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Nutrition > Nutrition > Flashcards

Nutrition Flashcards

1
Q

Macronutrients

A

Fats, Carbs, Protein

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2
Q

Carbs

A

DRI 45-65%, 4cal/g, 130g/day

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3
Q

Tell me about Simple and Complex Sugars

A

Simple are divided in to Monosaccrides (Fructose and Glucose) and Disaccarides (Lactose, Sucrose, Maltose)

Complex sugars are called polysaccrides=starches

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4
Q

Fat

A

20-35%, 9cal/g

Bad fats- saturated (saturation greater than 10%) and trans fats
Good Fat-Unsaturated fats and polyfats

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5
Q

Protein DRI%, grams/cal, grams/kg?

What are the building blocks?

A

10-35%, 4cal/g, 0.8g-1g/kg

Amino acids are the building blocks

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6
Q

Tell me about intestine part and what they digest

A

First portion of SI Duodenum=Minerals

Second portion of SI Jejunum=Water soluble vitamins and proteins

Third portion SI Illieum= Fats and fat soluble vitamins

Colon=Draws water out of tract/colon

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7
Q

Water Soluble Vitamins

A

B and C

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8
Q

Fat Soluble Vitamins

A

E, A, K, D

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9
Q

How is fiber digested?

Give examples of high fiber foods

What is the recommend g/day for general pop.?

A

Fiber is not digested in GI; it pulls water into GI tract

Raw fruits, vegetables, bran, oats, dried fruits, dried nuts (Evolve quiz listed raspberry)

General population should consume 25-30g/day

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10
Q

What does fatty acid deficiency cause?

A

Dermatitis

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11
Q

What does iron deficiency cause?

Names examples of foods high in iron.

A

Stomatitis, Cheilosis

Foods: soybeans, beef liver, pork liver, chicken liver, farina

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12
Q

What is Stomatitis and Cheilosis?

Associated with what mineral deficiency?

A

Stomatitis is inflammation of lips and mouth that result in ulcers in mouth

Cheilosis is cracks at corner of mouth from painful inflammation

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13
Q

Name examples of complete proteins.

A

Animal products: Milk and milk products, eggs, fish, and meats

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14
Q

Symptoms of vitamin D deficiency

A

Bone pain, rickets, osteomalacia, diarrhea, muscular weakness, excess sweating

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15
Q

What is tetany?

And what kind of deficiency manifest this ?

A

Intermittent muscle spasms and it’s a sign of calcium deficiency

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16
Q

What is folic acid used for?

And what are the signs and symptoms of its deficiency?

A

It’s used for red blood cell formation and growth.

Signs and symptoms include: Anemia, fatigue, sore tongue, diarrhea, forgetfulness, brittle nails

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17
Q

Cobalamin is also known as what?

Name example of foods high in colbalamin.

What are s&s of cobalamin deficiency?
Who is at risk for this deficiency?

A

Cobalamin is B12. Primarily absorbed in the illium of small intestines with the help of the hormone intrinsic factor (secreted from the stomach).

Foods with B12= animal protein, supplements, or foods foritfied with B12

S&S=Megaloblastic anemia (pernicious anemia), glossitis, parethesia/peripheral neuropathy

Strict Vegans that don’t take supplements.

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18
Q

Normal person’s LDL should be?

A

No more than 100

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19
Q

Normal person’s HDL should be?

A

Greater than 40-50

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20
Q

Normal’s person Triglycerides should be?

A

No more than 150

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21
Q

Total cholesterol should?

A

No more than 200

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22
Q

Name long acting insulin, the appearance, and nursing consideration

A

Glargine (Lantus) and Detemir (Levemir) is a long acting insulin that is clear and colorless.
It’s good for not causing hypoglycemia because it mimics basal rate of insulin in normal bodies.
It is given once per day.

Onset is within one hour with no peak time as insulin is given steady throughout day.

Nursing consideration: NEVER mix with another insulin and NEVER give via IV and IM. Only subQ injection

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23
Q

Name Rapid acting insulin and onset times.

A

Glulisine (Apidra), Aspart (Novolog) , Lispro (humalog)

Glulisine and Aspart=Onset time is 10-15 minutes, food needs to be eaten 5-10 mins after injection, and short duration of 3-5hrs.

Lispro= Onset 15-30 minutes with 3-6hours duration.

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24
Q

Name intermediate acting insulin.

What is the onset, peak, and duration?

What should you know about why this type of insulin is given?

What is the appearance?

A

Isophane NPH (Humulin N)

Onset: 1-2hours, Peak: 4-12hr, Duration=:6-24hr

This insulin with typically last pt half day or through the night.

It is often given with rapid/short acting insulin

Glycemic control between meals and bedtime so it is not given for hyperglycemia after meals due to it’s longer duration and onset time.

Cloudy in appearance

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25
Q

Name short acting insulin. What is the appearance?

What is the onset, peak, duration?

How do you administer with intermediate acting insulin?

A

Regular Insulin (Humulin R), clear in appearance

Onset=30-60 min., Peak=2-4hr, duration=6-10hr
Must be given with food.

Administered subQ and IV. Only one that can be admin IV

When given with intermediate acting insulin, remember clear before cloudy.

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26
Q

What is calcium serum levels for hypocalcemia?

What are Sx of hypocalcemia?

A

Less than 8.6mg/dL

Sx include low bone density,
frequent and painful muscle spasm (tetany),
increased DTR,
positive chvostek’s sign,
positive trousseau’s sign, arrhythmias =specifically prolonged QT and ST,
and seizures due to excitable nervous and skeletal system over stimulation

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27
Q

Why does calcium effect muscles?

A

Calcium regulates depolarization and generates action potential in muscles so low calcium causes muscle to contract more easily

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28
Q

What is Chvostek’s sign?

A

When you tap pt’s check, there will facial twitching of one side of mouth, cheek, and nose. Twitching facial muscles is a sign of hypocalcemia.

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29
Q

What is trousseau’s SIgn?

A

Hands and fingers go into spasm when BP cuff is inflated of systolic for 1-4 minutes. This is a sign of low calcium.

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30
Q

What types of pt’s require enteral feedings ?

A

Pt’s with face injuries/surgery, throat issue, dysphagia, obstruction in GI, MS, Parkinson’s Disease. These pt’s have working stomach and small intestines, but something is causing a risk getting there.

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31
Q

How can you tell if pt has dysphagia?

Which side is dysphagia on ?

A

Watch pt swallow to see if they can form a bolus in mouth and swallow.

Sx: Excessive drooling, chest pain (acid reflux), gargling voice (fluid accumulates in oral cavity will cause this), increase clearing of throat.

Dysphagia can be on either side or both sides.

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32
Q

When do you get out the liquid nutrients for Enteral feeding pt?

A

Keep in refrigerated until 30 mins. before you give so it can get to room temp,, but not long enough for bacterial growth increases.

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33
Q

How much fluid does a EN pt need per day ?

A

1500mL/day. Give in part throughout the day,,.like Give 4 hours.

