Med Surg III - Summer 2017 - Test 4

5 components of Treatment of hypocalcemia, hypoparathyroid:

1. Treat tetany 2. Rebreathing (paper bag) 3. EKG monitoring; 4. Lifelong treatment with Ca and Vit D; 5. High calcium diet

Name 4 complications of ascites:

1. pain 2. peritonitis 3. breathing problems 4. decreased CO

In Hepatic encephalopathy, INR _?_ Acute Vs. Chronic: chronic is failure lasting longer than_?_ weeks Liver transplant?

>/= 1.5 26

Which patient should be taught preventive measures for CKD by the nurse because this patient is most likely to develop CKD? A 50-year-old white female with hypertension A 61-year-old Native American male with diabetes A 40-year-old Hispanic female with cardiovascular disease A 28-year-old African American female with a urinary tract infection

A 61-year-old Native American male with diabetes

4 drug therapies for esophageal varices

Vasopressin, Octreotide Propranolol Histamine 2 receptor blockers

12 Manifestations of Addison's Disease:

Weakness, fatigue, anorexia, Skin hyperpigmentation, Hypotension, hypovolemia, Hyponatremia, hyperkalemia, hypoglycemia, Nausea, vomiting, diarrhea, ↓muscle size & ↓tone

List 3 target organs for GVHD phenomenon and the associated s/s

liver (elevated liver enzymes to hepatic coma) GI tract (diarrhea, abdominal pain, GI bleeding, malabsorption) skin (pruritic or painful maculopapular rash - involves palms and soles of feet).

Calcium in CKD is _?_ (high or low?) 4 S/S are:

low tingling around mouth TIngling of fingers tetany convulsions

In the early stages of CKD, patients usually do not report changes in _?_ . As the disease progresses, patients will have increasing difficulty with _?_ and require diuretics. Once on dialysis patients may develop _?_.

urine output; fluid retention anuria

When teaching the patient with acute hepatitis C (HCV), the patient demonstrates understanding when the patient makes which statement? "I will use care when kissing my wife to prevent giving it to her." "I will need to take adofevir (Hepsera) to prevent chronic HCV." "Now that I have had HCV, I will have immunity and not get it again." "I will need to be checked for chronic HCV and other liver problems."

"I will need to be checked for chronic HCV and other liver problems."

A patient is taking an antacid for treatment of a peptic ulcer. Which of the following statements best indicates that the patient understands how to correctly take the antacid? "I should take my antacid before I take my other medications." "I need to decrease my intake of fluids so that I don't dilute the effects of my antacid." "My antacid will be most effective if I take it whenever I experience stomach pains." "It is best for me to take my antacid 1-3hrs after meals."

"It is best for me to take my antacid 1-3hrs after meals."

Which statement by the nurse regarding continuous ambulatory peritoneal dialysis (CAPD) would be of highest priority when teaching a patient new to this procedure? "It is essential that you maintain aseptic technique to prevent peritonitis." "You will be allowed a more liberal protein diet once you complete CAPD." "It is important for you to maintain a daily written record of blood pressure and weight." "You will need to continue regular medical and nursing follow-up visits while performing CAPD.

"It is essential that you maintain aseptic technique to prevent peritonitis."

The nurse instructs a 50-year-old woman about cholestyramine to reduce pruritis caused by gallbladder disease. Which statement by the patient to the nurse indicates she understands the instructions? "This medication will help me digest fats and fat-soluble vitamins." "I will apply the medicated lotion sparingly to the areas where I itch." "The medication is a powder and needs to be mixed with milk or juice." "I should take this medication on an empty stomach at the same time each day."

"The medication is a powder and needs to be mixed with milk or juice."

A patient with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is teaching the patient about the meds prescribed clarithromycin (biaxin), esomeprazole (nexium), and amoxicillin (amoxil). Which statement by the patient indicates the best understanding of the medication regimen? "My ulcer will heal because these medications will kill the bacteria." "These meds are only taken when I have pain from my ulcer." "The meds will kill the bacteria and stop the acid production." "These meds will coat the ulcer and decrease the acid production in my stomach."

"The meds will kill the bacteria and stop the acid production."

The signs and symptoms of primary hyperparathyroidism are those of hypercalcemia. They are classically summarized by: _?_, _?_, _?_, _?_ and _?_

"stones, bones, abdominal groans, thrones and psychiatric overtones".

_?_ is a spectrum of clinical abnormalities caused by excess corticosteroids, particularly glucocorticoids

.Cushing syndrome:

Normal lipase is from _?_ to _?_ Normal amylase is from _?_ to _?_

0 to 160 0 to 130

After AKI, Renal healing and function may take up to _?_

1 year.

3 characteristics of Dilutional hyponatremia are: 1) serum sodium of _?_ 2) serum osmo of _?_ 3) urine SpGr of _?_

1) serum sodium < 134 meQ/l 2) serum osmo < 280mOsm/kg 3) urine SpGr > 1.025

Clinical manifestations of hepatitis classified into 2 phases: Acute & Chronic Acute: lasts_?_ Many will be Asymptomatic If there are s/s, they will be:

1-4 months Malaise Anorexia, nausea/vomiting Abdominal pain, hepatomegaly Can be icteric or anicteric If icteric jaundice, dark urine, light stools, pruritus

The Referral Process to GOH: It is the responsibility of hospital staff to initiate the organ donation process when: 1. A patient begins to lose _?_ 2. _?_ 3. A patient dies after _?_

1. A patient begins to lose brain stem reflexes 2. The discussion to remove the patient from life support is planned 3. A patient dies after a cardio-pulmonary arrest

4 Causes of SIADH:

1. ADH secreting tumors (usually cause chronic SIADH) 2. Head trauma and CNS disorders 3. Some medications ; 4. Infections:

Hyperglycemic-hyperosmolar State (HSS) - 6 characteristics:

1. Acute, life-threatening condition 2. Characterized by profound hyperglycemia (greater than 600 mg/dL) 3. hyperosmolarity that leads to dehydration 4. absence of ketosis 5. Gradual onset over several days 6. If left untreated, can lead to coma and death

6 steps of Treatment for DKA

1. Airway management 2. Oxygen administration 3. Large bore IV 4. Correct fluid/electrolyte imbalance: IV infusion 0.45% or 0.9% NaCl 1L/hr (restore urine output/raise blood pressure) 5. When blood glucose levels approach 250 mg/dL: 5% dextrose added to regimen to prevent hypoglycemia. 6. Administer needed electrolytes: Potassium replacement-must watch K level; if pt hypokalemic, giving insulin will cause further decrease in K level

Treatment for DKA: 1. Airway management 2. Oxygen administration 3. Large bore IV 4. Correct fluid/electrolyte imbalance: IV infusion_?_ (restore urine output/raise blood pressure) 5. When blood glucose levels approach _?_, add _?_ to regimen to prevent hypoglycemia. 6. Administer needed electrolytes: Potassium replacement-must watch K level; if pt hypokalemic, giving _?_ will cause further decrease in K level

1. Airway management 2. Oxygen administration 3. Large bore IV 4. Correct fluid/electrolyte imbalance: IV infusion 0.45% or 0.9% NaCl 1L/hr (restore urine output/raise blood pressure) 5. When blood glucose levels approach 250 mg/dL: 5% dextrose added to regimen to prevent hypoglycemia. 6. Administer needed electrolytes: Potassium replacement-must watch K level; if pt hypokalemic, giving insulin will cause further decrease in K level

5 components of Nursing Care for HHS/DKA:

1. Always treat the underlying cause (infection), 2. Rapid isotonic fluid (0.9% NS) 3. Follow with hypotonic fluid (0.45% NS) 4. When serum glucose levels approach 250 mg/dL, add glucose to IV fluids to minimize the risk of cerebral edema associated with drastic changes in serum osmolarity and prevent hypoglycemia 5. Administer regular insulin (Humulin R) 0.1 unit/kg as an IV bolus dose and then follow with a continuous IV infusion of regular insulin at 0.1 unit/kg/hr.

7 Hypophysectomy Post-op Instructions:

1. Avoid vigorous coughing, sneezing, and straining 2. Avoid tooth brushing for 10 days 3. Good oral care 4. HOB elevated 5. Send clear nasal drainage to lab 6. Bacitracin nose drops 7. Hormone replacement

Name 3 drugs that may be used to treat Hyperparathyroidism

1. Bisphosphonates (Fosamax); 2. Cinacalcet (Sensipar) 3. Diuretics

What 5 types medications might be prescribed for a patient with AKI?

1. Ca supplements 2. Phosphate binders 3. PPI/H2 blocker 4. Treat low BP with drugs to increase squeeze 5. Lower K using insulin/bicarb or diuretics

4 components of treatment of DI:

1. Correct underlying cause - essential 2. IV and oral fluids (depending on patient condition) 3. Medications 4. Patient teaching for long term management

Name 4 medications that may be useful in treating DI

1. Desmopressin acetate (DDAVP) an analog of ADH given PO or as a spray 2. Vasopressin (Pitressin) 3. Carbamazepine (Tegretol - antiseizure med 4. chlorpropamide (Diabenese; an anti-diabetic med)

7 Clinical Manifestations of Cushing Syndrome

1. HTN (excess mineralcorticoid), secondary to fluid retention ; 2. Menstrual irregularities; 3. Hirsutism in women; 4. Gynecomastia & impotence in men; 5. Hypokalemia; 6. Inhibition of immune response; 7. Glucose metabolism altered - glucose intolerance and ↑gluconeogenesis by the liver

2 "classes" of Disorders of the Anterior Pituitary Gland

1. Hyperpituitarism 2. Hypopituitarism

3 characteristics of Addison's Disease:

1. Hypofunction of the adrenal cortex; 2. Autoimmune disorder resulting in antibodies destroying adrenal gland 3. All 3 classes of corticosteroids are deficient

Client Education regarding HHS/DKA; 5 indications for patient to call MD:

1. Illness last more than 1 day 2. Blood glucose is greater than 240 mg/dL, 3. Patient is unable to tolerate food or fluids 4. Ketones are found in urine for more than 24 hours 5. Temperature for 24 hours of 38.6 °C. (101.5 °F.)

2 Medications for Cushing Syndrome are _?_ and _?_.. Both are essentially a medical _?_ . What is their method of action?

1. Ketoconazole (Nizoral) 2. Aminoglutethimide (Cytadren) adrenalectomy: both inhibit corticosteroid synthesis

5 stages of CKD

1. Kidney damage with normal GFR(slow progression) 2. Kidney damage with slightly ↓ GFR (60-89)- watch progression carefully 3. Moderate ↓ in GFR (30-59)—evaluation and treating complications 4. Severe ↓in GFR (15-29)- prepare for kidney replacement therapy 5. Kidney failure GFR (< 15)-- dialyze

3 Risk factors for DKA

1. Lack of sufficient insulin r/t undiagnosed/ untreated type 1 diabetes mellitus or nonadherence to a diabetic regimen; 2. Reduced or missed dose of insulin(insufficient or error in dosing; 3. Any condition that increases carbohydrate metabolism: physical/emotional stress, illness/infection (#1 cause of DKA), surgery, or trauma that requires an increased need for insulin

Treatment for HHS

1. Medical emergency with High mortality rate 2. Therapy similar to DKA except HHS requires greater fluid replacement 3. Patient-centered care - 4. Nursing care - Monitor blood glucose hourly. Blood glucose of less than 200 mg/dL is the goal for resolution. 6. Monitor serum potassium levels. Potassium levels will initially be increased with insulin therapy, but potassium will shift into cells and the client will need to be monitored for hypokalemia. 7. Administer sodium bicarbonate by slow IV infusion for severe acidosis (pH of less than 7.0). Monitor potassium levels because correcting acidosis too quickly may lead to hypokalemia.

5 Treatments for Cushing syndrome

1. Monitor V/S, 2. fluid and electrolyte status, 3. Monitor for & prevent infection; 4. Prevent injury - avoid exposure to extreme temperatures and stress; 5. Emotional support (due to changes in appearance)

What are the 3 components of treatment for ileus/paralytic ileus:

1. NG tube 2. Reglan to speed up peristalsis 3. f/e replacement

3 types of Diabetes Insipidus (DI):

1. Neurogenic DI (aka central) 2. Nephrogenic DI, 3. Psychogenic DI (aka primary)

6 Risk Factors for HHS

1. Older adults who have inadequate fluid intake and become dehydrated experience osmotic diuresis due to high blood glucose. 2. Older adults who have decreased kidney function are unable to excrete the excess glucose into urine, with resulting high blood glucose 3. Medical conditions such as myocardial infarction, cerebral vascular injury, or sepsis. 4. Certain medications- glucocorticoids, diuretics, phenytoin, propranolol, and calcium channel blockers. 5. Infection 6. stress

3 Phases which mark the clinical course of intrarenal AkI

1. Oliguric phase 2. Diuretic phase 3. Recovery phase

8 Clinical Manifestations of HHS

1. Polyuria 2. Polydipsia 3. Blurred vision 4. H/A 5. Orthostatic hypotension 6. Change inLOC 7. Seizures 8. Reversible paralysis

3 components of treatment of Addisonian Crisis

1. Treat the Cause: Treat with vasopressors, 2. corticosteroids (main is hydrocortisone), 3. IVF (NS or/and D5W)

Besides administration of too many steroids and ACTH-secreting pituitary tumors, what are 3 other types of tumors which may cause Cushing Syndrome?

1. adrenal tumors 2. lung tumors 3. pancreas tumors

List 4 conditions/situations in which the risk for biliary disorders increases

1. estrogen therapy 2. sedentary 3. family history 4. obesity

3 stages of liver damage

1. fatty liver 2. liver fibrosis 3. cirrhosis

What are 3 ways in which the underlying cause may be treated in SIADH?

1. fluid restriction 2. treat hyponatremia 3. diuretics

Diabetic Ketoacidosis (DKA) Acute, life-threatening condition. Characterized by 5 signs and symptoms:

1. hyperglycemia (greater than 300 mg/dL) 2. ketosis 3. acidosis 4. dehydration 5. Rapid onset

Two possible causes of GI ischemia that may lead to necrosis are:

1. mesenteric clot 2. hypotension (decreased perfusion to bowel)

Rhabdomyolysis: Clinical Manifestations Course of rhabdomyolysis varies, depending on cause.; Symptoms can occur in one area or affect the whole body.; Complications : occur in early and later stages; The "classic triad" includes _?_, _?_, and _?_

1. muscle pain in the shoulders, thighs, or lower back; 2. muscle weakness or trouble moving arms/legs; 3. dark red or brown urine or decreased urination

4 Causes of Hypopituitarism:

1. pituitary tumor (most common) 2. autoimmune disorders 3. infections 4. pituitary infarction

Name 6 signs and symptoms of Diabetes Insipidus:

1. polyuria (5-20 L/da) 2. low specific gravity of urine 3. high serum osmolality 4. dehydration symptoms 5. increased sodium 6. mental dullness to coma

What are the 5 types of adrenocortical insufficiency?

1. primary 2. secondary 3. pituitary disease 4. Tumor 5. abrupt withdrawal of corticosteroid medications

What are 3 things that must be involved in a diagnostic work-up of SIADH?

1. serum sodium 2. measured (not calculated) serum osmolality 3. urine specific gravity

Clinically Important Bleeding is defined as: Overt bleeding (hematemesis, hematochezia = maroon colored stools or melena) complicated by one of following within 24 hrs after onset of bleeding if no other causes for these symptoms: 1. spontaneous decrease in SBP of more than _?_ 2. decrease of more than _?_ in SBP with pt sitting up 3. increase of more than _?_ beats/min in HR 4. decrease in hemoglobin level of more than _?_ g/dl

1. spontaneous decrease in SBP of more than 20mmHG 2. decrease of more than 10mmHG in SBP with pt sitting up 3. increase of more than 20 beats/min in HR 4. decrease in hemoglobin level of more than 2g/dl

Hyperparathyroidism increases the risks of 8 things...

1. stroke 2. HF 3. A fib 4. Cardiomyopathy 5. renal failure 6. shingles 7. Bone fx/pain 8. HTN

3 Considerations for older adult patients with HHS:

1. teach older adult patients to check blood sugar every 1-4 hours when ill; 2. emphasize the importance of not skipping an insulin dose when ill; 3. maintain hydration because older adult patients may have a diminished thirst sensation

Name 3 types of "stress" that may send someone into an Addisonian crisis:

1. trauma 2. infection 3. surgery

Oliguria of intrarenal failure: sp gr of urine _?_ ; urine osmolality of __?_; and the presences of 4 things:

1.010 and 300 (the same as plasma, indicating tubular damage) with high sodium, RBC, WBC, & casts (of RBC or epithelial cells - indicate nephron damage)

What is normal specific gravity of urine?

