GI disorders Flashcards

glomerular filtration
Terms Definitions
CREST syndrome-
Scleroderma
Normal CrCl
115-125 mL/min
Goodpastures
Glomerulonephritis with pulmonary hemorrhageCharacterized by URI followed by hemoptysis, SOB, renal insufficiency with proteinuria, HTNTx with immunosuppressants
Coca-cola Urine
Suggests a glomerular sourceBilirubinuria Myoglobin – seen in Rhabdomyolysis Large amounts in urine turn colorPositive dip stick, negative for red cells
Cause Functional Incontinence
Cognitive impairmentPhysical impairmentEnvironmental barriersPhysical restraints, iInaccessible toiletsPsychological problemsDepression, anger, hostility
CREST syndrome
calcinosis, raynauds, Esophageal dysmotility Sclerodactyl Teleangectasia
detrusor muscle
contracts under parasympathetic stimulation to promote urination
Scleroderma
Scleroderma is a connective tissue disease that involves changes in the skin, blood vessels, muscles, and internal organs. It is a type of autoimmune disorder, a condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue.
Glomerulus
part of renal corpusle contains the single celled epithelium, podocytes; specialized cells which function to filter material with long foot light processes and fenestrations basal lamina or basement membrane
Treatment: Functional Incontinence
Prompted voidingGarment and paddingExternal collection devices
History pertinent to urinary complaints
DiabetesHypertensionPolycystic Kidney DiseaseAlport’s Disease- Nephrolithiasis
Cystourethrogram used to
Detect vesicoureteral reflux (peds) – VCUGEvaluates filling defectspelvic trauma, fistula, Level of urinary incontinence, urethral strictures
What is GERD?
Gastro-esophageal reflux disease; a reflux of gastric contents into the esophagus which causes pain and discomfort .
Chronic Renal Failure causes
DM (30%), HTN (30%), glomerulonephritis (15%), polycystic kidney disease, obstructive uropathy
Abdominal Plain Film (KUB)
Determine renal size and shapeRadioopaque renal calculi are often apparentCalcium, Struvite, cystineCalcified neoplasmsNephrocalcinosisTBTrauma
BUN/Cr ratio
Ratio > 20:1 – suspect pre-renal source (increased BUN reabsorption)Ratio 10-20:1 – suspect post-renal (BUN normally absorbed by kidney)Ratio
BUN Fluctuations secondary to;
Dietary intake of proteinDaily catabolic rateGI bleeding (more produced)Volume depletion (i.e. dehydration) – d/t increased reabsorption of sodiumLiver disease – BUN decreasedVarious medications
Kidney stone pearls
Most commonly calciumUric acid stones- radiolucentStruvite – from UTIs – ammonium/magnesium/calcium Stones less then 5 mm usually passComplications; hydronephrosis from obstruction with ARFTx; fluids, flomax, pain meds, urology for large stones Surgery; lithotripsy, scoping for extraction, ureteral stenting, nephrostomy tube placement
Provides a gauge of renal functionMeasured clinically by collecting timed samples of blood and urineMost easily obtained by measuring the concentration of creatinine and urea nitrogen in the serum
Glomerular Filtration Rate
Instillation of water into the bladder can identify bladder contractions and pressures
Simply cystometry
Medication use: causes problems with urination
nasal decongestantstricyclic antidepressantsAnticholinergics
coca cola urine, positive blood on dipstick, but NO RBC in microscopy
myoglobin- rhabdo
What is gastritis?
inflammation of the gastric mucosa; mucosal barrier fails
IVP (intravenous pyelography)useful in detecting
Good for delineating kidney anatomyIndicated for flank pain, obstruction, bleeding, ?neoplasm
Creatinine Clearance testing
on a 24-hour basis with blood sample drawn when urine collection is completetwo 1-hour urine specimens are collected & a blood sample is drawn in betweenPractically, using Cockcroft-Gault equation for estimated CrClVariables; Gender, age, weight, serum Cr
cause and treatment of stress incontinence
Cause:Hypermobility of bladder base and urethral incompetence frequently caused by lax perineal musclesTreatment:Pelvic muscle exercise, vaginal cones, biofeedbackTimed voidingEstrogensSurgeryCymbalta – experimental
Renal Function through Glomerular Filtration
Maintained through Starling Forces and surface areaNet filtration pressure is a function ofGlomerular capillary blood pressureOpposing fluid pressure in Bowman’s spaceOsmotic force of plasma protien Net result is 16 mmHg180 L of fluid filtered daily (125ml/min)
What are some s/sx of GERD?
heart burn, substernal pain, regurgitation, sour taste, wheezing, dysphagia
Risk factors for urinary tract malignancy
40-70 years of ageTobacco useAnalgesic abusePelvic irradiationOccupational exposures – industrial solventsSchistosomiasis Irritative voiding symptoms Most common symptom – gross hematuriaUrothelial cell carcinomas most common
Constriction of the afferent arteriole
↓s the renal blood flow, glomerular filtration pressure and thus, the GFR
What are some interventions for ulcers?
dietary changes, rest (physical and mental), ng tube, ns lavage, meds (antacids, H2 receptor antagonist, prostoglandin analogs, mucosal barrier fortifers, surgery
The nurse is conducting dietary teaching with a client who has dumping symdrome. The nurse encourages the client to avoid which of the foods that the client usually enjoys?
