Medsurg 3 part 2 Flashcards
1
Q
an erosion of the mucosal lining of the stomach or duodenum
A
peptic ulcer
2
Q
PUD: The mucous membranes can become eroded to the point that the epithelium is exposed to gastric acid and pepsin, which can precipitate
A
bleeding and perforation
3
Q
PUD: Perforation that extends through all the layers of the stomach or duodenum can cause
A
peritonitis
4
Q
PUD prevention: use ___ management techniques
A
stress
5
Q
2 drugs that can cause PUD
A
NSAIDS and steroids
6
Q
which blood type is a risk factor for PUD
A
type O
7
Q
when does a Gastric ulcer occur
A
30 to 60 minutes after meal
8
Q
when does a duodenal ulcer occur
A
1.5 to 3 hours after meal
9
Q
ulcer that often occurs at night
A
duodenal
10
Q
ulcer where pain is exacerbated by ingestion of food
A
gastric ulcer
11
Q
duodenal ulcer pain is relieved by
A
ingestion of food or antacid
12
Q
Pain findings in someone with PUD
A
pain on palpation
back pain
13
Q
PUD: Pain that radiates to the back may indicate
A
perforation is imminent
14
Q
Where might you find blood with PUD pt
A
Bloody emesis (hematemesis) or stools (melena).
15
Q
PUD pt’s weight might
A
decrease
16
Q
PUD: Gastric samples are collected via an ___ to test for H. pylori.
A
endoscopy
17
Q
C 13 urea breath testing is used for
A
detecting H pylori in PUD
18
Q
IgG serologic testing documents the presence of
A
H pylori in PUD
19
Q
provides a definitive diagnosis of peptic ulcers and may be repeated to evaluate the
effectiveness of treatment
A
EGD
20
Q
PUD: Monitor for __ __ and tachycardia as these findings are suggestive of gastrointestinal bleeding.
A
orthostatic hypotension
21
Q
PUD: Administer ___ lavage via nasogastric tube, if prescribed.
A
saline
22
Q
PUD: A combination of two to three different ___ may be used to eliminate H pylori
A
antibiotics
23
Q
Medication used to prevent stress ulcers in clients who are NPO after major surgery, have large areas of burns, are septic, or have increased intracranial pressure.
A
histamine blocker
24
Q
Histamine blocker tx for PUD: Instruct clients to notify the provider of
A
obvious or occult GI bleeding
25
PPIs: Reduce gastric acid secretion by
irreversibly inhibiting the enzyme that produces gastric acid.
26
Mucosal protectant: when should they take the meds?
1 hr before meals and bedtime
27
Mucosal protectant: monitor for
constipation
28
PUD: areas of bleeding may be treated with ___ or ___ ___
epinephrine or laser coagulation.
29
Vagotomy
a PUD procedure where certain nerves are cut (the nerves that cause acid secretion)
30
Surgical procedure for PUD: after the procedure, Notify the provider before
repositioning or irrigating the nasogastric tube (disruption of sutures)
31
PUD surgery, POST op: Consume small, frequent meals while avoiding large quantities of ___ as directed.
carbohydrates
32
rebound tenderness in someone with PUD can indicate
perforation (which is an emergency)
33
if someone with PUD has a perforation and you palpated the abd it would feel
rigid and stiff
34
PUD perforation: maintain BP by
increasing fluids
35
PUD perforation: insert
NG tube
36
PUD perforation: provide
saline lavages
37
Complication of PUD: ___ anemia occurs due to a deficiency of the intrinsic factor normally secreted by the gastric mucosa.
Pernicious anemia
38
Pernicious anemia: Monthly lifelong vitamin __ injections will be necessary.
B12
39
a group of manifestations that occur following eating. A shift of fluid to the abdomen is triggered by rapid gastric emptying or high-carbohydrate ingestion.
dumping syndrome
40
Dumping syndrome: In response to the sudden influx of a hypertonic fluid, the small intestine pulls fluid from the
extracellular space to convert the hypertonic fluid to an isotonic fluid
41
Dumping syndrome: instruct the client to __ __ when vasomotor manifestations occur
lie down
42
Dumping syndrome: Client teaching: Eliminate liquids with meals for
1 hr prior to, and following a meal.
