Medical Nursing Week 3

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Gia_bella
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171750
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Medical Nursing Week 3
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2012-09-25 23:02:33
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Class Notes Week
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week 3 from Class Notes
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  1. Gastrointestinal system
    Anatomy
    • Mouth
    • Teeth
    • Salivary glands
    • Esophagus
    • Stomach
    • Small and large  intestine
    • Liver- bile
    • Pancreas
  2. Purpose of the Gastrointestinal System
    • Digestion and Absorbtion
    • Detoxification
    • Protective Barrier
    • Hydration
  3. Gastorintestinal System
    Pathologic symptoms
    • Dysphagia- difficult swallowing
    • vomiting
    •     Digested material
    • Regurgitation
    •    Undigested material
    • Diarrhea
    • Icteric
    •    Jaundice
    •    Yellow discoloration
    •     Liver
    • Weight loss
    • PU/PD
  4. Gastrointestinal System
    Terminology
    • Dysphagia- difficulty swallowing, dental disease
    • Dyschezia- Difficult or painful defication
    • Melena- Bloody Feces, black in color, Indicates upper GI Bleed
    • Hematamesis- Blood in Vomit
    • Bile- Vomiting yellow bile reflux due to an empty stomach
    • Anorexia- not eating and emaciation
    • Pyrexia- fever
    • Borgorygmus- bowel sounds, gas
    • Tenesmus- Straining in pain for defication or urination
  5. Gastrointestinal System
    Diagnostic Tests
    • Blood Panel- Leukocytes, infections
    • Pancreas- Elevated Amylase and Lipase
    • Liver- Elevated Bilirubin, SGOT, SGPT, Alkaline Phosphate, GGT, bile acids
    • Elevated PVC
    • Maldigestion test
    •     Trypsin- Like Immunoreactivity (TLI)
    •      Folate and Cobalamine test
    • Fecal- Parasites
    •   Malabsorption- sudden strain
    • Fat Droplets
  6. SGOT
    SGOT:     Serum glutamic  oxaloacetic transaminase, an enzyme that is normally  present in liver and heart cells. SGOT is released into  blood when the liver or heart is damaged.
  7. SGPT
    SGPT: Serum glutamic pyruvic transaminase, an enzyme that is normally present in liver and heart cells. SGPT is released into blood when the liver or heart are damaged
  8. Gastrointestinal System
    Diagnostic Tests
    • Radiographs
    •    Stomach shape
    •        Obstruction (foreign body)
    •        Neoplasia
    • Upper GI- Barium Study
    •     Used for foreign body or transit time
    •      Intussusception- intestine going into intestine
    • Endoscopy
    •     Stomach, Duodenum and Colon
    • Visualization for ulcers and neoplasia
    • Tissue biopsy
    •    Noninvasive
    • Biopsy and cultures
    • Ultrasound
    •   Liver size and gall bladder
    • Shunts
    • Ultrasound guided biopsy
    • Lymph nodes
    •  Intussusception
  9. Gastrointestinal System
    Diseases- Stomach
    Clinical Signs and History
    • Vomiting
    • Loss of appetite
    • Salivating- Nausea
    • Abdominal Pain
    • Melena
    • Polydyspsia
  10. Gastrointestinal System
    Gastritis
    Etiology
    • Inflammation caused by continuous damage to gastric mucosa
    • Infections
    •      Parvo Virus
    •      Distemper
    •      Viral
    •      Fungal
    •     Bacterial
    • Toxins
    •     Ethylene glycol- antifreeze
    •     lead
    •    arsenic
    •    Plants and fertilizer
    • Foreign objects
    •   Rocks
    •   Balls
    •   Plastic
    •    String
    • Drugs
    •   NSAIDS
    • Dietary indiscretion
    • Hepatic
    • Renal
    • Neoplasia
  11. Gastrointestinal System
    Gastritis
    Diagnostic Tests
    • Radiographs
    • Blood panel
    • Viral Screens
    • Endoscopy
    • Barium Study
  12. Gastrointestinal System
    Gastritis
    Treatment
    • Dietary
    •    NPO for 8-12 hours
    •    Bland diet if no vomiting in a 12-24 hour period
    • Antibiotics
    • Antiemetics
    •    Reglan- metoclopramide
    •    Cimetidine (Tagamet)
    •    Ranitidine (Zantac)
    • Protein Pump inhibitors
    •    Most potent agent to decrease stomach secretions and acidity
    •     Omeprazole (prilosec)
