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Med surg 2 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Digestion

A

begins with the act of chewing, in which food is broken down into small particles that can be swallowed and mixed with digestive enzymes

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2
Q

Absorption

A

Absorption is the major function of the small intestine. Vitamins and minerals absorbed are essentially unchanged. Absorption begins in the jejunum and is accomplished by active transport and diffusion across the intestinal wall into the circulation

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3
Q

Elimination

A

phase of the digestive process that occurs after digestion and absorption when waste products are eliminated from the body

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4
Q

Chyme

A

mixture of food with saliva, salivary enzymes, and gastric secretions that is produced as food passes through the mouth, esophagus, and stomach

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5
Q

Amalase

A

an enzyme that aids in the digestion of starch

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6
Q

dyspepsia

A

indigestion; upper abdominal discomfort associated with eating

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7
Q

hydrochloric Acid

A

acid secreted by the glands in the stomach; mixes with chyme to break it down into absorbable molecules and to aid in the destruction of bacteria

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8
Q

intrinsic Factor

A

a gastric secretion that combines with vitamin B12 so that the vitamin can be absorbed

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9
Q

Lipase

A

an enzyme that aids in the digestion of fats

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10
Q

Pepsin

A

a gastric enzyme that is important in protein digestion

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11
Q

trypsin

A

enzyme that aids in the digestion of protein

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12
Q

microbiota

A

the complement of microbes in the GI tract

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13
Q

gingivitis

A

inflammation of the gums

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14
Q

Periapical abscess

A

abscessed tooth. Acute infection or chronic slow progressive infection.
Presence of pus in the apical dental periosteum and tissue surrounding the apex

Clinical manifestations: pain, cellulitis, facial edema, fever, malaise

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15
Q

Managing a peripheral abscess

A

Medical
Needle aspiration
Drill opening to relieve pressure, pain, and promote drainage
After acute phase tooth may be extracted
Antibiotics

Nursing
Assess for bleeding
Instruct to use warm saline/water rinse
Take antibiotic and analgesic
Keep follow up appointment

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16
Q

Parotitis

A

inflammation of the parotid gland

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17
Q

sialadenitis

A

inflammation of the salivary glands

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18
Q

sialolithiasis

A

salivary stones

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19
Q

Neoplasms

A
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20
Q

Leukoplakia

A

white patches in the buccal mucosa
- may become malignant
Oral hairy Leukoplakia: potentially viral, typically found on the tongue

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21
Q

Lichen Planus

A

Radiating white striations on the tongue and buccal mucosa

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22
Q

Erythroplakia

A

red patch on the oral mucosa

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23
Q

kaposi sarcoma

A

Appears first on the oral mucosa as red, purple or blue lesions

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24
Q

stomatitis

A

Erythema and edema of the oral mucosa

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25
Q

manifestations of oral cancer

A

Early Stage
Few or no symptoms in early stage
Painless sore or mass that does not heal; indurated ulcer with raised edges
Lesions that do not heal within 2 weeks should be reported
May bleed easily and present with red or white patch

Later manifestations include:
Complaints of tenderness
Difficulty in chewing, swallowing, or speaking
Coughing up blood-tinged sputum
Enlarged cervical lymph nodes

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26
Q

3 main types of oral cancer

A

Squamous cell carcinoma
Most common
May be present on lips, tongue, buccal mucosa and oropharynx

Basal Cell
Affects the lips and skin around the mouth

Kaposi’s sarcoma
Can be found on the hard palate, gums, tongue or tonsils

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27
Q

xerostomia

A

dry mouth

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28
Q

radical neck dissection surgery

A

A radical neck dissection involves removal of all cervical lymph nodes from the mandible to the clavicle and removal of the sternocleidomastoid muscle, internal jugular vein, and spinal accessory muscle on one side of the neck

The associated complications include shoulder drop and poor cosmesis (visible neck depression)

Modified radical neck dissection used more often
Leaves sternocleidomastoid intact

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29
Q

chyle fistula

A

Milk like drainage from the thoracic lymphatic duct into the thoracic cavity

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30
Q

achalasia

A

Absent or ineffective peristalsis of the distal esophagus by failure of the esophageal sphincter to relax in response to swallowing

Treatment
Pneumatic Dilation

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31
Q

Diverticula

A

Out-pouching of mucosa and submucosa that protrudes through a weak portion of the esophagus
Most common type: Zenker Diverticulum
May need to be surgically removed

( things can go into then and that can increase the risk for infection)

