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Med Surg 1 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Major functions of the GI tract

A

Digestion: breakdown of food particles
Absorption: absorbing food into the blood stream at the small and large intestines
Elimination: follows absorption, eliminating undigested and unabsorbed materials

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2
Q

Digestion in older patients

A

Difficulty chewing & swallowing
Higher risk for developing reflux & pyrosis (heartburn)
Food intolerance, malabsorption, decrease in B12 absorption
Less hydrochloric acid (vital in killing bacteria on food)
Decrease in digestive enzymes/secretion of digestive enzymes
Indigestion & constipation
Decrease in peristalsis
Decrease in muscle tone
Decrease in salivation/mucus
Fecal incontinence

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3
Q

Major role of the mouth in digestion

A

Process of digestion begins here
Chewing & swallowing
Contains aliva & salivary amylase containing ptyalin which is aids in digestion
After food is swallowed the epiglottis moves to cover the tracheal opening so food is not aspirated

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4
Q

Major role of the stomach in digestion

A

Contains hydrochloric acid, pepsin, and instrinsic factor which allows you to absorb B12 into your small intestines, cant absorb B12 with it, get it from stomach.

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5
Q

Major role of the gallbladder in digestion

A

Contains bile, which helps to break down fat

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6
Q

Major role of the pancreas in digestion

A

Contains glucagon - raises your blood sugar
Contains insulin - brings your blood sugar down
Contains amylase - breaks down carbohydrates
Contains lipase - breaks down lipids
Contains trypsin - breaks down proteins

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7
Q

What should you collect regarding GI history

A 
Pain
Dyspepsia - upper abdominal discomfort with eating, indigestion
Gas
Nausea & vomiting
Diarrhea & constipation
Blood in stool
Medications can alter color of stool
Surgeries
Appetite and eating patterns
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8
Q

Components of the RUQ

A

Gallbladder
Right kidney
Liver
Head of pancreas

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9
Q

Components of the LUQ

A

Left kidney
Pancreas body/tail
Stomach
Spleen

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10
Q

Components of the RLQ

A

Appendix

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11
Q

Components of the LLQ

A

Descending and sigmoid colon

**pain here is usually diverticulitis

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12
Q

Describe the diagnostic test of a stool specimen

A

Examine for consistency, color, and blood

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13
Q

Describe the diagnostic test for breath tests

A

Testing for h.pylori which causes ulcers in the stomach & duodenum

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14
Q

Describe the diagnostic test for abdominal ultrasounds

A

Noninvasive, detects an enlarged gallbladder or pancreas, presence of gall stones, enlarged ovaries, ectopic pregnancies, or appendicitis

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15
Q

Describe the diagnostic test for DNA testing

A

Identifies genetic risk factors

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16
Q

Whats the difference between an upper and lower GI study

A

Upper- drink barium and xray how it travels through

Lower- barium sulfate as an enema and then xray

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17
Q

Describe the diagnostic test for endoscopic procedures

A

Looking with a scope

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18
Q

Disorder of the teeth: glue like gelatin substance that gets stuck on the teeth

A

Plaque

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19
Q

Disorder of the teeth: cavities or decay

A

Dental caries

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20
Q

Disorder of the teeth: abscess under the tooth that fills with pus, can be acute or chronic

A

Periapical abscess

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21
Q

Disorder of the teeth: misalignment, genetic or trauma, sucking thumb

A

Malocclusion

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22
Q

Disorder of teeth where gums grow over teeth is caused by what medicine

A

Dilantin for seizures

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23
Q

What are the 3 temporomandibular disorders and how do you treat them

A
  1. myofascial pain (discomfort)
  2. internal derangement of joint (dislocation)
  3. degenerative joint disease (arthritis)
    Treatment: ROM, NSAIDS, opioids, muscle relaxants, antidepressants, orthotics to relieve pressure, may need surgery
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24
Q

What are the 2 disorders of the lips, mouth, and gums

A

Xerostomia: dry mouth
Stomatitis: irritation of oral mucosa

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25
Q

What is GERD?