1.010 to 1.025

In the kidney donor, we want creatinine to stay below _?_

1.4

Normal GFR is about _?_ ml/min., and approximates the urine creatinine clearance.

125

What is a normal GFR

125

End-stage renal disease (ESRD), or stage V, occurs when the GFR is < _?_ ml/min. (at this stage _?_ or _?_ is required, if patient is uremic and desires a transplant)

15; dialysis or transplant

Patient has Upper GI Bleed: Endoscopy: Coagulate or thrombose with heat or lasers or may inject with epinephrine _?_ If can't do an endoscopy or bleeding persists after endoscopy may do _?_

1:10,000 angiography

When teaching a patient with chronic kidney disease about prevention of complications, the nurse instructs the patient to: 1. Monitor for proteinuria daily with a urine dipstick. 2. Weigh daily and report a gain of greater than 4 pounds. 3. Take calcium-based phosphate binders on an empty stomach. 4. Perform self-catheterization every 4 hours to accurately measure I & O.

2. Weigh daily and report a gain of greater than 4 pounds.

Etiology/Patho of Bowel Obstruction: 1. Distention d/t decreased absorption of fluids and electrolytes (F/E's) and stimulates intestinal secretions 2. increased pressure in the _?_ (as the fluid increases) which impairs capillary permeability & causes leakage of fluid and electrolytes into the peritoneal cavity 3. leads to decrease in _?_which 4. leads to _?_ 5. which leads to decreased blood flow to bowel 6. which leads to ischemia, necrosis, bowel perforation.

2. lumen of the bowel 3. circulating blood volume 4. hypotension/hypovolemic shock

Most corticosteroids are given as follows: _?_ in the morning _?_ in the late afternoon (provided the patient has a "normal" wake/sleep cycle)

2/3 in morning 1/3

Diagnostic Studies-- Adrenal Disease (Cushing): 24-hour urine for _?_; _?_ suppression test - used if 24 hour test (described above) is borderline diagnostic ; Plasma _?_levels (may ↑ due to loss of diurnal variation);

24-hour urine for free cortisol; Dexamethasone suppression test - used if 24 hour free cortisol is borderline diagnostic ; Plasma cortisol levels (may ↑ due to loss of diurnal variation);

normal osmolality =

278-300mOsm/kg approximately depending on lab parameters

Client Education for HHS and DKA: 1. provide the patient with education to prevent recurrence; 2. encourage all to wear a medical alert bracelet 3. take measures to decrease dehydration - drink at least_?_unless contraindicated 4. monitor glucose _?_ when ill, and continue to take insulin 5. consume liquids with carbohydrates and electrolytes when unable to eat solid foods

3 liters of water/day every 4 hours

When drawing blood for serum lipase and amylase, draw _?_ to _?_ ml; use the tube with the _?_ top.

3 to 5 ml red

While on dialysis, B/P must be taken every_?_ minutes, or more frequently if indicated

30-60 (**Usually every 15 minutes)

Perioteneal dialysis may require up to _?_ exchanges per day; Fluids should be _?_

4 warmed to body temp

How many types of hepatitis are there? What are they?

6 viral; A, B, C, D, E and G also there are bacterial causes of hepatitis

Etiology/Patho of Bowel Obstruction: _?_ Liters of fluid enters the small bowel every day Most absorbed before it reaches the _?_ 75% of intestinal gas is swallowed air With obstruction: _?_ and __?_ accumulate above the obstruction causing distention or collapse of the distal bowel.

6-8 colon gas & fluid

What is a normal Ca level? Is an increase in Ca ever "normal"?

8.4-10.2 no

Manifestations of Addison's Disease are not apparent until _?_% of the adrenal cortex is destroyed

90

Oliguric Phase of AKI: (Urine output of_?_). Begins within hours to days of initiating event and typically usually lasts_?_

< 400 ml/24 hours; 10-14 days

CKD is defined by the National Kidney Foundation as the presence of kidney damage or glomerular filtration rate (GFR) _?_ ml/min/1.73m² for _?_ or longer. It is irreversible.

< 60 3 months

Systemic changes occur when overall renal function is _?_ % of normal, or GFR ≤_?_ ml/minute. Manifestations of uremia vary among patients - many are very tolerant

<20-25% <15

Normally, ADH is secreted in response to serum osmolality, which is monitored by osmoreceptors in hypothalamus.If blood is Hypo-osmolar (_?_): then, _?_

<278mOsm/kg ADH ↓and renal water excretion↑

Normally, ADH is secreted in response to serum osmolality, which is monitored by osmoreceptors in hypothalamus.If blood is hyperosmolar(_?_): then, _?_

> 300mOsm/kg ADH increases and renal water is reabsorbed

Oliguria of prerenal failure: sp gr of urine _?_ and low _?_ concentration in urine

>1.025 Na

To declare brain death: Known etiology of condition No drug intoxication or poisoning Core temperature _?_ _?_ unresponsiveness Absence of _?_ reflexes Pupils fixed and non-reactive No ocular movement (no dolls eyes, no response to cold caloric exam) No _?_ or _?_ reflex

>or= 32 C (90) Cerebral brain stem cough or gag

Drug Therapy for Hepatitis No drug therapies for acute hepatitis _?_infections

A

A patient with a severe pounding headache has been diagnosed with hypertension. However, the hypertension is not responding to traditional treatment. What should the nurse expect as the next step in management of this patient? Administration of β-blocker medications Abdominal palpation to search for a tumor Administration of potassium-sparing diuretics A 24-hour urine collection for fractionated metanephrines

A 24-hour urine collection for fractionated metanephrine

The nurse is caring for a group of patients. Which patient is at highest risk for pancreatic cancer? A 38-year-old Hispanic female who is obese and has hyperinsulinemia A 23-year-old who has cystic fibrosis-related pancreatic enzyme insufficiency A 72-year-old African American male who has smoked cigarettes for 50 years A 19-year-old who has a 5-year history of uncontrolled type 1 diabetes mellitus

A 72-year-old African American male who has smoked cigarettes for 50 years

The nurse is caring for a woman recently diagnosed with viral hepatitis A. Which individual should the nurse refer for an immunoglobin (IG) injection? A caregiver who lives in the same household with the patient A friend who delivers meals to the patient and family each week A relative with a history of hepatitis A who visits the patient daily A child living in the home who received the hepatitis A vaccine 3 months ago

A caregiver who lives in the same household with the patient

A 58-year-old woman is being discharged home today after ostomy surgery for colon cancer. The nurse should assign the patient to which staff member? A nursing assistant on the unit who also has hospice experience A licensed practical nurse who has worked on the unit for 10 years A registered nurse with 6 months of experience on the surgical unit A registered nurse who has floated to the surgical unit from pediatrics

A registered nurse with 6 months of experience on the surgical unit

What is Acute Kidney Injury (AKI)?

A term used to encompass the entire range of the syndrome including a very slight deterioration in kidney function to severe impairment

Lower GI Bleed Treatment: Emergency care: _?_ Respiratory status: airway, breathing V/S, peripheral perfusion Abdominal exam History BMP (monitor BUN), CBC, PT/INR, PTT, liver enzymes, ABG, Type and cross match, UA including specific gravity

ABCs

What are the 2 type of tissue typing that must be done prior to transplant? Some organ transplants require greater histocompatibility match than other organs. Corneas, for example can be accepted by nearly any individual because corneas are avascular, and no antibodies reach the cornea to cause rejection

ABO blood (do not need same Rh factor) HLA (human leukocyte antigen) typing

Diagnostic Studies-- Adrenal Disease (Cushing): _?_ levels (may be normal, or ↑ depending on cause; Alkalosis, _?_ serum K, glucosuria, hypercalciuria,; _?_glucose, _?_ WBC (eos and lymphs), water retention; MRI and CT

ACTH levels (may be normal, or ↑ depending on cause; Alkalosis, ↓ serum K, glucosuria, hypercalciuria,; ↑glucose, ↑WBC (eos and lymphs), water retention; MRI and CT

5 lab tests for Hep are: Plus: HAV & HBV (antibodies are _?__) HCV: (antibodies indicate _?_) May have liver biopsy

ALT, AST, GGT, Alkaline phosphatase (ALP), serum bilirubin HAV & HBV (antibodies are protective) HCV: (antibodies indicate chronic disease)

Liver DIagnostic tests: What are the normal lab values for the following? AST ALT LDH (elevated in alcohol abuse) Serum Ammonia

AST 10-30 ALT 10-40 LDH < 200 Ammonia 15-45 mcg/dl

The patient is taking lansoprazole (Prevacid) for chronic management of peptic ulcer disease. The nurse advises the patient to take which of these over the counter medications if needed for a headache? Naproxen (Aleve) Ibuprofen (Motrin) Acetaminophen (Tylenol) Acetylsalicylic (Aspirin)

Acetaminophen (Tylenol)

5 disorders of the anterior pituitary related to overproduction:

Acromegaly (due to ↑GH when adult) Gigantism (due to↑GH when child) Cushing syndrome (due to↑ACTH) Hyperthyroidism (due to↑TSH) Prolactinomas (due to ↑prolactin)

5 disorders of the anterior pituitary related to overproduction: Acromegaly (due to _?_ when adult) Gigantism (due to_?_ when child) Cushing syndrome (due to_?_ ) Hyperthyroidism (due t_?_ ) Prolactinomas (due to _?_ )

Acromegaly (due to ↑GH when adult) Gigantism (due to↑GH when child) Cushing syndrome (due to↑ACTH) Hyperthyroidism (due to↑TSH) Prolactinomas (due to ↑prolactin)

A patient with cholelithiasis needs to have the gallbladder removed. Which patient assessment is a contraindication for a cholecystectomy? Low-grade fever of 100° F and dehydration Abscess in the right upper quadrant of the abdomen Activated partial thromboplastin time (aPTT) of 54 seconds Multiple obstructions in the cystic and common bile duct

Activated partial thromboplastin time (aPTT) of 54 seconds

_?_is an acute inflammatory process; autodigestion by enzymes

Acute pancreatitis

_?_ occurs within first 6 months after transplantation; it is mediated by patient's lymphocytes, which have been activated against the donated (foreign) tissue or organ Usually reversible with additional _?_therapy, which may include _?_ or _?_

Acute rejection immunosuppressive corticosteroid doses or polyclonal or monoclonal antibodies.

_?_ is a type of intrarenal injury caused by ischemia, nephrotoxins, or pigments (such as myoglobin); It is the most common cause of _?_ AKI.

Acute tubular necrosis (ATN); intrarenal

Adrenal Cortex Hypofunction - Primary is called _?_. Which corticosteroids are affected?

Addison's disease all 3 (gluco ,mineral, androgen) are all reduced

_?_ is a Life threatening response to acute adrenal insufficiency

Addisonian Crisis

How is an apnea test conducted? Serial ABGs after five minutes until PCO2 >or= 60 mmHg Reconnection of ventilator when test is complete if respiratory movements are absent and arterial PCO2 is _?_ mm Hg the apnea test result is positive (brain dead) If hypotension, arrhythmia, or severe desaturation occurs, reconnect ventilator immediately & consider other test

Adjust vasopressors to a systolic blood pressure ≥100 mm Hg. • Preoxygenate for at least 10 minutes with 100% oxygen to a PaO2 >200 mm Hg. • If pulse oximetry oxygen saturation remains >95%, obtain a baseline blood gas • Disconnect the patient from the ventilator. • Preserve oxygenation • Look for respiratory movements for 8-10 minutes. • Abort if systolic blood pressure decreases to <90 • Abort if oxygen saturation measured by pulse oximetry is <85% for >30 seconds. • If no respiratory drive is observed, repeat blood gas after approximately 8 minutes. • If respiratory movements are absent and arterial PCO2 is ≥60 mm Hg the apnea test result is positive (brain dead).

Adrenal Cortex Hypofunction aka _?_

Adrenocortical insufficiency

_?_ is a hormone that is secreted by the anterior pituitary. It stimulates the adrenal glands to release corticosteroids

Adrenocorticotropic Hormone (ACTH)

8 Non-traumatic causes of rhabdomyolysis:

Alcohol/drug use such as heroin/cocaine, Extreme muscle strain (exercise), Prescription drugs: antipsychotics, statins, Heat stroke/high body temp, Seizures or delirium tremens (DTs), Diabetic ketoacidosis, Viral infections such as influenza, Sepsis, Previous hx of rhabdo

Adrenal Cortex: Synthesizes 3 classes of steroid hormones. 1 class is mineralocorticoids, primary _?

Aldosterone

A frail 72-year-old woman with stage 3 chronic kidney disease is cared for at home by her family. The patient has a history of taking many over-the-counter medications. Which over-the-counter medications should the nurse teach the patient to avoid? Aspirin Acetaminophen (Tylenol) Diphenhydramine (Benadryl) Aluminum hydroxide (Amphogel)

Aluminum hydroxide (Amphogel)

Diagnostics for Chronic Pancreatitis Assess signs and symptoms Lab tests _?_ and _?_may be slightly elevated or normal - depends on how much fibrosis May have increased serum _?_and alkaline phosphatase

Amylase and lipase bilirubin

What are 6 s/e of monoclonal antibodies such as muromonab-CD3 (Orthocione OKT3)?

Anaphylaxis Fever Chills Nausea Vomiting Dyspnea Chest Pain

A patient with cirrhosis of the liver is admitted to the hospital. What hematologic symptoms might be noted in this patient? Select all that apply. Anemia Leukemia Leukopenia Polycythemia vera Thrombocytopenia

Anemia Leukopenia Thrombocytopenia

5 gastrointestinal clinical manifestations of CKD

Anorexia nausea vomiting gastointestinal bleeding gastritis

Drug therapy for Duodenal ulcer, gastric ulcer, acute gastritis: _?_ and _?_ H2-receptor blockers, Proton Pump Inhibitors (PPI)

Antacids, Sucralfate (Carafate)

The patient with chronic gastritis is being put on a combination of medications to eradicate H. pylori. Which drugs does the nurse know will probably be used for this patient? Antibiotic(s), antacid, and corticosteroid Antibiotic(s), aspirin, and antiulcer/protectant Antibiotic(s), proton pump inhibitor, and bismuth Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs)

Antibiotic(s), proton pump inhibitor, and bismuth

2 hormones secreted by the posterior pituitary

Antidiuretic hormone (ADH) Oxytocin

A 78-year-old patient has Stage 3 CKD and is being taught about a low potassium diet. The nurse knows the patient understands the diet when the patient selects which foods to eat? Apple, green beans, and a roast beef sandwich Granola made with dried fruits, nuts, and seeds Watermelon and ice cream with chocolate sauce Bran cereal with ½ banana and milk and orange juice

Apple, green beans, and a roast beef sandwich

Collaborative care for _?_ I/O, Daily Weights, Abdomen girths HOB elevated Paracentesis

Ascites

Complications of Cirrhosis: _?_ - I/O, Daily Weights, Abdomen girths; HOB elevated; Paracentesis _?_ - observe for bleeding

Ascites - I/O, Daily Weights, Abdomen girths HOB elevated Paracentesis Esophageal Varices - observe for bleeding

Complications of Acute Liver Failure: _?_ risk of peritonitis (SBP =spontaneous bacterial Peritonitis) _?_ - kidney disease due to interrupted blood flow through the liver restricting blood flow to the kidneys _?_ - brain function affected due to toxins build up Liver cancer, especially if hepatitis B and/or C

Ascites- Hepatorenal syndrome Hepatic encephalopathy

A 52-year-old man with stage 2 chronic kidney disease is scheduled for an outpatient diagnostic procedure using contrast media. Which action should the nurse take? Assess skin turgor to determine hydration status. Insert a urinary catheter for the expected diuresis. Evaluate the patient's lower extremities for edema. Check the patient's urine for the presence of ketones

Assess skin turgor to determine hydration status.

3 Manifestations of Acromegaly: Cardio

Atherosclerosis, HTN, CHF,

_?__: automatic device called a cycler is used to deliver dialysate- allows PD while asleep; cycles 4 or more exchanges per night, although must have a couple exchanges during the daytime

Automated Peritoneal Dialysis (APD)

Primary etiologies of acute pancreatitis cause autodigestion. Name 9

Biliary tract disease Alcoholism trauma (including surgery) viral infections (mumps, HIV) penetrating duodenal ulcer Abscesses cystic fibrosis metabolic disorders (hperparathyroidism, renal failure) Meds (corticosteroids, thiazide diuretics, oral contraceptives, sulfonamides, NSAIDS)

How do the catecholamines work?

