AE2 Exam 2
Specific nursing actions for circulatory overload transfusion reaction
-Elevate HOB and give O2 -Give diuretics and morphine Give future transfusions at slower rate
Primary goals for the treatment of AKI
-Eliminate the *cause* -Manage signs and symptoms -Prevent complications -Ensure adequate intravascular volume and cardiac output
Patient education for management of UTIs
-Emphasize taking FULL course of antibiotics -Second or reduced drug may be ordered in susceptible patients -Watch urine for changes in color/consistency and cessation of symptoms -Counsel on persistance of lower tract symptoms beyond treatment or onset of flank pain or fever should be reported immediately (infection could be moving up toward the kidney)
Risks of (BPD-DS) surgery
-Enteric coated medications can pass all the way through the GI system without ever being absorbed -Much decreased absorption of nutrients -No pyloric sphincter -Dumping syndrome -Major surgery with multiple internal wounds -All the anastamoses = great chance for leakage of gastric juices (periotnitis) -Bowel adhesions
Classifications of breast cancer based on hormone receptor and genetic status
-Estrogen and progesterone receptor status (positive or negative) -HER-2 genetic status (positive or negative)
Best practices to prevent CAUTI
-Everyday ask if the catheter is needed -Hand hygiene -Aseptic technique on insertion -Tape tube to thigh to avoid tugging --Keep bag below bladder -Perineal care with soap and water
How are peptic ulcers formed
-Excessive HCl in the stomach leads to mucosa tissue damge -Results in cellular damage and inflammation
What are common restrictions HF patients may have
-FLUID RESTRICTIONS (they already have too much fluid) -Sodium restrictions
Signs and symptoms of febrile, non-hemolytic transfusion reaction
-Fever and chills -Headache -Flushing -Muscle pain -Anxiety
Signs/Symptoms of acute hemolytic transfusion reacrion
-Fever and chills -Lower back pain -Tachycardia -Tachypnea -Hypotension
Post-op suprapubic prostatectomy
-Foley catheter AND suprapubic catheter -Foley removed after 2-4 days -Suprapubic tube may cause bladder spasms
In someone with liver disease who has an elevated INR, what will we anticipate administering them
-Fresh Frozen Plasma -Vitamin K
How is HAV usually spread
-From person-to-person, rarely through blood transfusion -Infected food handler can spread the disease -Can contract by consuming contaminated water or seafood from contaminated water -Sexual intercourse
How do we prevent gallstones after gastric surgery
-Gall bladder is removed during surgery -Highly reduced if Actigall is used: Bile-acid medication that reduces the formation of gallstones
Steps of BPD/DS (Duoedenal switch)
-Gallbladder removed -Sleeve gastrectomy performed -Duodenum cut at 1 inch below pyloric sphincter -Ileum cut in half, with last end attached to duodenum just below pyloric valve -First end of ileum connected to last end right before the ileocecal junction
Non-modifiable risk factors for developing breast cancer
-Gender (female) -Early menarche/late menopause -Age 60 or older -BRCA 1/2 inherited mutation (80% lifetime risj) -Family history (1st degree relative =1.5-3X risk) (2 1st degree relatives= 5X risk)
Chronic post-kidney transplant rejection signs
-Gradual over months to years -Increas in BUN and creatinine -Imblanaces in proteinuria and electrolytes -Fatigue
Diagnosis of nephrolithiasis
-H&P -Urinalysis -Urine culture -retrograde pyelogram -Ultrasound, Cystoscopy, CT Scan/ IVP -Get the stone analyzed (use a filter to catch the stone when it is passed) -Serum BUN/Creatinine
Drug therapy for treating PUD
-H2 receptor blockers -PPIs -Antacids -Antibiotics (if caused by H. pylori) -Anticholinergics
Patient education for anyone having a restrictive gastric surgery
-Healthy food choices are essential -After the operation, patients can usually only eat 3/4 of a cup of food without feeling discomfort/nausea -Food MUST be well-chewed (helps the stomach do its job easier)
Signs/Symptoms of septic transfusion reaction
-High fever and chills -Vomiting -Diarrhea -Shock
Diagnostic studies for breast cancer
-History -Physical exam -Mammogram -Ultrasound -Biopsy -Stages: TNM classification -Ploidy status -Axillary node vs. sentinel node dissection
Diagnosis of hepatitis
-History and physical (have you traveled somewhere, do you have close contact with someone with hepatitis, blood transfusion, illicit drug use, unprotected sex??) -Check lab values
Electrolyte trends in AKI
-Hyperkalemia -Hypermagnesia
Clinical manifestations of CKD
-Hypertension and edema -Hyponatremia/hypernatremia -Hyperkalemia -Metabolic acidosis -Hypocalcemia (bc of lack of Vitamin D activation) -Hyperphosphatemia *-Calcyphylaxis*
Systemic effects of kidney failure
-Hypocalcemia -Hyperphosphatemia -Proteinuria -anemia -low BP
Post-dialysis assessment
-Hypotension -Headache -Nausea/vomitting -Malaise -Muscle cramps (removal of certain electrolytes)
Main ways that Hepatitis C is spread
-IV drug users -Dialysis patients and personnel -Intercourse -Contaminated piercing and tattooing tools
How do we decrease afterload in the treatment of HF
-IV nitroprusside- potent vasodilator -Nesiritide - both afterload and preload reducer
Active surveillance for prostate cancer
-If a patient is diagnosed with prostate cancer but has a life expectancy of less than 10 years, they have serious comorbidities, or the tumor is low-grade, we use watchful waiting Keep an eye on the tumor and treat the symptoms
How does solute load affect nephrolithiasis
-If you are dehydrated and solute load in the urine is increased, it is more likely that the solute will crash out of solution and form into a stone
Types of urinary diversion surgeries requiring collection devices
-Ileal conduit -Cutaenous Ureterostomy -Nephrostomy
Patient education post-op urinary diversion
-Increase fluid intake to "flush" the continent urinary diversion -"mucus looking" urine is normal -Meticulous skin stoma care
What lab values are diagnostic for hepatitis infection
-Increased AST and ALT, alkaline phosphate, LDH, billirubin, and erythrocyte sedimentation rate -Increased prothrombin time PT/INR -Leukocytosis -Increased billirubin -Antibody testing for detection of specific viruses
Diagnosis of AKI
-Increased BUN/Creatinine levels -Electrolytes -Urinalysis -Kidney ultrasonography -Renal scan -CT scan/MRI/MRA -Renal biopsy
Results of alpha 1 receptor activators pertaining to the bladder
-Increased closure of internal sphincter of the bladder
Names of some of the combined weight loss surgeries
-Roux-en-Y gastric bypass (restrictive and metabolic) -Billiopancreatic Diversion with Duodenal Switch (BPD-DS)
Why does chronic infection prohibit someone from receiving a kidney transplant
-The antiobiotics they are taking may be nephrotoxic -Infection could destroy the kidney
Why do CKD patients develop secondary hyperparathyroidism
bc they don't have enough vitamin D so they also dont absorb enough calcium -This is why CKD patients are given vitamin D supplements in the form of Calcitriol PO
Patient education for PDE-5 side effects
Hypotension Headache -DO NOT TAKE WITH NITROGLYCERINE bc causes severe hypotension
What is the MAIN cause of orthostatic hypotension
Hypovolemia Lack of blood volume (when they stand up the fluid flows toward their feet)
Indication for administration of albumin
Hypovolemic shock, hypotension during hemodialysis and very low albumin levels, sometimes given in severe third-space edema
Potential complications of gastric bypass
Leaks Infection Hernia bleeding bowel obstruction Gallstones -33%
Which sided HF is most common
Left
Which sided HF usually occurs first
Left
What is the most common cause of right sided HF
Left sided HF
Acute pulmonary edema casued by HF is usually a result of damage to which part of the heart? Left atrium Left Ventricle Right atrium Right Ventricle
Left ventricle
Anaphylactic tranfusion reaction
Recipient's antibodies respond to the donor's IgA proteins manifests within 1 to 45 minutes of start of transfusion
What is a circulatory overload transfusion reaction
Recipient's blood volume expands too quickly for the heart to handle
Normal appearance of the stoma
Red/pink *•Moist* •Healthy skin around stoma •No yeasty odor
Treatment goals for PUD
Reduce degree of gastric acidity Enchance mucosal defense mechanisms and minimize harmful effects on mucosa -smoking cessation -Rest
Why are antihistamines given to hepatitis patients
Reduce itching *use caution in elderly, glaucoma, or urinary retention patients
A patient that is recently diagnosed with HF is prescribed furosemide in an effort to physiologically do what for the patient -Decrease afterload -Decrease preload -Promote vasodilation -Increase contractility
Reduce preload
What is a common clinical practice for "stress ulcer" prophylaxis
Reduce stress
Defining feature of systolic HF
Reduced L ventricular ejection fraction
Steatosis caused by obesity
abnormal condition of fat (increased fat at the cellular level often affecting the *liver*) -Fat cells envelop liver -Can lead to hepatic failure/cirrhosis
What is cor pulmonale
abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels.
What is hydroureter
accumulation of urine in the ureter
Diagnostic criteria for AKI
acute reduction in urine output and/or elevation in serum creatinine
Most common cause of AKI
acute tubular necrosis
What is SV
amount of blood pumped out by a ventricle with each beat
What is plasmapheresis?
an in-hospital procedure prescribed by a health care provider in which the patient plasma is treated to remove the antibodies causing the disease.
Why do we give recombinant interferon to hepatitis patients
antiviral agent that inhibits virla replication
How many adults will recover from Hep B
approxmately 95% of adults will recover completely and will not develop chronic hepatitis
What is a cystoscopy
direct visualization of the urinary bladder through a cytoscope inserted into the urethra.
UTI classification
• Classified by location -Upper urinary tract infection -Lower urinary tract infection
*What BNP level indicates HF?*
>500
Are PPIs or H2 blockers more effective in promoting esophageal healing
PPI
Dysuria
Painful urination
Complications of acute hepatitis
-Coagulopathies
Most common sites for ulcers in PUD
-Esophagus -Stomach -Duodenum
Signs and symptoms of hyperkalemia
Arrhytmias (VFib) Heart block
When can patients drink alcohol after weight loss surgery
Avoid alcohol for one month after surgery
What sits on top of the kidneys
Adrenal glands
How is GERD related chest pain relieved
Antacids
What is the most common cause of post renal failure
BPH
MOA for 5 ARIs
Blocks dihydrotestosterone Shrinks the prostate
Sliding hiatal hernia
*most common type* -Stomach slides through hiatal opening when patient is lying down (supine) and slides back into abdominal cavity when patient stands up
Characteristic cough of someone with left sided HF
-Blood is backing up into the lungs a productive cough with moist, pink, frothy sputum
What are the most common sites of breast cancer metastasis
-Bone, lungs, brain, liver lymph nodes
Common complication of Nissen Fundoplication
Post-operative bleeding
What is the most common pathogen leading to UTI
E. Coli
What to avoid when treating UTI
Bladder irritants Caffeine Alcohol citrus juices chocolate highly spiced foods
Why is bleeding common after TURP
Bladder is a highly vascularized organ
Catheter care
Keep bag below bladder Perineal care with soap and water Anchor bag to leg or abdomen
Treatment of hepatic encephalopathy
LACTULOSE bc it decreases serum ammonia
Patient selection for dialysis
AKI Stage 4 CKD Stage 5 CKD -Selection begins when patient's uremia can no longer be adequately managed conservatively
What is right sided HF
RV fails to pump effectively
nEUROLOGICAL findings in someone with HF
Restlessness, confusion, decreased attention or memory
What is bladder cancer
Bladder transitional cell carcinoma (90% of bladder cancer cases) (non invasive usually)
Manifestations of inflammatory breast cancer
-Breast looks red, feels warm -Breast skin has a thickened appearance, resembling an orange peel AKA breast is inflamed
Indications for TURP
moderate BPH
What is preload
volume of blood in ventricles at end of diastole
Clinical manifestations of BPH
*nocturia often first symptom* Hyperirritable bladder (pain) -Urgency and frequency -Compression of urethra leads to: decrease in caliber and force of the urinary stream, difficulty in initiating voiding, intermitency of voiding, dribbling -Overflow urinary incontinence -Hypertrophied bladder wall muscles
Manifestations of glomerulonephritis
*not really specific to kidney* -Onset is about 10 days from the time of the infection -Changes in urination pattern *-Hematuria -Proteinuria* -Headache *-Facial edema -Weight gain* -Fever -Sore throat -Anemia -HTN/ HF
Nursing considerations for a patient experiencing neprholithiasis
*pain* -strain urine -hematuria for a few days -hydration! -Possibility of infection -
Brachytherapy for prostate cancer
-Best suited for earlt stages -Internal radiation (may use like internal beads or something) -May be offered in combination with external radiation therapy in advanced cases
Biliary cirrhosis
-Ducts that carry bile out of the liver become inflamed and blocked Exact cause unknown
Characteristics of fibroadenoma
-Easily detectable on physical examination -Growth is slow and often ceases when the size reaches 2-3 cm. -Usually small, painless, round, well-delineated, and very mobile
Clinical manifestations of gastric outlet obstruction
*related to contents building up in the stomach/gastric distention* Upper abdominal discomfort *projectile vomitting* key symptom -Load peristalsis -Visible peristaltic waves -Constipation -Anorexia
Clinical manifestations of hepatitis
*symptoms are the same across all types* Signs and symptoms progress overal several stages
Post-op considerations for mastectomy
-Bleeding (*drains* and dressing) -Drain is inserted and left in place until the area heals -Drain care -Monitor site for infection -The area must be kept dry -Deodorant should not be applied to the area until it is healed
What lab values are we assessing in the diagnosis of glomerulonephritis
-*proteinuria* -increased uric acid, hematuria, increased specific gravity/osmalality of the urine -Albuminuria, proteinuria, hypoalbuminemia -Antiglomerular basement membrane antibody test -Increased serum BUN and creatinine, decreased GFR, -Hyperkalemia, hypernatremia *-Metabolic acidosis!!*
Indication for use of fresh frozen plasma
-Bleeding due to lack of clotting factors V and VII -elevated PT and INR
Acute post-kidney transplant rejection signs
-1 week to 2 years -Oliguria, anuria -Fever -High BP -Flank tenderness -Lethargy -Increased BUN, K, Creatinine -Fluid retention
Clinincal manifestations of bladder cancer
*gross painless hematuria* (most common finding) Bladder irritability with dysuria, frequency, and urgency -Back pain and fatigue if advanced stage
Clinical manifestations of nephrolithiasis
*manifestations result from blockage of urine flow* *Pain may be absent if the stone is non obstructing or not moving* Abdominal or flank pain (usually severe) Hematuria renal colic nausea vomitting cool, moist skin
Characteristics and action plan for stage 5 CKD
"End stage renal disease" GFR <15 renal replacement therapy necessary for life
Which of the following does not indicate a good understanding of the signs and symptoms of GERD -"I should eat small, frequent meals" -"It is important I avoid eating right before bedtime" -"I have to limit my intake of alcohol" -"I will try to lie down after eating a meal"
"I will try to lie down after eating a meal"
Standard practices in the care of patients with CBI
*monitor for bleeding* CAUTI bundle/prevention of UTI
Treatment goals for CHF
* Treat the underlying cause and contributing factors* Maximize CO Reduce symptoms Improve ventricular function Improve quality of life (paliative care if necessary)
Drug treatment of hyperkalemia
*-Sodium polystyrene sulfonate (Kayexelate) -Calcium gluconate IV -Salmeterol/albuterol* -sodium bicarbonate -regular insulin IV + dextrose 50%
Clinical manifestations of hiatal hernia
*50% of patients are asymptomatic* -Heartburn, dysphagia, pain, and regurgitation -Most common abnormality found on upper GI X-ray
Criteria for CKD diagnosis
*All of these must be present for >3months* -One or more of the following markers for kidney damage: albumineria, urine sediment abnormalities, Electrolyte and other abnormalities due to tubular abnormalities, abnormalities detected by histology, structural abnormalities detected by imaging study, history of kidney transplantation -Decreased GFR of <60ml/min
BRCA 1 and BRCA2 gene changes
*BRCA1/2 are normal genes, it is their mutation that becomes an issue* -Inherited mutated gene = high risk of breast cancer
What are the potential complications of urinary diversion surgeries
*Hematuria*
Management of urinary tract calculi