A

Gastro esophageal reflux disorder

-Inflamed loose floppy lower esophageal sphincter

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26
Q

Risk factors for GERD

A

obesity, pregnancy, smoker, hiatal hernias

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27
Q

Clinical manifestations with GERD

A

nocturnal coughing, pyrosis (another term for heartburn)

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28
Q

Complications with GERD

A

esophagitis, Barrett’s esophagus (HCl coming up to burn the esophagus, risk for cancer

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29
Q

Diagnostic studies with GERD

A

Barium swallow

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30
Q

Interventions for people with GERD

A

lifstyle modifications such as not eating 2-3 hours before bed, small low fat meals, nutrition, drug, and endoscopic therapy

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31
Q

Medications to take with GERD

A 
Antacids (tums)
H2 blockers (pepcid)
Proton pump inhibitors (Prizol)
avoid anticholinergics
avoid sympathomimetics
anything to speed up perstalsis
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32
Q

What is achalasia?

A

Opposite of GERD
Lower esophageal sphincter is too tight
Food blocks or gets blocked sometimes causing vomit

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33
Q

Signs and symptoms of achalasia?

A 
Heart burn
Burning, teary eyes, uncomfortable
Reduced peristalsis in esophagus
Failure of esophageal sphincter to relax for swallowing
Pyrosis
Dysphagia- difficulty swallowing
Weight loss
Hypersalivation
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34
Q

Inflammation of gastric or stomach mucosa
Can be drug related: NSAIDs, h. pylori
Gastric mucosa membrane becomes edematous and hyperemic and undergoes superficial erosion
Will not get instrinsic factor with this

A

Gastritis

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35
Q

Prevention is key
Can be because of undercooked meat, unclean vegetables, human to human, unpasteurized milk
Can cause extreme or bloody diarrhea

A

Food poisoning

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36
Q

Purposes of GI intubation

A 
Suction decompresses the stomach
Lavage the stomach
Diagnose GI disorders
Administer medications
Way of feeding
Treat obstruction
Compress a bleeding site
Aspirate gastric contents
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37
Q

Types of gastric tubes

A

Levin - single lumen
Sump salem - radiopaque, 2 lumen
Enteric - means farther into the stomach or intestines

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38
Q

Describe parenteral nutrition

A

Provides nutrients via IV
Goal is to better nutrition, wont cause weight loss
–proteins, carbs, fats, electrolytes,vitamins, trace minerals, sterile water
Parenteral needs to be sterile cuz its going in IV
Enteral goes directly in the stomach so it does not need to be sterile, just clean

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39
Q

Reasons for parenteral nutrition

A

Poor nutrition intake
Bowels not working right
Patient not willing to ingest food: anorexic
If you cant use tube feeding, can use TPN
Prolonged pre or post op nutritional needs

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40
Q

Advantages of enteral feeding

A

Meet nutritional requirements
Safe and cost effective
Preserve GI integrity
Preserve normal intestinal and hepatic metabolism
Maintain fat metabolism and lipoprotein synthesis
Maintain normal insulin and glucagon ratios

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41
Q

What are the 2 feeding tubes

A

Nasogastric or nasoenteral

Gastrostomy or jejunostomy

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42
Q

What are 4 methods for tube feeding

A

Intermittent bolus feediing
Intermittent gravity drip
Continuous infusion
Cyclic feeding

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43
Q

Ways to reduce complications of feeding tubes

A

Right rate, method, and can they tolerate it?
Measure risidual more than 200mL
Water
Dont mix feeding tubes with medications
Dont hang feeding for longer than 4 hours
Diarrhea
Prevent dumping syndrome: feel like they have to go to the bathroom
Not cold: can cause cramping
HOB up to at least 30 degrees

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44
Q

Rapid onset of symptoms usually caused by dietary indiscretion, medications, alcohol, bile reflux, and radiation therapy. Ingestion of strong acid or alkali may cause serious complications – suicide attempt

A

Acute gastritis

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45
Q

Prolonged inflammation due to benign or malignant ulcers of the stomach or by Helicobacter pylori, autoimmune diseases, dietary factors, medications, alcohol, smoking, or chronic reflux of pancreatic secretions or bile.

