HESI NSG 219 Flashcards by Breanna Castello

Metformin
(Antidiabetic) PO Tab
–improving glycemic control, stabilizing body weight, and improving the lipid profile
-half life=5hrs, full=20hrs
**RISK Lactic Acidosis
**–>SX to NOTIFY DOC= hyperventilation, myalgia, malaise, and drowsiness
HOLD: sepsis, hypoxemia, dehydration, and hypoperfusion
S.E.: Diarrhea, abdominal bloating, and unpleasant metallic taste

Metformin
(Antidiabetic) PO

*Risk of Lactic Acidosis
**HOLD: sepsis, hypoxemia, dehydration, and hypoperfusion

How well did you know this?

Not at all

Perfectly

Why admin Calcitonin to a pt. with Paget’s DZ?

Decrease Bone Reabsorption
–>Calcitonin works in conjunction with parathyroid hormone (PTH) to regulate calcium by decreasing the rate of bone resorption and regulating bone metabolism.

How well did you know this?

Not at all

Perfectly

DISEASE of the bone is caused by the excessive breakdown and formation of bone; this is followed by disorganized bone remodeling. This causes affected bone to weaken; pain and fractures are a concern, and arthritis in the joints near the affected bones results.

Paget’s Disease

How well did you know this?

Not at all

Perfectly

Pt. needs a subQ injection of regular insulin (short acting) and NPH. Which one do you draw up first?

Draw up the regular insulin FIRST, and then the NPH insulin in the same syringe.
**Roll med not shake to mix
***“clear before cloudy”

How well did you know this?

Not at all

Perfectly

Hypothyroidism; thyroid supplement
Levothyroxine
–take in AM on EMPTY stomach @ same time each day to prevent insomnia; Takes 1-3 wks to work
–REPORT chest pain=may be an OD
S.E: GI= ^ appetite, nausea, diarrhea
–Adjust dose if pregnant or plan to be
**Don’t STOP suddenly= Addisonian Crisis

Hypothyroidism med
Levothyroxine

**take in AM on EMPTY stomach
*Don’t STOP suddenly=Addisonian Crisis

How well did you know this?

Not at all

Perfectly

Topical glucocorticoids
Tx: skin conditions
S/E: anti-inflammatory, antimitotic (inhibits cell growth by stopping mitosis) ,immune-system suppressing actions
— can be absorbed in sufficient amounts to produce systemic toxicity.
*PRIMARY concerns are growth retardation (in children) and adrenal suppression in all age groups. Systemic toxicity is more likely under extreme conditions

Topical glucocorticoids
( anti-inflammatory skin tx)

*RISK of Systemic Toxicity=Adrenal Suppression

How well did you know this?

Not at all

Perfectly

Fludrocortisone acetate
(long-acting PO med w/ mineralocorticoid and moderate glucocorticoid)
TX: long-term management of Addison’s disease. (Low cortisol levels from adrenal gland)
ACTION: act on the renal distal tubules to enhance the reabsorption of NA and CL and the excretion of K and H
**Do not STOP abruptly= hypotension and fluid & electrolyte imbalance

Fludrocortisone acetate

TX: Long-term for Addison’s DZ to promote electrolyte balance
Don’t STOP Suddenly

How well did you know this?

Not at all

Perfectly

Vasopressin
(Vasoconstrictor/ antidiuretic)
USES: DI= Diabetes Insipidus (low ADH levels)
ACTION: directly stimulates contraction of smooth muscle, causes vasoconstriction, stimulates peristalsis and Decreases urinary output

Vasopressin
(Vasoconstrictor/ Antidiuretic)

*DI pt. = decreases urinary output and Bleeding

How well did you know this?

Not at all

Perfectly

Glipizide
(Oral hypoglycemic agent)
that is taken AM
**Decreases Blood Glucose

Glipizide
(Oral Hypoglycemic)

*Lowers BG**

How well did you know this?

