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med surg exam 5 Flashcards

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1
Q

hard, dry, small, or difficult to pass BM or less than 3 BM/week

A

constipation

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2
Q

t/f constipation and diarrhea are diseases

A

false, they are symptoms

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3
Q

how much fiber should you have a day

A

25-30g

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4
Q

more than 3 BM/day of altered consistency

A

diarrhea

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5
Q

what are the 3 types of diarrhea

A

acute (1-2 days)
persistent (2-4 weeks)
chronic (over 4 weeks)

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6
Q

what 3 main things can cause diarrhea

A

meds, infection, stress hormones

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7
Q

maintain skin integrity
increase fluid and decrease bulk intake
avoid alc, dairy, and fatty foods
medications

A

interventions for patients that have diarrhea

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8
Q

what electrolyte imbalance can you have from throwing up or diarrhea?

A

hypokalemia

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9
Q

recurrent involuntary passage of stool for at least 3 months

A

fecal incontinence

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10
Q

what is another name for a fecal management system

A

butt foley

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11
Q

what is a mechanical bowel obstruction

A

when something is in the way like a tumor, hernia, or abscess

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12
Q

what is a nonmechanical obstruction

A

when the bowel gets paralyzed and nothing goes thru the colon

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13
Q

whats another name for nonmechanical obstruction

A

paralytic ileus or adynamic

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14
Q

what are the assessment findings for a small bowel obstruction

A
  • pain
  • visible peristaltic waves upper & middle
  • nausea, perfuse vomiting, maybe fecal vomit
  • obstipation
  • fluid and electrolyte imbalances
  • metabolic alkalosis
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15
Q

obstipation

A

no stool

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16
Q

what are the assessment findings for a large bowel obstruction

A
  • intermittent lower abdominal cramping
  • lower abdominal distention (they look pregnant)
  • minimal or no vomiting
  • obstipation or ribbon-like stools
  • no major imbalances
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17
Q

what anorectal disorder is inflammation of rectal mucosa

A

proctitis

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18
Q

what is proctitis caused by and treated with

A
  • infection or irritation
  • antibiotics and/or antivirals
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19
Q

what anorectal disorder is a tear in the anal lining

A

anal fissure

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20
Q

how do you treat an anal fissure

A

topical cortisone

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21
Q

what anorectal disorder is a retrograde infection caused by obstruction of the anal gland

A

anorectal abscess

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22
Q

what anorectal disorder is a tract leading from anal canal to peri-anal skin

A

anal fistula

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23
Q

what is an anal fistula typically caused by and what is its treatment

A
  • an abscess
  • surgery
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24
Q

what anorectal disorder is dilated veins in the anal canal

A

hemorrhoids

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25
Q

what are hemorrhoids caused by

A

increased pressure

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26
Q

what anorectal disorder is an abscess on the innergluteal cleft

A

pilonidal sinus or cyst

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27
Q

what is pilonidal sinus or cyst caused by and treated with

A
  • trauma or prenatal
  • incision and drainage then excision of sac
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28
Q

what can you do after each BM to relax the sphincter spasms

A

sitz bath and clean the area (not with tp)

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29
Q

what is the 3rd most common cancer that’s responsible for causing death in the US

A

colorectal cancer

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30
Q

what kind of diet puts you at risk for colorectal cancer

A

low fiber
lots of fast food
high protein

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31
Q

what are the 2 symptoms of colorectal cancer

A

change in bowel or bladder habits
passing blood in stool

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32
Q

what screening tests are used for colorectal cancer

A

fecal occult blood test or double contrast barium enema
colonoscopies

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33
Q

what happens in a colon resection surgery

A

removal of a tumor and regional lymph nodes

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34
Q

what surgery is a colon removal

A

colectomy

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35
Q

what surgery creates an opening of the colon through the abdomen

A

colostomy

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36
Q

what diet should a patient with colorectal cancer strive to have

A

increased fiber, complex carbs, and veggies
broccoli, cabbage, cauliflower, sprouts

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37
Q

what are the functions of the liver

A

glucose metabolism
drug metabolism
protein metabolism
fat metabolism
vitamin & iron storage
bile formation
bilirubin excretion
ammonia conversion

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38
Q

what is used to monitor hepatitis, cirrhosis, or treatment that can be toxic to the liver

A

ALT

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39
Q

what indicates damage to any tissue with high metabolic activity such as the heart, liver, or kidney

A

AST

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40
Q

what indicates biliary cholestasis or alcohol abuse

A

GGT/ GGTP

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41
Q

what is lower in cirrhosis, ascites, chronic hepatitis, and poor nutrition

A

albumin

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42
Q

what follows the same as albumin but shows up faster and is a better indicator of ACUTE malnutrition

A

pre-albumin

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43
Q

what is elevated in liver disease and will not respond to vit K in the presence of severe liver damage

A

prothrombin time (PTT)

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44
Q

the level of this rises in liver failure as the liver is responsible for converting it to urea. leads to alteration in mental status and coma

