Medsurg 3 Flashcards
Liver function tests
AST ALT ALP bilirubin albumin
Aspartate aminotransferase (AST) elevation
Elevation occurs with hepatitis or cirrhosis.
Aspartate aminotransferase (AST) normal range
5 to 40 units/L
Alanine aminotransferase (ALT) normal range
8 to 20 units/L
Alanine aminotransferase (ALT) elevation indicates
Elevation occurs with hepatitis or cirrhosis.
Alkaline phosphatase (ALP) elevation indicates
liver damage
Amylase and Lipase elevation indicates
pancreatitis
Albumin decrease may indicate
liver disease
elevated Alpha-fetoprotein indicates
liver cancer
Ammonia elevation indicates
liver disease
Urine Bilirubin test is aka
urobilirubin
urobilinogen is indicated when there’s a suspected problem with ___ or ___
liver or biliary tract
A positive or elevated ____ finding indicates possible liver disorder (cirrhosis, hepatitis) or biliary obstruction
urobilinogen
2 indications for fecal tests
Gastrointestinal bleeding
Unexplained diarrhea
A positive finding for blood in stool is indicative of gastrointestinal bleeding (__ ___ or __
(ulcer, colitis, cancer)
Clostridium difficile is an ___ infection
opportunistic
C diff usually becomes established secondary to use of ___-___ antibiotics
broad-spectrum
A change in the ___ gene can be an indicator of colorectal cancer.
vimentin
Occult blood – Provide the client with cards impregnated with ____ that can be mailed to provider or with a specimen collection cup
guaiac
Occult blood – Provide the client with cards impregnated with guaiac that can be mailed to provider or with a specimen collection cup. If the cards are used, __ samples are usually required
3
Stool for ova and parasites and bacteria – Provide the client with a
specimen collection cup
Endoscopy: A ___ ___ may be injected to allow visualization of structures beyond the capabilities of the scope.
contrast medium
If someone has these 3 symptoms, they may be indicated for endoscopy (the 3 A’s)
Anemia (secondary to bleed)
Abd discomfort
Abd distention
Endoscopy: Previous radiographic examinations – Any recent radiographic examinations using ___ may affect the provider’s ability to view key structures
barium
If a biopsy was performed, ___ restrictions may be prescribed.
food
colonoscopy anesthesia type
moderate sedation
colonoscopy position
Left side with knees to chest
colonoscopy prep: May include laxatives, such as ____ and polyethylene ___
bisacodyl
glycol
Colonoscopy prep: must be on clear liquid diet and avoid ___ ___ and ___ liquids
red orange purple
Colonoscopy prep, must be NPO starting at
midnight
Colonoscopy Postprocedure: encourage increased
fluids
Colonoscopy Postprocedure: instruct the client they might have increased
gas
EGD
Insertion of endoscope through the mouth into the esophagus, stomach, and duodenum.
EGD position
left side
EGD: NPO for
6 to 8 hours
EGD: remove
dentures
after an EGD, withhold
fluids until gag reflex returns
ERCP
Insertion of a endoscope through the mouth into the biliary tree via the duodenum.
Allows visualization of the biliary ducts, gall bladder, liver, and pancreas.
ERCP
EGD anesthesia type
Moderate sedation – topical anesthetic
ERCP anesthesia type
Conscious sedation – topical anesthetic
ERCP position
Initially semi-prone with repositioning throughout procedure
ERCP must be NPO
6 to 8 hours
ERCP must remove the
dentures
ERCP withhold fluids until
gag reflex returns
Sigmoidoscopy anesthesia
none
Sigmoidoscopy position
left side
Sigmoidoscopy bowel prep may include laxatives like __ and ___
bisacodyl and polyethylene glycol
Sigmoidoscopy: pre procedure diet
clear liquid
Sigmoidoscopy: NPO?
