Test 3: GI and Renal Flashcards
(155 cards)
1
Q
What is the pathology of gastroenteritis?
A
Inflammation of gastric mucosa and intestines, most commonly the small bowel caused by viral or bacterial infections
2
Q
How is gastroenteritis spread?
A
By fecal oral route
If the infected person vomits, the virus can become airborne with an incubation period of 1-2 days
3
Q
What are the system specific assessments for gastroenteritis?
A
Fever, N/V, colicky, cramping abdominal pain, watery diarrhea, hyperactive bowel sounds
4
Q
What are some of the potential complications of gasteroenteritis?
A
Fluid volume deficit (dehydration & hypovolemia)
Electrolyte imbalance (hypokalemia)
Cardiac dysrhythmias
GI bleed
Hypotension and shock
5
Q
If a patient is experiencing a fluid volume deficit from gastroenteritis, what assessments would we observe?
A
Acute weight change (> 2% or 1 kg/24 hours)
↓ urine output
Dry mucous membranes
↑ BUN, serum osmo, H&H, urine specific gravity
Tachycardia, hypotension, syncope
Postural hypotension
Confusion, change in mental status
↑thirst, ↓skin turgor***
6
Q
What is the nursing priority action for gastroenteritis?
A
Administer fluid replacement per order
Oral hydration preferred (ORT)
IVF replacement with electrolyte replacement may be necessary
7
Q
What should we be monitoring in a patient with gastroenteritis?
(Hint: How would we be able to tell if a patient was experiencing complications of gastroenteritis)
A
-VS, I&O, urine output, orthostats
-Electrolytes– replace as needed per protocol
-Acid-base balance
-Skin integrity
-Older Adults and Immunocompromised due to risk
8
Q
What is Cholelithiasis?
A
Stones in the gallbladder– typically asymptomatic until they cause and blockage of a duct and lead to cholecystitis
9
Q
What is cholecystitis?
A
Inflammation of the gallbladder usually caused by cholelithiasis obstructing the cystic and/or common bile duct
10
Q
What are the risk factors for cholecystitis?
A
4 F’s: Female, Forties, Fat and Fertile
Trauma
Surgery
Coronary events
Diabetes (high triglycerides)
Fasting
Immobility
Pregnancy
Hormone replacement (estrogen therapy)
Low calorie, liquid protein diet, prolonged fasting
High triglycerides
Rapid weight loss or obesity
Genetics
Aging
11
Q
When does Cholecystitis move to symptomatic?
A
-Asymptomatic until common bile duct or cystic duct partially or completely obstructed
12
Q
Where is the symptomatic pain of cholecystitis occur, and when is it exacerbated?
A
Sharp or vague RUQ pain radiating to right shoulder or scapula
-Pain exacerbated after eating high-fat foods (episodic biliary colic)
13
Q
What are the gastrointestinal symptoms of cholecystitis?
A
N/V
-Anorexia
-abdominal fullness
-Dyspepsia
-belching
-flatulence
-clay-colored stools
-steatorrhea
-dark urine
14
Q
What are the systemic symptoms of cholecysitis?
A
-Tachycardia,
-pallor
-diaphoresis
-Jaundice
15
Q
How can older adults symptoms vary in cholecystitis?
A
Older adults may only experience localized tenderness or acute confusion
16
Q
What lab values are indicative of cholecystitis?
A
↑ WBC
↑ Bilirubin
↑ Serum cholesterol
Aspartate aminotransferase (AST)
Lactate dehydrogenase (LDH)
Alkaline phosphatase (ALP)
Amylase
Lipase
17
Q
What are the diagnostic tests for cholecystitis?
A
RUQ ultrasound
Abdominal X-ray
Hepatobiliary scan (HIDA) NPO - also, a decreased bile flow means obstruction
18
Q
What are the priority interventions for cholecystitis?
A
-Pain management with opioid analgesia (morphine or hydromorphone) preferred
-Pain management with Ketorolac (Toradol) and NSAIDs for mild discomfort
-Antispasmodics/anticholinergics: Dicyclomine (Bentyl)
-Anti-emetics
-Antibiotics (if suspected infection)
-Small, frequent meals
-Administration of fat-soluble vitamins and bile salts
19
Q
When managing severe pain for cholecystitis, what should you look out for?
