Final Flashcards

Question

CKD Nursing Interventions/Tx

Answer 1

- daily weights (1 kg = 1 L retained) - strict I&Os - Safety **seizure & fall precautions!** - Monitor anemia & electrolytes! - monitor urine output - **low protein, fluid, Na, K , phosphorous diet!**

Answer 2

Removes wastes & excess water from blood (replacing fx of the kidneys) **typically 3 days/wk for 3-5hrs per session** - Heparin admin to prevent clotting in tubing!

Answer 3

Solutes are removed too quickly from the blood -> brain cells swell -> increased ICP -> cerebral edema -> AMS, confusion, death

Answer 4

- Double lumen large bore hemodialysis catheter - Red cap = arterial blood, blue cap = venous blood - inserted in internal jugular, subclavian, or femoral veins - increased risk of infection - *used temporarily in AKI or as a bridge until permanent access* - ONLY used for dialysis, NO MEDS!

Answer 5

- **GOLD standard of permanent access!** - usually in forearm - takes 4-6wks to mature!! - **No BPs or needle sticks on this arm!!** - Can palpate a bounding thrill *no lifting > 5lbs, no tight restrictive clothing on the arm*

Answer 6

- synthetic graft material btwn artery & vein - used when vessels are not suitable for fistula (scleroses, stenosed) **risk of infection, thrombosis!**

Answer 7

Before dialysis assess: - fluid status - VS - fistula (feel thrill, auscultate bruit **if not present alert MD!**) - Hold meds that cause LOW BP! (ACEs, ARBs, BBs, CCBs, diuretics, dilators, nitro) - meds that will be dialyzed out (PCNs or cephs, digoxin, water soluble vits B, C, folic acid) - Calcium and insulin

Answer 8

- Dialysate (Hypertonic fluid) introduced into peritoneal cavity via catheter - fluid dwells in peritoneal cavity and then is drained via gravity - removes toxins and wastes like urea, creatinine, metabolic wastes via **diffusion & osmosis** - *slower than HD!* **Before starting tx**: - obtain weight - warm fluid! - must show they can lift 8L dialysate bag & understand how to access catheter!

Answer 9

**Peritonitis** = fever, tachy, cloudy drainage (infection) **leakage** = kink in catheter, coughing/emesis increases abd pressure **Bleeding** = may occur 1-2 days after insertion or during menstruation **Incomplete recovery of fluid** = put 8L in and should get 8L out! If this happens: - inspect catheter but DO NOT REPOSITION IT! - turn pt on side to get full drainage - can be d/t constipation - alert MD if none of these methods work

Answer 10

- indicated for ESRD - can be from living donor or heartbeat only donor Post-op: - antirejection meds for LIFE! - Prevent infection (high risk d/t immunosuppressants) - Assess for rejection! **increased WBCs, S&S of kidney failure, fever, tenderness over implanted kidney - monitor urinary fx (large amount of urine immediately post op) - continuing care = daily weights, I&Os at home, strict renal diet, infection control

Answer 11

- Stones/calculi formed in urinary system or kidneys respectively - blood, minerals, wastes form the crystals Causes: - consuming high amounts of purines, oxalates, salt, Ca/Vit D supplements - hyperparathyroidism - hypercalcemia - hyperuricemia - urine stasis - low activity

Answer 12

- PAIN!! - N/V - Fever - Cloudy, odorous urine - urinary retention - **Hydronephrosis from urine backing up** Diagnosis: - KUB = kidney ureter bladder X-ray - US/CT - Pyelogram , IVP dye (contra if renal failure) - Urinalysis , assess for crystals/infection

Answer 13

- pain management - **HIGH** fluid intake **3-4L/day** - Monitor I&Os - Strain urine! - Prev education on staying hydrated! - stones < 5mm usually pass on their own For stones > 5mm: **Extracorporeal Shock Wave (ESWL)** = noninvasive , shockwaves break up stone **percutaneous nephrolithotomy** = invasive, stone removed by urologist **Nephrostomy tube** = catheter placed in renal pelvis to drain urine until healed

Answer 14

- blunt force trauma to lower abd/pelvic region - **indwelling catheter contraindicated if blood at urinary meatus until tear is r/o** - can be caused by unintentional injury during Sx - may cause fistula of ureter & vagina!

