326 final

relationship/ potential impact of PBH on kidney function

-bacteria can migrate up to kidneys - post-renal acute issues - back flow of utine into kidneys

serum creatine

0.6 - 1.3 mg/dL Measures somatic protein; related to muscle mass Excreted by kidneys with little reabsorption With BUN assesses kidney function May indicate muscle wasting

assessment before giving laxatives/stool softeners

- abdominal assessment - last bm - what was the stool like (color, consistancy, amount) to get a baseline, determine what meds are indicated and to determine if its working/needed

Estimated Glomerular Filtration Rate (eGFR)

- below 15 ml/min = kidney failure - above 60 ml/min = ideal - above 90 ml/min = normal *do not need to know staging of chronic kidney disease based of GFR A glomerular filtration rate (GFR) test shows how well your kidneys are working. It may be done to diagnose or monitor chronic kidney disease. A blood test will be done to measure the amount of creatinine in your blood. This level of creatinine is used in a formula to calculate the GFR. Other factors are used to calculate GFR. These include age, gender, weight, height, and race.

pt w/ cirrhosis develops severe constipation: what concerns do we have?

- build up of toxins - can bleed excessively (especially if clotting factors are gone too) - rupture of varices in GI venous system from portal hypertension

newborn with jaundice: relationship to GI functioning?

- change in stool color -> pale, yellow - poor feeding - isn't gaining weight

newborn with jaundice: critical client teaching?

- educate on signs of jaundice and when to call doctor Your baby's skin becomes more yellow The skin on your baby's the abdomen, arms or legs looks yellow The whites of your baby's eyes look yellow Your baby seems listless or sick or is difficult to awaken Your baby isn't gaining weight or is feeding poorly Your baby makes high-pitched cries Your baby develops any other signs or symptoms that concern you

what factors are considered in decision making for dialysis

- kidney failure - kidney transplant - hyperkalemia - acute kidney injury - GFR = 15 or less - diabetes and hypertension (predisposed to kidney disease) - uramic symptoms (nausea, pruritus, malaise, confusion/neurologic sx) - uncompensated metabolic acidosis (inadverting overdose of medication (acute))

patient is prescribed clindamycin - how will that affect GI system? what if they develop diarrhea?

- kills good bacteria = risk for c.diff > assess smell, amount, frequency - can increase/cause diarrhea

pt w/ cirrhosis develops severe constipation: what assess ments, treatments, and evaluations are anticipated>

- lactulose

pt w/ liver dysfunction appears

- malnourished - decreased energy muscle wasting - ascites (abnormal accumulation of fluid in the abdomen) - ~1.4 L/min of blood flows through liver, back up can cause problems like portal hypertention

exocrine functions

- pancreases acini release enzymes for digestion - enzymes secreted by pancreas in in-active form - enzymes activated once in duodenum - digestive enzymes break down carbohydrates, fats, and proteins

pt w/ cirrhosis develops severe constipation: what could have prevented this?

- proper nutrition - increased fluid intake - fiber

function of kidneys

- regulate fluid volume - regulate acid-base balance - regulate electrolyte balance - influence hormone and immune regulation

pt w/ cirrhosis develops severe constipation: why would a pt w/ cirrhosis be on diuretics? (why could they contribute to a problem?)

- to aid w/ fluid buildup can result from liver impairment - decrease portal hypertension

Serum Electrolytes

* Mg+ 1.5-2.5 * Phos 2.5-4.5 * K+ 3.5-5 * Ca 8.5-10.9 * Chl 95-105

Loperamide (Imodium)

*class*: antidiarrheal *Indication* acute diarrhea, decrease drainage post ileostomy *Action*: inhibits peristalsis, reduces the volume of feces while increasing the bulk and viscosity *Nursing Considerations*: -may lead to constipation - insure proper use - assess bowel function - assess fluid and electrolyte levels

Indications for dialysis

-Renal failure that can no longer be controlled by conservative management -Worsening of uremic syndrome associated with end-stage renal disease (ESRD) -Severe electrolyte and/or fluid abnormalities that cannot be controlled by simpler measures

blood urea nitrogen (BUN)

8-20 mg/dL A common blood test, the blood urea nitrogen (Bterm-57UN) test reveals important information about how well your kidneys and liver are working. A BUN test measures the amount of urea nitrogen that's in your blood.

When blood pressure is lower than normal, the juxtaglomerular cells will secrete: A Renin B Aldosterone C Anti-diuretic Hormone (ADH) D Erythropoietin

A A drop in BP signals the release of renin, and begins the RAAS system. Follow-up question: Where is aldosterone secreted from? - glomerulosa cells of the adrenal cortex in the adrenal gland What does it do? - Increases reabsorption of sodium and increases secretion of potassium Erythropoietin (EPO) is a hormone produced primarily by the kidneys. It plays a key role in the production of red blood cells (RBCs). ADH is a hormone made by the hypothalamus, stored in the posterior pituitary gland, and when released tells the kidneys how much water to conserve. ADH constantly regulates and balances the amount of water in your blood.

