NUR 360 Flashcards
1
Q
Cholecystitis
A
Inflammation of the gallbladder
2
Q
Cholelithiasis
A
calculi in the gallbladder
3
Q
Cholangitis
A
Cholangitis is an infection of the common bile duct, the tube that carries bile from the liver to the gallbladder and intestines. Cholecystectomy- removal of the gallbladder
4
Q
Cholecystectomy
A
Removal of the gallbladder
5
Q
Cholangiogram
A
imaging of bile ducts by x-ray
6
Q
Icterus
A
Jaundice
7
Q
ERCP
A
an endoscopic procedure using fiberoptic technology to visualize the biliary system.
8
Q
Bile
A
A liquid made by the liver that helps digest food.
9
Q
Common Causes of Constipation
A
diet, fluid, activity, medications (pain meds, anti-depressants, vitamins, BP meds, antihistamines)
10
Q
Common causes of constipation, conditions
A
hypothyroidism, IBS, depression, pregnancy & childbirth, weakness, fatigue
11
Q
Fecal impaction
A
Complication of constipation, A fecal impaction is a large lump of dry, hard stool that remains stuck in the rectum.
12
Q
Fissures
A
Complication of constipation, An anal fissure is a small split or tear in the thin moist tissue (mucosa) lining the lower rectum
13
Q
Megacolon
A
complication of constipation, Megacolon is an abnormal dilation of the colon (a part of the large intestine).[1] The dilation is often accompanied by a paralysis of the peristaltic movements of the bowel
14
Q
Bulk Forming
A
work by increasing the amount of water in the stool, making it softer and easier to pass. These are generally the preferred laxatives for most ages.
15
Q
Lubricant
A
Mineral oil (liquid petrolatum) coats and softens stool. Like stool softeners, mineral oil is used by patients who need to avoid straining
16
Q
Stimulant
A
Stimulant laxatives induce bowel movements by increasing the contraction of muscles in the intestines, and are effective when used on a short-term basis.
17
Q
Fecal Softener
A
prevent hardening of the feces by adding moisture to the stool. Used more to prevent constipation, not treat it.
18
Q
Common causes of diarrhea
A
Viral infections, bacterial infections, parasitic infections, functional bowel disorders, intestinal diseases, food intolerances and sensitivities, medications
19
Q
Diarrhea complications
A
Fluid & electrolyte, dehydration, cardiac dysrhythmias, skin breakdown
20
Q
Diverticulosis
A
Multiple diverticula without inflammation
21
Q
Diverticulitis
A
Infection and inflammation of diverticula
22
Q
Obstruction within the lumen of the bowel or, pressure from outside the lumen
A
Mechanical obstruction
23
Q
Intussusception
A
Part of the intestine slides into an adjacent part of the intestine. This “telescoping” often blocks food or fluid from passing through. Intussusception also cuts off the blood supply to the part of the intestine that’s affected. Intussusception can lead to a tear in the bowel (perforation), infection and death of bowel tissue.
24
Q
Volvulus
A
A volvulus is a subtype of malrotation in which a loop of bowel is twisted about a focal point along the mesentery, which may result in a bowel obstruction.[
25
Strangulated hernia
Can be any place where gap in musculature; bowel sort of just slides through there. Problem begins when it gets out there then gets stuck and can’t slide back; problem with circulation/necrosis/gangrene
26
90% of acute cholecystitis is caused by….
Gallstones
27
Follows surgery, trauma, burns, torsion, cystic duct obstruction, multiple transfusions, alterations in fluid and e-lytes, visceral blood flow
Acalculous cholecystitis
28
ERCP
Endoscopic retrograde cholangiopancreatography- an endoscopic procedure using fiberoptic technology to visualize the biliary system.
29
Lipolysis
breakdown of fat
30
Proteolysis
breakdown of protein
31
Anemia
Decreased RBCs or decreased hemoglobin
32
Anemia causes (3)
Loss of RBCs, decreased production of RBCs, Increased destruction of RBCs
33
Epoietin
Antianemic, stimulates erythropoiesis, may decrease bleeding times and require additional heparin
34
Whole blood
human blood from a standard blood donation
35
packed red blood cells
have been collected, processed, and stored in bags as blood product units available for blood transfusion purposes.