Answer 15

Caused by pelvic fx or multiple blows to abd when bladder is full ** #1 S&S is gross hematuria**

Answer 16

- tumors typically arise at base of bladder , involving ureteral orifices & bladder neck - Dx w/ cystoscopy, CT, US Tx: - transurethral resection of fulguration (cauterization) - simple cystectomy or radical cystectomy - chemo & radiation

Answer 17

- implanting ureters into loop of ileum led out to abd wall - **urine collected via ileostomy bag!**

Answer 18

- ureters detached from bladder & brought to abd wall - stoma created, usually flush with skin or retracted

Answer 19

**Most common CONTINENT urinary diversion** - segment of ileum and cecum created to form reservoir for urine - Pouch must be drained at regular intervals w/ catheter - maintain aseptic technique and prevent urine from sitting on skin!

Answer 20

- stoma should be **pink/red and moist** - If stoma appears **dusky, purple, brown, black** = BAD, ischemia and/or necrosis! - dusky color is superficial ischemia and outer layer of mucosa may slough off in several days

Answer 21

Islet of Langerhans produce: insulin, glucagon, somatostatin, pancreatic polypeptide

Answer 22

Acinar cells secrete **digestive enzymes** into pancreatic ducts -> flows through **ampulla of vater** (fusion of pancreatic & common bile duct) -> into duodenum where digestive enzymes ACTIVATE

Answer 23

Muscular valve that controls release of digestive enzymes and **prev reflux of stomach contents into pancreas & bile duct**

Answer 24

Sudden inflammation of pancreas - something triggered digestive enzymes to activate INSIDE pancreas -> **high amylase & lipase in blood** - limited structural change, damage is reversible!! - mainly caused by alcohol and gallstones - can progress to pancreas digests itself -> tissue dies -> cyst/abscess of dead tissue forms -> can rupture/hemorrhage -> infection/sepsis!! - Activated digestive enzymes can spread to surrounding organs and cause damage

Answer 25

Chronic inflammation of the pancreas - **IRREVERSIBLE** damage to structure of pancreas - fibrosis overtime and can’t produce digestive enzymes - caused by YEARS of alcohol abuse! (Recurrent acute pancreatitis d/t alc) - also caused by **Cystic Fibrosis**!

Answer 26

- Abd pain *worst when lying flat* - Sudden, v painful **mid epigastric pain or LUQ + back** - Pain may start after eating greasy/high fat meal or alc! - fever - Tachy/hypotension - N/V - Hyperglycemia - **Cullen sign** = bluish discoloration around belly button - **Grey Turner sign** = bluish discoloration on flanks

Answer 27

- persistent, chronic epigastric pain! Or no pain d/t pancreas not producing any enzymes - pain is worst after eating greasy/fatty meal or alc - **steatorrhea** = oily/fatty stools d/t lack of pancreatic enzymes & bile - Mass & swelling of abd - weight loss d/t no enzymes to digest foods for nutrients - Jaundice/dark urine = damage to common bile duct -> bile build up - S&S of DM d/t no or inadequate insulin production

Answer 28

- Rest pancreas = NPO until S&S subside then reintroduce food slowly (**liquids first) - maintain IV hydration - Pt edu on foods to avoid , eating low fat small meals - NGT - Monitor BGL - Admin Pancreatic enzymes **give RIGHT BEFORE meal, do NOT mix w/ alkaline foods like ice cream, pudding, milk, yogurt** - admin pain meds **NO MORPHINE -> spasm of sphincter of oddi** - positioning to relieve pain = lean forward, sit up, NO SUPINE - decrease acid secretion w/ PPIs, H2 blockers

Answer 29

Inflammation of gallbladder Caused by Cholelithiasis or Acalculous

Answer 30

Gall bladder stone obstructs bile duct -> increased pressure in gallbladder -> inflammation damages walls -> blood flow compromised -> death of organ Risk Factors: - Female > Male - obese - old age - fam hx - preg

