Exam 2 Flashcards
factors that affect nutrition
lifespan, ethnicity and culture, personal preferences, religion, economics, medications, health, alcohol, and sex
malnutrition
deficit excess or imbalance in essential components of balanced diet
under-nutrition
poor nourishment due to inadequate diet or disease
over nutrition
ingest more food than required
causes of protein calorie malnutrition (PCM)
socioeconomic status, patients with physical illness, incomplete diets, eating disorders, and food-drug interactions
clinical manifestations of PCM
muscles wasted and flabby, edema, dry flaky skin, lethargy, memory problems, intolerance to cold, delayed wound healing, more susceptible to infection, brittle nails
diagnosis of PCM
decreased serum albumin pre albumin transferrin hemoglobin and hematocrit creatinine and BUN and serum vitamin levels. Increased liver enzymes
acute interventions for PCM
increased stress= increased need for proteins and calories, elevated temperature increases metabolic rate, daily weights and accurate recording of I&O
under nourished patients need
meal supplements, small meals, or appetite stimulants (megestrol acetate or dronbinol)
tube feeding
enteral nutrition, inserted into stomach duodenum or jejunum, can supply nutrition alone or along with oral and parental nutrition
tube feeding is _____, ______, and ______ than parental
safer, more physiologically efficient, and less expensive
contraindications for enteral nutrition
GI obstruction, prolonged ileus, severe diarrhea or vomiting, fistula
delivery options for tube feeding
continuous by infusion pump, intermittent by gravity, intermittent bolus by syringe, cyclic feedings by infusion pump
gastrostomy and jejunostomy tube feeding
may be used in those needing tube feed for extended period, can be put in surgically radiologically or endoscopically, can begin feeding 24-48 hrs after placement regardless of flatus
Percutaneous endoscopic gastrostomy PEG
radiologically placed gastrostomy, using endoscopy tube is inserted through the esophagus into the stomach and then pulled through the stab wound made in the abdominal wall
for a pt with a tube feed the nurse should
weigh 3 times a week, monitor I&O, initial glucose checks (TF are high sugar/carb), monitor bowel sounds, slow feed if diarrhea, keep open formula refrigerated, give formula at room temp.
gastrostomy and jejunostomy tube feeding problems
skin irritation and pulling tube out
Parenteral nutrition
IV administration, used when GI tract cannot be used for digestion absorption or ingestion (normally when GI is dysfunctional or trauma/ surgery), can be either central (long term) or peripheral (short term)
Central parenteral nutrition
through a catheter whose tip lies in the superior vena cava, subclavian or jugular vein, PICCs, long term
peripheral parenteral nutrition
can be a peripherally inserted catheter or vascular access device, short term, used when protein and caloric requirements not high or central is too high risk
complications of parenteral nutrition
infection, fluid overload, electrolyte imbalance- hyperglycemia (monitor glucose q4-6 hrs) or hypoglycemia (decreased infusion when discontinuing)
parenteral nutrition nursing implications
VS q 4-8 hrs, daily weight, electrolytes and CBC 3 times a week until stable then weekly, observe dressing and site, must use infusion pump (check volume)
catheter related infections local manifestations
erythema, tenderness, exudate at catheter insertion site
catheter related infections systemic manifestations
fever, chills, N/V, malaise
if bag of PN is not available hang ____ for CPN or _____ for PPN
10-20% dextrose or 5% dextrose
bariatrics-health science
focuses on extremely obese patients
Normal BMI
18.5-24.9
Morbidly Obese BMI
greater than or equal to 40
causes of obesity
genetics, environmental, psychosocial
1 pound of body fat is equal to
3500 kcal
things to know for a patient trying to lose weight
goal of 1-2 pounds lost per week is 10% of body weight in 6 months, plateaus can last days to weeks, daily weight is not recommended, having a group can lead to greater success
exercise
is essential and should be 30 minute to an hour each day
drug therapy for weight loss
two categories- reduce appetite (Meridia, subutramine) or reduce nutrient absorption (Xenical, orlistat) , drugs the increase energy are not approved by the FDA
bariatric surgery
used for morbidly obese, only treatment found to have a successful and lasting weight loss, BMI greater than or equal to 40 or 35 with one other obesity related complication
restrictive bariatric surgery
