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Nursing School > 👩🏾‍🎓- Respirtory, MH & Hepatic Test > Flashcards

👩🏾‍🎓- Respirtory, MH & Hepatic Test Flashcards

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0
Q

ABG normal values

Ph, PaCO2, PaO2, HCO3

A

Ph 〰️ 7.35-7.45

PaCO2 〰️ 35-45

PaO2 〰️ 80-100

HCO3 〰️ 22-26

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1
Q

BMI ranges

Underweight, ideal, overweight, obese (class 1&2), morbid

A

Underweight < 18.5

Ideal body weight 18.5 - 24.9

Overweight 25 - 29.9

Obese > 30
Class 1: 30-34.9
Class 2: 35-39.9

Morbid < 40 or 100lb over ideal body weight

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2
Q

Leptin

A

Hormone produced by fat cells

  1. Communicates to the hypothalamus satiety (the feeling of being full)
  2. Regulates energy expenditure or balance
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3
Q

⬆️ leptin vs ⬇️ leptin

A

⬆️ - increases energy expenditure decreased appetite = weight loss

⬇️ - decreased energy expenditure increased appetite = weight gain

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4
Q

Food-drug interactions

A
  1. Tyramine foods (cheese, aged,picked meat) + MAOIs (antidepressants) = ⬆️BP
  2. No milk with tetracycline
  3. Grapefruit increases blood level of medication & decreases elimination time
  4. Take antibiotics with food
  5. Licorice = ❤️ issues, ⬇️ BP, arrhythmias
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5
Q

Orlistat , lorcaserin , phentermine/topiramate

A

Orlistat- inhibits pancreatic lipase, thereby reducing dietary fat absorption
SE: loose stools, abd cramps, nausea

Lorcaserin- regulates appetite and increase the feeling of fullness after eating, so less food is eaten (for seizures and migraines)

Phentermine/topiramate- extended release is a combination medication

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6
Q

Roux-en-Y

A

Gastric bypass

A combination procedure that involves the creation of a restrictive 30-mL pouch and bypass of a portion of the small intestine

Can cause malabsorption

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7
Q

List the 3 short term life-threatening complications of bariatric surgery

A

Pulmonary embolism

Infection

Anastomosis leak**

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8
Q

Long term complications and side effects of bariatric surgery

A
  • band slippage, obstruction, hernia
  • esophageal erosion, ulcers, acid reflux
  • vitamin deficiency, osteoporosis, anemia and dumping syndrome
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9
Q

Dumping syndrome

Manifestations

A

Occurs when stomach contents are rapidly “dumped” into the small intestine

Manifestations- n/v/d, abdominal pain, cramps, dizziness, bloating, belching, fatigue, heart palpitations, tachycardia

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10
Q

Normal range of HGB

A

12-18 g/dL

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11
Q

Normal range of HCT

A

38-49%

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12
Q

Normal range of albumin vs prealbumin

A

Albumin: 3.5-5.0 g/dL

Prealbumin: 19.5-35.8 mg/dL

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13
Q

Eteral feeding vs TPN

A

Enteral - used for those not getting adequate nutrition, but have fully functioning GI tract

TPN - used for those not getting adequate nutrition AND who do not have the full use of their GI tract

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14
Q

What to know about TPN

A
  • monitor fluid, electrolyte and glucose levels closely
  • ⬆️ risk of infection related to ⬆️ sugar intake
  • risk of hyperglycemia, hypoglycemia, air embolism hypervolemia
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15
Q

Kubler-ross grief cycle

A 
Stage 1 denial 
Stage 2 anger 
Stage 3 depression 
Stage 4 bargaining 
Stage 5 acceptance
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16
Q

Domain 7: Care of the imminently dying

A

-symptom management (pain, general discomfort, respiratory distress, delirium)

-stages of dying:
Early (accept its near)
Middle
Late (hours or days)

