2800 Exam Three Flashcards
GERD
Gastroesophageal reflux disease
Mucosal damage caused by reflux of acid into the esophagus
What are some things that affect lower esophageal sphincter pressure?
Meds like bethanechol and metoclopramide
Things like alcohol, chocolate, fatty foods, nicotine, and tea
What are clinical manifestations of GERD?
Heartburn Dysphasia Dyspepsia Regurgitation Respiratory symptoms Hoarse voice
What are complications associated with GERD?
Chronic cough Worsening asthma Sleep disruption Esophageal strictures Respiratory complaints Esophagitis Barrett’s esophagus
Esophagitis
Inflammation of the esophagus that causes ulceration and scar tissue formation
Barrett’s esophagus
Metaplasia of esophageal cells. A precancerous condition that increases risk for esophageal cancer
What are some lifestyle changes that can help with GERD?
Avoid factors that trigger symptoms
Weight loss
Stress management
Smoking cessation
What are some nutrition suggestions for patients with GERD?
Avoid foods that irritate esophagus (like fat, chocolate, citrus fruits, caffeine, etc)
Avoid foods that decrease LES pressure
Avoid eating late evening meals
Have small frequent meals
How long should patients with GERD stay upright after eating?
2-3 hours
How should patients with GERD try sleeping?
With head elevated (possibly putting blocks under mattress to prop up head)
Clothing recommendation for GERD patients?
Avoid tight clothes and belts
PUD
Peptic ulcer disease
Open sores in stomach or intestines caused by the erosion of GI mucosa due to the action of pepsin and hydrochloric acid
What is a chronic ulcer?
An ulcer that has been there for a long time and eroded through muscular wall with the formation of fibrous tissue
What usually causes a chronic ulcer?
H. Pylori or chronic NSAID use
What are clinical manifestations of PUD?
Burning epigastric pain 1-2 hours after meals Aggravated by food Cramplike pain Bloating Belching
What are some complications associated with PUD?
Hemorrhage from ulcers
Perforation of an ulcer
Gastric outlet obstruction caused by fibrous tissue
What can gastric outlet obstruction with PUD cause?
Edema
Inflammation
Pylorospasm
Scar tissue formation
What are therapies and recommendations for those with PUD?
Rest Smoking cessation Diet modification Drug treatment Stress management
What are health promotion interventions for PUD?
Early detection Effective treatment Having patients take NSAIDs with food Rest Stress reduction
What would be considered an emergency situation with PUD?
Throwing up blood or any other sign of GI bleeding
What is a potential surgery for those with PUD?
Partial gastrectomy (removing part of the stomach)
What complication can a partial gastrectomy commonly cause?
Dumping syndrome
Explain dumping syndrome
Stomach loses control of the gastric chyme entering the stomach, allowing the hypertonic fluid to enter the intestine. This draws lots of water into the bowel, and everything moves through the GI tract very rapidly
What are symptoms of dumping syndrome?
Weakness Dizziness Sweating Palpitations Cramps Excessive abdominal sounds Urge to defecate
What can reduce the chance of dumping syndrome?
Rest after meals Have smaller, more frequent meals Drink fluids before meals Avoid concentrated sweets Increase protein and fat intake
Constipation
Difficult, infrequent, hard to pass stools or feeling of incomplete evacuation
What are manifestations of constipation?
Hard, dry, absent, or difficult to pass stools
Bloating
Abdominal distension
Increased flatulence and rectal pressure
Hemorrhoids
What often causes constipation in children?
Fear Stress Environmental changes Normal development Deliberately holding it, especially when potty training
What is encopresis?
When a child resists having a bowel movement
What can encopresis cause?
Impaction or fecal incontinence
What are valsalva maneuvers?
Straining to evacuate
Why are valsalva maneuvers serious?
They can lead to hemorrhoids
It can also decrease venous return to the heart due to increasing abdominal pressure. When pressure releases, the increased return to the heart is hard on the heart and can cause lightheadedness, syncope, or even death
What are some important teachings related to constipation?
Fiber and fluid intake Regular exercise Keep a log of BMs Regular time to defecate Avoid laxatives Don’t delay defecating if you need to go
What is inflammatory bowel disease?
Chronic inflammation of the GI tract with periods of exacerbation and remission
Ulcerative colitis
IBD that’s limited to the colon, usually in the mucosal layer
Who are some at risk populations to develop ulcerative colitis?
Adolescents
Those living in developed/industrialized countries
Those with family history of it
Crohn’s disease
IBD that can involve any segment of the GI tract from the mouth to the anus
What abnormal GI developments are common with Crohn’s disease?
Strictures and fistulas
Clinical manifestations of IBD
Diarrhea Weight loss Abdominal pain Fever Fatigue Rectal bleeding Anemia Dehydration Blood in stool Skin breakdown around perineum
What are some GI complications of IBD?
