Quiz 2 - End of Renal & beginning of GI Flashcards
(80 cards)
1
Q
________ is a test used to look for problems with the filling and emptying of the bladder.
A
Cystometrogram
2
Q
How bladder handles the pressure of the fluid
A
Cystometrogram
3
Q
Insert scope and Graphic recording of pressures in bladder during bladder filling and emptying
A
Cystometrogram
4
Q
Helps diagnose stress incontinence
A
Cystometrogram
5
Q
Describes loss of urine from pressure (stress) exerted on the bladder by coughing, sneezing, laughing, exercising, or lifting something heavy
A
Stress Incontinence
6
Q
A competent sphincter will not allow for any loss of urine, even with a full bladder and maneuvers such as cough, laugh, or position change
A
True
7
Q
2 different types of disorders
A
- Neurogenic disorders
2. Non-neurogenic disorders
8
Q
Bladder dysfunction caused by an interruption of normal bladder nerve innervation
–CVA, Dementia,
Diabetes, Multiple
Sclerosis, Parkinson’s
A
Neurogenic Disorders
9
Q
What kind of disease is Spinal Cord Dysfunction: Acute injury or Degenerative disease?
A
Neurogenic Disorders
10
Q
Overactive bladder, Post surgery, Stress incontinence
–Stroke problem,
A
Non-neurogenic Disorders
11
Q
Caused by trauma or damage to nervous system/spinal cord (multiple sclerosis & diabetes) for both empty bladder by way of catheterization
A
Reflex incontinence
12
Q
Result in a flaccid bladder that fills until it “leaks”
- Nerve that goes from anterior horn of spinal cord to the muscle/bladder
- Bladder/muscle is flaccid no more control of bladder, it fills and fills until leaks,
- Need catheterization to drain the bladder
A
Lower Motor Neuron Injury
13
Q
- Spinal cord lesion above the voiding reflex arc; results in a spastic bladder
- brain until anterior horn of spinal cord
- CNS control
- Spastic bladder so it is always contracting (not strong) constant contracting so often urine dribbling
- Not good contraction of bladder so does not fully empty so need catheterization to empty it
A
Upper Motor Neuron Injury
14
Q
In motor neuron injury patients, some need a bladder training program and have to sometimes catheterize themselves in order to adequately drain bladder and prevent UTI.
A
True
15
Q
Strong urge to void that cannot be suppressed followed by involuntary loss of urine; often individuals have only a few seconds warning. --Occurs with urinary tract infections, neurologic dysfunction (Parkinson’s disease, Alzheimer’s, Stroke), nervous system damage (multiple sclerosis)
A
Urge/Overflow Incontinence
16
Q
Urge Incontinence with no known cause
A
Overactive bladder
17
Q
involuntary loss on urine due to over distention of bladder- may see dribbling because of a flaccid bladder, urethral damage, or diabetic neuropathy, tumors or obstructions, prostate conditions --Inability to empty the bladder/retention --May also see weak urine stream
A
Overflow Incontinence
18
Q
urinary tract is intact but other factors involved – physical or mental impairment prevents toileting in time: Example- a person with severe arthritis may not be able to undress quickly enough to prevent incontinence.
A
Functional Incontinence
19
Q
involuntary loss of urine due to extrinsic factors- medications like alpha adrenergic blockers that relax bladder neck to point where urine leaks with even minimal pressure
A
Iatrogenic:
20
Q
What are the risk factors for developing urinary incontinence?
A
- Being female
- Advancing age
- Overweight
- Smoking
- Other diseases (renal disease, diabetes)
21
Q
DRIPS = causes of acute urinary incontinence
A
D = delirium, dehydration, diapers R = retention, restricted mobility I = impaction, infection, inflammation P = Pharmaceuticals- opioids, calcium channel blockers, anticholinergics cause retention, alpha-adrenergic antagonists cause urethral relaxation, diuretics increase urine production, antidepressants have anticholinergic effects S = Stool impaction (Constipation)
22
Q
Treatments for incontinence
A
- Determine the cause: history taking, urodynamic testing (cystometrogram – looking at filling pressures of bladder)
- Biofeedback, behavioral therapy/bladder training
- Scheduled toileting (helpful in elederly)
- Anticholinergic agents: Ditropan, dicyclomine—blocks acetylcholine and an effect of this is urinary retention so these drugs are long acting are better with less cognitive decline in elderly. What would these do to bladder contraction?
