NUS 111 Test #3 Flashcards

1
Q

this releases thyroid stimulating hormone

A

pituitary gland

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2
Q

iodine is needed to synthesize these

A

T3 and T4

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3
Q

what does the thyroid gland affect

A

metabolic rate, growth and developement, brain function and metabolism

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4
Q

decreased basal metabolic rate creating weight gain, supresses glucose

A

hypothyroidism

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5
Q

weight loss, caloric requirement goes up; graves disease causes 75% of this

A

hyperthyroidism

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6
Q

this is caused by the destruction of the thyroid gland and/or defect in the production of hormones

A

hypothyroidism

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7
Q

decreased production of ____ leads to the stimulation of the secretion of _____ which stimulates the secretion of T3

A

T4
TSH

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8
Q

T3 increases the secretion of _____ which leads to the hypertrophy of the thyroid gland

A

T4

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9
Q

what is transient hypothyroidsm

A

temporary/reversible

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10
Q

waht is primary hypothyroidism

A

disfunction of thyroid gland itself; or not enough iodine

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11
Q

this is thyroid deficiency is present at b irth

A

cretinism

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12
Q

drugs for hypothyroidism

A

lithium

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13
Q

what is the most common cause of hypothyroidism in the world

A

iodine deficiency

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14
Q

modifiable risk of hypothyroidism - 2

A

use of lithium
diet iodine deficiency

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15
Q

Non modifiable risk factors of hypothyroidism - 6

A

age, 30-60 yrs old
genetics
autoimmune disease
females
hyperthyroidism, part of thyroid removed, meds for hyperthyroid at any point, head or neck radiation

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16
Q

old ppl considerations for hypothyroidism - 6

A

depression
decreased mobility
presents atypically*
constipation
thyroid replacement therapy
CV & neurologic side effects with thyroid replacement therapy

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17
Q

early symptoms of hypothyroidism - 8

A
  1. fatigue
  2. amenorrhea
  3. loss of libido
  4. non pitting edema
  5. mental sluggishness
  6. parasthesia and nerve entrapment syndrome
  7. hair loss, dry skin, brittle nails
  8. constipation
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18
Q

late symptoms of hypothyroidism - 10

A
  1. slow speech
  2. cold intolerance
  3. subdued emotional response,
  4. apathy
  5. absence of sweating
  6. constipation
  7. thickening of skin
  8. dyspnea
  9. weight gain (without increase in food consumption)
  10. thinning of hair, alopecia (Severe)
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19
Q

severe hypothyroidism resulting in decompensated metabolic state and mental status change

A

myxedema coma

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20
Q

what part of myxedema coma is pt a medical emergency

A

enlarged tongue
depressed resp drive

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21
Q

advanced stage of hypothyroidism

A

personality and congnitive changes - looks like dementia

respiratory issues:
-muscle weakness
-pleural effusion
-sleep apnea

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22
Q

severe stage of hypothyroidism

A

elevated level of serum cholesterol
CAD/ Poor left ventricular function
myxedema coma
-hypothermic
-Lethargy/unconscious /coma
-Non pitting and periorbital edema
-Enlarged tongue (hoarseness)
-Depressed respiratory drive

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23
Q

how do you manage myxedema coma

A
  1. supportive (airway, rewarming)
  2. hydrocortisone
  3. levothyroxine, T4
  4. +/- T3 supllementation
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24
Q

what are the laboratory findings for myxedema coma

A

hypoglycemia
hyponatremia
hypoxemia
prolonged QT, low voltage
pericardial effusion
hypercapnia

