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334 Cards in this Set
- Front
- Back
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Hepatic Artery |
supplies the liver with oxygenated blood |
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Portal Vein |
supplies the liver with deoxygenated blood |
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hepatocytes |
liver cells |
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ammonia |
converted to urea and excreted in urine |
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melena |
black tarry stools |
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pruritis |
itching of the skin |
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jaundice |
occurs when there is dysfunction with normal metabolism or excretion of bilirubin, causes yellowing of the skin |
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PT |
lab result that is prolonged with liver damage (abbreviation) |
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supine |
proper position for liver biopsy |
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right |
proper side position after liver biopsy |
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hemorrhage |
complication to monitor following liver biopys |
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fat |
ADE and K are FAT soluble vitamins |
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fatty |
type of liver disease wen fat makes up 5 to 10 % of weight of liver |
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portal hypertension |
increased pressure in liver blood flow |
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ascites |
accumulation of fluid in the peritoneal cavity |
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2G sodium |
diet commonly ordered to treat ascites |
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spironolactone |
increase pressure in liver blood flow |
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hypovolemia |
monitor BP and pulse before during and after a paracentesis to monitor for this complication |
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esophageal varices |
caused by portal hypertension, most significant source of bleeding with cirrhosis |
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hepatic encepalopathy |
life threatening complication of liver disease that can lead to coma, caused by increased ammonia levels |
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asterixis |
flapping tremor of the hands seen with hepatic encepalopthy |
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neomycin |
medication given to decrease the number of bacteria in the colon capable of converting to urea |
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low protein |
type of diet ordered to help manage increased ammonia levels |
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liver biopys used for |
removal of small amount of liver tissue to examine liver cells |
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paracentesis used for |
removal fluid from peritoneal cavity to improve resp status and patient comfort |
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TIPS used |
to treat ascites (decrease NA retention, improve response to diuretic and prevent reoccurence of fluid accumulation) |
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Balloon Tamponade |
to treat esophageal varices- balloon inflated in esophagus and stomach to apply pressure on bleeding vessels to stop the bleeding |
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endoscopic sclerotherapy |
to treat esophageal varices- sclerosing agent (causes hardening anf shifting of varices) injected through fiberoptic endoscope to promote thrombosis and sclerosis of varices |
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esophageal banding |
treats esophageal varices- an endoscope with an elastic rubber band is passed through an over tube directly onto the varicie to be banded |
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preop liver biopys |
PT, PTT and platelet count Check Vitals Explain what to expect Have patient Void |
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intraop for liver biopy |
position supine with arms raised ( specifically right arm) to allow visualization of abdomen during US to locate liver ask patient to hold breath with insertion of needle (to immobilize diaphragm and chest wall) |
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Post op for liver biopsy |
position on right side for at least 4 hours frequent VS (monitor for shock and hemorrhage) monitor for bleeding and severe abd pain no heavy lifting or straining pain at insertion site for first 24 hours is normal complication and finding |
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preop for paracentesis |
procedure done if there is no response to med and diet regimen or if there is severe ascites Check VS Explain procedure have pt void |
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Intraop for paracentesis |
position in upright position - promote movement of peritoneal fluid close to abdominal wall for easier removal |
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post op for paracentesis |
measure, describe,, and record amount of fluid collected label samples before sending to lab check temp (infection) monitor puncture site for leakage monitor VS for s/ SX of hypovolemia no heavy lifting or straining |
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what is a TIPS procedure? |
x ray guided, a stent is inserted to serve as a shunt between the portal and hepatic vein |
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preop TIPS |
verify order and consent VS Explain procedure |
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preop for balloon tamponade |
check VS explain what to expect goal is to use no more than 12 hours |
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intra op for balloon tamponade |
4 openings -gastric aspirate -esophageal aspirate -gastric balloon inflation -esophageal balloon inflation |
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post procedure for balloon tamponade |
ICU! - risk of airway obstruction and asphyxiation frequent oral care and suctioning comfort and prevent aspiration precautions : to prevent pt displacement of tube |
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post procedure for endoscopic scleropathy |
observe for bleeding perforations of esophagus aspiration pneumonia and esophageal stricture antacids proton pump inhibitors to counteract effects or sclerosing agent and acid reflux |
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post op for esophageal banding |
monitor for dysphagia, transient chest pain and esophageal stricture (rare) |
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path/def hiatal hernia |
opening of diaphragm becomes enlarged and part of upper stomach shifts into thorax/ upper stomach moves into lower portion of esoph r/t increased pressure |
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path/ def of GERD |
Inc pressure (delayed emptying) or decreased LES tone>>backflow of gastric or duodenal contents into the esophagus |
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path/ def of barrets esophagus |
Lining is altered/Reflux causes changes in cells lining lower esophagus/ changes the cells cuz it is exposed to acid |
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S&S of hiatal hernia |
50% - no S&S others mimic GERD -sliding heartburn regurgitation dysphagia -paraesophageal chest fullness/ pain no reflux no heartburn |
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Dx of hiatal hernia |
Xray studies barium swallow |
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Management of Hiatal Hernia |
frequent small feedings don't recline after eating (1 hour) elevate HOB on 4-8in blocks (pillow wedges) surgery for 15% - Nissen Fundiplocation - reinforce by wrapping the stomach around it |
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S&S of GERD
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indigestion dysphagia odynophagia incr saliva pyrosis (esophagus burning) regurgitation nocturnal cough wheezing hoarseness |
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Diagnostics for GERD |
Barium Swallow Ambulatory pH monitoring |
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Management of GERD |
avoid eating and drinking 2 hours before bedtime weight modification no tight garments elevate HOB surgery (open or lap) |
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Medications for GERD
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Antacids 2-3 hours after ingestion H2s (Zantac and Tagamet) PPI's - decent amount of acid produced by 90% Prokinetics (reglan) - helps with motility issues |
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S&S of Barrettes esophagus
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GERD S&S |