Answer 31

Gallbladder not working, does not contract! Risk Factors: - high acuity pts - post op - severe illness (sepsis, burns, major trauma) - TPN for long time (gallbladder not stimulated)

Answer 32

- N/V , bloating - Fever - epigastric abd pain that **radiates to R shoulder esp after greasy meal!** - **Murphy’s Sign** = palpate under ribs on R side at mid clav line, have pt take a deep inhale, pt stops breathing in d/t pain of palpation - steatorrhea - jaundice - dark brown urine - clay colored stools

Answer 33

“GALLBLADDER” **G**I rest = NPO until recovered -> clear liquids **A**nalgesics & Antiemetics **L**ow fat, gas free foods **L**arge bore IV for hydration & electrolytes **B**reathing in stopped (Murphy’s sign) **L**abs = electrolytes, Bili, WBC, liver enzymes, pancreatic enzymes **A**bx (IV) **D**rain care **D**eterioration = AMS, tachy, hypotension, high temp, high WBC count, worsening abd pain **E**RCP = remove gallstones **R**emoval of gallbladder (cholecystectomy)

Answer 34

Cholecystostomy tube placed thru abd wall into gallbladder - indicated for pt that can’t have immediate cholecystectomy but infected bile needs to be removed - keep collection bag **at waist level to drain** - Empty & record drainage, not color - monitor insertion site for infection - flush per MD order to prevent blockage

Answer 35

Works as a drain and for testing (dye injected into tube, X-ray taken to visualize stones) - drainage bag **kept at abdomen** - pt should be upright in semi-Fowler’s - bile is harsh on skin, maintain integrity - **drainage should be < 500mL / day** - must have MD order to flush! - *may have MD order to clamp tube 1hr before & after meals so bile can enter duodenum to digest fats!*

Answer 36

- Meds - Excessive Alc intake - Illicit drugs - Viruses (Hep A-E)

Answer 37

- CMP for Liver Enzymes - ALT (enzyme) = 7-56 - AST (enzyme) = 10-40 - Bilirubin = < 1 or 1.2 - Ammonia = 15-45 *Lactulose admin for HIGH ammonia -> diarrhea*

Answer 38

- May be asymptomatic - Jaundice / dark urine - N/V, stomach pain, loss of appetite - Fever - Fatigue - Clay colored stool - Arthralgia (joint pain)

Answer 39

- **ACUTE ONLY** no long term complications - **Fecal-Oral transmission** - Can be contagious for 2wks before S&S and contagious 1-3 wks after S&S subside - Diagnosed by blood work for Anti-HAV abs! - Anti-HAV IgM = **active infection!** - Anti-HAV IgG = **past infection or immunity from vaccine** - HANDWASHING for prevention!! - Hep A Vaccine = 2 doses, 6 months apart *Hep A immunoglobulin can be given within 2wks of exposure for temporary passive immunity*

Answer 40

- **Acute AND Chronic (leads to cirrhosis or liver cancer)** *infants & young children at greatest risk for chronic!* - **Blood and bodily fluid transmission!** - Blood work for Hep B surface antigen , positive = current infection! - Anti-HBs = recovered or immune - Tx Chronic Hep-B with antiviral meds or interferon - Prevent w/ handwashing, sharps precautions - **Vaccine for ALL INFANTS (3-4 doses 6-18mo course)** - All preg women tested , immunoglobulin give 12hrs post birth if POS - Immunoglobulin given within 24hrs for all other exposures

Answer 41

- Acute AND Chronic! - **blood & bodily fluids transmission!** - Blood work for anti-HCV abs (ONLY FOR CHRONIC) - Tx w/ antiviral meds - Prevent w/ handwashing, sharps precautions, *strict screening for blood transfusions & organ donors!* - **NO VAX OR IMMUNOGLOBULIN THERAPY**

Answer 42

- Acute AND Chronic - **Blood & bodily fluid transmission** - **ONLY infects a person when they have HEP B!!** - Blood test for HDAg and anti-HDV - Tx w/ antiviral meds or interferon - Prevent w/ handwashing & sharps precautions - Hep B vaccine to prevent development of Hep D! *no immunoglobulin for post exposure*

