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Med Surg 1 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

factors that affect nutrition

A

lifespan, ethnicity and culture, personal preferences, religion, economics, medications, health, alcohol, and sex

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2
Q

malnutrition

A

deficit excess or imbalance in essential components of balanced diet

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3
Q

under-nutrition

A

poor nourishment due to inadequate diet or disease

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4
Q

over nutrition

A

ingest more food than required

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5
Q

causes of protein calorie malnutrition (PCM)

A

socioeconomic status, patients with physical illness, incomplete diets, eating disorders, and food-drug interactions

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6
Q

clinical manifestations of PCM

A

muscles wasted and flabby, edema, dry flaky skin, lethargy, memory problems, intolerance to cold, delayed wound healing, more susceptible to infection, brittle nails

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7
Q

diagnosis of PCM

A

decreased serum albumin pre albumin transferrin hemoglobin and hematocrit creatinine and BUN and serum vitamin levels. Increased liver enzymes

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8
Q

acute interventions for PCM

A

increased stress= increased need for proteins and calories, elevated temperature increases metabolic rate, daily weights and accurate recording of I&O

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9
Q

under nourished patients need

A

meal supplements, small meals, or appetite stimulants (megestrol acetate or dronbinol)

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10
Q

tube feeding

A

enteral nutrition, inserted into stomach duodenum or jejunum, can supply nutrition alone or along with oral and parental nutrition

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11
Q

tube feeding is _____, ______, and ______ than parental

A

safer, more physiologically efficient, and less expensive

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12
Q

contraindications for enteral nutrition

A

GI obstruction, prolonged ileus, severe diarrhea or vomiting, fistula

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13
Q

delivery options for tube feeding

A

continuous by infusion pump, intermittent by gravity, intermittent bolus by syringe, cyclic feedings by infusion pump

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14
Q

gastrostomy and jejunostomy tube feeding

A

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

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15
Q

Percutaneous endoscopic gastrostomy PEG

A

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

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16
Q

for a pt with a tube feed the nurse should

A

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.

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17
Q

gastrostomy and jejunostomy tube feeding problems

A

skin irritation and pulling tube out

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18
Q

Parenteral nutrition

A

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)

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19
Q

Central parenteral nutrition

A

through a catheter whose tip lies in the superior vena cava, subclavian or jugular vein, PICCs, long term

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20
Q

peripheral parenteral nutrition

A

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

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21
Q

complications of parenteral nutrition

A

infection, fluid overload, electrolyte imbalance- hyperglycemia (monitor glucose q4-6 hrs) or hypoglycemia (decreased infusion when discontinuing)

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22
Q

parenteral nutrition nursing implications

A

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)

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23
Q

catheter related infections local manifestations

A

erythema, tenderness, exudate at catheter insertion site

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24
Q

catheter related infections systemic manifestations

A

fever, chills, N/V, malaise

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25
Q

if bag of PN is not available hang ____ for CPN or _____ for PPN

A

10-20% dextrose or 5% dextrose

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26
Q

bariatrics-health science

A

focuses on extremely obese patients

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27
Q

Normal BMI

A

18.5-24.9

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28
Q

Morbidly Obese BMI

A

greater than or equal to 40

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29
Q

causes of obesity

A

genetics, environmental, psychosocial

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30
Q

1 pound of body fat is equal to

A

3500 kcal

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31
Q

things to know for a patient trying to lose weight

A

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

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32
Q

exercise

A

is essential and should be 30 minute to an hour each day

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33
Q

drug therapy for weight loss

A

two categories- reduce appetite (Meridia, subutramine) or reduce nutrient absorption (Xenical, orlistat) , drugs the increase energy are not approved by the FDA

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34
Q

bariatric surgery

A

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

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35
Q

restrictive bariatric surgery

A

reduces size of stomach to 30 ml or less, causes pt to feel full quicker, normal digestion and absorption, AGB

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36
Q

adjustable gastric band

A

lapband, limited stomach space by band, can be inflated or deflated to change stoma size, can be modified or reversed, fewer risks

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37
Q

malabsorptive surgery

A

bypass lengths of small intestine, less absorption, long lasting results, BPD

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38
Q

Biliopancreatic diversion

A

removes 3/4 of stomach, nutrients pass without being digested

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39
Q

combination of roux-en-y surgical procedure

A

low complication rates, excellent pt tolerance, stomach is decreased in size with a pouch that empties directly into the jejunum

