Acute Exam 4

• decreased urine output

• fluid retention

• edema in the lower extremities

• shortness of breath

• fatigue

• proteinuria

• disturbances in fluid and electrolyte balance

• disturbances in acid-base balance

• buildup of nitrogen based waste in the urine

• loss of kidney hormone function

Glomerular filtration- first process in urine formation, filters blood and pulls water, electrolytes, and small particles

• kidneys self regulate their blood pressure and blood flow so this is constant

• increased or decreased depending on blood pressure and blood flow

Tubular reabsorption- second process in urine formation, most water, electrolytes, and small particles are returned to the blood

• kidneys vary the volume or concentration of urine to help regulate fluid and electrolyte balance regardless of fluid intake

Tubular secretion- third process or urine formation, allows substances to move from the blood into the urine

• potassium and hydrogen ions are moved from the blood to the urine to maintain fluid and electrolyte balance and acid-base balance

Renin- assists in blood pressure control

• released when there is a decrease in blood flow, blood volume, or blood pressure through the renal arterioles, or there is too little sodium in kidney blood

• causes the production of angiotensin II which increases systemic blood pressure

• when blood flow to the kidney is reduced, it prevents fluid loss and maintains circulating blood volume

Prostaglandins- help regulate glomerular filtration, kidney vascular resistance, and renin production

• increase sodium and water excretion

Erythropoietin- produced and released in response to decreased oxygen in the kidney’s blood supply

• triggers RBC production in the bone marrow

Vitamin D- converted to active form in the kidneys

• activated vitamin D is needed to absorb calcium and regulate calcium balance

• to measure kidney size

• to evaluate contour to assess for injury, masses, or obstruction in kidneys or the urinary tract

• assess renal blood flow

• when contrast is used, ensure that there is sufficient oral or IV intake to dilute and excrete the contrast media

• it is potentially kidney damaging (nephrotoxic)

  • highest risk for older adults, dehydration, pre-existing CKD, diabetes, heart failure, current hypotension

  • those taking metformin should be temporarily discontinued before receiving contrast

• noninvasive method of estimating bladder volume

• used to screen for postvoid residual volumes

• determine the need for intermittent catheterization

• before scanning select male or female icon

• serum creatinine- no other condition besides kidney disease increases this, creatinine is excreted solely by the kidneys

• blood urea nitrogen (BUN)- kidneys filter this so if it is high it may indicate kidney disease

• glomerular filtration rate (GFR)

• color of urine

• odor of urine

• specific gravity

• allows exchange of wastes, fluid, and electrolytes to occur in the peritoneal cavity

• peritonitis (connection site contamination)

• pain

• exit site and tunnel infections

• fibrin clot formation

• dialysate leakage

• bleeding

• bowel perforation

• removes excess fluids and waste products and restores fluid and electrolyte and acid-base balance

• involves passing the patient’s blood through an artificial semipermeable membrane to perform the kidney’s filtering and excretion function

• hypotension

• dialysis disequilibrium syndrome

• cardiac events

• reaction to dialyzers

• access complications (thrombosis, stenosis, infection)

• an acute inflammation of the vermiform appendix that occurs most often among young adults

• condition where the appendix becomes inflamed and filled with pus

• occurs when the lumen (opening) of the appendix is obstructed which leads to infection as bacteria invades the walls of the appendix

• initial obstruction is usually a result of very hard pieces of feces

• rebound tenderness in the lower right abdominal quadrant

• nausea

• vomiting

• poor appetite

• fever

• appendectomy

• antibiotics

• if untreated can lead to infection (peritonitis) and systemic complications

• widespread chronic inflammation of the rectum and rectosigmoid colon but can extend to the entire colon

• periodic remissions and exacerbations

• bloody and mucusy stool

• tenesmus

• lower abdominal and colicky pain relieved with defecation

• malaise

• anorexia

• anemia

• dehydration

• fever

• weight loss

• drug therapy- aminosalicylates, glucocorticoids, antidiarrheal drugs, immunomodulators

• may be kept NPO to ensure bowel rest

• TPN

• nutrition therapy

• surgical management for complications of UC

• a chronic disease that presents inflammation in the digestive tract that causes thickened bowel walls

• can affect any part of the GI tract mouth to anus but usually affects the small intestine and the beginning of the large intestine

