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Psych Exam #4 > Med surg Exam 4 > Flashcards

Med surg Exam 4 Flashcards

1
Q

What is TURP

A

Transurethral resection of the prostate for BPH
A surgery to remove parts of the prostate gland through the penis

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2
Q

Why do we need TURP?

A

Relieve the symptoms of an enlarged penis or other benign prostate disease

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3
Q

What lab is associated with continuous bladder irrigation (CBI)?

A

CBC

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4
Q

Side effects for breast cancer

A

Fatigue, N/V, breast changes, pain, nail changes, dryness, and heart problems

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5
Q

Treatment for breast cancer

A

Chemo, radiation, surgical removal of breast and surround lymph nodes

NB: tamoxifen is a hormone drug therapy treats breast cancer in pre&pro menopausal women

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6
Q

What is a mastectomy?

A

A way of treating breast cancer by removing the entire breast through surgery

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7
Q

Side effects for a total mastectomy

A

pain/tenderness, swelling, blood buildup, clear fluid leakage,

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8
Q

Therapeutic communication for mastectomy

A
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9
Q

What is Peau de orange?

A

used to describe a symptom in which the skin becomes thick and pitted, with a texture and appearance similar to that of orange peel

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10
Q

What does peau de orange signify?

A

inflammatory breast cancer

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11
Q

What is cholecystitis?

A

Inflammation of the gallbladder wall
Causes:
Gallstones obstructing the cystic/common bile ducts causing bile to back up and gall bladder to become flamed (colelithiasis)

It can cause obstruction of pancreatic duct causing pancreatitis and secondary peritonitis (gallbladder to rupture)

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12
Q

What is cholelithiasis?

A

The formation of gallstones related to the precipitation of either bile or cholesterol into stones

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13
Q

What is cystic duct obstruction?

A

Distention of the gallbladder and produce intermittent binary pain

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14
Q

Side effects for cholecystitis, cholelithiasis, and cystic duct obstruction?

A

pain in upper abdomen, tenderness, N/V, fever

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15
Q

Meds used for cholecystitis, cholelithiasis, and cystic duct obstruction?

A

Analgesics:
Opioid analgesics - morphine sulfate or hydromorphine (for acute biliary pain)
NASAID- ketorolac

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16
Q

What is gastric cancer?

A

Cancer that starts in the cells within the lining of the stomach

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17
Q

What are the causes of gastric cancer?

A

Infection with H. pylori

History of pernicious anemia, gastric polyps, chronic atrophic gastritis, achlorhydria

Eating pickled foods, nitrates from processed foods, and salt added to foods

Prior gastric surgery

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18
Q

Treatment for gastric cancer

A

Nonsurgical management
-Radiation, chemotherapy

Surgical management
-Gastrectomy or subtotal (partial) gastrectomy

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19
Q

Symptoms of gastric cancer

A
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20
Q

What is a gastrectomy?

A

Surgical removal of a total or partial of the stomach due to cancer or gastric bypass surgery.

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21
Q

NGT management

A

It allows surgery to take place without contamination of the peritoneal cavity. After surgery, it prevents vomiting and pressure on the incision.

Nurse actions/interventions:
Monitor for fluid and electrolyte imbalances
Monitor I&O
Assess nasal skin for irritation
Provide oral hygiene every 2hr
Asess NGtube patency and placement.
Irrigate every 4 hr, or as prescribed
Maintain intermittent suction as prescribed

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22
Q

What is the purpose of a NGT?

A

Treating intentional obstruction, relieve abdominal distention and giving nutritional support.
Treatment continues until the obstruction resolves or is removed.

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23
Q

What labs do we monitor with gastrectomy’s?

A

WBC, RBC
Vitamins &minerals levels- due to decreased absorption after a gastrostomy such as vitD, B12, Ca, Fe & Folate

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24
Q

S/S of gastrectomy complications

A

Perforation/hemorrhage - pain, abdomen become tender and rigid (boardlike), rebound tenderness, chock, hypotension, tachycardia, dizzy, confusion, decrease hg

