Med Surg Exam 1 Flashcards
1
Q
intubation placement puts at risk for…
A
…R-sided aspiration (likely to put tube all way in R lung and not supply air to L)
2
Q
3 components of respiration
A
- ventilation
- perfusion (blood flow)
- diffusion of gas
3
Q
components of air
A
- 79% nitrogen
- 21% oxygen
- TRACE amounts of CO2, water vapor, helium, argon
4
Q
stridor =
A
obstruction of upper airway
5
Q
orthopnea
A
SOB when lying down
6
Q
hemoptysis `
A
spitting/coughing up of blood
7
Q
pulse oximetry parameters
A
94-99%
**SaO2 can’t read above 100% but you have unbound free-floating O2 (so you can OVERoxygenate)
8
Q
percentage of unbound O2
A
2% (important for partial O2)
9
Q
normal end tidal CO2
A
30-40
**continuous waveform capnography is diagnostic
10
Q
CT for respiratory diagnostic imaging
A
** more specific
11
Q
CT angiography
A
- can show pulmonary embolism
- injection of contrast media into vein to show blood flow
12
Q
MRI
A
-very detailed view of tissues (ex. carcinoma)
13
Q
bronchoscopy
A
**direct inspection of airway and can also remove foreign bodies, mucus plug, secretions, or for diagnostics
-AEROSOL generating procedure
14
Q
thoracentesis
A
**fluid can be sent for analysis
15
Q
URI’s
A
Upper Respiratory Infections
**90% of these are viral
16
Q
rhinitis=
A
common cold (inflammation and irritation of nasal mucus membrane
17
Q
risk factors for rhinitis
A
- more common in women
- most common in Sept, Jan, April
18
Q
management rhinitis
A
-symptom management with NSAIDS, antihistamines, expectorants, antitussives
**colds are self limiting= only lasts so long and goes away on its own
19
Q
topical nasal decongestants
A
*can result in rhinitis medicamentosa (chemical rhinitis) where overuse results in inflammation of mucosa membrane
20
Q
rhinosinusitis is either…
A
…viral or bacterial and bacterial tends to last longer
21
Q
rhinosinusitis definition
A
-inflammation of paranasal sinuses and nasal cavity
22
Q
risk factors for rhinosinusitis
A
- NG tube presence (HIGH risk)
- environmental hazards
- immunocompromised
- foreign body
23
Q
management of rhinosinusitis
A
- decongestants
- antihistamines
- saline lavage (neti-pot)
- ABx reserves for those with prolonged symptoms
24
Q
patient education on rhinosinusitis
A
- hydration (increase secretions)
- steam inhalation
- sleep with head of bed elevated
25
complications of rhinosinusitis
- orbital cellulitis
| - osteomyelitis
26
pharyngitis
-inflammation of pharynx
**typically VIRAL but can be streptococcal (bacterial, like strep throat)
27
risk factors pharyngitis
5-15 age
28
symptoms pharyngitis
- red pharyngeal membrane
- tonsillar exudate
- enlarged lymph nodes
29
viral pharyngitis
-will typically resolve in 3-10 days
30
untreated bacterial pharyngitis
- otitis media
- peritonsillar abscesses
- meningitis
- rheumatic heart dz
- glomerulonephritis
31
laryngitis risk factors
- overuse
- exposure to dust or chemicals
- URI
- GERD
32
symptoms laryngitis
- hoarseness
- aphonia (no voice)
- dry cough
- sore throat
33
management of laryngitis
**most pts. recover with conservative therapy (ex. if its from GERD, treat the GERD)
**more severe respiratory infections utilizes ABx
34
patient education on laryngitis
- rest voice
- avoid irritants like smoking
- AVOID DECONGESTANTS (can dry out the throat which leads to greater irritation)
35
signs of airway compromise in URI
- drooling
| - inability to swallow
36
OSA (obstructive sleep apnea)
*recurrent episodes of upper airway obstruction that cause apnea during sleep
(relaxation of muscles + gravity)
37
patho of OSA
-airway recurrently gets obstructed as patient sleeps leading to periods of apnea (**AT LEAST 5x AN HOUR), hypoxia, and a strong sympathetic response (high HR and BP)
38
OSA risk factors
- men
- obesity
- older age
- more prevalent in those with CAD, HF, and T2DM
39
OSA symptoms
- frequent, loud snoring
- breathing cessation 10 seconds or longer
- apnea following by waking abruptly w/ loud snort
- hypoxia
- daytime sleepiness/insomnia
- morning headaches
40
OSA management (noninvasive)
- CPAP (continuous positive airways pressure...one pressure throughout entire respiratory cycle)
- BiPAP (bilevel positive airways pressure)
41
BiPAP specifically
-2 levels of pressure (change in pressure "pulling" air from lungs/uncomfortable)
42
surgical management of OSA
- uvulopalatopharyngoplasty (surgical resection of uvula and pharyngeal soft tissue) **LAST RESORT & effective in 50%**
- tonsillectomy
43
medications OSA
