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Advanced MedSurg > Test 3 > Flashcards

Test 3 Flashcards

Liver, Gall Bladder, Pancreas, Renal, Neuro, Renal Peds, Neuro Peds

0
Q

Functions of the liver (8)

A
  1. Glucose metabolism (gluconeogenesis)
  2. Ammonia conversion (excreted in urine)
  3. Protein metabolism
  4. Fat metabolism
  5. Vitamin and Iron storage
  6. Bile formation (bile salts from cholesterol help increase fat digestion)
  7. Bilirubin excretion (increased levels in blood indicate liver disease)
  8. Drug metabolism**
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1
Q

Organ that is important in the regulation of glucose and protein metabolism, and secretes bile

A

The liver

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2
Q

Caused by exposure to hepatotoxic chemicals, meds, and botanical agents

A

Toxic Hepatitis

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3
Q

Signs and Symptoms of Toxic Hepatitis

A

Anorexia
Nausea/vomiting
Jaundice
Hepatomegaly

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4
Q

This hepatitis has no effective antidote and has rapid recovery if toxin is removed early

A

Toxic Hepatitis

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5
Q

Most common cause of acute liver failure

A

Drug-induced Hepatitis

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6
Q

True hepatotoxins (4)

A
  1. Carbon tetrachloride
  2. Phosphorus
  3. Chloroform
  4. Gold compounds
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7
Q

Drug-induced hepatitis clinical manifestations

A 
Chills, fever 
Rash, pruritis 
Arthralgia 
Anorexia, vomiting 
Jaundice, dark urine, enlarged liver (late stages)
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8
Q

Sudden and severely impaired liver function in a previously healthy person

A

Fulminant Hepatic Failure

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9
Q

Most common cause of fulminant hepatic failure

A

Viral hepatitis

Can also be cause by: toxic meds, chemical exposure, metabolic disturbances

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10
Q

Replacement of normal liver tissue with diffuse fibrosis

A

Cirrhosis

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11
Q

Clinical manifestations of hepatitis

A 
Fever
Fatigue
Anorexia/loss of appetite 
Nausea, vomiting 
Abdominal pain 
Gray-colored stools 
Joint pain 
Jaundice
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12
Q

Types of cirrhosis (3)

A
  1. Alcoholic - most common (scar tissue around portal areas)
  2. Post-necrotic - acute viral hepatitis (broad bands of scar tissue)
  3. Biliary - chronic biliary obstruction and infection (scar tissue around biliary ducts)
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13
Q

Cirrhosis nursing care

A 
Promote rest
Improve nutrition 
Provide skin care 
Decrease injury risk 
Monitor for complications (bleeding, hepatic encephalopathy, fluid excess)
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14
Q

Hepatic cirrhosis is diagnosed by…

A

Liver biopsy

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15
Q

Symptoms of hepatic dysfunction

A 
Jaundice 
Ascites 
Esophageal varices 
Hepatic encephalopathy and coma 
Edema and bleeding 
Vitamin deficiency 
Metabolic disorders 
Pruritis/skin changes 
Liver abscess
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16
Q

Caused by an elevated bilirubin blood level

A

Jaundice (greater than 2.5)

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17
Q

Movement of fluid into the peritoneal cavity

A

Ascites

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18
Q

Contributing factors to Ascites (3)

A

Portal hypertension
Increased capillary pressure
Obstruction of venous blood through liver

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19
Q

Commonly manifested by increased abdominal girth and weight gain

A

Ascites

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20
Q

Assessment of ascites

A

Percussion differences, daily weight and abdominal girth measurements

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21
Q

Management of ascites

A 
Decreased fluid intake
Diuretics (aldactone)
Decreased sodium diet
Paracentesis  
Bed rest
Electrolyte monitoring
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22
Q

Development of dilated tortuous veins in the esophagus

A

Esophageal varices

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23
Q

Manifested by coughing, throat discomfort, and spitting up blood

A

Bleeding esophageal varices (can result in hemorrhagic shock)

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24
Q

Esophageal varices assessment and management

A

Assessed using endoscopy

Nursing management: support and bleeding prevention

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25
Q

Life threatening complication that can be reversible with recovery of liver function

A

Hepatic encephalopathy and coma

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26
Q

Major contributing factor of hepatic encephalopathy

A

Ammonia

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27
Q

Clinical manifestations of hepatic encephalopathy

A 
Mental changes
Motor disturbances
Asterixis (hand tremors)
Constructional apraxia (inability to replicate shapes)
Fetor hepaticus (fecal breath)
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28
Q

