Week Six Modules Flashcards
what are the two most common inflammatory diseases?
crohn’s disease and ulcerative colitis
where are the highest rates of chronic inflammatory bowel diseases found?
is the risk for chronic inflammatory bowel disease greater in urban or rural areas?
the risk for chronic inflammatory bowel disease is greatest for people of what background?
highest rates are found in the northern hemisphere and industrialized nations
greater in urban areas
risk is greater for ashkenazic jews and whites
what is irritable bowel syndrome?
what kinds of environmental factors change the microbial flora and make the body more susceptible?
an autoimmune disease to the patient’s own intestinal tract
stress, diet, smoking, and alcohol
what is the difference between crohn’s disease and ulcerative colitis?
crohn’s disease causes fat wrapping, muscle hypertrophy, and cobblestone appearance of the GI tract
ulcerative colitis causes ulceration within the GI mucosa
ulcerative colitis mainly affects the _____, fistulas and abscesses are ____, and strictures are ____
mucosa; rare; occasional
crohn’s disease affects the _____ of the bowel wall, fistulas and abscesses are _____, and strictures are also ____
entire thickness; common; common
what is the etiology of ulcerative colitis?
what is the exact cause of ulcerative colitis?
widespread inflammation of mainly the rectum and colon
it is unknown
ulcerative colitis has immunologic causes meaning it can cause ______ and in long term disease, cellular changes can increase the risk of ______
autoimmune dysfunction; colon cancer
what are some signs and symptoms of ulcerative colitis?
abdominal distention, diarrhea/bloody diarrhea, and fever & tachycardia
when performing a psychosocial assessment on a patient that has been diagnosed with UC what are we looking for?
relationship of life events to disease exacerbations, stress factors that lead to s/s, and genetic basis/cancer risk
with ulcerative colitis, we expect the hgb and hct levels to be ____ due to the chronic ______ which can lead to anemia
low; blood loss
with ulcerative colitis, we also expect there to be an _____ in WBC, CRP, and ESR which tells us that the patient is suffering from an ______
increase; inflammatory disease
with ulcerative colitis, we also expect ____ levels of Na+, ___, and ____ due to the ___ and malabsorption
low; K+; Cl-; diarrhea
what are some diagnostic tests we can use to check for ulcerative colitis?
endoscopy/colonscopy and CT scans with barium enema
it’s important to prepare your patient for endoscopy/colonscopy because the ____ may be painful
bowel prep
what are some potential problems we might see in patients who have been diagnosed with ulcerative colitis?
diarrhea due to the inflammation of the bowel mucosa, acute or chronic pain from the inflammation, and potential for lower GI bleeding
what is the main nursing intervention we want to focus on when taking care of a patient with ulcerative colitis?
the main issue is to decrease the episodes of diarrhea
the occurrence of frequent bloody diarrhea and fecal incontinence can lead to tenesmus
what is tenesmus?
an urgent and unpleasant sensation to defecate
what are the three overall treatment goal of a patient with ulcerative colitis?
decrease diarrhea, formed stools, and control of bowel movements, which would allow for mucosal healing
what would be some things that consist of the “nursing game plan” for ulcerative colitis?
reduce intestinal motility, decrease inflammation, promote intestinal healing, and surgical vs. non surgical interventions
what are some non-surgical nursing interventions for ulcerative colitis?
medications like glucocorticoids, anti-diarrheal meds, and immunomodulators; monitor the patient’s nutrition, monitor color, consistency, and volume of stools, and monitor the skin in the peri-anal area
what are some surgical nursing interventions for ulcerative colitis?
pre-op teaching for surgery and hemorrhage, toxic megacolon, and ileostomy/colostomy teaching
when giving anti-diarrheal drugs you want to give them with caution because these drugs can cause ______ and ______
colon dilation; toxic megacolon
what are some examples of anti-diarrheal drugs?
lomotil and loperamide
what are some examples of glucocorticoid drugs that are used to treat ulcerative colitis?