-modafinil (reduces daytime sleepiness)
***CNS stimulant
44
OSA pt. education
- weight loss
| - avoidance of alcohol and hypnotic meds (MELATONIN WORSENS SLEEP APNEA)
45
nasal cannula and OSA
-helps w/ hypoxia but not apnea
46
OSA complications
- higher prevalence HTN (SNS activated)
- increased risk of MI, stroke, and death
- predisposed to arrhythmias
- impacts metabolic changes such as insulin resistance
47
epistaxis
(nosebleeds)
| - hemorrhage from nose caused by rupture of tiny vessels
48
risk factors epistaxis
- local infections and inflammation
- drying of mucus membranes (O2 pts)
- trauma (nose-picking)
- drug use
- ANTICOAGULANTS
49
management of epistaxis
- direct pressure
- topical admin of vasoconstrictors
- cauterization
- nasal packing (Rhino-Rocket)
- continually assess airway
50
pt. education epistaxis
- sit with head tilted forward and pinch nose midline of septum (5-10 minutes)
- avoid vigorous activity for few days
- avoid tobacco and forceful nose blowing (this raises your BP so you are more likely to bleed)
- humidify O2
51
nasal obstruction
-passage of air obstructed by foreign body, deviated septum, nasal polyps
52
nasal obstruction signs
- congestion
- frequent infections
- sleep deprivation
53
management of nasal obstruction
- nasal corticosteroids for polyps
| - Abx underlying infection
54
pt. education national obstruction
-after surgery for removal of obstruction: elevate head of bed for drainage, sinus precautions (no straws, incentive spirometry, nose blowing), and ORAL hygiene
55
IMPORTANT to determine: nasal fractures
- CLEAR FLUID from nostril suggest cribriform plate fracture and leakage of CSF
* CSF has glucose and can be differentiated from nasal mucus with dipstick (Halo test)
56
management of nasal fractures
* control bleeding utilizing packing
- uncomplicated fractures can be tx with analgesia, ice, and ENT follow up and some can heal spontaneously but if misaligned you may need surgical intervention
57
pt education nasal fractures and CSF
- educate pt. not to blow nose/cough
- sneeze with open mouth
- elevate head of the bed
58
complications with CSF leakage specifically
-meningitis
59
more complications nasal fracture
- hematoma
- infection
- abscess
- necrosis
60
facial fractures?
NOTHING in nose (no NG tube)
61
laryngeal obstruction
- cause by edema and is SERIOUS (often fatal)
| - can be caused by severe inflammation of throat such as scarlet fever, in anaphylaxis, or when laryngospasm occurs
62
risk factors for laryngeal obstruction
- inhalation of foreign body
- use of ACE inhibitors (-ilil)
- previous tracheostomy
63
symptoms of laryngeal obstruction
- stridor
- hoarseness
- use of accessory muscles/dyspnea
64
if unsuccessful in dislodging obstruction
-tracheotomy is necessary immediately
65
if obstruction due to anaphy...
-admin of epinephrine and corticosteroid
66
most common form of laryngeal cancer
-squamous cell carcinoma
67
risk factors laryngeal cancer
- tobacco/alc
- more common in men
- 60-70 age
- AA population
68
symptoms laryngeal cancer
- hoarseness for more than 2 weeks
| - persistent cough/sore throat
69
late symptoms laryngeal cancer
- dysphagia
- dyspnea
- foul breath (halotosis)
- persistent hoarseness
- unintended weight loss
70
goals of tx laryngeal cancer
- provide safe swallowing
- preservation of voice
- cure
- avoidance of permanent tracheostomy
71
med management of laryngeal cancer
- surgery (total laryngectomy, partial resection)
- radiation (more effective early dx, preserves voice, can be used in combo with surgery)
- chemotherapy (usually used for reoccurrence or metastatic dz, utilized to shrink tumor before surgery)
72
total laryngectomy
*permanent tracheal stoma
- NO voice
- pt. will have normal swallowing
- speech therapy consulted preop.
73
nursing implications laryngeal cancer
- post-op, raise head of bed to decrease surgical edema
- monitor for hypoxia (SOB, restlessness, apprehension)
- encourage TCDB
- suction PRN (large amount mucus common)
74
possible complications from laryngectomy
respiratory distress/hypoxia
- hemorrhage (notify surgeon IMMEDIATELY if active bleeding)
- infection
- wound breakdown
- aspiration
- tracheostoma stenosis
75
pt. education after laryngectomy
- ORAL HYGEINE
- carry medical ID (stoma ventilation)
- hair spray, loose hair, and powder should not go near stoma
76
endotracheal intubation
**for those unable to maintain airway (ex. comatose or obstruction)
- no more than 21 days (breaks down trachea) ***!!!!!