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17
Q

S&S of approaching death

A 
Coolness 
Sleeping 
Disorientation 
Restlessness 
Incontinence 
Decrease in appetite & fluid intake 
Urine decrease 
Breathing-pattern change 
Respiratory congestion 
Decreased socialization
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18
Q

List the 8 domains of palliative care

A
  1. Structure and process of care (family education)
  2. Physical aspect of care
  3. Psychological & psychiatric aspects of care
  4. Social aspects of care
  5. Spiritual, religious and existential aspects of care
  6. Cultural aspects of care
  7. Care of the imminently dying
  8. Ethical and legal aspects of care
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19
Q

Passive vs active euthanasia

A

Passive- not directly causing death
“Allowing natural death”
Withdrawing or withholding life-sustaining therapy

Active- actively causing death

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20
Q

Clinical presentation of pulmonary embolism

A

Rapid onset:

Chest pain 
Dyspnea 
Tachypnea
Apprehension 
Tachycardia 
Petechiae on chest 
Refractory hypoxemia
Anxiety/restlessness
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21
Q

Refractory hypoxemia

A

Unresponsive to increasing oxygen

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22
Q

Treatment of pulmonary embolism

A
  • oxygen
  • anticoagulant (lovenox, heparin)
  • thrombolytics
  • embolectomy
  • IVC filter
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23
Q

What does d dimer test for

A

Used to rule out the presence of an inappropriate blood clot (dvt, pe)

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24
Q

Acute respiratory failure

A

A change in respiratory gas exchange such that normal cellular function is jeopardized

PaO2 < 60 or PaCO2 > 50

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25
Q

Acute respiratory failure

Early, late findings

A

Early- dyspnea, restlessness, anxiety, fatigue, hypertension, diaphoresis, tachycardia, tachypnea

Late- confusion, somnolence, pink skin coloration, hypercapnia/hypoxia, lethargy, central cyanosis

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26
Q

When to intervene in ARF

A

Increased O2 need, increased HR, change in mental status, change in lung sounds, increased dyspnea, call MRT/RRT,

Look at trends over last 24hrs/past couple days, activity level

⬇️ urine output= ⬇️ cardiac output

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27
Q

Acute respiratory distress syndrome

Causes

A

Widespread inflammation in the lungs/stiffening of the lungs and loss of compliance (elasticity)

Causes- sepsis, fluid overload, shock, trauma, neurological injuries, burns, DIC, aspiration

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28
Q

What is the number one cause of ARDS

A

Sepsis

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29
Q

P/F ratio

Formula, ranges

A

Formula- PaO2/FiO2

Normal > 500
Respiratory failure < 300
ARDS < 200
Low survival rate < 100

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30
Q

Clinical manifestations of ARDS

A
  • Tachypnea
  • Decreased breath sounds
  • Dyspnea
  • Refractory hypoxemia
  • Decreased pulmonary compliance (due to alveoli damage)
  • pulmonary infiltrates (increased alveolar fluid, pulmonary edema)
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31
Q

TRAILI

Treatment, cause

A

Transfusion related acute lung injury

Cause- giving expired packed RBC that causes ARDS, RBC good for 40 days

Treatment- fluid, analgesic, O2

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32
Q

Treatment of ARDS

A
  • mechanical ventilation (PEEP, sedation/analgesia)
  • prevention of nosocomial infection
  • maintain nutritional status and fluid balance (⬆️ protein, calories, fluid)
  • glucocorticoids May be used to decrease inflammatory response*
  • prone position in severe situations
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33
Q

BiPAP

A

Patient receives two different levels of airway pressure

Higher pressure during inhalation assists with opening of the alveoli

Lower pressure during exhalation keeps the alveoli from collapsing during exhalation

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34
Q

CPAP

A

One continuous pressure throughout the respiratory cycle to help keep the alveoli open through inspiration and expiration

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35
Q

What is prone position

A

Lies flat with chest down and the back up

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36
Q

Barotrauma

A

Injuries caused by increased air or water pressure , such as during airplane flights or scuba diving