Binds to adrenergic receptor on cells -

_?_ is a 3 lumen tube used for the tamponade of gastro-oesophageal bleeding that is unresponsive to medical and endoscopic treatment

Blakemore Tube

The nurse should monitor for increases in which laboratory value for the patient as a result of being treated with dexamethasone (Decadron)? Sodium Calcium Potassium Blood glucose

Blood glucose

A patient with a history of end-stage kidney disease secondary to diabetes mellitus has presented to the outpatient dialysis unit for his scheduled hemodialysis. Which assessments should the nurse prioritize before, during, and after his treatment? Level of consciousness Blood pressure and fluid balance Temperature, heart rate, and blood pressure Assessment for signs and symptoms of infection

Blood pressure and fluid balance

Interventions for _?_ Placement of NG or intestinal tubes Surgery: strangulated obstruction is a surgical emergency! May use laporoscopy for repair. Nonsurgical: colonoscopy to remove polyps, dilate strictures, and remove or destroy tumors with laser.

Bowel obstruction

_?_ is the #1 cause of death in transplant patients. This is due a side effect of medication: _?_

CAD hyperlipidemia

Lab test for Gallbladder disease : _?_ (will show elevated _?_ d/t inflammation) direct and indirect _?_ (both elevated if obstruction present); alkaline phosphatase, ALT, AST may be elevated; serum amylase and lipase increased if pancreas involved

CBC (WBC elevated d/t inflammation); bilirubin

Rhabdomyolysis: Collaborative Care Lab work including chemistries and _?_ levels, urine __?_, serum _?_;

CK myoglobin myoglobin

_?_ is a progressive reduction of functioning renal tissue such that the remaining kidney mass can no longer maintain the body's internal environment.

CKD

Normal Lab values for the following are: CO2: BUN: Creatinine: Phosphorous:

CO2: (normal 23-30 mEq/L) BUN: (normal 6-20 mg/dl) Creatinine: (normal 0.6-1.3 mg/dl) Phosphorous: (normal 2.4-4.4 mg/dl)

RRT also includes _?_ and _?_ because it is any way in which the blood is filtered

CRRT and transplant

Lower GI Bleed Treatment: May not require medical treatments except monitoring If continue to bleed: _?_ to localize (see) area bleeding; can use embolization to stop bleeding Need _?_ blood loss Tagged RBC scan (nuclear med) Can see bleeding if > 0.1ml/min blood loss Unreliable localization; High false positive rate

CT angiography > 0.5ml/min

5 Criteria for hyperparathyroidism surgery:

Ca > 12, < 50 years old, hypercalciuria, ↓ bone density, kidney stones

Name 2 types immunosuppressive agents: _?_ such as: cyclosporine (Sandimmune, Neoral, Gengraf) and tacrolimus (Prograf, FK506). _?_ is the most widely used _?_ such as: (prednisone, methyprednisolone [Solu-Medrol]IV)

Calcineurin Inhibitors tacrolimus Corticosteroids

Normal values of the following labs are: Calcium: Magnesium: Hematocrit: Hemaglobin:

Calcium: (normal 8.6-10.2 mg/dl) Magnesium: (normal 1.5-2.5 mEq/L) Hematocrit: (normal 35-50%) Hemaglobin: (normal 11.7-17.3 g/dl)

The patient has had type 1 diabetes mellitus for 25 years and is now reporting fatigue, edema, and an irregular heartbeat. On assessment, the nurse finds that the patient has newly developed hypertension and difficulty with blood glucose control. The nurse should know that which diagnostic study will be most indicative of chronic kidney disease (CKD) in this patient? Serum creatinine Serum potassium Microalbuminuria Calculated glomerular filtration rate (GFR)

Calculated glomerular filtration rate (GFR)

Care of NG/ Intestinal Tubes includes 4 things:

Care of NG/ Intestinal Tubes Mouth care/ Nose care Placement/flush Patency Clamping schedule

_?_ is a medication which is a lymphocyte-specific inhibitor of purine synthesis with suppression of both B and T cells

Cell Cept

Side effects of _?_include diarrhea, neutropenia, thrombocytopenia

CellCept

Testing for Diabetes Insipidus involves: 1. withhold fluids for 8-16 hours & assess B/P, weight, and urine osmolality hourly 2. then vasopressin administered and urine osmo measured in one hour _?_= rise in urine osmo _?_ = no response

Central DI ; Nephrogenic DI

What are 4 causes of the neurological changes in the AKI patient?

Change in electrolytes, build up of waste products (BUN, Cr), hypotension (decreased kidney perfusion), excessive fluid (increases ICP)

The following are clinical manifestations of _?_ Indigestion to moderate to severe pain Fever Jaundice Tenderness in rt upper quadrant - referred pain to rt shoulder and scapula N/V Restlessness Diaphoresis If chronic in nature: intolerance to fatty foods, dyspepsia, heartburn, flatulence

Cholecystitis

The following are meds for _?_: Interferon (Intron A) Pegylated interferon (PegIntron, Pegasys) Nucleoside and nucleotide analogs Lamivudine (Epivir) Adefovir (Hepsera) Entecavir (Baraclude) Telbivudine (Tyzeka) Tenofovir (Viread)

Chronic HBV

The following are meds for _?_ Pegylated interferon Ribavirin (Rebetol, Copegus) Protease inhibitors Telaprevir (Incivek) Boceprevir (Victrelis)

Chronic HCV

_?_ is a continuous, prolonged, inflammatory, fibrosing process; progressive destruction as replaced by fibrotic tissue; may see remissions and exacerbations.

Chronic pancreatitis

_?_ occurs over months or years; Is irreversible and can occur for unknown reasons or from repeated episodes of acute rejection Results in _?_ and _?_ of the organ. No definitive treatment, rather supportive --- poor prognosis

Chronic rejection fibrosis and scarring

Post-hyperparathyroidism surgery: Assess _?_ and _?_

Chvostek's (facial muscles) & Trousseau's signs (carpal spasms)

2 parts of the Lower GI

Colon Rectum

11 S&S of Addisonian Crisis

Coma and life threatening!, Hypotension, Tachycardia, Dehydration, Hyponatremia, Hyperkalemia, Hypoglycemia, Fever, weakness, confusion, N/V

Diagnosis of Pheochromocytoma: Consider this diagnosis when patient doesn't respond to _?_. Do not allow consumption of _?_

Consider this diagnosis when patient does not respond to usual anti-hypertensive drugs; Don't give anything that ↑B/P (like caffeine!)

A patient is diagnosed with acute pancreatitis. When providing dietary teaching, what are the points that a nurse should tell the patient? Select all that apply. Consume a low-fat diet. Avoid consuming alcohol. Limit fluid intake. Consume a high-carbohydrate diet. Consume a low-carbohydrate diet.

Consume a low-fat diet. Avoid consuming alcohol. Consume a high-carbohydrate diet.

Following a gastric resection, on post-op day 3, the patient's nasogastric tube is draining bile-colored liquid containing coffee-ground material. What is the best nursing action? Continue to monitor the amount of drainage and correlate it with any changes in vital signs. Reposition the NG tube and irrigate the tube with normal saline. Call the MD and discuss the possibility that the patient is bleeding. Irrigate the NG tube with iced saline solution and attach the tube to gravity suction.

Continue to monitor the amount of drainage and correlate it with any changes in vital signs.

_?_:manual exchanges 3-4 times a day - more labor intensive

Continuous Ambulatory Peritoneal Dialysis (CAPD)

_?_ provides a method to slowly remove solutes and fluids continuously in the hemodynamically unstable patient Only for those who do not need rapid resolution A more physiologic way to remove fluid over 24 hours

Continuous renal replacement therapy (CRRT)

The physician has decided to use renal replacement therapy to remove large volumes of fluid from a patient who is hemodynamically unstable in the intensive care unit. The nurse should expect which treatment to be used for this patient? Hemodialysis (HD) 3 times per week Automated peritoneal dialysis (APD) Continuous venovenous hemofiltration (CVVH) Continuous ambulatory peritoneal dialysis (CAPD)

Continuous venovenous hemofiltration (CVVH)

The patient with right upper quadrant abdominal pain has an abdominal ultrasound that reveals cholelithiasis. What should the nurse expect to do for this patient? Prevent all oral intake. Control abdominal pain. Provide enteral feedings. Avoid dietary cholesterol.

Control abdominal pain.

The nurse reviews lab tests that have been prescribed for a patient in acute renal failure. Which is the best indicator of renal function? Potassium Creatinine BUN (blood urea nitrogen) ALT (alanine aminotransferase)

Creatinine

_?_ - uses serum from the recipient mixed with donor lymphocytes to test for any preformed anti-_?_ antibodies to the potential donor organ; may be used as a screening tool when multiple possible living donors are being considered, or once a cadaver is selected.

Crossmatch HLA

4 Traumatic Causes of rhabdomyolysis:

Crush injury (auto accident, fall, building collapse), Prolonged immobilization (after fall, lying on hard surface during illness or under influence), Electrical shock injury, lightning strike, burn, Venom from snake or insect bite

Thinning of hair, red cheeks, buffalo hump, muscle atrophy, poor wound healing, acne, moon face, purple striae, pendulous abdomen, and ecchymosis are all characteristics of someone with _?_

Cushing Syndrome

_?_is caused by a pituitary gland tumor (usually benign) that over-secretes the hormone ACTH, thus overstimulating the adrenal glands' cortisol production

Cushing disease

_?_ refers to the signs and symptoms associated with excess corticosteroids (especially glucocorticoids) in the body, regardless of the cause.

Cushing syndrome

Name 3 immunosuppressive agents: _?_ such as: Mycophenolate mofetil (CellCept), Sirolimus (Rapumune), azothioprine (Imuran), & cyclophosphamide (Cytoxan, Neosar) _?_ such as: muromonab-CD3 (Orthoclone OKT3), daclizumab (Zenapax), basiliximab (Simulect) _?_ such as : Lymphocyte immune globulin (Atgam)

Cytotoxic agents: Monoclonal Antibodies Polyclonal Antibody

Side effects of _?_ include neutropenia, hemorrhagic cystitis

Cytoxan:

_?_ is a medication which crosslinks DNA, leading to cell injury

Cytoxan; Neosar (cyclosphamide)

Underproduction/undersecretion of ADH by the pituitary gland causes _?_

DI (diabetes insipidus)

Ms. Schudde recovered from her AKI. What health promotion activities would you discuss with her prior to discharge? Daily Weights Diet __?_ Hydration Meds _?_ IV dye _?_ Lab Monitoring _?_ Infections _?_ F/U appointments

Daily Weights Diet - low Na, low protein, increased carb and fat Hydration Meds - no nephrotoxic drugs IV dye renal dosing with bicarb Lab Monitoring f/e, BUN, Cr, Urine Output Infections treat immediately F/U appointments

After a subtotal gastrectomy, the nurse should anticipate that NG tube drainage will be what color for about 12-24 hours after surgery? Dark brown Bile green Bright red Cloudy white

Dark brown

What is the #1 medication which can be used for SIADH? What is its method of action?

Declomycin; blocks the effect of ADH on the renal tubules which allows for more dilute urine

Treatment for bowel obstruction may include: decompression of the intestine using _?_ Correction and maintenance of _?_ Relief or removal of the obstruction

Decompression with NG tube fluid and electrolyte balance

During hemodialysis, the patient develops light-headedness and nausea. What should the nurse do for the patient? Administer hypertonic saline. Administer a blood transfusion. Decrease the rate of fluid removal. Administer antiemetic medications.

Decrease the rate of fluid removal.

5 disorders of the anterior pituitary related to underproduction:

Deficiency of TSH Deficiency of ACTH Deficiency of GH Deficiency of FSH and LH Hypothyroidism (deficiency of TSH)

The nurse knows the patient with AKI has entered the diuretic phase when what assessments occur (select all that apply)? Dehydration Hypokalemia Hypernatremia BUN increases Serum creatinine increases

Dehydration Hypokalemia

ADH insufficiency causes _?_

Diabetes insipidus

7 Major causes of CKD:

Diabetic nephropathy Hypertensive nephrosclerosis Chronic glomerulonephritis Chronic pyelonephritis Systemic lupus erythematosus Polycystic kidney disease Autoimmune process

_??_ - Movement of fluid and molecules across a semipermeable membrane from the blood to the dialysate solution.

Dialysis

_?_ is used to correct fluid and electrolyte imbalances and to remove waste products in renal failure (can also be used for some drug overdoses). Begun when uremia can no longer be treated with conservative medical management (usually GFR< 15)

Dialysis

4 components of CKD treatment

Dietary and fluid management Pharmacology Supportive and surgical therapy Dialysis

Principles of dialysis - uses concentration gradients _?_ - movement of solutes from area of greater to lesser concentration (urea, creatinine, uric acid, and electrolyes move from blood to dialysate

Diffusion

3 Principles of dialysis - uses concentration gradients

Diffusion Osmosis Ultrafiltration

_?_ is an increasingly rare syndrome characterized by neurologic symptoms of varying severity that affect dialysis patients, particularly when they are first started on hemodialysis. It is thought to be due primarily to cerebral edema. S/S: confusion, HA, Nausea with or without vomiting, Dizziness, Muscle cramp, Blurred vision, Tremors, Restlessness, Agitation, Alteration of consciousness, Seizure, Coma, Sudden cardiac arrest Treatment is to infuse _?_

Disequilibrium Syndrome Treatment: 3-5 hypersaline

The patient was diagnosed with prerenal AKI. The nurse should know that what is most likely the cause of the patient's diagnosis? IV tobramycin (Nebcin) Incompatible blood transfusion Poststreptococcal glomerulonephritis Dissecting abdominal aortic aneurysm

Dissecting abdominal aortic aneurysm

Signs of a _?_ Small bowel obstruction (SBO): Emesis (orange-brown in color, foul odor like feces, not as rapid onset; multiple areas of fluid on xray; abdominal pain

Distal

2 drug therapies for ascites

Diuretics and spironolactone

Bleeding can also occur in the lower GI tract (colon) Name several causes of Lower GI Bleed:

Diverticular bleeding Ischemia Hemorrhoids, fissures Neoplasia Irritable Bowel, infectious colitis, post polypectomy Arteriovenous malformations Unknown causes

After administering a dose of promethazine (Phenergan) to a patient with nausea and vomiting, what common temporary adverse effect of the medication does the nurse explain may be experienced? Tinnitus Drowsiness Reduced hearing Sensation of falling

Drowsiness

The patient is having a gastroduodenostomy (Billroth I operation) for stomach cancer. What long-term complication is occurring when the patient reports generalized weakness, sweating, palpitations, and dizziness 15 to 30 minutes after eating? Malnutrition Bile reflux gastritis Dumping syndrome Postprandial hypoglycemia

Dumping syndrome

Diagnostics for Chronic Pancreatitis Usually mild leukocytosis and increased sed rate Secretin stimulation test - used to assess degree of pancreatic function _?_ used to see pancreatic and common bile ducts CT, MRI, ultrasound - show calcifications, ductgal dilation, pseudocysts, pancreatic enlargement

ERCP

Collaborative Care for Gallbladder disease: ERCP w/ _?_ Extracorporeal shock-wave lithotripsy _?_ : Ursodeoxycholic acid (Actigall); chenodeoxycholic acid (chenodiol) _?_ : laparoscopic cholecystectomy; open cholecystectomy

ERCP w/ sphincterectomy Extracorporeal shock-wave lithotripsy Dissolution therapy: Ursodeoxycholic acid (Actigall); chenodeoxycholic acid (chenodiol) Surgical therapy: laparoscopic cholecystectomy; open cholecystectomy

A patient is seeking emergency care after choking on a piece of steak. The nursing assessment reveals a history of alcoholism, cigarette smoking, and hemoptysis. Which diagnostic study is most likely to be performed on this patient? Barium swallow Endoscopic biopsy Capsule endoscopy Endoscopic ultrasonography

Endoscopic biopsy

Treatment if esophageal or gastric varcies do begin to bleed: Name 3 or 4 therapies that may be used

Endoscopic therapies Balloon tamponade, transjugular intra-hepatic porto- systemic shunt (TIPS), DSRS (distal splenorenal shunt)

5 Manifestations of Acromegaly: Musculoskeletal

Enlargement of hands and feet, Fingertips club, forehead enlarges, Maxilla lengthens, Coarsening of facial features, Tongue enlarges and voice deepens,

Name 3 catecholamines released by the adrenal medulla.

