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aa Orgo > Medsurg 3 > Flashcards

Medsurg 3 Flashcards

1
Q

Liver function tests

A 
AST
ALT 
ALP
bilirubin
albumin
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2
Q

Aspartate aminotransferase (AST) elevation

A

Elevation occurs with hepatitis or cirrhosis.

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3
Q

Aspartate aminotransferase (AST) normal range

A

5 to 40 units/L

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4
Q

Alanine aminotransferase (ALT) normal range

A

8 to 20 units/L

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5
Q

Alanine aminotransferase (ALT) elevation indicates

A

Elevation occurs with hepatitis or cirrhosis.

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6
Q

Alkaline phosphatase (ALP) elevation indicates

A

liver damage

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7
Q

Amylase and Lipase elevation indicates

A

pancreatitis

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8
Q

Albumin decrease may indicate

A

liver disease

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9
Q

elevated Alpha-fetoprotein indicates

A

liver cancer

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10
Q

Ammonia elevation indicates

A

liver disease

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11
Q

Urine Bilirubin test is aka

A

urobilirubin

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12
Q

urobilinogen is indicated when there’s a suspected problem with ___ or ___

A

liver or biliary tract

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13
Q

A positive or elevated ____ finding indicates possible liver disorder (cirrhosis, hepatitis) or biliary obstruction

A

urobilinogen

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14
Q

2 indications for fecal tests

A

Gastrointestinal bleeding

Unexplained diarrhea

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15
Q

A positive finding for blood in stool is indicative of gastrointestinal bleeding (__ ___ or __

A

(ulcer, colitis, cancer)

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16
Q

Clostridium difficile is an ___ infection

A

opportunistic

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17
Q

C diff usually becomes established secondary to use of ___-___ antibiotics

A

broad-spectrum

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18
Q

A change in the ___ gene can be an indicator of colorectal cancer.

A

vimentin

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19
Q

Occult blood – Provide the client with cards impregnated with ____ that can be mailed to provider or with a specimen collection cup

A

guaiac

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20
Q

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

A

3

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21
Q

Stool for ova and parasites and bacteria – Provide the client with a

A

specimen collection cup

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22
Q

Endoscopy: A ___ ___ may be injected to allow visualization of structures beyond the capabilities of the scope.

A

contrast medium

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23
Q

If someone has these 3 symptoms, they may be indicated for endoscopy (the 3 A’s)

A

Anemia (secondary to bleed)
Abd discomfort
Abd distention

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24
Q

Endoscopy: Previous radiographic examinations – Any recent radiographic examinations using ___ may affect the provider’s ability to view key structures

A

barium

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25
Q

If a biopsy was performed, ___ restrictions may be prescribed.

A

food

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26
Q

colonoscopy anesthesia type

A

moderate sedation

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27
Q

colonoscopy position

A

Left side with knees to chest

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28
Q

colonoscopy prep: May include laxatives, such as ____ and polyethylene ___

A

bisacodyl

glycol

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29
Q

Colonoscopy prep: must be on clear liquid diet and avoid ___ ___ and ___ liquids

A

red orange purple

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30
Q

Colonoscopy prep, must be NPO starting at

A

midnight

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31
Q

Colonoscopy Postprocedure: encourage increased

A

fluids

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32
Q

Colonoscopy Postprocedure: instruct the client they might have increased

A

gas

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33
Q

EGD

A

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

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34
Q

EGD position

A

left side

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35
Q

EGD: NPO for

A

6 to 8 hours

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36
Q

EGD: remove

A

dentures

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37
Q

after an EGD, withhold

A

fluids until gag reflex returns

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38
Q

ERCP

A

Insertion of a endoscope through the mouth into the biliary tree via the duodenum.

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39
Q

Allows visualization of the biliary ducts, gall bladder, liver, and pancreas.

A

ERCP

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40
Q

EGD anesthesia type

A

Moderate sedation – topical anesthetic

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41
Q

ERCP anesthesia type

A

Conscious sedation – topical anesthetic

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42
Q

ERCP position

A

Initially semi-prone with repositioning throughout procedure

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43
Q

ERCP must be NPO

A

6 to 8 hours

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44
Q

ERCP must remove the

A

dentures

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45
Q

ERCP withhold fluids until

A

gag reflex returns

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46
Q

Sigmoidoscopy anesthesia

A

none

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47
Q

Sigmoidoscopy position

A

left side

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48
Q

Sigmoidoscopy bowel prep may include laxatives like __ and ___

A

bisacodyl and polyethylene glycol

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49
Q

Sigmoidoscopy: pre procedure diet

A

clear liquid

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50
Q

Sigmoidoscopy: NPO?

