NRSG 126 - Week 11 Flashcards
(77 cards)
1
Q
what is the functional unit of the kidney
A
nephron
2
Q
issues with removing waste results in? (assessment or diagnostic)
A
o Serum (blood) levels build up
o Elevated urea (BUN) and creatine (Cr)
3
Q
how to fix issues with drug metabolism (assessment or diagnostic)
A
o May need to alter medication dosages
4
Q
blood pressure (assessment or diagnostic)
A
renin - vasoconstriction and fluid and Na retention
5
Q
what happens when fluid and electrolyte imbalance (assessment or diagnostic)
A
o Fluid and electrolytes balance
o Failure = retention/elevated electrolytes
6
Q
RBC’s (assessment or diagnostic)
A
o EPO (erythropoietin)
o Decreased production can lead to anemia
7
Q
bone health (assessment or diagnostic)
A
bone disease
8
Q
kidney - changes with aging
A
- The function unit – nephron decreases with age by age 80 GFR can go down from 125 to 60 – 70 ml/min
- Vessel hardening impacts perfusion
- Leads to decreased function and decreased waste filtered
- Increases risk for
o UTI
o Overall kidney damage
9
Q
normal Gu functions (Micturition, normal output, how much per day, colour)
A
o Micturition – “void”
o Normal output of 30ml/hour minimum
o 1-2 L per day
o Clear/yellow urine
o Continent
10
Q
how much should the bladder hold and void and how does the signal work
A
- Bladder should hold 500F, 700M, Void when there is 200-350 mls
- Bladder fills-sensory nerves signal the brainstem. Forebrain activity controls voluntary micturition. Afferent signals result in simultaneous contraction of the bladder and relaxation of the sphincter
11
Q
urinary tract length and uti risk
A
- Male – 18 – 20 inches
- Female – 2 – 4 inches
- Who is a greater risk to develop a UTI – females because of the short urinary tract
12
Q
GU Function - Changes With Age
A
- What are some changes that occur in the bladder with ageing
o Bladder capacity = hardening and less elasticity
o Bladder muscle strength decreases?? - Increases risk for UTI, incontinence, and leakage
- May have difficulties emptying or emptying fully leaving a PVR (post void residual, the residual left in bladder) of over 50 (which is the norm)
13
Q
kidney damage, where is the pain, what happens to fluid, how does it impact output
A
- Where is the pain? Back pain
- What happens to fluid? – can lead to fluid retention
- How does it impact output? – can impact output (polyuria, oliguria, hematuria, dysuria, anuria)
14
Q
what is uria, polyuria, oliguria, hematuria, dysuria, anuria)
A
o Uria = urine
o Poly – lots
o Olig = little
o Heme = blood
o Dys = difficult
o an = none (failure to produce urine
15
Q
GU Function – Factors Influencing Urination
A
- Psychological factors
- Sociocultural factors
- Fluid balance
- Diagnostic examination
- Surgical procedures
- Pathological conditions
- Medications
16
Q
GU Function – Common Alterations
A
- Urinary tract infections (UTIs)
- Urinary incontinence: involuntary leakage of urine
- Nocturia: waking at night to urinate
- Urinary retention: accumulation of urine caused by the inability of the bladder to empty
- Urinary diversions: diversion of urine to external source
- Renal failure
17
Q
what is cystitis, pyelonephritis, bactermia
A
- Cystitis:
o infection of the bladder/lower urinary tract - pyelonephritis:
o aka pyelo infection of the kidney/upper urinary tract (kidney) - Bacteremia:
o Bacteria has spread to the blood stream – urosepsis
18
Q
GU – UTI Risks (MOST COMMON HAI)
A
- CAUTI: Catheter associated UTI
- Sexual Activity
- Pregnancy= more sugar, protein and hormones, baby also puts pressure on bladder and can decrease emptying.
- Low Estrogen (post menopause) - helps to produce antimicrobial and strengthens urinary tract.
- Diabetes- higher sugar concentrations can promote bacterial growth.
