
A
- antibiotics
- laxatives
- chemo
- XRT
7
Q
what other things can cause dirrhea?
A
- food
- allergies
8
Q
what causes a mallory-Weiss Tear?
A
severe or prolonged coughing/ vomiting
9
Q
what is a mallory-weirs tear?
A
tear of the tissue in lower esophagus
10
Q
what are some causes of an esophageal tear?
A
- varices
- ingestions of sharp things (bones, glass)
- procedure/ surgery
- severe vomiting
11
Q
what are some causes of ulcers?
A
- H. Pylori
- GERD
- NSAIDS
- ASA
- steroids
- anticoagulants
- smoking
- stress
- alcohol
- spicy food
12
Q
describe meckel’s diverticulum
A
- out pouching
- full of embryonic tissue from development
- normally in small intestine
13
Q
describe intussusception
A
- intestine fold in on itself
- most common cause of blockage in 3months - 6 year old
14
Q
how do you know someone has an upper GI bleed?
A
- hematemesis
- melena stool
- coffee ground emesis
15
Q
how do you know if someone has a lower GI bleed?
A
- hematochezia
- ## frank blood bowel movements
16
Q
how do you differentiate if someone has an upper or lower GI bleed?
A
- ligament of treitz
17
Q
which is most common, upper or lower GI bleeds ?
A
upper
18
Q
what are different types of causes for upper GI bleeds?
A
- NSAIDS
- esophageal varices
- cancer
- H. Pylori
19
Q
what are different causes of lower GI bleeds?
A
- colitis
- colonoscopy
- cancer
- hemorrhoids
20
Q
If we know a patient has a GI bleed, when do we become more concerned?
A
hemodynamically unstable
- resting HR is tachy (loss of <15%)
- supine hypotension
- hemoglobin <90
21
Q
what does iatrogenic mean?
A
new symptoms the pt feels due to physician’s activity/ therapy
22
Q
what medical issues can cause a perforation?
A
- Crohn’s
- colitis
- liver issues
23
Q
what iatrogenic things can cause perforation?
A
- scopes
- ERCP
24
Q
what medications can cause a perforation?
A
- corticosteroids
- NSAIDS
- antibiotics
25
what symptoms might you see if you suspect you pt has GI issues?
- abd pain
- bloating/ distension
- hypo/hyperactive bowel sounds
- melena stools
- N/V
- hematochezia
- guarding
- changes to bowel patterns
- tenesmus
- rebound tenderness
26
what does hematochezia mean?
passage of fresh blood through anus in or with stool
27
what does tenesmus mean?
feeling of needing to pass stool even though bowel is empty
28
what are S/S of dehydration?
- skin turgor
- low BP
- low hematocrit
- dry mucous membranes
- thirsty
- light headed
29
what are signs and symptoms of peritonitis?
- fatigue
- going the toilet less
- SOB
- tachycardia
- dizziness
30
what are some complications of GI issues?
- sepsis
- dehydration
- hypovolemia
- anemia
31
when diagnosing a GI issue, what can a stool sample be tested for?
- fecal occult blood
- C. Diff
- obium paricite
- C&S
32
when diagnosing a GI issue, what blood work is helpful?
- CBC
- electrolytes
- iron
- liver panel
- renal panel
- INR/ PTT
- CRP
lactate
33
in regards to blood work that's helpful when diagnosing a GI issue, what does CRP indicate?
- Crohn's or colitis
- see if there is an inflammatory process going on
34
in regards to blood work that's helpful when diagnosing a GI issue, what does lactate indicate?
elevated means sepsis
35
what diagnostics are used for GI issues?
- barium swallow with fluoroscopy
36
what are less invasive treatments for GI issues? what does it do?
- pantroloc
- lines/ helps stomach
37
what are less invasive treatments for Crohn's and colitis?
- steroids
- corticosteroids
- anti-inflammatories
38
what are less invasive treatments for C.Diff?
antibiotics
39
what percentage of your intracellular body is made of water ?
40% body weight (28L)
40
how much fluid do your kidneys filter/ you end up peeing every day?
1-2L/ day
41
how do you loose fluid throughout the day?