Hepatic encephalopathy assessment and management

A

Assessed by EEG monitoring

Managed by lactulose (decrease ammonia levels), monitoring of respiratory and mental status

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29
Q

Most common type of primary liver tumor

A

Hepatocellular carcinoma (HCC)

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30
Q

Manifested by weight loss, anemia, weakness, and pain

A

Liver metastases

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31
Q

DNA virus transmitted through blood

A

Hepatitis B (1-6 month incubation)

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32
Q

This is the most definitive diagnosis of liver cancer

A

Liver biopsy

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33
Q

Hepatitis B prevention

A

Screening blood
Good hygiene
PPE
Active/passive immunity (vaccinations)

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34
Q

Bloodborne transmission that has no vaccine and can result in a chronic carrier state

A

Hepatitis C (15-160 day incubation)

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35
Q

Requires Hepatitis B surface antigens for replication

A

Hepatitis D (30-150 day incubation)

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36
Q

Transmitted via a fecal-oral route, most commonly through contaminated water

A

Hepatitis E (15-65 day incubation) - self limiting

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37
Q

Cryptogenic virus that is commonly received via blood transfusions

A

Hepatitis G, GB virus C

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38
Q

Hollow, sac like organ that lies on the inferior surface of the liver

A

Gallbladder

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39
Q

When the flow of bile in the gallbladder is obstructed it causes… (Clinical manifestation)

A

darkened urine and clay colored stool

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40
Q

Signs/Symptoms of Cholecystitis

A 
Fever and leukocytosis (inflammation)
Nausea and vomiting
Pain in the upper right quadrant
Anorexia/Loss of appetite
Abdominal distension and feeling of fullness
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41
Q

Acute inflammation of the gallbladder

A

Cholecystitis

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42
Q

Caused by an obstruction created by a gallbladder stone

A

Calculous Cholecystitis (most common)

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43
Q

Acute gallbladder inflammation without an obstruction

A

Acalulous Cholecystitis (can occur after surgery or trauma - bile stasis and increased viscosity)

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44
Q

Another name for calculi or gallstones

A

Cholelithiasis

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45
Q

This type of stone cannot be dissolved and doesn’t react to lithrotripsy

A

Pigment stone

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46
Q

This type of stone can be dissolved and is more common

A

Cholesterol stone

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47
Q

Risk factors of pigment stones

A

Liver cirrhosis
Hemolysis
Biliary tract infection

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48
Q

Signs/Symptoms of a gallstone

A

Pain - upper right quadrant
Biliary colic - associated with N/V; noticeable after heavy meal
Jaundice
Pruritis - Due to bile salts on the skin
Urine and stool changes - Darkened urine; clay colored stool
Vitamin deficiency - Can lead to bleed deficiencies (decreased Vitamin K levels)

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50
Q

Most common diagnostic test for gallstone diagnosis

A

Endoscopic Retrograde Cholangiopancreatoaphy (ERCP)

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51
Q

Nursing Care of cholelithiasis

A 
Relief of pain
Maintaining respiratory status
Skin integrity
Nutritional status (low fat diet)
Monitoring for potential complications
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52
Q

Functions of the Pancreas

A

Exocrine - Secretion of amylase, tripsin, lipase, secretin

Endocrine - Secretion of insulin, glucagon, somatostin; control of carbohydrate metabolism

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53
Q

Biliary tract disease or a history of alcoholism are risk factors for…

A

Acute pancreatitis

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54
Q

Caused by the self digestion of the pancreas by trypsin

A

Acute pancreatitis

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55
Q

Signs/Symptoms of Acute Pancreatitis

A 
Acute onset of severe mid-epigastric pain (will cause patient to seek treatment)
Abdominal distention 
Decreased peristalsis
Vomiting (gastric/bile)
Fever
Jaundice
Confusion
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56
Q

Abnormal lab values in acute pancreatitis can include…

A

Increased levels of serum amylase and lipase
Increased WBC
Hypocalcemia
Transient hyperglycemia/bilirubin levels

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57
Q

Nursing Management of acute pancreatitis/chronic pancreatitis

A 
Pain relief
Pulmonary assessment
Nutritional assessment
Skin assessment
Monitoring for potential complications (ascites, hypovolemia, shock, renal failure)
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58
Q