37
Q

Pulmonary barotrauma

A

Too much air in lung stretched alveoli

38
Q

Positive end expiratory pressure

A

Amount of pressure that is held in the lungs at the end of exhalation

Improves oxygenation by recruiting alveoli (restoring alveoli and reactivating surfactant)

Normal range 3-5 cmH2O water pressure

39
Q

Synchronized intermittent mandatory ventilation

A

Mode of ventilation used to stimulate spontaneous breaths or to prevent respiratory alkalosis. Can be used as a weaning mode by decreasing mandatory breaths

40
Q

Nurses role during intubation

A

Administer medications (sedation, analgesia, paralytic)

Confirmation of ETT placement by auscultation

Suctioning as requested

Hyperoxygenation between attempts

SpO2 monitoring

41
Q

Ventilator bundles

Set or interventions for ventilator patients to prevent VAP

A

HOB > 30 degrees

DVT prophylaxis

Stress ulcer prophylaxis (prilosec)

Turning q2 hrs

VAP prevention (mouth care q2 hrs)

42
Q

Functions of the liver

A

Blood storage

Blood filtration

Production of bilirubin

Synthesis & removal of clotting factors

Metabolism of carbs, fat and protein

Detoxify the blood

Storage area for fat soluble vitamins & iron

43
Q

Clinical manifestations of hepatitis

A

Abdominal pain, irritability, pruritus (due to ⬆️ bilirubin), malaise, Fever, n/v, jaundice, oliguria, edema (ascites), clay colored stools & dark amber urine

44
Q

Abnormal lab values related to hepatitis

A

Elevated liver enzymes (AST, ALT, GGT & LDH), alkaline phosphate, elevated bilirubin, elevated serum ammonia and decreased albumin

45
Q

3 stages of hepatitis

A

Stage 1- preicteric stage (before jaundice) malaise, anorexia, weight loss, fatigue, n/v, RUQ abd pain, enlarged liver and lymph nodes, electrolyte imbalance, fever, arthralgia & skin rash

Stage 2- icteric statge (jaundice) jaundice, pruritus, light colored stools, brown urine, malaise

Stage 3- post icteric phase is decrease in fatigue, appetite returns to normal, lab work normalizes, pain subsides

46
Q

Hepatitis A

A

Primarily spread through the oral route from food, water or shellfish that has been infected with the virus

47
Q

Hepatitis B

A

Spread my blood, body fluids, during childbirth or through contact with a contaminated needle

Vaccination available in 3 shot series (1st, 2nd 1 month from first, 3rd 6 months from first; atleast 2 months from 2nd)

At risk population- male homosexuals, multiple sex partners, injection drug users, blood transfusions, transplants

48
Q

Hepatitis C

A

Spread through blood, body fluids, childbirth

NO VACCINE

At risk population- IV drug users, dialysis, high risk sex behaviors, tattoos/piercing, blood transfusions

49
Q

Hepatitis D

A

Not common in the U.S

REQUIRES HEP B TO REPLICATE

Transmitted via blood or body fluids

No vaccine

50
Q

Hepatitis E

A

Transmitted via fecal-oral route

Most common mode of transmission: contaminated drinking water

No vaccine

51
Q

Hepatitis G

A

Spread by blood transfusions

Discovered in 1996

Acute disease, little known, no vaccine

52
Q

Nursing management of hepatitis

A

Vitamin k for prolonged bleeding

Antihistamines for pruritus

Antiemetics

Questran

Diet (⬆️ carbs & ⬇️ fat) (Na restriction)

Hepatitis is a reportable disease

53
Q

What is questran and what does it do

A

Drug used to rid body of extra bile this decreasing pruritus

Bile acid-binding resin

54
Q

Cholecystitis

A

Inflammation of the gallbladder due to an obstruction of bile flow

55
Q

Cholelithiasis

A

Gallstones

3 types- cholesterol stones, pigmented, mixed

56
Q

Clinical manifestations of cholecystitis

A

None or RUQ pain (colicky)

