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Nurs 2023 - Health of Adults > Week 6 - Abdominal > Flashcards

Week 6 - Abdominal Flashcards

1
Q

what are the 5 factors that effect nausea

A 
Anxiety
Increased Intracranial Pressure (ICP)
Movement
Gastric changes (stasis, constipation, obstruction)
Biochemical Changes (e.g. drugs)
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2
Q

what are the The Emetic Pathway

A

Vomiting Centre

  • Cerebral Cortex
  • Pressure Receptors
  • Vestibular Nucleus
  • Gastrointestinal Tract
  • Chemoreceptor Trigger Zone
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3
Q

what medication can induce nausea

A

Histamine Antagonists
Acetylcholine (muscarinic) Antagonists
Serotonin Antagonists
Dopamine Antagonists

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4
Q

WHY DO WE NEED a Digestive System?

A

All organisms must obtain nutrients from their environment to survive
Single-cell organisms – no need for GIT
More complex organisms – more cells 
need organisation and coordination

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5
Q

what is the Gastrointestinal tract (GIT)

A

A hollow muscular tube starting from the oral cavity
Passes through the pharynx, esophagus, stomach & intestines to the rectum and anus
Accessory organs assist by secreting enzymes to help break down food into its component nutrients
The salivary glands, liver, pancreas & gall bladder have important functions
Food is propelled along the length of the GIT by peristaltic movements of the muscular walls.

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6
Q

what are the primary Functions of the GIT

A

Ingestion

Digestion

Absorption

Elimination

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7
Q

what function does the mouth serve

A

Oral cavity – teeth and tongue: mechanical processing, moistening, chemical digestion starts
Salivary glands – enzymes and lubrication
Pharynx – muscular propulsion of materials into oesophagus

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8
Q

what are the common disorders of the mouth

A

Stomatitis
Primary or secondary
Can affect any or all parts of the mouth
Symptoms of pain, halitosis, swelling, bleeding, ulceration

Other common disorders of the mouth?

Oral Cancer

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9
Q

what are the common disorders of the oesophagus

A

Gastro –Oesophageal Reflux Disease (GORD)
Definition – the backward flowing of gastric contents into the oesophagus
Pathophysiology
Contributing factors e.g. Increased gastric volume; positioning & increased gastric pressure
Manifestations
Complications

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10
Q

what is the HIATAL HERNIA

A

this is when part of the stomach pokes through the diaphragm

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11
Q

name of stomach areas

A

refer to image on power point Topic 5 abdominal bowel considerations slide 15

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12
Q

what are the disorders of the stomach

A 
Gastritis
Definition – inflammation of the stomach lining as a result of irritation of the gastric mucosa.
Two types – acute and chronic
Manifestations
Nursing management
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13
Q

key points of stomach cancer

A

Incidence increases with age
Risk factors – H. Pylori infection –35%-89%
Most common type – Adenocarcimona
Metastatic spread to liver lungs, ovaries and peritoneum
Manifestations – few – similar to gastritis
Treatment – medical / oncology; gastrostomy tube
Nursing intervention

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14
Q

Disorder of the Bowel

A 
Bowel Obstruction
Intestinal obstruction is failure of intestinal contents to move through the bowel lumen. 
Can be in the small or large intestine.
Mechanical or functional 
Manifestations
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15
Q

Disorders of the Liver

A 
Hepatitis
Inflammatory condition of the liver
Generally caused by one of 5 virus’s
Mode of Transmission
Manifestations: Acute hepatitis
Manifestations: Chronic hepatitis
Can be brief, severe & life threatening
Liver can regenerate tissue - but can lead to cirrhosis & chronic liver dysfunction and cancer
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16
Q

Disorders of the Pancreas

A 
Pancreatitis
Inflammation of the pancreas
 Acute : Manifestations
Chronic : Manifestations
Causes – alcohol main cause but not the only one
Nursing interventions
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17
Q

Pancreatic Cancer

A 
Accounts for 1/6 of all cancer deaths 
5 year survival rate of less than 6 %
Often advanced on diagnosis – only 30% offered curative treatment
Risk Factors
Manifestations
Nursing Management
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18
Q

what is the GALL BLADDER

A

Site of bile storage
Bile is released into the duodenum in response to the hormone cholecystokinin (CCK)
CCK is produced in the duodenum

