2800 Exam Three Flashcards
(325 cards)
1
Q
GERD
A
Gastroesophageal reflux disease
Mucosal damage caused by reflux of acid into the esophagus
2
Q
What are some things that affect lower esophageal sphincter pressure?
A
Meds like bethanechol and metoclopramide
Things like alcohol, chocolate, fatty foods, nicotine, and tea
3
Q
What are clinical manifestations of GERD?
A
Heartburn Dysphasia Dyspepsia Regurgitation Respiratory symptoms Hoarse voice
4
Q
What are complications associated with GERD?
A
Chronic cough Worsening asthma Sleep disruption Esophageal strictures Respiratory complaints Esophagitis Barrett’s esophagus
5
Q
Esophagitis
A
Inflammation of the esophagus that causes ulceration and scar tissue formation
6
Q
Barrett’s esophagus
A
Metaplasia of esophageal cells. A precancerous condition that increases risk for esophageal cancer
7
Q
What are some lifestyle changes that can help with GERD?
A
Avoid factors that trigger symptoms
Weight loss
Stress management
Smoking cessation
8
Q
What are some nutrition suggestions for patients with GERD?
A
Avoid foods that irritate esophagus (like fat, chocolate, citrus fruits, caffeine, etc)
Avoid foods that decrease LES pressure
Avoid eating late evening meals
Have small frequent meals
9
Q
How long should patients with GERD stay upright after eating?
A
2-3 hours
10
Q
How should patients with GERD try sleeping?
A
With head elevated (possibly putting blocks under mattress to prop up head)
11
Q
Clothing recommendation for GERD patients?
A
Avoid tight clothes and belts
12
Q
PUD
A
Peptic ulcer disease
Open sores in stomach or intestines caused by the erosion of GI mucosa due to the action of pepsin and hydrochloric acid
13
Q
What is a chronic ulcer?
A
An ulcer that has been there for a long time and eroded through muscular wall with the formation of fibrous tissue
14
Q
What usually causes a chronic ulcer?
A
H. Pylori or chronic NSAID use
15
Q
What are clinical manifestations of PUD?
A
Burning epigastric pain 1-2 hours after meals Aggravated by food Cramplike pain Bloating Belching
16
Q
What are some complications associated with PUD?
A
Hemorrhage from ulcers
Perforation of an ulcer
Gastric outlet obstruction caused by fibrous tissue
17
Q
What can gastric outlet obstruction with PUD cause?
A
Edema
Inflammation
Pylorospasm
Scar tissue formation
18
Q
What are therapies and recommendations for those with PUD?
A
Rest Smoking cessation Diet modification Drug treatment Stress management
19
Q
What are health promotion interventions for PUD?
A
Early detection Effective treatment Having patients take NSAIDs with food Rest Stress reduction
20
Q
What would be considered an emergency situation with PUD?
A
Throwing up blood or any other sign of GI bleeding
21
Q
What is a potential surgery for those with PUD?
A
Partial gastrectomy (removing part of the stomach)
22
Q
What complication can a partial gastrectomy commonly cause?
A
Dumping syndrome
23
Q
Explain dumping syndrome
A
Stomach loses control of the gastric chyme entering the stomach, allowing the hypertonic fluid to enter the intestine. This draws lots of water into the bowel, and everything moves through the GI tract very rapidly
24
Q
What are symptoms of dumping syndrome?
A
Weakness Dizziness Sweating Palpitations Cramps Excessive abdominal sounds Urge to defecate
25
What can reduce the chance of dumping syndrome?
```
Rest after meals
Have smaller, more frequent meals
Drink fluids before meals
Avoid concentrated sweets
Increase protein and fat intake
```
26
Constipation
Difficult, infrequent, hard to pass stools or feeling of incomplete evacuation
27
What are manifestations of constipation?
Hard, dry, absent, or difficult to pass stools
Bloating
Abdominal distension
Increased flatulence and rectal pressure
Hemorrhoids
28
What often causes constipation in children?
```
Fear
Stress
Environmental changes
Normal development
Deliberately holding it, especially when potty training
```
29
What is encopresis?
When a child resists having a bowel movement
30
What can encopresis cause?
Impaction or fecal incontinence
31
What are valsalva maneuvers?
Straining to evacuate
32
Why are valsalva maneuvers serious?
They can lead to hemorrhoids
It can also decrease venous return to the heart due to increasing abdominal pressure. When pressure releases, the increased return to the heart is hard on the heart and can cause lightheadedness, syncope, or even death
33
What are some important teachings related to constipation?
```
Fiber and fluid intake
Regular exercise
Keep a log of BMs
Regular time to defecate
Avoid laxatives
Don’t delay defecating if you need to go
```
34
What is inflammatory bowel disease?
Chronic inflammation of the GI tract with periods of exacerbation and remission
35
Ulcerative colitis
IBD that’s limited to the colon, usually in the mucosal layer
36
Who are some at risk populations to develop ulcerative colitis?
Adolescents
Those living in developed/industrialized countries
Those with family history of it
37
Crohn’s disease
IBD that can involve any segment of the GI tract from the mouth to the anus
38
What abnormal GI developments are common with Crohn’s disease?