A

Chronic gastritis

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46
Q

What are some manifestations (things that happen) when you have acute gastritis

A 
Abdominal discomfort
Headache
Lassitude 
N/V
Hiccupping
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47
Q

What are some manifestations (things that happen) when you have chronic gastritis

A 
Epigastric discomfort
Anorexia
Heart burn after eating
Belching
Sour taste in mouth
N/V
Intolerance of some foods
Malabsorption of B12
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48
Q

What should you do to manage acute gastritis

A

No food/alcohol

Neutralize strong acid or strong alkalytic agents

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49
Q

What should you do to manage chronic gastritis

A 
Modify diet
Promote rest
Reduce stress
Avoid alcohol
Avoid NSAIDs
Meds
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50
Q

What diet works best for children with gastritis

A 
BRAT
bananas
rice
applesauce
toast
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51
Q

What is a peptic ulcer?

A

Erosion of the mucus membrane due to H. pylori

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52
Q

What are risk factors of peptic ulcers

A 
Too much stomach acid
Diet
NSAIDs
Alcohol
Smoking
Family history
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53
Q

Signs/symptoms of peptic ulcers

A

Dull gnawing pain/burning in mid epigastrium
Heart burn/vomiting
Melena (stool may be black & tar like, indicates upper GI bleed)

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54
Q

Treatments for peptic ulcers

A 
Medications
Reduce stress
Regular schedule
Rest periods during the day
Stop smoking
No hot or cold foods
No meat
No alcohol 
No coffee
Small meals
Occasionally surgery
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55
Q

What are 3 surgical procedures for stomach ulcers

A

Vagotomy - cut the vagus nerve
Pyloroplasty - transect nerves
Billroth 1 & 2 - cut and replace location

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56
Q

What is a hemorrhage and how do you manage it

A

Escape of blood from a ruptured vessel
-could be experiencing bleeding, shock, hematemesis, n/v, constipation, epigastric fullness, wt loss, anorexia
Treatment: IV fluids, NG tube, saline or water lavage, O2, treatment shock, vital signs, urine output-should be at least 30 mL/hr, endoscopic coagulation, surgical intervention, pyloric obstruction, electrolytes, balloon dilation

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57
Q

What is perforation and how do you manage it

A

When something goes through any of the anatomy in the stomach
Signs/symptoms: upper ab pain probably referred to as shoulder pain, vomiting, tender board like abdomen, shock
Have to go to surgery

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58
Q

What is bariatric surgery

A

Surgery used to induce wt loss in morbidly obese patients but has high health complications
Selection factors are based on body wt, pt history, failure to lose wt, absence of endocrine disorders, psychological stability, meds have failed

59
Q

6 aspects of care for patients undergoing bariatric surgery

A

Pre op: evaluate and counsel
Post op: gastric surgery and obesity tissue
Post op diet: 6 small feeds/ day, 600-800 cal/ day
Psychosocial interventions
Follow up care
Education regarding long term effects

60
Q

Constipation and its causes

A

Its infrequent and irregular, when you cant use the bathroom
Causes: occurs with older age, medications, chronic laxative use, weakness, immobility, fatigue, inability to increase intra-abdominal pressure, diet, ignoring urge to defecate, lack of regular exercise

61
Q

Manifestations/things that occur with constipation

A 
Less than 3 bowel movements a week
Distended
Not hungry
Headache
Tired
Indigestion
Straining
Hard, dry stool
62
Q

Complications that can occur with constipation

A 
Hemorrhage
Fecal impaction
Hemorrhoids
Fissures
Megacolon
63
Q

Patient learning with constipation

A

Drink water and lots of fiber
Go when you have to go
Exercise
Laxatives

64
Q

What is diarrhea and what causes it

A

When you have more than 3 stool a day and its lots of loose stool
Urgent perianal discomfort, incontinence
Cant be acute or chronic
Caused by infection, medications, tube feeding, metbolic or endocrine disorders, various disease processess

