Med surg final Flashcards
1
Q
What is the most common kidney stone?
A
Calcium Stone
2
Q
What stone is more common in women and is caused by bacteria produced in urease?
A
Struvite Stone
3
Q
Which stone is predominate in men and is caused by high uric acid levels or diets high in purines (animal protein)?
A
Uric Acid stone
4
Q
What stone is rare and is cause by an autosomal recessive genetic disorder that affects the absorption of cystine?
A
Cystine stone
5
Q
What are some risk factors for kidney stones?
A
Genetics
Diet
Medical conditions
medications
Lifestyle
6
Q
What is the gold standard diagnostic test for kidney stones?
A
Non-contrast CT
7
Q
What diagnostic test is used when a patient is pregnant?
A
Ultrasound
8
Q
What does a urinalysis detect?
A
hematuria
crystalluria
infection
pH levels
9
Q
What is a treatment option for a stone <4mm?
A
It will pass on its own and should strain the urine to capture the stone for analysis
10
Q
What should the nurse encourage the patient to do?
A
Drink at least 2-3 L of fluids a day
11
Q
What is another intervention that can help a patient pass the stone?
A
Ambulation
12
Q
What is a least invasive surgical treatment for kidney stones?
A
ESWL lithotripsy
13
Q
How does Lithotripsy remove a stone?
A
Uses shock waves to break the stone making it easier to pass
14
Q
Normal GFR
A
90-120
15
Q
Stage 1
A
90
16
Q
Stage 2
A
60-89
17
Q
Stage 3a
A
45-59
18
Q
Stage 3b
A
30-44
19
Q
Stage 4
A
15-29
20
Q
Stage 5
A
<15
21
Q
What is the leading cause of CKD?
A
Diabetes Mellitus
22
Q
what is the second leading cause of CKD?
A
Hypertension
23
Q
Other causes of ckd
A
Nephrotoxic medication
glomerulonephritis
polycystic kidney disease
24
Q
What electrolytes would you monitor with CKD?
A
Hyperkalemia
hyponatremia
hypocalcemia
hyperphosphatemia
25
What is the cause for anemia for CKD?
Lack of erythropoietin (decreased RBC production)
26
Uremic syndrome
Accumulation of waste products in the blood due to severely impaired kidney function
27
Symptoms of Uremic syndrome
pruritis
oliguria
28
What is the most common cause of PUD?
H. Pylori
29
What are the risk factors for PUD?
H Pylori
NSAIDS
Alcohol
Smoking
Coffee
Stress
30
What are 3 complications if PUD is left untreated?
Gi Bleeding
Perforation
Gastric Outlet obstruction
31
What is the expected outcome for PUD
Pain management
Self care and management of disease
Follow up and compliance with medication
Be free of complications
32
Patient Education pud
Avoid foods that cause epigastric distress
Adequate rest
avoid cigarettes
reduce alcohol consumption
Avoid OTC unless approved by provider
33
What is IBS?
Chronic abdominal pain and altered bowel patterns
34
what are the 4 types of IBS?
IBS-C
IBS-D
IBS-M
IBS-U
35
What are the causes of IBS?
Altered GI Motility
Gut-Brain axis
psychosocial factors
Altered gut microbiota
36
Risk factors IBS
Family History
History of GI infection
Diet intolerance
37
Assessment for IBS
Patient history on symptoms and patterns
How long has this occurred?
38
Prevention of flare- ups
Dietary changes
Food Diary
39
Crohn's disease
Inflammatory process that affects the whole GI from mouth to anus
40
Characteristics of Crohn's
Skip lesions which means it can be mixed in with healthy segments and affects the entire thickness of the GI wall
41
Crohn's stool
Diarrhea that is not bloody
42
Crohn's Pain
Cramps found in the LRQ
43
Complications of Crohn's
Fistula
strictures
Perforation
Increased risk of cancer
44
Dietary Recommendation for Crohn's
High calorie
Low fiber
Avoid caffeine, alcohol, lactose
Small frequent meals
Should keep a food diary
May need nutritional support (enteral or parenteral)
45
Ulcerative Colitis
Inflammation limited to the mucosa and constant lesions of inflammation throughout the rectum and colon
46
Ulcerative colitis stool
tenesmus and bloody diarrhea
47
Complication of UC
Toxic megacolon
Perforation
High incidence of colorectal cancer in 10 years
48
UC pain
Severe constant pain
49
What are non modifiable risk factors for CAD?
Age
Gender
Family history
50
What are modifiable risk factors of CAD?
HTN
Hyperlipidemia
Smoking
DM
Obesity
Alcohol consumption
51
What is the golden standard diagnostic testing for CAD?