43
Dumping syndrome: Client teaching: diet should be low in
sugar, diary, fiber, and carbs
44
Dumping syndrome: Client teaching: diet should be high in
protein and fat
45
an inflammation in the lining of the stomach
Gastritis
46
___ enzymes produce mucosal prostaglandins that form a protective layer over the lining of the stomach.
Cox 1
47
Chronic gastritis has a slow onset and, if profuse, may damage parietal cells resulting in ___ anemia.
pernicious
48
autoimmune diseases that increase risk for gastritis
SLE and RA
49
___ therapy can increase risk for gastritis
radiation therapy
50
A risk factor for Gastritis is excessive ___
stress
51
Pt with gastritis might have weight
loss
52
what's the main bacteria you want to check for in gastritis
H pylori
53
what do you tell the pt about anesthesia/pain having to do with an upper endoscopy
a local anesthetic will be sprayed onto the back of the throat, but throat may be sore following the procedure
54
With what drug should you monitor for Monitor for neutropenia and hypotension
histamine blockers
55
Do not give antacid to clients with
kidney problems
56
Monitor aluminum antacids for
constipation
57
Monitor magnesium antacids for
diarrhea
58
2 Medications that should be taken on an empty stomach
antacid and PPI
59
Medication that needs an IV filter
PPI
60
Medication: Advise to allow 30 min before eating and not to crush or chew pills
PPI
61
PPI: It can take up to
4 days to see the effects
62
Gastric bleeding intervention: Insert a nasogastric (NG) tube for ___ ___
gastric lavage
63
Gastric bleeding intervention: Insert a nasogastric (NG) tube for gastric lavage (irrigate with __ __ or ___ to stop active gastric bleed)
normal saline or water
64
Gastric bleeding intervention: After you insert the NG, but BEFORE you use it you must
do an x ray to confirm the proper placement
65
distended or edematous intestinal veins resulting from increased intra-abdominal pressure (straining, obesity)
Hemorrhoids
66
Hemorrhoids result from
increased intra-abdominal pressure (straining, obesity, pregnancy)
67
A hernia that cannot be ________________ is considered irreducible and should be treated surgically.
moved back into place with gentle palpation
68
Physical finding of hernia
Protrusion or “lump” at involved site
69
Hernia for a nonsurgical pt: Instruct client to wear
truss pad with hernia belt during waking hours and to inspect skin daily
70
Hernia for surgical pt: Instruct client to avoid increased intra-abdominal pressure for
2 to 3 weeks postoperatively
71
IBS: Avoid foods that contain
dairy, eggs, and wheat products
72
IBS: eat lots of
fiber
73
Although IBS is difficulty to dx with a specific test, one test used is the
Hydrogen Breath Test
74
2 IBS-specific medications
Alosetron and Lubiprostone
75
Intestinal obstruction can result from ___ or ___ causes
mechanical or nonmechanical
76
Intestinal obstruction: Mechanical obstructions have ___, ___ pain that is milder.
colicky, intermittent
77
Intestinal obstruction: Nonmechanical obstructions tend to have vague, diffuse, constant pain and significant
abdominal distention
78
Intestinal obstruction: bowel sounds are
hyperactive above the block, hypoactive below
79
Intestinal obstruction: nonmechanical obstruction is aka
paralytic ileus
80
an electrolyte imbalance that can lead to nonmechanical obstruction (aka paralytic ileus)
hypokalemia
81
Small or Large intestine block? Severe fluid and electrolyte imbalance
small
82
Small or Large intestine block? Minor fluid and electrolyte imbalance
large
83
Small or Large intestine block? Metabolic alkalosis
small
84
Small or Large intestine block? Metabolic acidosis
large
85
Small or Large intestine block? Visible peristaltic waves
small
86
Small or Large intestine block? Significant abdominal
| distention
large
87
Small or Large intestine block? Abdominal pain, discomfort
small
88
Small or Large intestine block? Intermittent abdominal cramping
large
89
Small or Large intestine block? Profuse, sudden projectile vomiting with fecal odor; vomiting relieves pain
small
90
Small or Large intestine block? Infrequent vomiting
large
91
Small or Large intestine block? Diarrhea or “ribbon-like” stools around an impaction
large
92
In bowel obstruction, ___ hemoglobin, BUN, creatinine, and hematocit may indicate dehydration.