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32
Q

Barrett’s Esophagus

A

Lining of the esophageal mucosa to resemble the intestinal mucosa
Occurs in association with GERD
Only precursor to Esophageal Adenocarcinoma
( just because you have barrett’s does not mean you are going to get the cancer. )

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33
Q

Hiatal Hernia

A

located in the opening of the diaphragm

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34
Q

dysphagia

A

difficulty swallowing

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35
Q

odynophagia

A

pain on swallowing

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36
Q

GERD Gastroesophageal reflux disease

A

Common disorder marked by backflow of gastric or duodenal contents into the esophagus that causes troublesome symptoms and/or mucosal injury to the esophagus
Excessive reflux may occur because of an incompetent lower esophageal sphincter, pyloric stenosis, hiatal hernia, or a motility disorder

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37
Q

Antacids

A

Calcium antacids (TUMS) may lead to the development of kidney stones and increased gastric acid secretion.
Antacids containing magnesium must be avoided in patients with renal failure.
Sodium bicarbonate is a highly soluble antacid form with a quick onset but short duration of action. (contraindicated for patients with hypertension or heart issues)

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38
Q

H2 Receptor Antagonists
Cimetidine
Ranitidine
Famotidine

A

Inhibits action of histamine on H2 receptor sites of parietal cells decreasing gastric acid secretion
* can cause confusion in elderly*
Adverse Reactions: CNS: Dizziness, confusion
GI: Constipation, diarrhea

Indications:GERD (gastroesophageal reflux disease)
-Erosive Esophagitis
-Peptic ulcer disease
-Adjunct therapy in the control of upper GI bleeding

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39
Q

Proton Pump Inhibitors
Omeprazole
Pantoprazole
Lansoprazole

A

Inhibits proton pump activity by binding to hydrogen-potassium adenosine triphosphate, located at secretory surface of gastric parietal cells, to suppress gastric acid secretion
* take 30 min to an hour before 1st meal.*

Adverse Reactions: GI: Diarrhea, abdominal pain, possible predisposition to C. Diff
Musculoskeletal: Long term use potentially linked to osteoporosis

Indications: - H. Pylori
-NSAID induced ulcers
-Erosive esophagitis
-Symptomatic GERD that is unresponsive to H2 Receptor Antagonists

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40
Q

Gastritis

A

Inflammation of the stomach
Acute: rapid onset of symptoms usually caused by dietary indiscretion. Other causes include medications, alcohol, bile reflux, and radiation therapy. Ingestion of strong acid or alkali may cause serious complications
Chronic: prolonged inflammation due to benign or malignant ulcers of the stomach or by Helicobacter pylori. May also be associated with some autoimmune diseases, dietary factors, medications, alcohol, smoking, or chronic reflux of pancreatic secretions or bile

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41
Q

Peptic Ulcer Disease

A

Erosion of a mucous membrane forms an excavation in the stomach, pylorus, duodenum (most common), or esophagus
Manifestations include a dull gnawing pain or burning in the midepigastrium; heartburn and vomiting may occur
Treatment includes medications, lifestyle changes, and occasionally surgery

H. Pylori infection is most common cause. (antibiotics needed)

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42
Q

NSAIDs

A

Contraindicated in GI issues

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43
Q

Misoprostol

A

Prevention of ulcers related to NSAID (taking nsaids for a long time)

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44
Q

Gastric Ulcer

A

pain 30-60 mins after meal. less pain at night. malnourished, weight loss. Hematemesis: vomiting blood (looks like coffee grounds).

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45
Q

Duodenal ulcer

A

Pain 1.5-3 hours after meals. wakes up with pain during the night. pain relieved by ingestion of food or antacid. well nourished. Melena (blood in the stool).

46
Q

The most common site for peptic ulcer formation is

A

the pylorus

47
Q

Perforation

A

board-like ridged abdomen. this can be fatal. GI contents are going everywhere in the body

48
Q

Penetration

A

erosion into the surrounding structures. most common site is the pancreas.

49
Q

Pyloric obstruction

A

gastric outlet obstruction
- feels full easily, nauseous, vomiting profusely.

NG tube can be used.

