Exam 3 Flashcards
GERD risk factors/triggers
Caffeine
Alcohol
Chocolate
Spicy/fried foods
Smoking
S/S of GERD
Similar to MI
Coughing/wheezing at night
Belching
Nausea
Hoarseness
GERD occurs when
30-60 min after meal
Exacerbated with laying down or bending forward
Hiatal hernia
Part of stomach protrudes through esophageal hiatus into chest cavity
Hiatal hernia what to report
SOB
Abd pain with N/V and fever
Hiatal hernia teaching
Symptoms worse after eating
Elevate HOB
No late meals- small freq meals
Gastritis
Inflamed stomach
Could have edema, hemorrhage or erosion of mucosa
Gastritis teaching/nursing interventions
Don’t take with NSAIDS or ASA
Priority- hydration status/ electrolytes
Daily wts, strict I&Os and VS’s
Peptic ulcer disease causes
Break in mucosa lining of GI tract from continued contact with gastric juice
Smoking
Highest risk for Peptic ulcer disease
H. Pylori infection
Peptic ulcer disease tx/screening
Screen for H. pylori - HP breath test or endoscopy
Steroids exacerbate peptic ulcer
S/S of Peptic ulcer disease
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
What to report for Peptic ulcer disease
Tachycardia
Hypotension
Vomiting blood
Perforation is medical emergency
Medication Tx for Peptic ulcer disease
Sucralfate - mucosal barrier fortifier
Gastric cancer
Develops over years-changes in stomach lining
Gastric cancer teaching
Administer protein & vitamins for tissue repair
Eat small, freq meals
Diet high in fiber and water but reduce fluids between meals
Tx for gastric cancer
Gastrectomy- lifelong B12 shots after
Screening for gastric cancer
Adults over 45
Endoscopy & sigmoidoscopy q5yrs
Colonoscopy q10yrs
IBS
Abd pain and cramping- diarrhea, constipation
Risk factors for IBS
Caffeine
Alcohol
Carbonated beverages
Diet high in fats & gas producing foods
Smoking
Stress
anxiety/depression
Intestinal obstruction
Partial/complete blockage of bowel
Mechanical obstruction
From stool, food, tumor or adhesions
Non-mechanical obstruction
Paralytic ileus
Tx of abdominal obstruction
Managing fluid/electrolyte imbalances
Treating cause with f obstruction
Relieving symptoms
Surgery if gastric decompression (NG tube) doesn’t relieve symptoms
Small bowel obstruction S/S
Distended Abd
Bloated sensation
Altered bowel sounds
Complete SBO can lead to reverse peristalsis and propel contents towards mouth
Resection surgery
Ileostomy/colonoscopy could be permanent or temporary for bowel onstruction
Stoma care
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
Large bowel obstruction S/S
Constipation/ obstipation
Intermittent lower Abd cramping
Ribbon like stools
Sign of bowel perforation
Sudden sever pain
Board-like abdomen
Dx of bowel obstruction
Barium enema - reveals distended, air filled colon
Monitor for bowel movements after enema (barium can harden)
Appendicitis
Appendix inflamed and fills with pus
S/S of appendicitis
Severe Abd pain with guarding
Fever
High WBC
Pin at McBurney’s point (location of appendix)
Rebound tenderness
Pain relieved by bending knees
Peritonitis S/S
Board-like abd
Tx of peritonitis
NG decompression
TPN
Colloids (plasma/blood cells)
Gastroenteritis
“Stomach flu”
Inflammation is stomach/small intestine
Gastroenteritis S/S
Diarrhea
Abd pain
Cramping
Low K
N/V
Fever
Distention
Rectal tenesmus (urge to go)
Excessive borborygmi (bowel sounds)
Tx for gastroenteritis
Replace electrolytes
IV fluids
Monitor cardiac dysrhythmias
Inflammatory bowel disease
Unknown etiology
Chronic-incurable
Crohns & ulcerative colitis
Diet for inflammatory bowel disease
Lean meats
Legumes
Water
NO corn, nuts, alcohol or gassy foods/beverages
Tx for inflammatory bowel disease
Monoclonal antibodies (adalimumab/humira)
Lowers immune system- protective isolation
Crohn’s disease
Inflammatory bowel disease
Fistulas can develop- cobblestone appearance of lumen
S/S of Crohn’s disease
RLQ abd pain
N/V
REPORT- cold-like symptoms/sore throat
Tx for Crohn’s disease
Monoclonal antibody (-mumab)
Teaching for Crohn’s disease
Self administer B12 injections
If sick- total bowel rest and on TPN
May have fecal matter emesis
May have frequent stools- diarrhea/mucous/bloody
Ulcerative colitis