Pernicious anemia -pallor, fatigue, paresthesias, glossitis

Dumping syndrome -weakness, diaphoresis, palpitations, dizzy, diarrhea

Pyloric obstruction- Nausea, fullness, distention

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25
How do you prep for a colonoscopy?
Use of a flecible fiber ootic colonoscope, which enters through the anus, to visualize the rectim and the sioid, descending, transverse, and ascending colon -bowel prep (laxatives eg bisacodyl & polyethylene glycol not on older pts) -clear liquid diet -NPO after midnight -avoid meds such as NSAIDS, anticoagulant, antiplatelets
26
What is a fecal occult test? FOBT
A lab test used to check stool samples for hidden (occult) blood. Nurse action: Be aware of any medication restrictions (anticoagulant, NSAIDs) for 7 days before the test and dietary food (vit C, red meat, chicken, fish). Interpretation: at least 3 repeats of + guaiac FOBT confirms GI bleeding
27
What are you looking for with a fecal occult test?
GI bleeding, Colon cancer or polyps
28
What is Benign prostatic hyperplasia (BPH)?
enlarged prostate, but not cancerous
29
S/S of BPH?
Urine frequency and urgency - Difficulty urination - "Weak" pee Stream - Leaking
30
What is gastric reflux?
Gastric content and enzyme back-flow into the esophagus (tube connecting your mouth and stomach)
31
Whats not working correctly with gastric reflux?
The muscles where the esophagus and stomach meet don't close tightly enough causing back flow of stomach content into the esophagus. Also: incompetent lower esophageal sphincter Hiatal hernia Excessive intra-abdominal/intragastric pressure Motility problems
32
How do you treat gastric reflux?
Diet Lifestyle changes Advancing to medication use Surgery
33
Nursing interventions for gastric reflux?
To know what the client has been using to treat the problem Teach the client to elevate the HOB by sleeping with wedge pillow under the head Teach the client to avoid acidic drinks and food Instruct pt to eat 4-6 small meals a day and limit fluids during mealtimes Discuss behavior modification with pt
34
What are the post-operative care for nurses?
Monitor vital signs Assess for complications Notify the provider of severe pain/perforation/hemorrhage Monitor for rectal bleeding Resume normal diet Maintain an open airway until the client is awake Encourage ^ fluid intake Respiratory status Instruct client not to drive for 12-18hr Instruct the client there is ^ of flatulence Withhold fluids until return of gag reflux Discontinue IV if the client tolerate fluid Use lozenges is sire throat or horse voice
35
What is cirrhosis?
Permanent scarring that damages your liver and interferes with its functioning
36
Cirrhosis S/S or cues
Fatigue Ascites- fluid in the belly (gain weight) Abdominal pain Pruritus - itching Jaundice Red palms lack of body hair Encephalopathy-confusion
37
What is cirrhosis patients at risk for?
Jaundice Splenomegaly Ascites Bleeding Asterixis (coarse tremor of wrist and fingers) Fetoe hepaticus (fruity smell) Hepatic encephalopathy Confusion
38
Meds given for cirrhosis
Diuretic Lactulose Nonabsobarble antibiotic Beta blocking agent
39
Nursing interventions for cirrhosis patients
nurses play an important role in the management and prevention of complications of the disease and improvement in patients’ quality of life
40
What makes the bleeding worse?
Enlarged esophageal veins (varices) Portal hypersensitive gastrophy
41
What is colon cancer?
A growth of cells that begins in a part of the large intestine
42
Risk factors for colon cancer
Diet of High fat, Low fiber &High protein Age Smoking & tobacco use Family’s history of colon cancer/polyps Obesity History of IBD
43
S/S for colon cancer
Episodes of diarrhea and constipation
44
What is GERD?
Occurs as a result of back flow of stomach contents into esophagus
45
Gerd S/S
heartburn/pyrosis, regurgitation, eructation(burping), flatulence, debtal caries, Pain relieved by drinking, sitting upright or taking anti-acids radiation pain worsen in bending or laying down Throat irritation, hypersalivation, bitter taste Chest congestion and wheezing can induce an adult-onset asthma [chronic] dysphagia, odynophagia (pain on swallowing)
46
Treatment for GERD
Acid suppressive agents: PPI (-zole) : at routine dosing times usually after breakfast antacids (-carbonate and -hydroxide) : H2 receptor antagonists (-tidine): at routine dosing times with meals & at bedtime Mucosal barrie agent: on empty stomach Prokinetics (metoclopramide)
47
Non-surgical treatment for GERD