Epinephrine(major hormone) Norepinephrine Dopamine;

5 Manifestations of Pheochromocytoma

Episodes of severe hypertension; Severe headache, tachycardia, profuse sweating, unexplained abdominal and/or chest pain;

_?_ Tortuous veins at lower end of esophagus, enlarged & swollen d/t portal hypertension

Esophageal varices

2 Complications of portal hypertension:

Esophageal varices Gastric varices

3 parts of the Upper GI

Esophagus Stomach Small Intestines

The nurse is caring for a 68-year-old woman after a parathyroidectomy related to hyperparathyroidism. The nurse should administer IV calcium gluconate if the patient exhibits which clinical manifestations? Facial muscle spasms or laryngospasms Decreased muscle tone or muscle weakness Tingling in the hands and around the mouth Shortened QT interval on the electrocardiogram

Facial muscle spasms or laryngospasms

The nurse is caring for a group of older patients in a long-term care setting. Which physical changes in the patients should the nurse investigate as signs of possible endocrine dysfunction? Absent reflexes, diarrhea, and hearing loss Hypoglycemia, delirium, and incontinence Fatigue, constipation, and mental impairment Hypotension, heat intolerance, and bradycardia

Fatigue, constipation, and mental impairment

Signs & Symptoms of Oliguric Phase of AKI Fluid volume _?_ and 4 electrolyte imbalances:

Fluid volume excess, Sodium imbalance, Potassium excess, Calcium Imbalance Phosphorous imbalance

A patient with type 2 diabetes mellitus has been diagnosed with nonalcoholic fatty liver disease (NAFLD). The nursing teaching plan should include which of the following? Having genetic testing done. Eliminating carbohydrates from the diet. Following measures to gain tighter glucose control. Avoiding alcohol until liver enzymes return to normal

Following measures to gain tighter glucose control.

Overall mortality rate for acute hepatitis is < 1%. _?_ viral hepatitis: severe impairment or necrosis of liver cells, hepatic failure Chronic hepatitis - most at risk with Hep _?_ Cirrhosis of the liver Hepatocellular carcinoma

Fulminant C

What are the "Risk" criteria for classification of AKI for both GFR and urine output:

GFR: increased creatinine (1.5 times) or GFR decrease > 25%; Urine: output < 0.5 ml/kg/h x 6 hour

What are the "Injury" criteria for classification of AKI for both GFR and urine output:

GFR: increased creatinine (2 times) or GFR decrease > 50%; Urine: output < 0.5 ml/kg/h x 12 hour

What are the "Failure" criteria for classification of AKI for both GFR and urine output:

GFR: increased creatinine (3 times) or GFR decrease > 75% or creatinine > 4 mg per 100 mL; Urine: output < 0.3 ml/kg/h x 24 hour or anuria x 12 hour

What are the 3 most common deficiencies associated with hypopituitarism?

GH and gonadotropins (LH, FSH)

_?_ is complete penetration of any part of the wall of the gastrointestinal tract in which intestinal contents flow into the abdominal cavity Potential for bacterial contamination of the abdominal cavity called _?_

GI perforation Peritonitis

Once organ donation has been authorized, _?_assumes medical care of donor and sends medical information about the donor to _?_ for matching with potential recipients.

GOH's Organ Recovery Coordinator United Network for Organ Sharing (UNOS)

_?_ Located in upper portion of stomach (fundus); d/t portal hypertension

Gastric varices

Federal law requires hospitals to notify _?_ each time a patient dies or is about to die to determine if patient is a potential donor.

Gift of Hope

Adrenal Cortex: Synthesizes 3 classes of steroid hormones, called collectively corticosteroids. They are:

Glucocorticoids Mineralocorticoids Androgens

Diagnostic Labs for DKA: Glucose = _?_ Na _?_ K _?_ BUN _?_ Cr _?_ Urine Ketones _?_ Serum ketones _?_ Serum osmo _?_ pH _?_

Glucose >300 mg/dl Na - high K - low BUN >30 mg/dl Cr >1.5 mg/dl Urine Ketones present Serum ketones - present Serum osmo - increased pH < 7.3

Diagnostic Labs For HHS: Glucose Na K BUN Cr Urine ketones Serum ketones Serum osmo pH

Glucose >600 mg/dl Na - high K - low BUN >30 mg/dl Cr >1.5 mg/dl Urine ketones - negative Serum ketones - negative Serum osmo - > 320 pH > 7.4

4 Metabolic functions of the Liver: Also: Regulates Blood Coagulation Detoxification Drug & Toxin metabolism Bile synthesis & secretion Bile formation Bilirubin excretion

Glucose metabolism Ammonia conversion Protein metabolism Fat metabolism, vitamin & iron storage

__?__ occurs when an immunodeficient patient is transfused with immunocompetent cells. Begins _?_ days post transplant

Graft vs Host Disease (GVHD) 7-30

5 hormones secreted by the Anterior pituitary

Growth hormone (GH) Prolactin Thyroid Stimulating Hormone (TSH) Adrenocorticotropic Hormone (ACTH) Follicle-stimulating Hormone (FSH)

Name 3 causes of SIADH that relate to the nervous system:

Guillian Barre, skull fx, subdural hematoma (these are usually self-limiting)

5 cardiovascular clinical manifestations of CKD

HTN HF CAD Pericarditis PAD

Manifestations of hyperparthyroidism: 2 Cardiovascular:

HTN, arrhythmias

What does chronic rejection cause in each of the following organs? 1. Heart 2. Lungs 3. Liver 4. Kidney

Heart: accelerated CAD Lungs: bronchiolitis obliterans Liver: loss of bile ducts Kidney: fibrosis and glomerulopathy

What are the clinical manifestations of AKI for each of these systems? Hematologic (1) Neurologic (2) Metabolic (5)

Hematologic - anemia within 48 hours Neurologic - confused, decreased LOC Metabolic - hypermetabolic, metabolic acidosis, Increased P, Decreased Ca, Increased Mg

In _?_, an artificial membrane used as the semi-permeable membrane and is in contact with patient's blood

Hemodialysis (HD):

_?_ jaundice causes: blood transfusion reactions, sickle cell crisis, hemolytic anemia

Hemolytic

_?_ jaundice: Causes by increased breakdown of RBC's

Hemolytic

3 types of Jaundice:

Hemolytic Hepatocellular Obstructive

Mode of transportation: Fecal-oral Incubation time: 15-50 days; average 28 days Sources of infection/spread of disease: Crowded areas, poor sanitation, poor hygiene; contaminated food, milk, water, shellfish; persons with subclinical infections; infected food handlers Most infectious 2 weeks prior to onset of symptoms; still infectious for 1-2 more weeks after onset of symptoms Onset is acute - mild flu like symptoms Almost all resolve

Hep A

Drug Therapy for Hepatitis _?_ treated only if severe hepatitis and liver failure Hep C: treat w/ pegylated interferon within 1st 12-24 weeks of infection...decreases development of chronic hep C. Antiemetics & Analgesics - caution if liver secreted Prochlorperazine (Compazine), promethazine (Phenergan), ondansetron (Zofran)

Hep B

Mode of transportation: percutaneous (parenteral)/permucosal exposure to blood or blood products (before 1971); sexual contact; perinatal transmission, tatoos and piercings Incubation time: 45-180 days; average 56-96 days Infectivity: before and after symptoms appear; infectious for 4-6months; carriers continue for person's life 30% asymptomatic More infectious than HIV Gradual onset - symptoms more severe but fewer GI symptoms. Approximately 15-25% of chronically infected persons die from chronic liver disease

Hep B

Mode of transportation: percutaneous (parenteral)/permucosal exposure to blood or blood products; high risk sexual contact; perinatal contact Incubation period: 14-180 days; average 56 days Sources of infection/spread of disease: Blood & blood products; needles and syringes; sexual activity with infected partners Infectivity: 1-2 weeks before symptoms appear; continues during clinical course; 75-85% go on to develop chronic hepatitis 10% due to occupational exposure, hemodialysis, and perinatal transmission. 80% are asymptomatic - Scary!!

Hep C

Mode of transportation: can cause infection only when Hep B is present Incubation time: 2-26 weeks; Sources of infection/spread of disease: Same as HBV Infectivity: blood infectious at all stages Vaccination against HBV reduces risk

Hep D

Mode of transportation: fecal oral route; outbreaks associated with contaminated water supplies in developing countries Incubation period: 15-64 days; average 26-42 days Sources of infection/spread of disease: infected food-borne, contaminated water; poor sanitation; found in Asia, Africa, Mexico; not common in US Infectivity: not known; may be similar to HAV

Hep E

Hep _?_ is blood-borne and there is no treatment

Hep G

Treatment for _?_ includes: sustain life and decrease ammonia levels Assess mental and motor status Assess fluid and electrolyte imbalances

Hepatic Encephalopathy

Treatment of _?_ includes: sustain life and decrease ammonia levels Assess mental and motor status Assess fluid and electrolyte imbalances

Hepatic Encephalopathy

The condition of a patient who has cirrhosis of the liver has deteriorated. Which diagnostic study would help determine if the patient has developed liver cancer? Serum α-fetoprotein level Ventilation/perfusion scan Hepatic structure ultrasound Abdominal girth measurement

Hepatic structure ultrasound

Nursing implications for _?_ Comfort measures for pruritus, headache, muscle aches, and pain - caution with liver toxic meds! Nutrition - no special diet needed; might see small frequent meals with high calorie, low fat, vitamin supplements Rest - reduces demands of liver and promotes cell regeneration Avoid alcohol intake and meds cleared by liver Teaching - prevention, bleeding tendencies, risk for injury, meds, and monitoring for relapse

Hepatitis

In _?_ jaundice, hepatocytes are damaged, leak bilirubin. Causes: hepatitis, cirrhosis, hepatocellular carcinoma.

Hepatocellular

_?_ jaundice: caused by the liver's altered ability to take up bilirubin from the blood or to conjugate or excrete it

Hepatocellular

Phosphorous levels in CKD are _?_ (high or low?) 3 S/S

High Tingling around mouth Tingling of fingers parathesia

The nurse is caring for a 68-year-old patient admitted with abdominal pain, nausea, and vomiting. The patient has an abdominal mass and a bowel obstruction is suspected. The nurse auscultating the abdomen listens for which of the following types of bowel sounds that is consistent with the patient's clinical picture? Low pitched and rumbling above the area of obstruction High pitched and hyperactive above the area of obstruction Low pitched and hyperactive below the area of obstruction High pitched and hypoactive below the area of obstruction

High pitched and hyperactive above the area of obstruction

5 Contraindications of peritoneal dialysis:

Hx of multiple abdominal surgeries or pathologies Abdominal wall or inguinal hernia Excessive obesity Back problems Severe COPD

Treatment of Addison's Disease Replacement therapy:

Hydrocortisone (Solu-cortef) has both glucocorticoids & mineralocorticoids;

Which assessment finding is a consequence of the oliguric phase of AKI? Hypovolemia Hyperkalemia Hypernatremia Thrombocytopenia

Hyperkalemia

__?__ is a rare condition that increases the secretion of parathyroid hormone

Hyperparathyroidism

2 types of disorders of Parathyroid Gland:

Hyperparathyroidism Hypoparathyroidism

Acromegaly Treatment: Surgery:

Hypophysectomy usually using transphenoidal approach.

Complications of Hemodialysis: _?_- occurs from rapid fluid removal, ↓ cardiac output (CO), ↓system intravascular resistance S/S: nausea, light-headedness, sz, vomiting, visual ∆s, chest pain Treatment: ↓volume of fluid being removed and give N.S. iv

Hypotension

Post-hyperparathyroidism surgery: _?_ must be readily available (i.e. in the Pixus)

IV Calcium glucanate

How is Calcium given to treat tetany from hypocalcemia/hypoparathyroidism?

IV Calcium: (give slowly may cause bradycardia esp in patients on digitalis). Extravasation may cause necrosis and sloughing;

Lower GI Bleed Treatment: Oxygen (ABCs); monitor V/S 2 large bore IVs infusing _?_ or _?_ Monitor Fluid & Electrolytes Foley catheter Keep HOB elevated

IV fluid LR or .9NS & blood products

Manifestation of Acromegaly: endocrine

Impaired glucose tolerance Diabetes

Two days following a colectomy for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms occur as a result of which of the following? Irritation of the bowel Nasogastric suctioning Impaired peristalsis Anastomosis site inflammation

Impaired peristalsis

Side effects of _? _include bone marrow suppression, neutropenia, anemia, thrombocytopenia

Imuran

A patient has renal failure. The nurse, reviewing the lab results, recognizes which finding as indicative of the diminished renal function associated with the diagnosis? Hypokalemia Increased serum urea and serum creatinine Anemia and decreased blood urea nitrogen Increased serum albumin and hyperkalemia

Increased serum urea and serum creatinine

Effects of Corticosteroid Therapy: _?_ effect of norepinephrine acts on renal tubules to reabsorb Na+ (so,.. potassium and hydrogen are excreted) Mood & behavior changes Hypo_?_ Peptic ulcer Skeletal muscle atrophy _?_ intolerance Delayed healing _?_B/P Edema Susceptibility to _?_ Hypo_?_- related to anti-vit D protein depletion, leading to _?_

Increased vasoconstriction effect of norepinephrine acts on renal tubules to reabsorb Na+ (so,.. potassium and hydrogen are excreted) Mood & behavior changes Hypokalemia Peptic ulcer Skeletal muscle atrophy Glucose intolerance Delayed healing ↑B/P Edema Susceptibility to infection Hypocalcemia- related to anti-vit D protein depletion, leading to pathologic fractures

The nurse is caring for a patient who has a duodenal ulcer. The nurse identifies what assessment data as indicative of a gastric perforation? Increasing abdominal distention and tight abdomen. Decreasing hemoglobin and hematocrit with bloody stools. Diarrhea with increased bowel sounds and hypovolemia Decreasing blood pressure with tachycardia and disorientation.

Increasing abdominal distention and tight abdomen

Diffusion, osmosis, and ultrafiltration occur in both hemodialysis and peritoneal dialysis. The nurse should know that ultrafiltration in peritoneal dialysis is achieved by which method? Increasing the pressure gradient Increasing osmolality of the dialysate Decreasing the glucose in the dialysate Decreasing the concentration of the dialysate

Increasing osmolality of the dialysate

When planning care for a patient with cirrhosis, the nurse will give highest priority to which nursing diagnosis? Impaired skin integrity related to edema, ascites, and pruritus Imbalanced nutrition: less than body requirements related to anorexia Excess fluid volume related to portal hypertension and hyperaldosteronism Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume

Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume

PD solutions high in glucose Three phases of PD cycle (or "the exchange") are: _?_- fill, usually 2 liters over 10 minutes _?_- equilibration, diffusion/osmosis, 20-30 minutes up to 8 hours _?_- 15-30 minutes, gentle massage of abdomen glucose is most commonly used agent in PD solutions, but problem → ↑ triglycerides, ↑glucose, membrane dysfunction Amino acid PD solution is available

Inflow Dwell Drain

PD solutions high in glucose Three phases of PD cycle (or "the exchange") are:

Inflow, Dwell, Drain

A patient presents to the ED with severe abdominal pain with rebound tenderness, anorexia, and chills. The vital signs include temperature of 38.7 degrees C, HR 130, RR 34, and BP 82/50. Of the following collaborative interventions, which one should the nurse implement first? Obtain a CT scan of the abdomen with and without contrast. Infuse 1000ml of lactated ringer's solution over 30min. Administer IV ketorolac (toradol) 15mg Give IV ceftriaxone (rocephen) 1gm

Infuse 1000ml of lactated ringer's solution over 30min.

_?_ occurs when reduced blood flow occurs- causes pain; can affect small or large intestine, or both; if blood flow not restored, intestines can be come necrotic Need surgery to remove necrotic section of intestines, possible colostomy depending of size/area

Intestinal ischemia

3 causes of mechanical intestinal obstruction

Intussusceptions Volvulus Hernia

Demerol is no longer given for patients with CKD because _?_

It is not excreted appropriately with patients with renal issues

_?_ is the yellowish discoloration of body tissues d/t alteration in normal bilirubin metabolism or flow of bile into hepatic or biliary duct system. Jaundice is _?_, not a _?_ Results if bilirubin concentration in blood to high, has to be _?_ times normal for jaundice to occur.