    •            0.7 mg/kg PO SID
    • Misoprostol
    •    NSAID ulceration prevention
    •     2-5 mg/kg PO TID
  13. 2 ligaments attached to the stomach
    • hepatogastric
    • hepatoduodenal
  14. nephropathy
    A disease of the kidney. Also called renopathy
  15. hydronephrosis
    swelling of the kidneys when urine flow is obstructed
  16. Gastric Dilation Volvulus
    GDV or Bloat
    Clinical Signs
    • Distended abdomen
    •   Gas filled (ping)
    • Dry heaves and salivation
    • Grunting
    • Collapse
    • Hypotension and shock
    • Arrhythmias
    •    Myocardial Ischemia
  17. Gastric Dilation Volvulus
    GDV or Bloat
    Etiology
    • Dogs and Cattle
    • Diet in Cattle
    •    No evidence in dogs
    •    Running or playing after eating (postprandial exercise)
    •    Cattle
    •        High protein diet
    •            gas production (alfalfa)
    • Genetic Tendency
    •    Deep chested dogs
    •        Great danes, Rottweilers, Chows, Golden Retrievers, Akita, etc.
    • Laxity of hepatogastric and hepatoduodenal ligament
  18. Gastric Dilation Volvulus
    GDV or Bloat
    Diognostic Test
    • Radiographs
    •    Bloat
    •    Double bubble appearance
    •    Gas distention
    •     Spenomegaly
    • EKG
    •    arrhythmias
    • Blood Panel
    •    Acidosis
    •     anemia
  19. Gastric Dilation Volvulus
    GDV or Bloat
    Treatment
    • Shock Treatment
    •    Fluids
    •    Corticosteroid
    • Decompression
    •    Stomach tube
    •    Trocarization
    • Surgery
    •   Gastrology
    •    Splenectomy
    • Antibiotics
    • Antiarrhythmics
    •     Lidocaine
    •     Procainamide
    •     Mexiletine  (mexitil)
    • Prokinetic Agents (Ileus)- enhances gastrointestinal movement
    •     Reglan
    •     Cisapride
  20. Gastrointestinal system
    diseases of  Liver
    Clinical Signs and history
    • Lethargic
    • Vomiting and diarrhea
    • Anorexia
    • Fever
    • Icterus
    • Seizures
    •    Hepatic encephalopathy- brain disorder, seizures
    •         Elevated Ammonia
    • Lactulose- sythetic, non digestible sugar
  21. Gastrointestinal system
    diseases of  Liver
    Etiology
    • Infections
    •    Bacterial
    •     Viral
    •     Fungal
    • Autoimmune
    • Neoplasia
    • Idiopathic- unknown
    • Chronic disease- failure
    • Toxicity
  22. Gastrointestinal system
    diseases of  Liver
    Diagnostic Tests
    • Blood panel
    •    elevated liver enzymes
    • Bile acids
    • Radiographs
    •    Neoplasia
    • Ultrasound
    •    Biopsy
    •   
  23. Gastrointestinal system
    diseases of  Liver
    Treatment
    • Antibiotics
    •     Amoxicillin
    •     Cephalosporines
    •     Metronidazole
    • Nutritional support
    •    PEG tube or nasal gastric tube
    •    low protein diet and low fat (K/D)
    •    B Vitamins
    • Corticosteroid
  24. Gastrointestinal system
    diseases of  Pancreas
    Clinical Signs and history
    • Vomiting and diarrhea
    • Abdominal pain
    • Fever and Anorexia
  25. Gastrointestinal system
    diseases of  Pancreas
    Etiology
    • Diet- pica (pattern of eating non-food materials)
    •     High fat diet
    •     Table scraps
    • Liver Disease- pancreas
    •    Inflammation to pancreas
    • Infections
    • Trauma
    • Schnauzers- high fat
    •    Due to idiopathic hyperlipidosis
  26. Gastrointestinal system
    diseases of  Pancreas
    Diagnostic Tests
    • Blood Panel
    •    elevated Amylase and Lipase
    •    Leukocytes
    • Radiographs
    •     Hazy cranial abdomenal and peritonitis
    • Ultrasound
    •    Thick pancreas
  27. Gastrointestinal system
    diseases of  Pancreas
    Treatment
    • Fluid Therapy
    • Antibiotic therapy
    • NPO for 72 hours
    • Antiemetics
    •  Bland Diet
    •     Low Fat- I/D
  28. Gastrointestinal system
    Hemorrhagic Gastroenteritis
    HGE
    • Caused by loss of fluids
    • Bloody vomit and diarrhea
    • Fever
    • Lethargic
    • Dehydration
  29. Gastrointestinal system
    Hemorrhagic Gastroenteritis
    HGE

    Etiology
    • Unknown
    • Stress
    • Diet Change
    •  Possible clostridium
    • Breeds
    •   Primary in small dogs
    •      Toy Poodles, Dachsunds, Etc.