- urine
- sweat
- lungs
- intestines
42
how does the thirst sensation work?
- increase in renin, RAAS, vasoconstriction
- increase ADH to prevent fluid loss
- SNS activation (increased HR, blood vessels constrict)
- CVS detects Changs with ANP
43
what are some disease processes of injury states that affect fluid and electrolytes?
- diabetes
- pancreatitis
- bowel obstruction
- burns/ trauam
- GI issues
- kidney problems
- liver problems
- HF
44
what are some medications or treatments that effect fluid and electrolytes?
- steroids
- diuretics
- TPN
- lasix
45
what are some examples of abnormal losses of body fluids that effect fluid and electrolytes?
- bleeding
- diarrhea
- NG suction
- swallowing disorder
- head or neck injury
46
what are some examples of intake that affect fluid and electrolytes?
intake inadequate and for how long
47
what are some examples of dietary restrictions that might effect fluid and electrolytes?
- NPO
- low Na diet
48
in regards to medications or treatments that effect fluid and electrolytes, what do you need to pay attention to for lasix?
- look at potassium and electrolytes
- determine how they're effected
49
what are examples of isotonic solutions?
- 0.9% NS
- RL
- D5W
50
what can to much isotonic solution result in?
hypervolemia
51
what are some examples of HPYOtonic solutions?
- 0.45% NS
- 0.33% NS
52
what can HYPOtonic solutions cause?
- change in LOC
- shock b/c cells well
53
what are examples of HYPERtonic solutions?
- 3% NS
- D5NS
- D10W
- D50W
54
once D5W is metabolized in the body what does it turn into? why?
- isotonic
- dextrose is metabolized
55
what can happen if someone has to much HYPERtonic solution?
- intravascular overload
- pulmonary edema
56
what is an example of a volume expander?
D5 1/2NS
57
what do IV crystalloid solutions have in them?
- sterile water
- electrolytes
58
how is RL metabolized?
in liver and converts lactate to bicarbonate
59
who should you not give Ringers lactate to? Why?
pt with:
- liver impairment
- lactic acidosis
- alkalosis
- increases lactate and is an alkalizing solution
60
what does hypertonic solution increase the risk of? why?
- thrombosis
- causes vessel irritation
61
who should you not give hypertonic solution to?
- renal failure
- cardiac conditions
- dehydrated
62
if a patient is on hypertonic solutions what do you need to teach them ?
alert staff if you are feeling SOB or palpitations
63
who should you not give hypotonic solution to ? why?
ICP/ cerebral edema
- increase ascites
liver disease
- increases ascites
trauma/ burns
- decreases intravascular volume
- could result in cardiovascular collapse
-
64
who should you not give hypotonic solution to ? why?
ICP/ cerebral edema
- increase ascites
liver disease
- increases ascites
trauma/ burns
- decreases intravascular volume
- could result in cardiovascular collapse
65
if a pt is on hypotonic solution, what do you need to teach them?
alert staff if you are feeling dizzy or funny
66
describe colloids
- high volume weight solution
- contain large molecules
67
what do colloids do?
draw fluid into intravascular compartment via oncotic pressure
68
what is oncotic pressure?
pressure exerted by plasma proteins not capable of passing through membranes on capillary walls
69
what are example of colloids?
- FFP
- albumin
- hetastarch
- pentastarch
70
what do you need to watch out for if a patient is getting colloids?
fluid volume overload
71
what are the signs of fluid volume overload ?
- increased BP
- dyspnea
- crackles
- increased JVD
- bounding pulses
72
if a patient has high levels of myoglobin in their urine what will it look like?
ice tea
73
if you do a urinalysis for a pt with myoglobinuria what will the test strip show? why?
- positive result for blood
- no RBCs can be seen on microscopy
- occurs b/c reagent on test strip reacts with myoglobin
74
what does creatine kinase tell us if elevated?
- muscle injury
- will remain elevated for 1-3 days
75
what is creatine kinase?
- enzyme in muscles
- stores and releases energy
76
where do you find creatine kinase in the body?
- skeletal muscle
- cardiac muscle
- small amount in lungs
- small amount in brain
77
if myoglobin is elevated what does this tell us?
