NUR 2122 Exam 1

c. discussing relevant laboratory and diagnostic tests

Blood in the urine (hematuria) and/or protein in the urine (proteinuria) Decreased estimated glomerular filtration rate (eGFR) and elevated creatinine and urea (blood urea nitrogen or BUN), which are early signs of kidney dysfunction

Acute Kidney Injury

-a sudden episode of kidney failure or kidney damage that happens within a few hours or a few days. AKI causes a build-up of waste products in your blood and makes it hard for your kidneys to keep the right balance of fluid in your body. Causes: •Prerenal: external factors that reduce blood flow. Examples: Severe blood loss and low blood pressure related to major cardiac or abdominal surgery, severe infection •Intrarenal: direct damage to the renal system •Postrenal: mechanical obstruction of lower urinary tract Medications: Diuretics and avoid nephotoxic agents such as dyes or use with extreme caution Complications: Hyperkalemia (>5.0) that can lead to life threatening cardia dysrhythmias. May require urgent dialysis. Avoid NSAIDs. Elevated BUN, elevated creatinine, hyperkalemia Uremia is a condition caused by a buildup of nitrogenous waste products due to kidney impairment. It is characterized by anorexia, itching, nausea, vomiting, and muscle cramps. s/s:decreased urine output, edema, Metabolic acidosis develops due to Inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate

g. explaining the use of kidney transplantation as a treatment option

-a surgical option for pts with ESRD. The need for dialysis is removed and dietary and fluid restrictions are reduced. There needs to be lifelong monitoring for comorbidities such as hypertension, diabetes, and heart disease and the suppression of rejection with immunosuppressive medications.

Peritoneal dialysis, Hemodialysis. Why? When?

dialysis keeps your body in balance by: removing waste, salt and extra water to prevent them from building up in the body. keeping a safe level of certain chemicals in your blood, such as potassium, sodium and bicarbonate. helping to control blood pressure Peritoneal d helps perform some of the work usually done by the kidneys Hyperkalemia is an indication for hemodialysis. Sodium is also removed. Weigh the client to establish a baseline for later comparison before starting.

e. explaining the collaborative care related to clients with cirrhosis of the liver, hepatitis and pancreatitis

hep: §Nursing Interventions - Actions •Administer medications as ordered •Provide small, frequent meals •Administer antiemetics •Promote balance between physical activity and rest •Encourage rest periods

S/S of hypo/hypercalcemia, hypo/hyperkalemia, hypo/hypermagnesemia, hypo/hypernatremia

hypocalcemia s/s: paresthesia, muscle spasms, cramps, tetany, circumoral numbness, and seizures. twitching and my fingers and toes tingling hypercalcemia s/s: Loss of appetite. Nausea and vomiting. Constipation and abdominal (belly) pain. The need to drink more fluids and urinate more. Tiredness, weakness, or muscle pain. Confusion, disorientation, and difficulty thinking, headaches, and depression. hypokalemia s/s: Weakness. Fatigue. Muscle cramps or twitching. Constipation. Arrhythmia (abnormal heart rhythms) hyperkalemia s/s: Muscle weakness. Numbness and tingling. Nausea and vomiting. Irregular heartbeat. Shortness of breath. hypomagnesemia s/s: Abnormal eye movements (nystagmus) Convulsions. Fatigue. Muscle spasms or cramps. Muscle weakness. Numbness. hypermagnesemia s/s: weakness, confusion, decreased breathing rate, and decreased reflexes (accumulates with kidney failure) hyponatremia s/s: N/v, headache, confusion, loss of energy, drowsiness and fatigue, restlessness and irritability, muscle weakness, spasms or cramps, seizures and coma. hypernatremia s/s: excessive thirst, lethargy, fatigue and lack of energy, confusion. Advanced cases may also cause muscle twitching or spasms

Dietary restrictions/concerns for renal pts

limiting fluids, eating a *low-protein* diet, limiting salt, potassium, phosphorous, and other electrolytes, and getting enough calories if you are losing weight

b. relating pathophysiology to clinical manifestations of liver disease

liver disease s/s: yellow eyes and skin (jaundice), nausea, abdominal pain and swelling, and swelling of the legs, itchy skin, dark urine.