An inflammatory process that is identified with progressive pancreas destruction

A

Chronic pancreatitis

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59
Q

Signs/Symptoms of Chronic Pancreatitis

A 
Severe upper abdominal/back pain
Vomiting, weight loss
Malabsorption, impaired protein and fat digestion
Steatorrhea
Calcium stones in bile duct
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60
Q

This test is the most valuable in providing information regarding chronic pancreatitis

A

ERCP

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61
Q

Walled off fibrous tissue cysts resulting from necrosis with acute pancreatitis

A

Pancreatic Pseudocyst

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62
Q

Pain, jaundice, and weight loss are the classic signs of…

A

Pancreatic Cancer

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63
Q

Signs of insulin deficiency

A

Glucosuria
Hyperglycemia
Abnormal glucose tolerance test

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64
Q

Nursing management of Pancreatic Cancer

A

Pain management
Nutritional management
Palliative care

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65
Q

Tumors at the head of the pancreas signs/symptoms

A

Jaundice, clay-colored stool, dark urine
Malabsorption of nutrients/vitamins
Abdominal discomfort, pain
Anorexia, weight loss, malaise

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66
Q

Types of Pancreatic Islet Tumors (2)

A

Insulinoma

Nonfunctioning islet cell cancer (doesn’t affect insulin secretion)

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67
Q

This tumor causes the hypersecretion of insulin

A

Insulinoma

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68
Q

Nursing management of this type of tumor involves monitoring for hypoglycemia

A

Insulinoma

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69
Q

Normal GFR

A

85-105 ml/min

less than 65 = abnormal kidney function

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70
Q

Reversible clinical syndrome with a sudden and almost complete loss of kidney function

A

Acute Renal Failure

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71
Q

Most common causes of ARF (2)

A

Ischemia (hypotension, hypovolemia, hypoperfusion)

Nephrotoxins (medications, contrast dyes, endotoxins)

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72
Q

Categories of ARF (3)

A
  1. Prerenal
  2. Intra-renal
  3. Post-renal
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73
Q

Results from impaired blood flow that leads to hypoperfusion of the kidneys (ARF category)

A

Prerenal (fix blood flow = fix kidney damage)

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74
Q

Results from actual parenchymal damage to the glomeruli (ARF category)

A

Intra-renal

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75
Q

Results from an obstruction somewhere distal to the kidney (ARF category)

A

Post-renal

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76
Q

Can cause an abrupt and progressive decline of renal function

A

Acute Tubular Necrosis (most common cause of ARF)

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77
Q

Phases of ARF (4)

A
  1. Initiation (exposure to kidney damage)
  2. Oliguria (Decreased output, increased BUN/Creatinine)
  3. Diuresis (Improvement in kidney function)
  4. Recovery (Normal kidney function)
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78
Q

Treatment for the Diuresis phase of ARF

A

HDTV (Hyperkalemia, Dilation of renal arteries, Total volume, Volume control)

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79
Q

Best form of prevention of ARF in high risk patients

A

Hydration

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80
Q

Major problems associated with ARF (3)

A

Fluid volume excess
Pulmonary edema
Electrolyte imbalances

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81
Q

Most life-threatening complication of ARF is

A

Hyperkalemia (Oliguric phase of ARF)

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82
Q

Renal diet for a patient with ARF

A

Low sodium/potassium, Low protein, Fluid restrictions

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83
Q

Nursing management of ARF

A

Monitor for fluid and electrolyte imbalances
Reduce metabolic rate (cluster care)
Promote pulmonary function (TCDB, Incentive spirometry)
Prevent infection
Promote skin integrity
Provide support

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84
Q

Progressive irreversible deterioration in renal function

A

Chronic Renal Failure

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85
Q

Stages of Chronic Renal Failure (4)

A
  1. Reduced renal reserve
  2. Renal insufficiency
  3. Renal Failure
  4. End Stage Renal Failure
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86
Q

CRF Clinical Manifestations

A 
Confusion, altered mental status
Hypertension, edema, Hyperkalemia**
Crackles, Kussmaul's Breathing**
Anemia (decreased erythropoiten)**
Anorexia, Nausea, Ammonia odor (uremic fetor)**
Purpura**, Pruiritis, Ecchymosis
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87
Q

GFR less than 15, Increased creatinine and BUN, Metabolic acidosis, anemia, and altered calcium/phosphorus levels are all indicative of…

