exam 2 Flashcards

Question

DASH diet

Answer 1

- 6-8 servings of grains/day - 4-5 servings of fruits/day - 4-5 servings of veggies/day - low-fat or nonfat dairy servings 2-3/day - lean meats, fish, or poultry servings 6 or fewer/day - nut, seeds, legumes servings 4-5/week - fats and oils servings 2-3/day - sweets 5 or fewer/wk

Answer 2

- cardiac - renal - neuro - visual acuity - vascular

Answer 3

- administer meds - initiate DASH diet - promote adherance to meds and lifestyle changes - educate on how to take BP - s/s of complications - overall stress management

Answer 4

- coronary artery disease - stroke - hypertensive crisis - peripheral vascular disease - end organ damage: HF, KF - retinal damage

Answer 5

- include urgency and emergency - both are severly elevated BP - emergency = s/s of organ damage - acute and life threatening emergency: SBP >180, DBP >120 - requires immediate treatment - monitor neuro and renal status - strict I&Os

Answer 6

- supply adequate circulation of blood to body tissues - ensure adequate capillary exchange between blood plasma, interstitial fluid, and tissue cells

Answer 7

- plaque formation, typically from cholesterol, on interior of vessel wall - arteriosclerosis often used interchangeably BUT not the same (arterio= genetic term) - describeds thickening/hardening of arterial wall associated w/ aging - increases stiffness of artery wall and decreases elasticity of vessel - comprised of 3 possible path process (medial calcific sclerossis or calcium deposits, arteriolar sclerosis or thickening of smaller arterioles, or atherosclerosis or LDL build up on arterial wall - primary cause of many vascualr disorders

Answer 8

- starts in childhood and increases w/ age - elevated LDL or HDL - elevated triglycerides - HTN - diabtetes - smoking - family hx - sedentary lifestyle - males or postmenopausal women - black and hispanic people have increased incidence of smoking, diabetes, and HTN - whites have high abnormal serum lipids

Answer 9

- disease in which LDL builds up on arterial walls - slow developing complex disorder - begins from vessel damage causing inflammation leading to accumulation of atherosclerotic plaque, once inflamed fatty streaks appear on lining of artery - lipids become deposited on arterial wall thickening arterial wall and decreases internal diameter of artery - causes decreased BF and O2 to affected tissues - plaques may rupture and cause blood clots to form and block blood flow entirely

Answer 10

- little to no s/s - progresses as the vessel narrowing becomes critical; pt typically ends up in ER for MI, unstable angina, sudden cardiac arrest, stroke, or death - depends on location and degree of severity of atherosclerotic disease - frequently manifests as chest pain (angina), SOB, fatigue, arrythmias

Answer 11

MI or cardiac arrest

Answer 12

pain and reduced functionality of extremities can cause gangrene (death of body tissue r/t lack of blood flow and oxygenation

Answer 13

- identify and control risk factors for development - med management and decrease lipid levels - anticoagulants to prevent clot formation - diabetes management - encourage modification of dietary habits, smoking, exercise, stress levels/relief techniques

Answer 14

reserved for irreversible manifestations of atherosclerosis

Answer 15

- manifestations vary based on arteries involved - complete pt hx and cardiovascular assessment - assess BP in both arms - palpate pulses at all major sites in body (note differences at any/all locations - auscultate for bruits - lab values, fasting lipid profile, triglyceride levels, homocysteine, glyc

Answer 16

- risk for ineffective tissue perfusion - pain r/t decreased BF - activity intolerance/fatigue

Answer 17

- assessments - administer meds or management of HTN and lipids - BP management - lifestyle changes

Answer 18

- well managed through diet, activity, and stress management - smoking cessation - evaluate severity and/or resolution of symptoms - pt's will be monitored through follow up care with providers as lifelong treatment

Answer 19

- affects >230 million - significant morbidity, mortality, and alterations in quality of life - atherosclerosis is MAIN contributor to PAD - risk factors of atherosclerosis are also risk factor of PAD

