176 Exam 2 Flashcards
Weeks 5-8
what are some terms associated with impaired urinary elimination?
anuria (absence of urine)
dysuria (painful urination)
polyuria (frequency of urination)
Oliguria (Low o/p)
Nocturia (Night time urination)
Hematuria (Blood in urine)
hesitancy (has urge to pee but difficulty starting stream)
What are the main parts of the digestive tract?
Mouth
* Amylase initeates breakdown of carbs
* Tongue mixes food w/ saliva & presses it against teeth
* When bolus is swallowed, tongue forces food into pharynx
Pharynx
* Shared by resp. and digestive tract
* Joins mouth and nasal passage
* When swallowing, epiglottis covers airway preventing food from entering resp. tract
esophagus
* Long muscular tube that passes through diaphram into stomach
* Wave like contractures propel food down digestive tract (peristalsis)
stomach
* 3 sections: Fundus, body, & pylorus
* Gastric secretions: Rennin (breaks down milk proteins), lipase ( breaks down fats), Pepsin/hydrochloric acid (digest protiens)
small intestines
* 3 sections: duodenum, jejunum, & illeum
* Liver and pancreas secretions leak into duodenum
large intestines
* 5 sections: cecum (appendix location), ascending colon (right side of abd.), transverse colon (across abd.),descending colon (down left side of abd.), Sigmoid colon ( between iliac crest & rectum)
anus
* Last part of large intestine
* Where waste leaves the body
What is the function of the large intestine?
Absorb water from chyme & eliminate remaining solid waste in form of feces
What are the main parts of the urinary tract?
Kidney
* Cortex receives large blood supply & is very sensitive to changes in BP and blood volume
* Medulla collects urine and drains it into calyces, which drain into renal pelvis
* Uriters carry urine from renal pelvis to bladder
Bladder
* Made of smooth mucles that strech to store urine, rests on floor of pelvic cavity behind peritoneum
* Upper portion of bladder called apex, base of bladder called fundus
Urethra
* Muscular tube lined with mucous membranes that carry urine from bladder out of body
* functions as sphincter (contracts to hold urine & relaxes to release flow)
Loss of urine during physical exertion
* Ex: coughing, sneezing, laughing
Causes
* increased abd. pressure under stress (weak pelvic floor muscle)
* urethreal trauma, sphincter injury
Nursing interventions:
* Teach kegel exercises
* Advise patient to void frequently
* Administer drugs as ordered to stimulate sphincter
Stress incontinence
Involuntary contraction of bladder muscles
* Usually follows a strong desire to void
Causes:
* Nervous system disorders
* UTI
* Bladder obstruction
Nursing interventions:
* Toilet scheduling
* Limit fluid intake 2 hrs before bed
* Admin drugs as ordered
Urge incontinence
Untimely urination d/t issues
* Ex: Cognition, obsticles, unsteadiness
Causes:
* Dementia
* Head injury
* Stroke (CVA)
Nursing interventions:
* Scheduled toileting
* Reinforce appropriate behavior
* Remove enviornmet barriers
Functional incontinence
Loss of urine associated w/ a full bladder
* Blockage of urethra
* Frequent voiding
Causes:
* urethral obstruction
* Disorders of bladder, nerves, or muscles
* Spinal cord injuries
Nursing intervention:
* Cath.
* Admin drugs as ordered
* Cutaneous triggers (teach stimulation tech.)
Overflow incontinence
(Urinary)
urine leakage that is caused by a temporary situation such as an infection or new medicine
* Temporary
* Resolves self
Transient incontinence
Uncontrolled, frequent passage of small, semi-soft stool
Cause:
* Constipation
* entire colon full of fecal matter
Nursing interventions:
* Admin laxitives & enemas as ordered
* increase fluids and fibers
Overflow bowel incontinence
Uncontrolled passage of stool several times a day
Cause:
* Weak pelvic muscles
* Loss of anal reflexes
* poor rectal sphincter
* Rectal prolapse
Nursing interventions:
* Teach kegel exercises
* Prepare for surgery if planned
Anorectal bowel incontinence
Formed stools passed after meals
* usually seen in dementia patients
Causes:
* Gastrocolic reflex stimulates defecation
* Patient does not delay until apropriate time
Nursing Interventions:
* Ensure toilet scheduling
Neurogenic bowel incontinence
Incontinet stools (usually diarrhea)
* Not related to other fecal incontinence types
Causes:
* Colon or rectal disease
Nursing Interventions:
* Provide comfort
* Proper skin care
* prepare for dx tests/ procedures
Symptomatic bowel incontinence
What is the correct order of an abdominal assessment?
- Inspect
- Ausculate
- Percuss
- Palptate
What is the lab value BUN an indicater for?