36
Leukocyte-reduced RBCs
packed red blood cells that have been passed through filter to get all of WBC out of it as possible to decrease reaction
37
Washed RBCs
wash to get coating off, get immune causing factors out of blood
38
FFP (Fresh frozen plasma)
refers to the liquid portion of human blood that has been frozen and preserved after a blood donation[1] and will be used for blood transfusion.
39
Cryoprecipitate
Cryoprecipitate is prepared from plasma and contains fibrinogen, von Willebrand factor, factor VIII, factor XIII and fibronectin. (For bleeding)
40
Administration of incompatible blood
Preexisting antibodies against transfused RBCs
Improper administration (dextrose-containing fluids)
Acute hemolytic reactions
41
Fever, chills, nausea, dyspnea, low back pain, hemoglobinuria, tachycardia, hypotension, cardiovascular collapse, renal failure, DIC, pain at infusion site
Acute hemolytic reaction
42
Mild to severe response to foreign substance
Allergic reaction
43
Flushing, hives, itching, dyspnea, hypotension, chest pain,
Allergic reaction
44
Recipient antibodies to donor leukocytes
Bacterial contamination
Inflammatory cytokine release
Febrile reaction
45
Rise in temp 1.8 degree F. or greater within two hours after transfusion
chills
Febrile reaction
46
Contamination of blood product during procurement, storage, preparation, or administration of product.
Bacterial contamination
47
Fever, chills, sepsis
bacterial contamination
48
Too rapid infusion of too much volume
circulatory overload
49
Cough, dyspnea, pulmonary congestion, HTN, tachycardia, distended neck veins
Circulatory overload
50
Allogenic lymphocytes in transfused blood engraft in profoundly immunocompromised patient
Transfusion associated graft versus host disease
51
Fever, rash, hepatitis, diarrhea, bone marrow suppression, infection
Transfusion associated graft versus host disease
52
Neutropenia
Absolute neutrophil less than 1,500
53
Agranulocytosis
ANC < 200
54
Filgrastim- Neupogen
been out for 10-15 yrs
| Helps your body make white blood cells. This will help prevent infections during cancer treatments
55
Pegfilgrastim- Neulasta
newer form of filgrastim; longer acting form
| Helps your body make white blood cells. This will help prevent infections during cancer treatments
56
large amount of chemo, patients will typically have low WBC, ANC, platelets (at high risk for bleeding and infection)
Chemo induction
57
Type of ongoing treatment that is provided to cancer patients who appear to be in remission. The goal of this type of cancer therapy is to kill off any residual cancer cells that may be present, effectively increasing the potential of a complete recovery. The dosage of the chemotherapy is usually somewhat high, allowing the treatments to be highly effective.
Chemo consolidation
58
The ongoing use of chemotherapy (the use of drugs to destroy cancer cells) or another treatment to help lower the risk of recurrence (return of cancer) after it has disappeared following initial therapy. Maintenance therapy also may be used for patients with advanced cancer (cancer that cannot be cured) to help keep it from growing and spreading farther. Lower doses for 2-3 years.
Chemo maintenance
59
"B" symptoms
Fever, night sweats, unintentional weight loss > 10%
| For Hodgkins lymphoma, requires more aggressive treatment.
60
Urine for Bence-Jones protein and protein electrophoresis is a diagnosis for….
Multiple myeloma
61
Serum electrophoresis is a diagnosis for….
Multiple myeloma
62
bisphosphonates
Bisphosphonates are a class of drugs that prevent the loss of bone mass, used to treat osteoporosis and similar diseases.
63
Plasmapheresis
used to remove from the blood the large chain immune complexes that are frequently produced by these tumor cells.
64
Thalidomide
Thalidomide blocks the flow of blood to tumor cells.
Thalidomide interferes with the growth of tumor cells in the bone marrow.
Thalidomide stimulates the immune system to attack tumor cells.
65
SERMS-tamoxifen
5 years after dx, estrogen and fits into estrogen and progesterone on the cells so that persons intrinsic hormones cannot bind to the cells.
Tamoxifen has many of the same side effects and OCP, increased risk for DVT, hot flashes, menopause, decreased bone density.
66
Aromatase inhibitors
block the hormonal precursor of estrogen from turning into estrogen, use for 5 years is the standard after dx. Cut down the rate of recurrence of women who are candidates of BC.