CTA
52
Interventions for CAD?
Non invasive first (dietary changes, exercise, stop smoking)
Then medications (Aspirin or statins)
53
Stable Angina
Occurs in a pattern usually during exercise or stress
54
What is the treatment for Stable angina?
Nitroglycerin or rest
55
Unstable angina
Chest pain that occurs at rest, does not follow a pattern and does not go away easily with medication
56
What is the treatment for unstable angina?
Aspirin and nitroglycerin
57
Prinzmetal angina (Vasospastic)
Occurs at rest
58
What is the treatment for Prinzmetal?
Nitrates and or CCB
59
Microvascular angina
More common in women and is triggered by daily activities such as shopping or work
60
What is the treatment for microvascular angina?
Nitroglycerin
61
What is the most common cause of myocarditis?
Viral infection
62
What is the golden standard diagnostic testing for myocarditis?
Endomyocardial biopsy
63
What is the least invasive diagnostic for myocarditis?
Echocardiogram
64
Ace inhibitor MOA for myocarditis
Reduce the workload
65
Diruetics MOA for myocarditis
Reduce preload
66
Digoxin MOA for Myocarditis
Improve contractility
67
Clinical manifestation of myocarditis
SOB with exertion
Chest pain
68
What is the most common cause of pericarditis?
Coxsackvirus A and B
69
What is the golden standard diagnostic testing for pericarditis?
ECG (ST elevations)
70
Positioning Intervention for pericarditis
Sitting up and leaning forward helps relieve pain
71
What is a hallmark clinical assessment finding for pericarditis?
Pericardial Friction rub
72
Clinical manifestation of pericarditis
Severe sharp chest pain that can radiate to neck, arm or left shoulder
Worst with inspiration and laying flat
73
Risk Factors for Infective Endocarditis
Poor dental hygiene
IV drug use
Heart defects
Valve issues
74
IV drug users and infective endocarditis
sharing of needles and non sterile technique can introduce bacteria into the blood stream
75
What is the golden standard diagnostic test for infective endocarditis?
Blood cultures
76
Complications of Infective endocarditis
HF
**Stroke**
Regurgitation
sepsis
arrhythmia
77
What does the P wave represent?
Atrial depolarization
78
What does the QRS represent?
Ventricular depolarization
79
What does the T wave represent?
Ventricular repolarization
80
What are the primary risk factors for HF?
HTN
CAD
81
Complications of heart failure
Pleural Effusion
Hepatomegaly
Cardiorenal Syndrome
Anemia
82
What is the MOA of Anticoagulants in HF?
Prevent Clots
83
What is the MOA of Diuretics in HF?
Reduces Preload
84
What is the MOA of Ace inhibitors in HF?
Decreases the after load to improve Cardiac output
85
Lifestyle modifications for HF
Weight Management
Diet (sodium restriction)
Regular exercise
86
Tension Pneumothorax
Life threatening condition where air enters the pleural space and cannot escape
87
Assessment findings of tension Pneumothorax
Tracheal deviation to the UNAFFECTED side
88
Clinical Manifestation of tension pneumothorax
Sudden onset of chest pain
dyspnea
tachypnea
decreased or absent breath sounds
HYPERRESONNANCE on percussion
Asymmetrical chest movement
89
Priority Intervention for Tension Pneumothorax
Emergency Needle Decompression followed by chest tube insertion
90
Primary Spontaneous Pneumothorax
Occurs without an apparent cause and in the absence of significant lung disease often in tall thin individuals
91
Secondary Spontaneous Pneumothorax
Occurs with patient who have a preexisting lung disease such as COPD
92
Priority intervention with spontaneous pneumothorax
Observation
Oxygen therapy
Needle aspiration or chest tube insertion for severe cases
93
Hemothorax
Accumulation of blood in the pleural space
94
Causes of Hemothorax
Traumatic
Iatrogenic (medical procedure)
Non-traumatic (bleeding disorders)
95
Clinical manifestation of Hemothorax
Dyspnea
Tachypnea
Diminished or absent breath sounds
hypotension
Tachycardia
DULLNESS to percussion on the affected side
96
Priority intervention of Hemothorax
Chest tube insertion
Autotransfusion
Surgical intervention
97
Clinical Manifestation of PE
Dyspnea
Tachypnea
Chest pain (unilateral)
Hemoptysis
Crackles
Wheezing
Diminished breath sounds on affected side
98
What is the golden standard for diagnostic test for PE?