Hemorrhage Perforation Abscesses Fistulas Toxic megacolon
What are some systemic complications of IBD?
Anemia
Nutritional deficiencies
Colorectal cancer risk
What are potential surgical options for IBD?
Resection of diseased area with reanastamosis of remaining intestine
Strictureplasty to open narrow areas
Proctocolectomy with creation of an ostomy bag
What are some nutrition considerations for patients with IBD?
High calorie/vitamin/protein
Low residue and lactose
Iron and vitamin D supplementation
Elemental or parenteral nutrition may be needed
What nursing interventions will be priority for patients with IBD?
Fluid and electrolyte balance Nutrition assessment Energy conservation Anemia correction Diarrhea control and skin care Stress management
What does the acronym DRIP tell us about?
Causes of incontinence
DRIP acronym
D: delirium, dehydration, depression
R: restricted mobility, rectal impaction
I: infection, inflammation, impaction
P: polyuria, polypharmacy
Best intervention for stress incontinence
Pelvic strengthening exercises
Best intervention for urge incontinence
Bladder retraining
Best intervention for overflow incontinence
Catheterization
Best intervention for reflex incontinence
Self-catheterization
What is reflex incontinence?
No warning before incontinent episode occurs
Best intervention for functional incontinence?
Getting to the patient quickly and frequent toileting
What kind of incontinence do men usually have?
Overflow incontinence due to BPH
What kind of incontinence do women usually have?
Stress and urge incontinence due to childbirth and weak pelvic floor muscles
What are some complications of incontinence?
UTI’s
Insomnia
Social isolation
Skin breakdown
What are some lifestyle modifications that can help with incontinence?
Smoking cessation Weight reduction Reduction of bladder irritants Alcohol avoidance Good bladder schedule
What are some common bladder irritants?
Caffeine
Aspartame
Citrus
What is timed voiding?
Toileting on a fixed schedule (usually every 2-3 hours)
Should patients struggling with incontinence reduce their fluid intake?
No, because that increases UTI risk
What are some examples of pelvic floor muscle rehabilitation?
Kegel exercises
Vaginal weight training
Biofeedback
Electrical stimulation
When can one expect to see changes with pelvic floor muscle exercises?
Within 4-6 weeks
What are kegel exercises?
Tightening and relaxing pelvic floor muscles to build strength. Usually done 40-50 times per day
What are containment devices?
Catheters (or condom catheters or female urethral inserts)
Absorbent pads
What is BPH?
Increased size of prostate gland due to increased cell proliferation. Leads to urinary retention
What are the irritative symptoms of BPH?
Inflammation, infection, nocturia, frequency and urgency, dysuria, bladder pain, incontinence
What are obstructive symptoms of BPH?
Decreased caliber and force of urine stream, intermittent urine, dribbling urine
What are potential complications of BPH?
Acute urinary retention
UTI
Hydronephrosis
What does Inter professional care for BPH look like?
Drug treatment
Minimally invasive or surgical therapy
What is a TURP?
Transurethral resection of the prostate, which is a minimally invasive procedure and the current most effective intervention for BPH
What is the most common cause of decreased output during post-op continuous bladder irrigation?
Blood clots
When should men get PSA screenings?
Every two years after age 55
What are some health promotion considerations relating to BPH?
PSA screenings
Avoiding caffeine and bladder irritants if they’re an issue
Urinating every 2-3 hours
Adequate fluid intake
What are post-operative care considerations when clients have surgery for BPH?
Catheter care
Bladder irrigation
What complications can occur after BPH surgery?
Hemorrhage
Bladder spasms
Urinary incontinence
Infections
What is continuous bladder irrigation?
Continuous flushing of the bladder with saline to remove clotted blood and ensure drainage
What should the nurse do if outflow is less than inflow with CBI?
Assess patency of tube
If blocked, stop the infusion and call the doctor
What causes bladder spasms?
Irritation of the bladder mucosa from the surgical process
What can relieve pain from bladder spasms and decrease the spasms?
Not urinating around the catheter
Using antispasmodics
Relaxation techniques
What are some potential changes in sexual function after prostate surgery?
ED
Retrograde ejaculation
Anxiety
How long may it take for complete sexual function to return after prostate surgery?
Up to one year
How long may it take for the bladder to return to normal capacity after prostate surgery?
Up to 2 months
What interventions can help patients regain continence after prostate surgery?
Drink 2-3 liters of fluid daily
Urinate every 2-3 hours
Avoid bladder irritants
What are some teaching points when sending a patient home after prostate surgery?
Catheter care
Incontinence management
Maintain fluid intake (2-3 liters/day)
Observe for signs and symptoms of infection
Prevent constipation
Avoid lifting/driving/sexual intercourse for specified amount of time
What is cirrhosis?
