Module 8 Flashcards by Sydney Klyczek

Kidney Function (renal function)
the kidneys filter
nephrologists are physicians that specialize in ?
alter drugs and drug dosage based on
the kdineys metabolize most (some eliminated by?)

waste and excess water from the blood

kidney function

patient’s kidney function

drugs (liver)

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Acute kidney failure/renal failure 
-conditions that result in limited blood flow to the kidneys
blood ..
in..
M
hert
...
liver..
use of certain ? 
-..agents 
-dyes used in 
NS...
al..
severe 
severe 
severe

loss-fluid loss 
infection 
MI 
heart disease 
lupus 
liver failure 
drugs 
-chemotherapy agents 
radiographic imaging 
NSAIDs
alcohol 
burns 
dehydration 
allergic reaction (anaphylaxis)

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Chronic Kidney failure: diseases that impact on kidney function 
-...
high 
plyscystic 
recurrent

Diabetes (DM) -IDDM
type 1 and type 2

blood pressure - hypertensio (HTN)
-kidney disease
kidney infection

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Kidney damage in COVID-19
the protein spikes on this virus detect ?
the virus uses the ACE2 receptors to enter the ?
some organ cells have greater expression of ACE2 receptors which put those organs at greater risk from ?

ACE2 receptors found on cells in the host
cells of the host
SARS CoV-2 includes the kidneys

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How does COVID damage the Kidneys:
the virus itself infects the ? kidney’s have receptor cells that allow the virus to ? (similar receptors found on?)
too little oxygen causes kidneys to ? (low oxygen levels in blood leads to ?)
the body’s reaction to the infection (…storm)
-body sends out ? that help cells communicate as the immune system tries to fight ?
but this results in severe ? this inflammatory reaction can destroy ? including?
COVID-19 causes tiny ? this can clog the small blood vessels leading to and within ? which impairs ?
repair of kidneys following COVID is ?

kidneys
-attach and invade (lungs and heart)
-malfunction/ kidney damage
cytokine/ cytokines/ an infection / inflammation / healthy tissue including kidney tissue

blood clots to form in blood stream/ kidneys / kidney function

uncertain

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Kidney damage in COVID:
reduced kidney function can occur despite no prior history of ?
up to 30% of patients hospitalized in china and ny developed ?
detected through abnormal ?
patients may require ?
kidney issues and the need for dialysis can persist beyond the ?

kidney dysfunction 
moderate or severe kidney injury 
lab work findings (BUN and Creatinine) 
dialysis 
acute phase of illness

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Dialysis: 
a process to remover ? from the blood of the body when kidneys are not ? 
typically completed? 
duration of dialysis is about ? 
considerations for SLP intervention 
-
-
-

waste products and fluid from blood of body / functioning properly
3 times per week
4 hours

positioning
fatigue
cognitive status

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Clinical symptoms of renal impairment: 
xero..
H...
shortness of 
reduced 
n..
v...
dehy...
wea...
...cramps 
f...
dry...
and possible

xerostomia 
HTN 
breath 
appetite 
nausea 
vomiting 
dehydration 
weakness 
muscle cramps 
fatigue 
dry,itchy skin 
changes in cognitive function

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Dialysis: hemodialysis and peritoneal dialysis
acute
chronic

renal failure (ARF) 
renal failure - chronic kidney disease (CKD)

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Lab values: renal function
creatinine: a waste product made when your body breaks down ?
increased creatinine may indicate that kidneys are not

protein you eat and when muscles are injured

not working normally

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BUN-
urea is a waste product of ?
produced from breakdown of protein already ?
BUN can increase if intake of ?
patients with kidney disease are frequently placed on?
lower in? may also have ?
increased BUN levels can mean kdiney function is ?
BUN levels may also be elevated related to

blood urea nitrogen 
-metabolism 
in body and in diet 
protein increases 
-renal diet
-sodium, phosphorous and protein/ fluid restrictions 
reduced from normal 
-other conditiosn

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Complete Metabolic panel”

includes

BUN and Creatinine

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The gastrointestinal System: 
GI structures: what receptors 
includes: 
-
-
-

ACE 2
liver
intestine
pancreas

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COVID- GI function
impact on GI function
-initial symptoms of infection can include

limited number of ?
for patients with chronic GI issues, monitoring was ?

in patients with COVID injury/disorders of the GI system have been found including
liver 
acute 
acute 
feeding

diahrrea, vomiting and abdominal pain

endoscopic procedures completed
limited

liver injury 
acute cholecystitis 
acute pancreatitis 
-necrotizing pancreatitis 
feeding intolerance 
-medications 
virus itself

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Importance of GI function on decision making for evaluation of swallowing/PO intake
-is digestive tract
are there digestive issues that impact on patient’s ability to ?
sall?
bowel ?
NGT suction of ?
impact of anasthesia on

functional
eat by mouth/ receive non oral nutrition via the gut

small bowel obstruction (SBO)
-bowel sounds (present/absent)
gastric contents
GI function

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Aritifical nutrition:
enteral:
utilizes the
delivered by ?