A

ammonia

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45
Q

what 3 things are elevated in biliary obstruction & decreased in parenchymal liver disease

A

HDL, LDL, and cholesterol

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46
Q

what is elevated in liver and biliary tract disease to induce jaundice

A

bilirubin

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47
Q

what looks at clotting time but is dependent upon liver function. therefore this level does not respond to vitamin K if the liver is severely damaged

A

prothrombin (PT)

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48
Q

what is the most common complication with a liver biopsy

A

peritonitis

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49
Q

what is caused by blocking the flow of bile or excessive destruction of red blood cells

A

jaundice

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50
Q

what are the 2 types of jaundice that are associated with liver disease

A

hepatocellular & obstructive jaundice

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51
Q

what is caused by the inability of damaged liver cells to clear normal amounts of bilirubin from the blood

A

hepatocellular jaundice

52
Q

what is caused by occlusion of the bile duct, an inflammatory process, or an enlarged organ

A

obstructive jaundice

53
Q

what is caused by increased destruction of red blood cells more than the liver can handle.
often seen in transfusion reactions

A

hemolytic jaundice

54
Q

what is caused by inherited disorders such as Gilbert syndrome. patients will have light/clay colored stools, puritis, and potentially orange, foamy urine

A

hereditary hyperbilirubinemia

55
Q

the movement of albumin from the serum to the peritoneal cavity where it attracts more fluid is called what

A

ascites

56
Q

rapid weight gain
increased abdominal girth
positive ballottement test
positive fluid wave test
^ these are all signs of what

A

ascites

57
Q

what are the 3 main treatments for ascites

A

paracentesis
TIPS
peritoneovenous shunt

58
Q

what is the removal of fluid from the peritoneal cavity through a puncture or small surgical incision

A

paracentesis

59
Q

the treatment for ascites where a stent is placed in the portal vein is called what

A

transjugular intrahepatic portosystemic shunt (TIPS)

60
Q

what is the diet for every patient with chronic liver disease

A

supplements of vit A,B, C,K and folic acid

61
Q

a deficiency of what leads to eye and skin changes, night blindness

A

vitamin A

62
Q

a deficiency of what leads to lesions in skin and mucous membranes

A

riboflavin

63
Q

a deficiency of what leads to neurologic changes and lesions in skin and mucous membranes

A

pyridoxine

64
Q

a deficiency of what leads to scurvy (hemorrhagic disease)

A

vitamin C

65
Q

a deficiency of what leads to low platelets and bleeding

A

vitamin K

66
Q

a deficiency of what leads to macrocytic anemia

A

folic acid

67
Q

benign liver tumors typically occur in who

A

women who take oral contraceptives

68
Q

primary liver tumors are caused by what

A

chronic liver disease
hepatitis B or C infections
cirrhosis

69
Q

what is cirrhosis

A

scaring of the liver

70
Q

liver metastases are typically from primary cancer sites in what parts of the body

A

digestive system
breast
lungs

71
Q

alpha fetoprotein is elevated in what while carcinoembryonic antigen (CEA) is elevated in what
(these help to detect the presence of cancer)

A

alpha fetoprotein- primary liver cancer
CEA - cancers of GI tract

72
Q

when no other treatment is available, what do you do to treat end stage liver disease

A

total removal/ liver transplant

73
Q

what is used to determine the allocation of the liver t0 be transplanted

A

MELD score

74
Q

what are the 3 most common complications for the recipient of the liver transplant to have?

A

bleeding, infection, and rejection of the organ

75
Q

what is released when the hormone cholecystokinin is released by the intestinal wall & has a high concentration of bilirubin

A

bile

76
Q

if the flow of bile is blocked, what can build up in the bloodstream?

A

bilirubin

77
Q

what enzymes are included in the exocrine function of the pancreas

A

amylase
trypsin
lipase

78
Q

what do the following enzymes digest:
amylase
trypsin
lipase

A

amylase - carb digestion
trypsin - protein digestion
lipase - fat digestion

79
Q

what biliary diagnostic test rules out other intestinal causes of abdominal pain

A

an abdominal x-ray

80
Q

what is the biliary diagnostic procedure of choice for detecting gallstones or a dilated bile duct but the pt must have a period of NPO prior to procedure for accurate results

A

ultrasonography

81
Q

what biliary diagnostic test uses radioactive IV dye to track the flow through the biliary tract

A

HIDA scan
aka cholescintigraphy

82
Q

what med can be given during a HIDA scan to induce sphincter contraction

A

morphine

83
Q

what biliary diagnostic test uses a substance that the patient drinks followed by x-rays 12 hours later and gallbladders show up as a shadow

A

oral cholecystography

84
Q

what biliary diagnostic test uses a fiberoptic scope inserted through the esophagus to the duodenum to evaluate stones

A

endoscopic retrograde cholangiography (ERCP)

85
Q

what biliary diagnostic test is reserved for those whom ERCP may be unsafe due to a previous surgery

A

percutaneous transhepatic cholangiography (PTC)

