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MedSurg > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

GERD risk factors/triggers

A

Caffeine
Alcohol
Chocolate
Spicy/fried foods
Smoking

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2
Q

S/S of GERD

A

Similar to MI
Coughing/wheezing at night
Belching
Nausea
Hoarseness

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3
Q

GERD occurs when

A

30-60 min after meal
Exacerbated with laying down or bending forward

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4
Q

Hiatal hernia

A

Part of stomach protrudes through esophageal hiatus into chest cavity

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5
Q

Hiatal hernia what to report

A

SOB
Abd pain with N/V and fever

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6
Q

Hiatal hernia teaching

A

Symptoms worse after eating
Elevate HOB
No late meals- small freq meals

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7
Q

Gastritis

A

Inflamed stomach
Could have edema, hemorrhage or erosion of mucosa

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8
Q

Gastritis teaching/nursing interventions

A

Don’t take with NSAIDS or ASA
Priority- hydration status/ electrolytes
Daily wts, strict I&Os and VS’s

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9
Q

Peptic ulcer disease causes

A

Break in mucosa lining of GI tract from continued contact with gastric juice

Smoking

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10
Q

Highest risk for Peptic ulcer disease

A

H. Pylori infection

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11
Q

Peptic ulcer disease tx/screening

A

Screen for H. pylori - HP breath test or endoscopy

Steroids exacerbate peptic ulcer

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12
Q

S/S of Peptic ulcer disease

A

Inflammation and pain (worse after/during eating a meal)
May occur late at night
Minimal bleeding- occult blood in dark/tarry stools
N/V
Wt loss/ anorexia
Belching
Dyspepsia/ indigestion
Distended abdomen that’s painful
Peristalsis diminishes
Paralytic ileus develops

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13
Q

What to report for Peptic ulcer disease

A

Tachycardia
Hypotension
Vomiting blood

Perforation is medical emergency

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14
Q

Medication Tx for Peptic ulcer disease

A

Sucralfate - mucosal barrier fortifier

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15
Q

Gastric cancer

A

Develops over years-changes in stomach lining

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16
Q

Gastric cancer teaching

A

Administer protein & vitamins for tissue repair
Eat small, freq meals
Diet high in fiber and water but reduce fluids between meals

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17
Q

Tx for gastric cancer

A

Gastrectomy- lifelong B12 shots after

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18
Q

Screening for gastric cancer

A

Adults over 45
Endoscopy & sigmoidoscopy q5yrs
Colonoscopy q10yrs

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19
Q

IBS

A

Abd pain and cramping- diarrhea, constipation

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20
Q

Risk factors for IBS

A

Caffeine
Alcohol
Carbonated beverages
Diet high in fats & gas producing foods
Smoking
Stress
anxiety/depression

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21
Q

Intestinal obstruction

A

Partial/complete blockage of bowel

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22
Q

Mechanical obstruction

A

From stool, food, tumor or adhesions

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23
Q

Non-mechanical obstruction

A

Paralytic ileus

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24
Q

Tx of abdominal obstruction

A

Managing fluid/electrolyte imbalances
Treating cause with f obstruction
Relieving symptoms
Surgery if gastric decompression (NG tube) doesn’t relieve symptoms

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25
Q

Small bowel obstruction S/S

A

Distended Abd
Bloated sensation
Altered bowel sounds

Complete SBO can lead to reverse peristalsis and propel contents towards mouth

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26
Q

Resection surgery

A

Ileostomy/colonoscopy could be permanent or temporary for bowel onstruction

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27
Q

Stoma care

A

Pouch changed weekly
Empty when 1/3-1/2 full
Stoma deep pink- skin barrier AROUND stoma not on
Hot liquids help with cramping
Distention/cramping=warm compresses or lightly massage abd
NO enemas

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28
Q

Large bowel obstruction S/S

A

Constipation/ obstipation
Intermittent lower Abd cramping
Ribbon like stools

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29
Q

Sign of bowel perforation

A

Sudden sever pain
Board-like abdomen

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30
Q

Dx of bowel obstruction

A

Barium enema - reveals distended, air filled colon
Monitor for bowel movements after enema (barium can harden)

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31
Q

Appendicitis

A

Appendix inflamed and fills with pus

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32
Q

S/S of appendicitis

A

Severe Abd pain with guarding
Fever
High WBC
Pin at McBurney’s point (location of appendix)
Rebound tenderness
Pain relieved by bending knees

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33
Q

Peritonitis S/S

A

Board-like abd

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34
Q

Tx of peritonitis

A

NG decompression
TPN
Colloids (plasma/blood cells)

