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Med-Surg I > Final Exam Quizlet > Flashcards

Final Exam Quizlet Flashcards

1
Q

hypovolemia

A

loss of water AND electrolytes

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2
Q

hypovolemia defining characteristics

A

confusion, combative, coma
tachycardia/pnea
irritable
dizzy, weak, fever
orthostatic hypotension
increased hct, BUN, and Na+
decreased hgb

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3
Q

hypovolemia interventions and assessments

A

monitor Na+, urine specific gravity, osmolality, vitals, I&Os, abd girth, daily weight
salt free foods
IV fluids
replace lost fluids over 48h
skin care and O2

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4
Q

hypervolemia

A

sodium and water retention

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5
Q

defining characteristics of hypervolemia

A

confusion, disoriented, convulsion, coma
increased BP
decreased BUN, hct, sodium, specific gravity
SOB, tachypnea, dyspnea, weak, crackles, pleural effusion, pulmonary edema, peripheral edema, ascites, polyuria, weight gain

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6
Q

hypervolemia interventions and assessments

A

monitor ABG, resp status, response to diuretics, rate of IV therapy, abd girth for ascites, strict I&Os, weight
restrict sodium and fluid intake, administer diuretics as prescribed, O2 therapy, elevate HOB

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7
Q

hypervolemia interventions and assessments

A

monitor ABG, resp status, response to diuretics, rate of IV therapy, abd girth for ascites, strict I&Os, weight
restrict sodium and fluid intake, administer diuretics as prescribed, O2 therapy, elevate HOB

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8
Q

resp acidosis risk factors

A

hypoventilation (COPD, PNA, atelectasis)
resp depression (barb or sedative, Guillain-barre)
resp arrest

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9
Q

resp acidosis clinical manifestations

A

neurological (coma, drowsy, disoriented)
cardio (hypotension, tachy)
resp (shallow, dyspnea, tachy, brady)
muscular (weak, tremors)
GI (N/V/D)

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10
Q

resp alkalosis risk factors

A

hyperventilation, anxiety, salicylates, disease states, mechanical overventilation, hypermetabolic states, acute hypoxia, pulmonary disease, anemia, hypotension

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11
Q

resp alkalosis clinical manifestations

A

neurologic: hyporeflexia, disoriented, weak, coma
muscular: tetany, hyperreflexia
respiratory: hyperventilation, dyspnea, tachypnea
cardiac: syncope, chest pain, EKG changes
diaphoresis

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12
Q

metabolic acidosis risk factors

A

cardiac arrest, ASA overdose, excess production of acids (DKA, lactic)
inadequate loss of acids (uremia)
excess loss of base (diarrhea)

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13
Q

metabolic acidosis clinical manifestations

A

neurologic: hyporeflexia, disoriented, weak, coma
GI: n/v/d, abdominal pain, dehydration
Cardiac: peripheral edema, weak pulse, hypotension
respiratory: hyperventilation

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14
Q

metabolic acidosis nursing interventions

A

treat underlying cause (diarrhea, DKA)
monitor K+ levels, neurologic status
provide mechanical ventilation
dialysis as ordered

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15
Q

metabolic alkalosis risk factors

A

loss of acids (vomit, excess gastric suctioning)
base or buffer imbalance (K+ deficit, excess NaHCO3 intake)
disease states (cushings, kidney)
multiple transfusions
over correction of acidosis

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16
Q

metabolic alkalosis clinical manifestations

A

neurologic: confusion, stupor, coma
GI: anorexia, nausea, vomiting
MS: weakness, tetany, paresthesia
hyperreflexia, tremors, cramps
respiratory: hypoventilation, cyanosis

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17
Q

potassium important info

A

NEVER IM OR IV PUSH/BOLUS
never on empty stomach

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18
Q

diuretics cause what

A

K+/Na+ loss

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19
Q

5 pain stimulating substances

A

histamine
bradykinin
acetylcholine
potassium
prostaglandins

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20
Q

3 pain controlling substances

A

enkephalins, endorphins, serotonin

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21
Q

acute pain

A

SYMPATHETIC nervous system responses
related to specific injury
protective pain
pt restless, anxious
goes away within 3 months
distinct starting point and cause

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22
Q

chronic pain

A

PARASYMPATHETIC
adaptation response
6 months+

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23
Q

chronic pain treatment

A

decrease time loss from work
increase quality of relationships
decrease anxiety

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24
Q

superficial pain

A

in cutaneous area
mild to moderate pain with sympathetic manifestations (rapid, shallow, respirations)

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25
Q

deep somatic pain

A

felt below the cutaneous area
both sympathetic and parasympathetic
ex. tendons, ligaments, bones, blood vessels, nerves

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26
Q

visceral pain

A

can have superficial or deep somatic pain that localized
confined to a specific area

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27
Q

referred pain

A

felt in a part of the body other than where the pain was produced
a type of visceral pain
usually originates in one organ but felt in the skin

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28
Q

intractable pain

A

severe pain

resistant to treatment and any of the usual relief measures

pt usually referred to neurologist

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29
Q

breakthrough pain

A

acute exacerbation of pain that is transitory
ex. pt given q4 hours but experiences pain in between the doses
still must be treated

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30
Q

cancer-related pain

A

progression of cancer
can be caused by treatment
acute or chronic
large dose of pain meds
not PRN, around the clock

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31
Q

adaption response

A

vitals are normal, no symptoms
only discuss pain if asked
sleepiness, shifting away or guarding, facial expressions, withdrawing from socialization

