105 Test 2 Flashcards
Define Palliative
Reduces ore relieves the intensity of symptoms
Define Constructive
Restores lost function as a result of congenital anomalies.
Nubain is what type of analgesic?
It is an opioid analgesic.
The rapid emptying of food into the small intestines is called what?
Dumping Syndrome.
True or False: Dumping syndrome causes abdominal distension?
True
What causes Late Dumping Syndrome?
a rapid rise and fall in blood sugar levels. Insulin is obviously involved.
What are the symptoms of Dumping Syndrome?
Abdominal distension, syncope, palpitations and pallor
What are symptoms of Late Dumping Syndrome?
Diaphoresis, confusion
What can help prevent Late Dumping Syndrome?
Decreasing the amount of food eaten in one sitting.
What kind of symptoms are indicative of the early stage of stomach cancer?
None. Stomach Cancer only shows up when the disease is in the advanced stage.
How does stomach cancer spread?
Through the lymphatic system. Specifically, through the regional lymphatics and lymph nodes.
What is the first thing a person should do when they see Justin?
Pinch his cheeks and say, “Assessing buccal turgor is part of the cephalocaudal assessment.”
What is the overall survival rate for folks with stomach cancer.
Poor. The cancer has already metastacized (spelling) before you know you have it.
What is the largest risk factor for stomach cancer?
H. Pylori. Momma says H. Pylori is the debil and that it gives you the stomach cancers.
True or False: Patients with gastric pollups, chronic atropic gastritis and alklorhydria are at a greater risk for stomach cancer.
True.
True or False: There is a correlation with stomach cancer and eating pickled food, salty food and/or processed food.
True.
True or False: A low intake of fruits and vegetables increases the odds of getting stomach cancer.
True.
True or False: Asians have a high risk of stomach cancer.
True. The teacher said it is because the smoke fish. The question is, whether or not they smoke fish in a water bong.
Does gastric surgery increase the risk of gastric cancer?
Yes.
Which demographics are at greatest risk for gastric cancer?
Asians, Pacific Islanders, Native Americans, African Americans and Alaskan Natives.
What is the therapeutic range of digoxin?
.8ng/ML to 2.0 ng/ML (ng = nanograms)
What is the maintenance dose of digoxin?
.25 mg/day
True or False: CHF can lead to either Right Sided heart failure or Left Sided heart failure.
For testing purposes, this is true.
What is a toxic level of digoxin?
anything greater than 2.0 ng/mL.
True or False: If an NG tube is in place, it can be moved.
FALSE. You never move an NG tube once it has been placed.
What is used for decompression of the stomach or feeding?
An NG tube.
A surgery performed to improve a patient’s functional ability is called:
Restorative Surgery
What is atelectasis?
The collapsing of alveoli.
Monitoring elderly patients for F/E imbalance is important.
True.
What are some complications associated with overnutrition?
It stresses the cardiac system, makes it more difficult to assess a wound site, increases the risk for wound dehisence, increases odds of wound infection, increases risk of incisional hernia.
Which vitamin is associated with epithelialization?
Vitamin A
Which vitamin is important for the synthesis of collagen and new cappilaries?
Vitamin C
This is needed to replace or repair tissue, is involved in collagen formation and wound remodeling?
Protein
This vitamin acts as coenzymes:
Vitamin B
Why is it important to cover Deep Breathing exercises during pre op teaching?
Lungs are not fully inflated during surgery, cough reflex is suppressed and, as a result, mucous accumulates in the airway passages.
This technique improves lung expansion and oxygen delivery without excess energy.
Diaphragmatic breathing
What minimizes pain during coughing?
A splinting incision
This breathing technique involves slow, deep, relaxed breathing and helps clear anesthetics out of the airway:
Diaphragmatic breathing
Why is it important to cover exercise during pre-op teaching?
During surgery, venous blood flow to the legs slows down and this “stasis of circulation” may lead to thrombi/clots.