• recurrent with remissions and exacerbations

• diarrhea

• abdominal pain

• low grade fever

• weight loss

• anemia

• anti-inflammatory medications-NSAIDs

• steroids

• immunosuppressive drugs

• vitamins

• antibiotics

• Surgery- bowel resections

• self care- dietary fiber

• enemas

• TPN

• cancer of the large intestine

• highly curable, especially if diagnosed early

• major risk factors- older than 50, genetic predisposition, family history of cancer

• starts at 45

• colonoscopy every 10 years

• people who have a personal or family history will have screening beginning earlier and more frequently

• small growths covered with mucosa and attached to the surface of the intestine

• most are benign

• significant because some have the potential to become malignant

• radiation

• chemotherapy

• colon resection

• colectomy

• colostomy

• abdominoperineal resection

• life threatening acute infalmmation and infection of the visceral/parietal peritoneum and endothelial lining of the abdominal cavity

• contamination of the peritoneal cavity by bacteria or chemicals

• perforation- appendicitis, diverticulitis, peptic ulcer disease

• external penetrating wound

• gangrenous gallbladder or bowel segment

• bowel obstruction

• ascending infection through the genital tract

• rigid, board-like abdomen

• abdominal pain

• distended abdomen

• nausea, anorexia, vomiting

• diminishing bowel sounds

• inability to pass flatus or feces

• rebound tenderness in the abdomen

• high fever

• tachycardia

• dehydration from high fever

• decreased urine output

• hiccups

• possible compromise in respiratory status

• broad spectrum antibiotics

• abdominal surgery may be needed to identify and repair the cause

• tube feeding

• via NET, NG tube, or NDT

• PEG

If a patient cannot achieve adequate nutrition via oral intake

• those who can eat but cannot maintain adequate nutrition by oral intake of food alone (older adults or patients receiving cancer treatment)

• those with permanent neuromuscular impairment who cannot swallow (brain attack, severe head trauma, advanced MS)

• those who do not have permanent neuromuscular impairment but cannot eat because of their condition

• refeeding syndrome

• tube misplacement and dislodgment

• abdominal distension and nausea/vomiting- caused by overfeeding

• fluid and electrolyte imbalances

• this form of nutrition is introduced into the veins

• administered with an infusion pump

• an internal anastomosis of an artery to a vein

• do not take blood pressure on this arm

• takes 2-3 months to form

• is used for hemodialysis

• looped plastic tubing tunneled beneath the skin, connecting, an artery and a vein

• do not take blood pressure on this arm

• takes 1-3 weeks to be ready

• used for hemodialysis

• progressive, irreversible disorder, lasting more than 3 months

• when kidney function and waste elimination are too poor to sustain life, CKD becomes end-stage kidney disease (ESKD)

• different stages based on GFR

• affects all body systems

• patient is at risk for fluid overload

• ability to produce diluted urine is reduced

• urine output decreases

• extracellular volume can occur because the body loses the ability to secrete sodium

• in the later stages, kidney excretion of sodium is reduced as urine production decreases

• it only takes a small increase in dietary sodium to get hypernatremia because they do not have the ability to excrete it from their body

• sodium can seem falsely low because water is also being retained (dilution)

• to identify abnormalities of the bladder wall and urethral and ureteral occlusions

• to treat small obstructions of lesions via fulguration, lithotripsy, or removal with a stone basket

• an endoscopy scope is inserted through the urethra into the bladder, urethra, and lower portions of the ureters

• monitor for airway patency and breathing, changes in vital signs, changes in urine output, excessive bleeding, and infection

• observe for the complications of bladder puncture (severe pain, nausea, and vomiting)

• when kidney function decline is sudden and results in failure to maintain waste elimination, fluid and electrolyte balance, and acid-base balance

• occurs over a few hours or days

• can be a temporary condition that resolves or can progress to CKD

• affects many body systems, but not all

• reduced perfusion to the kidneys (blood or fluid loss, heart attack, sepsis, severe dehydration)

• damage to kidney tissue (glomerulonephritis, lupus, blood clot in nearby veins and arteries)

• obstruction of urine outflow (bladder cancer, cervical cancer, prostate cancer, kidney stones)