Kidneys ability to excrete urea (end product of protein metabilism)
* Nephrotoxic drugs, high protein diet, GI bleed, dehydration, MI, shock, burns, & sepsis
Lab value: 10-20
Waste product of skeletal muscle breakdown
* Renal function test
Not influenced by diet, hydration, nutritional status, or liver function
Lab value: 0.6-1.2
Cr
Elevated primarily in renal disorders and is a better measurement of kidney function
Normal functioning kidneys = very low levels & high urine levels
Serum Creatinine
Monitored in pts w/ renal issues d/t the serious consequences that occur w/ electrolytes
Renal failure = Na & K levels are elevated & Ca levels are decreased
Serum Electrolytes
Identifies microorganisms in urine
- Collect specimen first voide of the day
- Clean catch tech
- Collect before antibiodic therapy
- If cath, collect specimen after disregarding small urine amount
Nursing intervention:
* Cap specimen & refrigerate or send to lab (unless specimen has preservative)
Urine cultuer & sensitivity
Measures glomerular filtration rate; decreases w/ renal disease
* Provide specimen container
* Document first void for next 12-24hrs as ordered
* Keep specimen refrigerated
* If foley cath, place drainage bag in basin of ice & empty into refrigerated container hourly
Nursing intervention:
* No special care needed
Urine Creatinine Clearance
Detects GI bleeding when blood is not readily seen
* Advice need of stool sample
* If test is done at home, explain the procedure
Nursing intervention:
* No special care required
Occult Blood Test
Provides radiographic view of kidneys, uterus, & bladder
* No special prep
* Schedule test before studies that use contract
Nursing intervention:
* No special care required
KUB
(Kidney, urterer, bladder)
Uses radiographics and fluoroscope to outline kidneys
* Tell pt contrast will be injected & radiographs taken to study urinary tract
* Give laxitives & enemas as ordered before tests
* NPO status 8-10hrs before test
Nursing interventions:
* Encourage fluids to flush contrast
* Monitor signs of iodine allergy (urticaria, rash, n/, swollen parotid gland)
* Check injection site for inflammation
Intravenous Pyelogram
Detects abnormalities of large intestine
* Contrast admined. by enema & radiographs take w/ pt in various positions
* Radiographs taken initially & repeated 6hrs later to see how much barium has passed through the stomach
* clear liquid
* NPO after midnight
* Fluid given on morning of procedure
Nursing intervention:
* Monitor stool up to 2 days for white stool showing barium being eliminated (normal stool after 3 days)
* Laxities may be ordered to promote elimination
* Provide food, extra fluids, & rest
Barium enema
Uses lit scope inserted through the urethra, bladder, & ureteral openings
* obtain consent
* NPO if anesthesia usage
* Give laxities/enemas as ordered
* Give sedative as ordered for anxiety
* Antibiotics given 2-3 days before & continued after
Nursing intervention:
* Safety precaution d/t orthostatic hypotension
* Monitor I/O’s, vitals, urine color (may be pink)
* Report severe pain & give pain meds
* Sitz bath
* Drink 2-3 L of fluids
Cystoscopy
Visualizes esophagus, stomach, & Duodenum
* Inform pt scope will not interfere with breathing
* NPO 6-8hrs; give sedative before test if ordered
* Remove dentures
Nursing interventions:
* NPO until return of gag reflex
* Monitior for signs of trauma (bleeding), perforatium (distension/cramping)
* Warn of sore throat
* Contact PCP if severe pain, fever, dyspnea, or hematesis
Esophagogastroduodenoscopy
(EGD)
Visualizes anus, rectum, & entire colon
* NPO 6-8hrs before test
* Restricted to only liquids on previous day/evening
* Bowel cleansing done w/ cathartics, suppositories & enemas
Nursing intervention:
* Tell pt to report blood in stool (bleeding suggests perforation of colon)
* Monitor BP & HR
* Inspect abd. for distention
* Encourage fluids when fully alert to replace loss
Colonoscopy
What labs would you run in relation to elimination?
Urinalysis
Renal function test (BUN/Cr,Cr clearance)
Cultures (specific gravity, stool/urine)
Occult blood culture(done when expected GI bleed)
What radiographic tests would you run in relation to elimination?
X-ray, KUB
ultrasound
CT, MRI
What direct observation tests would you run in relation to elimination?
Colonoscopy
Cystoscopy
Esophagogastroduodenoscopy (EGD)
Bladder scanner
inflammation of bladder
* bacteria travels up urethra, infects urine & inflames the bladded lining
* Women more than men
S/s:
* low grade fever
* Pain, pelvic/abd. discomfort
* Bacteria in urine
* Urgency/frequency/dysuria/nocturia/bladder spasms/incontinence
* Dark, tea colored,cloudy urine
Dx:
* Urinalysis
* Culture & sensitivity
Tx:
* Oxybutynin chloride (Ditropan) - Antispasmotic
* Antibiodics, continuous prohylactic antibiodics
* Mild analgesics (acetaminophine)
* Teaching on peri care, avoid scents/perfumes on genitlas
* Shower instead of bath, sitz bath
* Void after sex & void frequently
* Increase fluids
Cystitis
What are risk factors for Cystitis?
Prolonged immobility
Renal calculi, urinary diverson
Indwelling cath
Radiation therapy, chemo
Gender (women more than men affected)
How would you educate a pt with Cystitis?
Teach to avoid risk of furure infection:
* Wear cotton undergarments
* Avoid tight fitting clothes in perineal area
* Avoid carbonated caffeine, tea/coffee, apple/orange/grapefruit, & tomato juice (irritated bladder)
* Drink cranberry juice
* Wipe front to back for females
* Complete entire first course of antimicrobial therapy
Inflammation of renal pelvis that may affect one or both kidneys
* Most often results from inadequate closure of ureterovesical junction during voiding
Acute: Ascending bacterial infection, may be blood born
Chronic: Persistant/recurrent; results in damage to parenchyma (functional tissue)
S/s:
* Decreased activity & urine o/p
* slight aches over kidney(s)
* Bladder irritation
* High fever, chills, n/v
* Dysuria
* Severe pain, constant, dull aches in flank area
Labs:
* BUN/Cr
* UA, culter & sensitivity
Pyelonephritis
How would you treat Pyelonephritis?
