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308 Adult II > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

GERD
Etiology
Treatment
Education

A
  • occurs due to backward flow of stomach contents into esophagus, hiatal hernias increase risk
  • antacids (aluminum or mag based, gaviscon), histamine receptor antagonist (ends in - tidine), proton pump inhibitor (ends in - prazole)
  • healthy eating, limit fatty fried & spicy foods & caffeine, sit upright for an hour after eating, smoking cessation, decrease alcohol
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2
Q

Gastric vs duodenal ulcers
Etiology
Clinical presentation
Treatment
Ulcer disease complications

A

Duodenal more common (younger pt) gastric ulcers (elderly pt)
- impaired mucosal defenses, gastric/duodenal stress, use of NSAIDs, H. Pylori,
- episodic pain 30min-2Hr ; epigastric pain radiates to back; occurs 1-3hrs after meal, anorexia or weight loss,
- antacids, mucosal protective agents (Sucralfate, Misoprostol), proton pump inhibitors, gastric resection/vagotomy
- hemorrhage, perforation, intractable pain & obstruction

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3
Q

Ulcerative colitis vs Chron’s disease
Stools
Complications
Pharmacological Treatment step 1-4

A
  • Begins in rectum & flows to cecum / terminal ileum, patchy involvement
  • bloody / non-bloody
  • UC: hemorrhage, nutritional deficiencies, bowel perforation, toxic megacolon, peritonitis
  • CD: fistulas, nutritional deficiencies
  • step 1: sulfasalazine (contra sulfa allergy) or mesalamine (less side effe)
    Step 2: corticosteroids (prednisone)
    Step 3: immunomodulators (methotrexate, infliximab)
    Step 4: selective immunosuppressive - vedolizumab
    Antibiotic- flagyl for Chron’s
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4
Q

Management of stoma
S/S of complications
Irrigation

A

Maintain electrolyte balance, monitor output, monitor for complications (leaks, bleeding, necrosis), measure size weekly (shrinks 6-8 weeks)

  • ischemia, bleeding, mucocutaneous separation, retraction, abnormal rashes
  • irrigate with tap water
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5
Q

Cholelithiasis vs cholecystitis
Risk factors
Clinical presentations
Assessment
Treatment

A

Stone formation / acute or chronic inflammation
- women, obesity, middle age, fatty meals
- N/V, acute pain (murphys sign), charcot’s triad (RUQ pain, jaundice, fever)
- HIDA scan, MRCP, ERCP
- high fiber low fat diet, small frequent meals, lithotripsy (cholelithiasis), laparoscopic cholesystectomy,

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6
Q

stages of viral herpes s/s
Preicteric
Icteric stage
Posticteric

A
  • malaise, fatigue, anorexia, N/V/D (bilirubin & ALT/AST levels are elevated)
  • jaundice, pruritis (elevated bilirubin)
  • everything returns to normal (bilirubin & enzymes return)
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7
Q

HAV recommendations / transmission / prevention

HBV recs / transmission/ prevention

HCV recs / transmission/ prevention

A
  • Hand washing, avoid contaminated food or water / fecal-oral / pre-exposure vaccine, gamma globulin, hygiene
  • Safe sex, avoid blood products / parental, sexual, perinatal / vaccine, HBIG, screening blood donors
  • Avoid drug use & sharing needles / parental, sexual, perinatal / no vaccine, minimize risk behaviors, needle precautions
    Hep C: most common & leading cause of chronic liver disease
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8
Q

Nursing management of feeding tubes

A

Verify placement, patency, residual
Change tubing Q24H
Flush before & after meds
Document intake & residuals
Assess for N/V/D, aspiration, hyperglycemia, tube problems

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9
Q

TPN vs PPN
Considerations

A

TPN - central, dextrose > 10% , stressed patient without GI fxn, CVC or PICC

PPN - peripheral, dextrose 5-10%, short term use, not for critically Ill, peripheral line

  • via infusion pump, filter tubing, change 72hrs
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10
Q

Considerations for bariatric surgery

A

Ambulation as soon as possible
6 small feedings & prevent dehydration
Observe signs of dumping syndrome
Monitor abdominal girth

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11
Q

UTI etiology
common causes of infection
presentations
Treatment

A
  • E. Coli, candida, catheters
  • intercourse, pregnancy, diabetes, obstruction of urination, catheters
  • frequency, dysuria, urgency, confusion in elderly
  • trimethoprim/sulfamethoxazole, nitrofurantoin, amoxicillin, phenazopyridine (for symptoms)
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12
Q

Pyelonephritis clinical presentation
Management

A
  • flank pain, CVA tenderness on percussion, fever, nausea, vomiting, tachycardia, malaise, dysuria
  • fluids, antibiotics, analgesia , drink 3L of fluids a day, monitor daily weight & urinary output
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13
Q

Nephrotic syndrome etiology
Clinical presentation
Management

A
  • allergic reaction, infections, systemic diseases, cancer, decreased GFR
  • proteinuria, edema formation, decreased albumin levels, Hyperlipidemia
  • ACE inhibitors, mild diuretics, increase protein, prevent dehydration,
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14
Q

Renal artery stenosis etiology
Manifestations
Patient education

A
  • narrowing of renal arteries reduce blood flow to kidneys
  • abrupt onset HTN, abdominal bruits, Azotemia, disparity in kidney size
  • Smoking cessation, HTN management, low fat diet & increase exercise
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15
Q

Nephrosclerosis etiology
Clinical manifestations
Patient education

A
  • HTN, atherosclerosis, Diabetes
  • proteinuria, casts, nocturia
  • HTN management (I&O, weight), dietary modifications, exercise, need for future dialysis or transplant if ESKD develops
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16
Q