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35
Q

Gastroenteritis

A

“Stomach flu”
Inflammation is stomach/small intestine

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36
Q

Gastroenteritis S/S

A

Diarrhea
Abd pain
Cramping
Low K
N/V
Fever
Distention
Rectal tenesmus (urge to go)
Excessive borborygmi (bowel sounds)

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37
Q

Tx for gastroenteritis

A

Replace electrolytes
IV fluids
Monitor cardiac dysrhythmias

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38
Q

Inflammatory bowel disease

A

Unknown etiology
Chronic-incurable
Crohns & ulcerative colitis

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39
Q

Diet for inflammatory bowel disease

A

Lean meats
Legumes
Water
NO corn, nuts, alcohol or gassy foods/beverages

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40
Q

Tx for inflammatory bowel disease

A

Monoclonal antibodies (adalimumab/humira)
Lowers immune system- protective isolation

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41
Q

Crohn’s disease

A

Inflammatory bowel disease
Fistulas can develop- cobblestone appearance of lumen

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42
Q

S/S of Crohn’s disease

A

RLQ abd pain
N/V
REPORT- cold-like symptoms/sore throat

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43
Q

Tx for Crohn’s disease

A

Monoclonal antibody (-mumab)

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44
Q

Teaching for Crohn’s disease

A

Self administer B12 injections

If sick- total bowel rest and on TPN
May have fecal matter emesis
May have frequent stools- diarrhea/mucous/bloody

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45
Q

Ulcerative colitis

A

Inflammatory bowel disease
Only large intestine- hemorrhages, abscess
Risk for colon cancer

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46
Q

S/S of Ulcerative colitis

A

Pain in LLQ
Blood/mucous/pus in stool
Urgent sensation to go
5-30 stools a day- usually bloody
Wt loss/anorexia
Fatigue/weakness
Fever

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47
Q

Dx of Ulcerative colitis

A

Anemia
High WBC
Fluid/electrolyte imbalances
Albumin/folic acid levels low
Stool cultures

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48
Q

Diverticulosis

A

Pouches that bulge from colon (aneurysms of colon)

Need adequate fluid and high fiber diet

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49
Q

Risk factors for Diverticulosis

A

Over 40
Obese
Smoker
Physically inactive
Diet high in animal products
NSAIDS/steroids/opiods

No specific diet triggers attacks

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50
Q

Diverticulitis

A

Pouches are infected/inflamed

51
Q

Diverticulitis teaching

A

Liquid/low fiber diet

No greens diet- green beans, celery, fatty foods, nuts, corn

Give Tylenol - no opioids or laxatives

52
Q

Hepatitis A

A

Fecal-oral route from contaminated food/water

From poor handwashing
Vaccine available

53
Q

Hepatitis B

A

Spread from unprotected sex, sharing needles, hemodialysis

Can lead to liver CA

Vaccine series available

54
Q

Hepatitis C

A

Transmitted via sex, sharing needles, needle sticks, unsanitary tattoo equipment, HIV, birth

Leads to cirrhosis & liver CA

55
Q

Hepatitis D

A

Requires co-infection with Hep B from sexual contact with infected person

56
Q

Hepatitis E

A

Spreads through contaminated food, swimming in contaminated water, crowded and unsanitary conditions

57
Q

5 F’s of Gallbladder disease

A

Fat
Forty
Female
Fertile
Flatulence

58
Q

Symptoms of Gallbladder disease

A

Gallstones
Severe RUQ abd pain- radiates to right shoulder/back
Pain after eating
N/V

59
Q

Tx of Gallbladder disease

A

Cholecystectomy
ERCP

60
Q

ERCP (endoscopic retrograde cholangio-pancreatography)

A

Used to evaluate and remove stones from common bile duct

61
Q

ERCP teaching/nursing interventions

A

NPO 8hrs before
Ask if any implanted devices
Conscious sedation
Endoscope introduced using numbing gel
Stent may be placed
Post procedure- monitor for return of gag reflex (usually within 1-2 hrs)

62
Q

Teaching for Gallbladder disease

A

Low fat diet
Foods not well tolerated- eggs, pork, onions, poultry, milk, coffee, oranges, corn, beans, nuts

63
Q

S/S of malnutrition

A

Muscle wasting
Lethargy
Intolerance to cold
Dry skin
Poor wound healing
Infection
Possible death

64
Q

Teaching for Gallbladder disease

A

Encourage 6 meals, high calorie/protein shakes

65
Q

BMI measurements

A

18.5-24.9 normal
25-29.9 overweight
30-34.9 obese class 1
35-39.9 obese class 2
40-49.9 obese class 3

