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NSG 320 - MED SURG > Exam 3 Collective > Flashcards

Exam 3 Collective Flashcards

1
Q

total parenteral nutrition (TPN)

A

entire nutrition is inside an IV bag and goes right into the blood

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2
Q

what line is TPN given through

A

given CENTRAL LINE! not peripheral IV

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3
Q

when is central line feeding usually given

A

to a client who is NPO (patients with pancreatitis and Crohns)

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4
Q

How should TPN be administered and stopped?

A

start and stop SLOW and GRADUALLY

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5
Q

patients receiving TPN are at high risk for

A

hyper or hypoglycemia

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6
Q

how often should TPN tubing be changed?

A

every 24 hours

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7
Q

what should the nurse do if the TPN bag is almost empty, but the next bag is not ready..

A

Hang 10% dextrose water (to help avoid hypoglycemia)

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8
Q

nursing care for TPN

A

-daily weights
-monitor electrolytes and I&Os
-monitor GLUCOSE LEVELS

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9
Q

signs of hyperglycemia

A

Polydipsia, polyuria, polyphagia, nausea, HA, abdominal pain

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10
Q

enteral feeding

A

Nutrients supplied to the gastrointestinal tract orally or by feeding tube (NGT, PEG, G-Tube)

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11
Q

Complications of enteral feeding

A

-tube displacement
-clogged tubes
-aspiration
-abdominal distention

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12
Q

Refeeding syndrome

A

happens within 24-48 hours of starting enteral or parenteral nutrition; giving too much nutrition in a short amount of time

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13
Q

Refeeding Syndrome S/S

A

24-48hrs of therapy d/t fluid shifts: bradypnea, lethargy, confusion, weakness

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14
Q

how to avoid refeeding syndrome

A

give GRADUALLY
increase calories SLOWLY

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15
Q

gastritis

A

inflammation/irritation of the lining of the stomach

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16
Q

GERD

A

esophageal irritation by stomach acid that travels into the esophagus

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17
Q

if GERD is not treated what can it lead to…

A

Barretts esophagus

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18
Q

Peptic Ulcer Disease

A

open sores/ulcers in the lining of stomach or small intestine

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19
Q

gastric vs duodenal ulcers

A

Gastric = ulcer in the stomach; Duodenal = ulcer in the small intestine

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20
Q

S/S of GERD

A

-dyspepsia “heartburn”

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21
Q

diet consideration for GERD and PUD

A

-avoid eating fried and fatty foods, citrus, dairy, chocolate, peppermint/spearmint, caffeine (coffee)
-avoid spicy food
-no alcohol
-no caffeine
-no cigarettes

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22
Q

education for GERD

A

-no cigarettes and alcohol
-avoid eating before laying down (3 hours after meals)
-elevate HOB at night
-eat small meals (no bedtime snacks unless it is 3 hours before bedtime)

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23
Q

common treatment for GERD

A

-antacids
-H2 blockers
-PPIs

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24
Q

antacid administration teaching

A

always take 1 hour before or after other medications, NEVER TOGETHER

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25
Q

when should H2 blockers and PPIs be taken?

A

take 30 minutes before meals

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26
Q

what diagnostic assessment is done to determine the function of the LES

A

upper GI endoscopy

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27
Q

if an ulcer is suspected, what diagnosis assessment is done

A

esophagogastroduodenoscopy

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28
Q

signs of peritonitis

A

-fever >100.3
-rebound tenderness
-rigid or board like abdomen
-increase pain and tenderness
-restlessness
-increase HR and RR

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29
Q

after an endoscopy, what needs to be done?