- tube passed thru mouth or nose into trachea and once inserted cuff inflated to prevent air leakage around tube
77
ET tube nursing interventions
- nurse should have bag valve mask device (Ambu bag) at bedside
- suction and suction catheters should be set up at bedside
78
trach tubes cuffed vs uncuffed
-cuffed for mechanically ventilated patients
79
fenestrated
allows some air to move thru larynx so they can communicate
80
necessities at bedside for pt w/ trach
-spare tracheostomy tube (cuffed) and obturator (assists with putting in new trach)
81
thick secretions in trach
-thick secretions common because upper airway has been bypassed (hyper secretion because not dehumidifying same way)
82
trach pts. positioning
-semi fowlers
83
atelectasis commonly caused by
lack of deep breathing
*post-op pts. at increased risk
84
atelectasis symptoms
- dyspnea, cough, leukocytosis (elevated WBC)
- sputum production
- diminished breath sounds
85
PREVENTING atelectasis
- early ambulation
- spirometry
- DBCT
- chest physiotherapy (percussion and vibration...i.e. hitting pts. backs help cough up secretions)
86
how often to you use spirometry
6-10x a session (every hour) while awake
87
pneumonia
-infection of lower respiratory tract
88
pneumonia risk factors
- smoking
- COPD or asthma
- immunosuppression therapy
- older than 65 yo
- immobility
- poor dental hygiene
- artificial airways
89
VAP
-ventilator associated pneumonia
* prevent:
- suction
- oral care
- early mobility
- elevating HOB
90
pneumonia symptoms
- fever
- cough CAN BE PRODUCTIVE OR NONPRODUCTIVE
- hypoxia
- headache
- tachypnea
- diminished breath sounds/crackles
- altered mental status
91
O2 therapy
-titrate O2 to lowest level clinically indicated
92
cannula liters and percentage
1-6 L
*23-42%
93
simple mask liters and percentage
6-8 L
*40-60%
94
partial nonrebreather mask liter and percentage
8-11
*50-75%
95
nonrebreather mask liter and percentage
12-15L (can't last long on this...start making backup plan)
***MUST BE INFLATED to deliver highest concentration of FIO2 (don't let collapse on inspiration)
*80-100%
96
venturi mask
suggested flow rate is variable
*24%, 26%, 28%, 30%, 35%, 40%, 50%
***precise FIO2 (specific oxygen delivery)
97
incentive spirometer vs flutter valve
- spirometer (breathe in, inflate alveoli)
| - flutter valve (breathe out, loosens secretions and send vibrations thru bronchial tree)
98
pneumonia complications
- septic shock
- respiratory failure
- atelectasis
- pleural effusion
- superinfection
99
TB affects...
...the lung parenchyma
100
risk factors TB
- homelessness
- poverty
- overcrowding
- immunocompromised
- malnutrition
101
symptoms TB
- hemoptysis (coughing blood)
- dyspnea
- chest pain
- fever
- night sweats
- weight loss
102
symptoms of TB can last
weeks to months
103
pharm for TB
- INH
- rifampin
- pyrazinamide
- ethambutol
104
pleurisy
-inflammation of the membranes that cover the lungs
105
risk factors pleurisy (may develop with)
- pneumonia
- URI
- trauma
- PE
- after thoracotomy
106
pleurisy symptoms
-severe sharp pain during inspiration
107
management of pleurisy
tx underlying condition and analgesics
108
pleural effusion
-collection of fluid in the pleural space
**usually secondary (to heart failure, TB, pneumonia)
109
empyema
collection of purulent fluid (pus) within the pleural space
110
symptoms of PE are...
...dependent on size and the underlying condition
**dyspnea is most common symptom of large pleural effusion
111
management of PE
- tx of underlying condition
- thoracentesis
- chest tube insertion
112
PE and malignancy
-if caused by malignancy, reoccurrence is common
113
thoracentesis warning
-amounts removed that are greater than 1-1.5 L can result in re-expansion pulmonary edema
114
nursing interventions for thoracentesis
- gather supplies
- obtain specimen for testing
- help position and monitor pt
- documentation
115
ARF
- acute respiratory failure
* sudden life-threatening deterioration of gas exchange (differentiated between hypoxic {probs w/ oxygenation} or hypercapnic {probs w/ CO2})
116
causes of ARF
ex. injury to C-spine (above C4 or C3)
**numerous causes
117
ARF early symptoms
- restlessness
- fatigue
- headache
- dyspnea
- air hunger
- mild tachycardia/pnea
- increased BP
118
ARF late symptoms
- confusion and lethargy
- tachycardia/tachypnea
- central cyanosis
- diaphoresis
- respiratory arrest
119
settings for vent
- rate (# of breaths machine gives each minute...breathing over vent=good)
- FIO2 (inspired oxygen level...100% not good means pt not oxygenating well)
- Tidal volume (amount of air given with each breath in mL)
- positive end expiratory pressure (PEEP) (pressure used to keep alveoli open during expiration....5 is normal)
120
ARDS
- acute respiratory distress syndrome
* severe form of an acute lung injury (PROGRESSES QUICKLY TO SHOCK)
* mortality 50-60%
121
risk factors ARDS
- sepsis
- aspiration
- trauma
122
symptoms ARDS
- sudden pulmonary edema
- increasing bilateral infiltrates
- hypoxemia refractory to supplemental oxygen
- decreased lung compliance
123
management of ARDS
- tx underlying condition
- supportive care/intubation
- circulatory support
- proning
124
pulmonary artery hypertension is...
...usually secondary to cause such as COPD (hypercapnia and hypoxia causes vasoconstriction in pulm arteries) or L ventricular failure
125
as pressure in pulm artery rises...