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34
Q

What pt’s need to be watched more carefully and cautiously when receiving fat emulsion in parenteral feeding?

A

Pt’s with pancreatitis, liver failure, respiratory disease

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35
Q

Fat emulsion parenteral feeding is contradicted in what pt?

A

Pt with hyperlipidemia

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36
Q

Pts that require central parenteral feeding are usually on what kind of diet?

Why is this type of diet done with central parenteral feeding vs parpherial parenteral feeding?

A

These pts need high protein and calorie intake.

It’s done with central PN because high protein and calorie TPN is a hypertonic solution measuring around 1500mOsm/L with glucose content at 20-50% and can’t be given through perpheiral PN.

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37
Q

What does GERD stand for?

A

Gastroesphageal Reflux Disease

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38
Q

What is GERD?

A

It’s the backwards movement of gastric content into esophagus

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39
Q

What causes GERD to happen?

A

Either the esophageal sphincter or pylorus sphincter relaxes too much/incompetence allowing back flow, pyloric stenosis, increased gastric volume, or slowed mobility of foods

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40
Q

What are some complications if GERD is chronic?

A

Barrett’s Esophagus/Epithelium=risk of cancer due to chronic inflammation from gastric juices, Esophagitis, dental erosion, Laryngeal and bronchial spasms
(asthma, chronic bronchitis, pneumonia)

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41
Q

What are Sx of GERD?

A

Pyrosis (can be felt when recumbent, bending over, or straining), Regurgitation, Hypersalivation, dyspepsia, difficulty swallowing (dysphagia), frequent nighttime coughing due to increase irritation when lying down, so coughing or wheezing or dyspena, globus

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42
Q

What is pyrosis?

A

Heartburn which a painful burning below or behind the breastbone

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43
Q

What is dyspepsia?

A

Uncomfortable and burning in upper abd/chest typically after meals

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44
Q

What are some Dx test that can be down with GERD ?

A

Diagnosis can be made with pH test, esphagoscopy used to rule out malignancy

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45
Q

What are some pt education a nurse can tell a pt to prevent GERD?

A

don’t eat 2 hours before bedtime, eat smaller more frequent meals as oppose to larger less frequent meals, avoid acid and spicy foods, avoid foods that reduce lower esophageal sphincter tone, eat a low fat high fiber diet, avoid medications that decrease gastric emptying like (anticholinergics)

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46
Q

What types of food reduce lower esophageal tone?

What types of pts should avoid these types of foods?

A

Peppermint, chocolate, carbonated drinks, fried, and fatty foods.
Smoking decreases tone of sphincter too.

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47
Q

What are some nursing actions when caring for GERD pt?

A

Keep HOB elevated, monitor I/O, monitor for N/V

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48
Q

What medications are used to treat GERD and why those types of drugs?

A

Antacids=prevents burning pain/chest pain

H2 receptor antagonist=decreases gastric acid secretion by blocking acid secretion

PPI (proton pump inhibitors)= decreases gastric secretion

cholinergic = Bethanechol (activates parasympathetic system)

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49
Q

What are examples H2 receptor antagonist?

What does it do?

What disease do you use this drug to treat?

What are the side effects?

A

-dines

Famotadine, Rantidine, Cimetidine, Nizatidine

It blocks H2 receptors in stomach to decrease acid secretion in stomach thus lowering pH.

Used to treat PUD, GERD, pancreatitis, Zollingers-Ellison syndrome

Side effects include:
Risk for pneumonia because more basic enivornment allow bacteria to colonize and possible migration to lungs

Decrease in RBD, WBD, and platelets

Gynecomastia

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50
Q

What are examples of PPI?

What does it do?

What do you use this drug to treat?

What are the side effects?

Nursing Considerations?

A

Proton-pump inhibitors, your -prazole
Omeprazole, Prantoprazole, Lansoprazole, Esmoprazole

This drug decreases acid secretion by irreversibly blocks the Hydrogen-Potassium ATP pump.

This drug is used treat GERD, PUD, Zollingers-Ellison’s Syndrome

The side effects include nausea, diarrhea/contispation, headache, decrease in Ca+ serum (bone fractions), depression, Rhabdomylosis (breaking down of muscles=elevated creatine)

Nursing consideration: Don’t’ take with food, give an hour before or after meal. Also, don’t give with other meds..space the time out for other meds.

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51
Q

What does PUD stand for?

A

Peptic Ulcer Disease

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52
Q

What does PUD do to the body?

A

Causes ulcers in stomach or duodenum

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53
Q

What can cause PUD?

A

H.pyroli or too much acid secretion

Bile Reflux and incompetent pyloric sphincter are risk factors

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54
Q

What is Zollinger-Ellison Syndrome?

A

Gastrin secreting tumor of the pancreas that results in gastrointestinal ulcers

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55
Q

What modifiable factors can contribute to PUD?

A

stressful lifestyle and certain diets like high caffeine and alcohol intake

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56
Q

What are Sx of gastric PUD?

A

Pyrosis, pain 30min. to 1hr. after meal, GI distress hematemesis

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57
Q

What are Sx of duodenal PUD?

A

Pyrosis, pain midepigastric region after 2-5 hours after eating, melena, weight loss, pain is relieved by eating

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58
Q

What foods can cause irritation to ulcers?

A

Coffee, alcohol, spicy food, tea, chocolate, high sodium, caffeinated drinks

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59
Q

What things should you educated the pt on to help alleviate some of the symptoms of PUD?

A

Smoking cessation if pt is smoker.
Eat small frequent meals
Avoid aspirin and NSAIDs (ibuprofen) because they cause GI bleeding

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60
Q

What are some nursing actions when caring for PUD pt?

A

Monitor Hemtocrit and hemoglobin and for bleeding, Elevate HOB

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61
Q

What are some surgical options for PUD pt?

A

Gastric resection, Billroth I (dueodenum) and Billroth II (jejunnum)

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62
Q

What do you need to watch for after gastric surgery?

A

Dumping Syndrome

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63
Q

What is Dumping Syndrome?

A

Rapid emptying of stomach in to small intestines, not allowing for digestion or absorption of food. Sometimes seen after removal of pylorus and stomach.

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64
Q

What are the Sx dumping Syndrome?

A

nausea, vomiting, feeling fullness, tachycardia, diarrhea

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65
Q

What are nursing actions when caring for pt after gastric surgery?

A

Keep pt in high folwer’s position, assess for bowel sounds (borymi), Maintain pt NPO for three days for healing, laying down after eating

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66
Q

What are some pt education for pt after gastric surgery?

A

Avoid taking fluids with meals to prevent dumping syndrome, avoid salt, eat small meal when you are able to eat again

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67
Q

What are some medications to treat PUD?

A

PPI with antibiotics
H2 receptor inhibitors
Antacids
Sucralfate (Carafate)

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68
Q

What disease is a mutation of CFTR gene?

A

Cystic Fibrosis

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69
Q

In CF which organs are primarily effected?