Not at all

Perfectly

A client dx with DM receives 8 units of regular insulin subQ at 7:30 am. The nurse would be most alert to signs of hypoglycemia at what time during the day?

9:30-11:30
-Short-acting insulin
Peak: 2-4 hours
-onset 30min BG levels start to lower (pt. Needs to eats b4 the 30min)

How well did you know this?

Not at all

Perfectly

Pioglitazone
(antidiabetic)
USES: type 2 diabetes mellitus
–Take 15-30 min before meals

Pioglitazone
(Antidiabetic)

*DM type 2

How well did you know this?

Not at all

Perfectly

Desmopressin
(antidiuretic hormone).
USES: DI
The nurse monitors the client’s fluid balance to determine the effectiveness of the medication.

Desmopressin
(Antidiuretic hormone)

*DI pt.
*RN monitors DAILY wt.

How well did you know this?

Not at all

Perfectly

Acarbose
(an alpha-glucosidase inhibitor)
TX: Type 2 DM
ACTION: delays absorption of carbs from sm. Intestines
–Take W/ EACH MEAL w/ 8oz of water
S.E.: GI disturbances: flatulence, cramps, and abdominal distention

Acarbose
(Alpha-Glucosidase Inhibitor)

Tx: Type 2 DM
-similar to metformin
**can be used to help manage dumping syndrome and hypoglycemia

How well did you know this?

Not at all

Perfectly

A client is reporting dyspepsia and pain that generally occurs about 90 minutes after eating. The pain worsened this afternoon about 3 hours after eating a large bowl of spaghetti with tomato sauce. Which medication therapy would the nurse anticipate being prescribed? What is the condition?

Duodenal Ulcer
-Triple Therapy
–>Esomeprazole (PPI) to decrease gastric acid secretions
–>Metronidazole & Clarithromycin (antibiotics) commonly used to treat H.Pylori

How well did you know this?

Not at all

Perfectly

S/SX: pain occurs about 90 minutes after consuming food

Duodenal Ulcer

How well did you know this?

Not at all

Perfectly

Lansoprazole
(proton-pump inhibitor)
USES: peptic ulcer disease, esophagitis, and gastroesophageal reflux disease (GERD).

Lansoprazole
(PPI)
**Decreases gastric secretions
**avoid Irritants to stomach

How well did you know this?

Not at all

Perfectly

GASTRECTOMY
Complication: vit. B12 and folic acid def. B/C a deficiency of the intrinsic factor and/or inadequate absorption of food
—>food may enter the bowel too quickly after this type of surgery.

Gastrectomy Complications

*Often to tx stomach cancer

How well did you know this?

Not at all

Perfectly

HEARTBURN
Intervention:
-high protein/ Low fat
-Sit up for >2hr after eating
-AVOID over eating = increases stomach pressure; NO fruit juices, to acidic

HEARTBURN: Intervention

How well did you know this?

Not at all

Perfectly

Colorectal Cancer
Modifiable RISKs: implement a high-fat and low-fiber diet
RISK: age >40 years, first-degree relative with colorectal cancer, and hx of bowel problems such as ulcerative colitis or familial polyposis.

Colorectal Cancer
RISK factors

How well did you know this?

Not at all

Perfectly

Esophagogastrostomy POST-OP
–Bed at semi-Fowlers or High-Fowlers (promotes ventilation and decreases reflux)
–Provide oral hygiene q2hr while NG tune in place
–Encourage Deep Breathing Exercises and use of Incentive Spirometer
–when diet is resumed Drink fluids in between meals not w/=risk for diarrhea
**AVOID irrigation of NG tube or repositioning=disturbs sutures
**No drainage from NG NOTIFY HCP

POST-OP INTERVENTIONS:
Esophagogastrostomy
–>the diseased portion of the esophagus and stomach (if involved) is removed, and remaining portions of the esophagus and stomach are anastomosed

How well did you know this?