After a thyroidectomy, the client develops a positive Trousseau's sign. What medication does the nurse anticipate that the provider will order? A Administer calcium gluconate B Administer potassium chloride C Administer liothyronine therapy D Administer levothyroxine therapy

A Damage to the parathyroid glands can inadvertently occur during a thyroidectomy. This may cause a decrease in serum calcium, which causes muscle hyperexcitability and tetany. The treatment for a client who develops hypocalcemia and tetany following a thyroidectomy is calcium gluconate. Hypokalemia (low potassium)does not cause a positive Trousseau's sign. Decreased thyroid hormones will not cause tetany, however, the client will have to take thyroid replacement therapy following a thyroidectomy. Trousseau's and Chvosteks sign are important assessments for hypocalcemia and are often conducted after a thyroidectomy to determine damage to the parathyroid.

Deoxygenated blood flows into the liver through which of the following? A Portal vein B Esophageal vein C Renal vein D Subclavian vein

A Follow up question: What is it called when a diseased liver cannot process the flow of blood from the portal vein? What are the resulting clinical manifestations?

In patients who have liver failure, which of the following results when synthesis and storage functions decline? A Hypoglycemic events B Encephalopathy C Drug toxicity D Hyperbilirubinemia

A The liver stores glycogen which provides glucose when broken down. The other answer choices, while all important aspects to liver disease, relate to the functions of metabolism and detoxification rather than the storage and synthesis functions of the liver.

Bilirubin levels

A bilirubin test measures the levels of bilirubin in your blood. Bilirubin is a yellowish pigment that is made during the normal breakdown of red blood cells. Bilirubin passes through the liver and is eventually excreted out of the body. Higher than normal levels of bilirubin may indicate different types of liver or bile duct problems. Occasionally, higher bilirubin levels may be caused by an increased rate of destruction of red blood cells (hemolysis). Bilirubin testing is usually done as part of a group of tests to check the health of your liver. Bilirubin testing may be done to: - Investigate jaundice — a yellowing of the skin and eyes caused by elevated levels of bilirubin. A common use of this test is to measure bilirubin levels in newborns to check for infant jaundice. - Determine whether there might be blockage in your bile ducts, in either the liver or the gallbladder. - Help detect liver disease, particularly hepatitis, or monitor its progression. - Help evaluate anemia caused by the destruction of red blood cells. - Help follow how a treatment is working. - Help evaluate a suspected drug toxicity.

In a diseased or damaged kidney specific gravity can be high or low. Pick one, and explain how it might occur.

A urine specific gravity test compares the density of urine to the density of water. This quick test can help determine how well your kidneys are diluting your urine. Urine that's too concentrated could mean that your kidneys aren't functioning properly or that you aren't drinking enough water. Urine that isn't concentrated enough can mean you have a rare condition called diabetes insipidus, which causes thirst and the excretion of large amounts of diluted urine.

A nurse is preparing to administer the medication atropine to a patient. Which assessment findings would make the nurse question whether this medication is safe to give? (Select all that apply): A Hypoactive bowel tones B Hard, dry stools C Loose watery stools D Tachycardia E Mild abdominal cramping

A, B, D Atropine is a medication that slows down the PNS....which decreases rest and digest - therefore, decreases peristalsis. As a result of decreasing the PNS, the SNS then yields a greater response...which leads to increased heart rate. We would question giving this medication if the patient already demonstrated signs of slowed peristalsis OR increased heart rate. Loose, watery stools can be found in "normal" diarrhea and would be an indication of appropriate antidiarrheal use. (with the exception of antibiotic use leading to C. Diff!, which the question does not indicate.) Mild cramps are also not a contraindication of administering an anti-diarrheal.

What patient assessment findings by the nurse indicate pulmonary edema? Select all that apply. A Crackles in lung bases B +2 Pedal pulses C Pulse oximetry reading of 96% D Anxiety E Difficulty breathing lying supine

A, D, E +2 pedal pulses is a normal finding of amplitude/strength of pulse. However, 2+ pitting pedal edema could be an indicator to assess the lung fields for crackles, indicating pulmonary edema. Anxiety occurs when a person has difficulty breathing. It is very common to have difficulty breathing particularly when lying flat with pulmonary edema.

urinalysis (UA)