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25
precipitating factors of myxedema comma
infection, cold exposure, stroke, meds (amiodarone, lithium)
26
nursing assessments - hypothyroidism
vitals - low pulse, bp, RR is tachy palpate thyroid - is it enlarged, soft, rubbery skin changes constipation weight gain hair loss, brittle nails how tolerate cold cardiac function assess mouth for enlarged tongue slurred speech dyspnea numbness/tingling
27
nursing interventions for hypothyroidism
nutritional support - iodine, risk for weight gain healthy diet assess for signs of myxedema, LOC, CV changes, sedatives/opioids - avoid teach pt - 1. dont switch brands without talking to provider 2. take meds 1-2 hours before breakfast 3. how to manage symptoms 4. mild soap, use lotion, avoid skin breakdown 5. constipation, stool softener, increase fiber
28
medication for hypothyroidism
levothyroxine
29
what are the considerations for levothyroxine
benzos & sedatives - can cause myxedema coma anticoagulants - watch for bleeding, increased risk insulin - may need more digoxin - can cause angina & arrhythmias dilantin - decreases effect tricyclic antidepressant - effects decreased
30
should levels of TSH be low or high for hypothyroidism
high if thyroid issue low if pituitary or hypothalamus
31
hypothyroidism low or high T3
low
32
hypothyroidism low or high T4
low
33
hypothyroidism low or high LDL
high
34
hypothyroidism low or high anemia
low
35
hypothyroidism low or high hemoglobin
low
36
BMR - hypothyroidism low or high
low
37
safety measures for hypothyroidism
1. chest pain 2. HR over 100 3. medications 4. supportive management; education, oral and written instructions if needed 5. monitoring physical status; CV collapse; respiratory issues
38
collaborative goals for hypothyroidism
-adhere lifelong therapy -weight reduction -monitor thyroid hormones, keep within normal range -report herbal and OTC meds to provider
39
modifiable risks of hyperthyroid
smoking overmedication too much iodine diet meds
40
non modifiable risks of hyperthyroid
graves disease female cancer, thyroid, pituitary 20-40 year old raidation thyroiditis
41
non modifiable risks of hyperthyroid
graves disease female cancer- thyroid, pituitary 20-40 years radiation thyroiditis
42
when the thyroid gland makes too much T3 and T4 so pituitary gland will not produce TSH
hyperthyroidism
43
this is the clinical effects of hyper metabolism from too much circulation T3 & T4
thyrotoxicosis
44
this is associated with goiter
thyrotoxicosis
45
hyperthyroidism for old ppl - considerations
1. unexplained weight loss 2. isolated episodes of atrial fibrillation 3. less common in elderly 4. new or worsening heart failure 5. difficulty climbing stairs when it wasnt before 6. mental deterioration 7. may need beta blockers
46
symptoms of thyroid storm (Thyrotoxic crisis)
high fever agitation delirium congestive heart failure loss of consciousness
47
nursing assessments for hyperthyroidism
vital signs thyroid gland - enlarged, soft, thrill-palpable pulse respiratory - watch for airway, possible stridor, resp distress, difficulty swallowing peripheral edema tachycardia dyspnea; crackles; jugular vein distention
48
nursing intervention for hyperthyroidism
high calorie diet - 4000-5000 avoid stimulants low fiber food peristalsis increases risk for diarrhea cool environment monitor for thyrotoxic crisis already stimulated so avoid; nicotine, caffeine, soda, alcohol
49
clinical manifestations of hyperthyroidism
exophthalmos - bulging/buggy eyes nervousness/ emotionally excitable Tremors weight loss Thinning of hair high HR palpitations elevated systolic BP hyperhidrosis heat intolerance/Hyperthermia itchy skin Systolic murmur increased peristalsis increased appetite muscle fatigue
50
these block synthesis of hormones
antithyroid meds
51
what are the antithyroid meds
PTU methimazole
52
meds for hyperthyroid
antithyroid meds adjunctive therapy radioisotopes iodine
53
what is the priority during post op of a thyroidectomy
airway - assess airway every 2 hours for first 24 hours. high risk for airway issue
54
how much of thyroid is removed during thyroidectomy
5/6th
55
hyperthyroidism lab TSH - high or low
low
56
hyperthyroidism lab T3 - high or low
high
57
hyperthyroidism lab T4 - high or low
high
58
hyperthyroidism lab BMR - high or low
high
59
pt education for post treatment of thyroidectomy
see physician 2-3 mos before improvement of symptoms continue meds as directed monitor for a year closely for hypothyroid education on diet
60
which system is activated causing hunger which activates the sympathetic nervous system
parasympathetic
61
this mimics alcohol intoxication early on
hypoglycemia
62
what are the risk factors of hypoglycemia
too little or delayed food intake too much exercise medication or food taken at right time
63
manifestations of hypoglycemia
hunger shaking, nervous, anxious diplopia lethargic, weakness slurring faint, lightheadedness, syncope