Not at all

Perfectly

Pernicious Anemia
(Aka Addisons Anemia: decrease in RBC r/t malabsorption of vit. B-12)

MAJOR RISK: gastric resection
Other RISK: Central nervous system and musculoskeletal disorders

Pernicious Anemia RISKS
**Major = Gastric Resection

How well did you know this?

Not at all

Perfectly

EXPECTED OUTCOMES:
Peptic Ulcer DZ
–Pain meds is relieving discomfort.
–Client reports no pain before meals.
–Client eliminates foods that exacerbate the condition.
–Client reports ability to sleep through the night w/out pain.

EXPECTED OUTCOMES:
Peptic Ulcer DZ

How well did you know this?

Not at all

Perfectly

Pt. with bleeding esophageal varices gets perscribed Vasopressin. Why?

-it restricts blood flow b/c it is a vasoconstrictor

VASOPRESSIN
(synthetic antidiuretic hormone)
ACTION: vasoconstrictor
USES: Administration of this hormone into the bloodstream reduces bleeding. It acts directly on gastrointestinal smooth muscle as a vasoconstrictor

How well did you know this?

Not at all

Perfectly

Vasopressin is prescribed for a client with a diagnosis of bleeding esophageal varices. The nurse would prepare to administer this medication by which route?

IV infusion through central line

How well did you know this?

Not at all

Perfectly

Which solution and amount would the nurse plan to use for periodic catheter irrigations prescribed by the primary health care provider?

To maintain catheter patency and drainage, the catheter is irrigated with 10 to 20 mL normal saline.

A client has cirrhosis complicated by ascites. Which expected but adverse laboratory result would the nurse monitor for?

Low Serum Albumin

Anal fistulas -->abnormal openings or tunneling leading from the anus or from the rectum. *COMPLICATIONS associated with Crohn’s disease and occur as a result of the inflammatory changes in Crohn’s.

Crohn's COMPLICATION *Anal Fistulas

INTERVENTIONS: Hiatal Hernia --elevation of the thorax after meals and during sleep --intake of small, frequent, and bland meals --use of histamine antagonists (H2 Blockers) and antacids.

INTERVENTIONS: Hiatal Hernia

INTERVENTIONS: Uncomplicated Diverticular DZ --high-fiber diet/ LOW Carbs --->Foods high in carbohydrates are usually low in residue (fiber) (e.g., white bread, cereals, pasta). --->Fruits and vegetables are high in fiber. --Fluid intake should be increased because fiber retains water, thereby decreasing the amount absorbed by the body.

INTERVENTIONS: Uncomplicated Diverticular DZ **^ fiber/ Low Carbs, ^Fluid intake, ^ fruits and vegetables

Avoid w/ Acute Pancreatitis --Smoking (overstimulates) --Alcohol (precipitate an attack) --Caffeine drinks ex: cola/ coffee (overstimulates)

Avoid w/ Acute Pancreatitis *Stimulants/ alcohol/ smoking **SX: PAIN located in epigastric area that radiates to the back**

At RISK for C. Diff --Enteral nutrition ---->bypasses the stomach acid's protective mechanism that kills pathogens. --HIV ---> ^risk for opportunistic infections due to the client's weakened immune system. --Proton pump inhibitors (PPIs) ---> decrease the acidity of stomach acid, which can allow pathogens to bypass this protective mechanism. --Antibiotics --->kill the normal gastrointestinal (GI) flora that protect the GI tract from opportunistic infections.