A
-May cause Sphincter of Oddi spasms
-Constipation, CNS depression, urinary retention
20
Q
When managing mild pain for cholecystitis with Ketorolac (Toradol) and NSAIDs what should you look out for?
A
Be sure to monitor the patient for increased pain, tachycardia, and hypotension because the drug can cause GI bleeding
21
Q
What are the criteria to make a patient with cholecystitis eligible for Extracorporeal Shock Wave Lithotripsy (ESWL)?
A
-Are of normal weight
-Have small, cholesterol-based stones
-Have good gall bladder function
-Are non-surgical candidates
22
Q
How does Extracorporeal Shock Wave Lithotripsy work?
A
-The patient lies on a water-filled pad, and shock waves break up the large stones into smaller ones that can be passed through the digestive system.
-requires analgesia for gallbladder spasms and movement of stones during procedure
-often requires several procedures to break up stones
23
Q
What is a Cholecystectomy?
A
surgical procedure to remove gall bladder
24
Q
What is the nursing priority action post Cholecystectomy?
A
After a laparoscopic cholecystectomy, assess the patient’s oxygen saturation level using pulse oximetry frequently until the effects of the anesthesia have passed.
Remind the patient to perform deep-breathing exercises every hour.
25
How often can activities be resumed for a laproscopic cholecystectomy?
How soon for an open cholecystectomy?
Laparoscopic: Activities resumed in approx. 1 week
Open: Activity precautions for 4 to 6 weeks before resuming normal activities
26
After a laproscopic cholecystectomy, where will the patient most likely experience pain?
May have pain under right clavicle, shoulder and scapula associated with CO2 instilled during procedure (relieved by ambulation)
Incision care (small incisions at umbilicus with possible additional small incisions around abdomen)
27
How long is the T-tube or JP drain left in after an open cholecystectomy?
T-Tube or JP drain left in 1-2 weeks post-operatively
28
What are the procedures for meals after an open cholecystectomy?
-Clamp T-tube 1 hour before and after meals to provide bile for food digestion
-Clear liquid diet advanced to solids as peristalsis returns
29
What GI symptoms are expected after an open cholecystectomy?
-Stool should return to brown within 1 week when biliary flow re-established
-Diarrhea is common
30
What are assessments that can indicate a complication after an open cholecystectomy?
-↑ in drainage (may be blocked bile duct)
-Bile peritonitis (pain, fever, jaundice)
-Biliary obstruction
(Ischemia, gangrene, and gall bladder rupture)
-Pruritis from accumulation of bile salts in skin
-Jaundice and icterus from accumulation of bilirubin
-Peritonitis from gall bladder rupture
-Pancreatitis from obstruction of pancreatic duct
Infection
-Bile peritonitis if bile is not adequately drained from surgical site (Pain, Fever, Jaundice)
31
What can indicate postcholecystectomy syndrome?
-A large intake of fatty foods may result in abdominal pain and diarrhea, which could result in a mild postcholecystectomy syndrome (PCS)
-If the patient experiences repeated abdominal or epigastric pain with vomiting and/or diarrhea even a few months after surgery, this is possible PCS
32
What is the pathology of pancreatitis?
a serious and at times life-threatening inflammation of the pancreas.
This inflammatory process is caused by a premature activation of excessive pancreatic enzymes that destroy ductal tissue and pancreatic cells, resulting in autodigestion and fibrosis of the pancreas.
33
What is the patient education for decreasing risks for cholecystitis?
-Consume a low-fat diet with small frequent meals
-Avoid dairy, fried foods, chocolate, nuts, gravies and gas-forming foods
-Introduce fatty foods one at a time into diet in small amounts
-Take fat-soluble vitamins or bile salts to enhance absorption and aid digestion
-Exercise regularly, Stop smoking, Manage weight
34
What is the difference between acute and chronic pancreatitis?
Acute: result of autodigestion
Chronic: progressive destruction of pancreas with calcification, fibrosis, and necrosis (periods of exacerbations & remissions) ↑ pancreatic insufficiency
35
If a patient is experiencing upper quadrant pain with grey stools this can indicate?
