Adult health 2 - unit 2 exam

Question 1

Metabolic Alkalosis
what is it and what does it look like

Answer 1

Increased pH and Increased bicarbonate

if it is an increase in base components it requires medical treatment and disease process

it looks like CNS overexcitement/ Muscle cramps and arrhythmias

Question 2

what causes it metabolic alkalosis

Answer 2

Severe vomiting/ Excessive gi suctioning/ diuretics/ excessive NaHCO3

Question 3

Metabolic alkalosis
what are you going to do about it?

Answer 3

correct underlying causes, hydration oxygen, electrolyte monitoring Administer medications (Bronchodilators, Antiemetics. Antidiarrheals)

Question 4

Respiratory Acidosis
what is It? what does it look like?

Answer 4

increased production of hydrogen ions

it looks like hyperventilation, rapid shallow respirations, pale muscous membranes/ headache/ hyperkalemia/ drowsiness/ muscle weakness/ hyperreflexia

Question 5

Respiratory acidosis
what causes it?

Answer 5

Respiratory depression, inadequate chest expansion, airway obstruction, reduced alveolar-capillary diffusion, improper mechanical ventilation

Question 6

Respiratory acidosis
what am I going to do about it?

Answer 6

administer Oxygen, Semi-fowlers position, TCDB, Monitor potassiun levels,

Question 7

Respiratory alkalosis
what is it? what does it look like?

Answer 7

what is it? fluid imbalance caused by excessive loss of carbon dioxide

what does it look like S/S? Tachycardia, Hyperventilation, Tetany, EKG changes, hypotension or normal blood pressure, Deep rapid breathing, Lethargy/ confusio, N/V

Question 8

Respiratory alkalosis
what causes it?

Answer 8

Hyperventilation/ mechanical ventilation

Question 9

what are you going to do about respiratory alkalosis

Answer 9

correct underlying causes, hydration, oxygen, electrolyte monitoring, administer the medications

(Bronchodilators, Antiemetics/ Antidiarrheals)

Question 10

Metabolic acidosis
what is it?
what does it look like?

Answer 10

What is it? a fluid imbalance tha is caused by overproduction of hydrogen Ions

what does it look like? Kussmal Respirations, N/V, Decreased muscle tone and reflexes, Hyperkalemia, Warm, flushed skin/ Muscle twitching

Question 11

Metabolic acidosis
what causes it?

Answer 11

overproduction of hydrogen ions/ underelimination of hydrogen ions/ underproduction of bicarbonate ions/ over-elimination of bicarbonate ions

Question 12

what are you going to do about Metabolic acidosis?

Answer 12

what are you going to do about it? Monitor Intake and output, Administer Iv solution of sodium bicarb, initiate seizure precautions, Monitor potassium levels
(dialysis for kidney disease)
(for DKA give insulin and monitor for hypovolemia due to polyuria)

Question 13

hypernatremia

Answer 13

what is it? high value of sodium electrolyte levels
what is the value of Hypernatremia? >145
what does it look like? (FRIED) fever, restlessness, increased bp, Edema, Decreased Urine, Dehydration
what causes it? Hyperaldosteronism, Kidney failure, Corticosteroids, Cushing syndrome or disease, Excessive Oral Sodium ingestion, Excessive administration of sodium-containing IV fluids
what are you going to do about it? Medications, Monitor I/O’s, Dietary Na restrictions, Iv fluids

Question 14

Hyponatremia

Answer 14

what is it? a low sodium value
what is the diagnostic value? <136
what causes it? excessive diaphoresis, Diuretics, wound drainage, decrease secretion of aldosterone, Low sodium diet
what does it look like? sudden onset of confusion/ increased confusion, Muscle weakness, GI changes
what are you going to do about it? Fluid restriction, Oral Na supplements, Dietary teaching, Hypertonic solutions

Question 15

Hypocalcemia

Answer 15

what is it? low calcium level in the blood
what does it look like? Convulsions, Arrhythmias, Tetany, Spasms/ stridor and skeletal changes
what are you going to do about it? Drug therapy Nutrition therapy
what are signs of hypocalcemia? Positive ckvostek sign and Trousseau sign

Question 16

Hypercalcemia

Answer 16

what is it?high level of calcium
what Is the diagnostic value for the calcium? >10.5 mg/dL
what does it look like? Cardiovascular changes, Neuromuscular changes, Intestinal changes
what causes it? excessive oral intake of calcium, Excessive oral intake of Vitamin D, Kidney failure, Use of thiazides diuretics
what are we going to do about it? Drug therapy, ROM exercises, rehydration, dialysis, Cardiac monitoring

Question 17

Hypomagnesemia

Answer 17

what is it? low level of magnesium in the body
what is the diagnostic value? <1.3
what does it look like? Neuromuscular changes(Increased nerve impulse transmission), intestinal changes (decreased intestinal smooth muscle)
what causes it? Malnutrition, Starvation, Diarrhea, Steatorrhea, Celiac disease, Crohn’s disease, Medications
what are you going to do about it? Balance and maintain, Drug therapy replace the Magnesium intravenously but always have Calcium gluconate available

