MedSurge Fall 2025 Exam 1

GERD

Risk to the esophageal lining due to exposure of the stomach contents due to a weak or incompetent sphincter

Barret’s esophagus

squamous cells are replaced by columnar cells which increases the risk of cancer

Dieting for GERD

Less of fatty foods alcohols, and garlic foods

more whole grains and fibers

Bernstein test

swallow acid & normal saline then test for gerd symptoms like heart burn

Antacids

Tums , Rolaids

PPI’s

Pantoprazole

omeprazole, blocks the production of stomach acid, longer last affect than H2. blockers

H2 blockers

Famotidine

Metoclopramide - increased gastric emptying

faster release than PPI’s, decreases the release of hydrochloric acid

manifestations of GERD

Dry throat

Chest pain/ Heart Burn

difficulty swallowing , vomiting

Short bowel syndrome

result of surgery where part of bowels are removed and there is less time for nutrients to be absorbed

Celiac Disease Outcome

Vitamin deficiency, dehydration, Muscle wasting

Rickets - bow legged

treatment of celiac disease

high k-cal high protein, lowfat diet

weight daily & I&O’s

Lactose tolerance test

blood is drawn to see if glucose levels rise after consuming dairy ( if lactaste is present the glucose levels will rise)

Lactose breath test

after consuming dairy the amount of hydrogen is measured in your mouth because if lacking lactase it will ferment in your stomach and create gases

Hepatitis

usual viral infection of the liver ,

disrupts liver function, bile production ( digestion)

Hepatitis A& E

comes form contaminated foods and water

Hepatitis B, C,D

usually stems from blood and bodily fluids

can lead to chronic conditions such as liver cirrosis or cancer

Treatment of Hepatitis

Antivirals ending in “ vir” tenovir

reduces viral load by interrupting dna replication

Liver cirrosis

irreversible scarring of the liver

Iceric Phase

Jaundice occurs

liver is tender , fatigue , nausea

Liver produces prothrombin, risk for bleeding

jaundice causes ichyness

Hepatitis Intervention

wear cool clothing

no NSAIDS, ( ibuprofen, naproxence like aleve)

Tylenol for pain control

Crystalloids

smaller and in water

electrolytes and glucose

Colloids

larger, contains proteins such as albumin or fresh frozen plasma

can cause adverse reactions

shock, rapid volume expansion, increase clotting

Isotonic fluids

normal sailine (.9) , lactated ringer, d5W
maintains fluides& increases ECF volume

dextrose water

isotonic until in the body then hypotonic once in body

provides calories

Lactated ringers

increase ECF volume and buffers ph

avoid in hyperkalemia & hypocalcemia

Hypotonic Fluids

water being moved into cell , less than 0.9

for cellular dehydration, hyperglycemia, DKA)

avoid for burns

Cellular lysis

rupture of cell

hypertonic Fluids

more than 0.9

water being moved outside of cell

risk for fluid volume overload

avoid using with anything else

Potassium Chloride

additive in Iv fluids , never push

well diluted

Kidney Function

regulates acid base balence

eliminates wastes

regulates bp

prerenal

common cause of AKI,

might be due to hypovolemia

low cardiac output

intrarenal

disease to the actual kidney

acute tubular necrosis / damage to nephrons

Post Renal

obstructive cause : BPH , prostate cancer

Manifestations ofn AKI

younger : decreased urine output

older: Postural hypotension

Nutrition for AKI

increase in carbohydrates

restrict fluids

limit protein to 0.6g/kg

Cardiovascular Effects of CKI

edema

hypertension

dysrhythmia

Respiratory Effects of CKI

Kussmal respirations ( deep rapid labored breathing)

pulmonary edema

GI effects of CKI

Uremic fetur ( metallic breath)

ulcers

treatment of CKI

there are increase half lives of mediations

Antihypertensives

ferosumide

AVOID NSAIDS , metformin, mycins, and cephalosporins

Specific Gravity

High is dry

1.005-1.0030

1.010= CKD

Urinary Calculi

kidney stones that can occur in any part of the urinary tract

severe flank pain that may radiate to genitals

Lithiasis

stone formation

Nephrolithiasis

stones located in the kidney

Risks of Kidney Stones

Obesity

Dehydration

Frequent UTi’s

Complications of Kidney Stones

Hydronephrosis - urine produced behind the blockage

may lead to renal failure

Surgical Intervention

ESWL

Percuatnueus

Laser : All of these are usedto fragment the kidney stones in order to make them easier to pass