- Tricyclic Antidepressants: May have a urinary functions ex are nortriptyline, doxepin
- Pseudoephedrine for Stress incontinence
- Estrogen- restores mucosal, vascular, and muscular integrity to urethra
23
Q
Strategies for management (Incontinence)
A
- Be aware of fluid intake and times
- Take diuretics in AM
- No caffeine, alcohol, or aspartame (nutrasweet)
- Avoid constipation
- Void regularly
- Pelvic floor exercises
- Stop smoking- leads to coughing-leads to incontinence
24
Q
Kidney stones aka ______/______:: You can have them in the ureter, pelvis of kidney, or calyces of the kidneys, can be anywhere a long the urinary tract
A
Urolithiasis/Nephrolithiasis
25
Stones or ____ in the urinary tract: Occur when substances like calcium oxalate, calcium phosphate, and uric acid increase
calculi
26
- Theory: Can form when deficiency of substances such as citrate or magnesium exist (These prevent crystallization of urine)
- Theory: Can form when patient in dehydrated state
Theories of
27
Causes of ______: infection, stasis of urine, immobility, increased calcium
Urolithiasis-Nephrolithiasis
28
Urolithiasis-Nephrolithiasis is more common in men and ________
Caucasians
29
-Hyperparathyroidism
-Cancers
-TB or sarcoidosis-these cause increased Vitamin D production by the granulomatous tissue
-Excessive dairy intake
Leukemias, multiple myeloma: increased bone marrow production of blood cells
-Gout-uric acid stones
-Proteus, Pseudomonas, Klebsiella-cause struvite stones produced in a ammonia-rich urine
-Inflammatory bowel disease, ileostomy patients- absorb more oxalate
-Medications: antacids, laxatives, Diamox, high doses of aspirin
Causes of stone development
30
Myth is that most stones are made form calcium so let’s not tell patients to avoid dairy or calcium products
True
31
- INTENSE deep pain in the Costovertebral region (in the pic, if have kidney then will CVA tenderness)
- Hematuria, foul-smelling
- Nausea, vomiting
-Spasming; renal colic/colicky pain (pain
fluctuates in intensity lasting
20-60 minutes)
-Fever, chills
signs/symptoms of Urolithiasis/Nephrolithiasis
32
- **Opioids and NSAID’s for pain
- **Fluids, fluids, fluids
- Dietary restriction of protein, sodium, perhaps calcium
- Protein diet linked to increased urinary excretion of calcium and uric acid
Medical treatment for Urolithiasis/Nephrolithiasis
33
NSAID’s inhibit prostaglandin E which causes _______ of ureters and increases renal blood flow
contraction
34
```
Medical treatment for ___________: low purine foods; avoid shellfish, anchovies, asparagus, organ meats, mushrooms-
-Treat Gout and for
Uric Acid stones: Take
allopurinol (Zyloprim) –
Decrease uric acid
production
```
Uric Acid Stones
35
Avoid spinach, strawberries, rhubarb, chocolate, tea, peanuts, wheat bran
Oxalate Stones
36
Calcibind, thiazide diuretics: Raise calcium levels so if we have calcium stones we will take patient off of these drugs
True
37
Extracorporeal Shock Wave Lithotrypsy
Disintegrating calculi
38
Delivering shock waves over the kidney area and that will cause busting up the major stones that could not otherwise be eliminated by voiding,
-Laser and forceps are used to grab the calculus and remove it through fiber optic scope
Extracorporeal Shock Wave Lithotripsy-
39
Noninvasive procedure to break up stones
May or may not use anesthesia, depending on size of stone and number and intensity of shock waves
Strain urine after procedure; look for stone fragments
Observe s/s of infection
May also perform a
percutaneous nephrolithotomy
Extracorporeal Shock Wave Lithotripsy
40
If stone cannot be broken down by ESWL, do Percutaneous nephrolithotomy to retract stones
True
41
Males more than females: (3 to 1)
50-70 years of age
More common in Caucasians
4th leading cause of death in males
Main Cause: cigarette smoking (people who smoke get bladder cancer twice as much as those who do not)
Cancers arising from prostate, colon, and rectum may metastasize to bladder.
Bladder Cancer
42
Visible, painless hematuria
Bladder Cancer
43
Sometimes UTI, frequency, urgency and dysuria
Alteration in voiding pattern
Bladder Cancer
44
- environmental carcinogens
- High cholesterol
- pelvic radiation – for treatment of prostate cancer
Risk factors for Bladder Cancer
45
Cystoscopy
CT scan
Biopsy
Examination
Bladder tumor antigens, other markers
Diagnostic evaluation of bladder cancer
46
Cauterization of simple benign epithelial tumors
Cystectomy or removal of the bladder
Radical cystectomy in male: removal of bladder, prostate, and seminal vesicles
Also consider transurethral resection of bladder tumor, radiation, and chemotherapy
Management of Bladder Cancer
47
Combination of methotrexate, 5-fluorouracil, vinblastine, doxorubicin (Adriamycin), cisplatin
Chemotherapy for bladder cancer
48
instillation of antineoplastic agent directly into bladder-BCG-Bacillus Calmette Guerin- most effective intravesical agent for recurrent bladder cancer because it enhances body’s immune response to cancer.
