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NSG 322 Med Surge I > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

what is a nurse’s role in pain?

A

assessment and management; make sure to use PQRST

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2
Q

consequences of untreated pain

A

unnecessary suffering, physical and psychosocial dysfunction, immunosuppression, sleep disturbances

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3
Q

behavioral pain

A

observable actions used to express or control pain

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4
Q

physiologic pain

A

genetic, anatomic, and physical determinants influence how stimuli are recognized and described

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5
Q

explain the affective dimension of pain

A

how the patient perceives pain; their emotional respons to pain experience like anger, fear, depression, anxiety; severe distress

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6
Q

cognitive dimension of pain

A

it is culturally driven

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7
Q

sociocultural dimension of pain

A

includes demographics, support systems, social roles, and culture

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8
Q

nociception of pain

A

physiologic process that communicates tissue damage to the CNS

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9
Q

transduction of pain

A

conversion of noxious, mechanical, thermal, or chemical stimulus into a neuronal action potential

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10
Q

what is nociceptive pain?

A

pain you expect; damage to somatic or visceral tissue like surgical incision, broken bone, or arthritis

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11
Q

what is somatic pain?

A

deep aches; arises from bone, joint, muscle, skin, or connective tissure

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12
Q

neuropathic pain

A

damage to peripheral nerve or CNS; phantom limb pain and diabetic neuropathy are examples

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13
Q

visceral pain

A

tumor involvement of obstruction; arises from internal organs like intestine or bladder

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14
Q

do we want the patient to be at 0 pain?

A

no, we want them to feel some pain so they don’t overwork whatever is hurting

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15
Q

what is an analgesic ceiling?

A

if something is not working and you take more, it’s not really going to do anything

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16
Q

what are some rules when scheduling a pain medication?

A
  • do not wait for sever pain
  • make a plan with the patient
  • use the smallest dose to provide effective pain control with fewest side effects
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17
Q

tolerance

A

need more of the drug; patient is adapted to it

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18
Q

physical dependence

A

normal response to ongoing exposure to pharmacologic agents manifested by withdrawal when drug is abruptly decreased

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19
Q

pseudoaddiction

A

mimics addiction, but behaviors resolve with adequate treatment of the patient’s pain

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20
Q

addiction

A

still want drug

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21
Q

what occurs in the older population with drugs?

A
  • they metabolize drugs more slowly
  • risk of GI bleeding with NSAIDs
  • polypharmacy
  • cognitive impairment, ataxia can be exacerbated by analgesics
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22
Q

define malnutrition

A

deficit, excess, or imbalance in essential components of balanced diet

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23
Q

malabsorption syndrome

A

impaired absorption of nutrients from the GI tract

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24
Q

what might malabsorption syndrome result from?

A
  • decreased enzymes
  • drug side effects
  • decreased bowel surface area
  • fever increases BMR
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25
Q

what kind of people are incomplete diets found in?

A
  • alcoholics
  • drug abusers
  • chronically ill
  • those with poor dietary practices
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26
Q

what are the primary sources of energy?

A

carbohydrates

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27
Q

where can you find monosaccharides (simple) sugars?

A

glucose, fructose, fruits and honey

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28
Q

where can you find disaccharides (simple) sugars?

A

sucrose, maltose, lactose, table sugar, malted cereal, milk

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29
Q

where can you find complex carbs (polysaccharides)?

A

starches such as cereal grains, potatoes, and legumes

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30
Q

examples of harmful fats

A

saturated fat and trans fat

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31
Q

examples of healthier fats

A

monounsaturated and polysaturated fats

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32
Q

example of heart-healthy fats

A

polyunsaturated, omega-3 fatty acids; avocado, canola, corn, grapeseed, olive, peanut, safflower, sesame, soybean and sunflower oils

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33
Q

what are proteins essential for?

A

tissue growth, repair, and maintenance

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34
Q

where must amino acids come from and what do they do?