- Urine retention (Weakening of the bladder and pelvic floor muscles can lead to incomplete emptying of the bladder and incontinence.), enlarged prostate, kidney stones (calcium, salt)
- Bowel incontinence (Types of bacteria that are normally found in the bowel, such as E. coli, are commonly responsible for UTIs.)
- Urinary incontinence
- Immobility (For example, those who must lie in bed for extended periods of time.)
- Surgery of any area around the bladder
19
Q
GU – UTI and S&S in Adults
A
- Dysuria = painful urination
- Nocturia = waking up at night regularly to urinate
- Urgency (due to cystitis = inflamed bladder)
- Frequency
- Hematuria = blood in urine (may or may not be visible) or cloudy foul smell
- Fever/chills (later)
- N/V, fatigue (later)
- Pain back/side/groin - pyelonephritis
- Costovertebral angle (CVA) tenderness – pain with pressure to the kidney area – pyelonephritis
20
Q
GU – UTI S&S in Older Adults
A
- May exhibit some/no signs of symptoms experienced in adults
o Change in LOC***
o Confusion
o Delirium
o Agitation
o Behaviour change
o Falls
21
Q
does asymptomatic bacteriuria have to be treated?
A
- asymptomatic bacteriuria may not need to be treated/ may have asymptomatic bacteriuria does not necessarily need to be treated as it may not cause infection
22
Q
Urine – how do we test this directly?
A
o Routine urine aka urinalysis (RU)
o Culture and sensitivity (C&S)
o 24hr. (kidney function)
23
Q
Non-invasive diagnostics
A
o Bladder scan/ PVR
o Renal US (ultrasound)
24
Q
invasive diagnostics
A
cystoscopy
25
laboratory results - kidney function
o Blood urea nitrogen (BUN)
o Creatinine (CR)
o Estimated glomerular filtration rate (eGFR)
o Can also check other blood work related to infection – WBCs, platelets, RBCs
26
UTI treatment
o Fluids to increase GFR
o Antibiotics to treat bacteria causing infection
27
UTI prevention
o Adequate hydration
o Movement
o Incontinent care
o Caution with indwelling catheter
28
GI System
o mastication, mix with saliva
- esophagus
o move down with esophagus
- Stomach
o stomach stores and mixes
- Intestines
o Small and large intestines absorb water and nutrients
- Digestion of proteins, carbs and fats begin with the help of saliva and pancreatic enzymes. Liver excretes bile giving stool colour.
29
GI System – Mouth
- Mechanical and chemical forces
- Teeth
- Saliva – dilutes and softens. Starts carb digestion
- Lips
- Tongue
- Epiglottis
30
GI System – Esophagus
- 25 cm tube
- Peristalsis
- Secondary Peristalsis- food doesn’t go down and it relaxes below the food and contracts above to push it down.
- Tertiary Peristalsis- pain brought on by stomach acid.
- *primary is the classic wave like pattern of contraction
31
GI System - Stomach
- Storage and Digestive mixing
- Gastrin & Ghrelin
- HCl
- Intrinsic Factor
- Protected by mucus
- Turns food into chyme
- Intrinsic smooth muscle cells cause contractions. Innervated by the SNS and PNS.
32
Hormones
o double G’s (gastrin and ghrelin). Help with digestion and acid secretion.
- HCl
o helps to digest protein and is antibacterial.
- Intrinsic factor
o B12 absorption
- Mucus protects from acidity
33
Empties (leaves stomach) 1st to last
water, carbs, protein, fats.
34
GI System – Small Intestine
- Digestion
- Pancreatic enzymes (amylase, protease, lipase)
- Bile
- Water, electrolyte & nutrient absorption
- 1st two components are most important. All about 7m long.
35
duodenum
o Secretin (stimulates pancreas to release bicarb) and cholecystokinin (stim pancreas to release protease, amylase, lipase)
With lots of fats more cholecystokinin is released getting more help from the gallbladder to release bile.
pancreatic duct- fats= emulsified fats (broken down into milky substance)
36
jejunum
o absorb carbs and protein
37
ileum
o absorbs water, vitamins, iron, fat, bile salts
38
GI System – Large Intestine
- Absorption & Elimination
- Absorb water, Na, Cl
- Produces waste & flatus
- Collects all the goods the small intestine missed!
