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Test Five
Renal, GI, Conscious Sedation
| Question | Answer |
|---|---|
| How do the kidneys help maintain homeostasis? | regulating the composition and volume of extracellular fluid |
| What is the glomerular filtration rate? | the amount of filtrate made by the kidneys per minute |
| What are some common medication types affected by the decreased glomerular filtration rate in aging adults? | cardiac drugs, antibiotics, histamine H2 antagonists, antidiabetic agents |
| What is kidney agenesis? | absence of the kidney |
| What is kidney hypoplasia? | underdevelopment of the kidney |
| What is polycystic kidney disease? | hereditary disease characterized by cyst formation and massive kidney enlargement, affects both children and adults |
| What are the two forms of polycystic kidney disease? | autosomal dominant form and autosomal recessive form |
| What is the difference between the autosomal dominant and autosomal recessive forms of polycystic kidney disease? | autosomal dominant affects adults, autosomal recessive is present at birth |
| Which form of polycystic kidney disease is more common? | autosomal dominant is relatively common, affecting 1 in every 300-1000 people. autosomal recessive is rare |
| By what age do polycystic kidney disease symptoms usually develop | by age 40 to 50 |
| What are common manifestations of polycystic kidney disease? | flank pain, microscopic or gross hematuria, proteinuria, polyuria, nocturia, UTI, renal calculi, HTN |
| Renal insufficiency and chronic renal failure typically develop by what age? | by age 60 to 70 |
| What diagnostic tests are used to determine the extent of polycystic kidney disease? | renal ultrasonography, intravenous pyelography, CT scan |
| What are appropriate nursing diagnoses for a client with polycystic kidney disease? | excess fluid volume, anticipatory grieving, deficient knowledge, and risk for ineffective coping |
| What is the leading cause of chronic renal failure in the United States? | disorders and diseases involving the glomerulus |
| What is the glomerulus? | tuft of capillaries surrounded by a thin, double-walled capsule (Bowman's capsule). |
| When the glomerular filtration rate decreases, it leads to azotemia. What is azotemia? | increased blood levels of nitrogenous waste products |
| What common manifestation of polycystic kidney disease is considered to be the most important indicator of glomerular injury? | proteinuria because it increases progressively with increased glomerular damage |
| What is glomerulonephritis? | inflammation of the glomerular capillary membrane |
| What are manifestations of acute proliferative glomerulonephritis? | hematuria, proteinuria, azotemia, salt & water retention, brown or cola-colored urine, HTN, edema (particulary in the face), fatigue, anorexia, n/v, and headache |
| What is Goodpasture's Syndrome? | rare, autoimmune disorder of unknown etiology. It is characterized by formation of antibodies to the glomerular basement membrane. |
| Who does Goodpasture's Syndrome usually affect? | young men between the ages 18 and 35, although it can occur at any age and affect women as well |
| What are manifestations of Goodpasture's Syndrome? | hematuria, proteinuria, edema, cough, shortness of breath, hemoptysis |
| What is nephrotic syndrome? | a group of clinical findings as opposed to a specific disorder. It is characterized by massive proteinuria, hypoaluminemia, hyperlipidemia, and edema |
| What is the most common cause of nephrotic syndrome in children? | minimal change disease (MCD). This also accounts for 20% of adults with nephrotic syndrome |
| What is the most common cause of idiopathic nephrotic syndrome in adults? | membranous glomerulonephropathy |
| What is the leading cause of End Stage Renal Disease in North America? | Diabetic nephropathy, kidney disease common in the later stages of diabetes mellitus |
| How does the laboratory value for BUN change with renal disease? | It is elevated |
| How does the laboratory value for Serum Creatinine change with renal disease? | It is elevated |
| How does the laboratory value for Potassium change with renal disease? | increased in renal insufficiency |
| How does the laboratory value for Sodium change with renal disease? | decreased in nephrotic syndrome |
| How does the laboratory value for Calcium change with renal disease? | decreased in renal failure |
| How does the laboratory value for Phosphorus change with renal disease? | increased in renal failure |
| How does the laboratory value for Red Blood Cell Count change with renal disease? | decreased in chronic renal failure |
| How does the laboratory value for Urine Creatinine change with renal disease? | decreased in disorders of impaired renal function |