A

Chronic Renal Failure

88
Q

Nursing Management of CRF

A 
Fluid status assessment
Identifying sources of imbalance
Implementing dietary program
Promote positive self feelings
Education
89
Q

Patients with CRF should contact their provider if…

A

Worsening signs/symptoms of renal failure
Signs/symptoms of hyperkalemia
Signs/symptoms of access problems

90
Q

Complications of a hemodialysis access site include…

A
  1. Thrombosis

2. Infection

91
Q

Complications of hemodialysis include…

A
  1. Disequilibrium syndrome (shift in CSF; HA and nausea)
  2. Hypotension
  3. Muscle cramps r/t electrolyte changes
  4. Loss of blood
  5. Sepsis
92
Q

When preparing a patient for hemodialysis, the nurse should…

A

Assess vital signs
Assess the condition of the access device (thrill and bruit)
Weigh patient (before and after)

93
Q

This is the biggest complication of PD

A

Peritonitis (Infection)

94
Q

This type of dialysis doesn’t require vascular access, has a more liberal diet, has an increased risk for infection, and increased serum triglycerides

A

Peritoneal Dialysis

95
Q

This type of dialysis requires vascular access and heparin, can result in rapid fluid/electrolyte shift, has a more restrictive diet, and an improved control over serum triglycerides

A

Hemodialysis

96
Q

Pediatric Renal Differences (4)

A
  1. Function is reduced with stress
  2. Premature infants can’t concentrate urine
  3. Young children have shorter urethras
  4. Most children with ARF regain normal function
97
Q

Pediatric symptoms of a UTI include…

A

Poor feeding, failure to gain weight
Persistent diaper rash, incontinence (in older children), foul smelling urine
Irritability, fever

98
Q

Pediatric risk factors for UTI

A
  1. Urinary stasis (i.e. ignoring urge to void, constipation)
  2. Mechanical factors (i.e. bubble baths, tight diapers, incorrect wiping)
  3. Sexual abuse
  4. Vesicoureteral reflux
99
Q

Inappropriate urination at least 2 times per week for at least 3 months in a child older than 5 years is referred to as…

A

Enuresis

100
Q

Nursing interventions for Enuresis

A

Restrict fluids at bedtime
Bladder training schedule
Medications (as a very last resort)

101
Q

Inflammation of the kidney than can progress to gram negative septic shock in children

A

Pyelonephritis

102
Q

Backflow of urine up the ureter than leads to urinary stasis

A

Vesicoureteral reflux

103
Q

Clinical manifestations of vesicoureteral reflux

A

Urinary frequency, urgency, dysuria, hematuria
Fever, flank/suprapubic tenderness
N/V/D
Irritability, poor feeding, toxic look

104
Q

Nursing interventions for vesicoureteral reflux

A

Antibiotics
Encourage frequent voiding, frequent diaper changes
Push fluids
Teach proper cleansing (front to back)

105
Q

Manifestation of glomerular damage and altered glomerular permeability (not a disease, but the first sign of damage)

A

Nephrotic Syndrome (occurs from chronic kidney conditions)

106
Q

Symptoms of Nephrotic Syndome

A 
Decreased urine output, proteinuria
Edema**, weight gain
Normal or HYPOtensive blood pressure
Dark, frothy urine
Poor appetite, irritability
Muehrcke bands (on finger nails)
Hyperlipidemia, hypoalbuminemia
107
Q

Nephrotic Syndrome Treatment includes…

A

Prednisone and diuretics

108
Q

Nursing Interventions for a child with Nephrotic Syndrome

A

Corticosteroids, diuretics, fluids
Assess I/O, daily weights, pulmonary status
Turn frequently, provide skin care
High protein diet, no salt

109
Q

Active inflammation of the glomeruli

A

Acute glomerulonephritis

110
Q

Symptoms of Acute Glomerulonephritis

A

Brown, tea colored urine**, decreased output
HYPERtension
Edema
Weakness, activity intolerance

111
Q

The most common type of glomerulonephritis is…

A

Acute Post-Streptococcal Glomerulonephritis

112
Q

One of the most common causes of sudden, short-term kidney failure in children

A

Hemolytic Uremic Syndrome (HUS)