Jaundice symptom, not a disease. 3

_?_ - best treatment for ESRD

Kidney transplant

Secondary Adrenocortical insufficiency is caused by a lack of _?_ but not necessarily a lack of __?_

Lack of pituitary ACTH secretion- may not lack mineralcorticosteroids

_?_ is titrated on the # of stools (usually desire 4 per day). It is used to eliminate _?_

Lactulose Ammonia

3 drug therapies for Hepatic Encephalopathy

Lactulose Neomycin; rifaximin

The following are signs of _?_ gradual onset Rare episodes of vomiting Low grade, crampy pain Absolute constipation or diarrhea around impaction Greatly increased abd size

Large Bowel Obstruction

Rhabdomyolysis: Collaborative Care _?_helps maintain urine production prevents kidney failure; Monitor urine output/intake; _?_ - not always needed; _?_to relieve compartment syndrome if present; Usually IMC or ICU for close monitoring; If rhabdo d/t med, stop the med; If d/t medical condition, treat medical condition

Large amounts of IV fluids Dialysis fasciotomy

A patient is recovering in the intensive care unit (ICU) after receiving a kidney transplant approximately 24 hours ago. What is an expected assessment finding for this patient during this early stage of recovery? Hypokalemia Hyponatremia Large urine output Leukocytosis with cloudy urine output

Large urine output

The nurse is caring for a 55-year-old man patient with acute pancreatitis resulting from gallstones. Which clinical manifestation would the nurse expect the patient to exhibit? Hematochezia Left upper abdominal pain Ascites and peripheral edema Temperature over 102o F (38.9o C)

Left upper abdominal pain

The nurse is caring for a patient admitted with suspected hyperparathyroidism. Because of the potential effects of this disease on electrolyte balance, the nurse should assess this patient for what manifestation? Neurologic irritability Declining urine output Lethargy and weakness Hyperactive bowel sounds

Lethargy and weakness

The patient with systemic lupus erythematosus had been diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What should the nurse expect to include in this patient's plan of care (select all that apply)? Obtain weekly weights. Limit fluids to 1000 mL per day. Monitor for signs of hypernatremia. Minimize turning and range of motion. Keep the head of the bed at 10 degrees or less elevation.

Limit fluids to 1000 mL per day. Keep the head of the bed at 10 degrees or less elevation.

A nurse is collecting data from a patient admitted with hepatitis A. Which information given by the patient may indicate the patient's susceptibility to contract hepatitis A? Select all that apply. Living in slums Working as local plumber Working in a chemical factory Working as a sewage cleaner Working as a waiter and dishwasher

Living in slums Working as local plumber Working as a sewage cleaner

Name 4 infections that can cause SIADH:

Lung, meningitis, encephalitis, HIV;

The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which of the following instructions would be most helpful to prevent further episodes of constipation? Eat several small meals per day to maintain bowel motility. Reduce intake of medications causing constipation. Sit upright during meals to increase bowel motility by gravity. Maintain a high intake of fluid and fiber in the diet.

Maintain a high intake of fluid and fiber in the diet.

A patient has undergone cholecystectomy. What postoperative care should the nurse perform for this patient? Select all that apply. Maintain a low-fat diet. Monitor for any bleeding. Instruct not to do deep breathing. Place patient in shock position. Place the patient in Sims' position.

Maintain a low-fat diet. Monitor for any bleeding. Place the patient in Sims' position.

Clinical manifestations of hepatitis classified into 2 phases: Acute & Chronic 4 Chronic S/S

Malaise Easy fatigability Hepatomegaly Elevated liver enzymes (AST, ALT)

A nurse is attending to a patient with jaundice. The health care provider instructs the nurse to prepare the patient for percutaneous liver biopsy. The nurse understands that presence of certain conditions may need the procedure to be rescheduled. Which conditions may require percutaneous liver biopsy to be rescheduled? Select all that apply. Chronic hepatitis Marked ascites Hepatic cirrhosis Low hemoglobin levels Bleeding disorder

Marked ascites Low hemoglobin levels Bleeding disorder

_?_intestinal obstruction: May result from a detectable occlusion of the lumen of the intestinal tract

Mechanical

2 types of intestinal obstructions

Mechanical: Non-Mechanical:

S/S of GI bleeds: _?_ indicates a slow bleed from upper GI source _?_is bloody vomitus appearing as fresh, bright red blood or coffee ground material in NG aspirate _?_is small amounts of blood in gastric secretions/vomitus/stools not apparent by appearance; detected by hemocult/guaiac

Melena (black, tarry stools) Hematemesis: Occult bleeding:

After an abdominal hysterectomy, a 45-year-old woman complains of severe gas pains. Her abdomen is distended. It is most appropriate for the nurse to administer which prescribed medication? Morphine sulfate Incorrect Ondansetron (Zofran) Acetaminophen (Tylenol) Metoclopramide (Reglan)

Metoclopramide (Reglan)

A patient with type 2 diabetes and cirrhosis asks the nurse if it would be okay to take silymarin (milk thistle) to help minimize liver damage. The nurse responds based on what knowledge? Milk thistle may affect liver enzymes and thus alter drug metabolism. Milk thistle is generally safe in recommended doses for up to 10 years. There is unclear scientific evidence for the use of milk thistle in treating cirrhosis. Milk thistle may elevate the serum glucose levels and is thus contraindicated in diabetes.

Milk thistle may affect liver enzymes and thus alter drug metabolism.

_?_ is a 4 lumen tube used for the tamponade of gastro-oesophageal bleeding that is unresponsive to medical and endoscopic treatment

Minnesota Tube

A patient with ascites is admitted to the hospital. What should be the primary nursing actions in this case? Select all that apply. Monitor fluid and electrolytes. Provide a high-sodium diet. Encourage high-fluid intake. Administer an albumin infusion. Anticipate paracentesis

Monitor fluid and electrolytes. Administer an albumin infusion. Anticipate paracentesis

The patient has a form of glomerular inflammation that is progressing rapidly. She is gaining weight, and the urine output is steadily declining. What is the priority nursing intervention? Monitor the patient's cardiac status. Teach the patient about hand washing. Obtain a serum specimen for electrolytes. Increase direct observation of the patient.

Monitor the patient's cardiac status.

A patient with peptic ulcer disease (PUD) complains he has been nauseated for most of the day and is now feeling lightheaded and dizzy. Based on these complaints, which nursing actions would be most appropriate for the nurse to take? Select all that apply. Administer an antacid hourly until the nausea subsides. Monitor the patients vital signs. Notify the MD of the patient's symptoms. Initiate oxygen therapy. Reassess the patient in 1 hour.

Monitor the patients vital signs. Notify the MD of the patient's symptoms.

5 Drug Therapies for Acute Pancreatitis

Morphine Antispasmodics - [dicyclomine (bentyl)] Carbonic anhydrase inhibitors [acetazolamide (Diamox)] Antacids PPI

Complications of Hemodialysis: _?_ - due to hypotension, hypovolemia, high ultrafiltration rate, and low Na dialysate solution

Muscle cramps

The nurse is caring for a 36-year-old woman with possible hypoparathyroidism after a thyroidectomy. It is most appropriate for the nurse to assess for which clinical manifestations? Polyuria, polydipsia, and weight loss Cardiac dysrhythmias and hypertension Muscle spasms and hyperactive deep tendon reflexes Hyperpigmentation, skin ulcers, and peripheral edema

Muscle spasms and hyperactive deep tendon reflexes

Small Bowel Obstruction Clinical signs and symptoms vary (depends on location of obstruction): May include (4):

N/V, abdominal pain, distention, inability to pass flatus and/or stool

Collaborative Care for Gallbladder disease: IV fluids _?_, later progress to low-fat diet Antiemetics Analgesics (sphincter of Oddi spasms) _?_ vitamins Anticholinergics and antispasmodics Antibiotics (for secondary infections)

NPO with NG tube Fat-soluable

What type of diabetes insipidus can be caused by medications? Which medications? Explain how this affects ADH

Nephrogenic; Lithium and dilantin (can cause hypokalemia and hypercalcemia leading to nephrogenic DI), renal tubules no long respond to ADH

What type of DI is the most common? Explain how ADH insufficiency occurs:

Neurogenic DI; disruption of the hypothalamus or pituitary by surgery or IICP

A histamine (H2) receptor antagonist will be prescribed for a patient. The nurse identifies which of the following meds as being H2 receptor antagonists? Select all that apply. Nizatidine (Axid) Ranitidine (Zantac) Famatidine (Pepcid) Cimetidine (Tagamet) Esomeprazole (Nexium) Lansoprazole (Prevacid)

Nizatidine (Axid) Ranitidine (Zantac) Famatidine (Pepcid) Cimetidine (Tagamet)

_?_intestinal obstruction: May result from a neuromuscular or vascular disorder

Non-Mechanical

_?_ jaundice: caused by damage from liver tumors, hepatitis, or cirrhosis, common bile duct obstructions from stones, strictures, sclerosing cholangitis, pancreatic cancer.

Obstructive

Acromegaly:

Occurs when sustained GH secretion begins during adulthood. Bones increase in thickness and width. Not common - one out of 3 million adults diagnosed each year.

The patient receiving chemotherapy rings the call bell and reports the onset of nausea. The nurse should prepare an as-needed dose of which medication? Morphine sulfate Zolpidem (Ambien) Ondansetron (Zofran) Dexamethasone (Decadron)

Ondansetron (Zofran)

The patient with a gastric ulcer has an order for sucralfate (carafate) 1 gm po QID. The nurse would schedule the medication for which of the following times? With meals and at bedtime One hour before meals and at bedtime Every 6 hours around the clock One hour after meals and at bedtime

One hour before meals and at bedtime

CKD characteristics: onset _?_ (gradual or sudden?) #1 cause _?_ diagnosis GFR < _?_ for _?_ reversible _?_ (yes or no?) mortality _?_ primary cause of death_?_

Onset: gradual (years) Cause: diabetic nephropathy Dx: GFR < 60 x 3 months &/or kidney damage > 3 months Reversible: NO Mortality: 19-24% Primary cause of death: Cardiovascular disease

AKI characteristics: onset _?_ cause _?_ diagnosis _?_ reversible? _?_ mortality _?_ primary cause of death_?_

Onset: sudden Cause: acute tubular necrosis (ATN) Dx: UOP ↓ and Cr ↑ Reversible: maybe Mortality: up to 60% Primary cause of death: infection

Diet with CKD: PO4 (high or low?) K+ (high or low?) Na (high or low?) Protein (high or low?) Maybe _?_ restriction

PO4 - low K+ - low Na - low Protein - low Maybe fluid restriction

Severe hypomagnesium leads to suppression of_?_

PTH secretion

Hypoparathyroidism is an uncommon condition associated with inadequate circulating _?_

PTH;

Name 8 clinical manifestations of pancreatitis:

Pain Nausea/Vomiting Fever Jaundice Bowel sounds decreased or absent Abdomen tenderness & distention Skin discoloration to umbilical area (Cullen's Sign) & flank area (Grey Turner's Spots) Shock

2 drug therapies for Chronic Pancreatitis

Pancreatic enzyme products [pancrelipase (Pancrease, Zenpep, Creaon, Viokase)] Insulin

_?_ indicates that recipient's sensitivity to various HLAs before receiving a transplant. The potential recipient may have been exposed to HLA antigens by means of previous blood transfusions, pregnancy, or a previous organ transplant.

Panel of Reactive Antibodies - (PRA)

Treatment of hyperparathyroidism: Surgical therapy:

Parathyroidectomy

What is the most effective treatment of primary and secondary hyperparathyroidism?

Parathyroidectomy

Which assessment parameter is of highest priority when caring for a patient undergoing a water deprivation test? Serum glucose Patient weight Arterial blood gases Patient temperature

Patient weight

What are 7 s/e of steroids?

Peptic ulcers HTN Osteoporosis Na and H2O retention Hyperglycemia Infection Delayed Healing

In _?_, the peritoneal membrane used and acts as semi-permiable membrane

Peritoneal dialysis (PD):

Manifestations of hyperparthyroidism: 4 Neuro:

Personality (emotional) disturbances, memory impairment, hyperactive deep-tendon reflexes, fatigue

_?_ is an endocrine disorder which may be related to medications (anti-hypertensives, opiods, radiologic contrast media, and tricyclic antidepressants (TCAs)

Pheochromocytoma

Drug therapy for Esophageal Varices (Arterial bleeding): _?_which can be given systemically or intraarterially

Pitressin

_?_ and _?_ have been given/used to lower the number of preformed HLA antibodies in highly sensitized patients in need of organ transplant

Plasmaphoresis and IV immune globulin

7 Clinical Manifestations HHS

Polyuria Polydipsia Blurred vision/H/A Orthostatic hypotension Change in LOC Seizures Reversible paralysis

The following are _?_ etiologies which may lead to AKI: benign prostatic hyperplasia (BPH) and prostate cancer, renal calculi, bladder cancer, trauma, and extrarenal tumors

Postrenal AKI

The following are characteristics of _?_ AKI: hypovolemia, decreased CO, decreased peripheral vascular resistance; decreased renovascular blood flow.

Prerenal

What are the 3 etiologies which may lead to AKI?

Prerenal, Intrarenal, Postrenal

_?_ hyperparathyroidism is caused by benign neoplasms or adenoma in the parathyroid gland

Primary

3 Hyperparathyroid Classifications:

Primary Secondary Tertiary

Name 3 Antiemetics & Analgesics that may be used for hepatitis - caution if liver secreted

Prochlorperazine (Compazine), promethazine (Phenergan), ondansetron (Zofran)

A patient reports having a dry mouth and asks for something to drink. The nurse recognizes that this symptom can most likely be attributed to a common adverse effect of which medication that the patient is taking? Digoxin (Lanoxin) Cefotetan (Cefotan) Famotidine (Pepcid) Promethazine (Phenergan)

Promethazine (Phenergan)

Treatment of Addison's Disease besides replacement therapy: Protect against _?_ Protect from noise, light, and environmental temperature extremes; Wear _?_ Carry emergency kit with _?_ Diligent administration of _?_ Other meds that require glucocorticoid dose to be increased (_?_, _?_, _?_, _?_) _?_ inhibits steroid metabolism

Protect against infection Protect from noise, light, and environmental temperature extremes; Wear medical alert bracelet Carry emergency kit with IM inection of cortisone Diligent administration of corticosteroids Other meds that require glucocorticoid dose to be increased (Dilantin, barbs, rifampin, antacids) Estrogen inhibits steroid metabolism

6 Complications of chronic pancreatitis include:

Pseudocyst Bile duct or duodenal obstruction Pancreatic ascites or pleural effusion Splenic vein thrombosis Pseudoaneurysms Pancreatic cancer

Which type of Diabetes Insipidus is also called "primary". Explain what occurs:

Psychogenic extreme water intake caused by a structural lesion in thirst center or psychiatric disorder

_?_classification is used to describe the stages of AKI.

RIFLE Classification

_?_is a medication used to prevent kidney-transplant rejection (it is not for liver or lung transplant patients) S/E: leukopenia, thrombocytopenia, hyperlipidemia, increased risk of lymphomas and skin cancers.

Rapamune

The patient with an adrenal hyperplasia is returning from surgery for an adrenalectomy. For what immediate postoperative risk should the nurse plan to monitor the patient? Vomiting Infection Thomboembolism Rapid BP changes

Rapid BP changes

6 components of hyperkalemia treatment

Regular insulin IV NaHCO3 (IV) sodium bicarbonate Calcium gluconate (IV) Dialysis Kayexalate Dietary restriction

Following administration of a dose of metoclopramide (Reglan) to the patient, the nurse determines that the medication has been effective when what is noted? Decreased blood pressure Absence of muscle tremors Relief of nausea and vomiting No further episodes of diarrhea

Relief of nausea and vomiting

What are the clinical manifestations of AKI for each of these systems? Respiratory (2) GI (5)

Respiratory - edema, crackles GI - hypoactive bowel sounds; ileus, anorexia, n/v

When caring for a patient during the oliguric phase of acute kidney injury (AKI), what is an appropriate nursing intervention? Weigh patient three times weekly. Increase dietary sodium and potassium. Provide a low-protein, high-carbohydrate diet. Restrict fluids according to previous daily loss.

Restrict fluids according to previous daily loss.

The nurse is caring for a 68-year-old man who had coronary artery bypass surgery 3 weeks ago. If the patient is now is in the oliguric phase of acute kidney disease, which action would be appropriate to include in the plan of care? Provide foods high in potassium. Restrict fluids based on urine output. Monitor output from peritoneal dialysis. Offer high protein snacks between meals.

Restrict fluids based on urine output.

_?_is caused by the breakdown of skeletal muscle

Rhabdomyolysis

What does "RIFLE" stand for?