A

Lungs, pancreas, and liver

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70
Q

What is the main test for diagnosis CF?

What is a positive diagnosis with this test?

A

Sweat Chloride test

Results of above 60mEq/L on two separate days

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71
Q

What channels are blocked in CF and what are some side effects of this channel being blocked?

A

Sodium and Chloride Channels are blocked that are on skin, lungs, pancreas, gallbadder.

This causes the skin to be saltier because of increased salt in sweat. Since NaCl can’t get into lungs to bring water, the mucus in lungs are thick and sticky causing respiratory problems. In the pancreas, the duct to the intestines can be blocked and enzymes that digest fat, proteins, and carbs can’t do there jobs. This blockage in pancreas can cause damage to pancreas (pancreatitis). The gallbadder duct can get blocked too, and bile can’t get out to emulsify fats.

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72
Q

What are some Sx of CF?

A

Chronic lung infections, Pneumonia, Bronchoilitis, Chronic hypoxemia, Nasal Polyp/Obstruction, Failure to Thrive due to malnutrition/malabsorption , Rectal Prolaspe, Salty Skin, no vas def in males, steatorrhea, DIOS, meconium lleus in neonates

More severe Sx: Hemoptysis, Bronchiectasis, Cor Pulmonale, Chronic lung infection and CF Exacerbation that can lead to respiratory failure

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73
Q

What are sx of respiratory failure?

A

Cyanosis, rapid breathing, and confusion

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74
Q

Why do CF pt have lung infections more than a normal person?

Which bacteria are common for the lung infections?

A

Thick mucus in lung make it hard for cilla to move mucus out of lung so more mucus in lung=bacteria growth

Staphylococcus and Pseudomonas like this type of environment

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75
Q

What is bronchiectasis?

Why do CF pt’s get this?

A

Permanent widening and damage to bronchi

Chronic bronchiolitis (inflammation and bacterial infection) leads to this condition

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76
Q

What is Cor pulmonale?

A

Alteration in the structure and function of the right ventricle of the heart causes by primary disorder of the respiratory system

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77
Q

What is Hemoptysis?

What can cause it in CF pt ?

A

Coughing up blood

Bacterial infection erodes through blood vessels

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78
Q

What are the main vitamins CF pts will have deficiencies?

What are some manifestation of these deficiencies?

A

Fat soluble vitamins= A,k, E,D

Eye sight will effected (A), decreased prothrombotic (K), decrease bone density->ostepenia->osteoprosis (D), hemolytic anemia (E)

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79
Q

What are some ways to manage CF?

A

Daily chest physiotherapy (CPT), noting changes in respiration, high protein high calorie diet, fat vitamin replacement, monitoring blood glucose level, get immunizations, Pancreatic enzymes with every meal,

Medications=Bronchodilator, Albuterol with hypertonic saline through nebulizer, Antibiotic (Thobramycin and azithromycin), Dorsnase Alpha

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80
Q

What is Dorsnase Alpha?

How does this medication work?

A

A medication given to CF pt to thin mucus to make it easier to get out.

This medication cuts nucleic acid in mucus to thin it out

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81
Q

What is gastroenteritis?

A

Inflammation of mucosa of the small intestines and stomach

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82
Q

What is Celiac Disease?

A

An autoimmune disease where the intestines become inflamed when pt eats gluten causing damage to the villas that absorb nutrients.

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83
Q

What are some Sx of Celiac Disease?

A

Steatorrhea, weight loss, fat and protein malabsorption, dental enamel hypoplasia and possible decrease bone density, anemia, dermatitis Herpetiformis (rash on head), abdominal distention

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84
Q

What are some Dx test for Celiac Disease?

A

HLA-DQ2& HLA-DQ8 antigen, Duodenal biopsy

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85
Q

What are some nursing actions when caring for pt with Celiac Disease?

A

Gluten free diet= no brans, rye, wheat, products with gluten, oats (unless pure oat that’s not contaminated)

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86
Q

What kind of diet should pt’s with Celiac Disease eat?

A

High protein and high fat

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87
Q

What is Celiac Crisis?

What are the Sx? What medication used to treat?

A

Rare but Life-threatening complication with celiac

Watery V/D (f&e imbalance)
Decrease in Ca and Albumin
Acidosis
Infection

Treat with Corticosteriods

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88
Q

What is an objective way to tell if baby or child is FTT?

A

If child is below 5 percentile on growth chart in weight and height of children of that same age. Child is behind in development to stages.

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89
Q

What are the normal weight gains for birth to 1 years old?

A

Double weight at 5 months and tripled weight at 1 year

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90
Q

At what age do babies transition to solid foods?

A

6-12 months

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91
Q

What things does FTT assessment needs to include?

A

Timing of development stages, social economics, observe feeding and family dynamics, OB Hx and how is family adjusting, family assessment (including all caregivers),

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92
Q

At what age does a baby develop fear of strangers?

A

6 months

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93
Q

Child with FTT will require how much caloric intake and for how long?

A

150% of daily intake, around 24cal/oz until child is caught up to normal for age or above 50% on growth chart

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94
Q

What should the child restrict drinking when FTT?

A

Juices

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95
Q

What is Pediasure?

A

It’s high caloric milk for FTT toddlers

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96
Q

How much weight should a FTT child gain if following correct diet to increase weight?

A

2oz/day

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97
Q

What kind of environment will prompt eating for FTT child ?

A

Quiet calm environment

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98
Q

What is Type 1 diabetes and what causes it?

A

Little to no insulin production due to autoimmune destruction of beta cells in pancreas

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99
Q

What is type 2 diabetes and what causes it?

A

Pancreatic beta cells don’t produce enough insulin or the body becomes immune it. Typically is caused by obesity and hyperlipidemia.

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100
Q

What is the normal, prediabetic, and Diabetic ranges for Hemglobin A1C?

A

Normal= 4-6%
Prediabetic=5.6-6.4%
Diabetic=over 6.5%

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101
Q

What is the only insulin that can be given IV?

A

Short acting insulin ( Regular Insulin)

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102
Q

What the sx of diabetes?

A

Polyuria, polyphagia, polydipsia

Elevated blood glucose
Blurred vision
non-healing wounds
neuropathy 
Decreased circulation 
End organ damage due to damage vessels
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103
Q

What are some end organ damage for diabetic pts?

A

Heart disease, renal failure, glaucoma

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104
Q

What instructions should you give to a patient with diabetes and numbness in the feet when teaching about diabetic foot care?

A

Keep feet dry
Wear shoes and socks that are not tight
Walk regularly and exercise
Protect the feet from extreme heat and cold

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105
Q

What is the 15 rule with diabetics?

A

Admin 15g of CHO then recheck in 15 min

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106
Q

Why is feet care in diabetics so important?

A

Because of neuropathy and poor circulation, wounds on foot go unnoticed and don’t heal.

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107
Q

How should a nurse care of diabetic foot wounds and infections?

A

Wounds and infections should receive meticulous care

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108
Q

When is insulin required?