65
Q

Manifestations that occur with diarrhea

A 
Abdominal cramping
Distention
Anorexia
Thirst
Borborygmus
Tenesmus
66
Q

Complications that occur with diarrhea

A

Fluid and electrolyte imbalance: losing vit, K?
Dehydration: causes muscle weakness, tingling, hypotension, drowsiness
Skin break down
Cardiac dysrhythmias

67
Q

Patient teaching/learning with diarrhea

A 
Rest
Diet and fluid intake
Avoid irritating food or drinks
Perianal skin care
Medications
Avoid milk, fat, whole grains, fresh fruit, and veggies
68
Q

What is anemia

A

Low hemoglobin, low RBC

69
Q

Term for not producing enough RBC

A

Hypoproliferative

70
Q

Components of a great RBC

A

Iron
B12
Folic acid

71
Q

Term for excess destruction of RBC

A

Hemolytic

72
Q

The spleen in responsible for..

A

destruction of bad or old RBC

73
Q

Manifestations that occur with anemia are all different depending on the anemia but most are…

A 
Fatigue, weakness, malaise
Pallor or jaundice
Excess of bilirubin
Cardiac and respiratory problems: heart is enlarged, pumps too quickly, peripheral edema
Tongue changes
Nail changes: brittle, dry
Pica: craving things like dirt
Neurological problems: numbness
74
Q

What to avoid with angular cheilosis

A

Hot things
Spicy things
Anything that can burn you or create a sore

75
Q

What is angular cheilosis

A

inflammatory condition that occurs in 1 or both angles of the mouth. This condition typically presents with erythema, painful cracking, scaling, bleeding, and ulceration at the corners of the mouth.

76
Q

What are complications of severe anemia

A

May develop heart failure: RR will increase
Angina: chest pain
Paresthesia
Confusion

77
Q

Iron supplements can cause

A

Black or dark colored stool
Abd. cramping or pain
Feeling nauseous

78
Q

Serum B12 levels allow you to look at what type of anemia? low B12 levels means this anemia which also looks the same as folic acid deficiency anemia
Schillings test with this anemia also..

A

Pernicious anemia

79
Q

Decreased erythropoietin levels show what

A

kidney function

80
Q

Ways to manage amenia

A

*Transfusion of RBC
*Immunosuppressive therapy
Manage causes of GI bleeds (more common in alcoholics)
Manage menstruation
Pregnant women need 30% more blood
Occult tests are used to look for hidden blood in stool
Look at tongue for beefy or redness
Are they taking any supplements
Are they getting enough B12, iron, folic acid?
Introduce nutrients into the system
–add fruits, vegetables, dairy
Look at extreme exercise
Look at alcohol intake

81
Q

Term for when all cells are low

-erythrocytes, leukocytes, thrombocytes

A

Pancytopenia

82
Q

What is aplastic anemia

A

deficiency of all types of blood cells caused by failure of bone marrow development
marrow is being replaced by fat
immune attacks against marrow

83
Q

Cause of aplastic anemia

A

Usually an unknown cause

-could be because of sepsis or nasty infection, pregnancy, medications, chemical exposure, radiation

84
Q

What is significant about a neutropenic diet with aplastic anemia

A

Eat fully cooked foods such as carrots rather than fresh carrots because they could still have bacteria on them

85
Q

What is the most common anemia

A

Iron deficiency
-commonly due to blood loss
male (14-17 mg/dL)
female (12-16 mg/dL)

86
Q

With anemia, you have to have healthy kidneys because..