Hospitilization
IV antibiodics, UT antiseptics, analgesics (NSAIDS), antispasmotic
HTN medications
IV fluids w/ n/v
* Monitor I/O
Dietary salt & protein restriction
Assist w/ ADLs
What are risk factors for Pyelonephritis?
Long term UTIs
ESRD
Fluid and electrolyte imbalance
Dialysis
Enlarged prostate gland (men over 50)
* Cells arent malignant
Glands press against & pinch urethra
Bladder walls become thicker & may weaken to lose ability to empty completly
S/s:
* Difficulty starting urination
* Straining/ pushing out urine
* Weak/slow urine flow
* Frequency, urgency, nocturia
* Dribbling, incomplete emptying of bladder
Treatment:
* Finasteride (proscar) - Hormone
* Tamsulosin (Flomax) - BPH agent/ alpha blocker
* Transurethral resection of prostate (TURP; most recommended)
* Fluid intake of 1500-2000mL/day
* Fluid restriction 2hrs before bed
* Avoid caffeine & alco.
* Prostatectomy
Benign Prostatic Hyperplasia
(BPH)
What are some Dx tests & labs that would be obtained for BPH?
Dx:
* Digital rectal exam
* Ultrasound
* Prostate-specific antigen (PSA)
Labs:
* UA, Culture & sensitivity
What are risk factors for BPH?
Men age 40 and up
Family Hx
Obestity
T2DM
Heart & circulatory disease
used after removal of prostate to maintain continous irrigation & bladder drainage
* AKA “standard cath”
continous irrigation intended to clear bladder of blood & debris
If cath o/p is less than irrigating fluid delivered, catheter may be obstructed
* Manual irrigation is needed as ordered to clear colts & restore drainage
* Notify Dr ASAP if drainage is not restored
Triple-lumen urinary catheter
What is the normal Hemoglobin level?
12-18 combined
M : 14-18
F : 12-16
What is a normal WBC level?
5000-10,000
What is the normal platelet level?
150,000-400,000
What is the normal urine Specific Gravity level?
1.001-1.035
What is the normal PTT range?
25-35 seconds
Hormone - PO
* Used to treat BPH
reduces hyperplastic cell growth, treats male pattered baldness
CAUTION: DONT TOUCH PILL IF PREG
Adverse reactions:
* Impotence
* Decreased libido
* Decreased ejaculation
Finasteride (Proscar)
Which type of tx may be used for neurogenic incontinence?
A) Fluid restriction
B) Pelvic exercises
C) Toilet scheduling
D) Consumption of mineral oil
C) Toilet scheduling
How would you perform care after a transurethral resection of the prostate (TURP)?
Continuous/intermittent bladder irrigation
Close observation of drainage system
* Increased bladder distension causes pain & bleeding
Manage bladder spasms
Pain control w/ analgesics & decreased activity first 24hrs
Avoid straining w/ BM
How does a UTI spread?
urethra to the bladder, then ascends into kidneys
Build up of waste in blood makes it hard for kidneys to keep correct fluid balance
Arteries in renal parenchyma become narrowed d/t artherosclerosis, HTN, nephrosclerosis, or blood components (sickled RBC,Hgb or myoglobin)
S/s:
* fluid retention/ hypovolemia
* SOB, cp or pressure
* Irregular heartbeat
* edema lower extremities
* Change in urine o/p
* systolic bp > 70mm Hg
Labs/ Tests:
* UA, BUN/Cr
* CBC
* Kidney biopsy
* GFR
* Ultrasound, CT/MRI, X-ray
Acute Renal Failure
What medications will you anticipate for acute renal failure?
Oliguria:
* treat w/ diuretics
Hyperkalemia:
* Kayaxelate (PO/recal; sodium polystyrene)
* IV Insulin/glucose
* Calcium gluconate
IV fluids w/ dopamine, furosmide, or both (loop diuretics)
Amino acid supplements
TPN if GI tract not functioning
What nursing interventions/ treatements will you anticipate for acute renal failure?
Fluid restriction, direct restriction
* IV fluids w/ dopamine, furosmide, or both (loop diuretics)
Restore electrolyte imbalance
* restrict Na, K & phos intake (give kayaxelate)
* Place on cardiac monitor
* Hemodialysis
* Diet individualized by electrolyte imbalance
Avoid nephrotoxic drugs
Prevent FVO
* monitor for crackles, cyanosis, increased RR, ect.
Continuous Renal Replacement Therapy
Daily weight
* Same time, same scale, same clothing types, ect.
Monitor s/s related to immobility (constipation, skin breakdown)
What are the causes of AKI?
Prerenal:
* Decreased blood flow to glomeruli
* need to sustain systolic Bp 70mm Hg or > to sustain glomeruli function
Intrarenal:
* Nephrotoxic meds (antibiodics)
* Kidney infection (pyelonephritis, polycystic kidney disease)
* DM, trauma (bleeding/bruising)
Postrenal:
* Obstruction (kidney stones)
* BPH
* Prostate cancer
What are s/s of AKI?