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32
Q

NSAIDS do what

A

block prostaglandins in PERIPHERY

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33
Q

acetaminophen does what

A

blocks prostaglandins in CNS

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34
Q

analgesic adjuvants

A

anticonvulsants and anti anxiety

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35
Q

pain management WHO ladder

A

mild-moderate: nonopioids like ASA, NSAIDS, paracetamol
mod-severe: mild opioids (codeine), with or without nonopioids
severe: strong opioids (morphine) with or without non opioids

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36
Q

pain meds effective within how long

A

30-60 min

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37
Q

elderly nursing responsibilities (drugs)

A

more sensitive
monitor opioid doses, titrate down
reduced sensory perception and metabolism

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38
Q

PCA

A

Patient is getting a continuous dose every hour, but is allowed to get a bolus infusion every 15 minutes if they need more relief.
- Used for cancer pain and post op pain
-Morphine/ Hydromorphone

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39
Q

cancer treatment considerations

A

biopsy
neutropenic precautions
hospice
chemo
internal radiation
chemo

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40
Q

3 kinds of biopsy

A

excision
incision (large tumor where part are removed for analysis)
needle biopsy (tissue samples from mass are aspirated)

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41
Q

neutropenic precautions

A

no flowers/fresh fruit/raw veggies
wear mask, gown, gloves
avoid crowds
keep door closed
disposable equipment used

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42
Q

hospice

A

6 months or less to live

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43
Q

chemo

A

systemic intervention
antineoplastics (kills cancer cells)
Primary, adjuvant, or neoadjuvant
Given VAD (larger veins in chest, implanted in chest, dressing changed every 48 hours), or a PICC
MONITOR NEUTROPHILS

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44
Q

chemo side effects

A

finger numbness, bone marrow suppression (MONITOR FOR 100 DAYS), n/v, anorexia, GI disturbance, alopecia, mucositis (culture lesions), stomatitis, loss of libido, impotence

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45
Q

internal radiation

A

brachytherapy
sealed/unsealed source
radioactive device in patient

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46
Q

brachytherapy

A

device in pt so radiation is in continuous contact with tumor
pt is radioactive while device is in them
strict bedrest with bathroom privileges, low residue diet, antidiarrheals, urinary catheter

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47
Q

internal radiation safety standards

A

distance, time, shielding
avoid handling if dislodged
6 feet away at all times except essential care
30 min/8 hours
give meds at same time as assessments
pt alone in room

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48
Q

internal radiation systemic side effects

A

nausea, fatigue, myelosuppression (thrombocytopenia, leukopenia, anemia)

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49
Q

internal radiation localized effects

A

stomatitis, dysgeusia (altered taste sensation), xerostomia (dry mouth)

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50
Q

cancer excision surgery

A

tumor is small and excised
removed entirely and sent to lab for examination

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51
Q

paliative surgery

A

done when cure is not possible to improve quality of life

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52
Q

microcytic anemia

A

iron deficiency

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53
Q

megaloblastic anemia

A

folic deficiency

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54
Q

pernicious anemia

A

B12 deficiency

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55
Q

hypoproliferative anemia

A

underproduction of RBCs by bone marrow

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56
Q

hemolytic anemia

A

increased destruction of RBCs
RES destroys RBCs

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57
Q

hgb levels and clini manifestations

A

mild: 10-12
asymptomatic, fatigue
moderate: 6-10
fatigue, dyspnea, palpitations, tachy, diaphoresis on exertion
severe: below 6
chronic fatigue, severe symptoms, peripheral edema

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58
Q

anemia diagnostics

A

history and physical CBC
reticulocyte count
coag screening (INR, PT, PTT)
bone marrow aspiration

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59
Q

INR/PT

A

warfarin

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60
Q

PTT

A

heparin

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61
Q

iron deficiency anemia (microcytic) risk factors

A

blood loss
hemorrhoids
menstruating and pregnant
adolescents, children, infants

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62
Q

microcytic anemia nursing care

A

diet rich in eggs, meat, leafy greens, liver (best source), vit C
minimal milk, fiber, soy, coffee, tea
supplemental iron (rinse, straws)
Z track injections
monitor for dark tarry stools (can indicate internal bleeding)
avoid antacids

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63
Q

folate deficiency anemia risk factors

A

does not affect nervous system
alcohol
seizure meds
genetics (crohns, celiac)
infants

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64
Q

megaloblastic anemia treatment

A

oral/dietary supplements (folic acid from diet, vit B12)
treat underlying condition
decrease alcohol

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65
Q

S&S of megaloblastic anemia

A

decreased appetite
irritable, fatigue, diarrhea, glossitis, pallor

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66
Q

B12 deficiency (pernicious anemia) diet

A

meat, fish, fortified cereal, tofu

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67
Q

pernicious anemia risk factors

A

decreased b12/malabsorption
ileal resection
crohn’s disease
gastrectomy
hereditary lack of intrinsic factor
vegans
autoimmune
anything harming gastric lining

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68
Q

pernicious anemia symptoms

A

slow onset
decreased mental status (peripheral neuropathy)
glossitis (beefy red tongue)
mood swings
decreased CO
decreased RBC, hgb. hct
vitiligo and greying hair

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69
Q

pernicious anemia diagnosis

A

schilling test
PO administration
small dose of radioactive vit B12
if urine is radioactive, it means they have enough B12 so it’s being excreted, which is good

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70
Q

pernicious anemia management

A

Vit B12 injections
never orally if caused by gastrectomy
cyanocobalamin (IM or nasal spray), monthly, response within 24-48 hr, within 72 hr RBC and reticulocyte count increases
iron supplements
o2 administration
blood transfusions
erythropoietin injections twice a week until iron stores are replenished