after midnight
HR in a pt with oversedation
tachy
BP in a pt with oversedation
could be low or high
Manifestations of hemorrhage include
bleeding,
cool and clammy skin,
hypotension (and the other symptoms that go with hypotension)
dizziness
After endoscopic procedures, a really important lab to monitor is
Hgb and Hct
3 things the client should report to the provider after an endoscopy
bleeding
fever
pain
Manifestations of aspiration include dyspnea, tachypnea, adventitious breath sounds, tachycardia, and
fever
Perforation of the gastrointestinal tract: Manifestations include ___ or ___ pain
chest or abd
Perforation of the gastrointestinal tract: Manifestations include /
N/V
Perforation of the gastrointestinal tract: Manifestations include f___
fever
Perforation of the gastrointestinal tract: Manifestations include abdominal ____
distention
Upper gastrointestinal imaging is done by having the client drink a radiopaque liquid, which is
barium
If someone presents with these signs, they may be indicated for a GI series: abdominal pain, altered ___ ___, or gastrointestinal bleeding
altered elimination habits (constipation, diarrhea)
In order to decrease peristalsis before a GI series, the patient needs to avoid
chewing gum
smoking
Barium enema studies must be scheduled prior to
upper gastrointestinal studies
After a GI series, you can promote elimination of contrast material by
increasing fluids
After a GI series, the client should report diarrhea accompanied by
weakness
After a GI series, Instruct the client that stools will be white for
24 to 72 hr until barium clears
After a GI series, the client should report abdominal ____
fullness
The actions of GOLYTELY begin within __ hr after consumption
2 to 3
Fecal occult blood testing is a screening procedure for ___ cancer
colon
Clients are instructed to stop taking ____ prior to obtaining stool specimens for fecal occult blood testing because they can interfere with the results
anticoagulants
Clients are instructed to avoid consuming red meat prior to
FOBT
Fecal occult blood testing does not identify
parasites
Serum alpha-fetoprotein is a laboratory test used in cases of suspected ___ ___
liver cancer
An ERCP is used to visualize the duodenum, biliary ducts, gallbladder, liver, and ____
pancreas
Urine bilirubin is a laboratory test used in cases of a possible liver disorder or __ ___ ___
biliary tract obstruction
Enteral Feedings are indicated in certain diseases that make swallowing difficult, such as ____, ___ ___, ___
parkinsons
MS
stroke
Enteral Feedings: Overfeeding results from infusion of greater quantity of feeding than can be readily digested by the client, resulting in ___ ___, ___, and ___ (obvious things)
abdominal distention, nausea, and vomiting
Enteral Feeding: if aspiration is suspected: ___ the feeding
stop
Enteral Feeding: if aspiration is suspected: Turn the client to his
side and suction the airway
Enteral Feeding: if aspiration is suspected: Administer __ if indicated
O2
Enteral Feeding: if aspiration is suspected: Monitor vital signs for
an elevated temperature
Enteral Feeding: if aspiration is suspected: Notify the provider and obtain a __ __ if prescribed.
chest x-ray
TPN administration may be through a central line, such as a
tunneled triple lumen catheter
TPN could be through a single- or double-lumen
PICC line
peripherally inserted central catheter
TPN: Standard IV bolus therapy is typically less than or equal to ___ calories/day.
700
PPN is intended for short-term use, and administered in a large ___ ___
peripheral vein
PPN includes a risk for
phlebitis
PPN: Usual dextrose concentration is
10% or less
One indication for TPN is severe
burns
Basic guidelines regarding when to initiate TPN: a ___ state
hypermetabolic
Basic guidelines regarding when to initiate TPN: A weight loss of __ body weight and NPO for _ days or more
7% of body weight and NPO for 5 days
Never abruptly stop
TPN
TPN: Follow ___ procedures to minimize the risk of sepsis.
sterile
TPN solution is prepared by the pharmacy using ___ technique with a laminar flow hood.