True or False: Air dropping Miley Cyrus over Assad-controlled Syria would knock out two birds with one stone.
True.
Why is it important to turn the patient frequently and encourage leg exercises?
It increases leg circulation (which prevents thrombi/clots)
True or False: A family member is an acceptable witness to informed consent.
False. Falso. Nyet.
True or False: Informed consent must be signed before pre-op meds are taken.
True.
Why are opioids sometimes prescribed as pre-op meds?
They decrease anxiety and promote sedation
Why are anticholenergics prescribed as pre-op meds?
They decrease secretions.
Why are antiemetics prescribed as pre-op meds?
They decrease nausea and vomiting.
Name three common narcotics/opioids frequently given pre-op, intra-op and post-op.
Morphine, Demerol, Sublimaze
Why are narcotics given pre-op?
To decrease anxiety and promote sedation.
Why are narcotics given intra-op?
For the induction and maintenance of anesthesia.
Why are narcotics given post-op?
For pain management.
Demerol is also known as:
Meperidine
MS Contin and Duramorph are also known as:
Morphine Sulfate
Sublimaze is also known as:
Fentanyl
What is Meperidine (Demerol) used for?
It is an analgesic that causes sedation.
What are common side effects for Meperidine (Demerol)?
Lightheadedness and Dizziness. Take safety precautions for drowsiness.
What are some side effects (not to be confused with adverse affects) of Morphine Sulfate?
Dizziness, Hypotension, Nausea, Vomiting, Resp. Depression.
What are some ADVERSE affects of Morphine Sulfate?
Circulatory Collapse, Cardiac Arrest (with rapid IV infusion)
What is Sublimaze used for?
It is an opioid analgesic that is used pre and post op as an adjunct to general and regional anesthesia.
What are anticholenergics used for?
They decrease oral and respiratory secretions and prevent bradycardia.
What are three common drugs that fall into the category of “anticholenergics”?
Atropine, Robinol, Scopalamine
What does atropine do?
Suppresses secretions, and INCREASES cardiac output and heart rate. This is pretty much the same definition as “anticholenergics”.
What are common side effects of atropine?
Pupil dilation and paralysis of accommodation.
Name a synthetic anticholenergic.
Robinol
What is another name for Robinol?
glycopyrrolate
When is Robinol primarily used?
Pre-op. (to inhibit secretions in mouth and resp. tract)
What medication is used to increase gastric emptying and for prophylaxis of post-op nausea and vomiting?
Metoclopramide (Reglan)
What is droperadol (inapsine) used for?
Decreases nausea and vomiting.
What are two other names for Hydroxine Hydrochloride?
Vistaril, Atarax
What is Hydroxine Hydrochloride (Vistaril, Atarax) used for?
antianxiety, antihistamine, antiemetic and sedative
True or False: Hydroxine Hydrochloride is administered via IV.
False. You NEVER administer Hydroxine Hydrochloride through an IV!
What are three common benzodiazepines?
Versed, Valium, Ativan
What is Versed used for?
Decreases anxiety
What is valium used for?
To induce sedation
What is ativan used for?
To induce amnesia
Versed is also known as:
midazolam
Valium is also known as:
diazepam
Ativan is also known as:
lorazepam
midazolam, diazepam, lorazepam fall into what class of medications?
benzodiazepines
True or False: Midazolam, diazepam and lorazepam are cousins of Shadrack, Meshach and Abednego.
Probably not.
Sodium Citrate is a type of:
Antacid
What is the purpose of an antacid?
To increase gastric pH.
Name the three H2 receptor antagonists.
Tagamet, Pepcid, Zantac
Which medication would be given to increase gastric pH?
Tagamet
Which medication would be given to decrease gastric volume?
Pepcid
What are some complications associated with using inhalation agents in anesthesia?
coughing, laryngospasms, broncospasms, increased secretions, respiratory depression
For purposes of this test, nitrous oxide and any drug that ends in -ane is what type of agent?