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71
Q

aplastic anemia

A

normocytic and normochromic erythrocytes (normal size and heme content, low in number)
bone marrow hypoplasia: incomplete RBC development
bone marrow aplasia: lack of RBC development
pancytopenia: BM suppression, decreased RBC, WBC, PLT

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72
Q

aplastic anemia risk factors

A

congenital
idiopathic
idiosyncratic (drug reaction)
acquired (myelotoxins)
autoimmune infections: epstein barr

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73
Q

aplastic anemia causes

A

altered stem cell: inhibits division
altered BM (replaced by fat)

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74
Q

aplastic anemia S&S

A

pancytopenia
petechia (low PLT)
purple/red spots
purpura (bleeding under skin)
retinal hemorrhage
hypoxia
anemia S&S

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75
Q

aplastic anemia care

A

immediate withdrawal of offending agent
transfusions
radiotherapy
bone marrow transplant
bone marrow aspiration/biopsy

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76
Q

TB

A

reportable, communicable, inflammatory, destructive disease
spread from person to person via inhalation of infected droplet nuclei

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77
Q

TB risk factors

A

homeless, malnutrition, overcrowded areas, health care workers, immune dysfunction, alcoholism, children under 3, elderly, certain geographic areas, men double the rate of women

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78
Q

TB microorganism characteristics

A

aerobic
acid fast
reproduces slowly in the body
destroyed by heat, sun, and pasteurization

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79
Q

TB sensitization

A

1st time individual is infected= develops a sensitivity reaction
occurs 2-10 weeks after primary infection
positive reaction to tuberculin skin tests

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80
Q

TB infected individuals

A

residual remains dormant in lungs
asymptomatic
partial destruction of most organisms can occur
may reactivate later when resistance is decreased
can be triggered by mental and physical stress, oncology, inadequate drug treatment

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81
Q

TB skin test

A

people with HIV may get false negative, contraindicated in BCG vaccine patients
reliable
appearance of a “wheal”, induration area read within 48-72 hours
10mm or more is positive reaction

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82
Q

TB converters

A

someone who develops a positive skin test, negative test converted to positive
high risk for developing TB
placed on INH preventative therapy for 6-12 months

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83
Q

quantiFERON-TB gold test

A

preferred to those with BCG
results in 24-36 hours
negative test means no latent or active TB

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84
Q

TB sputum culture

A

confirms diagnosis
3 specimen on consecutive days

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85
Q

negative TB test

A

no longer contagious
contagious until treated

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86
Q

TB patient room

A

isolated
negative pressure until negative sputum culture
wear mask for 3 weeks

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87
Q

TB management

A

treatment for 6-12 months

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88
Q

primary resistance TB

A

one or more line of anti TB agents

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89
Q

secondary (acquired) resistance

A

resistance to one or more anti TB agents and undergoing therapy

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90
Q

multi-drug resistance TB

A

resistance to 2+ agents like INH and rifampin

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91
Q

first line TB drugs

A

INH and rifampin
pyrazinamide (PZA, for active TB)
ethambutol (myambutol)

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92
Q

TB interventions

A

teach regimen and side effects, importance of compliance
prevention of spread
what to avoid with INH
high protein, high calorie, high calcium diet with iron and B6 supplements

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93
Q

5 foods to avoid with INH

A

tuna, red wine, aged cheese, soy sauce, yeast extract

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94
Q

asthma incidence, etiology, risks

A

allergy, esophageal reflux, male, genetics, elderly, urban areas, ethnicity

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95
Q

asthma clinical manifestations

A

wheezing, chest tightness, dyspnea, SOB, no wheezing if blocked, cough, tachycardia, diaphoresis, anxiety, panic, mood changes, hyperventilation

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96
Q

bronchodilators

A

increases smooth muscle relaxation
no effect on inflammation
increase fluid intake
take 5 min before other inhaled drugs
monitor HR

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97
Q

methylxanthines

A

long acting
theophylline
dilates bronchi, used when other drugs ineffective
can build up and become toxic

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98
Q

cholinergic agonists

A

intermediate acting
ipratropium

watch for increased HR

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99
Q

anti inflammatory drugs asthma

A

corticosteroids
long acting, local or systemic
pulmicort/flovent/azmacort= most common
significant S/E= delayed wound healing, personality changes, fluid retention, taper doses, rinse mouth

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100
Q

asthma complications

A

pneumonia, atelectasis, hypoxemia, respiratory acidosis, respiratory failure, emphysema, chronic hypoxia, chronic bronchitis, asthmaticus

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101
Q

COPD

A

emphysema and chronic bronchitis

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102
Q

symptoms of COPD

A

worsening breathlessness upon exertion, leads to breathlessness at rest

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103
Q

COPD etiology and risk factors

A

smoking, alpha 1-antitrypsin deficiency, air pollution, occupational exposure, infection

104
Q

clinical manifestations of COPD

A

distended neck veins, right ventricular enlargement, lower sternal pulsations, GI disturbance, weight loss, dependent edema, metabolic and resp acidosis, pulmonary hypertension, hypoxia, fatigue, weak, enlarged/tender liver, bounding pulse, warm cyanotic extremities, cough

105
Q

oxygen therapy for COPD

A

heated, humidified system
clear secretions
monitor liter flow and effectiveness with pulse ox., oxygen toxicity and oxygen induced hypoventilation, skin breakdown, anxiety

teach at home use

106
Q

COPD complications

A

pulmonary hypertension, cardiac dysrhythmias, pneumonia, atelectasis, pneumothorax, bronchospasm, RF