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40
Q

after bariatric surgery

A

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

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41
Q

Osteoarthritis

A

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

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42
Q

Diagnostic studies and treatment of osteoarthritis

A

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

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43
Q

Arthroscopic surgery

A

Effective in reducing pain of OA and improving function when it is used to repair ligament tears and remove bone bits

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44
Q

Rheumatoid arthritis

A

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

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45
Q

Clinical manifestations of RA

A

rheumatoid nodules (hard non tender, can break down and cause infection), Sjögren’s syndrome (in 10-15% of RA, reduced lacrimal and salivary secretions)

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46
Q

Diagnostic studies of RA

A

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

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47
Q

Treatment of RA

A

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)

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48
Q

When is cold therapy beneficial?

A

During acute disease exacerbation for 10-15 minutes

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49
Q

When is heat therapy beneficial?

A

Chronic stiffness for 20 minutes

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50
Q

Never use heat device with

A

Heat producing cream (capsaicin)

51
Q

Synovectomy

A

Take out fluid and part of joint, joint replacement is more common

52
Q

Systemic lupus erythematosus

A

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

53
Q

Diagnostic findings of lupus

A

No single test can confirm, ANA (anti nuclear antibody) ESR, LE prep, anti smith (sm) 30-40% will show positive that have lupus

54
Q

Treatment for lupus

A

NSAIDs, anti malarial-hydroxychloroquine (plaquenil) need eye exams q 6-12 months, corticosteroids, immunosuppressives

55
Q

Nursing care during acute exacerbation of sle

A

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

56
Q

Gout

A

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

57
Q

Primary gout

A

Controlled with Meds, under or over production of uric acid

58
Q

Secondary gout

A

Can be changed, from obesity hypertension diuretic use alcohol consumption or high purine foods (breaks down uric acid)

59
Q

Diagnostic test of gout

A

Presence of sodium urate crystals in synovial fluid, elevated serum uric acid levels, elevated 24 hour urine for uric acid levels, X-ray

60
Q

Management of gout

A

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

61
Q

Non invasive testing

A

X-ray, ct scan, DEXA, MRI

62
Q

X-ray considerations

A

No prep, mobility on to table, give pain Meds prior

63
Q

Ct scan

A

Can be done with/without dye (check allergy), gives cross sectional view of body, may last for 30-90 minutes

64
Q

MRI considerations

A

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

65
Q

DEXA (dual energy x-ray absorptiometry)

A

No food or fluid restriction, no metal, takes 15-30 minutes

66
Q

Invasive procedures

A

Arthrogram, bone scan, arthroscopy, myelogram, arthrocentesis

67
Q

Bone scan

A

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

68
Q

Arthroscopy

A

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

69
Q

Arthrogram (arthrography)

A

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

70
Q

Myelogram

A

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

71
Q

Arthrocentesis

A

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

72
Q

Sprain

A

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

73
Q

Strain

A

Excessive stretching of muscle or tendon, may result in pain limited motion muscle spasms or swelling

74
Q

Treatment of strains and sprains

A

Prevention, PRICE (prevent, rest, ice, compression, elevation) and analgesics/ NSAIDS, after 48 hrs mild heat x 15-30 minutes, temporary splint or elastic bandage

75
Q

Avulsion fracture

A

With traumatic sprain/strain that takes off a piece of bone

76
Q

5 P’s circulation assessment

A

Pain pulse pallor paresthesia paralysis

77
Q

Dislocation

A

Severe injury of the ligaments surrounding the joint (complete separation of joint surfaces), may cause deformity pain loss of joint function and swelling

78
Q

Subluxation

A

Partial or incomplete displacement of joint surface (bone may be dying)

79
Q

Major complications of dislocation

A

fractures, avascular necrosis, neurovascular tissue damage

80
Q

Herniated intervertebral disk

A

Slipped disk from repeated stress

81
Q

Degenerative disk disease

A

Disk dries out as age increases

82
Q

Intervertebral disk disease clinical manifestation

A

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)

83
Q

Diagnosis of disk disease

A

Straight leg raising test, X-ray, MRI, ct scan, myelogram

84
Q

Collaborative care of disk disease

A

Restrict activity for several days (do normal things), medication, local ice or heat, physical therapy (massage), surgery

