Term
| Since PKD is one of the MOST COMMON INHERITED DISORDERs, does this mean it is only congenital? |
|
Definition
| No, it is imp to know it is one of the most common inherited diseases, but there is 5-10% with PKD who have NO FAMILY HX. |
|
|
Term
| Who is PKD most common in? |
|
Definition
|
|
Term
| What happens with PKD? Are cysts ONLY ON THE KIDNEYS with this disease?? |
|
Definition
| PKD causes fluid filled cysts to grow and it will eventually replace the functioning nephron tissue which leads to renal failure. Key to know is: cysts often grow in other parts of the body. About 40% have compromised renal function and in other organs. Cysts can form in other tissue such as the liver, brain, and blood vessels. (the rupture in the last 2 are the most likely to kill you!) Really listen if they have a headache. |
|
|
Term
| What is to know about the 2 forms of PKD? |
|
Definition
| Just know that one kind is very aggressive (ADPKD1) and one kind grows more slowly (ADPKD). |
|
|
Term
| _____________ is in 60% of PKD patients. _______________ MUST be controlled to help maintain the kidney function. |
|
Definition
|
|
Term
| What are the key features of PKD? What is often the presenting symptom? |
|
Definition
| Abd or flank pain is often the presenting symptom of PKD. Other features are: Nocturia (as kidney gets bigger, increased night peeing), have distended abds & increased girth, constipated b/c of the increased size, they have "bloody or cloudy" urine, get kidney stones and HYPERTENSION! |
|
|
Term
| What assessment findings are looked for & found with PKD? |
|
Definition
| UA: shows proteinuria and/or hematuria. Serum BUN & creatinine are increased & assesses the kidney fx. A renal sonogram, CT or MRI scan. |
|
|
Term
| During assessment, should you palpate a suspected or diagnosed PKD patient? |
|
Definition
| No, do NOT palpate PKD pt's - you could rupture a cyst. |
|
|
Term
|
Definition
| There is no way to prevent PKD, at present. Although early detection and mgmt of HTN may slow the progression of renal impairment. Perhaps genetic counseling if parents have PKD and want kids. |
|
|
Term
| What is done to treat/help patients with PKD? What is avoided too? |
|
Definition
| MANAGE PAIN, but avoid NSAIDs! TREAT CONSTIPATION (increase fluids, increase fiber, regular exercise) TREAT HYPERTENSION (ace inhibitors are BEST! the "prils") EDUCATE THE PATIENT on the disease and on renal failure + transplant (PKD most likely ends in renal failure unfortunately) |
|
|
Term
| Client education for PKD: |
|
Definition
| Measure & record BP daily, take temp if suspect fever, do daily weights, limit intake of salt to control BP, notify if urine is really foul smelling, notify if you have a headache or visual disturbances that do not go away, monitor BM's to prevent constipation |
|
|
Term
| Hydronephrosis, Hydroureter and Urethral Stricture are all problems of urine _____ ___________. |
|
Definition
|
|
Term
| ______________ is the obstruction of urine outflow and urine accumulates in the renal pelvis and kidney tissue. |
|
Definition
| Hydronephrosis. It's basically, excessive fluid in the kidneys. |
|
|
Term
| The renal pelvis normally holds ___ - ___ mL of urine. |
|
Definition
|
|
Term
| Hydronephrosis can cause severe damage, how quickly? |
|
Definition
| within a few hours... if there is a urinary obstruction - it needs to be treated asap. With pressure over time, the kidneys become non-functional. |
|
|
Term
| With severe hydronephrosis (obstruction of outflow & excessive fluid in the kidneys) the kidneys can become ___________. |
|
Definition
| obliterated & nonfunctioning |
|
|
Term
| _______________ is obstruction in the lower urinary tract (lower down). It can be from anything that causes obstruction, such as tumors, stones, trauma, fibrosis or congenital structural defects. Urine backs up and dilates the URETER... the whole thing gets distended. |
|
Definition
| HydroURETER (lower down the urinary tract) |
|
|
Term
| ________________ or ________ ____________ disease is when the arterial lumen narrows and leads to reduced blood flow to the kidneys. This leads to tissue ischemia and atrophy of renal tissue. |
|
Definition
| Nephrosclerosis or Renal Vascular Disease |
|
|
Term
| _________________ Disease is usually associated with renal artery stenosis or thrombosis, HTN, diabetes and arteriosclerosis. |
|
Definition
|
|
Term
| Signs of Renovascular disease (reduced blood flow to kidneys) are... |
|
Definition
| Difficulty controlling hypertension, Usually there is an onset of HTN when the person is 40-50 & there is not family hx of HTN. There is increased serum creatinine and decreased creatinine clearance. |
|
|
Term
| How is nephrosclerosis (arterial narrowing that leads to reduced blood flow to kidneys) diagnosed? |
|
Definition
| usually done by renal arteriography |
|
|
Term
| How is Nephrosclerosis (narrowing of arterioles, causing reduced blood flow to kidneys) usually treated? |
|
Definition
| Really want to try & control BP with medication until a renal angioplasty or renal artery bypass surgery is done. |
|
|
Term
| What is the # 1 cause of End Stage Renal Disease (ESRD)? |
|
Definition
|
|
Term
| 50% of diabetics will develop nephropathy after having diabetes for 20 years. The more damage there is over time + more BG is off = more damage done to the kidneys. The point is ... |
|
Definition
| Must control blood glucose to save your kidneys. Remember, diabetic nephropathy is the # 1 cause of ESRD. Diabetes is # 1, but it's followed close by HTN. Obesity + diabetes + HTN = renal failure |
|
|
Term
| If a client has diabetic nephropathy, what are their labs like? |
|
Definition
| PERSISTENT ALBUMINURIA (more than 300 mg/dL). Diabetics need one UA a year b/c we're looking for microalbuminuria. If present, the albuminuria needs to be confirmed 2x on separate occasions 3-6 months apart. If positive, means compromised renal function d/t diabetes. Want to catch this before the, RELENTLESS DECLINE IN GLOMERULAR FILTRATION RATE that occurs. Remember, normal GFR is 125 mL/min. INCREASED ARTERIAL PRESSURE |
|
|
Term
| __________________ shows up earliest in diabetics having compromised renal functioning. |
|
Definition
| microalbuinuria. Then there is compromised, decreased GFR & increased arterial pressure (higher BP) |
|
|
Term
| What kind of changes in the kidneys are common when damage occurs? |
|
Definition
| There is THICKENING OF THE GLOMERULAR BASEMENT MEMBRANE, EXPANSION OF THE EXTRACELLULAR MATRIX (stuff that holds the kidneys together), RENAL ATHEROSCLEROSIS (increased lipids & they lay down easier). Kidneys are our filter, it gets thickened - that along with the pressure. All of these together happen in many years... |
|
|
Term
| Diabetic Nephropathy is a microvascular complication of diabetes. Therefore, when does the damage occuring show up on the tests?? Before, right away or after the damage occurs to the kidneys? |
|
Definition
| The damage in done in diabetic nephropathy is done by the time it shows up on tests. |
|
|
Term
| Why is it SO important to encourage diabetics to have at least a yearly eye exam to look for retinopathy? |
|
Definition
| Because microvascular changes in the retina reflect/correlate with the changes in the kidneys. |
|
|
Term
| Know that diabetics are ALWAYS at risk for ______ failure. |
|
Definition
|
|
Term
| What are the stages of disease progression of Type 1 diabetic renal disease (Terry said look at this table on 1722) |
|
Definition