*Pain relief* -Ensure there is no urinary tract blockage -Adequate fluid intake -Encourage mobility -Safety measures id using opiod pain management
Findings upon palpation if someone has a perforation
*Rebound tenderness* THIS IS GOING TO BE ON TEST FOR SURE
Common mode of transmission for HEP B
*Unprotected sex* Mother-infant tattoos Needle stick organ transplant IV drug use
Assessment for GI bleed in someone with PUD
*Watch for signs/symptoms of hypovolemia and shock* -Changes in vital signs -Increase in amount of redness of aspirate (NGT) (signals major Upper GI bleed) -*Decreased pain*
Clinical manifestations of prostate cancer
*asymptomatic in early stage* Eventually may experience lower urinary tract symptoms similar to BPH: -Dysuria, dribbling, frequency, hematuria, nocturia, and retention -Prostate feels hard, enlarged, and fixed during prostate exam -Pain in lumbosacral area with radiation down the hips and legs are indicative of meetastasis -Distant metastasis and pain
Paraesophageal (rolling) hiatal hernia
*fixed position* Fundus and greater curvature of stomach roll up through diaphragm , forming a pocket alongside the esophagus
Diagnostic studies for glomerulonephritis
-24-hour urine collection Kidney biopsy -Ultrasound -IV pyelogram -Abdominal CT -Lab values
Amount of weight gain that is concerning in HF patients
-3lbs in 2 days 3-5 lbs over a week should be reported to healthcare provider
What specific drugs do we give for BPH
-5 Alpha Reductase Inhibitor (5 ARI) -Alpha-adrenergic blockers (blocks alpha 1)
Radiation therapy for breast cancer treatment
-5-6 weeks long -Used to shrink a large tumor to an operable size --Palliative treatment for pain -
Describe the steps of gastric bypass
-A small stomach pouch is created to restrict food intake -Next, the last 2/3 of the small intestine is connected to the small pouch to allow food to bypass the lower stomach, duodenum, and first portion of jejunum, where most fats and sugars are absorbed
Complications fo BPH
-Acute urinary retention -UTI and sepsis -Bladder calculi -Hydroureter -Hydronephrosis -Renal failure -Pyelonephrosis -Bladder damage
Examples of revision surgery
-Adjustable band added over a gastric bypass -sleeve gastrectomy to gastric bypass or duodenal switch
Specific nursing actions for mild allergic transfusion reaction
-Administer antihistamines -For mild symptoms that have been resolved, blood can continue to be administered slowly
Patient eating post operatively after bariatric surgery
-Advise patients to drink slowly (drinking from medicine cup can help with this) -Patients are NPO immediately post op -POD#1 patients can have clear fluids ONLY -Medications should be administered in liquid form or as a crushed pill (NO enteric coated medication) -Teach patients about smart food choices: liquids should have zero or low calories. dont drink soda -Drink protein shakes before they can eat solid food
Risk factors for bladder cancer
-African Americans/Hispanics -Cigarette Smoking (4X higher chance) -Expsure to dyes used in rubber and cable industries -Chronic abuse of certain anelgesics -Arsenic in drinking water -Women treated with radiation for cervical cancer -Cylophasmphamide -Chronic recurrent bladder stones and chronic lower urinary tract infeections -Chronic bladder Irritation and infection
What are three common types of cirrhosis
-Alcoholic cirrhosis -Post necrotic cirrhosis -Billiary Cirrhosis
Care of hepatitis patients in regards to skin care
-Alkaline soaps restricted, emollients and liquid creams prescribed -Keep skin moist, use emmolients, avoid alkaline soaps -Use antihistamines with caution (can cause delerium in older patients) -Encourage patients not to scratch; keep nails short -Loose/soft clothing
AV fistula for HD dialysis
-An artery and a vein have been combined into one -Turbulent blood flow in artery flows into veins through anastamosis
Adverse patient reaction during blood transfusion
-Anaphylaxis *give epinephrine IM* -Circulatory overload (TACO) *give diuretic*
Aside from H. Pylori, what are other causes of PUD
-Aspirin, NSAIDs, steroids, chemo -Alcohol/coffee/smoking -Hypotension, severe injury, extensive burns, complicated surgery -Diseases -Phsyiological stress
Nursing interventions during blood transfusion
-Assess for adverse reaction for 15 mins -Ensure accuracy of blood product at bedside with another RN -4 hours max infusion rate
nursing management of AKI patients
-Assess vital signs -measure intake/output -Monitor electrolytes -Assess for uremia, HTN, fluid overload, -If fluid overloaded, limit fluid intake -Assess mental status and LOC (increased BUN can cause changes in mental status) -Assess lung sounds and heart rhythm -Manage hyperkalemia -Renal Replacement Therapy (RRT)-- observe dialysis access -Nutritional therapy
Dietary modifications in PUD patients
-Avoid foods that cause symptoms: caffeine, alcohol, spicy foods, high fat foods, and cream -Non-irritating or bland diet, 6 small meals in acute phase -Avoud foods high in roughage
How to prevent GERD symptoms
-Avoid triggers -HOB >30 degrees -Stay upright for 2 hours after eating -No eating *3 hours* before bed -Drug therapy -Patient teaching
Lifestyle modifications for someone with GERD
-Avoid triggers Maintain appropriate weight Stress management Smoking cessation Small frequent meals
Health promotion actions to prevent UTI
-Avoid unnecessary catheterization and do early removal of catheters -Aseptic technique when inserting catheters -Handwashing -Gloves for care of urinary symptoms -Thorough perineal care *Avoid incontinence by answering call light and offering bedpan frequently* -Wipe perineal areas front to back Adequate fluids (unless HF; contraindicated)
proper catheter care
-Bag is secured to the leg -Bag is lower than the bladder -use alcohol wipes to clean the ports/drainage spout whenever you use them
How can immobility cause nephrolithiasis
-Being immobile causes body to leach calcium from the bones -Hypercalcemia causes more free calcium in the bloodstream = more opportunity for the calcium to develop into a stone
Side effects of duodenal switch
-Can cause anemia bc iron and other RBC components are supposed to be absorbed in terminal ileum, which has been moved up and connected to the stomach before bile is availabel to help break down food AKA lack of absorption in ileum
What components are included in CAUTI bundle
-Catheter insertion is STERILE procedure -Keep collection bag below level of bed -Soap and water to clean perineal area after insertion -Ask every day if catheterization is necessary every day
Risk factors for nephrolithiasis formation
-Caucasian -Family history of nephrolithiasis -Previous history -Summer months bc dehydration -urinary stasis -Urinary retention -Immobility -Genetics -Lifestyle/work
Pre-renal AKI and causes
-Cause of kidney damage occurs before the kidney *CAUSES include conditions that reduce blood flow to the kidney*: -Hypotension/hypoveolemia -Dehydration -Renal artery stenosis OVERALL the cause is decreased renal perfusion leading to decreased GFR
Ileal conduit care
-Change pouch every 3-5 days -Pat dry; dont rub the stoma -Use water for cleaning -Use electric razor to shave the hair around stoma -Use of night bag as appropriate -Avoid wearing tight belts over stoma -empty pouch when 1/3-1/2 full -Report changes in color, consistency, leakage -Hydrate aqequately -Avoid heavy lifting
Treatment for end stage HF
-Chronic inotropic therapy -Mechanical circulatory support devices (MCS) -Palliative care/hospice -Heart transplant
Symptoms/side effects of liver necrosis (like in hepatitis)
-Cirrhosis (if it continues) Jaundice light colored stools dark urine bleeding tendency (increased PT) hypoglycemia ascites and edema -gynecomastia, loss of body hair, menstrual dysfunction,
Symptoms of hepatitis in the icteric phase
-Clay colored stool -Dark urine -Jaundice -Pruritis Hepatomegaly & splenomegaly
What methods do we use for collecting urine for a urinalysis
-Clean catch method -Collect sample from catheter
Catheter care for patients after prostate surgery
-Clean urethral meatus with soap and water before insertion -Secure around thigh or abdomen
What anatomical factors predispose someone to get a UTI
-Congenital defects leading to obstrucition or urinary stasis -Fistula -Having a vagina Fecal stream -Short urethra -BPH
Pre-op considerations for mastectomy
-Consent labs explain procedure -Discontinue ASA, NSAIDs, vitamin E, ginkgo biloba, garlic, warfarin for at least a week
Kock' Pouch
-Continent ileal conduit -Intra-abdominal reservoir that is catherterizable by self catherization or has an outlet controlled by rectal sphincter -Reservoirs from ileum, ileosecal segment, or colon -Either has a stoma for catheterization or neobladder for urinating the normal way
MOA of sodium bicarbonate in the treatment of CKD
-Corrects acidosis
Manifestations of UTI in older adults
-Could be asymptomatic -non-localized abdominal discomfort rather than dysuria -*cognitive impairment* New incontinence -Less likely to have a fever
Donor sources for a kidney transplant
-Deceased donor with compatible blood type -Blood relatives (less chance for rejection) -Emotionally related living donors -Altruistic living donors -Paired organ donation
What are our goals when treating HF
-Decrease intravascular volume (diuretics) -Decreased preload -Decrease afterload -Improve gas exchange and oxygenation -Improve cardiac function -Decrease anxiety
Diagnosis of cirrhosis
-Decreased RBC, WBC, and platelets -Increased bilirubin, Alkaline Phosphate, AST, ALT -Decreased albumin levels -Hypoglycemia -Increased PT and aPTT and INR -Increased bilirubin and dark color in urine -check patency of portal vein
Features of recovery phase of AKI
-Decreased edema -Normalization of fluid and electrolyte balance -Return of GFR to 70-80% of normal
Nursing care for post-operative kidney transplant patients
-Dehydration must be avoided (espeically with the abundance of urine output) -Assess for hyponatremia/hypokalemia -Acute tubular necrosis can occur from the cold conditions of the surgery and bc the donor may have been dead. Lack of oxygen to the kidney and it cant repair itself. Monitor for this bc if it happens, dialysis is necessary -Maintain catheter patency/CAU
Diagnostic studies for BPH
-Digital rectal exam (DRE) -Serum creatinine and BUN -Prostate Specific Antigen (PSA -Urodynamic flow studies -Cystoscopy -
Diagnosis of prostate cancer
-Digital rectal exam (not a definitive diagnostic test) -Elevated PSA (not a definitive diagnostic test bc not specific and can signal other disorders) -Trans-rectal ultrasound *prostate biopsy to confirm* CT or MRI to assess metastasis -Elevated alkaline phosphate -TNM classification
What is dumping syndrome
-Direct result of surgical removal of a large portion of the stomach and pyloric sphincter -Leads to decreased reservoir capacity of stomach (AKA stomach is less able to store food) -Results in rapid gastric emptying because there is not enough space to hold the food -End result is meals having a hyperosmolar composition bc nutrients and electrolytes do not have enough time to be absorbed from the food into the stomach. Fluid is following the food out of the body
What is fibroadenoma
-Discrete benign breast lumps in young woman -Frequent cause of breast masses in women younger than 25
Complications of dialysis
-Disequilibrium syndrome -Hypotension (from blood loss) -Infectious disease -Anemia (blood loss/ destruction of RBCs) -Muscle cramps
What is continuous bladder irrigation
-Done post-op -Influx of normal saline into bladder through the catheter to flush out the bladdeer -Use of 3-way catheter; removes clots, urine, mucus -Urinary catheter with retention balloon placed into bladder * patient will feel a continuous uncomfortable urge to void*
What are the functions of the liver
-Drug metabolism -Production of clotting factors -Filters toxins -Produces bile (can't excrete bile) -Stores glycogen -Makes antibodies
Routine nursing management of dialysis patients
-Infection prevention -Check AV fistula for thrill and bruit (you want this; means it is patent) -Check weight before and after dialysis -*Monitor CBC to check for electrolytes* -Monitor electrolytes before and after dialysis -Timing of meds: before or after dialysis? Only some are dialyzable -Care of access site (Prevent CLABSI) *fluid restrictions-- 1L per day* -Blood transfusion during dialysis
What are some things that can lead to inflammation of the glomeruli, which is the underlying pathophysiology of glomerulonephritis
-Infections (antibody-antigen complexes) -Immune diseases -Vasculitis
What are options for treatment for severe HF
-Intra-aortic balloon pump -Mechanical hearts -Ventricular Assist Devices -Heart transplant
Two types of drains they may use after mastectomy
-Jaxson-Pratt -Hemovac
Discharge teaching for patients after radical prostatectomy
-Kegel exercises to prevent incontinence -No lifting heavy objects -No driving -No sex -Drink 2-3L/day -Stool softeners -High fiber diets -Patient may go home with a catheter; teach catheter care
What is the kidney's role in the production of RBCs
-Kidney produces erythropoetin -Erythropoeitin stimulates the bone marrow to produce more RBCs
Names of some of the restrictive weight loss surgeries
-Laproscopic adjustable gastric band (LAP-BAND) (Purely restrictive) -Sleeve gastrectomy (
Tumor size and prognosis for breast cancer
-Large tumor= poor prognosis -More well differentiated tumor = less aggressive -Poorly differentiated tumors appear morphologically disorganized and are more aggressive
How does obesity cause obstructive sleep apnea
-Large weight on neck blocks trachea when laying flat Can lead to prolonged hypoxia
Causes of right sided HF
-Left sided HF is the most common cause -RV infacrtion -PE cor pulmonale
What is ADH secreted in heart failure patients and what is the result
-Less cerebral tissue perfusion signals the brain to release ADH -ADH is antidiuretic so it causes fluid retention to try and increase CO; however, this actually just worsens HF
Specific dietary restrictions in someone with AKI/CKD
-Limit phosphate intake bc this is already elevated on its own (persimmons) -Limit vitamin C intake (guava) bc vitamin C can alter the pH in the kidney nephrons and damage them even more -Increased protein intake in people with *stage 5 CKD/on dialysis* -Avoid OTC antacids (bc they contain magnesium -Sakt substitutes
Signs and symptoms of lower UTI
-Localized (not systemic) symptoms -Cystitis Urethritis frequency urgency burning
Alcoholic cirrhosis
-Long term ETOH use: 5 or > drinks/day for 10-15 years -Scar tissue surrounds portal area
How can we assess for post-operative bleeding after Nissed Fundoplication
-Look for tarry stools -Check vital signs (BP and HR)
Dietary changes for liver failure patient
-Low protein -High carb -Bland diet -High calorie -Low fat -Alcohol abstinence
Nutrition therapy for HF patients
-Low sodium diet is necessary(2g/day) -Fluid restrictions for severe HF
Complications of peritoneal dialysis
-Major complication is infection (peritonitis) -Constant sweet taste (dialysate has sugar) (can also cause hyperglycemia) -May get a hernia -Altered body image/sexuality -Anorexia -Low back pain -Protein loss
Key functions of the kidney
-Making strong bones through vitamin D activation -Excreting/filtering waste from the blood -Controlling BP through RAAS -Boosting production of RBCs -Maintaining fluid/electrolyte balance
Common side effects of urinary diversion surgeries
-Malabsorption issues bc part of the small intestine is being used for a different function (B12 deficiency) -Diarrhea
Breast cancer screening guidelines
-Mammograms yearly starting at 45 for women at average risk -at 55, mammograms every other year-- but you can still do annually if you want -Regular mammograms continue as long as woman is in good health *breast exams are no longer recommended*
Health promotion to prevent further kidney stones
-May want to reduce sodium/calcium in their diet depending on the type of stone -Drink plenty of fluids (unless counterindicated like in a HF patient) -Stop taking certain OTC meds like vitamin C -Limit intake of foods high in calcium or oxalate
Why do we ask patients to avoid milk products when they have GI problems such as GERD and PUD
-Milk can increase gastric acid secretion and can aggravate ulcers -Milk products and protein can neutralize gastric activity
What are some common GERD triggers that patients should try to avoid
-Milk products at night -Late night snacks or meals -Caffeine Alcohol Citrus fruits Chocolate High-fat foods
Nursing implications for hepatitis patients that may experience coagulopathies
-Minimize IM injections-- may cause hematoma -Handle patient gently
Pre-operative care of weight loss surgery patient
-Most patients are admitted to the hospital on the day of the surgery -All patients given prophylactic antibiotics -Pre and post screening for gall stones is recommended for all patients who have not had a cholesysectomy.