Risk, injury, failure, loss, end stage

6 S/S and 2 Treatments of hypotension due to hemodialysis:

S/S: nausea, light-headedness, sz, vomiting, visual ∆s, chest pain Treatment: ↓volume of fluid being removed and give N.S. or albumin given by iv (may also increase squeeze with dopamine or levafed)

GOH would like the following vital signs for donors: SBP HR Urine Output ABG pO2 Temp

SBP > 100 HR <100 Urine Output > 100 ml/hr ABG pO2 > 100 Temp between 36 and 38.5

Overproduction/oversecretion of ADH results in _?_

SIADH (syndrome of inappropriate antidiuretic hormone)

Treatment for Cirrhosis Complication - Esophageal Varices: _?_ or ligation procedures Balloon tamponade ?_ Shunt (TIPS)

Sclerotherapy Transjugular Intrahepatic Portosystemic

3 treatments for esophageal varices bleeding

Sclerotherapy or ligation procedures Balloon tamponade Transjugular Intrahepatic Portosystemic Shunt (TIPS)

__?__ hyperparathyroidism is caused by a compensatory response to chronic hypocalcemia

Secondary

Liver Diagnostic Tests: What are the normal lab values for the following? Serum albumin: Prothrombin Time: Alkaline phosphatase: PT/INR

Serum albumin: 3.5 -5 g/dl Prothrombin Time: 12-16 seconds Alkaline phosphatase: 17-142 U/L (biliary tract obstruction) PT/INR: Prolonged (normal PT is 11-16 seconds)

The nurse is attending to a patient with tentative diagnosis of acute pancreatitis. Which diagnostic tests should the nurse anticipate for the health care provider to prescribe to confirm the diagnosis? Select all that apply. Serum amylase Serum lipase Computed tomography (CT) scan Liver biopsy Serum alpha-fetoproteins

Serum amylase Serum lipase Computed tomography (CT) scan

The nurse is caring for a 56-year-old man receiving high-dose oral corticosteroid therapy to prevent organ rejection after a kidney transplant. What is most important for the nurse to observe related to this medication? Signs of infection Low blood pressure Increased urine output Decreased blood glucose

Signs of infection

Types of Bowel Obstruction: _?_ is a blockage of the lumen of the intestine in one spot.

Simple Obstruction

The following are signs of _?_ Rapid onset Frequent/Copious Vomiting Colicky, Intermittent Pain Feces for a short time Minimally increased abd size

Small Bowel Obstruction

Normal lab values for the following are: Sodium: Potassium: Chloride:

Sodium: (normal 135-145 mEq/L) Potassium: (normal 3.5-5.0 mEq/L) Chloride: (normal 98-110 mEq/L)

Drug therapy for upper GI bleed: _?_ or _?_: reduce splanchnic blood flow and acid secretion _?_ and _?_ if H-Pylori infection

Somatostatin or octreotide (Sandostatin) Antibiotics and PPI

Collaborative care for acute liver failure: Rest Admin of B-complex vitamins Avoid alcohol; minimize/avoid: aspirin/tylenol/ NSAIDS Sodium restriction May give albumin Diuretic therapy (loop & potassium sparing) _?_ : antagonist of aldosterone IV antibiotics Paracentesis Peritoneovenous Shunt If ammonia elevated: _?_ and neomycin or rifaximin (Rifampin)

Spironolactone Lactulose (Cephulac)

Labs for Bowel Obstruction: CBC - an increase in WBC may indicate _?_ or _?_ Serum Electrolytes - Obstruction in _?_ causes quick dehydration Amylase BUN (Blood Urea Nitrogen)/Creatinine Hemoccult Stool- check for occult blood

Strangulation Perforation Small Bowel

A 50-year-old female patient smokes, is getting a divorce, and is reporting eye problems. On assessment of this patient, the nurse notes exophthalmos. What other abnormal assessments should the nurse expect to find in this patient? Puffy face, decreased sweating, and dry hair Muscle aches and pains and slow movements Decreased appetite, increased thirst, and pallor Systolic hypertension and increased heart rate

Systolic hypertension and increased heart rate

5 Other causes of Addison's Disease (besides autoimmune dysfunction):

TB, AIDS, carcinoma, histoplasmosis, medications (NIZORAL)

Drug alert for _?_ and _?_: A substance in grapefruit and grapefruit juice prevents metabolism of these drugs. Consuming grapefruit or grapefruit juice while using these drugs could increase their toxicity.

Tacrolimus Cyclosporine

What are 8 types medications that can cause SIADH?

Tegretol (carbamazepine) thiazide diuretics SSRI & tricyclic antidepressants opioids oxytocin anesthesia agents neoplastic agents

Dialysis Vascular Access Sites: _?_ and _?_ are sites for immediate use, but use for only 1-3 weeks, no longer; placed in I.J., subclavian or femoral veins. They may NOT be used for _?_ unless directly ordered by nephrology; you must also know whether they contain _?_

Temporary (Quintins) and semipermanent venous catheters (Ash cath - tunneled cath); IV fluids Must ALSO know if that line has HEPARIN in it!!

_?_ hyperparathyroidism is caused by a loss of response to serum Ca levels (Clinical manifestations r/t hypercalcemia and hypophosphatemia)

Tertiary:

Adrenal Cortex: Synthesizes 3 classes of steroid hormones. 1 class is androgens _?_ and _?_

Testosterone, Estrogen

_?_ is tingling of lips, fingertips and occasionally feet with increased muscle tension. It is caused by hypocalcemia/ hypoparathyroidism

Tetany

3 Manifestations of Hypocalcemia--hypoparathyroidism:

Tetany Positive Chvostek's Positive Trousseau's signs

The patient with a history of lung cancer and hepatitis C has developed liver failure and is considering liver transplantation. After the comprehensive evaluation, the nurse knows that which factor discovered may be a contraindication for liver transplantation? Has completed a college education Has been able to stop smoking cigarettes Has well-controlled type 1 diabetes mellitus The chest x-ray showed another lung cancer lesion.

The chest x-ray showed another lung cancer lesion

The home care nurse visits a 34-year-old woman receiving peritoneal dialysis. Which statement, if made by the patient, indicates a need for immediate follow-up by the nurse? "Drain time is faster if I rub my abdomen." "The fluid draining from the catheter is cloudy." "The drainage is bloody when I have my period." "I wash around the catheter with soap and water."

The fluid draining from the catheter is cloudy."

The nurse is providing discharge instructions to a patient with diabetes insipidus. Which instructions regarding desmopressin acetate (DDAVP) would be most appropriate? The patient can expect to experience weight loss resulting from increased diuresis. The patient should alternate nostrils during administration to prevent nasal irritation. The patient should monitor for symptoms of hypernatremia as a side effect of this drug. The patient should report any decrease in urinary elimination to the health care provider.

The patient should alternate nostrils during administration to prevent nasal irritation.

The patient with cirrhosis has an increased abdominal girth from ascites. The nurse should know that this fluid gathers in the abdomen for which reasons (select all that apply)? There is decreased colloid oncotic pressure from the liver's inability to synthesize albumin. Hyperaldosteronism related to damaged hepatocytes increases sodium and fluid retention. Portal hypertension pushes proteins from the blood vessels, causing leaking into the peritoneal cavity. Osmoreceptors in the hypothalamus stimulate thirst, which causes the stimulation to take in fluids orally. I Overactivity of the enlarged spleen results in increased removal of blood cells from the circulation, which decreases the vascular pressure.

There is decreased colloid oncotic pressure from the liver's inability to synthesize albumin. Hyperaldosteronism related to damaged hepatocytes increases sodium and fluid retention. Portal hypertension pushes proteins from the blood vessels, causing leaking into the peritoneal cavity.

_?_ is a hormone that is secreted by the anterior pituitary. Its job is to stimulate the thyroid to secret T3 and T4

Thyroid stimulating hormone (TSH)

Treatment for esophageal and gastric varices: To avoid bleeding /decrease risk, avoid _?_, _?_ and irritating foods. Treat respiratory infections promptly and control coughing _?_ are meds that may reduce BP

To avoid bleeding/decrease risk, avoid alcohol, aspirin, and irritating foods Treat respiratory infections promptly and control coughing Beta blockers

A patient is brought to the ED having experienced blood loss related to a GI bleed. Fresh frozen plasma (FFP) is ordered and transfused. The nurse understands that the rationale for transfusing FFP in this client is To treat the loss of platelets To promote rapid volume expansion To increase the H/H To promote clotting

To promote clotting

Gigantism:

Too much GH as child; Onset occurs before closure of epiphyses, therefore can grow as tall as 8 feet.

A patient complains of nausea. When administering a dose of metoclopramide (Reglan), the nurse should teach the patient to report which potential adverse effect? Tremors Constipation Double vision Numbness in fingers and toes

Tremors

When instructing a patient regarding a urine study for free cortisol, what is most important for the nurse to tell the patient? Save the first voided urine in the morning. Maintain a high-sodium diet 3 days before collection. Try to avoid stressful situations during the collection period. Complete at least 30 minutes of exercise before collecting the urine sample.

Try to avoid stressful situations during the collection period.

DKA most likely occurs in _?_ DM

Type 1

GOH's Organ Recovery Coordinator receives a list of possible "matches" from _?_ ; coordinator calls the transplant center for the potential recipient who tops the list for each organ; the recipient's transplant surgeon accepts or declines the organ.

UNOS

Collaborative Care for Gallbladder disease: List 3 diagnostic tests:

Ultrasound ERCP --(Endoscopic retrograde cholangiopancreatography) Percutaneous transhepatic cholangiography

The _?_ Regulates organ and tissue donation

Uniform Anatomical Gift Act (UAGA)

_?_ allows for fair and consistent transplantation laws among all states. Patients are matched to available donors based upon: ABO blood HLA typing, medical urgency, time on the waiting list, geographic location, and other factors specific to organs: age, weight, etc.

Uniform Anatomical Gift Act (UAGA)

Immediate assessment of patient with suspected _?_ Oxygen (ABCs); monitor V/S 2 large bore IVs & IV fluid LR or .9NS & blood products Monitor Fluid & Electrolytes PPI therapy Foley catheter NG or OG tube (might see lavage) Keep HOB elevated

Upper GI Bleed

Health promotion for _?_: Identify high risk patients Avoid irritants Take only prescribed medications Reduce stress If patient has _?_ avoid irritants and treat any _?_

Upper GI Bleed esophageal varices upper respiratory infection.

Interventions for _?_ Thorough Assessment and History for dehydration & F/E imbalances NPO Strict I&O (include vomitus and tube drainage) Comfort Measures Care of NG/ Intestinal Tubes

Upper GI Perforation

Emergency care for _?_ : ABCs; Respiratory status: airway, breathing V/S, peripheral perfusion Abdominal exam History BMP (monitor BUN), CBC, PT/INR, PTT, liver enzymes, ABG, Type and cross match, UA including specific gravity Test stools/emesis for occult blood

Upper GI bleed

What are the clinical manifestations of AKI for each of these systems? Urinary (7) Cardiovascular (4)

Urinary - oliguria, cells in urine, increased BUN, Cr; changes in K, Mg, Na Cardiovascular - edema; increased BP initially; possible dysrhythmias (d/t increase in K); HF (d/t increase in fluids)

Signs & Symptoms of Oliguric Phase of AKI _?_ changes, Metabolic _?_, _?_ disorders, _?_accumulation _?_ disorders

Urinary changes, Metabolic acidosis, Hematologic disorders (impaired WBC and RBC production) Waste product accumulation Neurologic disorders (seizures, coma, confusion)

What points should a nurse emphasize while teaching a patient ways to protect oneself from exposure to hepatitis B infection? Select all that apply. Use disposable needles and syringes. Avoid eating food prepared in unhygienic ways. Avoid sharing toothbrushes and razors. Avoid touching or coming in contact with people with hepatitis B. Avoid unsafe sex with multiple partners, and always use condoms.

Use disposable needles and syringes. Avoid sharing toothbrushes and razors. Avoid unsafe sex with multiple partners, and always use condoms.

When caring for a patient with liver disease, the nurse recognizes the need to prevent bleeding resulting from altered clotting factors and rupture of varices. Which nursing interventions would be appropriate to achieve this outcome (select all that apply)? Use smallest gauge needle possible when giving injections or drawing blood. Teach patient to avoid straining at stool, vigorous blowing of nose, and coughing. Advise patient to use soft-bristle toothbrush and avoid ingestion of irritating food. Apply gentle pressure for the shortest possible time period after performing venipuncture. Instruct patient to avoid aspirin and NSAIDs to prevent hemorrhage when varices are present.

Use smallest gauge needle possible when giving injections or drawing blood. Teach patient to avoid straining at stool, vigorous blowing of nose, and coughing. Advise patient to use soft-bristle toothbrush and avoid ingestion of irritating food. Instruct patient to avoid aspirin and NSAIDs to prevent hemorrhage when varices are present.

6 Indications for the use of Peritoneal Dialysis:

Vascular access problems Diabetic Less complicated than HD Fewer dietary restrictions Can be done at home Fewer BP problems *Note: because PD exchange takes place all day, everyday, functions more like kidney

4 Drug Therapies for Cirrhosis Complication of Esophageal Varices:

Vasopressin, Octreotide Propranolol Histamine 2 receptor blockers

When caring for a patient with a biliary obstruction, the nurse will anticipate administering which vitamin supplements (select all that apply)? Vitamin A Vitamin D Vitamin E Vitamin K Vitamin B

Vitamin A Vitamin D Vitamin E Vitamin K

2 therapies for Clotting abnormalities

Vitamin K Blood products

8 Renal Replacement Therapy (RRT) indications Volume overload resulting in_?_ or _?_ ↑ K+ Metabolic acidosis BUN > _?_ mg/dL Significant decrease in _?_ Pericarditis, pericardial effusion or _?_

Volume overload resulting in cardiac or pulmonary compromise ↑ K+ Metabolic acidosis BUN > 120 mg/dL Significant decrease in mental status Pericarditis, pericardial effusion or cardiac tamponade

6 Renal Replacement Therapy (RRT) Indications

Volume overload resulting in cardiac or pulmonary compromise (i.e. Pericarditis, pericardial effusion or cardiac tamponade) ↑ K+, Metabolic acidosis, BUN > 120 mg/dl (normal is 6-20) Significant decrease in mental status,

Types of Bowel Obstruction: _?_occurs when the lumen of the intestine is blocked in two different spots; the obstruction is proximal to the isolated segment of bowel.

Volvulus

Types of Bowel Obstruction: Strangulation/Gangrene - occurs if there is not immediate attention/treatment. _?_, _?_, and _?_ are the most common causes.

Volvulus, hernias, or adhesions

Large bowel obstruction- vomiting may be absent if the ileocecal valve is competent Vomiting and dehydration - late or early signs? Abdominal pain and constipation Abdominal distention - late or early sign? Abdominal tenderness/rigidity

Vomiting and dehydration - late Abdominal distention - early

Treatment for DKA- Insulin therapy: Withheld till fluid resuscitation begun; bolus followed by insulin drip at _?_; Don't drop glucose to rapidly

Withheld till fluid resuscitation begun; bolus followed by insulin drip at 0.1 units/kg/hr; Don't drop glucose to rapidly

Diuretic phase of AKI: Begins with _?_ and may last _?_

a gradual ↑ in daily urine output to 1-3L per day (may be 3-5L/day); May last 1-3 weeks

Severity of AKI dysfunction can range from a small increase in _?_ to a decrease in _?_ to the development of _?_

a small ↑ in serum creatinine or ↓ in urine output to the development of azotemia (BUN, creatinine in the blood)

List 4 s/s of ileus/paralytic ileus:

abdominal pain distention vomiting constipation

12% of patients on dialysis receive PD Access: obtained by inserting catheter through _?_ into _?_ Wait _?_ to use catheter - pending healing and sealing of exit site

abdominal wall into peritoneal cavity. 7-14 days

Acute kidney injury has a(n) _?_ onset. With _?_ it is often reversible.

abrupt onset (hours or days) and with prompt intervention is often reversible (has a high mortality rate).