A

must come from dietary sources and they build and repair

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35
Q

what would be a problem in someone with a vegan diet?

A

they can develop megalobastic anemia and neurologic signs of deficiency

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36
Q

when is enteral tubing a good idea?

A

when their GI tract is still working

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37
Q

what is another name for enteral nutrition?

A

tube feeding

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38
Q

where is a tube feed inserted into?

A

the stomach, duodenum or jejunum

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39
Q

why is enteral nutrition better than parenteral?

A
  • it is safer
  • more physiologically efficient than parenteral
  • less expensive
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40
Q

when would a tube feeding be used?

A

for those who need feedings for extended periods of time

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41
Q

when can feedings start with enteral nutrition?

A

usually 24 hours after placement

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42
Q

when tube feeding, how should the patient be positioned?

A

HOB at 30-45 degrees and remains there for 30-60 minutes

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43
Q

what should occur before/after each feeding and drug administration?

A

residual checks

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44
Q

what if there is too much residual?

A

stop feeding and call provider

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45
Q

what are methods used to check tube placement?

A
  • aspiration of stomach contents
  • pH check (pH < 5 is indicative of stomach contents)
  • most accurate assessment is an x-ray visualization
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46
Q

what can increased residual volumes lead to?

A

aspiration

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47
Q

when is pump tubing changed?

A

every 24 hours

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48
Q

what complications are the gerontologic population more vulnerable to?

A

nausea, vomiting, dehydration

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49
Q

parenteral nutrition

A

administration of nutrients by route other than GI tract

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50
Q

what is a regular IV solution?

A

dextrose in water or dextrose in lactated ringer’s, NO protein, 170 calories per liter (adults need 1200-1500 calories/day)

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51
Q

what are indications for parenteral nutrition?

A

injury, surgery, burns, malnourishment, chronic or intractable diarrhea and vomiting, complicated surgery or trauma, GI obstruction, GI tract anomalies and fistulae, malnutrition

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52
Q

what is parenteral nutrition composed of?

A

dextrose and protein in the form of amino acids, electrolytes, vitamins, fat emulsion

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53
Q

central line

A

long-term, top of heart (subclavian vein), needs multiple things through IVs, can’t access a good vein

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54
Q

how are PN solutions prepared?

A

under aseptic technique and must be refrigerated until 30 minutes before use

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55
Q

if a patient’s potassium is off, what is affected?

A

HR

56
Q

if BP is low, what does that mean?

A

not enough fluids

57
Q

what else do we monitor with those taking PN?

A

daily weights, BG, electrolytes, BUN, CBC, vital signs

58
Q

if you suspect an infection with PN, when should you check cultures for infection?

A

before antibiotics

59
Q

primary obesity

A

excess caloric intake for the body’s metabolic demands

60
Q

secondary obesity

A
  • chromosomal and congenital anomalies
  • metabolic problems
  • CNS lesions and disorders
61
Q

what shape presents the highest cardiac risk?

A

visceral fat: fat around heart and lungs

62
Q

concerning waist circumference in males and females

A

> 35 for females
40 for males

63
Q

android obesity

A

apple-shaped body with fat located in abdominal area

64
Q

gynoid obesity

A

pear-shaped body with fat located in upper legs

65
Q

what does leptin do?

A

suppresses appetite, increases physical activity, increases fat metabolism

66
Q

what does ghrelin do?

A

regulates appetite through inhibition of leptin

67
Q

two major consequences of obesity

A
  1. increase in fat mass
  2. production of adipokines: contribute to insulin resistance and atherosclerosis
68
Q

what density lipoproteins are the “bad guys”? “good guys”?

A

high LDLs are the bad guys
HDLs are the good guys

69
Q

examples of HDLs

A

avocado, fish, nuts, omega-3

70
Q

normal triglycerides

A

150

71
Q

what can help someone with diabetes mellitus?