A

Kidneys produce erythropoietin which is a hormone secreted by the kidneys that increases the rate of production of red blood cells in response to falling levels of oxygen in the tissues

87
Q

Symptoms of iron deficiency anemia

A 
Tachycardia
Pallor
Fatigue
Glossitis
Cheilitis
88
Q

Things that disrupt the absorption of iron

A

disorder of the duodenum
antacids
dairy with medication
tea, coffee

89
Q

Ways to give iron

A 
IM
IV
Iron dextran
Test dose
Z-track or air lock
90
Q

Anemia consisting of folic acid deficiency and B12 deficiency
Takes years to see

A

Megaloblastic anemia

91
Q

Causes of megaloblastic anemia

A

Disease of stomach, small bowel or pancreas, family history, history of immune disorders

92
Q

Interventions for megaloblastic anemia

A

Folic acid 1mg/day
Vitamin B12
-both IM injections

93
Q

What is sickle cell anemia

A

A defective hemoglobin molecule with a sickle shape
Cannot get oxygenated blood to that area of tissue
Damages every organ: kidneys, heart, eyes, brain (strokes)
Very painful and involves monthly blood transfusions

94
Q

Monthly blood transfusion for sickle cell anemia where the blood is pulled out and the good blood is put back in

A

Aphoresis

95
Q

Sickle cell anemia is inherited from..

A

African descent
Mediterranean
Middle east
Some eastern indians

96
Q

Treatments for sickle cell anemia

A

Bone marrow expands in childhood
Peripheral bone marrow stem cell transplant
Hydroxyurea & arginine
Transfusions
Get enough fluids (dehydration causes stickiness and cant get the blood to move through smoothly)
Pain managements
–apsirin, NSAIDs, morphine, dilaudid, PCA, corticosteroids (inflammation)

97
Q

What is the Frank Starling law

A

How much the heart is stretched– the more blood the more stretch

98
Q

What is the cause of varicose veins

A

Weak valves, because they don’t stay closed and gravity moves the blood down instead of back up to the heart

99
Q

What is coronary artery disease

A

Damage or disease in the heart’s major blood vessels

100
Q

What happens when an area of tissue is not getting oxygenated blood

A

It will die and become scar tissue meaning its not coming back and becomes very weak

101
Q

Leading cause of death in US

A

Cardiovascular disease

102
Q

Most common causes of cardiovascular disease

A

Atherosclerosis

Coronary atherosclerosis

103
Q

Abnormal accumulation of fat/ lipid deposits and fibrous tissue within arterial walls
Repeated arterial inflammation, wall injury

A

Atherosclerosis

104
Q

blockage & narrowing of coronary vessels- reduce blood flow to myocardium

A

Coronary atherosclerosis

105
Q

Risk factors of coronary artery disease

A 
Increased lipids
Increased LDLs
Smoking
Diabetes
Obesity
Family history
Peripheral artery disease
Abdomenal aortic aneurysm
Hypertension 
Metabolic syndrome
106
Q

What are other things that can reduce blood flow to the heart

A 
Vasospasm of coronary artery
Myocardial trauma
Congenital problem
Blood loss
Tachycardia
Thyrotoxicosis
Cocaine use
107
Q

Nonmodifiable risk factors for atherosclerosis and peripheral vascular disorders

A

Age
Gender
Familial genetics
Genetics plays a huge role in CAD

108
Q

What is PTCA

A

Percutaneous transluminal coronary angioplasty

Through the skin, through the lumen, change the shape of the vessel

109
Q

What is laser angioplasty

A

burning up the plaque with a laser

110
Q

What is an atherectomy

A

cutting out the built up plaque

111
Q

What can happen after PTCA

A

An MI can happen if the balloon is kept in there
Beware of bleeding
For blocked vessels a heart cath is typically done and surgery is a last minute thing

112
Q

What is angina pectoris and how does it feel

A

Severe pain in the chest
Feels like a choking sensation
Will have an upset stomach
Heavy pressure like someone is sitting on their chest

113
Q

What can cause angina pectoris?