reduces size of stomach to 30 ml or less, causes pt to feel full quicker, normal digestion and absorption, AGB
adjustable gastric band
lapband, limited stomach space by band, can be inflated or deflated to change stoma size, can be modified or reversed, fewer risks
malabsorptive surgery
bypass lengths of small intestine, less absorption, long lasting results, BPD
Biliopancreatic diversion
removes 3/4 of stomach, nutrients pass without being digested
combination of roux-en-y surgical procedure
low complication rates, excellent pt tolerance, stomach is decreased in size with a pouch that empties directly into the jejunum
after bariatric surgery
diet should be high protein and low in carbs fats and roughage, six small feedings, no fluid with meals and only 1000 mL of fluid per day
Osteoarthritis
Slowly progressive noninflammatory disorder of synovial joints, can be from age obesity injury or muscle weakness, causes joint pain/stiffness and heberdens / bouchards nodes, normally older than 40, in more females after 50 and males before 50
Diagnostic studies and treatment of osteoarthritis
Bone scan ct scan MRI X-ray and synovial fluid analysis. Treatment is focused on managing pain, preventing disability and improving joint function non drug therapy
Arthroscopic surgery
Effective in reducing pain of OA and improving function when it is used to repair ligament tears and remove bone bits
Rheumatoid arthritis
Chronic systemic autoimmune disease, inflammation in synovial joints, periods of remission and exacerbation, frequently has extra-articular manifestations, normally in young to middle age females
Clinical manifestations of RA
rheumatoid nodules (hard non tender, can break down and cause infection), Sjögren’s syndrome (in 10-15% of RA, reduced lacrimal and salivary secretions)
Diagnostic studies of RA
Positive RF in most pts, antinuclear antibody tiers, X-ray bone scan MRI, indications of active inflammation (erythrocyte sediment rate, C-reactive protein, and synovial fluid examination
Treatment of RA
Physical therapy, occupational therapy, drug therapy- disease modifying anti rheumatic drugs which lessen permanent effects of RA (methotrexate) biologic/ target therapy which slows the disease (etanercept) NSAIDs, and corticosteroids for symptom control (short term)
When is cold therapy beneficial?
During acute disease exacerbation for 10-15 minutes
When is heat therapy beneficial?
Chronic stiffness for 20 minutes
Never use heat device with
Heat producing cream (capsaicin)
Synovectomy
Take out fluid and part of joint, joint replacement is more common
Systemic lupus erythematosus
Chronic multi-system inflammatory autoimmune disease, manifestations a lot like RA main differences are butterfly rash and sun or light sensitivity, flared triggered by stress fatigue sun infection or pregnancy
Diagnostic findings of lupus
No single test can confirm, ANA (anti nuclear antibody) ESR, LE prep, anti smith (sm) 30-40% will show positive that have lupus
Treatment for lupus
NSAIDs, anti malarial-hydroxychloroquine (plaquenil) need eye exams q 6-12 months, corticosteroids, immunosuppressives
Nursing care during acute exacerbation of sle
Assess fever pattern, joint inflammation, limitation of motion, pain, weight and I/O, 24 hr urine collection, observe for signs of bleeding, neurological assessment, asses for neuropathy, mostly in females, big COD w/ SLE is infection
Gout
Systemic disease in which urate crystals deposit in joints causing inflammation, may be due to over or under secretion of uric acid by the kidneys or increase of foods with purines
Primary gout
Controlled with Meds, under or over production of uric acid
Secondary gout
Can be changed, from obesity hypertension diuretic use alcohol consumption or high purine foods (breaks down uric acid)
Diagnostic test of gout
Presence of sodium urate crystals in synovial fluid, elevated serum uric acid levels, elevated 24 hour urine for uric acid levels, X-ray
Management of gout
Increase fluids and rest, low purine diet, avoid alcohol fad diets aspirins and diuretics, drug therapy (colchicine- anti inflammatory greatly decreases pain also given with Tylenol or NSAIDs), use things like cradle to protect painful area
Non invasive testing
X-ray, ct scan, DEXA, MRI
X-ray considerations
No prep, mobility on to table, give pain Meds prior
Ct scan
Can be done with/without dye (check allergy), gives cross sectional view of body, may last for 30-90 minutes
MRI considerations
Can take 60-90 minutes, must lie supine without movement, can have open MRI, no metal (can cause burn or projectile), transdermal patches need to be removed with dr consent