107
Q

emphysema

A

increased ventilatory “dead space”, hyperinflation of the lung, loss of elasticity, increased mucus, destruction of alveolar walls, alveoli collapse, spontaneous pneumothorax, chest tube for re-expansion of lung

caused by smoking, genetics, pollution

108
Q

emphysema clinical manifestations

A

severe SOB at rest
PaO2 level below 40mmHg
chronic productive cough
barrel chest
wheezing, crackles, rhonchi
diminished breath sounds
tachypnea
hypoxia
hypoxemia
hypercapnia
fatigue
anorexia

109
Q

PVD

A

stasis of blood in lower extremities from damage or obstruction (raise them)
muscle pumping action during activity is not sufficient to help pump blood to the heart

110
Q

venous insufficiency nursing care

A

thigh high stockings when awake
elevate legs above heart when sleeping (and for 4 min 4x/day)
avoid crossing legs, prolonged sitting or standing
daily walks
no warm soaks, avoid topical therapy, high cal and protein diet

111
Q

clinical manifestations PVD

A

reddish blue discoloration
muscle cramps
increased pain w ambulation
dilated superficial veins w edema
mild ankle swelling
heaviness, erythema, lipodermatosclerosis, stasis dermis/ulcers

112
Q

S&S arterial insufficiency

A

claudication numbness and tingling, decreased or absent pulses bilaterally, pale elevated leg and dusky/red when dependent, cool, absent or mild edema, dry skin, ulcers on toes and gangrene

113
Q

S&S of venous insufficiency

A

feeling of fullness with prolonged sitting or standing
difficult to find pulse
cyanotic on dependency
warm
edema present
moist skin
superficial ulcers with gangrene

114
Q

PE risk factors

A

venous stasis, HRT, fracture (fat embolus)

115
Q

PE S&S

A

chest pain
tachy
dyspnea
dry cough
blood tinged sputum
petechiae
hypotension
low grade fever

116
Q

PE treatment

A

monitor for bleeding in urine or tarry stool, teeth brushing
anticoags
complete bed rest

117
Q

HTN guidelines

A

lower SBP <140, diastolic <90
based on 2+ BP readings taken on 2+ separate occasions with HCP

118
Q

essential (primary) htn

A

no known cause
associated w obesity, smoking, family hx, sodium or alcohol, stress, ethnicity, gender

119
Q

secondary HTN

A

specific disease states (identifiable causes such as kidney disease or meds)

120
Q

malignant HTN

A

severe increase in BP with rapid progression
ages 30-50
systolic may be 200+

121
Q

pulmonary HTN

A

vasoconstriction of pulmonary arterial circulation creates high pulmonary artery BP
poor tissue perfusion, hypoxemia, may get right sided HF

122
Q

isolated systolic HTN

A

mostly seen in older adults
systolic >140, diastolic normal
more energy needed for circulation

123
Q

HTN urgency

A

high BP
no evidence of organ damage
fast acting oral agents, normalize BP within 24-48h

124
Q

HTN emergency

A

BP >180/120
damage to organs
IV vasodilators reduce BP by 25% within 1 hour
gradual reduction over 6 hours

125
Q

type 1 DM

A

insulin dependent

126
Q

S&S of type 1 DM

A

3 Ps
weight loss
fatigue
frequent infections
muscle wasting/cramps
ketosis (fruity breath)

127
Q

type 2 diabetes

A

functioning pancreas

128
Q

risks of type 2 DM

A

obesity, inactivity, heredity, sedentary lifestyle, genetics, above 50, hx of high BP, fatigue, decreased energy, frequent infections

129
Q

hypoglycemia clinical manifestations

A

glucose below 60
give OJ, honey, hard candy
JUICE, STARCH, PROTEIN
TIRED: tachy, irritable, restless, excessive hunger, diaphoresis/depression
assess glucose, urine, mental changes, N/V/D

130
Q

DKA

A

dehydration, hypovolemic shock, lactic acidosis, slow onset, fruity breath, tachy, hypotension, acidosis, high blood sugar, hyperkalemia
D: diuresis, delirium, dizzy, dehydrated
K: kussmaul/ketone breath
A: abd pain

131
Q

DKA treatment

A

dehydrate with NS, reverse shock, restore potassium, administer insulin
monitor blood sugar and urine (ketones and proteins)

132
Q

HHNS

A

only in type 2 DM
urine test + for glucose but - for ketones
no acidosis
glucose from 600-3000
give fluid and electrolytes with insulin

133
Q

rapid acting insulin times

A

onset: 5-15
peak: 30-60
duration: 2-4h

134
Q

rapid insulin examples

A

lispro (humalog), aspart (novolog), glulisine
given with meals and can be IV

135
Q

short acting insulin times

A

onset: 30-60 mins
peak: 2-3h
duration: 4-6h

30-60 min before a meal and can be IV

136
Q

intermediate insulin times

A

onset: 2-4h
Peak: 4-12h
duration: up to 12h
given after food

137
Q

intermediate insulin examples

A

novolin L and novolin N

138
Q

Long acting insulin times

A

onset: 1-6h
no peak or duration
DO NOT MIX

139
Q

diabetes and exercise

A

exercise for 20-45 min, 3x/day
complex carbs to prevent hypoglycemia

140
Q

diabetes diet

A

10-20% protein
20-30% fat (10% sat)
50-60% carbs

141
Q

DM diagnosis

A

fasting glucose >126 (NPO 8-12h)
glucose tolerance: check glucose q3h, nothing but water and the drink
postprandial: >200, check 2h after meal
HbA1c: >6.5% (goal is <7%)