A

after midnight

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51
Q

HR in a pt with oversedation

A

tachy

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52
Q

BP in a pt with oversedation

A

could be low or high

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53
Q

Manifestations of hemorrhage include

A

bleeding,
cool and clammy skin,
hypotension (and the other symptoms that go with hypotension)
dizziness

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54
Q

After endoscopic procedures, a really important lab to monitor is

A

Hgb and Hct

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55
Q

3 things the client should report to the provider after an endoscopy

A

bleeding
fever
pain

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56
Q

Manifestations of aspiration include dyspnea, tachypnea, adventitious breath sounds, tachycardia, and

A

fever

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57
Q

Perforation of the gastrointestinal tract: Manifestations include ___ or ___ pain

A

chest or abd

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58
Q

Perforation of the gastrointestinal tract: Manifestations include /

A

N/V

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59
Q

Perforation of the gastrointestinal tract: Manifestations include f___

A

fever

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60
Q

Perforation of the gastrointestinal tract: Manifestations include abdominal ____

A

distention

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61
Q

Upper gastrointestinal imaging is done by having the client drink a radiopaque liquid, which is

A

barium

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62
Q

If someone presents with these signs, they may be indicated for a GI series: abdominal pain, altered ___ ___, or gastrointestinal bleeding

A

altered elimination habits (constipation, diarrhea)

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63
Q

In order to decrease peristalsis before a GI series, the patient needs to avoid

A

chewing gum

smoking

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64
Q

Barium enema studies must be scheduled prior to

A

upper gastrointestinal studies

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65
Q

After a GI series, you can promote elimination of contrast material by

A

increasing fluids

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66
Q

After a GI series, the client should report diarrhea accompanied by

A

weakness

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67
Q

After a GI series, Instruct the client that stools will be white for

A

24 to 72 hr until barium clears

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68
Q

After a GI series, the client should report abdominal ____

A

fullness

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69
Q

The actions of GOLYTELY begin within __ hr after consumption

A

2 to 3

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70
Q

Fecal occult blood testing is a screening procedure for ___ cancer

A

colon

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71
Q

Clients are instructed to stop taking ____ prior to obtaining stool specimens for fecal occult blood testing because they can interfere with the results

A

anticoagulants

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72
Q

Clients are instructed to avoid consuming red meat prior to

A

FOBT

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73
Q

Fecal occult blood testing does not identify

A

parasites

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74
Q

Serum alpha-fetoprotein is a laboratory test used in cases of suspected ___ ___

A

liver cancer

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75
Q

An ERCP is used to visualize the duodenum, biliary ducts, gallbladder, liver, and ____

A

pancreas

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76
Q

Urine bilirubin is a laboratory test used in cases of a possible liver disorder or __ ___ ___

A

biliary tract obstruction

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77
Q

Enteral Feedings are indicated in certain diseases that make swallowing difficult, such as ____, ___ ___, ___

A

parkinsons
MS
stroke

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78
Q

Enteral Feedings: Overfeeding results from infusion of greater quantity of feeding than can be readily digested by the client, resulting in ___ ___, ___, and ___ (obvious things)

A

abdominal distention, nausea, and vomiting

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79
Q

Enteral Feeding: if aspiration is suspected: ___ the feeding

A

stop

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80
Q

Enteral Feeding: if aspiration is suspected: Turn the client to his

A

side and suction the airway

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81
Q

Enteral Feeding: if aspiration is suspected: Administer __ if indicated

A

O2

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82
Q

Enteral Feeding: if aspiration is suspected: Monitor vital signs for

A

an elevated temperature

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83
Q

Enteral Feeding: if aspiration is suspected: Notify the provider and obtain a __ __ if prescribed.

A

chest x-ray

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84
Q

TPN administration may be through a central line, such as a

A

tunneled triple lumen catheter

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85
Q

TPN could be through a single- or double-lumen

A

PICC line

peripherally inserted central catheter

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86
Q

TPN: Standard IV bolus therapy is typically less than or equal to ___ calories/day.

A

700

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87
Q

PPN is intended for short-term use, and administered in a large ___ ___

A

peripheral vein

88
Q

PPN includes a risk for

A

phlebitis

89
Q

PPN: Usual dextrose concentration is

A

10% or less

90
Q

One indication for TPN is severe

A

burns

91
Q

Basic guidelines regarding when to initiate TPN: a ___ state

A

hypermetabolic

92
Q

Basic guidelines regarding when to initiate TPN: A weight loss of __ body weight and NPO for _ days or more

A

7% of body weight and NPO for 5 days

93
Q

Never abruptly stop

A

TPN

94
Q

TPN: Follow ___ procedures to minimize the risk of sepsis.