DEXA (dual energy x-ray absorptiometry)
No food or fluid restriction, no metal, takes 15-30 minutes
Invasive procedures
Arthrogram, bone scan, arthroscopy, myelogram, arthrocentesis
Bone scan
Nuclear scan used to detect early bone disease bone metastasis and bone response to therapeutic regimens, considerations: can eat and drink before test, radioisotopes will be injected 2-3 hour wait, patient drinks 4-6 glasses of fluid
Arthroscopy
Surgical procedure used to examine the internal structure of a joint using arthroscope, considerations: NPO for 8 hrs, pain Meds, neurovascular check of extremity, compression bandage, walking without weight bearing after sensation returns, notify MD if fever increase pain or edema occurs more than 3 days after procedure
Arthrogram (arthrography)
Contrast medium or air is injected into joint cavity, client moves (or is moved) through series of movements while X-rays are taken, considerations: NPO, minimize joint movement 12 hrs after, pain Meds and ice, call MD if edema or pain lasts more than 2 days, may experience crepitus in joint
Myelogram
Used to detect defects around spine, considerations: pre-procedure force fluids night before than NPO 4-8 hrs before and void before procedure, post procedure prevention of lumbar puncture headaches by increasing fluids maintaining bed rest and completing neurological assessment
Arthrocentesis
Aspiration of synovial fluid, considerations: need compression bandage and ice post procedure, analgesics, joint rest 8-24 hrs after, notify MD if fever or swelling occurs
Sprain
Stretch and/or tear to the ligaments surrounding the joint, can result in loss of function a popping or tearing sensation discoloration pain and swelling
Strain
Excessive stretching of muscle or tendon, may result in pain limited motion muscle spasms or swelling
Treatment of strains and sprains
Prevention, PRICE (prevent, rest, ice, compression, elevation) and analgesics/ NSAIDS, after 48 hrs mild heat x 15-30 minutes, temporary splint or elastic bandage
Avulsion fracture
With traumatic sprain/strain that takes off a piece of bone
5 P’s circulation assessment
Pain pulse pallor paresthesia paralysis
Dislocation
Severe injury of the ligaments surrounding the joint (complete separation of joint surfaces), may cause deformity pain loss of joint function and swelling
Subluxation
Partial or incomplete displacement of joint surface (bone may be dying)
Major complications of dislocation
fractures, avascular necrosis, neurovascular tissue damage
Herniated intervertebral disk
Slipped disk from repeated stress
Degenerative disk disease
Disk dries out as age increases
Intervertebral disk disease clinical manifestation
Low back pain, sciatic nerve pain (shooting pain down one or both legs) reflexes may be decreased or absent, bowel and bladder incontinence can occur (considered emergency)
Diagnosis of disk disease
Straight leg raising test, X-ray, MRI, ct scan, myelogram
Collaborative care of disk disease
Restrict activity for several days (do normal things), medication, local ice or heat, physical therapy (massage), surgery
Types of spinal surgery
Laminectomy (most used for slipped disk), microdiskectomy, spinal fusion (uses bone and/or rods)
Nursing management after spinal surgery
Maintain proper alignment, pain Meds, observe for headache or colorless leakage on dressing, neurovascular checks, assess bladder and bowel function, prevent constipation, check orders before before getting pt out of bed
Fracture classifications
Communication or noncommunication with external environment, complete or incomplete, direction of fracture line, displaces (unstable) or nondisplaced (stable), compound (open) or simple (closed)
Common signs and symptoms of fracture
Pain shock swelling bruising deformity guarding site and crepitation
Goal for fracture repair
Anatomical realignment (reduction-closed or open), immobilization (splint cast sling traction brace) , restore function
Spica cast
Normally from waist down
Cast nursing management
Keep cast/extremity elevated, allow it to dry for 24-72 hours after applied (handle wet plaster with palms), petal cast (covering the end of cast), monitor for signs of infection
Traction
Continuous pull on affected part for a period of time to attain or maintain normal anatomical position
Types of Traction
Skin- straight running traction, attached to skin to control muscle spasms, 10-15 lbs short term. Skeletal- attached directly to pts skeletal system, uses pins screw wires or tongs, 5-45lbs, long term
External fixation
Used to manage open fractures with soft tissue damage, never adjust hardware
Pin care