Chronic pancreatitis
36
What are the causes of pancreatitis?
-Biliary tract disease/cholelithiasis
-Penetrating gastric or duodenal ulcers
-ETOH misuse
-Autoimmune
-High intake of dietary fats
37
What are the symptoms of pancreatitis?
-Severe knife-like abdominal pain– mid-epigastric or LUQ & radiates to back, L flank, L shoulder exacerbated s/p eating or lying down
-Partial relief with fetal positioning or sitting
-N/V
-Jaundice
-Weight loss
-Hyperglycemia (3 P’s– polyuria, polydipsia, polyphagia)
-Ascites
-Steatorrhea, clay-colored stools
-Dark urine
-S/s of hypovolemia (tachycardia, â UO, dry mucous membranes, dizziness)
38
What are the two signs that a patient might be experiencing hypocalcemia from pancreatitis?
Chvostek’s Sign
Trousseau’s Sign
39
What is Turner's sign?
Discoloration of the left flank associated with acute hemorrhagic pancreatitis.
40
What is Cullen's sign?
Superficial edema with bruising in the subcutaneous fatty tissue around the peri-umbilical region. This is also known as peri-umbilical ecchymosis. It is most often recognised as a result of haemorrhagic pancreatitis.
41
What are the increased lab values associated with pancreatitis?
Increased Amylase
Lipase
Bilirubin
Alkaline phosphatase
ALT & AST
WBC
ESR
Glucose
42
What do increased amylase levels mean in pancreatitis?
In patients with pancreatitis, amylase levels usually increase within 12 to 24 hours and remain elevated for 2 to 3 days.
Persistent elevations may be an indicator of duct obstruction or pancreatic duct leak
43
How long are lipase levels raised in pancreatitis?
Serum levels may rise later than amylase and remain elevated for up to 2 weeks
44
Why do we see decreased calcium and magnesium levels in pancreatitis?
Fatty acids combine with calcium, seen in fat necrosis
45
What are the diagnostic tests used to diagnose pancreatitis?
CT with contrast (gold standard)
Abdominal US
Abdominal X-Ray
46
What is one of the biggest safety priorities for a patient with acute pancreatitis?
For the patient with acute pancreatitis, monitor for significant changes in vital signs that may indicate the life-threatening complication of shock.
-Hypotension and tachycardia may result from pancreatic hemorrhage, excessive fluid volume shifting, or the toxic effects of abdominal sepsis from enzyme damage. Observe for changes in behavior and level of consciousness (LOC) that may be related to alcohol withdrawal, hypoxia, or impending sepsis with shock.
47
What are the priority nursing actions for a patient with pancreatitis?
Rest the pancreas (NPO until pain-free or TPN/Enteral nutrition for severe pancreatitis)
Anti-emetics/Analgesics
NG Tube (for severe vomiting or paralytic ileus)
Position pt for comfort
Monitor blood glucose & hydration status
Administer fluids/electrolytes as needed
48
After pain subsides and a patient is able to begin eating after being NPO for pancreatitis, what is the dietary recommendations?
Begin with clears and advance as tolerated to bland, low-fat, high protein PO diet with small, frequent meals
49
What are the medications associated with pancreatitis?
Pain: Morphine or hydromorphone
Antibiotics: Imipenem (necrotizing pancreatitis)
H2: Cimetidine
PPi: Omeprazole
Pancreatic Enzyme: Pancrelipase
50
What are the administration considerations for
Pancreatic Enzyme Pancrelipase?
-Contents can be sprinkled on foods
-Drink full glass of water following admin
-Wipe lips/rinse mouth after admin
-Take after antacid/H2
-Take with every meal or snack
-Contraindicated if someone can't eat pork
51
What are the expected outcomes for successful treatment of pancreatitis?
Relief of abdominal pain
Able to tolerate PO foods without abdominal discomfort
Absence of N/V
Urinary output > 0.5 mL/kg/hr
Amylase, lipase, LFTs trending down
Absence of pancreatic complications
52
What are the complications associated with pancreatitis?
Hypovolemia
Pancreatic Infection
Type 1 Diabetes
Left lung effusion
Atelectasis
Coagulation defects
Multi-system organ failure
53
Why is hypovolemia a complication of pancreatitis?