...heart must work harder to compensate (often have R hypertrophy of R ventricle of heart)
126
symptoms of pulmonary artery hypertension
- dyspnea and weakness
- chest pain
- symptoms of R sided HF (distended neck vein, ascites, peripheral edema)
127
management of pulmonary artery HTN
- tx underlying condition
- supplemental oxygen
- vasodilators (sildenafil)
128
Pulmonary Embolism symptoms
- SOB
- pleuritic chest pain (sharp pain w/ inspiration)
- cough
- hemoptysis
- crackles
- tachypnea/tachycardia
129
diagnostics for pulmonary embolism
- D-dimer (blood test for pt. w/ poss PE....lots of false + but rarely false -)
- CT angio (BEST TEST FOR PE)
- ABG
130
saddle pulmonary embolism
(blocks blood flow to L and R side of lungs)
131
pulmonary embolism risk factors
- surgery/trauma
- obesity
- immobility
- older than 40
- pregnancy/oral contraceptives (more common in women)
- hypercoagulable conditions
132
preventing a pulmonary embolism
- prevent DVTs
- active leg exercise/early ambulation
- TED hose/SCDs
- prophylactic anticoagulation
133
management of pulmonary embolism
- anticoagulation (Heparin, Plavix)
- thrombolytic therapy (clot-buster...Altepase, only for unstable pts)
- surgical intervention (embolectomy)
- O2 admin
134
pulmonary edema symptoms
- PINK FROTHY SPUTUM
- confusion
- dyspnea/hypoxemia
- anxiety
- crackles
135
management of pulmonary edema
- tx the cause
- administer supplemental O2
- intubation if needed (but it is hard to manage because of all the sputum)
136
occupational lung dz
exposure to: metal dust, mineral dust, toxic fumes, asbestos
*this exposure results in fibrinous lung changes that are irreversible
137
management of occupational lung dz
CANT REVERSE (supportive tx)
138
lung cancer (bronchogenic carcinoma)
**ALWAYS assess for metasasis (commonly spreads to other areas, usually the lymphs)
139
risk factors bronchogenic carcinoma
- smoking
- radon gas exposure
- occupational exposure to carcinogens
140
airway clearance techniques for lung cancer pts
- suctioning
- directed cough
- deep breathing exercises
141
tumors of mediastinum (malignant or benign) symptoms
-result of pressure put on intrathoracic organs (chest wall bulging, cough, wheezing, superior vena cava syndrome, neck distension), dysphagia, weight loss
142
complications of mediastinum tumors
- hemorrhage (eat thru lining of big vessel possibly)
| - infection
143
blunt trauma
* most common cause is MVAs
- falls
- bicycle crashes
144
penetrating trauma
- gunshot wounds
- stab wounds
**any penetrating trauma to head/neck/thorax/pelvis is a MEDICAL emergency
145
trauma management
- immediate life threats (hemorrhage)
- airway
- breathing
- circulation
- disability
- exposure
146
sternal fractures
most commonly due to MVAs
147
rib fractures
*most common type of chest trauma (fractures of UPPER ribs usually from high impact trauma so less common)
148
symptoms rib fractures
-pain that worsens when taking deep breath/coughing resulting in atelectasis
149
management of rib fractures
- pain relief
| - incentive spirometer (cant get to 500? ICU.)
150
surgical fixation of rib fractures
RARELY necessary (most rib fractures heal in 3-6 weeks)
*in old ppl: rib fx--> atelectasis --> pneumonia --> sepsis --> die
151
flail chest
3 or more adjacent ribs are fractures in 2 or more spots resulting in free-floating rib segments
***result of HIGH impact trauma (almost always cardiac or pulmonary contusion w/ this)
152
symptoms flail chest
- paradoxical chest wall movement
- SOB
- hypoxia
153
management of flail chest
- ventilatory support
- pain control
- monitoring
154
pulmonary contusion
-damage to lung that results in hemorrhage and localized edema (AKA a bruise)
**takes 24 for it to worsen and to really see it (delayed response)
155
symptoms pulmonary contusion
- crackles
- decreased breath sounds
- hypoxia
- blood-tinged secretions
- constant but ineffective cough
156
management of pulmonary contusion
- monitor pt
- maintain airway
- O2 therapy
- pain control
157
complications of pulmonary contusion
-pulmonary infections
158
cardiac tamponade
-buildup of blood fluid in pericardial sac/compression of heart resulting from fluid or blood within pericardial sac
159
subcutaneous emphysema
air passages injured and air enters tissue under skin
160
subcutaneous emphysema symptoms
- tissues crackle when palpated (crepitus)
| - misshapen appearance in face, neck, body
161
pneumothorax
-parietal or visceral pleura is punctures and pleural space exposed to positive atmospheric pressure resulting in air entering pleural space and causing lung to collapse
***MANAGE: chest tube insertion
162
hemothorax
-blood enters pleural space and causes lung to collapse
***MANAGE: chest tube insertion
163
tension pneumothorax
-air drawn into pleural space and is trapped (results in pressure on heart and trachea in addition to collapsed lung)
***EMERGENCY=cardiac arrest can occur
164
symptoms tension pneumothorax
- air hunger/SOB
- anxiety/hypoxia
- tracheal deviation (LATE sign)
165
management tension pneumothorax
- needle decompression
| - followed by CT insertion
166
water seal chamber
-tidaling normal but bubbling is NOT (air leak)
167
drainage chamber
-more than 100 mL per hr or serosanguinous drainage all the sudden then be concerned
168
chest tubes suction
set to continuous suction at 80-100 mmHg
169
chest tube accidentally dislodged.....
cover site with occlusive dressing (taped on 3 sides)
170
complications of aspiration
- aspiration pneumonitis (inflammation of lungs from chemical burn from acid)
- pneumonia
- respiratory failure
171
COPD
dz state characterized by chronic airflow limitation that is not fully reversible (usually progressive)
*combo of chronic bronchitis and emphysema
172
ABG of COPD pt
- elevated paCO2
- normal PH (compensating)
- elevated HCO3 (compensating)
- low paO2
**respiratory acidosis
173
3 primary symptoms COPD
- dyspnea
- chronic cough (more than 3 mo)
- sputum production
174
diagnostics for COPD
pulmonary function testing
175
COPD med management
**stop progression of dz, improve QOL, and prevent exacerbation
- smoking cessation
- flu/pneum. vaccines
- pulmonary rehab
- pharmacotherapy
176
COPD pharmacologic management
- bronchodilators (metered dose inhaler, nebulized, or dry powder inhaler) to relieve bronchospasm and reduce airway obstruction
- corticosteroids (oral, IV, inhaled)...NOT a rescue device {ex. fluticasone, beclomethasone}
177
bronchodilators
- short acting (ex albuterol) w/ asthma attack/rescue device
- long acting (ex tiotropium) lasts 12-24 hrs maintenance.