Answer 20

- progressive and chronic condition - blood flow through large peripheral arteries is obstructred causing partial or total occlusion - caused by combo of atherosclerosis, inflammation, stenosis, embolus, or thrombus - deprives lower extremities of oxygen and nutrients - causes ischemia, necrosis, and cell death

Answer 21

- most often seen as atypical lower extremity pain or intermittent claudication (muscle pain occurring during exercise) - described as ache, cramp, numbness, or sense of fatigue - most often in calf - typically relieved by rest - limited or painful joints, ulcerated or cold extremities, painful stretching - limits exercise ability and QOL

Answer 22

- no claudication/pain - bruit may be heard - pedal pulses are decreased or absent

Answer 23

- muscle pain, burning, and cramping experienced w/ exercise and relieved by rest - pain is reproducible with same amount of exercise

Answer 24

- pain at rest - often awakens pt at night - numbness and burning in distal portions of extremity - relieved by putting extremity in dependent position

Answer 25

- ulcers and blackened tissue in toes, forefoot, or heel - gangrenous odor may be present

Answer 26

- complete vascular assessment (pulses, auscultation of femoral bruits, inspection of legs and feet) - all physical assessment findings must be confirmed w/ diagnostics - ankle-brachial index (doppler probe to compare BP at ankle to brachial artery, ankle should be higher) - plethysomography (evaluates arterial flow to lower extremities done through pulse volume measurements and tracings) - anatomical imaging reserved for highly syptomatic patients who need to undergo surgery (duplex u/s, CTA, MRA, invasive angiography)

Answer 27

>1.30 - noncompressible arteries - 1-1.29 = normal - 0.91-0.99 = borderline - 0.41-0.9 = mild to moderate - 0-0.4= severe PAD

Answer 28

- provide relief of symptoms and improve QOL - prevent progression of arterial disease - prevent cardiovascular complications - provide further education about disease

Answer 29

- first line: nonpharmacological interventions - weight loss, smoking cessation, exercise, adherance to low fat diet

Answer 30

- target risk factors that may profress the atherosclerotic process - antihypertensives - antiplatelets - statins

Answer 31

- positioning and promotion of vasodilation (legs in dependent position) - exercise - percutaneous transluminal angioplasty (helps improve arterial BF by inserting cannula into occluded artery placing a stent to open up artery - laser-assisted angioplasty (cannula inserted into occluded artery and laser probe heat vaporizes blockage in smaller occlusions and vessels) - rotational atherectomy (hard, calcified lesions to remove plaque by breaking it into small peices)

Answer 32

- when clients have severe pain at rest or claudication interfering with ability to perform ADLs - revascularization through surgical bypass graft placement to byspass BF and use autogenous grafts

Answer 33

- critcal limb ischemia - acute limb ischemia

Answer 34

- sustained and severe decrease in arterial blood flow - leads to chronic ischemia, pain at rest, ulceration, gangrene - present after long term PAD - prognosis generally poor - further risk of infection, cellulitis, and tissue breakdown - requires revascularization surgery with about 40% needed limb amputation within 6 months

Answer 35

- sudden decrease in blood flow to extermity - acutely thretens tissue viability - may be first presenting symptoms of PAD - may be caused by acute event - most common cause = embolus - more common in lower extremities - manigested by severe pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia (six P's) - requires immediate intervention to preserve tissue and save limb - anticoag and potential revascularization treatment

Answer 36

- clinical manifestations vary with affected tissue - bilateral BP - palpate all pulses in both legs - visual assessment of feet and legs - temperature of bilateral lower extremities - assess pain and s/s of infection in lower extremities

Answer 37

- ineffective peripheral tissue perfusion - risk for impaired skin integrity - chronic pain - bleeding risk - risk for unstable blood pressure - impaired mobility - risk for infection

Answer 38

- assess client - admin meds - properly position patient to help w/ tissue perfusion - independent positioning to help w/ BF - inspect feet daily and report skin changes - report chest discomfort or neuro changes - lifestyle changes; DASH diet, limit alc, smoking cessation, moderate exercise

