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Fall > 314 Final > Flashcards

314 Final Flashcards

1
Q

What cells in the pancreas secrete glucagon and which ones secrete insulin

A

Alpha =glucagon
Beta = insulin

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2
Q

Where is glycogen broken down into glucose?

A

Liver

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3
Q

What is the key to the cell that lets in glucose and potassium

A

Insulin

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4
Q

What is a leading cause of blindness, ESRD, and amputations

A

Diabetes mellitus

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5
Q

What would the fasting glucose of 115 be considered

A

Pre diabetes

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6
Q

If you have gestational diabetes what are the risks

A

High risk of c section
Increase risk for neonatal complications
63% chance of developing type 2 diabetes within 16 years

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7
Q

Signs of hyperglycemia poly =more

A

Polyphagia
Polyuria
Polydipsia
Dry skin
Blurred vision
Delayed wound heal
Weak

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8
Q

What are signs of hypoglycemia remember TIRED

A

Tachycardia
Irritable
Restless
Excess hunger
Dizziness
Sleepy
Pallor/clammy

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9
Q

In general, would we rather have patients be high or low blood sugar?

A

High.

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10
Q

Hypoglycemia management rule of 15

A

Glucose <70 PO 15g fast acting sugar
Recheck in 15 min
If still low, treat again with 15g carbs and recheck 15 min later
Still low 2-3 times; contact physician

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11
Q

If a glucose is <40 what might be ordered

A

IV dextrose
(1 ampule of D50)

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12
Q

For inpatient settings at what level is hyperglycemia management usually started AND what is it

A

At 150. Insulin: short acting insulin (homologous/novolog)
Adjust basal-bolus regimen
(Basal =long acting insulin, bolus = short acting)

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13
Q

Why are clients generally taken off oral antidiabetic medications in an inpatient setting?

A

Because metformin doesn’t play well with contrast imaging and if they need to get that done and are on metformin, it will cause an issue/delay

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14
Q

If a patient is on an insulin pump upon admission, what do you do?

A

You do not use the pump if unfamiliar with it. Most patients with pumps are taken off pumps on admit and put on sliding scale insulin

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15
Q

What is Dawn Phenomenon

A

Blood sugar slowly rises throughout the night due to peaks of growth hormone = morning fasting hyperglycemia

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16
Q

What is somogyi effect?

A

Too much insulin Given or Insulin peaking at night which creates hypoglycemia = body over responding during the night to compensate resulting in hyperglycemia in early morning

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17
Q

If a patient is experiencing a Dawn phenomenon would they maybe need a little more or less insulin given at night

A

More

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18
Q

Patients with DKA are experiencing severe dehydration
Life threatening

A

Yep

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19
Q

Kussmauls respiration is a deep rapid respiration and associated with what

A

DKA
Compensation for metabolic acidosis

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20
Q

What’s treatment for DKA

A

Fluid replacement (usually includes K+)
IV insulin (always regular)
Hourly blood sugar checks
Monitor potassium levels (may have false elevated serum potassium)
Possible sodium bicarbonate to correct acidosis.

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21
Q

When treating DKA, what glucose measure would be appropriate to switch from IV insulin to SQ

A

About 200

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22
Q

Upper GI disorders affect what

A

Stomach and above. (Esophageal)

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23
Q

Explain GERD

A

Painful irritation and inflammation of esophagus from HCL acid and pepsin secretions leaking from a dysfunctional (relaxed sphincter between the stomach and intestines )

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24
Q

Acid reflux is due to a relaxed sphincter between where

A

Esophagus and stomach

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25
Q

S/s of GERD

A

Heartburn
Dyspepsia
Regurgitation
Chest pain (might feel like a heart attack)
Hoarseness and sore throat

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26
Q

Complications of GERD

A

Esophagitis —- long term can cause cancer (Barrett’s esophagus precancerous)
Dental erosion
Respiratory complications

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27
Q

How is GERD diagnosed

A

Barium swallow
Endoscopy

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28
Q

What drugs would be administered with Acid Reflux

A

PPI, histamine blocker,

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29
Q

GERD treatment

A

Lifestyle modification
PPI or H2 inhibitors (short term)
Cytoprotective= sulcrafate (coats stomach and protect it from the acid PO)
Prokinetics: promotes gastric emptying =metoclopramide
Antacids (short term)
Surgery- Nissan fundoplication

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30
Q

What is a hiatal hernia

A

Stomach protrudes into esophagus or through an opening in diaphragm

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31
Q

Complications of hiatal hernia

A

Lower esophageal Sphincter stenosis
Ulcerations
Strangulations of hernia.

