Exam 3 - Summary Set Flashcards
the normal physiologic response to disease-causing microorganisms and toxic substances
immunity
___ and ___ are the two types of immunity
innate, adaptive
____ is present at birth and non-antigen specific
innate immune system
what are 3 reasons that older adults are at higher risk of immune issues?
(1) reduced response to pathogens
(2) increase in autoimmune diseases
(3) impaired inflammation with comorbidities
type I immune responses are ____ reactions
allergic
tissue-specific or cytotoxic reactions are
type II immune responses
Serum sickness and Lupus are examples of ___ immune responses
type III
cell-mediated or delayed hypersensitivity is which immune response?
type IV
virus that affects the immune system and weakens it
HIV
which cells are impacted in HIV?
CD4+ T-helper cells and memory cells
name at least 4 risk factors / causes for HIV contraction
(1) direct contact with bodily fluids
(2) unprotected sexual activities
(3) sharing needles
(4) blood transfusion
(5) breast milk
(6) birth canal
the 3 phases of HIV are:
(1) phase I acute infection
(2) latent phase
(3) AIDS
s/s of acute HIV infection
(1) fever
(2) sore throat
(3) rash
(4) night sweats
(5) chills
(6) headache
(7) muscle aches
the diagnostic criteria for AIDS is
CD4+ count <200
at the beginning of HIV, we see a sharp increase in ____ and a sharp decrease in _____
HIV RNA virus; CD4+ T-cell count
the latent phase can last ___
1-11 years
why is it important to get re-tested for HIV?
because during the window period, there is a higher risk for false-negative test results
3 supportive diagnostics that indicate progression of HIV include:
(1) lymphocyte count
(2) CD4+ count
(3) viral load testing
treatment for HIV is ____
lifelong antiretroviral therapy (ART)
what is the key to HIV medication therapy?
combination of a med to decrease viral load and a med to support the immune system
The purpose of ART is to ___
prevent HIV from replicating AKA to decrease viral load
name at least 3 adverse effects of ART
(1) weight loss
(2) fatigue
(3) diarrhea
(4) mood changes
(5) high cholesterol
(6) N/V
(7) rash
what are the 5 outcomes / goals for HIV?
(1) prevent progression of HIV
(2) prevent transmission
(3) prevent opportunistic infections
(4) prevent complications r/t ART
(5) coordinate care
extensive, irreversible scarring of the liver from inflammation
cirrhosis
name 4 common causes of cirrhosis
(1) viral hepatitis
(2) hepatitis C
(3) chronic alcoholism
(4) chronic biliary obstruction
the 3 main impacts of cirrhosis are:
(1) fluid overload that can impact breathing
(2) confusion from ammonia
(3) impaired liver functions
testing frequency for HIV treatment efficacy should be ____
q4-6 weeks
name at least 3 s/s of hypovolemic shock related to cirrhosis
(1) increased HR (first sign)
(2) low BP
(3) low O2
(4) increased RR
(5) cool skin
(6) slow cap refill
hepatic encephalopathy in cirrhosis can lead to ____
mental status changes
name at least 3 early s/s of cirrhosis
(1) fatigue
(2) weight changes
(3) anorexia
(4) vomiting
(5) pain of abdomen and liver
name at least 3 late s/s of cirrhosis
(1) GI bleeding
(2) jaundice
(3) ascites
(4) spontaneous bruising
(5) dry and itchy skin
explain the labs that will be present with cirrhosis
(1) elevated - AST, ALT, LDH, Bilirubin, ammonia
(2) low - albumin
(3) prolonged PT / INR ratio
(4) anemia
the 3 things used to diagnose cirrhosis are
(1) abdominal x-ray
(2) CT or MRI
(3) liver ultrasound
the 6 priorities for cirrhosis are:
(1) fluid overload
(2) hemorrhage
(3) confusion
(4) pruritus
(5) avoid hepatotoxic meds
(6) avoid alcohol
what are two things to look at to monitor for ascites?
(1) increased abdominal circumference
(2) weight gain
T/F: Ascites can impact breathing
T
what are 4 ways to manage fluid overload in cirrhosis?
