Final Exam Flashcards
Stimuli that induce nausea and vomiting
Distention of stomach
Torsion or trauma to ovaries, testes, uterus, bladder, or kidneys
Activation of chemoreceptor trigger zone
What neurons are stimulated to induce N/V?
Neurons in the medulla oblongata
Most effective drug for N/V
Serotonin receptor agonists (ondasteron, zofran)
What can be given with ondasteron to increase its effectiveness
Dexamethasone
GERD
Reflux of gastric acid and Pepsi from stomach to esophagus
Caused by relaxation of LES
Treatment for GERD
Metoclopramide
PUD
Erosion of ulcer in upper GI tract
Cause of PUD
H. Pylori NSAIDS Pepsi Stress Smoking
Treatment of PUD
Amoxicillan, tetracycline, metronazole
Ulcerative colitis
Large intestine
Large continuous lesions
Clinical manifestations of ulcerative colitis
Inflammation of the rectum and colon
Diarrhea 4x a day
Bloody stools
Treatment for ulcerative colitis
Sulfasalazine
Gold standard for ulcerative colitis
Proctocolectomy with ileo-anal anastomosis
Internal patch
Chron’s disease
Small and large intestine
Rarely involves rectum
Patchy
Clinical manifestations of Crohn’s disease
Malabsorption of B12, folic acid, vitamin D (may have to use TPN)
Treatment for Crohn’s disease
Smaller meal
Eliminate triggers
Treat symptoms
Smoking cessation
Sulfazaline (azulfidine)
Anti inflammatory used to treat UC and RA
Sucralfate (carafate)
Creates a barrier against acid and pepsin
Metoclopramide (reglan)
Prokinetic - blocks dopa and serotonin receptors
Decrease nausea and increased motility
Adverse effects of metoclopramide
Sedation
On the BEERS list
When should you take metoclopramide
30 minutes before each meal and at bed time
Ondasteron (zofran)
Most effective drug to treat nausea
Blocks receptors in brain and gut
ADR for ondasteron
Lengthens QT interval - dysrythmias
Dexamethasone
Steroid that treats inflammation
Promethazine
Antihistamine
Control pain, nausea, vomiting
Can cause necrosis!
Metamucil
Bulk forming, give PO with lots of water for obstruction
Swell in water to form gel softening the stool
Docusate
Stool softener
Doesn’t allow water to be reabsorbed from stool in large bowel
Docusate should not be used in which patients
Pts on q sodium restricted diet
Lactulose
Non digestible sugar compound used to treat chronic constipation and hepatic encephalopathy
Removes ammonia
How to treat elevated ammonia
Lactulose
PEG
Miralax
Bowel cleansing solution that contains PEG plus electrolytes
Cleans bowel in short amount of time
Bisacodyl
Stimulates large bowel motility to increase H2 and electrolytes into instestine
What decreases absorption of bisacodyl
Antacids and milk
When should you take bisacodyl
Bedtime
Magnesium citrate
Osmotic laxative
Caution in renal and heart failure
Liver cirrhosis
Irreversible inflammatory, fibrotic liver disease
Liver failure commonly associated
Liver is hard or firm when palpated
Lab values for cirrhosis
Elevated AST/ALT, bilirubin, alkaline phosphatase
Decreased albumin
ALT normal range
7-55
ALAST normal range
8-48
Ascites
Accumulation of fluid in the peritoneal cavity
Most common factor is liver cirrhosis
What causes ascites
Portal HTN –> low oncotic pressure –> leakage of fluid into peritoneal cavity
How can ascites cause sepsis
Increased capillary permeability can promote translocation of GI bacteria into peritoneal space = peritonitis –> sepsis
Hepatic encephalopathy
Neurological syndrome (impaired cerebral fxn, asterixis, EEG changes
What causes hepatic encephalopathy and what can be used to treat
Accumulation of toxins in blood which affect brain: particularly ammonia
Remove ammonia with lactulose
AST/ALT levels for viral liver failure
ALT higher than AST
AST/ALT for alcoholic liver failure
AST higher than ALT