Up to 6L of fluid can be third spaced because the retroperitoneal loss of protein-rich fluid from proteolytic digestion
This can put the patient into hypovolemic shock
54
What is the relation between hypovolemia, pleural effusion, pneumonia and ARDS in pancreatitis?
Pancreatic ascites results in failure to breath adequately
Splinting of chest due to pain upon coughing and breathing
55
How does pancreatitis cause DIC?
Release of thromboplastic endotoxins secondary to necrotizing hemorrhagic pancreatitis
This also can cause multisystem organ failure
56
What is appendicitis?
Acute inflammation of the vermiform appendix caused by the lumen becoming obstructed (can be caused by hard pieces of stool) and leading to infection, gangrene, perforation and sepsis.
57
What are the symptoms of appendicitis?
Initial: mild cramping, epigastric or periumbilical pain
Later: constant, intense RLQ abdominal pain
N/V, anorexia
Rebound tenderness over McBurney’s Point
Normal to low grade temperature
58
How does one tell the difference between the symptoms of appendicitis and gastroenteritis?
N/V before abdominal pain = gastroenteritis
Abdominal pain before N/V = appendicitis
59
Abdominal pain that increases with cough or movement and is relieved by bending the right hip or the knees in a patient with appendicitis suggests?
perforation and peritonitis
60
What are the first-do nursing priorities for appendicitis?
NPO
Morphine for pain management
Initiate IV fluids
Position in Semi-Fowler’s
Avoid laxatives or heat to site– can cause perforation
Prepare for surgery– assessment, labs, consents, IV access, abx, belongings, education
Monitor for potential perforation or peritonitis
61
Why do we look at the WBC counts for appendicitis?
What are the increased WBCs for appendicitis?
What about for peritonitis?
Laboratory findings do not establish the diagnosis, but often there is a moderate elevation of the white blood cell (WBC) count (leukocytosis) to 10,000 to 18,000/mm3 with a “shift to the left” (an increased number of immature WBCs). A WBC elevation to greater than 20,000/mm3 may indicate a perforated appendix.
62
What are some of the post operative nursing care priorities after an open appendectomy?
Strict I&O, monitor fluid & e-lyte status, hemodynamics
Irrigate peritoneal catheter with aseptic technique per order
Incision Care
Clear liquid diet advanced to solids as peristalsis returns
63
What is peritonitis??
A life-threating inflammation of the visceral/parietal peritoneum and the endothelial lining of the abdominal cavity is commonly caused by bacterial contamination, contamination from bile, pancreatic enzymes, or gastric acid.
64
Why does peristalsis stop in peritonitis?
Peritalsis stops due to this inflammation and bowel becomes distended with gas and fluid
65
What are the symptoms of peritonitis?
Sharp, constant abdominal pain poorly localized
Pain that decreases with flexion of R hip
Pain that increases with coughing or movement
Abdominal muscle rigidity/board-like abdomen
Guarding, tensing
Rebound tenderness
Febrile > 101F
N/V, anorexia
Absent or diminished bowel sounds
Inability to pass flatus or feces
Tachycardia, tachypnea
WBC > 20 K/uL
Abdominal distention
S/s of hypovolemia
Decreased UO
Septicemia
66
What are the complications of peritonitis?
Respiratory complications
Adhesions
Abscess
Third-spacing
hypovolemia
Acute renal failure
Septic shock
MODS
death
67
What is a nursing safety priority for patients following abdominal surgery?
Monitor the patient’s level of consciousness, vital signs, respiratory status (respiratory rate and breath sounds), and intake and output at least hourly immediately after abdominal surgery. Maintain the patient in a semi-Fowler position to promote drainage of peritoneal contents into the lower region of the abdominal cavity. This position also helps increase lung expansion.
68
What are some of the causes of an upper GI bleed?
esophageal varices
gastritis
peptic ulcer
cancer
69
What are some of the causes of a lower GI bleed?
colitis
polyps
cancer
70
What are the clinical manifestations of a GI bleed?
Bright red or coffee-ground emesis (hematemesis)
Black tarry stools (melena)
+ FOBT– fecal occult blood test (guaiac)
71
A guaiac card requires tests from how many days?