| How does the laboratory value for Urine Protein change with renal disease? | increased in disorders of impaired renal function |
| What medications are used in clients with glomerular disorders? | no drugs are available to cure, but are used to treat underlying disorders: antibiotics, aggressive immunosuppressive therapy, oral glucocorticoids, ACE inhibitors, antihypertensives |
| What is plasmapheresis? | plasma exchange therapy, a procedure to remove damaging antibodies from the plasma using a blood cell seperator. The RBCs are then returned to the client along with albumin or human plasma to replace the plasma removed. |
| What are complete proteins? | proteins that provide all essential amino acids needed for growth and tissue maintenence. Examples are milk, eggs, cheese, meats, poultry, fish, and soy |
| What are incomplete proteins? | proteins that lack one or more essential amino acids or contain inadequate proportions. Examples are vegetables, bread, cereals and grains, legumes, seeds, and nuts |
| What are the primary manifestations of kidney trauma? | hematuria, flank or abdominal pain, oliguria or anuria, localized swelling, tenderness, eccymoses in the flank region |
| What are manifestations of acute renal arterial occlusion? | sudden, severe localized flank pain, n/v, fever, hypertension |
| What are manifestations of renal vein occlusion? | gradual or acute deterioration of renal function may be the only manifestation |
| What are manifestations of renal tumors? | They are often silent, with few manifestations. The classic triad of symptoms: gross hematuria, flank pain, and a palpable abdominal mass is seen in only about 10% of clients |
| What is the extent of the tumor in Stage 1 renal cell cancer? | confined to the kidney capsule |
| What is the extent of the tumor in Stage 2 renal cell cancer? | invasion through the capsule but confined to local fascia |
| What is the extent of the tumor in Stage 3 renal cell cancer? | regional lymph node, ipsilateral renal vein, or inferior vena cava involvement |
| What is the extent of the tumor in Stage 4 renal cell cancer? | locally invasive or distant metastases |
| What is renal failure? | condition in which the kidneys are unable to remove accumulated metabolites from the blood, leading to altered fluid, electrolyte, and acid-base balance |
| The causes and pathophysiology of acute renal failure are commonly categorized as what? | prerenal, intrinsic, and postrenal |
| Which category of acute renal failure is the most common? | prerenal acute renal failure is the most common, accounting for 55% of the total cases |
| What is prerenal acute renal failure? | hypoperfusion leading to acute renal failure without directly affecting the integrity of the kidney tissues (55% of cases) |
| What is intrinsic (or intrarenal) acute renal failure? | direct damage to functional kidney tissue, acute damage to the renal parenchyma and nephrons (40% of cases) |
| What is postrenal acute renal failure? | obstructive causes of acute renal failure, any conditions that prevents urine excretion can lead to postrenal ARF (~ 5% of cases) |
| What is acute tubular necrosis? | destruction of tubular epithelial cells, causes an abrupt and progressive decline in renal function. This is the most common intrarenal cause of acute renal failure. |
| The course of acute renal failure due to acute tubular necrosis typically includes how many phases? | three phases: initiation, maintenence, and recovery |
| Describe the initiation phase of ARF due to acute tubular necrosis. | it begins with the initiating event (e.g. hemorrhage) and ends when tubular injury occurs. May last hours to days. |
| Describe the maintenence phase of ARF due to acute tubular necrosis. | significant fall in glomerular filtration rate. Even though urine may be produced, the kidney cannot efficiently eliminate metabolic wastes, water, electrolytes, and acids from the body |
| Describe the recovery phase of ARF due to acute tubular necrosis. | characterized by a process of tubule cell repair and regeneration and gradual return of FGR to normal or pre-ARF levels. Renal function improves rapidly for the first 5 to 25 days of recovery and continues to improve for up to a year |
| What are the treatment goals for acute renal failure? | identify & correct underlying cause, prevent additional kidney damage, restore urine output and kidney function, and compensate for renal impairment until kidney function is restored |
| What is hemodialysis? | procedure in which blood passes through a semipermeable membrane filter outside the body. It uses the principles of diffusion and ultrafiltration to remove electrolytes, waste products, and excess water from the body |
