module 3 Flashcards
pancreatitis
keeping the stomach empty and dry so that the pancreas stops releasing enzymes that are causing the pain in the first place
pancreatitis patho
endocrine: insulin
exocrine: digestive enzymes
causes: GB or alcohol
normally: eat - enzymes go to pancreatic duct - then to the intestine then activate
pancreatitis: obstruction - enzymes activate in the pancreas - auto digestion
BMI greater than 25 indicates
overweight or obese
DASH
diet appropriate to stop hypertension
pancreatitis s/s
s/s: pain that increases with eating, abdominal distension (ascites), swollen pancreas you can palpate
peritonitis- rigid board like abdomen, blood
grey turners- bruising flank cullens-bruising umbilicus
fever, n/a, jaundice, hypotension
orthopedics fractures s/s
pain and tenderness unnatural movement deformity shortening of extremity crepitus swelling discoloration worry about compartment syndrome **
fracture treatment
tx: immobilize adjacent joints and bone ends, support function above and below site, move as little as possible, splints help prevent fat emboli and muscle spasms, cover open function with sterile dressing
neuro vascular checks: pulse, color, movement, sensation, cap refill, temp
maternity s/s
presumptive: amenorrhea, nausea and vomiting, urinary frequency, breast tenderness
probable: + pregnancy test, goodell’s, chadwicks, hegar’s, uterine enlargement, pigmentation changes, braxton hicks
positive: FHR, ultrasound, fetal movement
Definitions : Gravidity
number of pregnancy
Definitions : Parity
number of pregnancy with 20 week fetus
Definitions : Viability
24 weeks gestation
Definitions : Naegele’s Rule
1st day of LMP + 7 DAYS - 3 MONTHS + 1 YEAR
TPAL
term, preterm, abortion, living children
clients with pancreatitis
keep stomach empty and dry
4 major functions of the liver
detoxify the body
helps your blood to clot
the liver helps to metabolize (break down) drugs
the liver synthesizes albumin
cirrhosis
liver cells are destroyed and are replaced with connective/scar tissue - alters the circulation within the liver- BP in the liver goes up (portal HTN)
if liver is sick…
decrease the dose of medications
enlarged spleen
immune system is involved
s/s of cirrhosis
firm, nodular liver, abdominal pain, spenaomegaly, decreease serum albumin, increase ALT & AST, anemia
when liver is sick
ammonia in the body increases
protein
breaks down to ammonia - liver converts ammonia to urea - kidneys excrete urea
hepatic coma
patho
s/s
treat
liver is impaired and cannot break down the ammonia so LOC goes down.
s/s: difficult to arouse, asterixis, decrease reflexes, EEG slow
tx: lactulose (decrease ammonia), decrease protein in diet, enemas
blackmore tube
balloon tamponade is for bleeding varices and it holds pressure on the bleed
peptic ulcers
patho, diagnosis, tx
common cause of gi bleeds
gastroscopy (EGD): npo pre and post procedure (when gag reflex returns), watching for pain, bleeding, trouble swallowing. upper GI: look at esophagus and stomach with dye. npo past midnight, no smoking, chewing gum, or mints
tx: anatacids- take on empty stomach, PPI (ZOLE), H2 (famotidine)
may appear malnourished, pain is usually half hour - 1 hour after meals; food does not help, but vomiting does, vomit blood
gastic ulcers
appear well nourished, night time pain is common and also occurs 2-3 hours after meals; food helps; blood in stools
duodenal ulcers
hiatal hernia
patho
s/s
tx
hole in diaphragm is too large so the stomach moves up into the thoracic cavity
s/s: heartburn, regurg, dysphagia
tx: small frequent meals, hob, sit up 1 hour after eating, surgery
dumping
stomach empties too quickly after eating and client experiences many s/s.