aseptic
TPN: Change tubing and solution bag (even if not empty) every
24 hours
TPN: Use sterile procedures, including a ___, when changing the central line dressing
mask
TPN: Check capillary ___ every 4 to 6 hr for at least the first 24 hr.
glucose
Clients receiving TPN frequently need supplemental ___ ___
regular insulin
TPN: Keep ___ __ in water at the bedside in case the solution is unexpectedly ruined or the next bag is not available
dextrose 10%
TPN: Older adult clients have an increased incidence of
glucose intolerance
TPN: Metabolic complications include ___, ___ and ___ deficiency
hyperglycemia, hypoglycemia, and vitamin deficiency
TPN: Fluid needs are typically replaced with a separate IV bolus to prevent
fluid volume excess
TPN: sudden onset of dyspnea, chest pain, anxiety, hypoxia can indicate
air embolism
TPN: if air embolism is suspected the firs thing you do is
clamp the catheter
TPN: if air embolism is suspected, how do you position the client
on his left side in trendelenburg to trap the air
TPN: if there’s an air embolism, after you stop the infusion and position the patient,
Administer oxygen and notify provider so trapped air can be aspirated
TPN: Change the sterile dressing on a central line per protocol (typically every ____).
48 to 72 hr
TPN: Change IV tubing per protocol (typically every ___)
24 hr
TPN has a risk for fluid volume ___ because
excess because it’s hyperosmotic
TPN: Clients who have a history of heart failure may need a more
concentrated solution to avoid fluid overload
Ascites is an abnormal accumulation of protein-rich fluid in the abdominal cavity most often caused by cirrhosis of the
liver
the determining factor in the use of a paracentesis to treat ascites, and in the evaluation of treatment effectiveness is
respiratory distress
Clients with ascites are typically more comfortable in what position
sitting up
Administer prescribed IV bolus fluids or ___, prior to or after a paracentesis, to restore fluid balance
albumin
Paracentesis: Explain that there may be pressure or pain with
needle insertion
Paracentesis requires ___ precautions
standard
Paracentesis, what do you need to do after the procedure for several minutes
put pressure on the insertion site
Paracentesis: If the insertion site continues to leak after holding pressure for several minutes,
dry sterile gauze dressings should be applied and changed as often as necessary.
After paracentesis, Diuretics such as ___ and ___ may be prescribed to
control fluid volume.
spironolactone and furosemide
After paracentesis, Assist the client into a position of comfort with the head of the bed
elevated to promote lung expansion
Paracentesis: Albumin levels can drop dangerously low because the peritoneal fluid removed contains a large amount of protein. The removal of this protein-rich fluid can cause shifting of intravascular volume, resulting in
hypovolemia
___ perforation is a rare but possible complication of Paracentesis
Bladder
Paracentesis: ____ can occur as a result of injury to the intestines during needle insertion.
peritonitis
Paracentesis: Manifestations of ____ include sharp, constant abdominal pain, fever, nausea, vomiting, and diminished or absent bowel sounds.
peritonitis
___ ___ gastroplasty involves stapling a portion of the stomach to decrease its functional size.
Vertical banded
___ ___ surgery includes bypassing the stomach and part of the small intestine to decrease the absorption of nutrients and calories.
Intestinal bypass
Intestinal bypass surgery involves removal of a portion of the stomach and creating a pouch or sleeve with the remaining portion (___ ____)
sleeve gastrectomy
Client Presentation of someone indicated for bariatric surgery
BMI greater than 40, or BMI greater than 35 with comorbidities
Bariatric surgery: Monitor for leak of ___ (increasing back, shoulder, abdominal pain; restlessness; tachycardia; oliguria)
anastomosis
Bariatric surgery: emergency complication
anastomosis
Bariatric surgery: the NG tube
is usually sutured in place; don’t try to adjust it
Bariatric surgery: position the client
semi fowlers to promote breathing
Bariatric surgery: Apply an abdominal ___ as prescribed to prevent dehiscence if there is an abdominal incision.
binder
Bariatric surgery: ___ the client as soon as possible.