Sometimes rebound tenderness or guarding, indigestion, fever, tachycardia, referred pain to shoulder/scapula

Occurs 3-6hrs after high fat meal or lying down

57
Q

Murphy’s sign

A

Pain on palpation of RUQ during deep inspiration

58
Q

Hepatobiliary iminodiacetic acid scan

A

Studies the production and flow of bile

Visualizing the liver, gallbladder, bile ducts and small intestine

59
Q

Endoscopic retrograde cholangiopancreatography

A

Visualizes the common bile duct for gallstones

60
Q

Cholangiogram

A

Used during OR to visualize the biliary tree & remove gallstones

61
Q

Treatment of cholecystitis

A

-diet (avoid fried foods, ice cream, dairy products, red meats, heavy alcohol use)

Choose foods low in saturated fats (rice, potatoes, pasta, yogurt, fruits, lean meats, whole grains)

  • NPO to prevent excretion of cholecystokinin which is activated when eating and causes gallbladder to release bile, which causes pain
  • Demerol/meperidine
  • lithotripsy and oral meds to dissolve stones

PREFERRED METHOD IS LAPAROSCOPIC SURGERY

62
Q

Pancreatitis

Cause

A

Inflammation of the pancreas

Occurs from the release of pancreatic enzymes that “auto digest” the pancreas

Cause by- gallbladder disease, chronic alcohol intake, smoking, trauma, viral infections, drugs

63
Q

Clinical manifestations of acute pancreatitis

A

Sudden onset of epigastric pain in the LUQ or mid abdomen that radiates to the back/shoulder blades, tachycardia, tachypnea, hypotension, Fever

Pain characterized as deep and very sharp (intense within minutes of eating foods high in fat content or lying down)

Not relieved by vomiting 🤮

Abdominal discoloration (turners/Cullen’s Sign)

64
Q

Grey turners Sign vs Cullen’s Sign

A

Grey turners Sign- (flank bruising)

Cullen’s Sign- (peri umbilical bruising)

65
Q

Amylase vs lipase

A

Amylase- enzyme that aids in the digestion of carbs

Lipase- aids in the digestion of fat. Only enzyme produced in pancreas

66
Q

Treatment of Acute pancreatitis

A

NPO (IV fluids)

Opioid analgesics, anticholinergics, histamine blockers and pancreatic enzymes

67
Q

Complications of acute pancreatitis

A
  • sterile (areas free of bacteria) and infected (caused by bacteria) necrotizing pancreatitis , can lead to sepsis, shock & multiple organ failure
  • pancreatic hemorrhage
  • pseudocysts, encapsulated areas of fluid that contain pancreatic enzymes. If it becomes infected its known as an abscess
  • respiratory complications
68
Q

Clinical manifestations of chronic pancreatitis

A

Upper abdominal pain which can spread to the back and feels worse after eating or drinking

N/v, weight loss, diarrhea, pale or clay colored stools, jaundice, DM and steatorrhea

69
Q

Clinical manifestations of pancreatic cancer

A

Pain, jaundice, and weight loss

70
Q

Exhibitionistic disorder

A

Achievement of sexual excitement through genital exposure , usually to an unsuspecting stranger

71
Q

Fetishistic disorder

A

Recurrent, intense sexual arousal from use of an inanimate object or from a very specific focus on a non genital body part

72
Q

Frotteuristic disorder

A

Act of touching or rubbing one’s genitals up against another nonconsenting person

73
Q

Sexual masochism disorder

A

Act of being humiliated or made to suffer in order to achieve sexual excitement

74
Q

Sexual sadism disorder

A

Experiencing sexual arousal in response to the extreme pain, suffering or humiliation of others

75
Q

Transvestic disorder

A

Sexual atousal from cross dressing

76
Q

Voyeuristic disorder

A

Sexual arousal from observing an unsuspecting person who is naked , disrobing or engaged in sexual activity

77
Q

Covert sensitization

A

is a form of behavior therapy in which an undesirable behavior is paired with an unpleasant image in order to eliminate that behavior.