lay down on left side, no fluids with meals, small/frequent meals
what side to lay on
left side= leaves food in the stomach
right side= releases the food
ulcerative colitis vs. crohns
s/s
uc- ulcerative inflammatory bowel disease; in large intestine
crohns- aka regional enteritis; inflammation and erosion of the ileum, but can be found anywhere in the small or large intestines
s/s: diarrhea, rectal bleeding, dehydration, rebound tenderness, cramping, weight loss
coloscopy
clear liquid diet 12-24 hours pre procedure
NPO 6-8 hours pre procedure
avoid NSAIDS
polyethylene glycol
colon prep drank icy cold with no straw
POST: watch for perforation (pain and unusual discomfort)
mcburneys point
RLQ appendix
TPN
central line needed, filter needs, may have to start taking insulin, gradual discontinue to avoid hypoglycemia, check urine for glucose or ketones
only hung for 24 hours, change tubing with new bag
central line
position? tredelenberg to distend veins
if air gets in the line- left side, tredelenberg
with what type of fractures do you see fat embolisms or shock
long bones (Femur), pelvic fractures, crushing injuries
s/s of fat emboli
petechiae or rash over chest, conjunctival hemorrhage, snow storm on CXR
muscle becomes swollen and hard and the client reports severe pain that is not relieved with pain meds; pain is disproportionate to the injury could lead to amp
compartment syndrome
tx for compartment syndrome
if they have a cast, losen cast to restore circulatio
traction
never release it unless you have doc order
total hip replacement
client education
neuro checks, monitor drains, firm mattress, trapeze bar overhead
neutral rotation; limit flexion but want extension of the hips, isometric exercises , abduction
avoid crossing legs or beding over; 1 day post op you can walk or when doc says
walking/swimming/rocking; avoid flexion: low chairs, traveling long distances, sitting more than 30 mins, lefting heavy objects, stair climbing
how do you prevent contratures
extension!!!
what position would extend the hip or knee joints
prone
amputation
stump shaped cone, need a limb sock, massage stump
walker
you walk into a walker
crutches
up with the good leg, and down with the bad leg
canes
use on strong side of the body
hormone that induces amenorrhea
progesterone
softening of the cervix; second month
goodells
bluish color of the vaginal mucosa and cervix; 4th week
chadwicks
softening of the lower uterine segment; 2 or 3 month
hegars
contractions which occur throughout pregnancy; moves blood through the placenta
braxton hicks
mask of pregnancy
facial chloasma
bleeding, cramping, backache think
miscarriage
first trimester
1-13 weeks expect weight gain 1-4 lbs folic acid- prevents neural tube defects always take iron with vitamin C do not let heart rate get above 140
normal protein
40-45
increases to 60 first trimester
danger signs and potential complication of maternity (8)
sudden gush of vaginal fluid, bleeding, abdominal pain, increase temps, persistent vomiting, edema, severe headache, no fetal movement
doc visits the first 28 weeks
once a month
doc visits 28-36 weeks
every 2 weeks or twice a month
ultrasounds
drink water before to distend the bladder
ultrasound before a procedure we want them to void
second trimester
weel 14-26 increase to 300 calories a day general 1 pound weight gain NO n/v, NO urinary frequency, YES breast tenderness FHR 110-160
kegel exercises
exercise frequently to strengthen the pubococcygeal muscles; helps stop urine flow and keeps uterus from falling out
third trimester
27-40 weeks
no more than 1 pound a week
2 or more pounds a week we worry about
preclampsia
preclampsia
bp of 160/110
increased bp, proteinuria, edema
mag sulfate
ruptured membranes think
prolapsed cord until proven otherwise
when should client go to the hospital
contractions are 5 minutes apart or when the membrane ruptures
non stress test
2 or more accelerations of 15 beats/ min or more without fetal movement
want reactive because this means accelerations are present
biophysical profile test BPP
observation time is 30 mins by sonogram
parameters count 2; 10/10 is perfect
HR, muscle tone, movement, breathing and the amount of amniotic fluid around the baby
