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MED SURG II > exam 2 study guide > Flashcards

exam 2 study guide Flashcards

1
Q

prodromal stage of hepatitis ( PREICTERIC)

A
  • Begins 2 weeks after exposure
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2
Q

clinical manifestations of prodromal stage of hepatitis

A
  • HIGHLY INFECTIOUS
  • N/V
  • anorexia
  • diarrhea
  • weight loss
  • Fatigue, fever, flu like symptoms ends in ENDS IN JAUNDICE
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3
Q

ICTERIC ( JAUNDICE) phase of hepatitis

A
  • illness, JAUNDICE IS PRESENT

- Begins 1 week after prodromal phase and lasts up to 6 weeks

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4
Q

clinical manifestations of ICTERIC PHASE

A
  • Actual illness, JAUNDICE IS PRESENT
  • fatigue
  • RUQ pain
  • dark urine
  • clay colored stools
  • yellow sclera
  • pruritus
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5
Q

RECOVERY phase of hepatitis (POSTICTERIC)

A

Can last 2-12 weeks

  • Jaundice resolves
  • symptoms diminish
  • liver function return to normal
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6
Q

Management of hepatitis

REST! REST! REST!

A
  • based on the type they have
  • Nursing intervention for all patients with hepatitis: ACTIVITY RESTRICTION, REST AND NUTRITION
  • VACCINE: hep A and B = prevention
  • NO VACCINE FOR HEP C
  • Blood and body fluid precautions—any body fluid needs to be treated as infectious
  • antiemetics for nausea
  • Corticosteroidd becuase hepatitis can cause inflammation
  • Low fat/low sugar/low protein/high fiber/high calorie diet
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7
Q

HEPATITIS B AT RISK POPULATION

A
  • Men who have sex with men
  • Household contact of chronically infected = you are dealing with people with chronic illness, touching body fluids
  • hemodialysis patients
  • Health care and public safety workers
  • Transplant recipients

CAN BE TRANSMITTED PARENTALLY DURING BIRTH AND PERCUTANEOULSY

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8
Q

Hepatitis C: HEALTH HISTORY

A
  • Sexual behavior—high risk sexual behavior
  • Drug abuse, especially IV
  • Occupation exposure
  • Dialysis
  • Peritoneal exposure—dialysis
  • One peritoneal (peritoneum) and one via blood (hemodialysis)—dialysis
  • Blood transfusions before 1992
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9
Q

Hepatitis A: Heath teaching

A

FOCUS ON TRANSMISSION
- THROUGH FOOD: poor preparation, poor sanitary conditions, contaminated food and water

TRANSMITTED: ORAL FECAL ROUTE

  • you can get other hepaittis if you have 1- they are not transmitted the same way
  • Educate on hand-washing, food preparation, avoiding restaurants
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10
Q

what is cirrhosis

A
  • A chronic liver disease characterized by WIDESPREAD DESTRUCTION OF HEPATIC CELLS REPLACED BY FIBROUS CELLS (SCARING)
  • hepatitis can lead to cirrhosis but it doesnt have to

CIRRHOSIS IS MORE SEVERE

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11
Q

early and late cirrhosis

A

early cirrhosis = liver enlarged, firm and hard

late cirrhosis: shrinks in size

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12
Q

Medications for cirrhosis

A

Lactulose/CHEPHULAC: PO, NG tube, rectally

- Helps you go to bathroom through diarrhea/bowel movements
 Lower ammonia levels
 Assess hydration and electrolyte imbalance—> ASSESS NEURO STATUS

  • Aldactone/spironolactone: diuretic (K-sparing0
  • Maalox/mylanta: coats the stomach
  • Questran/cholestyrimine
  • Antivirals: if hepatitis is the cause
  • Beta blockers for portal hypertension
  • Coltrasine (USED FOR GOUT): not given to all patients with cirrhosis—but can help regenerate the liver
    • Used for gout
  • STEROIDS
  • Vasopressants for esophageal varices—to help avoid varices from bleeding
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13
Q

Hepatic Encephalopathy: (Hepatic Coma)

A

ALTERED MENTAL STATUS, FECTOR HEPATICUS, APRAXIA

  • liver is unable to covert ammonia (CNS toxin) into glutamine leading to INCREASED SERUM AND CEREBRAL AMMONIA LEVEL
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14
Q

Prodromal stage of hepatic encephalopathy

A
  • Subtle changes-
  • FORGETFULLNESS
  • DISORIENTED
  • CANNOT SLEEP
  • SLIGHT TREMOR
  • DIMINISHED AFFECT
  • SLURRED SPEECH
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15
Q