- muscle trauma
- ischemia
- inflammation
- MI
78
what can elevated myoglobin lead to?
acute kidney injury
79
describe myoglobin
02 binding muscle protein
80
what is the most common cause of high magnesium?
acute kidney injury
81
what are the signs and symptoms of hyperkalemia?
- muscle cramps
- urine abnormalities
- respiratory distress
- decreased cardiac contractility
- EKG changes
- reflexes
82
if someone has hyperkalemia, what are somethings you might find in the CVS?
- irregular pulse
- bradycardia
- decreased CO
- hypotension
- cardiac arrest
83
if someone has hyperkalemia, what are somethings you might find regarding muscles?
- progresses to weakness
- decreased reflexes
- flaccid paralysis
- can affect resp. muscles
84
if someone has hyperkalemia, what are somethings you might find regarding GI?
- nausea
- cramping
- diarrhea
85
what medications/ treatments do you use to treat hyperkalemia?
- beta agonists
- bicarbonate
- insulin
- glucose
- kayexalate
- calcium gluconate
- diuretics
- dialysis
86
what is an example of a beta agonist that is used to treat hyperkalemia?
salbutamol
87
how does salbutamol, bicarbonate and insulin treat hyperkalemia ?
shifts potassium into cells
88
how does kayexalate treat hyperkalemia ?
- removes potassium through pooping
89
what is kayexalates generic name?
polystyrene sulfate
90
how does calcium gluconate treat hyperkalemia?
helps to stabilize the cells > caustic to vein
91
what is not generally recommended to treat hyperkalemia, why?
- bicarbonate
- can lower calcium
92
how do you administer insulin when using it to treat hyperkalemia? why?
- IV 10-15 units of regular insulin with 50mL of 50% dextrose
- to prevent hypoglycaemia
93
what are signs and symptoms of hypokalemia?
- alkalosis
- shallow RR
- irritability
- confusion
- drowsiness
- weakness
- fatigue
- arrythmias
- bradycardia
- tachycardia
- lethargy
- thready pulse
- decreased intestinal motility
- N/V
94
how do you treat hypokalemia?
- IV fluids
- NPO
95
what are the signs and symptoms of hyponatremia?
- lethargy
- headache
- confusion
- apprehension
- seizures
- coma
96
hyponatremia occurs when?
serum sodium is < 135 mEq/L
97
what causes hynonatrenmia?
- to much water
- increased sodium loss
- blood is diluted
- GI suctioning
- diarrhea
- mannitol
- diuretics
- vomiting
- SIADH
- diabetes
98
what are GI and nervous system signs and symptoms of hyponatremia?
- N/V
- anorexia
- short attention span
- delirium
- disorientation
- weakness
- lethargy
- muscle twitching
- tremors
99
what does aldosterone do for hyponatremia?
- helps regulate sodium
- increases sodium reabsorption/ expansion of volume
100
how do you treat hyponatremia?
- NS to 3%NS
101
if you treat someone with 3% NS what do you need to monitor them closely for?
- fluid overload
- neurological status
102
if someone has a sodium level of <125mEq/L what might they not show?
signs and symptoms
103
if someone has a sodium level of 115-120 mEq/L what might they show?
GI symptoms
104
if someone has a sodium level of <110 mEq/L what might they show?
neurological changes
105
poor nutrition increase risk for what?
- infection
- pressure injuries
- anemia
- GI loss of nutrients
106
what are risks associated with TPN?
- infection
- fluid overload
- hyperglycemia
- liver injury
- can increase or decrease phosphate and potassium
107
what causes low magnesium?
- poor intake
- laxative use
108
will clients show S&S of hypomagnesia is levels under 1.8 mEq/L
not all the time
109
how do you treat hypomagnesia? Why do you need to be careful?
- IV hyhypomagnesemia
- must be administered slowly so it does not trigger cardiac arrest
110
if there are S&S of hypomagnesemia what does it cause?
- CNS excitability
- refeeding syndrome
111
what is refeeding syndrome?
- potentially fatal fluid/ electrolyte shift from artificial refedding
- little or no nutritional intake for previous 5-10 days
112
what is refeeding syndrome marked by?