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19
Q

Cholecystitis

A

Cholecystitis

  • Commonly caused by gall stones lodged in the common bile duct
  • May produce jaundice
  • Extremely painful; often mistaken by sufferers for a heart attack
  • Episodic in nature; acute episodes often brought on by an influx of high-fat food
  • Typical patient fits the ‘three Fs’: ‘fair’, ‘fat’ and ‘forty’
  • Affects 20% of people over 40 years; more in women
  • Treated surgically
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20
Q

how can Common Disorders of the GIT occur

A

Results from food intolerance, psychological distress or increased gastric juices

Signs &symptoms - constipation & diarrhoea, abdominal distention & pain, mucous in stools

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21
Q

Gastroenteritis

A

Inflammation of the stomach and intestines
Causes
Manifestations
Can be dangerous due to loss of fluids and electrolytes
Nursing Management

22
Q

Appendicitis

A

Inflammation of the appendix
Manifestations
Complications
Nursing Management

23
Q

Inflammatory Bowel Disease

A

Ulcerative colitis and Crohn’s disease are caused by abnormal activation of the immune system in the intestines
Ulcerative colitis : Manifestations

Crohn’s disease : Manifestations

About 25 to 40 % of ulcerative colitis patients must eventually have their colons removed because of massive bleeding, severe illness, rupture of the colon or risk of cancer.

Nursing Management

24
Q

what is a STOMAS

A

Stoma is the Latin term for
Opening, and it is artificially made by a surgeon

There are 3 types of “ostomy” 
Colostomy
Ileostomy
Urostomy 
Name usually depends on the 
site it is situated.
25
Q

why are stomas necessary

A

Approximately 36,000 Australians receiving ostomy support.
Newborns may require a stoma due to congenital deformities.
They may be necessary due to trauma or disease
They may be permanent; or temporary

26
Q

what are the clinical observations a nurse should observe

A

Observe for signs of nutritional alteration.

General appearance- alert/responsive or listless/confusion
Muscles- tone, development, presence of fat
CNS- reflexes, attention span, sensation
CVS- HR, BP, rhythm
GI – appetite, digestion
Hair – lustre, scalp
Skin/nails – colour, dry, scaly
Eyes – lustre, membranes
Oral cavity – mucous membranes, teeth, lips

27
Q

what are the relevant health information

A

Past medical/ health history chronic and acute

Surgical procedures

Medications & Allergies

Developmental problems – growth, birth history, milestones, functional abilities if applicable

Obstetric and reproductive history

Genito-urinary problems

Substance use- Alcohol and cigarettes

28
Q

what is the importance of the renal system

A 
Prevent build up of waste 
• Prevent build up of fluid 
• Maintain electrolyte balance 
• Produce hormones for BP regulation 
• Stimulate production of red blood cells 
• Maintain strength of bones
29
Q

GLOMERULAR FILTRATION

RATE (GFR)

A

Glomerular Filtration Rate (GFR) - the rate at
which fluid filters from the glomerulus into
the Bowman’s capsule
• GFR provides a measure to assess renal
function
• Creatinine clearance is used in clinical
practice to estimate GFR
• Normal GFR 90-140 ml/min (men), 80-125
ml/min (women)

30
Q

Renal system - Terminology

A 
Renal 
• Nephrology 
• Urology 
• Glomerular filtration rate 
• Diuretic 
• Diuresis
31
Q

what considered RENAL FAILURE (RF)

A 
Severe decrease in GFR.( Glomerular 
Filtration Rate) 
• Kidneys fail to remove metabolic end 
nitrogenous  products from the blood 
(azotemia). 
• Failure to regulate electrolyte & acid – base 
balance of the ECF. 
• Two types of renal failure 
– Acute renal failure (ARF)  
– Chronic renal failure (CRF)
32
Q

what is considered ACUTE RENAL FAILURE

A

School of Nursing
& Midwifery
• Sudden decline in renal function sufficient to
increase plasma levels of nitrogen waste products
(azotaemia) and impair water-electrolyte balance
• Sudden decline in renal function with a Decrease in
urinary output to less than 400ml / day

33
Q

what are the 3 classifications of acute renal failure

A 
–  1. Pre-renal 
     - Marked decrease in renal blood flow  
–  2. Intra-renal 
 - Damage of kidney structures 
–  3. Post-renal obstruction
34
Q

what causes Pre-renal failure

A 
– Hypovolemia 
• Massive haemorrhage  
• Dehydration 
• Excessive fluid loss due to burns 
– Heart failure (myocardial infarction) 
– Decreased vascular filling 
• Anaphylactic shock 
– Drugs and toxins 
• E.g. NSAIDs, endotoxins
35
Q

what causes INTRA-RENAL FAILURE

A

– Glomerulonephritis (common)
– Pyelonephritis
– Acute tubular necrosis
– Transfusion reactions
– Nephrotoxic agents (methanol, lead, arsenic)
– Antibiotics (Gentamycin and other aminoglycosides)