Increased
93
In bowel obstruction, ____ serum amylase and WBC count may be due to strangulating obstructions
Increased
94
Intestinal block dx test that evaluates the presence of free air and gas patterns.
x ray
95
Intestinal block dx test that determines the cause of obstruction.
endoscopy
96
Intestinal block dx test that determines the cause and exact location of the obstruction.
CT scan
97
Intestinal block: if surgery is needed for a mechanical block, withhold food until
peristalsis returns
98
Intestinal block: with suspected bowel strangulation, the best meds are
broad spectrum antibiotics
99
Intestinal block: Monitor for ___ instability
hemodynamic
100
Intestinal block: after surgery, advance diet as tolerated when prescribed, beginning with clear liquids – clamp tube after
eating for 1 to 2 hr
101
Small intestinal obstruction causes vomiting, leading to metabolic
alkalosis
102
a lower level obstruction causes metabolic acidosis because
alkaline fluids aren't being reabsorbed
103
Edema and inflammation of the rectum and sigmoid colon
Ulcerative colitis
104
Ulcerative colitis
Edema and inflammation of the rectum and sigmoid colon
105
Crohn’s disease
Inflammation and ulceration of the gastrointestinal tract, often at the distal ileum.
106
Inflammation and ulceration of the gastrointestinal tract, often at the distal ileum.
Crohn’s disease
107
Ulcerative colitis may cause
obstruction
108
Ulcerative colitis: intestinal mucosal cell changes may cause ___ ___
colon cancer
109
Ulcerative colitis: intestinal mucosal cell changes may cause insufficient production of intrinsic factor, resulting in
insufficient absorption of vitamin B12 (pernicious anemia).
110
Crohn’s disease: supplemental ___ may be needed
B12
111
Diverticula may perforate and cause
peritonitis
112
A diet low in ___ may predispose a client to ulcerative colitis and the development
of diverticula.
fiber
113
Ulcerative colitis: pain
Abdominal pain/cramping: often left-lower quadrant pain
114
Ulcerative colitis or Crohn’s disease: Steatorrhea
Crohn’s disease
115
Ulcerative colitis or Crohn’s disease: Rectal bleeding
Ulcerative colitis
116
Crohn’s disease: pain
RLQ
117
Small intestine ulcerations and narrowing may be consistent with
Crohn’s disease
118
Ulcerative colitis and Crohn’s disease: seek emergency care if you have ___, severe abdominal pain, ___
fever, vomiting
119
Ulcerative colitis and Crohn’s disease: Educate the client to eat foods that are
high in protein and calories, and low in fiber
120
Ulcerative colitis and Crohn’s disease: take a multivitamin that contains
iron
121
Diverticulitis: give client ___ for pain
opiates
122
Diverticulitis: Educate the client to consume a ___ __ diet until manifestations subside
clear liquid
123
Diverticulitis: Instruct the client to add fiber to the diet once solid foods are tolerated without other manifestations. The client should slowly advance to a
high-fiber diet as tolerated
124
Diverticulitis: Teach client to avoid seeds or indigestable material, which can block diverticulum (3 examples)
nuts, popcorn, seeds
125
Diverticulitis: limit fat to ___ of daily calorie intake
30%
126
Ulcerative colitis and Crohn’s disease: 5 ASA is prescribed to
decrease inflammation
127
Ulcerative colitis and Crohn’s disease: steroids are prescribed to
decrease inflammation
128
Surgical Procedure for Ulcerative Colitis
Colectomy with or without ileostomy
129
Surgical Procedures for Crohn’s Disease
Stricturoplasty
or
Surgical repair of fistulas
130
Surgical Procedures for Diverticulitis (dependent on problem type)
Colon resection
Double-barrel colostomy, but may be temporary
Treatment of complications (peritonitis, abscess, obstruction, fistula, bleeding)
131
An ileostomy may drain as much as __ mL/day.