l. discussing the use of the nursing process as a framework to provide

These are assessment, diagnosis, planning, implementation, and evaluation.

k. explaining treatment modalities for prostatic disorders

Treatments: Intermittent catherterization, transurethral resection of the prostate- surgical removal of the entire inner prostate, leaving the outer layer, transurethral incision of the prostate, open prostatectomy, laser surgery, transurethral microwave therapy, transurethral needle ablation, prostatic stents- is a stent used to keep open the male urethra and allow the passing of urine in cases of prostatic obstruction and lower urinary tract symptoms, and water-induced thermotherapy and transurethral ethanol ablation.

b. relating pathophysiology to clinical manifestations of renal disease

"a decreased production by the kidneys of the hormone erythropoietin, which is the cause of anemia" Avoid salt subititutes because they can cause hyperkalemia. Constipation can cause hyperkalemia. calcium acetate lowers the phosphate level. sodium polystyrene sulfonate decreases potassium. Chronic Kidney Disease clinical manifestations: anemia, calcium and vitamins d deficiency, oliguria, azotemia, hypertension, decreased GFR, fluid retention, and uremia Usually caused by a long-term disease that leads to decreased renal function over time: uncontrolled diabetes, uncontrolled hypertension, malnutrition, and polycystic kidney disease Laboratory values: Slowed increase in BUN (7-20) and creatinine (0.84-1.21), decreased in serum calcium (8.5-10.5), decreased hemoglobin (11-12) and hematocrit (33-36), increased serum phosphate (2.5-4.5), snd increased urine protein.

BPH, priority nsg diagnosis,

- enlarged prostate. Urine retention

Chvostek's sign

- twitching of the facial muscles in response to tapping over the area of the facial nerve. Caused by hypocalcemia.

Benigh prostatic hyperplasia (BPH)

-An enlarged prostate. S/s: difficulty starting the flow of urine, weak stream of urine, multiple interuptions during urination, dribbling once urination is complete, urgency, frequency, feeling that the bladder is not completely emptied after urination, Meds: Alpha blockers and 5-alpha reductase inhibitors Treatments: Intermittent catherterization, transurethral resection of the prostate (TURP)- surgical removal of the entire inner prostate, leaving the outer layer There will be an indwelling urinary catheter and a continuous bladder irrigation in place, transurethral incision of the prostate (TIP)- for small large pros. through the urethra small incisions relieve compression of the urethra and opens the channel, open prostatectomy- an incision is made in the abdomen and the prostate is removed, laser surgery- for smaller large prostates, burns away prostate tissue, transurethral microwave therapy- electrode goes through the urethra and produces microwave energy that destroys the inside of the prostate, transurethral needle ablation (TUNA)- needle and radio waves destroy the prostate tissue that is constricting the urethra, prostatic stents- keep the urethra open, and water-induced thermotherapy and transurethral ethanol ablation- Bothe destroy the prostate tissue. A client who just had a transurethral resection of the prostate reports pain in the operative area. What should the nurse do first? Inspect the drainage tubing for occlusion. *An indwelling urinary catheter is required for at least a day.

Glomerular Filtration Rate (GFR)

90-120 mL/min of blood

Priority concern for pt who has undergone TURP and renal biopsy

A transurethral resection of the prostate (TURP) is surgery to remove parts of the prostate gland through the penis. Bleeding is a priority concern.

Laboratory AST, ALT, LDH, and ALP BUN and Creatinine PT, PTT, INR Electrolytes WBC Serum lipase, amylase

AST: M: 13-40 units/L F: 24-36 units/L (5-40) ALT: Males: 20-40 units/L and females 24-36 (7-56) LDH: 140 units per liter (U/L) to 280 U/L ALP used to diagnose liver damage: 44 to 147 international units per liter (IU/L) BUN: 7-20 Creatinine: 0.84-1.21 PT: 10-13 sec PTT: 25-35 sec INR: 2.0-3.0 Electrolytes WBC: 4,000-11,000 Serum lipase: 12-70 breaks down fats into fatty acids. Amylase: 30-110 U/L breaks down carbohydrates into simple sugars.