(1) Low Na diet
(2) IV vitamins
(3) diuretics
(4) paracentesis
we can prevent hemorrhage in cirrhosis with ___
beta blockers
we can control hemorrhage bleeding in cirrhosis with ___
vasoactive meds like octreotide
what is used to reduce the ammonia levels via the stool?
lactulose
to avoid confusion in cirrhosis, we want to ___
minimize the number of meds that are metabolized by the liver
we can treat pruritus with …
(1) moisturizers
(2) cool compresses
(3) corticosteroids cream
(4) NSAIDs
____ and ___ are both hepatotoxic meds
acetaminophen and NSAIDs
severe, critical illness that occurs when the virus infects type 2 alveolar epithelial cells
COVID-19
name at least 4 risk factors for COVID-19
(1) >65 yo
(2) cancer
(3) chronic kidney, liver, or lung disease
(4) DM
(5) heart conditions
(6) HIV
(7) smoking
name at least 4 s/s of COVID-19
(1) upper respiratory symptoms
(2) fever
(3) chills
(4) N/V
(5) diarrhea
(6) loss of taste and smell
what s/s necessitate immediate treatment in COVID-19?
(1) difficulty breathing
(2) tachypnea
(3) hypoxemia
(4) chest pain
(5) confusion
(6) cyanosis
the two main diagnostics used for COVID-19 are
(1) Lab - NAAT
(2) Chest x-ray
what are the 3 priorities for COVID-19?
(1) prevent transmission
(2) promote gas exchange
(3) reduce risk of progression
___ and ___ are the two medications for COVID-19
Nirmatrelvir-Ritonavir; Remdesivir
Nirmatrelvir-Ritonavir indication
treat mild to moderate COVID-19 at high risk of progressing to severe
Nirmatrelvir-Ritonavir side effects
(1) diarrhea
(2) altered taste
Nirmatrelvir-Ritonavir education
take a missed dose within 8 hours of time; if more than 8 hours, skip the missed dose
Remdesivir indication
for hospitalized patients with COVD-19 or non-hospitalized within 7 days of onset
Remdesivir side effects
(1) nausea
(2) hepatotoxicity
Remdesivir monitoring
(1) hepatic panel
(2) PT value before administration
(3) hypersensitivity during and following administration
what are the 3 outcomes of COVID-19?
(1) prevent transmission
(2) promote gas exchange
(3) reduce risk of progression
lung infection causing inflammation in the airways and fluid or exudate (thick) buildup in the alveoli, leading to impaired gas exchange
pneumonia
name the 4 risk factors for community-acquired pneumonia
(1) older adults (over 50)
(2) no pneumococcal vaccine
(3) influenza
(4) COVID-19
name at least 4 risk factors for hospital / ventilator-associated pneumonia
(1) older adults (over 50)
(2) chronic lung disease
(3) altered LOC
(4) recent aspiration
(5) endotracheal or NG tube
(6) mechanical ventilation
(7) immobility
name at least 3 risk factors for pneumonia because of reduced immunity
(1) babies <1 yo
(2) organ transplants
(3) on corticosteroids
(4) cancer patients
(5) RA
(6) HIV
2 ways to prevent hospital-acquired pneumonia are
(1) good oral care BID
(2) pulmonary hygiene
4 ways to prevent ventilator-associated pneumonia are
(1) HOB >30 deg
(2) oral care per protocol
(3) HH
(4) sterile suctioning
people over ___ yo should get the pneumonia vaccine
50
name at least 3 systemic s/s of pneumonia
(1) fever
(2) chills
(3) malaise
(4) loss of appetite
(5) myalgia
name at least 3 pulmonary s/s of pneumonia
(1) cough (w/ or w/o sputum)
(2) dyspnea
(3) pleuritic chest pain
(4) increased RR
(5) labored breathing
(6) diminished breath sounds
(7) crackles, rhonchi, wheezing
(8) low O2
a sign of pneumonia in older adults is ____
confusion
how is pneumonia diagnosed?