Oliguric phase:
* Oliguria (urine o/p < 400mL/ day; occurs w/in 1-7 days of kideny injury)
* UA (casts, RBC/WBC, Sp. grvty fixed at 1.010)
* Metabolic acidosis, hyperkalemia, hyponatremia
* Elevated BUN/Cr
Diuretic phase:
* Gradual increase in urine o/p ( 1-3L/day)
* Hypovolemia/ dehydration, hypotension
* BUN/Cr normalize (indicate working - Dont need hospital)
Recovery phase:
* Begins when glomerular filtration rate (GRF) increases
* BUN/Cr level plateau then decrease
Kidneys damaged & cannot propperly filter blood
* progressive destruction of nephrons of both kidneys that is describes in stages 1-5
* Develops slowly
Excess fluids and waste from blood remain in body causing other problems (heart disease, stroke)
Cr clearance is important
* < 15 = stage 4, severe funtion loss
S/s:
* Elevated BUN/Cr
* Elevated serum K (hyperkalemia, hypocalcemia, high phosphate)
* Decreased GFR
* increased BP
* High LDL
* Polyuria leading to oliguria
* Change ins Sp. Grvty d/t decreased ability to concentrate urine
* hypernatremia
* Hypervolemia
Chronic Kidney disease
What are the most common causes of Chronic Kidney disease?
HTN
DM
Artherosclerosis
What labs & tests are expected to be ordered for Chronic Kidney disease?
BUN/Cr
UA
ultrasound, CT/MRI, X-ray
CBC
Metabolic panel
What are S/s of ESRD?
electrolyte imbalance
FVO
increased BP
alt. mental status
* depression, confusion, w/drawn behavior
Dry, flaky, yellow/gray/ecchymosis skin
Purpura (small blood vessels leak blood under the skin)
Anemia
What nursing interventions/ treatments would you anticipate for Chronic Kidney disease?
Diuretics, ACE inhibitors (“-pril”), Calcium- channel blockers (decrease HTN)
Water souble vitamins
“-statin” drugs in early stages
Promote elimination of waste & maintanance of fluid balance
* Fluid restriction
* Na, K restriction
Iron supplements
Dialysis
IV insulin & glucose
Erythropoetin
Monitor for s/s of infection, BM status, nutrition, and any sign of skin trauma
Blood leaves body and goes through device to filter out toxins in blood, then blood is returned
Done at hospital, clinic, or home
performed 3-5x/week for 3 or more hours
Requires access to circulatory system to route blood:
* Fistula ( joins artery & vein; lowers risk of infection)
* AV Graft (synthetic graft betwen artery & vein; increases risk for infection; needs more heparin)
For pts w/ acute/ irriversible (chronic) renal failure & fluid & electrolyte imbalance
Hold BP meds until after dialysis
Monitor for hypotension - check BP q15min
Hemodialysis
Blood doesnt leave body. Body fluid intrills into peritoneal cavity. Filter then pulls out waste from blood vessles
* Not everyone qualifies
Done at home
4x/day for 40 min
Pt uses own peritoneum as a semipermeable dialyzing membrane
* Peritoneal cath
Use Aseptic tech. (sterile, everyone wears mask)
CANNOT be used on pts w/:
* recent abd. surgery
* extensive trauma
* open abd. wound
Peritoneal dialysis
What are advantages & disadvantages of hemodialysis?
Advantages:
* useful in emergent situations (femoral/jugular site)
* Rapid waste, electrolyte, & fluid removal
Disadvantages:
* Need vascular space
* Use of anticoagulent (heparin)
* Potential hemorrhage/ anemia
How do you asses a dialysis site?
Assess fistula/graft for infection
Assess circulation in distal extremities
Ausculate Bruit, Palpate Thrill
No IV, Bp, or blood draws in arm
* If dialysis site on both arms, take bp on thigh
What are advantages & disadvantages of peritoneal dialysis?
Advantages:
* Less anemia
* Decreased cost
* Fewer dietary & fluid restrictions
* “Norm” kidney function
Disadvantages:
* Risk peritonitis
* Cath. site infection
* hyperglycemia
* Increased serum lipid levels
What are some complications associated with hemodialysis?
Cardiovascular disease
Anemia
Air embolism
Disequalibrium syndrome (rapid change in fluid & electrolytes)
Hypotension
Irregular heart rhythem
What are some nursing interventions for a patient attending dialysis?
Daily weight before and after
Maintaine dialysis site
Prevent/manage infections
Monitor for S/s of electrolyte imbalance
What are some complications associated with peritoneal dialysis?
Peritonitis (most serious)
Infections at cath. site or where it is tunneled under the skin
Encapsulating peritoneal sclerosis (thick membrane developes around bowel)
Abd. pain
Hernia
Lower back pain
Intolerance of gluten (wheat, barley, rye, & oats)
* AKA “gluten enteropathy” or “celiac spur”
Results in accumulation of amino acid glutamine (toxic to intestinal mucosal cells)
S/s:
* Abd. pain/ distention
* Large, bulky, foamy, & foul smelling stool
* Steatorrhea (execive fat in stool)
* Irritability
* Acute or insidious diarrhea (watery stool w/ pale color & foul oder)
Risk factors:
* T1DM
* Addisons disease
* Down syndrome
* Fam hx
Celiac disease
What are some labs & tests that will be ordered for Celiac disease?
Endoscopy w/ small bowel biopsy
Lactose deficiency based off lactose tolerance test
Breath test for abnormal hydrogen levels
Biopsy of internal mucosa
What are some nursing interventions/ treatments anticipated with Celiac disease?
