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Nursing 111 & Pharmacology > NUS 111 Test #3 > Flashcards

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
Q

precipitating factors of myxedema comma

A

infection, cold exposure, stroke, meds (amiodarone, lithium)

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26
Q

nursing assessments - hypothyroidism

A

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

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27
Q

nursing interventions for hypothyroidism

A

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

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28
Q

medication for hypothyroidism

A

levothyroxine

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29
Q

what are the considerations for levothyroxine

A

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

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30
Q

should levels of TSH be low or high for hypothyroidism

A

high if thyroid issue
low if pituitary or hypothalamus

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31
Q

hypothyroidism

low or high T3

A

low

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32
Q

hypothyroidism

low or high T4

A

low

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33
Q

hypothyroidism

low or high LDL

A

high

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34
Q

hypothyroidism

low or high anemia

A

low

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35
Q

hypothyroidism

low or high hemoglobin

A

low

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36
Q

BMR - hypothyroidism low or high

A

low

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37
Q

safety measures for hypothyroidism

A
  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
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38
Q

collaborative goals for hypothyroidism

A

-adhere lifelong therapy
-weight reduction
-monitor thyroid hormones, keep within normal range
-report herbal and OTC meds to provider

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39
Q

modifiable risks of hyperthyroid

A

smoking
overmedication
too much iodine
diet meds

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40
Q

non modifiable risks of hyperthyroid

A

graves disease
female
cancer, thyroid, pituitary
20-40 year old
raidation
thyroiditis

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41
Q

non modifiable risks of hyperthyroid

A

graves disease
female
cancer- thyroid, pituitary
20-40 years
radiation
thyroiditis

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42
Q

when the thyroid gland makes too much T3 and T4 so pituitary gland will not produce TSH

A

hyperthyroidism

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43
Q

this is the clinical effects of hyper metabolism from too much circulation T3 & T4

A

thyrotoxicosis

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44
Q

this is associated with goiter

A

thyrotoxicosis

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45
Q

hyperthyroidism for old ppl - considerations

A
  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
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46
Q

symptoms of thyroid storm (Thyrotoxic crisis)

A

high fever
agitation
delirium
congestive heart failure
loss of consciousness

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47
Q

nursing assessments for hyperthyroidism

A

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

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48
Q

nursing intervention for hyperthyroidism

A

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

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49
Q

clinical manifestations of hyperthyroidism

A

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

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50
Q

these block synthesis of hormones

A

antithyroid meds

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51
Q

what are the antithyroid meds

A

PTU
methimazole

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52
Q

meds for hyperthyroid

A

antithyroid meds
adjunctive therapy
radioisotopes iodine

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53
Q

what is the priority during post op of a thyroidectomy

A

airway - assess airway every 2 hours for first 24 hours. high risk for airway issue

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54
Q

how much of thyroid is removed during thyroidectomy

A

5/6th

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55
Q

hyperthyroidism lab
TSH - high or low

A

low

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56
Q

hyperthyroidism lab
T3 - high or low

A

high

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57
Q

hyperthyroidism lab
T4 - high or low

A

high

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58
Q

hyperthyroidism lab
BMR - high or low

A

high

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59
Q

pt education for post treatment of thyroidectomy

A

see physician
2-3 mos before improvement of symptoms
continue meds as directed
monitor for a year closely for hypothyroid
education on diet

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60
Q

which system is activated causing hunger which activates the sympathetic nervous system

A

parasympathetic

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61
Q

this mimics alcohol intoxication early on

A

hypoglycemia

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62
Q

what are the risk factors of hypoglycemia

A

too little or delayed food intake
too much exercise
medication or food taken at right time

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63
Q

manifestations of hypoglycemia

A

hunger
shaking, nervous, anxious
diplopia
lethargic, weakness
slurring
faint, lightheadedness, syncope

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64
Q

nursing assessment hypoglycemia

A

blood glucose level
cold clammy skin
slurred speech
diaphoretic
tachycardia, palpitations
seizure, coma, loss of consciousness
unsteady walking, impaired coordination