| STAGE 1, TIME DIABETES IS DIAGNOSED: kidney size & GFR are increased. Blood sugar control can reverse to the changes. STAGE 2, 2-3 YEARS AFTER DIAGNOSIS: glomerular & tubular capillary basement membrane changes result in microscopic changes, with loss of filtration surface area and scar formation. glomerular changes are called glomerulosclerosis. STAGE 3, 7-15 YRS AFTER DIAGNOSIS: miroalbuminuria is present. The GFR may still be normal or may be increased. STAGE IV: Albuminuria is detectable by dipstick. GFR is decreased. BP is increased, an retinopathy is present. STAGE V: GFR decreases at an average reate or 10 mL/min/yr. |
|
|
Term
| What kind of substances are very important for diabetics to avoid... to save their kidneys? |
|
Definition
| Diabetics need to avoid NEPHROTOXIC SUBSTANCES (such as aminoglycoside antibiotics and contrast dyes). Doses are adjusted for diabetics & renal patients. It's a fine line, do you take care of another problem or hurt their kidneys? |
|
|
Term
| Clients with worsening renal function may have frequent hypoglycemic episodes and reduced need for insulin. Why does this not mean that their diabetes is getting "better"? |
|
Definition
| Explain to the client that the kidneys metabolize & excrete insulin. This really just means their renal function is getting worse. When renal function is reduced, the insulin is available for longer amt of time & so less insulin is needed. Unfortunately, many clients believe this means their diabetes is improving. THe result is more rapid progression of ESRD. |
|
|
Term
| _________ ________ failure is a RAPID DECREASE in renal function... Leading to the collection of metabolic waste in the body. This is the ABRUPT detereoration of renal function over hours to weeks that results in azotemia (waste in the body). |
|
Definition
|
|
Term
| Acute renal failure results in ___ & ___ alterations. |
|
Definition
|
|
Term
| Acute Renal Failure leads to ____________ urinary output. |
|
Definition
|
|
Term
| Is Acute Renal Failure REVERSIBLE??? |
|
Definition
| Yes, if caught & treated early |
|
|
Term
| Is Acute Renal Failure the primary reason for care given? |
|
Definition
| NEVER, ACUTE RENAL FAILURE is ALWAYS a COMPLICATION of ANOTHER ILLNESS OR TRAUMA. |
|
|
Term
| What is the mortalitity rates for acute renal failure victims? |
|
Definition
| ARF patients have a 50-80% mortality rate/chance of death. Of course it depends on age & pre-existing renal functioning. |
|
|
Term
| Acute Renal Failure + Sepsis = ___% mortality rate. |
|
Definition
|
|
Term
| Acute Renal Failure + Trauma or Surgery = __% chance of death. |
|
Definition
|
|
Term
| Nephrotoxic substances have a ___ - ___ % chance of death with acute renal failure. |
|
Definition
|
|
Term
| If an acute renal failure patient requires dialysis, their mortality rates are high... what are they? |
|
Definition
|
|
Term
| What is the major cause of death for Acute Renal Failure? |
|
Definition
| INFECTION w/ RF is the major cause of death |
|
|
Term
| ___________ is the build up of waste products, increased BUN and Creatinine WITHOUT symptoms or renal failure. |
|
Definition
|
|
Term
| _________ is increased waste products WITH outward signs & symptoms of renal failure. |
|
Definition
|
|
Term
| ___________ is urine output of less than 100 mL/24 hrs |
|
Definition
|
|
Term
| _________ is urine output of less than 400 mL/24 hr |
|
Definition
|
|
Term
| __________ is urine output of more than 2 L/24 hrs. |
|
Definition
|
|
Term
| ____-Renal is decreased blood flow to the kidneys causing ischemic damage to the nephrons. Causes about 20% of ARF cases. It's a systemic problem that deprives kidneys of oxygen. (Can be transient hypoperfusion, hypotension, decreased CO, decreased effective arterial blood volume) |
|
Definition
|
|
Term
| _____-Renal failure is caused by diseases/damage to the renal parenchyma. Causes about 70% of cases. |
|
Definition
| INTRA This is like when something has hurt the kidneys - like meds maybe. |
|
|
Term
| ________ ____________ ____________ is responsible for about 45% of Intrarenal Failure cases. |
|
Definition
|
|
Term
| _______-Renal failure is caused by obstruction anywhere in the urine collecting system/Obstruction of the urinary tract. Causes about 10% of ARF cases. |
|
Definition
|
|
Term
| Prerenal Causes of Acute Renal Failure are: |
|
Definition
| HYPOVOLEMIA (3rd space fluid sequestration such as capillary leakage, edema, vasodilation, liver failure). Hemorrhage or dehydration, burns, vomiting, diarrhea, excessive use of diuretics, glycosuria. Decreased Cardiac Output, shock, CHF, pulmonary embolism, anaphylaxis, pericardial tamponade, sepsis, renal artery occlusion or dissecting aneurysm. |
|
|
Term
| Prerenal failure is caused by anything that causes ______ volume of blood & oxygenation of the kidneys |
|
Definition
|
|
Term
| The physical findings of prerenal failure are related to the _____________ problem |
|
Definition
|
|
Term
| What is the Urine Sodium, Urine Osmolality, BUN, Cr and BUN/Cr Ratio like in Prerenal Failure? |
|
Definition
| Urine Sodium is LOW (less than 20 mEq/L), Urine Osmolality is HIGH (greater than 500), BUN is elevated, Cr is WNL. BUN/Cr rato: 30:1 (can get up to this high) |
|
|
Term
| Intrarenal (Intrinsic) Renal Failure is caused by: |
|
Definition
| anything that compromises the kidneys like: Acute Interstitial Nephritis, Exposure to Nephrotoxins, Acute Glomerulonephritis, Renal Trauma (if bleedinginto), Acute Tubular Nephrosis (there are 2 kinds explained next) |
|
|
Term
| What are the 2 kinds of Acute Tubulular Necrosis? |
|
Definition
| ISCHEMIC (injury to the basement membrane of the nephron tubule d/t prolonged hypoxia). NEPHROTOXIC (injury to the epithelial membrane of the nephron tubule). |
|
|
Term
| What are some Nephrotoxins that cause damage? What renal failure does this cause? |
|
Definition
| INTRArenal failure is d/t nephrotoxins. Some examples are: Analgesics: NSAIDs, ANESTHETICS: Enflurane, ACE Inhibitors, ANTIMICROBIALS: Acyclovir, Cephalosporins, Tetracycline, CONTRAST MEDIA, CHEMOTHERAPY, PESTICIDES & SOlVENTS |
|
|
Term
| What history question is important in Intrarenal Failure? |
|
Definition
| Any hypotension or exposure to nephrotoxic drugs or radiographic procedures? Any episode of hypotension d/t exposure to anything? |
|
|
Term
| What physical history is so important in Intrarenal Failure? |
|
Definition
| Intrinsic Nephron damage alters fluid & electrolyte balance. A decreased ability to excrete excess fluid & waste. S/S of fluid retention, S3, edema and pulmonary congestion. Oliguria and fatigue. |
|
|
Term
| In Intrarenal failure, ______ develops d/t fluid retention and impaired RAAS system. |
|
Definition
|
|
Term
| What are the Intrarenal Lab findings? |
|
Definition
| INCREASED BUN/CR ratio, Specific gravity less than 1.010, UA: shows INCREASED proteins, RBCs, eosinophils and casts. Serum K+ is more than 5.0 (Hyerkalemia) & Calcium is less than 9.0 (hypocalcemia). Acidosis is found b/c pH is less than 7.40, Bicarbonate is low, less than 22. |
|
|
Term
| If Hyperkalemia is found in Intrarenal Failure... what is given? |
|
Definition
| Kayexalate b/c they'll poop out excess K+ (not Lasix, need to avoid the kidneys!) |
|
|
Term
| _____renal failure is urinary tract obstruction that leads to back pressure. The back pressure causes interstitial edema and necrosis of nephrons. So, anything that blocks afterwards & causes back up pressure. |
|
Definition
|
|
Term
| What does the severity of postrenal failure depend on? |
|
Definition
| Severity depends on if the obstruction is unilateral, bilateral, partial or complete and how long it lasts... |
|
|
Term
| What are some causes of Postrenal Failure? |
|
Definition
| Benign Prostatic Hypertrophy (prostate enlargement), Renal Calculi (Kidney stones), Neurogenic Bladder (CNS dysfunction affecting bladder), Blood Clots, Tumors, Retroperitoneal fibrosis |
|
|
Term
| What is the highest percentage of renal failures? Pre, intra or post? |
|
Definition
|
|
Term
| What are the 4 stages/phases of Acute Renal Failure? |
