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NRSG 421 > Week 4 - F&E and GI > Flashcards

Week 4 - F&E and GI Flashcards

1
Q

what is chrons?

A
  • inflammation in the entire GI system from gum to bum
  • affects all layers
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2
Q

what is colitis?

A
  • inflammation in the large intestine
  • affects inner mucosa
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3
Q

what is diverticulitis ?

A
  • inflammation/ infection causes lining pouches
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4
Q

where is diverticulitis normally found?

A

lower part of large intestine

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5
Q

what GI issues result in diarrhea?

A
  • IBS
  • Crohn’s
  • colitis
  • bacteria
  • flu/norovirus
  • malabsorption
  • dumping snydrome
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6
Q

what medications cause diarrhea?

A
  • antibiotics
  • laxatives
  • chemo
  • XRT
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7
Q

what other things can cause dirrhea?

A
  • food
  • allergies
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8
Q

what causes a mallory-Weiss Tear?

A

severe or prolonged coughing/ vomiting

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9
Q

what is a mallory-weirs tear?

A

tear of the tissue in lower esophagus

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10
Q

what are some causes of an esophageal tear?

A
  • varices
  • ingestions of sharp things (bones, glass)
  • procedure/ surgery
  • severe vomiting
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11
Q

what are some causes of ulcers?

A
  • H. Pylori
  • GERD
  • NSAIDS
  • ASA
  • steroids
  • anticoagulants
  • smoking
  • stress
  • alcohol
  • spicy food
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12
Q

describe meckel’s diverticulum

A
  • out pouching
  • full of embryonic tissue from development
  • normally in small intestine
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13
Q

describe intussusception

A
  • intestine fold in on itself
  • most common cause of blockage in 3months - 6 year old
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14
Q

how do you know someone has an upper GI bleed?

A
  • hematemesis
  • melena stool
  • coffee ground emesis
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15
Q

how do you know if someone has a lower GI bleed?

A
  • hematochezia
  • ## frank blood bowel movements
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16
Q

how do you differentiate if someone has an upper or lower GI bleed?

A
  • ligament of treitz
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17
Q

which is most common, upper or lower GI bleeds ?

A

upper

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18
Q

what are different types of causes for upper GI bleeds?

A
  • NSAIDS
  • esophageal varices
  • cancer
  • H. Pylori
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19
Q

what are different causes of lower GI bleeds?

A
  • colitis
  • colonoscopy
  • cancer
  • hemorrhoids
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20
Q

If we know a patient has a GI bleed, when do we become more concerned?

A

hemodynamically unstable
- resting HR is tachy (loss of <15%)
- supine hypotension
- hemoglobin <90

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21
Q

what does iatrogenic mean?

A

new symptoms the pt feels due to physician’s activity/ therapy

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22
Q

what medical issues can cause a perforation?

A
  • Crohn’s
  • colitis
  • liver issues
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23
Q

what iatrogenic things can cause perforation?

A
  • scopes
  • ERCP
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24
Q

what medications can cause a perforation?

A
  • corticosteroids
  • NSAIDS
  • antibiotics
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25
Q

what symptoms might you see if you suspect you pt has GI issues?

A
  • abd pain
  • bloating/ distension
  • hypo/hyperactive bowel sounds
  • melena stools
  • N/V
  • hematochezia
  • guarding
  • changes to bowel patterns
  • tenesmus
  • rebound tenderness
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26
Q

what does hematochezia mean?

A

passage of fresh blood through anus in or with stool

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27
Q

what does tenesmus mean?

A

feeling of needing to pass stool even though bowel is empty

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28
Q

what are S/S of dehydration?

A
  • skin turgor
  • low BP
  • low hematocrit
  • dry mucous membranes
  • thirsty
  • light headed
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29
Q

what are signs and symptoms of peritonitis?

A
  • fatigue
  • going the toilet less
  • SOB
  • tachycardia
  • dizziness
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30
Q

what are some complications of GI issues?