142
Q

diabetes foot care

A

properly fitting, non restrictive shoes
avoid prolonged sitting, standing, crossing legs, walking barefoot, open toed shoes
inspect feet daily using a mirror
cut nails straight across after bath/shower
avoid lotion between toes, dry thoroughly

143
Q

microvascular complications of DM

A

diabetic retinopathy (control glucose and BP)
nephropathy

144
Q

neuropathic complications of DM

A

mononeuropathy
polyneuropathy
autonomic neuropathy
nerves become edematous, myelin sheath becomes damaged, nerves become damaged
feet and lower limbs become numb, ache, or throb
can cause impotence or decreased libido

145
Q

macrovascular complications of DM

A

CAD
CVD
HTN
PVD
infections from immobilized WBC, usually in mouth, feet, bladder, female genitals, causes gingivitis
high lipids when glucose is high
high bad fats

146
Q

complications of insulin administration

A

local: rash at site
systemic: hives
lipodystrophy: disturbance of fat metabolism with insulin absorption
lipoatrophy:loss of fat w dimpling
lipohypertrophy: fibro-fatty masses at site with scarring

147
Q

hyperthyroidism

A

fine tremors, heat intolerance, many loose stools daily, diaphoresis, warm moist skin (salmon color), palpitations, rapid pulse at rest
hyperactive DTR, increased appetite, insomnia, weakness, nervous, restless, emotional hyperexcitability, irritable, apprehensive, rapid speech

148
Q

nursing care of hyperthyroidism

A

monitor SE of meds, S&S of thyroid crisis, place in private room with cold temp, stimulus should be avoided

149
Q

hypothyroidism

A

subnormal temp, intolerance to cold, decreased metabolism, dry skin with course, thick, pale, carotene look, thick and brittle nails, hair thins, hypotension and bradycardia, weight gain, paresthesia of fingers, hypoventilation, expressionless face, apathy, large tongue, slow speech, drooling, large goiter

150
Q

hypothyroidism nursing care

A

provide high bulk, low calorie diet
administer cathartics/stool softeners
after replacement check for signs of hyperthyroidism
encourage med alert bracelet
prevent myxedema coma
education pt on infection reporting & importance of medication
medication effects not seen for at least 2 weeks, monitor for levothyroxine SE

151
Q

subtotal thyroidectomy

A

5/6 part of the thyroid gland is removed
prolonged remission
remaining gland is sutured to trachea

152
Q

total thyroidectomy

A

for thyroid cancer
lifelong HRT

153
Q

thyroid surgery

A

done for children, adolescents, pregnant women, who cannot tolerate PTU or those who have large goiters causing esophageal compression
risky, may cause nerve damage or hemorrhage

154
Q

preop management

A

euthyroid for 2-3 months
to decrease size and vascularity of gland
given thioamide 4-6 weeks before surgery

155
Q

postop pt teaching thyroid surgery

A

coughing and deep breathing
support neck
no talking
lifelong HRT
on empty stomach, 30 min before meals

156
Q

postop management thyroid surgery

A

monitor for hypocalcemia
airway humidification
suctioning
restrict visitors
increase cals, protein, and carbs
small, frequent meals
weight, intake and output

157
Q

thyroid storm

A

life threatening
sudden surge of large amounts of thyroid hormone in blood (abrupt)
high fever (106º), severe agitation, confusion, n/v/d, malignant exophthalmos, dyspnea, coma, vascular collapse

158
Q

cholelithiasis

A

calculi in the gallbladder
gallstones composition (pigment: 25%, cholesterol: 75%)
biliary colic with obstruction of cystic duct
stone may retreat or pass

159
Q

cholelithiasis diagnostics

A

ultrasonography, cholecystography, endoscopic retrograde cholangiopancreatography, PCT, MRI, blood test, X-ray

160
Q

cholelithiasis treatment

A

ERCP and PTC (removal of stones) and extracorporeal lithotripsy to dissolve stones
NG tube
nutrition: low fat
avoid alcohol, gas forming foods, fried foods
drug therapy: antibiotics, lipid/cholesterol lowering drugs, antispasmodics, analgesics

161
Q

cholecystectomy

A

surgical procedure to remove gallbladder

162
Q

cholelithiasis postop care

A

assess, monitor vitals, O2 sat, skin care, biliary drainage, t-tub or NG tube, pain control, I&O, encourage activity
low fat diet, ideal weight, limit pregnancies
report fever, jaundice, pruritus, dark urine, pale stools

163
Q

dumping syndrome

A

food rapidly enters jejunum
vasomotor disturbances
within 10-30 minutes after eating
vertigo, tachy, syncope, sweating, pallor, palpitations, N/D, weakness

164
Q

dumping syndrome pt teaching

A

small frequent meals
avoid drinking with meals
high protein, high fat, low carb, low fiber (dry diet)
antispasmodics
lying down after meals

165
Q

GERD

A

Backflow of gastric contents into the esophagus
incompetent LES and inflamed esophageal mucosa
mucus and saliva are protective factors

166
Q

GERD risk factors

A

unknown cause
pressure zones, weight gain, obesity, pregnancy, lying flat, spicy food, high fat foods, caffeine, carbonation, chocolate, chewing tobacco, elderly
NSAIDs and stress increase gastric acid

167
Q

clinical manifestations of GERD

A

dyspepsia
pain after activities/meals, supine position, radiates to the back of neck or jaw (confused with angina), walking
esophageal spasm/odynophagia
intermittent dysphagia
acid regurgitation
water brash
eructation
distended abdomen

168
Q

GERD diagnosis

A

barium swallow, esophagoscopy, esophageal biopsy, cytology, gastric secretions, acid tests