(1) increased WBC
(2) sputum culture
(3) blood culture
(4) ABGs
(5) electrolytes
(6) BUN/Creatinine
(7) chest x-ray
which acid-base imbalance is associated with pneumonia?
respiratory acidosis
the 4 nursing priorities for pneumonia are
(1) impaired gas exchange
(2) possible airway obstruction
(3) possible sepsis
(4) anxiety
name at least 3 nursing interventions to support impaired gas exchange in pneumonia
(1) elevate HOB
(2) early mobilization
(3) supplemental O2
(4) incentive spirometry
(5) cough and deep breathing
(6) bronchodilators
name at least 3 ways to avoid possible airway obstruction in pneumonia
(1) cough and deep breathing
(2) IS
(3) 2-4 L/day fluids
(4) medications
(5) expectorants
what do we want to monitor to avoid sepsis / catch it early in patients with pneumonia?
(1) blood cultures
(2) anti-infectives
(3) monitor vitals
(4) maintain BP
the 2 meds to support breathing in pneumonia are
(1) bronchodilator
(2) IV (to PO) steroids - methylprednisolone
bronchodilator action
manage bronchospasms
bronchodilator side effects
tachycardia, tremors
steroids to support breathing action
manage airway inflammation and swelling
steroids administration / monitoring
(1) don’t stop abruptly
(2) monitor blood glucose levels
which 2 meds are used to manage infection in pneumonia?
(1) cephalosporin (ceftriaxone)
(2) fluoroquinolones (levofloxacin)
cephalosporin side effects
(1) one of the safest antimicrobials!
(2) rare - allergic rxn
fluoroquinolone side effects
(1) c. diff
(2) yeast infection
(3) tendon rupture
(4) N/V
fluoroquinolone teaching
(1) take with food
(2) avoid sun exposure
(3) complete the course
extreme response to infection that can lead to tissue damage, organ failure, and death
sepsis
name the general pathophysiology of sepsis
(1) local infection
(2) systemic infection
(3) SIRS
(4) organ failure
(5) MODS
(6) death
the two biggest risk factors for sepsis are
reduced immunity and lines/drains/tubes/etc.
3 ways to prevent sepsis are…
(1) get rid of invasive lines ASAP
(2) proper sterile technique
(3) sepsis screening
___, ___, and ___ are 3 screening tools for sepsis
MEWS, qSOFA, and SOFA
lab results will show an increase in which values for sepsis?
(1) procalcitonin
(2) lactate
(3) WBC (sometimes)
(4) glucose
___ will be present in blood cultures in sepsis
bacteria
late-stage sepsis will show the following lab values:
(1) low HCT
(2) low Hgb
(3) low fibrinogen
(4) low platelets from DIC
in early sepsis, BP and HR will be
high
in late sepsis, BP will ___
drop
at which stage of sepsis can DIC occur?
septic shock
sepsis RR
increased
neuro symptoms of sepsis are
restless, something is wrong, confusion
skin s/s of sepsis
(1) warm
(2) no cyanosis until shock
(3) cool, clammy, pale, mottling
(4) petechiae and ecchymosis
urine output will be ___ in sepsis
low
the two nursing priorities for sepsis are
(1) widespread infection
(2) potential for organ dysfunction
name the steps of the hour-1 sepsis management bundle
(1) measure lactate level
(2) obtain blood cultures
(3) administer broad-spectrum abx
(4) begin rapid admin of crystalloid
(5) apply vasopressors if hypotensive during or after fluid
what is the goal MAP in managing hypotension in sepsis?