|
Definition
| Onset, Oliguric, Diuretic & Recovery Phases |
|
|
Term
| The __________ phase begins with the precipitation event and lasts until oliguria (UO of less than 400 mL/24 hrs) happens. How long does this stage usually last? Is it reversible? |
|
Definition
| ONSET phase. Usually lasts 12-24 hours. YES, it is reversible if recognized & treated early. |
|
|
Term
| When does the Oliguric Phase occur & how long does it last? What happens in this phase? What is Urine Output like? |
|
Definition
| Begins 12-24 hrs after injury & lasts 1-3 weeks. Oliguric Phase progresses to NEPHRON DAMAGE. Oliguric Phase is characterized by urine output of 100-400 mL/24 hrs & their body is NOT RESPONDING to diuretics or fluid challenges. This is the stage to really watch for fluid overload! |
|
|
Term
| During the Diuretic Phase, renal function _________. |
|
Definition
|
|
Term
| Onset of the diuretic phase can occur over several days, but what kind of diuresis is happening? |
|
Definition
| Putting out as much as 10 L/day! Pushing out tons of F & E, can lead to imbalances. |
|
|
Term
| How long does the diuresis phase last? |
|
Definition
|
|
Term
| During the Recovery Phase of acute renal failure, renal function is going to improve for a long time. How long? |
|
Definition
| Renal Function is improving for the next 12 months. |
|
|
Term
| What happens with BUN & Cr during Recovery phase? |
|
Definition
|
|
Term
| ____% of people with acute renal failure will have residual tubular damage. This many will never return to their preacute RF functioning. |
|
Definition
|
|
Term
| For the 12 months of recovery after renal failure, they need to be really careful, whY? |
|
Definition
| B/c the renal status is VERY vulnerable to injury during this time. |
|
|
Term
| What are the nursing preventions & interventions for acute renal failure? |
|
Definition
| Promptly identify and treat underlying causes: monitor VS, daily wts & I & O's. OPTIMIZE PRELOAD: keep them well hydrated! INCREASE urine output: cautiously use diuretics though. MAXIMIZE CARDIAC OUTPUT. |
|
|
Term
| WHat therapeutic mgmt is necessary during the Oliguric Phase? (Remember, oliguric means less then 400 mL/24 hrs) |
|
Definition
| Though they are barely having any urine output, we must do FLUID RESTRICTION b/c we can't have fluid overload. They may require DIALYSIS. Correct the ELECTROLYTE IMBALANCES (Hyperkalemia, Hypocalcemia & Hyperphosphatemia). Possible DIET CHANGES: increase calories and carbs, increase calcium, but restrict potassium, phosphorus, sodium & protein. PREVENT INFECTIONS: watch for s/s of infection and keep away from others with infection. WASH HANDSS! |
|
|
Term
| What interventions are necessary during the diuretic phase of ARF? (Think, they are losing even 10 L/day... what would you do?) |
|
Definition
| Maintain adequate fluid volumes b/c they're losing so much. Maintain their electrolyte imbalances - lab values will be monitored closely and replaced as needed. |
|
|
Term
| What interventions are done during the Recovery Phase of ARF? |
|
Definition
| Need to monitor kidney function studies - Note the "Residual Renal Insufficiency." Plan care to provide rest periods b/c they have less energy & stamina than before the illness. Avoid Nephrotoxic drugs & dyes b/c the kidneys are very vulnerable to additional damage during this time. |
|
|
Term
| ________ ________ failure is the SLOW, PROGRESSIVE loss of renal function d/t nephron damages. |
|
Definition
|
|
Term
| Chronic renal failure progresses to __________ _______ disease once the patient requires renal replacement therapy. |
|
Definition
| ESRD (End-Stage Renal Disease) |
|
|
Term
| What is the #1 cause of Chronic Renal Failure in adults? |
|
Definition
|
|
Term
| What are some other causes of chronic renal failure? |
|
Definition
| Inflammatory (ie Glomerulonephritis), Infections (ie Pyelonephritis), Toxins (ie radiographic dye, medications), Obstrutions (ie Nephrolithiasis), Congenital (ie polycystic kidney disease), Renal Vascular Disease (ie Diabetes Mellitus, Hypertension). There are many, many diseases that cause chronic renal failure... it may be secondary to acute renal failure. |
|
|
Term
| What are the 3 stages of Chronic Renal Failure? |
|
Definition
| Stage 1: Diminished Renal Research, Stage 2: Renal Insufficiency, Stage 3: End-Stage Renal Disease |
|
|
Term
| In Stage 1: Diminished Renal Reserve, how many nephrons are damaged? |
|
Definition
|
|
Term
| In Stage 1: Diminished Renal Reserve, what are the symptoms? |
|
Definition
| Usually asymptomatic, may have polyuria and nocturia |
|
|
Term
| In Stage 1: Diminished Renal Reserve, what are the BUN & Creatinine levels? When is it diagnosed? |
|
Definition
| BUN & Creatinine levels are normal. It often goes UNDIAGNOSED at this stage. HTN & BG CONTROL are vital in stage 1 of chronic renal failure. |
|
|
Term
| In Stage 2, Renal Insufficiency, how many nephrons are destroyed? |
|
Definition
|
|
Term
| In Stage 2: Renal Insufficiency, _____uria & ___turia continue d/t decreased ability to concentrate urine. |
|
Definition
| POLYuria & NOCturia. So, in Stage 2 of Chronic Renal Failure - there is increased urine output. |
|
|
Term
| In Stage 2: Renal Insufficiency, what happens to the BUN & Creatinine? |
|
Definition
| BUN & Creatinine increase b/c metabolic waste begins to accumulate. |
|
|
Term
| In Stage 2: Renal Insufficiency, the person is rated as mild, moderate or severe depending on _____. |
|
Definition
|
|
Term
| At what stage of chronic renal failure, are we going to be talking about dialysis & transplants. |
|
Definition
| In Stage 2: Renal Insufficiency |
|
|
Term
| In Stage 3: ESRD or Kidney Failure, more than __% of the nephrons are destroyed. |
|
Definition
|
|
Term
| In Stage 3: ESRD or Kidney Failure, what happens to GFR? What is the usual GFR for Stage 3 of Chronic Renal failure? |
|
Definition
| GFR falls. GFR is usually below 15 mL/min. |
|
|
Term
| In Stage 3: ESRD or Kidney Failure, the body is unable to excrete waste products such as urea and creatinine that accumulate in the blood. ___________ is occuring. |
|
Definition
| UREMIA (Remember, this is the one WITH outward signs/symptoms of renal failure.) |
|
|
Term
| In Stage 3: ESRD or Kidney Failure, the bodies GFR is dropping SO low, the nephrons are nearly completely destroyed and the body is unable to excrete all the waste products. ____uria and ___uria develop. |
|
Definition
| OLIGuria and ANuria. So, in stage 3 of chronic renal failure, there is only between 100-400 mL/24 hrs being excreted... very little urine output. LOTS of waste in the body. |
|
|
Term
| What is the specific gravity of urine in Stage 3: ESRD or Kidney Failure? |
|
Definition
| It is really dilute and fixed |
|
|
Term
| Kidney damage with normal or increased GFR, would have more than ___ mL/min for the GFR. |
|
Definition
|
|
Term
| Kidney damage with MILD decreased GFR, would have a GFR of ___--___ mL/min. |
|
Definition
|
|
Term
| Kidney damage with MODERATELY decreased GFR, would have a GFR of ___-______ mL/min. |
|
Definition
|
|
Term
| SEVERELY decreased GFR, would have a GFR of ___-______ mL/min. |
|
Definition
|
|
Term
| Kidney Failure, would have a GFR of ___-______ mL/min. |
|
Definition
| less than 15 (or dialysis) |
|
|
Term
| The DECREASED GFR leads to ___________ syndrome. |
|
Definition
|
|
Term
| The decreased H+ ion excretion, excess H+ ions in the body leads to: Metabolic ___________. |
|
Definition
|
|
Term
| The decreased Potassium excretion that happens in Renal Failure causes ____________. |
|
Definition
|
|
Term
| The decreased Na+ & Water excretion in renal failure, causes _____________ and fluid retention. |
|
Definition
|
|
Term
| The decreased phosphate excretion in renal failure leads to _________________. |