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65
Q

nursing intervention of hypoglycemia

A

PB - carb + protein
eating snack at peak insulin time

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66
Q

medications for hypoglycemia

A

glucagon IM
50% dextrose IN
medical alert bracelet

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67
Q

collaborative safety goals - hypoglycemia

A

watch for signs and symptoms
watch for N & V
if pt is unconscious, treat blood sugar then once conscious give snack

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68
Q

this is a group of metabolic disease characterized by elevated blood glucose levels in the blood

A

diabetes

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69
Q

what do you have, if you have sweet urine

A

diabetes

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70
Q

what are the four types of diabetes

A

prediabetes
DM type 1
DM type 2
gestational diabetes

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71
Q

this is produced by the pancreas that controls blood glucose levels by regulating production, use and storage of glucose

A

insulin

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72
Q

in this type of diabetes - insufficient release, damage to pancreatic cells. not enough made. betas cells damaged or destroyed

A

type 1

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73
Q

deficient hormone signals - insulin resistance - which diabetes is this

A

type 2

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74
Q

what is the function of insulin

A

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

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75
Q

characteristics of prediabetes

A
  1. impaired glucose intolerance
  2. not high enough numbers to be diabetes
  3. increased glucose levels
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76
Q

manifestations of metabolic syndrome

A
  1. hypertension
  2. high blood sugar
  3. abnormal cholesterol levels
  4. abdominal obesity
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77
Q

non modifiable risk factors of prediabetes

A

ethnicity - native americans, latinos
gestational diabetes - can develop to type 2 later in life
age 45 +

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78
Q

modifiable risk factors of prediabetes

A

weight
hypertension
sedentary lifestyle
HDL cholesterol level

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79
Q

primarily autoimmune - immune destruction of beta cells

A

type 1a diabetes

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80
Q

failure without an immune mediated etiology

A

type 1b

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81
Q

children and young adults mostly get this type of diabetes

A

type 1

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82
Q

nonmodifiable risk factors for type 1 diabetes

A

onset can occur at any age but usually under 30
genetics
exposure to virus

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83
Q

clinical manifestations for type 1 diabetes

A

polyuria
polydipsia
polyphagia
weight loss
vision changes
numbness/tingling in hands/feet
dehydration

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84
Q

priority assessment for type 1 diabetes

A

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

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85
Q

manifestations of diabetic ketoacidosis

A

feeling tired and sleepy
confusion, passing out
stomach pain, feeling sick
high ketones, polyuria
blurred vision
sweet smelling breath
polydipsia
high blood sugar levels

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86
Q

priority interventions for type 1 diabetes

A

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

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87
Q

medications for type 1 diabetes - types of insulin

A

exogenous insulin admin
insulin pumps

insulin
-rapid - lispro
-short - regular insulin
-intermediate - NPH
-long acting - glargine/detemir

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88
Q

priority diagnostics of type 1 diabetes

A

fasting blood glucose levels
random glucose level
urine
hemoglobin A1C >6.5%
urinalysis
C peptide test

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89
Q

what age of population tends to get type 2 diabetes

A

older population

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90
Q

pathophysio of DM type 2

A

insulin resistance
impaired insulin secretion

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91
Q

b-cells become fatigued from compensatory overproduction of insulin

-don’t get ketosis
HHNS

A

impaired insulin secretion - type 2 diabetes

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92
Q

body tissues do not respond to action of insulin
DKA
gets ketosis

A

insulin resistance - type 2 diabetes

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93
Q

nonmodifiable risk factors - DM type 2

A

age 45
family history
ethnicity - minorities
gestational diabetes

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94
Q

modifiable risk factors -DM type 2

A

weight
smoking
sedentary lifestyle
HTN
high cholesterol
high blood sugar

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95
Q

clinical manifestations pf type 2 diabetes

A

fatigue
visual changes
slower onset
reoccuring infections
polyuria
polydipsia
polyphagia
prolonged wound healing

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96
Q

nursing assessment for type 2 diabetes

A

body mass index
measuring abdominal girth
skin assessment
CV assessment
numbness/tingling
cognition status