Strictures and fistulas
39
Clinical manifestations of IBD
```
Diarrhea
Weight loss
Abdominal pain
Fever
Fatigue
Rectal bleeding
Anemia
Dehydration
Blood in stool
Skin breakdown around perineum
```
40
What are some GI complications of IBD?
```
Hemorrhage
Perforation
Abscesses
Fistulas
Toxic megacolon
```
41
What are some systemic complications of IBD?
Anemia
Nutritional deficiencies
Colorectal cancer risk
42
What are potential surgical options for IBD?
Resection of diseased area with reanastamosis of remaining intestine
Strictureplasty to open narrow areas
Proctocolectomy with creation of an ostomy bag
43
What are some nutrition considerations for patients with IBD?
High calorie/vitamin/protein
Low residue and lactose
Iron and vitamin D supplementation
Elemental or parenteral nutrition may be needed
44
What nursing interventions will be priority for patients with IBD?
```
Fluid and electrolyte balance
Nutrition assessment
Energy conservation
Anemia correction
Diarrhea control and skin care
Stress management
```
45
What does the acronym DRIP tell us about?
Causes of incontinence
46
DRIP acronym
D: delirium, dehydration, depression
R: restricted mobility, rectal impaction
I: infection, inflammation, impaction
P: polyuria, polypharmacy
47
Best intervention for stress incontinence
Pelvic strengthening exercises
48
Best intervention for urge incontinence
Bladder retraining
49
Best intervention for overflow incontinence
Catheterization
50
Best intervention for reflex incontinence
Self-catheterization
51
What is reflex incontinence?
No warning before incontinent episode occurs
52
Best intervention for functional incontinence?
Getting to the patient quickly and frequent toileting
53
What kind of incontinence do men usually have?
Overflow incontinence due to BPH
54
What kind of incontinence do women usually have?
Stress and urge incontinence due to childbirth and weak pelvic floor muscles
55
What are some complications of incontinence?
UTI’s
Insomnia
Social isolation
Skin breakdown
56
What are some lifestyle modifications that can help with incontinence?
```
Smoking cessation
Weight reduction
Reduction of bladder irritants
Alcohol avoidance
Good bladder schedule
```
57
What are some common bladder irritants?
Caffeine
Aspartame
Citrus
58
What is timed voiding?
Toileting on a fixed schedule (usually every 2-3 hours)
59
Should patients struggling with incontinence reduce their fluid intake?
No, because that increases UTI risk
60
What are some examples of pelvic floor muscle rehabilitation?
Kegel exercises
Vaginal weight training
Biofeedback
Electrical stimulation
61
When can one expect to see changes with pelvic floor muscle exercises?
Within 4-6 weeks
62
What are kegel exercises?
Tightening and relaxing pelvic floor muscles to build strength. Usually done 40-50 times per day
63
What are containment devices?
Catheters (or condom catheters or female urethral inserts)
| Absorbent pads
64
What is BPH?
Increased size of prostate gland due to increased cell proliferation. Leads to urinary retention
65
What are the irritative symptoms of BPH?
Inflammation, infection, nocturia, frequency and urgency, dysuria, bladder pain, incontinence
66
What are obstructive symptoms of BPH?
Decreased caliber and force of urine stream, intermittent urine, dribbling urine
67
What are potential complications of BPH?
Acute urinary retention
UTI
Hydronephrosis
68
What does Inter professional care for BPH look like?
Drug treatment
| Minimally invasive or surgical therapy
69
What is a TURP?
Transurethral resection of the prostate, which is a minimally invasive procedure and the current most effective intervention for BPH
70
What is the most common cause of decreased output during post-op continuous bladder irrigation?
Blood clots
71
When should men get PSA screenings?
Every two years after age 55
72
What are some health promotion considerations relating to BPH?
PSA screenings
Avoiding caffeine and bladder irritants if they’re an issue
Urinating every 2-3 hours
Adequate fluid intake
73
What are post-operative care considerations when clients have surgery for BPH?
Catheter care
| Bladder irrigation
74
What complications can occur after BPH surgery?
Hemorrhage
Bladder spasms
Urinary incontinence
Infections
75
What is continuous bladder irrigation?
Continuous flushing of the bladder with saline to remove clotted blood and ensure drainage
76
What should the nurse do if outflow is less than inflow with CBI?
Assess patency of tube
| If blocked, stop the infusion and call the doctor
77
What causes bladder spasms?
Irritation of the bladder mucosa from the surgical process
78
What can relieve pain from bladder spasms and decrease the spasms?
Not urinating around the catheter
Using antispasmodics
Relaxation techniques
79
What are some potential changes in sexual function after prostate surgery?
ED
Retrograde ejaculation
Anxiety
80
How long may it take for complete sexual function to return after prostate surgery?
Up to one year
81
How long may it take for the bladder to return to normal capacity after prostate surgery?
Up to 2 months
82
What interventions can help patients regain continence after prostate surgery?
Drink 2-3 liters of fluid daily
Urinate every 2-3 hours
Avoid bladder irritants
83
What are some teaching points when sending a patient home after prostate surgery?