|
Definition
|
|
Term
| The decreased Nitrogen waste excretion that occurs in kidney failure leads to __________. |
|
Definition
|
|
Term
| THe Uremic Syndrome that happens in Chronic Renal Failure is the OUTWARD signs of waste buildup. What are the signs & Symptoms? |
|
Definition
| Fever, Malaise, Anorexia, Nausea, Mild Neural Dysfunction, Uremic Pruritis (ITCHING!) |
|
|
Term
| What kind of systemic effects (on the bones) does the Uremic build-up cause? What happens to the bones in ESRD? |
|
Definition
| Osteomalacia (Rickets), Bone Pain, Arthritic symptoms, Spontaneous fractures, Bone demineralization. |
|
|
Term
| The Hypocalcemia/hyperphosphatemia leads to a prolonged __ interval, _____cardia, __________ cardiac contractility, ____tension. what does it do to their strength & muscles? |
|
Definition
| QT, bradycardia, decreased cardiac contractility, HYPOtension. They have WEAKNESS & TETANY <-- muscle spasms b/c of low calcium. |
|
|
Term
| Uremia causes CALCINOSIS, what is that? |
|
Definition
| There is more Ca++ in tissues, then in their bones. You can feel the calcium deposits under the skin. Calcium being deposited in other areas of the body is not good. |
|
|
Term
| What are the interventions we do to help treat all the bone/skeletal problems that happen d/t the uremia in ESRD? |
|
Definition
| INCREASE dietary intake of calcium and decrease phosphorus. Give Calcium & Vitamin D supplements. Tums do give increased Calcium by the way. Give Phosphate binders such as Phoslo (Calcium Acetate) and Renagel (Sevelamer). Remember, give the Ca++ binders with meals! Also going to decrease carbonated beverages. |
|
|
Term
| What happens to the cardiopulmonary system b/c of all the Uremia? |
|
Definition
| HYPERTENSION, Pericarditis with fever, Pulmonary edema, CHF, Chest Pain, Pericardial Friction Rub, KUSSMAUL's RESPIRATIONs (deep, labored, hyperventilation breathing), HYPERLIPIDEMIA. |
|
|
Term
| How are we going to try to help, what interventions are done, for these cardiopulmonary problems when Uremia occurs? |
|
Definition
| Control Hypertension with fluid restrictions and a low sodium diet, Give antihypertensive meds: is usually a multi-drug regimen, antihyperlipidemic meds. Monitor I & O & Daily weights. Dialysis. Remember, diuretics are used only int eh early stages of CRF - not later when azotemia is occuring. |
|
|
Term
| What the NEUROLOGICAL effects of uremia? |
|
Definition
| ENCEPHALOPATHY (disease of the brain): causing fatigue, decreased attention span and problem solving. PERIPHERAL NEUROPATHY: causing pain, burning, numbness in hands/feet. There is loss of motor coordination, twitching of muscles, stupor (low LOC, only responds to pain) and coma. |
|
|
Term
| What are the HEMATOLOGICAL effects of uremia? There is ______________ erythropoietin production by the kidneys, leads to anemia. |
|
Definition
|
|
Term
| What are the HEMATOLOGICAL effects of uremia? The uremic toxins, iron & folic acid deficiencies lead to ___________ RBC survival time. |
|
Definition
|
|
Term
| What are the HEMATOLOGICAL effects of uremia? Uremic toxins ___________ platelet function and __________ bleeding times. |
|
Definition
impaired plated fx, increased bleeding times.
All in all, there is less RBC production, less RBC survival time in the body and impaired clotting + increased bleeding. |
|
|
Term
| What are the GASTROINTESTINAL effects of uremia? |
|
Definition
| there is NAUSEA/VOMITING, anorexia, hiccups, diarrhea, constipation, stomatitis/mouth ulcers, gastritis, peptic ulcers and GI bleeding, changes in taste and uremic fetor (breath with ammonia/urinous breath) |
|
|
Term
| We would not give any antacids w/ ________________ or _____________ b/c they'll get toxic. |
|
Definition
| Aluminum or Magnesium (No, MOM, Mylanta, etc...) |
|
|
Term
| What happens to the SKIN/Integumentary system b/c of Uremia in ESRD? |
|
Definition
| PRURITIS (itching! is very common. In 15-50% of CRF pt's and 50-75% of dialysis patients), Skin looks DRY & YELLOW, DECREASED SKIN TURGOR, ECCHYMOSIS (bruises easily), SOFT-TISSUE CALCIFICATIONS, UREMIC FROST (Urea crystals on the skin) |
|
|
Term
| What are the IMMUNOLOGICAL effects of Uremia? |
|
Definition
| Increased risk for infection (especially scary b/c easily can lead to sepsis --> death. This is b/c of suppression of cell mediated immunity, reduced number and function of lymphocytes and phagocytes) |
|
|
Term
| What are the REPRODUCTIVE effects of uremia? |
|
Definition
| Sexual Dysfunction, Menorrhagia (heavy periods), Amenorrhea (absence of period), Infertility, Decreased libido. All of this is super depressing, who's in the mood for anything? |
|
|
Term
| What is the nutrition/diet for Chronic Renal failure? |
|
Definition
| The Chronic renal failure diet is a HUGE challenge and requires the assistance of a dietitian. The help is necessary to PREVENT CATABOLISM, a negative nitrogen balance and malnutrition. Increased calories and carbs if allowed. Increase Calcium & Iron intake. Decrease Protein intake. Decrease Sodium & Phosphorus. Offer herbs/spices instead of salt. |
|
|
Term
| Many supplements are needed for Chronic Renal Failure patients, like what? |
|
Definition
| Daily Multivitamin. A low protein diet is usually deficient in vitamins and water soluble vitamins are removed during dialysis. Give Iron Supplements. Anorexia sometimes requires the patient to use supplemental nutrition shakes. |
|
|
Term
| What Psycho-Social Issues are concerning for chronic renal failure patients? |
|
Definition
| Want to consider Quality of Life: peritoneal vs. hemodialysis, dialysis vs. transplant or choosing to stop dialysis. These pt's are dealing with depression and alterations in body image and changes in roles and relationships. The demands of dialysis regimen are super time consuming + the huge cost of care and medications. What aren't these people dealing with?! Be understanding of their short tempers & listen to them about THEIR routines & ways of doing it. |
|
|
Term
| WHat does dialysis do to a persons life expectancy? |
|
Definition
| Dialysis means ESRD. Dialysis will drastically decrease life expectancy. |
|
|
Term
| What is the criteria for a renal failure patient to start doing dialysis? |
|
Definition
| Fluid overload & is unresponsive to diuretics. Development of Pericarditis. Uncontrolled HYPERTENSION. Neurological symptoms. Worsening signs & symptoms such as: nausea/vomiting, worsening anemia, pruritis, decreased cognition and attention span. When GRF dips below 15 - then they usually get medical coverage. |
|
|
Term
| The principles of hemodialysis are on ________ & osmosis. |
|
Definition
|
|
Term
| Hemodialysis relies on the principles of ____________. Meaning it works similarly. It is the movement of molecules from an area of higher concentration to lower concentration. Diffusion in dialysis occurs on a membrane with a large surface and large pores and a WARMED SOLUTION. Molecules such as RBCs and plasma proteins are too large to cross the membrane. |
|
Definition
|
|
Term
| Excess water is removed from the blood by _________ in hemodialysis. |
|
Definition
|
|
Term
| A "_______________" is the "artificial kidney." It is made up of a blood compartment, a semi-permeable membrane and an enclosed structural support. |
|
Definition
|
|
Term
| The dialysate composition is altered for each individual, why? |
|
Definition
| It's altered to treat the individuals electrolyte imbalance needs. |
|
|
Term
| The dialysate is a clear filtered liquid that is free of chemicals, drugs or metabolic waste. Dialysate is usually warmed to _____ degrees F, why? |
|
Definition
| 100 F (37.8 C) - to INCREASE the efficiency of diffusion + prevent fall in body temp. |
|
|
Term
| The Hemodialysis Machine is going to alarm for: |