What are the 3 broad compensatory mechanisms that the heart entails to try to adjust for HF
-Neurohormonal (RAAS, SNS) -Ventricular dilation -Ventricular hypertrophy
Why are large amounts of urine produced following a kidney transplent and what is the result of this
-New kidney's increased ability to filter BUN -Abundance of fluids during the operation -Initial renal tubular dysfunction Can result in fluid/electrolyte imbalance
Post-mastectomy considerations/exercises
-No lifting for 2-3 weeks (up to 6 weeks) -Surgical bra -Exercises to retain muscle strength and prevent lymphadema (will be given specific exercises by doctor) -High protein diet to encourage healing -Breast reconstruction -Adjuvant therapy (radiation therapy)
Tips for measuring BP properly
-No smoking, exercising, drinking caffeine or alcohol within 30 mins of reading -Rest with arm up on chair for 5 mins before taking BP -Sit in chair with feet flat on floor with back straight -Take at least 2 readings at least 1 min apart
What genetics put you more at risk for prostate cancer
-No specific gene -3 or more 1st degree relatives with prostate cancer -Prostate cancer in 3 generations of the same sidef of the family -2 or more close relatives on the same side fo the family diagnosed with prostate cancer before age 55 -Man with a father, brother, or son who has prostate cancer is 2-3 X more likely to develop the disease
Patient education after gastric sleeve gastric surgery
-Non reversible -Patient will need to take B-12 due to reduced stomach size and decreased intrinsic factor production by the parietal cells in the stomach. B-12 deficiency can cause anemia. May need to receive B-12 shots to replace the B-12 -Can be converted to gastric bypass or duodenal switch if weight loss ceases
What to remember about the imaging studies used to diagnose AKI
-Nothing with iodized contrast media bc the dye is nephrotoxic
Nursing care for a patient receiving continuous bladder irrigation
-Observe for hemmorhage : 24-36 hours, blood clots = normal. Means it is working -Monitor I/O and drainage color -Maintain flow -Anchor catheter -CAUTI prevention -
Specific nursing actions for septic transfusion reaction
-Obtain a blood sample for culture -Return remaning blood to blood bank -Give fluids and antibiotics as prescribed -Give vasopressors as prescribed for shock
Symptoms of gastric ulcer specifically
-Occur in stomach -Epigastric pain 1-2 hours after eating -Heartburn, chest discomfort are commonly seen -Can cause gastric carcinoma
Symptoms of duodenal ulcers specifically
-Occur in the duodenum -Epigastric pain 2-5 hours after eating -Heart burn and chest discomfort are less common -Pain may awaken patient during the night
Features of diuretic phase of AKI
-Occurs when cause of AKI is resolved -Renal tubule scarring and edema -Increased GFR -Daily urine output above 400mL/day (usually around 1-3 L/day) -Possible electrolyte depletion from excretion of more water and osmotic effects of high BUN
What are the 4 phases of AKI
-Onset phase -Oliguric phase (anuric) -Diuretic phase -Recovery phase
*Hyperacute post-kidney transplant rejection signs*:
-Onset within 48hours -Malaise, high fever -Graft tnederness -Organ must be removed
Process of emptying Jackson-Pratt drain
-Open valve and pour out drainage (measure amount) -Squeeze drain -Replace valve and seal while squeezing
What are some potential adverse reactions to longterm corticosteroid use (prednisone)
-Opportunistic infections -Hyperglycemic -Hypokalemia -Hypernatremia
What three things govern dialysis
-Osmosis -Diffusion -Ultrafiltration
Possible skeletal findings in CKD patients
-Osteomalacia, osteofibrosis CKD mineral and bone disorder (CKD-MBD) Caused by the leaching of calcium triggered by the lack of vitamin D activation in the kidney (and subsequent activation of parathyroid hormone)
Main difference between fibroadenoma and fibrocystic breast condition
-Pain in breast in fibrocystic breast condition (usually around menstruation) Age range -Fibroadenoma: younger than 25 -Fibrocystic breast condition: 35-50
What should be the nurse's priority assessment post extracorporeal shock-wave lithotripsy
-Pain management -Track urine output (see if the ureters are unblocked now)
Expected findings when assessing an AV fistula
-Palpable thrill -Audible bruit
Common ways that Hep B is spread
-Parenteral needle pokes (healthcare workers) -Infants born to infected mothers -Sexual activity
Surgical interventions for management of PUD
-Partial gastrectomy -Vagotomy -Pyloroplasty
Cardiac remodeling as a consequence of HF
-Pathologic ventricular remodeling is an actual change in the structure (dimensions, mass, shape) of the heart -This altered shape of the ventricles eventually leads to increased ventricular mass, increased wall tension, increased O2 consumption, and impaired contractility. The actual shape of the heart becomes less elliptical and more spherical. Although the ventricles become larger, they become less effective pumps.
Psychological care of patients undergoing bariatric surgery
-Patients undergo psychological checklist before approved for surgery -Psychiatric evaluation and counseling are important before and after surgery -WLS patients are more likely to get a divorce -There are WLS support groups
Drug therapy for CKD
-Phosphate binders -sevelemer -Calcium supplements -Iron and Vitamin C -Vitamin D -Antihypertensives and DM meds -cardiac meds; statins -Stool softeners -Antiseizure meds -Erythropoeitin -Flu/pneumonia vaccine *Avoid NSAIDs, dyes, nephrotoxic meds*
Purpose of kidney biopsy in diagnosing glomerulonephritis
-Pinpoints the actual pathology of the disease What type of bacteria/virus is actually causing the damage, is there structural problems, blood flow issues?
What are some common complications of HF
-Pleural effusion (from liquid building up in lungs) -Arrythmias (AFib) -Stroke cirrhosis renal issues GI distress
What are the usual causes of infiltrate in the lungs
-Pneumonia -HF
What are some further complications of HF
-Pneumonia (especially in Left HF bc of all of that liquid pooling in the lungs)
What types of infections are post-kidney transplant patients at risk for
-Pneumonia/flu -Incision site infection -UTI
Characteristics of estrogen/progesterone receptor NEGATIVE breast cancer
-Poorly differentiated -Increased incidence of aneuploidy and higher proliferative indices -Frequently recur -Unresponsive to hormone therapy
Prevention of lymphedema
-Post mastectomy exercises -*avoid BP, injections, phlebotomy on affected arm* -Use the arm and stay active -Compression garment, moisturize, avoid injury, treat injury ASAP
Indications for hormonal breast cancer therapy
-Post menopausal women w/o lymph node involvement -BRCA 2 mutation -Increased risk for breast cancer
What is lymphedema
-Potential complication after mastectomy -Accummulation of protein fluid in the subcutaneous tissue after mastectomy (especially if the lymph nodes were removed bc there is less drainage available) -Can be difficult to manage, and lifelong measures must be taken to prevent it
What are the three phases of hepatitis infection and how long do they last
-Pre-icteric (1-5 days) Icteric (1-2 weeks) Post-icteric or Recovery (2-12 weeks)
Nursing care of bariatric surgery patient
-Pre-op education about physical, psychosocial, and nutritional factors (patients required to attend one support group and watch educational video before surgery) -Encourage coughing and deep breathing to prevent atelectasis -Incisions, laproscopic insertion sites, and drains require close monitoring to detect any anastamotic leakage -Monitory for tachycardia, tachypnea, -Encourage early ambulation -Antiembolic stockings while in bed *patient must walk within 6 hours of surgery*
Who should receive hepatitis vaccinations
-Pregnancy -HIV/Immunocompromised -Healthcare workers (Hep B) -men who have sex with men -kidney failure/dialysis -chronic liver disease DM -Post exposure (ex: needle stick)
Which patients are more likely to have triple negative breast cancer
-Premenopausal -African Americans -Hispanics BRCA 1 mutations
Nursing management for patient's post-op urinary diversion
-Prevent complications: atelectasis, DVT, paralytic ileus, small bowel obstruction -NGT may be required -Maintaining urine output -Stoma care -Psychosocial support
What two classes of drugs are used to treat GERD
-Proton Pump Inhibitors -Histamine-2 receptor blockers (H2 blockers) *these help with esophageal healing*
What are some social/economic things to keep in mind/teach patients who are undergoing gastric bypass
-Pts may need help evaluating fincanial resources to accommidate complete wardrobe changes, medical office visits, and potential lost wages from time off of work -Nurse should stress that weight loss surgery success requires TOTAL lifestyle changes from the aptient and should not be considered a cure for obesity -Weight loss surgery success depends on motivation of patient, commitemnt to follow-up
Trend of weight loss after gastric bypaSS
-Rapid weight loss in first 6 months -Weight loss usually stops aorund 12-18 months
Nursing management/education for patient's pre-op urinary diversion surgery
-Recognize anxiety and fear -consent forms -lab results -Patient's family should be involved during teaching process -What the stoma will look like, what the ostomy bag will look like, etc -Social aspects of living with stoma should be included -Self-catheterization and irrigation of pouch (for neo-bladder aka Kock's pouch) -Explain problems of incontinence -Concerns about sexual activity should be addressed
Recommendations for prostate cancer screening
-Recommendations AGAINST prostate-specific antigen (PSA) based screening for prostate cancer
Contraindications for receiving a kidney transplant
-Reftactory/untreated cardiac disease -Cancer -Chronic resp failure -Extensive vascular disease -Chronic infection -unresolved psychosocial problems
What are possible complications of a kidney transplant
-Rejection -Acute tubular necrosis -Thrombosis (can be an immune response) -Renal artery stenosis -Infections
Care of a post-op TURP patient
-Relieve bladder spasms - belladonna, opium, suppositories, antispomadics -Promote sphincter tone (kegel exercises) -monitor for signs of infection -Avoid activities that increase intraabdominal pressure -Stool softeners
What is a modified radical mastectomy
-Removal of breast and axillary nodes -Preserves pectoralis major muscle
How long does it take to treat PUD
-Requires many weeks of therapy; Healing may take 3-9 weeks -Pain disappears in 3-6 days
Why does dumping syndrome cause hypoglycemia
-Result of uncontrolled gastric emptying of bolus of fluid high in CHO into small intestine -Causes a rebound release of excessive amounts of insulin into circulation
Clinical manifestations of fibcrocystic breast disease
-Round, palpable, rubbery, freely moveable well defined mass -Painful/tender (especially around menses) -Nipple discharge (milky, watery-milky) -Symptoms usually resolve after menstruation, then recur before the nect menstrual period in a cyclic fashion
What are the first steps to take if someone is presenting with signs and symptoms of transfusion reactions
-STOP THE TRANSFUSION -Remove the tubing that contained the blood and replace it with new tubing connected to NS -Allow NS to run to keep the vein open -NOTIFY PHYSICIAN
What are some reasons why someone would have both systolic and diastolic HF
-Seen in cardiomyopathy -Biventricular failure
Patient education for Kock's Pouch
-Self catheterization using STRICT sterile aseptic technique every 4-6 hours No external pouch
Specific nursing actions for acute hemolytic transfusion reaction
-Send blood and urine samples to the blood bank with the remaining blood -Treat for shock -Insert an indwelling catheter for hourly urine output measurements
Instructions to give GERD patients for eating small frequent meals rather than large meals
-Should eat about 6 small meals throughout the day to prevent too much food entering the stomach at one time -Should drink fluid (a cup of water) with those meals to decrease the aciditiy of the stomach acids
Patient education in patients who had gastric bypass
-Should reduce intake of fats and sugars, bc they can not be absorbed and will just act as osmotic pull throughout the GI system and cause dumping sundrome
Clinical manifestations of breast cancer
-Single lump, thickening, or mammogram abnormality -Painless, hard lump with irregular edges is more likely to be cancerous -lump is poorly delineated, non-mobile, and non-tender -orange peel appearance -swelling of all or part of the breast -skin irritation or dimpling -breast or nipple pain -discharge other than breast milk -redness, scaliness, or thickening of breast or nipple tissue
What is the plan for the patient with ascites
-Sit them up because the pressure from the fluid could compress their airway/make it hard for them to breath -Administer albumin -Diuretics -Paracentesis
Lifestyle modifications for hiatal hernia
-Small, frequent feeding -Elimincate alcohol -Smoking cessation -Avoid lifting or straining -Not to recline for 1 hour after meals -Drug therapy (anracids, PPIs)
Care of hepatitis patients in regards to diet
-Small, frequent, palatable meals as tolerated (high calorie, high protein, -May need parenteral or enteral feeding -Alcohol is PROHIBITED *Supplement with vitamins A,D,E* -Na+ restriction in patients with edema
Why is GERD a complications of sleeve gastrectomy
-Smaller stomach, so risk of food creeping back up esophagus is higher
Why would glomerulonephritis be causing hypertension
-Sodium retention can be a result of glomerulonephritis, which can lead to fluid overload and hypertension
Mechanism of weight loss of duodenal switch
-Some restriction (gastric sleeve) with severe malaborption (no absorption happening until large intestine/shifting around the order of the intestines)
What are the stages of CKD
-Stage 1 -Stage 2 -Stage 3 Stage 4 Stage 5
Nursing techniques to prevent CAUTI
-Sterile technique -Soap and water -Ask every day if we still need the foley
pH of stomach/esophagus
-Stomach is acidic -Esophagus is alkaline This is why it is such a problem when acidic gastric juices enter the esophagus
Describe a Biliopancreatic Diversion with Duodenal Switch
-Stomach is surgically reduced in size 80-85% -Ileum is connected to pouch of stomach on one end and to the ascending colon on the other end -Duodenum anastamizes with the ileum at the ascending colon carrying bile Therefore, bile (which breaks down food) doesnt come in contact with food until it reaches the colon, effectively preventing absorption in the full stomach and small intestine
Indications for surgical removal of urinary tract calculi
-Stones are too large for spontaneous passage -Stones associated with bacteruria -Stones causing impaired renal function -Stones causing persistant pain, nausea, or ileus -Patient with one kidney
Clinical manifestations of a GI perforation
-Sudden, severe abdominal pain unrelated in intensity and location to pain that brough patient to the hospital -Rigid-board like abdomen with *rebound tenderness* -Severe, generalized abdominal and shoulder pain with drawing up of knees
3 drug therapies to treat UTI
-Sulfa-Trimethoprim-Sulfamethazole (TMP-SMX) -Pyridium -Hyocyamine
If you're infusing 3% Saline, what are potential complications and what should be your priority assessment
-Super hypertonic so side effects include demyelination of neurons and atrophy of neuro cells -Assess patient neurological status (can also be from an overcorrection of sodium). Check for LOC, lethargy, convulsions, confusion, etc.