178
corticosteroids...be careful of...
...THRUSH
179
symptoms COPD exacerbation
- increased dyspnea
- increased sputum production (often purulent)
- respiratory failure
- ABG abnormalities
180
prevention of COPD exacerbation
helps preserve lung fxn
181
COPD complications
- pneumonia
- exacerbation
- pulmonary arterial HTN
- heart failure/cardiac hypertrophy
- pneumothorax
182
goal of O2 therapy in pt w/ severe COPD
88-92% or at pt's chronic baseline
**O2 usually titrated to O2 saturation of 90% in pts w/ COPD
**SHOULD NOT withhold O2 from a hypoxic pt, but should be titrated conservatively
183
pursed lip breathing
-slowly inhale, exhale with pursed lips (helps w/ SOB)
184
pt education in COPD
- how to use nebulizer
- how to use MDI
- long term O2 therapy associated w/ increased survival
- infection prevention
185
using an MDI
- inhale evenly and slowly and hold breath after inhalation
| * space can help deliver more of med to lungs
186
asthma
-chronic dz characterized by bronchial hyperresponsiveness and airflow obstruction
187
asthma symptoms
-diffuse airway inflammation (chest tightness, wheezing, SOB)
188
asthma complications
- status asthmaticus
- respiratory failure
- total airway obstruction
189
2 goals in asthma management
1. limit need of inhaled SABA (albuterol) to 2 or fever times a week
2. limit nighttime awakenings from asthma to 2 or fewer nights a month
**ALSO use peak flow meter
190
pharmacologic management asthma
- SABA or Inhaled Short Acting Beta-Agonist... rescue inhaler ...ex. albuterol
- ICS or Inhaled Corticosteroids ...prevents exacervations as maintenance inhaler (Pulmicort) PREVENTS is key word here
- LABA or Long-Acting Beta-Agonist ...typically given in combo with ICS as maintenance (Advair)
- Leukotriene Modifiers...oral anti-inflammatory meds (Singulair)
191
status asthmaticus
-severe, continuous reaction resistant to initial tx
192
management of status asthmaticus
- ICU or ED monitoring
- systemic corticosteroids
- continuous nebs
- ipratropium
*may need intubation/mechanical vent
193
exercise and asthma
**use rescue inhaler prior to exercise for pts with exercise induced asthma
194
inhaled corticosteroids
used daily to prevent acute asthma events (and spacer recommended with corticosteroids)
*rapid acting bronchodilator (albuterol) should be used for acute respiratory distress
195
stomatitis (mucositis)
-inflamed, sore mouth (white patches, ulcer, redness)
196
replacing toothbrush
every 2 months
197
nursing management post op TMD
- rigid fixation/rubber band fixation
- no chew...liquid diet
- wire cutters/scissors (need if begin to vomit)
198
sialadenitis
* *infection of salivary glands characterized by:
- inflammation
- pain
- edema (often from dehydration)
- purulent discharge
199
sialadenitis common causes
- dehydration
- radiation therapy
- stones
- stress
- malnutrition
200
sialadenitis tx
- ABx, corticosteroids
- massage
- hydration, warm compress
- surgical drainage/excision
201
parotitis
**most common form of sialadenitis
-often caused by staph
202
mumps
epidemic parotitis
203
parotitis risk factors
- elderly
- acutely ill
- decreased salivary flow
204
parotitis symptoms
-fever, edema, tender
205
med management of parotitis
- adequate nutrition and fluids
- oral hygiene
- discontinue meds (ESP diuretics)
- Abx/analgesics
- surgical drainage/excision OR parotidectomy
206
most commonly affected oral and oropharyngeal cancers
-lips, tongue, floor of mouth
207
manifestation of oral cancer
-non-healing painless sore or mass (doesn't heal in 2x weeks)
208
risk factors oral cancer
- alc and tobacco
- male
- smoked meat ingestion
- sun exposure (lips)
209
oral and oropharyngeal cancer metastases
-frequently to lymph nodes, requiring neck dissection surgery `
210
assessment neck dissection post op
- respiratory status
- wound infection
- hemorrhage
211
xerostomia
w/ both neck dissection and oral cancers
212
common side effect of chemo/radiation (oral)
- stomatitits
| * prophylactic mouth care is important
213
achalasia
-absent or ineffective peristalsis of distal esophagus and failure of esophageal sphincter to relax with swallowing (narrowing of sphincter proximal to stomach)
214
achalasia symptoms
- dysphagia (most common symptom of esoph. dz)
- sensation of food being stuck
- regurgitation (spontaneous or intentional)
- chest pain/ pyrosis (heartburn)
215
risk for achalasia
risk for aspiration
216