Guaiac cards require tests from three consecutive days
72
What medication needs to be held before a guaiac test?
Aspirin, Vit C, iron, red meats restriction 48 hrs prior to testing
NSAIDS, corticosteroids, salicylates restriction upwards of 7 days prior
73
A negative guaiac test does not?
Negative results do not r/o lower GI bleed
74
If a GI bleed is prolonged and slow, what can be the manifesation?
Anemia
75
If a GI bleed is rapid and acute it can result in?
Hypovolemic shock
76
A Hgb level of under ____ can indicate the need for a blood transfusion?
9
77
Packed Red blood cells are used in the treatment of?
Excessive blood loss (trauma, surgery, etc.)
Anemia
Kidney Failure
78
Platelets are used to treat?
Thrombocytopenia/Platelet dysfunction
Active Bleeding
Invasive Procedures
79
Fresh Frozen Plasma is used to treat?
Replaces clotting factors in hemorrhages, DIC, coagulopathies, prolonged bleeding
Normally used in mass transfusion
80
What is the time frame that platelets are given over?
200-300mg is given over 15 to 30 minutes
81
What is the time frame that FFP is given over?
200mL over 30 to 60 (2 hr on slides) minutes
82
When does a type and crossmatch have to be performed to be valid for a transfusion?
<72hr
83
Which type of blood is typed based on antigens?
Everything but plasma
84
Blood Type:
A can receive?
A, O
85
Blood Type:
B can receive?
B, O
86
Blood Type:
AB can receive?
A, B, AB, O
87
Blood Type:
O can receive?
O
88
What are the symptoms of a febrile transfusion reaction?
Chills, tachycardia, fever, hypotension, tachypnea within 2 hours
89
What is the cause of a febrile transfusion reaction?
S/p mx blood transfusions or platelet transfusions
Caused by anti-WBC antibodies
90
What is the cause of a hemolytic transfusion reaction?
Caused by ABO or Rh incompatibility
Ag-Ab complexes destroy transfused cells and initiate inflammatory response in body (mild to severe)
91
What are the symptoms of a hemolytic transfusion reaction?
Fever, chills, DIC, circulatory collapse
Apprehension, HA, chest pain, low back pain
Tachycardia, tachypnea, hypotension
Hemoglobinuria
Sense of impending doom
92
What causes a Transfusion-Related Acute Lung Injury (TRALI)?
Caused by donor blood containing antibodies against recipient’s neutrophils and/or HLA
93
What are the symptoms and treatment of a Transfusion-Related Acute Lung Injury?
Rapid onset of dyspnea, hypoxia within 6 hrs of infusion (life-threatening)– most require intubation and mechanical ventilation
94
What is the cause of Transfusion-Associated Circulatory Overload?
Caused when product infused too rapidly (especially common in older adults)
95
What are the symptoms and treatment of Transfusion-Associated Circulatory Overload?
Pulmonary rxn difficult to differentiate from TRALI at first, especially when receiving mx units
HTN, bounding pulse, JVD
Dyspnea, restlessness, confusion
Tx with slower administration and diuretics
96
What causes Transfusion-Associated Graft vs Host Disease?
Occurs more often in immunosuppressed client
Donor T cell lymphocytes attack host
97
What are the symptoms and treatment of transfusion associated Graft vs. Host disease?
Sx begin within 1-2 weeks s/p infusion
Thrombocytopenia, anorexia, N/V, weight loss, chronic hepatitis, recurrent infection
Requires transfusion of irradiated donor blood product to destroy most T cells
98
What are the symptoms of a bacterial transfusion reaction
Tachycardia, fever, chills, shock
99
What are the steps when a tranfusion reaction occurs?
-Stop the transfusion and remove the blood tubing
-Keep the bag & tubing to return to blood bank for further testing & analysis
-Initiate RRT
-Do not flush the contents of the blood transfusion tubing, which would cause more blood product to enter client
-If no other IV access, keep the access and flush with NS
-Apply supplemental O2
-Administer diphenhydramine IVP per order
-If shock present, fluid resuscitation and hemodynamic monitoring initiated
-Additional meds may be needed: antipyretics, vasopressors
100
What are the two types of lower UTIs?