A

sterile

95
Q

TPN solution is prepared by the pharmacy using ___ technique with a laminar flow hood.

A

aseptic

96
Q

TPN: Change tubing and solution bag (even if not empty) every

A

24 hours

97
Q

TPN: Use sterile procedures, including a ___, when changing the central line dressing

A

mask

98
Q

TPN: Check capillary ___ every 4 to 6 hr for at least the first 24 hr.

A

glucose

99
Q

Clients receiving TPN frequently need supplemental ___ ___

A

regular insulin

100
Q

TPN: Keep ___ __ in water at the bedside in case the solution is unexpectedly ruined or the next bag is not available

A

dextrose 10%

101
Q

TPN: Older adult clients have an increased incidence of

A

glucose intolerance

102
Q

TPN: Metabolic complications include ___, ___ and ___ deficiency

A

hyperglycemia, hypoglycemia, and vitamin deficiency

103
Q

TPN: Fluid needs are typically replaced with a separate IV bolus to prevent

A

fluid volume excess

104
Q

TPN: sudden onset of dyspnea, chest pain, anxiety, hypoxia can indicate

A

air embolism

105
Q

TPN: if air embolism is suspected the firs thing you do is

A

clamp the catheter

106
Q

TPN: if air embolism is suspected, how do you position the client

A

on his left side in trendelenburg to trap the air

107
Q

TPN: if there’s an air embolism, after you stop the infusion and position the patient,

A

Administer oxygen and notify provider so trapped air can be aspirated

108
Q

TPN: Change the sterile dressing on a central line per protocol (typically every ____).

A

48 to 72 hr

109
Q

TPN: Change IV tubing per protocol (typically every ___)

A

24 hr

110
Q

TPN has a risk for fluid volume ___ because

A

excess because it’s hyperosmotic

111
Q

TPN: Clients who have a history of heart failure may need a more

A

concentrated solution to avoid fluid overload

112
Q

Ascites is an abnormal accumulation of protein-rich fluid in the abdominal cavity most often caused by cirrhosis of the

A

liver

113
Q

the determining factor in the use of a paracentesis to treat ascites, and in the evaluation of treatment effectiveness is

A

respiratory distress

114
Q

Clients with ascites are typically more comfortable in what position

A

sitting up

115
Q

Administer prescribed IV bolus fluids or ___, prior to or after a paracentesis, to restore fluid balance

A

albumin

116
Q

Paracentesis: Explain that there may be pressure or pain with

A

needle insertion

117
Q

Paracentesis requires ___ precautions

A

standard

118
Q

Paracentesis, what do you need to do after the procedure for several minutes

A

put pressure on the insertion site

119
Q

Paracentesis: If the insertion site continues to leak after holding pressure for several minutes,

A

dry sterile gauze dressings should be applied and changed as often as necessary.

120
Q

After paracentesis, Diuretics such as ___ and ___ may be prescribed to
control fluid volume.

A

spironolactone and furosemide

121
Q

After paracentesis, Assist the client into a position of comfort with the head of the bed

A

elevated to promote lung expansion

122
Q

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

A

hypovolemia

123
Q

___ perforation is a rare but possible complication of Paracentesis

A

Bladder

124
Q

Paracentesis: ____ can occur as a result of injury to the intestines during needle insertion.

A

peritonitis

125
Q

Paracentesis: Manifestations of ____ include sharp, constant abdominal pain, fever, nausea, vomiting, and diminished or absent bowel sounds.

A

peritonitis

126
Q

___ ___ gastroplasty involves stapling a portion of the stomach to decrease its functional size.

A

Vertical banded

127
Q

___ ___ surgery includes bypassing the stomach and part of the small intestine to decrease the absorption of nutrients and calories.

A

Intestinal bypass

128
Q

Intestinal bypass surgery involves removal of a portion of the stomach and creating a pouch or sleeve with the remaining portion (___ ____)

A

sleeve gastrectomy

129
Q

Client Presentation of someone indicated for bariatric surgery

A

BMI greater than 40, or BMI greater than 35 with comorbidities

130
Q

Bariatric surgery: Monitor for leak of ___ (increasing back, shoulder, abdominal pain; restlessness; tachycardia; oliguria)

A

anastomosis

131
Q

Bariatric surgery: emergency complication

A

anastomosis

132
Q

Bariatric surgery: the NG tube

A

is usually sutured in place; don’t try to adjust it

133
Q

Bariatric surgery: position the client

A

semi fowlers to promote breathing

134
Q

Bariatric surgery: Apply an abdominal ___ as prescribed to prevent dehiscence if there is an abdominal incision.