prednisone, prednisolone, and budesonide
what are some adverse effects of glucocorticoids that we should be on the lookout for?
hyperglycemia, PUD, and increased risk of infection
if the ulcerative colitis patient is prescribed aminosalicylates, we must teach the patient to take _____ because sulfa decreases its absorption
folic acid supplements
treatment drugs like immunomodulators, ___ the patient’s immune response, when used in ____ with steroids, they offer _____ effects
alter; combination; synergistic effects
remember, immunomodulators cause ______
if the patient is taking immunomodulators, you must teach the patient to report s/s of ____, including a ____, and to avoid being in _____ or in the presence of others who are sick
immunosuppression
infection; cold; large crowds
with nutritional therapy, often times patients with _____ ulcerative colitis are kept _____ to rest the bowel
severe; NPO
some patients with UC find that _____ and _____ increase the diarrhea and cramping
alcohol and caffeine
patients who have less severe UC may be prescribed elemental formulas like _____ where the contents of the beverage are absorbed in the _____ and reduce the _____
vivonex; small intestine; bowel stimulation
with nutritional therapy, some UC patients will avoid _____ and _____ that can cause an increase in GI s/s
raw vegetables; high fiber foods
it’s important to remember that with ulcerative colitis, _____ containing foods may be poorly _____ and should be _____ from the patient’s diet
lactose; tolerated; eliminated
another nursing intervention for patients with ulcerative colitis would be ____
during exacerbations for “flare-ups”, patients are often placed on _____
rest; bed rest
putting a patient on bed rest restrictions reduces ____, provides comfort, and promotes ____
intestinal activity; healing
when the patient who has ulcerative colitis is placed on bed rest, you always want to make sure that the patient has easy access to a ____, _____, or the ______ in case of urgency or tenesmus
bedpan; bedside commode; bathroom
why might a patient with ulcerative colitis be a good candidate for surgery?
the patient might be a good candidate if they have complications such as hemorrhage, bowel perforation, and toxic megacolon
before the surgery occurs for a patient with ulcerative colitis, the surgeon must do what?
consult with a certified wound, ostomy, and continence nurse
what is toxic megacolon?
massive dilation of the colon
toxic megacolon can lead to ______ and _____
with toxic megacolon, the colon is ____ to remove gas or feces
if gas/feces builds up in colon, the colon may _____
gangrene and peritonitis
unable
rupture
it’s important to remember that a ruptured colon is ______
life-threatening
after our patient receives an ileostomy/colostomy, what is our job as a nurse?
manage and reinforce how to care for the ileostomy and colostomy
what is the etiology of crohn’s disease?
crohn’s disease is a chronic inflammatory disease of the small intestine, the colon, or both
crohn’s disease can affect anywhere in the GI tract from the ___ to the ___
crohn’s disease is _____ and is an _____ with involvement of multiple regions of the intestine
the exact cause of crohn’s disease is ______
like ulcerative colitis, crohn’s disease is recurrent with ______ and _____
mouth; anus
progressive; unpredictable disease
unknown
remissions and exacerbations
what does the appearance of crohn’s disease look like?
cobblestone like appearance and skip lesions
what are some s/s of crohn’s disease?
presents as inflammation that causes a thickened bowel wall
strictures and deep ulcerations (cobblestone appearance) occur
the patient is at risk for developing bowel fistulas (which are abnormal openings between two organs)
the patient with crohn’s disease is also at risk for developing strictures and fistulas which can result in what?
strictures/fistulas can result in severe diarrhea and malabsorption of vital nutrients often leading to anemia
what are some complications of crohn’s disease?
severe malabsorption by the small intestine, patients can also become very malnourished and debilitated which can lead to things like WEIGHT LOSS
what are some common s/s that patients most commonly report with crohn’s disease?
diarrhea, abdominal pain, and low-grade fever
when performing an assessment for crohn’s disease we must perform a thorough _______, look for signs of _____, muscle guarding, and _____
abdominal assessment; distention; rigidity
when we examine the crohn’s disease patient history what are we looking for?