The following are diagnostic studies for _?_ AST, ALT, GGT Total protein, albumin Serum bilirubin PTT; PT/INR Ammonia level (arterial if possible) Ultrasound, EGD, CT, MRI CBC, CMP, tylenol level, Viral hepatitis serologies Tylenol level Viral hep panel Cholesterol level (d/t abnormal fat metabolism) Analysis of ascites fluid Liver biopsy

acute liver failure

Nursing interventions for _?_ may include: Monitor for hemodynamic stability Monitor for respiratory failure Monitor for hypocalcemia Monitor for infection Monitor for hyperglycemia and steatorrhea Maintain IV fluids as ordered Relieve pain NPO - NG tube

acute pancreatitis

ACTH deficiency can lead to _?_ and _?_ due to sodium and water depletion.

adrenal insufficiency and hypovolemic shock

Treatment for Cushing syndrome: If adrenal tumor, treat with _?_

adrenalectomy

_?_ regulates Na and K balance

aldosterone (a mineralocorticoid)

Approximately 85% of the cases of endogenous Cushing syndrome are due to _?_

an adrenocorticotropic hormone (ACTH) secreting pituitary tumor

When testing for Cushing Syndrome, a cortisol level is taken prior to the administration of dexamethasone. Then another cortisol level is taken. With Cushing Syndrome, we will see _?_

an increase in cortisol

3 hematologic clinical manifestations of CKD

anemia bleeding infection

ADH is _?_ (or _?_); it regulates water balance and osmolarity

antidiuretic hormone (or vasopressin)

What are 2 psychological clinical manifestations of CKD?

anxiety depression

Medications like Ketoconazole and aminoglutethimide are used for patients with Cushing Syndrome who _?_. These meds are not used all of the time because _?_

are not candidates for surgery; the are toxic in doses necessary to inhibit cortisol secretion

ADH is also known as _?_ or _?_

arginine vasopressin (AVP) or vasopressin

4 Vascular Access Sites for dialysis:

arteriovenous fistulas arteriovenous grafts temporary and semipermanent venous caths

Dialysis Vascular Access Sites: _?_-- best patency, least complications - artery and vein, usually cephalic, or forearm - insert 3 months prior to use

arteriovenous fistulas (AVF)

Dialysis Vascular Access Sites: _?_ is made of teflon and acts as "a bridge",; may use in 2-4 weeks, has bruit and thrill to be assessed. No _?_ or _?_ in that arm

arteriovenous grafts (AVG) no BP or lab draws in that arm

Liver Transplant if possible, but preferable before disease worsens - before _?_ and _?_develop 2 options for obtaining a liver:

ascites and coagulopathies Cadaver or live (partial)

Collaborative care for _?_ includes: Rest Admin of B-complex vitamins Avoid alcohol; minimize/avoid: aspirin/tylenol/ NSAIDS Sodium restriction May give albumin Diuretic therapy (loop & potassium sparing) Spironolactone : antagonist of aldosterone IV antibiotics Paracentesis Peritoneovenous Shunt If ammonia elevated: Lactulose (Cephulac) and neomycin or rifaximin (Rifampin)

ascites/liver failure

Prevention of _?_ may include: cease alcohol consumption early identification of viral hepatitis or other causes Nutrition - regenerate liver tissue small frequent meals, high calorie caution - protein & sodium use Rest - restore liver tissue: keep HOB elevated caution - pneumonia, pressure ulcers, clots Teaching - signs of complications, skin therapy, counseling for sexual problems, avoidance of hepatoxic meds, abstinence from alcohol (AA), nutrition, rest

ascites/liver failure

_?_ is associated with hepatic encephalopathy. It is also called liver flap

asterixis

To be eligible for _?_ , the patient must have a non-survivable illness or injury that results in ventilator dependency, with a Glasgow Coma scale score of 5 or < A physician must determine that the pt. most likely will _?_ and _?_ within _?_ after the withdrawal of life support

asystolic donation arrest and expire 60 min.

_?_ donors: If pt. has some intact neuro function & there will be an "end of life" discussion or if the family has already elected to remove the pt. from life support. Gift of Hope evaluates to see if client meets criteria for _?_ donation &/or tissue donation

asystolic organ asystolic organ

_?_ and _?_ are medications which suppress T Cell activation and proliferation

azathioprine (Imuran) Sirolimus (Rapamune)

Complications of Hemodialysis: Loss of _?_ Hepatitis - hep B (now low incidence due to vaccine; now, hep C is more common --- with 10% of HD patients + for anti HCV (meaning previous infection) _?_ _?_ Syndrome

blood sepsis Disequilibrium

2 Systemic diseases that may cause GI bleeding:

blood dyscrasias renal failure

What will urine look like post-renal transplant? What volume of fluids will be given?

bloody; replace urine output ml for ml

S/S of GI Perforation: pain, _?_ tenderness, _?_ abdomen distention, fever, chills

board-like rigidity of abdomen, rebound tenderness,

If an x-ray shows free gas/air in abdominal cavity, what is that indicate?

bowel perforation

Mechanisms of Action for _?_ Prevents cell-mediated attack against transplanted organ - no bone marrow suppression or alteration of normal inflammatory response. Used in combo w/ corticosteroids, sirolimus, & mycophenolate mofetil. Acts on T helper cells to prevent production and release of IL-2 and y- interferon Inhibits production of T cytotoxic lymphocytes and B cells

calcineurin inhibitors (cyclosporine/tacrolimus)

Side Effects of _?_ used in transplant patients: Nephrotoxicity Neurotoxicity (tremors, seizures) Hepatotoxicity Hirsutism Gingival hyperplasia Increased risk of infection Lymphoma Leukopenia

calcineurin inhibitors (cyclosporine/tacrolimus)

2 metabolic clinical manifestations of CKD

carbohydrate intolerance hyperlipidemia

Tissue Donor Criteria: Any pt. who suffers _?_ is potentially eligible The pt. must have a known time of death or have been witnessed as alive within the _?_ prior to being found deceased

cardiac death 24 hours

A 56-year-old woman with type 2 diabetes mellitus and chronic kidney disease has a serum potassium level of 6.8 mEq/L. The nurse should assess the patient for fatigue. flank tenderness. cardiac dysrhythmias. elevated triglycerides.

cardiac dysrhythmias.

Adrenal Medulla: Releases _?_

catecholamines

What is "steal syndrome"? Three methods to assess:

caused by ischemia (not enough blood flow) resulting from a vascular access device pallor, peripheral pulses, Allen's test

Prevention of Cirrhosis cease _?_ early identification of _?_or other causes Nutrition - regenerate liver tissue; small frequent meals, high calorie caution - _?_ and _?_ use Rest - restore liver tissue: keep _?_ caution - pneumonia, pressure ulcers, clots Teaching - signs of complications, skin therapy, counseling for sexual problems, avoidance of hepatoxic meds, abstinence from alcohol (AA), nutrition, rest

cease alcohol consumption early identification of viral hepatitis or other causes Nutrition - regenerate liver tissue; small frequent meals, high calorie caution - protein & sodium use Rest - restore liver tissue: keep HOB elevated caution - pneumonia, pressure ulcers, clots Teaching - signs of complications, skin therapy, counseling for sexual problems, avoidance of hepatoxic meds, abstinence from alcohol (AA), nutrition, rest

Nursing Care Pre-Dialysis: 2 methods to check condition of vascular access -

check temperature and skin condition thrill and bruit

Gall Bladder disease is a common health problem for adults with _?_ ranking as one of the most common surgical procedures in the US. _?_ is a term meaning "stones in gallbladder" _?_ is a term meaning "inflammation of gallbladder"

cholecystectomy Cholelithiasis Cholecystitis

Complications of _?_ Gangrenous _?_ _?_— disease characterized by accumulation of infected fluid between diaphragm, liver, & spleen Pancreatitis _?_ (inflammation of biliary ducts) Biliary cirrhosis Fistulas Rupture of gallbladder Cholelithiasis (stones) Carcinoma Peritonitis

cholecystitis cholecystitis Subphrenic abscess Cholangitis

The following are clinical manifestations of _?_ Severe symptoms or no symptoms - depends if _?_stationary or mobile and if obstruction present Lodged _?_ in ducts or moving _?_ in ducts can cause spasms May produce severe steady pain Tachycardia, diaphoresis Pain usually 3-6 hours after high-fat meal or when person lies down

cholelithiasis stones stones stones

3 other causes of hypocalcemia besides hypoparathyroidism:

chronic kidney disease vitamin D deficiency hypomagnesium

Nursing Interventions for _?_ Focus on prevention of further attacks, relief of pain, control of pancreatic exocrine and endocrine insufficiency Pain control: may take large, frequent doses of analgesics for pain control diet, pancreatic enzyme replacement (Creon, Zenpep, Pancrease), control of DM

chronic pancreatitis

The following may cause _?_: EtOH abuse CF, Lupus Gallstones Tumor Trauma

chronic pancreatitis

The pain in _?_ is described as cramping, burning, gnawing

chronic pancreatitis

_?_ can be distinguished from _?_ in that food and antacids will help the second condition, but not the first

chronic pancreatitis gastric ulcers

Nursing Interventions for _?_ during _?_ Monitor for hemodynamic stability Monitor for respiratory failure Monitor for hypocalcemia Monitor for infection Monitor for hyperglycemia and steatorrhea Maintain IV fluids as ordered Relieve pain NPO - NG tube

chronic pancreatitis; acute pancreatitis

Infiltration of T and B cells characteristic of an ongoing immune-mediated injury is a feature of _?_ rejection

chronic rejection

Early manifestations of _?_ are: anorexia, nausea/vomiting, diarrhea or constipation, flatulence, dyspepsia Abdominal pain & palpable liver Fever Lassitude Slight weight loss Enlargement of liver and spleen

cirrhosis

In _?_, the liver cells attempt to regenerate; process is disorganized and results in abnormal blood vessels and bile duct architecture. This distorts liver's normal lobular structure; lobules irregular size and shape with impeded blood flow Decreased liver function d/t above, poor cellular nutrition, and hypoxia Usually insidious, prolonged course

cirrhosis

Later manifestations of _?_: may be severe and result from liver failure and portal hypertension Jaundice Peripheral edema Ascites Hematologic disorders Thrombocytopenia, leukopenia, anemia, coagulation disorders Endocrine disturbances Peripheral neuropathies

cirrhosis

_?_ is a chronic progressive disease of liver characterized by extensive degeneration & destruction of the liver parenchymal cells.

cirrhosis

Lower GI Bleed Treatment: Usually no need for emergent _?_ If stable but continuing to bleed: Rapid ingestion of golytely and colonoscopy done in 6-12hrs

colonoscopy

Liver Diagnostic Tests: Serum bilirubin, direct Serum bilirubin, total Urine bilirubin Urine urobilirubin Fecal urobilirubin All of these measure the liver's ability to _?_ and _?_ bilirubin

conjugate and excrete

What is the pain like with a paralytic ileus?

constant

The term _?_refers to any one of these three types of hormones produced by the adrenal cortex

corticosteroid

3 classes of medication which may cause GI bleeding:

corticosteroids, nonsteroidal anti-inflammatory drugs, salicylates

The adrenal cortex synthesizes 3 classes of steroid hormones. 1 class is glucocorticoids, primary _?_

cortisol

Diagnostic Studies for Addison's Disease: cortisol levels are _?_ potassium levels are _?_ sodium levels are _?_ chloride levels are _?_ glucose levels are _?_ BUN levels are _?_ RBC -levels are _?_ due to pernicious anemia MRI and CT to check for _?_ Also check for infections such as _?_

cortisol levels (decreased); potassium (increased) sodium (decreased) chloride (decreased) glucose (decreased); BUN (increased) RBC - decreased due to pernicious anemia MRI and CT to check for tumors/adrenal calcifiction Also check for infections such as TB

A final _?_ is done prior to transplant. _?_ is especially important for kidney transplants, and may not be done for lung, liver, and heart.

crossmatch Crossmatching

Hyperacute rejection is a rare event as the final _?_ usually determines whether the recipient is sensitized to any of the donor's _?_ (Most common in _?_ transplant)

crossmatch HLAs. kidney

Name some foods that would be high in calcium and therefore included in a hypoparathyroid patient's diet:

dark green veggies (broccoli), soy tofu Raw Milk Kale (cooked) Sardines (with bones) Yogurt or Kefir Watercress Cheese Bok Choy Okra Almonds

H and H in CKD is _?_ because of _?_. Treat with _?_

decreased ; decreased erthyropoetin epogen

If you are secreting too little ADH, _?_ will occur. If you are secreting too much ADH, _?_ will occur

dehydration; edema

Syndrome of Inappropriate ADH (SIADH): Occurs when ADH is released despite normal or low plasma osmolarity with 7 results:

dilutional hyponatremia hypochloremia, fluid retention, weight gain without edema, hypo-osmolality, concentrated urine (high specific gravity) normal renal function

Besides viruses and bacteria, what are 4 other causes of hepatitis?

drugs including alcohol, chemicals, auto-immune diseases, metabolic abnormalities

Tetany involves painful tonic spasms of smooth and skeletal muscles. It leads to _?_ and _?_; Positive _?_ and _?_ signs are seen

dysphasia and laryngealspasms; Positive Chvostek's & Trousseau's signs :

5 Signs of high K

dysrhythmias peaked T waves bradycardia flaccid paralysis muscle weakness (put them on cardiac monitor)

How will we treat the anemia that comes with AKI?

epogene to replace erythropoietene

3 causes of GI bleeding in the Esophagus:

esophageal varices, esophagitis, Mallory-Weiss tear

4 neurologic clinical manifestations of CKD

fatigue headache sleep disturbances encephalopathy

_?_ hormone is secreted by the anterior pituitary. It is involved in reproduction and puberty

follicle-stimulating hormone (FSH)

If an autotransplant of parathyroid tissue is performed, where might the tissue be implanted? What if it fails?

forearm or near sternocleidomastoid muscle may be done must take calcium for life

6 causes of bleeding in the Stomach & duodenum:

gastric CA, hemorrhagic gastritis, peptic ulcer disease, polyps, stress-related mucosal disease, drug induced.

Reduce risk for CVD: Optimal _?_ control Maintain _?_within normal range Prevent kidney insult (such as UTI's or kidney infections) Appropriate screening -[African(4x's that of whites) & Native Americans (2x's that of whites)] at increased risk

glycemic B/P

_?_ is a hormone released by the anterior pituitary. It is involved with carb/fat/protein metabolism, growth of long bones and skeletal muscle development

growth hormone (GH)

2 methods of dialysis

hemodialysis Periotoneal dialysis

In _?_ jaundice, unconjugated bilirubin is high conjugated bilirubin is normal urine bilirubin is negative urine urobilinogen is high stool urobilnogen is high

hemolytic

_?_ jaundice is caused by blood transfusion reactions, sickle cell crisis, hemolytic anemia

hemolytic

3 Major complications for hyperparathyroidism surgery :

hemorrhage, fluid and electrolyte disturbances tetany

__?_ is an inflammatory process throughout whole liver; Infected Hepatocytes destroyed; Cellular necrosis _?_ is most common cause;

hepatitis Viral hepatitis

In _?_ jaundice, unconjugated bilirubin is high conjugated bilirubin is high or low urine bilirubin is high urine urobilinogen is normal to high stool urobilnogen is normal to low

hepatocellular

In CKD potassium is usually _?_

high

The PRA is calculated as a %, with a_?_ (high or low?) PRA indicating a _?_ (high or low?) number of cytotoxic antibodies, and is highly sensitized, so is a poor chance of finding a crossmatch-negative donor.

high high

Transplantation success has been due to advances in _?_testing, surgical techniques, and more effective immunosuppressants.

histocompatibility

How might post-menopausal women be treated for hyperparathyroidism if they have signs of osteoporosis? Does this treat the underlying parathyroidism? What 2 conditions/diseases does it put them at greater risk for?

hormone-replacement therapy; no; CA, DVT

_?_ occurs minutes to hours after transplant because the blood vessels are rapidly destroyed d/t person having preexisting antibodies No treatment except _?_

hyperacute rejection to remove the affected organ.

4 endocrine/reproductive clinical manifestations of CKD

hyperparathyroidism Thyroid abnormalities amenorrhea erectile dysfunction

1 ocular clinical manifestation of CKD

hypertensive retinopathy

An 18-year-old male patient is undergoing a growth hormone stimulation test. The nurse should monitor the patient for hypothermia. hypertension. hyperreflexia. hypoglycemia

hypoglycemia

Antidiuretic hormone (ADH) is made in the _?_, but stored in the __?_. It regulates _?_

hypothalamus; posterior pituitary fluid balance

_?_ is the most common cause of Cushing Syndrome.

iatrogenic administration of corticosteroids such as prednisone

Most common cause of hypoparathyroidism

iatrogenic damage to or removal of the parathyroid glands during thyroidectomy, or radical neck

Describe the "treat hyponatremia" portion of SIADH treatment:

if less than 120 mEq/l, give hypertonic saline (3-5%) by very slow infusion; Don't raise the Na level too quickly or overshoot!