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32
Q

Gastritis (very common inflammation of gastric mucosa) can be caused by what?

A

Acute: (NABS); nsaids, acid/alkali ingestion, bacteria [salmonella].
Chronic: autoimmune, H.Pylori

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33
Q

Complications of gastritis

A

Pernicious anemia due to absorb cobalamin r/t loss of intrinsic factor.

Erosive ulcers: due to extensive gastric mucosal wall damage.

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34
Q

Treating gastritis

A

Hydration (Iv if unable to tolerate PO fluid)
Antiemetics
Eliminate cause.
-——
NPO diet, advance as tolerated
H2 antagonists (-tiding), PPI (prazole), antacids, prostaglandins.

35
Q

PUD causes

A

H. Pylori
NSAIDs, Aspirin(ASA)
Stress

36
Q

Ulcers are identified based on location. What differentiates gastric from duodenal

A

Gastric= pain 30-60 min after meal, malnourished,hematemesis (bright red blood or coffee grounds blood in vomit)

Duodenal= pain 1.5- 3hr post meal, awakening at night with pain, well-nourished, melena (dark tarry stools).

37
Q

H. Pylori treatment meds

A

PPI
Amoxicillin
Clarithromycin.

38
Q

Complications of PUD

A

Pernicious anemia
Hemorrhage
Perforation
Gastric outlet obstruction (inflammation of tissues blocking food getting out of stomach)

39
Q

Tx for PUD

A

No NSAID
Medications to reduce acids (similar to GERD)
Antibiotics for h pylori
Surgery if severe- gastrectomy.

40
Q

What are pre and post procedure guidelines for EGD (endoscopy)

A

Pre:
NPO for 6-8 hrs
No red dyes.
Post:
Monitor VS and airway
Sore throat, hoarseness to be expected.

41
Q

What is a barium swallow used for

A

Diagnose hiatal hernia, strictures or structural abnormalities.

42
Q

What can be a complication of a barium swallow that is reduced by administration of post procedure stool softener and laxatives

A

Failure to eliminate barium places client at risk for fecal impaction

43
Q

Crohn’s disease is an inflammation of any segment of GI tract from mouth to anus but usually in the bowels

A

Yep

44
Q

S/s of crohns

A

Diarrhea, cramping, weight loss.

45
Q

Tx for Crohns

A

Meds: anti inflammatory, corticosteroids, immunosuppressants (potential high risk for infection with these)
-most require surgery: colectomy, repairing fistula, strictures (narrowing of irritated bowel)

46
Q

Explain Ulcerative colitis

A

Inflammation and ulceration of colon and rectum. Affects mucosa and submucosal layers

47
Q

Ulcerative colitis complications

A

Can lead to bowel obstruction
Mucosal changes can lead to colon cancer, pernicious anemia

48
Q

Ulcerative colitis symptoms

A

Bloody diarrhea and pain
Mucus in diarrhea sometimes

49
Q

Medications for ulcerative colitis

A

Anti inflammatories, corticosteroids, immunosuppressants (puts them at higher risk for infection)

50
Q

Diverticulitis develops from what.

A

Diverticulosis.

51
Q

Tx for diverticulitis

A

Antibiotics
Diet is low fiber during and after it is resolved high fiber.
Avoid inflammatory foods
Hydrate!!
Possible surgery: colon resection with or without osteomyelitis placement.