A

weight loss and exercise improve glucose control by helping insulin be more effective

72
Q

what is a main respiratory problem that can occur with obesity?

A

sleep apnea ~ treat with CPAP

73
Q

in doing a weight loss program, how much body weight might one lose?

A

10% and this is associated with significant health benefits

74
Q

to achieve weight loss of 1-2 lbs/week, how much must calories be reduced by?

A

500-1,000 calories a day

75
Q

how many calories are in a pound?

A

3,500 calories

76
Q

how much is 1 portion of animal protein?

A

3 ounces

77
Q

how much is one portion of chopped vegetables?

A

1/2 cup

78
Q

how many glasses of water should you drink in a day?

A

8-10 glasses

79
Q

what are the appetite-suppressing drugs?

A

amphetamines and nonamphetamines

80
Q

what is important to watch for in those taking amphetamines?

A
  • people might take their children’s ADHD meds which stimulates the CNS
  • higher abuse potential
  • not recommended or approved by the FDA
81
Q

how do nutrient absorption-blocking drugs work?

A

by blocking fat breakdown and absorption in intestine, inhibits lipase; undigested fat is excreted in feces but fat-soluble vitamins may also be excreted

82
Q

what might occur before a bariatric surgery takes place?

A

psychologic, physical, and behavioral conditions

83
Q

what are some of the risks that can occur after a bariatric surgery?

A
  • risk for deep venous thrombosis
  • infection, dehiscence, delayed healing
84
Q

metabolic syndrome

A

also known as syndrome X; collection of risk factors that increase an individual’s chance of developing cardiovascular disease, stroke, and DM

85
Q

what factors make someone have metabolic syndrome?

A

three or more:
- waist circumference >40 in men and >35 in women
- treatment of triglycerides >150
- HDL cholesterol <40 men, <50 women
- BP >130 or >85
- fasting glucose >100

86
Q

what can happen in someone with metabolic syndrome in terms of insulin?

A

insulin resistance related to excessive visceral fat

87
Q

what is the DM the leading cause of?

A
  • adult blindness
  • end-stage kidney disease
  • nontraumatic lower limb amputations
88
Q

what is DM a contributing factor of?

A
  • heart disease
  • stroke
  • hypertension
89
Q

type 1 diabetes

A
  • absent insulin
  • autoimmune disorder
  • B-cells self destroy
90
Q

type 2 diabetes

A
  • insufficient insulin or poor utilization of insulin
91
Q

normal blood glucose level

A

70 - 120

92
Q

what does insulin do?

A

promotes glucose transport in skeletal muscle and adipose tissue ~ stores calories

93
Q

counterregulatory hormones

A

glucagon, epinephrine, GH, cortisol ~ increases BG

94
Q

most prevalent type of diabetes

A

type 2

95
Q

risk factors of type 2 diabetes

A

overweight, obesity (greatest risk factor), advancing age, family history

96
Q

what happens in type 2 diabetes?

A
  • pancreas continues to produce some endogenous insulin
  • insulin is insufficient or poorly utilized
97
Q

prediabetes fasting glucose level

A

100-125: glucose should be under 100 if fasting

98
Q

in gestational diabetes, do the moms usually become diabetic permanently?

A

50% of them will become type 2 diabetics

99
Q

classic symptoms of type 1 diabetes

A
  • polyuria
  • polydipsia
  • polyphagia
  • weight loss
  • fatigue
100
Q

clinical manifestations of type 2 diabetes

A
  • recurrent infection
  • recurrent vaginal or yeast infection
101
Q

what does an A1C show?

A

reflects glucose levels over the past 2-3 months

102
Q

what is the goal of an A1C test?

A

less than 6.5%-7%

103
Q

do all patients with type 1 diabetes require insulin?

A

YES

104
Q

exogenous insulin

A

insulin from an outside source ~ required for type 1 diabetes and for those with type 2 who cannot control BG by other means

105
Q

what should you do if a patient requires insulin and has food coming?