Kidney transplant rejection signs

Acute rejection signs: fever, swelling, tenderness over the grafting site, decreased urine output, and a rise is serum creatinine level Chronic rejection signs: progressive azotemia (elevation of BUN), proteinuria, and hypertension

Mech. of action for anticholinergic meds. Side effects of immunosuppressive medications Delegation of tasks to UAP

Anticholinergics block acetylcholine from binding to its receptors on certain nerve cells. They inhibit actions called parasympathetic nerve impulses. These nerve impulses are responsible for involuntary muscle movements in the: gastrointestinal tract. Immunosuppressive meds s/s: an increased risk of infection. Other, less serious side effects can include loss of appetite, nausea, vomiting, increased hair growth, and hand trembling. These effects typically subside as the body adjusts to the immunosuppressant drugs Taking and recording blood pressure, temperature, pulse, respiration, and body weight. Do not delegate what you can EAT: Evaluate, Assess, and Teach.

Lab Values

Calcium: 8.5 to 10.5 mg/dl Phosphous: 2.5 to 4.5 mg/dL Potassium: 3.5-5.0 mmol/L Sodium: 135-145 mEq/L BUN: 7-20 mg/dL Creatinine: 0.84 to 1.21 milligrams per deciliter albumin3.4 to 5.4 g/dL in the urine range between 2.0 and 20 mg/mmol in men and between 2.8 and 28 mg/mmol in women. Clients with urinary albumin levels greater than 300 mg/24 hr (200 mcg/min) are at risk of developing end-stage kidney disease. Billirubin: 0.3-1.2 AST: 5-40 units per liter ALT: 7-56 units per liter PT: 11-13 sec INR: 1.0-1.5 (prevents bleeding) GFR: 90-120 Glucose (fasting): 100-125 Hemoglobin: 11-12 Hematocrit: 33-36 Ammonia: 15 to 45 µ/dL Amylase: 30-110 (elevated = pancreatitis) Lipase: 12-70 U/L Magnesium: 1.7 to 2.2 mg/dL

d. differentiate between acute and chronic renal failure

Chronic kidney failure is a condition where the kidneys' ability to filter waste from the bloodstream becomes worse over time, generally over a period of years. Has no cure. Acute kidney failure is the sudden loss of this important ability. If your kidneys have experienced a direct injury or an obstruction, you are at risk.

h. describing the nursing management of clients with cirrhosis, hepatitis and pancreatitis

Cirrhosis: Nursing Management - Nursing diagnoses Fluid volume excess Fluid volume deficit Altered nutrition, less than body requirements Impaired skin integrity Nursing Interventions - Assessments Respiratory Vital signs Peripheral edema Abdominal girth Bleeding Signs of organ rejection Skin, sclera, urine, stool color (pale or red) Mental status Intake and output Daily weight Acid-base balance Nursing Interventions - Actions Administer medications as ordered Electrolyte replacement Restrict protein intake Elevate HOB and legs Administer blood products Promote rest periods Nursing Interventions - Teaching Overview of disease process Lifestyle changes: No alcohol intake Educate about medications metabolized in liver Seek routine care Consume adequate calories to minimize weight loss Minimize risk of bleeding Hepatitis: Nursing Management - Nursing diagnoses Activity intolerance Acute pain Altered nutrition Altered thought processes Nursing Interventions - Assessments Vital signs Serum liver enzymes Serum bilirubin Color of skin Nutritional intake Daily weight Intake and output Signs of organ rejection Nursing Interventions - Actions Administer medications as ordered Provide small, frequent meals Administer antiemetics Promote balance between physical activity and rest Encourage rest periods Nursing Interventions - Teaching Nutritional teaching Good hand hygiene Avoid behaviors that contribute to transmission Importance of vaccinations Safe public water supply Pancreatitis: Medical Management - Medications Opioid analgesics Anticholinergics Histamine blockers Pancreatic enzymes Antibiotic therapy Nursing Management - Assessment and analysis Sudden onset of acute unbearable abdominal pain Elevated heart rate and respiratory rate, and low blood pressure Pain Elevated serum lipase, amylase, and glucose values Hypocalcemia Steatorrhea, clay-colored stoolsHypovolemia Hypoxia Pleural effusion Clinical manifestations of Adult Respiratory Distress Syndrome (A R D S) Multiple organ dysfunction Nursing Management - Nursing diagnoses Acute pain Ineffective breathing pattern Imbalanced nutrition, less than body requirements Nursing Interventions - Assessments Vital signs Oxygen status Pain location, intensity, duration Abdominal assessment Grey Turner's and/or Cullen's signs Serum lipase and amylase Nursing Interventions - Assessments (continued) Serum glucose Serum calcium, Trousseau sign or Chvostek sign Stool color Nutritional intake Daily weight, monitoring of fluid intake and output Nursing Interventions - Actions Maintain N P O status N G T to low suction, as ordered Administer ordered medications Administer analgesics Administer antiemetics Administer histamine blockers Administer sedatives and anti-anxiety medications Promote bedrest in semi-Fowler's position or fetal position Encourage coughing and deep breathing