Nontropical celiac disease:
* Avoid gluten products (Barley, Reye,Oats, Wheat)
Tropical Spur:
* Antibiodics
* Oral folate
* Vit B12 injections
Lactose deficiency can be treated by eliminating milk & milk products
Endoscopy
Read food lables
Inflammatory bowel disease that can occur anywhere in the GI tract
* Increases risk for colon cancer
* most often found in the ileum and in the colon
Most often affects the terminal ileum & leads thickening & scarring, a narrowed lumen, fistulas, abscesses & ulcerations
S/s:
* Dehydration
* Electrolyte imbalance
* Malnutrition, anemia
* Abd. distention, flatus
* cramp like/ colicky pain after meals
* Diarrhea (semisolid - containes mucus and pus)
* weight loss
* N/V/A
* bleeding uncommon
5-6 soft, loose stools / day
Crohn’s Disease
What labs & tests will be ordered for Crohn’s Disease?
CBC, CT, Ultrasound
Abd. radiography
Colonoscopy w/ biopsy
Barium enema exam w/ air contrast
Cell studies
What nursing interventions/ treatments will you anticipate for Crohn’s Disease?
Monitor I/o
Measure & count diarrhea stools
Sitz bath
Easy toilet access
Administer antidiarrheals, antispasmodies, anticholinergics, antibiodics & corticosteroids
Admin TPN
Ulcerative & inflammatory disease of bowels resulting in poor absorption of nutrients
* Begins in rectum and ascends towards cecum
* Increased risk of cancer in large intestine
Affects large intestine ONLY
Colon becomes edematous & may develope ulcers which lead to perforation
* Scar tissue developes = loss of elasticity & ability to absorb nutrients
S/s: (bleeding common)
* Weight loss
* Abd tenderness & cramping
* Fever
* Severe diarrhea (w/ blood & mucus)
* Malnutrition, dehydration, electrolyte imbalance
* Muscle hypertrophy
* Vit K deficiency
* Hemorrhage
* 15-20 liquid, bloody stools/ day
Ulcerative Colitis
What labs & tests will be ordered for ulcerative Colitis?
CBC
Abd. radiography
Colonoscopy w/ biopsy
Barium enema exam w/ air contrast
Ultrasound
CT
Cell studies
antianemic (IV, SUBQ)
* used to treat anemia in patients with chronic renal failure to those receiving chemotherapy.
erythropoietin is a factor controlling the rates of RBC production
* product is developed by recombinant DNA technology
Side effects:
* seizures
* hypertension
* rash
* encephalopathy
* DVT
* stroke
* MI
* Decreased endogenerous erythropoietin
Monitor the BP and CBC with differentials & Maintain serum iron at normal level - watch platelets
epoetin alfa (epogen)
what should you monitor for with epoetin alfa?
CNS symptoms
seizures
pure cell aphasias
BP
CBC
loop diuretic - po, IV,IM
potassium wasting
* Inhibits reapsorption of Na
used for worsening crackles, new edema in the legs, edema w/ HF, rapid weight gain, pulmonary edema, & hepatic disease
monitor BUN & Cr
only give if K+ is in range
furosemide
what are side and adverse effects of furosemide?
hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia
thrombocytopenia
orthostatic hypotension
rash
ototoxicity and deafness
dehydration
antianginal, vasodilator - IV
produce vasodilation, decrease preload and afterload and reduce myocardial oxygen consumption
* Check expiration date
do not use with erectile dysfunction drugs (viagra)
5 min between each tab, only give 3
LIGHT SENSITIVE - Dont take if Preg
side effects & adverse effects:
* headache
* orthostatic hypotension
* dizziness, weakness
* faintness
* nausea, vomiting
* flushing or pallor
nitroglycerin
beta blocker, antihypertensive - PO/IV
* Used for Mild-mod HTN/ acute MI
decreasing cardiac output, decrease heart rate and decrease blood pressure, decrease workload of the heart, stable angina
do not give with asthma
DO NOT STOP ABRUPTLY
side effects & adverse effects:
* bronchospasm
* bradycardia
* hypotension
* weakness, fatigue
* N/V
* hyperglycemia
* agranulocytosis
* behavior or psychotic response, depression
metoprolol
Antiarrhythmic, Antihypertensive - IV, PO
helps heart contract, slows heart rate, increases cardiac output , decreases preload, fluid retention decreased
* Inhibits Na K pump
DONT use w/ renal disease
* Hold when the apical pulse is lower than 60 bpm
Therapeutic range: 0.5-2.0
side effects & adverse effects:
* diplopia, blurred vision, yellow-green halos, photophobia (visual disturbances)
* drowsiness, fatigue, weakness
* bradycardia
* n/v/d/ headache/ anorexia
digoxin
Reduces serum level of cholesterol, triglycerides, or low density lipoprotein - PO
report unexplained muscular pain
lower risk of coronary disease
side effects & adverse effects:
* constipation
* GI disturbances
* heartburn, nausea, belching, bloating
simvastatin
opioid analgesic and vasodilator - PO/IV
used to treat severe pain, sedation, & cancer pts
* narcotic drug derived from opium
Monitor for resp. depression
morphine
antihypertensive, ace inhibitor - PO
used for mild-moderate hypertension
Monitor for vertigo, dizziness, hypotension
Report dry cough
lisinopril
NSAID
used for mild to moderate pain or fever
* Relieves muscle aches, toothaches, common cold, and headaches.