Catheter care
Incontinence management
Maintain fluid intake (2-3 liters/day)
Observe for signs and symptoms of infection
Prevent constipation
Avoid lifting/driving/sexual intercourse for specified amount of time
84
What is cirrhosis?
A chronic progressive disease of the liver. Cirrhosis is end stage liver disease, where there is extensive degeneration/destruction of liver cells
85
What are the most common causes of cirrhosis?
Chronic hepatitis C and alcohol-induced liver disease
86
What is cardiac cirrhosis?
Hepatic derangement due to long term right sided heart failure
87
What are early assessment findings with cirrhosis?
Fatigue
| Enlarged liver
88
What are some dermatologic manifestations of cirrhosis?
Jaundice
| Spider angiomas
89
Why does jaundice happen in liver failure?
Buildup of bilirubin due to decreased ability to conjugate and excrete bilirubin into the small intestine
90
What are spider angiomas?
Small, dilated blood vessels with a bright red center and spider-like branches. Often happen on face and neck
91
What are hematologic problems common in cirrhosis?
Thrombocytopenia
Leukopenia
Anemia
Coagulation issues
92
Why is anemia an issue in cirrhosis?
Inadequate RBC production
Poor diet/malnutrition
Poor folic acid absorption
Bleeding from varices
93
Why are there coagulation issues with cirrhosis?
Liver is unable to produce prothrombin and other clotting factors
94
What is a normal PT level/time?
11-13.5 seconds
95
How is PT changed with cirrhosis?
Increased/longer PT
96
What are common manifestations of coagulation problems with cirrhosis?
```
Epistaxis
Púrpura
Petechiae
Easy bruising
Gingival bleeding
Heavy menstrual bleeding
```
97
What is portal hypertension?
Increased venous pressure in portal circulation due to blood flow obstruction
98
What can portal hypertension cause?
Splenomegaly
Esophageal varices
Ascites
99
What are esophageal varices?
Complex of enlarged veins at the lower part of the esophagus that are very fragile and can rupture easily
100
What is the most life-threatening complication of liver failure?
Bleeding from varices
101
Why is peripheral edema an issue in cirrhosis?
Decreased oncotic pressure from impaired albumin synthesis and increased pressure from portal hypertension
102
What is ascites?
Accumulation of serous fluid in peritoneal or abdominal cavity due to portal hypertension and hypoalbuminemia
103
What is encephalopathy?
Neuropsychotic manifestation of cirrhosis due to increased ammonia and inflammation. Causes confusion and other mental changes
104
What is asterixis?
Flapping tremors unique to cirrhosis. Patient cannot hold out arms and hands without hand flapping up and down
105
What are nutritional recommendations for ascites?
```
Low sodium
Low fat
High carb
Possible protein restriction
Folic acid supplements
```
106
Why might protein restriction be needed after ascites flare ups?
Protein can cause increased ammonia buildup
107
What medications could help with ascites?
Diuretics
108
What surgical procedure is often used for ascites?
Parecentesis
109
What is the goal of management of hepatic encephalopathy?
Reduction of ammonia formation (lactulose)
110
What can be done to prevent cirrhosis?
Abstaining from alcohol
| Adequate nutrition for at risk individuals
111
What can help cirrhosis patients manage anorexia/nausea/vomiting?
Oral hygiene
| Having snacks and favorite foods available for when the patient is hungry
112
What can be done to help cirrhosis patients with pruritis?
```
Baking soda
Bath oils
Calamine lotion
Antihistamines
Short nails to prevent scratching injury
```
113
What might stool and urine look like for cirrhosis patients?
Dark brown urine
| Gray/tan stool
114
What position would help with dyspnea due to ascites?
Semi-Fowler’s or Fowler’s
115
What are some interventions to help with skin care for cirrhosis patients?
Alternating air pressure mattress
ROM
Elevating lower extremities
Frequent moving and repositioning
116
What do we teach cirrhosis patients about activity and rest?
Strength conservation and adequate rest are crucial
117
What are assessment findings of type one diabetes?
```
Polyuria
Polyphagia
Polydipsia
Weakness
Fatigue
DKA
```
118
What are assessment findings for type two diabetes?
```
Slow healing
Fatigue
Recurrent infections
Visual changes
3Ps
```
119
What are collaborative interventions for diabetic clients?
```
Eye exam
Dental exam
Neuro exam
Podiatry
Kidney function monitoring
```
120
What are recommendations for carbs for diabetics?
Monitor carbs by carb counting or exchange lists
121
What all counts as carbs for the diabetic patients?
```
Fruits
Veggies
Grains
Legumes
Low fat milk
```
122
What are recommendations for fat intake for diabetic patients?
Minimize trans fats and saturated fats
Limit cholesterol to less than 200 mg/day
2 or more servings of fish per week
123
What are protein recommendations for diabetic patients?
Usually individualized to the patient, but high protein for weight loss is usually not recommended
124
What are recommendations for alcohol intake for diabetic patients?
Limited to moderate intake: max one per day for women or two per day for men
Drink with food
125
What can drinking alcohol on an empty stomach cause in a diabetic and why?
Hypoglycemia, because the liver is busy processing the alcohol and cant do glycogenesis
126
How do diabetic exchange lists work?