67
Antacids
These increase the pH of the stomach, and they coat the stomach
68
Histamine receptor antagonists
Huge breakthrough drugs
| Lower gastric acid secretion
69
Proton pump inhibitors
Reduce gastric acid production for up to 24 hours
| Binds to enzyme & prevents final transport of H ions to gastric lumen
70
Gastric emptying agents
Blocks dopamine receptors in chemoreceptor zone of CNS; stimulates motility of UGI, accelerates gastric emptying
71
Two causes of actue pancreatitis.....
Alcholol abuse & Gall stones lodged at the ampulla of vater (obstruct flow of pancreatic juice)
72
symptoms of acute cholecystitis
pain, tenderness, rigidity of URQ, may radiate to mid-sternum, right shoulder
Nausea, vomiting
Fever, chills, elevated WBCs
73
diagnostics of acute cholecystitis
ultrasound (identifies stones)
HIDA scan (tracks flow of bile from liver to sm. intestine
ERCP
74
Medical interventions of acute cholecystitis
Decrease inflammation (IV antibiotics, Rest)
NPO-low fat diet
Pain management (opoid)
Dissolution therapy
75
Signs of peritonitis
```
Fever
Abdominal pain
Paralytic ileus
Increased or absent bowel sounds
Abdominal distention
```
76
Signs of perforation & penetration
```
Sudden, severe upper abdominal pain
May be referred to right shoulder or back
Vomiting and collapse
Tender, boardlike abdomen
Hypotension, tachycardia
Shock
```
77
```
Painless enlargement of one or more lymph nodes on one side of neck
Cervical, supraclav, mediastinal
Mediastinal mass
Pruritis (HL)
Pain after drinking alcohol
```
Hodgkins’ Lymphoma S/Sx
78
Hepatocellular Jaundice
Damaged liver cells unable to clear normal amounts of bilirubin from the system
79
Obstructive Jaundice
Bile can’t flow normally into intestine. Becomes backed up in the liver, is reabsorbed into the blood, & carried throughout the body.
80
Hemolytic
Caused by increased destruction of RBCs rather than liver dysfunction
81
WBC range
4.5-10.5
82
RBC range
3.8-5.1
83
Platelet range
150,000-400,000
84
Hematocrit range
36-46%
85
Hemoglobin range
12-15.5
86
Shrinking
Unintentional weight loss of 10 or more pound in last year
87
S.P.I.C.E.S
```
Sleep disorders
Problems with eating or feeing
Incontinence
confusion
Evidence of falls
skin breakdown
```
88
MiniCOG
First the 'patient' is asked to repeat three unrelated words, the patient is then asked to draw a clock, The 'patient' is then asked to recall the three words.
If the 'patient' is unable to recall any of the three words then they are categorized as ‘probably demented.’
Results of The Clock Drawing Test: If the 'patient draws a clock that is in any way abnormal they are considered as 'probably demented'. If the clock is normally constructed then they are considered 'probably not demented'.
89
Vague presentation
Non-specific sx that may signify impending acute illness in an older adult (confusion, self-neglect, falling, incontinence.)
90
Altered presentation
Patient presents with symptoms not usually associated with specific acute illness
ex. MI, infection
91
Non-presentation
many illnesses may go unrecognized and untreated for many years in older adults, significantly impact QOL. (depression, incontinence, falling, dementia, hearing loss) Insidious onset, vague symptoms, reluctance of older adults to complain, difficulties communicating s/sx, tendency to regard as "normal" part of aging
92
Institute of healthcare improvement
This non profit organization leads the improvement of health care worldwide by: inspiring change, cultivating innovative concepts for improving patient care, and implementing program to put ideas into action. (100,000 and 5 million lives campaign)
93
100,000 lives campaign interventions
Deploy rapid response teams, prevent VAP, prevent adverse drug events, prevent central line infections, prevent surgical site infections, deliver evidence-based care to treat MI.
94
5 million lives campaign interventions
Reduce surgical complications, prevent harm from high-alert meds, prevent pressure ulcers, MRSA, deliver reliable EBC for HF.
95
Reservoirs for MRSS
anterior nares, skin of the axillae, perineum, hand, arms, GI tract, ostomy sites, pressure ulcers, sputum.
96
Six medications types stood out as significantly risky:
insulin, heparin, opiods, injectable potassium chloride, neuromuscular blocking agents, chemotherapy.