parenteral: bypasses the ? and delivers nutrition to the body via the

GI tract (stomach or intestines) 
-mouth, via tube, or a combo of two

GI tract/ blood stream (via a vein)

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Non Oral means of Nutrition
utilizing the GI Tract (enteral nutrition) 
short term: 
oral 
naso 
-large 
-small

longer term:
peri…
gas..
jeuji

oral gastric tube (OGT)
Nasogastric tube (NGT)
large bore
small bore

pericutaneous endoscpoic gastrostomy (PEG) 
Gastric tube (GT) 
jeujinostomy tube (J-tube)

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Nasogastric tube: 
lare bore ? 
aka? 
double ? can also ? 
-frequently placed in 
sometimes remains in place after

nasogastric tube (NGT or OGT) 
salem slump tube 
lumen/suction gastric contents 
intubated patients 
extubation

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DHT: 
smaller ? 
placed at the bedside by 
a guide wire is used with tube for ? then? 
placement is checked by ?

bore/diamter than the NGT
qualified nurse (RN)
placement (stiffness) then removed
X-ray prior to intiaiton of any feedings

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Risk of nasal tube placement: 
patient ...
difficulty with 
...
digestive ? 
-intolerance o the ?
.. syndrome (rapid stomach emptying into? )
gastro..
aspiration of tube feedings due to ?

discomfort 
placement 
sinusitis 
issues 
-tube feeding formula 
-dumping syndroe (small intestine) 
-gastroesophageal reflux 
-incorrect tube placement or tube displacement

Percutaneous Endoscopic Gastrostomy:
an .. procedure
-
-

endoscopic procedure

gastroenterology
PEG

radiology procedure

interventional radiology
IR-guided percutaneous gastrostomy

G-tube:
Sometimes the term G-tube is used intechangeably with

cand be confused with an

initially it was the sole way of ?

G-tube placement requires ?

a surgical procedure where an incision is placed in

PEG

open g-tube

placing feeding tube

general anasthesia

upper abdomen to expose stomach

Percutaneous Endoscopic Jeujunostomy:
feeding goes directly to

typically administered via

small intestine

pump (slow, constant delivery of nutrition)

Gastro-jejunal (GJ) tube:
placed in the stomach but with a ?

feeds directly into the ?

has a ? as well which can be used to give? drain? vent?

can use the gastric port for? if safe to do so depending on patients

a PEG can be converted to a ?
-often done if patient is not

thin long tube that is threaded into the jejunal portion of the small intestine

jejunum, second part of small intestine

feedings as well/ condiiton

GJ tube
-tolerating tube feedings

Tube Feeding Delivery: bolus feedings: more in line with ? can help to mantain continuous feedings: completed if body is not tolerating -... issues always provide if the feeding tube is ?

typical consumption of 3 meals per day -circadian rhythms bolus feeds -GI tract issues lower in the GI tract than stomach (within intestine)

``` Formulations for enteral nutrition: formula: varous ? depending on? who decides? - - - - ```

brand and types depending on pt needs or tolerance MD or clinical dietitian ensure boost glucerna jevity

Things to consider: the impact of a feeding tube that is in place may? may see decreased ? due to presence of NGT risk of ? Pt's mental status for compliance to ? patient/family?

``` have impact on swallowing function pharyngeal clearance of bolus / decreased epiglottic inversion aspiration with tube feedings leave tube in place wishes ```

``` Total Parenteral nutrition: feeding directly into the utilized only when the GI tract is ? through a ? contains: - - - - - - custom prepared by a ? for each individual patient ```

bloodstream (bypasses GI tract) -non-functional vein ``` lipids dextrose vitamins minerals amino acids water ``` pharmacist

Non-oral means of nutrition - bypassing GI tract - sending nutrition directly into the blood stream - -

total parenteral nutrition (TPN) peripheral Parenteral nutrition (PPN)

total parenteral nutrition: typically administered ? per day can be completed ?

10-12 hours during sleep

Resections:

intestine small intestine/bowel large intestine/bowel

``` Nutritional status/nutritional recommendations: NPO NPO except NPO with? oral diet: -clear... -full... ...diet mechanical ? regular **** what initiative ```

nil per os meds non oral means of nutrition clear liquid (post-surgical) full liquid (includes liquids not clear) soft consistency diet (chopped vs. ground meats/veggies) -regular consistency diet **international dysphagia diet standardization initiative (IDDSI)

``` Other diet considerations: other necessary diet alterations, other than texture can include: sodium cardiac ...diet ...diet ...diet fluid ... ...diet ```

``` restrictions (Na restiction) cardiac diet/ heart healthy diet diabetic diet (ADA diet) low-residue diet low-fat diet fluid restrictions 1800 calorie diet ```

``` Lab Values: nutritional status visceral protein status: ... low albumin levels indicate albumin levels are also linked with ? -consider these levels when determining typically monitored by the ? can become an issue for patients receiving SLP services with regard to ? or poor ? -calorie count by ? elderly patients in hospital with dysphagia only consumed? ```

non-muscle proteins circulating in the blood malnourishment -strength of immune system pneumonia risk in a pt with aspiration clinical dietician / prolonged nPO status or poor oral intake on modified diet clinical dietician 14.5% of their estimated energy requirements

``` Albumin Levels: albumin: half life of approx. ? -thus not the best indicator of ? does not show albumin levels may be ? if patient is dehydrated ``` prealbumin: half life of ? - a better indicator of current ?