Patient gets to choose specific number of helpings of food items per meal or snack
127
What are teaching points related to exercise for diabetic patients?
Doesn’t have to be strenuous to be effective
Exercise after eating
Wear good footwear
Warm up and cool down properly
Monitor blood glucose before, during, and after exercise
128
What are chronic complications associated with diabetes?
```
Stroke
Hypertension
Dermopathy
CAD
Nephropathy
Atherosclerosis
Gastroparesis
Neuropathy
Infection
Gangrene
Neurogenic bladder
Erectile dysfunction
```
129
What can prevent diabetic retinopathy?
Annual eye exam
| Blood sugar and hypertension control
130
What can be done to prevent nephropathy in diabetes?
Annual screening and aggressive control of BP and blood glucose
131
Sensory neuropathy
Affects PNS (hands/feet bilaterally) causing numbness, tingling, and pain
132
Autonomic neuropathy
Can affect all body systems, causing things like diarrhea, incontinence, urinary retention, and postural hypotension
133
What are important teachings related to diabetic foot care?
```
Wash daily with soap and warm water
Pat dry
Examine daily for breaks in skin or injuries
Prevent cracking
Avoid open toed shoes
Don’t go barefoot
Don’t cut off circulation
```
134
What can be done to minimize complications of infection in diabetics?
Prompt and vigorous treatment
Hand hygiene
Avoiding sick people
Annual vaccines
135
What should diabetics know about medical identification and travel?
Wear a medical alert band
Plan ahead for travel
Get up and take a walk every couple hours if sitting for a long time
Bring all labels for meds and medical equipment
136
What are gerontologic considerations for clients with diabetes?
Over 25% of those over 65 have it with higher rates of death and complications
More likely to be unaware of hypoglycemia
Many more comorbidities in these patients
137
What is hyperthyroidism?
Hyperactivity of thyroid (increased TH synthesis and release)
138
What is Graves’ disease?
Autoimmune disease characterized by thyroid enlargement and excess TH secretion
139
In whom and when does Graves’ disease most often develop?
Women between the age of 20 and 40
140
What are clinical manifestations of hyperthyroidism?
```
Goiter
Increased HR
Hypertension
Increased appetite
Weight loss
Thin nails
Hair loss
Dyspnea/increased RR
Nervousness
Restlessness
Diarrhea
Heat intolerance
```
141
What is exophthalmos?
Bilateral protrusion of eyeballs from their orbits that is often present in hyperthyroidism
142
What can be complications of exophthalmos?
Double vision
Corneal ulcers
Vision loss
143
What is a goiter and when is it seen?
Enlarged thyroid gland seen in hyper/hypothyroidism
144
What is a crisis complication of hyperthyroidism? How does it present?
```
Acute thyrotoxicosis (thyroid storm)
S/S: tachycardia, HF, agitation, delirium, seizures, increased BP, bounding pulse, nervousness, tremors, attention issues
```
145
What are potential therapies for hyperthyroidism?
Radioactive iodine
Surgical treatment
Drugs (beta blockers, anti thyroid drugs)
146
What are nutrition recommendations for hyperthyroidism?
```
High calorie (often 4000-5000 calories/day)
High protein
Frequent meals
Increase carbs
Avoid high fiber and spicy foods (increased diarrhea risk)
Drink a lot of fluids
Avoid caffeine
Adequate iodine intake
```
147
What is hypothyroidism?
Deficiency of thyroid hormone that causes metabolic slowing
148
What are manifestations of hypothyroidism?
```
Fatigue
Lethargy
Impaired memory
Slowed speech
Weight gain
Decreased cardiac output
Dry skin
Constipation
Low activity tolerance
```
149
Why is myxedema?
Serious adult hypothyroidism that alters physical appearance, causing puffiness, edema, and a mask-like effect
150
What are collaborative cares for patients with hypothyroidism?
TH replacement (lifetime therapy)
Monitor TH levels
Nutritional therapy
Teaching
151
What should ambulatory clients with hypothyroidism know to report to their provider?
Signs of overdose on TH (will look like hyperthyroidism)
152
When should thyroid replacement drugs be taken?
In the morning before food
153
What else should hypothyroidism patients be taught?
Take measures to prevent skin breakdown
Avoid sedatives
Take measures to minimize constipation
Avoid enemas
154
What is cancer?
Group of diseases characterized by uncontrolled and unregulated cell growth
155
What are the most common types of cancer for men?
Prostate
Lung
Colon
156
Most common types of cancer for women?
Breast
Lung
Colon
157
What are the priorities of the nursing role as relates to cancer?
Screen for cancer
Help individuals decrease cancer risk
Help patients comply with cancer treatment
Help patients and families cope with diagnosis
158
What are carcinogens?
Cancer causing agents like chemicals, radiation, or viruses that are capable of producing cell alterations
159
What is metastasis?
Rapid growth of a primary cancer tumor leading to cancer spread to other sites in the body
160
What is the difference between benign and malignant neoplasms?
Benign: well-differentiated tumor
Malignant: less differentiated, more likely to metastasize
161
Why is tumor classification important?
```
To facilitate standardized communication
To assist in determining treatment
To help with treatment evaluation
Prognosis prediction
Comparison between similar cancers
```
162
What is staging (of cancers) and why is it important?