1. Eggs
2. Cheese
3. Fruit
4. Pork
3 Dumping syndrome, in which gastric contents rapidly enter the bowel, can occur following gastrectomy. Dietary fats and proteins are increased, and carbohydrates such as fruits, are reduced. This helps slow the GI transit time and reduce the GI cramping, diarrhea, and vasomotor symptoms associated with dumping syndrome.
Core issue: Knowledge of foods to avoid when the client has dumping syndrome.
What is a hiatal hernia?
weakness in the diaphragm and part of the stomach goes up to the thoracic cavity.
The client returning from a colonoscopy has been given a diagnosis of Crohn's disease. The oncoming shift nurse expects to note which of the following manifestations in the client?
1. Steatorrhea
2. Firm, rigid abdomen
3. Constipation
4. Enlarged hemorrh
1 Steatorrhea is often present in the client with Crohn's disease. Diarrhea is also key feature, but unlike ulcerative colitis, the loose stool usually does not contain blood and is usually less frequent in number of episodes.
Core issue: Knowledge and identification of common symptoms of Crohn's disease.
The nurse is caring for a client with a history of alcoholism. Which of the following findings would indicate that the client has possibly developed chronic pancreatitis?
1. Steady weight gain
2. Flank pain on the left side only
3. Fatty stools
4. Excess
3 Manifestations of chronic pancreatitis include vomiting, nausea, weight loss, flatulence, constipation, and steatorrhea that result from a decreases in pancreatic enzyme secretion. Weight gain is the opposite of what occurs with this disorder, while options 2 and 4 are unrelated.
Core issue: Ability to identify assessment findings that are consistent with the development of chronic pancreatitis.
What is an abdominal hernia and what are the different types?
intestine protrudes through a weakened area of the abdominal muscle related to increased intra-abdominal pressure. types: reducable, irreducable or incarcerated, and strangulated.
The nurse caring for a client with uncomplicated cholelithiasis anticipates that the client's laboratory test results will show an elevation in which of the following?
1. Serum amylase
2. Alkaline phosphatase
3. Mean corpuscular hemoglobin concentration (
2 Obstructive biliary disease causes a significant elevation in alkaline phosphatase. Obstruction in the biliary tract causes an elevation in direct bilirubin, not indirect bilirubin. Options 1 and 3 are unrelated
Core issue: Use nursing knowledge and process of elimination to make a selection
What is acute gastritis and what can cause it?
short term problem caused by alcohol, drugs or food poisoning.
The client who has ulcerative colitis is scheduled for an ileostomy. When the client asks the nurse what to expect related to bowel function and care after surgery, what response should the nurse make?
1. "You will be able to have some control over your b
2 A client with an ileostomy has no control over bowel movements and must always wear a collections device. The drainage tends to be liquid but becomes pastelike with intake of specific foods.
Core issue: Knowledge of stool characteristics and associated stoma appliance needs following ileostomy
A client is being evaluated for possible duodenal ulcer. The nurse assess the client for which of the following manifestations that would support this diagnosis?
1. Epigastric pain relieved by food
2. History of chronic aspirin use
3. Distended abdomen
4.
1 The pain of a gastric ulcer is dull and aching, occurs after eating, and is not relieved by food as is the pain from a duodenal ulcer. The pancreatic juices that are high in bicarbonate are released with food intake and relieve duodenal ulcer pain when the client eats. Chronic aspirin use is irritating to the stomach. The manifestations in 2,3 are unrelated.
Core issue: Expected assessment findings in duodenal ulcer. Recall the effect of pancreatic juices on the duodenal ulcer surface and use the process of elimination to make a selection.
RBC casts
glomerulunephritis
Anuria
(Absence of urine formation
Alport’s Disease
genetic disorder characterized by: glomerulonephritis endstage kidney disease hearing lossIt can also affect the eyes The presence of hematuria is almost always found in this condition
Dialysis Indicated
Severe metabolic derangements Worsening acidosisSevere volume overload/decompensated CHFSevere uremic symptomsPericarditis, coagulopathy, encephalopathy
epithelial cell casts
acute tubular necrosis, glomerulonephritis
Acontractile bladder
IdiopathicNeurologic – spinal cord injury, stroke, diabetes
Stress Incontinence
Leakage associated with increased intra-abdominal pressure (coughing/sneezing)
Hematuria Throughout stream?