> = 65 mmHg
when do we know it’s time to call for help with sepsis?
when we put someone on a non-rebreather for O2
name the outcomes of sepsis / lab values
(1) ABGs normal
(2) UO >= 0.5 mL/kg/hr
(3) MAP >= 65 mmHg
(4) absence of MODS
(5) cap refill <3 sec
(6) extremities warm
when a stool can’t pass through the GI tract due to an obstruction
intestinal obstruction
___ is when there is a physical block by adhesions
mechanical obstruction
___ is when peristalsis is decreased or absent due to neuromuscular disturbance
non-mechanical obstruction / paralytic ileus
___ is scarring in the intestinal system
adhesions
stool stuck right at the rectum is ___
fecal impaction
name at least 4 causes of intestinal obstruction
(1) adhesions
(2) tumors
(3) fecal impaction
(4) Crohn’s disease
(5) intussusception
(6) volvulus
(7) postoperative ileus
the best way to avoid intestinal obstruction is to ___
prevent constipation
name at least 3 s/s of a small bowel obstruction
(1) mid-abdominal pain or cramping
(2) upper abdominal distention
(3) N/V
(4) constipation
(5) F&E imbalance
(6) metabolic alkalosis
name at least 3 s/s of a large bowel obstruction
(1) intermittent lower abdominal cramping
(2) lower abdominal distention
(3) minimal vomiting
(4) constipation
(5) ribbon stools
(6) metabolic acidosis
bowel sounds above the obstruction will be ___
hyperactive
bowel sounds below the obstruction will be ____
hypoactive
you should immediately report a ___ in intestinal obstruction
perforation
name the s/s of a perforation in intestinal obstruction
(1) severe pain followed by relief
(2) fever
(3) tachycardia
(4) hypotension
(5) rigidity
how do you diagnose an intestinal obstruction?
(1) Labs
(2) abdominal CT
which acid-base imbalance is associated with small bowel obstruction?
metabolic alkalosis
which acid-base imbalance is associated with large bowel obstruction?
metabolic acidosis
what are the 4 nursing priorities for intestinal obstruction?
(1) reduce risk of life-threatening complications
(2) acute pain
(3) nausea
(4) F&E imbalances
be careful with ___ and ___ in intestinal obstruction because they can cause constipation
opioids; antiemetics
name the key nursing interventions for intestinal obstruction
(1) NPO
(2) NGT for decompression
(3) IVF and electrolyte replacement
(4) frequent oral care
(5) pain control
what is the gold standard for confirming proper NGT placement?
x-ray
what do we monitor with NGT and low, continuous suctioning?
(1) output
(2) proper placement
2 ways to control pain in intestinal obstructions are
semi-fowler’s and analgesics
do not remove a NGT until ___ after surgery for intestinal obstruction
GI motility returns or tolerating intake well
post-op monitoring for intestinal obstruction includes ___ and ___
high-risk for post-op pneumonia; pain management
notify the provider if there is a sudden increase in ____ in NGT output
bile
rapid reduction in kidney function
acute kidney injury (AKI)
name at least 3 causes of AKI
(1) damage to tissue
(2) dehydration
(3) nephrotoxic meds
(4) sepsis
(5) BP meds
(6) MI
(7) shock
(8) CT contrast
(9) kidney stones
name at least 3 risk factors for AKI
(1) Nephrotoxic meds
(2) dehydration
(3) older age
(4) recent surgery
(5) DM
(6) HTN
name 4 key nephrotoxic meds
(1) NSAIDs
(2) antibiotics
(3) metformin
(4) CT contrast
the 3 ways our body compensates with AKI are:
(1) constriction of kidney blood vessels
(2) activation of RAAS
(3) release of ADH
if UO is ____ or ___, report it!
<30 mL/hr for 2 hours or
0.5 mL/kg/hr
decreased ___ and ___ are the main s/s of AKI
perfusion, cognition
name the s/s of decreased perfusion in AKI
(1) Low BP (MAP <65)
(2) increased HR
(3) weak peripheral pulses
how do you diagnose AKI?
(1) labs
(2) CT
(3) US
(4) KUB
(5) kidney biopsy
what will lab results be in someone with AKI?
(1) increased creatinine and BUN
(2) increased blood osmolality
(3) increased K
(4) metabolic acidosis
what are the 3 nursing priorities for AKI?
(1) impaired elimination
(2) risk for F&E imbalance
(3) risk for acid-base imbalance
to prevent AKI, the 3 nursing interventions are…
(1) encourage 2-3 L/day
(2) maintain BP
(3) reduce exposure to nephrotoxic meds
when using contrast, what two things should nurses do?