any recent weight loss history, frequency and consistency of stools, presence of blood in the stool, and any recent fever
fever is common in ____, inflammation, and ____
fistulas; abscesses
with our assessment of a crohn’s disease patient, we are also looking at their ______
the result of increased catabolism from chronic inflammation can lead to _____, and _____
anorexia and malabsorption can lead to _____ fluid and electrolyte imbalance, as well as, ______
nutrition
anemia; malabsorption
impaired; nutrient deficiencies
patient’s with crohn’s disease need at least _____ calories a day for tissue repair and healing
3000
medications like ____ or ______ may be needed to help supplement the patient with crohn’s as well
supplements like ____ and ___ are also encouraged
total enteral nutrition (TEN); total parenteral nutrition (TPN)
ensure; vivonex
when performing a PSYCHOSOCIAL assessment of a patient with crohn’s disease what are we assessing?
it is our job to assess things like coping skills, identifying support systems, and looking for signs of clinical depression and anxiety which are common in patients with crohn’s
in a patient with crohn’s disease, ____ is common from slow bleeding and poor nutrition
folic acid and vitamin b12 are also ____ from malabsorption
we can also expect to see ____ levels of albumin due to ____ and ____ loss
CRP and ESR levels will be _____ due to inflammation
anemia
low
decreased; amino acid; protein
increased
we can also expect to see low levels of ____ and ____ due to severe diarrhea or a fistula
potassium; magnesium
what are some medications that can be used in treatment of crohn’s disease?
azathioprine + mercatopurine are often prescribed for moderate to severe disease
monoclonal antibody drugs aka biologic response modifiers (which are only used when other drugs have been ineffective)
drugs like remicade and humira are also used to inhibit tumor necrosis factor (TNF)
if the patient is receiving glucocorticoids for their crohn’s disease treatment you want to take caution because glucocorticoids tend to do what?
mask symptoms of sepsis or abscesses
what is an example of a glucocorticoid?
prednisone
_____ are commonly used in patients who have fistulas, infections, or abscesses in crohn’s disease
antibiotics
what are some surgical interventions for crohn’s disease?
patient may need resections for a fistula
other indications that surgery is needed would be problems like perforation, massive hemorrhage, strictures, or abscesses
what is the main nursing intervention for a patient with crohn’s disease?
TEACHING
as a nurse, we need to teach the patient how to ____ their care at home
teach patients how to manage their ___, ____, and _____ of their disease
ensure that the patient has _____ access to the bathroom at home
educate the patient on when they should ____ their provider
manage
diet; stoma; complications
easy
notify
diabetes mellitus is a _____ disease
diabetes mellitus is characterized by _____ insulin production and/or _____ insulin use
chronic multisystem
abnormal; impaired
diabetes is a disorder of glucose metabolism due to ____ or _____ insulin supply
the ADA recognizes ___ different types of diabetes mellitus
absent; insufficient
4
insulin is a hormone that is made by the _____ in the islets of _____ in the pancreas
when food is ingested, ____ insulin is released
what is the normal range for blood glucose?
beta cells; langerhans
more
74 - 106
the liver and muscle cells store ____ glucose as ____
excess; glycogen
type 1 diabetes is a ____ disease
with type 1 diabetes, the body makes ____ to the beta cells in the islets of langerhans
with type 1 diabetes the auto-antibodies ____ and ____ the beta cells
as a result, the insulin producing beta cells are ____, so the body is ____ to make its own insulin
auto-immune
antibodies
attack; destroy
destroyed; unable
insulin is ____ in order for patients to live who have been diagnosed with type 1 diabetes
what is idiopathic type 1 diabetes?
required
form of type 1 diabetes that is inherited and not related to autoimmunity
in what populations does idiopathic diabetes affect?
individuals of african, hispanic, or asian descent
what are non-modifiable risk factors for type 1 diabetes?
family history, people with HLA-DR3 or HLA-DR4 antigens, viral infections such as mumps or cocksackie virus, and being Caucasian
what is cocksackie virus?
