Kidneys
Describe how hemodialysis is performed via an access site that is within the arm and how you would assess and what is contraindicated
HD is performed via an AV fistula or Graft or a hemodialysis fistula
Assess: Listen for Thill and feel fro bruit, look for bleeding or redness
Contraindicated:lab draws, IV placement or BP risk of infection or causing dysfunction by compromising it’s integrity or cause clotting, rupture.
If a patient has had anemia for several years and has a noted low hgb, they may display s/sx of:
What is shortness of breath and possibly edema. A significant complication of anemia is heart failure from chronic diminished blood volume and the heart’s compensatory effort to increase cardiac output.
Name some changes and challenges that may affect older adults' intake:
Economic challenges and limits to preparing meals. Poor appetite can be due to sensory changes(smell, decreased taste buds or sight impairments) or physical changes (atrophy of gastric mucosa) and the tongue has atrophy/reduction of taste buds.
Describe a Whipple surgery for the pancreas
This procedure involves removal of the gallbladder, a portion of the stomach, duodenum, proximal jejunum, head of the pancreas, and distal common bile duct. Reconstruction involves anastomosis of the remaining pancreas and stomach to the jejunum
Name a brand name of insulin that has no peak
Lantus
Name three types of urinary diversion devices
Types: ileal conduit, orthotopic neobladder reconstruction, or continent urinary diversion (Indiana pouch)
An an autoimmune disorder in which the body develops antibodies against insulin or the pancreatic B cells that produce insulin. Can cause polydipsia, polyuria, and polyphagia
What is diabetes mellitus Type I
Describe what a nuclear scans are used to evaluate at within the kidneys. Discuss what a patient must do after the procedure.
Used to evaluate acute and chronic kidney injury, renal masses, and blood flow before and after kidney transplantation.
After the procedure is completed, the patient is encouraged to drink fluids to promote excretion of the radioisotope by the kidneys.
Name some teaching interventions that may prevent a Sickle Cell Anemia Crisis:
Staying warm and hydrated to prevent vasoconstriction from cold and dehydration causing vaso occlusion.
Describe the best diagnostic test to visualize stomach ulcers and how it works:
EGD directly visualizes the mucosal lining of the esophagus, stomach, and duodenum with a flexible endoscope (endo goes in esophagus) where(colo goes in lower colon). In the EGD, tests can detect inflammation, ulcers, tumors of stomach or esophagus, varices
Name the culprit for the most common gallbladder disease in the U.S.
Cholesterol Stones causing cholelithiasis: Accounts for most of the remaining 75% of cases of gallbladder disease in the United States
Describe some of the medications used for GERD
Drug therapy for GERD are as follows: Proton Pump Inhibitors- Pantoprazole (protonix), omeprazole (Prilosec)- these decrease gastric acid by inhibiting the proton pump responsible for the release. H2 Receptors- block histamine on H2 receptors to reduce HCI acid secretion (Pepcid or famotidine). Prokinetic agents like metoclopramide (Reglan)- increase gastric motility and emptying (NO FOR PARKINSONS- can cause worse tremors/dyskinesias called extrapyramidal side effects). Antiulcer protectant (sucralfate)- forms a protective layer to protect against acids in the stomach. Antiacids like Mylanta may also be given
oThe involuntary loss of urine associated with a strong urge to void that cannot be suppressed. Called overactive bladder due to overactive detrussor muscle- neuro diseases, malignancies, or cystitis
What is urge incontinence
Removal or damage to the Parathyroid Gland can cause this electrolyte imbalance
What is hypocalcemia?
Name three medications that assist with treating Nephrosclerosis:
Treatment would be ACE inhibitors, Calcium Channel blockers, and diuretics.
Name the medical management of Anemia
vCorrect or control the cause
vTransfusion of packed RBCs
vTreatment specific to the type of anemia
oDietary therapy
oIron or vitamin supplementation: iron, folate, B12
oTransfusions
oImmunosuppressive therapy
Discuss what a Diverticuli in the esophagus is
Is an out-pouching (like a little cavern) of mucosa and submucosa that protrudes through a weak portion of the musculature of the esophagus. A true diverticuli pouches through all layers of Esophagus
Name the disease that these manifestations represent: Liver enlargement, portal obstruction, ascites, infection and peritonitis, varices, GI varices, edema, vitamin deficiency, anemia, mental deterioration
Liver Cirrhosis
Name the medical management for Sickle Cell Disease Crisis
O2 and pain medication
Transfusions
Hydroxyurea: effective in increasing levels of fetal hemoglobin (i.e., hemoglobin F), which in turn decreases the formation of sickled cells
Describe "Timed Voiding"
oTime voiding
~ every 2 hours or ”by the clock”
Is an autoimmune disorder that results from an excessive output of thyroid hormones caused by abnormal stimulation of the thyroid gland by circulating immunoglobulins
What is Grave's Disease
Name some changes that occur in the Kidney for the older than 65 population and related effects
Older adults susceptible to kidney injury R/T renal structural and functional changes:
Sclerosis of the glomerulus and renal vasculature
Decreased blood flow
Decreased GFR
Decreased renal reserve
Altered tubal function and acid–base balance
Incomplete emptying of bladder, urinary stasis, decreased nerve innervations
Decreased drug clearance = increased drug–drug interactions
Name the reaction that these symptoms represent in a blood transfusion: Fever, chills, low back pain, nausea, chest tightness, dyspnea, and anxiety
What is Acute hemolytic reaction?