A chronic progressive disease of the liver. Cirrhosis is end stage liver disease, where there is extensive degeneration/destruction of liver cells
What are the most common causes of cirrhosis?
Chronic hepatitis C and alcohol-induced liver disease
What is cardiac cirrhosis?
Hepatic derangement due to long term right sided heart failure
What are early assessment findings with cirrhosis?
Fatigue
Enlarged liver
What are some dermatologic manifestations of cirrhosis?
Jaundice
Spider angiomas
Why does jaundice happen in liver failure?
Buildup of bilirubin due to decreased ability to conjugate and excrete bilirubin into the small intestine
What are spider angiomas?
Small, dilated blood vessels with a bright red center and spider-like branches. Often happen on face and neck
What are hematologic problems common in cirrhosis?
Thrombocytopenia
Leukopenia
Anemia
Coagulation issues
Why is anemia an issue in cirrhosis?
Inadequate RBC production
Poor diet/malnutrition
Poor folic acid absorption
Bleeding from varices
Why are there coagulation issues with cirrhosis?
Liver is unable to produce prothrombin and other clotting factors
What is a normal PT level/time?
11-13.5 seconds
How is PT changed with cirrhosis?
Increased/longer PT
What are common manifestations of coagulation problems with cirrhosis?
Epistaxis Púrpura Petechiae Easy bruising Gingival bleeding Heavy menstrual bleeding
What is portal hypertension?
Increased venous pressure in portal circulation due to blood flow obstruction
What can portal hypertension cause?
Splenomegaly
Esophageal varices
Ascites
What are esophageal varices?
Complex of enlarged veins at the lower part of the esophagus that are very fragile and can rupture easily
What is the most life-threatening complication of liver failure?
Bleeding from varices
Why is peripheral edema an issue in cirrhosis?
Decreased oncotic pressure from impaired albumin synthesis and increased pressure from portal hypertension
What is ascites?
Accumulation of serous fluid in peritoneal or abdominal cavity due to portal hypertension and hypoalbuminemia
What is encephalopathy?
Neuropsychotic manifestation of cirrhosis due to increased ammonia and inflammation. Causes confusion and other mental changes
What is asterixis?
Flapping tremors unique to cirrhosis. Patient cannot hold out arms and hands without hand flapping up and down
What are nutritional recommendations for ascites?
Low sodium Low fat High carb Possible protein restriction Folic acid supplements
Why might protein restriction be needed after ascites flare ups?
Protein can cause increased ammonia buildup
What medications could help with ascites?
Diuretics
What surgical procedure is often used for ascites?
Parecentesis
What is the goal of management of hepatic encephalopathy?
Reduction of ammonia formation (lactulose)
What can be done to prevent cirrhosis?
Abstaining from alcohol
Adequate nutrition for at risk individuals
What can help cirrhosis patients manage anorexia/nausea/vomiting?
Oral hygiene
Having snacks and favorite foods available for when the patient is hungry
What can be done to help cirrhosis patients with pruritis?
Baking soda Bath oils Calamine lotion Antihistamines Short nails to prevent scratching injury
What might stool and urine look like for cirrhosis patients?
Dark brown urine
Gray/tan stool
What position would help with dyspnea due to ascites?
Semi-Fowler’s or Fowler’s
What are some interventions to help with skin care for cirrhosis patients?
Alternating air pressure mattress
ROM
Elevating lower extremities
Frequent moving and repositioning
What do we teach cirrhosis patients about activity and rest?
Strength conservation and adequate rest are crucial
What are assessment findings of type one diabetes?
Polyuria Polyphagia Polydipsia Weakness Fatigue DKA
What are assessment findings for type two diabetes?
Slow healing Fatigue Recurrent infections Visual changes 3Ps
What are collaborative interventions for diabetic clients?
Eye exam Dental exam Neuro exam Podiatry Kidney function monitoring
What are recommendations for carbs for diabetics?
Monitor carbs by carb counting or exchange lists
What all counts as carbs for the diabetic patients?
Fruits Veggies Grains Legumes Low fat milk
What are recommendations for fat intake for diabetic patients?
Minimize trans fats and saturated fats
Limit cholesterol to less than 200 mg/day
2 or more servings of fish per week
What are protein recommendations for diabetic patients?
Usually individualized to the patient, but high protein for weight loss is usually not recommended
What are recommendations for alcohol intake for diabetic patients?
Limited to moderate intake: max one per day for women or two per day for men
Drink with food
What can drinking alcohol on an empty stomach cause in a diabetic and why?
Hypoglycemia, because the liver is busy processing the alcohol and cant do glycogenesis
How do diabetic exchange lists work?