RNA enterovirus that cause hand, foot, and mouth disease, usually occuring in children, but can also impact adults too
what happens in type 2 diabetes?
one of two things:
- there is not enough insulin produced by the beta cells
- the insulin receptors are resistant to the insulin
what are some modifiable risk factors for type 2 diabetes?
what is an acceptable level of HDL for WOMEN?
what is an acceptable HDL level for MEN?
physical inactivity; the american diet; obesity/excess weight; and lowering the HDL level
less than 50 mg/dL
less than 40 mg/dL
what are the 5 components of metabolic syndrome?
what is the criteria for metabolic syndrome?
increased glucose levels; abdominal obesity; HTN; high trig levels; and decreased HDLs
having any 3 out of the 5 components
METABOLIC SYNDROME
what is the fasting blood glucose?
what is the waist circumference for WOMEN / MEN?
what are the HTN requirements for both?
what are the triglycerides requirements for both?
> = 100
> = 35in/89 cm; > = 40in/102 cm
SBP >=130 mmHg; DBP >=85 mmHg
greater than 150 mg/dL
what is the age of onset for type 1 diabetes?
what is the type of onset for type 1 diabetes?
what is the prevalence for type 1 diabetes?
is endogenous insulin present?
are there environmental factors that influence type 1 diabetes?
are islet cell antibodies present?
what is the primary defect?
more common in young people - can occur at any age
s/s are usually abrupt; disease process can be for several years
absent
yes, things like viruses and toxins
often present at onset
absent or minimal insulin production
what is the age of onset for type 2 diabetes?
what is the type of onset for type 2 diabetes?
what is the prevalence for type 2 diabetes?
is endogenous insulin present?
are there environmental factors that influence type 2 diabetes?
are islet cell antibodies present?
what is the primary defect?
more common in adults
gradual, may go undiagnosed for years
accounts for 90-95% of all diabetes cases
yes, the presence is increased in response to insulin resistance
obesity, lack of exercise
absent
insulin resistance, decreased insulin production
what are common symptoms for type 1 diabetes?
is ketosis present with type 1 diabetes?
is insulin therapy required for type 1 diabetic patients?
what is the nutritional status?
is nutrition therapy essential for type 1 diabetic patients?
polyuria, polydipsia, polyphagia
present at onset or during insulin deficiency
required
thin, WDL, or obese
yes, it is essential
what are common symptoms of type 2 diabetes?
is ketosis present with type 2 diabetes?
is insulin therapy required for type 2 diabetes?
what is the nutrition status?
is nutrition therapy essential for type 2 diabetes?
often none - fatigue, recurrent infections
not present except during times of infection or stress
required for some not all patients
often overweight, obese
essential
what are some tests that the patient will receive PRIOR to their diabetes diagnosis?
hemoglobin A1C, a fasting blood sugar which is a finger stick blood sugar test, or an oral glucose tolerance test
after a patient has been diagnosed with type 2 diabetes what is an acceptable number for HA1C?
Diabetic patients need to have their HA1C test done every __ - ___ months depending on how well they control their diabetes
7%
3 - 6
what are some s/s of hyperglycemia?
if the blood sugar is greater than ____ then the patient has hyperglycemia
recurrent infections; recurrent vaginal yeast infections; prolonged wound healing; vision problems; nonspecific symptoms: “i feel terrible”
> 250
_____ is a type of hyperventilation that is used to blow off acid to compensate for things like _____ or ____
kussmaul breathing; metabolic acidosis; DKA
what are some s/s of hypoglycemia?
if the blood sugar is less than ____ then the patient has hypoglycemia
shakiness; nervousness; palpitations “pounding heart”; tachycardia; headache
< 70
what is the 15/15 rule for hypoglycemia?