66
Q

Tx for obesity

A

Bariatric surgery - gastroplasty, gastric bypass

67
Q

Lap band

A

Surgically implanted device (laparoscopic)
Adjustable band reduces size of stomach
Not permanent
Less invasive and recovery time but less successful

68
Q

Roux-en-Y bypass

A

Invasive surgical procedure to modify digestive system to consume and absorb less calories

Bypass stomach and small pouch left over

69
Q

Roux-en-Y bypass post-op

A

Don’t reposition/remove NG tube without order- place safety signage above bed
Semi Fowlers position
Early ambulating and anticoagulants

70
Q

Roux-en-Y bypass teaching

A

No opiods- decreases peristalsis
Leaks are most common but dangerous complication
Preven dehiscence by abd binder
Dumping syndrome

71
Q

Dumping syndrome

A

Rapid gastric emptying

72
Q

S/S of dumping syndrome

A

Tachycardia
N/V
Diarrhea
Hypoglycemia
Abd cramping

73
Q

Tx of dumping syndrome

A

Small meals and less sugars

74
Q

Diet after Roux-en-Y bypass

A

NPO after surgery until bowel sounds- then clear liquids
if tolerated - add puréed, thinned foods with broth, milk, then soft foods
Could take a month to get back to solid food

75
Q

Nasal cannula

A

1-6 L/min
40% oxygen
Humidifier if over 4L

76
Q

Venturi mask

A

Most precise oxygen delivery
Up to 60% oxygen
Humidifier MUST be used

77
Q

Non-rebreather mask

A

60-80% oxygen
10-15 L/min
No humidifier
Reservoir bay full before placed on pt
And should NOT deflate between breaths

78
Q

CPAP/BiPAP

A

Non invasive ventilation
Assist with added pressure
Increases risk for aspiration
Mask should fit tightly/snuggly

79
Q

Bronchial breath sounds

A

Heard over trachea
Higher, louder pitch inspiration and expiration
Pause between inspiration and expiration

80
Q

Bronchovesicular breath sounds

A

Located on sides of sternum
Moderate pitched, blowing sound with equal inspiration and expiration phase

81
Q

Vesicular breath sounds

A

Heard over thorax
Lower pitched and softer than bronchial breathing
Inspiratory phase longer than expiratory phase

82
Q

Obstructive sleep apnea

A

Airway can be obstructed by tongue
Lasting >10 sec increases carbon dioxide and lowers pH levels
May improve if change sleeping position, lose wt, or reduce alcohol/smoking

83
Q

Risk factors for sleep apnea

A

Obesity
Short or thick neck
Smoking
Enlarged tonsils
Oropharyngeal edema
Chronic nasal congestion
Diabetics
Alcohol
Sedatives/tranquilizers

84
Q

Symptoms of sleep apnea

A

Excessive snoring
Daytime sleepiness
Irritability
Headache when walking

85
Q

Tx of sleep apnea

A

CPAP - opens airway to prevent alveoli from collapsing but doesn’t prevent tongue from occluding airway

86
Q

Airway obstruction S/S

A

Hoarseness
Stridor
Dramatic SOB

87
Q

Airway obstruction

A

No air movement

88
Q

S/S of partial airway obstruction

A

Gagging
Dysarthria
Accessory muscle use with breathing
Coughing

89
Q

Tracheostomy

A

Surgically inserted tube if unable to extubation within 2 weeks

90
Q

Tracheostomy teaching/nursing interventions

A

Suction for 10-15 sec max on way out only with twirling motion
Never instill saline prior
Hyperoxygenate before suctioning
Suction Setting- 80-120
Shower shield when bathing
Cover opening with breathable cloth
Humidified oxygen

91
Q

Trache care

A

Done every shift
Sterile procedure
Clean stoma site + trache plate (1/2 saline and 1/2 peroxide)
T-drain sponge
Place new ties before removing old ones

92
Q

Asthma S/S

A

Wheezing
SOB
Chest tightness
Coughing

93
Q

Asthma triggers

A

Pollen
Irritants
Pet dander
Dust mites
Smoke

94
Q

Asthma attack

A

Absence of wheezing without tx may indicate complete airway obstruction

95
Q

Tx of asthma

A

Bronchodilators or meter dosed inhalers

96
Q

Bronchodilators side effects

A

Can cause irritability, tachycardia, headache, dry mouth, cough. Hoarseness
Thrush common- use spacer to prevent and rinse mouth after