| What is peritoneal dialysis? | uses the peritoneum surrounding the abdominal cavity as the dialyzing membrane |
| What is continuous renal replacement therapy? | blood is continuously circulated through a highly porous hemofilter from artery to vein or vein to vein (newer form of dialysis that may be used to treat ARF) |
| What is the most frequent complication during hemodialysis? | hypotension, related to changes in serum osmolality, rapid removal of fluid from the vascular compartment, vasodilation, and other factors |
| What is continuous arteriovenous hemofiltration (CAVH)? | Removes fluid & some solutes. Arterial blood circulates through a hemofilter, then returns to client through venous line; ultrafiltrate collects in a drainage bag |
| What is continuous ateriovenous hemodialysis (CAVHD)? | Removes fluid and waste products. Arterial blood circulates through a hemofilter surrounded by dialysate, then returns to client through venous line; ultrafiltrate collects in a drainage bag |
| What is continuous venovenous hemodialysis (CVVHD)? | Removes fluid and waste products. Venous blood circulates through a hemofilter surrounded by a dialysate, then returns to client through double-lumen venous catheter; ultrafiltrate collects in a drainage bag |
| In chronic renal failure, what is most often used for vascular access? | arteriovenous graft |
| What is an arteriovenous graft? | a graft, a tube made of Gortex, is surgically implanted and connects the artery and the vein. Blood flows through the graft from the artery to the vein. |
| What is the leading cause of chronic renal failure? | diabetes is the leading cause, followed by hypertension, glomerulonephritis, cystic kidney disease, and all other causes |
| What are the stages of progression for chronic renal failure? | There are four stages of chronic renal failure: Decreased renal reserve, renal insufficiency, renal failure, end stage renal disease |
| Describe stage 1 (Decreased Renal Reserve) of chronic renal failure. | glomerular filtration rate appoximately 50% of normal; no manifestations, normal BUN and creatinine |
| Describe stage 2 (Renal Insufficiency) of chronic renal failure. | glomerular filtration rate 20% to 50% of normal; ployuria with low, fixed specific gravity, azotemia, anemia, hypertension |
| Describe stage 3 (Renal Failure) of chronic renal failure. | glomerular filtration rate < 20% of normal; increasing azotemia, edema, metabolic acidosis, hypercalcemia, possible uremia |
| Describe stage 4 (End-Stage Renal Disease) of chronic renal failure. | glomerular filtration rate < 5% of normal; kidney atrophy and fibrosis, overt uremia |
| What is uremia? | urine in the blood; refers to the syndrome or group of symptoms associated with ESRD |
| What are the effects of uremia on the endocrine system? | hyperparathyroidism, glucose intolerance |
| What are the effects of uremia on the respiratory system? | pulmonary edema, pleuritis, Kussmaul's respirations |
| What are the effects of uremia on the urinary system? | proteinuria, hematuria, fixed specific gravity, nocturia, oliguria, anuria |
| What are the effects of uremia on the gastrointestinal system? | anorexia, n/v, gastroenteritis, hiccups, abdominal pain, uremic fetor; potential complications of peptic ulcer, GI bleeding |
| What are the effects of uremia on the musculoskeletal system? | osteodystrophy, bone pain, spontaneous fractures |
| What are the effects of uremia on the neurologic system? | apathy, lethargy, headache, impaired cognition, insomnia, restless leg syndrome, gait disturbances, paresthesias; potential complications of seizures, decreased LOC, coma |
| What are the effects of uremia on the cardiovascular system? | hypertension, edema, coronary heart disease, dysrhythmias; potential complications of pericarditits, pericaridal effusion, cerebrovascular disease, heart failure |
| What are the effects of uremia on the hematologic system? | anemias, impaired clotting |
| What are the effects of uremia on the reproductive system? | amenorrhea (female), impotence (male); potential complications of spontaneous abortion |
| What are the effects of uremia on the integumentary system? | pallor, uremic skin color (yellow-green), dry skin, poor turgor, pruritis, ecchymoses, uremic "frost" |
| What are the effects of uremia on the immune system? | diminished leukocyte count, increased susceptibility to infection |
| How often is hemodialysis for ESRD typically done? | three times a week for a total of 9 to 12 hours. The amount of dialysis needed is individually determined by factors such as body size, residual renal function, dietary intake, and concurrent illness |
| Where are most transplanted kidneys obtained from? | cadavers (58.5%); however living donors are increasing and currently account for 41.5% |