Cystitis
Urethritis
101
What is cystitis?
inflammation/infection of bladder
irritants can cause cystitis without infection
102
What is Urethritis?
inflammation/infection of urethra
STIs most common cause
103
What is pyelonephritis?
infection of the kidney & renal pelvis, renal tissue inflammation
104
What is the pathophysiology of pyelonnephritis?
Microbial invasion of renal pelvis →Inflammatory response→Resulting fibrosis (scar tissue) → Decreased tubular reabsorption and sectretion→impaired kidney function
105
What are the risk factors for UTIs?
Alkaline urine (promotes bacterial growth)
Indwelling urinary catheter
Stool incontinence
Bladder distension
Urinary conditions (anomalies, stasis, calculi, residual urine)
Disease (diabetes)
106
In aging females, what can be a risk factor for a UTI?
-Decreased estrogen promotes atrophy of the urethral opening toward the rectum (increasing risk of urosepsis)
-Bladder prolapse
-Hypoestrogenism affecting mucosa of vagina and rectum, which causes bacteria to adhere
107
What are some of the symptoms of a UTI in older patients?
Confusion
Incontinence
Loss of appetite
Nocturia
Dysuria
Hypotension
Tachycardia
Tachypnea
Fever (indicates urosepsis)
108
What are some of the symptoms of acute pyelonephritis?
Fever
Chills
Tachycardia and tachypnea
Flank, back, or loin pain
Tenderness at the costovertebral angle (CVA)
Abdominal, often colicky, discomfort
Nausea and vomiting
General malaise or fatigue
Burning, urgency, or frequency of urination
Nocturia
Recent cystitis or treatment for urinary tract infection (UTI)
109
What are the symptoms of urosepsis?
Confusion/change in mental status/restlessness
Tachycardia (HR > 90 bpm)
Tachypnea (RR > 20 bpm)
Temp change (> 100.4F or < 96.8F)
Change in WBCs (WBC < 4K/uL or > 12 K/uL)
↑ in bands (shift to the left)
N&V
S/s of poor perfusion
↑ lactate
Delayed diagnosis & ↑ complications for older adults with nuanced sx
Impaired renal f(s)– HTN, hyperkalemia, metabolic acidosis, ↓ urine production
110
Why do we see poor peripheral perfusion in urosepsis?
Because just like in ARDS, we are going to move from proper oxygenation and aerobic metabolism to anaerobic metabolism
111
What are laboratory values that indicate a UTI?
Color:
Clarity:
Protein:
Glucose:
Ketones:
Specific gravity:
RBCs:
WBCs:
Bacteria:
Nitrites:
Leukocyte esterase:
Casts:
Crystals:
Color: dark yellow, dark amber, blood-tinged
Clarity: cloudy/turbid with sediment
Protein: + (Proteinuria)
Glucose: negative (+ Glucosuria in presence of hyperglycemia)
Ketones: negative (+ Ketonuria if DKA or dehydrated)
Specific gravity: 1.005 to 1.030
RBCs: ↑(hematuria)
WBCs: ↑ (pyuria)
Bacteria: + (needs C&S)
Nitrites: + or -
Leukocyte esterase: +
Released when WBC undergo lysis, and this occurs in the presence of bacteria. When this is present there is a pretty good indication of a UTI
Casts: - or ↑
Cylindrical particles, however, can be present in people that work out all the time–multiple UAs with casts might be indicative of a greater problem
Crystals: negative
Indicate the chance or development of renal calculi, can be from gout
112
If nitrites are positive on a urinalysis, what does this indicate?
Nitrates are converted to nitrites by bacteria; positive is indicative of an E. coli infection
113
What is the amount of fluid recommended for someone with a UTI?
3L if not contraindicated
114
What are the nursing considerations for Trimethoprim/sulfa-methoxazole (Bactrim)?
Ask patients about drug allergies (especially sulfa), teach patients to drink a full glass of water with each dose and to have overall fluid intake of 3L, teach about photosensitivity, and educate about finishing full drug regime.
C-diff, Steven Johnson Syndrome, QT prolongation
Contrainicated during pregnancy
Precipitates in renal tubules (take with full glass of water)
115
What are the nursing considerations for Ciprofloaxacin and Levofloxacin?