**Stretta**- a procedure uses radio frequency energy to decrease vagus nerve activity which cause the lower esophageal muscle (LES) to contract and tighten.
48
GERD physiology problems
Greater risk for esophageal cancer aka *Barret’s*esophagus or carcinoma of the esophagus Common comorbid disease is adult-onset asthma
49
What is EGD?
Esophagostroduodenoscopy Examines the lining of the esophagus, stomach, and first part of the small intestine (duodenum) to identify or treat areas of bleeding, dilate an esophageal structure, and diagnose gastric lesions or disease.
50
How do you prep for EDG?
NPO 6-8hr Remove dentures prior procedure Positioning: left side-lying with head of bed elevated Anesthesia: moderate sedation per IV access
51
What is EDG looking for?
to identify or treat areas of bleeding, dilate an esophageal structure, and diagnose gastric lesions or disease.
52
How does EDG work?
Insertion of endoscope through the mouth into the esophagus, stomach and duodenum
53
What is flatulence?
Accumulation of gas (Fart) due to air instillation during the procedure
54
What is ascites?
The accumulation of protein rich fluid in the peritoneal cavity causing abdominal swelling, girth and distention Caused by cirrhosis
55
What is a colostomy?
A surgical operation in which piece of the colon is diverted to an artificial opening in the abdominal wall so as to bypass a damaged part of the colon
56
What does a colostomy do?
Collects stool through a pouch placed over the stoma
57
How do you care for a ostomy bag? (Empty, remove, replace disk, replace bag)
-assess the type and fit of the ostomy appliance -empty pouch when it is 1/3 to 1/2 full of drainage and place a new one -Record the stool description -clean stoma and surround area -Acess stoma and surrounding area for infection or abnormalities -monitor any leakage
58
Ileostomy vs colostomy
**Ileostomy**- a surgical opening into the ileum to drain stool. Which is typically frequent and liquid because colon is by passed (right) -more liquidity/diarrhea Indication: when the entire colon must be removed due to Crohn’s disease and ulcerative colitis **Colostomy**- a surgical opening into the large intestine to drain stool (left) -formed stool (constipation) Indication: when a portion of the bowel must be removed eg cancer,&ischemic injury or when requires rest for healing eg diverticulitis &trauma
59
How do you take care of the stoma?
-empty pouch and place a new now -clean stoma and surround area -Acess stoma and surrounding area for infection or abnormalities(norm is pink&moist) -apply skin barriers and creams
60
What is a pap smear?
A test carried out on a sample of cells from the cervix to check for abnormalities that may be indicated of cervial cancer
61
Who gets pap smears?
Women ages 21 to 65
62
What is pancreatitis?
Inflammation of the pancreas
62
What is peritonitis?
Inflammation of the peritoneum S/S ^ temp ^ HR ^WBC Decreased BP Rigid abdomen
63
How does one get peritonitis?
septic patient, infections, or GI trouble Results from infection due to: puncture (surgery or trauma) Rupture of part of the GI tract Continuous ambulatory peritoneal dialysis
64
Who gets pancreatitis?
65
What is the treatment for pancreatitis?
Nutritional Support Fluids
66
Do and don'ts with pancreatitis
Do: side lying knees to chest help to pain NPO Don’t: give food
67
Medication to treat/help with pancreatitis
68
S/S with pancreatitis
Pain radiates to right shoulder
69
What labs show pancreatitis issues?
Amylase (23-85) lipase digestive enzymes High glucose & lipids
70
Nursing care for pancreatitis
71
Potential complications with pancreatitis
72
General endoscopic procedures. Pre procedure: nursing interventions
Evaluate understanding of procedure Consent from the dr has been signed Vital signs Lab tests Medical history Age Current health status Cognitive statys Support system Recent food or fluid intake (aspiration^) Medication Previous radiographic examinations Electrolyte and fulid status Proper bowel preparation NPO after midnight before the procedure
73
Gallbladder stones. What s/s or cues would the pt have to let the nurse know there was a potential issue?
74
What type of suction can be used for GI bleeding?
BioVac suction device
75
What issue would a person have that who just had gastrectomy?
decreased absorption of vitamins and minerals after a gastrostomy such as vitD, B12, Ca, Fe & Folate
76
Risk factor of developing gastric cancer
Smoking Substance abuse Family history of Crohn’s disease and colon cancer History of gastric ulcers Unplanned significant loss of weight

Psych Exam #4 (1 decks)

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