Answer 43

- ACUTE ONLY! - **Fecal-Oral transmission!** - Blood test for HEV abs - no Tx, rest & supportive for S&S - prev w/ HANDWASHING! - Use bottled water outside of US & cook meat thoroughly! - **No Vax or IGs!** *Can cause major complications in 3rd Tri of pregnancy!*

Answer 44

**H**andwashing **E**at low fat & high carb diet - helps w/ liver regeneration **P**ersonal hygiene products NOT to be shared **A**ctivty conservation - rest to heal liver **T**oxic substances avoided - esp hepatoxic OTC like alc, sedatives, ASPARIN, Tylenol **I**ndiviual bathrooms **S**mall but freq meals - helps w/ nausea *pt should NOT cook for others until not infectious!*

Answer 45

Remove bacteria, debris, parasites, and old RBCs from blood entering liver

Answer 46

Produce bile, metabolize drugs/substances, store clotting factors, conjugate bilirubin, detox

Answer 47

excess glucose synthesized and stored as glycogen! *in cirrhosis can’t synth glycogen -> hyperglycemia! And the reverse, can’t convert glycogen to glu -> hypoglycemia!*

Answer 48

- Stores vit B12, A, E, D, K, minerals, Iron - Bile is ESSENTIAL for absorption of fat soluble vitamins *Cirrhosis impairs bile prod -> decreased absorption & storage of fat sol vitamins*

Answer 49

- Bilirubin in bile and stool - Old RBCs removed by Kupffer cells break down Hgb to heme & globin - Hepatocytes metabolize heme into Fe & bilirubin - Bilirubin put into bile and excreted via stool *in cirrhosis Hepatocytes leak bili into the blood -> jaundice*

Answer 50

Produces albumin, fibrinogen, prothrombin

Answer 51

Liver disease that leads to scarring of liver Causes: - Viral infection of Hep B & C - Alc consumption - Fatty liver (obese, HLD, DM) - Autoimmune disease (attacks liver) - Bile duct issues (bile stays in liver & damages cells)

Answer 52

- Typically asymp - intermittent mild fever - Ankle edema! - Unexplained epistaxis - Palmer erythema - Vascular spider veins - Splenomegaly - Firm, enlarged liver

Answer 53

- Ascites - Jaundice - Muscle wasting & weight loss - Continuous mild fever - hypotension - clubbing of fingers - GI bleeding from esophageal varices

Answer 54

**T**remors of hands (**asterixis** or hand flapping d/t increased toxins in blood **H**epatic foetor (late sign, pungent, sweet, musty smell to breath) **E**yes and skin yellow (jaundice) **L**oss of appetite (spleen pushes on stomach) **I**ncreased bili & ammonia **V**arices (esophageal d/t increased pressure in portal vein) **E**dema in legs (low albumin) **R**educed plts & WBCs **I**tchy skin (toxins in blood) **S**pider angiomas (chest, d/t increased estrogen in blood) **S**plenomegaly & Stool clay colored **C**onfusion or Coma (high toxins & ammonia) **A**scites (low albumin) **R**edness on palms (increased estrogen in blood) **R**enal failure **E**nlarged breasts in men (increased estrogen) **D**eficient on vitamins (fat soluble vitamins)

Answer 55

Portal v becomes narrowed d/t scar tissue in liver -> reduces blood flow to liver -> increased pressure in portal vein -> affects connected organs like spleen & GI structures (esophagus) -> varices!