| What are the requirements a cadaver must meet to qualify as a transplantable kidney? | meet criteria for brain death, less than 65 years old, free of systemic disease, malignancy, or infection, including HIV and hepatitis B or C |
| Why are immunosuppressive drugs used after an organ transplant? | a grafted organ stimulates an immune response to reject the transplanted organ (except when donor & recipient are identical twins). Immunosuppressive drugs minimize this response |
| What is acute rejection of a transplanted kidney? | develops within months of the transplant & is caused by a cellular immune response with T-lymphocyte proliferation |
| What is chronic rejection of a transplanted kidney? | may develop months to years following the transplant, is a major cause of graft loss. both humoral and cellular immune responses are involved and does not respond to increased immunosuppression |
| What is inflammatory bowel disease? | chronic inflammation of the bowel common to a group of conditions that includes Crohn's disease and ulcerative colitis |
| When is the peak incidence of ulcerative colitis? | in adolescents and young adults between the ages of 15 and 35 years, secondary peak between 50 and 70 years |
| When is peak incidence of Crohn's disease? | 10 to 30 years |
| Describe the abdominal pain characteristics of ulcerative colitis. | cramping in left lower quadrant; relieved by defecation |
| Describe the abdominal pain characteristics of Crohn's disease. | cramping or steady right lower quadrant or periumbilical pain; tenderness and mass noted in right lower quadrant |
| What are manifestations of ulcerative colitis? | diarrhea that contains blood and mucous is the predominant manifestation, fever rare; may have associated arthritic, skin, or other organ involvement, such as erythema nodosum or uveitis |
| What are manifestations of Chron's disease? | fever, malaise, fatigue; may have some associated conditions plus urinary complications |
| What are acute complications of ulcerative colitis? | toxic megacolon, perforation, massive hemorrhage |
| What are acute complications of Chron's disease? | obstruction, fistulization, abscess formation, malabsorption |
| What is ulcerative colitis? | chronic inflammatory bowel disorder that affects the mucosa and submucosa of the colon and rectum |
| What is Chron's disease? | AKA regional enteritis. a chronic, relapsing inflammatory disorder affecting the GI tract. Can affect any portion of the GI tract from the mouth to the anus, but usually affects the terminal ileum and ascending colon. |
| What is an ileostomy? | an ostomy made in the ileum of the small intestine. The colon, rectum, and anus are usually completely removed. |
| What are risk factors associated with colorectal cancer? | age over 50 years, polyps of the color and/or rectum, family history of colorectal cancer, inflammatory bowel disease, exposure to radiation, diet high in animal fat and kilocalorie intake |
| What is a colostomy? | ostomy made in the colon. Takes the name of the portion of the colon from which it was formed: ascending colostomy, transverse colostomy, descending colostomy, and sigmoid colostomy |
| What is the most common permanent colostomy performed? | sigmoid colostomy, particularly for cancer of the rectum |
| What is a hernia? | a defect in the abdominal wall that allows abdominal contents to protrude out of the abdominal cavity |
| What are risk factors for hernia formation? | trauma, surgery, and increased intra-abdominal pressure caused by such conditions as pregnancy, obesity, weight lifting, or tumors |
| What is intestinal obstruction? | failure of intestinal contents to move through the bowel lumen, may affect either the large or small bowel |
| Are bowel obstructions more common in the small or large intestine? | small intestine |
| What is the most common reason for small-bowel surgery? | obstruction |
| What are manifestations of small-bowel obstruction? | cramping, colicky abdominal pain that may be intermittent or increasing in intensity, vomiting (as bacterial fermentation occurs, vomitus often contains fecal matter) |
| What are common complications of small-bowel obstruction? | hypovolemia and hypovolemic shock with multiple organ dysfunction |
| What are manifestations of large-bowel obstruction? | constipation, colicky abdominal pain, distended abdomen, high-pitched tinkling bowel sounds with rushes and gurgles, vomiting is a late sign if it occurs at all |
| What is diverticulitis? | inflammation in and around the diverticular sac. It typically affects only one diverticulum, usually in the sigmoid colon |