-Do not crush
-Do not take within 2 hours of taking an antacid
-Monitor pulse (prolonged QT interval)
-photosensitivity
-C-diff
-tendonitis, tendon rupture
-peripheral neuropathy
-seizures
-Precipitates in renal tubules (take with full glass of water)
116
What are the nursing considerations for Amoxicillin-Clavualanate?
Assess allergy, take drug with food, call provider is severe/watery diarrhea occurs (risk of colitis), can interfere with oral contraceptives
117
What are the nursing considerations for Nitrofurantoin (Macrobid)?
Pulmonary fibrosis, N/V, hepatoxcity
118
What are the complications that can be caused by acute pyelonephritis?
Interstitial inflammation
Tubular cell necrosis
Abscess formation in the capsule, renal cortex, or medulla
Temporary Altered kidney function
119
What are the symptoms of renal calculi?
Severe colicky pain (10/10)– wavelike, excruciating
Level of pain can be so severe that it can cause the patient to go into shock
Flank pain that radiates to abdomen, groin, testicles
Pain intensifies as it moved into ureter
N&V
Diaphoresis
Pallor
Urinary frequency, dysuria, oliguria, or anuria
Hematuria
Tachycardia
Tachypnea
Hypertension
120
What can urine pH tell us about Renal Calculi?
Urine pH can help in the determination of stone type.
121
What kinds of stones are associated with High urine acidity (low urine pH)?
uric acid and cystine stones
122
What kinds of stones are associated with High urine alkalinity (high urine pH)?
calcium phosphate and struvite stones.
123
What renal calculi demographics necessitate the need for intervention?
Prepare for intervention if stone not passed in 2 weeks, causes obstruction, or > 7 mm
less than 5mm will generally pass on its own
Over 7mm and not passed in 2 weeks will necessitate surgery
124
What medications are used to treat calcium oxalate stones?
Allopurinol
vitamin b6
125
What are the dietary recommendations for calcium oxalate stones?
Avoid spinach, black tea, rhubarb, beets, pecans, peanuts, okra, chocolate, swiss chard, and lime peel
Decrease sodium
126
What are the dietary recommendations for calcium phosphate stones?
Avoid high amounts of animal protein, Na & Ca
127
What medications are used to treat calcium phosphate stones?
thiazide diuretics
orthophosphates
128
What medications are used to treat uric acid stones?
allopurinol
potassium/sodium citrate
sodium bicarbonate
129
What are the dietary recommendations for uric acid stones?
Limit organ meat, poultry, fish, red wine, gravies and sardines because they contain purines
130
What medications are used to treat cysteine stones?
captopril
131
What are the dietary recommendations for cysteine stones?
Limit animal protein
Increase fluid intake to at least 500mL every 4 hours while awake or 750mL while at night to prevent the crystals from forming
132
What medications are used to treat struvite stones?
hydroxyurea
133
What are the dietary restrictions for struvite stones?
Avoid high-phosphate food (dairy, red meat, organ meat and whole grains)
134
What are the three measures are commonly used to treat and/or prevent uric stone formation?
Increasing urine pH
Increasing fluid intake
Decreasing uric acid production (limit purines)
135
To increase urine pH and prevent uric acid stone formation, what should we do?
To alkalinize the urine, drugs such as potassium citrate, 50% sodium citrate, and sodium bicarbonate are used.
136
To decrease uric acid production, and prevent uric acid stones, what should we do?
Modifying the diet to restrict purines can be effective in decreasing uric acid production.
Foods that contain high levels of purines include organ meats, sardines, and red meats.
The use of xanthine oxidase inhibitors such as allopurinol (what we typically give for gout anyways) and febuxostat can also be used to decrease the body’s production of uric acid.
137
Hydroureter and Hydronephrosis are both complications of what?
Renal calculi blockage that leads to a problem with urine elimination
138
What is considered an acute kidney injury?
sudden or rapid decline in kidney function (↓ eGFR)
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What are the three categories of causes for AKI/ARF?
Prerenal: Reduced Perfusion
Intrarenal: Kidney damage
Postrenal obstruction of the urine
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What are the characteristics of an acute kidney injury?