Impending stage of hepatic encephalopathy

A
  • Tremor progresses into asterixis (hallmark of hepatic coma)
  • lethargy
  • wandering behavior
  • apraxia = loss of ability to carry out learned movements)
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16
Q

Stuporous stage of hepatic encephalopathy

A
  • Hyperventilation
  • stunned
  • confused
  • slow to react
  • difficult to arouse but when aroused can be abusive and combative
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17
Q

Comatose stage of hepatic encephalopathy

A
  • Hyperactive reflexes
  • positive Babinski sign
  • fector hepaticus, coma
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18
Q

Lab values of CAD ACS

A

cardiac enzymes = troponin

  • Ck-MB
  • Myoglobin
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19
Q

Modifiable risk factors of CAD AND ACS

A
  • elevated serum lipids
  • HTN
  • smoking
  • obesity
  • physical inactivity, - DM
  • Diet
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20
Q

Diet for cardiac patients

A

–↓ Saturated fats and cholesterol

  • ↑ Complex carbohydrates and fiber
  • ↓ Red meat, egg yolks, whole milk
  • ↑ Omega-3 fatty acids.
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21
Q

o Non-modifiable risk factors of CAD ACS

A
  • Age
  • Gender
  • Ethnicity
  • Family history
  • Genetic predisposition
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22
Q

treatment of CAD and AC

A
  • 12-lead ECG
  • Upright position
  • Oxygen – keep O2 sat > 93%
  • V access, Nitroglycerin (SubLingual)
  • ASA (chewable)
  • Statins
  • Morphine
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23
Q

• Stable angina intervention

A
  • Medications
  • Oxygen
  • Reduce and control risk factors
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24
Q

o Medications for CAD

A
  • Nitroglycerin
  • Beta-adrenergic blocking agents
  • Calcium channel blocking agents
  • Antiplatelet and anticoagulant medication
  • Aspirin
  • Clopidogrel and Heparin
  • Lipid lowering drugs
  • Sodium current inhibitor
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25
Q

what does ACS branches off to

A

unstable angina and Non-ST segment elevation MI or ST –segment elevation MI

Unstable Angina and NSTEMI/STEMI

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26
Q

treatment of NSTEMI

A

reperfusion therapy

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27
Q

treatment choice for confirmed STEMI

A
  • Emergent Percutaneous Coronary Intervention (PCI)

- Goal: 90 minutes from door to catheter laboratory and Balloon angioplasty + stent(s)

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28
Q

Thrombolytic therapy (STEMI)

A
  • Only for patients with a STEMI
  • Agencies that do not have cardiac catheterization resources
  • Given IV within 30 minutes of arrival to the ED
  • Patient selection critical
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29
Q

Any patients admit to cardiac unit with chest pain must be

A

attach to the cardiac monitor first

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30
Q

• Any dysrhythmias on the monitor…

A

check the patient first and assess them for the cause

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31
Q

• If patient not much responsive, what do you check for

A
  • check for pulse

- always check the nearest pulse to the heart—that is the CAROTID ARTERY

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32
Q

who’s sicker, unstable angina and stable angina who are both complaining of chest pain

A

the unstable angina is more sicker

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33
Q

The 6 P’s to Neurovascular Assessment

A

Pain, pallor, pulse, Paresthesia(numbness and tingling)

  • paralysis
  • poiklothermic(affected extremity is cold to touch)
34
Q

STEMI—cath lab-baloon angioplasty

A

after procedure, keep for FEMORAL ARTERY

—keep leg straight, distal pulses, site for bleeding

35
Q

Morphine indications for CAD ACS

A
  • reduce myocardium o2 demand
  • relieve pain
  • reduce anxiety
36
Q

Simvaststin CAD ACS

A
  • do not miss a dose
  • muscle pain side effect
  • monitor liver function test
37
Q

o Nitroglycerine CAD ACS

A
  • vasodilation and reduce pre load

- call ems if no relieve in pain after taking S/L nitro

38
Q

what is HEART FAILURE

A

A clinical syndrome resulting from structural or functional cardiac disorders that impair the ability of the ventricles to fill or eject blood

39
Q

• Clinical manifestations of LEFT heart failure

A
  1. Pulmonary congestion, crackles
  2. S3 or “ventricular gallop”
  3. Dyspnea on exertion (DOE)
  4. Low O2 sat
  5. Dry, nonproductive cough initially
  6. Oliguria
40
Q