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Diagnostics of Barrets esophagus
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Biopsies evidence HGD (high grade dysplasia) |
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Management of Barret's Esophagus
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biopsies, ablative therapies, esophagectomy - Treat the GERD or it continues to progress |
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Acute Gastritis
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due to diet, overuse of of ASA, NSAIDS, ETOH, bile reflux, radiation, surgery, illness |
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Severe Acute Gastritis
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ingestion of strong acid/alkali (rapid onset)
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Chronic Gastritis
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*
h pylori, autoimmune disease (pernicious anema), meds, ETOH (slower onset/lasts longer) |
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Gastritis
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(engorged w/ blood and fluid) and undergoes superficial erosion |
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S&S of Gastritis |
Abdominal discomfort, HA, NV, anorexia, heartburn, lassitude (gerenal feeling of weakness) belching, sour taste. |
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Diagnostics for Gastritis |
Xrays, EGD, Upper Gi |
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Management of Gastritis
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Diet Restriction - refrain from food, bland foods (if they do eat) clear fluids, to allow mucosa to heal. no ETOH neutralizing agent. give reverse of what they had NG's and IVF |
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meds for gastritis
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Antibiotic Antidiarrheal H2 receptor antagonist PPI's |
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Peptic Ulcer Disease
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result from an imbalance between resitance of mucosa to injury and the amount of gastric secretions caused by infection with H. pylori, excessive secretion of HCL, stress, milkl, caffeine, ETOH, smoking, overuse of ASA & NSAIDS |
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S&S of PUD
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dull gnawing pain, burning sensations, heartburn, vomiting constipation/ diarrhea, bleeding (15%) some have no S&S 20-30 % perforate/ hemorrhage with no S&S |
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Diagnostics of PUD
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endoscopy stool for blood urea breath test and biopsy for H pylori, and stool antigen test |
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Management of PUD
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Medications for PUD |
prevpac - eg 2 punch ammoxyclin & clerethromycin -antibiotic] -PPI -Bismuth salts -H2s - used for non h pylori ulcers -Antacids |
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Patho for IBS |
Motility Disorder disruptions to GI tract and peristalsis pretty and pink may be r/t lactose intolerance, stress, anxiety and family hx no visible damage |
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S&S of IBS |
variable, mild to sever const / diarrhea pain bloating abd distention |
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Dx of IBS |
3 days a month for 3 months including 2 or more---- relief of defecation, change of frequency, change in form of stool stool studies proctoscopy xrays BE conlonoscopy |
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Management of IBS |
control stress diet symptom relief removal of irritating foods educate patient on disorder and diet ETOH cessation |
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Medications for IBS |
probiotics hydro colloids antidiarrheal antidepressants anticholinergics |
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path for Appendicitis |
appendix becomes kinked/ occluded and inflamed |
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S&S Appendicits |
Pain @ Mcburneys point RLQ rebound tenderness roysings sign - pressure on LLQ triggers pain in RLQ low grade fever N/V anorexia |
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Dx of Appendicitis |
Physical exam labs - WBC, ESR (inflammation) Xrays US CT |
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Management of Appendicitis |
appendectomy IVF pain relief positioning maintain hydration reduce anxiety maintain skin integrity optimal nutrition |
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Meds for appendicitis |
antibiotics analgesics antiemetics |
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path of diverticulitis |
outpouching wall of large intestines increased pressure within the lumen and causes herniation through mucosa r/t low fecal volume increased intraluminal pressre decreased motor strength in colon wall |
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S&S of Diverticulitis |
LLQ pain bleeding NV fever and cills blood in stools crampy LLQ abdominal pain |
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Dx of diverticulitis |
Hx and symptoms colonoscopy & BE if no inflammation CT w/ contrast if inflammation labs - CBC, increased WBC and ESR |
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Management of Diverticulitis |
Dietary ---avoid sm. Non digestional items Diverticulosis (No inflam) – high fiber, Metamucil q day, lots of fluids (get it soft/ push it thru) Diverticulitis (Inflam) – NPO or clear liquids, IV fluids -Hospitalization: elderly, immunocompromised, steroids ,NGT, IVFs, antibx -Surgery – (if complications/ if interferes w/ quality of life) |
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Meds for Diverticulitis |
antibiotics analgesics - not morphine stool softener bulk forming laxatives psyllium products antispasmodics |
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patho for peritonitis |
inflammation of peritoneum caused by bacteriia, leaked of content from abd organs, bacterial proliferation Appendicitis Diverticulitis PUD |
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S&S of Peritonitis |
pain/tender belly ascites edema rebound tenderness paralytic ileus anorexia Fever. NV tachycardia hypotension |
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Dx of Peritonitis |
Xrays US CT scan MRI Peritoneal aspiration culture of fluids WBC increased altered Electrolytes |
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Management of Peritonitis |
IVF NG tube O2 surgery to correct underlying cause ** monitor wound for evisceration and abscess formation |
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Medications for peritonitis |
Antibiotcs** ALOT Analgesics Antiemetics |
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path for Small Bowel Obstruction |
parial or complete - impairment of forward flow of intestinal contents\ Mechanical - identifiable obstructing force Functional - intestinal musculature unable to propel contents |
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S&S of SBO |
wavelike/ colicky pain no BM vomiting feces distended abd dehydration hypovolemia |
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Dx of SBO |
Xrays CT |
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Medical MGMT of SBO |
NG IV Surgery |
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Nursing MGMT of SBO |
maintin NG I&O IVF hydration acess flatus and bowel sounds must reutn |
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Patho Large Bowel Obstruction |
fluid accumulation proximal undramatic dehydration slower |
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S&S of LBO |
slower to develop and progress constipation change in stool - string like stools weakness weight loss/ anorexia later abd distention and fecal vomiting |
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Dx of LBO |
diagnose based on Sx Xray CT MRI |
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Medical MGMT of LBO |
IVF NG - rest the bowel - suction Colonoscopy or cecostomy surgical resection |
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Nursing MGMT |
support IVF NG care Srgical prep wound care post op education |
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Path of Crohns disease |
Transmural Inflammation periods of remission and exacerbation lesions not continuous contact separated by unaffected normal tissue affected areas - cobblestone pattern luminal narrowing thickening intestinal wall mucosal nodularity granulomas occur |
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S&S of Crohns |
RLQ abd pain cramping after eating diarrhea steatorrhea anorexia weight loss malnutrition cramping anemia 3-5 semi solid stools a day w/ mucus plugs |
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Dx of Crohns |
