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86 Cards in this Set
- Front
- Back
Function of Kidneys
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-Excretion
-Regulating acid base -Regulating electrolytes -Auto regulation of BP -Stimulate RBCs *Increased BP can cause damage to the kidneys |
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Urinalysis
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-Albumin
-Appearance -Glucose -Ketones -Leukocytes -Specific Gravity -Clean catch -24 hour urine *test kidney fx (creatinine clearance) *urine needs to refridgerated *pt should urinate and discard urine at beggining of test |
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Radiological Studies
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-KUB: kidneys, ureters, bladder Flat x-ray
-IVP: intravenous Pyelogram Iodine based dye in kidneys (x-ray) -Retrograde pyelogram: dye into bladder forced up the ureters (x-ray) -Cystoscopy: bladder endoscope -Urodynamic Studies: Bladder and voiding |
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Altered Urinary Elimination
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-Frequency: more than normal
-Urgency: sudden strong urge to void -Dysuria: painful and difficult -Nocturia: at night -Hesitancy: inability to start flow |
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Urinary Retention
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-Inadequate emptying of bladder which leads to urinary stasis
*which can lead to infection -Causes: *obstruction: prostate, tumor, stone *surgery *drugs: anticholenergics, antiparkinson *neurologic: not able to control spincter |
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Reasons for Catheterization
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-Urinary retention
-Incontinence (only in extreme cases) -Accurate I&Os |
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Types of Catheters
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-Intermittent
*In and Out *Straight: check for residual <50cc good *Clean -Foley *indwelling *retention -Supra-pubic |
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Urinary Obstructions
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-Stones: nephro-lithiasis
-Renal Calculi -Stones are composed of substances normally found in the urine *calcium oxylate: most common *Calcium phosphate *Uric acid: d/t increased protein *Struvite: infection stones -75% of stones are calcium based |
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Care for Patient with Stones
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-Control pain once stone starts to migrate from kidneys
-Straine urine -Provide hot bath -Increase fluid intake |
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Stone Removal
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-Extracorpeal shock wave lithotripsy (ESWL): non invasive procedure to break up stone
-Stone Dissolution: infusion of chemolytic solution -Lithotomy: surgical removal -Endoscopy: removal through endoscope |
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Patient Education for Stones
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-Prevent the recurrence
-Increase fluids -Diet: *limit calcium *acid ASH: acidify urine (prevents infection); aluminum oxide used in struvite and oxylate *Alkaline ASH: alkalinize urine to prevent uric acid stones *decrease protein in diet |
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Male conditions
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-Phimosis: prepuce is constricted in uncircumcised males where the fore-skin is stuck & can't be retracted over the glans; may be d/t poor hygeine
-Paraphimosis: foreskin can not be retracted from behind the glans back over the glans -Priapism: uncontrolled erection without sexual desire (emergency situation) |
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Conditions of the Testes
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-Cryptorchidism: undescended testicle
-Epididymitis: infection of epidiymis usually from UTI or chlamedia or gonorrhea -Orchitis: infection of the testicle (mumps may cause) -Testicular Ca: most common cause of Ca in men age 15-35 *educate men on monthly self-exam |
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Male Condtions
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-Hydrocele: cystic fluid filled mass around the testicle
-Spermatocele: sperm containing cyst -Varicocele: dilated veins (decrease in sperm production) -Torsion: twisted spermatic cords and blood vessels |
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Erectile Dysfunction/Impitence
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-Persistnet inability to achieve an erection or erection not significant enough to partake in intercours
-Psychological Causes -Organic Causes: DM, spinal cord injury, Hypertension, Surgical trauma, medciations (dilantin, sedatives, antihypertensives) |
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Erectile Dysfunction Treatment
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-Oral Meds: viagra, spontane, liritra, sialsis
-Suppository: inserted into tip of penise, MUSE: medicated urethral system for erection -Injection therapy: caverjet, edex -Devices: vacuum pump |
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How Viagra works
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-A man takes a Viagra® pill.