| What are manifestations of diverticulitis? | pain (usually left-sided and may be mild to severe and either steady or cramping), constipation or increased frequency of defecation, n/v, low-grade fever, tenderness, palpable mass in the left lower quadrant |
| What is the test performed when a ruptured appendix or pelvic abscess is suspected? | Obturator Muscle Test |
| What is the test performed when acute appendicitis is suspected? | Iliopsoas Muscle Test |
| Rebound tenderness when palpating McBurney's point indicates what? | Appendicitis |
| Where is McBurney's point located? | halfway between the umbilicus and the right anterior iliac crest |
| Diagnostic tests for Crohn's disease and ulcerative colitis are the same except for what exception? | The client needs sigmoidoscopy, colonoscopy, and barium enema. The exception is the client who is thought to have Crohn's also has a barium swallow with a small bowel follow through. |
| What are the two classic symptoms of diverticulitis? | changes in bowel habits, no matter what type of change and crampy pain in the LLQ of the abdomen |
| What is cirrhosis? | chronic, degenerative disease of the liver in whch scarring has occurred |
| What is the term used for cirrhosis caused by alcohol ingestion? | Laennec's cirrhosis, responsible for about 50% of the cirrhosis cases |
| What are manifestations of obstructive jaundice? | yellow staining of the skin, mucous membrane, and sclera; orange, foamy urine; light, clay colored stools; puritis from the bile salts on the skin; dyspepsia; constipation |
| What are the three major complications of cirrhosis? | portal hypertension, nutritional deficiencies, hepatic encephalopathy |
| What is portal hypertension? | elevated pressure in the portal venous system that causes rerouting of blood to adjoining lower pressure vessels |
| What is ascites? | excess fluid in the peritoneal cavity |
| What is hepatic encephalopathy? | altered consciousness, mentation, and motor function affecting cirrhotic clients |
| How is ascites treated? | low sodium diet and diuretics, a paracentesis may be done to relieve the pressure on the abdominal organs and diaphragm |
| What is the only treatment for hepatic encephalopathy? | lactulose, either PO, PR, or NGT. It increases the excretion of ammonia in the feces |
| What are the reversal agents for opioids (fentanyl, morphine, and demerol)? | naloxone (Narcan) and nalmefene (Revex) |
| What is the reversal agent for benzoiazepines (Versed)? | flumazenil (Romazicon) |
| What are opioids (fentanyl, morphine, and demorol) used for? | pain control |
| What are benzodiazepines (Versed) used for? | sedation and amnesia |
| What are barbituates (Nembutal) used for? | sedation |
| What score does a client need on the PADSS to be discharged from post anesthesia? | score of 8 to 10 |
| What is the PADSS? | post anesthesia discharge scoring system |
| What five areas are scored with the post anesthesia discharge scoring system? | vital signs, activity & mental status, pain & n/v, surgical bleeding, and fluid intake & output |
| What are common manifestations of osteoporosis? | loss of height, progressive curvature of spine, low back pain, and fractures of the forearm, spine or hip |
| Care of the client with osteoporosis focuses on what? | stopping or slowing the process, alleviating the symptoms, and preventing complications. Proper nutrition and exercise are important components of the treatment program |
| What diagnostic tests are used for osteoporosis? | dual energy x-ray absorptiometry (DEXA), AST, and serum bone glaprotein |
| What are the best sources of calcium? | milk and milk products are best sources. Other food sources are sardines, clams, oysters, salmon, dark green leafy vegetables |
| What is Paget's disease? | also called osteitis deformans, a progressive metabolic skeletal disorder that results from excessive metabolic activity in bone, with excessive bone resporption followed by excessive bone formation |
| What is the most common manifestation of of Paget's disease? | localized pain of the long bones, spine, pelvis, and cranium. |
| What is gout? | metabolic disease that occurs from an inflammatory response to the production or excretion of uric acid resulting in high levels of uric acid in the blood and other body fluids, including synovial fluid |
| What are the manifestations of gout? | hyperuricemia, recurrent attacks of inflammation of a single joint, tophi, renal disease, and renal stones |
| What are the three stages of untreated gout? | asymptomatic hyperuricemia, actue gouty arthritis, and tophaceous gout |
| What are the manifestations of the 2nd stage of gout (acute gouty arthritis)? | acute pain, red hot swollen and tender joint, fever, chills, malaise, elevated WBC and sedimentation rate (usually monoarticular, affecting metatarsophalangeal joint of great toe, instep, ankle, knee, wrist or elbow) |