Answer 56

Plts & WBCs are trapped in spleen d/t increased pressure in portal vein

Answer 57

Increased pressure in portal vein causes vessels to become weak & rupture. **At risk of TOTAL BLEED OUT d/t low levels of clotting factors & plts!!**

Answer 58

Ascites -> risk of infection from bacteria in GI system (reduced WBCs from spleen sequestration)

Answer 59

Liver unable to detoxify -> ammonia builds up & collects in brain -> AMS / Coma, neuromuscular problems, asterixis, hepatic foetor

Answer 60

- Liver biopsy to see how much scarring present in liver - Labs to evaluate liver enzymes (ALT/AST) , albumin, plt, & PT levels, Hep B & C titers, bili levels

Answer 61

- monitor for BLEEDING! Limit invasive procedures & **hold pressure at injection sites for 5mins or more!** - Monitor for esophageal varices by looking for dark-tarry stools, bloody emesis. Limit coughing, vomiting, drinking alc, constipation - monitor reflexes & AMS - monitor BGL Tx: - liver transplant - shunting Sx to alleviate Ascites - Diuretics to remove excess fluid - BB & Nitrates to help with portal HTN - Admin blood products & Vit K to help w/ clotting - Lactulose to decrease ammonia levels - **Paracentesis** = removal of fluid from abd

Answer 62

**Tx of choice for ESLD** - total Sx removal of diseased liver Post op complications: - bleeding - infection (immunosuppressants) - REJECTION - Delayed graft fx - Biliary leaks & obstruction - Hepatic artery thrombosis - Portal vein thrombosis

Answer 63

- type of bleed that occurs anywhere in digestive system - may be d/t injury, infection, or inflammation - sudden HEAVY bleeding is more immediately dangerous - Upper GI bleed = **anywhere above the ligament of Treitz (first part of Small intestine)** - Lower GI Bleed = **anywhere below ligament of Treitz**

Answer 64

Abnormal or enlarged blood vessel in the GI tract

Answer 65

May cause bleeding when they weaken lining of GI tract

Answer 66

Ulcers in large intestine may bleed! UC is an inflammatory bowel disease that can cause GI bleeding

Answer 67

Can cause GI bleeding, some may be cancerous

Answer 68

GI bleeding caused by small pouches that herniate outward, pushing against weak spots in colon wall

Answer 69

Lower esophageal sphincter is weak and stomach acid damages esophagus & causes bleeding

Answer 70

If untreated leads to ulcers

Answer 71

Caused by severe vomiting , a tear in mucous membrane at the junction of the esophagus and the stomach

Answer 72

direct effect of gastric acid on esophagus mucosa -> inflammation of esophagus *if severe, can cause serious bleeding!*

Answer 73

Cough, bronchospasm, laryngospasm, cricopharyngeal spasm -> develop asthma, bronchitis, pneumonia

Answer 74

Esophageal metaplasia Normal squamous epithelium replaced w/ columnar epithelium **precancerous lesion!** MUST be monitored every 2-3yrs w/ endoscopy!

Answer 75

Block ATPase that secretes HCl Most common SE is headache Long term/high doses increase risk of fxs of hip, wrist, spine *assoc w/ increased risk of C. Diff in hospitalized pts!*

Answer 76

*Cimetidine* Decreases conversion of pepsinogen to pepsin - decreases secretion of HCl - increases ulcer healing - no common SEs

Answer 77

*Mylanta* Increase gastric pH by neutralizing HCl Quick acting but short lived

Answer 78

*metoclopramide* Promotes gastric emptying = reduced risk of reflux

Answer 79

Erosion of GI mucosa d/t digestive action of HCl and pepsin Gastric ulcer = **lower eso & stomach** Duodenal ulcer = duodenum **#1 cause of peptic ulcers is H. Pylori!!**

Answer 80

H Pylori - produces urease -> inflammation Asa/NSAIDs - inhibit prostaglandins that protect mucosa Corticosteroids - decrease rate of mucosal cell renewal = decreased protection from HCl Lifestyle - alc, caffeine, smoking, stress (increases HCl)

Answer 81

*occurs in any portion of stomach or lower esophagus* *less common* - affects F>M & older adults > 50yo - **pain HIGH in epigastrium (r/o MI)** - Occurs 30min-2hrs post meals - Burning, gaseous feeling - certain foods worse for pain like OJ, spicy, tomato sauce