- Ileum sends in chyme (semi fluid, partially digested food from stomach) to cecum.
- Gastrocolic reflex- food causing peristalsis
39
Process of defecation
o Distension causes relaxation of the internal anal sphincter and signals an awareness of the need to defecate.
o At the time of defecation, the external sphincter relaxes and abdominal muscles contract to force the stool out.
40
positioning during defection
- Use the Valsalva maneuver – caution with CV disease – this increased intrathoracic pressure and can cause tachy then brady and cardiac arrest.
o Closing your nose and breathing out to bring pressure to abdomen
41
normal expectations for GI output
o 3 – 4x/day
o Colour
o Consistency
o Soft abdomen
o BS (bowel sounds) x4 (5 – 30/minutes)
o Tolerating food and fluids
42
how to assess normal GI function
- Nutritional assessment: remember FASTCHECK
- Consider cognition and MSKL affecting ability for nutrition, hydration and elimination.
43
GI Normal – Age Related Changes (Decrease)
o Saliva production
o Motility
o Parietal cells – decreases B12, Fe, Ca, folic acid absorption
o Sphincter tone
- Degeneration of gastric mucosa (stomach not protected as well from the acid)
- Atrophy of intestinal muscle (the microvilli erode atrophy is decreasing, leads to malabsorption)
44
GI – Factors Influencing Defecation
- What can impact defecation
o Diet
o Fluid intake (or loss)
o (Lack of) Physical activity
o Personal bowel elimination habits
o Privacy
45
GI – Commons Alterations
- Age-related changes (already discussed)
- Infectious diseases
- Medical conditions
- Acute Medical Concerns and Interventions
46
GI – Common Alteration: Infection Diseases (Norwalk aka norovirus
o direct contact (person to person), indirect (from contaminated object), reservoir (food/water/infected human), vehicle transmission (food/water)
47
GI – Common Alteration: Infection Diseases (C. Diff)
o causes colitis- “col”=colon & “itis”= inflammation
48
GI – Common Alteration: Infection Diseases (Rotavirus)
o viral infection, non-bacterial food borne illness
49
GI – Common Alteration: Medical Conditions - IBD (Inflammatory Bowel Disease)
o thought to be autoimmune.
o Pain, fever, vomiting, diarrhea, rectal bleeding, anemia, weight loss.
o No cute.
o Tx- corticosteroids, immunosuppressants, diet changes, surgery.
50
GI – Common Alteration: Medical Conditions - IBS (Irritable Bowel Syndrome):
o changes cannot be explained, due to diet, stress, psychological – triggered by GI infection.
o Treat with bulking foods, antispasmodic (anticholinergic) and antipsychotic.
51
GI – Common Alteration: Medical Conditions - DM (Diabetes):
o constipation, diarrhea or both. GI autonomic neuropathy (damage to nervous controlling digestive system) – gastroparesis (stomach paralysis) .
o High BS (bowel sounds) slow gastric motility and emptying.
o Reduce fat and increase fiber.
52
GI – Common Alterations: Acute Medical Concerns/Interventions
- Pain
- Pelvic floor trauma
- Acute illness, surgery, anesthesia
- Medications
- Enteral feeding
53
What are some acute and chronic causes of constipation? (acute or chronic
o Medications (narcotics, polypharmacy)
o Immobility (paralysis)
o Poor water intake
o Poor fiber intake
o Many health conditions (ex. Diabetes, heart failure, depression, ED)
54
constipation is defined as any of two of...
o Straining
o Lumpy hard stools
o Sensation of incomplete evacuation
o Use of digital maneuvers
o Sensation of anorectal obstruction or blockage with ¼ of BMs
o Decrease in stool frequency (less than 3 BMs/week)
55
What is fecal impaction?