Spiral CT with an IV injection contrast media (CT angiogram)
99
Priority intervention for PE
Oxygen therapy
Anticoagulant Therapy
Cardiopulmonary support
100
Risk factors for PE
Immobility
surgery within last 3 months
History of VTE
Cancer
obesity
Oral contraceptives
hormone therapy
smoking
prolonged air travel
HF
Pregnancy
Clotting disorders
101
Most Common Causes of PE
Arise from DVT in the legs
102
What do you do when the Chest tube is disconnected from the drainage system?
Place the distal end of the tubing in a container with sterile water
103
What do you do when the chest tube becomes dislodged from the patient?
Cover the incision with petroleum and gauze and tape it on Three sides
104
What is the indication for a thoracentesis?
Pleural effusion
Empyema
hemothorax
Pneumothorax
drainage to analyze fluids
105
How do you confirm placement for a thoracentesis?
Ultrasound or chest X-ray
106
Encephalitis
Acute inflammation of the brain due to viral causes
107
Primary cause for encephalitis
Viral
CMV
MMR
Chicken pox
108
Clinical Manifestation of Encephalitis
Fever
Headache
nausea
vomiting
Tremors
seizures
personality changes
photophobia
Nuchal Rigidity
109
Diagnostic Test for Encephalitis
Lumbar Puncture and CSF analysis
110
Treatment for encephalitis
Antiviral Therapy
Symptom management
Fever management
Corticosteroids
Supportive care
Immunisuppressive therapy
111
Nursing Management of Encephalitis
HOB 30 degrees to promote reduced ICP
Seizure precautions
Keep environment quiet and dim
112
Bacterial Meningitis
Bacterial replication in the subarachnoid space triggers inflammatory response which leads to production of CSF and increased intracranial pressure and edema of the brain tissues
113
Clinical Manifestation Meningitis
Fever
Severe headache
Nuchal rigidity
Nausea
photophobia
Petechial rash
114
What is the Brudzinski sign?
Involuntary lifting of the legs when the neck is flexed
115
What is the Kernig's sign?
Resistance and pain when attempting to extend the knee with the hips flexed
116
What is the diagnostic testing for Bacteria meningitis?
Lumbar puncture and CSF analysis
CT scan/ MRI
Blood cultures
117
Treatment for Bacteria Meningitis
Antibiotics Broad spectrum (ceftriaxone or Vancomycin)
Dexamethasone
Supportive care (hydration, fever, pain, Monitoring complications)
118
Bacterial Meningitis CSF findings
Elevated WBC
Decreased Glucose
Increased Protein
Cloudy or purulent appearance
119
Viral Meningitis
Virus enters the bloodstream throgh common entry ports and enter into the bloodstream and cause inflammation of the meninges.
120
Clinical Manifestations of Viral Meningitis
Symptoms are less milder and is self- limiting and resolve in 7-10 days
Headache
Fever
Nuchal rigidity
Photophobia
Nausea and Vomiting
121
Diagnostic Test for viral meningitis
Lumbar puncture and CSF analysis
VIral Cultures and PCR
Blood test
CT scan/MRI
122
CSF analysis for Viral meningitis
Clear and colorless
Increased WBC
Normal or slightly elevated protein levels
NORMAL glucose levels
123
Treatment for Viral Meningitis
Self Limiting
Supportive care (hydration, pain relief)
Acyclovir (HSV or VZV)
Rest
124
Complete Fractures
The bone is broken completely through with 2 or more distinct pieces
125
Incomplete Fracture
A fracture in which the bone is not broken all the way through
126
Closed Fracture
Fracture where the skin remains in tact and the bone does not break skin
127
Open Fracture
Fracture where the bone breaks through the skin, creating an open wound
128
Comminuted fracture
Bone is shattered into 3 or more pieces
129
Segmental Fracture
Fracture that creates 2 or more bone fragments that separated from the main body of the bone
130
Avulsion fracture
Fragment of bone is pulled off by a tendon or ligament due to a sudden contraction or stretch
131
Displaced fracture
The bone ends are out of normal alignment
132
Non displaced Fracture
The bone ends retain their normal position even though the bone is broken
133
Closed Reduction
Manual realignment of the bone fragment without surgical intervention
134
Open Reduction
Surgical realignment of bone fragments using internal fixation
135
Cast and splints
Used to immobilize fraction and allow healing
136
External fixation
Pins or screws are placed in the bone and connected to a stabilizing frame outside the body
137
InSurgical interventionInternal fixation
Metal rods, plates, screws are inserted to hold bone fragments in place
138
Bone Grafting
May be necessary in case of bone loss of poor healing
139
Rehab
Physical therapy
Weight-bearing exercise
140
Nursing Management
-Assess for circulation
-Monitor for compartment syndrome (pain, Pallor, paresthesia, paralysis and pulselessness)
-Pain management
-Prevent complications (infection and fat embolism syndrome)