Answer 82

*More common!* - seen at any age but especially increased 35-45yo - Blood type O at increased risk! - caused by H. Pylori in 90 to 95% of pts!!! - **Mid-epigastric pain beneath xyphoid process** - **back pain if ulcer located in posterior duodenum** - PAIN 2-5hrs POST MEALS!! - **AWAKENING IN PAIN IS CLASSIC SIGN!!** - burning, cramp like pain that comes & goes `

Answer 83

EMERGENCY - d/t erosion of granulation tissue at base of ulcer during healing - STOP BLEEDING -> bedside endoscopy to cauterize or OR - Replace fluids (NS, LR) - Blood products if needed - Cerial CBCs - Monitor VS (hemorrhage = hypoT, tachy) - NGT for decompression

Answer 84

MOST LETHAL! *common in large penetrating duodenal ulcers that have not healed!* - d/t ulcer penetrating serosa w/ spillage of contents into peritoneal cavity -> peritonitis - will have sudden, **severe upper abd pain!** - Tachy w/ weak pulse - **Rigid, board like abd** - Shallow, rapid respirations - Bowel sounds ABSENT - N/V - stop spillage into peritoneal cavity w/ NGT and/or Sx - Abx for peritonitis! *risk of septic shock!*

Answer 85

Ulcer -> histamine -> inflamm of pyloric sphincter -> food stuck in stomach - pain worsens towards **EOD as stomach fills** - pain relieved with belching & vomiting (emptying stomach) - swelling in stomach & upper abd - loud peristalsis (borborygmus) - NGT for decompression - Correct fluid & electrolyte imbalances

Answer 86

- multiple Abx used to eradicate H. Pylori infection - **usual Tx is 7-14 days or longer!!** - Dual therapy = ranitidine bismuth citrate w/ clarithromycin - another option is Amox, calrithromycin, and omperazole

Answer 87

- coats esophagus and stomach lining - accelerates ulcer healing - used for short term tx! - given Q6h, **NPO 1hr before/after, issues w/ pt compliance!**

Answer 88

*gastroduodenostomy* - partial gastrectomy w/ removal of distal 2/3 of stomach and anastomosis of gastric stump to duodenum!

Answer 89

*gastrojejeunostomy* Partial gastrectomy w/ removal of distal 2/3 of stomach and anastomosis of gastric stump to jejunum!

Answer 90

*severing of vagus nerve* - vagus nerve innervates stomach and activates HCl prod - partial vagotomy -> decreased innervation/stimulation to parietal cells -> decreased acid prod - decreased gastric motility & gastric emptying *pyloroplasty done after vagotomy to enlarge pyloric sphincter and increase gastric emptying!*

Answer 91

- direct result of Sx removal of large portion of stomach and/or pyloric sphincter - stomach can’t control amount of gastric chyme entering SI -> a large bolus of hypertonic fluid enters SI - fluid drawn into bowel lumen 15-30mins after eating - acute weakness, sweating, palpitations, dizziness, cramps, intense urge to defecate!!

Answer 92

*variant of dumping syndrome* - uncontrolled gastric emptying -> bolus of fluid high in carbs in SI -> raises BGL -> excessive insulin release -> rebound hypoglycemia - approx 2hrs post meals sweating, weakness, AMS, confusion, palpitations, tachy, anxiety

Answer 93

- NGT for decompression - observe aspirate for color, amount, odor - color will be bright red first, darkening within 24hrs, yellow-green within 36-48HRS - IV fluids - **Diet = small, DRY feedings, low carb, restrict sugar, mod protein/fat , LIMIT 4oz FLUID W/ MEALS, rest for 30mins post meals**

Answer 94

- freq loose/watery stools of > 200g/day - causes can be drugs/abx, chemo - Infectious agents: viral (rotavirus) , bacterial (salmonella, C. Diff) , Parasitic (giardia) - electrolyte imbalances (**hypokalemia, metabolic acidosis**)

Answer 95

- outpouching of bowel lining - diverticulosis = multiple diverticulum - most common in **sigmoid colon** but can happen anywhere - May not have sig S&S - crampy abd pain in LLQ relieved by flatus or BM - **alternating between constipation & diarrhea** - Prev w/ **HIGH FIBER** diet & adequate fluid intake - Bulk lax like Metamucil - anticholinergics relieve spasm