what is used for dx in achalasia
- manometry
| * x-ray, CT endoscopy is supplemental
217
tx for achalasia
- aspiration precautions
- calcium channel blockers/nitrates
- botox to inhibit contractions of that smooth muscle
- pneumatic dilation (balloon put in and stretches that area, monitor for PERF here)
- esophagomyotomy
218
hiatal hernia
-opening in diaphragm where esophagus passes is enlarged and part of stomach moves up into lower portion of thorax
219
4 types hiatal hernias
1. sliding (MOST COMMON) --upper stomach and gastroesophageal jxn displaced upward and slide in and out of thorax
2. rolling (paraesophageal) -- all or part of stomach pushes thru diaphragm beside esophagus
3. sliding/rolling mix -- cardia and fundus displaced upwards
4. simultaneous w/ another organ
220
hiatal hernia risk factors
**more common in women
221
symptoms hiatal hernia
* **50% are asymptomatic
- pyrosis
- regurgitation
- dysphagia
222
dx for hiatal hernia
- xray
| - barium swallow and fluoroscopy
223
complications w/ hiatal hernias
- hemorrhage
- obstruction
- strangulation
224
tx hiatal hernia
- frequent small meals w/ aspiration precautions
- w/sliding hernia: sit up 1 hr after eating HOB
- surgery
225
diverticulum (esophageal)
-outpouching of mucosa and submucosa that protrudes thru weak portion of musculature at any location of esophagus
226
clinical manifestations diverticulum
- Zenker's diverticulum (lots of fullness in neck, bulging, dysphagia, regurgitation, food in pouches)
- Midesophageal diverticulum (lot of same symptoms just not as severe and could possibly have no symptoms)
227
esophageal diverticulum tx
NPO until imaging shows no leaks or fistula development
| liquids to solids as tolerated and NG tube may be placed
228
esophageal perforation clinical manifestations
- persistent pain
- dysphagia
- fever/leukocytosis
- severe HTN
- sepsis signs (spilling out)
229
med/nursing management esophageal perf
- broad spectrum ABx
- NPO (enteral or parenteral nutrition)
- surgery
- repeat barium swallow
230
esophageal dx: foreign bodies
MOST COMMON: food boluses
**identified in an XRAY or endoscopy to tx
231
complications of foreign bodies
*may cause obstruction or trauma: perf or dyspnea
232
meds for esophageal foreign bodies
- glucagon (IM shot relaxes esophagus so food bolus can flow down)
- sodium bicarb and Tartaric acid (nebulize)
233
injury depends on what for chemical burn
- strong alkaline substances
- undissolved meds
**severity based on what chemical
234
risk for chemical burns
- dysphagia
| - airway compromise
235
evaluation of chemical burn
esophagoscopy
236
tx in chemical burns
AIRWAYYYYYYY***
- pain
- vomiting/gastric lavage are AVOIDED (causes damage when comes back up and can perf)
- NPO/NGT
237
complication chemical burn
- strictures may form from trauma and require dilation
| - sometimes esophagectomy
238
GERD
-incompetent lower esophageal sphincter, pyloric stenosis, or motility disorder
239
clinical manifestation
- pyrosis (heartburn)
- dyspepsia
- regurgitation
- dysphagia
240
nocturnal regurgitation
-often alcohol induced and comes up while sleeping and you can choke
241
medical/nursing management Barrett's esophagus
- repeat EGD in 6-12 mo if cellular changes are mild
- PDT (photodynamic therapy)
- ablation
242
risk factors cancer of esophagus
- male
- alcohol
- tobacco use
**VERY treatable and curative if in early stages (but often asymptomatic)
243
nursing priority cancer of esophagus
***airway directly after surgery
- nutrition promotion
- prevent aspiration pneumonia
- NG tube maintenance
244
priorities of care for any tube feedings
- risk of aspiration ***
| - prevent dumping syndrome (too much food too fast)
245
labs and TPN
FLUSH before you draw labs
*and TWO NURSES check contents and order
246
discontinuing TPN
* *never just stop
| - run D5 if line pulled out
247
acute and chronic gastritis
acute: diet or NSAIDS or alc or reflux or radiation
chronic: benign or malignant ulcers of stomach or by H. pylori
248
clinical manifestations gastritis
- headache
- anorexia
- n/v stomach pain
- hiccuping
- achlorhydria/hypochlorhydria/hyperchlorhydria
249
tx for gastritis
* cause from acids? antacids will neutralize
* cause from alkalis? diluted vinegar or lemon juice will neutralize
****LAVAGE and EMETICS avoided if danger of perf and/or esophageal damage
250
chronic gastritis tx
- diet
- rest
- avoid NSAIDS alc
251
peptic ulcer dz can be...