A

Required for Type 1

Required for Type 2 when diet and exercise don’t work to control BG anymore

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109
Q

What is Lipoatrophy?

A

Loss of fat tissue of injection site used

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110
Q

What is Lipohypertrophy?

A

Fatty mass at injection site

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111
Q

What causes lipoatrophy and lipohypertrophy?

What can prevented this?

A

Repeated use of same injection site.

To prevent rotate site.

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112
Q

What is Dawn Phenomenon?

A

Reduced sensitivity to insulin between 2am and 8am resulting hyperglycemia during those times.

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113
Q

What are interventions for Dawn Phenomenon?

A

Avoid eating carbs before bedtime

Check blood glucose in morning

Increase insulin amount of insulin at night to help normalize the blood glucose level in the morning

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114
Q

What is Somogyi Effect ?

A

Rebound hyperglycemia from low BG during the night causing actions from body to release glucose into body to counteract the low BG. So in the morning pt is hyperglycemic.

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115
Q

What can prevent Somogyi effect?

A

Decease insulin at night or eat bedtime snack

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116
Q

How often should a sick diabetic check their blood glucose?

A

Every 4 hours during illness because being sick initiates counterregulatory hormones to release glucose in blood

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117
Q

What is Diabetic Ketoacidosis ?

A

Found only in type 1 diabetics

The breakdown of fats with the byproduct of ketones (acid)

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118
Q

What is associated with sudden onset of DKA?

A

Stress or infection

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119
Q

How do you know if a person is in DKA?

A

Ketones in urine

Dehydration

blood sugar above 250mg/dL

Kussmual’s respiration

pH below 7.3

Bicarb less than 16

Orthostatic hypotension

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120
Q

What is Kussmual’s respiration?

When you do see this kind of breathing?

A

Deep labored breathing

You see this kind of breathing in pt’s in DKA

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121
Q

List treatments for DKA by priority?

A
  1. 0.45% or 0.9% NaCl for re-hydration
  2. Insulin to bring blood glucose down, correct acidosis
  3. Electrolytes to correct electrolyte imbalance
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122
Q

What do you need to monitor the most when treating a DKA pt? And why?

A

Monitor potassium because it will rapidly decrease as insulin is administered causing cardiac dysrhymias.

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123
Q

Repaglinide and Nateglinide are what kind of medications for what kind of pts?

A

These medication simulate the pancreas to produce more insulin for type 2 diabetics

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124
Q

What class of medications are Repaglinide and Nateglinide?

A

Meglitinides

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125
Q

What can you administer to pt with severe hypoglycemia?

A

1 mg glucagon

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126
Q

DKA pt’s blood sugar level approaching 250mg/dL, what can you add to fluid regimen?

A

5 to 10% dextrose

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127
Q

Posterior fontanels should be closed by how many months in babies?

A

8months

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128
Q

Anterior fontanels should be closed by how many months?

A

18 months

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129
Q

When do babies sit up?

A

4-7 months

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130
Q

When can babies completely roll over?

A

6 months

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131
Q

When can babies stand?

A

1 year

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132
Q

What is one sign that a baby may be malnutrition if they don’t hit this developmental milestone?

A

Anxiety to strangers

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133
Q

When do babies start to coo, smile, and cry?

A

2-3 months

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134
Q

When do babies understand “no”

A

11 months

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135
Q

How many weight should a 1-3 year gain each year?

A

4-6lbs

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136
Q

When does the head circumference and chest circumference be the same in children?

A

1-2 years

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137
Q

Which trimester will a pt with gestational diabetes have an increase need for insulin?

Why?

A

2 and 3 trimester because increase insulin resistance with increase hormones in placenta

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138
Q

What diabetic sx is more likely to be seen in gestational diabetic pt in the 2 and 3 trimester?

A

hypoglycemia

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139
Q

What happens with insulin requirements after gestational pt gives birth? And why does this happen?

A

Decrease because placenta is out

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140
Q

What is the babies size from gestational diabetic mother than non-diabestic mothers?

A

Baby grows bigger and faster

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141
Q

What a some therapeutic management for pt’s with gestational diabetes?

A

Check urine at every prenatal visit

Diabetic diet

Glybride

Monitor sign of diabetic complications like edema, HTN, signs of infection

Closely watch mother and newborn’s glucose during labor and delivery

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142
Q

What are you checking urine for in gestational diabetes?

A

Glucosuria and ketonuria

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143
Q

What is glybride?

A

Oral hypoglycemic agent preferred over insulin in management of gestational diabetes because only small amount of this med can cross placenta

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144
Q

What happens to glycogen during labor and delivery?

A

Labor and delivery depletes glycogen

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145
Q

Who are a risk for gestational diabetes>

A

advanced maternal age

family history of diabetes

obese

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146
Q

Women with gestational diabetes have a high risk for what?

A

C-section
babies have increase risk for prinatal death
birth injury
neonatal complications

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147
Q

Why might pt’s with gestational diabetes go into labor early?

A

Early labor may be due to extra stress like HTN, poor metabolic control, or uteroplacental insufficiency causing fetal growth restrictions

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148
Q

What is the recommended time of when mothers should start breast feeding ?

A

One hour after birth

149
Q

What is recommend for breast feeding mothers?

A

Continue prenatal vitamins and increase 500 calories daily during breastfeeding

150
Q

What is pancreatitis?

A

Inflammation of the pancreas from autodigestion

151
Q

What are some common causes of acute pancreatitis?

A

gall stones, high alcohol consumption, obstruction of ducts

152
Q

What are some common causes of chronic pancreatitis?

A

Prolonged alcohol abuse, CF, hyperlipidemia, PUD

153
Q

What is the difference between acute and chronic pancreatitis?

A

Acute is sudden onset can return normal function and chronic have irreversible damage

154
Q

What endocrine enzymes does the pancreas produce?

A

Amylase, lipase, trypsine, nuclease

155
Q

What exocrine hormone does the pancreas produce?

A

Insulin and glucagon

156
Q

What are some Sx of pancreatits?

A

Primarily acute- Extreme Midepigastric pain, LUQ pain that radiates to back, onset of pain is after eating (especially fatty foods)

Adb tenderness and distension

Ascites

Dark brown urine

Jaundice

decreased/absent bowel sounds

Leukocytosis

Cullen’s and Tuner’s sign

Steatorrhea

weight loss

157
Q

What are some lab results that would be seen in pancreatitis?

A

Increase amylase, lipase, bilirubin, WBC, ALP

Decrease calcium

158
Q

What is cullen’s sign? When would you see this?

A

Bruising around umbilicus

Serious sx of acute pancreatitis

159
Q

What is turner’s sign? When would you see this?

A

Flank bruising

Serious sx of acute pancreatitis

160
Q

What are some therapeutic management of pancreatitis?

A

Keep pt NPO

Monitor blood glucose

NG tube to suction stomach content or to prevent vomiting

Pain meds as per order

ERCP

161
Q

Why do you keep a pancreatitis pt NPO?