(1) monitor kidney function
(2) increase hydration
stop ___ 24 hours before contrast use
Metformin
when is temporary dialysis indicated?
(1) symptomatic uremia
(2) K > 6.5
(3) severe metabolic acidosis (pH <7.1)
(4) fluid overload
progressive, irreversible, >3 months damage to the kidney that alters elimination
chronic kidney disease (CKD)
___ is when elimination is too poor to sustain life
ESKD
in stage 1 & 2 of CKD, what are the main goals?
risk factor reduction and mitigation
in stage 3 of CKD, we prioritize ___
strategies to slow progression
at which stage of CKD might we stop ACEIs temporarily?
stage 3
what are the goals of stage 4 CKD?
manage complications and prepare for dialysis
during stage ___, you should discuss goals of care
4
stage 5 / ESKD treatment options are
(1) dialysis
(2) transplant
name at least 4 signs of progression of CKD
(1) increased BUN
(2) increased creatinine
(3) decreased UO
(4) fluid overload
(5) electrolyte buildup
(6) uremia
the 3 main causes / risk factors for CKD are
(1) AKI
(2) DM
(3) HTN
___ is the best indicator of fluid overload
weight gain
metabolic complications associated with CKD:
(1) increased K
(2) metabolic acidosis
(3) increased Phos
(4) decreased Ca
(5) bone fractures (altered Phos, Ca, Vit D)
cardiac complications associated with CKD:
(1) HTN
(2) HLD
(3) HF
(4) pericarditis
hematologic complication associated with CKD is ____
anemia
GI complications associated with CKD are ___ and ___
nausea; anorexia
CKD can lead to changes in ___
cognition
the main neuro s/s of CKD is
fatigue
___ can cause lethargy, seizures, coma, and weakness
CKD
the cardiac s/s of CKD are
(1) fluid overload
(2) HTN
CKD can lead to ____ acid-base imbalance
metabolic acidosis
what are the respiratory impacts of metabolic acidosis in CKD?
(1) Tachypnea
(2) Kussmaul respirations
name the 3 hematology s/s of CKD
(1) anemia
(2) bruising / bleeding
(3) reduced WBC
name the GI s/s of CKD
(1) anorexia
(2) nausea
(3) metallic taste
(4) foul breath
in later stages of CKD we see ___ and ___ (GU symptoms)
oliguria; anuria
skin s/s of CKD
(1) pruritus
(2) dry skin
(3) yellow pallor or darkening of skin
3 MSK s/s of CKD are
(1) weakness
(2) bone pain
(3) fractures
CKD can lead to which psychosocial s/s?
(1) depression
(2) fatigue
(3) sleep disturbances
(4) sexual dysfunction
(5) unemployment
labs in CKD:
(1) elevated BUN and creatinine
(2) decreased GFR
(3) hyponatremia - early stages
(4) hypernatremia - late stages
(5) elevated phos
(6) metabolic acidosis - late stages
the 5 nursing priorities for CKD are:
(1) F&E imbalances
(2) decreased cardiac function
(3) weight loss
(4) injury
(5) psychosocial compromise
___ is usually done 3x per week for 3-4 hours
Hemodialysis (HD)
which medications are used for F&E imbalances in CKD?
(1) phosphate binders
(2) multivitamins
Diuretics (Thiazide), Ca channel blockers, ACEIs, and beta blockers can all be used to ___ in CKD
control HTN
what are the nutrition guidelines for CKD?
(1) protein restriction in early CKD
(2) restrict Na, K, and Phos to manage chronic uremia & for HD
(3) fluid restrictions
(4) give Ca and Vit D supplements; multivits; iron
anemia in CKD puts patient at risk for
bleeding
which medications can help with anemia and bleeding risk?
(1) iron
(2) epoetin alfa
which medications should be avoided / monitored with CKD?