Inhalation
What kind of tube is used for a patient who is receiving an inhalation agent?
Endotrachial tube.
What are some ADVERSE affects associated with using inhalation agents?
Seizures, liver damage, cardiac dysrhythmia, nausea, vomiting, death.
What is always the highest priority when assessing a patient in any situation?
ABC! Airway, Breathing, Circulation. These are the top priority. There will probably be a test question on this.
After ABC’s, what is the next assessment priority?
Vitals.
Decreased, BP, increased HR and RR, thready pulse, restless and cooly, clammy, pale skin are signs and symptoms of:
Hemorrhage/Hypovolemic Shock
When is the only time you will use an NG tube?
For feeding or a stomach issue.
True or False: The elderly are more susceptible to hypothermia.
True.
Edema, pain and warmth are associated with:
Deep vein thrombosis
Where do pulmonary embolisms first develop?
In legs or pelvis
What are some advantages of low weight molecular heparin over unfractioned heparin?
less bleeding, fewer incidents of thrombocytopenia, better absorption, longer duration of action, as effective or more effective and no lab monitoring.
An increased RR, dyspnea, fever, crackles, productive cough are signs and symptoms of:
Atelectasis
Fever, chills, productive cough, chest pain, purulent mucus, dyspnea are signs and symptoms of:
Pneumonia
Dyspnea, sudden chest pain, cyanosis, tachychardia, decreased BP are signs and symptoms of:
A pulmonary embolism.
How many mL/hr would you like to see a patient urinate after surgery?
30
True or False: It is normal for a patient to not urinate immediately after surgery. Sometimes it can be 6-8 hours.
True.
A non-mechanical intestinal obstruction where the bowel is either partially or totally occluded is called a:
Paralytic Ileus
What are S/S of paralytic ileus?
decreased or no bowel sounds. Abdominal distension. Painful abdomen. As it progresses, the bowel sounds are completely absent. Vomiting. Unable to pass flatus or stools.
In this type of wound closure a wound is left open to heal. It heals from the bottom of the wound to the top and from the outside to the inside. This is known as:
Secondary Intention
In this type of wound closure the edges are brought together and they heal well with little scarring. This is known as:
Primary intention
In this type of wound closure The wound is initially left open and then at a later date they come back and close it. This is called:
Tertiary intention
How do you know a patients wound is about to dehisce?
A patient’s wound would be doing fine and then suddenly drain a lot.
Discuss the etiology of pain and discomfort in a patient.
could be related to the wound or the surgery or how the patient was positioned. Could be anything. Pain usually hits its peak on the second day. The doctor frequently orderes IM meds for the first 72 hours. After that PO meds PRN.
90% of all oral cancers are:
squamous cell
What are Montgomery straps used for and how are they beneficial?
They are used to hold a dressing in place when frequent dressing changes are anticipated and help prevent skin irritation from frequent tape removal.
What is the most common reason for hospitalization in people over the age of 65?
Congestive Heart Failure
How do you know if a patient is having ventricular failure?
The “hallmark” of Left ventricular failure is a decrease in the ejection fraction (i.e. how much blood the ventricle pumps out). Left ventricular failure is also known as “forward failure”.
True or False: someone who is suffering from ventricular failure is a candidate for an AED.
True. Left Ventricular Failure is a “shockable rhythm”.
What are the two subtypes of Left-sided heart failure?
Systolic and Diastolic.
What exactly is systolic heart failure?
It is when the heart is unable to contract forcefully enough during systole to eject adequate amounts of blood into circulation. Essentially, it is “ineffective pumping” of the ventricle.
Preload increases with decreased contractility and afterload increases as a result of peripheral vascular resistance in WHICH subtype of left sided heart failure?
Systolic Heart Failure
The ejection fraction drops below 40%, tissue perfusion decreases and blood accumulates in the pulmonary vessels in WHICH subtype of left sided heart failure?