|
Definition
| Changes in temperature, Air in the system, blood leaks in the compartments, pressure or composition changes in teh blood or dialysis compartments. |
|
|
Term
| The vascular access for hemodialysis requires easy availability of a large amount of blood flow. Atleast ____ - _____ mL/min for 3-4 hours on average! |
|
Definition
|
|
Term
| There are 3 types of Vascular Access for Hemodialysis. Arteriovenous Fistula, Arteriovenous Graft and Venous Temporary Catheter. Which one lasts longer and is less likely to clot or get infected? |
|
Definition
|
|
Term
| There are 3 types of Vascular Access for Hemodialysis. Arteriovenous Fistula, Arteriovenous Graft and Venous Temporary Catheter. Which one tends to have more problems with infection & clotting? This type needs to be replaced more often. |
|
Definition
|
|
Term
| There are 3 types of Vascular Access for Hemodialysis. Arteriovenous Fistula, Arteriovenous Graft and Venous Temporary Catheter. Which one is used if dialysis is needed immediately? This type has problems with clotting, infection and narrowing of the vein? |
|
Definition
| Venous "Temporary" Catheter |
|
|
Term
| If your patient has an AV fistula, graft or shunt - what is the best way to care for them & their arm? (Remember, it is their lifeline!) |
|
Definition
| Check for pulses in the access daily, do not put pressure on access site (no tight clothing, jewelry or lifting heavy objects with this arm), we do NOT take BP in this arm, we do NOT sleep with pressure on the access arm, we use the access site for dialysis only, do not start an IV in this arm, ausculate for bruits & palpate for thrills Q 4 hrs, encourage ROM exercises, check for bleeding at needle insertion site, look for signs of infection at insertion site, tell client not to life heavy objects or anything that compresses the extremity where the vascular access is placed, tell not to sleep on top of that extremity. |
|
|
Term
| When a pt returns from surgery getting vascular access, what should be checked first? |
|
Definition
| Assess peripheral pulses, check for bruits & thrills. If no? Call the Physician right away! ALWAYS, ALWAYS check: LOC, VS, Orthostatic Hypotension, Vascular site & be sure bleeding is done. |
|
|
Term
| If an access site is not patent & the patient is becoming hypoxic... this is called ________ Syndrome |
|
Definition
|
|
Term
| The dialysis has red & blue colors, which is artery & which is venous? |
|
Definition
| Red = arterial, Blue = venous. Blood flows out the arterial side (red) to the machine.. |
|
|
Term
| Patients on dialysis require dry weights & wet weights, what do they mean? |
|
Definition
| Wet weight = weight before dialysis. Dry weight = weight after dialysis, when fluids are taken off. |
|
|
Term
| Dialysis ________________ syndrome is cerebral edema that leads to increased intracranial pressure. |
|
Definition
|
|
Term
| What are the s/s of dialysis disequilibrium syndrome? |
|
Definition
| headache, nausea, vomiting, restlessness, decreased levels of consciousness, confusion, seizures and coma. |
|
|
Term
| How can the possibility of Dialysis Disequilibrium Syndrome be decreased? |
|
Definition
| by slowing the rate of dialysis |
|
|
Term
| ______________ Dialysis is when diffusion & osmosis occur across the semi-permeable membrane of the peritoneal membrane and capillaries after dialysate is instilled through a surgically placed siliconized plastic catheter in the abd cavity. |
|
Definition
|
|
Term
| What are the advantages of PERITONEAL Dialysis? |
|
Definition
| It is better for clients who are hemodynamically unstable, it does not require heparin to be infused (HD does to prevent blood clotting), Good for people who cannot get vascular access, offers more flexibility if client's status changes frequently - it is preferred for elderly and children (can do it over the night), it is simple to perform & easy to do at home. |
|
|
Term
| What are the disadvantages of peritoneal dialysis? |
|
Definition
| It requires surgical insertion of the catheter, it can't be used if the patient has adhesions or decreased peritoneal membrane area, can't be used 6-8 wks after abd surgery, it IS EXPENSIVE, but they both are (equal expense really), It is a SLOW PROCESS & the correction of fluid & electrolyte imbalances are SLOW. Pt's cannot use hot tubs or pools or take baths (can't soak), |
|
|
Term
| What happens in the 3 phases of Peritoneal Dialysis? |
|
Definition
| 1. Fill 1-2 L of prescribed dialysate infuses over 10-20 mins as the pt tolerates is 2. Dwell: each batch of dialysate stays in for a prescribed time. 3. Drain: effluent drains out by gravity. |
|
|
Term
| The advantages of Hemodialysis are: |
|
Definition
| More efficient clearance & shorter time for treatment. |
|
|
Term
| Which procedure is more complex, HD or Peritoneal Dialysis? |
|
Definition
| HD: is more complex & requires specially trained nurses. Peritoneal Dialysis: is simple, training is less complex for peritoneal dialysis |
|
|
Term
| Which dialysis requires a restricted diet? |
|
Definition
| Hemodialysis (peritoneal dialysis allows for a more flexible diet) |
|
|
Term
| What are the nursing concerns when it comes to dialysis? |
|
Definition
| Ask them, "How can I help you?" They know. Nurses have to maintain sterility with peritoneal dialysis. Watch out for infections. |
|
|
Term
| Continuous Ambulatory Peritoneal Dialysis offers the advantage of continuous removal of fluid & waste. It is more like our own kidneys & we do not have so many ups & downs. We are going to infuse how much, how often? |
|
Definition
| Infuse four 2 Liter exchanges of Dialysate. Each stays in 4-8 hours, 7 days a week. The client can choose to continuous drain or disconnect for more independence. There is an increased risk for infection b/c of open & closed, open & closed though. |
|
|
Term
| What option is an automated machine that continuously cycles dialysate in and out of the peritoneal cavity. The exchanges occur at night while the patient sleeps. The final exchange of the night is left in during the day and is drained the next night. |
|
Definition
| Continuous-cycle Peritoneal. Most is at night, one during the day and again at night. |
|
|
Term
| What is the most common complication of Peritoneal Dialysis? |
|
Definition
| Peritonitis - it is an infection of peritoneum. The effluent should always be clear. If it is cloudy effluent... they've got an infection, get sample & send to the doctor. |
|
|
Term
| Your patient is complaining of pain with peritoneal dialysis, what do you say? |
|
Definition
| It is common for the first few exchanges. It is more painful if the dialysate is cold. |
|
|
Term
| In peritoneal dialysis, the infections in the exit site & within the tunnel are... |
|
Definition
| hard to treat & become chronic |
|
|
Term
| Other complications I want to include for Peritoneal Dialysis are... |
|
Definition
| Possibility of bowel or bladder perforation. Insufficient flow or leakage of dialysate. |
|
|
Term
| If the dialysate is going in & the pt is complaining of lots of cramping... |
|
Definition
| try to slow it down & let them know the pain will decrease over time too. |
|
|
Term
| are kidney transplants considered the cure? |
|
Definition
| No, kidney transplants are not considered a cure! They are a treatment! |
|
|
Term
| Patients who receive a kidney transplant will have a lifetime of ______________ therapy. |
|
Definition
|
|
Term
| In 2005, there were about 65,000 people awaiting kidney transplants. Where do the majority come from? |
|
Definition
|
|
Term
| What are the survival rates like for kidney transplants? |
|
Definition
| Really good... Slightly better if received from a living person, but they have a 94-97% chance to live a year & 75-82% chance to live 5 years. The median waiting time is about 670 days, a lot of people die before the transplant happens. |