A

To decrease digestive enzymes from being released

162
Q

Why do you monitor a pancreatitis pt’s blood glucose?

A

because insulin may not be release due to inflammation or damage to pancreas

163
Q

What are some things to teach pt about preventing recurring acute episodes of pancreatitis?

A

Avoid alcohol

Eat low fat, high protein diet

Monitor blood glucose (specifically for chronic pancreatitis pts)

Eat complex carbs (fruit, veg, grains) over refined sugars

164
Q

What do you want to manage first in acute pancreatitis?

A

Pain

165
Q

What meds are used in treatment of pancreatitis?

A

Analgesics

H2 blockers

Insulin

Pancreatic enzymes

Anticholinergics

166
Q

Why do you give anticholinergics to a pancreatitis pt?

A

To decrease pancreatic simulation of PNS (rest, ingest)

167
Q

What is Creon?

A

pancreatic enzyme supplement to be given along with meals or snacks

168
Q

How do you know if creon, pancreatin, and panrelipase is working?

A

Fecal fat check, decrease of absent of staeorrhea

169
Q

What is leukocytosis ?

A

Increase WBC

170
Q

What can be given for hypovolemic shock in pancreatitis?

A

albumin

171
Q

How should an acute pancreatitis pt lay to reduce pain?

A

On their side with knee up because supine will increase pain

172
Q

Name an autoimmune hyperthyroid disease

A

Graves’s Disease

173
Q

What is hyperthyroidism?

A

Sympathetic overdrive

174
Q

What are some Sx of hyperthyroidism?

A

Weight loss

Heat tolerance, sweaty

HTN

Tachycardia

Amenorrhea

smooth skin and silky hair

Diarrhea

Irritable

Goiter

175
Q

Why are pts with hyperthyroidism intolerant to heat?

A

Increase metabolic rate

176
Q

What is Pretibial myxedema?

A

Waxy discolored skin

177
Q

When diagnosing hyperthyrodism, what is elevated?

A

T3 and T4

178
Q

What are the lab values with TSH in hyperthyroidism?

A

Decreased or absent

179
Q

What is the radioactive iodine uptake test?

What is a positive result and what is it positive for?

A

Pt ingest iodine (pill form) and thyroid scanned to for uptake. High uptake is positive result for Graves’

180
Q

What are sx of thyroid storm?

A

Tachy, fever, chest pain

181
Q

How dangerous is a thyroid storm?

A

Life threatening

182
Q

What are some nursing intervention and pt teaching for hyperthyroidism?

A 
Keep room quiet and dark 
Never suddenly stop taking meds 
Avoid foods rich in iodine 
Avoid aspirin
Watch for signs of drug toxicity
183
Q

What does the thyroid regulate?

A

Body metabolism, body temp

184
Q

Why does normal person need to eat iodine rich food

A

because body cannot make T3 and T4 without iodine

185
Q

What are iodine rich foods?

A

Seafood, dairy products, eggs

186
Q

What is the function of T3 and T4?

A

burn calories, regulates how fast digest food, stimulates sympathetic nervous system

187
Q

What are classic sx of Graves’ disease?

A

Protruding eyes and pretibial myxedma

188
Q

Why should pts with hyperthyroidism avoid aspirin?

A

aspirin increase thyroid hormones

189
Q

What are some common medications for hyperthyroidism?

A 
Tapzole 
Methomazole
PTU
Beta Blockers
Radioactive iodine given as capsule
190
Q

Name anti-thyroid hormone medication? Who is this prescribed for?

A

Methimazole(Tapazole)
PTU-Propylthiouracil

Prescribed for pts with hyperthyroidism

191
Q

What is a side effect of anti-thyroid medication?

Contraindicated in what types of pts?

A

Liver failure and decrease WBC

Pregnant women should not take

192
Q

Why are beta blockers prescribed to hyperthyroidism pt?

A

Provide rapid relief in minutes for cario sx like palpitations, arrhythmias, tremors, anxiety, and heat intolerance

193
Q

Why is radioactive iodine given to pts with hyperthyroidism?

What are some common side effects?

What type of pt is this contraindicated in?

What pt education is needed?

A

it destroys thyroid gland over time

Nausea, swollen salivary gland

Pregnant women

Avoid preparing food for others, lander clothes/towels separate from others, avoid being close to pregnant women and child for one week after. Can gargle with salt and soda 3-4times/day to relieve dry mouth and irritation

194
Q

What do post op nurse need to monitor for after pt removes thyroid?

A

Thyroid storm/thyrotoxicosis from leaked T3 and T4 into body

Hypocalcium

195
Q

What are some things you need to keep in mind when caring for post op thyroid removal pt?

A

Keep in semi-folwers

Keep trach in room

Monitor airway closely

Splint throat when coughing

Monitor for hypocalcemia (parathyroid)

196
Q

How many calories per kg body weight per day to maintain weight?

A

25-30cal/kg per body weight per day

197
Q

How many calories per kg body weight per day to lose weight?

A

20-25cal/kg per body weight per day

198
Q

How many calories per kg body weight per day to gain weight?

A

30-35cal/kg per day

199
Q

What is metformin?

A

Oral anti-diabetic medication for type 2 diabetes

200
Q

How does metformin work?

A

Decrease glucose production and increase insulin sensitivity

201
Q

What are some side effects of metformin?

A

nausea, vomiting, diarrhea, metallic taste in mouth

More serious: DKA and lactic acidosis

202
Q

What type of pt is metformin contraindicated in ?

A

Pts with renal insufficiency

203
Q

What are some nursing considerations for metformin?

A

Hold med for 1-2 days if pt is going to have IV contrast and 2 days after to avoid renal failure and lactic acidosis

Used to manage diabetes, not cure

204
Q

What kind of drug is Glybride and Glipizide?

A

Sulfonylureas 2nd generation

205
Q

What do you use Glybride and Glipizide for?

A

Oral medication for type 2 diabetes

206
Q

How does Glybride and Glipizide work?

A

it increases insulin production by simulating the pancreatic islets

207
Q

What is a side effect to watch when taking sulfonylureas like Glybride and Glipizide?

A

Hypoglycemia

208
Q

What are some pt education for taking Glybride and Glipizide?

A

Avoid alcohol
Avoid breast feeding
don’t take with beta blockers

209
Q

What is hypothyroidism?

A

Decrease production of T3 and T4 hormones leading to decrease metabolic rate

210
Q

What causes hypothyroidism?

A

Hashimoto’s disease
not eating enough iodine
tumor on anterior pituitary gland
treatment of hyperthyroidism

211
Q

what is hasimoto’s disease?

A

autoimmune disease where body attacks thyroid gland

212
Q

What are sx of hypothyroidism?

A

weight gain

lethargy

decrease HR

decrease BP

constipation

dried skin and brittle nails

slowed thinking

myxedema on face and eyes

213
Q

What labs would you check with hypothyroidism?

And what woud they show?

A

Decrease in T4

Increase in TSH

214
Q

What should you monitor when caring for a hypothyroidism pt?