Patient gets to choose specific number of helpings of food items per meal or snack
What are teaching points related to exercise for diabetic patients?
Doesn’t have to be strenuous to be effective
Exercise after eating
Wear good footwear
Warm up and cool down properly
Monitor blood glucose before, during, and after exercise
What are chronic complications associated with diabetes?
Stroke Hypertension Dermopathy CAD Nephropathy Atherosclerosis Gastroparesis Neuropathy Infection Gangrene Neurogenic bladder Erectile dysfunction
What can prevent diabetic retinopathy?
Annual eye exam
Blood sugar and hypertension control
What can be done to prevent nephropathy in diabetes?
Annual screening and aggressive control of BP and blood glucose
Sensory neuropathy
Affects PNS (hands/feet bilaterally) causing numbness, tingling, and pain
Autonomic neuropathy
Can affect all body systems, causing things like diarrhea, incontinence, urinary retention, and postural hypotension
What are important teachings related to diabetic foot care?
Wash daily with soap and warm water Pat dry Examine daily for breaks in skin or injuries Prevent cracking Avoid open toed shoes Don’t go barefoot Don’t cut off circulation
What can be done to minimize complications of infection in diabetics?
Prompt and vigorous treatment
Hand hygiene
Avoiding sick people
Annual vaccines
What should diabetics know about medical identification and travel?
Wear a medical alert band
Plan ahead for travel
Get up and take a walk every couple hours if sitting for a long time
Bring all labels for meds and medical equipment
What are gerontologic considerations for clients with diabetes?
Over 25% of those over 65 have it with higher rates of death and complications
More likely to be unaware of hypoglycemia
Many more comorbidities in these patients
What is hyperthyroidism?
Hyperactivity of thyroid (increased TH synthesis and release)
What is Graves’ disease?
Autoimmune disease characterized by thyroid enlargement and excess TH secretion
In whom and when does Graves’ disease most often develop?
Women between the age of 20 and 40
What are clinical manifestations of hyperthyroidism?
Goiter Increased HR Hypertension Increased appetite Weight loss Thin nails Hair loss Dyspnea/increased RR Nervousness Restlessness Diarrhea Heat intolerance
What is exophthalmos?
Bilateral protrusion of eyeballs from their orbits that is often present in hyperthyroidism
What can be complications of exophthalmos?
Double vision
Corneal ulcers
Vision loss
What is a goiter and when is it seen?
Enlarged thyroid gland seen in hyper/hypothyroidism
What is a crisis complication of hyperthyroidism? How does it present?
Acute thyrotoxicosis (thyroid storm) S/S: tachycardia, HF, agitation, delirium, seizures, increased BP, bounding pulse, nervousness, tremors, attention issues
What are potential therapies for hyperthyroidism?
Radioactive iodine
Surgical treatment
Drugs (beta blockers, anti thyroid drugs)
What are nutrition recommendations for hyperthyroidism?
High calorie (often 4000-5000 calories/day) High protein Frequent meals Increase carbs Avoid high fiber and spicy foods (increased diarrhea risk) Drink a lot of fluids Avoid caffeine Adequate iodine intake
What is hypothyroidism?
Deficiency of thyroid hormone that causes metabolic slowing
What are manifestations of hypothyroidism?
Fatigue Lethargy Impaired memory Slowed speech Weight gain Decreased cardiac output Dry skin Constipation Low activity tolerance
Why is myxedema?
Serious adult hypothyroidism that alters physical appearance, causing puffiness, edema, and a mask-like effect
What are collaborative cares for patients with hypothyroidism?
TH replacement (lifetime therapy)
Monitor TH levels
Nutritional therapy
Teaching
What should ambulatory clients with hypothyroidism know to report to their provider?
Signs of overdose on TH (will look like hyperthyroidism)
When should thyroid replacement drugs be taken?
In the morning before food
What else should hypothyroidism patients be taught?
Take measures to prevent skin breakdown
Avoid sedatives
Take measures to minimize constipation
Avoid enemas
What is cancer?
Group of diseases characterized by uncontrolled and unregulated cell growth
What are the most common types of cancer for men?
Prostate
Lung
Colon
Most common types of cancer for women?
Breast
Lung
Colon
What are the priorities of the nursing role as relates to cancer?
Screen for cancer
Help individuals decrease cancer risk
Help patients comply with cancer treatment
Help patients and families cope with diagnosis
What are carcinogens?
Cancer causing agents like chemicals, radiation, or viruses that are capable of producing cell alterations
What is metastasis?
Rapid growth of a primary cancer tumor leading to cancer spread to other sites in the body
What is the difference between benign and malignant neoplasms?
Benign: well-differentiated tumor
Malignant: less differentiated, more likely to metastasize
Why is tumor classification important?