Systolic Heart Failure.
What happens during diastolic heart failure?
The left ventricle is unable to relax adequately during filling; the ventricle stiffens. The ventricle gets a stiffy? It does not fill with blood normally during diastole.
True or False: The ejection fraction in DIASTOLIC heart failure can be normal.
True. It is only below 40% in SYSTOLIC heart failure.
This type of Left-Sided heart failure is mostly found in older adults and women with chronic hypertension and undetected coronary artery disease.
Diastolic heart failure
What usually causes diastolic heart failure?
It is usually the result of left ventricular hypertrophy. Folks who get left sided heart failure usually have hypertension, coronary artery disease or some type of valvular disease of the mitral or aortic valve.
True or False: You normally get pulmonary congestion with diastolic heart failure.
True.
True or False: Most failure starts in the right ventricle.
False. Most failure starts in the left ventricle, but can progress to both ventricles.
What are some symptoms of left sided heart failure?
decreased tissue perfusion and pulmonary congestion
Can right sided heart failure be caused by a failure of the left ventricle?
Yes.
What are some causes of Right sided heart failure?
A failure of the Left ventricle, right ventricular myocardial infarction, or pulmonary hypertension.
What happens in Right sided heart failure?
The right ventricle is unable to empty completely.
What are some compensatory mechanisms when a person has CHF?
The sympathetic nervous system is stimulated. This causes the heart rate and BP to increase, vasoconstriction takes place. Renin-Angiotensin activation occurs, and hormones such as ADH and BNP are released and myocardial hypertrophy occurs
What is the most immediate compensatory mechanism the body uses when it has CHF?
Sympathetic nervous system stimulation (this causes heart rate and bp to increase)
True or False: Stroke Volume is also increased by sympathetic nervous system stimulation.
True.
Renin-Angiotensin System Activation is one of the compensatory mechanisms the body has when it suffers CHF. What triggers the Renin-Angiotensin System Activation?
A reduced blood flow to the kidneys
What happens during Renin-Angiotensin system activation?
Vasoconstriction becomes more pronounced, and aldosterone causes sodium and water retention. Preload and Afterload increases, Angiotensin II contributes to ventricular remodeling which results in progressive myocyte contractile dysfunction.
True or False: Most of the neurohormonal responses to CHF make the problem worse.
True.
The thickening of the heart walls (which results in more forceful contractions and increased cardiac output) is called:
Myocardial Hypertrophy.
Why is Myocardial Hypertrophy a bad thing?
The heart continues to increase in size until it can no longer function.
What are some other causes of heart failure?
substance abuse, congenital disease, cardiac infections/inflammation, hyperkinetic conditions, acute myocardial infarction, COPD, fluid volume overload, and other things.
During Left sided heart failure where does the blood get backed up into?
It escapes the left ventricle and is pushed back into the left atrium and then is pushed out of the atrium and back into the pulmonary veins (which causes pulmonary hypertension and pulmonary edema)
Pink, frothy sputum is seen in WHICH type of heart failure (right or left)?
Left. It a cardinal sign of pulmonary edema
What are some key features of Left Sided Heart Failure?
Fatigue, weakness, oliguria during the day, angina (not man-gina), confusion, restlessness, dizziness, tachycardia, pallor, weak peripheral pulses, cool extremities, hacking cough, breathlessness, crackles/wheezing, tachypnea, pink-frothy sputum
During Right sided heart failure, where does the blood get backed up into?
It first gets backed up into the right atrium, then into the superior and inferior vena cava (which causes systemic venous pressure)
What are some key features of Right sided heart failure?
Juggular vein distension, enlarged liver and spleen, anorexia and nausea, dependent edema, distended abdomen, swollen hands and fingers, polyuria at night and weight gain.
What are some labs that might be done on a person with heart failure?