97
Roots of all cardiac evil
Smoking, diabetes, obesity, dyslipidemia, and hypertension.
98
Total cholesterol range
<200
| comes from animal fats
99
HDL cholesterol
Men >45, women >55
100
Triglycerides
150 or less
Diabetics will have high levels due to not breaking things down properly.
101
LDL cholesterol
130 or less, must be <70
| Bad cholesterol
102
Metabolic syndrome
insulin resistance, High triglycerides, low HDL, possibly high LDL, Central obesity, hypertension
BMI > 24.9
Waist >35” women, >40” men *12 x greater risk for diabetes
Triglyceride level > 150 mg/dl
HDL < 40 mg/dl
B/P > 140/90
2 elevated FBG levels > 126 mg/dl or a random BG >200 mg/dl
103
Treatment for metabolic syndrome
Lifestyle modifications-weight loss, diet
Lipid Management: diet, medications
B/P Management
Medications:
1) ACEIs and ARBs preserve renal function
2) Beta-blockers prevent endothelial damage (but increase lipid levels and insulin resistance)
3)Thiazides are particularly effective in African Americans and elderly; prevent osteoporosis, but they increase LDL and triglycerides and increase uric acid;
4) Calcium Channel blockers appropriate if patients don’t tolerate beta blockers
5) Oral hypoglycemics (metformin most commonly used)
104
Statin side effect
Muscle pain. When muscles break down they release creatinine. Check to see if muscle has been damaged, and if they have, take them off the statin.
Whenever giving a patient their first dose of statin, always warn patient of muscle pain.
105
Cardiogenic Shock
Failure of the heart to pump adequately to meet perfusion needs of the body *ineffective pumping
>40% damage to myocardium to cause cardiogenic shock
85% mortality
Tachycardia, hypotension, decreased urine output, cold, clammy skin, mental changes, HF, CP, tachypnea
106
Cardiac Tamponade
Fluid accumulates rapidly in the pericardium
Can be caused by myocardial rupture following an MI or during cardiac surgery
Symptoms (Beck’s Triad):
1. JVD
2. Muffled heart sounds
3. Hypotension (Decreased CO)
**Pulsus Paradoxus
107
Pulsus Paradoxus
Drop in systolic B/P of 10 mmHg or more on inspiration (r/t decreased CO)
Caused by decrease LV stroke volume
108
Papillary Muscle Dysfunction
Causes mitral valve regurgitation
Systolic murmur at apex
Dyspnea, pulmonary edema, decreased CO
109
Causes: AKI
```
Severe Hypotension
Sustained hypotension decreases perfusion
Shock
Dehydration
Cardiac Disease
Low cardiac outputDecreased perfusion
Nephrotoxic Agents
Obstruction
Acute Glomerulonephritis
Vasculitis
Hepatorenal Syndrome of Cirrhosis
```
110
Pre-renal
physiologic state of diminished perfusion
111
Intra-renal
Renal cortical involvement of toxic, vascular, infectious or immunologic processes
112
Post –renal
Associated with obstruction of the urinary collecting system
113
Pre-renal ARF causes
```
Severe dehydration
Excessive volume losses (GI, Renal, Cutaneous, or Hemorrhage)
Hypotension
Cardiac failure
Embolism
Thrombosis
Sepsis
Vascular obstruction
```
114
Intra-renal ARF causes
```
Acute tubular necrosis
Diabetes
Glomerulonephritis (autoimmune process)
Pyelonephritis (infectious process)
Severe hypertension
Transfusion reaction
Toxins
Ibuprofen
ACE inhibitors
```
115
Post-renal ARF causes
Urethral obstruction
Bladder obstruction
Neurogenic problem
Renal calculi
116
Common Nephrotoxins
Aminoglycosides* -Gentamycin, neomycin, tobramycin, etc.
Angiotensin-converting enzyme inhibitors* (ACE-inhibitors)
Nonsteroidal anti-inflammatory drugs*
Radiocontrast media*
117
Oliguria
low output of urine
| Does not respond to fluid challenge or diuresis
118
A rise in Cr could occur from…?
medications
119
A rise in BUN can occur without…?
renal injury such as in GI bleeding, steroid use, and protein loading.
120
Electrolytes in AKI
Hyperkalemia, hyperphosphatemia, hypocalcemia