64
nursing assessment hypoglycemia
blood glucose level cold clammy skin slurred speech diaphoretic tachycardia, palpitations seizure, coma, loss of consciousness unsteady walking, impaired coordination
65
nursing intervention of hypoglycemia
PB - carb + protein eating snack at peak insulin time
66
medications for hypoglycemia
glucagon IM 50% dextrose IN medical alert bracelet
67
collaborative safety goals - hypoglycemia
watch for signs and symptoms watch for N & V if pt is unconscious, treat blood sugar then once conscious give snack
68
this is a group of metabolic disease characterized by elevated blood glucose levels in the blood
diabetes
69
what do you have, if you have sweet urine
diabetes
70
what are the four types of diabetes
prediabetes DM type 1 DM type 2 gestational diabetes
71
this is produced by the pancreas that controls blood glucose levels by regulating production, use and storage of glucose
insulin
72
in this type of diabetes - insufficient release, damage to pancreatic cells. not enough made. betas cells damaged or destroyed
type 1
73
deficient hormone signals - insulin resistance - which diabetes is this
type 2
74
what is the function of insulin
transports and metabolizes glucose for energy signals to stop release of glucose enhances storage of dietary fat inhibits breakdown of glucose facilitiates transport of K+ to cells stimulates storage of glucose as glycogen in liver and muscle cells
75
characteristics of prediabetes
1. impaired glucose intolerance 2. not high enough numbers to be diabetes 3. increased glucose levels
76
manifestations of metabolic syndrome
1. hypertension 2. high blood sugar 3. abnormal cholesterol levels 4. abdominal obesity
77
non modifiable risk factors of prediabetes
ethnicity - native americans, latinos gestational diabetes - can develop to type 2 later in life age 45 +
78
modifiable risk factors of prediabetes
weight hypertension sedentary lifestyle HDL cholesterol level
79
primarily autoimmune - immune destruction of beta cells
type 1a diabetes
80
failure without an immune mediated etiology
type 1b
81
children and young adults mostly get this type of diabetes
type 1
82
nonmodifiable risk factors for type 1 diabetes
onset can occur at any age but usually under 30 genetics exposure to virus
83
clinical manifestations for type 1 diabetes
polyuria polydipsia polyphagia weight loss vision changes numbness/tingling in hands/feet dehydration
84
priority assessment for type 1 diabetes
thin, below ideal body weight slow wound healing lethargic eye exam numbness/tingling in hands/feet GI assessment, urinary assessment, skin assessment CV assessment, tachycardia, hypotension kussmaul breathing sweet breath/urine 3 Ps
85
manifestations of diabetic ketoacidosis
feeling tired and sleepy confusion, passing out stomach pain, feeling sick high ketones, polyuria blurred vision sweet smelling breath polydipsia high blood sugar levels
86
priority interventions for type 1 diabetes
assess and monitor blood glucose levels educate on meal planning urine glucose testing educaton on exercise educate on alcohol usage and its effects educate on insulin choices and how to admin reading food labels, carrying snacks with them at all times pay attention to blood sugar when high educate to know signs/symptoms of hyper and hypoglycemia
87
medications for type 1 diabetes - types of insulin
exogenous insulin admin insulin pumps insulin -rapid - lispro -short - regular insulin -intermediate - NPH -long acting - glargine/detemir
88
priority diagnostics of type 1 diabetes
fasting blood glucose levels random glucose level urine hemoglobin A1C >6.5% urinalysis C peptide test
89
what age of population tends to get type 2 diabetes
older population
90
pathophysio of DM type 2
insulin resistance impaired insulin secretion
91
b-cells become fatigued from compensatory overproduction of insulin -don't get ketosis HHNS
impaired insulin secretion - type 2 diabetes
92
body tissues do not respond to action of insulin DKA gets ketosis
insulin resistance - type 2 diabetes
93
nonmodifiable risk factors - DM type 2
age 45 family history ethnicity - minorities gestational diabetes
94
modifiable risk factors -DM type 2
weight smoking sedentary lifestyle HTN high cholesterol high blood sugar
95
clinical manifestations pf type 2 diabetes
fatigue visual changes slower onset reoccuring infections polyuria polydipsia polyphagia prolonged wound healing
96
nursing assessment for type 2 diabetes
body mass index measuring abdominal girth skin assessment CV assessment numbness/tingling cognition status
97
priority nursing interventions for DM type 2
nutrition exercise monitor blood sugar signs/symptoms of hyper/hypoglycemia
98
medications for type 2
biguanides - metformin sulfonylureas - glipizide nonsulfonylureas a glucosidase inhibitors dipeptidyl peptidase - 4 exogenous insulins amylin analog - pramlintide
99
diagnostics for DM type 2