To facilitate standardized communication To assist in determining treatment To help with treatment evaluation Prognosis prediction Comparison between similar cancers
What is staging (of cancers) and why is it important?
Classifying cancer by extent of the disease
What is a biopsy?
A pathology evaluation of part of a tumor to see whether it is benign or malignant and to begin to plan treatment options
What are the three treatment goal options for patients with cancer?
Cure
Control
Palliation
What does “late effects” mean when it comes to cancer?
Effects that can occur as a side effect of cancer treatment even years after treatment has ended
What are some examples of late effects?
Strictures Fistulas Radiation necrosis Cardiac toxicity Cataracts Renal insufficiency Hepatitis Osteoporosis Skin cancer Neurocognitive dysfunction
What is the primary cause for all lung cancers?
Smoking
What are other common causes of lung cancer?
Pollution
Radiation
Asbestos
How will lung cancer often present itself?
It will appear as a chronic pneumonia that is not responsive to treatment
What are some other presenting manifestations of lung cancer?
Often nonspecific symptoms Persistent cough Dyspnea Wheezing Chest pain
What can be unique about the chest pain associated with lung cancer?
It is often localized or on only one side of the body
What causes the later manifestations of lung cancer?
Metastasis of cancer
What are some later manifestations of lung cancer?
Anorexia Fatigue Weight loss N/V Hoarseness Dysphagia Palpable lymph nodes Oxygenation issues
What test is needed for definitive diagnosis of lung cancer? How is it obtained?
Biopsy of cancerous area, obtained by bronchoscopy
What are screening recommendations for lung cancer?
Annual screening in those between 55 and 80 with a smoking history
What does a 30 pack year history of smoking mean?
One pack a day for 30 years
How long can it take for lung cancers to grow enough to become visible on x-ray?
8-10 years
What are nursing interventions to help prevent lung cancer?
Smoking prevention or cessation
Modeling healthy behaviors
What are some treatments for lung cancer?
Surgical removal of tumor Radiation Chemo (for non-resectable tumors) Targeted therapy Immunotherapy
What symptoms should lung cancer patients report to their provider?
Hemoptysis Dysphagia Chest pain Hoarseness Severe pain
What are lymphomas?
Malignant neoplasms in bone marrow and/or lymphatic structures that causes disruption of proliferation of WBCs
What is Hodgkin’s lymphoma?
Proliferation of abnormal giant lymphocytes with multiple nuclei located in the lymph nodes
What are the abnormal multi-nucleated cells indicative of HL called?
Reed-Sternberg cells
What are assessment findings for patients with Hodgkin’s lymphoma?
Enlarged cervical, auxiliary, or inguinal lymph nodes that are often movable and non-tender
Weight loss
Fatigue
Weakness
Fever
Tachycardia
Alcohol induced pain at the site of disease
What are “B symptoms” of Hodgkin’s lymphoma?
Fever
Drenching night sweats
Weight loss
What do care options for HL look like?
Least amount of treatment to achieve a cure, usually chemo and/or radiation
What are secondary cancers?
Cancers occurring ten or more years after Hodgkin’s lymphoma (often lung, breast, or skin cancer)
What are some things the nurse will need to manage with Hodgkin’s lymphoma?
Pain Side effects Pancytopenia Emotions/coping Evaluating long term effects
What is non-Hodgkin’s lymphoma?
The most commonly occurring blood cancer; a heterogenous group of malignant neoplasms
Lymphadenopathy
Swelling of lymph nodes
What are clinical manifestations of NHL?
Painless lymph node enlargement
Symptoms in the area where the disease has spread
Other similar symptoms to HL
When B symptoms are likely to be found in NHL?
High grade lymphomas in the leukemic phase
What types of treatment are used for NHL?
Chemo
Radiation
Antibiotic or antivirals if basis is infection
What are some nursing considerations for managing NHL?
Managing problems related to the disease or side effects of treatment Understanding disease progression Patient support and education Pain control Fertility issues for patient Infection prevention strategies
End stage renal disease
GFR of less than 15 mL/min, dialysis or transplant required
Why is there an increasing prevalence of CKD?
Aging population
Obesity and inactivity
Increase in diabetes and hypertension
What is uremia?
When kidney function declines to a point where symptoms develop in multiple body systems
What are metabolic disturbances with CKD?
Increased BUN and creatinine
Increased triglycerides
Altered carbohydrate metabolism
Normal GFR rate
90-120 mL/min
Normal BUN level
7-20 mg/dL
Normal serum creatinine level
0.6-1.2 mg/dL
What happens to insulin metabolism in ESRD?
Kidneys stop excreting insulin, so diabetics might need less insulin once they start dialysis
What are major electrolyte imbalances with CKD?
Sodium Potassium Calcium Phosphate Magnesium Acid and bicarb
What will happen to sodium levels with CKD?
