EXAM 3: Units 5 and 6 Flashcards
Prevention of the initial occurrence of disease or injury
Primary prevention
Early detection and treatment of disease with the goal of limiting severity and adverse events
Secondary prevention
Reducing the limitations of disability and promoting rehabilitation following health alterations
Tertiary prevention
Initial phase of care before surgery where physical and psychological preparations are made for the patient
Preoperative phase
Time period from which patient is moved to the OR table to transfer to recovery or PACU
Intraoperative phase
Final phase immediately after surgery
Postoperative phase
________ are double checked as a safety consideration prior to a surgical procedure
Allergies
2 safety considerations according to the National Patient Safety Goals for Surgery (preventing 2 things)
Preventing wrong site surgery
Preventing post-op infection
Prevents conduction of pain impulses by affecting both the motor and sensory nerves at the surgical site
Local anesthesia
Causes a temporary loss of feeling in an area of the body
Regional anesthesia
The use of drugs or inhalants to suppress the nervous system
general anesthesia
Permits thew client to remain relaxed and calm so they can follow commands without pain or anxiety
Moderate or Conscious sedation
In the post-op phase, what is a priority?
Maintaining a patent airway
In the post-op phase, focus is on these two things
Safety and physiologic systems
During the post-op phase, vitals should be monitored on this frequency
Every 5-15 minutes for the first hour, then every 4 hours for the next 24 hours
this is encouraged to promote deep breathing and coughing post-operatively
Incentive Spirometry
Tool to assess how well a patient is recovering after anesthesia
Aldrete Scoring System
If antibiotics are prescribed post-op, they should be given on this regimen
given 1 hour prior to procedure, then d/c within 24 hours after surgery
Computerized pump connected to an IV line that can administer pain medications in small amounts by the press of a button
Pain Control Analgesia Pump (PCA Pump)
In order for the patient to be eligible for discharge, they must have an aldrete scoring of
7-10
obesity is defined as a BMI of
30 or greater
this is a strong indicator of long-term complications associated with obesitry
waist circumference (central obesity)
3 medications for obesity management (O, P, H)
Orlistat
Phentermine-topiramate
Hydrogel pill
MOA Orlistat
Inhibits the digestion of fats
MOA Phentermine-topiramate
Acts as an appetite suppressor by inducing a feeling of satiety
MOA Hydrogel pills
Expands in the stomach when in contact with water to take up space and create a feeling of fullness
Patient consideration with orlistat
Do not take the medication with foods that don’t contain fats
3 AE with orlistat
Oily stools
Flatulence
Reduced absorption of vitamins and food
Patient consideration with phentermine-topiramate
Take in the morning to prevent insomnia
The hydrogel pill is contraindicated in this patient
Hx of a surgery that has altered GI motility
2 kinds of bariatric surgeries
Restrictive and Malabsorptive
Bariatric surgery that restricts the amount of stomach volume capacity, which limits the amount of food the patient can eat at a time
Restrictive surgery
Bariatric surgery that bypasses part of the small intestine and created a decreased capacity of food absorption
Malabsorptive Surgery
2 kinds of bariatric restrictive surgeries
Gastric band
Gastric sleeve
1 kind of malabsorptive bariatric surgery
Gastric bypass
bariatric surgery that removes part of the stomach and leaves a “sleeve” to hold less food.
Is this reversible?
gastric sleeve
is not reversible
bariatric surgery that uses a band to reduce the size of the stomach
Is this reversible?
gastric band
is reversible
bariatric surgery where the upper half of the stomach is created into a small pouch and a large portion of the small intestine is bypassed, so that food will go directly from the smaller stomach to the middle part of the small intestine
Is this reversible?
Gastric Bypass
is not reversible
Post-surgery, if a client had an NG placed during surgery, the nurse should
NOT reposition it - it can disrupt sutures
Post-operatively (for bariatric surgeries) , should an NG tube be inserted?