HgA1C fasting blood glucose >126 lipid profile CPB urine - high glucose, mincroalbuminuria (protein)
100
collaborative and safety goals type 1 & 2 diabetes
nutrition blood sugar within normal limits miaintain good quality of life control caloric intake to maintain healthy body weight exervcise, cholesterol levels and have good lipid levels and BP 15g carbs = 1 carb = 1 unit of insulin affects of alcohol drinking a lot at risk of DKA type 1 higher change to get hypoglycemia important to know effects of exercise
101
risk factors for old ppl and pre diabetes
liver or pancreatic disease, heart disease diet, inactivity altered insulin secretion and resistence
102
age related changes for old ppl and pre diabetes
cognitive impairment kidney functions decrease decrease GI motility dental and oral care chronic disease socioeconomic factors potential drug interactions activity/exercise sensory changes
103
clinical manifestations of pre diabetes
slow wound healing fatigue 3 Ps - polyuria, polydipsia, polyphagia
104
assessment of pre diabetes
screening of blood glucose levels check ATI or honan
105
interventions of pre diabetes
education on diet education on glucose screening
106
pre diabetes medication
metformin
107
this produces antidiabetic effects by decreasing hepatic production of glucose and facilitating the action of insulin on peripheral receptor sites
metformin
108
diagnostics pre diabetes
impaired fasting 100-125 impaired glucose tolerance 140-199 hemoglobin A1C 5.56-6.5 lipids - low hdl, high ldl See ATI
109
collaborative goals pre diabetes
monitor risks factors maintain healthy weight meds - statin for cholesterol healthy diet at risk for CV education on prediabetes for risk factors
110
3 main types of macrovascular complications
CAD, CVA, PVD
111
what are the macrovascular complications of diabetes
-changes in medium to large vessels -blood vessel walls thicken, sclerosis occurs and become occluded by plaque -changes tend to occur at earlier stage in patients whose diabetes is poorly managed
112
microvasulcar complications of diabetes
thickening of membrane of capillaries due to formation of abnormal glucose molecules in basement membrane of small blood vessels
113
three types of microvascular complications of diabetes
diabetic retinopathy nephropathy neuropathy
114
what is this microvascular damage to retina is the leading cause of blindness glacuoma and cataracts occur more frequently
diabetic retinopathy
115
this results from damage to small blood vessels that supply glomeruli of kidney shows 10-15 yrs with type 1 10 year with type 2
nephropathy
116
nerve damage that occurs bc of the metabolic derangements associated wtih diabetes
neuropathy
117
this happens to 60-70% of pts with diabetes
neuropathy
118
increased incidence of MI due to . Typical ischemic symptoms may not be present in diabetics
CAD
119
cerebral blood vessels affected by accelerated arthrosclerosis
CVA
120
usually affects vascular of lower extremities, smoking couple with diabetes greatly increases risk
PVD
121
life threatening syndrome that can occur in pts with diabetes who are able to produce enough insulin to prevent hyperglycemia, osmotic diuresis and extracellular fluid depletion
hyperglycemic hyperosmolar nonketotic syndrome (HHNS)
122
type 2 blood sugar is high, normal blood sugar is 600-1200
hyperglycemic hyperosmolar nonketotic syndrome (HHNS)
123
infection, medication or acute/chronic condition can cause this. the medication is glucocorticoid steroids
hyperglycemic hyperosmolar nonketotic syndrome (HHNS)
124
risk factors of hyperglycemic hyperosmolar nonketotic syndrome (HHNS)
pts over 60 with undiagnosed type 2 diabetes impaired thirst sensation functional inability to replace fluids (aspiration) inadequate fluid intake prevention of illness/infection
125
clinical manifestations of HHNS
dehydration hypotension skin turgor, dry mucus membranes confusion tachycardia stroke symptoms hemiparesis aphasia polyuria polydipsia
126
nursing assessment of HHNS
hypotension CV and skin assessment - dry mucous membranes, skin turgor neuro assessment - confusion, alteration of sensorium, seizures, hemiparesis
127
nursing interventions HHNS
-replacement of fluid is initiated that is dependent on pts cardiac status and degree of fluid volume deficit -insulin - IV and pen -monitor electrolytes -monitor i & o -monitor blood sugars, vital signs and skin turgor -have on cardiac monitor, EKG -watch symptoms of overload -pt education - how to prevent, how to respond, include family in teaching -determine the cause
128
medications for HHNS
insulin half normal saline or normal saline, potassium as needed
129
diagnostics HHNS
-blood glucose >600 as blood sugar -serum osmolarity >340 mOsm/L produces severe neurological symptoms -glucose in urine -ketones absent or minimal -elevated BUN and creatinine
130
the higher the serum ____, the more profound the dehydration, and the greater risk for ____ _____ and ____ status changes