85
Q

Types of spinal surgery

A

Laminectomy (most used for slipped disk), microdiskectomy, spinal fusion (uses bone and/or rods)

86
Q

Nursing management after spinal surgery

A

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

87
Q

Fracture classifications

A

Communication or noncommunication with external environment, complete or incomplete, direction of fracture line, displaces (unstable) or nondisplaced (stable), compound (open) or simple (closed)

88
Q

Common signs and symptoms of fracture

A

Pain shock swelling bruising deformity guarding site and crepitation

89
Q

Goal for fracture repair

A

Anatomical realignment (reduction-closed or open), immobilization (splint cast sling traction brace) , restore function

90
Q

Spica cast

A

Normally from waist down

91
Q

Cast nursing management

A

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

92
Q

Traction

A

Continuous pull on affected part for a period of time to attain or maintain normal anatomical position

93
Q

Types of Traction

A

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

94
Q

External fixation

A

Used to manage open fractures with soft tissue damage, never adjust hardware

95
Q

Pin care

A

No standardized method, small amount of clear drainage, observe site q 8hrs, watch for infection

96
Q

Fat embolism

A

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

97
Q

Acute compartmental syndrome

A

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

98
Q

The 6th P

A

Pressure, expect intracompartmental pressure to be between 0-10 mm Hg, readings higher than 30 indicate compartment syndrome

99
Q

Arthroplasty

A

Reconstruction or replacement of joint, make sure pt is in best possible health before surgery

100
Q

Hip fractures

A

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

101
Q

Signs and symptoms of hip dislocation

A

Increased pain at surgical site swelling and immobilization, groin pain, shortening of leg, abnormal rotation, restricted movement of leg, popping sensation

102
Q

Complications of joint surgery

A

Infection, DVT, fat embolism syndrome, shock, and dislocation (in hip)

103
Q

Osteoporosis

A

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

104
Q

Clinical manifestations of osteoporosis and diagnosis

A

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)

105
Q

Medications for osteoporosis

A 
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
106
Q

incidence of ____, _____, and ______ cancer have decrease

A

lung, colorectal, and oral

107
Q

incidence of _____ and ______ cancer have increase

A

non-Hodgkin’s lymphoma and skin

108
Q

cancer is high in

A

men, people over 65, and it is the second most common COD

109
Q

prevention of cancer

A

avoid or reduce exposure to known carcinogens, eat balanced diet, exercise regularly, obtain adequate rest

110
Q

signs of cancer

A

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

111
Q

diagnosis of cancer

A

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

112
Q

Biopsy

A

can be diagnostic and/or curative

113
Q

excisional biopsy

A

removal of entire tumor along with surrounding tissue (like a mole)

114
Q

incisional biopsy

A

preformed when tumor is too large to be totally removed

115
Q

factors that determine treatment modality

A

cell type, location and size of tumor, extent of disease, physiologic and psychologic status, expressed needs and desires

116
Q

Surgical interventions of cancer can be

A

curing, prevention, support and palliative care

117
Q

chemotherapy

A

use of chemicals as a systemic therapy in cancer

118
Q

radiation therapy

A

local treatment, can be external radiation (teletherapy) or internal radiation (brachytherapy)

119
Q

BARFS side effects of chemo

A

Bone marrow depression, Alopecia, Retching- n/v, Fear and anxiety, Stomatitis- sores in mouth

120
Q

pulmonary effects with nursing implications for cancer treatment

A

may be progressive and irreversible, can have cough dyspnea pneumonitis and pulmonary edema, treatment is rest bronchodilators cough suppressants and O2

121
Q

cardiovascular effects with nursing implications for cancer treatment

A

pts with preexisting coronary artery disease are more vulnerable for arrhythmias

122
Q

reproductive effects with nursing implications for cancer treatment

A

use shielding, warn pt of effects, refer to counseling if needed

123
Q

extravasation

A

caused by vesicant meds, infiltration of drug into tissues surrounding the infusion causing local tissue damage, should stop infusion immediately

124
Q

infection in cancer patients

A

main COD, sites normally the lungs GI tract Mouth rectum blood and peritoneal cavity

Med Surg 1 (4 decks)

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