Can increase, decrease, or stay normal
What happens to calcium and phosphate levels in CKD?
Phosphate increases
Calcium decreases
Why is anemia an issue in CKD?
Decreased epo production and RBC production
Dialysis blood loss
Increased PTH inhibiting erythropoiesis
Iron deficiency
Why are there increased bleeding tendencies in CKD?
Defect in platelet function
Increased factor 8 and fibrinogen
Why do patients with CKD experience higher incidence of cardiovascular disease?
Hypertension
Vascular calcification
Arterial stiffness
High potassium and lipid levels
How does CKD affect the musculoskeletal system?
Mineral and bone disorders (decreased activated vitamin D and serum calcium, increased phosphate leading to osteomalacia)
What are skin changes with CKD?
Pruritus
Itching
Uremic frost (only with very high BUN levels)
What is the preferred method to determine kidney function?
GFR
What is the top goal for patients with CKD?
Preserve existing kidney function
What can be done to prevent CKD?
Early detection and treatment
Monitor BP/treat high BP early and aggressively
Ensure proper diabetes detection and treatment
Screening for high risk populations
What do clients with CKD need to know to report to a provider?
SOB
Weight gain
Increased BP
Edema
What are advantages to peritoneal dialysis?
Can be started immediately Less complicated and can be done at home Portable Fewer dietary restrictions Easier on the heart Better for diabetic patients
What are disadvantages of PD?
Peritonitis Greater protein loss Infections at catheter site Self-image issues Hyperglycemia Contraindicated for patients with lots of abdominal surgeries or problems Education/training needed
Once a PD cath is healed, what does daily catheter care look like?
Clean with soap and water
Pat dry
No dressing change needed
no sitting in baths of water
What are the three phases of a PD exchange?
Inflow
Dwell
Drain
How long is the inflow period?
10 minutes
What happens during PD dwell and how long is it?
Diffusion and osmosis occur between solution and the blood
Can be 20-30 minutes up to 8 hours depending on the method
How long is the drain phase of PD?
15-30 minutes
What can facilitate a faster drain period?
Massaging abdomen or changing positions
What is automated PD?
Cycler delivers and regulates fluid exchanges while the patient sleeps (4 or more exchanges per night with fluid left in peritoneum during day)
What is continuous ambulatory peritoneal dialysis?
Exchanges are done by the patient every few hours during the day (average of 4 hour dwell time)
What would indicate that peritonitis is occurring?
Abdominal pain
Rebound tenderness
Cloudy peritoneal effluent
Increased WBC count
What other complications can PD cause?
Exit site infection Hernias Lower back problems Bleeding Protein loss Pulmonary complications
What are the advantages of hemodialysis?
Rapid fluid removal Rapid urea/creatinine removal Effective potassium removal Less protein loss Decreased serum triglycerides Can be done at home
What are disadvantages of hemodialysis?
Vascular access problems Diet and fluid restrictions Heparin use Lots of equipment Hypotension Anemia Surgical placement of access Fatigue
Thrill
Buzzing sensation
Bruit
Whooshing sound of blood in access
What are hypotension assessment findings?
Lightheaded ness Nausea Vomiting Seizures Vision changes Chest pain
How do we treat and prevent hemodialysis complications?
Frequent monitoring of BP Correct dry weights Rinse back all blood Infection control Hep C screening and vaccinations
what is cerebral palsy?
a group of permanent disorders of the development of movement and posture
what causes cerebral palsy?
some disruption of blood flow to the brain of an infant or young child (could be hypoxia or stroke, etc)
what developmental milestones might be delayed in CP?
rolling over raising head sitting up crawling walking
what are some possible motor signs of CP?
persistent primitive reflexes poor head control after 3 months old limp posture unable to sit up on own by 8 months of age favoring one side of the body clenching fists after 3 months
what are common feeding issues with CP?
gagging
choking
tongue pushing soft food out of the mouth
what are behavioral findings in CP?
extreme irritability and crying
failure to smile
lack of interest in surroundings
what muscle tone alterations may be seen with CP?
muscle contractures
what are some associated disabilities for those with CP?
altered learning and reasoning
seizures (up to 85% of those with CP)
vision/hearing impairment
impaired behavior and relationships
what does intellect look like for those with CP?
usually normal or slightly impaired, may be more altered in more severe cases
what is constraint therapy?
constraining the strong side of the body in a child with CP to force use/strengthening of the weak side of the body
what are some common complications of CP?
respiratory infection malnutrition failure to thrive injury contractures back pain/spasms/tight muscles incontinence
what are some factors that contribute to complications in CP?
weight gain poor posture spinal deformities discontinuing PT walking when it is increasingly difficult incorrect or inappropriate surgery
what kinds of therapy are crucial help maximize functional ability in CP?