glucose renal impairment mental
131
this is not a disease but a syndrome
gastroesophageal reflux disease
132
Chronic symptom of mucosal damage caused by reflux of stomach acid into the lower esophagus
GERD
133
risk factors for GERD
Advanced age (delayed gastric emptying and weakening tone of sphincter) Obesity Sleep apnea NG Tube Hiatal hernia H.Pylori Diet (spicy foods citrus foods caffetine, chocolate) calcium channel blockers, metra nitrates
134
manifestations of GERD
dyspepsia - indigestion pyrosis- heartburn dysphagia- difficulty swallowing odynophagia- painful swallowing regurgitation- acid in mouth esophagitis Excessive salivation
135
how often do GERD symptoms need to happen to be diagnosed
4-5x/week
136
what is odynophagia
pain on swallowing
137
what is pyrosis
heartburn
138
what is dyspepsia
pain/uncomfortable feeling in upper middle part of your stomach area
139
assess for GI symptoms for GERD
-wakes up at night, pain when it occurs -pain in upset stomach, upper gastric -regurgitation - bitter, hot in mouth
140
what other symptoms of GERD that aren't GI
respiratory - wheezing, coughing, hard time sleeping sore throat, hoarse voice globus sensation hypersalivation pain worse after eating - lasts 20 to 2 hours increase in faltus
141
what serious condition does GERD mimic
heart attack
142
how do you tell if pt is having heart attack or GERD
give antacid and if pt gets better then its gerd
143
diagnostics of GERD
upper GI endoscopy with biopsy and cytolic analysis esophagogram - barium swallow motility (manometry) tests pH monitoring radionuclide test
144
what does the radionuclide tests detect
reflux and rate of esophageal clearance
145
medications for GERD
antacids - magnesium calcium carbonide H2 receptor antagonists - Famotidine etc proton prump inhibitors - omeprazole etc prokinetic agents - metoclopramide (reglan)
146
what do prokinetic agents do
increases motility of esophagus. blocks effects of dopamine - has extrapyramidal effects especially pts with parkinsons give slowly eg iv over 10 mins
147
do you take antacids with other meds
no. take seperate. take at bedtime or 1-3 hours after eating or taking other meds
148
how do you take H2 receptors?
With food Caution with kidney disease
149
PPI medication considerations
risk for CDiff, Fractures, Hypoglycemia, Electrolyte imbalance
150
Surgical nursing intervetions for GERD
after endoscopy - make sure gag reflux is back, have pt swallow and drink something afterwards make sure pt signs consent tell pt to avoid smoking, alcoho,, and carbonated beverages
151
Priority nursing interventions for GERD
Avoid tight fitting clothes Avoid eating 2-3hrs before bed raise head of bed 30 degrees Take meds as prescribed Weight dietary changes. avoid peppermint/spearmint, carbonated drinks, caffeine alcohol
152
what is the surgerical intervention for GERD
fundoplication
153
what is a fundoplication
reconstructing sphincter to make it work better to reduce reflux --only ppl not getting relief from meds will get this
154
lifestyle modifications for GERD
eat smaller meals break time between meals and lying down dont smoke control weight avoid wearing tight clothes relaxation techniques medications food to avoid - acidic foods, alcohol, caffeine, spicy foods, fried foods, carbonated beverages
155
a condition characterized by erosion of gastroduodenal mucosa resulting from digestive action of hcl and pepsin
peptic ulcer disease
156
this is due to increased concentration or activity of acid pepsin
peptic ulcer disease
157
decreased resistance of mucosa ---- less mucus production
peptic ulcer disease
158
Occurs in small intestine result of increase in acid Most common Often have multiple
duodenal ulcer
159
less common than duodenal ulcer. Higher mortality rate because of age @ onset and complications Occur near pyloric sphincter Mucosal breakdown is cause Acid levels normal H.Pyloric bacteria
choronic gastric ulcers
160
this is caused by H. pylori bacteria
chronic gastric ulcers
161
Located in esophagus Result of acid reflux/GERD
esophageal ulcer
162
risk factors for peptic ulcers
stress age (40-60 years average) men more likely - once women hit menopause it's equal smoking type O blood alcohol caffeine milk spicy foods H.Pylori NSAIDs/corticosteroid use COPD & Chronic Kidney disease Pernicious anemia
163
manifestations of peptic ulcer
chest pains reflux, heartburn in epigastric (can look like cardiac pain) eating helps pain pain - type/onset/comes back 2-5 hours after eating /straight after meal/ or at night? bowel movements - constipation or diarrhea vomiting if obstruction bleeding hematemesis melena - dark tarry stools sharp, localized tenderness when doing abdominal assessment
164
assessments of peptic ulcer