Acidity (pH). The pH level indicates the amount of acid in urine. Abnormal pH levels may indicate a kidney or urinary tract disorder. Concentration. A measure of concentration, or specific gravity, shows how concentrated particles are in your urine. A higher than normal concentration often is a result of not drinking enough fluids. Protein. Low levels of protein in urine are normal. Small increases in protein in urine usually aren't a cause for concern, but larger amounts may indicate a kidney problem. Sugar. Normally the amount of sugar (glucose) in urine is too low to be detected. Any detection of sugar on this test usually calls for follow-up testing for diabetes. Ketones. As with sugar, any amount of ketones detected in your urine could be a sign of diabetes and requires follow-up testing. Bilirubin. Bilirubin is a product of red blood cell breakdown. Normally, bilirubin is carried in the blood and passes into your liver, where it's removed and becomes part of bile. Bilirubin in your urine may indicate liver damage or disease. Evidence of infection. If either nitrites or leukocyte esterase — a product of white blood cells — is detected in your urine, it may be a sign of a urinary tract infection. Blood. Blood in your urine requires additional testing — it may be a sign of kidney damage, infection, kidney or bladder stones, kidney or bladder cancer, or blood disorders.

urinary retention

def: unable to void/output is significantly lower than input causes: kidney disease, acute pain, chronic bladder infections, certain mediations, BPH, tumors, stones

other lab tests that can be ordered in addition to AST/ALT to assess liver function. (May be too hard?)

Alkaline phosphatase (ALP). ALP is an enzyme found in the liver and bone and is important for breaking down proteins. Higher-than-normal levels of ALP may indicate liver damage or disease, such as a blocked bile duct, or certain bone diseases. Albumin and total protein. Albumin is one of several proteins made in the liver. Your body needs these proteins to fight infections and to perform other functions. Lower-than-normal levels of albumin and total protein may indicate liver damage or disease. Bilirubin. Bilirubin is a substance produced during the normal breakdown of red blood cells. Bilirubin passes through the liver and is excreted in stool. Elevated levels of bilirubin (jaundice) might indicate liver damage or disease or certain types of anemia. Gamma-glutamyltransferase (GGT). GGT is an enzyme in the blood. Higher-than-normal levels may indicate liver or bile duct damage. L-lactate dehydrogenase (LD). LD is an enzyme found in the liver. Elevated levels may indicate liver damage but can be elevated in many other disorders. Prothrombin time (PT). PT is the time it takes your blood to clot. Increased PT may indicate liver damage but can also be elevated if you're taking certain blood-thinning drugs, such as warfarin.

difference between uremia and azotemia

Azotemia is regarding the elevated lab values. So, if you have a BUN greater than 20 mg/dL and creatinine levels greater than 1.3 mg/dL, then you have azotemia (it's the increase of nitrogenous wastes accumulating in the body). Uremia is then the signs and symptoms of having azotemia, or accumulation of these nitrogenous waste products, which can cause things like heart palpitations and hyperkalemia (think of it that you don't have adequate kidney function, so you're holding in extra potassium leading to heart dysrhythmias), heart failure, pulmonary edema, peptic ulcers. Uremia causes a lot and this accumulation of waste products affects really every body system

The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of a headache and nausea and is extremely restless. The nurse assesses the client and determines they are hypovolemic. What is the next most appropriate nursing action? A Monitor the client. B Notify the health care provider. C Elevate the head of the bed. D Medicate the client for nausea.

B The presentation of the patient in context with just completing hemodialysis (HD) is too emergent to just "monitor". Elevating the HOB may be contraindicated in hypovolemia. In hypvolemia we are concerned about perfusion to the brain, and may instead want to lower the HOB. Giving meds for nausea will not correct the underlying problem of hypovolemia. The nurse should notify the provider for orders to get labs and replace fluids and electrolytes (albeit cautiously!)

Which acid-base imbalance is caused by chronic renal failure, loss of bicarbonate during severe diarrhea, or metabolic disorders that result in overproduction of lactic acid? A Metabolic alkalosis B Metabolic acidosis C Respiratory alkalosis D Respiratory acidosis

B The kidneys have two very important roles in maintaining the acid-base balance: They reabsorb bicarbonate from urine. They excrete hydrogen ions into urine. They are ineffective in these roles in the presences of disease/failure. In CKD there is a particular problem with retaining bicarb. Metabolic acidosis arrives from one of two problems: not enough bicarb or too much acid.

A patient has surgery and the estimated blood loss is 900 mL. This patient is most likely to experience which type of renal injury? A Post-renal B Glomerulonephritis C Pre-renal D Intra-renal

C Estimated Blood Loss (EBL) of 900ml or more indicates a significant blood volume loss that can affect perfusion to vital organs and be a precursor to the development of shock. Inadequate perfusion to the kidneys causes a pre-renal injury.

Approximately 25% of cardiac output (blood) is filtered by the renal corpuscle each minute. What lab value describes this process? A Creatinine Clearance B Serum Creatinine C Glomerular Filtration Rate D Blood Urea Nitrogen

C Glomerular Filtration Rate (GFR) is correct. Follow up question: What (GFR) rate is considered normal? - above 60 ml/min = ideal - above 90 ml/min = normal What (GFR) rate is the need for dialysis considered? - below 15 ml/min = kidney failure

Which of the following is true about liver function? A The liver stores glucose, synthesizes clotting factors, and secretes angiotensin converting enzymes and protease. B The liver detoxifies ammonia into urea, deaminates proteins into amino acids, and secretes aldosterone. C The liver synthesizes serum albumin and clotting factors, stores glycogen, and detoxifies metabolic waste. D The liver secretes glucagon, synthesizes serum albumin, and detoxifies ammonia.