1,000
132
Complications of ulcerative colitis, Crohn’s disease, and diverticulitis: ___ may occur due to perforation of the bowel
Peritonitis
133
hallmark sign of peritonitis
rigid, board like abd
134
a life threatening inflammation involving the abd cavity
peritonitis
135
peritonitis positioning
Fowler or semi-Fowler’s position. (This promotes comfort and allows for the
client to breathe easier.)
136
Peritonitis: No __ __ for at least 6 weeks.
heavy lifting
137
Abscess and fistula formation: diet should be
high in protein and calories (at least 3,000 calories/day), and low in fiber.
138
an inflammation of the gallbladder wall
Cholecystitis
139
cholelithiasis
gallstones
140
Cholecystitis can obstruct the pancreatic duct, causing
pancreatitis
141
Cholecystitis: health promotion: consume a diet that is
low-fat diet rich in HDL sources (seafood, nuts, olive oil)
142
Cholecystitis: Sharp pain in the right upper quadrant, often radiating to the
right shoulder
143
Cholecystitis: Pain with deep inspiration during
right subcostal palpation (Murphy’s sign)
144
Cholecystitis: Intense pain after
ingestion of high-fat food
145
Cholecystitis findings: s____
steatorrhea
146
Cholecystitis findings: ___ ___ stools
clay-colored stools
147
Cholecystitis findings: J____
jaundice
148
Cholecystitis findings: ___ urine
dark
149
Cholecystitis findings: p____
pruritus
150
Older adult clients who have diabetes mellitus may have atypical presentation of cholecystitis (absence of ___ or ___)
pain or fever
151
Cholecystitis findings: Amylase and lipase are
increased
152
Cholecystitis findings: increased (AST), (LDH), and (ALP) may indicate the
common bile duct is obstructed.
153
Cholecystitis Dx: _____ visualizes gall stones and a dilated common bile duct.
Ultrasound
154
Cholecystitis Dx: An abdominal ___ or ___ scan can visualize calcified gallstones and an enlarged gall bladder
x-ray or CT
155
Cholecystitis Dx: ___ scan (HIDA) assesses the patency of the biliary duct system after an IV injection of contrast
hepatobiliary
156
Cholecystitis Dx: allows for direct visualization using an endoscope that is inserted through the esophagus and into the common bile duct via the duodenum
(ERCP)
157
Cholecystitis Dx: involves the direct injection of contrast into the biliary tract through the use of a flexible needle. The gallbladder and ducts can be visualized.