-black tarry stools -history of diet -medications - NSAIDs, corticosteroids, aspirin -what makes it worse/better -how does pain relate to when you eat, not eat, does it happen overnight -onset, duration pain assessment -family history -lifestyle -stress -alochol use -smoking -dyspepsia -any bleeding -do a full focused abdominal assessment -check labs and studies
165
nursing interventions of peptic ulcer
1. teach pt about medications - understand side effects, any interactions, etc 2. make lifestyle changes 3. decrease stress 4. have them pay attention to what is aggravating or alleviating pain
166
what are the 3 major complications of peptic ulcer
1. hemorrhage 2. perforation 3. pyloric obstruction
167
nursing intervention for hemorrhage of peptic ulcer
-test vomit and stool -blood pressure, shock, vital signs (check for bleeding severity) -intake and output - check hourly -check HR, mental status, faintness/dizziness -stop bleeding - gastric lavage -give blood products (?????) -keep checking for signs of bleeding potentially need NG tube for gastric decompression
168
nursing intervention for perforation of peptic ulcer
monitor fluid and electrolyte balance look for signs of shock, infection listen for bowel sounds any abdominal pain -stomach will be distented -sudden, severe upper abdominal pain, vomiting, callapse, extremely tender and rigid, hypotension and tachycARDIA
169
nursing intervention for pyloric obstruction of peptic ulcer
first consider NGtube to decompress stomach upper GI study or endoscopy is performed to confirm this
170
this is the erosion of ulcer through the gastric serosa into the peritoneal cavity without warning. it's an abdominal catastrophe. needs emergency surgery.
perforation
171
what labs for peptic ulcer
CBC, AST (liver enzymes), ABG amylase and lipase - stool, rapid urea test, biospy
172
diagnostics for peptic ulcer
diagnostic studies for H. pylori upper endoscopy (EGD) biopsy and histologic exam barium contrast study stool tested for H. pylori
173
medications for peptic ulcer healing
H2 receptor antagonists proton pump inhibitors
174
what medications are H2 receptors antagonists
ranitidine nizatidine famotidine cimetindine
175
what meds are PPIs - proton pump inhibitors
omeprazole lansoprazole rabeprazole esomeprazole
176
what meds do you use for h. pylori bacteria for first line therapy
PPI + clarithromycin + amoxicillin or metronidazole
177
what meds do you use for h. pylori bacteria for second line therapy
bismuth salt compound + tetracycline + metronidazole + PPI
178
what meds do you use for NSAID ulcers
PPIs
179
surgical therapy for peptic ulcers
vagotomy dumping syndrome pyloroplasty antrectomy
180
severing of the vagus nerve. this decreases gastric acid by diminishing cholinergic stimulation to the parietal cells, making them less responsive to gastrin.
vagotomy
181
nursing interventions for surgical therapy of peptic ulcer
-stop drinking fluids with meals, and not to drink for one hour afterwards. -education -help relieve stress
182
when the circular area of muscle surrounding the pylorus hypertrophies and obstructs gastric emptying.
hypertrophic pyloric stenosis
183
risk factors of hypertrophic pyloric stenosis
genetic disposition hyential hernia history of reflux newborns at greatest risk
184
what race is at greatest risk of hypertrophic pyloric stenosis
caucasian
185
what gender is at greater risk of getting hypertrophic pyloric stenosis
male
186
are preterm, term or postterm babies at greatest risk of getting hypertrophic pyloric stenosis
term babies
187
clinical manifestations of hypertrophic pyloric stenosis
projectile vomiting (becomes worse as obstruction worsens) pt is hungry, thin, pale, failure to thrive vomiting happens after eating typically, but can be several hours after dehydration signs on newborns Olive shaped mass in RUQ Peristaltic waves move left to right when baby supine Metabolic alkalosis
188
Assessments of hypertrophic pyloric stenosis
Abdominal assessment: see peristalsis after eating firm round mass right upper quad - olive shaped mass Distention Hypoactive bowel sounds History of feeding and timing of vomiting baby will be irritable after eating pH status is alkaline metabolic alkaosis - acid is coming out so less in system signs of dehydration Poor skin turgor No tears Dry mucus membranes Sunken eyes and fontanelle Weak cry Electrolytes blood work CMP BMP Airway Weight I & O
189
Priority nursing interventions for hyertrophic pyloric stenosis
Educate parents on care for baby maintain fluids watch for dehydration, electrolytes and I&O assess vomit - color consistency Raise bedhead to prevent aspiration Monitor for signs of aspiration Monitor O2 Monitor for signs of Metabolic alkolosis
190
Pre-op Nursing interventions for Hypertrophich Pyloric stenosis
Pass NG tube for decompression Monitor how much and quality of what is removed NPO IV Fluids Educate parents on procedure and expected outcomes
191
how to diagnosis hypertrophic pyloric stenosis
abdominal ultrasound
192
whatis the treatment for hypertropic pyloric stenosis
laparoscopic pyloromyotomy - ramstedts operation