Renal lesionUreteric lesionDiffuse lesions
Treatment Overflow Incontinence
Surgical correction of obstructionAlpha blockers in men (flomax)Intermittent catheter drainage
Overflow Incontinence
Leakage from a mechanically distended bladderComplain of frequency, nocturia, leakageUrodynamic testing to evaluate (pressures, imaging, flow, fullness)
Pyuria
Presence of >4 WBCs per high-power fieldSuggests urinary tract infection or inflammation
signs/symptoms for ARF
Decreased urine outputMental status changesGI symptomsEvidence for volume overloadPericarditisIncreased BUN and serum creatinineHyperkalemiaAcidosisHypocalcemiaHyperphophatemiaAbnormal urinalysis
Blood urea nitrogen
Product of hepatic protien catabolism ammoniaBUNTransported via RBCs for renal excretionMore variable in plasma then Cr.  d/t reabsorption Elevated BUN = azotemia; normal 10-20 mg/dl
Livedo reticularis
Semipermanent bluish mottling of skin on the legs & hands, and is aggravated by exposure to cold
Clearance rate
urine concentration (Cr) x urine volume excreted/plasma concentration (Cr)
Macula densa
the distal tubular site nearest glomerulus is characterized by densely nucleated cellsDense in NaCl and pressure receptorsFxn to decrease afferent arteriolar resistance  increased GFRStimulate renin secretion
Juxtaglomerular cells
Special secretory cells which are modified Smooth muscle cells of the media of the adjacent afferent arterioleContain granules of inactive renin
IVP (intravenous pyelography)
IV administration of iodinated radiographic contrast medium (excreted by glomerular filtration)Contrast medium concentrates in renal tubules and produces a nephrogram image within first few mins of injection allowing visualization of calyces, renal pelvis, ureters, bladder as medium passes into collecting system
Causes of Rapidly Progressive Renal Failure
Obstructive uropathyMalignant hypertensionRapidly progressive glomerulonephritisTTP/HUS – microangiopathic diseasesAtheromatous embolic diseaseBilateral renal artery stenosisScleroderma crisisMultiple myelomaSepsis
Major protinuria (>3.5g/day), edema, hyperlipidemia
Nephrotic syndromeof Glomerular disease
SSX: chronic renal failure
Lethargy, malaise, pruritus, anorexia, N/V, impotence, leg cramping, dyspnea, poor concentrationEcchymosis, pallor, edema, rales, pleural effusions, HTN, pericardial friction rub, cardiomegaly, mental status change
suspect post-renal (BUN normally absorbed by kidney)
BUN/Cr ratio Ratio 10-20:1
Etiologies Proteinuria
Functional – exercise, acute febrile illnessOverload – Multiple Myeloma, RhabdomyolysisIntrinsic nephropathy – ATN, fanconi’s syndromeInfectious (HIV, hepatitis)Autoimmune – SLE, Wegener’s granulomatosis
Condition Associated Risk Factors for Intrinsic Renal Disease
DiabetesHTNAtherosclerotic occlusive diseases such as renal artery stenosisPeripheral Vascular DiseaseContrast administrationSystemic Lupus Erythematosus – can cause lupus nephritisScleroderma
CT Most helpful in evaluating:
Renal masses or stonesComplex cystsPerinephric pathologyVascular pathology (renal vein thrombosis) Used to guide kidney biopsy or fluid collection (ie perinephric abscess)
System of high-pressure filtration is maintained by
glomerulus…located between 2 arterioles
Used to estimate the source of renal insufficiency
BUN/Cr ratio
Most easily obtained by measuring the concentration of creatinine and urea nitrogen in the serum
Glomerular Filtration Rate
What problems does GERD cause?
gastric contents irritate esophagus tissues and causes a breakdown which causes inflammation, erosions and ulcerations. The body tries to repair itself by making Barrets type epithelium which is pre-cancerous tissue.
Neuro PE Findings of Renal Disease Patient
Mental status changesSensation changesRestlessnessFasiculationsHyper-reflexia
What are some s/sx of IBS?
several episodes of constipation, diarrhea, or combo of both, may have pain which subsides after defecation which is not being caused by an organic problem.
What can cause GERD?
decreased tone and pressure of the LES, increased intra-abdominal pressure, increased gastric volume, acites, nicotine, caffeine, alcohol, beta and ca+ blockers, straining, etc.
The client with diverticular disease is scheduled for a sigmoidoscopy. He suddenly complains of severe abdominal pain. On examination, the nurse notes a rigid abdomen with guarding. What action should the nurse take next?