A

keep the client NPO until the gag reflex returns, otherwise, they are at risk for ASPIRATION

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30
Q

causes of PUD

A

-H. pylori
-NSAIDs (naproxen, indomethacin, ibuprofen)
-stress

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31
Q

gastric ulcer s/s

A

-increase pain WITH food (30-60 minutes after meal)
-weight loss
-vomit blood (hematemesis)

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32
Q

duodenal ulcer s/s

A

-DECREASE pain with food (2-3 hours after meals)
-worse at night
-weight gain
-blood in stool (melena)

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33
Q

antibiotics of H. Pylori

A

amoxicillin, clarithromycin, tetracycline, metronidazole, bismuth (pepto)

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34
Q

Mucosal protective agents and teaching

A

Sucralfate
-take on empty stomach
-dont take wit other medications

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35
Q

education for PUD

A

-decrease diet irritants
-decrease stress
-avoid NSAIDS
-report black tarry stool

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36
Q

diverticulosis

A

a disorder in which sac-like pouches develop in weakened areas of the wall of the large intestine (colon)

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37
Q

diverticula is usually caused by

A

Diet with decreased fiber (causing constipation which increases pressure in the bowels)

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38
Q

diverticulitis

A

inflammation of the diverticula causing infection and swelling

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39
Q

S/S of Diverticulitis

A

-fever chills
-PAIN LLQ (in descending and sigmoid colon)

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40
Q

Labs for diverticulitis

A

-decreased Hbg and Hct
-increased WBCs
(if diverticula rupture it can cause bleeding)

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41
Q

complications of diverticulitis

A

Peritonitis (MEDICAL EMERGENCY)

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42
Q

nursing care for diverticulitis

A

-avoid constipation and straining
-NPO (want to give bowel some rest_
-Pain medications (morphine, hydromorphone)
-IV normal saline

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43
Q

diet for diverticulitis flare up

A

-NPO
-clear liquid

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44
Q

diet for diverticulosis

A

-high fiber
-AVOID popcorn, seeds, nuts

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45
Q

hepatitis

A

Inflammation of the liver, usually caused by a viral infection, alcohol or autoimmune

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46
Q

Hepatitis A transmission

A

fecal-oral (contaminated food, improper handwashing)

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47
Q

Hepatitis B transmission

A

blood and body fluids
-IV drug use, tattoos, piercings, sharing razor, unprotected sex

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48
Q

Hepatitis C transmission

A

blood and body fluids
-IV drug use, tattoos, piercings, sharing razor, unprotected sex, semen, vaginal secretions

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49
Q

S/S of viral hepatitis

A

-flulike symptoms (HA, fever, fatigue, N/V)
-elevated AST ALT, bilirubin

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50
Q

S/S of Hepatitis

A

-pruritus (from bile salts that build up under the skin)
-elevated bilirubin
-jaundice
-dark-colored urine
-clay color stools
-elevated PT and aPTT (bruising)
-low albumin (edema)

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51
Q

interventions for hepatitis itching (pruritus)

A

-apply moisturizer
-avoid the sun
-apply COLD compress (not heat)

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52
Q

diagnostics for hepatitis

A

-liver biopsy

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53
Q

client teaching after a liver biopsy

A

lie on right side after procedure to prevent bleeding

54
Q

education for hepatitis

A

-small frequent meals
-low protein
-low fat
-frequent rest periods
-protected sex
-avoid alcohol and acetaminophen
-avoid sharing razors and toothbrushes

55
Q

what food needs to be decreased if ammonia levels are high

A

protein

56
Q

cirrhosis

A

scarring and dysfunction of the liver caused by chronic liver disease

57
Q

Hepatic encephalopathy s/s

A

-asterixis
-twitching of extremities
-confusion
-inappropriate behavior
DUE TO INCREASE AMMONIA LEVELS

58
Q

what medication is avoided with cirrhosis

A

acetaminophen

59
Q

Acetaminophen antidote

A

acetylcysteine

60
Q

since the liver is not working as a “recycling company” what can happen

A

-increased ammonia
-decreased drug metabolism (drug toxicity!)
-hypoalbuminemia
-decreased bile
-increased cholesterol and bilirubin
-decreased clotting factors (huge bleeding risk)

61
Q

S/S of cirrhosis

A

-increased BP (PORTAL HTN)
-esophageal varices
-ascites
-hepatic encephalopathy
-pruritus