| What are the manifestations of the 3rd stage of gout (tophaceous chronic gout)? | tophi evident on joints, bursae, tendon sheaths, pressure points, helix of ear; joint stiffness, limited ROM, and deformity; ulceration of tophi with chalky discharge |
| What are tophi? | small white nodules in subcutaneous tissue composed or urate deposits resulting from gout |
| What is osteomalacia? | often referred to as adult rickets, a metabolic bone disorder characterized by inadequate or delayed mineralization of bone matrix in mature compact and spongy bone, resulting in softening of bones |
| What are the primary causes of osteomalacia? | vitamin D deficiency and hypophosphatemia |
| What are the manifestations of osteomalacia? | bone pain and tenderness, difficulty changing from lying to sitting position, muscle weakness, waddling gait, dorsal kyphosis, and pathologic fractures |
| What is osteoarthritis? | also labeled degenerative joint disease, most commonly occuring form of arthritis, leading cause of pain and disability in older adults. Characterized by loss of articular cartilage in articulating joints and hypertrophy of the bones at the articular mar |
| What is osteomyelitis? | infection of the bone |
| What is the cardiovascular manifestation of osteomyelitis? | tachycardia |
| What are the gastrointestinal manifestations of osteomyelitis? | nausea and vomiting, anorexia |
| What are the musculoskeltal manifestations of osteomyelitis? | limp in involved extremity, localized tenderness--especially in the involved extremity |
| What are the integumentary manifestations of osteomyelitis? | drainage and ulceration at involved site; swelling, erythema, and warmth at involved site; lymph node involvement, especially in the involved extremity |
| How is osteomyelitis diagnosed? | bone scans, MRI, blood tests, and biopsy |
| What is the primary treatment for a client with chronic osteomyelitis? | surgical debridement |
| What are the primary risk factors for septic arthritis? | persistent bacteremia (bacteria in the blood) and previous joint damage |
| What is septic arthritis? | the type of arthritis that develops when a joint space is invaded by a pathogen |
| What are manifestations of septic arthritis? | typically an abrupt onset, marked by pain and stiffness of the infected joint. The joint is red, swollen, hot and tender to the touch |
| How is septic arthritis treated? | infected joint is treated with rest, immobilization, elevation, and systemic antibiotics |
| What is the difference between primary and metastatic bone tumors? | bone tumors may either be primary (arising in the bone itself) or metastatic (seeded from a tumor elsewhere in the body) |
| What are the three main manifestations of bone tumors? | pain, a mass, and impaired function |
| What is systemic sclerosis? | also known as scleroderma; a chronic disease characterized by the formation of excess fibrous connective tissue and diffuse fibrosis of the skin and internal organs |
| What is the cause of systemic sclerosis (scleroderma)? | the cause is unknown, but genetic, immune, and environmental factors are thought to play a role |
| What is Sjogren's syndrome? | an autoimmune disorder that causes inflammation and dysfunction of exocrine glands throughout the body |
| Who is at greatest risk for Sjogren's syndrome? | primarily affects women, the highest incidence is between the ages of 40 to 60 years |
| What should be included in nursing care for a client with Sjogren's syndrome? | teach measures to protect the client's eyes and oral mucosa, instill artificial tears as needed, encourage the client to sip fluids throughout the day, provide frequent oral hygiene, ensure the client has sufficient fluids to drink during meals |
| What is fibromyalgia? | common rheumatic syndrome characterized by musculoskeletal pain, stiffness, and tenderness |
| What is hydronephrosis? | dilatation of the kidney from obstruction, stones, tumors, malformations |
| What are pancreatic cancer risk factors? | smoking, industrial chemicals, environmental toxins, high-fat diet, chronic pancreatitis, diabetes mellitus |
| What are manifestations of pancreatic cancer? | anorexia, nausea, weight loss, flatulence, dull epigastric pain, pain increases as tumor grows, bile obstruction |
| What are treatments for pancreatic cancer? | Whipple's procedure (pancreatoduodenectomy), radiation, chemotherapy |
| What is included in post-op nursing care of pancreatic cancer clients? | Semi-Fowler's, NGT to LIWS, analgesics, TCDB, watch for hemorrhage, hypovolemic shock, hepatorenal failure |
Created by:
lhawthorne
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