|
|
Term
| Facts about kidney transplants... |
|
Definition
| 1. Successful transplants started in 1963 w/ the introduction of azathioprine cream combined with steroid treatments. (didn't even know about rejection & immune systems then, only successful were between identical twins). 2. The average graft lifetime exceeds 10 years. 3. Combined kidney/pancreas transplantation is the treatment of choice for patients with type 1 diabetes & ESRD |
|
|
Term
| Contraindications for Kidney Transplants are... |
|
Definition
| Cardiopulmonary insufficiency, Morbid Obesity, Peripheral and Cerebrovascular Disease, Tobacco Abuse (Continue to smoke? No transplant), Hepatic Insufficiency, Other factors that increase the risks associated with major surgery. Had a stroke? Not a good candidate. |
|
|
Term
| What are the contraindications of Immunosuppression? |
|
Definition
| INFECTIONS: all infections must be resolved at time of transplant. MALIGNANCY: in general one should wait 5 years following successful treatment. HIV: is currently and an absolute contraindication to receiving immunosuppressants. OTHER: Poor social support, substance abuse and intractable financial problems. |
|
|
Term
| Recipient of Kidney transplants for through evaluations of... |
|
Definition
| EKG & Stress testing, Chest x-rays, Pulmonary studies, colonoscopy/barium enema, non-invasive vascular studies, abdominal and renal ultrasound, testing for HIV, hepatitis, CMV and viral infections, studies of bladder capacity and function. |
|
|
Term
| A patient receiving kidney transplant requires anti-rejection medications that cause immunosuppression. What are they? |
|
Definition
| CALCINEURIN INHIBITORS: Cyclosporine, Tacrolimus (Prograf) or Sirolimus (Rapamunel). These drugs BLOCK T-cell proliferation. They have significant dose-related nephrotoxicity (ironic, drug needed for kidney & it's toxic). They are metabolized in theliver by the P450 system. Since a lot of other meds are metabolized in the same system, they are often fighting for the pathyway (may have increased or decreased doses). |
|
|
Term
| STEROIDS are another drug given for anti-rejection, what are some examples? |
|
Definition
| Prednisone, Solu-Medrol, etc.. |
|
|
Term
| PURINE SYNTHESIS INHIBITORS are another med for anti-rejection, what are some examples? |
|
Definition
| Mycophenolate mofetil (Cellcept), Azathioprine (Imuran) or Rapamycin. They are known for GI toxicities: nausea & diarrhea. Some can not take b/c their bodies never get accustomed to them. |
|
|
Term
| What unfortunate complications can occur after a kidney transplant? |
|
Definition
| Opportunistic Infections, Vascular & Ureter related complications (arterial stenosis, venous thrombosis, ureteral obstruction and urine leakage). Early post-op complications include: Delayed Graft Function, rare with living donors due to lack of cold ischemic time. Cold ischemic time=organ on ice & how long it is outside the body. The longer this is, the longer it takes for the graft function to get to a serviceable level. |
|
|
Term
| Acute Transplant REJECTION happens in about ___ - ___% of patients. |
|
Definition
| 15-25% will outrightly reject the transplant |
|
|
Term
| When there is transplant rejection, what are the usual signs at first? |
|
Definition
| It's usually asymptomatic: may have fever & some pain at the graft site. There is an UNEXPLAINED RISE IN CREATININE LEVELS. Confirmed by biopsy then. Treated with a short course of increased steroids. |
|
|
Term
| How is Hepatitis A transmitted? |
|
Definition
| It is spread the fecal/oral route. So, orally ingesting fecal contaminants. Sources of infection include: contaminated water, shellfish caught in contaminated water, and food contaminated by food handlers infected with Hep A virus. Hep A may also be spread by oral-anal sexual activity. Hep A is more common in less developed countries. The disease is not life-threatening. |
|
|
Term
| How is Hepatitis B transmitted? |
|
Definition
| Is PARENTERAL. Unprotected sex with infected person (homo or heterosexual), sharing needles, accidental needle sticks for HC workers, blood transfusions (that have not been screened for the virus), hemodialysis, maternal-fetal route. |
|
|
Term
| How is Hep C transmitted? |
|
Definition
| Parenteral too. HCV is most commonly transmitted by: Illicit IV drug needle sharing, blood, blood products, or organ transplants received before 1992, needle stick injury with HCV contaminated blood (HC workers at high risk), tattoos (unsanitary equipment), intranasal cocaine use (sharing of intranasal cocaine). Hep C is NOT transmitted by causal or by intimate household contact. However, if you're infected - do not share razors, toothbrushs or pierced earrings b/c may have microscopic blood on these items. |
|
|
Term
| What foods should people with GERD avoid? |
|
Definition
| THey have increased acid, so we want to avoid acidic foods like raw tomates, oranges. Limit caffeine, spicy and acidic foods for GERD. Also, avoid large meals and should advise to eat 4-6 small meals, instead of 3 large ones. Avoid carbonated beverages too. Avoid evening snacks and try not to eat 3 hrs before going to bed. Can't adhere to this? Chew food really well. |
|
|
Term
| What medications are given for GERD? |
|
Definition
| Imeprazole (PRILOSEC) - is a proton pump inhibitor. these provide effective, long acting inhibition of gastric acid secretion. They reduce gastric acid by about 90% over a 24 hour period with a single dose. |
|
|
Term
| What additional non-pharm measure would help improve symptoms of GERD? |
|
Definition
| Elevate the HOB about 6 inches while sleeping. |
|
|
Term
| Identify the 2 serum studies that are "cardinal" to the diagnosis of Pancreatitis. |
|
Definition
|
|
Term
| What are common nursing diagnoses for clients with acute pancreatitis? |
|
Definition
| 1. Acute Pain related to biologic and injury agents (pancreatic inflammation and enzyme leakage) 2. Imbalanced Nutrition: Less than body requirements related to the inability to ingest food and absorb nutrients |
|
|
Term
| Abd pain is the prominent symptom of pancreatitis. The main focus of nursing care is aimed at reducing discomfort and pain by the use of interventions that decrease GI tract activity. What are the nonsurgical initial attempts by HC workers to relieve pain? What are the pain medications given to relieve pain associated with Pancreatitis? <-- last is the important one! |
|
Definition
| Initially attempts to relieve pancreatitis pain is fasting (to rest the pancreas & reduce pancreatic enzyme secretion), drug therapy, and comfort measures. Drugs given to decrease pain are OPIOIDS by means of a PCA pump. MEPERIDINE (DEMEROL) is the traditional drug of choice for relieving abdominal pain assoc with acute pancreatitis. Other opioids include FENTANYL & MORPHINE> |
|
|
Term
| Why is an NG tube used for patients with Acute Pancreatitis? |
|
Definition
| Fasting is done to rest the pancreas and reduce pancreatic enzyme secretion, food and fluids are withheld in the acute period. NG drainage and suction is reserved for clients who have continuous vomiting or biliary obstruction. Gastric decompression prevents gastric digestive juices from flowing into the duodenum. B/c paralytic ileus is a common complication of acute pancreatitis, prolonged NG tube intubation may be necessary. Assess frequently for the presence of bowel sounds, including before the NG tube is removed. |
|
|
Term
| Chronic Pancreatitis patients stool looks like what? |
|
Definition