(1) Abx
(2) opioids
(3) antihypertensives
(4) diuretics
(5) insulin
(6) heparin
when medication, diet, and fluid restrictions are no longer effective in CKD
hemodialysis (HD)
with short-term HD, what is placed?
temporary HD catheter
with long-term HD, what is placed?
AV fistula (AVF)
what are two key considerations with AVF?
(1) assess for bruit & thrill
(2) clotting can occur (may use heparin)
why do we need to give some meds after HD?
some meds can dialyze off
name 4 meds that should be given after HD
(1) cephalosporins (cefazolin)
(2) anticonvulsants (phenobarbital)
(3) enalapril
(4) aspirin
name the 6 safety considerations with AVFs
(1) No BP cuff
(2) No blood draws or IVs
(3) assess function & perfusion
(4) monitor for bleeding after dialysis
(5) monitor for infection
(6) don’t compress the extremity
___ exchanges wastes, fluids, and electrolytes in the peritoneal cavity
peritoneal dialysis (PD)
___ is the biggest risk factor for PD
infection
name at least 3 s/s of infection with PD
(1) cloudy or opaque effluent
(2) fever
(3) abdominal pain
(4) malaise
(5) nausea
when using warm bags or warming chambers for PD pain, what should you not do?
microwave them
wait time for a kidney transplant can be ____
3-5 years
3 candidate criteria for a kidney transplant are:
(1) advanced kidney disease
(2) reasonable life expectancy
(3) medically fit for surgery
name the 3 contraindications for kidney transplant
(1) active substance abuse
(2) active cancer
(3) nonadherence
the 3 general nursing considerations for post-op of a kidney transplant are:
(1) monitor kidney function
(2) rejection
(3) infection
monitor for ___ when assessing risk of rejection of a kidney transplant
abrupt decrease in UO
to monitor kidney function after a kidney transplant, we ____
use a catheter to get hourly output
s/s of kidney transplant infection are
(1) low-grade fever
(2) mental status change
(3) discomfort
phosphate binders example
Ca acetate, Sevelamer (non-Ca)
phosphate binders action
prevent absorption of dietary phosphorus
phosphate binders / Ca acetate nursing considerations / teaching
(1) take with meals
(2) don’t take within 2 hours of other meds
(3) monitor Ca and Phos
(4) monitor for constipation
(5) monitor for muscle weakness, irregular pulse, confusion
muscle weakness, irregular pulse, and confusion could be signs of ___
low phos
parathyroid hormone modulator example
cinacalcet
parathyroid hormone modulator action
reduce PTH to maintain blood Ca and phosphorus levels
parathyroid hormone modulator nursing considerations
maintain Ca and phos levels
cinacalcet / parathyroid hormone modulator side effects
(1) diarrhea
(2) muscle pain
erythropoietin-stimulating agents example
epoetin alfa
erythropoietin-stimulating agents action
prevent or correct anemia
erythropoietin-stimulating agents monitoring
monitor Hgb (if it’s getting too high)
Epoietin alfa / erythropoietin-stimulating agents side effects
(1) chest pain
(2) high BP
(3) rapid weight gain
(4) swelling
an infection in any area of the urinary tract and kidneys
UTI
recurrent UTI is defined as
> 2 infections in 6 months or
3 infections in a year
lower UTI is infection of the ___ and ___
urethra; bladder
upper UTI is infection of the ___ and ___
ureters; kidneys
pyelonephritis and urosepsis are examples of ____
upper UTIs
more than 80% of UTIs are caused by ____
e. coli
the most common reason for hospital-related UTIs is
CAUTIs
the 5 main risk factors for UTIs are
(1) reduced immunity
(2) indwelling foley
(3) female
(4) menopause
(5) low estrogen
name at least 3 ways we can prevent UTIs
(1) ask: Is catheter needed?