c. differentiate types of jaundice

Conjugated- Conjugated hyperbilirubinemia results from reduced secretion of conjugated bilirubin into the bile, such as occurs in patients with hepatitis, or from impaired flow of bile into the intestine, as in patients with biliary obstruction. Conjugated bilirubin can enter the bile. The conjugated bilirubin isthen actively secreted into canalicular bile, and drains into the small intestine. conjugation works to promote the elimination of potentially toxic metabolic waste products. Unconjugated- Unconjugated hyperbilirubinemia (albumin-bound) usually results from increased production, impaired hepatic uptake, and decreased conjugation of bilirubin. In neonates, jaundice typically occurs due to unconjugated hyperbilirubinemia, which is characterized by the increased levels of indirect or unconjugated bilirubin (UCB) in the serum. Unconjugated bilirubin is a waste product of hemoglobin breakdown that is taken up by the liver, where it is converted by the enzyme uridine diphosphoglucuronate glucuronosyltransferase (UGT) into conjugated bilirubin. Conjugated bilirubin is water-soluble and is excreted into the bile to be cleared from the body.

Genitourinary Disorders

Electrolyte imbalances, anticipated nsg actions, ECG has piked T waves when there is hyperkalemia. Lab values.

d. discussing relevant laboratory and diagnostic tests

Elevated AST (5-40) and ALT (7-56), increased PT (11-13 sec), elevated bilirubin (0.3-1.2),

CKD, treatments options for anemia in renal patients

Erythropoietin (EPO) injections, Vit B12 and folic acid, iron supplements

Priority nsg actions for pt with abnormal looking dialysate return

Notify healthcare provider then culture it.

f. compare and contrast hemodialysis and peritoneal dialysis

Hemodialysis- uses the process of diffusion and filtration to remove waste products, electrolytes, and excess water from the body. IV access may be secured using a central venous double-lumen catheter in the subclavian or internal jugular vein. Pts undergo hemodialysis 3x per week for 3-5 hours. Long term hemodialysis needs an arteriovenous fistula Peritoneal dialysis- A soft plastic tube (catheter) is placed in your belly by surgery. A sterile cleansing fluid is put into your belly through this catheter. 30-40 min. After the filtering process is finished, the fluid leaves your body through the catheter. Fewer dietary restrictions and the clearance of metabolic wastes is slower. "The peritoneum acts as a semipermeable membrane through which wastes move by diffusion and osmosis." Allowing an area of high concentration (the blood) to an area of lower concentration (the dialysate).

Systemic complications of hemodialysis

Hypotension, muscle cramps, h/a, nausea, dizziness, malaise, bleeding, systemic infection, dementia, dialysis disequilibrium syndrome that causes cerebral edema, n/v, h/a, confusion, restlessness, seizures, coma.

e. explaining the collaborative care related to clients with acute or chronic renal failure including areas for delegation

Nursing Interventions - Assessments Vital signs Urine output Laboratory values Weigh daily Oxygenation and breath sounds Peripheral vascular system

