N211 Gi & Renal Lecture Notes

Front 1

How much should hematocrit rise with each unit of PRBCs?

Back 1

3%

Front 2

How does chronic alcohol use affect the stomach lining?

Back 2

Causes a type of gastritis, can lead to ulcers

Front 3

How does smoking affect the stomach lining?

Back 3

Decreases blood flow, can lead to ulcers

Front 4

Where do peptic ulcers occur?

Back 4

Gastric
Duodenal

Front 5

Relative risk of malignancy, gastric vs. duodenal ulcers:

Back 5

Higher risk with gastric

Front 6

Relative risk of reoccurance, gastric vs. duodenal:

Back 6

High risk of reoccurance with both

Front 7

At what point after initiation of H. pylori therapy should retesting occur?

Back 7

10-14 days

Front 8

What do we want stomach pH to be in treating ulcers?

Back 8

Above 5

Front 9

What pH activates gastrin in the stomach?

Back 9

5 or less

Front 10

When should antacids be taken in relation to meals?

Back 10

2 hours after

Front 11

Diarrhea pattern with Crohn's disease:

Back 11

Nighttime

Front 12

UC vs. CD: which is curable?

Back 12

UC, via colectomy

Front 13

Extent of CD:

Back 13

Entire GI tract

Front 14

Extent of UC:

Back 14

Limited to colon

Front 15

UC vs. CD: which has bloody diarrhea?

Back 15

UC

Front 16

Define tenesmus:

Back 16

Painful urge to defecate

Front 17

First-line therapy for UC:

Back 17

5-ASA drugs, i.e. mesalamine

Front 18

Determining if a CD/UC patient is in remission:

Back 18

Clinical presentation is improved/normal
Endoscopy shows improvement in lesions

Front 19

How soon does CRP reflect inflammation?

Back 19

6-8 hours

Front 20

What is the most serious complication of UC/CD?

Back 20

Toxic megacolon

Front 21

What is the definitive diagnostic test for UC/CD?

Back 21

Colonoscopy with biopsy

Front 22

What is the extent of CD in the intestinal wall?

Back 22

Transmural

Front 23

What is the extent of UC in the intestinal wall?

Back 23

Only in the mucosa

Front 24

Complications of severe/fulminant disease:

Back 24

Hemorrhage
Peritonitis
**

Front 25

Surgical indications for UC:

Back 25

Refractory to medical tx
IV steroids not helping
Deterioration/acute negative changes

Front 26

Likely site for fistulas in UC:

Back 26

Anorectal

Front 27

Potential complications of J-pouch (etc) surgery healing:

Back 27

Pouchitis
Dehiscence
Poor healing due to steroids

Front 28

**UC medications

Back 28

*

Front 29

**Complications of severe UC

Back 29

*

Front 30

Define nephrolithiasis:

Back 30

Kidney stones

Front 31

Where are kidney stones found?

Back 31

Anywhere from kidney to urethra

Front 32

Problems associated with kidney stones:

Back 32

Pain
Hydronephrosis
Bleeding
Pyelonephritis

Front 33

When are kidney stones most likely to occur in the year?

Back 33

July

Front 34

What is the biggest risk for kidney stones?

Back 34

Dehydration

Front 35

What categories of workers are likely to get kidney stones?

Back 35

People who work outdoors or very active and not hydrated

Front 36

Where, geographically, are kidney stones most likely to occur?

Back 36

In warmer regions

Front 37

What are the most common type of kidney stone?

Back 37

Calcium

Front 38

Four types of kidney stone:

Back 38

Uric acid
Struvite
Cystine
Calcium stones

Front 39

Who is prone to uric acid stones?

Back 39

Men more than women
People with gout or chemo

Front 40

Who is most prone to struvite stones?

Back 40

Women with UTIs

Front 41

Who is most prone to cystine stones?

Back 41

Men and women alike
Esp. with family history

Front 42

Who is most prone to calcium stones?

Back 42

Men more than women
20's-30's

Front 43

What does calcium bind with in kidney stones?

Back 43

Oxalate most commonly
Phosphate
Carbonate

Front 44

What are good sources of oxalate in food?

Back 44

Strawberry and rhubarb!
Berries
Spinach and many greens
Tea, cocoa, chocolate
Wheat bran/germ, quinoa
Soy

Front 45

What's the most common manifestation of a kidney stone?

Back 45

Unilateral back pain

Front 46

What are the s/s of kidney stones?

Back 46

Severe pain
Hematuria
Chills/fever
N/V

Front 47

Describe kidney stone pain:

Back 47

Sudden onset
Severe
Belly or side of the back
Groin or testicular pain

Front 48

Diagnostic tests for kidney stones:

Back 48

UA
IV pyelogram

Front 49

What do we look for in a UA for kidney stones?

Back 49

Crystals in the urine
Blood in the urine
Pyuria or WBCs (maybe)

Front 50

Goal of tx for a kidney stone pt:

Back 50

Relieve symptoms and promote passage

Front 51

What drugs are used for kidney stones?

Back 51

Opioids
Maybe NSAIDs

Front 52

Techniques for easing spontaneous (at home) kidney stone passage:

Back 52

High fluid intake
Strain all urine
Hot compress on the back
PRN opioid Rx

Front 53

Medical tx for kidney stones:

Back 53

Profoundly overhydrate (IV and po fluids) and give Lasix to dump all the fluids rapidly
Morphine or other opioid
Potentially allopurinol or abx

Front 54

When would you give allopurinol for kidney stones?