Question 18

Hypermagnesemia

Answer 18

what is it? a high value of Magnesium in the body

what does it look like? cardiac changes, CNS changes, Neuromuscular changes

what causes it? Increased Magnesium intake, decreased kidney excretion

what are you going to do about it? reducing serum magnesium levels, drug therapy, Calcium

Question 19

Hypokalemia

Answer 19

What is it? low potassium level in the body
what does it look like? toxicity to digoxin, U wave on EKG, Constipation, Irregular/ weak pulses, Numbness, Respiratory changes
what causes it? Diuretics, Poor Diet, Fluids, N/V/D, Prolonged NG suction, Wound drainage
what are you going to do about it? Prevention by increasing K supplements, IV potassium, Nutrition therapy

Question 20

Hyperkalemia

Answer 20

what is it? too much potassium in the body
what causes it? Ingesting potassium, IV potassium, Adrenal insufficiency, potassium-sparing diuretics, ACE inhibitors
what does it look like? Cardiac changes, Tingling and burning, Hyperactive bowel sounds
what can you do to treat it? Kayexalate, Stop Potassium-containing IV infusion, Stop oral potassium meds, Dietary restrictions

Question 21

Hypophosphatemia

Answer 21

what is it? low phosphate level in the body
what is the diagnostic value? less than 3.0
what does it look like? anemia, coma, constipation, muscle weakness, Hypoactive bowel sounds
what causes it? Diet, Malabsorption
what are you going to do about it? Drug therapy, oral replacement if stable, iv oral replacement if symptomatic

Question 22

Hyperphosphatemia

Answer 22

what is it? too much phosphate in the system
what is the diagnostic value? level greater than 4.5
what does it look like? Tetany, Calcification, Convulsions, Cardiac arrest, prolonged QT interval
what causes it? renal failure, excessive intake of phosphorus
what are you going to do about it? Diet Modifications, Dialysis if renal failure is underlying cause, Drug therapy Phosphate binders

Question 23

Hypochloremia

Answer 23

what is it? low chloride levels
<98
what does it look like? Tetany-like symptoms, diaphoresis, Fever, weakness
what causes it? Diarrhea, Vomiting, Excessive Sweating, Kidney problems
what are we going to do about it? rehydration, treat symptoms

Question 24

Hyperchloremia

Answer 24

What is it? high levels of chloride in the blood
what does it look like? Dyspnea, Fatigue, Muscle weakness, Tachycardia
what causes it? Excess salt intake, renal failure, metabolic acidosis, Hypertonic fluids
what are you going to do about it? treat dehydration, stop fluids with saline and dietary restrictions

Question 25

what are examples of Hypotonic fluids

Answer 25

0.45% NACL/ 5% Dextrose

Question 26

what are examples of isotonic fluids

Answer 26

0.9% NS/ 5% albumin/ Lactated ringers

Question 27

what are examples of hypertonic fluids

Answer 27

3% Saline/ Mannitol/ 20% Albumin/ D51,2Ns/

Question 28

Albumin

Answer 28

what is it’s diagnostic lab values? 3.5-5 g/dL
what can low levels indicate? kidney injury/ Malnutrition/ Used to Shift Fluids

Question 29

Irritable Bowel Disease

Answer 29

what is it? chronic inflammation of the GI tract
what does it look like? it can look like Crohns or Ulcerative Colitis
what causes It? there is no exact cause but can be influenced by a combination of factors, including environmental factors, genetic predisposition, and alteration in the function of the immune system.
what education would you provide for the patient? avoid the long-term use of NSAIDs it can cause excessive gastric secretions,
what are some of the clinical manifestations? Diarrhea, Bloody stools, weight loss, abdominal pain, fever, fatigue, Mild to severe exacerbations
what are some interventions you can implement? implement a Bland diet, Aminosalicylates, Antimicrobials, Corticosteroids, Immunosuppressants, and biologic and targeted therapy, Antidiarheal Medications

Question 30

Gallbladder disease or cholecystitis

Answer 30

what is it? Inflammation of the Gallbladder it can be classified as chronic or acute stones in the gallbladder
what does it look like? clay colored stools, severe pain that lasts for an hour then usually subsides, the attack of pain occurs 3-6 hours after a high fat meal and the patient lies down , diaphoresis.
what are the risk factors? 4 F’s (fluffy, farty, female, fertile) in females over 40 years old, sedentary lifestyle, familial tendency, and obesity
what are some education you would provide for the patient? don’t eat fatty foods, proper dietary management
what are some interventions you can implement?
NONSURGICAL
- Avoid fatty foods, opiod analgesic, Ketorlac, Urosodiol and Chenodiol, Extracorporeal shock wave lithotripsy

