Final Exam Flashcards
1
Q
Stimuli that induce nausea and vomiting
A
Distention of stomach
Torsion or trauma to ovaries, testes, uterus, bladder, or kidneys
Activation of chemoreceptor trigger zone
2
Q
What neurons are stimulated to induce N/V?
A
Neurons in the medulla oblongata
3
Q
Most effective drug for N/V
A
Serotonin receptor agonists (ondasteron, zofran)
4
Q
What can be given with ondasteron to increase its effectiveness
A
Dexamethasone
5
Q
GERD
A
Reflux of gastric acid and Pepsi from stomach to esophagus
Caused by relaxation of LES
6
Q
Treatment for GERD
A
Metoclopramide
7
Q
PUD
A
Erosion of ulcer in upper GI tract
8
Q
Cause of PUD
A
H. Pylori NSAIDS Pepsi Stress Smoking
9
Q
Treatment of PUD
A
Amoxicillan, tetracycline, metronazole
10
Q
Ulcerative colitis
A
Large intestine
Large continuous lesions
11
Q
Clinical manifestations of ulcerative colitis
A
Inflammation of the rectum and colon
Diarrhea 4x a day
Bloody stools
12
Q
Treatment for ulcerative colitis
A
Sulfasalazine
13
Q
Gold standard for ulcerative colitis
A
Proctocolectomy with ileo-anal anastomosis
Internal patch
14
Q
Chron’s disease
A
Small and large intestine
Rarely involves rectum
Patchy
15
Q
Clinical manifestations of Crohn’s disease
A
Malabsorption of B12, folic acid, vitamin D (may have to use TPN)
16
Q
Treatment for Crohn’s disease
A
Smaller meal
Eliminate triggers
Treat symptoms
Smoking cessation
17
Q
Sulfazaline (azulfidine)
A
Anti inflammatory used to treat UC and RA
18
Q
Sucralfate (carafate)
A
Creates a barrier against acid and pepsin
19
Q
Metoclopramide (reglan)
A
Prokinetic - blocks dopa and serotonin receptors
Decrease nausea and increased motility
20
Q
Adverse effects of metoclopramide
A
Sedation
On the BEERS list
21
Q
When should you take metoclopramide
A
30 minutes before each meal and at bed time
22
Q
Ondasteron (zofran)
A
Most effective drug to treat nausea
Blocks receptors in brain and gut
23
Q
ADR for ondasteron
A
Lengthens QT interval - dysrythmias
24
Q
Dexamethasone
A
Steroid that treats inflammation
25
Promethazine
Antihistamine
Control pain, nausea, vomiting
Can cause necrosis!
26
Metamucil
Bulk forming, give PO with lots of water for obstruction
| Swell in water to form gel softening the stool
27
Docusate
Stool softener
| Doesn't allow water to be reabsorbed from stool in large bowel
28
Docusate should not be used in which patients
Pts on q sodium restricted diet
29
Lactulose
Non digestible sugar compound used to treat chronic constipation and hepatic encephalopathy
Removes ammonia
30
How to treat elevated ammonia
Lactulose
31
PEG
Miralax
Bowel cleansing solution that contains PEG plus electrolytes
Cleans bowel in short amount of time
32
Bisacodyl
Stimulates large bowel motility to increase H2 and electrolytes into instestine
33
What decreases absorption of bisacodyl
Antacids and milk
34
When should you take bisacodyl
Bedtime
35
Magnesium citrate
Osmotic laxative
| Caution in renal and heart failure
36
Liver cirrhosis
Irreversible inflammatory, fibrotic liver disease
Liver failure commonly associated
Liver is hard or firm when palpated
37
Lab values for cirrhosis
Elevated AST/ALT, bilirubin, alkaline phosphatase
| Decreased albumin
38
ALT normal range
7-55
39
ALAST normal range
8-48
40
Ascites
Accumulation of fluid in the peritoneal cavity
| Most common factor is liver cirrhosis
41
What causes ascites
Portal HTN --> low oncotic pressure --> leakage of fluid into peritoneal cavity
42
How can ascites cause sepsis
Increased capillary permeability can promote translocation of GI bacteria into peritoneal space = peritonitis --> sepsis
43
Hepatic encephalopathy
Neurological syndrome (impaired cerebral fxn, asterixis, EEG changes
44
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