Classifying cancer by extent of the disease
163
What is a biopsy?
A pathology evaluation of part of a tumor to see whether it is benign or malignant and to begin to plan treatment options
164
What are the three treatment goal options for patients with cancer?
Cure
Control
Palliation
165
What does “late effects” mean when it comes to cancer?
Effects that can occur as a side effect of cancer treatment even years after treatment has ended
166
What are some examples of late effects?
```
Strictures
Fistulas
Radiation necrosis
Cardiac toxicity
Cataracts
Renal insufficiency
Hepatitis
Osteoporosis
Skin cancer
Neurocognitive dysfunction
```
167
What is the primary cause for all lung cancers?
Smoking
168
What are other common causes of lung cancer?
Pollution
Radiation
Asbestos
169
How will lung cancer often present itself?
It will appear as a chronic pneumonia that is not responsive to treatment
170
What are some other presenting manifestations of lung cancer?
```
Often nonspecific symptoms
Persistent cough
Dyspnea
Wheezing
Chest pain
```
171
What can be unique about the chest pain associated with lung cancer?
It is often localized or on only one side of the body
172
What causes the later manifestations of lung cancer?
Metastasis of cancer
173
What are some later manifestations of lung cancer?
```
Anorexia
Fatigue
Weight loss
N/V
Hoarseness
Dysphagia
Palpable lymph nodes
Oxygenation issues
```
174
What test is needed for definitive diagnosis of lung cancer? How is it obtained?
Biopsy of cancerous area, obtained by bronchoscopy
175
What are screening recommendations for lung cancer?
Annual screening in those between 55 and 80 with a smoking history
176
What does a 30 pack year history of smoking mean?
One pack a day for 30 years
177
How long can it take for lung cancers to grow enough to become visible on x-ray?
8-10 years
178
What are nursing interventions to help prevent lung cancer?
Smoking prevention or cessation
| Modeling healthy behaviors
179
What are some treatments for lung cancer?
```
Surgical removal of tumor
Radiation
Chemo (for non-resectable tumors)
Targeted therapy
Immunotherapy
```
180
What symptoms should lung cancer patients report to their provider?
```
Hemoptysis
Dysphagia
Chest pain
Hoarseness
Severe pain
```
181
What are lymphomas?
Malignant neoplasms in bone marrow and/or lymphatic structures that causes disruption of proliferation of WBCs
182
What is Hodgkin’s lymphoma?
Proliferation of abnormal giant lymphocytes with multiple nuclei located in the lymph nodes
183
What are the abnormal multi-nucleated cells indicative of HL called?
Reed-Sternberg cells
184
What are assessment findings for patients with Hodgkin’s lymphoma?
Enlarged cervical, auxiliary, or inguinal lymph nodes that are often movable and non-tender
Weight loss
Fatigue
Weakness
Fever
Tachycardia
Alcohol induced pain at the site of disease
185
What are “B symptoms” of Hodgkin’s lymphoma?
Fever
Drenching night sweats
Weight loss
186
What do care options for HL look like?
Least amount of treatment to achieve a cure, usually chemo and/or radiation
187
What are secondary cancers?
Cancers occurring ten or more years after Hodgkin’s lymphoma (often lung, breast, or skin cancer)
188
What are some things the nurse will need to manage with Hodgkin’s lymphoma?
```
Pain
Side effects
Pancytopenia
Emotions/coping
Evaluating long term effects
```
189
What is non-Hodgkin’s lymphoma?
The most commonly occurring blood cancer; a heterogenous group of malignant neoplasms
190
Lymphadenopathy
Swelling of lymph nodes
191
What are clinical manifestations of NHL?
Painless lymph node enlargement
Symptoms in the area where the disease has spread
Other similar symptoms to HL
192
When B symptoms are likely to be found in NHL?
High grade lymphomas in the leukemic phase
193
What types of treatment are used for NHL?
Chemo
Radiation
Antibiotic or antivirals if basis is infection
194
What are some nursing considerations for managing NHL?
```
Managing problems related to the disease or side effects of treatment
Understanding disease progression
Patient support and education
Pain control
Fertility issues for patient
Infection prevention strategies
```
195
End stage renal disease
GFR of less than 15 mL/min, dialysis or transplant required
196
Why is there an increasing prevalence of CKD?
Aging population
Obesity and inactivity
Increase in diabetes and hypertension
197
What is uremia?
When kidney function declines to a point where symptoms develop in multiple body systems
198
What are metabolic disturbances with CKD?
Increased BUN and creatinine
Increased triglycerides
Altered carbohydrate metabolism
199
Normal GFR rate
90-120 mL/min
200
Normal BUN level
7-20 mg/dL
201
Normal serum creatinine level
0.6-1.2 mg/dL
202
What happens to insulin metabolism in ESRD?
Kidneys stop excreting insulin, so diabetics might need less insulin once they start dialysis
203
What are major electrolyte imbalances with CKD?
```
Sodium
Potassium
Calcium
Phosphate
Magnesium
Acid and bicarb
```
204
What will happen to sodium levels with CKD?
Can increase, decrease, or stay normal
205
What happens to calcium and phosphate levels in CKD?