SURGICAL
-laparoscopic cholescystectomy
-traditional cholescystectomy (abdominal Laparotomy) it is used from severe obstruction, Drainage tube JP drain and another drainage tube T tube

Question 31

Peptic Ulcer Disease

Answer 31

what Is it? Occurs when mucosal defenses become impaired, epithelium not protected from effects of acid and pepsin
what causes it? many of PUD is caused by the infection of H. Pylori and NSAIDs and other substances that increase gastric secretion
what does it look like? Epigastric tenderness and pain/ rigid board-like abdomen with rebound tenderness and pain (peritonitis) and chronic gastritis
what education are you going to tell the patient? Nutrition therapy and complementary and integrative therapies
what are the diagnostic assessments for PUD? testing for H. Pylori/ Hemoglobin and hematocrit/ Occult blood in the stool/ EGD/ Nuclear medicine scan
what are some interventions you will implement?
PPI Triple therapy (Two Antibiotics/ PPI). PPI quadruple therapy (PPI with Bismuth and two antibiotics) / H2 blockers these medications promote healing of the stomach ulcer by decreasing secretion of Gastic acid

Question 32

what are some complications of Peptic Ulcer disease

Answer 32

Hemorrhage/ Perforation
Hemorrhage is the most severe complication

Question 33

how Is Crohns disease different from Ulcerative Colitis?

Answer 33

Crohns disease can be anywhere in the GI tract and UC is limited to the large intestine and colon/ pattern of inflammation of Ulcerative colitis us typically found int he lower left abdomen and for Crohns it is also in the lower left abdomen/ Appearance of inflammation and location of the pain for Ulcerative colitis are in the ulcers the inner lining of the abdomen only and Crohn’s disease penetrates the entire thickness/ Bleeding in Ulcerative colitis is common during a bowel movement and for Crohns it is not

Question 34

Ulcerative colitis

Answer 34

What is It? Widespread chronic inflammation of the rectum and rectosigmoid colon
where does it affect?
what does it look like? periodic remission and exacerbations, stool contains blood and mucus, Low grade fever findings are nonspecific Decreased H/H, increased WBCs, C reactive protein, ESR low sodium, potassium, chloride and hypoalbuminemia

they can have diarrhea, acute or persistent pain and potential for lower GI bleeding
what causes it? Genetic, immunological and environmental factors it is often found in families and twins and cellular changes can increase colon cancer risk
what are some diagnostic assessments? MRE, Upper endoscopy, Colonoscopy
what education would you provide this patient with? how to manage the diarrhea, manage the pain at home, preventing or monitoring for Lower GI bleeding
what are some interventions the nurse will implement for the patient?
NONSURGICAL
-physical and emotional rest/ record weight/ color, volume, frequency & consistency of stools/ Perineal area
DRUG THERAPY
Aminosalicylates/ Glucocorticoids/ Antidiarrheal drugs such as Diphenoxylate hydrochloride, atropine sulfate, loperamide
(too much antidiarrheal drugs lead to toxic megacolon)/
Immunomodulators and nutrition therapy and rest of (NPO, TPN, DIET)
SURGICAL this is only necessary when complications occur such as Toxic megacolon, Hemorrhage, Dysplastic biopsy results, Colon Cancer
-End-to-end anastomosis/ restorative proctocolectomy with ileal pouch-anal anastomosis the procedure of choice
Ileostomy, STOMA

Question 35

How does Irritable Bowel Disease relate to Crohn’s Disease and Ulcerative Colitis?

Answer 35

Irritable bowel disease is the condition but is qualified in 2 sections that are Crohns and Ulcerative Colitis

Question 36

Crohns disease

Answer 36

what is it? Chronic inflammatory disease of small intestine, colon or both
what does it look like? unintentional weight loss, stool characteristics, fever, abdominal pain/ Assess for distention, masses, visible persistalsis/ Anemia is common
what are the diagnostic tests for it?
what are some education for the patient?
what are the interventions the nurse will collaborate with the doctor on?
NONSURGICAL
5 ASAs, Azathioprine/ Mercaptopurine/ Methotrexate (moderate to severe), Biologic response modifiers
SURGICAL
resection of diseased area
(this is only performed when improvements has not been made in the patient with the nonsurgical route or they have complication of the Crohns disease

Question 37

what are the complications of Ulcerative colitis?

Answer 37

Toxic Megacolon, Hemmorhage, Bowel perforation, Dysplastic biopsy results, Colon cancer

Question 38

what are the complications of Crohns disease

Answer 38

Hemorrhage, Severe Malaborption, Malnourishment, debilitation, Cancer

Question 39

Nasal Cannula

Answer 39

1-6 lpm

Question 40

simple face mask

Answer 40

start at 5 LPM

Question 41

Rebreather mask

Answer 41

6-11 ppm

Question 42

Non-rebreather mask

Answer 42

10-15 ppm