Pancreatitis Pancreatic lipase

Lipase- breaks down fats into fatty acids and glycerol 12-70 Amylase: 30-110 U/L breaks down carbohydrates into simple sugars. Labs: Albumin (3.4 to 5.4 g/dL) is decreased Amylase increased AST (5-40) elevated ALT (7-56) elevated Calcium (8.5-10.5) is decreased Direct bilirubin (0.3-1.2) elevated Lipase (4,000-11,000) elevated WBC elevated. NPO and NGT on low suction, stools are clay colored, Clinical Manifestations •LUQ epigastric pain ‒Deep and sharp ‒More intense when eating fatty food •Abdominal fullness ‒Gas, bloating •Hiccups, indigestion •Fever •Tachycardia •Hypotension §Medical Management - Treatment •NPO status •IV fluid •ICU level care if other organs involved •Treat cause of pancreatitis §Medical Management - Medications •Opioid analgesics •Anticholinergics •Histamine blockers •Pancreatic enzymes •Antibiotic therapy §Nursing Management - Assessment and analysis •Sudden onset of acute unbearable abdominal pain •Elevated heart rate and respiratory rate, and low blood pressure •Pain •Elevated serum lipase, amylase, and glucose values •Hypocalcemia •Steatorrhea, clay-colored stools §Nursing Management - Assessment and analysis (continued) •Hypovolemia •Hypoxia •Pleural effusion •Clinical manifestations of Adult Respiratory Distress Syndrome (A R D S) •Multiple organ dysfunction Monitor for hypovolemia

Dietary Considerations for clients with liver disease, gallbladder disease, pancreatic disease

Liver disease diet: for hep give a diet of high carbohydrates and moderate fat and protein Gallbladder disease diet: low fat and high-carbohydrate. Avoid fatty foods such as fried foods, ice cream, dairy products, red meats, alcohol. Choose foods low in saturated fats such as rice, potatoes, pasta, yogurt, fruit, lean meat, and whole grains. NPO for cholecystitis. Pancreatic disease diet: low fat no irritating foods/beverages Alcoholism causes. no kava. bile flow obstruction cause elevated AST. hypocalcemia caused by fat necrosis and malnutrition. elevated ALT caused by gallstone pancreatitis. The inflammatory processes causes an increase of WBC. Pancreatitis s/s: Hypotension 3) Nausea and vomiting 4) Elevated temperature 5) Severe epigastric pain

S/S of ESRD

Nausea and vomiting Constant headaches Loss of appetite Constant itching, dry skin, and skin that is lighter or darker than usual Fatigue, weakness, and a general ill feeling Difficulty sleeping Changes in how much you urinate Decreased mental sharpness, difficulty concentrating, confusion, and drowsiness Muscle twitches and cramps Bone pain Numbness or swelling in the hands, feet, ankles, or elsewhere Swelling of feet and ankles Chest pain Shortness of breath High blood pressure Weight loss even when you're not trying to lose weight Bad breath Nausea Vomiting Loss of appetite Fatigue and weakness Sleep problems Changes in how much you urinate Decreased mental sharpness Muscle twitches and cramps Swelling of feet and ankles Persistent itching Chest pain, if fluid builds up around the lining of the heart Shortness of breath, if fluid builds up in the lungs High blood pressure (hypertension) that's difficult to control Clients with end-stage renal disease usually have a serum pH that is less than 7.35 because of metabolic acidosis. A pH of 7.5 that exceeds the expected range of 7.35 to 7.45 is not anticipated because this is alkalosis. Clients with end-stage renal disease have decreased erythropoietin, which leads to decreased red blood cell production and hematocrit; a hematocrit of 54% exceeds the expected range, which is 39% to 50% for males and 35% to 47% for females; therefore, it is not anticipated. Clients with end-stage renal disease have a decreased ability to eliminate nitrogenous wastes, which leads to increased creatinine levels; a creatinine level of 1.2 mg/dL (106 mcmol/L) is within the expected range of 0.7 to 1.4 mg /dL (62 to 124 mcmol/L) and therefore is not anticipated.