113
Q

Common cause and symptom of HUS

A

Eating foods contaminated with bacteria

Noticeable by manifestation of bloody diarrhea**

114
Q

A rapidly growing, encapsulated tumor of the kidney

A

Wilm’s Tumor

115
Q

Wilm’s Tumor presentation in children

A

Swelling or mass within the abdomen (DO NOT PALPATE)

116
Q

Treatment for Wilm’s Tumor

A

Removal of affected kidney

117
Q

Post-tumor removal education for children (Wilm’s Tumor)

A

No contact sports, mountain biking, sky diving

Prevent UTI’s

118
Q

Most common PERMANENT neurologic disability in children

A

Cerebral Palsy

119
Q

NONPROGRESSIVE impairement of motor function control

A

Cerebral Palsy

120
Q

Risk factors for cerebral palsy include…

A

Premature birth
Low birth weight**
Multiple birth
Cerebral infection (i.e. meningitis)

121
Q

Early warning signs of cerebral palsy include…

A

Not meeting growth milestones (growth charts important)
Floppy or limb body in infants
Feeding difficulties

122
Q

Nursing interventions for cerebral palsy

A

Approach child at appropriate developmental level
Include the family and follow child’s usual care routine
Ensure adequate nutrition and skin care
Promote independence

123
Q

Abnormal accumulation of cerebrospinal fluid in the ventricles of the brain, most commonly caused by blockage of flow

A

Hydrocephalus

124
Q

Cerebrospinal fluid flow is blocked after it exits the ventricles (can move between ventricles) - Type of Hydrocephalus

A

Communicating

125
Q

Cerebrospinal fluid flow is blocked along one or more of the narrow pathways that connect the ventricles - Type of Hydrocephalus

A

Non-communicating

126
Q

Common sign of hydrocephalus

A

Protruding fontanel

127
Q

Clinical manifestations of hydrocephalus in INFANTS

A

Increased head circumference**, wide-spread sutures
Vomiting (due to increased ICP)
Sunsetting (downward deviation of eyes)

128
Q

Clinical manifestations of hydrocephalus in a CHILD

A

Headache, nausea, vomiting
Papilledema (swelling optic disc), sunsetting
Poor balance/coordination/gait**
Urinary incontinence**

129
Q

Most common treatment for hydrocephalus

A

Shunt placement (diverts flow of CSF)

130
Q

Nursing interventions for hydrocephalus

A

Monitor for infection post-op
Monitor head circumference, neuro checks
Educate family on ICP and infections signs

131
Q

When the circumference of the head is smaller than normal, and will fail to grow as the child progresses through infancy

A

Microcephaly (can result in mental retardation and seizures)

132
Q

A condition in which the cerebellum portion of the brain protrudes into the spinal canal

A

Chiari Malformation (can be manifested by difficulty swallowing)

133
Q

An infection of the fluid around the spinal cord and the fluid that surrounds the brain

A

Meningitis

134
Q

Most common form of meningitis that commonly resolves without treatment

A

Viral (aseptic) meningitis

135
Q

Contagious form of meningitis with a high mortality rate

A

Bacterial meningitis

136
Q

Classic symptoms of meningitis

A

Can develop over several hours or take 1-2 days**
Fever and chills**
Headache, stiff neck, nuchal rigidity**
Positive Brudzinski’s sign (flexion of extremities occurring with flexion of neck)
Positive Kernig’s sign (resistance to extension of child’s leg from flexed position)

137
Q

Symptoms of meningitis in infants

A

Tautness or bulging of soft spots
Poor feeding
Seizures or hearing loss

138
Q

Most definitive way to diagnose meningitis is by…

A

Spinal tap, blood culture, CT scan

139
Q

Treatment for meningitis

A

Antibiotics
Corticosteroids
Fluid replacement
Isolation

140
Q

Nursing interventions for meningitis

A

Respiratory isolation
Immediate administration of antibiotics after cultures are drawn
Decrease environmental stimuli

141
Q

Condition in which there is abnormal development of the spinal cord, spinal column, surrounding nerves, and neural tube

A

Spina Bifida (cleft spine)

142
Q

Mild form of Spina Bifida that may be manifested by a hairy patch, dimple, or birth mark over the area

A

Spina Bifida Occulta

143
Q

Moderate form of Spina Bifida in which a fluid filled sac is visible outside the body (can be transilluminated)

A

Spina Bifida Cystica

144
Q

Severe form of Spina Bifida in which the spinal cord and nerves develop outside the body and are contained in a fluid filled sac (cannot be transilluminated)