169
Q

medical management of GERD

A

mild- antacids, work in 30 minutes to increase gastric pH, avoid mg antacids

persistent- histamine receptor antagonists, reduce gastric secretions, take 1 hr before or after antacid

severe- cholinergic drugs (reglan) increases LES pressure and gastric emptying, taken before meals

PPIs (nexium) suppress gastric secretions

170
Q

GERD nursing interventions

A

small frequent slow meals
chew!
avoid hot or cold foods
don’t drink 2-3h before bed
elevate HOB 30
avoid tobacco, fatty, chocolate, caffeine
no strenuous activity after meals

171
Q

bowel obstruction

A

impairment of forward flow of intestinal contents
high mortality rate if not treated within 24 hours
partial or complete
mechanical (blockage) or nonmechanical (paralytic ileus)

172
Q

etiology of bowel obstruction

A

adhesions (most common), tumors, hernias, fecal impaction, strictures, narrowed blood vessels, intussusception, volvulus, ileus

173
Q

bowel obstruction assessment

A

hiccups, last BM, fever, ribbon like stools, tachycardia, bowel sounds may be absent or decreased or increased, a mass

174
Q

bowel obstruction clinical manifestations

A

abdominal cramps, fever, nausea with vomiting (may be orange or brown with fecal odor), hiccups, obstipation, partial obstruction, fluid and electrolyte imbalance

175
Q

diagnostics for bowel obstruction

A

CBC, BUN and electrolytes, elevated amylase if pancreas affected, ABG abnormal, abdominal X-rays, CT scan, colonoscopy

176
Q

bowel obstruction treatment

A

nonmechanical obstruction (NG)
mechanical obstruction (NG tube and removal of obstruction)
fluid and electrolyte replacement
pain management (avoid opioids)
antibiotics
surgery

177
Q

surgical options for bowel obstructions

A

laparotomy if the cause is unknown (to find cause), adhesions removed, bowel resection

178
Q

ulcerative colitis

A

starts at rectum and works way up, continuous, not deep, just first layer
inflamed mucosal lining of colon or rectum
unknown etiology
tobacco protects against development of UC (risk for Crohn’s)
LOW FIBER, LOW RESIDUE, LOW FAT DIET, high protein and calories

179
Q

UC S&S

A

many loose stools with pus, blood, or mucus (10-20 liquid stools per day)
dehydration
intermittent tenesmus (straining)
metabolic acidosis or alkalosis
fistulas from exertion
toxic megacolon

180
Q

crohn’s disease

A

deeper, not continuous, some lesions
inflammatory disease of the small intestine or beginning of colon
flares and remissions
healthy tissue interspersed with diseased tissue

181
Q

crohn’s S&S

A

steatorrhea from malabsorption (frequent fatty stools, 5-6 per day)
loss of appetite
periumbilical pain
low grade fever
increased WBC
urgency, straining

182
Q

ileostomy preop

A

psychological prep
bowel prep (neomycin)
cleaning enema
discuss post op incentive spirometry and breathing exercises
refer counseling

183
Q

permanent ileostomy

A

terminal ileum brought out through the abdominal wall
brought into intra-abdominal pouch
drained with catheter
emptied every 2 hrs in the first 2 weeks

184
Q

ileoanal anastomosis

A

colon and rectum removed

185
Q

J pouch

A

colon removed leaving rectal sphincter

186
Q

billroth 1

A

a gastroduodenostomy and involves resection of the lower portion of the stomach. offers a lower cure rate than the billroth 2

187
Q

billroth 2

A

a gastrojejunostomy, the lower portion of stomach removed

188
Q

MS

A

CNS (brain and spinal cord)
chronic, autoimmune, degenerative
inflamed nerve
loss of myelin (protects the nerves)
increase in oligodendrocyte (cells that produce myelin)
patches of plaque in white matter of CNS
schwann cells destroyed

189
Q

MS triggers

A

infection, trauma, pregnancy, fatigue, stress

190
Q

RRMS (relapse-remitting MS)

A

exacerbations and remissions

191
Q

PPMS (primary progressive MS)

A

symptoms gradually worsen

192
Q

SPMS (secondary progressive MS)

A

10-25 years after PPMS
no real recovery

193
Q

PRMS (progressive relapsing)

A

escalates severely, few remission periods

194
Q

MS etiology and contributing factors

A

unknown, age 20-40, immune system malfunction, viral, genetics, environmental
high suicide rate
maintain normal family function

195
Q

MS diagnosis

A

history, mcdonald criteria (2 episodes one month apart), neuro symptoms (blurred vision, muscle weakness)
MRI
evoked potential

196
Q

MS clinical manifestations

A

visual blurring, diplopia, blindness, nystagmus, oscillopsia
intentional tremors, poor condition, numbness, spasm, sensitivity to heat, fatigue, lassitude (collapse), poor memory, judgment, and reasoning

197
Q

MS nursing management

A

relieve symptoms, mobility (ROM exercises), bladder, high fiber diet
prevent overheating
wide-based gate walk
increase fluids to relieve constipation
void every 2 hrs to prevent UTI
kegel exercises
avoid laxatives

198
Q

MS meds

A

anticholinergics
amantadine HCL
antidepressants
beta blockers
antihistamines
muscle relaxants (baclofen)- spasticity
immunoregulatory (avonex, beta-interferon, rebif, copaxone, etc)

199
Q

MG

A

autoimmune neuromuscular disease
acetylcholine receptors depleted
weakness (hallmark symptom) in the presence of sustained contraction
relieved with rest
low acetylcholine