A
  • sepsis
  • dehydration
  • hypovolemia
  • anemia
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31
Q

when diagnosing a GI issue, what can a stool sample be tested for?

A
  • fecal occult blood
  • C. Diff
  • obium paricite
  • C&S
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32
Q

when diagnosing a GI issue, what blood work is helpful?

A
  • CBC
  • electrolytes
  • iron
  • liver panel
  • renal panel
  • INR/ PTT
  • CRP
    lactate
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33
Q

in regards to blood work that’s helpful when diagnosing a GI issue, what does CRP indicate?

A
  • Crohn’s or colitis
  • see if there is an inflammatory process going on
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34
Q

in regards to blood work that’s helpful when diagnosing a GI issue, what does lactate indicate?

A

elevated means sepsis

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35
Q

what diagnostics are used for GI issues?

A
  • barium swallow with fluoroscopy
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36
Q

what are less invasive treatments for GI issues? what does it do?

A
  • pantroloc
  • lines/ helps stomach
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37
Q

what are less invasive treatments for Crohn’s and colitis?

A
  • steroids
  • corticosteroids
  • anti-inflammatories
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38
Q

what are less invasive treatments for C.Diff?

A

antibiotics

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39
Q

what percentage of your intracellular body is made of water ?

A

40% body weight (28L)

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40
Q

how much fluid do your kidneys filter/ you end up peeing every day?

A

1-2L/ day

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41
Q

how do you loose fluid throughout the day?

A
  • urine
  • sweat
  • lungs
  • intestines
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42
Q

how does the thirst sensation work?

A
  • increase in renin, RAAS, vasoconstriction
  • increase ADH to prevent fluid loss
  • SNS activation (increased HR, blood vessels constrict)
  • CVS detects Changs with ANP
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43
Q

what are some disease processes of injury states that affect fluid and electrolytes?

A
  • diabetes
  • pancreatitis
  • bowel obstruction
  • burns/ trauam
  • GI issues
  • kidney problems
  • liver problems
  • HF
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44
Q

what are some medications or treatments that effect fluid and electrolytes?

A
  • steroids
  • diuretics
  • TPN
  • lasix
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45
Q

what are some examples of abnormal losses of body fluids that effect fluid and electrolytes?

A
  • bleeding
  • diarrhea
  • NG suction
  • swallowing disorder
  • head or neck injury
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46
Q

what are some examples of intake that affect fluid and electrolytes?

A

intake inadequate and for how long

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47
Q

what are some examples of dietary restrictions that might effect fluid and electrolytes?

A
  • NPO
  • low Na diet
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48
Q

in regards to medications or treatments that effect fluid and electrolytes, what do you need to pay attention to for lasix?

A
  • look at potassium and electrolytes
  • determine how they’re effected
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49
Q

what are examples of isotonic solutions?

A
  • 0.9% NS
  • RL
  • D5W
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50
Q

what can to much isotonic solution result in?

A

hypervolemia

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51
Q

what are some examples of HPYOtonic solutions?

A
  • 0.45% NS
  • 0.33% NS
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52
Q

what can HYPOtonic solutions cause?

A
  • change in LOC
  • shock b/c cells well
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53
Q

what are examples of HYPERtonic solutions?

A
  • 3% NS
  • D5NS
  • D10W
  • D50W
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54
Q

once D5W is metabolized in the body what does it turn into? why?

A
  • isotonic
  • dextrose is metabolized
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55
Q

what can happen if someone has to much HYPERtonic solution?

A
  • intravascular overload
  • pulmonary edema
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56
Q

what is an example of a volume expander?

A

D5 1/2NS

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57
Q

what do IV crystalloid solutions have in them?

A
  • sterile water
  • electrolytes
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58
Q

how is RL metabolized?

A

in liver and converts lactate to bicarbonate

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59
Q

who should you not give Ringers lactate to? Why?

A

pt with:
- liver impairment
- lactic acidosis
- alkalosis

  • increases lactate and is an alkalizing solution
60
Q

what does hypertonic solution increase the risk of? why?