C The liver stores glycogen, not glucose. The hormone glucagon signals to the liver to breakdown glycogen to form glucose when needed. The liver secretes angiotensinogen, not ACE. The liver DOES synthesize (make) clotting factors and albumin, deaminates proteins, and detoxifies ammonia into urea.

A patient had abdominal surgery three days ago. Today, you notice the patient has absent bowel sounds, abdominal distention, vomiting and a respiratory rate of 26. Which lab value is associated with this patient's clinical symptoms? A Tachypnea B Hematocrit 53% C Arterial pH of 7.33 D Concentrated, dark yellow urine

C The patient's clinical symptoms indicate a possible bowel obstruction, which could lead to acid-base imbalance. The lab value most associated with that from the answer choices is pH of 7.33. Concentrated urine and tachypnea are clinical manifestations and not lab values. A tip to read question stems carefully.

bowel retention

Causes: Ignoring the "urge to go", decreased movement, constipation (no BM for 3 days or longer), ileus, certian medication *longer BM is retained the harder and drier it becomes

Identify consequences of impaired hepatic function and the impact on the patient

Common clinical manifestations of Hepatic Dysfunction 1. Jaundice, resulting from increased bilirubin concentration in the blood 2. Portal hypertension, ascites, and varices, resulting from circulatory changes within the diseased liver and producing severe GI hemorrhages and marked sodium and fluid retention 3. Nutritional deficiencies, which result from the inability of the damaged liver cells to metabolize certain vitamins; responsible for impaired functioning of the central and peripheral nervous systems and for abnormal bleeding tendencies 4. Hepatic encephalopathy or coma, reflecting accumulation of ammonia in the serum due to impaired protein metabolism by the diseased liver.

The nurse monitors a client with cirrhosis for the development of hepatic encephalopathy. Which would be an indication that hepatic encephalopathy is developing? A Elevated blood pressure B Labored respirations C Decreased urine output D Decreased mental status

D See Liver Failure Case Study

fluid volume status: relationship to urinary function

DKA -> increased thirst, increased urination, dehydration - increased glucose it taking water out of cells and is being excreted through urination decreased hydration -> decreased urination

In general, what is included in a basic metabolic panel/complete metabolic panel (BMP/CMP) and what is it useful for?

Glucose, a type of sugar and your body's main source of energy. Calcium, one of the body's most important minerals. Calcium is essential for proper functioning of your nerves, muscles, and heart. Sodium, potassium, carbon dioxide, and chloride. These are electrolytes, electrically charged minerals that help control the amount of fluids and the balance of acids and bases in your body. Albumin, a protein made in the liver. Total protein, which measures the total amount of protein in the blood. ALP (alkaline phosphatase), ALT (alanine transaminase), and AST (aspartate aminotransferase). These are different enzymes made by the liver. Bilirubin, a waste product made by the liver. BUN (blood urea nitrogen) and creatinine, waste products removed from your blood by your kidneys.

life span considerations for elimination

Infants, toddlers, & children - infants and toddlers do not have urinary/ bowel control yet -> urinary and bowel incontinence Pregnancy - using an epidural or anesthetics - weakened pelvic floor - may use straight catheters - uterus pushing on bladder Old age - comorbidities - higher incidence of BPH - may have lots of medications -immobility

things that can elevate AST/ALT liver enzyme levels and why

More common causes of elevated liver enzymes include: - Over-the-counter pain medications, particularly acetaminophen (Tylenol, others) - Certain prescription medications, including statin - drugs used to control cholesterol - Drinking alcohol - Heart failure - Hepatitis A - Hepatitis B - Hepatitis C - Nonalcoholic fatty liver disease - Obesity Other possible causes of elevated liver enzymes include: - Alcoholic hepatitis (severe liver inflammation caused by excessive alcohol consumption) - Autoimmune hepatitis (liver inflammation caused by an autoimmune disorder) - Celiac disease (small intestine damage caused by gluten) - Cytomegalovirus (CMV) infection - Epstein-Barr virus - Hemochromatosis (too much iron stored in your body) - Liver cancer - Mononucleosis - Polymyositis (inflammatory disease that causes muscle weakness) - Sepsis (an overwhelming bloodstream infection that uses up neutrophils faster than they can be produced) - Thyroid disorders - Toxic hepatitis (liver inflammation caused by drugs or toxins) - Wilson's disease (too much copper stored in your body)

lactulose

PO or rectal - works to decrease ammonia production and trap it in the GI tract (more common) - may be used to treat constipation cirrosis - still give for cirrosis even if pt already has diarrhea - if given for constipation stop giving once stool is loose - can be used for duel purposes assessment prior to admin: - liver function - ammonia level - hydration - current LOC/mental status - abdominal assessment/BM expected side effects - loose stools/diarrhea

PTT PT INR

Prothrombin Time (PT) Measures the time it takes for the plasma of the blood to clot Normal range: 12 - 15 seconds PTT - partial thromboplastin time Measures how long it takes the blood to clot Normal range: 30 - 45 seconds INR Normal Range 0.8 - 1.2

How would you assess for peritonitis in a patient receiving peritoneal dialysis?