Ambulate
Bariatric surgery: fluids
start slow, maybe as little as 30ml
Bariatric surgery: food
6 smalls meals a day
Bariatric surgery: observe for ___ syndrome
dumping syndrome
cramps, diarrhea, etc
Bariatric surgery: post op exercise
walking 30 min daily
Bariatric surgery: the rules about fluids can put the client at risk for
dehydration
Bariatric surgery: post op dietary teaching
Tell the client to eat two servings of protein a day.
Tell the client to eat only nutrition-dense foods. Avoid empty calories, such as colas and fruit juice drinks.
NG decompression is required for clients that have
intestinal obstruction
Nasogastric Decompression: An NG tube is inserted, then ___ is applied to relieve abdominal distention
suction
Nasogastric Decompression: The obstruction can be mechanical (tumors, adhesions, fecal impaction) or ___ (paralytic ileus).
functional
Nasogastric Decompression: post op; assess for return of
flatus
indication for ileostomy
entire colon must be removed due to disease (Crohn’s disease)
Colostomy might be performed when a portion of the bowel must be removed (___ or ___ injury)
cancer or ischemic injury
Colostomy might be performed if the colon requires rest for healing (____ or trauma)
diverticulitis
Normal postoperative output:
Less than 1,000 mL/day
May be bile-colored and liquid
ileostomy
Normal postoperative output:
Small semi-liquid with some mucus 2 to 3 days after surgery
Blood may be present in the first few days after surgery
TRANSVERSE COLOSTOMY
Normal postoperative output:
Small to moderate amount of mucus with semi-formed stool 4 to 5 days after surgery
SIGMOID COLOSTOMY
Pattern of output: ileostomy
continuous output
Pattern of output: TRANSVERSE COLOSTOMY
Resumes a pattern similar to the preoperative pattern
Pattern of output: SIGMOID COLOSTOMY
Resumes a pattern similar to the preoperative pattern
Preprocedure:
Assess visual acuity, manual dexterity, cognitive status, cultural influences, and support systems.
Ostomy
The stoma should appear pink/red
and __.
moist
Empty the ostomy bag when it is
1⁄4 to 1⁄2 full of drainage
Ostomy: Foods that can cause odor include
fish, eggs, beans, and green leafy vegetables
Ostomy: Foods that can cause gas include
green leafy vegetables, beer, carbonated beverages, dairy products, and corn.
Ostomy: ___ can be ingested to decrease gas.
Yogurt
After an ostomy involving the small intestine is placed, the client should be instructed to: avoid
high fiber food for the first 2 months after surgery
After an ostomy involving the small intestine is placed, the client should be instructed to: __ food well
chew
After an ostomy involving the small intestine is placed, the client should be instructed to: Increase
fluids
After an ostomy involving the small intestine is placed, the client should be instructed to: slowly
increase fiber after the first 2 months and watch out for signs of blockage
Encourage the client to look at and ___ the stoma.
touch
If the stoma appears black or purple in color, this requires
immediate intervention
decreased urine output after a paracentesis means
bladder perforation
__ is not a finding indicating bowel perforation
Pallor
Gastroesophageal reflux disease (GERD) is a common condition characterized by
gastric content and enzyme backflow into the esophagus
Untreated GERD leads to inflammation, breakdown, and long-term complications, including ___ of the esophagus.
cancer
GERD prevention: Limit or avoid ___ and tobacco use.
alcohol
GERD prevention: maintain BMI below
30
Contributing factors of ___: fatty and fried foods, chocolate, caffeinated beverages (coffee), peppermint, spicy foods, tomatoes, citrus fruits, and alcohol
GERD
Increased abdominal pressure from obesity, pregnancy, bending at the waist, ascites, or tight clothing at the waist can cause
GERD
GERD can be caused by increased gastric acid caused by
medications (NSAIDs) or stress
___ hernia is associated with GERD
Hiatal hernia
Pain is “wavelike” and may radiate (neck, jaw, or back). The client reports feeling of having a heart attack.