aspirin
Vitamin B12 - PO
needed for adequate nerve functioning, RBC development
cyanocobalamin
opiate analgesic - PO
* Mild to severe pain
inhibits ascending pain pathways in the CNS, increases pain threshold, alters pain perception
Monitor for respiratory depression & substance abuse
hydromorphone
anticoagulant - SubQ
used to prevent the extension and formation of clots by inhibiting factors in the clotting cascade and decreasing blood coagulability
* Prevents DVT, PE in hip/knee replacements
monitor for hemorrhage
side effects & adverse effects:
* hemorrhage
* hematuria
* epistaxis
* ecchymosis, bleeding gums
* thrombocytopenia
* hypotension
Enoxaparin (Lovenox)
anti-infective - PO, IV
used in the treatment of anaerobic infections, Bone/joint pain, Resp tract infection, C-Diff
Nursing interventions:
* assess IV site, compatibility, CBC
* Toxic to the liver. Need to check liver functions before given
Monitor for reactions, seizures, aseptic (Viral) meningitis, bone marrow depression, metallic taste, & secondary malignancy
Patient teaching: eat with food, no alcohol, urine may be dark
Metronidazole (Flagyl)
Immunosuppressive drug, antianemic - SubQ
It can treat mod-severe arthritis, plaque psoriasis, ankylosing spondylitis, Crohn’s disease, and ulcerative colitis
Monitor for:
* serious infection (BLACK BOX WARNING)
* severe renal disease
* impaired hepatic function
* leukopenia
* thrombocytopenia
* bronchitis
Adalimumab (humira)
Immunosuppressive drug - IV
It can treat rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, plaque psoriasis, and ulcerative colitis
Monitor for:
* s/s of infection - contact MD
* seizures - implement seizures precautions
Don’t give with a live virus
Infliximab (Remicade)
They say to avoid alcohol products while taking METRONIDAZOLE (FLAGYL), besides an alcoholic beverage, what does that include?
mouthwash
aftershave
deodorant
bath splashes
What drugs would you use for HTN?
ACE inhibitors (“-pril”)
Beta-blocker (“-olol)
Calcium- channel blockers (“-pine” or “-amil”)
Digoxin
Diuretics
How can you dx HTN?
CXR
EKG
What are some tests you could run to determine the level of HF?
BUN/Cr
electrolytes
* sodium (Na)
* calcium (C)
* magnesium (Mg)
EKG, CXR
An adult patient is being discharged home on Digoxin. Which statements below verbalized by the patient demonstrates they understand how to properly take this medication? Select all that apply:
A. “I will limit by intake of foods high in potassium.”
B. “I will not take this medication and notify the physician if my heart rate is less than 70 bpm.”
C. “I will measure my pulse rate before every dose I take.”
D. “It is important that I immediately report any vision changes I may experience while taking this medication.”
C. “I will measure my pulse rate before every dose I take.”
D. “It is important that I immediately report any vision changes I may experience while taking this medication.”
The patient should always measure their pulse rate before taking each dose of Digoxin and hold the dose if it is less than 60 bpm (this is for adults). The patient should not restrict foods high in potassium because this could lead to hypokalemia, which can lead to Digoxin toxicity. Vision changes should be reported because this could indicate Digoxin toxicity.
What type of education would you give a patient with HTN?
limit Na and alcohol
monitor BP
stop smoking
increase exercise
Chronic pulmonary disease/ disorder
pressure from fluid buildup and causes backflow of fluids to the right ventricle
fluid backs into venous system/ rest or body
S/s:
* coughing, wheezing
* SOB when lying flat
* dizziness
* fluid retention
* hepatomegaly
* peripheral edema
right sided heart failure
occurs when the heart loses its ability to pump blood
* prevents organs from receiving enough oxygen
* affects pulmonary (edema)
S/s: (pulmonary symptoms)
* Decreased cardiac output
* Dyspnea, orthopnea
* Wheezing
* pink sputum
* Crackles
* SOB when exercising or sleeping
Left sided heart failure
sickles become stuck together causing severe pain
cause:
- infection
- dehydration
- overexertion
- cold weather
- excessive alcohol/ smoking
Tx:
- IV fluids (expands vascular space - NS/ bolus)
- pain meds, PQRST
- RBC transfusion
- Oxygen
sickle cell crisis
anemia caused by inadequate iron intake (most common)
* take vitamin C to help absorb iron
S/s:
* brittle nails
* pallor
* dyspnea
* tachycardia
* glossitis (inflammation/ burning tongue)
* Cheilitis (inflammation of lips)
Dx/Tx:
* CBC (decreased Hgb & O2)
* Bone marrow aspiration
* Stool sample, colonoscopy, endoscopy (check for blood)
* *treat cause/ iron supplements *
* increase fluids (use straw to prevent staining)
iron deficiency anemia
Vitamin B12 deficiency
* treatment: B12 injections
causes:
* hypoparathyroidism
* graves disease
* crohn’s disease
* celiac disease
* medications
S/s:
* weight loss
* fatigue, weakness
* loss of balance
pernicious anemia
abnormal activation of the proteins involved in blood coagulation, causing small blood clots to form in vessels and cutting off the supply of oxygen to distal tissues
* can lead to organ ischemia (not a disease)
S/s:
* petechiae & purpura
* hematuria
* melena (black tarry stool)
* nosebleeds
* Stroke, DVT, PE
* heart attack
Dx:
* Labs: D-dimer, Hgb, CBC, platelets (decreased platelet and fibrinogen)
* Prolonged clotting time (increased PT & PTT)
* Increased D-Dimer (indicated clots)
Tx:
* treat cause
* transfusion (packed RBC, FFP, platelets)
Disseminated Intravascular Coagulation (DIC)
condition where a build-up of fat deposits in the arteries restricting blood supply
* Common sites are femoral/ popliteal/ distal arteries
* increased risk or developing CAD
Narrow arteries (atherosclerosis) prevent oxygenated blood from getting to hands/feet
* ischemia & necrosis of extremity
S/s:
* Shape pain worse at night (“rest pain”), intermittent claudication
* Poor pulse, numbness/tingling
* Cool temp d/t no blood in extremities
* color: pale, hairless, dry, scaly, thin skin
* Wound: red sores w/ regular shape/round, “punched-out” appearance
* Gangrene d/t tissue death from lack of blood flow
treatment:
* CBC
* Angiography
* Doppler ultrasound
* Ankle-brachial index (ABI) (lower the number = greater risk)
* Vasodilators/ antiplatelets
* Assess pulses, insicion site, & extremity
* Avoid vasoconstriction
* Dangle extremity
* rest in dependent position
* education on foot care & skin integrity
peripheral arterial disease (PAD)
A patient is taking Digoxin. What medication on the patient’s med list increases the patient’s risk of experiencing Digoxin toxicity?
