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Psych Exam #4 > Med surg Exam 4 > Flashcards

Med surg Exam 4 Flashcards

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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
Q

How do you prep for a colonoscopy?

A

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

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26
Q

What is a fecal occult test? FOBT

A

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

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27
Q

What are you looking for with a fecal occult test?

A

GI bleeding, Colon cancer or polyps

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28
Q

What is Benign prostatic hyperplasia (BPH)?

A

enlarged prostate, but not cancerous

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29
Q

S/S of BPH?

A

Urine frequency and urgency
- Difficulty urination
- “Weak” pee Stream
- Leaking

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30
Q

What is gastric reflux?

A

Gastric content and enzyme back-flow into the esophagus (tube connecting your mouth and stomach)

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31
Q

Whats not working correctly with gastric reflux?

A

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
Q

How do you treat gastric reflux?

A

Diet
Lifestyle changes
Advancing to medication use
Surgery

33
Q

Nursing interventions for gastric reflux?

A

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
Q

What are the post-operative care for nurses?

A

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
Q

What is cirrhosis?

A

Permanent scarring that damages your liver and interferes with its functioning

36
Q

Cirrhosis S/S or cues

A

Fatigue
Ascites- fluid in the belly (gain weight)
Abdominal pain
Pruritus - itching
Jaundice
Red palms
lack of body hair
Encephalopathy-confusion

37
Q

What is cirrhosis patients at risk for?

A

Jaundice
Splenomegaly
Ascites
Bleeding
Asterixis (coarse tremor of wrist and fingers)
Fetoe hepaticus (fruity smell)
Hepatic encephalopathy
Confusion

38
Q

Meds given for cirrhosis

A

Diuretic
Lactulose
Nonabsobarble antibiotic
Beta blocking agent

39
Q

Nursing interventions for cirrhosis patients

A

nurses play an important role in the management and prevention of complications of the disease and improvement in patients’ quality of life

40
Q

What makes the bleeding worse?

A

Enlarged esophageal veins (varices)
Portal hypersensitive gastrophy

41
Q

What is colon cancer?

A

A growth of cells that begins in a part of the large intestine

42
Q

Risk factors for colon cancer

A

Diet of High fat, Low fiber &High protein
Age
Smoking & tobacco use
Family’s history of colon cancer/polyps
Obesity
History of IBD

43
Q

S/S for colon cancer

A

Episodes of diarrhea and constipation

44
Q

What is GERD?

A

Occurs as a result of back flow of stomach contents into esophagus

45
Q

Gerd S/S

A

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
Q

Treatment for GERD

A

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
Q

Non-surgical treatment for GERD

A

Stretta- a procedure uses radio frequency energy to decrease vagus nerve activity which cause the lower esophageal muscle (LES) to contract and tighten.

48
Q

GERD physiology problems

A

Greater risk for esophageal cancer aka Barret’sesophagus or carcinoma of the esophagus
Common comorbid disease is adult-onset asthma

49
Q

What is EGD?

A

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
Q

How do you prep for EDG?

A

NPO 6-8hr
Remove dentures prior procedure
Positioning: left side-lying with head of bed elevated
Anesthesia: moderate sedation per IV access

51
Q

What is EDG looking for?

A

to identify or treat areas of bleeding, dilate an esophageal structure, and diagnose gastric lesions or disease.

52
Q

How does EDG work?

A

Insertion of endoscope through the mouth into the esophagus, stomach and duodenum

53
Q

What is flatulence?

A

Accumulation of gas (Fart) due to air instillation during the procedure

54
Q

What is ascites?

A

The accumulation of protein rich fluid in the peritoneal cavity causing abdominal swelling, girth and distention

Caused by cirrhosis

55
Q

What is a colostomy?

A

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
Q

What does a colostomy do?

A

Collects stool through a pouch placed over the stoma

57
Q

How do you care for a ostomy bag?
(Empty, remove, replace disk, replace bag)

A

-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
Q

Ileostomy vs colostomy

A

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
Q

How do you take care of the stoma?

A

-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
Q

What is a pap smear?

A

A test carried out on a sample of cells from the cervix to check for abnormalities that may be indicated of cervial cancer

61
Q

Who gets pap smears?

A

Women ages 21 to 65

62
Q

What is pancreatitis?

A

Inflammation of the pancreas

62
Q

What is peritonitis?

A

Inflammation of the peritoneum

S/S
^ temp
^ HR
^WBC
Decreased BP
Rigid abdomen

63
Q

How does one get peritonitis?

A

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
Q

Who gets pancreatitis?

A
65
Q

What is the treatment for pancreatitis?

A

Nutritional Support
Fluids

66
Q

Do and don’ts with pancreatitis

A

Do: side lying knees to chest help to pain
NPO
Don’t: give food

67
Q

Medication to treat/help with pancreatitis

A
68
Q

S/S with pancreatitis

A

Pain radiates to right shoulder

69
Q

What labs show pancreatitis issues?

A

Amylase (23-85)
lipase digestive enzymes
High glucose & lipids

70
Q

Nursing care for pancreatitis

A
71
Q

Potential complications with pancreatitis

A
72
Q

General endoscopic procedures.
Pre procedure: nursing interventions

A

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
Q

Gallbladder stones. What s/s or cues would the pt have to let the nurse know there was a potential issue?

A
74
Q

What type of suction can be used for GI bleeding?

A

BioVac suction device

75
Q

What issue would a person have that who just had gastrectomy?

A

decreased absorption of vitamins and minerals after a gastrostomy such as vitD, B12, Ca, Fe & Folate

76
Q

Risk factor of developing gastric cancer

A

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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