GERD
GERD pain occurs
after eating and may last 20 min to 2 hr.
GERD symptom: hyper____
hypersalivation
GERD symptom: throat ____
Throat irritation (chronic cough, laryngitis)
GERD symptom: ___ taste in mouth
bitter
GERD pain is relieved immediately by
drinking water, sitting up, antacids
Manifestations occurring four to five times per week on a consistent basis are considered diagnostic.
GERD
Dx procedure for GERD
EGD
EGD allows visualization of the esophagus, revealing esophagitis or ____ epithelium (premalignant cells)
Barrett’s
Verify gag response has returned prior to providing oral fluids or food following this procedure:
EGD
Most accurate method of diagnosing GERD.
24-hr ambulatory esophageal pH monitoring
24-hr ambulatory esophageal pH monitoring: instruct the patient to
keep a food and activity journal
Esophageal manometry records
lower esophageal sphincter pressure
Dx procedure for GERD could be ___ swallow to identify a hiatal hernia, which would contribute to or cause GERD.
Barium
GERD- Instruct the client to take antacids when acid secretion is the highest, which is
(1 to 3 hr after eating and at bedtime)
Antacids should be ____ for at least an hour
separated from other meds
___ reduces the secretion of acid in GERD pts
Histamine blockers
Histamine blockers compared to antacids
Histamine takes longer to work, but it lasts longer once it kicks in
When do you take histamine blockers
with meals and at bedtime
Don’t mix histamine blockers with
vegetable juice
GERD medication that reduces gastric acid by inhibiting the cellular pump necessary for gastric acid secretion.
PPI
GERD patients should sleep on their ___ side
right side
In chronic esophagitis, the body continuously heals inflamed tissue, eventually replacing normal esophageal epithelium with
premalignant tissue (Barrett’s epithelium)
Esophageal varices are
swollen, fragile blood vessels in the esophagus
the most important thing to avoid in order to prevent Esophageal varices
alcohol
__ __ is the primary risk factor for the development of esophageal varices.
Portal hypertension
Hematemesis (blood in vomit) and melena (blood in feces) could indicate
esophageal varices (that are bleeding)
Dx procedure of esophageal varices
endoscopy
Medication for esophageal varices:
prescribed to decrease heart rate and consequently reduce hepatic venous pressure.
Used prophylactically (not for emergency hemorrhage).
beta blockers
___ cannot be given to clients who have coronary artery disease due to resultant coronary constriction
Vasopressin
esophageal varices: ___ bands can be placed during an endoscopic procedure. Used only for active bleeding and not prophylactically.
Ligating
esophageal varices: injection ____ can be performed during an endoscopic procedure. Used only for active bleeding and not prophylactically.
sclerotherapy
esophageal varices: Sclerotherapy carries a greater risk of postoperative.
hemorrhage
esophageal varices: ___ and ___ are given postoperatively
antacids and histamine blockers
esophageal varices: While the client is under sedation or general anesthesia, a catheter is passed into the liver via the jugular vein in the neck.
Transjugular Intrahepatic Portal-Systemic Shunt (TIPS)
esophageal varices: Transjugular Intrahepatic Portal-Systemic Shunt (TIPS): A stent is then placed between the portal and hepatic veins bypassing the liver. ___ ___ is subsequently relieved.
Portal hypertension
esophageal varices: Esophagogastric balloon tamponade: An esophagogastric tube with esophageal and gastric balloons is used to
compress blood vessels in the esophagus and stomach
esophageal varices: procedure that is reserved for clients who have unsuccessful TIPS procedures.
Esophagogastric balloon tamponade
esophageal varices: Clients are typically intubated and placed on mechanical ventilation prior to the procedure to prevent aspiration
Esophagogastric balloon tamponade