Back 54

Uric acid stones

Front 55

What type of kidney stone would get antibiotics?

Back 55

Struvite stones

Front 56

What is the priority nursing intervention for a kidney stone pt?

Back 56

Strain all urine

Front 57

First-line surgical intervention for kidney stones:

Back 57

Extracorporeal shock wave lithotripsy

Front 58

Indications for ESWL:

Back 58

Stone 1/2in or smaller
Beyond the minor calyx
Calcium-based (very hard) stone

Front 59

Refraining from sexual activity post-ESWL:

Back 59

Yes, maybe a week

Front 60

Discharge instructions post-ESWL:

Back 60

Strain all urine
Drink LOTS of water
Followup with physician in 7 days
Report a fever (101 or more) or severe pain
Bright red bloody urine: go back to ER
Take antibiotics through to completion
Expect diffuse bruising/pain; apply warm moist heat

Front 61

Priority nursing intervention for post-ESWL inpatient:

Back 61

Titrating continual bladder irrigation

Front 62

What color should urine be with CBI?

Back 62

Pink with no urine

Front 63

If clots are seen with CBI, what should you do?

Back 63

Increase the rate

Front 64

What's a common adverse effect of CBI?

Back 64

Bladder spasm

Front 65

What is the etiology of glomerulonephritis?

Back 65

Untreated strep infection leads to an autoimmune process in the glomeruli

Front 66

Common manifestations of GN:

Back 66

Edema
Smoky or rust colored urine
Hematuria
Joint pain/stiffness

Front 67

Where does edema manifest with GN?

Back 67

Generalized
Abdominal
Face/eyes especially
Feet/ankles

Front 68

Specific pre-renal causes of renal failure:

Back 68

Hypovolemia
Abruptio placenta
Hemorrhage
Burns
Renal artery stenosis

Front 69

Specific intra-renal causes of renal failure:

Back 69

Hemolytic transfusion reaction
DIC
Pyelonephritis
Interstitial nephritis

Front 70

Specific post-renal causes of renal failure:

Back 70

Obstructive uropathy

Front 71

Most common sign of a hemolytic transfusion reaction:

Back 71

Lower back pain

Front 72

Renal complication of Bactrim therapy:

Back 72

Interstitial nephritis

Front 73

General pre-renal causes of renal failure:

Back 73

Volume
Renal flow

Front 74

General intra-renal causes of renal failure:

Back 74

Infection
Necrosis
Hemolysis
Medications

Front 75

General post-renal causes of renal failure:

Back 75

Obstructions

Front 76

Three stages of renal failure:

Back 76

Oliguria
Diuretic
Recovery

Front 77

What occurs during the oliguria phase of renal failure?

Back 77

Acute decrease in urine production

Front 78

Define oliguria in terms of output:

Back 78

Less than 400ml in 24 hr

Front 79

What happens during the diuretic stage of renal failure?

Back 79

Filtration but no concentration

Front 80

What happens during the recovery stage of renal failure?

Back 80

Creatinine clearance returns to normal

Front 81

Where is erythropoietin produced?

Back 81

Kidneys

Front 82

What are the manifestations of oliguric renal failure?

Back 82

Generalized edema
Change in mental status
Arrhythmias
Hypertension
Anorexia
Metabolic acidosis
Dependent edema

Front 83

What causes arrhythmias in oluguric renal failure?

Back 83

Hyperkalemia

Front 84

How do we treat hyperkalemia in renal failure?

Back 84

D50/insulin/bicarb
Kayexalate
Dialysis (emergency)

Front 85

Is anasarca expected in renal failure?

Back 85

Yes

Front 86

Why does level of consciousness change with oliguric renal failure?

Back 86

Fluid retention leads to hyponatremia

Front 87

What causes a pericardial friction rub in renal failure?

Back 87

Uric acid crystallization

Front 88

How do we eliminate nitrogenous wastes in a patient in renal failure?

Back 88

Diuretics (if they work)
Dialysis

Front 89

Priority problems in diuretic phase of renal failure:

Back 89

Fluid volume deficit
High risk of electrolyte imbalances

Front 90

Patient teaching priority during the recovery phase of renal failure:

Back 90

Identifying nephrotoxins and preventing recurrence of underlying cause if possible

Front 91

Nephrotoxins:

Back 91

Amphoteracin B
NSAIDs
Fertilizers, home chemicals
Aminogycoside abx

Front 92

Taking a 24 hour urine collection:

Back 92

Dump first urine after the order
Indicate start time
Collect for 24 hours
Send to lab

Front 93

Skin findings in chronic renal failure:

Back 93

Yellow-brown skin color (from urea) with ecchymoses
Dry skin with petechiae
Decreased sensation
Uremic frost

Front 94

Why do chronic renal failure patients get ecchymoses?

Back 94

Clotting cascade interrupted
Capillaries are congested and leaky due to fluid overload

Front 95

Medication used in chronic renal failure:

Back 95

ACE inhibitors
Procrit

Front 96

Diet for chronic renal failure:

Back 96

Moderate in protein (or whatever is appropriate for pt)
High carbohydrate
Fluid restriction
Low in sodium, potassium, phosphorus
Supplement vitamins B, C

Front 97

How often is hemodialysis done and how long does it last?

Back 97

4-6 hours
3x/week