contraction stress test
performed on high risk pregnancies
determines if the baby can handle the stress of uterine contraction
NEGATIVE stress test is good
if blood flow decreases enough to cause hypoxia in the fetus, then the FHR will decrease from the baseline
deceleration
true labor
regular contractions
pain increases
contractions increase in frequency and duration
false labor
contractions irregular
discomfort is in abdomen
pain with change in activity decreases/goes away
steroid that helps the fetal lungs mature
betamethasone
epidural
lie on left side, legs flexed, prop up over the bedside
biggest complication hypotension
oxytocin
one on one care
contraction rate 1 q 2-3 mins each lasting 60 seconds
if late decels occur turn off oxytocin
tachycardia + postpartum think
hemorrhage
post partum uterus
fundus is midline below umbilicus
boggy uterus
massage the fundus until it is firm then check for bladder distension
lochia
rubra: 3-4 days and dark red
serosa: 4-10 days and pinkish brown
alba: 10-28 days and whitish yellow
clots are ok as long as they are smaller than a nickel
babies immediate care
erythromycin to kill gono or chlamydia
phytonadione which is vitamin k and promotes formation of clotting factors
rh
rh+ blood from baby comes in contact with moms rh - blood
mom looks at babys blood as a foreign body and the mom produces antibodies against rh + blood.
first baby not affected. second baby will be. give mom rhogam within 72 hours after birth so she doesnt produce antibodies
rhogam must be given
before the antibodies form
3 rules for measuring abdominal girth
mark the abdomen so everyone measures the abdomen in the same place
measure the abdomen at the area of the umbilicus or belly button
measuring tape should be snug but not compress the skin
what levels will be elevated for acute pancreatitis
amylase lipase AST ALT PT and PTT glucose
h2 receptors
end in dine
with TNA check the urine for
ketones and glucose
s/s of too much ammonia
think SEDATIVE minor mental changes motor problems difficulty in awakening decreased reflexes handwriting changes slow EEG asterixis GO INTO A COMA HEPATIC COMA OR HEPATIC ENCEPHALOPATHY
should you give the liver client narcotics via IM route
no we are trying to prevent bleeding
priority assessment post paracentesis to be assessed for what
FVD by looking at the BP and pulse
immediately post tube feeding how would you place a client
right side HOB elevated
position post liver biopsy
right side to apply pressure to the puncture site
appendictis patient waiting to go to surgery what position should they be in
right side HOB elevated
gastric ulcers vs. duodenal
G- pain after meals, looks malnourished, hematemesis
D- pain with empty stomach, looks nourished, blood in stool
BOTH - antacids provide relief, avoid caffeine, medication for one year
what to monitor after an EGD
gag reflex, bleeding, swallowing, VS, pain
only occurs in the large intestine
ulcerative colitis
occurs anywhere in the body
crohns
tx for ulcerative colitis
low fiber diet, antibiotics, steroids, total colectomy
tx for crohns
try not to do surgery, low fiber diet, antibiotics, steriods
no insoluble fiber for crohns disease
just know; foods with skins are not good
with a potential leg fracture what 3 things should you do
- immobilize the bone ends and adjacent joints
- support the fracture above and below the site
- move the leg as little as possible
before and after a splinting what do you need to do
a neurovascular check
pulse, color, movement, temp, sensation, cap refill
increase pressure with limited space
compartment syndrome
how do you know when a person develops compartment syndrome
pain that is not relieved with pain meds
difference between skin and skeletal traction
skin is short term (skin assessment is important)
skeletal is long term (continuous traction, intact pins)
both decrease muscle spasms, relieve pain, and immobilize fracture
term baby
38 weeks
a pregnant client with a rigid abdomen and uterine tenderness
placental abruption
if client has pre clampsia or eclampsia how long is she at risk for seizures after delivery
first 48 hours
newborn rr
30-60