Inflammatory bowel disease
Only large intestine- hemorrhages, abscess
Risk for colon cancer
S/S of Ulcerative colitis
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
Dx of Ulcerative colitis
Anemia
High WBC
Fluid/electrolyte imbalances
Albumin/folic acid levels low
Stool cultures
Diverticulosis
Pouches that bulge from colon (aneurysms of colon)
Need adequate fluid and high fiber diet
Risk factors for Diverticulosis
Over 40
Obese
Smoker
Physically inactive
Diet high in animal products
NSAIDS/steroids/opiods
No specific diet triggers attacks
Diverticulitis
Pouches are infected/inflamed
Diverticulitis teaching
Liquid/low fiber diet
No greens diet- green beans, celery, fatty foods, nuts, corn
Give Tylenol - no opioids or laxatives
Hepatitis A
Fecal-oral route from contaminated food/water
From poor handwashing
Vaccine available
Hepatitis B
Spread from unprotected sex, sharing needles, hemodialysis
Can lead to liver CA
Vaccine series available
Hepatitis C
Transmitted via sex, sharing needles, needle sticks, unsanitary tattoo equipment, HIV, birth
Leads to cirrhosis & liver CA
Hepatitis D
Requires co-infection with Hep B from sexual contact with infected person
Hepatitis E
Spreads through contaminated food, swimming in contaminated water, crowded and unsanitary conditions
5 F’s of Gallbladder disease
Fat
Forty
Female
Fertile
Flatulence
Symptoms of Gallbladder disease
Gallstones
Severe RUQ abd pain- radiates to right shoulder/back
Pain after eating
N/V
Tx of Gallbladder disease
Cholecystectomy
ERCP
ERCP (endoscopic retrograde cholangio-pancreatography)
Used to evaluate and remove stones from common bile duct
ERCP teaching/nursing interventions
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)
Teaching for Gallbladder disease
Low fat diet
Foods not well tolerated- eggs, pork, onions, poultry, milk, coffee, oranges, corn, beans, nuts
S/S of malnutrition
Muscle wasting
Lethargy
Intolerance to cold
Dry skin
Poor wound healing
Infection
Possible death
Teaching for Gallbladder disease
Encourage 6 meals, high calorie/protein shakes
BMI measurements
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
Tx for obesity
Bariatric surgery - gastroplasty, gastric bypass
Lap band
Surgically implanted device (laparoscopic)
Adjustable band reduces size of stomach
Not permanent
Less invasive and recovery time but less successful
Roux-en-Y bypass
Invasive surgical procedure to modify digestive system to consume and absorb less calories
Bypass stomach and small pouch left over
Roux-en-Y bypass post-op
Don’t reposition/remove NG tube without order- place safety signage above bed
Semi Fowlers position
Early ambulating and anticoagulants
Roux-en-Y bypass teaching
No opiods- decreases peristalsis
Leaks are most common but dangerous complication
Preven dehiscence by abd binder
Dumping syndrome
Dumping syndrome
Rapid gastric emptying
S/S of dumping syndrome
Tachycardia
N/V
Diarrhea
Hypoglycemia
Abd cramping
Tx of dumping syndrome
Small meals and less sugars
Diet after Roux-en-Y bypass
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
Nasal cannula
1-6 L/min
40% oxygen
Humidifier if over 4L
Venturi mask
Most precise oxygen delivery
Up to 60% oxygen
Humidifier MUST be used
Non-rebreather mask
60-80% oxygen
10-15 L/min
No humidifier
Reservoir bay full before placed on pt
And should NOT deflate between breaths
CPAP/BiPAP
Non invasive ventilation
Assist with added pressure
Increases risk for aspiration
Mask should fit tightly/snuggly
Bronchial breath sounds
Heard over trachea
Higher, louder pitch inspiration and expiration
Pause between inspiration and expiration
Bronchovesicular breath sounds
Located on sides of sternum
Moderate pitched, blowing sound with equal inspiration and expiration phase
Vesicular breath sounds
Heard over thorax
Lower pitched and softer than bronchial breathing
Inspiratory phase longer than expiratory phase
Obstructive sleep apnea
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
Risk factors for sleep apnea
Obesity
Short or thick neck
Smoking
Enlarged tonsils
Oropharyngeal edema
Chronic nasal congestion
Diabetics
Alcohol
Sedatives/tranquilizers
Symptoms of sleep apnea