Topical chemotherapy
49
6 week course of weekly instillations
Followed by a 3 week course at 3 months in tumors that do not respond
BCG has 43% advantage in preventing tumor recurrence, compared to 16-21%
advantage with other intravesical agents
Patient retains intravesical solution for 2 hours before voiding
At end of procedure, patient must drink fluids liberally to flush medication from bladder
BCG-Bacillus Calmette Guerin
50
Immediately post-op: monitor urine hourly
Need to see more than 30 mls/hr
Catheter may be inserted through conduit if prescribed by MD
Stents may be placed in ureters to ensure urine flow
Bladder removal post op
51
When bladder has been removed, what do you do to help them eliminate urine?
Formation of ileal conduit (Illeostomy), this includes taking 2 ureters stitching them to a part of the bowel, a segment of ileum is removed and we stitch the 2 ureters to that segment of ileum, we bring ileum to the front of abdominal cavity which is formed into a stoma. Kidneys make urine, drains into ureters, illeal conduit, outside of body via stoma, bag sealed over stoma, collected in the bag is the urine.
we may have to place stents in the ureters to keep them open to ensure good urine flow
52
____ should be beefy red;
| If dark, purple indicates decreased blood supply
Stoma
53
Inspect skin for irritation, bleeding, encrustation
Keep urine acidic (pH below 6.5)
May prescribe vitamin C
Patient may be prescribed ascorbic acid po
Will see large amounts of mucus mixed with urine so it will look like urine – tell patient to be well hydrated so stoma will not be clogged
Avoid foods that have an odor like asparagus, fish
Stoma care
54
Consumes, digests, and eliminates food
Gastrointestinal System
55
2 divisions of G.I tract
1. Upper division
| 2. Lower division
56
oral cavity, pharynx, esophagus, and stomach
Upper division of G.I tract
57
small intestine, large intestine, and anus
Lower division of GI tract
58
liver, gallbladder, and pancreas
Hepatobiliary system
59
Mucosa, submucosa, muscle, and serosa (connective tissue)
Four layers of G.I tract
60
Large serous membrane that lines the abdominal cavity, semi permeable, made of layers
Peritoneum:
61
Parietal peritoneum:
Outer layer
62
Visceral peritoneum:
Inner layer
63
space between the two layers
Peritoneal cavity
64
What happens if there is decreased blood supply to the G. I tract?
GI tract goes without good blood supply, no good intervention --> parelytic illeus: Intervention of blood supply to the gut is lacking so now food particles movement through gut is limited which can lead to sepsis and sever infection, obstruction
65
Double-layer peritoneum containing blood vessels and nerves that supplies oxygen and nutrients to the intestinal wall
Mesentery
66
Food enters through the mouth to begin chemical and mechanical digestion.
Upper GI Tract
67
opening from stomach to the duodenum
pyloric sphincter
68
______ is coordinated by the swallowing center in the medulla and cranial nerves 5 (trigeminial), 9 (glossopharyngeal), 10 (vagus), and 12 (hypoglossal nerve).
Swallowing
69
- expansion of the stomach as food enters;
- contractions of the stomach to break food into smaller particles
- release of gastric acid required for food processing;
Vagus nerve (X)
70
emptying of the stomach contents into the small intestine;
secretion of digestive pancreatic enzymes (amalayze, lipase, protease) that enable absorption of calories; and
controlling sensations of hunger, satisfaction and fullness.
Vagus Nerve (X)
71
______ Duct: synthesizes bile, needs this to digest and absorb fat, travel to L/R hepatic duct.
Hepatic
72
Where bile is stored
Gallbladder
73
Enzymes backup to the pancreas and cause inflammation and that’s how we end up with ________
pancreatitis
74
Metabolize carbohydrates, protein, and fats
Synthesize glucose, protein, cholesterol, triglycerides, and clotting factors
Store glucose, fats, and micronutrients and release when needed
Liver functions
75
Detoxify blood of potentially harmful chemicals
Maintain intravascular fluid volume
Metabolize medications to prepare them for excretion
Liver functions
76
Produce bile
Inactivate and prepare hormones for excretion
Remove damaged or old erythrocytes to recycle iron and protein
Serve as a blood reservoir
Convert fatty acids to ketones
Liver functions
77
Bile is produced by the?
Liver
78
Produces enzymes, electrolytes, and water necessary for digestion (lipase, protease, amalyase)
--Secreted into duodenum to help digest those foods
Exocrine functions (Pancreas)
79
Produces hormones (insulin) to help regulate blood glucose
Endocrine function (Pancreas)
80
Continues digestion
Absorbs nutrients and water
Lower GI Tract
