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NUR 405 (Med Surg II) > Exam 1 Review pt.4 > Flashcards

Exam 1 Review pt.4 Flashcards

1
Q

Routine screening for HIV

A

At least once, if without risk factors and are ages 13-75 years of age

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2
Q

Yearly Screening for high risk

A

MSM

Injection drug users

Persons who exchange sex for money / drugs

Sex partners of people who are HIV infected, bisexual, IVDU

Having sex with partners of unknown status

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3
Q

HIV antibody testing

A

ELISA Enzyme-linked immunosorbent assays

HIV-1/HIV-2 differentiation assays

Western blot

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4
Q

HIV antibody and antigen test

A

Four generation combination test

Able to identify early/acute infection

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5
Q

HIV criteria for postive

A

Postive ELILSA or combination assay followed by a postive confirmatory (western blot)

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6
Q

HIV criteria for negative

A

A negative screening ELISA or combination

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7
Q

HIV indeterminate

A

ELISA or combination assay is postive but confirmatory test is negative

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8
Q

What do you have to take into consideration when testing for HIV

A

The window period

Time between exposure to HIV infection and the point when the test will give an accurate result

Patient is VERY infectious

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9
Q

What is the best indicator of how active HIV is in patient body

A

VIral Load

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10
Q

When are the worse symptoms during HIV infection

A

2-6 weeks whenever HIV viral load peaks

Flu like symptoms

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11
Q

Stage 1 of HIV infection

A

Early infection
-Rapid replication
-Not detectable
-No symptoms
-INFECTIOUS

SEROCONVERSION
-Antibodies are detectable
-Flu like symptoms
-HIGHLY infectious

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12
Q

Stage 2 of HIV infection

A

Clinical latency
-Virus levels stabilized
-3-12 years without treatment
-Decades with treatment
-Asymptomatic

Rapid virus production

Persistent drop in CD4 cell count

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13
Q

Stage 3 of HIV infection

A

AIDS

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14
Q

HIV can be transmitted via

A

Semen
Vaginal secretions
Blood
Breastmilk
Cerebrospinal fluid
Synovial fluid

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15
Q

Post exposure prophylaxis

A

Initiate drug therapy ASAP (within 1-2 hours)

Follow up testing for HIV indicated 6-12 weeks and 6 months

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16
Q

Candidates for Pre-Exposure Prophylaxis

A

Have had anal or vaginal sex in past 6 months and:
-partner with HIV or unknown status
-Have not used condom
-Have been diagnosed with STD

People who inject drugs and have partner with HIV

People who share needles or syringes

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17
Q

Education Patient with AIDS

A

Avoid crowded areas or traveling to countries with poor sanitation

Avoid raw foods and undercooked foods

Avoid litter boxes

Keep home clean don’t allow sick visitors

Frequent monitoring of CD4 and viral load labs (every 3/4 months)

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18
Q

Abdominal Ultrasounds

A

Detects tumors cysts and stone

NPO 8 hours beforehand. Food can cause gallbladder to contraction

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19
Q

What is the best way to determine if patient has gallstones

A

Abdominal Ultrasounds

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20
Q

Hepatobiliary Scintigraphy

A

HIDA scan

Diagnose cholecystitis if it remains uncertain following ultrasound

Nuclear medicine injected via IV that is taken up by hepatocytes and excreted into bile

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21
Q

HIDA scan demonstrates

A

Patency of common bile duct and ampulla

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22
Q

Endoscopic Retrograde Cholangiopancreatography

A

Visualizes and accesses the pancreatic, hepatic, and common bile duct

NPO 8 hours
Consent
Sedation

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23
Q

ERCP post procedure

A

Check V.S (looking for perforation or infection)