• Clinical manifestations of RIGHT heart failure

A
  • Viscera and peripheral congestion
  • Jugular venous distention (JVD)
  • Dependent edema
  • Hepatomegaly
  • Ascites
  • Weight gain
41
Q

o Priority interventions OF HEART FAILURE

A

Medications
Diet: low-sodium diet and FLUID RESTRICTION.
Foods to avoid- cold cuts, Broths and stocks, canned foods

42
Q

Foods to avoid HEART FAILURE

A
  • cold cuts
  • Broths and stocks
  • canned foods
43
Q

PATIENT TEACHINGS HEART FAILURE

A
  • Monitoring for signs of excess fluid, hypotension, and symptoms of disease exacerbation, including daily weight
  • Exercise and activity program
  • Stress management
  • Prevention of infection
  • Know how and when to contact health care provider
  • Include family in education
44
Q

• Drugs FOR HEART FAILURE

A

o Angiotensin-converting enzyme (ACE) inhibitors: vasodilation; diuresis; decreases afterload; monitor for hypotension, hyperkalemia, and altered renal function; cough
o Angiotensin II receptor blockers: prescribed as an alternative to ACE inhibitors; work similarly
o Hydralazine and isosorbide dinitrate: alternative to ACE inhibitors
o Beta-blockers: prescribed in addition to ACE inhibitors; may be several weeks before effects seen; use with caution in patients with asthma
o Diuretics: decreases fluid volume, monitor serum electrolytes Side effect of Lasix—low potassium, so must be on k supplement—potatoes, orange juice, banana

o Digitalis: improves contractility, monitor for digitalis toxicity especially if patient is hypokalemic
o IV medications: indicated for hospitalized patients admitted for acute decompensated HF
o Milrinone: decreases preload and afterload; causes hypotension and increased risk of dysrhythmias
o Dobutamine: used for patients with left ventricular dysfunctio

45
Q

Digitalis

A

improves contractility, monitor for digitalis toxicity especially if patient is hypokalemic

46
Q

Milrinone

A

decreases preload and afterload; causes hypotension and increased risk of dysrhythmias

47
Q

Dobutamine

A

used for patients with left ventricular dysfunction

48
Q

nursing diagnosis for heart failure

A
  • if cannot do ADLS = activity intolerance related to fatigue
  • If cannot breath = fluid overload
49
Q

Any Heart Failure

A

Lasix/other name is furosemide

  • oxygen should result in less dysnpea and increase output
50
Q

o Who to see first heart failure

A
  • If patient health detroiating, O2 sat dropping
51
Q

Sinus tachycardia what to assess

A

Assess the patient for possible causes

52
Q

Vtach on monitor

A
  • pt unresponsive

- check pulse-carotid

53
Q

• Supra ventricular tachycardia

A

if symptomatic—vagal stimulation

• If non symptomatic = observe and monitor the rhythm

54
Q

• Atrial Fibrillation

A

irregular pulse with high rate

55
Q

• Which patient to see first dysrythmia

A

pulseless rhythms

  1. Ventricular fibrillation
  2. Asystole
  3. Ventricular tachycardia with no pulse
  4. Pulseless electrical activity( PEA)
56
Q

what hepatitis can ANTIVIRALS CAN BE USED

A
  • peg interferon and ribavirin

MOST OFTEN USED FOR HEPATITIS C

  • FOR HEPATITIS B ONLY IF IT IS SEVERE
57
Q

• Esophageal varices

A
  • These are enlarged veins in the esophagus, and they are at greater risk for rupturing—patient can bleed out
58
Q

Balloon tamponade ( Sengstaken-blakemore tube ) Esophageal varices

A
  • Exert pressure at the bleeding site

- Used for 24 hours

59
Q

Clinical manifestations OF HEPATITIS

A

o Increased AST and ALT (liver function)
o Jaundice
o Pruritus
o RUQ tenderness
o Anorexia
o fatty stools/steatorrhea
o dark urine
o pleural effusion (build up of fluid in up of fluid in belly
o asterixis (flapping tremor)
o Hallucinations
o bleeding and bruising tendencies
o spider Angiomas—blood vessels that look like spider webs (often on trunk, can be on face), TPI (purple spots on body)
o ascites
o fetor hepaticus (rotten egg smell in breath, or fruity—smell is a result of breakdown of ammonia and other toxins)
o gallstones
o esophageal varices—engorgement of veins
o decreased albumim
o increased ammonia—>can lead to hepatic encephalopathy from high ammonia level
o Elevated bilirubin
o prolonged pTT
o portal hypertension