Azotemia
Decreased urine output
Oliguria < 400 mL/day
Nonoliguria > 400 mL/day (reduced kidney function is present, but urine production is not affected)
Anuria < 50 mL/day
Failure to maintain waste elimination, fluid and electrolyte balance, and acid-base balance
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What is azotemia?
accumulation of nitrogenous waste products (creatinine, urea) in blood
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What are some of the Prenal Causes of AKI?
Conditions that cause a decrese in CO, decrease in blood flow, or impaired perfusion to the kidney
Hypovolemia, dehydration, blood loss, hemorrhage – (hypovolemic shock)
MI, decreased CO, heart failure – (cardiogenic shock)
Sepsis, severe burns, severe allergic reactions – (distributive shock)
Vascular occlusion
Cirrhosis, liver failure
Neurogenic shock
Meds: NSAIDs, vasoactive drugs (e.g., vasopressors)
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What are the Intrarenal Causes of AKI?
Conditions that cause direct parenchymal damage to the glomeruli, nephrons, or renal tubules
Ischemia from prolonged poor perfusion
Acute tubular necrosis
Nephrotoxicity from drugs, toxins, contrast dye, Chemotherapeutics, Antibiotics, Osteoporosis medications
Inflammatory disease (e.g., glomerulonephritis, Lupus)
Infection
HTN, DM
Blood transfusion rxn, trauma
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What are the post renal causes of AKI?
Bladder, Cervical, Colon, and Prostate cancer
Enlarged prostate
Kidney stones
Nerve damage involving the nerves that control the bladder
Blood clots in the urinary tract
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What are the 4 phases of AKI?
Initiation/Onset
Oliguric
Diuretic
Recovery
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What can occur during the oliguric phase of AKI?
Oligura <400mL per day
Increase BUN and Creatine
Metabolic Acidosis
Hyponatremia
Hyperkalemia
Neurologic (may escalate to seizures, coma,
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What is the timeline for these AKI phases:
Initiation/Onset
Oliguric
Diuretic
Recovery
Initiation/Onset: initial insult to oliguric phase
Oliguric: Begins within 1-7 days, can last 1/2 weeks
Diuretic: Evolves over 1-3 weeks
Recovery: Lasts up to 12 months
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If during the oliguric phase, the urine specific gravity becomes less than 0.005, what should you do?
If less than 0.005, notify the provider; moving to diuretic phase
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What are the first do priority concepts for an AKI?
Monitor for dysrhythmias because of electrolyte and fluid volume imbalances such as FVO or hypotension
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How would you treat hyperkalemia in a patient with an AKI?
Insulin glucose, calcium carbonate,
Kayexalate
Given 3-4 times a day, pulls potassium into stool resulting in loose, smelly stool
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What are the dietary recommendations for a patient with an AKI?
Diet of ↓ protein, ↓ Na, ↓ phosphate
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What are some of the ways for prevention/management of AKIs?
Maintain normal fluid balance (euvolemia) and prevent hypotension.
Recognize reduction in kidney perfusion even without systemic blood pressure drop.
Autoregulation and RAAS maintain kidney perfusion and filtration rate.
Aim for MAP of 80-85 mm Hg in hypertensive patients
Increases risk of A-Fib (because of reduced/held dose of beta blockers)
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What are the fluid recommendations for patients to avoid an AKI before contrast?
V fluids at a rate of 1 mL/kg/hr for 12 hours before the imaging test or at 3 mL/kg/hr for 1 hour just before the procedure to ensure hydration and dilution of the contrast medium
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What is Continuous Renal Replacement Therapy (CRRT)?
Provides slow solute clearance and volume removal
Runs over 24 hour period to more accurately resemble the kidney
Normally temporary → no more than 1 week
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What are the indications for CRRT?
Symptomatic uremia (significant change in mental status, nausea, pruritis, malaise)
Hyperkalemia
Hypervolemia/fluid overload
Onset of acute pulmonary edema
Heart failure
Metabolic acidosis (pH < 7.1)
No further compensation is possible
Creatinine > 4 mg/dL
BUN > 50 mg/dL
Pericarditis, pericardial effusion