1. Notify the physician
2. Place
1 Perforation of an obstructed diverticulum can cause abscess formation or generalized peritonitis. The manifestations of peritonitis are abdominal guarding and rigidity and pain.. Sigmoidoscopy is contraindicated in cases of perforation. Because treatment of this complication is beyond the scope of independent nursing practice, the physician must be notified.
Core issue: Ability to identify the occurrence of peritonitis as a complication of diverticular disease and determine the appropriate course of action.
MRA – renal arteriographyuseful in evaluation for
Suspected renal artery stenosis or thrombosisRenal massUnexplained hematuriaSuggested vascular malformation
Glomerular Filtration Rate - GFR
~125mL of filtrate is formed each minute and this is called Glomerular Filtration Rate (GFR)GFR = (140-age) x (lean body weight in kg) (serum creatinine mg/dl) x 72Multiply by 0.85 for women
What are some interventions for gastritis?
H2 receptor antagonists, vit. B-12 replacement, dietary changes, decrease in caffeine and alcohol, stress management.
What are some s/sx of gastritis?
pain-usually relived by food, can't tolerate spicy/fatty foods, weight loss.
What is a complication of gastritis?
Gastritis can damage chief and parietal cells that produce intrinsic factor which allows us to absorb vit. B-12 at puts you at risk for pernicious anemia.
Which of the following assessments made by the nurse could indicate the development of portal hypertension in a client with cirrhosis?
1. Hemorrhoids
2. Bleeding gums
3. Muscle wasting
4. Hypothermia
1 Obstruction to portal blood flow causes a rise in portal venous pressure resulting in splenomegaly, ascites, and dilation of collateral venous channels predominantly in the paraumbilical and hemorrhoidal veins, the cardia of the stomach, and extending into the esophagus. Bleeding gums would indicate insufficient vitamin K production in the liver. Muscle wasting commonly accompanies the poor nutritional intake commonly seen in clients with cirrhosis. Hypothermia is an unrelated finding.
Core issue: Knowledge of associated findings in a client with portal hypertension
What are two types of hiatal hernias?
Sliding hiatal hernia and rolling hiatal hernia.
The nurse is educating the client with gastroesophageal reflux disease (GERD) about ways to minimize symptoms. Which information in the client's history should the nurse address as an indicator that needs to be changed?
1. Lifting weights for exercise
2.
1 Lifestyle modifications can minimize symptoms of GERD. Anything that increases intra-abdominal pressure should be avoided, such as lifting weights. Obesity also aggravates symptoms, but a body mass index of 23 is normal. Being a vegetarian does not increase risk, and calcium carbonate tablets often aid in symptom relief.
Core issue: Ability to identify risk factors that aggravate GERD.
Calculation: C = UV / P
C = clearance rate (mL/minute)U = urine concentration (mg/dL)V = urine volume excreted (mL/minute or 24 hours)P = plasma concentration (mg/dL)Clearance rate = urine concentration (Cr) x urine volume excreted plasma concentration (Cr)
What is a reducable and irreducable hernia?
Reducable hernia the intestine can be returned (pushed back) to abdominal cavity where a irreducable hernia cannot.
The nurse is caring for a client who has ascites and the health care provider prescribes spironolactone (Aldactone). The client asks why this drug is being used. Which is the best response by the nurse?
1. "This drug will help increase the level of protei
3 Spironolactone (Aldactone) is used in clients with ascites that show no improvement with bedrest and fluid restriction. It inhibits sodium reabsorption in the distal tubule and promotes potassium retention by inhibiting aldosterone. The other options do not address this rationale.
Core issue: Knowledge of medication effects in a client with ascites.
What interventions can we do for GERD?
avoid or limit foods and meds that cause problems, avoid alcohol and nicotine, do not eat 2 hrs before bedtime, limit fluids with meals, don't lay down after a meal, avoid restrictive clothing, HOB up, avoid heavy lifting.
What is a rolling hiatal hernia and what are the s/sx?
Fundus of the the stomach and portion of the greater curvature of the stomach roll up into the thoracic cavity (LES stay in ab. cavity). S/sx: fullness after meal, breathlessness, chest pain, reflux rare.
A client was admitted to the hospital with cholelithiasis the previous day. Which of the following new assessment findings indicates to the nurse that the stone has probably obstructed the common bile duct?
1. Nausea
2. Elevated cholesterol level
3. Righ
4 Nausea and RUQ pain occur in cystic duct disease, but obstruction of the common bile duct results in reflux of bile into the liver, which produces jaundice. alkaline phosphatase increases with biliary obstruction but cholesterol level does not increase.
Core issue: Knowledge of clinical indicators of common bile duct obstruction. Think about the pathophysiology of blocked bile drainage and use the process of elimination to make a decision.
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