proctosigmoidoscopy initially stool sample barium study of upper GI endoscopy, colonoscopy, and biopsies BE sows ulcerations CT shows bowel wall thickening and fistula formation |
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Complications of Crohns |
intestinal obstruction strictures F&E imbalances malnutrition fistula and abscess formation inc risk of colon cancer |
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2 IBD disorders? |
Crohns Ulcerative Colitis |
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Patho for Ulcerative Colitis (UC) |
affects sueprficial mucosa (shallow) continuous inflammation only in COLON characterized by edema shallow mucosa ulcerations mucosa fragile and bleed spontaneously |
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S&S of UC |
bloody diarrhea LLQ pain Intermittent Tenesmus (urgency to defecate, relieved when defecated) Rectal bleeding ( anemia, pallor, fatigue) anorexia, weight loss Fever, Vomiting Dehydration Extraintestinal Infections |
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Dx for UC |
Physical exam, increased HR. BP. fever, pallor stool sample (blood, parasites) low Hgb/Hct elev WBC sigmoidoscopy, conlonoscopy, barium enema CT MRI US studies |
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Complications of UC |
toxic megacolon perforation bleeding |
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management of IBD - Goals |
reduce inflammation bowel rest maintain F&E relieve symptoms |
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management of nutrition for IBD |
low residue, low fat high protein high calories vit and minerals avoid problematic foods such as milk and cold food |
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Medical Management of IBD |
sedatves, antidiarrheals, antiperistaltic - rest bowel Aminosalicylates (azulfidine) – inflamm./ long term med Steroids Immunomodulators (Imuran, MTX) – after others have failed Monoclonocal antibodies ----Remicade – UC ------Tysabri – Crohns |
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Surgical Management of IBD |
Total Colectomy Continent Ileostomy restorative proctocolectomy |
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Gall bladder |
Storage for bile bile assists with the emulsification of fats in the distal ileum |
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Cholecystitis |
Acute inflammation of the gallbladder |
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S&S of Cholecystitis |
pain, tenderness, rigidity of the right upper abdomen that may radiate to the midsternal area N/C and usual S&S of infection Empyema is when the gallbladder becomes fill with pus |
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cholelithiasis |
pigment stones cholesterol stones |
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Cholelithiasis Risk factors |
2-3x more in women than men older 40 multiparous obese contraceptives, estrogen, or dofibrate, -meds are known to increase biliary cholesterol saturation |
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Cholelithiasis Manifestations |
may have no or minimal symptoms and can be acute or chronic epigastric distress acute symptoms occur with obstruction and inflammation or infection- fever, palpable abdominal mass, severs right abdominal pain that radiates to te back or right shoulder, N/V Jaundice if blocking the common bile duct |
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Cholelithiasis symptoms in elderly |
oliguria HTN change in mental status tachycardia tachypnea |
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Dx of GB problems |
US - shows stones 95% of time Abdominal Xray - shows stones 20 % of the time HIDA scan shows GB function ERCP - visualized stones by multiple Xrays |
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Cholescintigraphy |
radioactive dye shows images of g/b and biliary tract - wont show stones, used if US is inconclusive |
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PTC - percutaneous Transhepatic Cholangiography |
injection of dye outlines the hepatic ducts, common bile duct, cystic duct and the GB used to distinguish jaundice caused by liver disease or from gallstones and to diagnose cancer |
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Medical MGMT of Cholelithiasis |
cholecystectomy laproscopic chole dietary MGMT Medications - ursodeoxycholic acid and chenodeoxycholic acid non surgical removal by instrumentation, intracorporeal and extracorporeal lithotripsy |
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LAP chole patient Teaching |
morphine - post op abdominal complications to report: N/V, abdominal distention, and increased temperature right shoulder pain is due to CO2 migrating from abdominal cavity during the procedure may use a heating pad for right shoulder pain expect only a small amount of sero/sang drainage |
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Collaborative problems/ potential complications |
bleeding GI symptoms complications as r/t surgery in general -atelectasis -thromboplebitis -tenderness and rigidity of abdomen |
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Post op interventions for Chole |
low folers position may have NG NPO until bowel sounds return, then soft, low fat, high carb diet post op care of biliary drainage system admin analgesics as ordered and medicate to promote/permit ambulation and activities. including deep breathing turn and encourage coughing and deep breathing, splinting to reduce pain ambulation |
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Disorders of the pancreas |
Acute pancreatitis chronic pancreatitis pancreatic cancer |
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Acute pancreatitis |
A severe disorder that can lead to death Acute pancreatitis does not usually lead to chronic pancreatitis The pancreatic duct becomes obstructed and enzymes back up into the pancreatic duct, causing auto digestion and inflammation of the pancreas |
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Chronic Pancreatitis |
a progressive inflammatory disorder with destruction of the pancreas. Cells are replaces with fibrous tissue and pressure within the pancreas increases. mechanical obstruction of the pancreatic and common bile ducts and destruction of the secreting cells of the pancreas occur |
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Etiology of pancreatitis |
bacterial or viral infection Hx of alcohol abuse and smoking complication of mumps meds: steroids, thiazide diuretics, oral contraceptives *** usually hepatitis*** |
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Acute pancreatitis manifestations |
severe abd pain patient appears acurately ill abdominal guarding N/V Fever, Jaundice, confusion, and agitation may occur Ecchymosis in the flank or umbilical area may occur may develop resp disress, hypoxia, renal failure, hypovolemia, hpocalcemia, and shock |
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Chronic Pancreatitis Manifestations |
recurrent attacks of severe upper abdominal and back pain accompanied by vomiting weight loss steatorrhea |
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Medical Management of Pancreatitis |
ERCP to assess damage and get tissue specimens endoscopy to remove gall stones, correct strictures and drain cysts pacnreatcojejunostomy joins pancreatic duct to jejunum to allow for drainage of pancreatic enzymes into the jejunum pancreaticoduodenectomy/ whipple resection |
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Risk factors for pancreatic cancer |
cig smoking exposure to industrial chemicals or toxins diet high in fat and meat DM |
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Morphine/ Roxanol |
moderate to severe chronic or acute pain; pre-op and post-op Side Effects - hypotension, Addiction, Nausea |
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Fetanyl/ Duragesic |
before, during and after surgery; patch for chronic or breakthrough pain Side Effects - fever increases the release of medication from the patch |
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Dilaudid/ Hydromorphone |
Moderate to severe pain in adults side effects - Confusion, sedation |
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Anitemetics |
ondansetron promethazine prochlorperazine |
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Lipid Lowering Drugs |
cholestyramine lipitor, mevacor, pravachol, crestor, niacin, niaspan, Vitamin B |
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Oral Hypoglycemics |
glucotrol, metformin, starlix, prandin, actos, avandia |
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Antibiotics |
gentamycin, ciprofloxin, levaquin, penicillin, amoxil, septra, bactrim, tetracyclines, insoniazid, INH, Rifampin, Zithromax, Biaxin |
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Antacids |
Tagamet, Pepcid, Zantac, Tums, Milk of Mag, Protonix, Prevacid, Nexium, Carafate |
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Causes of Liver Disease |
Bacteria/viruses metabolic disorders toxins medications malnutrition related alcoholism nutritional deficiencies |