| Steatorrhea (excessive amounts of fat in stool). This is d/t pancreatic enzyme secretion being reduced by more than 80% & the resulting severe malabsorption of fats. These stools are pale, bulky, and frothy & have an offensive odor. There is also increased proteins in stool. If you inspected the stool, the fat content would be visible. In chronic pancreatitis, stool fat output may exceed 40 g/day. |
|
|
Term
| What is cholecystitis usually? |
|
Definition
|
|
Term
| Laparoscopic Cholecystectomy (gallbladder removal) involves what? |
|
Definition
| it's a minimally invasive surgery, is performed much more than open surgery (the other option), complications are not common, death rate is vey low, bile duct injuries are rare, client recovery is faster, postop pain is less severe. There is no special preop prep (besides NPO), very small midline puncture by umbilicus, abd cavity is inflated with 3-4 L of CO2 (promote ambulation d/t this), far less opioids are necessary postop, usually discharges within 1 day. Following laproscopic surgeries, they return to work & normal activities much sooner than an open. Usual activities resume in 1-3 weeks. |
|
|
Term
| Now, contrast the Laparoscopic & discuss the other Open Cholecystemtomy (Gallbladder removal)... |
|
Definition
| Use of the traditional/open surgery has declined in the last decade. Hospitalization is required for several days, galbladder is removed through incision in right & then explores bile ducts, the surgeon typically inserts a T-tube to ensure patency of the duct, additionally a JP drain is used to prevent fluid accumulation, postop is Demerol via PCA pump for pain relief, the surg dressing & drain removed w/in 24 hrs, but T-tube may be in for 6 weeks, gradually advance diet from clear liquids to solid foods. |
|
|
Term
| What is a T-tube often used for in an Open Cholecystectomy (gallbladder removal)? |
|
Definition
| It ensures patency of the bile duct & may be left in for 6 weeks following surgery. In immediate post-op period expect bloody drainage, which changes to green-brown bile. Bile output is about 400+ mL/day with a gradual decrease in amount. Report excess of 100 mL/day. NEVER irrigate, aspirate or clamp a T-tube without a physician's order. Assess drainage system for pulling, kinking or tangling of tubing. When the client is allowed to eat, clamp the T tube (per physicians orders) before and after meals. assessthe clients response to determine tolerance of food. |
|
|
Term
| What differentiates Crohns & Ulcerative Colitis? |
|
Definition
| Crohns: begins in intermittent ileum (lower part of long small intestine) w/ patchy involvement through all layers of bowel. Ulcerative Colitis: begins in Rectum & proceeds toward cecum (reverse way through the bowel). They both have unknown etiology. Crohns occurs in 15-40 yo's. Ulcerative COlitis occurs 15-25 & 55-65 yo's. Crohns stools are 5-6 loose stools/day with NO blood. Ulcerative COlitis is 10-20 liquid & bloody stools/day. They both have complications of fistulas & nutritional deficiencies, but ulcerative colitis additionally has hemorrhage & perforation. |
|
|
Term
| Intestinal/Bowel obstructions are partial or complete & classified as "mechanical" & "non-mechanical." what are each? |
|
Definition
| Mechanical obstruction is a physical obstruction (could be hernia, adhesion, tumor, stricture or fecal impaction) Non-Mechanical Obstruction (aka paralytic ileus) does not involve a physical obstruction. Instead, peristalsis is decreased or absent, causing a slowing or a back up of intestinal contents. |
|
|
Term
| What are the signs/symptoms of Mechanical bowel obstructions? |
|
Definition
| abdominal pain, cramping. Can be sporadic (if partial) or localized and steady (if complete). Vomiting often acompanies obstruction. When you examine the abd, look for abd distention (common in all forms of intestinal obstruction). Ausculate for high-pitched bowel sounds (occurs proximal to obstruction as intestine tries to push it fwd). Below the obstruction, the bowel sounds will be absent. |
|
|
Term
| What are the signs/symptoms of nonmechanical bowel obstruction? |
|
Definition
| Nonmechanical (paralytic ileus) pain is a constant discomfort. Colicky cramping is not characteristic of this type of obstruction. Abd Distention is typically present. Ausculation will have decreased bowel sounds in early obstruction and absent bowel sounds in later stages. Vomiting of gastric contents & bile is frequent. |
|
|
Term
| Elevated ______________ levels are usually cited as the cause of encephalopathy in hepatic failure & cirrhosis patients. They will have an altered level of consciousness, impaired thinking processes, and neuromuscular disturbances. (It may be acute & reversible w/ early intervention) |
|
Definition
|
|
Term
| ____________ is the accumulation of excess free fluid within the peritoneal cavity. Most commonly occurs in cirrhosis of the liver. Can lead to a distended abdomen. |
|
Definition
|
|
Term
| How does Ascites (n excessive amount of fluid built up within the peritoneal cavity) affect the diaphragm? |
|
Definition
| Breathing can be affected as the fluid-filled peritoneal cavity presses upon the diaphragm, a very necessary component of respiration. When pressure on the diaphragm from fluid build-up occurs, it lessens the ability of these diaphragm muscular fibers to expand and contract, and results in impaired breathing. |
|
|
Term
| _________ ___________ is a persistent increase in pressure within the portal vein, it is a major complication of cirrhosis. It results from increased resistance to obstruction of the flow of blood through the portal vein and its tributaries. Blood flow backs up into the spleen (causing splenomegaly). Veins in the esophagus, stomach, intestines, abdomen, and rectum become dilated. |
|
Definition
|
|
Term
| What is the relationship between cirrhosis of the liver & bleeding? |
|
Definition
| Bleeding esophageal varices occur when veins in the walls of the lower part of the esophagus and sometimes the upper part of the stomach are wider than normal (dilated). Bleeding varices are a life-threatening complication of increased blood pressure in the portal vein caused by liver disease (portal hypertension). The portal vein carries blood from the intestine to the liver. Increased pressure causes the veins to balloon outward. The vessels may break open (rupture). Any cause of chronic liver disease can cause bleeding varices. Signs are vomiting blood & black/tarry stools. |
|
|
Term
| What teaching does a nurse do with cirrhosis patients upon discharge? |
|
Definition
| Discharge Planning should include stressing the need to abstain/avoid alcohol & ilicit drugs. Tell them Do not consume any alcohol. Seek support services help if needed. By avoiding alcohol & drugs the client: prevents further scarring of the liver, allows the liver to heal & regenerate, prevents gastric & esophageal irritation, reduces the incidence of bleeding and prevents other life-threatening complications. |
|
|
Term
| The goal that has the highest priority for a client has a massive bleed from esophageal varices is to: |
|
Definition
| MAINTAIN A PATENT AIRWAY. The nurse should position the client to prevent aspiration and assess respirations and oxygen saturation. The nurse should assist HC provider in controlling the hemorrhage with a balloon tamponade. Third priority is to restore circulating blood volume with blood & IV fluids. |
|
|
Term
| The client is admitted to the hospital with a diagnosis of acute GI bleeding, which nursing diagnosis takes highest priority for this client? |
|
Definition
| deficient fluid volume related to bleeding |
|
|
Term
| Acute GI bleeds are one of the most common medical emergencies encountered today. Although bleeding stops spontaneously in 80% – 90% of cases, patients presenting with sudden blood loss are at risk for... |
|
Definition