A 
When the blood glucose level is too high
With diabetes
Blood that is too sugary destroys nerves so a person wont be able to tell if they are having chest pain or a heart attack
Anxiety/stress
Heavy meals
Cold weather
Exertion
114
Q

How do you treat chest pain

A 
Have them lie down
MONA
-morphine
-oxygen
-nitroglycerin
-aspirin to put under their tongue 
(sub-lingual gets into the blood stream faster)
115
Q

What will occur with right sided heart failure

A 
Back up of blood to the body
Dependent edema
JVD
Abdominal distention
--liver gets big, spleen gets full, gain weight
Hepatomegaly
Splenomegaly
Nausea
Anorexia
Increased blood pressure
116
Q

What will occur with left sided heart failure

A 
Pulmonary congestion
Crackles
Dyspnea
Tachypnea
Decreased blood to the body
Decreased pulse
Decreased blood pressure
117
Q

What does pulmonary edema look like with left sided heart failure

A

gets really foamy and can turn pink

118
Q

Interventions for heart failure

A 
Vital signs
Diuretics (in the morning so they dont pee all night)
Space out activities
Low sodium diet
Head of bed up
Probably also giving oxygen
119
Q

How do you recognize an ace inhibitor and whats its use

A

-pril

used for HTN and CHF

120
Q

How do you recognize a beta blocker and whats its use

A

-olol
slows down the heart
protects the heart from having another heart attack
also for hypertension

121
Q

What are nitrates used for

A

Vasodilation to increase blood flow to the heart

122
Q

How do you recognize anticoagulants and name a common one

A

-xaparin

Levanox

123
Q

How do you recognize calcium channel blockers

A

-dipine

124
Q

What are statins

A

Good for your cholesterol, bad for your liver

Lipitor (atorvastatin)

125
Q

When you don’t have good blow flow into the peripheries
Wont be able to find a pulse where there is not good arterial blood flow
You will also not have hair in places that don’t have good arterial blood flow

A

Peripheral arterial insufficiency

126
Q

What is intermittent claudication

A

If you have a patient that doesn’t have good blood flow they will have to stop when they are walking from these muscle cramps
Some patients it wont bother for a long time

127
Q

These occur in the feet, bony areas
Base of the foot – looks punched out, no active bleeding
Want a dangling position as well to increase the blood flow and if not it will be painful
Elevation will stop the blood flow causing the pain

A

Arterial leg ulcers

128
Q

What is the difference between atherosclerosis and arteriosclerosis

A

ath– plaque build up

art– no elasticity

129
Q

What is peripheral arterial occlusive disease

A

Intermittent claudication

130
Q

Ways to treat PAOD

A 
Meds (aspirin, trental, cilostazole)
Stop smoking
Control weight
Reduce cholesterol
Surgeries: endarterectomy, bypass grafts
131
Q

A bypass graft taken from small veins in legs

A

Femoral to popliteal bypass graft

132
Q

What is Raynauds disease

A

An arterial disorder with intermittent claudication
Happens to younger women
Need to protect the fingers
Scleroderma – hardening and contraction of skin and connective tissue
Turns white then turns blue then turns red
Can be caused by stress, smoking/tobacco, diet

133
Q

Why should patients on anticoagulants avoid vitamin K

A

It stops anticoagulants from working because vitamin K helps your blood to clot

134
Q

Who is at risk for venous thrombosis

A

People on BC
Post op
Smokers

135
Q

What are venous leg ulcers

A

Occur on the inner leg between ankle and mid calf
There will be drainage at the base
Skin will be purple tan
Very irregular borderse

136
Q

Ways to treat venous leg ulcers

A 
Gradually increase activity
--the more you walk around the more blood you push back up to your heart
Promote blood flow
Diversional activities
Pain meds
Good hygiene and wound care
Legs up
Avoid trauma
Good nutrition
137
Q

Lymph vessel that is inflamed or infected

A

Acute lymphangitis

138
Q

What is lymphedema

A

Chronic swelling
Elephantitis is a type that the skin gets very thick and you can fix it
Furosemide for lymphedema or surgery

139
Q

What is cellulitis

A

Inflamed or infected connective tissue

140
Q

Vascular surgeon makes an incision in affected artery & removes plaque contained in artery’s inner lining

A

Endarterectomy

141
Q

What is CABG

A

Coronary artery bypass graft

142
Q

What should be done after a CABG

A 
Arterial line
Intake and output
CT scans
Fluids
Blood pressure
Check temperatures
Vitamin K
143
Q

What renal injury should you watch for after cardiovascular surgeries

A

Kidney perfusion related to poor cardiac output

Med Surg 1 (4 decks)

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