Excessive snoring
Daytime sleepiness
Irritability
Headache when walking
Tx of sleep apnea
CPAP - opens airway to prevent alveoli from collapsing but doesn’t prevent tongue from occluding airway
Airway obstruction S/S
Hoarseness
Stridor
Dramatic SOB
Airway obstruction
No air movement
S/S of partial airway obstruction
Gagging
Dysarthria
Accessory muscle use with breathing
Coughing
Tracheostomy
Surgically inserted tube if unable to extubation within 2 weeks
Tracheostomy teaching/nursing interventions
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
Trache care
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
Asthma S/S
Wheezing
SOB
Chest tightness
Coughing
Asthma triggers
Pollen
Irritants
Pet dander
Dust mites
Smoke
Asthma attack
Absence of wheezing without tx may indicate complete airway obstruction
Tx of asthma
Bronchodilators or meter dosed inhalers
Bronchodilators side effects
Can cause irritability, tachycardia, headache, dry mouth, cough. Hoarseness
Thrush common- use spacer to prevent and rinse mouth after
Meter dosed inhaler
Breathe in slowly and deeply after releasing med into spacer and hold med in lungs for few sec
Teaching for bronchodilators and meter dosed inhalers
Bronchodilators- 15-30 min before exercise or after
Spacer with MDI
Asthma teaching
Avoid physical activity during extreme weather
Wash bedding in hot water to reduce dust mites
Obstain from MSG (monosodium glutamate
COPD
Leading cause of death
Bronchitis/emphysema
S/S of COPD
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
COPD interventions/teaching
Pursed lip breathing (smell flowers, blow out candle)
High protein/calorie diet
Minimum 2L of fluids/day
Encourage sitting in a chair
Lung cancer common symptoms
New/change in cough
dyspnea
wheezing
excessive sputum production
chest pain
malaise
fever
wt loss
fatigue
anorexia
Pulmonary resection
Removal of part or entire lung (pneumonectomy)
Treatment for lung cancer
May develop adhesions and serious fluid buildup
Thoracic surgery nursing interventions
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
Pneumonectomy
Phrenic nerve may be severed to paralyze diaphragm in elevated position
Bronchus severed and sutured
Place pt on non operative side after surgery for
Chest tube
Re-expand a collapsed lung and remove air/blood
Chest tube teaching/nursing interventions
Sterile procedure
If drainage stops suddenly- call DR
Compartments of chest tube
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)
Chest tube management
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
If tube disconnected from drainage system
Insert chest tube into container of sterile water below level of insertion and notify MD
Thoracentesis
Needle inserted into pleural space between lungs and chest wall
After procedure- CXR
Monitor for signs of pneumothorax
S/S of Influenza
chills
body aches
coughing and sneezing
extreme fever
fatigue
headache
nasal congestion
High risk for complications of influenza
individuals over 65 years of age
residents of nursing homes
patients with chronic pulmonary or cardiovascular disorders including asthma
Pts who should receive a killed virus vaccine every year (Fluviron)
Patients with chronic metabolic diseases, renal dysfunction, or immunosuppression
Pneumonia
Caused by bacteria, viruses, fungi, or parasites
May lead to empyema (pleural effusion)
Community acquired pneumonia usually caused by
Streptococcus
S/S of pneumonia
Coughing
fatigue/weakness/lethargy
dehydration
confusion
poor appetite
Pneumonia vaccine
recommended for patient 65 years of age or older
TB precautions
Airborne
Private room
Health care workers wear N95
Visitors and patient wear surgical mask
PAPR- powered air-purifying respirator
S/S of TB
persistent cough with weight loss
anorexia
night sweats
hemoptysis
shortness of breath
fever
chills
pleuritic chest pain
crackles
Fatigue
TB teaching
Transmission reduced after drug therapy for 2-3 weeks
Off isolation if negative AFB cultures on 3 consecutive days
TB tx
isoniazid (INH) for 6 - 12 months- empty stomach, avoid alcohol and multivitamin (B6)
Rifampin can cause secretions to turn orange
Pyrazinamide- photosensitive