50
Q

Meds given for ulcers

A

H2 end in dine (elderly can become confused
PPI end in zole. (can cause osteoporosis long-term use)

51
Q

Zollinger-Ellison syndrom (ZES)

A

Rare condition
Benign or malignant tumors of the pancreas and duodenum that secrete high levels of the hormone gastrin (promotes the release of hydrochloric acid)
Suspected when a patient has several peptic ulcers, or ulcers that are resistant to medications
Treatment includes
Medication (Acid-controlling medications)
Potential Chemotherapy
Surgical removal of gastrinomas

52
Q

Any condition that causes the body to reproduce cells and heal rapidly can cause

A

CANCER

53
Q

Patient coming in with GI issues are

A

NPO

54
Q

Steatorrhea

A

Fatty Stools, decrease fat intake

55
Q

If patient has diarrhea why are they given a CBC

A

Checks their WBC for infection, electrolyte imbalance (potassium: heart)

56
Q

Fecal Management System

A

catheter for the rectum, poop goes into a bag to prevent skin irritation.

57
Q

IBS irritable bowel syndrome

A

Chronic functional disorder characterized by recurrent abdominal pain associated with disordered bowel movements, which may include diarrhea, constipation, or both
15% of adults in the United States report symptoms of IBS; More common in women than men
Triggers: chronic stress, sleep deprivation, surgery, infections, diverticulitis, and some foods

58
Q

malabsorption

A

The inability of the digestive system to absorb one or more of the major vitamins, minerals, or nutrients

Conditions:
Mucosal (transport) disorders
Infectious disease
Luminal disorders
Postoperative malabsorption
Disorders that cause malabsorption of specific nutrients

59
Q

Celiac Disease

A

disorder of malabsorption caused by an autoimmune response to the consumption of products that contain the protein gluten

gluten free diet

60
Q

Appendicitis

A

Appendicitis is the most frequent cause of acute abdomen in the United States, most common reason for emergency abdominal surgery
Appendix becomes inflamed and edematous as a result of becoming kinked or occluded by a fecalith or lymphoid hyperplasia
The inflammatory process increases intraluminal pressure, causing edema and obstruction of the orifice
Once obstructed, the appendix becomes ischemic, bacterial overgrowth occurs, and eventually gangrene or perforation occurs

61
Q

Rovsing’s sign
Appendicitis assessment

A

Pain felt in the right lower quadrant with palpation of the left lower quadrant

62
Q

McBurney’s Point
Appendicitis assessment

A

Pain in the right lower quadrant associated with appendicitis

63
Q

Psoas Sign
Appendicitis assessment

A

pain when leg is lifted against resistance while lying supine

64
Q

Obturator Sign
Appendicitis assessment

A

pain with slow internal movement of the hip joint while the knee is flexed

65
Q

Diverticular Disease

A

Diverticulum: sac-like herniation of the lining of the bowel that extends through a defect in the muscle layer
May occur anywhere in the intestine but most common in the sigmoid colon
Diverticulosis: multiple diverticula without inflammation
Diverticulitis: infection and inflammation of diverticula
Diverticular disease increases with age and is associated with a low-fiber diet
Diagnosis is usually by colonoscopy

(antibiotics will be given)

66
Q

Intestinal Obstruction

A

Intestinal obstruction exists when blockage prevents the normal flow of intestinal contents through the intestinal tract
Mechanical obstruction:
Intraluminal obstruction or mural obstruction from pressure on the intestinal wall (can be Fecal Matter)
Functional or paralytic obstruction:
The intestinal musculature cannot propel the contents along the bowel
The blockage also can be temporary and the result of the manipulation of the bowel during surgery

(patient will be NPO or have an NG tube)

67
Q

Inflammatory Bowel Disease

A

Crohn’s disease (regional enteritis). Colectomy can be used to treat
Ulcerative colitis: more localized. bleeding is more common

(corticosteroids used to help with inflammation. they can increase sugar so watch diabetics)

68
Q

Indications for parenteral nutrition

A

Intake is insufficient to maintain anabolic state
Ability to ingest food orally or by tube is impaired
Patient is not interested or is unwilling to ingest adequate nutrients
The underlying medical condition precludes oral or tube feeding
Preoperative and postoperative nutritional needs are prolonged

69
Q

If TPN fluid runs out what must you have on hand to give patient?

A

Dextrose solution 10%

70
Q

Anorectal Conditions

A

Proctitis: inflammation of the rectum

Anorectal abscess

Anal fistula: Small tunnel between the end of the bowel and the skin near the anus

Anal fissure: Small tear in the lining of the anus

Hemorrhoids

Pilonidal sinus or cyst: Abnormal growth at the tailbone that contains skin and hair

71
Q

cheilitis

A

chapped lips

72
Q

80ml-120ml ?