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Most common manifestations of liver disease |
jaundice portal hypertension ascites varices nutritional deficiencies hepatic encepalopathy or coma |
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Hep A |
fecal oral transmission spead primarily by poor hygiene |
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S/Sx of hep A |
mild flu like symptoms, low grade, fever anorexia, late jaundice and dark urine, indigestion and epigastric distress, nausea, heartburn. flatulence, strong aversion to odors |
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Assess and diag findings of hep A |
enlargement of liver and spleen, anti-HAV, antibody in serum after symptoms appear
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prevention of Hep A |
hand hygiene, safe water, proper waste disposal, vaccinations, immune globulin if not vaccinated and exposed or household member/ sexual contacts |
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Medical MGMT hep A |
bed rest, nutritious diet, small frequent feedings, IVF if needed |
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NSG MGMT of Hep A |
education: activity/diet, ETOH avoidance, sanitation/hygiene |
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HEP B |
transmitted primarily through blood found in saliva, semen and vaginal secretions, sexually tramsitted, transmitted to infant at the time of birth incubation period 28-160 days |
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S&S of Hep B |
insidious and variable, similar to hep A ( loss of appetite, gen. aching, dyspepsia, malaise and weakness) may be jaundiced with light stools and dark urineq |
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Hep B medical management |
*Goals–minimize infectivity and liver inflamm, decrease sx *Alpha-interferonmost promise; daily or 3x/wk; MANYSE; (Pegasys (Peginterferon)1x/wk) *Lamivudine(Epivir)and Adefovir (Hepsera) –nucleoside analogues used for Hep B *Bedrest (until liver size decreased and enzymes imporved) Nutrition– monitor protein; no alcohol; treat GI sx B7) |
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HEP C |
Transmitted- blood, sex, needle sticks and needle sharing most common bloodborne infection causes 1/3 cases of liver cancer and most common reason for transplant |
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Risk factors for Hep C |
healthcare workers, Children of hep C moms, IV drug use, mult sex partners |
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Management of HEP C |
*Prevention–avoid high risk behav(IV drug use); needless systems in Hlthcr setting; standard and barrierprecautions; no multi-dose vials; sterilization of ptequipment (table 49-7) *Screeningof blood *Alcoholencouragesthe progression of the disease, so alcohol and medications that effect theliver should be avoided *Antiviralagents: peginterferon andribavirin (Rebetol) *Proteaseinhibitors: Telaprevir (Incivek)and Boceprevir (Victrelis);used in conjunction with antivirals *NewDrugs – (1)Harvoni (ledipasvir/sofosbuvir);(3) Daklinza (daclatasvir) |
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Nonviral Hepatitis |
Toxic Effects of certain chemicals no antidotes |
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Drug Induvced Hepatitis |
most common cause of acute liver failure *Medications– isoniazid, halothane, acetaminophen,methyldopa, certain antibx,antimetabolites, anesthetic drugs *Sx-chills, fever, rash, pruritus, arthralgia, anorexia, nausea; later-dark urine,jaundice, enlarged tender liver steroids and liver transplant |
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What type of hepatitis is transmitted bythe fecal-oral route via contaminated food, water, or direct contact with aninfected person? |
Hepatitis A |
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Which type of precaution should the nurseimplement to protect from being exposed to any of the hepatitis viruses? |
Standard Precautions |
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The school nurse is discussing ways toprevent an outbreak of Hepatitis A with a group of high school teachers. Whichaction is the most important intervention that the nurse must explain to theschool teachers?7D |
Thoroughly wash hands |
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Fulminant Liver failure |
sudden liver failure in a previously healthy person causes - viral hepatitis medications or chemicals metabolic disturbances and structural changes pt presents bc of jaundice and profound anorexia ICU - plasmaphoresis, antidotes if available and monitor intracranial pressure liver transplant is treatment of choice |
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Hepatic Cirrhosis |
normal tissue replaced by fibrosis/ scar tissue
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Alcoholic hepatic cirrhosis |
most common, scar tissue around portal areas |
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Post necrotic hepatic cirrhosis |
broad bands of scar tissue usually after viral hepatitis |
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Biliary hepatic cirrhosis |
scarring around bile ducts, result of chronic biliary obstruction; less common |
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Clinical Manifestations of Hepatic Cirrhosis |
liver enlargement- early portal obstruction and ascites infection and peritonitis GI varices Edema - lower and upper - presacral Vitamin Deficiencies and anemia, Vit A, C, K Mental Deterioration |
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Compensated Hepatic Cirrhosis |
Intermittent mild fever Vascular spiders Palmar erythema Unexplained epistaxis Ankle Edema Vague Morning Indigestion Flatulent dyspepsia Abdominal PainFirm, enlarge liver Splenomegaly |
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Uncompensated Hepatic Cirrhosis |
Ascites Jaundice Weakness Muscle Wasting Weight Loss Continuous mild fever Clubbing of fingers Purpura Spontaneous bruising Epistaxis Hypotension Sparse body hair White Nails Gonadal atrophy |
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Assess and Diagnosis of Cirrhosis |
Albumin decreased Globulin elevated alkaline phosphate, AST, ALT and GGT elevated increased bilirubin and PT US can tell difference between parenchymal and scar tissue CT MRI and Liver scans dertermine liver size and hepatic blood flow and obstruction Dx - liver biopsy |
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Medical MGMT of Cirrhosis |
*Antacids/H2receptor antagonists – GI distress, decr. chance of GI bleed *Supplements-nutritional status *Ksparing diuretics (spironolactone) – ascites *Propernutrition & NO ALCOHOL *Medicationwith Antifibroticaction – colchicine, Angiotensin system inhibitors, statins, diuretics, immunosuppressants, glitazones; ?Long term safety/efficacy |
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Nurse MGMT of Cirrhosis |
promote rest improve nutritional status skin care Reducing risk of injury monitor and manage complications such as bleeding, hepatic encepalopathy and FVE |
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primary liver tumors |
few cancers originate in the liver usually associated with hep B,C chronic liver disease and cirrhosis |
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Liver Metastasis |
liver frequent site of metastasis - digestive, breast and lung |
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Manifestations of Liver Cancer |
Pain, a dull continuous ache, in RUQ, epigastrum or back
jaundice if bile duct is occluted, ascites if portal vein obstructed |
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Surgeries for Liver Cancer |
Lobectomy Local ablation Liver transplant - stringent selection criteria |
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Liver Transplant |
used to treat ESLD when no other form of treatment available removal of diseased liver and replace with cadaver liver or right lobe from living patient must immunosuppress first |
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Indications for Liver Transplant |
*irreversibleadvanced chronic liver disease, fulminant hepatic liver failure, metabolicliver diseases, some hepatic malignancies |
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Classification for degree of need of liver transplant |
MELD- model for end stage liver disease |
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Complications of liver transplant |
bleeding, infection, rejection, LDLT complications - PE, bile duct injury, portal vein thrombosis, liver insufficiency, |
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Urinary System assessment - subjective |
hx of kidney disease, renal failure, cogenital abnormalities meds - bp meds, diuretics hematuria, dysuria, fever, chills, back pain |
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Objective data for urinary assessment |