A. Furosemide
B. Metformin
C. Nitroglycerin
D. Coumadin
A. Furosemide
Furosemide is a loop-diuretic and this medication wastes potassium. Remember hypokalemia (low potassium level) increases the risk of a patient developing Digoxin toxicity. Hypercalcemia and hypomagnesemia also increases Digoxin toxicity.
a surgical operation that creates an opening from the colon to the surface of the body to function as an anus
* includes the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum
Colostomy
Bringing end or loop of small intestines (ileum) out onto the surface of the skin
- Bowel cancer
- Growth
Liquid stool, irritating to skin
Ileostomy
Creates a stoma for the urinary system
* After extensive surgery
* Obstruction
Urostomy
Your patient is experiencing extreme fatigue, hypotension, palpations, and shortness of breath. You obtain an ECG and discover a rhythm of sinus bradycardia with a rate of 40 bpm. What finding below could be causing this condition?
A. Potassium level of 3.9 meq/L
B. Lisinopril 10 mg BID PO
C. Blood glucose 84
D. Digoxin 0.125 mg PO daily
D. Digoxin 0.125 mg PO daily
Digoxin slows down the heart rate and can lead to bradycardia.
Your patient, who is 55-years-old, is prescribed to take Digoxin. What patient finding requires that the nurse hold the dose of Digoxin and notify the physician?
A. Digoxin level of 1.2 ng/mL
B. Blood glucose 82
C. Heart rate 61 bpm
D. Potassium 2.8 mEq/L
D. Potassium 2.8 mEq/L
The patient’s potassium level is low (<3.5 mEq/L). Remember hypokalemia increases the chances of Digoxin toxicity developing. The nurse should notify the MD and hold the ordered dose until further instructions are given by the doctor
What EARLY signs and symptoms should the nurse assess for in a patient taking Digoxin that could indicate toxicity of this drug? Select all that apply:
A. Dysrhythmias
B. Anorexia
C. Drowsiness
D. Nausea
E. Vomiting
B. Anorexia
D. Nausea
E. Vomiting
GI-related signs and symptoms are the earliest indications that the patient may be having Digoxin toxicity. The other signs and symptoms occur later, especially dysrhythmias.
How does blood flow through the heart
Blood comes from superior/inferior ven cava into the right atrium from the body, moves into the right ventricle, through a valve and is pushed into the pulmonary arteries in the lungs. After picking up oxygen, the blood travels back to the heart through the pulmonary veins into the left atrium, to the left ventricle, through avalve and out to the body’s tissues through the aorta.
high blood pressure
2 types:
- primary HTN
- secondary HTN
BP cuff that is too small = false high BP
BP cuff that is too big = false low BP
emergency crisis: 180/100
normal: 120/ 80
S/s:
* asymptomatic “silent killer”
* blurred vision, headache
* CP, nosebleeds
hypertension (HTN)
Abnormally high BP not caused by a medical condition
Causes
* Arterial changes
* Genetic factors
* sedentary lifestyle, obesity, smoking
essential hypertension (primary)
Caused by a medical condition & subsides when disease is treated or corrected
Renal artery stenosis, increase in plasma renin and unilateral atrophy of kidney
(Fibromuscular dysplasia in young women)
Secondary hypertension
Chest pain caused by reduced blood flow to the heart
Warning sign of potential HA or stroke
* Monitor pain, echocardiogram, nitroglycerin, angioplasty
if untreated pt will be at higher risk for infection
Angina
T/F - If a patient has been in atrial fibrillation for more than 48 hours, anticoagulation is needed prior to a cardioversion due to blood clot risks.
True
Which medication below should not be used for the treatment of sinus bradycardia in a patient with a transplanted heart?
A. Isoproterenol
B. Atropine
C. Epinephrine
D. Glucagon
B. Atropine
What medication below is NOT a treatment for Sinus Tachycardia?
A. Verapamil
B. Metoprolol
C. Antipyretics
D. Dopamine
D. Dopamine
Dopamine increases the heart rate along with the blood pressure. It is used in Sinus Bradycardia. Verapamil is a calcium channel blocker and can slow down the heart. In addition, Metoprolol is a beta blocker that can slow down the heart rate as well. Antipyretics reduce a patient’s fever which can slow down the heart rate (if a fever is causing the sinus tachycardia).
