gi/gu Flashcards
pancreatitis is manifested by
what are the interventions and what to monitor?
lots of vomiting, very painful, epigastric pain
give opiods (pain med)
give saline (since pancreatitis causes hypovolemia)
monitor blood sugar since inflammation of the pancreas impair insulin and may cause hyperglycemia
surgery is not required for pancreatitis, unless its chronic (last a long time)
antibiotics are not require but may be given only if an infection is present.
steroids may be given to reduce inflammation.
complex carbohydrates is better because
higher fiber, lentils, etc..
think of CC: complex is the right carbohydrate, CC reduces CAD, cholesterol, complications, etc..
cerebral aneurysm, what does vomiting mean?
aneurysm has ruptured, immediate surgical intervention is required
nephrolithiasis, what is it, side effects, and interventions
what’s the diff b/w nephrolithiasis and pyelonephritis
urolithiasis/renal calculi/ nephrolithiasis / kidney stone. it is not an infection, so temp is normal. in pyelonephritis, you will see high temp/fever
all are names of kidney stones.
symptoms dysuria, inc. urinary frequency
flank pain, N/V
interventions: drinking water, peeing, pain medications
cystitis
dysuria, inc. urinary frequency
foul smelling urine, suprapubic discomfort
SIADH
high urine specific gravity (conc. urine)
acute graft rejection signs
so after a transplant, acute graft rejection can occur.
signs and symptoms: tachycardia, fever.
if this happens w/ liver transplant: inc. AST/ALT, flank pain, diminished bile drainage, change in bile color, or inc. jaundice
48hrs after surgery, is a moderate serosanguinous drainage normal?
yes it is normal.
serousanguinous: containing blood
sanguinous: primarily blood (that would be too much blood after 48hrs)
foul smelling is bad. but here that is not indicated.
serous, sanguinous, serosanguinous, purulent
serous: thin and clear
sanguinous: primarily blood
serousanguinous: has blood
purulent: yellow, green, white, pus like. may indicate an infection.
hydrocolloid
use in dressings when patient has shallow ulcers, partial thickness, eroded areas (but no necrotic areas)
alginate are used if there’s significant drainage, they can absorb a large amt of exudate
can you take urine from a catheter port?
yes, you can when its 1/2 full
no need to clamp urinary catheter tubing prior to discontinuation and cause extra fluids to go back into the bladder, may inc. risk for infection
collect urine sample when?
midstream
not first stream (inc. risk of contamination due to bacteria)
always discard the first urine, even when counting 24hr urine
dumping syndrome
what causes it?
s/s (4)
what’s an adverse effect?
common after gastric/esophageal surgeries
food gets dump in the small intestine before being properly digested. pyloric sphincter removed or damaged.
early dumping: 10-30mn after a meal
bloating, abdominal cramps, N/V, diarrhea, tachy, dizziness
late dumping symptoms: 1-3hrs after eating
pancreas try to reduce sugar which may cause hypoglycemia (weakness, confusion, tremors), GI symptoms, symptoms are high after meals high in simple carbohydrates
interventions:
diet changes: eating smaller meals, avoid sample sugar
eat proteins, fibers, complex carbohydrates (whole grain)
do not drink liquids with meals, *lay down after eating (to slow digestion)
meds slow down gastric emptying or inhibit insulin: acarbose
dumping syndrome (late dumping) managements
true or false
wait 30mn after meals to drink liquids
sit up 30mn after eating
eat 5-6 small meals
eat cold or hot foods to Dec. symptoms
true: wait 30mn after meals to drink liquids
false: sit up 30mn after eating (pt should lie down)
true: eat 5-6 small meals
false: eat cold or hot foods to Dec. symptoms (that inc. gastric motility & emptying, eat warm temp foods)
symptoms: diaphoresis, tachycardia, hypotension (fluid shift), hypoglycemia (worst), nausea, weak, abdominal cramps (small intestine are going to swell)
it goes on small intestine prematurely
symptoms of dumping syndrome resolves after how long
and what should the patient eat? what’s the dumping syndrome diet
several months to a year after gastrectomy surgery
patient should eat foods low in carbohydrates (or moderate in complex carbs and low in simple carbs), moderate - high protein, more fiber, avoids foods that are hot or cold, restrict fluids while eating. ex: eggs, rice cereal, chicken breast.
avoid pastries, cola
which therapist assess w/ mobility and fall risks
physical therapist
bedside commodes may reduce the risk for falls
clients w/ acne should avoid using oil based product and heavy cosmetic use b/c they clog pores
true or false
true
mild soap and tepid (warm) water
cut toenails straight across, not at lateral corners
how to avoid gluten
avoid barley, wheat, white flour, macaroni, pasta, soup, beer, malted milkshakes, cereals, bran
gluten free: meat, fish, eggs, gluten free four, fruits
stoma care
always wear a colostomy pouch over the stoma
thick mucus is normal
stoma should be reddish to pink in color
diabetes type of pain
neuropathic, chronic pain
explain the cystic fibrosis diet
cystic fibrosis diet: high in fat, high in protein, high in calorie
which is soft vs mechanical diet
chunky peanut butter
applesauce
raw carrot sicks
beef
jery
bananas
nuts
seeds
raw veggies
chunky peanut butter: chunky = mechanical
applesauce = soft
raw carrot sicks = mechanical
beef = mechanical
bananas = soft
nuts = mechanical
seeds = mechanical
raw veggies = mechanical
urine specific gravity
which diseases has high or low urine specific gravity
urine specific gravity: 1.005 - 1.30
higher means more conc.