A

jp drain

73
Q

BMI

A

Height and weight to determine BMI
Overweight = BMI 25 to 29.9
Obese = BMI exceeding 30
Severe/extreme obese = BMI exceeding 40

74
Q

HA1c Lab test

A

shows how glucose is from the last 3 months

75
Q

Sympathomimetic Amines
Approved by the FDA for short term use-no more than 12 weeks
Phentermine & Benzphetaminefor obesity

A

Stimulates sympathetic system (flight or flight)

Adverse Reactions
Palpitations and tachycardia
Tremors
Hypertension
Dizziness, insomnia, restlessness
Diarrhea or constipation

76
Q

Naltrexone/Bupropion
for obesity

A

Inhibits central opioid receptors and inhibits reuptake of dopamine and norepinephrine, resulting in diminished appetite and cravings

77
Q

Vagal Blocking for obesity

A

Blocking of vagus nerve via implanted device
Slows gastric contraction and emptying
Few side effects

78
Q

Intragastric balloon therapy

A

Endoscopic placement of saline-filled balloon
Remains in place for 3 to 6 months
Adverse effects: N and V, balloon rupture causing obstruction

79
Q

Bariatric Surgery

A

Results in weight loss of 10% to 35% body weight within 2 to 3 years

Improvement in comorbid conditions

Selection by multidisciplinary team

Selection criteria has changed to include BMI of 30 for patients with comorbid conditions

Surgery is performed only after nonsurgical methods have failed

80
Q

Bariatric Procedures

A
  • Roux-en-Y gastric bypass (RYGB): most common, small top pouch of stomach (20-30ml capacity) attached to the small intestine.
  • Gastric banding: it is reversible. 15-20ml capacity
  • Sleeve gastrectomy: most common, smaller stomach
  • Biliopancreatic diversion with duodenal switch
  • Performed by laparoscopy or by an open surgical technique
81
Q

Metabolic Functions of the liver

A

Glucose metabolism: stores as glycogen
Ammonia conversion
Protein metabolism
Fat metabolism: fat broken down by bile
Vitamin and iron storage
Bile formation
Bilirubin excretion
Drug metabolism

82
Q

Liver Function Tests

A

ALT: liver test. elevated is liver issues/failure
AST: elevated can be liver or something else in the system
GST: grandma got trashed. elevated for related to alcohol.

Alanine aminotransferase (ALT) 8-40 U/mL: levels increase primarily in liver disorders; used to monitor the course of hepatitis, cirrhosis, the effects of treatments that may be toxic to the liver

Aspartate aminotransferase (AST)10-40 U/mL: not specific to liver diseases however levels of AST may be increased in cirrhosis, hepatitis, and liver cancer

Gamma-glutamyl transferase (GGT) 10-30 U/L: levels are associated with cholestasis; alcoholic liver disease

Serum aminotransferases: indicators of injury to the liver cells; useful in detecting hepatitis

83
Q

More Lab tests for the liver

A

Serum Bilirubin (pigment derived from the breakdown of hemoglobin), total 0.3 to 1 mg/dL: Measure the livers ability to conjugate and excrete bilirubin. High in biliary tract disease. Associated with jaundice clinically

Serum Albumin 3.5 to 5.5 g/dL: Proteins are manufactured in the liver. Levels decreased in a variety of hepatic impairments

Prothrombin time 12-16 seconds: May be prolonged in liver disease. It will not return to normal with Vit K in severe liver cell damage

Ammonia 15-45 mcg/dL: Liver converts ammonia to urea. Ammonia level rises in liver failure

84
Q

Hepatocellular Jaundice

A

Mild or severely ill
Lack of appetite, nausea or vomiting, weight loss
Malaise, fatigue, weakness
Headache, chills, fever, infection

85
Q

Obstructive Jaundice

A

Dark orange-brown urine, clay-colored stools
Dyspepsia and intolerance of fats, impaired digestion
Pruritus

86
Q

Ascites

A

condition in which fluid collects in spaces within your abdomen

Treatment:
spironolactone is the diuretic of choice.
Paracentesis
salt-poor albumin
transjugular intrahepatic portosystemic shunt (TIPS)
peritoneovenous-ascites

87
Q

Portal Hypertension

A

Obstructed blood flow through the liver results in increased pressure throughout the portal venous system

Results in:
Ascites
Esophageal varices: varicose veins

88
Q

Hepatic Encephalopathy

Ammonia (should be 15-45) building up, gets into the blood stream and can cause swelling of the brain.