A

binder

135
Q

Bariatric surgery: ___ the client as soon as possible.

A

Ambulate

136
Q

Bariatric surgery: fluids

A

start slow, maybe as little as 30ml

137
Q

Bariatric surgery: food

A

6 smalls meals a day

138
Q

Bariatric surgery: observe for ___ syndrome

A

dumping syndrome

cramps, diarrhea, etc

139
Q

Bariatric surgery: post op exercise

A

walking 30 min daily

140
Q

Bariatric surgery: the rules about fluids can put the client at risk for

A

dehydration

141
Q

Bariatric surgery: post op dietary teaching

A

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.

142
Q

NG decompression is required for clients that have

A

intestinal obstruction

143
Q

Nasogastric Decompression: An NG tube is inserted, then ___ is applied to relieve abdominal distention

A

suction

144
Q

Nasogastric Decompression: The obstruction can be mechanical (tumors, adhesions, fecal impaction) or ___ (paralytic ileus).

A

functional

145
Q

Nasogastric Decompression: post op; assess for return of

A

flatus

146
Q

indication for ileostomy

A

entire colon must be removed due to disease (Crohn’s disease)

147
Q

Colostomy might be performed when a portion of the bowel must be removed (___ or ___ injury)

A

cancer or ischemic injury

148
Q

Colostomy might be performed if the colon requires rest for healing (____ or trauma)

A

diverticulitis

149
Q

Normal postoperative output:
Less than 1,000 mL/day

May be bile-colored and liquid

A

ileostomy

150
Q

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

A

TRANSVERSE COLOSTOMY

151
Q

Normal postoperative output:

Small to moderate amount of mucus with semi-formed stool 4 to 5 days after surgery

A

SIGMOID COLOSTOMY

152
Q

Pattern of output: ileostomy

A

continuous output

153
Q

Pattern of output: TRANSVERSE COLOSTOMY

A

Resumes a pattern similar to the preoperative pattern

154
Q

Pattern of output: SIGMOID COLOSTOMY

A

Resumes a pattern similar to the preoperative pattern

155
Q

Preprocedure:

Assess visual acuity, manual dexterity, cognitive status, cultural influences, and support systems.

A

Ostomy

156
Q

The stoma should appear pink/red

and __.

A

moist

157
Q

Empty the ostomy bag when it is

A

1⁄4 to 1⁄2 full of drainage

158
Q

Ostomy: Foods that can cause odor include

A

fish, eggs, beans, and green leafy vegetables

159
Q

Ostomy: Foods that can cause gas include

A

green leafy vegetables, beer, carbonated beverages, dairy products, and corn.

160
Q

Ostomy: ___ can be ingested to decrease gas.

A

Yogurt

161
Q

After an ostomy involving the small intestine is placed, the client should be instructed to: avoid

A

high fiber food for the first 2 months after surgery

162
Q

After an ostomy involving the small intestine is placed, the client should be instructed to: __ food well

A

chew

163
Q

After an ostomy involving the small intestine is placed, the client should be instructed to: Increase

A

fluids

164
Q

After an ostomy involving the small intestine is placed, the client should be instructed to: slowly

A

increase fiber after the first 2 months and watch out for signs of blockage

165
Q

Encourage the client to look at and ___ the stoma.

A

touch

166
Q

If the stoma appears black or purple in color, this requires

A

immediate intervention

167
Q

decreased urine output after a paracentesis means

A

bladder perforation

168
Q

__ is not a finding indicating bowel perforation

A

Pallor

169
Q

Gastroesophageal reflux disease (GERD) is a common condition characterized by

A

gastric content and enzyme backflow into the esophagus

170
Q

Untreated GERD leads to inflammation, breakdown, and long-term complications, including ___ of the esophagus.

A

cancer

171
Q

GERD prevention: Limit or avoid ___ and tobacco use.