62
Q

what is the priority if an esophageal varices pops

A

MAINTAIN AIRWAY
-turn patient to the side
-no NG
-no straining

63
Q

what lab levels are high in cirrhosis

A

-ammonia
-AST ALT
-biliruben
-PT, aPTT, INR

64
Q

what lab levels are low in cirrhosis

A

-albumin
-calcium
-platelets

65
Q

intervention for ascites

A

Paracentesis

66
Q

before a paracentesis, the nurse should

A
  1. tell client to empty bladder
  2. VS
  3. measure abdominal circumference and weight
  4. HOB High fowlers
67
Q

Diet for cirrhosis

A

-low protein (for hepatic encepholopathy)
-low sodium and fluid (for ascites
-no alcohol
-oral care before meal in patients with malnutrition

68
Q

what medication is used for hepatic encephalopathy

A

Lactulose (lose ammonia via bowels)

69
Q

how do you evaluate effectiveness of Lactulose

A

-2-3 soft stools/day
-lower ammonia levels
-improved mental status

70
Q

Cholecystitis

A

inflammation of the gallbladder, typically caused by gallstones
-stones block the duct causing backup of bile

71
Q

risk factors for Cholecystitis

A

Fat (high fat diet, obesity)
Female
Forty
Fertile
Familial

72
Q

s/s of Cholecystitis

A

-RUQ PAIN RADIATES TO RIGHT SHOULDER
-fever with chills
-tachycardia
-vomiting green/yellow bile
-pain gets WORSE with high fat foods
-steatorrhea

73
Q

priority intervention for Cholecystitis

A

NPO status

74
Q

treatment for Cholecystitis

A

-lithotripsy (shock waves to break up stones)
-cholecystectomy (removal of the gallbladder)

75
Q

diet education for Cholecystitis

A

avoid fatty fried foods
lose weight

76
Q

causes for flare ups for IBD

A

-stress
-smoking
-sepsis/infection

77
Q

ulcerative colitis

A

chronic inflammation of the colon with presence of ulcers that bleed

78
Q

s/s of UC

A

-15-20 BLOODY liquid stools per day
(can cause anemia and decreased Hgb and Hct)
-rebound tenderness
-abdominal pain

79
Q

Crohn’s disease

A

inflammation of the entire GI tract, sporadic skip lesions that do NOT bleed (cobblestoning appearance)

80
Q

S/S of Crohn’s disease

A

-5 loose stools /day
-steatorrhea
-Abdominal pain, weight loss

81
Q

nursing care for IBD

A

-fluid and electrolyte replacement
-diet
-pain: administer analgesics
-avoid alcohol
-reduce caffeine
-reduce stress

82
Q

fluid and electrolyte replacement for IBD

A

-strict I&O
-2L of water/day and increased with more diarrhea
-watch for hypokalemia

83
Q

diet for IBD

A

-high protein and calorie
-low fiber
-small frequent meals
-keep food journal

84
Q

s/s of UTI

A

dysuria, urgency, frequency, and cloudy foul smelling urine

85
Q

diagnostics for UTI

A

-urinalysis

86
Q

what may indicate UTI in the urine

A

cloudy and smelly
presence of WBCs
presence of nitrites

87
Q

s/s of pyelonephritis

A

-same at UTI
-costovertebral tenderness
-dull flank pain
-fever

88
Q

causes of UTI and pyelonephritis

A

-e.coli
-urinary retention
-foleys

89
Q

how do older adults present with UTI

A

confusion

90
Q

UTI analgesic

A

Phenazopyridine (for pain relief)

91
Q

Phenazopyridine SE

A

turns body fluid red/orange

92
Q

antibiotics for UTI

A

trimethoprim-sulfamethoxazole
levofloxacin
ciprofloxacin

93
Q

education for UTI and pyelonephritis

A

-increase fluid intake
-void after sex
-take cranberry supplements
-avoid caffeine and alcohol
-wipe front to back

94
Q

glomerulonephritis

A

inflammation of the glomeruli of the kidney, (instead of filtering protein, it leaks out)

95
Q

common cause of glomerulonephritis

A

strep infection

96
Q

s/s of glomerulonephritis

A
  • increased proteinuria
    -decreased albumin
    -increase blood clot
    -fever
    -increase WBCs
    -increase BUN and creatinine
    -low UO
    -fluid retention (increase BP, edema, JVD, crackles)
97
Q

treatment for glomerulonephritis

A

-Get rid of strep
-limit protein
-rest kidney by decrease BP

98
Q

what is the number one cause of bladder cancer

A

smoking/tobacco use

99
Q

s/s of bladder cancer

A

painless hematuria

100
Q

diagnostics for bladder cancer

A

cystoscopy

101
Q

Chronic Kidney Disease (CKD)