-The sildenafil citrate enters his bloodstream and flows throughout his body. -The sildenafil citrate attaches to the PDE5 enzyme in his penis and disables most of it. -When the man becomes sexually aroused, the brain sends the normal message to the NANC cells in his penis, which produce nitric oxide as usual. -The nitric oxide creates cGMP, which starts relaxing the arteries in his penis. -Since the PDE5 has been disabled, the cGMP in the penis does not break down. -Instead, it builds up and lets the arteries in the penis fully dilate. -His penis inflates with blood, and the man gets a full erection. |
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Implants
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-Non inflatable (semi-rigid)
*less parts to malfunction *less expensive *difficult to conceal -Inflatable: *pump is in scrotum *more natural appearance *requires ability to work pump *more complex surgery |
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Benign Prostatic Hypertrophy
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-Prostate should be walnut sized and smooth, firm to the touch, bouncy
-Enlargement of the prostrate gland -Related to aging and hormones -Cuase is unknown -Treatment: *avoid anticholinergics and antidepressants *prostate massage *PROSCAR: lowers androgen levels and will shrink prostate gland *Transurethral Resection of the Prostate (TURP) |
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TURP
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-Removal of the prostate through the urethra
-Post-op: three way foley irrigation to keep clots from forming -What to expect: *hematuria *mild voiding problems *retrograde ejaculation *bladder spasms: BNO (belladonna and opium) given for this |
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Prostate Cancer
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-Increased risk with age
-Cause unknown -Earyl detection will increase prognosis *Rectal exam anually starting at 40 *Prostatic Specific Antigen (PSA) +blood test +wait 7 days after digital rectal exam is done +Baseline for normal levels for a person is necessary to get |
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Prostate Cancer Treatment
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-Inhibit male homrones
*orchiectomy -Female hormones *DES, estrogen, lupron -Radiation *internally planted and external -Surgery *radical prostatectomy |
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Radical Prostatectomy
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-Suprapubic: abdominal incision
-Perineal: impitence common side effect -Retropubic *increased risk for contamination for last two listed |
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Urinary Tract Infection
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-Lower tract: urethra, bladder
-Upper tract: ureters, kidney -Ascending: moving upward (can occur d/t no treatment) -Descending: may be caused by an obstruction -More common in women |
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UTI risks
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-Catheterized patients
-Pregnant women: urinary stasis or obstruction -Elderly: hygiene -Multiple sex partners -DM: bacteria growth -Urinary stasis (enlarged prostate) -Poor Hygiene |
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UTI Treatment
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-Take all antibiotics ordered
-Encourage fluids (2L) -Acidify urine (cranberry juice) -Educate/practice proper hygiene -Empy bladder before and after intercourse -Void at first urge -Avoid coffee, tea, alcohol *diuretics |
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Gstro-Intestinal System
Diagnostic Tests |
-Endoscopy
-Upper GI: x-ray procedure, swallow barium -Barium enema |
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Achalasia
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-Motor disorder
-Absent or ineffective peristalsis -Failure of the lower esophageal sphincter (LES) or cardia sphincter *pain with swallowing *food sticking to the back of the mouth *symptoms increase with stress |
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Gastro-Esophageal Reflex Disease (GERD)
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-Backwards flow of stomach contents into the esophagus causing pain and irritation
-Associated with hiatal hernia *heartburn *dysphagia (most common) *acid regurgitation *pain relieved when standing |
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GERD treatment
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-Antacids
-Dietary management *small frequent meals -avoid hot and cold foods -avoid high fat foods -avoid nicotine -do not lie down after eating -elevate head of bed |
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Hiatal Hernia
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-Protrusion of an upper portion of the stomach through an area of weakness in the diaphragm
-More common in women *heartburn 30 minutes after a meal *substernal pain *belching *feeling of abdominal fullness *50% of patients who have it don't have symptoms |
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Hiatal Hernia Treatment
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-Avoid:
*Hot and spicy foods *Ingestion of large meals *apparel that is constrictive *Twisting, bending, lifting *Alcohol and nicotine *Limit carbonated beverages -do not lie down after a meal and elevate HOB -Antacids and H2 blockers -Anticholinergic -Surgery: *Nissan fundoplication (best results) *Hill and Belsey procedure *Chick Angel Device (old) |
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Gastritis
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-Inflammation of the gastric mucosa
-Caused by: NSAIDs, ASA, Digoxin, Spicy foods -Symptoms: anorexia, nausea, belching, vomiting, epigastric tenderness, + blood in stool -Treatment: small frequent meals, bland diet, avoid high fat foods, avoid nicotine -Antacids and H2 blockers |