(2) fluid intake of 2-3 L/day
(3) decrease stress
(4) peri hygiene
(5) empty bladder pre- and post-intercourse
(6) wear cotton and loose-fitting underwear
the 4 ways to prevent CAUTI are:
(1) HH
(2) appropriate indication only
(3) sterile technique / closed system
(4) unobstructed flow
cardinal s/s of a UTI include
(1) frequency
(2) dysuria
(3) urgency
s/s of complicated cystitis include
(1) fever
(2) chills
(3) malaise
(4) N/V
(5) flank pain
s/s of UTI in older adults include
(1) confusion
(2) fatigue
(3) delirium
(4) decreased function
(5) incontinence or falls
what are the typical VS in someone with a UTI?
(1) fever
(2) increased HR
(3) low BP
(4) increased RR
how do we diagnose a UTI?
(1) clean catch urine specimen
(2) serum WBC with differential
(3) CT
(4) H&P with labs
(5) cytoscopy
nitrofurantoin, trimethoprim, and fosfomycin are ____
first-line antibiotics for UTI
3 comfort measures for pain of a UTI include
(1) analgesics
(2) sitz baths 2-3x/day
(3) avoid cranberry juice
the 2 classes of drugs used to treat UTIs are
(1) antibiotics
(2) antispasmodics
UTI antibiotics nursing considerations
(1) complete the course
(2) increased sun sensitivity
UTI abx side effects
(1) diarrhea
(2) allergic reactions
antispasmodics example
phenazopyridine
antispasmodics action (UTI)
decrease bladder spasms and promote bladder emptying
antispasmodics / phenazopyridine nursing considerations
(1) take with food
(2) urine may be orange / red
immunologic defense against tissue injury, infection, or allergy
inflammation
elevated levels of nonspecific markers, such as CRP and ESR, are indicators of ___
chronic inflammation
swelling, pain, heat, and loss of function are signs of which stage of inflammation?
stage 1
inflammatory process due to activated pancreatic enzymes auto-digesting the pancreas, ranging from mild to necrotizing hemorrhagic
acute pancreatitis
progressive, destructive disease of inflammation and fibrosis of the pancreas
chronic pancreatitis
the primary cause of chronic pancreatitis is ____
alcohol use / abuse
name at least 3 risk factors for pancreatitis
(1) alcohol use
(2) biliary tract disease
(3) GI surgery
(4) kidney failure or transplant
(5) trauma
(6) genetic predisposition
(7) penetrating ulcer
(8) cigarette smoking
sudden onset of severe, boring pain is a sign of ____
pancreatitis
describe the pain associated with pancreatitis
(1) epigastric
(2) radiates to back, left flank, or shoulder
(3) worse when lying down
(4) may worsen with eating
besides pain, name at least 3 s/s of pancreatitis
(1) N/V
(2) weight loss
(3) generalized jaundice
(4) absent or decreased BS
(5) warm, moist skin
(6) fruity breath
(7) ascites
(8) tetany
pain in pancreatitis can be relieved with ____
fetal position or sitting
name at least 3 complications associated with pancreatitis
(1) hypovolemia
(2) pancreatic infection
(3) T1DM
(4) left lung effusion and atelectasis
(5) coagulation defects
(6) multi-system organ failure
describe lab results associated with pancreatitis
(1) increased blood amylase
(2) increased WBC
(3) increased glucose
(4) decreased platelets
(5) decreased Ca and Mg
(6) elevated erythrocyte sedimentation rate
describe feeding for someone with pancreatitis
(1) NPO until pain-free
(2) enteral or parenteral feedings
(3) bland, high-protein, low-fat diet when resumed
(4) no stimulants
(5) NGT for decompression
for which condition should you monitor blood glucose and administer insulin if needed?
pancreatitis (damage to the beta cells potentially)
name the 6 meds used for pancreatitis
(1) morphine/hydromorphone
(2) ketorolac (NSAID)
(3) imipenem (abx)
(4) cimitidine (histamine receptor antag)
(5) omeprazole (proton pump inhibitor)
(6) pancrelipase (pancreatic enzymes)
ketorolac indication
mild to moderate pain in pancreatitis
imipenem indication
acute necrotizing pancreatitis
what should you monitor for with imipenem?