Answer 96

*diverticula become infected & inflamed!* - can lead to abscesses - can lead to scarring - **LOW FIBER DIET** with active flares! - broad spec abx - increase fluids - bedrest to decrease gastric motility - may be NPO - if it goes down to serous layer -> bleeding/hemorrhage -> perforation

Answer 97

- gluten sensitivity - autoimmune response - damage to SI from ingestion of rye, wheat, barely - causes **steatorrhea** *pt must be careful w/ oats as often cross contamination*

Answer 98

- lack lactase -> can’t break down lactose - diarrhea, cramping 30mins after ingestion - can lead to osteoporosis (not absorbing Ca/Vit D in lactose containing prod)

Answer 99

- intermittent & recurrent abdominal pain - constipation - diarrhea - belching - **STRESS plays a huge role** TX: - 20g fiber / day - avoid gas producing foods - eliminate **fructose & sorbitol** - probiotics may help - anticholinergics - stress management - READ FOOD LABELS!

Answer 100

*encompasses Crohn’s & UC* - an **autoimmune** attack on intestinal tract - chronic, recurrent widespread inflammation and tissue destruction - **periods of remission & exacerbation** - any age but peaks **15-25yo** & white Jewish decent - Diet high in seed oils and red meat may be triggers - stress & smoking - chronic NSAIDs use (inhibit prostaglandins that protect lining)

Answer 101

*inflammation of ANY segment of GI tract* **SKIP LESIONS!** area of inflammation followed by non-inflamed tissue, then another spot of inflamm - distal/terminal ileum and Cecum are the HIGHEST RISK area for the disease! **common to have B12 deficiency** (soluble vitamins are absorbed in distal ileum) S&S: - diarrhea - cramping, abd pain - not as common is weight loss & rectal bleeding from inflammation - fat malabsorption

Answer 102

*inflamm starts at rectum & ascends thru large intestine* - high incidence of occurence in rectum & sigmoid colon - very severe flare up can go all the way to beginning of ascending colon S&S - diarrhea w/ **LARGE fluid & electrolyte imbalances** - bloody diarrhea, several to **20x / day!!** - weight loss - protein loss through stool *sometimes first S&S is skin rash*

Answer 103

- **COLONOSCOPY gold standard for diagnosis** - Stool cultures for pus, blood, mucus - Barium enema study, trans abd US, CT, MRI TX - rest bowel - control inflamm - combat infection - correct malnutrition / electrolyte imbalances - alleviate stress - immunosuppressants , corticosteroids - biological **anti-TNF** MONITOR FOR ALLERGIC RXN! DIET: - **low fiber** to decrease size of feces (pushing against colon walls) - hot & cold foods eaten SLOWLY - Liquid enteral feedings during acute exacerbations

Answer 104

- when its new, stoma is very swollen and large - as it heals it shrinks in size, wafer will have to be cut smaller - when healed should be **beefy red** in color - watch for skin breakdown for improperly fitting wafer - purple, dusky stoma is BAD! Inspect, adjust wafer, contact MD

Answer 105

**Mechanical** = adhesions, hernia, volvulus, intussusception, tumors **Non-mechanical** = Paralytic ileus d/t Sx, anesthesia **Volvulus** = twisted intestine **Intussusception** = telescoping DX - abd X-ray - barium enema (can also Tx) - colonoscopy - labs for CBC, electrolytes, BUN, amylase (increased in duo obstruction) TX - NGT to decompress - NPO - Correct fluid/electrolyte imbalance - remove obstruction

Answer 106

Acute inflammation/infection of appendix *pain precedes nausea* **McBurney’s Point** = halfway from ischial rim to belly button = rebound tenderness RLQ **Rovsing’s sign** = palpate LLQ, pain in RLQ DX w/ CT, CBC, UA Sx = laparoscopic or traditional incision

Answer 107

Blunt/penetrating trauma to abd - presents w/ guarding/splinting - hard, distended abd **Cullen’s sign** = periumbilical ecchymosis - abd X-ray, CT

Final Flashcards

(133 cards)