Procedures and Appliances Paracentesis Sengstaken-Blakemore Tube T-tube NGT Transjugular Intrahepatic Portosystemic Shunt (TIPS) Liver Biopsy Lithotripsy Cholecystectomy Murphy's sign Cullen's sign Grey Turner's sign Trousseau sign/Chvostek sign

Paracentesis- is a form of body fluid sampling procedure, generally referring to peritoneocentesis in which the peritoneal cavity is punctured by a needle to sample peritoneal fluid. Sengstaken-Blakemore Tube- medical device inserted through the nose or mouth and used occasionally in the management of upper gastrointestinal hemorrhage due to esophageal varices (develop when blood flow to the liver is blocked). T-tube- draining tube placed in the common bile duct after Common Bile Duct (CBD) exploration with supra-duodenal choledochotomy. It provides external drainage of bile into a controlled route while the healing process of choledochotomy is maturing and the original pathology is resolving. It drains bile from the liver. Bile helps digest fats. T tubes helps with cholecystitis- inflammation of the gallbladder. *If stones are present in the common bile duct, surgeons may place a T-tube, or biliary drainage tube, into the common bile duct to monitor bile drainage. This tube exits the patient's abdomen through the skin and is connected to a closed drainage system. This tube may stay in place for up to 2 weeks after surgery. Bile output should not exceed 500 mL in the first 24 hours. NGT- special tube that carries food and medicine to the stomach through the nose. Used in pancreatitis. Transjugular Intrahepatic Portosystemic Shunt (TIPS)- The stent forms a channel, or shunt, that bypasses the liver. This channel reduces pressure in the portal vein. is a procedure that may be used to reduce portal hypertension and its complications, especially variceal bleeding. *a shunt between the portal venous system and systemic venous system to reduce portal pressure to reduce fluid accumulation. Liver Biopsy- procedure in which a small needle is inserted into the liver to collect a tissue sample. After the liver biopsy, the nurse would take vitals every 15 minutes for 2 hours. Pt should be in a right side-lying position after procedure. It helps determines the type and stage if the liver cancer. Lithotripsy- medical procedure that uses shock waves or a laser to break down stones in the kidney, gallbladder, or ureter. Cholecystectomy- surgical removal of the gallbladder Murphy's sign- is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area. If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner's hand, Murphy's sign is positive. *Pain on the RUQ upon deep inspiration. Cullen's sign- is a hemorrhagic discoloration of the umbilical area due to intraperitoneal hemorrhage from any cause; one of the more frequent causes is acute hemorrhagic panniculitis. Grey Turner's sign- is bruising of the flanks. It occurs in severe, acute pancreatitis due to subcutaneous tracking of inflammatory, peripancreatic exudate from the pancreatic area of the retroperitoneum. Trousseau sign/Chvostek sign- the twitching of the facial muscles in response to tapping over the area of the facial nerve.

i. describing pathophysiology of prostate cancer and collaborative management

Pathophysiology: Prostate cancer is a slow-growing cancer. Tumors that develop on the prostate tend to develop on the periphery of the gland, which does not obstruct the flow of urine: hence, they go unnoticed until there is associated pain. Prostate cancer most commonly can metastasize to the lymph nodes, bone, rectum, and bladder. It may be curable when localized but responds to treatment even when widespread, In cases where the cancer has metastasized to the bone, patients may still experience an extended survival rate.

Medications Phenothiazines Ursodiol, Actigall, and Chenodiol Pancreatic Enzymes Lactulose Potassium/Magnesium/Phosphate/Sodium Vitamin K, A, B Complex, C and Folic Acid Morphine Demerol Anticholinergics Histamine blockers