A

progressive, irreversible loss of kidney function

102
Q

causes of CKD

A

diabetes and hypertension

103
Q

what elevated lab value indicates a bad kidney

A

creatinine

104
Q

creatinine clearance test

A

test done to measure the total amount of creatinine excreted in the urine, usually in 24 hours, to assess kidney function

105
Q

what needs to be done to urine after urine collection

A

put it on ice and keep it cold
discard the first specimen

106
Q

s/s of CKD

A

-oliguria
-Elevated serum creatinine levels
-Anemia due to decreased erythropoietin production in kidneys
-Metabolic acidosis
-Abnormalities in calcium & phosphorus
-Fluid retention(crackles, JVD, bounding pulses)
-uremic frost
-pruritis

107
Q

what is the number one complication with CKD

A

HTN crisis

108
Q

what can be given for hyperkalemia in CKD

A

-IV calcium gluconate
-IV 50% dextrose and regular insulin
-kayexalate
-dialysis

109
Q

nursing interventions for CKD

A

-daily weights
-avoid NSAIDS, antacids, antibiotics, and CT contrast dye

110
Q

1kg =

A

1 L of fluid

111
Q

diet for CKD

A

-restrict fluids
-restrict Na+
-restrict K+
-restrict phosphorous
-decreased protein

112
Q

Foods with potassium

A

leafy veg
avocado
strawberries
orange
banana
carrot
tomatoes
no salt substitute

113
Q

foods with phosphorus

A

dairy products (yogurt, pudding, milk)

114
Q

hemodialysis

A

the process by which waste products are filtered directly from the patient’s blood

115
Q

how often is dialysis

A

3-4x per week

116
Q

Before dialysis

A

-assess fluid status
-assess fistula (shunt)
-hold meds

117
Q

fistula (shunt) assessment

A

feel a thrill
hear a bruit

118
Q

what is added to dialysis to prevent clots

A

IV heparin

119
Q

disequilibrium syndrome

A

rapid change of extracellular fluid composition during dialysis resulting in cerebral edema; RESTLESSNESS AND DISORIENTED

120
Q

what is the intervention for disequilibrium syndrome

A

stop/slow the infusion and report to HCP

121
Q

care for fistula (AV shunt)

A

-squeeze/grip a rubber ball a few times a day
-pitting edema is normal
-check for thrill and bruit
-no restrictive clothing
-no BP on affected arm
-no sleeping on affected arm
-can use cream and lotion
-no lifting over 5 lbs (no purse)

122
Q

what should be done before peritoneal dialysis

A

take weight and warm solution

123
Q

benign prostatic hyperplasia (BPH)

A

prostate enlargement, which compresses urethra and surrounding bladder, most common in men >50

124
Q

s/s of BPH

A
  • weak/intermittent stream (dribbling)
  • Urinary retention
  • sensation on incomplete emptying
  • urgency and frequency
  • Straining to void
  • Recurrent UTI
  • Hematuria
  • Fatigue
  • Anorexia
125
Q

treatment for BPH

A

-bladder training
-FInasteride (Proscar)
-TURP
-prostatectomy

126
Q

Finasteride (Proscar)

A

shrinks prostate, takes 6 months to work

127
Q

transurethral resection of the prostate (TURP)

A

procedure of removing all or part of the prostate by the insertion of a resectoscope into the urethra

128
Q

After a TURP, what do you want the urine to be?

A

light pink

129
Q

after TURP what is placed

A

3-way foley cath for continuous bladder irrigation

130
Q

what signs need to be reported after a TURP

A

infection (UTI), urinary retention

131
Q

what is not normal 24 hours after a TURP

A

bloody urine

132
Q

teaching for TURP

A

-increase fluid intake
-bladder irrigation
-output should be more than input

NSG 320 - MED SURG (63 decks)

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