Phosphate increases
| Calcium decreases
206
Why is anemia an issue in CKD?
Decreased epo production and RBC production
Dialysis blood loss
Increased PTH inhibiting erythropoiesis
Iron deficiency
207
Why are there increased bleeding tendencies in CKD?
Defect in platelet function
| Increased factor 8 and fibrinogen
208
Why do patients with CKD experience higher incidence of cardiovascular disease?
Hypertension
Vascular calcification
Arterial stiffness
High potassium and lipid levels
209
How does CKD affect the musculoskeletal system?
Mineral and bone disorders (decreased activated vitamin D and serum calcium, increased phosphate leading to osteomalacia)
210
What are skin changes with CKD?
Pruritus
Itching
Uremic frost (only with very high BUN levels)
211
What is the preferred method to determine kidney function?
GFR
212
What is the top goal for patients with CKD?
Preserve existing kidney function
213
What can be done to prevent CKD?
Early detection and treatment
Monitor BP/treat high BP early and aggressively
Ensure proper diabetes detection and treatment
Screening for high risk populations
214
What do clients with CKD need to know to report to a provider?
SOB
Weight gain
Increased BP
Edema
215
What are advantages to peritoneal dialysis?
```
Can be started immediately
Less complicated and can be done at home
Portable
Fewer dietary restrictions
Easier on the heart
Better for diabetic patients
```
216
What are disadvantages of PD?
```
Peritonitis
Greater protein loss
Infections at catheter site
Self-image issues
Hyperglycemia
Contraindicated for patients with lots of abdominal surgeries or problems
Education/training needed
```
217
Once a PD cath is healed, what does daily catheter care look like?
Clean with soap and water
Pat dry
No dressing change needed
**no sitting in baths of water**
218
What are the three phases of a PD exchange?
Inflow
Dwell
Drain
219
How long is the inflow period?
10 minutes
220
What happens during PD dwell and how long is it?
Diffusion and osmosis occur between solution and the blood
| Can be 20-30 minutes up to 8 hours depending on the method
221
How long is the drain phase of PD?
15-30 minutes
222
What can facilitate a faster drain period?
Massaging abdomen or changing positions
223
What is automated PD?
Cycler delivers and regulates fluid exchanges while the patient sleeps (4 or more exchanges per night with fluid left in peritoneum during day)
224
What is continuous ambulatory peritoneal dialysis?
Exchanges are done by the patient every few hours during the day (average of 4 hour dwell time)
225
What would indicate that peritonitis is occurring?
Abdominal pain
Rebound tenderness
Cloudy peritoneal effluent
Increased WBC count
226
What other complications can PD cause?
```
Exit site infection
Hernias
Lower back problems
Bleeding
Protein loss
Pulmonary complications
```
227
What are the advantages of hemodialysis?
```
Rapid fluid removal
Rapid urea/creatinine removal
Effective potassium removal
Less protein loss
Decreased serum triglycerides
Can be done at home
```
228
What are disadvantages of hemodialysis?
```
Vascular access problems
Diet and fluid restrictions
Heparin use
Lots of equipment
Hypotension
Anemia
Surgical placement of access
Fatigue
```
229
Thrill
Buzzing sensation
230
Bruit
Whooshing sound of blood in access
231
What are hypotension assessment findings?
```
Lightheaded ness
Nausea
Vomiting
Seizures
Vision changes
Chest pain
```
232
How do we treat and prevent hemodialysis complications?
```
Frequent monitoring of BP
Correct dry weights
Rinse back all blood
Infection control
Hep C screening and vaccinations
```
233
what is cerebral palsy?
a group of permanent disorders of the development of movement and posture
234
what causes cerebral palsy?
some disruption of blood flow to the brain of an infant or young child (could be hypoxia or stroke, etc)
235
what developmental milestones might be delayed in CP?
```
rolling over
raising head
sitting up
crawling
walking
```
236
what are some possible motor signs of CP?
```
persistent primitive reflexes
poor head control after 3 months old
limp posture
unable to sit up on own by 8 months of age
favoring one side of the body
clenching fists after 3 months
```
237
what are common feeding issues with CP?
gagging
choking
tongue pushing soft food out of the mouth
238
what are behavioral findings in CP?
extreme irritability and crying
failure to smile
lack of interest in surroundings
239
what muscle tone alterations may be seen with CP?
muscle contractures
240
what are some associated disabilities for those with CP?
altered learning and reasoning
seizures (up to 85% of those with CP)
vision/hearing impairment
impaired behavior and relationships
241
what does intellect look like for those with CP?
usually normal or slightly impaired, may be more altered in more severe cases
242
what is constraint therapy?
constraining the strong side of the body in a child with CP to force use/strengthening of the weak side of the body
243
what are some common complications of CP?
```
respiratory infection
malnutrition
failure to thrive
injury
contractures
back pain/spasms/tight muscles
incontinence
```
244
what are some factors that contribute to complications in CP?
```
weight gain
poor posture
spinal deformities
discontinuing PT
walking when it is increasingly difficult
incorrect or inappropriate surgery
```
245
what kinds of therapy are crucial help maximize functional ability in CP?