A condition in which the blood is deficient in RBC’s, in hemoglobin, or in total volume resulting in pallor skin
effects perfusion
* HGB may fall to low & reduce the amount of O2 delivered to the tissue
effects gas exchange:
* decrease in RBC transporting O2 and CO2, impairs the body’s ability for gas exchange
Anemia
Rapidly progressive hypertension that can cause life-threatening damage to small arteries in major organs
Diastolic pressure is usually >140 mm Hg
life-threatening organ damage
- treatment based on severity
S/s usually don’t occur until vascular changes occur in the heart, brain, eyes, or kidneys
malignant hypertension
A rapid heart rhythm in which the electrical impulse begins in the ventricle (instead of the atrium)
* may result in inadequate blood flow and eventually deteriorate into cardiac arrest
* >100 BPM
* QRS wide/ bizarre
* leads to v-fib
cause:
* MI
* hypokalemia
* digoxin toxicity
S/s:
* CP, decreased cardiac output
* lightheadedness, SOB
* dizziness, syncope
treatment:
* Antiarrhythmics (amiodarone)
* Replace electrolytes
* Restore to normal rhythm
* CPR, ACLS, code blue
* synchronized cardioversion
Ventricular tachycardia (V-tach)
Disorganized, ineffective twitching of the ventricles, resulting in no blood flow and a state of cardiac arrest
* rapid/ undetectable
* fatal if not treated in 3-5 mins
* No P wave but has QRST complex
Causes:
* CP, SOB
* N/V
* MI, cardiac injury
* electrolyte imbalance
* untreated V tach
s/s:
* decreased LOC
* no pulse, RR, or BP
treatment:
* O2
* Defib, CPR/ ACLS
* Epinephrine, amiodarone, lidocaine
ventricular fibrillation
chaotic, rapid electrical impulses in the atria
* irregular/no P wave - has QRST wave
* 100-150 BPM
* Increases stroke risk
* most common
causes:
* HTN, MI, HF
* CHD, COPD
s/s:
* Palpitations, pulse deficit
* hypotension
* SOB, CP
* fatigue
* tachycardia
* possible stroke
treatment:
* prevent thrombi (warfarin/ anticoagulants - bleeding precaution)
* restore normal rhythm
* synchronized cardioversion/ D-fib
* Count apical pulse for 1 min
arterial fibrillation (AFib)
>100 bpm
* has PQRST complex
s/s:
* palpitations
* anxiety
* CP
* dizziness
causes:
* dehydration
* fever
* stress/anxiety/hyperventilation
* excessive caffeine
treatment:
* treat underlying cause
* slow HR - Metropolol IV
* can lead to stroke, HF, or death
Sinus Tachycardia
< 60 bpm
* Has PQRST complex
* slow rhythm
cause:
* Meds (digoxin, beta blockers)
* hyperkalemia
* vagal stimuli
* athletes
s/s:
* dizziness, syncope
* hypotension, orthostatic hypotension
* CP
Not treated unless symptomatic - Pt may need pacemaker
Sinus Bradycardia
slow and progressive circulation disorder
* narrowing, blockage, or spasms in a blood vessel, arteries or veins
Cause:
* smoking
* diabetes
* high cholesterol
* HTN
S/S:
* Dull, constant, achy pain
* Pulse may not be palpable d/t edema
* warm temp (blood in extremities)
* yellow/ brown in color
* Wounds: venous stasis ulcer, shallow/ irregular shaped wounds
* No gangrene
treatment:
* control DM
* decrease cholesterol (“-statin”)
* reduce BP
* antiplatelet medications, aspirin, clopidogrel
* control diet
* stop smoking
Peripheral Venous Disease (PVD)
What labs should you monitor for a patient who has anemia?
Hgb
Your patient has a potassium level of 6, what do you do?
give spironolactone (Aldactone)
What are labs used for MI?
troponin and creatine kinase
What do you monitor for while taking lovenox?
Bleeding
D-dimer
What type of precautions is C- Diff and what type of PPE do you need?
Contact
gown & gloves
genetic disorder that causes abnormal hemoglobin, resulting in some red blood cells assuming an abnormal sickle shape
interventions:
* Hydration
* Oxygen
* Pain management (opioids)
sickle cell anemia
Pt complains of the following symptoms associated with urinating; hesitancy, intermittent stream, frequency, urgency and nocturia what do you suspect is wrong?
BPH
What diet should a patient with pernicious anemia be on?
high protein diet
* meat
* eggs
* dairy
5-6 soft stools daily, pain in abdomen and joints, mucous in stool, loss of appetite, fever, fatigue, cramping are all S/S of what GI condition?
Crohn’s
what do you suspect is the problem with your pt complaining of being tired, weak, their skin is itchy and they have a dusky gray color to their skin?
Chronic Renal Failure
Beta Blocker Lopressor is used for what, and what do you do before administering?
HTN, take B/P before you give
How do you control bleeding in someone with hemophilia?
blood transfusion factor VIII & IX
bed rest
apply pressure and ice
Pts with UC (Inflammatory Bowel Disease) are at risk for what?
fluid and electrolyte imbalance and poor nutrition
Pt education on ostomy in ascending colon
stools will be liquid
Atherosclerosis, HTN, DM, obesity, smoking, family history, high fat diet, sedentary lifestyle are all contributing factors to what?
Coronary Artery Disease
which protein choice would align with Dietary Approaches to Stop Hypertension (DASH) eating plan?
A) 12 oz ribeye steak, grilled
B) 3 oz wild salmon, grilled
C) 8 Oz hamburger w/ cheese
D) 12 hot wings w/ skin and hot sause
B) 3 oz wild salmon, grilled
Explaination: DASH diet emphasizes lean sources of protein including poultry, fish, nuts, low-fat dairy, & lean red meats.