| decreased tissue perfusion and oxygen-carrying capability, which can affect every organ system in the body. If the patient has active, acute bleeding, begin resuscitation efforts immediately. As always, an assessment of airway, breathing, and circulation is a top priority. Protection of the airway with intubation may be needed to avoid respiratory compromise from aspiration of blood, especially in patients with altered mental status. Provide oxygen as needed, and begin cardiac monitoring. For patients in hypovolemic shock, they will require IV fluid volume replacement. Insert at least two large-bore IV catheters and administer normal saline, the fluid of choice, to maintain mean arterial pressure at 60 mm Hg or higher. Do not use normal saline for patients with liver disease, however, as it may lead to ascites; use Ringer’s lactate solution instead. |
|
|
Term
| a pt with a hx of cirrhosis of the liver has been admitted to the ER with massive, bright red hematemesis. The nurses first priority is to: a) initiate 2 IV lines with 18 gauge catheters b) prepare for endoscopy by performing a gastric lavage with NS c) perform a focused nursing assessment d) draw blood to be sent to the lab for a type & cross match |
|
Definition
| c) perform a focused assessment - The nurse must first assess for signs of shock by checking VS, urine output, and signs of decreased peripheral perfusion. Remember, in most situations assessment comes first. |
|
|
Term
| Deep tenderness at ___________ point is a sign of acute appendicitis. Where is this located? |
|
Definition
| McBurney's Point - it is located midway between the anterior iliac crest and the umbilicus in the right lower quadrant. "Rebound" tenderness occurs when the tissue that lines the abdominal cavity (the peritoneum) is irritated, inflamed, or infected. See:Peritonitis. |
|
|
Term
| Gastric & Duodenal Ulcers are most commonly caused by _________. |
|
Definition
|
|
Term
| What are the differences in pain between a person who has a gastric ulcer & a person who has a duodenal ulcer? |
|
Definition
| Gastric Ulcers have pain right after they eat (30-60 minutes after a meal & rarely at night, pain is accentuated by the ingestion of food). Duodenal Ulcers have pain quite a bit after a meal (1.5-3 hours after they eat, pain is often at night & awakens them at 1-2 am, they are relieved by the ingestion of food). |
|
|
Term
| What physical findings would confirm the diagnosis of Cholecystitis/Cholelithiasis (Gallstones)? |
|
Definition
| episodic pain in right upper quadrant that radiates to the right shoulder or back, pain begins about an hour after eating & may last 1-5 hrs, pain is caused by contraction of the gallbladder (in response to a fatty meal) against a gallstone in the cystic duct, pain is often described as intense & dull and typically subsides after several hours, when the galbladder stops contracting and the stone falls back into the gallbladder. Gallbladder pain can include diaphoresis, nausea & vomiting. |
|
|
Term
| What diagnostic tests confirm Cholelithiasis/Cholecystitis (Gallstones)? |
|
Definition
| Abdominal Sonograms: features acute cholecystitis includes gallbladder wall thickening (more than 5 mm), pericholecystic fluid, gallbladder distention (more than 5 cm) and a sonographic Murphy sign. Labs: WBC elevation. |
|
|
Term
| ID common underlying factors that contribute to the etiology of acute cholecystitis. |
|
Definition
| Obesity, high-fat diet, and hypertriglyceridemia are strongly associated w/ the formation of gallstones. Also, estrogen therapy, advancing age is a major risk factor, pregnancy. |
|
|
Term
| Which of the following meds are usually NOT given to clients for pain with gallbladder disease? a. Morphine b. Lomine c. Bentyl d. Demerol |
|
Definition
| Analgesics such as Meperidine (DEMEROL) are given to help gallbladder pain. Narcotics like Morphine are not advised. |
|
|
Term
| What is the usual surgical treatment for Cholecystitis (Gallbladder disease)? |
|
Definition
| elective cholecystectomy is the treatment of choice for symptomatic cholelithiasis (laproscopic if possible) |
|
|
Term
| If an exploratory laparotomy & cholecystectomy (gallbladder removal) is done with a T-Tube placement, what is the purpose of the T-tube placement? |
|
Definition
| Allows for healing of the common bile duct while providing method for drainage of bile. |
|
|
Term
| How does a nurse manage the t-tube best? |
|
Definition
| Keep the drainage system BELOW the level of the gallbladder! Also, empty and record output q 8 hrs. note color and consistenct of drainage on unit flow sheet. If applicable, assess T-tube insertion site for erythema, edema, tenderness, warmth & purulent drainage. Also assess for any leakage aroung the tube insertion site & skin excoriation. |
|
|
Term
| How long does the t-tube stay in place? |
|
Definition
| 7-10 days, a t-tube cholangiogram will be done to assess patency of the common bile duct before removal of t-tube |
|
|
Term
| Contrast Laparoscopic cholecystectomy with one done via a laparotomy... |
|
Definition
| Laparatomy is a shorter hospital stay, smaller incision with faster healing time, quicker return to work d/t lack of large abd incision. |
|
|
Term
| Dietary intake of fat following a cholecystectomy should be... |
|
Definition
| added slowly to determine tolerance level |
|
|
Term
| Patient comes to the ER with severe abd pain & is given a diagnosis of acute pancreatitis. List the clients data subjective & objective relevant to acute pancreatitis. |
|
Definition
| Pain is usually centered in the upper middle or upper left abdomen. THe pain may feel as if it radiates through to the back. The pain often begins or worsens after eating. The pain may feel worse when a person lies flat on their back. Nausea, vomiting, fever, tachycardia and abd distention may occur. Weakness, irritability, confusion and SHOCK may occur. |
|
|
Term
| What are the 2 serum studies "cardinal" to the diagnosis of pancreatitis? |
|
Definition
|
|
Term
| True or False? Abdominal Pain is the most prominent symptom of pancreatitis. |
|
Definition
|
|
Term
| True or False? Anticholinergics are given to increase vagal stimulation, increase GI motility and inhibit pancreatic enzyme and bicarbonate volume & concentration. |
|
Definition
|
|
Term
| True or False? Pain management for acute pancreatitis should begin with rapid infusion of opioids by means of a PCA pump. |
|
Definition
|
|
Term
| True or False? Helping the client to assume a cross-legged position may decrease the abd pain of pancreatitis. |
|
Definition
|
|
Term
| True or False? Surgical intervention for acute pancreatitis is usually not indicated. |
|
Definition
|
|
Term
| True or False? The client in the early stages of acute pancreatitis is usually maintained on NPO status. |
|
Definition
|
|
Term
| True or False? If Total Parenteral Nutrition is used for nutritional support, the nurse assesses for the glucose intolerance by monitoring for decreased blood glucose levels. |
|
Definition
| False. Glucose levels RISE in pancreatitis patients. |
|
|
Term
| Contrast Acute vs Chronic Pancreatitis... |
|
Definition
| Pain is less common in chronic pancreatitis. Chronic pancreatitis patients have an inability to produce insulin. Chronic pancreatitis patients have weight loss, bleeding and liver dysfunction. |
|
|
Term
| What are 5 common complications of chronic pancreatitis? |
|
Definition
| Steatorrhea, Malnutrition, Pseudo cysts and abcess, narcotic addiction, hyperglycemia, stenosis of the common bile duct |
|
|
Term
| What pain med is appropriate for pancreatitis? |
|
Definition
| Meperidine (Demerol) along with an antiemetic is preferred over the use of morphine b/c morphine may cause spasm of the sphincter of Oddi, which has the potential to worsen the condition. |
|
|