(1) evidence of infection
(2) seizures
cimetidine indication
to decrease gastric acid secretions in pancreatitis
cimetidine nursing considerations
take 1 hour before or 1 hour after antacid
omeprazole indication
to decrease gastric acid secretions in pancreatitis
omeprazole nursing moniotring
monitor for hypomagnesemia
pancrelipase indication
aid with digestion of fats and proteins when taken with meals and snacks
pancrelipase nursing considerations / education
(1) monitor and report persistent adverse effects
(2) you can sprinkle the med on non-protein foods
(3) drink a full glass of water following
(4) wipe lips and rinse mouth
(5) take after antacid or histamine receptor antag
(6) take with every meal and snack
meperidine is discouraged in pancreatitis d/t the risk of _____, especially in older adults
siezures
form of ventilation for patients with severe impairment of gas exchange; providing support until the underlying issue is resolved
mechanical ventilation
the main reasons for mechanical ventilation are
(1) hypoxic failure (too little O2)
(2) hypercapnic failure (too much CO2)
(3) mix of both
how much volume we take in with each breath is ____
minute ventilation
T/F: Ventilators will improve a chronic, end-stage pathology
False - they will NOT
name the nursing priorities when caring for a patient on a ventilator
(1) maintain patent airway
(2) assess patient first, ventilator second
(3) HOB 30 degrees
(4) monitor cuff pressure (RTs)
explain the DOPE acronym for assessing patients on mechanical ventilation
D - Dislodgement
O - Obstruction
P - Pneumothorax
E - Equipment
the 3 priorities for ostomy care are
(1) healthy stoma and peristomal
(2) F&E balance
(3) psychosocial support
___ is at the ileum and located at the RLQ
ileostomy
initial output can be up to 2 L/day for which type of ostomy?
ileostomy
output in a ____ will be green, loose, and odorless
ileostomy
stool from a ____ is irritating to the skin
ileostomy
___ is at the end of the large intestine
colostomy
what are the two diets for ileostomy vs. colostomy?
ileostomy - low-residue diet
colostomy - regular diet
colostomy higher in the colon will produce ____ output
more liquid
colostomy lower in the colon will produce ____ output
more formed
describe attributes of a healthy stoma
(1) red/pink
(2) moist
(3) protrudes 1-3 cm
describe a normal stoma immediately post-op
(1) edematous
(2) small bleeding is expected
(3) stool in 2-3 days
describe attributes of an unhealthy stoma
(1) dark red / purple / black
(2) dry means ischemia
(3) heavy bleeding
notify the surgeon immediately if you see ___ in a stoma
heavy bleeding
healthy peristomal will be ___
intact and free of redness
unhealthy peristomal will be ___
reddened, painful, moist, itchy
how do you prevent an unhealthy peristomal?
(1) cleanse and dry
(2) ensure good secure fit with 1/8” larger than stoma
which types of foods should patients avoid initially with an ostomy?
(1) stringy veggies
(2) popcorn
(3) fresh tomatoes
name 4 odor-producing foods to educate a patient on with an ostomy
(1) broccoli
(2) cabbage
(3) corn
(4) fish
which psychosocial challenge can patients with a stoma face?
impaired body image
___ is used for short-term iHD
AV graft
the downside to an AV graft is ____
plastic has a higer risk of infection
both AV graft and HD line have risk for ___
infection
which type of dialysis is used in the ICU and can pull a significant amount of fluid?
CRRT
the 5 cardinal signs of inflammation are
redness
heat
pain
swelling
loss of function
give ___ to manage adrenal insufficiency in sepsis
corticosteroids
what is the first choice blood replacement for poor clotting?
platelets
urine specific gravity is ____ in AKI and ____ in CKD
high; low
____ is an early sign of shock
increased HR / tachycardia
SIRS criteria
(1) temp <36 or >38
(2) tachycardia >90
(3) RR >20
(4) WBC <4000 or >12000 or WB Neutrophils >10%
(5) PaCO2 <32
Sepsis is
SIRS with confirmed or suspected infection
Severe sepsis requires ____ to maintain MAP >65
vasopressors
serum lactate >2 mmol/L despite fluid resuscitation is
severe sepsis