18-21 days (current status) immediate changes elevated 1-2 days -current status

Tube Feeding in Dementia: 34% of 186,835 nursing home patients with dementia were ? no evidence of? no evidence of? tube feeding may actually increase the risk of ?

tube fed increased QOL improved nutritional status developing pneumonia

Tube feeding in severe dementia: main results: there was no evidence of increased ? in patients receiving enteral tube feeding none of the studies examined ? and there was no evidence of benefit in terms of ? authors conclusions: despite the very large number of patients receiving this intervention there is insufficient evidence to suggest that enteral tube feeding is ? data are lacking on the ? of this intervention

survival QoL / nutritional status or prevalence of ulcers beneficial to patients with advanced dementia / adverse effects

Slp Involvemetn in non-oral nutrition / end of life discussions patient and family education regarding ? where are we now - what are the options moving forward -SLP family coordinate with ? .. care team

swallowing function and or comm. function -treatment management options family wishes clinical dietitian and physicians palliative care team

SLP end of life discussion can involve methods to facilitate? when possible to determine ? ... on ventilator cna involve teaching regarding ? for the least restrictive ? document??!!! can involve discussion with MD/care team regarding ? and will the findings have a role in ? are the patient and family wishes ?

communication/ patient wishes -minimal leak speech swallowing precautions for least restrictive PO diet -understood risk what will results of this evaluation demonstrate / moving forward with care for this patient already known?

Surgical intervention in GI: ... -resection of ... surgery

esophagectomy : removal of esophagus typically due to cancer small or large intestine bariatric surgery

anastomosis: a surgical connection between ? potential for stricture ?

between two tubular structures leak narrowing of lumen

Bariatric surgeries: roux en Y ? creates a small pouch from the ? connecting this newly created pouch to ? sleeve gastrectomy - typically a laparoscopic procedure meaning ? approx. 80% of stomach is ? leaving a ... about the size and shape of a banana dysphagia : - -

gastric bypass -stomach/ small intestine small instruments inserted through multiple small incisions in upper abdomen removed/ tube shaped stomach esophageal potential for oral/pharyngeal dysphagia

The esophagus: about .. long primary role: move ? passes behind the ? through the ? barrett's esophagus: acid coming up into the ? results in ? these cellular changes... can result in ?

25 cm long (from incisors to stomach) food/liquid from throat to stomach (peristalsis) heart/diaphragm esophagus from stomach (gastroesophageal reflux)/ cellular changes dysplasia/ cancer

Esophagectomy: removal of a portion of the ? rebuilding a structure to ? various

entire esophagus to remove disease replace esophagus surgeries

``` The immune system: recognizes ? destroys ? made up of ? - - - ``` cytokine storm in COVID: an over response to the body's ? that leads to ? which destorys?

``` pathogens invaded the body pathogens and clear them from the bod white blood cells (WBC) (Leukocytes) -lymphocytes (B&T cells) phagocytes granulocytes -neutrophils (largest number of WBC found within the body) ``` immune system inflammation/ healthy tissue

Immune system, lab values: elevated WBC counts indicate that there is an immune system ? an elevated ANC can indicate ? neutrophils are present in the oral cavity and work to ? changes to the immune response can occur after ? -this can result in a reduction in ? in this case, secretion of salive is? -leads to an increase in the number of ? which if aspirated presents a greater risk of

response taking place bacterial infection present trap bacteria and remove debris stroke or TBI (reduced WBC) - changes in oral protection from bacteria - diminished - bacteria/ infection

``` Immune system - lab values: WBC levels: low levels -indicate risk for -neutropenia can be caused by ? -risk for changes in ? high levels ? can indicate ? ```

also called neutropenia -developing infection systemic stress -oropharyngeal bacteria control can result in pneumonia neutrophilia acute infection

``` COVID testing: antigen testing: detects certain ... swab can be completed as a ? false negatives are ? patient is positive for COVID 19 but the test shows a? if COVID is highly suspected and results are negative an ? ``` molecular testing-polymerase chair reaction (PCR) detects ... how collected can be completed as a ? or with ? very ? with some reduction in accuracy when completed as a ?

proteins found in the virus nasal swab rapid test/ or results sent off to the lab possible with rapid test - negative result - MD may order PCR test genetic material of virus nasal swab, throat swab, saliva sample -rapid test or results sent to lab accurate/ rapid test

COVID antibody testing utilized to determine whether someone has ? not proven to detect ? but it is all that is available for testing patients who have ? timing of administration of this test is important for ?

HAD the virus antibodies following vaccination -immunocompromise accuracy in detecting antibodies