PTC
158
___ acid gradually dissolves cholesterol-based gall stones, with few adverse effects.
Bile acid (it's a medication)
159
Shock waves are used to break up gall stones
(ESWL)
160
Extracorporeal shock wave lithotripsy (ESWL) – Shock waves are used to break up stones. This may be used more on nonsurgical candidates of normal weight who
have small, cholesterol-based stones
161
open surgical approach to gallbladder removal: A ___ may be placed in the common bile duct
T-tube
162
open surgical approach to gallbladder removal: the T-tube drainage is
initially bloody, then green-brown bile
163
open surgical approach to gallbladder removal: the amount of T-tube drainage
more than 400 mL of drainage in 24 hr initially, with gradual decrease in amount
164
surgical approach to gallbladder removal: the stools will be ____ ___ until biliary flow is reestablished
clay-colored
165
Laparoscopic removal of gallbladder: in order to treat free air pain
ambulate pt
166
A rupture of the gallbladder wall can cause a local abscess or peritonitis (which is manifested by ___, ___ abdomen)
rigid, board-like
167
This can occur if adequate amounts of bile are not drained from the surgical site after gallbladder removal
Bile peritonitis
168
Manifestations of gallbladder disease can continue after surgical removal. This is called
Postcholecystectomy syndrome
169
an inflammation of liver cells
Hepatitis
170
Cirrhosis
permanent scarring of the liver that is usually caused by chronic inflammation
171
Use PPE for Hep A pts that are
incontinent
172
Use PPE for Hep B and C pts who are
bleeding
173
Hep A and E transmission
fecal-oral
174
Hep B and C transmission
blood
175
Hep that can be passed from mother to offspring
B
176
Hep that's a coinfection with Hep B
D
177
Hep findings: skin color
jaundice
178
Hep findings: stool
clay color
179
Hep findings: urine
dark
180
Hep: Dx test used to identify the intensity of the infection, and the degree of liver damage
liver biopsy
181
Hep: the most definitive diagnostic approach
liver biopsy
182
Before liver biopsy, pt must be NPO for
2 hours
183
Liver biopsy: Assist the client into the supine position with the
upper right quadrant of the
| abdomen exposed
184
Liver biopsy: instruct the client to breath by
Instruct client to exhale breath and hold for at least 10 seconds
185
Liver biopsy: After needle is removed
Pt can resume breathing after the needle is removed
Apply pressure to the insertion site
186
Liver biopsy: after the procedure, position the pt
right side-lying position and maintain for several hours.
187
Hepatitis A vaccination is recommended for ___ protection
postexposure
188
Acute Hep B: Tx
No medications, supportive care.
189
Chronic Hep B: Tx
Antiviral medications
190
Hepatitis C: Combination therapy with peginterferon and ___ is the preferred treatment.
ribavirin
191
Hepatitis D: Tx
same as Hep B
192
Hepatitis E: Tx
same as Hep B
193
Chronic Hepatitis results from which Heps?
BCD
194
Extremely progressive form of viral hepatitis.
Fulminating hepatitis
195
cirrhosis caused by viral hepatitis or certain medications or toxins.
Postnecrotic
196
cirrhosis caused by chronic alcoholism
Laennec’s
197
biliary cirrhosis is caused by chronic biliary obstruction or ___ disease
autoimmune
198
Cardiac cirrhosis results from severe right heart failure inducing necrosis and fibrosis due to
lack of blood flow
199
Cirrhosis: Personality and mentation changes such as
emotional lability, euphoria, sometimes depression
200
Cirrhosis Objective findings: Altered
sleep/wake pattern
201
Cirrhosis Objective findings: Ascites, specifically
fluid buildup in abdomen and legs
202
Cirrhosis Objective findings: 2 skin findings besides jaundice
petechiae
Ecchymoses
203
Cirrhosis Objective findings: Hands
red warm
204
Cirrhosis Objective findings: red lesions, vascular in nature called
spider angiomas
205
Cirrhosis Objective findings: Dependent ___ ___
peripheral edema
206
Cirrhosis Objective findings: tremor characterized by rapid, nonrhythmic extension and flexion of the wrists and fingers
Asterixis
207
Cirrhosis Objective findings: odor
fruit/musty breath
208
Cirrhosis: ALT and AST are elevated initially due to hepatic inflammation, and return to normal when liver cells are no longer able to
create an inflammatory response
209
Cirrhosis: ___ increases in cirrhosis due to intrahepatic biliary obstruction.
ALP (Alkaline phosphatase)
210
Cirrhosis: Bilirubin level
elevated
211
Cirrhosis: serum albumin level
decreased
212
Cirrhosis: serum protein level
decreased
213
Cirrhosis: H and H level
decreased
214
Cirrhosis: all blood components
decreased
215
Cirrhosis: PT/INR is
prolonged due to decreased synthesis of prothrombin
216
Cirrhosis: Ammonia and creatinine levels
increase
217
Cirrhosis: Dx test: used to detect ascites, hepatomegaly, splenomegaly, biliary stones, or biliary obstruction.
Ultrasound
218
Cirrhosis: Dx test: Used to visualize possible hepatomegaly, ascites, and splenomegaly.
Abdominal x-rays and CT scan
219
Cirrhosis: Dx test: Used to visualize mass lesions and determine whether the liver is malignant or benign.