A

Vitals signs

Monitor for signs that can lead to myxedema coma

Monitor for hyperthyroidism with medication

215
Q

What kind of diet is recommended for hypothyroidism

A

Low fat and calories, high fiber and fluid

216
Q

What are signs of myxedema coma?

A

Pt is unconscious with severely low BP, HR, RR, hypothermia, hyponatrimia, hypoglycemia

217
Q

What are common medications prescribed for hypothyroidism?

A

Lionthyronine (Cytomel)

Levothyroxine (synthyroid)

218
Q

What do you need to educate pt on in regards to medication for hypothyroidism?

A

Lifelong hormone therapy with routine blood work to see if medication is effective and no adjustments needed

Do not switch brands, discuss with MD before you do anything
Do not suddenly stop taking meds

219
Q

How does Levothyroxine work?

Who is it prescribe for?

A

It’s a synthetic T4 prescribed for hypothyroidism

220
Q

When should pt take Levothyroxine?

A

In the morning on empty stomach at the same time everyday

221
Q

What should labs you monitor when pt is on Levothyroxine?

A

Monitor TSH and T4

222
Q

About when does Levothyroxine start to show effectiveness?

A

6-7weeks

223
Q

What medication should be taken separately from levothyroxine?

And by how many hours?

A

Gastric meds like antacids by at least 4 hours

224
Q

What kind of side effects should you monitor for with Levothyroxine?

A

Hyperthyroidism like thyrotoxicosis, tremors, increase HR, palpation, chest pain

225
Q

What should a pt do if they miss a dose of levothyroxine meds?

A

Take a soon possible

226
Q

What can happen if a pt suddenly stops taking Levothyroxine meds?

A

Myxedema coma

227
Q

What interventions are needed with myxedma coma?

A

STAT IV fluid NS or hypertonic solution

STATE IV thyroid hormone

228
Q

What is Addison’s Disease?

A

Chronic Adrenal Insufficiency

Hyposecretion of the adrenal cortex hormones that sits on top of kidney

229
Q

What hormones do the adrenal cortex secrete?

A

Cortisol (glucocorticoid) and Aldosterone (mineralcorticoid)

230
Q

What does cortisol do?

A

decrease swelling and inflammation

increase blood glucose

231
Q

What does aldosterone do?

A

Retains sodium and excretes potassium

232
Q

What causes Addison’s disease?

A

Autoimmune
Infarction or trauma
TB
Fungal infection

Lack of ACTH (pituitary adrenocoticotropic hormone)

233
Q

What are sx of Addision’s disease?

A 
decrease BP
increase HR 
weight loss 
muscle weakness 
hyperpigmentation (bronze)
Hypercalcemia 
Hyperkalemia 
hypoglycemia
hyponatremia
dehydration 
Salt cravings
234
Q

Where do you see hyperpigmentation first in Addision’s disease?

A

hands, elbows, mouth

235
Q

What are some therapeutic managements?

A

Replacement of adrenal hormones
Steroid and electrolyte replacement
Lifelong medication

236
Q

what are some labs you need to monitor in Addison’s Disease?

A

K+
Na+
Ca+
Blood glucose (hypoglycemia)

237
Q

What are some pt education with Addision’s Disease?

A

Life long medication requirements

Wear a medical alert bracelet

Salt additives needed especially after exercising/sweaty a lot

During stress or infection steroid medication may need to be increased

238
Q

Name what you need to think of with the following imbalances:

Potassium
Sodium

A

Potassium=Cardiac

Sodium=Fluid, BP

239
Q

What are some medications prescribed for Addison’s disease?

A

Predisone(coriticorsteriod)
Glucose for hypoglycemia
Fludrocortisone acetate (mineralocorticoid)

240
Q

What are sx of hypercalcemia?

A

shorten QT interval on EKG

Loss of calcium from bones= risk for fractures

Confusion and Lethargy from decrease neuromuscular excitability

Kidney stones

Constipation due to weakness in muscles

Hypercoaglation

241
Q

What are sx of hyperkalemia?

A

Tall T wave in EKG

Muscle weakness

Abdominal cramps

Diarrhea

Arrhythmia

Decrease cardiac contractility so weak pulse and low BP

242
Q

What is the normal range for calcium serum?

A

8.6-10.2 mg/dL

243
Q

What is the normal range for potassium serum?

A

3.5-5 mEq/L

244
Q

What is the normal range for sodium?

A

135-145 mEq/L

245
Q

Why would a pt with Addison’s disease have hyponatremia?

A

Deficiency of aldosterone leads to inability to reabsorb sodium into kidney causing low sodium

246
Q

What are sx of hyponatremia?

A

N/V

Confusion

Lethargy

Seizures

hypovolemia and orthostatic hypotension

247
Q

What is Addisonian Crisis?

A

Life threatening acute exacerbation of Addison’s disease

248
Q

What clinical manifestation can Addisonian Crisis present as?

A

Hypovolemic shock

249
Q

What can cause Addisonian Crisis?

A

severe infection

trauma

dramatic decrease of glucocorticoid

not taking medication

250
Q

How can glucocorticoid medication be taken?

A

2/3 in morning and 1/3 late afternoon

251
Q

What is Cushing’s disease?

A

Hypersecretion of adrenal cortex hormone leading to elevated cortisol levels

252
Q

What are sx of Cushing’s Disease?

A

Hypertension with sign of CHF

Swollen face (moon face)
Buffalo hump

Excessive weight gain

Truncal obesity

Striae on abd and thighs

Muscle wasting

Hypocalcemia

Hypernatremia
Hypertension

hyperglycemia

Decrease immunity

253
Q

What is buffalo hump?

A

Hump on back of neck from fat deposits

254
Q

Why is there a decrease in immunity with Cushing’s disease?

A

Steriods decrease immune system

255
Q

Name calcium rich foods.

A

Milk, cheese, sardines, spinach, yogurt, collard greens,

rhubarb, tofu

256
Q

What can cause Cushing’s ?

A

Tumor on adrenal gland or pituitary gland

long term steroid use

257
Q

What do you need to monitor when monitor pt with Cushing’s?

A

Monitor vitals and electrolytes
Protect pt from infection
Skin assessment due to fragile skin
Provide meticulous would care

258
Q

What is a hemophilia?

A

Genetic blood clotting disorder X-link recessive from mother

259
Q

What organ produces clotting factor proteins?

A

Liver

260
Q

What is classic hemophilia?

A

Type A

261
Q

Which type of hemophilia is the most common?

A

Type A

262
Q

Which clotting factor is type A hemophilia missing?

A

8 VIIII

263
Q

What medication is used to treat type A hemophilia ?

A

DDAVP (Desmopressin)

264
Q

What does DDAVP do?

A

Stimulates vWF (stabilize VIII)

265
Q

What clotting factor is type B hemophilia missing?

A

9 IX

266
Q

What is the treatment for type B hemophilia?

A

Blood transfusion until they stop bleeding (sometimes can be take BT)

267
Q

What clotting factor is type C hemophilia missing?