  30. Gastrointestinal system
    Hemorrhagic Gastroenteritis
    HGE
    Diagnostic Tests
    • Blood Panel
    •    Elevated PCV
    •        50-80%
    • Parvo Test
    •    Negative results
    • Radiographs
    •      Normal
  31. Gastrointestinal system
    Hemorrhagic Gastroenteritis
    HGE
    Treatment
    • Fluid Therapy
    •    Treat dehydration and hemoconcentration
    • Antibiotics
    • Bland diet
  32. Gastrointestinal system
    Inflammatory Bowel Disease (IBD)
    Chromes
    Introduction
    • A group of gastrointestinal disease of stomach, small intestines and colon that are charactersitized by inflammatory cellular infiltrates in the lamina propria of these structures.
    • Effects both dog and cats of any age or sex
  33. Gastrointestinal system
    Inflammatory Bowel Disease (IBD)
    Chromes
    Etiology
    • Abnormal mucosal immune response to certain causative factors and antigenic stimulation
    •    Food Allergy
    •    Dietary
    •    Stress and behavioral
    •    Heredity
    •    Idiopathic
  34. Gastrointestinal system
    Inflammatory Bowel Disease (IBD)
    Chromes
    Clinical Symptoms
    • Diarrhea
    •   Chronic or acute
    •   Continual or intermittent vomiting
    • Vomiting
    •   Chronic or acute
    •   Continual or intermittent
    • Anorexia and weight loss
    • Tenesmus (or  feeling that you constantly need to pass stools) hematechezia
  35. Gastrointestinal system
    Inflammatory Bowel Disease (IBD)
    Chromes
    Diagnosis
    • Blood profile
    •    High wbc count and low proteins as albumin
    • Radiographs
    • Fecal
    • Endoscopey and tissue biopsy
    •      Definitive test
    • GI Blood Panel- canine or feline specific lipase
  36. Gastrointestinal system
    Inflammatory Bowel Disease (IBD)
    Chromes
    Treatment
    • Chronic long term treatment can control disease process, but cannot cure
    • Each case may require different combinations of medication and diet control
    • Control diet- bland diet as I/D or D/d
    • Prednisolone 1-2 mg/kg BID, then taper after one month
    • Aziothioprine 2mg/kg PO SID x 7 days, then q EOD
    • Sulfasalazine 25-50 mg/kg m2
    • Cyclophosphamide 50 mg/kg m2
    • Amoxicillin 10-25 mg/kg PO BID
    • Reglan- antiemetic
    • Carafate- gastric ulcer
    • Famotadine- H2 blocker
    • Metronidazole- anaerobic bacteria and antiinflammatory
    • Budesonide- local acting corticosteroid to GI tract
  37. Urinary System
    Anatomy
    • Kidney
    • Ureters
    • Bladders
    • Urethra
    •    Penis
    •    Vagina
  38. Urinary System
    Purpose
    • Filter and dispose Nitrogen waste
    • Acid base regulation
    • Chemical excretion
    • Electrolyte, mineral, glucose and protein regulation
  39. Urinary System
    Pathologic symptoms
    • PU/PD
    • Vomiting and diarrhea
    • Uremic breath
    • Anorexia
    • Incontinence
    • Weight loss
    • Urias
    •     Oliguria
    •     Hematuria
    •     Anuria
    •     Pollakiuria
    •     Stranguria
  40. Urinary System
    Terminology
    • Anuria- Not urinating
    • Stranguria- straining to urinate
    • Oliguria- diminished urine production
    • Pollakiuria- Frequent urination
    • Hematuria- Bloody Urine