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Medications
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-Antacids: neutralize acid
*maalox, tums, gaviscon -H2 blockers: inhibits secretion of gastric acid in parietal cells *tagamet, pepcid, zantac -Cytoprotective agents: produce ulcer adherent complex that hastens healing *carafate |
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Appendicitis
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-Inflammation of the veriform appendix
-7% of population -Most common in 10-30 -S/S: *right upper quadrant pain *acute pain at McBurney's point with rebound tenderness *Rigidity of abdomen *+ Rovsings sign (when left side palpated pain is felt in right side) *Increased WBC |
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Appendectomy Pre-op
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-NPO
-Hold analgesic until diagnosis has been comfirmed -NO enemas or cathartics (laxatives) -Surgery ASAP to prevent rupture |
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Appendectomy Post-op
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-NG post-op: open classic method
-Semifowlers position -NPO *Until bowel sounds return/passing gas -Complications include: *infection *hemorrhage *paralytic ileus |
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Intestinal Obstruction
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-When normal peristalsis does not take place
-Nutrients do not move through GI tract -Digestion and absorption is inhibited -Potenially life threatening -Mechanical of functional |
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Mechanical
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-Adhesions
-Intussusception: one portion of the bowel slides into the next -Volvulus: the rotation or twisting of a loop of intestine around itself -Hernia -Tumor |
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Functional
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-Achalasia
-Paralytic ileus *common after surgery *absent bowel sounds *abdominal distention -Mesenteric infarction *blood clot causes interrupted blood supply *acute pain |
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GI Manifestations
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-Nausea
-Vomiting -Diarrhea -Constipation |
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Laxatives
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-Bulk (metamucil): absorbs water and increases fecal bulk
-Stimulant (dulcolax): stimulates peristalsis through mucosal irritation -Stool softener (colace): facilitates the mixing of water into stool -Osmotic (milk of magnesia): retain water in the feces |
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Naso-Gastric Tubes
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-Reasons for them:
*diagnostic *Lavage *Gastric decompression *Delivery of food or meds -Types: *Levin: single lumen *Sump: air port for suction *Enteroflex: flexible, weighted tip |
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Gastric Tube Types
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-Gastrostomy: percutaneous to stomach
-Jejunostomy: percutaneous to jejunem -Percutaneous Endoscopic Gastrostomy (PEG) *placed by endoscopy |
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Care of patient with NG tube
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-Good oral care
-Keep patient in semi-fowler's position -Check tube for migration -check placement *Q shift and before giving meds or intrermitten bolus -Flush (irrigate tube) *before and after instilling meds/feedings *check residual Q 4 hours (should be <30cc) *Hold feedings if >150cc *weigh patient *Accurate I&Os *Assess lab values indicating fluid balance *Change bad and tubing Q 24 hours |
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Enteral Feedings
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-Advantages:
*meets nutritional needs and keeps blood flow to GI tract *Well tolerated by patients *Low cost *Discourages bacterial growth in GI tract -Disadvantages: *tube obstruction *aspiration *diarrhea *constipation *abdominal distention *dehydration *Dumping syndrome |
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Dumping Syndrome
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-Rapid emptying of the stomach contents into the small intestine
*characterized by sweating & weakness -Usually happens when a person is first put on tube feedings -Formula's high osmolarity causes cells to become dehydrated |
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Malabsorption Disorders
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-Diseases of the small intestine are the most common cause of malabsorption
-Categories of malabsorption: *Mucosal (transport) *Infectious diseases *Luminal problems *Post-operative *Disorders that cause malabsorption of specific nutrients -Lactose intolerance: limit lactose intake -Gluten Intolerance *S/Sa: steatorrhea: the presence of greater than normal amounts of fat in the feces which are frothy and foul smelling and floating; a symptom of disorders of fat metabolism and malabsorption syndrome *Sprue: tropical organism (weight loss, diarrhea, anemia) *Celiac disease: intolerance of gluten (rice, corn, soy) |
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Cholelithiasis (gallstones)
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-Calculi formation in the gallbladder
*stones are solid consituents of bile -Common: *most prevalent after age 40 *by age 75 one in three people will have gallstones |
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ERCP
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-Endoscopic Retrograde Cholangio pancreatography
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Cholecystitis