Ammonia normal level
15-45
Pancreatitis
Inflammation of pancreas which causes digestive enzymes in pancreas to back up and digest itself
Labs associated with pancreatitis
Increased amylase, lipase, glucose
Decreased Ca and Mg
Increased bilirubin, ALT, WBC
Treatment for pancreatitis
Stop autodigestion Narcotic for pain (fetanyl) NPO to rest but IV fluid H2 blockers
Acute pancreatitis
Epigastric, mid-abdominal pain that is constant, can be severe and incapacitating
Can lead to paralytic ileus
S/S of acute pancreatitis
Fever, elevated WBC, abdominal distention (fluid in abdominal cavity)
Major changes in electrolytes especially calcium
Chronic pancreatitis
Most common with alcohol use
Cysts form in pancreas
Clinical manifestations of chronic pancreatitis
Intermittent abdominal pain and weight loss
Ascites
Increases risk for pancreatic cancer
What may need to be replaced in chronic pancreatitis
Pancreatic enzymes (amylase, lipase)
Amylase normal range
23-85
Lipase normal range
0-160
What causes increased amylase
Pancreatic cell injury
What causes elevated lipase
Pancreatic cell injury
What could cause abnormal glucose
Pancreatic cell injury, resulting in impaired carbohydrate metabolism, decreased insulin release
What causes decreased calcium
Fatty acids combined with calcium seen in fat necrosis
What causes decreased Mg
Fatty acids combined with calcium, seen in fat necrosis
What causes elevated bilirubin
Hepato-biliary obstructive process
What causes elevated ALT
Hepato-biliary involvement
What causes elevated WBC
Inflammatory response
What are gall stones made up if
Cholesterol
When giving IV promethazine, why must you check IV site
IV site needs to be patient because promethazine can cause necrosis in your hands
Infiltration will cause major tissue damage
What drug is used most frequently in diabetics for gastroparesis
Metaclopramide
What drug decreases the immune response
Sulfasalazine
Key manifestation of SLE
Butterfly rash
Treatment of SLE
Immunosuppressive medications and steroids
Gout
Disruption of uric acid production or excretion
Uric acid level high enough to crystallize in connective tissue throughout body
Gouty arthritis
When crystals are in synovial fluid
Uric acid normal level
2.6-6
What does increased uric acid cause risk for
Kidney stones
Limit what foods when you have gout
Foods high in purines
Rheumatoid arthritis
Inflammatory, autoimmune joint disease
Effects connective tissues and joints
Manifestations of RA
Morning stiffness lasts > 1 hr
Arthritis > 3 joints
Arthritis of hand joints
Rheumatoid nodules
Treatment of RA
Methotrexate Sulfasalazine Enetarcept Rituximab Azathioprine Cyclosporine
Fibromyalgia
Chronic widespread diffuse joint pain, fatigue and tender points
Manifestations of fibromyalgia
Prominent symptom is diffuse, chronic pain that is burning or gnawing in nature
Absence of inflammation
Ankylosing spondylitis (AS)
Inflammatory joint disease of the spine
Systemic, immune inflammatory disease
What causes AS
Begins with inflammation of cartilage in vertebrae and SI joint
Inflammatory cells infiltrate and erode fibrocartilage
As repair begins, scar tissue ossified and calcified and the joint eventually fuses
Manifestations of AS
Low back pain
Lordosis
Kyphosis
Treatment of AS
Methotrexate, enetarcept, rituximab, azathioprine, cyclosporine
Osteomalacia
Deficiency of vitamin D
Ca can’t go into bone structure without vitamin D - soft bones
What gives bone its tensile strength
Collagen
Use NSAIDS with caution in what patients
Renal patients
Methotrexate is used for what patients
Cancer Autoimmune diseases (RA)
Mechanism of action for methotrexate
Interferes with folate metabolism - death to fast producing cells
Nursing actions for methotrexate