A
  • thrombosis
  • causes vessel irritation
61
Q

who should you not give hypertonic solution to?

A
  • renal failure
  • cardiac conditions
  • dehydrated
62
Q

if a patient is on hypertonic solutions what do you need to teach them ?

A

alert staff if you are feeling SOB or palpitations

63
Q

who should you not give hypotonic solution to ? why?

A

ICP/ cerebral edema
- increase ascites

liver disease
- increases ascites

trauma/ burns
- decreases intravascular volume
- could result in cardiovascular collapse

-

64
Q

who should you not give hypotonic solution to ? why?

A

ICP/ cerebral edema
- increase ascites

liver disease
- increases ascites

trauma/ burns
- decreases intravascular volume
- could result in cardiovascular collapse

65
Q

if a pt is on hypotonic solution, what do you need to teach them?

A

alert staff if you are feeling dizzy or funny

66
Q

describe colloids

A
  • high volume weight solution
  • contain large molecules
67
Q

what do colloids do?

A

draw fluid into intravascular compartment via oncotic pressure

68
Q

what is oncotic pressure?

A

pressure exerted by plasma proteins not capable of passing through membranes on capillary walls

69
Q

what are example of colloids?

A
  • FFP
  • albumin
  • hetastarch
  • pentastarch
70
Q

what do you need to watch out for if a patient is getting colloids?

A

fluid volume overload

71
Q

what are the signs of fluid volume overload ?

A
  • increased BP
  • dyspnea
  • crackles
  • increased JVD
  • bounding pulses
72
Q

if a patient has high levels of myoglobin in their urine what will it look like?

A

ice tea

73
Q

if you do a urinalysis for a pt with myoglobinuria what will the test strip show? why?

A
  • positive result for blood
  • no RBCs can be seen on microscopy
  • occurs b/c reagent on test strip reacts with myoglobin
74
Q

what does creatine kinase tell us if elevated?

A
  • muscle injury
  • will remain elevated for 1-3 days
75
Q

what is creatine kinase?

A
  • enzyme in muscles
  • stores and releases energy
76
Q

where do you find creatine kinase in the body?

A
  • skeletal muscle
  • cardiac muscle
  • small amount in lungs
  • small amount in brain
77
Q

if myoglobin is elevated what does this tell us?

A
  • muscle trauma
  • ischemia
  • inflammation
  • MI
78
Q

what can elevated myoglobin lead to?

A

acute kidney injury

79
Q

describe myoglobin

A

02 binding muscle protein

80
Q

what is the most common cause of high magnesium?

A

acute kidney injury

81
Q

what are the signs and symptoms of hyperkalemia?

A
  • muscle cramps
  • urine abnormalities
  • respiratory distress
  • decreased cardiac contractility
  • EKG changes
  • reflexes
82
Q

if someone has hyperkalemia, what are somethings you might find in the CVS?

A
  • irregular pulse
  • bradycardia
  • decreased CO
  • hypotension
  • cardiac arrest
83
Q

if someone has hyperkalemia, what are somethings you might find regarding muscles?

A
  • progresses to weakness
  • decreased reflexes
  • flaccid paralysis
  • can affect resp. muscles
84
Q

if someone has hyperkalemia, what are somethings you might find regarding GI?

A
  • nausea
  • cramping
  • diarrhea
85
Q

what medications/ treatments do you use to treat hyperkalemia?

A
  • beta agonists
  • bicarbonate
  • insulin
  • glucose
  • kayexalate
  • calcium gluconate
  • diuretics
  • dialysis
86
Q

what is an example of a beta agonist that is used to treat hyperkalemia?

A

salbutamol

87
Q

how does salbutamol, bicarbonate and insulin treat hyperkalemia ?

A

shifts potassium into cells

88
Q

how does kayexalate treat hyperkalemia ?

A
  • removes potassium through pooping
89
Q

what is kayexalates generic name?

A

polystyrene sulfate

90
Q

how does calcium gluconate treat hyperkalemia?

A

helps to stabilize the cells > caustic to vein

91
Q

what is not generally recommended to treat hyperkalemia, why?