- hypophosphatemia
- hypokalemia
- vitamin deficiencies
- congestive heart failure
- peripheral edema
113
what are the typical clinical findings for hypomagnesemia?
- seizures
- tetany
- anorexia
- arrhythmias
- rapid HR
- vomiting
- emotional lability
- deep tendon reflexes increased
114
how do you treat hypomagnesemia?
oral or IV magnesium
115
what do you need to watch for if you're giving a pt oral magnesium?
diarrhea
116
what do you need to watch for if you're giving a pt IV magnesium?
- respiratory status
- cardiac telemetry
- seizure precautions
117
what causes hypophosphatemia?
- shift from extracellular to intracellular
- decreased GI absorption
- loss through kidneys
118
what are S&S of hypophosphatemia?
- weakness
- myalgia
- confusion
- resp distress
- decreased contractility
119
how do you treat hypophosphatemia?
IV phosphate
120
what labs indicate hypophosphatemia?
below 1.8 mEq/L
121
if someone has hypophosphatemia what should they eat?
- dairy
- dried beans
- cheese
- eggs
- fish
- nuts/ seeds
- organ meat
- poultry
- whole grains
122
what is affected by hypophosphatemia?
- teeth
- bones
- cellular function (RBCs, metabolism)
- acid/ base
123
when you think about the effects of calcium, magnesium and phosphorus , what should come to mind?
- muscles
- nerves
124
what are some causes of hypocalcemia?
- not enough vitamin D
- malabsorption
- wasting of calcium from kidneys
- hypoparaythroidism
- massive blood transfusion
125
how do you manage hypocalcemia?
- PO or IV calcium gluconate or calcium chloride
- treat underlying problem
- cardiac monitoring
- seizure precautions
126
what causes hypercalcemia?
- hyperparathyroidism
- bone cancer
- prolonged immobility
- multiple fractures
- overuse of drugs containing calcium
127
how do you manage hypercalcemia?
- reduce intake
- increase excretion
- put/ keep calcium in bones
- monitor VS
- strain urine for calculi
128
in regards to the management of hypercalcemia, how do you increase excretion?
- increase fluid intake
- IV NS
- loop diuretics
129
in regards to the management of hypercalcemia, how do you put/ keep calcium in the bones?
- calcitonin
- bisphosphonates
- weight-bearing exercise
130
what do you use to calm muscles and nerves?
- calcium
- magnesium
131
what type of relationship does phosphorus and calcium have?
- inverse relationship
- when one is high the other is low
132
what does it look like when high magnesium, high calcium, or low phosphorus calm the muscles and nerves?
- muscle weakness
- depressed LOC
- bradycardia
- dysrhythmias
- N/V
- reduced deep tendon reflexes
133
what does it look like when low mg, low Ca, or high phosphorus make the muscles and nerves hyperactive?
- twitching
- muscle cramps
- seizures
- altered LOC
- anxiety
- irritability
dysrhythmias
- GI upset
- increased deep tendon reflexes
134
what electrolytes calm the muscles and nerves?
- high magnesium
- high calcium
- low phosphorus
135
what electrolytes hyperactive the muscles and nerves?
- low magnesium
- low calcium
- high phosphorus
136
what blood type can be given in an emergency ?
O negative
137
how do you treat severe anemia?
- PRBC
- isotonic fluid
138
how do you treat severe anemia if PRBC and isotonic fluid is ineffective?
- FFP
- pentaspan
139
what is pentaspan?
- volume expander
- colloid
- prevents 3rd spacing
- manages shock
140
how many units of PRBC should you give before thinking about giving FFP?
6 units
141
the human body responds to acute hemorrhage by activating 4 major physiologic systems, what are they?
neural
- SNS response
chemical
- H+
- O2
- CO2
hormonal
- RAAS
- ADH
hematologic
- coagulation cascade
142
what is the normal range for Mg (magnesium)?
1.5-2.5
143
what is the normal range for PO4 (phosphate) ?
2.5-4.5
144
what is the normal range for K (potassium)?
3.5-5
145
what is the normal range for Ca (calcium)?
8.9-10.1
146
what is the normal range for Cl (chloride)?
98-108
147
what is the normal range for Na (sodium)?
135-145