...caused by GERD
*excavation that forms in mucosal wall of stomach, in pylorus, duodenum, or esophagus (erosion from increased HCl or activity of acid-pepsin)
252
peptic ulcer complications
-can extend as deeply as muscle layers or thru peritoneum
253
ZES
-Zollinger-Ellison syndrome
tumors that secrete HCl
254
SRMD
* Stress-related Mucosal dz
- injury to lining of stomach and duodenum during physiologic stress
(can cause tumors)
255
major manifestation of peptic ulcer dz
-dull, gnawing pain/burning sensation in midepigastrium in in back
256
Zes-Gastric triangle
gallbladder, jxn of duodenum, jxn of head and neck of pancreas
257
drug tx PUD
- abx
- PPI
- histamine-2 (H2) receptor antagonists
- bismuth salts
258
vagotomy
-vagus nerve cut which decreases gastric secretions
259
nursing interventions for PUD
- hemorrhage risk
- perf risk
- penetration (from dx/surgery)
- pyloric obstruction (GOO)
260
perforation pain
-can be referred to shoulder, esp R shoulder because of irritation of phrenic nerve in diaphragm
261
manifestations perf
- vomiting
- collapse (fainting) from change in vital signs
- HTN and tachycardia (SHOCK indication)
262
morbid obesity
more than 2x ideal body weight OR BMI exceeds 30 OR more than 100 lbs greater than ideal body weight
263
morbid obesity puts at risk for
gallbladder dz and cancers (uterine, breast, colorectal, kidney, and gallbladder)
264
diet for bariatric surgery
* 6 small meals per day (w/ protein and fiber) and chew thoroughly (less than 1 cup total meal size)
265
diet before bariatric surgery
-cl liquids 2-3 weeks before surgery to shrink liver and filled w/ gas to make sure nothing nicked
266
hydration bariatric surgery
* drink slowly
| - 30 minutes (water) after each meal and 15 min before
267
nutritional deficiency after bariatric surgery
**absorption issues (MUST take supplements)
268
gastric cancer prognosis
POOR
-dx usually late because most pts. asymptomatic during early stages
**MOST are adenocarcinomas
269
clinical manifestation gastric cancer
- pain relieved by antacids resembling those of benign ulcers
- N/V, dyspepsia, early satiety, weight loss, bloating after meals
**symptoms VERY similar to PUD
270
duodenal tumors
**uncommon and usually benign and asymptomatic (vague nonspecific symptoms)
-if malignant, adenocarcinoma usually, may cause bleeding, pain, obstruction
271
complications constipation
- HTN
- fecal impaction
- hemorrhoids and fissures
- megacolon
272
types of diarrhea
- secretory
- osmotic
- mixed
273
monitor what w/ diarrhea
-serum electrolyte levels
274
malabsorption
-inability of digestive system to absorb one or more of major vitamins, minerals, and nutrients
**typically causes diarrhea or frequent, loose and bulky and foul smelling stools
275
tx for malabsorption
-avoid dietary substances that aggravate malabsorption and supplement nutrients that have been lost
276
risk in malabsorption
refeeding syndrome
**potentially fatal shifts in fluid and electrolyte imbalances
277
appendicitis clinical manifestation
- vague epigastric or periumbilical pain
| - fever, n/v, rigid abd, chills, anorexia, diarrhea/const, leukocytosis
278
appendicitis indicators
- RLQ pain improved w/ flexing right hip (this may suggest perforation)
- rebound tenderness
- Rovsing-sign (pain felt in RLQ upon palpation of L side of abd)
279
appendicitis can cause
peritonitis (leakage of contents from abdominal organs into abd cavity)
**may have drain placed in this case because you are worried about a perf and can become septic real fast
280
complications after appendectomy
- peritonitis
- abscess
- ileus
281
diverticulum
sac-like herniation of lining of bowel that extends thru defect in muscle layer
282
diverticulosis
- MULTIPLE diverticula are present w/out inflammatory symptoms
* may be asymp., sometimes mild symptoms
283
diverticulitis
- food and bacteria retained in a diverticulum and produce infection and inflammation
* at risk for perf and sepsis and abscesses
284
peritonitis usually result of...
...bacterial infection
285
tx for peritonitis
- fluids
- pain relief
- abx
286
peritonitis nursing interventions
- frequent abd assessment
- monitor vital signs
- monitor septic signs
287
IBD
-refers to two chronic inflammatory dx
1. Crohn's dz (regional enteritis)
2. Ulcerative colitis
(exact causes unknown, AUTOimmune dx)
288
IBD risk factors
men and women equally affected
289
Crohn's
subacute and chronic inflammation that extends thru all layers (ulcerations appear on inflamed areas)
290
clinical manifestations Crohn's
- prominent RLQ pain unrelieved by defecation
- diarrhea
- fatigue, fever, cramping, anorexia, bloating after meals
- tenesmus (feeling as tho you need to pass stools)
- Borborygmi
291
Crohn's...what do you worry about
**worry about fistula (eats away at colon)
292
complications
- intestinal obstruction or stricture
- perianal dz
- fluid/electrolyte inbalance
- malnutitrion
- fistula/abscess
293
UC
-recurrent ulcerative and inflammatory dz of mucosal and submucosal layers of colon/rectum
294
complications UC
- toxic megacolon
- perf
- blood loss
295
med management IBD
- reduce inflammation
- rest for diseased bowel
- improve QOL
296
interventions for IBD
- diet
- lab monitoring and vital signs
- abd assessment
- bowel fxn / intake/output
297
colorectal cancer
very tx-able earlt stages
* prone to metastasize
* often insidious signs, so late dx
298
worry about w/ colorectal cancer
-anastomosis
299
small bowel vs large bowel obstruction
small bowel: more rapid onset and treated w/ NG decompression
Large bowel: more gradual onset and may require creation of colostomy
300
3 causes intestinal obstruction
1. intussusception (movement of one segment of bowel into another)
2. volvulus of sigmoid colon (counterclockwise twist and edematous bowel)
3. hernia (inguinal) continuation of peritoneum of abd
301
ileostomy, worry about...