General treatment of breast cancer
-Surgical intervention -Radiation therapy -Drug therapy -Hormone therapy -Immunotherapy and targeted therapy
Treatment of fibrocystic breast condition
-Surgical removal (lumpectomy) (especially if very painful) -Supportive undergarment -OTC pain relievers -Caffeine (reduce intake) -Vitamins (vitamin E and B) -Low Na+ diet or diuretics -Hormones
Types of treatment for bladder cancer
-Surgical treatment -Radiation and chemotherapy -Intravesical therapy
What compensatory mechanisms are activated as a result of decreased perfusion in HF
-Sympathetics nervous system activation -ADH secretion -RAAS mechanism
Nursing care related to ileal conduit
-Teach patient to wear/change ostomy bag bc constant flow of urine (change every 3-5 days) -Shave around ostomy site so the bag will fit properly. electric razor!! -empty bag when 1/3-1/2 full
Patient teaching post- TURP
-Teach them how to do kegel exercises -Adequate fluid intake (2-3L/day) -Observe for UTI symptoms -Prevent constipation -Avoid heavy lifting for a few weeks -Refraining from driving or sexual Intercourse until healed -Sexual education (may experience erectile dysfunction/ retrograde ejaculation)
Why do anticholinergics work for PUD
-They can decrease the secretion of gastric juices -Decrease in acidity
Types of surgical therapy for treatment of bladder cancer
-Transurethral resection -Laser photocoagulation -Open loop ressection Cystectomy (segmental, partial, radical)
Etiology of hepatitis
-Typically caused by viruses (A,B,C,D,E) -Can also be caused by toxin-induced (drugs, alcohol, chemicals, and autoimmune)
Diagnosis of GERD
-Upper GI endoscopy -Barium swallow -Biopsy and histology specimens to differentiate stomach/esophageal cancer from Barrett's Esophagus -Esophageal manometric studies-- motility studies -Ambulatory esophageal pH monitoring
Diagnosis of PUD
-Upper GI series/endoscopy -Nuclear medicine scans (bleeding scan) -Fecal occult blood test (stool test) -Gastric biopsy -*test for H. Pylori* (noninvasive or invasive)
Location of upper UTIs
-Ureters -Renal parenchyma -Pelvis
Predisposing factors for UTI
-Urinary stasis -Foreign bodies (renal calculi, catheters) -Anatomical factors -Sexual intercourse, diaphragm use -Immunosuppression -Functional disorders -Pregnancy incontinence -adavanced age
Diagnostic studies for bladder cancer
-Urine for cytology -IVP/MRI/CT *Cytoscopy* if mass is present to do a biopsy to confirm cancer -TNM staging
Features of oliguric (Anuric) phase of AKI
-Urine output below 400mL/day and possibly as low as 100mL/hr -Increases in BUN and creatinine levels -Electrolyte disturbances, acidosis, and fluid overload
What types of questions will we be asking our patients when analyzing H&P while trying to diagnose nephrolithiasis
-Use of OTC meds and dietary supplements (vitamin C can cause this.) -History of high calcium levels, parathyroid disease, diabetes -Family history -Previous history of any kidney issues
Clinical manifestations of dumping syndrome
-Usually begins 15-30 minutes after eating Abdominal pain or cramping Diarrhea Feeling flushed Sweating, dizziness and weakness Palpitations urge to defecate borborygmi
What is a vagotomy
-Vagus nerve stimulates the feeling of hunger -Cutting the vagus nerve to reduce gastric secretions Used when ulcers can not be controlled by other means and *all* medications have failed -Done with partial gastrectomy
What are the resulting changes in the heart as a result of HF
-Ventricular dilation -Ventricular hypertrophy -Ventricular Remodeling
Relationship between kidneys and calcium/vitamin D
-Vitamin D is necessary for calcium absorption. -Kidneys convert vitamin D into active form -When kidneys malfunction there is a lack of activated Vitamin D which results in a decreased amount og calcium absorption and available calcium -Hypocalcemia triggers the parathyroid gland to release parathyroid hormone, which leaches calcium from the bones -Phosphate is released with the calcium Therefore, high phosphate levels and low calcium levels seen in kidney failure
Drug therapy in treating hepatitis
-Vitamin K supplementation -Antihistamines -Antiemetics -Immuniglobulin -Interferon for B and C -HAV and HBV vaccine -cORTICOSTEROIDS -Recombinant Interferon
How do we decrease intravascular volume in the treatment of HF
-We want to increase LV function by reducing venous return -Loop diuretic is the drug of choice: Furosemide or Bumetanide
How do we decrease preload in the treatment of HF
-We want to reduce the amount of volume returned to the heart -Furosemide or Bumetanide -Nitroglycerin (to vasodilate vaculature) -High fowler's position (let gravity help you)
Duration of oligura phase of AKI when cause is ischemia vs. when cause is nephrotoxic medication
-When cause is ischemia, the onset/duration of is faster. -When cause is nephrotoxic medication, the onset/duration of oliguria is a little slower. You won't see this effect immediately
Why does having chronic respiratory failure limit you from receiving a kidney translplant
-Won't be able to get proper oxygenation to the new organ, so its a waste of the organ
Side effects of long term steroid use
-hugh blood sugar -hypokalemia -hypernatremia -osteoporosis -risk for infection -Increased bP
What are the 3 phases of peritoneal dialysis
-inflow (when you inject dialysis fluid) -Dwell (equillibrium) (leave dialysis fluid inside) -Drain
What is a prophylactic mastectomy and/or oophrectomy and when are they done
-preemptive removal of breast tissue and/or ovaries -Usually done if BRCA1 gene mutation is done
Features of onset phase of AKI
-renal blood flow 25% of normal -Tissue oxygenation is 25% of normal -Urine output lower than 0.5mL
What are common triggers of the onset phase of AKI
-significant blood loss (blood loss, burns, fluid loss, disbetes insipidus)
Complications of BPD with duodenal switch
Bleeding -Leaking of gastric contents bc there are so many anastamoses that could leak -DVT -Rhabdomyolosis
Ambulatory esophageal pH monitoring
A tube is interted into the esophagus and it tracks the pH to see if gastric juices are entering the esophagus -and how frequently the juices are moving up
What is inflammatory breast cancer
A type of breast cancer in which lymph channels in skin in the breast becomes blocked by cancer cells
Characteristics of breast cancer in men
1% occurs in men -Presents as hard, painless, subareolar mass -Often widely spread disease -- detected at a later stage than in women
Physical process of dialysis
1. Arterial blood is taken out of the patient 2. Patient's blood is pumped into the dialyzer (acts as an artificial kidney) 3. Patient's blood is return to their veins to enter systemic circulation
What is the maximum amount of sodium that should be consumed by HF patients each day
1.5g
PDE-5 inhibitors
1st line oral drug -Relaxes corpora cavernosa to increase penile blood flow -Compress exit veins, limiting outward blood flow -Take 1 hour before sexual intercourse
How long does it take to see results after an adjustable band gastric surgery
2 years more gradual weight loss than other options
What is the normal ejection fraction
55-70%
How long is Continuous Bladder Irigation done for
2-3 days
How do we test for abnormal BUN, creatinine, electrolyte, etc... levels in someone with suspected CKD
24 HOUR urine collection to measure albumin/protein in the urine
Duration of diuretic phase of AKI
7-14 days
How long does it take for finasteride to work
3-6 months
How long does it take to see results after starting finasteride
3-6 months
How many Hepatitis C patients will become chronic carriers
75-85% It is latent/asymptomatic but can have flare ups when you can spread it
Duration of oliguric phase of AKI
8-14 days or longer depends on the nature of the AKI (ischemia vs nephrotoxins) and dialysis initiation
Normal GFR
85-135 mL/min average: 120
How many infants/children infected with Hep B will recover
90% of infants and 25-50% of children aged 1-5 will remain chronically infected with Hep B
Normal BNP
<100
BNP Levels
<100 = normal 100-499 = CHF 75% probable >500= CHF 95% probable
Early complications of sleeve gastrectomy
Bleeding -Leaking of stomach contents out of the stomach bc the wound is stapled closed -Torsion (tension around the wound)
How often is CAPD done
4 times a day, 7 days a week Patient who does it themselves
Patient education for someone receiving an adjustable gastric banding weight loss surgery
40-60% of excess weight lodd over 2 years Success depends on lifestyle modifications: -Healthy food choices -No grazing, sweets, liquid calories -Planned, regular exercise
What amount of weight gain would be symptomatic of HF
>3LB (1.4kg) in 2 days
Which information will be included when the nurse is teaching self-management to a patient who is receiving peritoneal dialysis? Select all that apply. A. Avoid commercial salt substitutes. B. Drink 1500 to 2000 mL of fluids daily. C. Take phosphate-binders with each meal. D. Choose high-protein foods for most meals. E. Have several servings of dairy products daily.
A C D
The provider prescribed Tamsulosin (alpha 1 blocker). What are the potential side effects to educate your patient about? A. dizziness B. Diarrhea C. Dry mouth D. Insomnia E. Heartburn F. Orthostatic hypotension
A F
What is melena
A black, tarry stool indicating a GI bleed
What is hydronephrosis
A condition characterized by excess fluid in a kidney due to a backup of urine.
What is gastric dumping syndrome
A group of symptoms most likely to develop after surgery to bypass all or part of the stomach or if all or part of the stomach is removed -Occurs when undigested gasric contents are moved too quickly (or dumped) into the small intestine
Skin changes in HF
A low CO can result in decreased perfusion to the skin of the extremities resulting in mottling, a blue or gray coloring. A coolness or clammy feeling to touch can occur with poor perfusion.
What is autotransfusion
A method for replacing blood volume that involves safely and aseptically collecting, filtering, and returning the patient's own blood lost during a major surgical procedure or from a traumatic injury. It is an important way to safely replace volume and stabilize bleeding patients
What is calciphylaxis
A rare but severe complication in CKD patients Caused by accumulation of calcium in small blood vessels around skin and in subcutaneous tissues -a risk factor for infection -Typically seen in lower extremities
A patient is being monitored with a peptic ulcer. Which assessment finding would most likely indicate perforation? -Bradycardia -Nausea and vomitting -Numbness in the legs -A rigid, board-like abdomen
A rigid board-like abdomen
Complications of continuous bladder irrigation
Bleeding Clot retention Dilutional hyponatremia Retrograde ejaculation
What types of diseases can cause PUD
COPD Cirrhosis of liver Chronic pancreatitis Chronic renal failure Hyperparathyroidism
What is the most common arrythmia secondary to HF
AFib
What should we monitor if a patient has a GI bleed
ABC Lab Tests - CBC, BMP Fluids, blood transfusion, vasopressors PRN -Manage shock
Drug therapy for HF
ACE inhibitors Angiotensin II receptor blockers Beta Blockers Aldosterone antagonists (potassium sparing diuretics) Nitro Digitalis
Common drug therapy for treating HF
ACE inhibitors (decreases afterload) ARBs (decreases afterload) Inotropic drugs (digoxin PDI III inhibitors) Vasodilators Beta Blockers Diuretics (furosemide; spironolactone) Anticoagulants (especially If they have afib) Antidysrhytmic drugs (Ca channel blockers)
Why are antithrombotic agents presecribed to HF patients
AF promotes thrombus formation within the atria. An enlarged LV and very low LVEF also increase the risk for thrombus formation in the LV.
Diagnosis of HF
CXR (cardiomegaly, pulmonary congestion) ECHO (for ejection fraction, dilation of chambers, valves) ECG (risk for MI and dysrhymias) Cardiac catheterization (pulmonary pressure, EF, CO) -Lab tests (*BNP**)
What is the contents of antacids
Calcium Magnesium Aluminum
Benefit of gastric sleeve surgery
Can be converted into a Duodenal switch surgery (BPD-DP) or gastric bypass during a second surgery, therefore limiting the amount of time patient spends under anesthesia -Can be done laproscopically -Only gastric surgery that has no malabsorption AND no foreign object. Most foods can be well tolerated
What is a major potential complication of administering isotonic solutions like NS and Lactared Ringers
Can cause pulmonary edema by causing fluid overload from increased fluid in the intravascular compartment
Main advantage of Bioliopancreatic Diversion with Duodenal Switch (BPD-DS)
Can cure type 2 DM
Complication of glomeurlonephritis
Can lead to end stage renal disesase
Frequency of heartburn in GERD patients
Can range from happening intermittently to happening more than twice a week with increasing severity, can even cause people to wake up at night
Indications for urinary diversion
Cancer of the bladder (especially after cystectomy) -Neurogenic bladder -Congenitcal anomalies -Strictures -Trauma to the bladder
Patient education after ileal conduit
Care of stoma and applicance (ostomy bag) (will require frequent emptying) Increase fluid intake Signs and symptoms of infection
Types of permanent hemodialysis access
AV fistula AV graft
GI findings in someone with HF
Abdominal distention, hepatosplenomegaly, ascites
Digital rectal exam findings in someone with prostate cancer
Abnormal findings include firmness, boginess, asymmetry
What causes acute glomerulonephritis
Accumulation of antigen, antibodies, and complement in the glomeruli, causing tissue damage. (antigen-antibody complex lodges in tissue of the glomerulus, causing tissue destruction) -Usually caused by strep throat infection
What are the 4 overarching treatments for prostate cancer
Active surveillance Radiation therapy Drug therapy surgery
What is Acute Kidney Injury (AKI)
Acute kidney injury is defined as the abrupt loss of kidney function over hours to days.
What type of hiatal hernia is a medical emergency
Acute paraesophageal hernia, because it can cut off the blood supply to this portion of the stomach
How do we increase oxygenation and gas exchange in the treatment of HF
Administer oxygen Possible intubaiton
Risk factors for prostate cancer
Age Race Genetics -Diet (high in animal fats, carbs, low fiber, red or processed meat)
Characteristics of inflammatory breast cancer
Aggressive and fast growing High risk for metastasis
Risk factors for BPH
Aging Obesity Lack of physical activity alcohol consumotion erectile dysfunction History of BPH in first degree relative
What class of drugs do we give to patients with BPH and why
Alpha blockers bc this blocks the activation of alpha 1 receptors, which cause the closure of the bladder sphincter when they are activated
Which drug has the strong potential to increase digoxin concentration in the body
Amiodarone -Must cut digoxin dose in half if also taking amiodarone
Ammonia encrustation
Ammonia is not typically in contact with bowel segments, so it may cause some damage to the segment -Also ammonia content in urine may cause skin irritation
Purpose of using Pyridium to treat UTI
Analgesic effects Provides soothing effect on urinary tract mucosa
What classification of cancer is prostate cancer
Androgen-dependent adenocarcinoma -Slow growing -Spread to pelvic bone, femur, lymph, lower spine, liver, and lungs
Possible hematologic findings in CKD patients
Anemia Bc the kidney failure leads to decreased erythropoeitin production
What are most cases of hospital acquired UTIs related to
Catheter use
Blood test results that would indicate immunity to Hep A infection
Anti-HAV IgG in the blood
What types of drugs are nephrotoxic
Antibiotics Contrast media NSAIDs
Management of glomerulonephritis
Antibiotics! (only if caused by infection) patient education; measure weight, rest, manage anziety -Limit salt, fluids, protein -Preventing complications leading to AKF -Drug therapy -Dialysis -Plasmapheresis Kidney transplantation
What drug therapy is common post-organ transplant
Antirejection meds -Immunosuppressants (prednisone)
Purpose of using Hyocyamine to treat UTI
Antispasmodic An anticholinergic
What can cause dumping syndrome
Any GI surgery Including bariatric surgery
What are the results of portal hypertension
Ascites (from increased interstitial pushing pressure) Edema Splenomegaly Anemia, thrombocytopenia, leukopenia varices (esophageal and gastric varices, hemmorhoids)
How to differentiate between heartburn and angina
Ask questions about when it gets worse; if it is more noticable after easting it is likely heartburn
Diagnosis of fibrocystic breast condition
Aspiration or needle biopsy Mammography or ultrasound
Esophageal manometric study
Assess the functioning of the upper esophageal sphincter
How do we assess if our treatment of PUD is being successful
Assess through X-Ray or endoscopic exam
Nursing care after a cystoscopy
Assess urine output Assess for bleeding Refrain from sexual activity Should have normal bladder function (pee) in 8 hours
Post necrotic cirrhosis
Associated with viral hepatitis or hepatic changes from drugs or toxins -Broad bands of scar tissue as a result of previous acute hepatitis
Ideal time to take alpha blockers
At night bc then you dont have to worry about orthostatic hypotension bc you are lying down
What are natriuretic peptides?