Management of pt with kidney stones

A

Pain relief
Increase Fluids, monitor fluid balance
NSAIDs, opiates, alpha 1 blockers
Strain all urines
Lithotripsy, stent, nephrolithotomy

17
Q

Risk factors for DM II
Storing insulin meds
Metformin is used for & contra

A
  • obesity, triglycerides >150, HDL <40, BP > 130/85, fasting glucose >110
  • between 36-86 degrees, discard unused leftovers after 28 days, refrigerate unused insulin
  • type 2 diabetes / stop before any diagnostic tests
18
Q

Meds for type 1 diabetes
Rapid acting / onset, peak, duration
Short acting
Intermediate acting
Long acting

A
  • aspart & lispro / 15min, 1-3hr, 3-5hr
  • regular / 30min, 2-4hr, 5-12hr
  • NPH / 1-4hr, 4-12hr, 10-24hr
  • glargine / 2-4hr, no peak, 24hr
19
Q

DKA S/S
Lab values
Treatment

HHNK S/S
Lab values
Treatment

A
  • 3 P’s, citrus breath, kussmaul breathing, N/V
  • glucose 250-600, osmolality 300-320
  • fluids, regular insulin
  • severe dehydration & hyperosmolality, altered LOC, increased HR, decreased BP
  • glucose 600-1200, osmolality 330-380
  • IV fluids, regular insulin
20
Q

Dawn phenomenon
Diagnosed & treated by

Somogyi phenomenon
Diagnosed & treated by

A

-night time release of hormones raising glucose at 5-6am / managed by proving more insulin for overnight period (increased evening dose)

  • morning hyperglycemia due to nighttime hypoglycemia / managed by ensuring adequate dietary intake at bedtime & preventing hypoglycemia
21
Q

Hyperthyroidism manifestations
Management

Thyroid storm manifestations
Management

A
  • heat intolerance, weight loss, fatigue, insomnia, graves (exophthalmos)
  • PTU, tapazole, beta blockers, radioiodine therapy
  • elevated temp, tachycardia, HTN, tremors, altered mental status
  • maintain airway, hydrate w/ NS, cold blanket, glucocorticoids
22
Q

Hypothyroidism manifestations
Management

Myxedema coma S/S
Treatment

A
  • cold intolerance, weight gain, fatigue, decreased appetite, myxedema coma
  • thyroid replacement (levothyroxine) , thyroidectomy
  • four H’s (hypo- tension, natremia, thermia, glycemia), resp failure, shock, coma
  • secure airway, warm blanket, check VS & neuro, turn every 2 hours
23
Q

Acute lymphocytic leukemia traits
Diagnosis
treatment

Acute myelogenous leukemia traits
Diagnosis
Treatment

A
  • Most common in children, leading cause of death in children
  • pancytopenia with circulating blast cells, CBC
  • chemo, prednisone, methotrexate
  • most common acute type in adults
  • myeloblast, bone marrow aspiration
  • cytarabine, doxorubicin, BMT
24
Q

Chronic lymphocytic leukemia
Diagnosis
Treatment

Chronic myelogenous leukemia
Diagnosis
Treatment

A
  • most common in adult pop.
  • lymphocytosis hallmark
  • chemo, rituximab, BMT, trenda
  • genetic marker Philadelphia chromosome
  • BMT, imatinib, interferon
25
Q

Graft vs Host disease (GVHD) is
Affects
Management

A

Major cause of morbidity & non-relapse mortality after hematopoietic cell transplant (HCT)
- all tissues
- suppress immune system

26
Q

Tumor lysis syndrome is
Causes

A

Large number of tumor cells are destroyed rapidly
- hyperkalemia, hypocalcemia, high uric acid & lactic acid

27
Q

Superior vena cava syndrome is
Signs
Treatment

A

Obstruction by tumor growth
- face & arm edema, dyspnea, erythema
- radiation therapy, metal stent in vena cava

28
Q

Hodgkin’s lymphoma presentation
Management

Non-Hodgkin’s lymphoma presentation
Management

A
  • Reed-Sternberg cells, enlarged lymph nodes (moveable, non tender, painless)
  • radiotherapy, combination chemo, Sperm banking
  • can originate outside lymph node & spread unpredictable, aggressive
  • radiotherapy, combination chemo, monoclonal antibody (rituximab)
29
Q

Normal lab values for blood
Hgb
Hct
Iron
MCV
MCH

A
  • 12-18
  • 40-50
  • 50-150
  • 80-100
  • 26-34
30
Q

Sickle cell disease symptom
Treatment

Thalassemia symptoms/labs
Treatment

Iron deficiency anemia s/s
Treatment

A
  • PAIN, CV changes, RESP changes
  • O2, pain management, fluids
  • fatigue, SOB, low Hct Hgb MCV MCH
  • blood transfusion if severe, iron contraindicated
  • low Iron MCV & Hgb, fatigue, brittle spoon shaped nails, cheilosis
  • ferrous sulfate, transfuse if Hgb <8
31
Q

Blood type Significance
AB+
O

Responsibility during transfusion
If reaction occurs

A
  • universal recipient
  • universal donor
  • slow transfusion, monitor for reactions first 15-30 min (hyperkalemia, hypocalcemia, SOB, hives, fluid overload) , vitals before starting infusion,
  • STOP INFUSION, keep vein open w NS, call physician
32
Q

HBV serology
-HBsAg / +HBsAb / -HBcAb IgG
+HBsAg / -HBsAb / +HBcAb IgM
-HBsAg / -HBsAb / +HBcAb IgG

A
  • vaccinated against HBV
  • acute disease or reactivation
  • eliminated virus & is immune

308 Adult II (3 decks)

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