Name some causes of stomach cancer:
What is Adenocarcinoma– can be caused from diets with smoked foods, salted fish, meat, and pickled vegetables (whole grains/fruits veggies associated with reduced risk), H.Pylori causes mucosal injury can cause dysplasia to cancer. Other causes smoking, ulcers, gastritis, pernicious anemia.
Discuss treatment and dietary modification for cholelithiasis
Dietary management
80% of the patients with acute gallbladder inflammation achieve remission with rest, IV fluids, nasogastric suction, analgesia, and antibiotic agents
Allows time for inflammation to subside prior to surgery
Low-fat diet after episodes & surgery
Name a medication class or brand name works on liver to decrease production of glucose, works on muscles/fat to uptake glucose, and GI to reduce glucose absorption. Describe when this medication is contraindicated.
Biguanide:(Metformin or Glucophage). Do not use metformin in patients with kidney disease, liver disease, or heart failure can cause lactic acidosis, note patients may have GI side effects, do not use in people who drink excessively.
Discuss what an extracorporeal shock water lithotripsy is used for, how it works, and what needs to be assessed post-procedure.
Extracorporeal shock water lithotripsy is used for most symptomatic, nonpassable upper urinary stones. Electromagnetically generated shock waves are focused over the area of the renal calculus. The high-energy dry shock waves pass through the skin and fragment the stone. Urine will be assessed for gravels and stones post procedure.
This is the recommended fluid restriction for SIADH
800-1000 ml/day
Describe prerenal, intrarenal, and postrenal
Prerenal – occurs within the circulatory system prior to the kidney being reached. It is a decreased perfusion (often from hypovolemia) that can lead in a decrease in GFR. It is typically reversible. Here are some examples for you all: hypotension, cardiac sufficiency, hemorrhage,
Intrarenal – WITHIN (Intratublar obstruction, glomerulonephritis- immune mediated injury to vasculature.
Post-Renal- this is from an obstruction anywhere from the renal pelvis to the urethra. Common causes of this include: prostatic hypertrophy from an enlarged prostate, kidney stones, nervous system disorders that delay bladder emptying like MS, Spinal cord injury, and it can be caused from some cancers.
Describe Disseminated Intravascular Coagulation *DIC and name the labs that would help you diagnose the condition.
What is altered hemostasis mechanism causes massive clotting in microcirculation. As clotting factors are consumed, bleeding occurs. Symptoms are related to tissue ischemia and bleeding and a progressive decrease in platelet count
What are: Please note that in DIC PTT and PT would be prolonged, Platelets would be reduced, Fibrinogen would be reduced, and D-dimer would be elevated. While monitoring a patient for the development of DIC, the nurse would want to look at platelet count, prothrombin time, and partial thrombin time (PTT)
Describe some symptoms upon your assessment that may indicate a patient with diverticulitis needs emergency surgery.
Assessment includes monitoring for bleeding, peritonitis, abscess, or obstruction.If patient is complaining of sudden fever, rigid abdomen on palpitation, and pain/tenderness– that might mean that the patient has perforated– CALL MD, as this may need surgical repair urgently
Describe a diet for a liver failure patient
High Protein intake of 1.2 to 1.5 g/kg/day, unless encephalopathy
High-calorie diet, sodium restriction
Supplemental vitamins, minerals, B complex, provide water-soluble forms of fat-soluble vitamins if patient has steatorrhea
Describe s/sx of both hyperglycemia vs. hypoglycemia from not enough or too much insulin.
Hyper: polydispsia, polyuria, polyphagia, blurred vision
Hypo: Pallor/clammy, confusion, dizziness, irritability, tachy, excessive hunger, diaphoresis
Describe causes of a neurogenic bladder and management
Causes:
vResults from a disorder or dysfunction of the nervous system and leads to urinary incontinence
vCauses
oSpinal cord injury, spinal tumor, herniated vertebral disc, multiple sclerosis, congenital disorders (spina bifida or myelomeningocele), infection, or complications of diabetes
Management:
vManagement
oSelf-catheterization
oIntermittent catheterization by CG or family
oCondom catheter (males)
oFoley catheter/ Suprapubic catheter
Describe the disorder that causes this: occurs—thus disorder leads to fluid rentention, serum hypoosmolarity, hyponatremia, and dilute concentrated urine with reduced output (dilutional hyponatremia).
SIADH (Syndrome of Inappropriate Antidiuretic Hormone)