fluid loss
302
jaundice
-impairment of liver's ability to metabolize and secrete bilirubin
303
vitamin deficiencies in hepatic dysfunction
- decreased secretion of bile salts into intestines may interfere with absorption of fat-soluble vitamins and dietary fats
- liver cells have inability to use vitamin K to make prothrombin, GI tract unable to absorb
304
ascites
-accumulation of fluid in peritoneal cavity
SYMPTOMS: increased abd girth, weight gain, swelling of lower extremities
305
tx of ascites
- sodium restriction
- diuretics
- paracentesis
- TIPS (shunt)
306
tx for active bleeding esophageal varices
- meds
- variceal banding
- EIS
- balloon tamponade
307
nursing interventions esophageal varices
- monitor bleeds
- perf of esophagus
- aspiration pneumonia
- esophageal stricture
308
hepatic encephalopathy
-results from accumulation of ammonia and other toxic metabolites in blood
309
hepatic encephalopathy
-asterixis (flapping tremor of hands)
310
tx hepatic encephalopathy
-lactulose (cephulac) give to reduce serum ammonia levels (laxative binds with ammonia) but be aware electrolyte/fluid imbalance
311
nursing care hepatic enceph.
-prevent injury, bleeding, and infection
312
viral hepatitis
-necrosis and inflammation of liver
A, B, C, D, E (acute or chronic liver dysfunction)
313
vaccine hepatitis
vaccine for Hep. A and B
314
hep a
fecal-oral route
*asymptomatic or acute symptoms (usually manage at home)
315
hep b
**LONG incubation period (insidious signs and symptoms)
-NO cure but most adults who get it will recover fully
316
hep b transmission
perinatal, percutaneous, sexual exposure, person-to-person
317
leading cause of liver disease
-Hep C
**PRIMARY indication for liver transplantation
318
Hep C
-injection of drugs and transfusion of blood products prior to 1992 is primary occurence
***MOST are asymptomatic
319
hepatitis D
cant get if you didnt have B
320
fulminant hepatic failure
-clinical syndrome of sudden severely impaired liver fxn in previously healthy person
***usually from Hep A, B, or E, OR acetaminophen
321
w/ cirrhosis, monitor for...
...encephalopathy
322
cirrhosis symptoms
- abd distention and bloating
- GI bleed
- bruising
- weight changes
323
hepatocellular carcinoma
- manifestations typically similar to cirrhosis
| * surgery and liver transplant
324
ESLD
- end stage liver dz / acute liver failure
| * tx of choice is transplantation
325
complications liver transplantation
- bleeding
- infection
- biliary leaks and obstruction
- hepatic artery thrombosis
- portal vein thrombosis
326
what to monitor for pt undergoing liver transplant
- infection
- bleeding prevention
- monitor protein and clotting factors
- monitor signs of liver dysfunction
- monitor s/s rejection
327
cholelithiasis
* gallstones
| - symptoms results from dz of gallbladder itself and obstruction of bile passages by gallstone
328
cholecystitis
- inflammation of gallbladder
| * upper right abdominal pain, n/v
329
tx cholecystitis
- medication
- cholecystectomy
- laproscopic procedure
330
risk factors for cholelithiasis
4 F's
- fat
- forty
- female
- fertile
331
pancreatitis labs
HIGH lipase
332
pancreatitis
autodigestion of pancreas from temporary pancreatic duct obstruction accompanied by hypersecretion of exocrine enzymes
333
ERCP
-endoscopic retrograde cholangiopancreatography
***can cause pancreatitis
334
tx pancreatitis
- NPO
- pain management
- fluids (worry about fluid overload)
335
4th leading cause cancer death US
-pancreatic cancer (low survival rates both w. and w/out surgery)
336
risk factors pancreatitis
- tobacco
- obesity
- chronic pancreatitis
337
whipple procedure
-remove part of small intestine, gallbladder, and bile duct
**major surgery
338
geriatrics and surgery
- less physiologic reserve
- less ability to respond to stress
- underreported pain
- HIGH delirium risk
- HIGH hypoxia risk
- HIGH hypothermia risk
339
IV solutions and geriatrics
-decreased cardiac output (so pulmonary effusion risk)
340
anesthesia and geriatrics
-less plasma proteins so more unbound anesthesia and stays in system longer
341
fatty tissue
higher risk for infection (obese pts.)
342
obese surgical pts.
- higher risk for dehiscence
- difficulty ambulating
- shallow breathing when supine
343
state of narcosis
-severe CNS depression
344
anesthesia hasn't worn off until
- motor
- sensory
- autonomic
no longer affected
345
shivering
increases O2 demand by 300% to 400% thus supplemental O2 should be administered
346
malignant hyperthermia early sign
tachycardia
| altered mechanism of Ca fxn in skeletal muscle cells
347
MH other signs
- hypotension, ventircular arrythmias, hyperthermia, tachypnea
- rigidity (often in jaw)
**CARDIAC ARREST IF NOT CORRECTED
348
late sign MH
- hyperthermia
| - core body temp rise rapidly, 2-4 degrees every 5 min
349
admin to tx MH
dantrolene
* discontinue triggering agent
* hyperventilation of pt. w/ 100% O2
350
DIC
- disseminated intravascular coagulation
* widespread hemorrhage and microthrombosis all over with ischemia
* can be precursor or caused by MH/ HIGH mortality rate
351
bleeding in DIC
- venipuncture sites
- mucous membranes
- GI and urinary tracts
352
hypopharnygeal occlusion
lower jaw and tongue fall backwards