Atrial natriuretic peptide (ANP) Brain natriuretic peptide (BNP) -Hormones released in response to increases in atrial volume and ventricular pressure -Promote venous and arterial vasodilation, reducing preload and afterload
What is the most common type of peritoneal dialysis
Automated Bc patient can do it while they sleep
Patient education for HAV
Avoid overcrowding and poor sanitation
Which of the following causes the majority of UTIs in hospitalized patients? A. lack of fluid intake B. Invasive procedures C. Inadequate perineal care D. Immunosuppression
B
Which hepatitis viruses have the highest risk for developing liver cancer
B and C
Which types of hepatitis are mostly related with cirrhosis and liver cancer
B and C not A
How does liver necrosis cause jaundice and light colored stool and dark urin
Bile is not readily transported to bile duct -Bilirubin cannot be broken down in bile duct -Bilirubin builds up in systemic circulation, causing yellow appearance -Lack of bilirubin breakdown = less billirubin in stool= light color -Bilirubin in bloodtream has to be excreted through kidneys now instead of through the stool = dark urine Bilirubin is what gives stool its dark color, so if it is absent in the stool and presence in the bloodstream, it will cause clay stools and dark urin
Why do patients with hepatitis experience pruritis
Bile salts distribute in their skin
What components of the dialysate do we want to diffuse through the semipermeable membrane and INTO the blood to introduce them to our body
Bicarbonate Calcium Chloride
how do we differentiate between respiratory or cardiac problems when a patient is reporting SOB or other respiratory issues
BNP is a good way to tell if the problem is stemming from the heart rather than the lungs
A pt presents to the ER with a HF exacerbation. Which of the following lab values is indicative of HF -K: 5.2 -BUN: 7 -BNP:900 -Troponin <.02
BNP:900
What is the priority assessment by the nurse for the patient receiving IV nitroprusside to treat HF -Lung sounds -BP -Urine Output -RR
BP
BRCA1 vs BRCA2 risk for developing breast cancer
BRCA1 = Lifetime risk as high as 80% (average 55-65%) BRCA 2= 45% risk
Risk factors for breast cancer in men
BRCA1/2 mutations -chest radiation -hyperestrogenism -family history -liver disease -Advance age
BUN/Creatinine in intrarenal AKI
BUN and Creatinine go up simultaneously. EX: BUN-60 and Creatinine- 4.0
BUN/Creatinine characteristics in AKI
BUN is dispraportionally higher than creatinine bc the problem is with perfusion NOT with filtration EX: BUN-70 and creatinine- 1.2
Why does urinary stasis lead to UTI
Bacteria can build up in the urine, which is typically sterile
Complications of GERD
Barrett's Esophagus Ulcers Risk of esophageal cancer Strictures Cough Bronchospasms Laryngospasms Cricopharyngeal spasms -Potential for asthma, bronchitis, pneumonia Dental erosion
Stomach dilation in sleeve gastrectomy
Basically if you go back to eating large meals and grazing, you're just going to stretch the stomach back to its original size
Why does CKD cause EKG changes
Bc of the resulting hyperkalemia
Why is thrombosis such a pertinent complication of dialysis
Bc the blood is coming in contact with foreign objects (aka dialyzer and tubing)
Typical components in dialysate
Bicarbonate Sodium Chloride Calcium dextrose
What other symptoms are related to the heartburn found in GERD
Bitter or sour liquid into mouth Post meal bloating, nausea and vomitting Wheezing, coughing, dyspnea Nocturnal discomfort and coughing with loss of sleep
MOA for alpha blockers
Blocks Alpha 1 receptors, therefore blocking their action and their effects
What are the results of left sided HF
Blood backs up into the pulmonary circulation -Pulmonary congestion and edema
What is Autologous Donation
Blood donations that individuals give for their own use - for example, before a surgery
How do we prevent Hep C
Blood donor screening Risk behavior modification
What is a portacaval shunt and how is it used in the treatment of cirrhosis
Blood is passed from the portal vein directly to the inferior vena cava to re-enter circulation -Blood bypasses the liver all together in order to prevent complications of portal hypertension (namely esophageal varices)
Mode of transmission of Hepatitis C
Blood or blood product transfusion
Risk factors for glomerulonephritis
Blood or lymphatic diseases Exposure to hydrocarbon solvents Mercury Cancer Infections (*strep*, viruses, endocarditis) Amyloidosis Antiglomerular basement membrane antibody disease Blood vessel diseases Heavy use of NSAIDs IgA nephropathy Lupus nephritis
How do we measure BNP
Blood test
What does elevated alkaline phosphate indicate
Bone metastasis of cancer (prostate)
Findings upon auscultation if someone has a perforation
Bowel sounds may be diminiahed or absent
What is hepatic encephalopathy?
Brain dysfunction and damage caused by increased ammonia in the blood, resulting from severe liver disease -Liver is supposed to break down urea in the blood, when it doesnt do so because of liver damage, the urea/ammonia builds up in the bloodstream
Describe a Duodenal Switch Gastric Procedure
Bypasses a large portion of the small intestine in combination with a sleeve gastrectomy -Food is shunted directly from stomach to large intestine without being broken down -Bile does not arrive until the food reaches large intestine = this gets rid of any and all absorption that would happen in the small intestine
The nurse teaches the patient who is just prescribed finasteride for BPH. Which statement requires clarification a. "I should not limit my fluid intake" b. "my pregnant wife should not touch the pill" c. "My uriantion will return to normal within the week" d. "My hair growth might be enhanced"
C Effects of finasteride seen in 3-6 months
Risk factors for HF
CAD Age Hypertension High cholesterol MI African american decent
What can be the resulting syndrome if AKI is not managed properly
CKD chronic kidney disease
What to be aware of in a patient with temporary hemodialysis access
CLABSI Must be cared for very cautiously
Equation for CO
CO = SV x HR
What is a risk factor for developing Right sided HF that is NOT left sided heart failure
COPD This causes increased pressure in the pulmonary artery, making the RV have to pump harder, which can lead to hypertrophy and ineffective pumping
How does urine pH affect kidney stone formation
Certain stones are more likely to form in alkaline or acidic conditions
Drug therapy options for treating breast cancer
Chemotherapy Aromatase Inhibitors Immunotherapy/targeted -herceptin Estrogen receptor blockers - Tamoxifen *combination drug therapy = better than single*
What is the gold standard for diagnosing HF
Chest XR Will show heart enlargement and fluid in the lungs
General symptoms of HF
Chest pain fatigue tachycardia skin changes behavioral changes (restlessness, confusion,etc)
What is one main side effect associated with gastric surgery? What do they do to prevent it
Cholelithiasis (gall stones) Along with your bariatric surgery, you may also have a cholesystectomy
Which type of glomerulonephritis usually leads to kidney failure
Chronic
Why does hepatitis cause increased PT
Clotting factors are developed in the liver, so if there is liver dysfunction, there will be fewer clotting factors and blood will take longer to clot
What to monitor Jackson-Pratt drain
Color and amount of drainage that is collected
Treatment of acute lymphedema
Complete decongestive therapy: -Massage like technique -Mobilizes subcutanous fluid accumulation -Compression bandages -Pneumatic compression sleeve -Elevate arm level with heart -Isometric exercises -Lymph node transplant
Management of UTI in ambulatory/home care
Compliance with antibiotic treatment Adequate fluid intake Voiding regularly Void after intercourse Discontinue use of diaphragm Follow-up care with urine culture Recurrent symptoms typically occur 1-2 weeks after therapy
Lymphedema prevention
Compression sleeves ball squeezing Handwall gliding
If someone has breast pain/breast lump combined with warm/red skin, what is the concern??
Concern is that there might be a blockage in the lymph flow secondary to the lump/cancer related to inflammatory breast cancer
What are some common symptoms after weight loss surgery
Constipation Diarrhea Flatulence cramping These are likely temporary and will resolve on their own
What types of funtional disorders can predispose someone to getting a UTI
Constipation (putting pressure on bladder) Voiding dysfunction Alzheimers (dont remember they need to pee)
What is noninvasive breast cancer
Contained within the lobule or duct within the breast tissue
How does the Koch's Pouch allow for continencee
Continence mechanism formed between large, low pressure reservoir and the stoma by intussuscepting a portion of the bowel
Types of peritoneal dialysis
Continuous ambulatory (capd) Automated Intermittent Continuous cycle
What additional intervention is done for patients posst-operatively after a TURP
Continuous bladder irrigation
Integumentary findings in someone with HF
Cool, diaphoretic skin. Cyanosis or pallor. Peripheral edema (right-sided HF)
Which of the following is NOT a typical sign and symptom of right-sided HF? -Jugular Vein Distention -Weight gain -Orthopnea -Crackles
Crackles
What is the most common cause of prerenal failure
Lack of renal perfusion
Drug therapy for the treatment of AKI
Diuretics Calcium Channel Blockers *be cautious of nephrotoxic meds* (adjust the dosage of these md
What is intrarenal AKI and what are the causes
Damage to the glomeruli, interstitial tissues, or tubules within the kidney/nephron CAUSED by damage to the nephron: -Glomerulonephritis -Acute tubular necrosis -Thrombi -Prolonged ischemia -Pyelonephritis -Trauma -Alcohol -drug (NSAIDs, antibiotics -*nephrotoxins (antibiotics, contrast dyes, etc)*
Function of H2 blockers
Decrease secretion of HCl acid Reduce symptoms and promote healing in 50% of GERD patients
How does liver necrosis cause increased bleeding
Decreased Vitamin K absorption in the liver Vitmain K necessary for formation of clotting factors
What are some other predisposing factors to developing GERD
Decreased esophageal clearance Hiatal hernia Decreased gastric emptying Pregnancy (applying pressure to the organs) Obesity Smoking
Side effects of 5 ARIs
Decreased libido decreased volume of ejaculation Erectile dysfunction -May increase risk of prostate cancel *FEMALE nurses should not touch this med with bare gloves bc it can absorb. Especially if you are pregnany, it can cause birth defects in a male fetus*
Why are behavioral changes associated with HF
Decreased perfusion to brain Or can be caused by aggitation from other symptoms (SOB for example)
Description of GERD related chest pain
Described as burning, squeezing, or radiating to neck, back, jaw, or arms -Can mimic angina
How do we diferentiate between fibroadenoma and breast cancer
Diagnosed by biopsy
What is another name for renal replacement therapy (RRT)
Dialysis
How do we increase cardiac functioning in the treatment of HF
Digitalis -newer inotropics (PDE III inhibitor; Milrinone) -Dobutamine
Contraindications on the arm of HD access
Do not do BP, blood draws, injections in this arm
What is paracentesis and why is it used in the treatment of ascites
Draining the excess fluid from the abdomen using a needle
Classifications of breast cancer based on tissue type
Ductal carcinoma (affecting milk ducts) Lobular carcinoma (affecting milk-producing glands)
Disadvantages of gastric bypass
Dumping syndrome (diarrhea, hypoglycemia, palpitations, nausea, vomitting) Gall stones Alters anatomy Higher rate of complications Malabsorption of some vitamins/minerals
Signs and symptoms of circulatory overload transfusion reaction
Dyspnea Crackles Hypertension Tachycardia Headache
Signs of Left sided HF
Dyspnea on exertion *Crackles in lungs* Orthopnea Paroxysmal nocturnal dyspnea Pulmonary congestion Coughing (productive) *fatigue related to decreased CO* tachycardia -Cyanosis (late sign)
Progression of diet after weight loss surgery
Fluids --> Pureed foods --> Soft foods --> Regular food *Beef, pasta, fresh breads, fibrous vegetables, and white rice come last and may not be well tolerated. These things MUST be well chewed to help break down the carbohydrates. Bread should ALWAYS be toasted*
Specific nursing actions for febrile, non-hemolytic transfusion reaction
Give antipyretics as prescribed Do not give the rest of the blood
Lifelong carrier risk for Hep A?
None
Specific nursing actions for anaphylactic transfusion reaction
Give epinephrine Do not administer the remaining blood
I can occur after streptococcal infection (either from skin or from throat). Which renal disease am I? -Glomerulonephritis -Cystitis -Urinary calculi -UTI
Glomerulonephritis
Link between glomerulonephritis and hyperlipidemia
Glomerulonephritis causes you to lose so much protein through the urine that the body tries to compensate by increasing lipid production
What are three ways we can reduce the amount of ammonia in the body
Lactulose Rifaximin reduce constipation
What is ventricular dilation and why/when does it occur
Enlargement of the chambers of the heart that occurs when pressure in the left ventricle is increased -Occurs in HF patients bc the heart is trying to have more room available for more blood so that more can get pumped since there is a low CO. -This begins as a compensatory mechanism but actually just worsens the HF
Clinical manifestations of PUD
Epigastric pain or tenderness -intermitten dull, gnawing pain -Burning, cramp like, gaseous pain Black, tarry stools Nausea and vomitting
diagnosis of hiatal hernia
Esophagogram Endoscopy
How does hypotension/severe injury cause PUD
Hypoperfusion states shunt blood away from GI system, which disrupts body's normal protective mechanism
Classifications of breast cancer based on invasiveness
Noninvasive (in situ) Invasive
Which lab results can point to liver disease
Eelevated -bilirubin -AST -ALT -Alkaline phosphate
What is retrograde ejcatulation
Ejaculation goes into the bladder rather than out of the body
When are HF patients considered most at risk for complications
Ejection fraction <30% Class III or IV HF These are strongly associated with cardiac dysrhytmias
The patient with an ileal conduit reports mucus-like appearance of the urine. Which action would be most appropriate? -Change the appliance bag -Notify the physician -Obtain a urine specimen for culture -Encourage a high fluid intaje
Encourage a high urine output
Invasive tests for H. Pylori
Endoscopic procedure Biopsy of stomach, rapid urease test
What is benign prostatic hyperplasia (BPH)
Enlargement of prostate gland = disruption of bladder outflow from bladder and urethra *NOT a problem with the kidneys*
Hemovac drain
Large portable would self-suction device with reservoir common after mastectomy
Modifiable risk factors for developing breast cancers
Excess weight Sedentary lifestyle Smoking Dietary fat intake Obesity Alcohol intaje Environmental factors (radiation) -External estrogen therapy
Radiation therapy in prostate cancer
External beam radiation therapy (EBRT) -low dose Brachyterapy-seeds
What is the mode of tramission for Hepatitis A Virus (HAV)
Fecal-oral Usually through ingestion of contaminated foods/liquid Also by sex
What are the benign breast disorders we learned about
Fibroademoma Fibrocystic breast condition
What does creatinine measure
Filtering capabilities of the kidneys
Examples of 5 ARIs
Finasteride Dutasteride
Graft vs fistula
Fistula is preferred bc it is natural and is not a foreign object -Graft has more change for getting clogged up
What is the main nursing priority in the immediate post-op period after kidney transplant
Flui/electrolyte balance
Results of right sided HF
Fluid backs up into venous system Fluid moves into tissue and organs
What is meant by "infiltrates in lungs"
Fluid in the lungs
Signs/symptoms of mild allergic transfusion reaction
Flushing Pruritis Urticaria
When do we give immunoglobulins for hepatitis
For people who were potentially exposed to Hep A or B
Where do kidney stones form
Form in the renal pelvis and then can either stay in kidey or travel into the urethra, where they can cause blockage of urine and intense pain
Possible GI findings in CKD patients
Foul breath ulcerations anorexia vomitting (body has metabolic acidosis, so it is trying ot get rid of acid)
Late complications of sleeve gastrectomy
GERD Stomach dilation Torsion Weight regain
Characteristics and action plan for stage 4 CKD
GFR 15-29 Severe decrease in GFR Preparation for renal replacement therapy
Diagnostic criteria for CKD
GFR < 60 for >3 months and/or kidney damage > 3 months
Characteristics and action plan for stage 3 CKD
GFR: 30-59 Kidney disease with a moderately decreased GFR
Characteristics and action plan for stage 2 CKD
GFR: 60-89 Kidney disease with slightly decreased GFR
Characteristics and action plan for stage 1 CKD
GFR>90 Kidney disease with normal or increased GFR
What are some underlying causes that could contribute to hepatic encephalopathy? How? How do we prevent this?