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97
Q

priority nursing interventions for DM type 2

A

nutrition
exercise
monitor blood sugar
signs/symptoms of hyper/hypoglycemia

98
Q

medications for type 2

A

biguanides - metformin
sulfonylureas - glipizide
nonsulfonylureas
a glucosidase inhibitors
dipeptidyl peptidase - 4

exogenous insulins
amylin analog - pramlintide

99
Q

diagnostics for DM type 2

A

HgA1C
fasting blood glucose >126
lipid profile
CPB
urine - high glucose, mincroalbuminuria (protein)

100
Q

collaborative and safety goals type 1 & 2 diabetes

A

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
Q

risk factors for old ppl and pre diabetes

A

liver or pancreatic disease, heart disease
diet, inactivity
altered insulin secretion and resistence

102
Q

age related changes for old ppl and pre diabetes

A

cognitive impairment
kidney functions decrease
decrease GI motility
dental and oral care
chronic disease
socioeconomic factors
potential drug interactions
activity/exercise
sensory changes

103
Q

clinical manifestations of pre diabetes

A

slow wound healing
fatigue
3 Ps - polyuria, polydipsia, polyphagia

104
Q

assessment of pre diabetes

A

screening of blood glucose levels

check ATI or honan

105
Q

interventions of pre diabetes

A

education on diet
education on glucose screening

106
Q

pre diabetes medication

107
Q

this produces antidiabetic effects by decreasing hepatic production of glucose and facilitating the action of insulin on peripheral receptor sites

108
Q

diagnostics pre diabetes

A

impaired fasting 100-125
impaired glucose tolerance 140-199
hemoglobin A1C 5.56-6.5
lipids - low hdl, high ldl

See ATI

109
Q

collaborative goals pre diabetes

A

monitor risks factors
maintain healthy weight
meds - statin for cholesterol
healthy diet
at risk for CV
education on prediabetes for risk factors

110
Q

3 main types of macrovascular complications

A

CAD, CVA, PVD

111
Q

what are the macrovascular complications of diabetes

A

-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
Q

microvasulcar complications of diabetes

A

thickening of membrane of capillaries due to formation of abnormal glucose molecules in basement membrane of small blood vessels

113
Q

three types of microvascular complications of diabetes

A

diabetic retinopathy
nephropathy
neuropathy

114
Q

what is this
microvascular damage to retina is the leading cause of blindness
glacuoma and cataracts occur more frequently

A

diabetic retinopathy

115
Q

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

A

nephropathy

116
Q

nerve damage that occurs bc of the metabolic derangements associated wtih diabetes

A

neuropathy

117
Q

this happens to 60-70% of pts with diabetes

A

neuropathy

118
Q

increased incidence of MI due to . Typical ischemic symptoms may not be present in diabetics

119
Q

cerebral blood vessels affected by accelerated arthrosclerosis

120
Q

usually affects vascular of lower extremities, smoking couple with diabetes greatly increases risk

121
Q

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

A

hyperglycemic hyperosmolar nonketotic syndrome (HHNS)

122
Q

type 2 blood sugar is high, normal blood sugar is 600-1200

A

hyperglycemic hyperosmolar nonketotic syndrome (HHNS)

123
Q

infection, medication or acute/chronic condition can cause this. the medication is glucocorticoid steroids

A

hyperglycemic hyperosmolar nonketotic syndrome (HHNS)

124
Q

risk factors of hyperglycemic hyperosmolar nonketotic syndrome (HHNS)

A

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
Q

clinical manifestations of HHNS

A

dehydration
hypotension
skin turgor, dry mucus membranes
confusion
tachycardia
stroke symptoms
hemiparesis
aphasia
polyuria
polydipsia

126
Q

nursing assessment of HHNS

A

hypotension
CV and skin assessment - dry mucous membranes, skin turgor
neuro assessment - confusion, alteration of sensorium, seizures, hemiparesis