A

11 XII

268
Q

what is the treatment for type C hemophilia ?

A

plasma

269
Q

Which gender is usually effected by hemophilia?

A

boys

270
Q

How can a person acquired hemophilia?

A

Liver failure, vit K deficiency, autoimmune against clotting factors, disseminated intravascular coagulation

271
Q

What is disseminated intravasular coagulation?

A

consumes clotting factors

272
Q

What are sx of hemophilia?

A 
Epistaxis
spontaneous bleeding 
hemarthrosis 
Ecchymosis
Swelling of the joints, soft tissue, and muscles
Hematuria
273
Q

What is epistaxis?

A

nosebleeds

274
Q

What is hemarthrosis?

A

bleeding into the joint space

275
Q

What is ecchymosis?

A

bruising

276
Q

What labs test should be done for hemophilia?

A

Platelets
Prothrombin time (PT)
Partial Thromboplastic time (PTT)
Genetic testing: Electrophoreisis

277
Q

What results do hemophilia get on PT, PTT, and platelets?

A 
Platelets=normal
Prothrombin time (PT)=normal
Partial Thromboplastic time (PTT)=prolonged
278
Q

Why is PTT abnormal while PT and platelets are normal in hemophilia?

A

PTT test intrinsic and common pathways (factors 7, 11, 9, 8, 10, 5, 2, 1) which include the clotting factors effected in hemophilia A, B, C

PT test extrinsic and common pathways (factor 7, 10, 5, 2, 1) does not include clotting factors for hemophilia

Platelets are not effected in hemophilia

279
Q

What should a nurse monitor when caring for hemophilic?

A 
Monitor neuro status that would indicate brain bleeding lead to a stroke or increase intracranial pressure 
Monitor for drooling, parenthesis 
Monitor for blood from any orifice 
melena 
Petechia
Pressure on joints 
Pain from swollen joints
280
Q

what is melena?

A

Black tarry stool associated with upper GI bleed

281
Q

what is petechia?

A

a small red or purple spot caused by bleeding into the skin.

282
Q

What are some generalized treatment and drugs of hemophilia?

A

Prophylaxis
Aminocaproic Acid (Amicar)
Antifibrinolytic agents
Injuries should rest, ice, compression, and elevated

283
Q

What is prophylaxis?

A

Clotting factor replacement therapy

Supplementing missing factor by injecting missing or nonfunctional clotting factor

284
Q

What is aminocaproic acid?

A

Drug that help hold clot in place once it’s formed

285
Q

What are some pt education for hemophilia?

A 
Avoid contact sports 
Preventive dental care 
Do not give aspirin or ibprophen for pain 
Give tylenol or codeine for pain 
Delayed growth in hemophiliac babies
286
Q

What does aspirin and ibprophen do to blood?

A

thins blood

287
Q

What is Deep Vein Thrombosis?

A

Blood clot in deep veins

288
Q

What part of body is DVT common?

A

Lower extremities

289
Q

What is primary hemostasis ?

A

Platelet plug

290
Q

What is secondary hemostasis?

A

Hard clot from fibrin on top of platelet plug from coagulation cascade

291
Q

what is thromboembolism?

A

A clot that is free flowing in body

292
Q

What are some risk for thromboembolism?

A

Stroke or pulmonary embolism

293
Q

Name the components of Virchow’s Triad?

A

Slowed blood flow or venous stasis
Hyper coagulation
Damage to blood vessel

294
Q

What is venous stasis caused by

A

Inactivity of skeletal muscle pump

295
Q

What can cause venous stasis?

A

Long periods of inactivity like bed rest

296
Q

What can cause hypercoagulation?

A

Genetics

Surgery that that damaged blood vessel initiating coagulation cascade

Birth control

Exogenous hormones (hormone therapy)

297
Q

What are some things that can cause damage to blood vessel causing DVT?

A

Infection
Chronic inflammation
toxins from smoking

298
Q

What types of pts are at risk for DVT?

A 
Bedrest 
Post op
Obesity 
Pregnant women 
Women on birth control or hormone therapy
299
Q

What are sx of DVT?

A 
Pain Swelling 
redness 
tenderness 
warmth 
Edema /pitting edema 
Distal toes bluish
Homan's sign
300
Q

what is Homan’s sign

A

calf pain on doriflexion

301
Q

What are some Dx test for DVT?

A

D-dimer blood test
Venography
Ultrasound

302
Q

What is D-dimer blood test used for?

Why is D-dimer blood test used?

A

To dx DVT

D-dimer detects fibrin break down which is high when there is a clot

303
Q

What are some treatments for DVT?

A

Anticoagulation meds and therapy

if too large then thrombectomy or thrombolytic enzymes

ICV filter

304
Q

What kind of anticoagulant meds used for DVT?

A

Low molecular weight heparin

305
Q

If pt is on heparin drip IV what labs do you need to monitor ?

A

Moinitor PTT q6hr

306
Q

What is Lovenox and how is it admin?

A

Anticoagulant

SubQ

307
Q

If pt is on Coumadin/Warfarin, what labs need to be monitor and how often?

How is this med admin.?

What does the lab result need to be?

A

PT and INR

PO

INR needs to between 2.5-3.0

308
Q

What is IVC filter and what is it used for?

A

Filter in inferior vena cava to prevent pulmonary embolism?

309
Q

What are ways to prevent DVT?

A

Compression stockings and calf exercises during sitting still to prevent stasis

SCD (sequential compression device)

Early mobilization of post op pt or for people in general

310
Q

What are some nursing actions for DVT?>

A

Elevate affected limb

Educate pt to take meds a prescribed and be aware of vit K high foods (increase clotting)

311
Q

What are some nursing actions when it comes to compression socks?

A

measure limb and apply correct compression stocking that isn’t too tight or too loose

312
Q

What are compression sock used for

A

Prevent DVT

313
Q

What is PAD?

A

Peripheral artery disease caused by blockage (organic PAD)

314
Q

What a typically the blockage in PAD?

A

Atherosclerosis or embolus

315
Q

What is the disease process of PAD?

A

Occulsion in artery-> decrease O2->ischemia->pain (claudication) ->necrosis

316
Q

What is stage 1 in PAD?

A

small occlusion or narrowed artery. Pt typically asymptomatic. Maybe pallor and cold in affected limb but no pain

317
Q

What is stage 2 in PAD?

A

Pain with pressure like walking on affected limb because of ischemia pain (claudication)

318
Q

What is stage 3 in PAD?

A

Resting pain

319
Q

What is stage 4 in PAD?

A

gangrene, necrosis from lack of O2
hairless an shiny in affected limb
sensation issues, increase bp

320
Q

What is claudication?

A

ischemic pain ( typically caused by obstruction of the arteries)

321
Q

What are sx of PAD?

A

ulcers that don’t heal
color changes:elevation pallor and dependent rubor
increased BP
sensation issue

322
Q

What is dependent rubor?