If serum osmo is much lower than urine osmo, this indicates _?_

inappropriate excretion of concentrated urine and presence of dilute serum

AKI is characterized by: a rapid ↓ of kidney function demonstrated by a progressive increase in _?_ and/or a decrease in _?_

increase in serum creatinine and/or decrease in urine output

To prevent an Addisonian Crisis, Addison's patients should _?_ during times of stress

increase their doses of steroids

Magnesium in CDK is usually _?_ (increased or decreased?) 5 S/S

increased don't give Mylanta or MOM Dysrhythmias GI Issues Decrease in RR Hypotension Impaired CNS functioning

In the Oliguric phase of AKI, there is impaired production of WBC and RBC. Due to this, there is an increased risk for _?_ -- one of the main causes of death in AKI

infection

Biggest problem with GVHD is _?_. _?_ and _?_ are types which predominate No treatment once it is established. _?_ may be used to alleviate some symptoms. _?_ and _?_ are used for prevention

infection - bacterial and fungal infection Steroids Methotrexate; cyclosporin

Complications of peritoneal dialysis: Exit site _?_ - staph aureus and s. epidermis _?_- improper technique; note if cloudy peritoneal effluent- signs: abdominal pain and GI symptoms Outflow problems -- adhesions; constipation Back problems & hernias Bleeding - (may be a normal finding for ovulating or menstruating females) Pulmonary problems - pneumonia Protein loss-- plasma proteins, amino acids, polypeptides can pass Carbohydrate & lipid abnormalities -- ↑ triglycerides and ↑ glucose

infection; Peritonitis

In _?_, etologies lead to actual damage to the nephrons

intrarenal AKI

The following are _?_ etiologies which may lead to AKI: prolonged prerenal ischemia, nephrotoxic injury, acute glomerulonephritis or acute pyelonephritis, myoglobinuria

intrarenal AKI

AKI that has not caused _?_usually resolves quickly with correction of the cause.

intrarenal damage

Describe the "fluid restriction" portion of SIADH treatment:

less than 800-1000 ml/day (but could be as low as 500 ml/day)

The pancreas will release _?_ and _?_ into the blood when injured or inflamed. Both levels rise within _?_ to _?_ hours. In 3 days, _?_ levels return to normal, but _?_ stays elevated for up to 7 to 10 days, helping in the late diagnosis of pancreatitis

lipase and amylase 2 to 12 hours. 3 days, amylase levels return to normal, but lipase stays elevated

What 3 enzymes do the following meds contain? Creon, Zenpep, Pancrease

lipase, amylase, trypsin

In addition to trying to correct the underlying cause, fluids (if necessary), other medications and patient teaching, what are 2 other possible treatments used in nephrogenic DI?

low sodium diet thiazide diuretics (HydroDiuril)

IN CKD, Na can be _?_, _?_ or _?_

low, normal or high

Name some contraindications to renal transplant: Are HIV and Hep B/Hep C included in this list?

lupus, untreated CAD, chronic infections, malignancies, unresolved psychosocial issues; NO

7 Risks associated with development of atubular necrosis while in the hospital:

major surgery shock sepsis blood transfusion reaction muscle injury from trauma prolonged hypotension nephrotoxic agents

It is necessary to do _?_ when measuring a patient's abdominal girth

mark on ptnt abdomen at the top and bottom of the tape measure both anterior and posterior to make sure all nurses measure at the same level

The location of the obstruction determines the extent of fluid, electrolyte, and acid-base imbalances. High obstruction (in pylorus) _?_ secondary to loss of hydrochloric acid from the stomach through -?_ or _?_

metabolic alkalosis vomiting or NG tube suctioning.

Diagnostic studies for CKD H&P Urinalysis: for presence of 5 things: _____ Renal ultrasound, CT scan, renal biopsy CMP CBC Creatinine Clearance GFR KUB - x-ray that looks at _?_ IVP - intravenous pylogram renal angiogram

microalbumin, RBCs, WBCs, protein, casts & glucose KUB - kidney, ureter, bladder

_?_ are a type of medication used short-term to reduce the risk of acute rejection

monoclonal antibodies

Rhabdomyolysis Leads to _?_ which puts the kidneys at risk for _?_

myoglobinuria (Kidneys @ risk for AKI)

A _?_ crossmatch indicates that no preformed antibodies are present and it is safe to proceed with the transplantation.

negative

Diagnosis of DI: History - If dehydrated, then: Water deprivation (restriction) test confirms _?_ .

neurogenic (central) DI

Organ Donor Criteria: Any pt. who suffers a devastating & irreversible _?_ insult or injury can become an organ donor The pt. must be maintained on a ventilator with intact blood pressure and HR It must be determined that there is no hope for recovery & that all medical & surgical intervention has been exhausted or is futile

neurologic

Brain Dead Donors: Patient must lack all _?_ function including _?_ reflexes

neurologic brain stem

What should ascites fluid look like if there is no infection? If there is infection?

no infection = light straw yellow, clear infection= cloudy

Ileus/paralytic ileus are _?_ causes of bowel obstruction

non-mechanical

Syndrome of Inappropriate ADH (SIADH): Occurs when ADH is released despite _?_ or _?_

normal or low plasma osmolarity

GI Perforation Goals: Relief of _?_ Return of normal bowel function within _?_ days Minimal to no discomfort No _?_ Normal fluid and electrolyte balance Normal acid-base state

obstruction 3 days emesis

In _?_ jaundice, unconjugated bilirubin is somewhat high conjugated bilirubin is moderately high urine bilirubin is high urine urobilinogen is low stool urobilnogen is low

obstructive

_?_ jaundice: Caused by decreased or obstructed flow of bile through the liver or biliary duct system

obstructive

Treatment if esophageal or gastric varcies do begin to bleed: Manage airway and give blood products Drugs: _?_- constricts splanchnic arterial bed _?_ is man-made form of ADH - from posterior pituitary - vasoconstrictor _?_ (vaso-dilator - used in combination with vasopressin); _?_ (propranolol) reduces portal venous pressure

octreotide (Sandostatin) Pitressin (vasopressin) nitroglycerin Beta Blockers

_?_ - movement of fluid from area of lesser concentration to greater concentration of solutes (glucose is added to the dialysate and creates osmotic gradient across membrane)

osmosis

_?_ and _?_ are produced by the hypothalamus, but stored in the posterior pituitary

oxytocin ADH

Manifestations of hyperparthyroidism: 6 GI:

pain, anorexia, N/V, constipation, peptic ulcers, pancreatitis

Manifestations of hyperparthyroidism: 5 Musculoskeletal:

pain, weakness, osteoporosis, fractures, decreased muscle tone,

_?_ is the fourth leading cause of cancer related deaths in the US and has a poor 5 year survival rate. (ACS) Etiology remains unknown _?_ procedure may be part of treatment

pancreatic cancer Whipple procedure

The following meds are __?__: Creon, Zenpep, Pancrease

pancreatic enzyme replacement

2 peripheral neuropathy clinical manifestations of CKD

parathesia restless leg syndrome

How is a parathyroidectomy performed?

partial or complete; out-patient procedure (endoscopy)

Drug Therapy for Hepatitis Hep C: treat w/ _?_ within 1st 12-24 weeks of infection...decreases development of chronic hep C.

pegylated interferon

Treatment for GI Perforation: surgical intervention to close perforation, _?_ to clean out abdomen, IV fluids, _?_ (type of med) NG tube to suction, bowel rest.

peritoneal wash Antibiotics

_?_ is a type of anemia; low levels of red blood cells caused by inability to absorb vitamin B12

pernicious anemia

What are the "Loss" criteria for AKI

persistent AKI (a complete loss of renal function > 4 weeks)

Disorders of the Adrenal Medulla: _?_ a tumor of the adrenal medulla that produces excessive catecholamines (epi and norepi) or inherited in persons with multiple endocrine neoplasia

pheochromocytoma

_?_ is an endocrine disorder that can lead to: hypertensive encephalopathy, DM, cardiomyopathy death

pheochromocytoma

_?_ can bring on an episode of phenochromocytoma crises:

physical/emotional stress

Hyperpituitarism is usually a result of _?_. Manifestations result from excess of which 4 hormones?

pituitary tumor; GH, prolactin, ACTH, or TSH.

20 Clinical Manifestations of DKA

polyuria Polydipsia Polyphagia Weight loss Nausea/vomit Blurred vision/H/A Orthostatic hypotension Fruity breath Kussmaul's respirations Metabolic acidosis Change in LOC; Lethargy/weakness Dehydration Poor skin turgor Dry mucous membranes Tachycardia Abdominal pain

A _?_ indicates that the organ recipient has cytotoxic antibodies to the donor and is an absolute contraindication to transplantation.

positive crossmatch

In _?_, the etiology is due to obstruction

postrenal AKI

In _?_ etiologies of AKI, decreased blood flow is the major conflict

prerenal AKI

Diagnosis of DI: History - If patient is overhydrating and hypovolemic then _?_ DI

primary or psychogenic

DKA is most likely caused by _?_

profound deficiency of insulin

__?__ is a hormone which stimulates milk production and development of secondary sex characteristics. It is secreted by the anterior pituitary gland

prolactin

AKI usually affects people with other life-threatening conditions. It is most common after _?_, _?_ or _?_.

prolonged hypotension hypovolemia exposure to nephrotoxic agents (Vanco, IV dye)

Signs of a _?_ Small bowel obstruction (SBO): the obstruction produces rapid-onset of nausea/Vomiting (bile), Pain

proximal

3 integumentary clinical manifestations of CKD

pruritus ecchyomosis dry, scaly skin

3 pulmonary clinical manifestations of CKD

pulmonary edema uremic pleuritis pneumonia

What is a major side effect of Bisphosphonates (Fosamax)?

reflux/ulcers/GERD

In the Diuretic phase of AKI, BUN and creatinine _?_

remain ↑ but may be losing electrolytes

Manifestations of hyperparthyroidism: 2 Renal:

renal calculi, polyuria

With esophageal and gastric varices, treat _?_ infections promptly and control _?_ to reduce risks of rupture

respiratory infections coughing

For those who are asymptomatic, how is hyperparathyroidism found?

routine Ca screening

What 5 lab values will be increased with pancreatitis?

serum amylase serum lipase urinary amylase blood glucose serum triglycerides

What lab value will be decreased with pancreatitis?

serum calcium

Normally, ADH is secreted in response to _?_, which is monitored by osmoreceptors in _?_

serum osmolality; hypothalamus

4 Manifestations of Acromegaly: Neuro

sleep apnea, Peripheral nerve damage (neuropathy), H/A & visual disturbances

What is the most common cause of SIADH?

small cell lung cancer

What are some types of tumors that cause SIADH? Why do they do this?

small cell lung cancer, pancreatic ca, lymphoid ca, thymus ca, colorectal and prostate ca; the tumor secretes ADH

Strategies to Prevent Liver Disease: No more than two alcoholic drinks a day Stop _?_ Be cautious about mixing drinks, combining with drugs OTC & prescription (< _?_ gm/day Tylenol) Avoid exposure to chemicals (esp. pesticides) whenever possible. Maintain a healthful, balanced diet Lose weight, avoid metabolic syndrome. Vaccinate against _?_ No sharing of needles, razors, toothbrushes. Practice _?_. Caution with medication such as _?_ and _?_ Hep B and C

smoking; less than 2 gm per day of Tylenol hepatitis. safe sex Cava Cava (herbal med) and Amiodarone

When treating Addison's disease, teach your patient to _?_ . He should also _?_ the dose of steriods during minor stress (like tooth extraction) and _?_ the dose during major stress (like resp. infection, surgery and trauma)

stand slowly due to hypotension; double the dose triple the dose

PTH regulates calcium and phosphate levels by _?_, _?_ and _?_

stimulating bone resorption of calcium Renal tubular reabsorption of calcium activation of vit D

Catecholamines are essential for the _?_ response

stress response

An Addisonian Crisis may be triggered by 3 things:

stress, sudden withdrawal of corticosteroid replacement therapy, after adrenal or pituitary destruction

Upper GI Bleed Characteristics: Usually _?_onset Severity depends on origin: venous/capillary/ arterial (arterial=_?_ bleeding) Massive upper GI bleed: loss of more than _?_ of blood or 25% of intravascular blood volume

sudden Bright red, profuse 1500 ml

When thinking of the 3 classes of steroid hormones synthesized by the adrenal cortex, think _?_, _?_ and _?_ to help you remember

sugar, salt, and sex

Treatment for Cushing syndrome: If pituitary tumor, treat with _?_

surgery (transphenoidal approach)

_?_ is indicated when upper GI bleeding continues regardless of therapy and when the site of bleeding has been identified

surgical therapy

Pre-op instructions for phenochromocytoma surgery:

sympathetic blocking agents (alpha and beta-blockers)

In the Diuretic phase of AKI, diuresis indicates _?_

that the nephrons have recovered sufficiently to permit urine excretion

The Recovery Phase of AKI: Begins when _?_

the GFR and tubular function have recovered to the extent that BUN and serum creatinine levels start to stabilize and then ↓.

How do thiazide diuretics help treat nephrogenic DI?

they decrease GFR allowing more water to be reabsorbed

16 Manifestations of SIADH:

thirst fatigue, Hyponatremia causes muscle cramps, weakness, pain, ↓urine output ↑ body weight, Dyspnea on exertion, Cerebral edema occurs leading to lethargy, anorexia, abdominal pain, confusion, H/A, muscle twitching, seizures, coma

Why will a patient who has hyperparathyroidism need to increase fluids?

to decrease risk of kidney stones

Why might diuretics be used in the treatment of hyper-parathyroidism?

to increase the excretion of calcium

Besides Declomycin, what other medications may be used for SIADH? What kind of medications are they? Who are they administered to?

tolvaptan Conviptan; vasopressin receptor antagonists; euvolemic hyponatremic hospitalized patients

What is the method of action for Cinacalcet (Sensipar)? What are 4 side effects?

tricks parathyroid into releasing less PTH joint/muscle pain respiratory infection n/v diarrhea

Preop instructions for phenochromocytoma surgery: Surgical removal of _?_

tumor (adrenalectomy

_?_ - results when there is an osmotic gradient or pressure gradient across the membrane

ultrafiltration

_?_ is a syndrome that incorporates all the disturbances seen in various systems throughout the body in chronic kidney failure --- all systems affected

uremia

Describe the "diuretics" portion of SIADH treatment:

use loop diuretics (such as Lasix) if Na is at least 125 mEq/l and treatment is for IICP (increased intracranial pressure)

3 musculoskeletal clinical manifestations of CKD

vascular and soft tissue calcification osteomalacia osteotis fibrosia

ADH regulates _?_ and _?_

water balance and osmolarity

Nursing Care Pre-Dialysis: 5 methods to assess fluid status:

weight, B/P, peripheral edema, lung & heart sounds

Name 3 diagnostic tools useful in determining GI perforation:

xray = free gas/air in abdominal cavity; CT = visualization of perforation; WBC elevated

Pheochromocytoma characteristics: It is seen in _?_ age

young-middle

AKI Usually results in _?_ urine output

↓ urine output although it is possible to have normal or increased urine output.

Treatment of Hyperparathyroid Treatment focuses on: _?_ serum calcium levels _?_ PTH calcium _?_ phosphorous _?_ alkaline phosphatase levels (if bone disease); Renal function (_?_ and _?_) X-rays - assesses metabolic bone loss; Avoid immobility; High fluid intake and moderate calcium intake; May replace _?_

↓serum calcium levels ↓ PTH, calcium (< 10), phosphorous (<3), and alkaline phosphatase levels (if bone disease); Renal function (creatinine and BUN, as they increase); X-rays - assesses metabolic bone loss; Avoid immobility; High fluid intake and moderate calcium intake; May replace phosphorous

Treatment for HHS: 1. Medical emergency with High mortality rate 2. Therapy similar to DKA except HHS requires greater_?_ 3. Patient-centered care - 4. Nursing care - Monitor blood glucose hourly. Blood glucose of less than_?_ is the goal for resolution. 6. Monitor serum _?_ levels (will initially be increased with insulin therapy, but will shift into cells and the client will need to be monitored for _?_ _ 7. Administer _?_ by slow IV infusion for severe acidosis (pH of less than 7.0). Monitor potassium levels because correcting acidosis too quickly may lead to hypokalemia.

1. Medical emergency with High mortality rate 2. Therapy similar to DKA except HHS requires greater fluid replacement 3. Patient-centered care - 4. Nursing care - Monitor blood glucose hourly. Blood glucose of less than 200 mg/dL is the goal for resolution. 6. Monitor serum potassium levels. Potassium levels will initially be increased with insulin therapy, but potassium will shift into cells and the client will need to be monitored for hypokalemia. 7. Administer sodium bicarbonate by slow IV infusion for severe acidosis (pH of less than 7.0). Monitor potassium levels because correcting acidosis too quickly may lead to hypokalemia.

A lack of PTH causes _?_ and _?_

hypocalcemia and ↑ phosphate