127
Q

nursing interventions HHNS

A

-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
Q

medications for HHNS

A

insulin
half normal saline or normal saline, potassium as needed

129
Q

diagnostics HHNS

A

-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
Q

the higher the serum ____, the more profound the dehydration, and the greater risk for ____ _____ and ____ status changes

A

glucose
renal impairment
mental

131
Q

this is not a disease but a syndrome

A

gastroesophageal reflux disease

132
Q

Chronic symptom of mucosal damage caused by reflux of stomach acid into the lower esophagus

133
Q

risk factors for GERD

A

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
Q

manifestations of GERD

A

dyspepsia - indigestion
pyrosis- heartburn
dysphagia- difficulty swallowing
odynophagia- painful swallowing
regurgitation- acid in mouth
esophagitis
Excessive salivation

135
Q

how often do GERD symptoms need to happen to be diagnosed

136
Q

what is odynophagia

A

pain on swallowing

137
Q

what is pyrosis

138
Q

what is dyspepsia

A

pain/uncomfortable feeling in upper middle part of your stomach area

139
Q

assess for GI symptoms for GERD

A

-wakes up at night, pain when it occurs
-pain in upset stomach, upper gastric
-regurgitation - bitter, hot in mouth

140
Q

what other symptoms of GERD that aren’t GI

A

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
Q

what serious condition does GERD mimic

A

heart attack

142
Q

how do you tell if pt is having heart attack or GERD

A

give antacid and if pt gets better then its gerd

143
Q

diagnostics of GERD

A

upper GI endoscopy with biopsy and cytolic analysis
esophagogram - barium swallow
motility (manometry) tests
pH monitoring
radionuclide test

144
Q

what does the radionuclide tests detect

A

reflux and rate of esophageal clearance

145
Q

medications for GERD

A

antacids - magnesium calcium carbonide
H2 receptor antagonists - Famotidine etc
proton prump inhibitors - omeprazole etc
prokinetic agents - metoclopramide (reglan)

146
Q

what do prokinetic agents do

A

increases motility of esophagus. blocks effects of dopamine - has extrapyramidal effects especially pts with parkinsons
give slowly eg iv over 10 mins

147
Q

do you take antacids with other meds

A

no. take seperate.

take at bedtime or 1-3 hours after eating or taking other meds

148
Q

how do you take H2 receptors?

A

With food
Caution with kidney disease

149
Q

PPI medication considerations

A

risk for CDiff, Fractures, Hypoglycemia, Electrolyte imbalance

150
Q

Surgical nursing intervetions for GERD

A

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
Q

Priority nursing interventions for GERD

A

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
Q

what is the surgerical intervention for GERD

A

fundoplication

153
Q

what is a fundoplication

A

reconstructing sphincter to make it work better to reduce reflux

–only ppl not getting relief from meds will get this

154
Q

lifestyle modifications for GERD

A

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
Q

a condition characterized by erosion of gastroduodenal mucosa resulting from digestive action of hcl and pepsin

A

peptic ulcer disease

156
Q

this is due to increased concentration or activity of acid pepsin

A

peptic ulcer disease

157
Q

decreased resistance of mucosa —- less mucus production

A

peptic ulcer disease

158
Q

Occurs in small intestine
result of increase in acid
Most common
Often have multiple

A

duodenal ulcer

159
Q

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

A

choronic gastric ulcers

160
Q

this is caused by H. pylori bacteria

A

chronic gastric ulcers

161
Q

Located in esophagus
Result of acid reflux/GERD

A

esophageal ulcer

162
Q

risk factors for peptic ulcers

A

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
Q

manifestations of peptic ulcer

A

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
Q

assessments of peptic ulcer

A

-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
Q

nursing interventions of peptic ulcer

A
  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
Q

what are the 3 major complications of peptic ulcer

A
  1. hemorrhage
  2. perforation
  3. pyloric obstruction
167
Q

nursing intervention for hemorrhage of peptic ulcer

A

-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
Q

nursing intervention for perforation of peptic ulcer

A

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
Q

nursing intervention for pyloric obstruction of peptic ulcer

A

first consider NGtube to decompress stomach
upper GI study or endoscopy is performed to confirm this

170
Q

this is the erosion of ulcer through the gastric serosa into the peritoneal cavity without warning. it’s an abdominal catastrophe.

needs emergency surgery.