PT, OT, and speech therapy
246
what can aid in mobility for clients with CP?
braces
wheelchairs
orthotics for legs and feet
play therapy
247
what can be done to help with feeding and nutritional issues with CP?
monitor weight gain closely
tailor diet to child's needs
manual jaw control to stabilize and help with swallowing
gastrostomy to supplement oral feeding
248
what is a stroke?
ischemia or hemorrhage in the brain causing death of brain cells and loss of function in those areas of the brain
249
what are manifestations of a stroke on the right side of the brain?
spatial-perceptual problems
motor function disruption
left side paralysis or neglect
rapid actions
short attention span
minimizing problem or pretending its not there
problems with judgement and impulse control
250
what are manifestations of a stroke on the left side of the brain?
```
right side paralysis
language issues
impaired left/right discrimination
caution
fear of falling/fear in general
slow performance in tasks
depression
anxiety
```
251
why are those with a left side of the brain stroke more likely to be depressed?
they are more aware of the deficits they have and more likely to be discouraged by them
252
what motor deficits are associated with stroke?
```
mobility issues
respiratory dysfunction
swallowing and speech issues
gag reflex problems
deficits in self care ability
```
253
aphasia
impaired ability to communicate
254
expressive aphasia
patient can no longer comprehend language but can still speak (but they only speak nonsense)
255
receptive aphasia
loss of ability to produce language, but can still understand
256
global aphasia
total inability to communicate (cannot speak or understand)
257
what are some good tips to communicate with clients with impaired speech?
```
use good non-verbals
use hand gestures and pictures
have the family assist with communication
be positive and patient
use speech therapy
treat them as an adult
ask simple questions
present one idea at a time
```
258
what is dysarthria?
disturbance in muscular control of speech, mainly affecting pronunciation and articulation
259
what are potential impacts of stroke on affect?
exaggerated or uncontrolled emotional responses
depression
frustration
unpredictability
260
how can intellectual functioning be impacted by stroke and how does it differ with each side of the brain?
memory and judgement issues can affect either side of the brain, but right sided strokes will be more cautious and fearful while left sided strokes are often more impulsive
261
what is homonymous hemianopsia?
also known as a "field cut", refers to patient experiencing blindness in the same half of visual fields of both eyes
262
what do clients with homonymous hemianopsia tend to do?
forget about or ignore everything on the other side of their visual field (the unseen side)
263
what is agnosia?
inability to recognize an object by sight, touch, or hearing
264
what is apraxia?
inability to carry out learned sequential movements on demand (like brushing teeth or other self-care activities)
265
what are some impacts of stroke on elimination?
urinary frequency, urgency, or incontinence
constipation
usually temporary effects or effects due to not being able to verbalize needs
266
what are some preventative actions to prevent strokes?
```
control of diabetes and hypertension
drug therapy
treatment of cardiac problems
smoking avoidance/cessation
cholesterol control
healthy diet
limit alcohol
```
267
what do rehabilitation prognoses for stroke patients depend on?
type of stroke and extent of damage
268
how can respiratory complications be avoided with stroke patients?
```
frequent airway assessment
oxygen
suctioning
optimal positioning
deep breathing
oral care for the mechanically ventilated
```
269
how can musculoskeletal complications of stroke be avoided?
```
PROM/ROM
positioning
transfer carefully and correctly
pay attention to weak side when positioning and transferring
don't pull on arms
use splints and supports as needed
```
270
how can integumentary complications of stroke be avoided?
provide pressure relief
ensure good hygeine
mobilize early and often
271
how can GI complications of stroke be avoided?
```
prevent constipation
check for impaction
adequate fluid and fiber intake
promote physical activity
bowel retraining
```
272
how can urinary complications of stroke be avoided?
remove catheter ASAP
avoid bladder over-distension
assist patient to a normal position for voiding
offer bedpans
273
what is included in bladder retraining?
fluids between 7 am and 7 pm
scheduled toileting every 2 hours
assessing for distension
observing for signs of needing to void
274
what is silent aspiration?
fluid entering the lungs with no obvious signs or symptoms from the patient
275
what are symptoms of dysphagia?
```
pain with swallowing
being unable to swallow
pocketing food in the mouth
drooling
hoarse voice
regurgitation
heartburn
feeling like food is stuck in the throat
```
276
what interventions can prevent aspiration?
```
position unconscious patient on their side
liquid meds
have suctioning available
thicken foods and beverages
elevate head to eat
cut food up
small frequent meals
avoid milk products
```
277
how can we help patients with strokes cope with sensory/perceptual alterations?
help them with their neglected side
arrange items within their perceptual field
ensure safety measures are taken
278
how should one help a stroke patient displaying an uncontrollable outburst of emotion?
distract them
279
what is parkinson's disease?
chronic progressive neurodegenerative disorder characterized by slowness in initiation and execution of movements
280
What does TRAP stand for?
```
manifestations of parkinson's
Tremors
Rigidity
Akinesia
Postural Instability
```
281
what is the triad of parkinsons?
akinesia
bradykinesia
postural instability
282
akinesia
absence or loss of control of voluntary movement (includes pill rolling tremors)
283
bradykinesia
slowness of movement, problems with facial and hand movements, getting "frozen" in place, shuffling gait
284
how can clients with parkinson's prevent getting "frozen"?
rocking from side to side
285
what are characteristics of parkinson's postural instability?
being unable to stop oneself from going forward or backward, often having a forward tilt to posture
286
what are potential complications of parkinson's?