if symptoms are mild, check the BS, if less than 70 mg/dL:
eat or drink something = to 15 grams of CHO (fruit juice, 3-4 glucose tablets, or 1 tbsp of jelly)
rest for 15 minutes, then recheck blood sugar
if still low, repeat 15 grams of CHO
always encourage the hypoglycemic patient to have a _____ with them
CHO snack
when patients are given medications for type 2 diabetes, what are their medications primarily targeting for treatment?
insulin resistance; decreased insulin production; and increased hepatic glucose production
what are the three types of medications that are prescribed for patients with type 2 diabetes?
biguanides; sulfonylureas; glucagon
what is an example of a biguanide?
what is the primary action of this drug?
metformin - most widely used oral agent
reduce glucose production by the liver which enhances insulin sensitivity at the tissue level
biguanides like metformin help to _____ glucose transport into the cells
improve
patients who are taking metformin must discontinue it before having tests with ______ to prevent contrast-induced kidney injury
iodine contrast media
what is an example of a sulfonylurea drug?
what is the primary action of this drug?
what is a major side effect we should look out for?
glimepiride, glyburide
increase insulin production by the pancreas
hypoglycemia
what is an example of a glucagon drug?
what is the primary action of this drug?
what are some side effects we should look out for?
liraglutide
stimulates the release of insulin and decreases glucagon secretion and slows gastric emptying
nausea, vomiting, diarrhea, and hypoglycemia
what are the FOUR types of insulin we need to know?
rapid acting insulin (lispro), short acting insulin (regular), intermediate acting insulin (NPH), and long acting insulin (glargine)
what is the onset time for rapid acting insulin?
what is the peak time for rapid acting insulin?
what is the duration time for rapid acting insulin?
10 - 30 minutes
30 min to 3 hours
3 to 5 hours
what is the onset time for short acting insulin?
what is the peak time for short acting insulin?
what is the duration time for short acting insulin?
30 minutes to 1 hour
2 - 5 hours
5 - 8 hours
what is the onset time for intermediate acting insulin?
what is the peak time for intermediate acting insulin?
what is the duration time for intermediate acting insulin?
1.5 - 4 hours
4 - 12 hours
12 - 18 hours
what is the onset time for long acting insulin?
what is the peak time for long acting insulin?
what is the duration time for long acting insulin?
0.8 - 4 hours
less defined or no pronounced peak
16 - 24 hours
can insulin be taken orally?
no, because it is inactivated by gastric juices
with glargine, you give the patient ____ units SQ at ____
with metformin HCl ER you give the patient ____ mg po daily
25; night
500 mg
IMPORTANT POINTS TO EMPHASIZE:
insulin can be kept at room temp for ___ weeks
unopened insulin should always be _____
when it comes to injections, the _____ has the fastest absorption rate, then the ____
inject the needle at a ___ angle or at a ___ angle if the patient is thin
4 weeks
refrigerated
abdomen; arm
90 degree angle; 45 degree
when it comes to nutrition therapy for diabetic patients you want to educate them to fill half their plate with ____, 1/4 of their plate with ___, and 1/4 of their plate with ____
also remind the patient to eat more ____ than ___
follow the 5:2 rule - 5 ___ and 2 ___ everyday
fruits and veggies; protein; complex carbohydrates
vegetables; fruits
vegetables; fruits
who is part of the nutrition therapy team?
nurse; medical team; registered dietician; and diabetes educator
how can we educate our type 2 diabetic patients on what to do on their “sick days”
always take your diabetes medications; check blood glucose at least 4x a day; record your levels for the doctor; check for ketones if your blood glucose is greater than 250
what are ketones?
ketone bodies are water soluble molecules produced by the breakdown of fat by the liver
the body breaks down fat into glycerol and fatty acids
what is the difference between ketosis and ketoacidosis?