No standardized method, small amount of clear drainage, observe site q 8hrs, watch for infection
Fat embolism
Three symptoms: Neurological dysfunction (confusion), acute respiratory failure, petechial rash (conjunctivae inner cheeks neck and axilla)
Treatment: prevention, support the respiratory system-high fowlers high concentration o2 correct fluids corticosteroids
Acute compartmental syndrome
Not common but emergency, results in infection motor weakness Contractures acute renal failure, can be from snake bites Or infiltrated IV
Treatment: prevention and early recognition, extremity should not be raise above heart level, no ice packs, may result in amputation
The 6th P
Pressure, expect intracompartmental pressure to be between 0-10 mm Hg, readings higher than 30 indicate compartment syndrome
Arthroplasty
Reconstruction or replacement of joint, make sure pt is in best possible health before surgery
Hip fractures
Most caused by falls due to osteo., if shaft breaks it’s more due to trauma
Treatment: buck traction until surgery, open reduction internal fixation
With total replacement avoid adduction for 4-6 weeks
Signs and symptoms of hip dislocation
Increased pain at surgical site swelling and immobilization, groin pain, shortening of leg, abnormal rotation, restricted movement of leg, popping sensation
Complications of joint surgery
Infection, DVT, fat embolism syndrome, shock, and dislocation (in hip)
Osteoporosis
When bone reabsorption exceeds the rate of bone reformation, bones become porous, primary (women from decreased estrogen) or secondary (from diabetes or medications), 80% in females
Clinical manifestations of osteoporosis and diagnosis
Kyphosis, annual loss of height, back pain (broken vertebrae), fractures (in arms to stop from falling)
Diagnosis: bone mineral density, quantitive ultrasound, DEXA (t-score >= -1 is normal, <= -2.5 is considered osteoporosis)
Medications for osteoporosis
Bisphosphonates (can cause jaw breakdown, ex. Alendronate or ibandronate) should be taken with full glass of water 30 minutes before food or other meds and remain sitting up for 30 minutes after taking. selective estrogen receptor modulators (raloxifene) Calcium (1000 mg per day pre menopause, 1500 mg per day post menopause) Vitamin D (800-1000) IU in post menopause
incidence of ____, _____, and ______ cancer have decrease
lung, colorectal, and oral
incidence of _____ and ______ cancer have increase
non-Hodgkin’s lymphoma and skin
cancer is high in
men, people over 65, and it is the second most common COD
prevention of cancer
avoid or reduce exposure to known carcinogens, eat balanced diet, exercise regularly, obtain adequate rest
signs of cancer
Change in bowel or bladder, A sore that doesn’t heal, Unusual bleeding or discharge, Thickening or lump in breast or elsewhere, Indigestion or difficulty swallowing, Obvious change in wart or mole, Nagging cough or hoarseness
diagnosis of cancer
mainly tissue biopsy, can also use: x-ray CBC chem profile liver function test endoscopic exams, radiological studies PET scans tumor markers genetic markers and bone marrow exam
Biopsy
can be diagnostic and/or curative
excisional biopsy
removal of entire tumor along with surrounding tissue (like a mole)
incisional biopsy
preformed when tumor is too large to be totally removed
factors that determine treatment modality
cell type, location and size of tumor, extent of disease, physiologic and psychologic status, expressed needs and desires
Surgical interventions of cancer can be
curing, prevention, support and palliative care
chemotherapy
use of chemicals as a systemic therapy in cancer
radiation therapy
local treatment, can be external radiation (teletherapy) or internal radiation (brachytherapy)
BARFS side effects of chemo
Bone marrow depression, Alopecia, Retching- n/v, Fear and anxiety, Stomatitis- sores in mouth
pulmonary effects with nursing implications for cancer treatment
may be progressive and irreversible, can have cough dyspnea pneumonitis and pulmonary edema, treatment is rest bronchodilators cough suppressants and O2
cardiovascular effects with nursing implications for cancer treatment
pts with preexisting coronary artery disease are more vulnerable for arrhythmias
reproductive effects with nursing implications for cancer treatment
use shielding, warn pt of effects, refer to counseling if needed
extravasation
caused by vesicant meds, infiltration of drug into tissues surrounding the infusion causing local tissue damage, should stop infusion immediately
infection in cancer patients
main COD, sites normally the lungs GI tract Mouth rectum blood and peritoneal cavity