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-Inflammation/infection of the gallbladder
-Usually caused by gallstones -Cause unknown -Risks (5 f's) *Fat *Forty *Fertile (oral contraceptive) *Fair *Female |
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Cholecystitis Signs & symptoms
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-May be assymptomatic
-Episodic right upper quad pain radiating to the back -Intolerance to fatty foods -Pale, clay colored stools -Pruritis associated with jaundice -Itchiness |
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Cholecystitis Treatment
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-Medications (chenodeoxycholic acid) to dissolve the gallstone
-Dietary management -Non surgical removal *lithotripsy *Endoscopic stone retrieval -Surgery (endoscopic or open) |
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Laparoscopic Cholecystectomy
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-Four small pin-like incisions
-Abdomen filled with CO2 -Gallbladder placed in a bag -Removed through the incisions -Minimal complications |
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Open Cholecystectomy
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-Surgical incision
-Gallbladder removed -More complications -T-tube *used to maintain patency of CBD until edema subsides *drains the bile made by the liver *monitor output-expect large output in first 24 hours |
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24 Hour Urine Collection
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-Measures urine output and urine
constituents for a 24 hour period -Patient voids at beginning of test and discards that void -All subsequent voids are measured and documented and refigerated for a full 24 hours |
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Small Intesting Absorption
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-Duodenum: iron and calcium
-Jejunum: fat, protein, carbs, sodium, and chloride -Ileum: B12 and bile salts |
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Liver
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-Upper right quadrant
-Stores and filters blood -Secretes bile and metabolizes sugar |
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Gallbladder
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-Reservoir for bile
-Bile helps alkalinize intestinal contents and absorbs and digests fats |
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Hematest
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-Emesis, urine, feces
-Testing for blood in excretions of GI or GU tracts |
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BUN
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-Blood Urea Nitrogen
-Normal values: 5-20mg/dl -Testing for glomerular function of in the kidneys -BUN increases with decreased kidney function, GI bleed, dehydration, fever, sepsis, increased protein intake -BUN decreases with end-stage liver disease, decreased protein intake, starvation, conditions resulting in expanded fluid volume (pregnancy) |
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Creatinine
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-Normal values: 0.7-1.5mg/dl
-Creatinine is an end-product of muscle metabolism -Concentrations are dependent on lean muscle mass -Creatinine increases when renal function decreases |
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Serum Bilirubin
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-A yellow bile pigment found as sodium
bilirubinate (soluble), or so an insoluble calcium salt in gallstones -Formed from hemoglobin during normal and abnormal destruction of erythrocytes by the reticuloendothelial system -Normally small amounts in blood -It is seen in conditions where there is excessive destruction of RBC or interference of mechanisms of excretions in the bile |
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Gastro-Intestinal Diagnostic Tests
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-ACT NOW
-A:allergies -C:consent form -T:teaching -N:NPO -O:positioning -W:vital signs |
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Esophagogastroduodenoscopy
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This is a test for visualization of the
GI tract from the mouth to the duodenum |
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Colonoscopy
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-Pt should limit food/liquid intak for
24-72 hours before procedure -18 hours before procedure pts drink golytely to stimulate evacuation of bowels -Laxatives and enemas may also be ordered -Routinely done at age 50 then every 5-10 years after that |
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Sigmoidoscopy
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-After procedure nurse monitors for
rectal bleeding and signs of intestinal perforation (fever, rectal drainage, abdominal distention, and pain) |
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Oral Cholecystogram
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-Radiographic record of gallbladder
structure and function after oral administration of a contrast medium |
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Intravenous cholangiogram
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-Record of the visualization of the
gallbladder and bile duct -Contrast medium is injected intravenously |
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Endoscopic Retrograde
Cholangiopancreatography (ERCP) |
-Examinatin of the hepatobiliary system
-Carried out via a fiberoptic endoscope -Inserted into the esophagus to the duodenum -Glucagon or anticholinergics may be given eliminate duodenum peristalsis |
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Urinary Incontinence
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-Stress: involuntary loss through