45
AST/ALT levels for viral liver failure
ALT higher than AST
46
AST/ALT for alcoholic liver failure
AST higher than ALT
47
Ammonia normal level
15-45
48
Pancreatitis
Inflammation of pancreas which causes digestive enzymes in pancreas to back up and digest itself
49
Labs associated with pancreatitis
Increased amylase, lipase, glucose
Decreased Ca and Mg
Increased bilirubin, ALT, WBC
50
Treatment for pancreatitis
```
Stop autodigestion
Narcotic for pain (fetanyl)
NPO to rest but
IV fluid
H2 blockers
```
51
Acute pancreatitis
Epigastric, mid-abdominal pain that is constant, can be severe and incapacitating
Can lead to paralytic ileus
52
S/S of acute pancreatitis
Fever, elevated WBC, abdominal distention (fluid in abdominal cavity)
Major changes in electrolytes especially calcium
53
Chronic pancreatitis
Most common with alcohol use
| Cysts form in pancreas
54
Clinical manifestations of chronic pancreatitis
Intermittent abdominal pain and weight loss
Ascites
Increases risk for pancreatic cancer
55
What may need to be replaced in chronic pancreatitis
Pancreatic enzymes (amylase, lipase)
56
Amylase normal range
23-85
57
Lipase normal range
0-160
58
What causes increased amylase
Pancreatic cell injury
59
What causes elevated lipase
Pancreatic cell injury
60
What could cause abnormal glucose
Pancreatic cell injury, resulting in impaired carbohydrate metabolism, decreased insulin release
61
What causes decreased calcium
Fatty acids combined with calcium seen in fat necrosis
62
What causes decreased Mg
Fatty acids combined with calcium, seen in fat necrosis
63
What causes elevated bilirubin
Hepato-biliary obstructive process
64
What causes elevated ALT
Hepato-biliary involvement
65
What causes elevated WBC
Inflammatory response
66
What are gall stones made up if
Cholesterol
67
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
68
What drug is used most frequently in diabetics for gastroparesis
Metaclopramide
69
What drug decreases the immune response
Sulfasalazine
70
Key manifestation of SLE
Butterfly rash
71
Treatment of SLE
Immunosuppressive medications and steroids
72
Gout
Disruption of uric acid production or excretion
| Uric acid level high enough to crystallize in connective tissue throughout body
73
Gouty arthritis
When crystals are in synovial fluid
74
Uric acid normal level
2.6-6
75
What does increased uric acid cause risk for
Kidney stones
76
Limit what foods when you have gout
Foods high in purines
77
Rheumatoid arthritis
Inflammatory, autoimmune joint disease
| Effects connective tissues and joints
78
Manifestations of RA
Morning stiffness lasts > 1 hr
Arthritis > 3 joints
Arthritis of hand joints
Rheumatoid nodules
79
Treatment of RA
```
Methotrexate
Sulfasalazine
Enetarcept
Rituximab
Azathioprine
Cyclosporine
```
80
Fibromyalgia
Chronic widespread diffuse joint pain, fatigue and tender points
81
Manifestations of fibromyalgia
Prominent symptom is diffuse, chronic pain that is burning or gnawing in nature
Absence of inflammation
82
Ankylosing spondylitis (AS)
Inflammatory joint disease of the spine
| Systemic, immune inflammatory disease
83
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
84
Manifestations of AS
Low back pain
Lordosis
Kyphosis
85
Treatment of AS
Methotrexate, enetarcept, rituximab, azathioprine, cyclosporine
86
Osteomalacia
Deficiency of vitamin D
| Ca can't go into bone structure without vitamin D - soft bones
87
What gives bone its tensile strength
Collagen
88
Use NSAIDS with caution in what patients
Renal patients
89
Methotrexate is used for what patients
```
Cancer
Autoimmune diseases (RA)
```
90
Mechanism of action for methotrexate
Interferes with folate metabolism - death to fast producing cells
91