Monitor CBC
Instruct patient to take folate daily
What is azathioprine used for
Kidney transplants
RA
Chron’s disease
UC
Mechanism of action for azathioprine
Immunosuppressant
Nursing actions for azathioprine
Monitor CBC’s (pay attention to low WBC)
Allopurinol is used to treat
Gout
Mechanism of action for allopurinol
Decreases the amount of uric acid the body makes
ADR for allopurinol
Joint swelling
Rash
Nursing actions for allopurinol
Instruct pt to drink plenty of fluids (3L/day)
What does colchicine treat
Gout
ADR for etanercept
Headache Upper respiratory infection Injection site reaction Infections (esp TB and fungus) Malignancies
Method of action for etanercept
Immunosuppressant
Delays progression of joint damage
Nursing actions for etanercept
Nephrotoxic (monitor Cr and BUN)
Monitor CBC
ADR for colchicine
N/V/D Agranulocytosis Leukopenia Thrombocytopenia Aplastic anemia
Nursing action for colchicine
Monitor CBC
Sprain
Tear or injury to ligament
Strain
Tear or injury to tendon “T”
What is silver sulfadiazine used for
Prevent and treat wound infections in patients with serious burns
Stops the growth of bacteria
Nursing action for silver sulfadiazine
Continue to give medication even if patient has leukopenia
Normal WBC range
5000-10000
Tretinoin (Retin A) used for
Retinoid derivative of vitamin A (cream) used to treat acne and fine wrinkles
Nursing actions for tretinoin
Increased sensitivity to sun (wear SPF 15 daily)
Causes reddened raw skin
Dry skin
Isotrenitoin is used for
Severe acne
Decreases sebum
Inflammation
Nursing action for isotrenitoin
Teratogenic: pregnancy is absolute contraindication for use –> iPLEDGE
Assess for rash
Risk for behavioral changes
Mild acne
Open comedones are most common
Severe acne
Characterized by abscesses and inflammatory cysts
Most common cancer type
Basal cell carcinoma
Second most common skin cancer
Squamous cell carcinoma
What can actinic keratosis turn into
Squamous cell carcinoma
What cancer is most likely to metastasize
Malignant melanoma
ABCDE
Asymmetry, border, color, diameter, evolving
Primary prevention for skin cancer
Sunscreen and limit UV radiation
Cells responsible for immunity in skin
Langerhans cells
Cellulitis
Infection of the dermis and hypodermis
1st degree burn
Epidermis only (superficial)
Sunburn without blisters
Heals 3-5 days
2nd degree burn
Include superficial and deep partial thickness
Superficial 2nd degree burn
Involve blisters and the tactile and pain sensors remain intact
Healing 3 to 4 weeks
Wound care extremely painful
Deep partial thickness 2nd degree burn
Involves entire dermis; leaves follicles and sweat glands intact
Healing takes several weeks
Can progress to third degree burn over several days
3rd degree burn
Destruction of dermis and underlying SQ tissue
Generally no pain because nerves have been destroyed
4th degree burn
Destruction of dermis, SQ, tendons, muscle, and bones
Black
Will not heal
What is used to estimate size of burns
Rule of 9’s
TBSA - total body surface area
Describe fluid loss in burns
Fluid loss is 5 to 10 times greater in damaged skin than in undamaged skin
Edema happens rapidly
Sodium leaking
Treatment for burns
Fluids (isotonic, LR)
Amount depends on pt weight and % of body surface burned
For first 24 hours >1000 mL/hr given
ABCDE for burns
Airway, breathing, circulation, disability, exposure/environment
What does increased capillary permeability lead to in burns
Vasodilation –> lowers BP
What does hypovolemia cause in burn patients
Hyperviscosity –> increased Hgb –> clumping up of RBC’s –> platelets because of decreased fluid volume –> chunky blood
What does tissue ischemia cause in burn patients
Acidosis –> decreased cardiac output –> lowers BP more