A
  • bicarbonate
  • can lower calcium
92
Q

how do you administer insulin when using it to treat hyperkalemia? why?

A
  • IV 10-15 units of regular insulin with 50mL of 50% dextrose
  • to prevent hypoglycaemia
93
Q

what are signs and symptoms of hypokalemia?

A
  • alkalosis
  • shallow RR
  • irritability
  • confusion
  • drowsiness
  • weakness
  • fatigue
  • arrythmias
  • bradycardia
  • tachycardia
  • lethargy
  • thready pulse
  • decreased intestinal motility
  • N/V
94
Q

how do you treat hypokalemia?

A
  • IV fluids
  • NPO
95
Q

what are the signs and symptoms of hyponatremia?

A
  • lethargy
  • headache
  • confusion
  • apprehension
  • seizures
  • coma
96
Q

hyponatremia occurs when?

A

serum sodium is < 135 mEq/L

97
Q

what causes hynonatrenmia?

A
  • to much water
  • increased sodium loss
  • blood is diluted
  • GI suctioning
  • diarrhea
  • mannitol
  • diuretics
  • vomiting
  • SIADH
  • diabetes
98
Q

what are GI and nervous system signs and symptoms of hyponatremia?

A
  • N/V
  • anorexia
  • short attention span
  • delirium
  • disorientation
  • weakness
  • lethargy
  • muscle twitching
  • tremors
99
Q

what does aldosterone do for hyponatremia?

A
  • helps regulate sodium
  • increases sodium reabsorption/ expansion of volume
100
Q

how do you treat hyponatremia?

A
  • NS to 3%NS
101
Q

if you treat someone with 3% NS what do you need to monitor them closely for?

A
  • fluid overload
  • neurological status
102
Q

if someone has a sodium level of <125mEq/L what might they not show?

A

signs and symptoms

103
Q

if someone has a sodium level of 115-120 mEq/L what might they show?

A

GI symptoms

104
Q

if someone has a sodium level of <110 mEq/L what might they show?

A

neurological changes

105
Q

poor nutrition increase risk for what?

A
  • infection
  • pressure injuries
  • anemia
  • GI loss of nutrients
106
Q

what are risks associated with TPN?

A
  • infection
  • fluid overload
  • hyperglycemia
  • liver injury
  • can increase or decrease phosphate and potassium
107
Q

what causes low magnesium?

A
  • poor intake
  • laxative use
108
Q

will clients show S&S of hypomagnesia is levels under 1.8 mEq/L

A

not all the time

109
Q

how do you treat hypomagnesia? Why do you need to be careful?

A
  • IV hyhypomagnesemia
  • must be administered slowly so it does not trigger cardiac arrest
110
Q

if there are S&S of hypomagnesemia what does it cause?

A
  • CNS excitability
  • refeeding syndrome
111
Q

what is refeeding syndrome?

A
  • potentially fatal fluid/ electrolyte shift from artificial refedding
  • little or no nutritional intake for previous 5-10 days
112
Q

what is refeeding syndrome marked by?

A
  • hypophosphatemia
  • hypokalemia
  • vitamin deficiencies
  • congestive heart failure
  • peripheral edema
113
Q

what are the typical clinical findings for hypomagnesemia?

A
  • seizures
  • tetany
  • anorexia
  • arrhythmias
  • rapid HR
  • vomiting
  • emotional lability
  • deep tendon reflexes increased
114
Q

how do you treat hypomagnesemia?

A

oral or IV magnesium

115
Q

what do you need to watch for if you’re giving a pt oral magnesium?

A

diarrhea

116
Q

what do you need to watch for if you’re giving a pt IV magnesium?

A
  • respiratory status
  • cardiac telemetry
  • seizure precautions
117
Q

what causes hypophosphatemia?

A
  • shift from extracellular to intracellular
  • decreased GI absorption
  • loss through kidneys
118
Q

what are S&S of hypophosphatemia?