Signs and symptoms of peritonitis include: - Abdominal pain or tenderness - Bloating or a feeling of fullness in your abdomen - Fever - Nausea and vomiting - Loss of appetite - Diarrhea - Low urine output - Thirst - Inability to pass stool or gas - Fatigue - Confusion If you're receiving peritoneal dialysis, peritonitis symptoms may also include: - Cloudy dialysis fluid - White flecks, strands or clumps (fibrin) in the dialysis fluid DIAGNOSTICS Blood tests. A sample of your blood may be drawn and sent to a lab to check for a high white blood cell count. A blood culture also may be performed to determine if there are bacteria in your blood. Imaging tests. Your doctor may want to use an X-ray to check for holes or other perforations in your gastrointestinal tract. Ultrasound also may be used. In some cases, your doctor may use a computerized tomography (CT) scan instead of an X-ray. Peritoneal fluid analysis. Using a thin needle, your doctor may take a sample of the fluid in your peritoneum (paracentesis), especially if you receive peritoneal dialysis or have fluid in your abdomen from liver disease. If you have peritonitis, examination of this fluid may show an increased white blood cell count, which typically indicates an infection or inflammation. A culture of the fluid may also reveal the presence of bacteria.

Explain what is meant by the lab test Fecal occult blood AND explain when that test is helpful.

The fecal occult blood test (FOBT) is a lab test used to check stool samples for hidden (occult) blood. Occult blood in the stool may indicate colon cancer or polyps in the colon or rectum — though not all cancers or polyps bleed. Typically, occult blood is passed in such small amounts that it can be detected only through the chemicals used in a fecal occult blood test. If blood is detected through a fecal occult blood test, additional tests may be needed to determine the source of the bleeding. The fecal occult blood test can only detect the presence or absence of blood — it can't determine what's causing the bleeding.

Enemas

The injection of liquid into the rectum through the anus for cleansing or stimulating bowel movement.

serum ammonia

This test measures the level of ammonia in your blood. Ammonia, also known as NH3, is a waste product made by your body during the digestion of protein. Normally, ammonia is processed in the liver, where it is changed into another waste product called urea. Urea is passed through the body in urine. If your body can't process or eliminate ammonia, it builds up in the bloodstream. High ammonia levels in the blood can lead to serious health problems, including brain damage, coma, and even death. High ammonia levels in the blood are most often caused by liver disease. Other causes include kidney failure and genetic disorders.

teaching points a nurse should give to a client who is ordered a creatinine clearance test (24 hour urine).

What Is a Creatinine Test? A creatinine test, also called a serum creatinine test, is a way for doctors to measure how well your kidneys are working. Creatinine is a waste product from the normal breakdown of muscle tissue. As your body makes it, it's filtered through your kidneys and expelled in urine. Your kidneys' ability to handle creatinine is called the creatinine clearance rate, and this helps estimate how fast blood is moving through your kidneys, called the glomerular filtration rate (GFR). Urine tests. Creatinine clearance can be pinpointed by measuring the amount of creatinine in a sample of pee collected over 24 hours. For this method, you store all your urine in a plastic jug for one day and then bring it in for testing. This method is inconvenient, but it may be necessary to diagnose some kidney conditions.

complete blood count (CBC)

White blood cells (WBCs). These help your body fight germs. If you have too many of them, it could be a sign of inflammation, infection, a medical reaction, or another health condition. If it's low, you could be at a higher risk for infection. A medication, a viral infection, or a bone marrow disease could also cause a low count. Red blood cells (RBC). These deliver oxygen throughout your body. They also help carry carbon dioxide. If your RBC count is too low, you may have anemia or another condition. Hemoglobin (Hb or Hgb). This is the protein in your blood that holds oxygen. Hematocrit (Hct). This test tells how much of your blood is made up of red blood cells. A low score may be a sign that you don't have enough iron, the mineral that helps your body make red blood cells. A high score could mean you're dehydrated or have another condition. Mean corpuscular volume (MCV). This is the average size of your red blood cells. If they're bigger than usual, your MCV will be higher. That could happen if you have low vitamin B12 or folate levels. If your red blood cells are smaller, you could have a type of anemia. Platelets. These help your blood clot. Red blood cell count Male: 4.35-5.65 trillion cells/L*(4.35-5.65 million cells/mcL**) Female: 3.92-5.13 trillion cells/L(3.92-5.13 million cells/mcL) Hemoglobin Male: 13.2-16.6 grams/dL (132-166 grams/L) Female: 11.6-15 grams/dL(116-150 grams/L) Hematocrit Male: 38.3-48.6 percent Female: 35.5-44.9 percent White blood cell count 3.4-9.6 billion cells/L(3,400 to 9,600 cells/mcL) Platelet count Male: 135-317 billion/L(135,000 to 317,000/mcL) Female: 157-371 billion/L(157,000 to 371,000/mcL)

