Exam 3 Collective Flashcards
total parenteral nutrition (TPN)
entire nutrition is inside an IV bag and goes right into the blood
what line is TPN given through
given CENTRAL LINE! not peripheral IV
when is central line feeding usually given
to a client who is NPO (patients with pancreatitis and Crohns)
How should TPN be administered and stopped?
start and stop SLOW and GRADUALLY
patients receiving TPN are at high risk for
hyper or hypoglycemia
how often should TPN tubing be changed?
every 24 hours
what should the nurse do if the TPN bag is almost empty, but the next bag is not ready..
Hang 10% dextrose water (to help avoid hypoglycemia)
nursing care for TPN
-daily weights
-monitor electrolytes and I&Os
-monitor GLUCOSE LEVELS
signs of hyperglycemia
Polydipsia, polyuria, polyphagia, nausea, HA, abdominal pain
enteral feeding
Nutrients supplied to the gastrointestinal tract orally or by feeding tube (NGT, PEG, G-Tube)
Complications of enteral feeding
-tube displacement
-clogged tubes
-aspiration
-abdominal distention
Refeeding syndrome
happens within 24-48 hours of starting enteral or parenteral nutrition; giving too much nutrition in a short amount of time
Refeeding Syndrome S/S
24-48hrs of therapy d/t fluid shifts: bradypnea, lethargy, confusion, weakness
how to avoid refeeding syndrome
give GRADUALLY
increase calories SLOWLY
gastritis
inflammation/irritation of the lining of the stomach
GERD
esophageal irritation by stomach acid that travels into the esophagus
if GERD is not treated what can it lead to…
Barretts esophagus
Peptic Ulcer Disease
open sores/ulcers in the lining of stomach or small intestine
gastric vs duodenal ulcers
Gastric = ulcer in the stomach; Duodenal = ulcer in the small intestine
S/S of GERD
-dyspepsia “heartburn”
diet consideration for GERD and PUD
-avoid eating fried and fatty foods, citrus, dairy, chocolate, peppermint/spearmint, caffeine (coffee)
-avoid spicy food
-no alcohol
-no caffeine
-no cigarettes
education for GERD
-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)
common treatment for GERD
-antacids
-H2 blockers
-PPIs
antacid administration teaching
always take 1 hour before or after other medications, NEVER TOGETHER
when should H2 blockers and PPIs be taken?
take 30 minutes before meals
what diagnostic assessment is done to determine the function of the LES
upper GI endoscopy
if an ulcer is suspected, what diagnosis assessment is done
esophagogastroduodenoscopy
signs of peritonitis
-fever >100.3
-rebound tenderness
-rigid or board like abdomen
-increase pain and tenderness
-restlessness
-increase HR and RR
after an endoscopy, what needs to be done?
keep the client NPO until the gag reflex returns, otherwise, they are at risk for ASPIRATION
causes of PUD
-H. pylori
-NSAIDs (naproxen, indomethacin, ibuprofen)
-stress
gastric ulcer s/s
-increase pain WITH food (30-60 minutes after meal)
-weight loss
-vomit blood (hematemesis)
duodenal ulcer s/s
-DECREASE pain with food (2-3 hours after meals)
-worse at night
-weight gain
-blood in stool (melena)
antibiotics of H. Pylori
amoxicillin, clarithromycin, tetracycline, metronidazole, bismuth (pepto)
Mucosal protective agents and teaching
Sucralfate
-take on empty stomach
-dont take wit other medications
education for PUD
-decrease diet irritants
-decrease stress
-avoid NSAIDS
-report black tarry stool
diverticulosis
a disorder in which sac-like pouches develop in weakened areas of the wall of the large intestine (colon)
diverticula is usually caused by
Diet with decreased fiber (causing constipation which increases pressure in the bowels)
diverticulitis
inflammation of the diverticula causing infection and swelling
S/S of Diverticulitis
-fever chills
-PAIN LLQ (in descending and sigmoid colon)
Labs for diverticulitis
-decreased Hbg and Hct
-increased WBCs
(if diverticula rupture it can cause bleeding)
complications of diverticulitis
Peritonitis (MEDICAL EMERGENCY)
nursing care for diverticulitis
-avoid constipation and straining
-NPO (want to give bowel some rest_
-Pain medications (morphine, hydromorphone)
-IV normal saline
diet for diverticulitis flare up