Pancreatitis is most common

Check for gag reflex

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24
Q

Before liver biopsy the nurse should

A

Check coags

Ensure patients blood is typed and crossmatched

Consent form signed

Baseline vitals signed

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25
Before needle insertion of liver biopsy patient should
Hold breath after expiration
26
Liver Biopsy: Post procedure
Frequent V.S Keep on right side x 2 hours HOB flat 2-4 hours Assess for complications
27
LIver Labs
ALT AST Alk phos Bilirubin Ammonia Protein Albumin PT
28
Increase in Serum Ammonia will alter
LOC Intellectual function Neurological function
29
What is the only way to distinguish between different types of hepatitis
Antigen / Antibody Testing
30
Which enzyme digest carbohydrates
Amylase
31
Which enzyme digests fats
Lipase
32
Cholelithiasis
Presence of glasstone
33
Cholecystitis
Inflammation of gallbladder
34
Cholelithiasis RF's
Middle age females Fair skin Overweight High-fat diet Oral contraceptives
35
Cholelithaisis and Cholecystitsis Manifestations
Episodic upper abdominal pain that radiates to right shoulder Pain triggered by high-fat or high-volume meal N/V/dyspepsia/eructation/flatulence CHRONIC: Jaundice Clay stools Dark urine Steatorrhea
36
Chole pain is typically triggered by
High fat or high volume meals
37
Cholecystitis Non-surgical care
Avoid fatty foods (NPO during flare) Opioids Anti-emetics - antispasmodic
38
Cholecystitis Surgical Care
:laparoscopic cholecystectomy Open cholecystectomy w/ T tube
39
Lap chole post op care
Remove bandages day after surgery then shower Gradually resume activities (1 week) Eventually can resume normal diet - try to stay low fat
40
Lap chole post op: notify the provider if
redness, swelling, purulent/bile-colored drainage from site Severe abdominal pain - N/V - fever - chills
41
Hepatitis Clinical manifestations
Anorexia N/V Weight loss RUQ discomfort Malaise Hepatomegaly Jaundice Pruritus Dark urine
42
Many hepatitis cases are asymptomatic
HCV = 80% HBV = 30%
43
Hepatitis Incubation period manifestations
Last 5-10 days Flu like symptoms RUQ discomfort
44
Hepatitis acute infection period
1-4 months Icteric or anicteric Palpable tender liver
45
Hepatitis convalescence period
Malaise and fatigue Full recovery 2-4 months
46
Chronic Hepatitis infection is only from
Hep B and Hep C High rate in hep C
47
HBV is the leading cause of
Liver cancer
48
HCV is the leading cause of
Liver transplant
49
HAV is spread via
Fecal-oral
50
HBV and HCV is spread via
Blood and high risk behaviors
51
Which hepatitis have a vaccine?
Hep A Hep B
52
Jaundice is present if bilirubin is above
2.5
53
Types of jaundice
Hemolytic (increase breakdown RBC) Hepatocellular (liver unable to take from blood) Obstructive (decreased or obstructed flow of bile)
54
Hepatitis: Patient and Family Education
-Maintain sanitation and wash hands -Drink water treated by purification -If traveling to underdeveloped country only drink bottled water. Avoid ice and tap water -Do not share bed linens -Do not share needles -Do not share razors -Use condoms during sex -Cover cuts and sores -If infected never donate blood, organs or body tissues
55
Hepatitis Treatment
No specific treatment Emphasis is on REST -degree of which is determined by symptoms
56
Cirrhosis: Early manifestations
Insidious Weight loss Weakness GI disturbances Hepatomegaly RUQ pain
57
Cirrhosis: Late manifestations
Jaundice Decrease albumin and PT Portal hypertension Ascites Splenomegaly (LUQ) Spider angiomas and caput medusae Esophageal varices Encephalopathy Asterixis (liver flap)
58
Cirrhosis: Measures to manage ascites / excess fuid volume
Assess/measure abdominal girth Sodium restriction / possibly fluid restriction Diuretics Paracentesis Portosystemic Shunt (TIPS) IV albumin Patient family teaching
59
Paracentesis goal
Releve respiratory distress
60
Paracentesis
Informed consent Baseline VS Void prior Position supine or high fowlers
61
Transjugular Intrahepatic Portosystemic Shunt
Non surgical procedure used to control ascites and varices Bypass the liver so can increase hepatic encephalopathy
62
Measures to manage varices
No ASA - Alc - Spicy - Bulky foods Monitor for ecchymosis - purpura - petechiae Avoid straining Apply pressure to bleed x 5 min
63
Procedures for varices
Sclerotherapy Variceal ligation (banding)
64
Hepatic Encephalopathy Care
Restrict protein to 20-40 grams daily Control Gi bleeding Avoid constipation Lactulose and titrate to 2-4 stools per day Assess EMV
65
Acute pancreatitis definition
Premature activation of excessive pancreatic enzymes that destroy pancreatic cells, resulting in autodigestion and fibrosis of pancreas
66
What are the most common causes of acute pancreatitis
Gallstone ETOH
67
What is the best way to diagnose Pancreatitis
CT scan Shows pancreatic diameter, calcificiations, pancreatic cysts or pseudocysts
68
Acute pancreatitis: Clinical Manifestations
Pain - inflammation N/V - Viscera pain Low-grade fever Jaundice - obstructive process Paralytic ileus - irritation causes motility to stop Cullens and Turners - enzymes leak into cutaneous tissues Hypovolemia / Tachy - plasma being last Increase amylase and lipase - pancreatic cell injury Increase triglycerides - fat necrosis Decrease calcium - fat necrosis
69
Acute pancreatitis: Complications
Pseudocyst: -Cavity surrounding outside of pancreas Abscess: -Large fluid-containing cavity within pancreas
70
Acute Pancreatitis: Measures to relive pain
IV morphine Assume positions that flex the trunk NPO- NG/LWS
71
Chronic Pancreatitis
Progressive destruction with remission and flares caused by inflammation and fibrosis
72
Chronic Pancreatitis: Clinical Manifestations
Intense abdominal pain Mass (pseudocyst or abscess) Ascites Respiratory compromise Steatorrhea Dark urine
73
PERT
Pancreatic Enzyme Replacement Therapy Standard care to prevent malnutrition, malabsorption, and weight loss Pancrelipase Record number of stools per day to monitor effectiveness LESS FREQUENT AND LESS FATTY = goal
74
Chronic Pancreatitis Weight Loss
Can be significant may require TPN because we want 4000-6000 calories per day
75
Prevention of exacerbations of chronic pancreatits
Avoid things make symptoms worse Avoid alcohol ingestion Avoid nicotine Avoid caffeine Eat bland - low fat - high protein Eat small meals and snacks high in calories Take enzymes with each meal and snack Rest frequently

NUR 405 (Med Surg II) (66 decks)

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