atropine

anti-cholinergic drug acts on muscarinic receptors. anti-parasympathetic drug, blocks the Parasympathetic NS not stimulating the Sympathetic NS mostly used for other reasons such as heart problems so assess heart heart, but also can result in constipation which can help treat diarrhea

newborn with jaundice: anticipated assessments, treatments, evaluations?

assessments: - skin color - gestational age - feeding habits - bilirubin - CBC - head circumference - stool assessment - coombs test treatments: fluids -> A loss of fluids (dehydration) will cause bilirubin levels to rise. Enhanced nutrition. To prevent weight loss, your doctor may recommend more-frequent feeding or supplementation to ensure that your baby receives adequate nutrition. phototherapy. Babies lie under lights with little clothing so their skin is exposed. The light changes the bilirubin to a form that can easily pass out of the body. Light-therapy blankets may also be used. exchange blood transfusion. This emergency procedure is done if very high bilirubin levels do not come down with phototherapy. The baby's blood is replaced with blood from a donor to quickly lower bilirubin levels. intravenous immunoglobulin (IVIg). Babies with blood type incompatibilities get this through an IV (into a vein). IVIg blocks antibodies that attack red blood cells and reduces the need for an exchange transfusion.

elevated BUN and serum creatinine =

azotemia seeing s/sx of those increased wastes? -> then the pt has uremia

bowel stimulants

bisacodyl - PO, PR senna - PO, tea most commonly abused don't chew or crush basacodyl senna may cause a harmless discoloration to urine cramping may occur 2-12hrs

Explain the relationship between serum blood urea nitrogen (BUN) and glomerular filtration rate (GFR).

both help determine kidney function

Rectal Suppositories

bowel stimulants bisacodyl, senna -Position client in left lateral position** -Insert suppository just beyond internal sphincter -Instruct client to retain medication 20 to 30 min for stimulation of defecation and 60 min for systemic absorption

fluid volume status: relationship to hepatic function

cirrhosis -> fluid overload -> ascites ascites -> accumulation of fluid in the peritoneal cavity cirrhosis can be caused by chronic heart failure which can cause fluid to back up in your liver complication of cirrhosis -> portal hypetension -. which can cause ascites and kidney failure

uremia

clinical manifestations of waste accumulation (uremia is the underlying cause of a majority of systemic effects)

urinary incontinence

cause: atrophy of muscles, decreased pelvic floor control definition: involuntary release of urine assess for: skin breakdown, bladder scanner risk factors: age, giving childbirth (especially to multiples), pregnancy, heavy lifting, increased stress/pressure, spinal cord injury *client may deny or be reluctant to reveal

newborn with jaundice: concerns related to development?

common in babies born before 38 weeks gestation and some breast fed babies usually occurs because babies liver isn't mature enough to get rid of bilirubin in bloodstream, In some babies, an underlying disease may cause infant jaundice. Rarely, an unusually high blood level of bilirubin can place a newborn at risk of brain damage, particularly in the presence of certain risk factors for severe jaundice. complications: - acute bilirubin encephalopathy -> bilirubin passing into the brain causing brain damage - kernicterus -> acute bilirubin encephalopathy causes permanent damage to the brain

what changes do you expect pre/post dialysis

consider: weight, BP, labs, CMP/BMP

Identify consequences of impaired elimination r/t bowel retention and the impact on the patient

constipation - pain - rectal prolapse - hemorrhoids - anal fissures

how does BPH later urinary elimination? or contribute to an infection?

creates an obstruction in the urethra resulting in urinary retention can cause infection if urine is sitting to long which allows for bacteria to grow. can also cause infection if BPH results in a rupture which could even cause sepsis

fecal impaction

def: the prolonged retention and buildup of feces in the rectum, large hard mass that cannot be pushed out causes: prolonged constipation treatment: surgical removal, manual removal ostomy

bowel incontinence

def: loss of bowel control, causing you to pass stool unexpectedly causes: atrophy, childbirth, diarrhea, impaired cognition, prolonged constipation

peritoneal dialysis

dialysis in which the lining of the peritoneal cavity acts as the filter to remove waste from the blood frequency: overnight or up to 4x per day everyday pros: - self managed - 20-30min duration - can be done overnight - beneficial if you live far from a clinical/hospital - can be at home (less time transporting to hospital) - less dramatic fluid shifts d/t frequency cons: - learn new skills for either pt or family member - no days off - can have retained fluid during day - those with critical, cognitive, and other co-morbidity problems prevents a pt from having this treatment available

fluid volume status: relationship to GI function

diarrhea, vomiting, GI suctioning -> causes hypovolemia constipation -> can result from decreased fluid volume IBD/IBS -> can cause dehydration