A

Myelomeningocele

145
Q

Major risk factor for neural tube defects

A

Lack of folic acid during pregnancy (found in leafy greens, beans, nuts, citrus fruits, fortified cereal)

146
Q

Clinical manifestations of Spina Bifida include…

A

Abnormal appearance of back

Bowel or bladder difficulties**

147
Q

Most important management for a patient with Spina Bifida

A

Prevent infection

148
Q

Positioning for a child with Spina Bifida

A

Prone (keep sac intact)

149
Q

Common complications from Spina Bifida

A

Infection

Hydrocephalus

150
Q

When assessing a child for seizures, the most important aspect includes…

A

History (what happens before, during, and after event)

151
Q

Seizure First Aid includes… (Important for family education)

A
  1. Lowering patient to floor, positioning on side, head aligned straight with body
  2. Remain with the child
  3. Remove potentially harmful objects
  4. Loosen tight clothing
  5. Monitor ABC’s
  6. Do NOT restrain child or place anything in mouth
152
Q

Normal intracranial pressure is…

A

0-10 mmHg (15 is the upper limit of normal)

153
Q

Normal cerebral perfusion pressure (CPP) is…

A

70-100 mmHg

154
Q

Cushing’s Triad

A
  1. Widening pulse pressure
  2. Bradycardia
  3. Decreased respirations
155
Q

Cushing’s Triad is a clinical manifestation of…

A

ICP

156
Q

Clinical manifestations of ICP include

A

Change in LOC
Posturing (Decorticate, Decerebrate)
Cushing’s Triad
Ocular changes (dilated pupils, slow eye response)

157
Q

A patient experiencing decerebrate posturing will exhibit…

A

Extended and adducted arms
Pronated** and flexed wrists
Plantar flexion

158
Q

A patient experiencing decorticate posturing will exhibit…

A

Flexed and adducted arms
Flexed wrists
Internally rotated legs
Plantar flexion

159
Q

A lumbar puncture is used to test for ICP. True or False?

A

False - can cause too quick of a pressure release, resulting in herniation

160
Q

Major red flag in ICP monitoring

A

Level of Consciousness change

161
Q

Nursing interventions for ICP

A

Report any s/s of increasing ICP
Maintain patent airway
Prevent infection

162
Q

Biggest risk in ICP monitoring

A

Infection!

163
Q

Basilar fractures of the skull can result in…

A

CSF leak

164
Q

A patient with a head injury is experiencing drainage from nose/ears, what should the nurse check for and how?

A

CSF using a dextrose stick (tests for glucose levels in fluid)

165
Q

Signs/Symptoms of a concussion

A

Headache
N/V
Photophobia
Blurred vision

166
Q

Signs/Symptoms of an epidural hematoma (indicative of worsening bleeding)

A

Restlessness, Agitation
Confusion
Coma

167
Q

A sudden decrease in blood flow to a localized area of the brain

A

Stroke

168
Q

Types of strokes (3)

A
  1. Thrombotic - plaque + clot
  2. Embolic - clot in a narrow artery
  3. Hemorrhagic - ruptured blood vessel
169
Q

The most effective way to decrease the burden of a stroke is through…

A

Prevention (modifiable/non-modifiable factors)

170
Q

Most important initial diagnostic study for a transient ischemic attack or stroke

A

CT

171
Q

Brief episode of neurologic dysfunction with clinical symptoms typically lasting less than 1 hour

A

Transient Ischemic Attack (blockage that resolves on it’s own)

172
Q

Most common clinical manifestations of a stroke

A

Weakness involving the face arm and sometimes leg
Communication loss
Sensory loss

173
Q

The inability to use or understand language

A

Aphasia

174
Q

Any disturbance in muscular content of speech

A

Dysarthria

175
Q

Loss of half of the visual field of one or both eyes

A

Homonymous Hemianopsia

176
Q

Inability to recognize one or more subjects that were previously familiar

A

Agnosia

177
Q

Inability to carry out some motor pattern

A

Apraxia

178
Q

Nursing management for a hemorrhagic stroke

A

ABC’s and LOC

Avoid: heparin, warfarin, aspirin, plavix

179
Q

Right-sided brain damage can include…

A

Changes in visual perception and ADL’s

180
Q

Left-sided brain damage can include…

A

Memory deficits, loss of basic simple tasks

181
Q

What nursing intervention is most important with stroke…

A

Patient education, assisting to adapt to changes

182
Q

The degeneration of dopamine generating neurons

A

Parkinson’s Disease

183
Q

Clinical manifestations of Parkinson’s

A

Tremor
Rigidity
Bradykinesia
Postural instability

184
Q

Characteristics of Parkinson’s Tremor

A

More prominent at rest
Aggravated by emotional stress or increased concentration
“Pill rolling”

185
Q

A firm diagnosis of Parkinson’s can be made….