increase in intra-abdominal pressure r/t coughing, sneezing, or position change; effects child bearing women -Urge: pt is aware of need to urinate but is unable to reach toilet in time -Overflow: overdistention of the bladder; seen in neurologic abnormalities, tumors, or obstructions -Reflex: absence of normal sensations r/t spinal cord injury -Functional: severe cognitive or physical impairment make it difficult for pt to identify need to void |
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Urine Retention
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-The inability to fully empty the
bladder -Can lead to overflow incontinence -Can occur post-op especially if surgery affected the perineal or anal regiions -General anesthesia also reduces bladder muscle intervention -S/S:pain, restlessness, chilling, flushing, headache, diaphoresis, increase in BP |
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Measuring Risidual Urine
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If the scanner measures more than 100mL
of urine after the pt voids, then a catheterization should be performed to reduce risk of UTI and bladder overdistention |
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Nursing care for pt with cath
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-insertion is sterile
-maintain closed drainage -tape catheter tubing securely -keep collection bad lower than bladder -good pericare -monitor I&Os -encourage fluid intake empty bag Q8hours or PRN -After removal, monitor for return of bladder function |
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Suprapubic Catheter
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-Catheter or tube placed into the
bladder through a suprapubin incision -Trial voiding: catheter is clamped for 4 hours and pt attempts to void normally *catheter is unclamped and residual measured, if <100ml (twice, am and pm) then Suprapubic cath. is usually removed *if not it is changed Q6-12 weeks |
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Benign Prostatic Hypertrophy
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-Enlargement of the prostate
-As it enlarges it extendes upward into the bladder and obstruct flow of urine S/S:fatigue, anorexia, N&V, epigastric discomfort, and multiple urinary symptoms |
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Impotence
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-Psychogenic: anxiety, fatigue, stress,
depression, pressure to perform sexually -Organic: occlusive vascular disease, endocrine disorders, trauma, alcohol, medications, and drug abuse |
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Nursing care of pt with renal calculi
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-pain relief
-hot baths or moist heat to flank area -Fluids are encourage -Diet restriction: *protein < 60g/day to decrease urinary excretion of calcium and uric acid *Sodium <3-4g/day *low calcium *restrict oxalate containing foods: spinach, strawberries, rhubarb, tea, peanuts -Urine is strained to catch stones |
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Risk factors of organic impotence
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-decreased sex hormone production
-neurologic damage -BPH -decreased arterial blood flow -prostate cancer -urologic dysfunction |
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Nursing care of pt s/p radical
prostatectomy |
-Strict I&Os
-S/S of F&E imbalance must be monitored for (>bp, confusion, resp. distress) -ambulation soon after surgery to asses pain -assess bladder for irritability, drainage -encourage walking but not sitting for long periods of time -no excessive straining |
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S/S of UTI in elderly
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-Altered sensorium
-Lethargy -Anorexia -New incontinence -Hyperventilation -Low grade fever -Generalize fatigue -Change in cognitive function |
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Urinary Antiseptics
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-Levaquin: bacterial DNA synthesis
-Macrobid: bacterial enzymes, should not be used in people with renal insufficiency -Cipro: |
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Medications
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-Antacids: neutralize or reduce acidity
*examples: maalox, tums, gaviscon -Laxatives: remedies that move the bowels *stool softeners: facilitate mixing h20 in stool; colace DSS *bulk formers: absorb water and increases fecal bulk; metamucil *surfactants: increases slipperiness of colon; oil retention enema *contact laxative: stimulates peristalsis through mucosal irritation; Dulcolax *osmotic: retains water in feces; lactulose, golytely, MOM |
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S/S of Intestinal Obstruction
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-Crampy wave-like, colicky pain
-pt may pass blood and mucus but no fecal matter and no flatus -vomiting -dehydration -intense thirst -vomiting of fecal matter -Hypovolemic shock Nurse reports: I&O imbalances, worsening pain, abdominal distention, increased NG output Meds: reglan, compazine, phenergan |
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Purposes of GI Intubation
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-to decompress the stomach
-remove gas and fluid -lavage the stomach -remove ingested toxins -dx disorders of GI motility -admin medications and feedings -treat an obstruction -aspirate contents for analysis |
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Complications of NG Tube Feeding
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-Diarrhea (most common)
-N&V -gas, bloating, cramping -constipation -aspiration pneumonia -tube placement -tube obstruction -residue -nasopharyngeal irritation -hyperglycemia -Dehydration and azotemia (excessive urea in the blood) -tube feeding syndrome: excessive urea and dehydration |