193
pre op nursing interventions for hypertrophic pyloric stenosis
weight monitor I &O electrolytes - CMP, CBC airway check for olive shape mass peristalsis bowel sounds will be hypoactive weigh baby daily vital signs NG tube for decompression baby needs to be NPO, fluid via IV monitor lab values raise head of bed to prevent aspiration assess for signs/symptoms for respiratory distress teach parents what to expect and why doing what doing
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post op nursing interventions for hypertrophic pyloric stenosis
Post op Vital signs check gag reflex Respiratory monitoring assess bowel sounds as at risk of delayed peristalsis start clear liquids 4-6 hrs post op (pedialyte) Advance to breast milk/formula 24-48hrs post op Document tolerance to feeding Continue IV until feeding established I&O and daily weights teach parents what to do if newborn starts vomiting again, not eating, signs of infection
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how to diagnose hypertrophic pyloric stenosis
ultrasound - see mass Flat plate X-ray eliminates constipation Barium swallow study, however not a good option if unable to flush barium through system because of blockage
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what labs do you do for hypertrophic pyloric stenosis
check electrolytes - low Cl, K, Na high pH (metabolic alkolosis) Bicarb and Bilirubin high
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Priority collaberative management hypertrophic pyloric stenosis
Drugs: none Safety considerations: Resolve symptons and problem so baby can thrive Collaberative management: Proper education for parents so they are able to manage recovery at home
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this occurs when small, bulging pouches develop in your digestive tract.
Diverticulosis
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when one or more Diverticula pouches become inflamed or infected, the condition is called
Diverticulitis
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what are the small pouches that develop in the digestive tract called...
diverticula
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Potential complications of Diverticulosis
Perforation Obstruction Abscesses Hemorrhage Fistula Sepsis Peritonitis
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Modifiable risk factors for diverticulosis
not enough fiber in diet low volume poop, high pressure in colon constipation
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Non-Modifiable risk factors for Diverticulosis
Advanced age (80 or over) Congenital disposition (under 40)
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the decrease muscle strength in the colon wall, from harden fecal masses create
constipation
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can include bowel irregularity, with intervals of diarrhea, nausea, anorexia and abdominal distention
diverticulosis
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this is acute onset of mild-severe pain in lower left quadrant pt will have nausea, vomiting, fever, chills, Leukocytosis (elevated WBC) rebound tenderness indicative of perforation can lead to sepsis
diverticulitis
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rebound tenderness for diverticulitis can suggest what
perforation
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what assessments do you do for diverticulosis/itis
get history, perform physical exam look for signs of fever, vital signs (afebrile in older ) assess labs - look at WBC, occult blood in stool get diet history - low fiber? obtain weight and height find out how active pt is - exercise? do focused abdominal assessment Signs and symptoms of peritonitis (rebound tenderness) Possible palpable mass if abscess
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Priority Labs for diverticulosis
CBC Blood culture (has it progressed to diverticulitis) Urinalysis Stool for occult blood ESR (erythrocyte sedimentation rate) inflammatory marker
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Priority diagnostics for Diverticulosis
**CT of the abdomen with contrast** Abdominal Xray for free air and fecal matter Colonoscopy risky because of pre op sedation and possibility of perf Barium enema visualizing colon and large intestines
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Define cretinism
Thyroid deficiency present at birth
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What is Euthyroid?
Thyroid hormone production that is within normal limits
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What is exophthalmos
an abnormal protrusion of one or both eyeballs that produces a startled expression. Often seen in Grave's disease
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What is Chvostek's sign ?
Facial twitching in response to tapping over the massetal muscle