-NPO
-clear liquid
diet for diverticulosis
-high fiber
-AVOID popcorn, seeds, nuts
hepatitis
Inflammation of the liver, usually caused by a viral infection, alcohol or autoimmune
Hepatitis A transmission
fecal-oral (contaminated food, improper handwashing)
Hepatitis B transmission
blood and body fluids
-IV drug use, tattoos, piercings, sharing razor, unprotected sex
Hepatitis C transmission
blood and body fluids
-IV drug use, tattoos, piercings, sharing razor, unprotected sex, semen, vaginal secretions
S/S of viral hepatitis
-flulike symptoms (HA, fever, fatigue, N/V)
-elevated AST ALT, bilirubin
S/S of Hepatitis
-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)
interventions for hepatitis itching (pruritus)
-apply moisturizer
-avoid the sun
-apply COLD compress (not heat)
diagnostics for hepatitis
-liver biopsy
client teaching after a liver biopsy
lie on right side after procedure to prevent bleeding
education for hepatitis
-small frequent meals
-low protein
-low fat
-frequent rest periods
-protected sex
-avoid alcohol and acetaminophen
-avoid sharing razors and toothbrushes
what food needs to be decreased if ammonia levels are high
protein
cirrhosis
scarring and dysfunction of the liver caused by chronic liver disease
Hepatic encephalopathy s/s
-asterixis
-twitching of extremities
-confusion
-inappropriate behavior
DUE TO INCREASE AMMONIA LEVELS
what medication is avoided with cirrhosis
acetaminophen
Acetaminophen antidote
acetylcysteine
since the liver is not working as a “recycling company” what can happen
-increased ammonia
-decreased drug metabolism (drug toxicity!)
-hypoalbuminemia
-decreased bile
-increased cholesterol and bilirubin
-decreased clotting factors (huge bleeding risk)
S/S of cirrhosis
-increased BP (PORTAL HTN)
-esophageal varices
-ascites
-hepatic encephalopathy
-pruritus
what is the priority if an esophageal varices pops
MAINTAIN AIRWAY
-turn patient to the side
-no NG
-no straining
what lab levels are high in cirrhosis
-ammonia
-AST ALT
-biliruben
-PT, aPTT, INR
what lab levels are low in cirrhosis
-albumin
-calcium
-platelets
intervention for ascites
Paracentesis
before a paracentesis, the nurse should
- tell client to empty bladder
- VS
- measure abdominal circumference and weight
- HOB High fowlers
Diet for cirrhosis
-low protein (for hepatic encepholopathy)
-low sodium and fluid (for ascites
-no alcohol
-oral care before meal in patients with malnutrition
what medication is used for hepatic encephalopathy
Lactulose (lose ammonia via bowels)
how do you evaluate effectiveness of Lactulose
-2-3 soft stools/day
-lower ammonia levels
-improved mental status
Cholecystitis
inflammation of the gallbladder, typically caused by gallstones
-stones block the duct causing backup of bile
risk factors for Cholecystitis
Fat (high fat diet, obesity)
Female
Forty
Fertile
Familial
s/s of Cholecystitis
-RUQ PAIN RADIATES TO RIGHT SHOULDER
-fever with chills
-tachycardia
-vomiting green/yellow bile
-pain gets WORSE with high fat foods
-steatorrhea
priority intervention for Cholecystitis
NPO status
treatment for Cholecystitis
-lithotripsy (shock waves to break up stones)
-cholecystectomy (removal of the gallbladder)
diet education for Cholecystitis
avoid fatty fried foods
lose weight
causes for flare ups for IBD
-stress
-smoking
-sepsis/infection
ulcerative colitis
chronic inflammation of the colon with presence of ulcers that bleed
s/s of UC
-15-20 BLOODY liquid stools per day
(can cause anemia and decreased Hgb and Hct)
-rebound tenderness
-abdominal pain
Crohn’s disease
inflammation of the entire GI tract, sporadic skip lesions that do NOT bleed (cobblestoning appearance)
S/S of Crohn’s disease
-5 loose stools /day
-steatorrhea
-Abdominal pain, weight loss
nursing care for IBD
-fluid and electrolyte replacement
-diet
-pain: administer analgesics
-avoid alcohol
-reduce caffeine
-reduce stress
fluid and electrolyte replacement for IBD
-strict I&O
-2L of water/day and increased with more diarrhea
-watch for hypokalemia
diet for IBD
-high protein and calorie
-low fiber
-small frequent meals