A

wait for their food to be in front of them

106
Q

when are short-acting insulins onset of action?

A

30-60 minutes

107
Q

what is (basal) background insulin used for?

A

to control glucose levels in between meals and overnight; it is long-acting and released steadily and continuously with no peak action

108
Q

what insulin can you mix with short and rapid acting insulins?

A

intermediate

109
Q

how long can in-use vials of insulin be used for?

A

they can be left in room temp. for up to 4 weeks

110
Q

what should you do with extra insulin?

A

keep it refrigerated

111
Q

how is insulin given?

A
  • SQ injection (45-90 angle)
  • regular insulin may be given IV
  • absorbs fastest from abdomen, then arm, thigh, and butt
  • must rotate injections!
112
Q

when would oral agents be given?

A

after trying diet/exercise, then oral, then insulin

113
Q

what do oral agents work on in type 2 diabetes?

A
  • insulin resistance
  • decreased insulin production
  • increased hepatic glucose production
114
Q

how much should a diabetic be exercising for?

A

150 minutes/week

115
Q

benefits of exercising with diabetes

A
  • dec. insulin resistance and BG
  • weight loss
  • dec. triglycerides and LDL
  • inc. HDL
  • improved BP and circulation
  • glucose-lowering effect up to 48 hours after exercise
116
Q

hypoglycemia

A
  • too much insulin
  • BG less than 70
  • untreated can progress to loss of consciousness, seizures, coma, and death
117
Q

what is the leading cause of diabetes-related death?

A

angiopathy

118
Q

if someone had a post transsphenoidal hypophysectomy, what would be advised not to do?

A
  • no teeth-brushing for at least 10 days
  • no cough, deep breathing because blood can go to the brain
119
Q

SIADH

A

pt. stops peeing; fluid in vascular space

120
Q

S/S of SIADH

A

fluid retention, serum hypo-osmolality, dilutional hyponatremia, low sodium

121
Q

treatment of SIADH

A

fluid restriction

122
Q

treatment for DI

A

fluid and hormone therapy, adequate hydration

123
Q

treatment of hyperthyroidism

A

anti-thyroid medications, radioactive iodine therapy, subtotal thyroidectomy

124
Q

if there is too much T3 and T4, what happens with TSH?

A

it will be low

125
Q

if there is too little T3 and T4, what happens with TSH?

A

it will be high

126
Q

manifestations of thyroid storm

A

severe tachycardia, shock, hyperthermia, seizures, abdominal pain, diarrhea, delirium, coma

127
Q

manifestations of hypothyroidism

A

fatigue, lethargy, personality and mental changes, decreased cardiac output, anemia, constipation

128
Q

sign of thyroid cancer

A

presence of a hard, painless nodule or nodules on enlarged thyroid gland

129
Q

hyperparathyroidism

A

increased secretion of PTH that leads to hypercalcemia and hypophosphatemia

130
Q

hypoparathyroidism

A

inadequate circulating PTH resulting in hypocalcemia which leads to tetany

131
Q

cushing syndrome

A

results from chronic exposure to excess corticosteroids

132
Q

addison’s disease

A

autoimmune disorder where the adrenal cortex is destroyed by autoantibodies

133
Q

manifestations of addison’s disease

A

weakness, weight loss, and anorexia and BUCCAL PIGMENTATION

134
Q

what would need to happen in someone with addison’s?

A

corticosteroid administration (causes weight gain), lifelong hormone therapy, protection against infection

135
Q

what is addisonian crisis triggered by?

A

stress, sudden withdrawal of corticosteroid hormone therapy, and post-adrenal surgery

136
Q

manifestations of addisonian crisis

A

postural hypotension, tachycardia, dehydration, hyponatremia, hyperkalemia, hypoglycemia, fever, weakness, confusion

NSG 322 Med Surge I (5 decks)

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