A
  • weakness
  • myalgia
  • confusion
  • resp distress
  • decreased contractility
119
Q

how do you treat hypophosphatemia?

A

IV phosphate

120
Q

what labs indicate hypophosphatemia?

A

below 1.8 mEq/L

121
Q

if someone has hypophosphatemia what should they eat?

A
  • dairy
  • dried beans
  • cheese
  • eggs
  • fish
  • nuts/ seeds
  • organ meat
  • poultry
  • whole grains
122
Q

what is affected by hypophosphatemia?

A
  • teeth
  • bones
  • cellular function (RBCs, metabolism)
  • acid/ base
123
Q

when you think about the effects of calcium, magnesium and phosphorus , what should come to mind?

A
  • muscles
  • nerves
124
Q

what are some causes of hypocalcemia?

A
  • not enough vitamin D
  • malabsorption
  • wasting of calcium from kidneys
  • hypoparaythroidism
  • massive blood transfusion
125
Q

how do you manage hypocalcemia?

A
  • PO or IV calcium gluconate or calcium chloride
  • treat underlying problem
  • cardiac monitoring
  • seizure precautions
126
Q

what causes hypercalcemia?

A
  • hyperparathyroidism
  • bone cancer
  • prolonged immobility
  • multiple fractures
  • overuse of drugs containing calcium
127
Q

how do you manage hypercalcemia?

A
  • reduce intake
  • increase excretion
  • put/ keep calcium in bones
  • monitor VS
  • strain urine for calculi
128
Q

in regards to the management of hypercalcemia, how do you increase excretion?

A
  • increase fluid intake
  • IV NS
  • loop diuretics
129
Q

in regards to the management of hypercalcemia, how do you put/ keep calcium in the bones?

A
  • calcitonin
  • bisphosphonates
  • weight-bearing exercise
130
Q

what do you use to calm muscles and nerves?

A
  • calcium
  • magnesium
131
Q

what type of relationship does phosphorus and calcium have?

A
  • inverse relationship
  • when one is high the other is low
132
Q

what does it look like when high magnesium, high calcium, or low phosphorus calm the muscles and nerves?

A
  • muscle weakness
  • depressed LOC
  • bradycardia
  • dysrhythmias
  • N/V
  • reduced deep tendon reflexes
133
Q

what does it look like when low mg, low Ca, or high phosphorus make the muscles and nerves hyperactive?

A
  • twitching
  • muscle cramps
  • seizures
  • altered LOC
  • anxiety
  • irritability
    dysrhythmias
  • GI upset
  • increased deep tendon reflexes
134
Q

what electrolytes calm the muscles and nerves?

A
  • high magnesium
  • high calcium
  • low phosphorus
135
Q

what electrolytes hyperactive the muscles and nerves?

A
  • low magnesium
  • low calcium
  • high phosphorus
136
Q

what blood type can be given in an emergency ?

A

O negative

137
Q

how do you treat severe anemia?

A
  • PRBC
  • isotonic fluid
138
Q

how do you treat severe anemia if PRBC and isotonic fluid is ineffective?

A
  • FFP
  • pentaspan
139
Q

what is pentaspan?

A
  • volume expander
  • colloid
  • prevents 3rd spacing
  • manages shock
140
Q

how many units of PRBC should you give before thinking about giving FFP?

A

6 units

141
Q

the human body responds to acute hemorrhage by activating 4 major physiologic systems, what are they?

A

neural
- SNS response

chemical
- H+
- O2
- CO2

hormonal
- RAAS
- ADH

hematologic
- coagulation cascade

142
Q

what is the normal range for Mg (magnesium)?

A

1.5-2.5

143
Q

what is the normal range for PO4 (phosphate) ?

A

2.5-4.5

144
Q

what is the normal range for K (potassium)?

A

3.5-5

145
Q

what is the normal range for Ca (calcium)?

A

8.9-10.1

146
Q

what is the normal range for Cl (chloride)?

A

98-108

147
Q

what is the normal range for Na (sodium)?

A

135-145

NRSG 421 (6 decks)

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