GI bleeding can cause increased ammonia levels bc when blood is broken down by the GI juices, it releases ammonia -Getting any GI bleeds under control will help reduce hepatic encephaloopathyu
What is the most common complication after gastric bypass
Gallstones
Aside from hemorrhage and perforation, what is a third complication of PUD
Gastric outlet obstruction
What food is high in roughage
Greens Grains Nuts
Diagnosis of CKD
H&P -Laboratory values (BUN,Creatinine, GFR, electrolytes, urinalysis, albuminuria, parathyroid hormone levels) -Imagin (renal ultrasound)
What is the main cause of PUD
H. pylori 90% of the time
PPIs or H2 receptor blockera PRN?
H2 receptor blockers can be PRN -PPIs are more likely to be given daily
What is a big reason that Hep B is so contagious
HBV can live outside of the body on surfaces for at least 7 days and still be capable of causing infection
Significance of HER-2 genetic status
HER-2 positive breast cancer is very aggressive
Ventricular dilation as a compensatory mechanism
HF compensatory mechanism Dilation is an enlargement of the heart chambers (Fig. 34.3, A). It occurs when pressure in the heart chambers (usually the LV) is elevated over time. The heart muscle fibers stretch in response to the volume of blood in the heart at the end of diastole. According to the Frank-Starling Law, the strength of the heart's contraction is directly proportional to its diastolic expansion. The implication is that increased preload (a greater influx of blood into the ventricle during diastole) will cause a more forceful contraction. This increased contraction initially leads to increased CO and maintains BP and perfusion. Dilation starts as an adaptive mechanism to cope with increasing blood volume. However, excessive preload exhausts the Frank-Starling mechanism, cardiac muscle fibers are overstretched, and further increases in preload no longer increase CO.
Nursing intervention for hiatal hernia
HOB elevation
Which patients are at higher risk for heart failure
HTN CAD MI Diabetes (damages blood vessels) sedentary lifesstyle
Positive side effect of finasteride (used for BPH)
Hair growth
Most common side effects of PPIs
Headaches
Factors affecting CO
Heart rate Preload Afterload Cardiac contractility
What is the most common symptom of GERD
Heartburn
What are we looking for during the urinalysis trying to diagnose nephrolithiasis
Hematuria
In men especially, which test result is usually indicative of kidney stones
Hematuria in 80% of cases, when there is blood in urine, it indicates a kidney stone
What is the most common complication of PUD
Hemorrhage Ulcers can erode through blood vessels
Which hepatitis viruses have vaccines
Hep A and Hep B
What is the #1 cause of liver cancer and cirrhosis
Hep B
How do we prevent thrombosis during dialysis
Heparin added to dialyzer
What is the most common type of post-transfusion hepatitis
Hepatitis C
Parastomal hernia
Hernia adjacent to an ostomy (e.g., colostomy)
Ventricular hypertrophy as a compensatory mechanism
Hypertrophy is an adaptive increase in the muscle mass and heart wall thickness as a slow response to overwork and strain (Fig. 34.3, B). -Initially, the increased contractile power of the muscle fibers leads to an increase in CO and maintains tissue perfusion. Over time, hypertrophic heart muscle has poor contractility, needs more O2 to perform work, has poor coronary artery circulation (tissue becomes ischemic more easily), and is prone to dysrhythmias.
Which electrolyte imbalances are associated with AKI/CKD
Hypocalcemia Hyperphosphatemia Hyperkalemia Hypermagnesemia
What is a stoma
Hole through the skin through which we drain fluids or whatever
Cause of BPH
Hormonal changes from the aging process -Excessive dihydrotestosterone (DHT) in prostate (taking testosterone supplement) -Increases proportion of estrogen over testosterone
Side effects of hormonal breast cancer treatment
Hot flashes nausea vomitting blood clots endometrial cancer *may cause blood clots and uterine cancer*
Duration of onset phase of AKI
Hours to days
Possible endocrine findings in CKD patients
Hyperparathyroidism
Possible cardiovascular findings in CKD patients
Hypertension HF Pericarditis
Possible ocular findings in CKD patients
Hypertensive retinopathy
What is the main side effect of dumping syndrome
Hypoglycemia
What electrolyte affects digoxin
Hypokalemia = digoxin toxicity
Is Hep A have the possibility of chronic infection
nO
What is the MOST common transmission route of Hepatitis C -Blood transfusion -Dialysis -Contaminated food or drink -IV drug use
IV drug use
Why is plasmapheresis done in glomerulonephritis patients
If having acute glomerulonephritis, this is done to remove the antibodies that are causing the inflammation in the glomeruli
How would GERD cause resp symptoms like coughing, wheezing, and dyspnea
If the gastric contents have been aspirated after they have reentered the esophagus
When would a kidney transplant not be an indicated treatment for glomerulonephritis
If the glomerulonephritis is caused by an autoimmune disease like Lupus because its is likely that the underlying autoimmune disease is just going to destroy the kidney
When would someone doing peritoneal dialysis call the doctor
If the outflow liquid is cloudy/white
Further complication of nephrolithiasis
If the stone is blocking urine flow, it can cause urinary stasis, which can cause UTI and UTI symptoms
When would be use imaging studies to diagnose UTI
If they believe the UTI may be caused by some type of obstruction IVP or CT when obstruction is suspected
Education for patients taking immunosupressants
If they ever have ANY fever, they need to go to the doctor
What is the most common type of urinary diversion surgeries
Ileal Conduit *incontinent urinary diversion*
How do we prevent Hep A
Immunization
How do we prevent Hep B
Immunization
When do the kidneys release erythropoeitin
In response to hypoxia/decreased blood flow to the kidneys
Causes of left sided HF
Inability of LV to empty adequately during systole, fill properly during diastole,
What is the primary predisposing factor to developing GERD
Incompetent lower esophageal sphincter (LES) -Decreased LES pressure allows gastric contents to move from stomach to esophagus -Can be due to certain foods (caffeine, chocolate) and drugs (anticholinergics)
Ileal conduit: incontient or continent
Incontinent
Function of cholinergic drugs in treating GERD. Examples of these meds
Increase LES pressure Improve esophageal empything Increase gastric emptying EX: bethanechol (Urecholine)
Describe nissen Fundoplicaiton
Laparoscpic anti-reflux surgery -Reinforces valve between esophagus and stomach\ -Wrap upper portion of stomach around esophagus
What is ventricular hypertrophy and why/when does it occur
Increase in the muscle mass and cardiac wall thickness in response to chronic dilation Occurs in HF patients bc the heart is having to pump harder to do the same amount of work (or less work)
Blood test results that would indicate acute Hep A infection
Increased Anti-HAV Igm in the blood
Effect of RAAS
Increased BP
Blood tests results that would indicate acute Hep-B infection
Increased HBsAg (Hep B Surface Antigen) Increased
Interaction between sulfa drugs and warfarin
Increased anti-clot effects Prolonged INR times
What might urinalysis show in someone with AKI
Increased specific gravity (bc of low urine output; the urine that can be excreted is very concentrated) Proteinuria
Precipitating factors for hiatal hernia
Increasing age trauma poor nutririon Forced recumbent position Congenital weakness -Increased intra-abdominal pressure (pregnancy, lifing heacy weights, obesity, ascites)
Risk factors for erectile dysfunction
Inflammation of prostate Surgery (prostatectomy) Pelvic fractures Vascular disease Diabetes Chronic neuro conditions Endocrine disorders Smoking and alcohols Drugs Poor overall health
Acute hemolytic transfusion reaction
Infusion of ABO-incompatible whole blood, RBCs, or components containing as little as 10 mL of RBCs. Antibodies in the recipient's plasma attach to antigens on transfused RBCs, causing RBC destruction.
What is glomerulonephritis
Injury to the glomeruli due to immune-inducing inflammation
Unique potential complications for banded gastric bypass
Intolerance to meat, bread, and rice leading to possible poor food choices, which can cause poor weight loss/weight gain
Invasive or noninvasive more common
Invasive -Noninvasive can become invasive
Two types of breast cancer
Invasive Noninvasive
Percentage of invasive vs. noninvasive forms of breast cancer
Invasive 80% Noninvasive 20%
What nutrients are malabsorbed in a gastric bypass patient
Iron Calcium B12 Vitmain D Zinc These may need to be supplemented in order to maintain healthy levels
What must be given along with erythropoetin to make it be effective
Iron and vitamin C
Side effects of bachytherapy for prostate cancer
Irritative or obstructive urinary problems are common -Erectile dysfunction
What is revision surgery
Is an option for patient who have gained weight or not lost sufficient weight after bariatric surgery -Another weight loss surgery is performed to allow the patient to lose more weight
When would it be normal for ejection fraction to decrease
It decreases as we age
How does Rifaximin remove ammonia from the body
It is an antibiotic that sterilizes the gut, thereby getting rid of the bacteria that create ammonia
Why is PSA screening not recommended anymore
It is not specific for prostate cancer It leads to a lot of unecessary TURP procedures which can also lead to unnecessary pain, fever, bleeding, infection, and bladder difficulties
CKD reversible?
It is progressive and irreversible
What is a hiatal hernia
It is when a portion of the stomach herniates through the diaphragm, into the thorax. -Hernia of portion of stomach into esophagus through an opening or hiatus in diaphragm
What is the purpose of prescribing Vitamin C (Ascorbic acid) to patientsa
It promotes wound healing Especially in post-surgical
What are some self management activities to consider to prevent complications after a prostatectomy (namely incontinence)
Kegel excercises
Why might the fluid/electrolyte balance be thrown off after kidney transplant
Kidneys control fluid/electrolyte balance -Large volume of urine are produced after the transplant
What is the RAAS mechanism and why is it triggered in HF patients
Kidneys release renin in response to decreased renal perfusion -Renin converts angiotensiongen to angiotensin 1 -ACE converts angiotensin 1 to angiotensin 2 -Angiotensin 2 is a vasoconstrictor and also triggers the release of aldosterone, both of which Increase the BP
Acetaminophen is toxic in high doses to which organ
LIVER Liver failure patients can still take acetaminophen, but the dose should be adjusted
Possible neurologic findings in CKD patients
Lethargy Seziures Coma Neuropathy (caused by metabolic acidosis)
What is fresh frozen plasma
Liquid portion of whole blood, separated from cells and kept frozen until ready for use
Treatment of urinary tract calculi (if they can not be passed on their own)
Lithotripsy Open surgical stone removal Percutaneous stone removal Ureteroscopic stone removal
Why are falls particularly harmful to patients with cirrhosis
Liver damage causes increased clotting times If patient falls and hits their head, they could have subdural hematoma
If left untreated, what are the further progressions of liver necrosis
Liver failure Hepatic encephalopathy Hepatic coma Death
How does liver necrosis cause gynecomastia, menstrual dysfunction, and loss of body hair
Liver is responsible for metabolising hormones like estrogen and androgens -When liver is damages, it is not able to do so so there are higher levels of these hormones in the body
How does liver necrosis cause hypoglycemia
Liver is the main storage/production center of glycogen -Glycogen is the stored form of glucose that is released when glucose levels drop -When the liver is damages, glycogen is not available to be released to manage glucose levels
How does liver necrosis cause ascites and edema
Liver is the primary creator of plasma proteins like albumin When the liver is damage, the liver is less able to metbaolize proteins
Examples of MCS devices
Long-term MCS devices include LV assist devices (VADs), including percutaneous devices (PVAD) and transplanted devices (LAVDs, BiVADs) (
Advantages of gastric bypass
No foreign body Greater, more reliable weight loss Low failure rate Reversible but not trivial
What is the function of urine cytology in the diagnosis of bladder cancer
Looking for abnormal, cancerous cells that may have been exfoliated from the bladder
Interactions between digoxin and diuretics
Loop diuretics can cause hypokalemia -Low potassium greatly increases the risk for digoxin toxicity
What do we check between donor and recipient before kidney transplant
Lots of histological studies blood typing HLA matching
Possible reproductive system findings in CKD patients
Low semen count infertility
Which types of bladder cancers are more easily cured
Low stage, low-grade cancers are more responsive to treatment and more easily cured
What are signs of kidney organ rejection
Low urine output
Manifestations of UTI
Lower: Dysuria Frquency Urgency Suprapubic discomfort or pressure Upper/complicated: Hematuria cloudy urine Flank pain (costovertebral angle) suprapubic tenderness fever
What are the two types of surgery used for breast cancer treatmnet
Lumpectomy Modified radical mastectomy
What immune diseases are likely to cause glomerulonephritis
Lupus Goodposture's syndrome IgA nephropathy
What do we want to include in the discharge teaching for our patients with HF
MAWDS Medications Activity Weight Diet Symptoms (when should they seek medical attention)
Discharge teaching for HF patients
MAWDS (medications, activity, weight, diet, symptoms) -Signs for when they should seek healthcare (weight gain, SOB getting worse, peripheral swelling) -Fluid restrictions -Sodium restrictions -Daily weights
MCS device length of implantation
MCS devices can be beneficial to carefully selected patients for short-term management, long-term and bridge-to-transplant management, or as destination therapy.12 Patients who are ineligible for heart transplant may be candidates for lifelong MCS.