o Infrequent stools
o Difficulty with stool passage
o In older adults, constipation may be associated with fecal impaction and overflow fecal incontinence
o Fecal impaction can cause stercoral ulceration (rare ulcers of the colon, specifically the sigmoid colon and rectum, caused by pressure and irritation from hard, impacted feces, often resulting from chronic constipation), bleeding and anemia
56
GI - Diarrhea
- Multiple loose stools/day
- Acute: Food, travel, viruses
- Chronic: Allergies/Intolerances, medication, IBS
- Nerves! SNS activation
- Multiple – 3+/day
57
GI - Complications: Constipation
o Hemorrhoids
o Anal fissure
o Fecal impaction
o Rectal prolapse
o Bowel obstruction
58
GI - Complications: Diarrhea
o Dehydration
o IAD type irritation
o Electrolyte imbalances
o Decreased intake
59
What electrolyte will we lose in diarrhea?
Potassium (loss it and it can affect heart function)
60
Ostomies – Bowel or Bladder Diversions and what could be a concern?
- Colo – large intestine
- Ileo – small intestine
- Uro – urinary
- Can be an option for diversion due to cancer blockages, inflammatory bowel diseases like chrons (inflammation anywhere from mouth to anus, may have healthy spots b/t the inflammation) and colitis (typically large intestine, all inflamed). They can cause diarrhea or constipation.
- nutrition and absorption
61
GI and GU Assessment - physical
o Skin- perineum, rectum
o Kidneys, Bladder
o Nutrition, Abd, Bowels
o Mobility/continence
62
GI and GU Assessment - Subjective
o PMHx (past medical history)
o Patterns of elimination
o Pain/discomfort
63
The patient has hemorrhoids
frank blood (regular blood)
64
the patient is on NSAIDS and has an upper GI bleed
UGIB - tar stool (blood has been digested making it black)
65
the patient is severely dehydrated
o dehydration = dark, foul smell, less urine, constipation
66
The patient has cancer and the bile duct is blocked
o Bile block = pale/clay stool, green dark urine
67
diagnostics - fecal specimens
- Fecal specimens
o Fecal occult (cant see) blood (FOB), FIT now used for Ca screening (fecal immunochemical test)
o Culture & sensitivity (C&S)
o Ova & parasites (O&P)
68
diagnostics (others)
x-ray, CT scan
Colonoscopy, endoscopy (through mouth)
69
GU Health Promotion
- Hygiene
- Appropriate fluid intake - restrict 2-hour before H.S.
- Promoting patterns
- Kegel exercises
- Avoid or decrease food/fluid which may worsen symptoms
70
GU Health Promotion – Constipation Management
- Exercise
o ↑ colonic motor activity upon waking
- Fluid
- Fiber diet
o 25-30 g/day
o Less with diarrhea to decrease s/s
- Medications
o Do not overuse!
71
Constipation - Bulk forming laxatives (absorb liquid in the bowels):
72
Constipation - Osmotic laxatives (work by drawing water into the intestines)
73
Constipation - Stimulant laxatives (triggers muscles in the bowels to contract, moving stool through)
o Senna
o Dulcolax (Bisacodyl)
74
Constipation - Stool softeners
o Colace (pulls H20 and fat, is classified as a stool softener, does not directly stimulate motility. Colace will not typically provide quick relief of constipation symptoms)
o Do not directly stimulate motility
o Can take a few days to take effect
75
Constipation - Suppositories
o Bullet shaped
o Glycerin (lubricate)
o Dulcolax (stimulant)
76
Constipation - Enemas
o Cleansing
o Oil
o Other types
77
GI Health Promotion – Diarrhea Management
- Check diet (brat diet – banana, rice, applesauce, toast)
- Slow peristalsis
o Loperamide
o Antibiotics for pathogens
- Treat cause
- Prevent dehydration and F&E imbalances
- Prevention- handwashing to avoid food-borne pathogens
- Soluble fiber can help as it slows the GI tract!
- Bulking agents: Metamucil, insoluble fiber.