A

When at least 2 of the 4 clinical manifestations are present

186
Q

Goal of Parkinson’s treatment

A

Correct imbalances of neurotransmitters (Drug)

Alleviate bradykinesia problems (Physical)

187
Q

Destruction of the myelin sheath around the axons of nerve cells

A

Multiple Sclerosis

188
Q

Common clinical manifestations of MS

A

Blurred vision, diplopia, decreased visual acuity

Numbness, tingling, buring

189
Q

Defect in the number of acetylcholine receptors at the postsynaptic muscle membranes

A

Myasthenia Gravis

190
Q

Myasthenia Gravis is characterized by…

A

Exacerbations and remissions

191
Q

Initial sign of Myasthenia Gravis

A

Ptosis (eye drooping)

192
Q

A patient is experiencing respiratory failure and hypertension with tachycardia. These symptoms improve with Tensilon. What is occurring?

A

Myasthenia Gravis Crisis

193
Q

A patient is experiencing respiratory distress, bradycardia, and hypotension. These symptoms are made worse with Tensilon. What is occurring?

A

Cholinergic Crisis

194
Q

Best diagnostic test for Myasthenia Gravis

A

Edrophonium (TENSILON) test (improved muscle tone within 30 to 60 seconds)

195
Q

Diet for patient with Myasthenia Gravis

A

High protein, high bulk, high roughage diet

196
Q

Also known as “Lou Gehrig’s Disease”

A

Amyotrophic Lateral Sclerosis

197
Q

Early sign of ALS

A

Fatigue while speaking

198
Q

Immune-mediated syndrome characterized by widespread demyelination of nerves in the peripheral nervous system

A

Guillain-Barre

199
Q

Clinical Manifestations of Guillain-Barre

A

Muscle weakness, diminished reflexes
Neuromuscular respiratory failure (Big complication)
Sensory symptoms

200
Q

Disorder of the 5th cranial nerve

A

Trigeminal Neuralgia

201
Q

Clinical manifestations of Trigeminal Neuralgia

A

Abrupt onset
Excruciating pain in lips, upper or lower gums, cheek, forehead, or side of nose (generally unilateral)
Attacks are brief in duration
Usually initiated by a trigger

202
Q

Acute, benign facial paralysis (usually unilateral)

A

Bell’s Palsy

203
Q

Clinical manifestations of Bell’s Palsy

A 
Pain around/behind ear
Fever
Tinnitus
Flaccidity of affected side
Unilateral loss of taste
204
Q

An injury at C4 results in…

A

Complete paralysis below the neck

205
Q

An injury at C6 results in…

A

Partial paralysis of hands and arms, as well as paralysis of lower body

206
Q

An injury at T6 results in…

A

Paralysis below chest

207
Q

An injury at L1 results in…

A

Paralysis below the waist

208
Q

A prognosis for a spinal injury can be made….

A

72 hours after the injury

209
Q

Most important thing to do in a suspected spinal cord injury

A

Immobilization!

210
Q

This condition occurs immediately as a response to a spinal injury, resulting in flaccid paralysis and loss of reflexes below the injury. Usually resolves within 24 hours.

A

Spinal shock

211
Q

This condition develops due to the loss of autonomic nervous system function below the level of the injury

A

Neurogenic shock (decreased BP, HR, CO; pooling in extremities)

212
Q

The most common precipitating factor of this condition is a distended bladder or rectum

A

Autonomic Dysreflexia

213
Q

Clinical manifestations of Autonomic Dysreflexia

A

SEVERE hypertension
Bradycardia
Headache
Flushing, diaphoresis

214
Q

Nursing interventions for Autonomic Dysreflexia

A

Elevate HOB
Assess the cause
Notify physician
Education

215
Q

Patients with injuries at or above T6 are especially at risk for…

A

Respiratory problems

216
Q

Especially important to assess for in patients with spinal injury

A

Areflexic bladder (leads to urinary retention)

Advanced MedSurg (3 decks)

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