A

perforation

171
Q

what labs for peptic ulcer

A

CBC, AST (liver enzymes), ABG
amylase and lipase - stool, rapid urea test, biospy

172
Q

diagnostics for peptic ulcer

A

diagnostic studies for H. pylori
upper endoscopy (EGD)
biopsy and histologic exam
barium contrast study
stool tested for H. pylori

173
Q

medications for peptic ulcer healing

A

H2 receptor antagonists
proton pump inhibitors

174
Q

what medications are H2 receptors antagonists

A

ranitidine
nizatidine
famotidine
cimetindine

175
Q

what meds are PPIs - proton pump inhibitors

A

omeprazole
lansoprazole
rabeprazole
esomeprazole

176
Q

what meds do you use for h. pylori bacteria for first line therapy

A

PPI + clarithromycin + amoxicillin or metronidazole

177
Q

what meds do you use for h. pylori bacteria for second line therapy

A

bismuth salt compound + tetracycline + metronidazole + PPI

178
Q

what meds do you use for NSAID ulcers

179
Q

surgical therapy for peptic ulcers

A

vagotomy
dumping syndrome
pyloroplasty
antrectomy

180
Q

severing of the vagus nerve. this decreases gastric acid by diminishing cholinergic stimulation to the parietal cells, making them less responsive to gastrin.

181
Q

nursing interventions for surgical therapy of peptic ulcer

A

-stop drinking fluids with meals, and not to drink for one hour afterwards.
-education
-help relieve stress

182
Q

when the circular area of muscle surrounding the pylorus hypertrophies and obstructs gastric emptying.

A

hypertrophic pyloric stenosis

183
Q

risk factors of hypertrophic pyloric stenosis

A

genetic disposition
hyential hernia
history of reflux
newborns at greatest risk

184
Q

what race is at greatest risk of hypertrophic pyloric stenosis

185
Q

what gender is at greater risk of getting hypertrophic pyloric stenosis

186
Q

are preterm, term or postterm babies at greatest risk of getting hypertrophic pyloric stenosis

A

term babies

187
Q

clinical manifestations of hypertrophic pyloric stenosis

A

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
Q

Assessments of hypertrophic pyloric stenosis

A

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
Q

Priority nursing interventions for hyertrophic pyloric stenosis

A

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
Q

Pre-op Nursing interventions for Hypertrophich Pyloric stenosis

A

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
Q

how to diagnosis hypertrophic pyloric stenosis

A

abdominal ultrasound

192
Q

whatis the treatment for hypertropic pyloric stenosis

A

laparoscopic pyloromyotomy - ramstedts operation

193
Q

pre op nursing interventions for hypertrophic pyloric stenosis

A

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

194
Q

post op nursing interventions for hypertrophic pyloric stenosis

A

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

195
Q

how to diagnose hypertrophic pyloric stenosis

A

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

196
Q

what labs do you do for hypertrophic pyloric stenosis

A

check electrolytes - low Cl, K, Na
high pH (metabolic alkolosis)
Bicarb and Bilirubin high

197
Q

Priority collaberative management hypertrophic pyloric stenosis

A

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

198
Q

this occurs when small, bulging pouches develop in your digestive tract.

A

Diverticulosis

199
Q

when one or more Diverticula pouches become inflamed or infected, the condition is called

A

Diverticulitis

200
Q

what are the small pouches that develop in the digestive tract called…

A

diverticula

201
Q

Potential complications of Diverticulosis

A

Perforation
Obstruction
Abscesses
Hemorrhage
Fistula
Sepsis
Peritonitis

202
Q

Modifiable risk factors for diverticulosis

A

not enough fiber in diet
low volume poop, high pressure in colon
constipation

203
Q

Non-Modifiable risk factors for Diverticulosis

A

Advanced age (80 or over)
Congenital disposition (under 40)