Only the right kidney is palpable. Kidneys produce EPO and Calcitrol(Helps with Vit Dmetabolism). Renin (renin-angiotensin system) to help regulate BP |
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KUB |
Kidneys ureter bladder xray of the abdomen can be used to study size shape and position of the kidneys to reveal any abnormalities such as calculi, hydronephrosis, cysts, tumors |
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CT - GU |
Usedin evaluating GU masses, nephrolithiasis(kidney stones), obstructions, chronic renal infections, urinary tract trauma,and soft tissue abnormalities to include lymph node enlargement. |
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Renal US |
Usedto detect renal or perirenalmasses, differential diagnosis of renal cysts, solid masses, and identificationof obstructionsph node enlargement. |
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IVP ( intravenous pyelogram) |
Toview the entire urinary system, the physician orders the “excretory urogram” or“intravenous pyelogram”. IntravenousPyelogram -injection of radiopaquecontrast medium that is filtered by the kidney and excreted through the urinarytract Identifiesabsence or presence, location, size and configuration of kidney, ureters andbladder |
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Renal Angiography |
Aninvasive radiographicalprocedure that evaluates the renal arterial system Dyeis injected through a femoral catheter directly into the renal artery. Thistest is used to show vascular abnormalities because it is not secreted into thecollecting system. Renalangiography is capable of evaluating masses (neoplasms or cysts) to determine changes in bloodflow. |
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pre and post renal angiography |
Thesame as IVP Inaddition: 1.Ensurethat patient maintains bed rest for 8 – 12 hours 2.Checkfemoral pulse, assess the circulation in the cannulatedextremity, and ensure extremity is kept in straight alignment3.Observefor bleeding, increased tenderness, and hematoma at catheter insertion site4.Maintaina pressure dressing over injection site for 24 hours |
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Cystoscopic Exam |
provides direct visualization using a lighted cytoscope. inserted through the urethra into the bladder, optical lens provides magnified, illuminated view of the bladder directly |
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Post cytoscopic Exam |
1.Forcefluids to insure adequate urine flow to wash outclots or bacteria present as a result of instrumentation2.Monitor I/O3.Assess for urinary retention secondary toedema following instrumentation4.Warm sitz baths and relaxant medications help torelieve retention, catherization may be necessary if no relief |
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retrograde pyelogram |
small caliber catheter is passed througb a cytoscope into ureters and renal pelvis |
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Forwhich of the following tests does the nurse need to ensure that a consent issigned? Select all that apply: 1. mri 2. IVP 3. CT 4. KUB |
1,2.3 |
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Duringwhich of the following would a physician obtain a biopsy? 1.MRI 2.IVP 3.Cystoscope 4.Retrogradepyelogram |
3 cystoscope |
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What is the first test orderedwhen a patient is suspected to have kidney stones? 1. MRI 2. IVP 3. Cytoscope 4. KUB |
4 kub` |
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Whatinstruction should the nurse give to a patient having an IVP? 1 “You will have a clear liquidbreakfast the morning of surgery.” 2. “You’ll feel a warm flush when thedye is injected.” 3. “We will give you laxatives themorning of the IVP.” 4. “You will be in lithotomyposition.” |
2 youll feel |
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Whichof the following is the most important question before an IVP? |
are you allergic to seafood |
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Renal function tests |
BUN Creatinine Creatinine clearance |
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BUN |
normal 5-25 index of renal function renal impairment causes increase in plasma levels BUN level starts to rise when the GFR falls below 40-60% |
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BUN is elevated by what nonrenal factors |
hypovolemia excess protein intake starvation surgery trauma fever corticosteroids |
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BUN decreased by |
ECF volume - increased ECF causes a decrease in BUN because of dilution - over hydration low protein diet End stage liver disease any condition that results in an expanded fluid volume - pregnancy |
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Creatinine |
0.7-12 excreted though the kidney by glomerular filtation - MOST ACCURATE MEASUREMENT OF KIDNEY DAMAGE AND PROGRESS OF RENAL FAILURE |
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increased serum creatining |
greater than 1.5 mg/dl indicated nephron loss normal levels can be found with 25% loss twice normal level indicates a 50% nephron loss ten times normal indicates ESRD or 90% loss creatinine is watched closely to determine the time to place fistula or other access device for dialysis |
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BUN- Creatinine Ratio |
normal is 10:1 to 15:1 increased ration suggests dehydration lower ratio suggest over hydration, low intake of protein or severe liver disease |
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Creatinine Clearance |
normal is > 70 ml/min measures the amount of blood cleared of creatinine in a minute - indicator of GFR poor clearance is sign of early renal disease |
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renal Biopsy |
used to diagnose existence, extent and origin of renal disease |
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Whichof the following lab tests indicate dehydration instead of renal failure? 1. BUN 50 Creatinine 4.0 2. BUN 40 Creatinine 1.2 3. BUN 25 Creatinine 1.5 4. BUN 15 Creatinine 3.0 |
2. BUN 40 Creatinine 1.2 |
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Whichof the following is the most accurate measure of renal function? 1. Renal biopsy 2. Blood Urea Nitrogen 3. Urine Urea Nitrogen 4. Creatinine Clearance |
4. Creatinine Clearance |
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Whichof the following would be of most concern to the nurse in a patient about to have a renal biopsy?? 1. BUN 50 mg 2. PT of 20 seconds 3. Creatinine of 1.5 mg 4. Blood in the urine |
2. PT of 20 seconds |
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Whichof the following comments by the patient who just had a renal biopsy would beof most concern to the nurse? 1. i feel the need to urinate 2. im feeling nauseated 3. my back is hurting me 4.im very sleepy |
3 my back is hurting me |
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Apatient with a 24 hour urine collection reports urinating in with a bowelmovement in a bedpan. The nurse should: 1. Startthe 24 hour urine over again at that time 2. Pourthe urine into the collection jug 3. Measureand record the amount of urine but discard it 4. Extendthe time of collection for one voiding and discard the urineIctR1hWZibA- |
1. start the 24 hour urine over again at that time |
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structural changes of kidneys in the elderly |
GFR decreases with age tubular function, including reabsorption and concentrating ability is reduced with age |
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changes in elderly males structures (GU) |
increased collagen in the bladder wall or secondary to prostatic enlargement in males |
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changes in elderly female structures (GU) |
vaginal and urethral issues atrophy and beome thinner in aging women due to decreased estrogen levels |
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GU functional changes in elderly |
decreased filtration and tubular function results in decreased ability to concentrate urine blood flow decreases secondary to decreased cardiac output and increased peroipheral resistance which decreased urinary output |
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Effects of Aging on GU |
bladder capacity decreases tendency to retain urine develops nocturia increases urinary sphincter weakens |
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Etiology of Urinary Retention |
Obstruction from: BPH Stricture Clots Tumors Stones Bladder outlet obstruction other--- anxiety, surgery, anorectal problems |
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Sensory Reasons for Urinary Retention |
CVA Diseases with neuro impact deficient detrusor muscle contraction strength |
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S&S of Urinary |
Distended bladder and bladder pain nocturia overflow incontinence: -bladder fills and increases pressure to where it exceeds sphincter control -voids 25-50cc each time |