A

dusky red color when limb lowered usually seen with arterial occlusion

323
Q

What are nursing actions with PAD?

A

Don’t elevate

324
Q

What are some risk factor for developing PAD?

A

smoking
diabetes
dyslipidemia
HTN

325
Q

What are some treatment for PAD?

A

Quit smoking
Exercise and healthy diet
medication to reduce clotting
angioplasty and bypass

326
Q

What are some dx test for PAD?

A

Ankle-Branchial Index (ABI)=best way
Whoosing bruit
Doppler ultrasound(dependent on person’s skill)

327
Q

What is ABI and what are the ranges for PAD?

A

Bp comparsion of arm and ankle
Positive result is when systolic BP in ankle divided over systolic BP in arm= less than 0.9

claudication=0.9-0.4
rest pain=0.4 to 0.2
tissue loss=0.2 to 0.0

328
Q

Name interventions for myxedema coma?

A 
O2 via mechanical ventilator 
Monitor cardiac VS
low pressure mattress to prevent skin breakdown 
IV fluids 
IV thyroid hormones
329
Q

What is sickle cell anemia?

A

Autosomal recessive trait where the RBCs sickles when it does get enough O2 (irreversible)

330
Q

What demographic typically have SCA?

A

African Americans

331
Q

What is sickle RBC?

A

Rigid, stiff, crescent shaped RBCs with short life

332
Q

What’s the worse disease process that can happen with SCA pt?

A

Sickle cell crisis

333
Q

What is sickle cell crisis ?

A

Vaso-occlusion to organs causing severe pain and ischemia

334
Q

What can cause sicke cell crisis?

A

Hypoxia, exercise, high altitude, and fever

335
Q

What are sx of sickle cell crisis?

A

Severe pain (typically adb. hands, and feet), fever, stroke, changes in vision, jaundice, hematuria, and priapism

336
Q

What are some sx of SCA?

A 
Pain
Pallor 
Fatigue 
Jaundice 
Gallstones 
Priapism 
Hepatomegaly 
Infant dactylitis 
Bones pain 
Infarction of spleen
Splenic sequestration = Splenomegaly 
Acute Chest syndrome
337
Q

what is SCA pain due to ?

A

decrease in blood flow and clots in vessel (vaso-occlusion) causes pain

338
Q

Why does SCA cause jaundice?

A

Rapid breadown of RBS cause increase bilirubin=jaundice

339
Q

What is Priapism?

A

Sickled RBCs may prevent blood from leaving penis during a sickle cell crisis causing painful prolonged erection

340
Q

What is dactylitis?

Why do SCA infants get this?

A

Swelling of hands and feet

seen in SCA infant due to vaso-occlusion in capillaries of bones of hands and feet=swelling

341
Q

Why do SCA pt get bone pain?

A

vaco-occlusion in bones causing avasular necrosis

342
Q

What is avascular necrosis?

A

death of bones tissues due to lack of blood supply

343
Q

What is infarction?

A

tissue death due to inadequate blood supply

344
Q

Why do SCA pt get infarction of spleen?

A

Vaso-occlusion of spleen from sickled RBCs blockage

345
Q

what is splenic sequestration?

What kind of pt do you see this in?

A

Seen in SCA pt where blood is backed up in spleen causing splenomegaly

346
Q

Without properly function spleen what can happen ?

A 
Without spleen=more susceptible to encapsulated bacteria like: 
Streotoccous pneumoniae
Influenza
Salmonella 
Meningitidis
347
Q

What is acute chest syndrome ? Commonly seenin what type of pt?

A

occurs in vaso-occlusive crisis when sickle cells occlude blood vessels of lungs

348
Q

What are some Dx test for SCA?

A

Newborn blood spot screen after 3 months from birth
Blood smear for sickled cells
Protein electrophoresis

349
Q

What are some tx for SCA?

A

Supplemental O2
Increase fluid intake/IV fluid for sickle cell crisis
Analgesia (opiods) for severe pain
Anti-inflammatory
Antibiotics for bacterial infection
prophylactic antibiotics for young children
Vaccinations
Blood transfusion
Hydroxyurea
Bone marrow transplant (Hematopoietic stem cell transplantation)

350
Q

Why given O2 to SCA pt?

A

To treat hypoxia and prevent further sickling of RBCs

351
Q

What is the most common cause of death in SCA pt?

A

Pneumonia

352
Q

What is hyroxyurea?

A

Medication for SCA that increase production of Hgb F to increase RBC volume and hydration

353
Q

What are some SCA pt education?

A 
Avoid high altitudes
Avoid strenuous exercise 
Avoid dehydration 
get vaccinations
warm compression for pain=vasodilation 
don't use cold compression=vasoconstriction
354
Q

Explain what high altitudes, strenuous exercise, and dehydration does to SCA pt?

A

high altitude=less O2 in high elevation->sickle cell crisis

Strenuous exercise=dehydration and increase O2 demand=sickle cell crisis

hydration=decrease sickle cells from sticking together causing clots

355
Q

what is albumin range?

A

3.5 to 5.0

356
Q

what is renal calculi ?

A

Stones that form in the urinary tract– in kidney or down ureter

357
Q

wath causes kidney stones?

A 
diet high in calcium (hypercalcemia), vit D, or purines
Dehyration 
increase uric acid 
infections 
obstruction somewhere in urinary tract
358
Q

what is the most common renal calculi?

A

Calcium oxalates (hypercalcemia)

359
Q

What are sx of renal calculi?

A

Flank pain which radiates from lumbar to side to testicles or bladder (pain can be severe or dull)

Renal Colic

Sign of UTI

Acute urinary retention

Hemauria

360
Q

What is renal colic

A

Sharp wavelike rhythmic constant pain causing pt to have hard time staying still
pt will walk around, sit down, get up lay down

361
Q

what are signs of UTI?

A

mild shock with cool, moist skin, dysuria, fever, and chills

362
Q

What are some Dx for renal calculi?

A

Ultrasound

Identify type CT-KUB

363
Q

What are some nursing actions when caring for renal calculi pt?

A 
Monitor VS looking for infection 
Monitor I/O
Increase fluid intake to 3000ml/day for urine output of 2000ml/day
Admin analgesia (opioids and NSAIDs)
Promote ambulation 
Strain urine to catch stone
364
Q

What are signs of infection ?

A

fever, tachy, increase WBC

365
Q

What are some treatment options of renal caculi?

A

EWSL (eletracorporeal shock-wave lithotripsy)

lithotomy

366
Q

What is EWSL? What does it do?

A

Electracorporeal shock-wave lithotripsy

shock wave that polarize kidney stone to powder to get out

367
Q

What is lithotomy?

A

surgical method for removal of calculi

368
Q

What are some renal calculi pt teaching?

A

Diet low in sodium during kidney stone

increase fluid intake during and after kidney stone(after to prevent reoccurence)

Avoid food like colas, coffee, and teas to prevent recurrence

369
Q

In diabetic pts albumin in urine indicates what disorder?

A

Nephropathy

Nutrition (3 decks)

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