Electrolytes, Renal Function, Urinalysis, CBC, BNP, ABG, EKG, and pulmonary artery catheters.
What are some nursing diagnoses you can come up with for a person with heart failure?
Impaired gas exchange, decreased cardiac output, activity intolerance, potential for pulmonary edema, excess fluid volume
What is the best way to increase Left Ventricular functioning?
Decreasing intravascular volume, Decrease venous return, decrease afterload, improve oxygenation and gas exchange, improving cardiac function and decreasing anxiety.
What type of diet might a person with heart failure be placed on?
A diet with both reduced sodium and reduced water (i.e. no more than 1500 mL/day
What are the the drugs of choice given to a person who has experienced heart failure?
Lasix, Bumex loop diuretics or Thiazide diuretics.
True or False: Patients can become dehydrated after using Loop diuretics.
True. The reason for this is that loop diuretics such as Lasix and Bumex continue to work even after excess water is removed.
Is dehydration a common problem in patients who take Thiazide Diuretics?
No. Thiazide diuretics are largely self-limiting after the excess fluid in the body is removed.
What position would you place a patient in if you wanted to decrease their venous return (also called “preload”)?
You would place them in a high fowler’s position.
Digoxin is also called by what name?
Digitalis.
What does Digoxin (Digitalis) do?
It increases cardiac contractility and it decreases the heart rate.
What must you do before giving a patient digoxin?
you MUST take an apical pulse for one full minute. If the pulse is below 60 you do not give the medication. (Remember, digoxin slows the heart rate)
True or False: Loop diuretics can lead to dehydration which can put the patient at risk for falls.
True.
What kind of nursing interventions would you give for a person on lasix?
monitor weight, monitor I/O, monitor electrolytes, etc.
True or False: NSAIDs can cause Gi bleeding
True
Echymosis around the umbilicus is called:
Cullen’s Sign (indicative of intra abdominal bleeding)
What is an EGD?
visual examination of the esophagus, stomach and duodenum. Esophagogastoduodenoscopy.
Oral Cavity problems are called:
stomatitis
Kanker sores are also called:
stomatitis
What is the most common type of stomatitis?
Primary stomatitis
What usually causes secondary stomatitis?
Infection
What’s the biggest problem with stomatitis?
it could potentially block the airway.
What is the treatment for stomatitis?
Good, careful oral hygiene, drug therapy, dietary changes. Avoid commercial mouthwashes that contain alcohol.
Long term oral mucous membrane irritation can cause:
Leukoplakia
A person that drinks a lot of alcohol and smokes like a freight train is most likely to develop which of the oral cancers in this module?
Squamous Cell
Which type of oral cancer usually shows up on the lips?
Basal Cell
What is the biggest risk factor for Basal cell cancer?
exposure to sunlight
Where is Karposi’s sarcoma usually found?
The hard palate
Which type of oral cancer in this module is often associated with AIDS?
Karposi’s Sarcoma
What position would you put a person in if you wanted to take aspiration precautions?
High fowler’s
True or False; People with GERD are at a higher risk for esophogeal cancer.
True.
Chocolate, fatty foods, caffeine, citrus fruits, tomatoes and tomato products, large meals, pepperming/spearmint, alcohol and tobacco products or placement of an NG TUBE can contribute to what? (this will be on the test)
GERD
True or False: A Hiatal Hernia can contribute to GERD
True
What are the symptoms of GERD?
Dyspepsia, regurgitation, coughing/hoarseness/wheezing at night, belching/bloating/gas after eating, dysphagia, odynophagia, chronic cough and atypical chest pain.
Heartburn is also referred to as:
Dyspepsia
What foods/drugs do you have a person avoid as part of a nutritional therapy to treat mild GERD? (this will be on the test)
Chocolate, fatty foods, caffeine, citrus fruits, tomatoes and tomato products, large meals, pepperming/spearmint, alcohol and tobacco products
What do you advise a GERD patient regarding eating before going to bed?