No
Following a bariatric surgery, solid foods can be continued after this much time
6-8 weeks after surgery
3 dietary considerations following a bariatric surgery
Eat 4-6 small meals per day
Do not exceed volume limitations (usually 1C)
Wait 30 min after meals before drinking liquids
life-threatening complication that can occur after surgery where two hollow organs that are surgically connected become disconnected and leak fluid
Anastomotic leak
Someone experiencing an anastomotic leak may experience the following symptoms: x2
Back/shoulder/abdominal pain
Reslessness/tachycardia
3 bariatric surgery complications
Anastomotic leak
Dehydration
Malabsorption
Greater than 50% of lower limb losses are related to complications of which two conditions
Peripheral artery disease
Diabetes mellitus
amputation performed through a joint
disarticulation
level of amputation is determined by
presence of adequate blood flow needed for healing
sensation of pain in the location of the extremity following amputation
Phantom pain
Common condition characterized by gastric contents and enzyme backflow in the esophagus
Gastroesophageal Reflux Disease (GERD)
4 kinds of medications that can be used to treat GERD
Antacids
Proton pump inhibitors
H2-receptor blockers
Prokinetics (increase motility)
condition where the lower lining of the esophagus changes from one cell type to another (similar to that of the small intestine)
Barrett’s esophagus
erosion of the mucosal lining of the stomach, esophagus, and/or duodenum
Peptic Ulcer Disease (PUD)
PUD is mostly caused by
H. pylori infection
PUD may be caused also by this class of medication
NSAIDs
discomfort in the upper abdomen characterized by heartburn, bloating, and nausea
Dyspepsia
black tarry stool that can indicate bleeding in the upper GI tract
melena
Bloody emesis
hematemesis
this testing provides a definitive diagnosis of ulcers
Esophagogastroduodenoscopy (EGD)
5 medications that can be used for PUD
PPIs
Antacids
Antibiotics (H. pylori)
H2 receptor blockers
Mucosal protectants (sucralfate)
All or part of the stomach is removed
Gastrectomy
Lower portion of the stomach is removed
Antrectomy
Lower portion of the stomach is excised and then anastomosed to the jejunum, and the remainig duodenum is surgically closed
Gastrojejunostomy
Vagus nerve is cut to decrease gastric acid production
Vagotomy
The opening between the stomach and small intestine is enlarged to increase the rate of gastric emptying
Pyloroplasty
condition where a hole or tear develops in the GI tract characterized by severe epigastric pain spreading across the abdomen, rebound tenderness, and shock
Perforation
immune-mediated inflammatory disease of the small intestine (gluten sensitive)
Celiac Disease
gluten is found in these three things
Wheat
Barley
Rye
treatment for celiac disease is
a lifelong gluten-free diet
some celiac patients may present with this skin finding
a rash called dermatitis herpetiformis
disease where small pouches (diverticula) form int he wall of the large intestine
Diverticular disease
sac-like herniation of the bowel lining
diverticulum
the presence of multiple diverticula without inflammation or symptoms
diverticulosis
inflammation and infection of the bowel mucosa caused by bacteria, food, or fecal matter trapped in one or more diverticula
diverticulitis
patient should avoid this while treating diverticulitis
seeds or indigestible material
Inflammation primarily in the rectum and rectosigmoid colon
Ulcerative colitis
Inflammation and ulceration of the GI tract often at the distal ileum
Crohn’s Disease
Ulcerative colitis can involve the
entire length of the colon
Crohn’s Disease can involve the
entire length of the GI tract
In Crohn’s Disease, which bowel layers are involved and how do these lesions characterized?
ALL layers of the bowel are involved and lesions are sporadic
Abdominal pain/cramping will often reside in this abdominal quadrant with Ulcerative Colitis
LLQ
Difference between stool presentation in Ulcerative Colitis and Crohn’s Disease
Blood can be in the stool with ulcerative colitis, whereas in Crohn’s, there normally isn’t blood
4 common findings with both ulcerative colitis and crohn’s disease
-Anorexia/weight loss
-Fever
-Abdominal distention/firmess
-High pitched bowel sounds
There are about this many loose stools per day in ulcerative colitis
~15-20 loose stools per day (diarrhea)
There are about this many loose stools per day in Crohn’s
~5 loose stools per day (diarhhea)
In lab findings for Ulcerative Colitis, which components of the blood will be elevated?
ESR
WBC
CRP
In lab findings for Ulcerative Colitis, which components of the blood will be low?
Hct
Albumin
Would occult blood be positive or negative in a patient with Ulcerative Colitis?
Positive
Why would corticosteroids be used to treat UC and CD?
To induce remission
(NOT for long-term therapy)
4 classes of medications that can be used to treat UC and CD
-Corticosteroids
-Immunosuppressants
-Antidiarrheals
-Sulfonamides
Surgical treatment option for UC
Colectomy with or w/o ileostomy
How often should a patient be weighed if they have UC or CD
1-2 times weekly
Educate a patient with UC or CD to eat this kind of dietq
High-protein
High-calorie
Low-fiber
Patients with UC or CD should avoid these two drinks
Caffeine and alcohol
Occurs when the entire colon must be removed due to disease (CD, UC)
Ileostomy
Occurs when a portion of the bowel must be removed due to disease or just requires rest for healing
Colostomy
a stoma should appear
pink and moist
empty the ostomy bag when it is this full
1/3-1/2 full
assess a patient for these 2 imbalances if they have an ileostomy or colostomy
fluid and electrolyte imbalances
Abdominal cramping with Crohn’s Disease will typically present in this abdominal quadrant
RLQ