Stool Softeners

docusate sodium (Colace) - drink w/ full glass of liquid - BM in 24-72hr

meds common for kidney disease

epoetin Alfa - "Epe Gen" - stimulates RBC production assess - pale, tired, fatigued, dizzy, activity tolerance - CBC- RBC, H/H Kayexalata - PO or rectal - decrease K+ through stool sodium bicarb - treats metabolic acidosis - if over-treat can cause metabolic alkalosis Insulin + D50W - dextrose 50% water - prevents hypoglycemia by giving insulin + dextrose - insulin treats hyperkalema by bringing K+ into the cell

fluid and dietary considerations on dialysis

hemodialysis fluids - restriction - decreased intake - 1000mg protein - 1.2 g/kg/day K+ - 2.4 g/day peritoneal dialysis fluids - none if weight and BP are stable protein - 1.3 g/kg/day K+ not restricted

relationship/ potential impact of PBH on liver function

hepatotoxic = macrolides

impaired kidney function example

impaired kidney function -> electrolyte imbalances -> potassium normally excreted by kidneys -> potassium retention -> at risk for hyperkalemia

Identify consequences of impaired elimination r/t a loss of control and the impact on the patient

impaired skin integrity - infection - pain impaired body image - may not want to go out - may be embarrassed - social impairment

azotemia

increased levels of nitrogenous waste products (ie. urea, creatine) - increased creatine, increased BUN

Identify consequences of impaired elimination r/t urinary retention and the impact on the patient

infection - pain - superinfection - infection can spread up to kidneys bladder rupture - pain - infection/sepsis - death

fluid volume status: relationship to renal function

kidney failure -> hypervolemia kidney obstruction -> kidney infection -> decreased urinary output

fecal occult blood test

lab test performed to detect blood in the feces

Drugs for detoxification

lactulose

contraindications for laxatives/stool softeners

laxatives: - severe abdominal pain - cramps - appendicitis - ulcerative colitis - bowel obstruction acute surgical abdomin fecal impaction/bowel obstruction magnesium and sodium phosphate: (milk of magnesia) - avoid if pt has kidney problem

In what organ is angiotensinogen produced?

liver

ALT/AST

liver function test Alanine transaminase (ALT). ALT is an enzyme found in the liver that helps convert proteins into energy for the liver cells. When the liver is damaged, ALT is released into the bloodstream and levels increase. Aspartate transaminase (AST). AST is an enzyme that helps metabolize amino acids. Like ALT, AST is normally present in blood at low levels. An increase in AST levels may indicate liver damage, disease or muscle damage

Anti-diarrheal

loperamide (Imodium) atropine (anti-cholinergic)

ABG

pH: 7.35-7.45 Partial pressure of oxygen (PaO2): 75 to 100 mmHg Partial pressure of carbon dioxide (PaCO2): 35-45 mmHg Bicarbonate (HCO3): 22-26 mEq/L Oxygen saturation (O2 Sat): 94-100% ABGs are drawn for a variety of reasons. These may include concern for: - Lung Failure - Kidney Failure - Shock - Trauma - Uncontrolled diabetes - Asthma - Chronic Obstructive Pulmonary Disease (COPD) - Hemorrhage - Drug Overdose - Metabolic Disease - Chemical Poisoning - To check if lung condition treatments are working

How to assess fistula

palpate to feel for a trill or vibration that indicates arterial and venous blood flow and patency. ausculate the vascular access with a stethoscope to detect a bruit or swishing sound that indicates patency

osmotic laxatives

polyethylene glycol (miralax) milk of magnesium (MOM) give w/ full glass of water higher dose will produce a BM faster 2-48hrs, depending on dose

precautions for laxatives/stool softeners

pregnancy and lactation

Provide educational points for preventing reliance on laxatives What assessments would you prioritize with Bowel elimination meds and why?

preventing laxative use - use only as last resort, frequent use can result in dependance - hydration - nutrition: fiber - exercise priority assessment - last BM -> to determine extent of constipation

normal function of the liver

production - clotting factors - decreased clotting factor -> increased risk of bleeding storage - Fe - vitamins -> fat soluble, A,D,E,K (vitamin K is for clotting) metabolization - carbohydrate - fat - proteins bile secretion - necessary for digestion and absorption of fats - elimination of waste products by secretion into bile > bilirubin, cholesterol, metabolites (liver problems increase these) detoxification - bacteria & toxins removed by kupffer cells (liver macrophes) - hepatocytes alter chemicals/foreign molecules to decrease toxicity and promote excretion - catabolism hormones (estrogen, testosterone) fat metabolism - breaks down triglycerides and fatty acids for energy; breakdown cholesterol for excretion - effects of decreased liver function > increased fatty acids > increased lipids > increased triglycerides > increased cholesterol protein metabolism - hepatocytes responsible for synthesis of plasma proteins (ie. albumin); break down AA for energy use; removal of ammonia carbohydrate metabolism - decreased glucose = glycogenolysis & gluconeogensis (stabalizes blood glucose when don't eat) - increased glucose in blood = store as glycogen