60
Q

Thrombocytopenia lab values

A

Normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood

  • More than 450,000 platelets is a condition called thrombocytosis; having less than 150,000 is known as thrombocytopenia
61
Q

Heparin Induced Thrombocytopenia (HIT)

A
  • Associated with increased use of heparin
  • Life-threatening
  • platelet count drops 50% from baseline
  • venous thrombosis can also develop
  • DVT and PE often results
62
Q

o Two major responses to an immune-mediated response to heparin

A
  • Platelet destruction and platelet count going below normal level after being on heparin or 5-10 days and Vascular endothelial injury
  • o Discontinue any heparin infusion, sub cutaneous heparin, heparin flushes
63
Q

Immune Thrombocytopenic Purpura (ITP)

A

Most common acquired thrombocytopenia, syndrome of abnormal destruction of circulating platelets, and primarily an autoimmune disease

Tretament: High doses of IV immunoglobulin (IVIG) and anti-Rho(D)

64
Q

Platelet transfusions

A

Platelet transfusions are generally not recommended until the count is below 10,000/μL (10 × 109/L) unless the patient is actively bleeding

65
Q

sign and symptoms of thrombocytopenia

A

Petechiae – micro hemorrhages
Purpura – bruise from numerous petechiae
Ecchymoses – larger lesions from hemorrhage

66
Q

• Nursing considerations for thrombocytopenia

A

teaching risk factors
Use electric razor, soft brush, no clippers and trimmers that is electric, avoid injection if can, no regular razor, no contact sport—increase risk for bleeding,

67
Q

drugs for patients with chronic ITP

A
  • Romiplostim (Nplate) and eltrombopag (Promacta)

- Direct thrombin inhibitors

68
Q

antifibrinolytic agent drugs used for severe bleeding

A
  • Aminocaproic acid (Amicar) =
69
Q

thromobocytopenia Precaution

A
  • When the count drops below 20,000/μL (20 × 109/L), spontaneous, life-threatening hemorrhages (e.g., intracranial bleeding) can occur. Patient can become lethargic and difficult to arouse
70
Q

• High risk behaviors for HIV

A

o Patient teaching for the adolescent and young adult populations is prevention of HIV transmission between sexual partners

71
Q

• Transmission fo HIV

A
  • through contact with certain body fluids

Blood, semen, vaginal secretions, and breast milk

72
Q

• Diagnostic tests for HIV

A

HIV-specific antibodies and/or antigens

73
Q

what is used to measure the presence of HIV vital genetic material in the blood

A

CD4 count (normal: 800 to 1200 cells/μL)

  • A positive viral load test can measure as few as 40 particles/mL
  • High viral loads can be greater than 80,000 HIV particles/mL
74
Q

• Lab values of HIV

A
  • Immune problems start when CD4+ T cell counts drop to less than 500 cells/μL
  • Severe problems develop when less than 200 CD4+ T cells/μL
75
Q

• Opportunistic Infections

A

Insufficient immune response allows for opportunistic diseases

76
Q

• Complications of HIV

A
  • If left untreated, a diagnosis of AIDS (Acquired immunodeficiency syndrome ) is made about 10 years after initial HIV infection.
  • CD4+ T cells decline closer to 200 cells/μL. Symptoms become worse. HIV advances to a more active stage
77
Q

• Symptomatic infection of HIV

A

Shingles, Persistent vaginal candidal infections, Oral or genital herpes, Bacterial infections

• Immune system severely compromised: Infections, Malignancies, Wasting and HIV-related cognitive changes

78
Q

• When does one develop AIDS

A

CD4+ T-cell count of less than 200 cells/µL.

79
Q

• What is needle exchange program

A

safer options to use injectable illegal drugs

80
Q

Nursing interventions while caring for patient with HIV

A

help patient to vent their feelings and listen to them

81
Q

• Meds teachings for HIV

A

o Most important factor- Patient’s ability to follow a complex medication regimen
o HAART – the effectiveness of antiretroviral therapy (ART) look at the viral load
o General side effects- Diarrhea, Peripheral neuropathy, Pain, Nausea/vomiting, Fatigue

o Patient teaching - not to miss any dose

• Who to assess first?—whose health is being compromised

82
Q

General side effects of HIV meds

A

Diarrhea, Peripheral neuropathy, Pain, Nausea/vomiting, Fatigue

o Patient teaching - not to miss any dose

MED SURG II (7 decks)

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