    • Azotemia- High BUN and Creatanine
    •                    Refers to renal disease
    • Urolith (urolithiasis)
    • Urinary calculi or stone
    • Dysuria- Painful Urination
  41. Urinary System
    Diagnostic Tests
    • Blood Panel
    •    Azotemia
    •    Hyperphosphatemia
    • Urinalysis- UTI (Cystitis) Inflammation
    • Radiographs- Contrast cystogram
    •                      Stones
    • Contrast cystogram
    •          IVP
    • Ultrasound
    •    Prostate
    •     Tumors
    • Exploratory Surgery
    •       Biopsy
  42. Urinary System
    Cystitis  (UTI)
    Clinical Signs and History
    • Pollakiuria
    • Stranguria
    • Hematuria
    • Dysuria
    • Febrile- feverish
  43. Urinary System
    Cystitis (UTI)
    Etiology
    • Infections
    •    Bacterial
    •    Viral
    • Secondary pyelonephritis- kidney infection
    • Bladder stones
    • Urachal diverticulum
  44. Urinary System
    Cystitis (UTI)
    Diagnostic Tests
    • Urinalysis 
    •      Bacteria
    •       Proteinuria
    • Urine culture and sensitivity
    • Radiographs and cystogram
    •    Stone
    •    Neoplasia
    • Blood Panel
    •    Kidney Disease
  45. Urinary System
    Cystitis (UTI)
    treatment
    • Antibodies
    •   7-14 days
    •   May be needed 6-8 weeks
  46. Urinary System
    Urolithiasis (bladder Stone)
    Cystic Calculi (urolith)
    Clinical signs and History
    • Dysuria and Hematuria
    • Stranguria
    • Vomiting and Diarrhea
    • Lethargic
    • Not Eating
  47. Urinary System
    Urolithiasis (bladder Stone)
    Cystic Calculi (urolith)
    Etiology
    • Dietary
    •  Infections
    • Congenital (Anatomical)
    •    Urachal diverticulum
  48. Urinary System
    Urolithiasis (bladder Stone)
    Cystic Calculi (urolith)
    Diagnostic Tests
    • Urinalysis 
    •     Cyrstals
    • Radiographs
    • Ultrasound
    • Contrast cystogram and IVP
    • Blood profiles
  49. Urinary System
    Urolithiasis (bladder Stone)
    Cystic Calculi (urolith)
    Common Urolith
    • Struvite
    •   Magnesium Ammonium phosphate
    •   Primate cats with FLUTD
    •   Dissolve crystals in acid PH of Urine
    •   C/D diet
    • Calcium Oxylate
    •   Most common urolith seen in dogs
    •    S/D diet
    • Urate
    •   1.Dalmations- usually males with urethral obstruction
    •   Due to incomplete oxidation of uric acid which forms urate crystals   Alkaline ph change to urine
    • 2. Allopurinol- binds xanthine oxides to prevent uric acid production
    • 15 mg/kg PO BID
    • 3. U/D diet- Alkaline diet
  50. Urinary System
    Urolithiasis (bladder Stone)
    Cystic Calculi (urolith)
    Treatment
    • Antibiotics
    • Dietary managment
    •     C/D
    •     Struvite (Alkaline
    •     S/D
    •     Calcium oxylate (Acidic)
    •     U/D
    •     Urate  (Acidic)
    •   
  51. Urinary System
    Urolithiasis (bladder Stone)
    Cystic Calculi (urolith)
    Surgery
    • Cystotomy- surgical incision of the urinary bladder
    • Nephrotomy- surgical procedure in which the kidney is cut
  52. Feline Lower Urinary Tract Disease
    FLUTD
    Feline Urological Syndrome
    Clinical Signs and History
    • Dysuria
    • Hamaturia
    • Pollakiuria