What are the 2 types of weight loss procedures
Malabsorptive procedure Restrictive procedure
Which gender is more likely to have kidney stones
Male Ages 20-55
What is prostate cancer
Malignant tumor of the prostate gland
What causes the symptoms of HF to manifest
Manifestations of HF are the result of neurohormonal compensatory mechanisms activated in response to myocardial dysfunction, leading to remodeling of myocardial structure and function
What is triple negative breast cancer
Negative for estrogen receptor, progesterone receptor, and HER2 receptor. -Aggressive tumors with poorer prognosis
What can cause fibroadenoma
May be due to increased estrogen sensitivity
WHat is important to remember regarding medications in someone with a low GFR
May have to reduce the dose bc the kidney is not filtering it out properly
Why does obesity cause osteoarthritis
Mechanical injury More pressure on the joints
Who is most likely to contract Hep A through sexual intercourse
Men who have sex with men
Which acid/base disorder is associated with AKI/CKD
Metabolic acidosis (decreased secretion of acid and decreased production of bicarb)
Ploidy status
Microscopic study that looks into tumor cell differentiation (abnormality) -correlates with tumor aggressiveness
Surgery for prostate cancer
Minimally invasive surgery Radical prostatectomy Bilateral orchiectomy
How to assess hepatitis patients for coagulopathies
Monitor PT levels (should be 10.5-13.5 seconds) -Monitor platelet count for thrombocytopenia -Monitor HgB and HCT-- decreases may signal occult bleeding -Monitor for stool occult blood -- Guaic test
Nursing implications for Hyocyamine
Monitor for tachycardia, blurred vision, urinary retention, constipation
Nursing implications for someone who had Nissen Fundoplication
Monitor vital signs and assess for signs of post-op bleeding
Signs and symptoms of upper UTIS
More systemic symptoms Fever Chills Flank pain
Function of antacids in treating GERD
Neutralize HCl acid
What is the type of surgery used to treat hiatal hernia
Nissen Fundoplication
Does BPH increase risk of prostate cancer
No Answer is unclear
Do restrictive gastric surgeries interfere with absorption
No Do not interfere with normal gastric process or calorie absorption
Is ejection fraction reduced in diastolic failure
No The AMOUNT is likely reduced by the PERCENTAGE of blood pumped is not
Complications of Hep B
Mortality as high as 10% Another 10% develop chronic hepatitis
Acute uncomplicated cystitis
Most common form of UTI Lower UTI in which the acute symptoms involve only the lower urinary tract EX:urgency, dysuria,
What is dialysis
Movement of body fluids across a semipermeable membrane -Used to correct fluid/electrolyte imbalances and to remove waste products for people in renal failure
Pathophysiology of breast cancer
Multiplication in the number of epithelial cells in the mammary ducts/lobes
Chronic PUD
Muscular wall erosion with formation of fibrous tissue Long duration—present continuously for many months or intermittently More common than acute erosion
Pre-operative care of weight loss surgery patient who has H.Pylori infection
Must be treated with a 2-week course of antibiotics and H2 blockera
How to properly use Jackson-Pratt drain
Must squeeze and close drain before inserting to patient bc this helps maintain the negative pressure and produce a slight suctioning
Pateitn education for HBV and HCV
NO BLOOD DONATION Modify sexual behaviors
What are examples of nephrotoxic medication
NSAIDs ACE-I ARB sulfa cipro statins mannitol loop diuretics
What medications could cause someone to develop PUD
NSAIDs Steroids SSRIs
Retracted stoma
Narrowing of stoma lumen
Symptoms of dumping syndrome
Nausea Vomitting weakness diarrhea abdominal cramps lightheadedness flushing palpitations hypoglycemia
Lifestyle changes as a result of vagotomy
Need to plan meals so that you still are eating bc you wont feel hungry
nursing considerations when someone has an AV fistula
No blood pressure on the arm No finger stick on the arm
What is ventricular remodeling
Normal myocardium will hypertrophy and dilate in an attempt to compensate for the infarcted muscle
What to assess in someone who has a fistula
Nuerovascaulr checks on the extremity distal to the fistula (the hand) Check for: pain pulse temperature
What can the dialysis line be used for
ONLY FOR DIALYSIS Can NOT be used for blood draw or to push meds
Why can obsesoty lead to type 2 diabetes
Obesity decreases insulin sensitivity
Uncomplicated UTI
Occurs in otherwise normal urinary tract Usually involves only the bladder
In which patients is GERD related chest pain most common
Older patients with GERD
Examples of PPI
Omeprazole *zole suffix (Prilosec)
What is the advantage of peritoneal dialysis
Once the catheter is placed, you can start dialysis immediately -Less complicated -Portable -Fewer dietary restrictions -Short training
Why does orthopnea occur in HF
Orthopnea occurs due to redistribution of fluid from the lower extremities into the lungs while in a supine position. The dyspnea is usually relieved with sitting up
What casues the diuretic phase of AKI
Osmotic diuresis bc the filtrate has a high osmotic pull bc of the increased concentration of urea in the glomerulus from when they were not functioning
What can cause decreased esophageal clearance
Overeating esophageal cancer Infection
What is gastric outlet obstruction
Overtime, edema, inflammation, and pylorospasm associated with active ulcer formation causes digestive tract to be narrowed at the pylorus (connection between stomach and duodenum)
Drug therapy for erectile dysfunction
PDE-5 inhibitors (Viagra)
If patient presents with positive Hepatitis b surface antigen (HBsAG), what does this mean
Patient currently has ACUTE Hepatitis B infection
Urea breath test
Patient ingests Urea with radio labeled Carbon Measures exhaled radio labeled Carbon. If H. Pylori is present, there will be large amounts of Carbon bc H. Pylori converts something into Carbon
What to remember about taking antacids with precription meds
Patient should take antacids at least 2 hours before taking other medications because antacids reduce the absoporption of medications in the GI tract by increasing the pH of the gastric juices
Pre-operative care of weight loss surgery patient who has obstructive sleep apnea
Patients must use CPAP for one month before the surgery
Disequilibrium syndrome
Patients who have just started dialysis experience neurological symptoms -Caused cerebral edema -If you take away the electrolytes/ Creatinie/BUN too fast, it lowers the osmolality of your plasma, which may cause leakage of fluid in the brain
When would it be indicated to be prescribing someone prophylactic or suppressive antibiotics for a UTI
Patients with recurrent UTIs Prevent recurrence, or a single dose before activities that are likely to cause UTI
What are the 3 Ps for treating HF
Pee it (diuretics) Pull it (vasodilator) Pump it (inotropics)
What does BUN measure
Perfusion of the kidneys
Signs of right sided HF
Peripheral edema jugular vein distention ascites organomegaly Weight changes -Nocturia (related to recumbant position at night leading to excess fluid pooling in kidneys)
Describe an adjustable gastric banding surgery
Place implantable device around uppermost part of stomach -Makes the available portion of the stomach much smaller, making you feel fuller quicker
Why do we want to increase protein intake in patients that have stage 5 CKD
Plasma proteins can be destroyed during dialysis so these patients may have hypoalbumineria
HF complications
Pleural effusion Arrhytmias (AF most common) Stroke hepatomegaly/cirrhosis renal insufficiency GI distress Cardiomyopathy
What is one pulmonary disease to look out for in someone with Left sided heart failure and why??
Pneumonia Can develop bc of all the excess fluid that is just sitting stagnant in the lungs
What is the defining side effect of the scarring found in liver cirrhosis
Portal hypertension
Significance of spider angiomas
Portal hypertension causes blood to shunt away from liver on its way back to the heart and into the abdominal vessels and others in the area, causing esophageal varices and spider angiomas
What is postrenal AKI and what causes it
Post renal AKI is an issue AFTER ht kidneys. anything wrong with ureters/bladder/urethra CAUSES are anything leading to obstruction of urine flow: -BPH -Stones -Cancer (bladder, cervical, colon, prostate) -Neurogenic bladder
MOA for sodium polystyrene sulfonates in the treatment of CKD
Potassium is exchanged for sodium in the gut = diarrhea is expected EX: Kayexelate
MOA of insulin + dextrose in the treatment of CKD
Potassium moves into cells when insulin is given
AKI reversible?
Potentially
Examples of alpha blockers
Prazosin, terazosin, doxazosin
What are the three types of AKI
Pre-renal Intra-renal Post-renal
What is cryoprecipitate
Prepared from FFP, thawed at 4 ° C. White precipitate is collected. Requires a lot of donors
What are we looking for to diagnose a UTI during urinalysis
Presence of nitrates, WBCs, and leukocyte estrase
Goals of CKD treatment
Preserve kidney function Reduce risks of CV disease Prevent complications Provide for patient's comfort
A client with acute hepatitis is prescribed lactulose. The nurse knows this medication will -Prevent hypoglycemia -Remove billirubin from the blood -Prevent the absorption of ammonia in the bowel -Metabolize Iron stores from the liver
Prevent the absorption of ammonia in the bowel
MOA for calcium gluconate in the treatment of CKD
Prevents dysrhytmias (caused by hyperkalemia) by raising the threshold for activation Stabilizes action potentials
Complications of PDE-5 inhibitors
Priapism -erect penis does not return to its flaccid state, despire stimulation, for 4 hours -medical emergency
Mode of transmission of Hep B
Primarily through blood, saliva, semen, or vaginal secretions
Laser photocoagulation
Procedure to shrink the cancerous tumor
Function of PPIs
Promote esophageal healing in 80-90% of GERD patients -Decrease incidence of esophageal strictures
Function of prokinetic drugs in treating GERD. Examples of these meds
Promotre gastric emptying Reduce risk of acid reflux EX: metoclopramide (Reglan)
What is the #1 Symptom of glomerulonephritis
Proteinuria
What is the defining symptoms of glomerulonephritis
Proteinuria (swelling as a result of the proteinuria) -Hypertension (due to decreased GFR/fluid retention)
What can cause urinary stasis
Urinary retention Obstruction (prolonged bedrest, pregnancy
Types of glomerulonephritis
Rapidly progressive (Acute) Chronic (slow progressing)
Mild allergic transfusion reaction
Recipeient is sensitized to the *plasma proteins* int he donor's serum Urticaria 2-3 after the start of transfusion
Why is fatigue associated with HF
Related to decreased CO
Why does HF cause chest pain
Related to decreased coronary perfusion from decreased CO and increased work of heart -HF can also lead to MI
When is BNP released
Released from ventricular myocytes in response to wall stretch
What is a pyloroplasty
Relieve narrowing of pyloric channel (used in gastric outlet obstruction) -Allows stomach contents to enter into duodenum more easily
Axillary node vs. sentinel node dissection
Removal of axillary or sentinal node during surgery to determine node involvement -The more lymph nodes= more risk for metastasis
What is an open radical prostatectomy
Removal of entire prostate along with the prostatic capsule and regional lymph nodes
What is a suprapubic prostatectomy?
Removal of the prostate through the abdominal wall and bladder
What is a lumpectomy
Removal of tumor with small amounts normal tissue removed -Conserves the breast and nipple tissue -Radiation post procedure -Axillary lymph node dissection vs. sentient lymph node dissection
What is ultrafiltration
Removal of water and fluid from the patient by using an osmotic gradient across a semipermeable membrane -Results when there is an osmotic gradient across the membrane -Patient loses more water than typical dialysis
Indication for cryoprecipitate
Replacement of clotting factors VIII, XIII and Fibrinogen, such as in DIC, sepsis, hemophilia, elevated PT and INR
Describe Sleeve Gastrectomy surgery
Resect 80-85% of the stomach Much smaller stomach = feel fuller faster
Symptoms of post-icteric phase of hepatitis
Resolution of symptoms -Decreased jaundice -Decreased hepatomegaly Increased appetitie
Treatment of cirrhosis
Rest, O2 -AVOID: alcohol, aspirin, NSAIDs, and anticoagulants Bleeding precautions Hemodynamic support Portacaval shunts
Which kidney is lower
Right
lower esophageal sphincter (LES)
Ring of muscles between the esophagus and the stomach. Also called cardiac sphincter.
Which gastric surgery is considered to be the gold standard for weight loss
Roux-en-Y gastric bypass
What is the main side effect of radiation that NURSES should look for on their assessment of a cancer patient
SKIN issues can have dryness, flaking, or even as bad as blisters and peeling skin
Possible respiratory findings in CKD patients
SOB Pleuritic pain (caused by pulmonary edema)
How to take daily weights on a HF patient
Same time each day; wearing the same type of clothes
BNP
Secreted by the ventricles Serves as a sign for HF A measure of the "stretch" of heart tissue -HIgh BNP= heart is struggling
Febrile Non-Hemolytic Transfusion Reaction (FNHTR)
Sensitization to donor WBCs (most common), platelets, or plasma proteins most common, usually towards the end of transfusion
Why does preventing constipation prevent too much ammonia in the body
The more stool you have sitting in your body, the more ammonia can be reabsorbed in the GI tract
Noninvasive tests for H. Pylori
Serum or whole blood antibody tests Urea breath test
Duration of recovery phase of AKI
Several months to one year
MOA for salmeterol/albuterol in the treatment of CKD
Shifts potassium into muscle cells to lower serum potassium.
malabsorptive weight loss surgery
Shortens the digestive tract and reduces the absorption of calories -However, also causes a decreased absorption of vitamins, minerals, and electrolytes
Normal character of peritoneal dialysate
Should look like NORMAL urine Clear and yellow
Nursing implications for Pyridium
Shouldnt be given for more than 3 days Antibiotic should be working by then
Asymptomatic bacteriuria
Significant bacteriuria with no clinical symptoms
Process of peritoneal dialysis
Siliconized rubber catheter surgically placed into abdominal cavity for infusion of diastylate -The peritoneal membrane acts as the semi-permeable membrane
What are AST, ALT, alk phosphate, and LDH
Similar to troponin, they are enzymes that are released by the liver in response to liver injury/inflammation -However, these values are not specific to JUST liver inflammation, so they are not diagnositc
Advantages to adjustable gastric band procedures
Simple to perform Normal absorption of nutrients Reversible Low risk for serious complications Same day surgery and discharge (as long as patient doesnt have obstructive sleep apnea) -Recovery time is 1-2 weeks
Why do obese patients have a higher anesthetic risk
The anesthetic agents are lipophillic and can lodge themselves into the fat cells of the patient, making it much easier for them to receive too much anesthetic
What is diffusion
The movement of particles from an area of high concentration to an area of low concentration.
Parastomal ulceration
Skin around stoma has ulcers
How can sleep apnea in obesity lead to strokes
Sleep apnea = hypoxia -In response to the hypoxia in the brain, more small blood vessels are created throughout the brain in an attempt to deliver more oxygen -These small vessels are more prone to rupturing and causing a stroke
What are the two types of hiatal hernia
Sliding Paraesophageal (rolling)
How to prevent dumping syndrome
Small meals low in CHO and simple sugars -No salt *Drink liquids between meals instead of with food*
What components of blood do we want to diffuse through the semi permeable membrane and INTO the dialysate to rid them from the body
Sodium Urea Potassium Creatinine Water
What is "AKI on top of CKD"
Someone who has managed CKI is now admitted with some type of problem that is causing them to have an episode of ACUTE kidney issues on top of their chronic issues
What are the precautions for hepatitis B
Standard precuations wash hands clean gloves no isolation or mask
Conservative therapies for treating BPH
Stents Prostatic balloons Indwelling catheter
Drug therapy for glomerulonephritis
Steroids (to manage inflammation) Anti-HTN Immunosuppresants Immunomodulators
Stoma prolapse
Stoma is longer than normal
When is lithotripsy indicated
Stones less than 2cm Best for stones in kidney and upper ureter
TURP pre-op considerations
Stop anticoagulants before therapy -Urethral catheter -Treat urinary infection -High fluid intake 2-3L/day NPO after midnight
Infections likely to cause glomerulonephritis
Strep Bacterial endocarditis Viral infection (HIV)
What are we looking for when using kidney ultrasonography to diagnose AKI
Structural abnormalities Tumor
Why are older adults at higher risk for developing hiatal hernia
Structural changes occur; such as weakening of the muscles in the diaphragm
Why are dysrhytmias complicatinos of HF
Structural changes, including myocardial stretch, fibrosis, and chamber dilatation, alter the electrical paths of the heart.
Purpose of using the drains after mastectomy
To reduce edema in the surgical site, which allows more oxygen to arrive to this area which encourages healing
Is HF more often caused by systolic or diastolic HF
Systolic
AV graft for HD dialysis
Sythetic material implanted under the skin and connected to the vein and the aftery -Graft is accessed for dyalysis
T/F: A critically ill patient can be commonly prescribed with stress ulcer prophylaxis
T
T/F?: CAUTI bundle provides evidence-based practices and strategies to reduce catheter-related UTIs
T
TNM Classification
T= Tumor size N= node involvement M= metastasis
Why does tachycardia occur in HF
Tachycardia is an early sign of HF. One of the body's first responses to compensate for a reduced CO is to increase the HR via activation of the SNS. At first, this compensatory response has a favorable effect on CO. But over time, persistent tachycardia is harmful and may worsen HF and the accompanying manifestation
Cardiovascular system findings in someone with HF
Tachycardia, S3, S4, murmurs. Pulsus alternans. PMI displaced inferiorly and posteriorly, lifts and heaves, jugular venous distention
Respiratory findings in someone with HF
Tachypnea, crackles, wheezes. Frothy, blood-tinged sputum
When to take antacids
Taken 1-3 hours after meals/at bedtime *Quick but short-lived relief*
What is the hormonal therapy used in breast cancer treatment
Tamoxifen Citrate (Novaldex) -Blocks estrogen production -Prevention in individuals with high risk for developing breast cancer
Patient education for all hepatitis patients
Teach them about standard precautions
Systolic HF
The "squeeze" is the problem, so heart is not able to pump enough blood
What is dialysate
The IV fluid used in dialysis
Why is proteinuria a side effect of kidney failure
The glomerulus, in a healthy kidney, should be filtering the blood and the plasma proteins should NOT be filtered into the filrate but should remain in the blood -In an unhealthy kidney, glomerulus does not function properly/is leaky and proteins can get through -Dangerous bc it messes with albumin concentration in the plasma
Why is feces clay colored in someone with hepatitis
The inflammation of the liver reduced delievry of bile into the bile ducts, which results in decreased billirubin in the feces -The bilirubin is excreted through the urine, making the urine dark
Why are so many vitamins usually ordered for alcholic patients
The lining of the stomach gets eroded from the alcohol, meaning there is less surface area for nutrient absorption The patient can not properly absorb the vitamins from food -They also probably dont eat very nutritious food or eat food at all
How is plasmapheresis used in glomerulonephritis
The antigens/antibodies can be removed from the blood
Why is aneurysm a complication of dialysis
The artery that is accessed for dialysis is already connected to a vein and can be weakened
How does H. pylori cause ulcers?