Bulk forming laxatives

psyllium, methylcellulose - fiber supplements - drink w/ full glass of liquid - BM in 24-72hrs

how to assess for peritonitis

redness, swelling, purulent drainage

laxatives

relieve constipation and facilitate passage of feces through the lower GI tract - bulk-forming agents - bowel stimulants - osmotic laxatives - lubricants

what do the kidneys retain? and what do they excrete?

retain - Na+ - HCO3- (base) excrete - K+ - H+ (acid) *kidneys job to excrete urea and creatine and synthesize and secrete ammonia (nitrogen + hydrogen)

Identify consequence of impaired renal function and the impact on the patient

risk for decreased cardiac output - due to fluid build up Risk factors may include - Fluid imbalances affecting circulating volume, myocardial workload, and systemic vascular resistance (SVR) - Alterations in rate, rhythm, cardiac conduction (electrolyte imbalances, hypoxia) - Accumulation of toxins (urea), soft-tissue calcification (deposition of calcium phosphate) Risk for Impaired Skin Integrity risk for impaired skin integrity - Altered metabolic state, circulation (anemia with tissue ischemia), and sensation (peripheral neuropathy) - Alterations in skin turgor (edema/dehydration) - Reduced activity/immobility - Accumulation of toxins in the skin Excess Fluid Volume Renal disorder impairs glomerular filtration that resulted to fluid overload. With fluid volume excess, hydrostatic pressure is higher than the usual pushing excess fluids into the interstitial spaces. Since fluids are not reabsorbed at the venous end, fluid volume overloads the lymph system and stays in the interstitial spaces leading the patient to have edema, weight gain, pulmonary congestion and HPN at the same time due to decrease GFR, nephron hypertrophied leading to decrease ability of the kidney to concentrate urine and impaired excretion of fluid thus leading to oliguria/anuria. Ineffective Tissue Perfusion: For optimal cell functioning the kidney excrete potentially harmful nitrogenous product-Urea, Creatinine, Uric Acid but because of the loss of kidney excretory functions there is impaired excretion of nitrogenous waste product causing in increase in Laboratory result of BUN, Creatinine, Uric Acid Level. Impaired Urinary Elimination: Renal Failure is a problem which results to loss of kidney functions and as GFR decrease, the kidney cannot excrete nitrogenous product and fluid causing impaired in Urinary elimination and together with prolonged use of medications such as NSAIDs this will lead to further kidney destruction which may thus decreasing the glomerular filtration and destroying of the remaining nephrons. This will result in to inability of the kidney to concentrate urine which makes the patient to have a nursing diagnosis of impaired urinary elimination.

docusate sodium (Colace)

stool softener

endocrine

the body's "slow" chemical communication system; a set of glands that secrete hormones into the bloodstream alpha - glucagon beta - insulin

What is dialysis?

the clinical purification of blood by dialysis, as a substitute for the normal function of the kidney. diffusion: solutes move from area of greater concentration to lesser concentration osmosis: fluid moves from area of lesser concentration to greater concentration (glucose added to dialysate)

hemodialysis

the process by which waste products are filtered directly from the patient's blood frequency: 4h 3x a week pros: - faster for critical kidney problem - efficient/effective hands-off for pts (docs, nurses etc present) cons: - fluid restrictions - food restriction - tired from treatment (cycling of blood, sitting for 4 hours) - transportation to hospital - fear of hospitals, needles, etc. may be distressing for some pts - more moniotring - risk for bleeding (heparin to prevent fistula from getting clogged) - may be too effective (bigger impact on BP, common for BP to drop low after treatment

creatinine clearance

timed urine collection + blood test measurement of the rate at which creatinine is cleared from the blood by the kidney Results are given in milliliters per minute (mL/min). The range for a normal test result depends on your age and gender. For adults younger than 40, normal levels are in these ranges: 107 to 139 mL/min or 1.78 to 2.32 mL/s (SI units) for men 87 to 107 mL/min or 1.45 to 1.78 mL/s (SI units) for women Creatinine clearance rates go down as you age. For every decade after age 40, a normal test result is 6.5 mL/min less than the numbers above. For newborns, the normal range is 40 to 65 mL/min. An abnormal creatinine clearance rate may mean you have a problem with your kidneys. Or it may mean a problem somewhere else in your body is affecting blood flow to the kidneys.