• increase of serum creatinine within 48 hours

• urine volume of less than 0.5/ml/hr for 6 hours

• decreased GFR (is not a good indicator because it can me impacted by many factors)

• symptoms from every body system

• extreme changes in…

  • creatinine

  • BUN

  • sodium

  • potassium

  • calcium

  • phosphorous

  • bicarbonate

  • hemoglobin

  • hematocrit

  • GFR

• widespread fibrotic (scarred) bands of connective tissue that change the liver’s anatomy and physiology

• in early disease the liver is enlarged and firm

• in later disease the liver shrinks and becomes harder

• Portal hypertension- persistent increase in pressure within the portal vein that happens due to obstruction or increased resistance of blood flow

• Ascites- collection of free fluid within the peritoneal cavity caused by increased hydrostatic pressure from portal hypertension

• Esophageal varices- when fragile, thin walled esophageal veins become distended and torturous from increased pressure

• Biliary obstruction

• Hepatic encephalopathy- complex cognitive syndrome that results from liver failure and cirrhosis

• chronic alcoholism

• chronic viral hepatitis

• bile duct disease

• hepatitis C

• hepatitis B

• hepatitis D

• nonalcoholic fatty liver disease

Early

• fatigue

• significant change in weight

• GI symptoms (anorexia, vomiting)

• pain in the abdominal area and liver tenderness

Late

• GI bleeding

• jaundice

• ascites

• spontaneous bruising

• RNA virus that can be killed by bleach

• spread via fecal-oral route by fecal contamination

Spread through…

• unprotected sex

• sharing needles

• blood transfusions

• direct contact with infected blood

• birth

• RNA virus

Spread through

• transmission is blood to blood

• illicit IV drug needle sharing

• blood, blood products, or organ transplant before 1992

• hemodialysis

• defective RNA virus

• occurs only with hepatitis B

• transmitted primarily by parenteral routes, mostly IV drug users or unprotected sex

• waterborne infection

• caused by fecal contamination of food and water

• not common in the US

• associated with aging, obesity, diabetes type II, and metabolic syndrome

• can progress to liver cancer, cirrhosis, or failure

• inflammation of the gallbladder

• can be acute or chronic

• episodic or vague upper abdominal pain or discomfort that can radiate to the right shoulder

• pain triggered by a high-fat or high-volume meal

• anorexia

• nausea and/or vomiting

• dyspepsia

• eructation

• flatulence

• feeling of abdominal fullness

• rebound tenderness

• fever

• jaundice, clay colored stools, dark urine

• steatorrhea

• calculous- chemical irritation and inflammation from gallstones that obstruct the cystic duct, gallbladder neck, or common bile duct

• acalculous- associated with biliary stasis caused by any condition that affects the regular filling or emptying of the gallbladder

• chronic- repeated episodes of cystic duct obstruction cause chronic inflammation

• treating the pain

• extracorporeal shock wave lithotripsy- breaks up large stones

• percutaneous transhepatic biliary catheter- opens blocked duct so bile can flow

• cholecystectomy- surgical removal of the gallbladder

• premature activation of excessive pancreatic enzymes that destroy ductal tissue and pancreatic cells, resulting in autodigestion and fibrosis of the pancreas

• trauma

• pancreatic obstruction (tumor, cysts, absecesses)

• metabolic problems (hyperlipidemia, hyperparathyroidism, hypercalcemia)

• alcoholism

• toxicities of drugs

• cigarette smoking and tobacco use

• CF

• gallstones

• hydration with IV fluids

• pain control

• drug therapy

• withhold food and fluids (NPO)

• surgical management is not usually indicated

• pancreatic infections

• hemorrhage

• acute kidney failure

• paralytic ileus

• hypovolemic shock

• pleural effusion

• acute respiratory distress syndrome

• atelectasis

• pneumonia

• multiorgan system failure

• DIC

• Type II diabetes

• mechanical obstruction

• nonmechanical obstruction

• indirect inguinal hernia

• direct inguinal hernia

• femoral hernia

• umbilical hernia

• incisional or ventral hernia

IBS D- diarrhea

IBS C- constipation

IBS A- alternating diarrhea and constipation

IBS M- mix of diarrhea and constipation

IBS D- antidiarrheal agents

IBS C- bulk forming laxatives

IBS A-

IBS M