52
Q

What is a risk that you should be aware could happen to patients with diverticulitis

A

Ruptured diverticula= contents emptying into peritenium (abdominal cavity)

53
Q

Manifestation of celiacs

A

Steatorrhea -fatty stool?
Foul smelling diarrhea
Flatulence, abdominal distention, malnutrition
Dermatitis herpetiformis- itchy vesicular rash

54
Q

Peritonitis is what and caused by what

A

Medical emergency
Life threatening inflammation of the peritoneum and lining of the abdominal cavity often due to bowel perforation
Can also be caused by
Peritoneal dialysis
Perforated diverticula
Ruptured appendix
surgery

55
Q

Rigid abdomen, sudden severe upper abdominal pain that spreads and radiates to the back could be a sign of what

A

Bowel perforation

56
Q

Rigid board like abdomen, abdominal distention, rebound tenderness, tachycardia, fever, nausea and vomiting can signify what condition

A

Peritonitis.

57
Q

Interventions for peritonitis

A

Semifowlers
NPO
Ensure O2 take vitals
Admin antibiotics, fluids and electrolytes if ordered
Prepare for surgery.

58
Q

What is a Cullens sign?

A

bruising around belly button
Sign of internal bleeding

59
Q

What is grey turners sign

A

Bruising of flank. Sign of internal bleeding

60
Q

Small bowel obstruction can present as what kind of acid base imbalance

A

Metabolic alkalosis

61
Q

A patient has an intestinal obstruction, what are the nursing interventions

A

Bowel rest: NPO, NG placement to LIS(low intermittent suction)
Fluid and electrolytes
Surgery may be necessary
Encourage ambulation

62
Q

Gold standard for NG tube placement confirmation

A

X-ray

63
Q

After PO medication administration through an NG tube, what is next step

A

Clamp NG tube 30-45 minutes so you don’t suction meds right out.

64
Q

A patient with toxic megacolon is at an increased risk for what

A

Bowel perforation

65
Q

Colonoscopy should be done at what age and how often

A

45, every 10 years

66
Q

What is pre and post procedure guidelines for colonoscopy

A

Pre:
Bowel prep night before
NPO after prep is complete
post:
Monitor for rectal bleeding
Resume normal diet, encourage fluids

67
Q

C diff is what precaution

A

Contact isolation and bleach wipes.

68
Q

When treating c diff , what beside antibiotics is given

A

Lactobacillus

69
Q

If stool is formed, it is most likely not c diff

A

Yep

70
Q

Dumping syndrome is what

A

Rapid movement of food through digestive tract.

71
Q

Early manifestations of dumping syndrome

A

Within 30 minutes of eating
S/s - nausea, sweating, dizziness, tachycardia, palpitations.
Diarrhea—- malnutrition

72
Q

Dumping syndrome interventions

A

Low Fowler after eating for 30 minutes to delay gastric emptying
Avoid triggers( high sugar high carb foods)
Consume small frequent meals
Monitor fluid and electrolyte balance

73
Q

Patients with an Ileostomy are at a higher risk for dehydration why

A

Most liquid is absorbed in the large intestine and the ileum is in the small

74
Q

When do you empty the ostomy bag

A

1/4-1/2 full.

75
Q

Patient education for ostomies

A

Diet modification depending on where the stoma is.
Burp bag
Support group
Stoma specific products being used.

76
Q

Pyloric stenosis risk factors

A

Male
White
Family history
3-6 weeks old

77
Q

Pyloric stenosis signs

A

Forceful Projectile vomiting of infant

78
Q

Intussusception is when the bowel folds on itself and what hallmark signs

A

Red currant jelly stool
Abdominal distention
Abdominal pain intermittent
In school age children

79
Q

Treatment of intussusception

A

Enema

80
Q

Hirschsprungs disease aka congenital megacolon might be a concern if what is observed

A

No bowel movement within first 48 hrs of life.

81
Q

Infant reflux does not require medications

A

True.
Smaller frequent feed
Upright during and after feeds
Loose diapers
Acid reducers are not helpful for infants.

82
Q

Pathological jaundice might be suspected if what signs are present besides normal expected elevated serum bilirubin that is indicative of physiological jaundice

A

Signs of bleeding
Weight loss
Dehydration
Lethargy
Abnormal tone and seizures ( indicating brain damage)
Hepatosplenomegaly

83
Q

Priority intervention for dumping syndrome?

A

Monitor blood glucose levels

84
Q

Priority Actions to take for a patient with a small bowel obstruction who is vomiting

A

NG tube insertion
Ondansetron

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