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complications of Urinary Retention |
increased risk of urinary tract infection increased risk of calculu upper respiratory tract pathology pyelonephritis hyronephrosis renal insufficiency acute renal failure bladder rupture |
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Nursing interventions for Urinary Retention |
immediate treatment is an in and out catheterization drain and record amount observe for decompression and complications -sweating -hypotension -pallor -hematuria bladder scan pre and post urecholine admin |
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stress incontinence |
urine leakage with sneezing coughing |
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urge incontinence |
sudden, uncontrollabe need to void with fullness may lose a significant quantity of urine before reaching toilet |
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overflow incontinence |
poor urinary stream, dribbling with symptoms of stress or urge incontinence detrusor hyperactivity with imapired contractility may mimic stress or overflow incontinence common in elderly |
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functional incontinence |
inappropriate voiding immobility impaired cognition |
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reflex incontinence |
involunatary bladder contractions occur without warning and no feeling of fullness |
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mixed incontinence |
two or more incontinence put together |
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treatment for incontinence |
treat causes such as UTI, caffeine, diuretics Kegel Exercises meds - anticholinergic agents inhibit involuntary contractions alpha- adrenergic blockers increase urethral resistance etrogen to improve pelvic structural integrity surgery |
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cystocele |
protrusion of the bladder into the vagina usually results from straining during childbirth |
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symptoms of cystocele |
pelvic pressure incontinence frequency urgency |
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manage cystocele |
kegel anatomical support devices surgery |
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pathology of cystitis |
inflammation of the bladder usually secondary t infection which is ascending e-coli via transurethral entry * most common bacterial infection that occurs in women** Shorter urethra in women makes ascension of bacteria more likely |
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upper tract cystitis |
renal parenchyma, pelvis and ureters
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lower tract cystitis |
lower urinary tract usually few to no systemic manifestaions |
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symptoms of lower tract cystitis |
pyuria dysuria freq and urgency hematuria suprapubic tenderness |
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uncomplicated cystitis |
occurs in otherwise normal tract usually only involves the bladder |
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urinalysis cystitis |
urine color urine clarity and odor urine pH and SG tests to detect protein, glucose, and ketone bodies in the urine microscopic exam: detects RBCs WBCs casts crystals and bacteria |
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culture and sensitivity cysstitis |
determine bacteria susceptibility to antibiotics identifies the organism responsible for the infection identifies the antibiotic that will inhibit the growth of the bacteria checks the effectiveness of a selected antibiotic to specific bacteria from culture |
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urine sampling cystitis |
clean catch sample preferred speciment by catheterization or suprapubic needle aspiration more accurate |
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Treatment for Cystitis |
antibiotics -sulfa's -and nitrofurantoin may resolve without treatment cranberry juice phenazopyridine (pyridium) - decrease dysuria |
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patient education for cystitis |
avoid tub baths avoid spermicides avoid oil based lubricants void after intercourse hygiene care - cleanse front to back |
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Apatient complains of “wetting her pants” when she sneezes. This is known as: 1. urge incontinence 2. stress inctoninence 3. functional 4. reflex |
2 stress incontinence |
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which factor is the most likely etiology of stress incontinence? 1. hx of having 4 children 2. a hx of diabetes and polyuria 3. a history of frequent UTIs 4. Taking baths instead of showers |
1. a Hx of having 4 children |
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due to the effects of aging, elderly patients are more likely to? 1. having pain with voiding 2. have hematuria 3. develop bladder tremors 4. develop UTIs |
4 develop UTIs |
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what should a nurse teach a patient with cystitis to prevent future recurrences 1. cleanse from front to back after BM 2. practice Kegel exercises 3. drink lots of Orange Juice 4. Take tub baths instead of showers |
1. cleanse from front to back after BM |
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Apatient is crying with bladder pressure and the PCT gives her a bedpan. Whichof the following would be of most concern to the nurse? 1.The urine was amber and aromatic 2.The amount voided was 50 ml 3.The patient had a hard timestarting the stream 4.The patient is receiving IV fluids |
2.The amount voided was 50 ml |
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BPH |
age related non malignant enlargement of the prostate gland that devevlops when the number of prostate cells increase |
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symptoms of BPH |
weakned and diminshed urinary stream, diff in starting stream, straining dribbling, frequency urgency with inability to empty bladder causing urnary stasis, infection, cystitis can elevate pressure within the bladder causing the wall to thicken and a diverticula to form hematura inability to void |
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Dx of BPH |
Digital Rectal Exam felt as a symmetrical enlargement of the gland with a rubbery to firm consistency |
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Treatment of BPH |
watchful waiting alpha blocker drug treatment prazosin HCL (Minipress) Terazosin (Hytrin) Finasteride (proscar) shrinks prostate balloon dilation Transurethral prostatic Resection - surgical treatment |
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S&S of prostate cancer |
serum prostatic acid phosphate eleveted LDH and BUN and creatinine elevated alkaline phophate increased with bone mets prostate specific antigen - elevation suggestive of prostate cancer |
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Dx of Prostate cancer |
Digital Rectal Exam Transrectal ultrasound PSA and other blood work annual digital rectal exm by 40 y/o annual PSA by age 50 y/i unless high risk) |
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stage 1 prostatic cancer |
tumor not clinically palpable but detectable in microscopic sections by biopsy |
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stage 2 prostatic cancer |
palpable tumor confined to prostate with no distant metastasis |
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Stage 3 prostatic Cancer |
tumor extending beyond prostatic capsule with withouth invasion of contiguous organs but witthout distant metastasis |
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Stage 4 of prostatic cancer |
metastasis confined to pelvis or distant |
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treatment of prostatic cancer |
watchful waiting horomonal manipulation - estrogen, orchiectomy radiation - kills cancer cells brachytherapy - internal radiation with seeds Diethylstillbestrol (DES) inhibits gonadotropins flutamide cyproterone finasteride goserelin radical prostatectomy - remocal of prostate and seminal vesicles |
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stage 1 prostatic cancer surgical treatment |
radicalperineal or retropubicprostatectomy |
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stage 2 prostatic cancer surgical treatment |
radicalpelvic lymph adenectomy andradiation therapyD%7D |
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stage 3 prostatic cancer surgical treatment |
radicalprostatectomy, pelvic node dissection, radiation, hormonal tx |
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stage 4 prostatic cancer surgical treatment |
hormonaltx,radiation, and chemotherapy |
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transurethral prostatectomy |
cytoscope inserted through urethra and prostate removed |
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retropubic resection |