PT, OT, and speech therapy
what can aid in mobility for clients with CP?
braces
wheelchairs
orthotics for legs and feet
play therapy
what can be done to help with feeding and nutritional issues with CP?
monitor weight gain closely
tailor diet to child’s needs
manual jaw control to stabilize and help with swallowing
gastrostomy to supplement oral feeding
what is a stroke?
ischemia or hemorrhage in the brain causing death of brain cells and loss of function in those areas of the brain
what are manifestations of a stroke on the right side of the brain?
spatial-perceptual problems
motor function disruption
left side paralysis or neglect
rapid actions
short attention span
minimizing problem or pretending its not there
problems with judgement and impulse control
what are manifestations of a stroke on the left side of the brain?
right side paralysis language issues impaired left/right discrimination caution fear of falling/fear in general slow performance in tasks depression anxiety
why are those with a left side of the brain stroke more likely to be depressed?
they are more aware of the deficits they have and more likely to be discouraged by them
what motor deficits are associated with stroke?
mobility issues respiratory dysfunction swallowing and speech issues gag reflex problems deficits in self care ability
aphasia
impaired ability to communicate
expressive aphasia
patient can no longer comprehend language but can still speak (but they only speak nonsense)
receptive aphasia
loss of ability to produce language, but can still understand
global aphasia
total inability to communicate (cannot speak or understand)
what are some good tips to communicate with clients with impaired speech?
use good non-verbals use hand gestures and pictures have the family assist with communication be positive and patient use speech therapy treat them as an adult ask simple questions present one idea at a time
what is dysarthria?
disturbance in muscular control of speech, mainly affecting pronunciation and articulation
what are potential impacts of stroke on affect?
exaggerated or uncontrolled emotional responses
depression
frustration
unpredictability
how can intellectual functioning be impacted by stroke and how does it differ with each side of the brain?
memory and judgement issues can affect either side of the brain, but right sided strokes will be more cautious and fearful while left sided strokes are often more impulsive
what is homonymous hemianopsia?
also known as a “field cut”, refers to patient experiencing blindness in the same half of visual fields of both eyes
what do clients with homonymous hemianopsia tend to do?
forget about or ignore everything on the other side of their visual field (the unseen side)
what is agnosia?
inability to recognize an object by sight, touch, or hearing
what is apraxia?
inability to carry out learned sequential movements on demand (like brushing teeth or other self-care activities)
what are some impacts of stroke on elimination?
urinary frequency, urgency, or incontinence
constipation
usually temporary effects or effects due to not being able to verbalize needs
what are some preventative actions to prevent strokes?
control of diabetes and hypertension drug therapy treatment of cardiac problems smoking avoidance/cessation cholesterol control healthy diet limit alcohol
what do rehabilitation prognoses for stroke patients depend on?
type of stroke and extent of damage
how can respiratory complications be avoided with stroke patients?
frequent airway assessment oxygen suctioning optimal positioning deep breathing oral care for the mechanically ventilated
how can musculoskeletal complications of stroke be avoided?
PROM/ROM positioning transfer carefully and correctly pay attention to weak side when positioning and transferring don't pull on arms use splints and supports as needed
how can integumentary complications of stroke be avoided?
provide pressure relief
ensure good hygeine
mobilize early and often
how can GI complications of stroke be avoided?
prevent constipation check for impaction adequate fluid and fiber intake promote physical activity bowel retraining
how can urinary complications of stroke be avoided?
remove catheter ASAP
avoid bladder over-distension
assist patient to a normal position for voiding
offer bedpans
what is included in bladder retraining?
fluids between 7 am and 7 pm
scheduled toileting every 2 hours
assessing for distension
observing for signs of needing to void
what is silent aspiration?
fluid entering the lungs with no obvious signs or symptoms from the patient
what are symptoms of dysphagia?
pain with swallowing being unable to swallow pocketing food in the mouth drooling hoarse voice regurgitation heartburn feeling like food is stuck in the throat
what interventions can prevent aspiration?
position unconscious patient on their side liquid meds have suctioning available thicken foods and beverages elevate head to eat cut food up small frequent meals avoid milk products
how can we help patients with strokes cope with sensory/perceptual alterations?
help them with their neglected side
arrange items within their perceptual field
ensure safety measures are taken
how should one help a stroke patient displaying an uncontrollable outburst of emotion?
distract them
what is parkinson’s disease?
chronic progressive neurodegenerative disorder characterized by slowness in initiation and execution of movements
What does TRAP stand for?
manifestations of parkinson's Tremors Rigidity Akinesia Postural Instability
what is the triad of parkinsons?
akinesia
bradykinesia
postural instability
akinesia
absence or loss of control of voluntary movement (includes pill rolling tremors)
bradykinesia
slowness of movement, problems with facial and hand movements, getting “frozen” in place, shuffling gait
how can clients with parkinson’s prevent getting “frozen”?