At Risk for C. Diff *Enteral Nutrition; HIV; Taking PPI's or Antibiotics* **C. Diff pt. @ RISK for Metabolic Acidosis** r/t diarrhea=loss of bicarbonate

Nitrofurantoin (Antibiotic) USES: tx or prevent UTI S.E.: N/V, loss of appetite, Dark colored urine, stain teeth (oral suspension), dizziness, drowsiness TEACH: ^ fluids, Frequent oral hygiene or rinse to not stain teeth

Nitrofurantoin (Antibiotic) **prevent/ tx UTI**

Acute Poststreptococcal Glomerulonephritis (APSGN) ---> Generalized body edema, HTN, oliguria, **hematuria (smoky or rusty appearance), and proteinuria (Foamy urine) **type of acute glomerulonephritis.

CLINICAL MANIFESTATIONS: Acute poststreptococcal glomerulonephritis (APSGN) *TYPE of Acute Glomerulonephritis (Caused by infectious agents like bacteria & viruses)

Ulcerative Colitis RISK: anemic r/t chronic blood loss in small amounts that occurs with exacerbations of the disease. These clients often have BLOODY STOOLS and are, therefore, at increased risk for anemia

Ulcerative Colitis Risks

Ulcerative Colitis chronic inflammatory bowel disease (IBD) -->abnormal rxn of immune system cause inflammation and ulcers on the inner lining of large intestine. NO CURE SX: rectal bleeding, bloody diarrhea, abdominal cramps, and pain DIET: AVOID r/t ^ risk of flare up; greasy/fried items, caffeine, alcohol, carbonation, spicy foods, raw vegetables, and some high-fiber foods like nuts, seeds, corn, or popcorn.

Ulcerative Colitis *RISK of anemia r/t blood loss in rectum and stools

Cholelithiasis *AKA gallstones are hardened deposits of digestive fluid that can form in your gallbladder. CAUSED BY: ^^ cholesterol, bile salts, or bilirubin (bile pigment) --->SX of OBSTRUCTION of the ducts: jaundice; clay-colored stools; dark, foamy urine (Proteinuria); steatorrhea; fever; and ^ WBC count.

Cholelithiasis AKA Gallstones *SX of Obstruction of Ducts

What foods are a good source of VIT B12?

Animals and Animal byproducts

FULL-thickness (3rd degree)=charring is visible, extremity movement is limited, and wound sensation is absent. PARTIAL-Thickness (2nd degree)= Blisters; pink to red coloring; and a wet, shiny, weeping surface

Burn Injury thickness Types

Which intervention would best enable the nurse to address the client's risk for incisional bleeding after a subtotal thyroidectomy?

Assess behind the client's neck to inspect for blood on the neck or linens.

Viral Hepatitis DIET --^^carbohydrates and calories --LOW Protein and fat i --Smaller, more frequent meals

DIET: Viral Hepatitis

Chronic Kidney DZ DIET --Incomplete proteins= plant-based foods AVOID Animal products and byproducts

DIET: Chronic Kidney DZ **Protein Restriction

Cholecystitis S/SX *Inflammation of the gallbladder. SX: dyspepsia; feelings of abdominal fullness; rebound tenderness (BLUMBERG's SIGN); upper abdominal pain can RADIATE to the right shoulder; pain triggered by a high-fat meal; clay-colored stools, dark urine, and possible steatorrhea; anorexia, N/V; eructation (Burping); flatulence; fever; and jaundice.

CLINICAL MANIFESTATION: Cholecystitis

The nurse would assess the results of which laboratory study to detect an adverse effect associated with a bilateral adrenalectomy?

Blood Glucose **Effects of adrenal insufficiency = hypoglycemia and hypovolemia

The significant other of a client diagnosed with Graves' disease expresses concern regarding the client's bursts of temper, nervousness, and an inability to concentrate on even trivial tasks. On the basis of this information, the nurse would identify which concern for the client?

Trouble with coping with a disease process

Cardiovascular Manifestations of Hypothyroidism SX: decreased pulse, distant heart sounds, anemia, variable changes in BP, weak contractility, and ^ RISK of angina, myocardial infarction, and heart failure.