Phenothiazines- are used to treat serious mental and emotional disorders, including schizophrenia and other psychotic disorders. Some are used also to control agitation in certain patients, severe nausea and vomiting, severe hiccups, and moderate to severe pain in some hospitalized patients. Ursodiol- a bile acid that decreases the amount of cholesterol produced by the liver and absorbed by the intestines. Ursodiol helps break down cholesterol that has formed into stones in the gallbladder. Ursodiol also increases bile flow in patients with primary biliary cirrhosis. Actigall- It can dissolve gallstones when they cannot be removed by surgery. It can also treat primary biliary cirrhosis (PBC), a liver disorder. Chenodiol- It can dissolve gallstones. Pancreatic Enzymes: LIPASE - breaks down fats into fatty acids. (12-70) PROTEASE - breaks down proteins into amino acids. AMYLASE - breaks down carbohydrates into simple sugars. (30-110) Lactulose- Laxative and Ammonia (14-45) reducer (elevated ammonia is caused by liver disease) Potassium- helps your nerves to function and muscles to contract. It helps your heartbeat stay regular /Magnesium- maintain normal nerve and muscle function, supports a healthy immune system, keeps the heartbeat steady, and helps bones remain strong Phosphate- to build and repair bones and teeth, help nerves function, and make muscles contract. Sodium- It helps keep the water (the amount of fluid inside and outside the body's cells) and electrolyte balance of the body. Sodium is also important in how nerves and muscles work. (Elevated sodium= kidney dysfunction) Vitamin K-key role in helping the blood clot, preventing excessive bleeding. (Administered when the liver is failing) A- is important for normal vision, the immune system, and reproduction. Vitamin A also helps the heart, lungs, kidneys, and other organs work properly. B- nutrient that helps keep the body's nerve and blood cells healthy and helps make DNA, the genetic material in all cells. Vitamin B12 also helps prevent a type of anemia called megaloblastic anemia that makes people tired and weak. C- helping to protect cells and keeping them healthy. maintaining healthy skin, blood vessels, bones and cartilage. Folic Acid- acts by helping the body produce and maintain new cells. In particular, red blood cell formation is dependent upon adequate levels of this vitamin Morphine- Narcotic that can treat moderate to severe pain. Can cause spasm of the oddi spincter. The sphincter of Oddi is the muscular valve surrounding the exit of the bile duct and pancreatic duct into the duodenum. Demerol- Narcotic It can treat moderate to severe pain. Anticholinergics- relax the smooth muscle, preventing biliary contraction and pain. Antiemetics may be administered, particularly promethazine or procholperazine. Histamine blockers- your stomach makes less acid

h. applying principles of perioperative care to the client undergoing kidney transplant

Pre-operative transplant management Initial clinical assessment pre-transplant Patients on the kidney transplant waiting list have usually undergone a thorough medical and surgical assessment prior to listing to identify significant comorbidities that would preclude transplantation. You may not be eligible to receive a kidney transplant due to: The presence of some other life-threatening disease or condition that would not improve with transplantation. This could include certain cancers, infections that cannot be treated or cured, or severe, uncorrectable heart disease.

Causes of AKI (prerenal, Intrarenal, postrenal), findings and treatment options for each

Prerenal- external factors (those that are not related to the anatomical structures of the urinary system) that reduce renal blood flow and lead to decreased glomerular perfusion and filtration Intrarenal- direct damage to the renal parenchynal tissues, resulting in impaired nephron functioning. Postrenal- involve mechanical obstruction of the lower urinary tract (the ureters, bladder, and urethra). Some casues are BPH, prostate cancer, calculi, trauma, and tumor

Chronic Kidney Failure

Risk Factors: Diabetes, hypertension, hyperlipidemia, smoking, recreational drug use, NSAIDs, and obesity. Clinical Manifestations: Alterations in sodium and fluid balance, hypertension, heart failure, pulmonary edema, altered potassium excretion, lethal arrhythmias, impaired metabolic waste elimination, n/v, anorexia, and neurological symptoms. Altered calcium and phosphorus. Bone breakdown, osteodystrophies, defective bone development. Decreased acid clearance and bicarbonate produtabolic acidosis. Endocrine. Infertility, amenorrhea, hyperparathyroidism, thyroid abnormalities, and chronic anemia. Medical Management Diagnosis: Elevated serum creatinine and decreased creatinine clearance, protein/ albumin in urine, uremia- high levels of waste products in the blood, renal ultrasound, CT scan, and a renal biopsy. Treatment: Renal replacement therapy such as dialysis, supporting remaining function of kidneys, treat clinical manifestations, and prevent complications. Surgical Management: Renal transplant Complications: rejection after renal transplant and long term immunosuppression. Kidney failure results in impaired erythropoietin production, which causes anemia and chronic fatigue; treating the anemia will help in managing the fatigue.

j. identifying clinical manifestations of benign prostatic hypertrophy

S/s: difficulty starting the flow of urine, weak stream of urine, multiple interuptions during urination, dribbling once urination is complete, urgency, frequency, feeling that the bladder is not completely emptied after urination.