rocking from side to side
what are characteristics of parkinson’s postural instability?
being unable to stop oneself from going forward or backward, often having a forward tilt to posture
what are potential complications of parkinson’s?
dyskinesias weakness dementia depression dysphagia malnutrition infection falls orthostatic hypotension pain hallucinations
what are some interprofessional cares for parkinsons?
drug treatment PT OT surgery deep brain stimulation diet treatment
what are nutritional considerations for parkinsons?
easily chewed and swallowed foods high fiber foods cut up food have 6 small meals ensure adequate vitamin b6 allow plenty of time for meals
what are key exercise focuses for parkinson’s clients?
strength and stretching
what can we do for parkinson’s patients to prevent falls and “freezing” episodes?
have them think about stepping over lines on the floor or stepping over rice kernels
have them lift their toes when walking
have them rock from side to side to keep moving
how can we modify the environment for parkinson’s patients to maximize independence?
remove rugs and excess furniture
elevate toilet
simplify clothing
use chairs with arms
epilepsy
continuing predisposition to seizures with cognitive, social, psychological, or neurobiological consequences
what is a seizure?
a transient uncontrolled electrical discharge of neurons in the brain that disrupts normal functioning
what are common triggers or causes for seizures?
acidosis electrolyte imbalance hypoglycemia hypoxia alcohol or drug withdrawal dehydration lupus lung/liver/kidney disease diabetes hypertension septicemia
what are the phases of seizure activity?
prodromal/aural, then ictal, then postictal
prodromal/aural phase
sensations or behavior changes that precede a seizure
what can be some signs in the prodromal/aural phase of a seizure?
smell manifestations
fear
headache
hearing noises
ictal phase
from first symptoms to the end of seizure activity
postictal phase
recovery from the seizure
what are generalized seizures?
seizures that involve both sides of the brain
tonic clonic seizures are also known as
grand mal seizures
what is involved in a tonic-clonic seizure?
losing consciousness
falling
stiffening muscles (tonic) then jerking limbs and body (clonic)
can include cyanosis, salivation, incontinence, and biting of the tongue or cheek
what is an absence seizure?
a brief blank staring/zoning out seizure
more common in children and very hard to detect
what is a myoclonic seizure?
sudden excessive jerk or twitch of the body and extremities
atonic seizures are also known as…
drop seizures
what is an atonic seizure?
tonic episode or loss of muscle tone, usually less than 15 seconds in length
what is a tonic seizure?
sudden extreme muscle stiffness
what is a clonic seizure?
loss of consciousness, then loss of muscle tone, then rhythmic limb jerking
what are focal seizures?
also known as focal seizures, usually begin in one area of the brain and manifest based on the function of the involved brain area
what is a simple focal seizure?
the patient is conscious but may experience unusual feelings or sensations
what feelings or sensations might be experienced in a simple focal seizure?
joy or anger
smells or sounds not actually present
what is a complex partial seizure?
change in level of consciousness, eyes are open but patient cannot interact, strange behavior and potential dangerous or embarrassing actions may occur
what is an automatism?
a repetitive, purposeless action
what are psychogenic seizures?
they closely resemble epileptic seizures but there is no electrical abnormality in the brain. often manifest because of physical or emotional trauma or abuse
what is status epilecticus?
continuous seizure activity for over 5 minutes
why is status epilecticus dangerous?
because it can become an ABC issue (hypoxia, dysrhythmias, etc)
what are psychosocial complications of epilepsy?
lifestyle interruptions ineffective coping depression social stigma transportation hindrances bipolar or other psychiatric diagnoses
which diagnostic test is most useful for epilepsy?
EEG
what are health promotion measures for epilepsy patients?
wearing a helmet when head injury could happen
improved infant care
have at risk patients avoid alcohol and sleep deprivation
what is included in seizure precautions?
rescue equipment at bedside bed in low position padded side rails airway assessment environmental safety
what are some things to do when a seizure occurs?
put patient on left side
help patient to the floor
dont restrain them and loosen any restrictive clothing
what are some things to assess when a seizure occurs?
onset course and nature of seizure length of each phase body parts involved airway status autonomic signs preceding signs of seizure
what do we do after a patient has a seizure?
assess vitals ensure comfort and rest quiet/non-stimulating environment reorient them check memory assess pupils and airway
when should an epileptic patient call EMS regarding a seizure?
if injury occurs if seizure occurs in water longer than 5 minutes pregnancy diabetes
what are some important teaching points for epileptic patients and caregivers?
take meds exactly as directed wear medical alert bracelet stay calm have family observe start and stop times eat regularly maintain safety during seizure (don't put anything in mouth!)