78
Q

Paranoid personality disorder

A

A pervasive, persistent, and inappropriate mistrust of others

–Individuals with this disorder are suspicious of others’ motives and assume that others intend to exploit, harm, or deceive them.
–The disorder is more common in men than in women.

79
Q

Clinical manifestations of paranoid personality disorder

A

-Insensitive to the feelings of others
–Oversensitive
–Tends to misinterpret minute cues
–Magnifies and distorts cues in the environment
–Does not accept responsibility for his/her own behavior
–Attributes shortcomings to others

80
Q

Schizoid personality disorder

A

Characterized primarily by a profound defect in the ability to form personal relationships.

–Failure to respond to others in a meaningful emotional way

81
Q

Clinical manifestations of schizoid personality disorder

A

-Aloof and indifferent to others
–Emotionally cold
–No close friends, prefers to be alone
–Appears shy, anxious, or uneasy in the presence of others
–Inappropriately serious about everything and has difficulty acting in a light-hearted manner

82
Q

Schizotypal personality disorder

A

A graver form of the pathologically less severe schizoid personality pattern

–Affects approximately 1 to 2 percent of the population

83
Q

Clinical manifestations of schizotypal personality disorder

A 
•Magical thinking
•Ideas of reference
•Illusions
•Depersonalization
•Superstitiousness
•Withdrawal into the self
-Exhibits bizarre speech pattern.
–When under stress, may decompensate and demonstrate psychotic symptoms.
–Demonstrates bland, inappropriate affect.
84
Q

Clinical presentation of cirrhosis

A

Ascites

Portal hypertension with esophageal varices (increased pressure in blood vessels leads to enlargement of esophagus vessels)

Hepatic encephalopathy (caused by increased levels of ammonia in brain causing mental changes including coma LEADS TO ASTERIXIS & FETOR HEPATICUS)

Coagulopathy, hepatorenal syndrome, spontaneous bacterial periotonitis, jaundice, skin changes (spider angiomas & Palmer erythema)

85
Q

Clinical manifestations of cirrhosis

A

Dull pain in RUQ

Hypo/hypertension

SOB

⬆️ abdominal girth, weight changes

⬆️ bleeding

Jaundice, dark urine, clay colored stools or melena

Mental changes

86
Q

Cirrhosis diagnostic studies

A

⬆️ liver enzymes

⬇️ albumin & ⬆️ serum bilirubin levels

⬆️ ammonia levels

Long prothrombin time

⬇️ platelets

87
Q

Collaborative care of cirrhosis

A

Rest

Administration of b-complex vitamins (water soluble & not stored in body)

Avoidance of alcohol, aspirin, Tylenol & NSAIDS

88
Q

Treatment of ascites

A
  • sodium restriction
  • albumin
  • diuretics
  • tolvaptan (samsca) vasopressin receptor antagonist used to correct hyponatreimia results in water excretion and ⬆️ Na levels
  • HOB elevated
  • paracentesis
  • transjuglar intrahepatic portostemic shunt (used if ascites doesn’t respond to diuretics)
89
Q

Paracentesis

A

the perforation of a cavity of the body or of a cyst or similar outgrowth, especially with a hollow needle to remove fluid or gas.

90
Q

Collaborative care for bleeding varices

A

Supportive measures for acute bleed

  • fresh frozen plasma
  • packed RBC’s
  • vitamin supplements including B & K (aquamephyton)
  • proton pump inhibitors (protonix)
  • lactulose (keeps protein & ammonia in gi tract. Then acts as laxative to push it out)
  • antibiotics
91
Q

Sengstaken-blakemore tube

A

Short term treatment for severe varices only used up to 24-36 hrs

Scissors should be kept beside for emergencies

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