The bacterium eats away at the protective mucosal lining of the stomach, exposing the inner lining to the highly acidic gastric juices, which causes damage to these cells
What makes the adjustable gastric banding (LAP-BAND) actually adjsutable
The band is hollow and is inflated with saline through a port that lies underneath the skin -To tighten the band/sjrink the stomach, the band is injected with saline. To loosen the band, saline is removed It can be tightened or loosened over time to change the size of the passage in the stomach
Septic transfusion reaction
The blood product was contaminated with infective materials
Why can anemia cause HF?
The body tissues are reporting low oxygenation, so the heart works harder to try to pump blood more in order to deliver more oxygen. When, in reality, the problem is not decreased blood flow it is just decreased O2 carrying capacity -over time this causes tachycardia, decreasing ventricular filling time, decreasing cardiac output
How does ultrafiltration work
The dialysis fluid is super hyperosmotic, causing the movement of water OUT of the patients body through osmosis (movement of water from area of high solute concentration to area of low solute concentration)
Why would glomerulonephritis be causing proteinuria
The glomerulus is meant to act as a filter and keep protein out of the filtrate, but when they are dysfunctioning, protein can enter the urine
What is the function of BNP
The natriuretic peptides have beneficial renal, cardiovascular, and hormonal effects. -Renal effects include: (1) increased glomerular filtration rate and diuresis and (2) excretion of sodium (natriuresis). -Cardiovascular effects include vasodilation and decreased BP. -Hormonal effects include (1) inhibition of aldosterone and renin secretion and (2) interference with ADH release.
Why is it more beneficial to have a live donor for a kidney transplant than to have a dead donor
The organ in the dead donor is more likely to have necrosis and be irreparably damaged
Location of new kidney during kidney transplant
The recipient's original kidneys are left inside The new kidmey is added lower down in the illiac crest
What is Peptic Ulcer Disease
The result of erosion of GI mucus membranes of stomach -Painful sores develop in the acidic environment in GI tract
Difference between gastric bypass and Banded gastric bypass
The same, except for the presence of a mesh that surrounds the gastric pouch -Banded gastruc bypass has 10% mroe weight loss
Why does portal hypertension occur?
The scarring of the liver tissue causes decreased elasticity of the tissue, leading to hardening of the vessels
Purpose of 24-hr urine collection in glomerulonephritis patients
To track total amount of protein that is in the urine
Purpose of using TMP-SMX for UTI
To treat empiric uncomplicated UTI Antibiotic (E.Coli resistance to TMP-SMX is rising)
Caring for hepatitis patients in regards to level of activity
These patients are very easily fatigued -Bed rest with gradual return to normal activity as symptoms subside -Provide best rest of at least 90 minutes before and after exercise Avoid activity immediately after meals -Keep objects of frequent use within reach
Why are GERD patients at risk for asthma attacks, bronchitis, and pneumonia
They are at risk for aspiration of gastric juices which could cause ant of these problems
Why are ACE inhibitors given for HF
They block the RAAS and reduce afterload and fluid retention
Why are coagulopathies common in hepatitis patients
They develop cirrhosis and are at much higher risk for bleeding because the liver is responsible for creating clotting factors and it is not able to do so when it is inflamed
Why are high-fat foods a trigger for GERD
They require lots of enzymes to break down, so they decrease the pH of the stomach, which could make the GERD symptoms worse
What is an IV pyelogram?
This test injects dye to assess the kidneys for renal calculi, strictures, etc..
Complications of permanent hemodialysis access
Thrombosis or stenosis -Infection -Aneurysm formation -Ischemia (steal syndrome)
Why are corticosteroids given to hepatitis patients
To control inflammation of the liver
What is the purpose of phosphate binders
To lower the phosphorus levels in CKD patients
Why do we want ileal conduit patients to increase their fluid intake
To prevent obstructions
Diagnostic studies for UTI
Urinalysis Urine Culture and Sensitivity Imaging studies in some cases
What is the GOLD STANDARD for BPH treatment
Transurethral resection of the prostate (TURP)
How does lactulose treat hepatic encephalopathy?
Traps the excess ammonia in the gut so that it does not enter bloodstream and enter brain
What is a nephrostomy
Tubes insterted into the kidney through the skin with drainage collection to collect the urine
Side effect of Pyridium
Turns urine reddish orange
List of comorbidities associated with obesity
Type 2 DM Hypertension Sleep apnea Hypercholesterolemia Osteoarthritis DVT Asthma GERD Fatty liver PCOS Heart disease Gallbladder disease Stroke
Complications of renal calculi
UTI Pyelonephritis hydronephrosis kidney failure
What is a perforation caused by PUD
Ulcer penetrates serosal surface with spillage of the gastric or duodenal contents into peritoneal cavity or other nearby organs (peritonitis)
Where is HAV most prevalent? why?
Underdevloped countries -Overcrowding and poor sanitation
Most common cause of upper UTI
Untreated lower UTI
Acute uncomplicated pyelonephritis
Upper UTI with persistent symptoms such as flank pain, flank tenderness, and fever
Where is fibrocystic breast disease msot common
Upper region of breast
Where is a common site for the obstruction of flow from a kidney stone
Ureterovesical junction (USV) is a common site of complete urinary obstruction Right where the ureters meet the bladder
What is a cutaneous ureterostomy
Ureters are brought directly through the abdomen to drain urine
Changes in urine output assocaited with HF
Urine output may be decreased because of decreased renal perfusion. HF patients often develop resistance to diuretics, which can result in a drop in urinary output.
Factors affecting nephrolithiasis stone formation
Urine pH Solute load (urine osmalarity) inhibitors in urine
Signs/Symptoms of anaphylactic transfusion reaction
Urticaria Wheezizng Anxiety
To prevent the most serious complication of Peritoneal Dialysis, What is most important for the nurse to do? -Infuse the dialysate slowly -Have patient empty the bowel before the influx phase -Use strict aseptic technique in the dialysis procedure Reposition the patient frequently and promote deep breathing
Use strict aseptic technique
Purposse/use for NG tube in PUD patients
Used for gastric decompression Suctioning of gastric contents/blood from the stomach to give the stomach a "break"
Restrictive weight loss surgery
Using bands or staples to restrict food intake and promote a feeling of fullness after eating
Which types of patients diagnosed with glomerulonephritis usually experience facial swelling/angioedema and what is the pathophysiology behind it
Usually pediatric patients -It is because the glomeruli are failing to properly filter the blood so proteins (namely albumin) flow from the blood into the urine -The lack of the albumin in the blood causes decreased plasma osmotic pressure, so fluid leaks into the interstitial space, causing swelling
Indication for infusing platelets
Usually, thrombocytopenia with platelets less than 20,000. In some cases, lower than 10,000. Check hospital/treatment protocol.
Symptoms of hepatitis during pre-icteric phase
Vague and nonspecific -anorexia -diarrhea fatigue, malaise fever, headache nausea, vomitting pharyngitis pruritis RUQ pain weight loss
Why do we give Vitamin K in hepatitis patients
Vitamin K is a key ingredient in development of many clotting factors; in cirrhosis patients, they are not able to form this
What medication do we give if someone is experiencing Afib
Warfarin
What medication is given to prevent clots in AFib
Warfarin
Expected side effects of lactulose
Watery diarrhea Bc the intestine is not hyperosmotic
What do we need to test to properly group HF into categories and how do we check it
We MUST assess the ejection fraction and we do so by looking at an echocardiogram
Does Heb B have the possibility of chronic infection
Yes
Does Hep C have the possibility of chronic infection
Yes
What nursing assessments are very important after adminsitering furosemide to a HF patient
We want to assess if the drug is workin! -Check I/O specifically urine output -Check BP/Pulse -Listen to heart and lung sounds
What MUST be done by patient and nurse during peritoneal dialysis
Wear a mask Aseptic technique Dont talk while setting it up to prevent spread of germs
Things that could cause stoma prolapse
Weight lifting weight gain abdominal straining
Characteristics of estrogen/progesterone receptor POSITIVE breast cancer
Well differentiated Low chance for recurrence Frequently hormone dependent and responsive to hormonal therapy
When would surgical means be indicated for treatment of urinary tract calculi
When the stone is bigger than 2 cm
Why does an infection (such as UTI) increase the risk for HF exacerbation
When your body is dealing with an infection, it has an increased metabolic demand, putting more of a strain on your heart
What is hepatitis
Widespread inflammation of the liver associated with a broad spectrum of clinical manifestations from asymptomatic infection to hepatic necrosis
How must the patient take calcium-based phosphate binders
With a meal
In gastric and duodenal ulcers, does food make the pain better or worse
Worse in gastric ulcers Better in duodenal ulcers
Is weight loss surgery effective
YES highly effective with 40-90% excess weight loss long-term when coupled with lifestyle behavior modification
Possible skin findings in CKD patients
Yellowish coloration Pruritis uremic frost (salt comes out of skin bc you cant pee it out. white appearance) calciphylaxis
What is cirrhosis
a chronic disease of the liver marked by degeneration of cells, inflammation, and fibrous thickening of tissue. It is typically a result of alcoholism or hepatitis. -Cell death in the liver results in new cell formation that causes scarring -The scarring causes disruption of blood and lymph flow
Barrett's Esophagus
a condition that occurs when the cells in the epithelial tissue of the esophagus are damaged by chronic acid exposure (due to GERD usually)
What is lithotripsy
a treatment, typically using ultrasound shock waves, by which a kidney stone or other calculus is broken into small particles that can be passed out by the body.
What are esophageal strictures
narrowing of the esophagus due to constant damage
Why does a GI bleed actually cause decreased pain in PUD patients
blood neutralizes acidic gastric contents
Description of heartburn
burning, tighs sensation felt beneath the lower sternum and spreading upward toward throat or jaw
What is the most common form of nephrolithiasis
calcium stones caused by calcium oxylate
Primary cause of death for CKD
cardiovascular disease
Most effective method of treating triple-negative breast cancer
chemotherapy
Example of an H2 blocker
cimetidine (Tagamet)
What is fibrocystic breast disease?
common benign breast condition consisting of fibrous and cystic changes in breast
Kock's pouch: incontinent or continent
continent
relationship between kidney function and creatinine/BUN measurement
creatinine increases as kidney function decreases
General complications of UTI
cystitis Pyelonephritis gram-negative bacteremia Yeast infection (caused by antibiotics)
Most common cause of CKD
diabetic nephropathy
With which patients is intrarenal AKI common
dialysis patients
Possible complications of UTI in males
prostatitis, epididymitis, and orchitis
Jackson-Pratt drain
drainage system that uses a compressed bulb, applies slight suction within the wound
Why does nocturia occur in HF
due to increased renal perfusion in the supine position.
How do we test ejection fraction
echocardiogram
Upper GI endoscopy
endoscopy of the esophagus, stomach, and duodenum -Insertion of camera down the esophagus to assess the organs of the upper GI tract
Other names for hiatal hernia
esophageal hernia diaphragmatic hernia
What organ is removed during a Duondenal switch
gallbladder
Which is the most popular weight loss surgery
gastric sleeve
What is GERD
gastroesophageal reflux disease reflux of gastric contents into the esophagus (not a disease but a syndrome)
Manifestations of hypocalcemia
hand and finger spasms during BP cuff inflation (trousseau sign) -Facial twitching when tapped (chvostek sign) -laryngeal spasm -numbing in fingers -numbing around lips/lip twitching jaw twitching
Types of dialysis
hemodialysis and peritoneal dialysis
Adverse effects of epogen
hypertension
Why would glomeurlonephritis be causing edema and weight gain
hypoalbuminemia in the blood causes third spacing glomerulonephritis can cause hypoalbuminemia -For pediatrics, the edema is usually facial/around the eyes
Digoxin toxicity related to
hypokalemia
Onset of AKI
sudden (hours to days)
Diastolic HF
impaired ability of the ventricles to relax and fill during diastole
What is erectile dysfunction
inability to achieve and maintain an erection sufficient to permit satisfactory sexual intercourse
Primary cause of death in AKI
infection
epididymitis
inflammation of the epididymis
Prostatitis
inflammation of the prostate gland
orchitis
inflammation of the testes
urethritis
inflammation of the urethra
Cystitis
inflammation of the urinary bladder
What is brachytherapy
internal radiation used to get the radiation close to the cancer or target tissue *only requires 5 days of treatment *
Common complications of breast cancet
invasion of lymph channels causing edema (lymphedema) -metastasis to lymph nodes -Ulceration of overlying skin
What is steal syndrome
ischemia of the distal extremities bc there is a lack of blood flow bc so much blood is being taken away and put through dialysis so the extremity distal to the shunt is not getting enough blood -Numbness, tingling, pain of fingers
What is pyelonephritis
kidney infection
Location of pain if the stone is obstructing UVJ
lateral flank testicles labia groin pain
What is an ileal conduit
loops of stapled off ileum made into a pouch, anastomosed to the ureters and then brought to the abdominal wall skin to allow drainage in urine in patients who undergo removal of bladder -Urine flows continuously -Need for collection device that will require frequent empyting
Risks of PPIs
may increase fractures of wrist, hip, and spine
What organs are part of the upper GI tract
mouth esophagus stomach Duodenum
What is osmosis
movement of water from an area of high water concentration to an area of low water concentration
Why is pleural effusion a complication of HF
ncreased capillary hydrostatic pressure in the systemic or pulmonary circulation from HF causes fluid leakage into the pleural space.
Is fibrocystic breast disease a risk factor for cancer?
no
Recurrent Uncomplicated UTI
occurence of >2 symptomatic episodes within 6 months or >3 symptomatic epidsodes in a year
in which patients is a hiatal hernia most common
older adults and women
What is the most common early sign of AKI
oliguria/anuria
Sife effects of alpha blockers
orthostatic hypotension dizziness decreased libido erectile dysfunction
What is overflow urinary incontinence?
over distention and overflow of bladder
What is rebound tenderness
pain upon releasing the palpating hand pushing on the abdomen
What is the most lethal complication of pud
perforation and peritonitis
What is afterload
peripheral resistance against which the left ventricle must pump
What is sevelamer?
phosphate-binding medication -Binds to phosphorus to be excreted TO BE GIVEN WITH MEALS
Possible urinary findings in CKD patients
polyuria oliguria anuria
What is chronic kidney disease (CKD)
progressive, irreversible loss of kidney function
Scientific name for heartburn
pyrosis
Why is it inmportant for PUD patients to constantly maintain these dietary restrictions
recurrence is common and is usually brought on by eating triggering foods
What is a partial gastrectomy
removal of part of the stomach
What is nephrolithiasis?
renal calculi aka kidney stones
What is the main reason for giving lactated ringers
replacing electrolytes and fluids (especially after surgery)
Describe the Roux-en-Y gastric bypass.
small portion of the stomach is tied off and connected straight to the duoedenum -Bypasses most of the stoamch and a portion of the small intestine, creating a 30 cc stomach pouch. Gall bladder does not connect until past the duoedeum, meaning no absorption is happening at any point above this. Leads to both less absoprtion and smaller appetite -Dumping syndrome is a risk
What is ejection fraction
stroke volume/end diastolic volume
What is cytology
study of cell structure
Acute PUD
superficial erosion and minimal inflammation
What is urinary diversion
surgical creation of an alternate route for excretion of urine can be done with or without cystectomy
what is epogen
synthetic erythropoietin given in kidney failure bc they cant produce their own erythropoetin
What is heart failure
the inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients
What is a cystectomy
the surgical removal of all or part of the urinary bladder Radical being the removal of the entire bladder
Describe TURP procedure
through urethra resect prostate -Enlarged portion of prostate is removed endoscopically -Outcome is usually excellent -Less likely to cause erectile dyfunction -Performed under spinal or general anesthesia and requires hospitalization* -*bleeding is common*
When is dialysis initiated
when GFR is less than 15 mL/min
What is invasive breast cancer
when it spreads outside membrane of lobule or duct into breast tissue