MRI
220
Cirrhosis: Dx test: most definitive
biopsy
221
Cirrhosis: Dx test: A liver biopsy identifies the ___ of the cirrhosis.
extent
222
Cirrhosis: Dx test: This is performed under moderate (conscious) sedation to detect the presence of esophageal
varices, ulcerations in the stomach, or duodenal ulcers and bleeding.
EGD
223
Cirrhosis: Dx test: Used to view the biliary tract to assist in removing stones, to collect specimens for biopsy, and for placement of a stent.
ERCP
224
EGD is performed under ___ sedation
moderate (conscious)
225
Cirrhosis: to decrease the itching, encourage
washing with cold water and applying lotion
226
Cirrhosis: Because the metabolism of most medications is dependent upon a functioning liver, general medications are administered ___
sparingly
227
Type of drug used for clients who have varices to prevent bleeding.
beta blockers
228
Cirrhosis: Drug used to promote excretion of ammonia from the body through the stool.
Lactulose
229
Paracentesis: Position the client
supine with head of bed elevated.
230
Cirrhosis: Performed in interventional radiology for clients who require further intervention with ascites or hemorrhage
Transjugular intrahepatic portosystemic shunt (TIPS)
231
This is a last resort for Cirrhosis clients who have portal hypertension and esophageal varices
Surgical bypass shunting procedures
232
Cirrhosis: Surgical bypass shunting procedures: The ascites is shunted from the abdominal cavity to the
superior vena cava
233
Clients who have severe cardiac and respiratory disease, metastatic malignant liver cancer, and a continued history of alcohol/substance abuse are not candidates for
liver transplantation
234
liver transplantation, acute graft rejection: t____
tachycardia
235
liver transplantation, acute graft rejection: f___
fever
236
liver transplantation, acute graft rejection: pain in the
RUQ (where the liver is....)
237
liver transplantation, acute graft rejection: increased ___ or ___ levels
ALT or AST
238
Cirrhosis pt: quitting drinking helps to
regenerate the liver
239
Cirrhosis diet: high __ and moderate ___
high calorie and moderate fat
240
Cirrhosis diet: low __ and ___
sodium and protein
241
Cirrhosis diet: Supplemental vitamin-enriched liquids like ___ or ___
ensure or boost
242
Cirrhosis complication: Portal systemic _____ (PSE)
Portal systemic encephalopathy (PSE)
243
What is this condition: Clients who have a poorly functioning liver are unable to convert ammonia and other waste products to a less toxic form. These products are carried to the brain and cause neurological symptoms
Portal systemic encephalopathy (PSE)
244
Portal systemic encephalopathy (PSE) medication
Lactulose (reduces ammonia level)
245
The main concern with varices is
bleeding (they are fragile)
246
Acute graft rejection post liver transplantation usually occurs around
4 to 10 days after surgery
247
Serum creatinine – produced due to ___ and ___ breakdown.
protein and muscle
248
Kidney disease is the only condition that increases serum ____ level
creatinine
249
Kidney function loss of at least __ will cause an elevation of serum creatinine values.
50%
250
Serum creatinine values are ____ in older adults unless kidney disease is present.
normal
251
Blood urea nitrogen (BUN) – results from breakdown of ____ in the liver
protein
252
Elevated BUN is highly suggestive of
kidney disease
253
Urinalysis: Collection of an ___ specimen provides a more concentrated sample.
early-morning
254
Kidney Dx tests: Allows for visualization of structures and to detection of renal calculi, strictures, calcium deposits, or obstructions.
X ray
255
Kidney Dx tests: Provides three-dimensional imaging of renal/urinary system to assess for kidney size and obstruction, cysts, or masses.
CT
256
Kidney Dx tests: IV contrast dye (iodine-based) may be used to enhance images.
CT
257
Kidney Dx tests: Useful in staging cancer
MRI
258
Kidney Dx tests: Used to assess size of kidney, image the ureters, bladder, masses, cysts, calculi, and obstructions of the lower urinary tract
Ultrasound