KETOSIS:
low level of ketones in the body; normal process of the body; safe function of a low-carb ketogenic diet
KETOACIDOSIS:
extremely high levels of ketones; can turn the blood acidic; occurs in diabetics who don’t take enough insulin
with diabetics you want to emphasize ___ and ____
feet care; hygiene
some tips for footcare:
wash and inspect feet ____
don’t go ____
wear ___, ____ shoes
break in new shoes, ____ at a time
cut your toenails ____ and file the edges
daily
barefoot
comfortable; supportive
a little
straight across
what are some long-term complications of diabetes?
stroke; retinopathy; HTN; dermopathy; atherosclerosis; CAD; islet cell loss; gangrene; and infections
type 1 diabetes can cause _____
what are some signs and symptoms of diabetic ketoacidosis?
what is ketone breath?
diabetic ketoacidosis
blood glucose >250, poor skin turgor, dry mucous membranes, tachycardia, kussmaul breathing, and ketone breath
sweet, fruity breath
what are some nursing interventions for diabetic ketoacidosis?
your first goal of therapy will be to place IVs, then begin IV fluid treatment
(fluids they will receive would be 0.45% or 0.9% NS)
check glucose and potassium levels - insulin drives K+ into the cells which can cause life threatening hypokalemia
place the patient on a regular insulin drip (continuous infusion) 0.1 u/kg/hr
true/false: the patient will be given a KCl piggyback while they’re receiving the IVF fluids
true
MORE DKA NURSING INTERVENTIONS:
always monitor the patients ____ for fluid volume loss
assess the lungs for ____ for fluid overload
you’ll want to prevent rapid drops in glucose to help avoid ____
____ will be added to the patient’s fluids once the BS is around ____
intake/output
crackles
cerebral edema
D5 0.45%; 250 mg/dL
what type of diabetics can get diagnosed with hyperosmolar hyperglycemia?
what is the main difference between diabetic ketoacidosis and HHS?
occurs in type 2 diabetics
with hyperosmolar hyperglycemia the patient has enough circulating insulin so that ketoacidosis doesn’t occur
what causes hyperosmolar hyperglycemia syndrome?
UTIs, pneumonia, sepsis, or any acute illness
with hyperosmolar hyperglycemia, the blood sugars are able to become ____ before the problem is detected
usually, hyperosmolar hyperglycemia the blood sugars will be >____ before its detected
quite high
600 mg/dL
what are some s/s of hyperosmolar hyperglycemia?
blood sugar > 600 mg/dL; excessive thirst; dry mouth; increased urination; warm, dry skin; fever
nursing interventions for hyperosmolar hyperglycemia:
HHS is a ______ and has a ___ mortality rate
management is similar to that of diabetic ketoacidosis: ____ and ____
HHS patients usually require ____ of fluid than DKA patients
medical emergency
insulin; fluids
higher volumes of fluid
hyperosmolar hyperglycemic patients are often ___ and require ____ administration of IVFs in order to prevent fluid overload
older; slower administration
what types of fluid treatments do hyperosmolar hyperglycemic patients receive?
0.45% NS or 0.9% NS
patient will receive D5 once the patient’s BS is around 250mg/dL
if the hyperosmolar hyperglycemic patient is receiving a regular insulin drip, then you’ll want to monitor for ___ as it may drop rapidly
potassium
is hypokalemia significant with hyperosmolar hyperglycemia?
no, not as significant
what are some chronic complications of hyperosmolar hyperglycemic?
microvascular complications: thickening of the membranes in the capillaries
macrovascular complications:
diseases of the large blood vessels (cerebrovascular, cardiovascular, and peripheral vascular)
what is the cause of neuropathy?
what are the two types of neuropathy?
nerve damage or reduced nerve conduction and demyelination
sensory and autonomic
what are two types of microvascular chronic complications?
retinopathy and nephropathy
how do we treat nephropathy?
if there is albumin in the urine, we will treat with an ACE inhibitor or ARB
what is sensory neuropathy?
how can we treat it?
affects hands or feet – leads to loss of sensation or abnormal sensation (tingling, burning, or itching)
control the blood sugar, use of medications like topical creams, SSRIs, and anti-seizure medications
about ___ to ____% of diabetic patients will have some form of _____
60; 70
neuropathy