low abdominal incision but bladder is not opened; foley inserted pos op |
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perineal prostatectomy |
incision between scrotum and rectum |
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complications of prostatic cancer |
urinary incontinence ED |
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impotence |
affects as many as 20 million men |
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hypogonadmis |
more than 1 clinical sign plus lab LowLibido •ED •↓Muscle Mass •↓Strength •↓Vitality or energy•Depression or mood alteration•↓BMD (Bone Mineral Density)•↑Adiposity (Body Fat) + •↓Testosterone Normal (300 -1000 ng/dL) |
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impotence |
occurs when erectile potency influencedby blood supply, nerve supply/physical causes, psychological aspects |
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impotence due to blood supply |
Vascular disease (alter blood flow)AtherosclerosisHypertensionDiabetes:blood flow; peripheral vascular disease. |
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impotence due to nerve supply/ physical cause |
Neurologicaldiseases i.e. MS, Parkinson’s diseasecan interrupt nerve impulses to the penis Diabetes:blood flow; peripheral neuropathy |
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physical causes of impotence |
Surgery:prostate, colon, bladder and other types of pelvic surgery can interrupt nerveimpulses substance abuse Spinalinjury- interruption of nerve impulses; para/quadriplegia/CVA Prescriptiondrugs- i.e. anti-hypertensives ie: Methydopa (Aldomet) Smoking (Nicotine),(Chronic Opioids),alcohol and illegal drugs (Marijuana, Cocaine)cause vasoconstriction , and alters sensory perception Kidneyfailure and dialysis cause reduced testosterone levels5 |
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psychological causes of impotence |
stress depression anxiety performance fear |
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treatment for impotence |
testosterone phetolamine papaverin alprostadil muse in urethra tadafil vardenafil sildenafil |
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malleable prosthesis - penile implants |
twobendable semi-rigid rods implanted in the erectile chambers therods can be bent to an erect position for intercourse and repositioned after |
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self contained inflatable prosthesis |
two erectile cylinders implanted with contain pump and saline reservoir |
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two piece inflatable penile prosthesis |
twoimplanted cylinders with a single pump implanted in the scrotum thepump is squeezed for an erection deflationis performed by bending the erect penis downward to 6-12 seconds |
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Vacuum induced erection |
thelubricated penis is placed in a plastic which is evacuated with a pump thelowered pressure causes the penis to engorge an elastic ring is placed around the base of the penis to restict outflow and maintain the erection effective but cumbersome |
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Thenurse should regulate a CBI following a TURP at what rate? 1.Fast enough for the urine to beclear yellow2.Fast enough for the urine to bepink 3.Fast enough for the urine to be red 4.At approximately 125 ml/hrexCo |
2 fast enough for the urine to be pink |
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Aclient is to receive belladonna and opium suppositories, as needed,postoperatively after a TURP. The nurse should give the client this drug whenhe demonstrates signs of... 1.Aurinary tract infection 2.Urinaryretention 3.Frequenturination 4.Painfrom bladder spasms |
4. pain from bladder spasms |
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Whichcomment by a patient after a suprapubic resection of the prostate indicatesunderstanding of teaching? 1.Mygrandchildren are coming to visit for a week and I can’t wait to pick them upand hold them. 2.I’mgoing back to my job as computer programmer for as many hours a day aspossible. 3.Iwill start working out at the gym immediately upon discharge 4.I’lltake Docusate Sodium (Colace) daily anddrink plenty of fluids-v |
4.I’ll take Docusate Sodium (Colace) daily and drink plenty of fluids -v |
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Aclient asks the nurse why the prostate specific antigen (PSA) level isdetermined before the digital rectal examination. The nurse’s best response iswhich of the following? 1.“It’s easier for the client.” 2.“A prostate examination can possibly decrease the PSA.” 3.“A prostate examination can possibly increase the PSA.” 4.If the PSA is normal, the client will not have to undergo the rectal examination.” |
3.“A prostate examination can possiblyincrease the PSA.” |
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Thenurse should teach the client with ED to alter his lifestyle to 1. avoid alcohol 2. follow a low salt diet 3. decrease smoking 4. increase attempts at sexual intercoure |
1 avoid alcohol |
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urolithiasis |
presence of stones in urinary tract may be formed in the bladder |
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uterolithiasis |
formation of stones in ureter |
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nephrolithiasis |
formation of stones in the kidney |
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renal calculi |
kidney stones Varyin size and shape from the size of a minute granular deposit to encompass theentire renal pelvis Varyin color, texture and composition Moremales affected then females 90%of stones pass spontaneously |
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predisposing factors for renal calculi |
Excessiveproduction of muco-proteinswhich form a fibrous matrix upon which crystals are deposited and trappedaccounts for family history of stones Certainmedications: High doses of ascorbic acid, antacids, antibiotics – sulfonamidesUrinarystasis DehydrationImmobility |
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calcium phosphate stones |
Hypercalciuria -75% of stones contain calcium- caused by conditions of increased calcium in theblood (hypercalcemia) and urine causingprecipitation of calcium and formation of stones.y>=&f |
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causes of hypercalcemia |
HyperparathyroidismRenaltubular acidosis CancersGranulamatousdiseases (sarcoidosis,tuberculosis)Excessiveintake of vitamin DExcessiveintake of milk Myeloprofliferativediseases: (leukemia, polycythemia vera,multiple myeloma) |
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prevent calcium stones |
liberal fluid intake restric protein to 60g a day to minimize urinary calcium excretion sodium restriction of 3-4g/day because excessive salt increases urinary calcium excretion in all people with hypercalciuria |
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calcium oxalate stones |
Causedby supersaturation ofurine with calcium and oxalate Striveto maintain a dilute urine Dietaryprescription may include acid ash foods, because calcium stones have analkaline chemistry Dietaryprescription may also include avoiding foods high in oxalate Avoidoxalate-containing foods:SpinachStrawberriesTeaAlmonds, cashewsChocolateBeetsRhubarb |
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struvite stones |
account for 15% of stones - also called triple phosphate because they are made of calcium phosphate, magnesium phosphate and ammonium phosphate - also known as an infection stone, a bacterial infection raises urine pH and causes phosphate to precipitare usuallt results in staghorn calculi- a large calcule that may be shaped by and virtually fill an entire renal pelvis |
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prevention of struvite stones |
maintain dilute urine (8x8 oza of h20 a day) maintain med regimen to rid urease - splitting bacteria such as proteusl, pseudomonas, kleibsiella, stapg, or mycoplasma may be maintained on mesd to produce acidic urin - acetohydroxamic acid or ammonium chloride |
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uric acid stones |
Caused by increased urateexcretion and hyperuricuria fromgout May be caused by high dietary intake of purine richfoods tend to form in more acidic urine |
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pt teaching for uric acid stones |
Teach patient to avoid these purine richfoods: sardines, anchovies, asparagus, mushrooms,red wines, and organ meats,{ pork, beef, chicken (eat only very sparingly)} Dietary prescription may include analkaline ash diet to make the urine more alkaline. Foods to include in an alkaline ash dietare: fruits (except cranberries, plums, andprunes), rhubarb, most vegetables, very small amounts of halibut, veal, troutand salmon are allowed (salmon eat onlyvery sparingly)} |
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meds for uric acid stones |