200
Q

MG clinical manifestations

A

ocular-diplopia and ptosis (drooping eyelid)
facial- dysphagia, dysphonia, mastication
larynx- dysarthria, aspiration, dysphagia
limbs- unsteady gait
weak diaphragm

201
Q

MG diagnosis

A

tensilon test or edrophonium chloride- blocks breakdown of acetylcholine, given 2mg of tensilon injected IV. if muscle tone increases, an additional 8mg is given
no response= pt given bromide injected IV
serum tests- antibodies to SCH receptors
electromyography (EMG)
chest x-ray (enlarged thymus gland)

202
Q

MG complications

A

MG crisis (increase anticholinesterase)
cholinergic crisis (decrease anticholinesterase)

203
Q

MG drugs

A

anti-cholinesterase (bromides)
immunosuppressives (prednisone, cytoxan)
plasmapheresis (removed acetylcholine receptor antibodies)
thymectomy (thymus excision)

204
Q

MG nursing management

A

medications at exact same time
given 30-60 min before meals
given before ADL’s
cut food into small bites, sit upright
main meal= when pt is least fatigued (AM over PM)
protect eyes (sunglasses)
wear medical alert bracelet
may need artificial tears
rest periods throughout the day

205
Q

parkinson’s

A

affects voluntary movement
chronic neurodegenerative disease, juvenile
idiopathic (unknown cause)
latrogenic (caused by drugs)
more men than women
destruction of cells in substantia nigra
DECREASED DOPAMINE
loss of control, coordination, and initiation of voluntary movement

206
Q

post encephalitic parkinsonism

A

pt had encephalitis as a kid, developed parkinson’s symptoms as they aged

207
Q

parkinson’s cardinal signs

A

tremors (resting, micrographia, pill-rolling)
supination/pronation
bradykinesia
rigidity
resting tremors disappear with slow, purposeful movement
propulsive gait
festination (short, shuffling steps)
hypomimia
dysphagia
rigidity of chest wall

208
Q

TRAP

A

tremors
rigidity
akinesia
postural instability

209
Q

parkinson’s teachings

A

high risk for falls, no rugs
firm chairs with arms
velcro/slip on shoes and clothes with buttons
rock back and forth to get up
eat sitting upright
wide based gait
raised toilet seat

210
Q

parkinson’s nursing care

A

give semisolid foods with thickeners for dysphagia
pyridoxine, no alcohol, evenly distribute low protein
drug holiday (no stimulation room)
PT
speech pathologist for swallowing

211
Q

parkinson’s diagnosis

A

presence of symptoms
trial of levodopa (consistent response to drug rules out parkinson’s like syndrome)
pt may have to walk around to observe for rigidity and resting tremors

212
Q

levodopa for parkinson’s

A

only lasts 5-10 years

213
Q

carbidopa for parkinson’s

A

combination: sinemet
gets more levodopa to the brain

214
Q

non ergot derivatives

A

requip, mirapex

215
Q

dopamine antagonist

A

parlodel, permax

216
Q

MAOIs for parkinsons

A

selegiline

217
Q

antivirals for parkinsons

A

amantadine

218
Q

other 3 meds for parkinson’s

A

COMT inhibitors
antidepressants
antihistamines

219
Q

guillian-barre

A

affects PNS

220
Q

clinical manifestations of guillian barre

A

rapid onset of pain
ascending pattern
paralysis (over a few hours, lasting 1-4 weeks), paresthesia
dyskinesia
loss of DTR
respiratory paralysis (late symptom)
vocal paralysis
bladder incontinence/incomplete emptying
constipation, dizzy, cramps, BP affected

221
Q

nursing management of guillian barre

A

ventilator, incentive spirometer, chest PT, suction to prevent aspiration, mobility, HOB15-30º. passive ROM, thigh high stockings, check bowel sounds, monitor gag reflex, TPN or G tube
refer to speech pathologist

222
Q

partial (focal) seizure

A

simple partial (no LOC, changes in senses, aware of surroundings but can’t control, lasts 30s)
complex partial (LOC, automatism, blacks out, bizarre behavior)

223
Q

generalized seizure

A

whole brain
tonic clonic, absence, myoclonic, atonic

224
Q

myoclonic seizure

A

brief jerking of muscles and LOC

225
Q

seizure diagnostic tests

A

history
EEG (within 24 hrs of seizure)
computer tomography
MRI
telemetry (brain activity monitor)
videotaping

226
Q

pharm therapy for seizures

A

control, raise threshold, therapeutic blood level, monitor for allergies/toxicity, give meds at same time each day

switching meds: 1 med is tapered as the other is increased

phenytoin, carbamazepine, clonazepam, diazepam or lorazepam (IV), luminal (phenobarbital)

227
Q

seizure pt teaching

A

phenytoin causes gingival hyperplasia, hirsutism, hypothermia, diplopia, BMS
avoid triggers
take meds on time and correct dose
avoid dangerous activities
wear protective headgear
lie down if experiencing aura
meticulous oral hygiene with phenytoin
wear medical alert bracelet

228
Q

nursing care for seizures

A

assess for aura and triggers
establish/maintain airway
move objects, remain until consciousness returns
do not insert anything into mouth
turn head to the side
padded siderails on the bed
do not restrain or shout
call ambulance if seizure is longer than 10 minutes
oxygen/trach equipment at bedside
maintain saline lock for pt incase medication is needed

229
Q

cast care

A

after swelling subsides, support extremity from underneath the palm
fingertips should NOT be pressed into cast
should not rest on hard or sharp surface before dried
cleanse pt of excess cast material
wait 30 min before weight bearing
dry plaster cast is odorless, resonant, and white, feels close to room temp