Diagnostic tests: PSA, GFR,

The PSA test is a blood test used primarily to screen for prostate cancer. The test measures the amount of prostate-specific antigen (PSA) in your blood. PSA is a protein produced by both cancerous and noncancerous tissue in the prostate, a small gland that sits below the bladder in men. 4.0-10.0 is suspicious... A glomerular filtration rate (GFR) is a blood test that checks how well your kidneys are working. Your kidneys have tiny filters called glomeruli. These filters help remove waste and excess fluid from the blood. A GFR test estimates how much blood passes through these filters each minute. 90-120 mL/min

Liver disease

The congested liver impairs venous return, leading to increased portal vein hydrostatic pressure and an accumulation of fluid in the abdominal cavity (ascites). Urinate before paracentesis Hep Medical management diagnosis: AST, ALT, and serum albumin.

Hepatobiliary Disorders a. reviewing the anatomy and physiology of the hepatic system

The hepatic portal system is a series of veins that carry blood from the capillaries of the stomach, intestine, spleen, and pancreas to capillaries in the liver. It is part of the body's filtration system. The liver is connected to two large blood vessels, the hepatic artery and the portal vein. The hepatic artery carries blood from the aorta to the liver, whereas the portal vein carries blood containing the digested nutrients from the entire gastrointestinal tract, and also from the spleen and pancreas to the liver.

g. applying principles of perioperative care to the client undergoing liver transplant

assessment of pt's comorbilities, Pre-transplant infections disease screening, Cardiac evaluation, Pulmonary evaluation, Renal evaluation

a. reviewing the anatomy and physiology of the genitourinary system

The organs of the urinary system include the kidneys, renal pelvis, ureters, bladder and urethra. The body takes nutrients from food and converts them to energy. After the body has taken the food components that it needs, waste products are left behind in the bowel and in the blood. The kidney and urinary systems help the body to eliminate liquid waste called urea, and to keep chemicals, such as potassium and sodium, and water in balance. Urea is produced when foods containing protein, such as meat, poultry, and certain vegetables, are broken down in the body. Urea is carried in the bloodstream to the kidneys, where it is removed along with water and other wastes in the form of urine.

Cholecystitis (gallbladder inflammation)

Your liver makes a powerful digestive juice called bile. Next, the bile passes to the gallbladder which concentrates and stores it for later use. Bile helps break down the food you eat.Add whole bran to reduce constipation after surgery. LOW FAT DIET: The presence of fat in the duodenum stimulates painful contractions of the gallbladder to release bile, causing right upper quadrant pain; fat intake should be restricted. Positive Murphy Sign- pain on the RUQ upon deep inspiration. T tube: Protect the abdominal skin from bile drainage. It helps drain bile from the liver. Risk Factors: Obesity Rapid weight loss Weight loss surgery High fat diet Genetics Medications Pathophysiology Gallstones Biliary stasis caused by decrease gallbladder contractility or spasms in sphincter of Oddi In most cases, gallstones blocking the tube leading out of your gallbladder cause cholecystitis. This results in a bile buildup that can cause inflammation. Other causes of cholecystitis include bile duct problems, tumors, serious illness and certain infections. Clinical Manifestations RUQ pain Rebound tenderness or guarding Fever Tachycardia nausea, vomiting, and anorexia Medical Management: Treatment NPO status IV hydration Correct fluid and electrolyte imbalance Pain management IV antibiotics Laparoscopic surgery Medications to dissolve gallstones: Ursodiol, Actigall, and Chenodiol Ursodiol- a bile acid that decreases the amount of cholesterol produced by the liver and absorbed by the intestines. Ursodiol helps break down cholesterol that has formed into stones in the gallbladder. Ursodiol also increases bile flow in patients with primary biliary cirrhosis. Actigall- It can dissolve gallstones when they cannot be removed by surgery. It can also treat primary biliary cirrhosis (PBC), a liver disorder. Chenodiol- It can dissolve gallstones. Nursing Interventions - Actions Administer medications as ordered, promote bedrest in semi-Fowler's position Repositioning Nasogastric tube to low suction Labs: Elevated AST (5-40) and ALT (7-56)

f. explaining the use of liver transplantation as a treatment option

a treatment option for people with liver failure whose condition can't be controlled with other treatments and for some people with liver cancer.