Tell them not to eat 3 hours before going to bed.
True or FALSE: A GERD patient should eat 4-6 smaller meals a day.
True.
Dyspepsia, regurgitation, coughing/hoarseness/wheezing at night, belching/bloating/gas after eating, dysphagia, odynophagia, chronic cough and atypical chest pain are symptoms of what?
GERD
True or False: The Laparoscopic Nissan Fundoplication is a new type of Japanese mini van.
False.
The protrusion of the stomach through the diaphragm is called:
a hiatal hernia
What diagnostic test would you use to detect a hiatal hernia?
A barium swallow.
True or False: The non surgical management for a Hiatal Hernia is the same for GERD.
True.
What is the non-surgical treatment for a Hiatal hernia?
Avoid chocolate, fatty foods, caffeine, citrus fruits, tomatoes and tomato products, large meals, pepperming/spearmint, alcohol and tobacco products. Do not eat 3 hours before going to bed. Try to eat 4-6 smaller meals instead of a few big ones.
The surgery of choice for a Hiatal Hernia is:
The Laparoscopic Nissan Fundoplication. It turns out it is not actually a Japanese mini van.
Are most esophageal tumors malignant?
Yes.
Sacs from the herniation of the esophageal mucosa are called:
Esophageal Diverticula
Dysphagia, regurgitation, nocturnal cough AND halitosis are signs and symptoms of:
Esophageal Diverticula
How is a person’s risk for perforation diagnosed when they have Esophageal Diverticula?
By performing an EGD
True or False: H. Pylori can lead to two of the three types of Gastritis.
True.
What dietary changes can you recommend to a person with gastritis?
A soft, bland diet and small meals.
A lesion of the stomach or duodenum is called:
A peptic ulcer
What are the complications of having peptic ulcer disease?
Hemorrhage, perforation, pyloric obstruction and intractable disease
What are the signs and symptoms of peptic ulcer disease?
Epigastric discomfort, abdominal tenderness, cramps, indigestion, nausea, dyspepsia, upper GI bleeding, decreased BP, syncope, low hematocrit and hemoglobin.
True or False: If you have Peptic Ulcer disease it is a good idea to drink lots of caffeine and/or acidic juices.
False. These would be bad.
What is the non-surgical management for Peptic Ulcer disease?
Pain Control, Drug therapy, Fluid Volume control
What types of drugs are given for Peptic Ulcer disease?
Proton Pump Inhibitors, antibiotics, antacids, H2 antagonists
True or False: You would watch for and manage hypovolemia and hemorrhage in a patient with Peptic Ulcer Disease.
True.
A rapid emptying of food into the small intestine can cause:
Dumping syndrome
A rapid release of insulin can cause:
Late dumping syndrome
Abdominal bloating and pain that occurs 60 minutes after eating could be the result of :
Afferent Loop Syndrome
Signs and symptoms of Acute Gastric Dilation are:
Epigastric pain, feeling of fullness, tachycardia, hypertension and/or hiccups
Dumping syndrome usually occurs when?
30 min after eating
A partial obstruction of the duodenal loop is called:
Afferent Loop syndrome
What kind of teaching can you do for a person who is about to have surgical management of a hiatal hernia?
Lose weight, quit or reduce smoking, prepare them for what to expect
If you remove the stomach, what kind of signs and symptoms would you see?
Tachycardia, sweat, abdominal distension, pain and palpitations
The pacemaker focuses on which ventricle?
The Left
Patients with severe cardiomyopathy (enlargement of the heart) might be a candidate for:
a heart transplant. you must be a class 3 or 4 according to the NYHA, you cannot have infection, you must have a stable pyschosocial status and no evidence of current drug or alcohol abuse.
Small volumes of fluid accumulate in the pericardium might lead to:
Cardiac Tampenon
S/S of Cardiac Tampenon are:
JVD, paradoxical pulse,