Nursing actions for methotrexate
Monitor CBC
| Instruct patient to take folate daily
92
What is azathioprine used for
Kidney transplants
RA
Chron's disease
UC
93
Mechanism of action for azathioprine
Immunosuppressant
94
Nursing actions for azathioprine
Monitor CBC's (pay attention to low WBC)
95
Allopurinol is used to treat
Gout
96
Mechanism of action for allopurinol
Decreases the amount of uric acid the body makes
97
ADR for allopurinol
Joint swelling
| Rash
98
Nursing actions for allopurinol
Instruct pt to drink plenty of fluids (3L/day)
99
What does colchicine treat
Gout
100
ADR for etanercept
```
Headache
Upper respiratory infection
Injection site reaction
Infections (esp TB and fungus)
Malignancies
```
101
Method of action for etanercept
Immunosuppressant
| Delays progression of joint damage
102
Nursing actions for etanercept
Nephrotoxic (monitor Cr and BUN)
| Monitor CBC
103
ADR for colchicine
```
N/V/D
Agranulocytosis
Leukopenia
Thrombocytopenia
Aplastic anemia
```
104
Nursing action for colchicine
Monitor CBC
105
Sprain
Tear or injury to ligament
106
Strain
Tear or injury to tendon "T"
107
What is silver sulfadiazine used for
Prevent and treat wound infections in patients with serious burns
Stops the growth of bacteria
108
Nursing action for silver sulfadiazine
Continue to give medication even if patient has leukopenia
109
Normal WBC range
5000-10000
110
Tretinoin (Retin A) used for
Retinoid derivative of vitamin A (cream) used to treat acne and fine wrinkles
111
Nursing actions for tretinoin
Increased sensitivity to sun (wear SPF 15 daily)
Causes reddened raw skin
Dry skin
112
Isotrenitoin is used for
Severe acne
Decreases sebum
Inflammation
113
Nursing action for isotrenitoin
Teratogenic: pregnancy is absolute contraindication for use --> iPLEDGE
Assess for rash
Risk for behavioral changes
114
Mild acne
Open comedones are most common
115
Severe acne
Characterized by abscesses and inflammatory cysts
116
Most common cancer type
Basal cell carcinoma
117
Second most common skin cancer
Squamous cell carcinoma
118
What can actinic keratosis turn into
Squamous cell carcinoma
119
What cancer is most likely to metastasize
Malignant melanoma
120
ABCDE
Asymmetry, border, color, diameter, evolving
121
Primary prevention for skin cancer
Sunscreen and limit UV radiation
122
Cells responsible for immunity in skin
Langerhans cells
123
Cellulitis
Infection of the dermis and hypodermis
124
1st degree burn
Epidermis only (superficial)
Sunburn without blisters
Heals 3-5 days
125
2nd degree burn
Include superficial and deep partial thickness
126
Superficial 2nd degree burn
Involve blisters and the tactile and pain sensors remain intact
Healing 3 to 4 weeks
Wound care extremely painful
127
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
128
3rd degree burn
Destruction of dermis and underlying SQ tissue
| Generally no pain because nerves have been destroyed
129
4th degree burn
Destruction of dermis, SQ, tendons, muscle, and bones
Black
Will not heal
130
What is used to estimate size of burns
Rule of 9's
| TBSA - total body surface area
131
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
132
Treatment for burns
Fluids (isotonic, LR)
Amount depends on pt weight and % of body surface burned
For first 24 hours >1000 mL/hr given
133
ABCDE for burns
Airway, breathing, circulation, disability, exposure/environment
134
What does increased capillary permeability lead to in burns
Vasodilation --> lowers BP
135
What does hypovolemia cause in burn patients
Hyperviscosity --> increased Hgb --> clumping up of RBC's --> platelets because of decreased fluid volume --> chunky blood
136
What does tissue ischemia cause in burn patients
Acidosis --> decreased cardiac output --> lowers BP more