A

alcohol

172
Q

GERD prevention: maintain BMI below

A

30

173
Q

Contributing factors of ___: fatty and fried foods, chocolate, caffeinated beverages (coffee), peppermint, spicy foods, tomatoes, citrus fruits, and alcohol

A

GERD

174
Q

Increased abdominal pressure from obesity, pregnancy, bending at the waist, ascites, or tight clothing at the waist can cause

A

GERD

175
Q

GERD can be caused by increased gastric acid caused by

A

medications (NSAIDs) or stress

176
Q

___ hernia is associated with GERD

A

Hiatal hernia

177
Q

Pain is “wavelike” and may radiate (neck, jaw, or back). The client reports feeling of having a heart attack.

A

GERD

178
Q

GERD pain occurs

A

after eating and may last 20 min to 2 hr.

179
Q

GERD symptom: hyper____

A

hypersalivation

180
Q

GERD symptom: throat ____

A

Throat irritation (chronic cough, laryngitis)

181
Q

GERD symptom: ___ taste in mouth

A

bitter

182
Q

GERD pain is relieved immediately by

A

drinking water, sitting up, antacids

183
Q

Manifestations occurring four to five times per week on a consistent basis are considered diagnostic.

A

GERD

184
Q

Dx procedure for GERD

A

EGD

185
Q

EGD allows visualization of the esophagus, revealing esophagitis or ____ epithelium (premalignant cells)

A

Barrett’s

186
Q

Verify gag response has returned prior to providing oral fluids or food following this procedure:

A

EGD

187
Q

Most accurate method of diagnosing GERD.

A

24-hr ambulatory esophageal pH monitoring

188
Q

24-hr ambulatory esophageal pH monitoring: instruct the patient to

A

keep a food and activity journal

189
Q

Esophageal manometry records

A

lower esophageal sphincter pressure

190
Q

Dx procedure for GERD could be ___ swallow to identify a hiatal hernia, which would contribute to or cause GERD.

A

Barium

191
Q

GERD- Instruct the client to take antacids when acid secretion is the highest, which is

A

(1 to 3 hr after eating and at bedtime)

192
Q

Antacids should be ____ for at least an hour

A

separated from other meds

193
Q

___ reduces the secretion of acid in GERD pts

A

Histamine blockers

194
Q

Histamine blockers compared to antacids

A

Histamine takes longer to work, but it lasts longer once it kicks in

195
Q

When do you take histamine blockers

A

with meals and at bedtime

196
Q

Don’t mix histamine blockers with

A

vegetable juice

197
Q

GERD medication that reduces gastric acid by inhibiting the cellular pump necessary for gastric acid secretion.

A

PPI

198
Q

GERD patients should sleep on their ___ side

A

right side

199
Q

In chronic esophagitis, the body continuously heals inflamed tissue, eventually replacing normal esophageal epithelium with

A

premalignant tissue (Barrett’s epithelium)

200
Q

Esophageal varices are

A

swollen, fragile blood vessels in the esophagus

201
Q

the most important thing to avoid in order to prevent Esophageal varices

A

alcohol

202
Q

__ __ is the primary risk factor for the development of esophageal varices.

A

Portal hypertension

203
Q

Hematemesis (blood in vomit) and melena (blood in feces) could indicate

A

esophageal varices (that are bleeding)

204
Q

Dx procedure of esophageal varices

A

endoscopy

205
Q

Medication for esophageal varices:

prescribed to decrease heart rate and consequently reduce hepatic venous pressure.

Used prophylactically (not for emergency hemorrhage).

A

beta blockers

206
Q

___ cannot be given to clients who have coronary artery disease due to resultant coronary constriction

A

Vasopressin

207
Q

esophageal varices: ___ bands can be placed during an endoscopic procedure. Used only for active bleeding and not prophylactically.

A

Ligating

208
Q

esophageal varices: injection ____ can be performed during an endoscopic procedure. Used only for active bleeding and not prophylactically.

A

sclerotherapy

209
Q

esophageal varices: Sclerotherapy carries a greater risk of postoperative.

A

hemorrhage

210
Q

esophageal varices: ___ and ___ are given postoperatively

A

antacids and histamine blockers

211
Q

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.

A

Transjugular Intrahepatic Portal-Systemic Shunt (TIPS)

212
Q

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.

A

Portal hypertension

213
Q

esophageal varices: Esophagogastric balloon tamponade: An esophagogastric tube with esophageal and gastric balloons is used to

A

compress blood vessels in the esophagus and stomach

214
Q

esophageal varices: procedure that is reserved for clients who have unsuccessful TIPS procedures.

A

Esophagogastric balloon tamponade

215
Q

esophageal varices: Clients are typically intubated and placed on mechanical ventilation prior to the procedure to prevent aspiration

A

Esophagogastric balloon tamponade

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