Week 6 - Abdominal Flashcards

Question

why are stomas necessary

Answer 1

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

Answer 2

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

Answer 3

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

Answer 4

``` 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 ```

Answer 5

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)

Answer 6

``` Renal • Nephrology • Urology • Glomerular filtration rate • Diuretic • Diuresis ```

Answer 7

``` 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) ```

Answer 8

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

Answer 9

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

Answer 10

``` – 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 ```

Answer 11

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

Answer 12

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

Answer 13

Refers to inflammation of the renal pelvis Mainly caused by bacterial infection Ascending infection from the bladder is the most common cause

Answer 14

``` 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) ```

Answer 15

- Extensive necrosis of tubular epithelial cells | - Most common cause of acute renal failure

Answer 16

``` • Causes – Ischaemia •Due to massive haemorrhage  shock – Nephrotoxins •Antibiotics, heavy metals ```

Answer 17

• 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

Answer 18

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

Answer 19

- 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

Answer 20

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

Answer 21

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 ```

Answer 22

2. 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

Answer 23

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

Answer 24

4. Cystine stones : are rare. * Genetic defect in renal transport of cystine * can be Managed

Answer 25

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

Answer 26

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