_ Allopurinol (Zyloprim) -may be prescribed to reduce serum uricacid levels and urinary uric acid excretion. |
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kidney stones symptoms |
Renal colic is the primary symptom,location is dependent on the location of the stone Renalpelvis - pain is caused by hydronephrosis andis dull and constant at costovertebralangle Ureter -pain is excruciating and intermittent - caused by spasm of ureter andanoxia of wall of ureter fromstone pain follows ureter to suprapubic area and radiates to external genitalia and is accompanies by n.v 2-3 attacks before passing stone |
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complications of kidney stone |
infection obstruction hematuria |
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goals for kidney stone |
eliminate pain and infection resolve causative factors prevent future calculi growth |
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nursing interventions for kidney stone |
force fluids 2-4 L/day strain urine teach diet by stone type med admin - analgesics, nsaids , thiazide diuretic ambulation if tolerated |
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Diff Diagnosis for diff disorders |
Appendicitis(R lower quad pain, rigid Rrectus abd muscle) Cholecystitis(Colicky R upper quad, radiatesto scapula) Pepticulcer (Burning pain to center of abd, radiates to epigastric region) Pancreatitis(epigastric to upper L quad,radiates to back) Ectopicpregnancy (lower abd on affected side, may reflect toshoulder, surgical emergency assoc. w rupture) Dissectinganeurysm (piercing pain from mid abd to back ) |
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lithotripsy |
ESWL- extracorporeal shock wave lithotripsy Electromagneticshock waves delivered from outside body to break up stone. stonebroken down to consistency of powder which can be passed spontaneously mayrequire manipulation to get stone into position that shock waves can reach |
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pecutaneous nephrolithotomy |
Apercutaneous tract is formed and nephroscope inserted through it Stoneis extracted or pulversized Fragmentsof stones may be irrigated and suctioned out or retrieved with basket orforceps. Somelarger stones may require further breakdown with ultrasonic disintegrationbefore above can be performed. Mayhave bruise on back |
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Pyelolithotomy- |
stone in kidney pelvis |
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Nephrolithotomy- |
stone is in the kidney
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Ureterolithotomy |
stone is in the ureter |
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Cystoscopy/ureteroscopy withbasket extraction |
for stones located in bladder or close to bladder in the ureter |
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RenalFailure - |
suddeninterruption of renal function, a partial or complete impairment of kidneyfunction. |
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acute renal failure |
sudden in onset and potentially reversible |
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prerenal |
diminished blood flow to kidneys |
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intrarenal |
damage to filtering structures |
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postrenal |
obstruction of urine outflow |
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phases of renal failure (acute) |
Initiation –hours to days Oliguric-<400 ml in 24 hours. 50% of patients do not exhibit oliguria. Lasts 10 to 14days. The longer the poorer the prognosis. Dialysis initiated at this time. Diuretic-gradual^ in urine output 1-3L/day up to 3-5 L/day caused by osmotic diuresis from thehigh urea concentration. Recovery –GFR increases, BUN and creatininelevels plateau then decrease/GGqJPHessoAe6ItMzNq2FKQKBgQD2 |
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potential causes of pre renal, renal failure |
poor perfusion of kidney from volumedepletion states i.e.: hemorrhage, impaired cardiac performance, CHF,cardiogenic shock, GI losses, vomiting, diarrhea, NG suctioning |
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potential causes of intra renal, renal failure |
structural damage to kidney i.e.: burns,crushing injury, infection, nephrotoxic agents such as aminoglycosideantibiotics: Gentamicin, Tobramicin. Heavy metals and chemicals: lead, mercury,ethylene glycol, carbon tetrachloride, arsenic. Infections: acute glomerulonephritis (GN). Dz |
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potential causes of post renal, renal failure |
urinary tract obstruction i.e. calculi, tumors, BPH, strictures, clots |
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CKD |
Chronic Kidney Disease results from gradual tissue destruction and loss of kidney function |
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stage 1 ckd |
GFR≥ 90 mL/minNormal-mild decrease in GFR |
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stage 2 CKD |
GFR≥ 60-89mL/minMild decrease in GFR |
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stage 3 CKD |
GFR≥ 30-59mL/minModerate decrease in GFR
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stage 4 CKD |
GFR≥ 15-29mL/minSeveredecrease in GFR |
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Stage 5 CKD |
GFR less than 15 mL a min - ESRD end stage, kidney failure |
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DX of CKD |
DecreasedpHDecreasedbicarbonateDecreasedhemoglobin and hematocritElevatedBUNElevatedcreatinineElevatedsodiumElevatedpotassium Fixedspecific gravity at 1.010ProteinuriaGlycosuriaRBCsLeukocytesCastsCrystals |
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Electrolyte imbalances caused by renal failure |
HyperkalemiaHyperphosphatemiaHypocalcemiaHypoor hypernatremiaHypermagnesemia |
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complications of Renal Failure |
HTN, FVO metabolic acidosis anemia pericarditis, effusion, retention of uremic waste bone disease/calcifications |
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clinical manifestations |
polyuria oliguria anuria |
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treatment of Renal Failure |
fluid restriction with daily weights diet restiction - 2 Gm sodium, 2 Gm potassium, 40-60 Gm protein control CV risk - antihypertensives treat low Ca and increased phos avoid antacids to prevent magnesium toxicity treat hyperglycemia treat anemia vitamin supplements if necessary |
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dialysis |
process used to remove fluid and waste products from body for kidneys removal of meds and toxins solutes diffuse through semipermeable membraes |
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Arterial-venousfistula |
:recommend 2-3 months to ripen and mature before use, bestoverall patency rates, and least complications 2x |
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Arterial-venousgraft |
2-4weeks to heal; synthetic material, stenosis, infection, thrombosis very common |
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shunts |
not frequently used except for CRRT due to infections and thrombosis |
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access problems for dialysis access |
nurse is responsible for assessing thrill and bruit of fistula. no BP, IV or Venipuncture to the access arm |
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hemodialysis |
Circulatesthe pt’s blood through a dialyzer to remove waste and excess fluid3times weekly for 3-4 hoursArtificialkidneys Dialysate Diffusion Osmosis Buffersystem |
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peritoneal dialysis |
indicated for patients unwilling or unable to undergo hemodialysis/ transplant Usespt’s peritoneal membrane as a semi permeable membrane to exchange fluid andsolutesDialysate: 2-3Liter/exchange depending on pt’s size (3 phases: inflow 10 min.; dwell 30min-2hrs; drain 20 min) =1 exchange; then repeat. Number of exchanges based onDr’s orders and labsTakes36-48 hours intermittently, often done 4 times daily,Canbe continuous if automated PD every nightUreaand creatinineremoved by diffusion Assoc.w pain/infection/peritonitis from Staph aureus |
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dialysis complications |
Doesnot alter natural course of CKD nor completely replace kidney functionDisturbslipid metabolism and ↑Trig,↑CV complicationsAnemiaMetallictaste, NV, Gastric ulcers due to physiologic stressHypotensionMalnutrition↓Calciummetabolism, osteodystrophy, bone pain, fracturesPgs.1335-1336 |
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Kidney Transplantation |
•Indicatedfor end stage renal disease•Costs1/3 of long term dialysis Pt’snative kidneys are usually not removed Donorkidney placed in iliac fossa/ant.illiaccrest for ↑ blood supply Onceblood supply has been re-established to donor kidney in OR, urine should beginto flow 1year graft survival rate for kidney transplantation= 90% for deceased donor 95% for live donor |