A

Two major alterations underlie its development in acute and chronic liver disease

Hepatic insufficiency: the inability of the liver to detoxify toxic by-products of metabolism

Portosystemic shunting: collateral vessels develop allowing elements of the portal blood (laden with potentially toxic substances usually extracted by the liver) to enter the systemic circulation

Early signs: mental changes and motor disturbances

89
Q

Asterixis

A

Inability to hold the hand in a flexed position

90
Q

Apraxia

A

Inability to reproduce a simple figure in two or three dimensions is referred to as constructional apraxia

91
Q

Spironolactone (aldactone)

A

patients with ascites from cirrhosis. It is potassium sparing.

Oral diuretics such as furosemide (Lasix) may be added but should be used cautiously. Ammonium chloride and acetazolamide (Diamox) are contraindicated because of the possibility of precipitating hepatic coma

92
Q

Esophageal Varices

A

enlarged veins in the esophagus

Occurs in about one third of patients with cirrhosis and varices
First bleeding episode has a mortality rate of 10% to 30% depending on severity
Manifestations include hematemesis, melena, general deterioration, and shock
Patients with cirrhosis should undergo screening endoscopy every 2 to 3 years

93
Q

Treatment of bleeding Varices

A
  • Treat for shock; administer oxygen
  • IV fluids, electrolytes, volume expanders, blood and blood products
  • Vasopressin (ADH), somatostatin (growth hormone), octreotide to decrease bleeding
  • Vasopressin (antidiuretic hormone) in combination with nitroglycerin to reduce coronary vasoconstriction
  • Propranolol and nadolol to decrease portal pressure; used in combination with other treatment
  • Balloon tamponade
94
Q

Hepatitis

A

Viral hepatitis: a systemic viral infection that causes necrosis and inflammation of liver cells with characteristic symptoms and cellular and biochemical changes

A and E: fecal–oral route
B and C: bloodborne
D: only people with hepatitis B are at risk
Hepatitis G and GB virus-C

Nonviral hepatitis: toxic and drug induced

95
Q

Fulminant Liver Failure

A

The liver just shuts down. Transplant is what you need.

96
Q

Cirrhosis

A

Scarring of the liver and hypertension on the hepatic portal vein.

97
Q

Lactulose

A

reduce serum ammonia levels
May lead to diarrhea (dehydration), hypokalemia and GI bleeding

98
Q

Amalayse

A

breaks down carbs

99
Q

Lipase

A

Breaks down fats

100
Q

Cholecystitis

A

inflammation of the gallbladder

101
Q

cholelithiasis

A

calculi in the gallbladder

102
Q

Medical treatment of Cholelithiasis

A

ERCP: Endoscopic retrograde cholangiopancreatography
- Gallstone removal can be done during this procedure

Dietary management: Low fat diet, avoid gas forming foods

Laparoscopic cholecystectomy: Open approach- JP drain or T-tube may be placed

Nonsurgical removal
- By instrumentation
- Intracorporeal (within the body) or extracorporeal lithotripsy (outside the body)

103
Q

Pancreatitis

A

Acute: pancreatic duct becomes obstructed (like from a moving gallstone), and enzymes back up, causing autodigestion and inflammation of the pancreas

Chronic: progressive inflammatory disorder with destruction of the pancreas; cells are replaced by fibrous tissue; pressure within the pancreas increases, obstructing the pancreatic and common bile ducts

104
Q

Pancreatitis

A

Acute: pancreatic duct becomes obstructed (like from a moving gallstone), and enzymes back up, causing autodigestion and inflammation of the pancreas

Chronic: progressive inflammatory disorder with destruction of the pancreas; cells are replaced by fibrous tissue; pressure within the pancreas increases, obstructing the pancreatic and common bile ducts. (common with alcohol)

105
Q

Turner’s Sign in pancreatitis

A

Ecchymosis on flank

106
Q

Cullen’s sign in pancreatitis

A

Bluish-gray periumbilical discoloration

107
Q

Chvosteks’s Sign in pancreatitis

A

facial twitching when facial nerve is tapped

108
Q

Trousseau’s Sign in pancreatitis

A

hand spasm when blood pressure cuff is inflated

109
Q

Lab tests for pancreatitis

A

Serum Amylase (Digestion of carbohydrates)
Normal range 25-150 U/L
Increase within 12 to 24 hours and remains elevated for 2 to 3 days

Serum Lipase (Breaks down fats)
Normal range 10-140 U/L
Increases slowly, but remains elevated for up to 2 weeks

110
Q

Cholesterol stones can be given medications to be broken up.

A

Ursodiol link (Actigall) and chenodiol link (Chenix)

monitor liver when taking the drugs.

111
Q

Pigment stones

A

can be broken up inside or outside of the body or use ERCP

Med surg 2 (5 decks)

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