36
Q

what is Glomerulonephritis

A

There is active proliferation of glomerular cells &
an extensive inflammatory process.
• The inflammation leads to a decrease in GFR,
it may be transient or progress to renal failure

• Manifestations: haematuria, proteinuria, salt
and water retention

37
Q

what is PYELONEPHRITIS

A

Refers to inflammation of the renal pelvis

Mainly caused by bacterial infection

Ascending infection from the bladder is the most common cause

38
Q

what are the symptoms of ACUTE PYELONEPHRITIS

A 
Fever, chills 
 Leukocytosis, pyuria common 
 Haematuria may be present 
 May follow cystitis 
 May subside w/o treatment (organisms may present in the urine for wks/mths)
39
Q

ACUTE TUBULAR NECROSIS

A
  • Extensive necrosis of tubular epithelial cells

- Most common cause of acute renal failure

40
Q

what causes ACUTE TUBULAR NECROSIS

A 
• Causes 
– Ischaemia  
•Due to massive haemorrhage  shock 
– Nephrotoxins 
•Antibiotics, heavy metals
41
Q

what are the 3 phases of ACUTE TUBULAR NECROSIS

A

• Initiating phase
– First 24-48 hours
– Clinical causing event (e.g. haemorrhage, poisoning)
– Abrupt decrease in urinary output  oliguria  anuria
• Maintenance phase
– Few days – tubular epithelium needs time to regrow
– Requires supportive care ± dialysis
• Recovery phase
– Urinary output increases  may be excessive initially
(polyuria) as new epithelium cannot yet fully reabsorb
components of filtrate  normal urine output

42
Q

what are the causes of POSTRENAL FAILURE

A 
– Obstructive disorders 
– Calculi and strictures in the ureters 
– Bladder tumours, neurogenic bladder 
– Prostatic hyperplasia  urethral 
obstruction
43
Q

what are the obstructive disorders

A
  • Pelvis
    >Calculi
    >Tumors
    >Ureteropelvic
- Ureter-intrinsic
  >Calculi
  >Tumors
  >Clots
  >Sloughed papillae
  • Ureter-extrinsic
    >Pregnancy
    >Tumors
    >retrioeritoneal fibrosis
  • Vesicoreteral reflux
  • Bladder
    >Calculi
    >Tumors
    >Functional
  • Urethra
    >Tumors
    >Posterior valve structure
  • Prostate
    >Hyperplasia
    >Carcinoma
    >Prostatitis
44
Q

what are the 4 types of RENAL CALCULI

A
  1. Calcium Stones
  2. Struvite Stones
  3. Uric acid stones
  4. Cystine stones
45
Q

key points of calcium stones

A
  1. Calcium stones : 70 – 80 %
• Calcium oxalate, calcium phosphate or 
combination of the two. 
• Associated with concentrated calcium in the 
blood & urine. 
• Risk factors 
• Management
46
Q

key points of struvite stones

A
  1. Struvite stones : magnesium ammonium
    phosphate stones formed in alkaline urine.

• These stones are always associated with urinary
tract infections.

• They are often called staghorn stones due to
their shape

• Risk factors & Managemen

47
Q

key points of Utic acid stones

A
  1. Uric acid stones: due to increase in uric acid in the
    urine
    • Risk factors – Gout and genetics
  • Not visible on x-ray films.
  • Management
48
Q

what are the key points of Cystine stones

A
  1. Cystine stones : are rare.
  • Genetic defect in renal transport of cystine
  • can be Managed
49
Q

what are the CLINICAL MANIFESTATIONS

OF ACUTE RENAL FAILURE

A

• Oliguria and anuria > diuresis > recovery
• ↓GFR > azotaemia (↑plasma creatinine, ↑ BUN
(blood urea nitrogen) and ↑ urea)
• Outcomes
– Complete recovery
– Progress to chronic renal failure
– Death

50
Q

Treatment Goals

A

Treatment goals are:
1.Identify the correct underlying cause
2.Prevent additional kidney damage
3.Restore urine output and kidney function
4.Compensate for renal impairment until kidney
function is restored

Nurs 2023 - Health of Adults (9 decks)

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