Intervention for Kidney Stones

lower Calcium and vitamin D

Analgesiscs

Thiazide diuretic

Polycystic Kidney Disease

Inherited Disorder : Fluid filled cysts that develop in the nephrons

Flank pain, Nocturia, increased abdominal girth

Chronic Pyelonephritis

Hypertension

Inability to conserve sodium

decreased concentration

Development of hyperkalemia and acidosis

Goodpasture Syndrome

Autoimmune disease that attacks the glomerular basement membranes

edema, hematuria, proteinuria

can progressivly lead to kidney failure

treatment for nephritis

includes corticosteroids and immunosuppressive agents to reduce inflammation and suppress immune response.

Ace inhibitors- reduce proteinurira and slowingthe progression of renal disease

Azotemia

Condition where the paitent’s body contains uncommon levels of components high in nitrogen .

Confusion, Decreased output, dry mouth , orthostatic hypotension, thirst

Acute Pyelonephritis

bacteria infection of the kidneys and pelvis ( UTI)

Fever, chills, tachycardia ,malaise

Hyperkalemia

signs are muscle weakness, palpitations, and peaked T waves on ECG

we can give calcium gluconate, insulin, and glucose

hypokalemia

signs are muscle cramps, weakness, and abnormal heart rhythms

we can give potassium supplements or IV potassium chloride

Hypercalcemia

signs are confusion, muscle weakness, and abdominal pain.
Treatment includes hydration and bisphosphonates.

Hypocalcemia

signs are muscle cramps, tingling, and seizures. Treatment includes calcium supplements and vitamin D.

hypermagnesemia

signs are nausea, vomiting, and muscle weakness, decreased DTR Treatment may involve intravenous calcium and hydration.

hypomagnesemia

signs aremuscle twitching, tremors, and seizures. Treatment includes magnesium supplements and dietary adjustments.

hypernatremia

signs are thirst, confusion, and muscle cramps.

Treatment often involves careful fluid replacement such as isotonic saline and monitoring electrolytes.

hyponatremia

signs are nausea, headache, confusion, and seizures.

Treatment may include fluid restriction and sodium replacement.

Rotavirus

viral infection , particularly in infants and young children. It leads to symptoms such as diarrhea, vomiting, and fever.

Fecal-oral transmission

Yersina Enterocolitis

bacterial infection , fecal oral transmission

common in <5yrs

there is a vaccination at 2,4,6 nmonths old

blood in diarrhea, abdominal pain

E.coli

bacterial infection ( naturally in the gut)

abdominal cramping, bloody stools, causes bloody diarrea

Salmonella

bacterial infection found in raw or undercooked food, leading to symptoms such as diarrhea, fever, and abdominal cramps.

Monitor or headache or confusion because MENIGITIS

Phases of AKI

Initiating - injury occurs

oliguric- low output

diuresis - excreting snd trying to compensate

recovering phase - 7 months to a year

Glomeular nephritis

can be due recent strep infection , look for signs of sore throat

causes proteinuria, oliguria

Treatment of C.Diff and G.LAMBLIA

Metronidazole , ending in zole

Oral vanco for c.diff

G. Lamblia

food, animals, people

Most common in under 5

pyelonephritis

is a type of urinary tract infection that affects one or both kidneys, often due to bacteria ascending from the bladder. Symptoms include fever, flank pain, and urinary changes.

spiralactone

A potassium-sparing diuretic used to treat conditions such as heart failure and ascites by reducing fluid buildup.

hyponatremia

is a condition characterized by low sodium levels in the blood, leading to symptoms like confusion, seizures, and muscle cramps.

It can result from excessive fluid intake

hypernatremia

is a condition marked by high sodium levels in the blood, often causing symptoms such as thirst, confusion, and muscle twitching.

It can result from dehydration or reduced fluid intake.