CARDIOVASCULAR MANIFESTATIONS: Hypothyroidism

-schedule for hemodialysis is 3-4 hr q 3 days a wk -AV fistula ready in 3-4 weeks for use

Hemodialysis

The nurse is planning care for the client with renal insufficiency. Which nursing measure would be the least likely to help in managing the client's fluid volume status?

Giving intravenous medications in the largest acceptable volume *Renal pt. prone to fluid overload= give less as possible

A client with dry skin is in need of a moisturizing agent. Which product would the nurse choose to be most effective?

A petrolatum-based ointment **Petrolatum provides the most effective moisturizing by forming an occlusive barrier on the skin and reducing water loss.

Epoetin alfa (erythropoietin) USES: Tx for anemia in Chronic Kidney DZ *RISK: HTN & Seizers

Epoetin alfa (erythropoietin) *TX for anemia **RISK: HTN & Seizers

What product would the nurse use when giving MOUTH CARE to a client with impaired oral mucous membranes? NO LEMON-GLYCERIN SWABS -->will dry the membrane further= ^ irritation and pain

-lip moistener to prevent lip cracking -soft toothbrush to prevent trauma -soothing cleansing rinses, such as nonalcoholic mouthwash -a pain reliever

Chronic Pancreatitis DIET --limit fat -small meals at each sitting -reduce the amount of carbohydrates and protein in each sitting

DIET: Chronic Pancreatitis

The nurse is preparing to move a quadriplegic client out of bed into a chair. What pad device should the nurse place on the seat of the chair as the most appropriate device for pressure relief?

-Foam - Water -Gel -Alternating air pads

Ofloxacin (Antimicrobial) RISK: Crystalluria (decrease risk by ^ intake of fluids 1500-2000ml qday) TEACH: AVOID milk=decreases absorption

Ofloxacin (Antimicrobial)

The client's blood pressure is assessed at 100/68 mm Hg and apical pulse is 76 beats per minute. To best interpret the client's current cardiovascular status, what intervention would the nurse implement first?

Compare it with the pt. Baseline

The nurse monitors which factor as the best indicator of aging affecting kidney function?

Hydration

Gastric and duodenal ulcers can cause gastrointestinal hemorrhage and can cause GASTIRC OUTLET OBSTURRUCTION r/t healing process. SX of Obstruction: epigastric ABD pain and postprandial vomiting r/t mechanical obstruction.

Acute and chronic PEPTIC ULCER DZ --->includes both gastric and duodenal ulcers, can cause gastric outlet obstruction.

Small Bowel Obstruction SX: Nausea and Hypoactive Bowel Sounds **NOTIFY surgeon if pt. is Muscle guarding or rebound pain ---> can be peritoneal irritation r/t complication of the obstruction

Small Bowel Obstruction ASSESSMENT (Life threatening) *Call surgeon if guarding

Levothyroxine sodium is (synthetically prepared thyroid hormone) ACTION: ^body metabolism and, therefore, increases energy level, promotes weight loss and ^ body temperature

Levothyroxine Sodium (synthitic thyroid hormone) Hypothyroid Med *^ metab, ^energy, ^ temp

Acute Glomerulonephritis Caused by: Infectious agents that could trigger the disorder include viruses, fungi, and parasites. --->ex: Strep infection

Acute Glomerulonephritis

Syndrome of inappropriate antidiuretic hormone (SIADH) ---results from overproduction of antidiuretic hormone (ADH) --Caused by: lung infections (tuberculosis, pneumonia, lung abscess); hypothyroidism; malignant tumors; certain medications (like tricyclic antidepressants); and CNS disorders.

Syndrome of inappropriate antidiuretic hormone (SIADH)

TX for AKI Continuous renal replacement therapy (CRRT) = removes uremic toxins when fluid is removed, while acid-base status and electrolytes are adjusted slowly ---(CVVH) removes both fluid and solutes and requires replacement of fluid. ---(SCUF) removes fluid but does not require fluid replacement. ---(CVVHD) removes both fluids and solutes and requires both dialysate and fluid replacement. ---(CVVHDF) removes both fluids and solutes and requires both dialysate and fluid replacement.