-keep food journal
s/s of UTI
dysuria, urgency, frequency, and cloudy foul smelling urine
diagnostics for UTI
-urinalysis
what may indicate UTI in the urine
cloudy and smelly
presence of WBCs
presence of nitrites
s/s of pyelonephritis
-same at UTI
-costovertebral tenderness
-dull flank pain
-fever
causes of UTI and pyelonephritis
-e.coli
-urinary retention
-foleys
how do older adults present with UTI
confusion
UTI analgesic
Phenazopyridine (for pain relief)
Phenazopyridine SE
turns body fluid red/orange
antibiotics for UTI
trimethoprim-sulfamethoxazole
levofloxacin
ciprofloxacin
education for UTI and pyelonephritis
-increase fluid intake
-void after sex
-take cranberry supplements
-avoid caffeine and alcohol
-wipe front to back
glomerulonephritis
inflammation of the glomeruli of the kidney, (instead of filtering protein, it leaks out)
common cause of glomerulonephritis
strep infection
s/s of glomerulonephritis
- increased proteinuria
-decreased albumin
-increase blood clot
-fever
-increase WBCs
-increase BUN and creatinine
-low UO
-fluid retention (increase BP, edema, JVD, crackles)
treatment for glomerulonephritis
-Get rid of strep
-limit protein
-rest kidney by decrease BP
what is the number one cause of bladder cancer
smoking/tobacco use
s/s of bladder cancer
painless hematuria
diagnostics for bladder cancer
cystoscopy
Chronic Kidney Disease (CKD)
progressive, irreversible loss of kidney function
causes of CKD
diabetes and hypertension
what elevated lab value indicates a bad kidney
creatinine
creatinine clearance test
test done to measure the total amount of creatinine excreted in the urine, usually in 24 hours, to assess kidney function
what needs to be done to urine after urine collection
put it on ice and keep it cold
discard the first specimen
s/s of CKD
-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
what is the number one complication with CKD
HTN crisis
what can be given for hyperkalemia in CKD
-IV calcium gluconate
-IV 50% dextrose and regular insulin
-kayexalate
-dialysis
nursing interventions for CKD
-daily weights
-avoid NSAIDS, antacids, antibiotics, and CT contrast dye
1kg =
1 L of fluid
diet for CKD
-restrict fluids
-restrict Na+
-restrict K+
-restrict phosphorous
-decreased protein
Foods with potassium
leafy veg
avocado
strawberries
orange
banana
carrot
tomatoes
no salt substitute
foods with phosphorus
dairy products (yogurt, pudding, milk)
hemodialysis
the process by which waste products are filtered directly from the patient’s blood
how often is dialysis
3-4x per week
Before dialysis
-assess fluid status
-assess fistula (shunt)
-hold meds
fistula (shunt) assessment
feel a thrill
hear a bruit
what is added to dialysis to prevent clots
IV heparin
disequilibrium syndrome
rapid change of extracellular fluid composition during dialysis resulting in cerebral edema; RESTLESSNESS AND DISORIENTED
what is the intervention for disequilibrium syndrome
stop/slow the infusion and report to HCP
care for fistula (AV shunt)
-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)
what should be done before peritoneal dialysis
take weight and warm solution
benign prostatic hyperplasia (BPH)
prostate enlargement, which compresses urethra and surrounding bladder, most common in men >50
s/s of BPH
- weak/intermittent stream (dribbling)
- Urinary retention
- sensation on incomplete emptying
- urgency and frequency
- Straining to void
- Recurrent UTI
- Hematuria
- Fatigue
- Anorexia
treatment for BPH
-bladder training
-FInasteride (Proscar)
-TURP
-prostatectomy
Finasteride (Proscar)
shrinks prostate, takes 6 months to work
transurethral resection of the prostate (TURP)
procedure of removing all or part of the prostate by the insertion of a resectoscope into the urethra
After a TURP, what do you want the urine to be?
light pink
after TURP what is placed
3-way foley cath for continuous bladder irrigation
what signs need to be reported after a TURP
infection (UTI), urinary retention
what is not normal 24 hours after a TURP
bloody urine
teaching for TURP
-increase fluid intake
-bladder irrigation
-output should be more than input