97
Q

Meter dosed inhaler

A

Breathe in slowly and deeply after releasing med into spacer and hold med in lungs for few sec

98
Q

Teaching for bronchodilators and meter dosed inhalers

A

Bronchodilators- 15-30 min before exercise or after
Spacer with MDI

99
Q

Asthma teaching

A

Avoid physical activity during extreme weather
Wash bedding in hot water to reduce dust mites
Obstain from MSG (monosodium glutamate

100
Q

COPD

A

Leading cause of death
Bronchitis/emphysema

101
Q

S/S of COPD

A

Chronic hypoxemia/ hypercapnea (too much CO2)
Fatigue
Respiratory acidosis
Wheezing/rhonchi
SOB
Expiratory>inspiratory
Progressive dyspnea on exertion (end stage- dyspnea at rest)
JVD
Pitting peripheral edema
Barrel chest
Accessory muscle use, retractions, asymmetrical chest expansion- REPORT

102
Q

COPD interventions/teaching

A

Pursed lip breathing (smell flowers, blow out candle)
High protein/calorie diet
Minimum 2L of fluids/day
Encourage sitting in a chair

103
Q

Lung cancer common symptoms

A

New/change in cough
dyspnea
wheezing
excessive sputum production
chest pain
malaise
fever
wt loss
fatigue
anorexia

104
Q

Pulmonary resection

A

Removal of part or entire lung (pneumonectomy)
Treatment for lung cancer
May develop adhesions and serious fluid buildup

105
Q

Thoracic surgery nursing interventions

A

Pulse ox and ABGs
TCDB q1-2hrs with splinting
Pursed lip breathing
Lung sounds - look for crackles/rales (BAD)
Absent breath sounds/unequal rise and fall of chest=pneumothorax

106
Q

Pneumonectomy

A

Phrenic nerve may be severed to paralyze diaphragm in elevated position
Bronchus severed and sutured
Place pt on non operative side after surgery for

107
Q

Chest tube

A

Re-expand a collapsed lung and remove air/blood

108
Q

Chest tube teaching/nursing interventions

A

Sterile procedure
If drainage stops suddenly- call DR

109
Q

Compartments of chest tube

A

Collection chamber- monitors volume, rate and nature of drainage

Water-seal chamber- one way valve- air can come out but can’t go in (shouldn’t have continuous bubbles)

Suction-control chamber- promotes drainage from pleural space (dial)

110
Q

Chest tube management

A

Dressing tight and intact
Check for difficulty breathing, breath sounds, chest rise, and alignment of trachea
Don’t strip tube - hand over hand is okay to get clot out
Drainage system lower than pts chest
Can use 20 gauge needle to obtain pleural sample culture from tubing

111
Q

If tube disconnected from drainage system

A

Insert chest tube into container of sterile water below level of insertion and notify MD

112
Q

Thoracentesis

A

Needle inserted into pleural space between lungs and chest wall

After procedure- CXR
Monitor for signs of pneumothorax

113
Q

S/S of Influenza

A

chills
body aches
coughing and sneezing
extreme fever
fatigue
headache
nasal congestion

114
Q

High risk for complications of influenza

A

individuals over 65 years of age

residents of nursing homes

patients with chronic pulmonary or cardiovascular disorders including asthma

115
Q

Pts who should receive a killed virus vaccine every year (Fluviron)

A

Patients with chronic metabolic diseases, renal dysfunction, or immunosuppression

116
Q

Pneumonia

A

Caused by bacteria, viruses, fungi, or parasites

May lead to empyema (pleural effusion)

117
Q

Community acquired pneumonia usually caused by

A

Streptococcus

118
Q

S/S of pneumonia

A

Coughing
fatigue/weakness/lethargy
dehydration
confusion
poor appetite

119
Q

Pneumonia vaccine

A

recommended for patient 65 years of age or older

120
Q

TB precautions

A

Airborne
Private room
Health care workers wear N95
Visitors and patient wear surgical mask
PAPR- powered air-purifying respirator

121
Q

S/S of TB

A

persistent cough with weight loss
anorexia
night sweats
hemoptysis
shortness of breath
fever
chills
pleuritic chest pain
crackles
Fatigue

122
Q

TB teaching

A

Transmission reduced after drug therapy for 2-3 weeks

Off isolation if negative AFB cultures on 3 consecutive days

123
Q

TB tx

A

isoniazid (INH) for 6 - 12 months- empty stomach, avoid alcohol and multivitamin (B6)

Rifampin can cause secretions to turn orange

Pyrazinamide- photosensitive

MedSurg (5 decks)

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