lower urine specific gravity: dilute urine, like diabetes insispidus. Diabetes Dilute.
how to assess pain
only client can assess pain, so from 0 - 10. also for hospice patients
if the patient can’t talk then press on nail beds to asssess
urine is very concentrated in SIADH, ex 1.60, this is b/c very little water gets released in the urine
safe foods for htn
smoked salmon
fish
scrambled eggs
boiled lentils
grilled chicken
fish in general has high sodium, smoked salmon has high sodium as well, bacon is extremely high in sodium.
scrambled eggs, boiled lentils, grilled chicken are low sodium diets (if prepared well of course), but on the NCLEX they’re safe.
where should catheter be placed for a female vs male
for a male, attach the catheter to a male’s lower abdomen (w/ penis pointed upward) or to their upper thigh
for a female, the catheter should be connected to their inner tigh
remove the device w/ alcohol swab, saline water to prevent shearing of skin.
steatorrhea is what type of stool
reduced fat absorption by intestine and that fat all goes into the stools
stool is pale, fatty, oily, maladorous
mechanical block in the biliary tract, emulsification of fat is not done
hematochezia
melena
which is a sign of upper vs lower GI tract bleeding
melena is upper, you can see melanin, upper gi bleeding
hematochezia: you can’t see blood inside the body, so blood is low. fresh blood from anus, signs of lower GI tract bleeding
phenylketonuria, which foods to avoid?
Phenyl: p for protein, p for phenylalanine
avoids foods high in protein & phenylalanine
avoid chicken, pork, eggs, beef, avoid dairy,
ischemic vs neuropathic pain
for ischemic, think of sickle cell, mi: squeezing, crushing, heavy
neuropathic: CNS issue, shooting, burning, numbness, tingling, shock like
diabetic foot care
keep feet dry (to prevent chafing from moisture), don’t put any lotion or creams between toes.
creams can be added to the top and bottoms of feet to prevent cracking, but not between toes (will create moisture and cause chafing) and inc. risk of fungal infections.
talcum powder and cornstarch may help the skin in between toes to be dry/stay dry
wear loose socks with closed toe shoes that fit well
bladder cancer main symptom
gross painless hematuria
kock’s pouch, how to urinate?
self Cath every 4-6hrs
no external pouch
neobladder
new bladder, patient with a neobladder can urinate normally, they don’t have an external pouch.
stoma, how often to change pouch
change pouch every 5 days
peritoneal dialysis
what causes insufficient outflow?
which correct position?
is alteplase indicated?
should you check the tubing for kinks or clots?
the tubing is clamped the allow the fluid to remain in the cavity.
insufficient outflow is usually caused by constipation. when distended intestines block the catheter’s hole. if outflow becomes sluggish, the nurses should assess for abdominal distension and perform appropriate interventions (stool softeners)
-side lying position
assess for clots and administer fibrinolytics (alteplase) as prescribed. check for kinks/clots
should type 1 diabetes reduce carbohydrates or stop taking insulin when they’re sick
and can clients check their urine for ketones?
don’t reduce carbohydrates
continue taking insulin
yes they can by the paper kits, like the ph kits. and check to see if they notice a color change in their urine (pink to purple), darker means a higher level of ketones.
peritoneal dialysis
when to use sterile technique
peritoneal dialysis should be a sterile procedure
infection control is a top priority
when spiking the bag and attaching the diasylate, that should be sterile
infection control is a priority over placing the bag below the level of the bladder
with kidney failure or with high creatnine, is IV contrast contraindicated
which BP med to avoid?
so, avoid IV contrast with kidney disease (acute kidney injury or ckd)
avoid ace inhibitors b/c they inc. k+ (which is already present in ckd), they make kidney retain k+. if patient k+ is already high, that puts them at risk for life threatening arrhytmia (Vfib, etc..)
as you get older
mucus membranes get drier
immune system diminish
the number of cilia mobility decreases, cilia is less mobile (which makes sense since older adults might have comorbidities that cause them to be less active)
the ability to cough forcefully decreases (strength decreases also with age)
chest wall stiffens (or becomes less flexible)
resp system is more likely to make mucus, poorer cilia motility harder to clear pathogens
diabetic neuropathy symptoms
feelings pins and needles
patient should have pulse in leg
if a pulse is not felt after using the Doppler, patient may be at risk.
GERD interventions
when I have acid reflux, I have to elevate hob in order to sleep. if not, I will not be able to. i’d feel the food coming back so, therefore elevate HOB when sleeping or when not is necessary in GERD
avoid spicy foods, tobocco, caffeine,
eat small frequent meals