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what do you look for during focused abdominal assessment for diverticulosis/itis
abdominal tenderness distention palpable mass watch for signs/symptoms of peritonitis, rebound pain loss of bowel sounds
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what do you expect to see on abdominal xray for diverticulosis/itis
free air/fecal matter
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What is Trousseau's sign?
Is a specific type of muscle spasm in the hand and wrist that is a sign of latent tetany
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what do you expect to see on CT of abdomen with contrast diverticulosis/itis
thickening of bowel and presence of abscesses
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what labs do you look at for diverticulosis/itis
CBC, blood cultures, urinalysis, stool for occult blood and ESR
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How do we assess for Trousseau's sign?
Inflate a BP cuff to a number above the systolic rate of the patient and leave it for 3 minutes. A positive Trousseau's will induce spasm in wrist and hand
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what do you expect to see on colonoscopy for diverticulosis/itis
pockets
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What does Trousseau's sign assess for?
Hypocalcemia
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waht medications do you use for diverticulosis/itis
antibiotics to treat infection antispasmodics for pain and to relax area bulk forming laxative - increase volume in colon
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what is the surgery used for diverticulitis
bowel resection and anastemosis Possible temporary colostomy to rest bowel before reanastemosis *this is last resort
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What does Chvostek's sign assess for?
Hyperexcitability of the facial nerve due to Hypocalcemia
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when is surgery used for diverticulitis
hemorrhaging, abscess, obstruction, peritonitis
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what are the outpatient nursing interventions for diverticulosis/itis
Medications: Oral antibiotics antispasmotics, bulk forming laxatives, dietary changes: clear liquids 2-3L per day to stay hydrated, high fiber and low fat, fresh veg Lifestyle changes: No straining, wear loose fitting clothing Goal- increase stool volume and decrease poop inside body time
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What is Goiter?
An enlarged thyroid gland that presents as swelling of the neck
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what are the inpatient nursing interventions for diverticulosis/itis
-NPO, NGtube -if vomiting or distention - clear out (abdominal decompression) -give IV fluids/antibiotics -avoid NSAIDs give opioids - advance diet as tolerated - monitor for infection/complications
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what can happen if give NSAIDs to pt with diverticulosis/itis
can cause perforation
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What is Grave's Disease?
An autoimmune disease of the thyroid gland that results in the binding of antibodies to TSH which causes over production of T3 and T4. A common cause of Hyperthyroidism
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what do you teach a pt to get them ready for discharge if they have diverticulosis/itis
-how to avoid constipation -high fluid intake -reduce weight -what factors would increase abdominal pressure (straining to poop, bending, lifting, vomiting, tight clothing, etc) -eat lots of fresh vegetables -avoid exacerbation of disease - know what to look for
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What is cushing's syndrome?
A Pituitary tumor that causes overproduction of ACTH. Hypothyroidism occurs
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What are striae ?
Purple stretch marks
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What is truncal obesity?
Obesity of the trunk and thinness of the extremeties.
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What is tetany?
Abnormal muscle spasms and overly stimulated peripheral nerves related to hypocalcemia
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What is metabolic rate?
the rate at which a person metabolizes
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What is Myxedema?
swelling of the skin and underlying tissues giving a waxy consistency, typical of patients with underactive thyroid glands. (Hypothyroidism)
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What is Thyrotoxicosis?
Symptoms of hyperthyroxinimea
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Why is the use of heating pads and electric blankets discouraged in Hypothyroid patients?
Because of the risk of peripheral vasodilation, further heat loss and vascular collapse