Acute Kidney Injury (AKI) TX -Continuous Renal Replacement Therapy (CRRT) TYPES

Adult Urinary Incontinence Types functional incontinence urge incontinence stress incontinence total or mixed urinary incontinence reflex or overflow incontinence.

Urinary Incontinence TYPES

AV FISTULA PROTECTION 1. Palpate for THRILLS and Auscultate for a BRUIT q4hr 2. check for bleeding and infection needle insertion sites 3. Avoid taking BPs or venipunctures in the extremity 4. TEACH pt. not to carry heavy objects or anything that compresses the extremity 5. TEACH pt. not to sleep in a position that places the body weight on top of the extremity 6. ASSESS pulses and circulation DITAL to the fistula.

AV Fistula for Hemodialysis INTERVENTIONS FOR PROTECTION

PERITONITIS Acute inflammation of the visceral and parietal peritoneum, the endothelial lining of the abdominal cavity. SX: distended ABD; ** rigid/board-like ABD**; diminished bowel sounds; can't pass flatus or feces; ABD pain (localized or REFFERED to the shoulder or thorax); anorexia, N/V; ABD rebound tenderness; ^^ fever; tachycardia; dehydration (r/t fever); Low urinary output; hiccups; & possible Resp. Complications

CLINICAL MANIFESTATIONS: Peritonitis **rigid/board-like ABD** *if pt. on peritoneal dialysis ASSESS for cloudy dialysate output as RISK*

Aldosteronism (hyperaldosteronism) condition that occurs when the adrenal glands produce too much aldosterone, the hormone responsible for balancing potassium and sodium in the body.

Aldosteronism AKA Hyperaldosteronism ** ^NA, Low K **Risk Heart DZ and Stroke

Pheochromocytoma -Tumor in the adrenal gland. It causes the gland to make too much of the hormones epinephrine and norepinephrine. S/SX: *^^BP*, headache, heavy sweating, tachy, tremors, pale skin, SOB and panic attack-type sx

Pheochromocytoma

Hepatic Cirrhosis Diet --LOW NA, ^cal./carb, Moderate Protein (enough to promote healing; to much will cause encephalopathy) --Ascites Present= Fluid Restriction

DIET: Hepatic Cirrhosis * Low NA/ ^ cal & carb moderate protein

Peritoneal Dialysis NO GO for pt.s w/: --An ABD DZ (ex: ruptured diverticula or malignancies) --extensive ABD surgeries --hx of peritonitis, obesity, or back problems, R/T: pt. aggravated by the fluid weight of the dialysate

Peritoneal Dialysis *Pt. who don't qualify *Good for Cardiovascular DZ pt. b/c hemodialysis is to harsh

The nurse understands that the client with a Clostridium difficile (C. difficile) infection is at increased risk for which acid-base imbalance?

Metabolic Acidosis

Nephrolithiasis AVOID: Foods that ^^ urinary oxalate excretion include spinach, rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea.

Nephrolithiasis: Foods to Avoid **pt. w/ stone made of calcium oxalate

Furosemide (Loop Diuretic) EFFECTIVE: Decreased BP/ edema/ CA lvls; ^ urine output ASSESS: Ortho. Hypo; K, NA, CL levels, HF TEACH: ^ K in diet (fresh fruits and veg); Photosensitivity (use sunblock); Take in AM with milk/ food to decrease GI irritability

Furosemide (Loop Diuretic) *Diet: ^ K (Fresh fruits & veg) * Photosensitivity

@ Risk for developing Cataracts --Down syndrome --Hypoparathyroidism (Low PTH) --DM

Cataracts --->cloudy area in the lens of your eye (the clear part of the eye that helps to focus light) *Pts at RISK