204
Q

the decrease muscle strength in the colon wall, from harden fecal masses create

A

constipation

205
Q

can include bowel irregularity, with intervals of diarrhea, nausea, anorexia and abdominal distention

A

diverticulosis

206
Q

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

A

diverticulitis

207
Q

rebound tenderness for diverticulitis can suggest what

A

perforation

208
Q

what assessments do you do for diverticulosis/itis

A

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

209
Q

Priority Labs for diverticulosis

A

CBC
Blood culture (has it progressed to diverticulitis)
Urinalysis
Stool for occult blood
ESR (erythrocyte sedimentation rate) inflammatory marker

210
Q

Priority diagnostics for Diverticulosis

A

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

211
Q

Define cretinism

A

Thyroid deficiency present at birth

212
Q

What is Euthyroid?

A

Thyroid hormone production that is within normal limits

213
Q

What is exophthalmos

A

an abnormal protrusion of one or both eyeballs that produces a startled expression. Often seen in Grave’s disease

214
Q

What is Chvostek’s sign ?

A

Facial twitching in response to tapping over the massetal muscle

215
Q

what do you look for during focused abdominal assessment for diverticulosis/itis

A

abdominal tenderness
distention
palpable mass
watch for signs/symptoms of peritonitis,
rebound pain
loss of bowel sounds

216
Q

what do you expect to see on abdominal xray for diverticulosis/itis

A

free air/fecal matter

217
Q

What is Trousseau’s sign?

A

Is a specific type of muscle spasm in the hand and wrist that is a sign of latent tetany

218
Q

what do you expect to see on CT of abdomen with contrast diverticulosis/itis

A

thickening of bowel and presence of abscesses

219
Q

what labs do you look at for diverticulosis/itis

A

CBC, blood cultures, urinalysis, stool for occult blood and ESR

220
Q

How do we assess for Trousseau’s sign?

A

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

221
Q

what do you expect to see on colonoscopy for diverticulosis/itis

222
Q

What does Trousseau’s sign assess for?

A

Hypocalcemia

223
Q

waht medications do you use for diverticulosis/itis

A

antibiotics to treat infection
antispasmodics for pain and to relax area
bulk forming laxative - increase volume in colon

224
Q

what is the surgery used for diverticulitis

A

bowel resection and anastemosis
Possible temporary colostomy to rest bowel before reanastemosis

*this is last resort

225
Q

What does Chvostek’s sign assess for?

A

Hyperexcitability of the facial nerve due to Hypocalcemia

226
Q

when is surgery used for diverticulitis

A

hemorrhaging, abscess, obstruction, peritonitis

227
Q

what are the outpatient nursing interventions for diverticulosis/itis

A

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

228
Q

What is Goiter?

A

An enlarged thyroid gland that presents as swelling of the neck

229
Q

what are the inpatient nursing interventions for diverticulosis/itis

A

-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

230
Q

what can happen if give NSAIDs to pt with diverticulosis/itis

A

can cause perforation

231
Q

What is Grave’s Disease?

A

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

232
Q

what do you teach a pt to get them ready for discharge if they have diverticulosis/itis

A

-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

233
Q

What is cushing’s syndrome?

A

A Pituitary tumor that causes overproduction of ACTH. Hypothyroidism occurs

234
Q

What are striae ?

A

Purple stretch marks

235
Q

What is truncal obesity?

A

Obesity of the trunk and thinness of the extremeties.

236
Q

What is tetany?

A

Abnormal muscle spasms and overly stimulated peripheral nerves related to hypocalcemia

237
Q

What is metabolic rate?

A

the rate at which a person metabolizes

238
Q

What is Myxedema?

A

swelling of the skin and underlying tissues giving a waxy consistency, typical of patients with underactive thyroid glands. (Hypothyroidism)

239
Q

What is Thyrotoxicosis?

A

Symptoms of hyperthyroxinimea

240
Q

Why is the use of heating pads and electric blankets discouraged in Hypothyroid patients?

A

Because of the risk of peripheral vasodilation, further heat loss and vascular collapse

Nursing 111 & Pharmacology (12 decks)

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