    • Urinating
    •   Abnormal areas
    •   Frequent trips to the litter box
    • Excessive licking of genitalia
  53. Feline Lower Urinary Tract Disease
    FLUTD
    Feline Urological Syndrome
    Etiology
    • Diet
    •   High in Magnesium and Ash
    • Infections
    • Alkaline PH urine
    • Anatomical 
    •     males
    •       Due to penis anatomy
  54. Feline Lower Urinary Tract Disease
    FLUTD
    Feline Urological Syndrome
    Diagnostic Tests
    • Physical exam
    •   Large painful and unexpressable bladder
    •   Distended penis
    •     Mucus plug
    •     Blue discoloration
    • Urinalysis
    •    Struvite crystals
    •         Triple phosphate
    • Blood Panel
    •    Azotemia
    • Hyperkalemia
    • Radiographs and Ultrasound
    •     Double contrast cystogram
  55. Feline Lower Urinary Tract Disease
    FLUTD
    Feline Urological Syndrome
    Treatment
    • Nonobstruction
    •   Antibiotics
    •    Diet management
    •          C/D diet Acid PH urine dissolves crystals
    • Propantheline
    •   Anticholinergic
    •   Reduces bladder spasms and urge and incontinance
    •   7.5 mg/kg PO every 3rd day
    • Phenoxybenzamine
    •    Minimize reflex dysnergia
    •    Urethral outflow problems
  56. Feline Lower Urinary Tract Disease
    FLUTD
    Feline Urological SyndromeTreatment
    Treatment
    • Obstruction
    • Urinary catheter
    •     Retro pulse 0.9% NaCL
    • Leave urinary catheter in for 2-4 days
    •     Until hematuria has resolved
    • Remove urinary catheter
    •   Cat urinating well by itself
    •    send home 24 hours later on antobiotics and C/D diet
    • IV fluids
    • Antibiotics
    • E-collar
    • Reccurring FLUTD
    •   Surgery
    •    Perineal urethromstomy (PU)
  57. Kidney Failure
    Clinical Signs and History
    • P/U P/D
    • Lethargic
    •    Inactivity
    •    Weakness
    • Anorexia
    • Weight loss
    • Vomiting
    • Oral Ulcerations
    • Stomatitis
    • Uremia
    •     Retention of toxic waste materials
    • Seizures and hypothermia
    • Diarrhea
  58. Kidney Failure
    Etiology
    • Degenerative disease (aging)
    • infections
    • Neoplasia
    • Congenital
    •    Basenji nephropathy
    •    Hydronephropathy
    • Polycystic kidney
    • Immune mediated
    • Amyloidosis
    •    Abyssinians and Shar Pei
    • Toxicity
    •   Ethylene glycol
  59. Kidney Failure
    Diagnostic Tests
    • Blood Panel
    •    Elevated BUN, Creatinine and phosphorus and anemia
    • Urinalysis
    • Specific gravity is <1.020
    •     Isosthenuria or Hyposthenuria
    • Radiographs
    •    Evaluation of kidney size and shape
    •    Nephrocalcinosis
    •    Uroliths
    • Ultrasound
  60. Kidney Failure
    Treatment
    • Fluid Therapy
    •   Iv Fluids
    •      Isotonic
    •   SQ fluids
    •      Cats
    • Anemia
    •    Erythropoietin
    • Vomiting
    •   H2 receptor antagonists
    •        Cimetidine (Tagamet)
    •        Ranitidine
    •   Reglan
    • Antibiotics
    •     No Aminoglycosides
    • Hyperphosphatemia
    •        Amphogel (aluminum Hydroxide)
    • Dietary Management
    •    Low Protein
    •       K/D

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