86
Q

t/f: fecal occult blood testing should be avoided if patient has a visibile active hemorrhoidal bleed

A

true

87
Q

which of the following commonly used methods for clearing a clogged NG tube is actually NOT recommended due to recent research stating it could increase risk for future clots?
a- use of digestive enzymes
b- use of commercial digestive enzymes
c- milking the tube
d- cranberry juice flushes

A

D

88
Q

t/f: although commonly used in practice, measuring gastric residual volumes has not been validated by research and is no longer recommended by the SCCM nor the American society for parenteral and enteral nutrition

A

true

89
Q

which body organ serves as the storage depot for bile

A

gallbladder

90
Q

which of the following is NOT a factor that increases risk for liver cancer
a- male gender
b-taking oral contraceptives
c- previous hepatitis B or C
d- chronic liver disease or cirrhosis

A

A

91
Q

what lab combinations are used to determine if a patient is protein deficient

A

albumin and pre-albumin

92
Q

which of the following IV accesses can NOT be used for TPN?
a- left internal jugular triple lumen catheter
b- right subclavian port-a-cath
c- left antecubital INT
d- right upper arm PICC line

A

c

93
Q

what is the most effective nursing action to prevent respiratory complications during post-procedure care of a patient after an EGD (esophogstroduodenoscopy)?

A

assess for gag reflex before offering anything to eat or drink

94
Q

glucagon is administered during a routine EGD. the purpose of this medication during the procedure is to:
a- slow gastric motility
b- decrease the patients BS
c- relax the muscles in the GI tract
d- provide sedation

A

C

95
Q

how often does the tubing need to be changed in a closed gastric feeding system

A

every 24 hours

96
Q

how does the liver receive blood

A

via the portal vein & hepatic artery

97
Q

palmar erythema

A

red hands

98
Q

what is asterixis

A

inability to maintain posture

99
Q

what is verices

A

overgrown blood vessels
(this increases the risk for bleeding)

100
Q

what is pruritis

A

itching from bile salts under the skin

101
Q

what is steatorrhea

A

dark urine/clay-colored stool

102
Q

what is caused by obstructed blood flow through the liver resulting in increased pressure throughout the portal venous system

A

portal hypertension

103
Q

what 2 main things can portal hypertension cause

A

ascites & esophageal varices

104
Q

what is the ballottement test

A

when you push the stomach and feel the fluid hit your hand that is touching the other side of the stomach

105
Q

what diuretics will the MD order for ascites

A

1st- aldosterone
2nd - lasix (furosemide)
NOT diamox

106
Q

what is a paracentesis

A

sticking a needle in the abdomen to drain the fluid

107
Q

what shunt pulls blood from the abdomen back into the blood vessels

A

peritoneovenous

108
Q

why do pts with ascites need to monitor their mental status

A

bc they can become confused from toxic metabolites like ammonia building up

109
Q

what is the most significant source of bleeding in cirrhosis

A

esophageal varices

110
Q

the inability of patients to copy accurately drawings or three-dimensional constructions (all the numbers on a clock only go half way around)

A

constructional apraxia

111
Q

the breath of a patient that smells like sweet poop

A

fetor hepaticus

112
Q

what are the types of viral hepatitis & their characteristics

A

hep A - from food
hep B - from blood & fluids & sex
hep C - from sex and drugs
hep D - continuation of B
hep E - continuation of A

113
Q

what mediation do you give to treat a tylenol OD

A

acetylcysteine (mucomyst)

114
Q

what are the functions of the gallbladder and exocrine pancreas

A

gallbladder- store bile
exocrine pancreas - release digestive enzymes

115
Q

what is cholecystitis

A

inflammation of gallbladder

116
Q

what is cholelithiasis

A

gallbladder stones

117
Q

what kind of gallstone is the coalescence of multiple small stones

A

pigment stones

118
Q

what kind of gallstone is composed of calcium bilirubinate and the most common type

A

cholesterol stones

119
Q

what are the 6 f’s for cholelithiasis risk factors

A

fair - white
fat- obese
female
fertile - had over 1 baby
forty
familial - fam hx

120
Q

what is known for causing progressive destruction of the pancreas during which the normal tissue is replaced by fibrous tissue & the bile and secreting ducts are damaged

A

chronic pancreatitis

121
Q

t/f: the majority of blood supply to the liver, which is poor in nutrients, comes from the portal vein

A

f

122
Q

which diuretic medication would most often be used for a patient with ascites
a- actazolamide (diamox)
b- ammonium chloride
c- furosemide (lasix)
d- spironolactone (aldactone)

A

D

123
Q

what is Candida Albicans

A

thrush

124
Q

what is the procedure called where you removal of gallbladder

A

cholecystectomy

125
Q

what is the procedure called where you send shock waves to break up stones so they get naturally passed thru body

A

lithotripsy

126
Q

what is the procedure called where you drain the fluids from the gallbladder

A

percutaneous cholecystostomy

nursing (15 decks)

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