```
dyskinesias
weakness
dementia
depression
dysphagia
malnutrition
infection
falls
orthostatic hypotension
pain
hallucinations
```
287
what are some interprofessional cares for parkinsons?
```
drug treatment
PT
OT
surgery
deep brain stimulation
diet treatment
```
288
what are nutritional considerations for parkinsons?
```
easily chewed and swallowed foods
high fiber foods
cut up food
have 6 small meals
ensure adequate vitamin b6
allow plenty of time for meals
```
289
what are key exercise focuses for parkinson's clients?
strength and stretching
290
what can we do for parkinson's patients to prevent falls and "freezing" episodes?
have them think about stepping over lines on the floor or stepping over rice kernels
have them lift their toes when walking
have them rock from side to side to keep moving
291
how can we modify the environment for parkinson's patients to maximize independence?
remove rugs and excess furniture
elevate toilet
simplify clothing
use chairs with arms
292
epilepsy
continuing predisposition to seizures with cognitive, social, psychological, or neurobiological consequences
293
what is a seizure?
a transient uncontrolled electrical discharge of neurons in the brain that disrupts normal functioning
294
what are common triggers or causes for seizures?
```
acidosis
electrolyte imbalance
hypoglycemia
hypoxia
alcohol or drug withdrawal
dehydration
lupus
lung/liver/kidney disease
diabetes
hypertension
septicemia
```
295
what are the phases of seizure activity?
prodromal/aural, then ictal, then postictal
296
prodromal/aural phase
sensations or behavior changes that precede a seizure
297
what can be some signs in the prodromal/aural phase of a seizure?
smell manifestations
fear
headache
hearing noises
298
ictal phase
from first symptoms to the end of seizure activity
299
postictal phase
recovery from the seizure
300
what are generalized seizures?
seizures that involve both sides of the brain
301
tonic clonic seizures are also known as
grand mal seizures
302
what is involved in a tonic-clonic seizure?
losing consciousness
falling
stiffening muscles (tonic) then jerking limbs and body (clonic)
can include cyanosis, salivation, incontinence, and biting of the tongue or cheek
303
what is an absence seizure?
a brief blank staring/zoning out seizure
| more common in children and very hard to detect
304
what is a myoclonic seizure?
sudden excessive jerk or twitch of the body and extremities
305
atonic seizures are also known as...
drop seizures
306
what is an atonic seizure?
tonic episode or loss of muscle tone, usually less than 15 seconds in length
307
what is a tonic seizure?
sudden extreme muscle stiffness
308
what is a clonic seizure?
loss of consciousness, then loss of muscle tone, then rhythmic limb jerking
309
what are focal seizures?
also known as focal seizures, usually begin in one area of the brain and manifest based on the function of the involved brain area
310
what is a simple focal seizure?
the patient is conscious but may experience unusual feelings or sensations
311
what feelings or sensations might be experienced in a simple focal seizure?
joy or anger
| smells or sounds not actually present
312
what is a complex partial seizure?
change in level of consciousness, eyes are open but patient cannot interact, strange behavior and potential dangerous or embarrassing actions may occur
313
what is an automatism?
a repetitive, purposeless action
314
what are psychogenic seizures?
they closely resemble epileptic seizures but there is no electrical abnormality in the brain. often manifest because of physical or emotional trauma or abuse
315
what is status epilecticus?
continuous seizure activity for over 5 minutes
316
why is status epilecticus dangerous?
because it can become an ABC issue (hypoxia, dysrhythmias, etc)
317
what are psychosocial complications of epilepsy?
```
lifestyle interruptions
ineffective coping
depression
social stigma
transportation hindrances
bipolar or other psychiatric diagnoses
```
318
which diagnostic test is most useful for epilepsy?
EEG
319
what are health promotion measures for epilepsy patients?
wearing a helmet when head injury could happen
improved infant care
have at risk patients avoid alcohol and sleep deprivation
320
what is included in seizure precautions?
```
rescue equipment at bedside
bed in low position
padded side rails
airway assessment
environmental safety
```
321
what are some things to do when a seizure occurs?
put patient on left side
help patient to the floor
dont restrain them and loosen any restrictive clothing
322
what are some things to assess when a seizure occurs?
```
onset
course and nature of seizure
length of each phase
body parts involved
airway status
autonomic signs
preceding signs of seizure
```
323
what do we do after a patient has a seizure?
```
assess vitals
ensure comfort and rest
quiet/non-stimulating environment
reorient them
check memory
assess pupils and airway
```
324
when should an epileptic patient call EMS regarding a seizure?
```
if injury occurs
if seizure occurs in water
longer than 5 minutes
pregnancy
diabetes
```
325
what are some important teaching points for epileptic patients and caregivers?
```
take meds exactly as directed
wear medical alert bracelet
stay calm
have family observe start and stop times
eat regularly
maintain safety during seizure (don't put anything in mouth!)
```