230
Q

compartment syndrome

A

impaired blood flow within fascia
caused by external pressure (casts, splints, crushing injury, surgery, trauma)
or internal pressure (blood or fluid accumulation)
compromise in circulation, tissue death, nerve injury, ischemic-edema cycle
4-6 hr untreated= irreversible neuromuscular damage
24-48 hr, limb becomes functionless (amputation)

231
Q

compartment syndrome manifestations

A

unrelieved ischemic pain (not controlled with analgesics)
pain with elevation (decreased arterial flow)
diminished or absent pulses distal to injury
cyanosis of extremity
tingling/paresthesia
coolness of extremity
weak
irreversible neuromuscular damage, functionless limb

232
Q

osteoporosis

A

disrupted remodeling process
osteoclast (bone resorption)
osteoblast (bone building)
low bone mass, loss of Ca, bone deterioration, porous bone
decreased bone mineral density (peaks between ages 10-35), decreased rapidly with postmenopause
increased bone fractures- hip, vertebrae, radius

233
Q

osteoporosis risk factors

A

female, post menopause, breastfeeding, caucasian, asian, african american, family hx, sedentary, smoking, alcohol, Ca and/or Vit D deficiency, liver disease, antithyroid med, anticonvulsant med, corticosteroids

234
Q

osteoporosis pt teaching

A

encourage dairy, Ca supplements, Ca foods (greens, sardines, salmon with bone, broccoli)
avoid high intake of protein, sodium, caffeine
weight bearing exercises (walking or running)
Ca supplements with 6-8oz of water and food
diphosphonates to increase BMD (taken 30-60 min before meals)

235
Q

osteoporosis med management

A

prevent loss of BMD
prevent bone resorption= hormone replacement therapy in post menopause

236
Q

osteoarthritis

A

slowly progressive chronic-joint disease
degeneration and loss of cartilage covering synovial joint surfaces
most common form of arthritis
risk factors- middle ages, obesity, knee arthritis, sports, work injuries, repetitive joint injuries, genetics (defective cartilage or joints)

237
Q

clinical manifestations of osteoarthritis

A

Early morning stiffness & joint pain, crepitus
Pain occurs during activity and relieved with rest
deficits in ROM
joint enlargement
heberden’s nodes (raised bony growths over distal interphalangeal joints of hand)
bouchard’s nodes (raised bony growths over proximal interphalangeal joints of hand)

238
Q

total knee replacement

A

continuous passive motion (8hr/day)
teach s&s of infection, DVT
physical therapy
prophylactic antibiotics

239
Q

total hip replacement

A

maintain 90º flexion of hip for 4-6 weeks
sit in straight and high chairs with arms
abduction pillow
avoid internal rotation of toes, crossing legs, twisting to reach objects, driving, tub baths, for 4-6 weeks
elevated toilet seat

240
Q

complications of THR and TKR

A

calf and groin DVT
pulmonary embolism (prophylaxis LMW heparin)
infection (wound drainage, fever, pain, odor)
long term complications: joint stiffness, post-traumatic arthritis, avascular necrosis, nonfunctional union after fracture, malunion

241
Q

arthrocentesis

A

surgical puncture of a joint

242
Q

pin assessment and care

A

check every 8 hours
ice for first 24-48 hours (only one hour at a time to prevent edema)
sterile cotton tipped swab used to clean one pin at a time

243
Q

buck’s traction

A

may be used before surgery
returns bone fragments to original position
partial weight bearing
no fowler position, joint ROM every shift

244
Q

volkmann’s contracture

A

permanent flexion contracture of the hand at the wrist
results in a claw-like deformity of the hand and fingers
cold fingers (white or blue)
more common in children
radial pulse absent
painful restricted passive extension of fingers

245
Q

fat embolism syndrome

A

fat globules (released from bone marrow) lodge in the pulmonary vascular bed or peripheral circulation

acute respiratory distress syndrome (ARDS)- may need mechanical ventilation

pulmonary embolus- hypotension, chest pain, fever above 105º, LOC changes

246
Q

kyphosis

A

forward thoracic curve of spine

247
Q

lordosis

A

inward curve of lumbar spine

248
Q

amputation care

A

improve function and quality of life
post op- pain relief, absence of altered sensory perceptions, wound healing, acceptance of altered body image
rehabilitation
obtain prosthesis

249
Q

amputation complications

A

hemorrhage, infection, phantom limb pain, neuroma, flexion joint contracture

250
Q

pruritus

A

most common symptom of skin disorders
nerve endings in skin trigger itching
may indicate more serious diseases (ex. diabetes, blood disorders, liver issues)
certain meds may induce pruritus (aspirin, hormones, opioids)

251
Q

pruritus nursing management

A

encourage pt to avoid scratching
assess for skin breakdown
apply cold compress
encourage tepid baths
use a humidifier (cool, moist environment)

252
Q

medical management of pruritus

A

topical antipruritic agents (lidocaine and capzasin)
topical corticosteroids
oral antihistamines

253
Q

melanoma

A

from a mole
asymmetrical
red blotchy color
diameter >6mm
can spread

254
Q

melanoma care

A

pain, anxiety, depression, knowledge deficit
treatment is usually surgical excision of tumor and maybe chemo

255
Q

psoriasis

A

chronic, noncommunicable skin disease
silvery plaques over elbows, knees, scalp, lower back, buttocks
no known cure
goal= slow down rapid turnover of epidermis

256
Q

head lice

A

parasitic insects that live on the hair shaft and cause itching

Med-Surg I (6 decks)

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