Answer 39

- symptoms relief - pain free and able to participate in normal activites - decreased progression of illness - improved QOL - adherance to lifestyle changes and med regimen

Answer 40

- common atherosclerotic vascular disease - typically begins developing in 40s - prevalence increases w/ age - higher incidence in males and white and native american populations

Answer 41

- smoking - HTN - diabetes - dyslipidemia - sedentary lifestyle - obesity - poor stress management - age <75 - male gender - hx of CAD

Answer 42

- vessel wall thickening plaque formation and progressive narrowing of carotid arteries - plaque disruption and thrombus formation is possible - stenosis is most significant at carotid bifurcation - severity based on vessel lumen diameter

Answer 43

- asymptomatic until vessel lumen is obstructed to point of causing cerebral perfusion impairment - bruit will be present past obstruction at bifurcations -s/s of transiet ischemic attack (sudden weakness, dizziness or loss of coordination, difficulty talking, facial drop on one side, sudden vision problems, sudden and severe headache

Answer 44

- physical assessment, noninvasive procedures, and occasionally invasive procedures - conventional carotid angiography is invasive procedure that is the gold standard for diagnosis of severity of external carotid artery stenosis - done through catheterization of femoral artery and use of contrast dye to visualize the blockages

Answer 45

- carotid duplex u/s - MRA - MRI - CTA

Answer 46

- depends on severity of occlusion and whether the patient is symptomatic or asymptomatic - asymptomatic patients w/o hx of stroke or TIA: optimal medical therapy which is a combo of lifestyle change and medications (antiplatelets, antihypertesnives, statins, etc.) - surgical intervention is controversial due to complications - symptomatic patients who present w/ TIA or stroke include OMT and surgical management

Answer 47

- procedures for revascularization - carotid endarterectomy (CEA): removal of plaque to improve BF and prevent stroke w/ med management of antiplatets, hypertesnives, and statins - carotid artery stenting (CAS): in combination w/ carotid angioplasty where stent is placed to open artery requiring lifelong aspiring

Answer 48

- tight BP monitoring - neuro assessments - bleeding prevention

Answer 49

- frequent VS monitoring - neuro assessments - access site monitoring

Answer 50

- typically asymptomatic until lumen is obstructing cerebral BF - symptoms of stroke may appear - auscultate carotid arteries for bruits - vital monitoring (!BP!) - neuro assessments - stroke hx or s/s of stroke

Answer 51

- risk of poor tissue perfusion - risk for injury - anxiety - risk for bleeding - risk for fluctuations in BP and HR

Answer 52

- post op monitoring of RR, SpO2, presence of stridor or tracheal deviation, vitals, cranial nerves and renal function - admin meds as ordered - manage diabetes and maintain glucose levels - postop: keep BP within ordered parameters, maintain neutral head alignment, encourage fluids - educate on s/s of stroke - lifestyle changes, DASH, exercise, smoking cessation, limitation of alcohol

Answer 53

- educated on risk factor modifications - compliance of medication regimen - adherence to lifestyle changes - goal of no clinical manifestations of stroke - no post-op complications of pain, swelling, or bleeding

Answer 54

- common in men - common in white people - common in those with atherosclerosis - thoracic aortic aneurysms (TAAs) more common in men 40-70yo - non-modifiable risks: family hx, advanced age, male sex, genetic abnormalities, known CAD, Marfan's syndrome - modifiable risks: smoking, high cholesterol, HTN

Answer 55

- atherosclerosis - chronic inflammation (aortitis) - blunt trauma

Answer 56

- permanent localized dilation of an artery that forms when middle layer of artery is weakned - causes stretching in artery walls increasing tension - can occur in ascending, descending (thoracic), or abdominal aorta - all 3 layers are weak

Answer 57

- imaging to detect aortic dilation - CT scan w/ IV contrast is gold standard - abdominal u/s or transthroacic echocardiography - cardiac MRI - ECG to rule out MI - meds: focus on reducing growth and preventing complications, aggresive HTN management, antibiotic to prevent infections, statins to reduce atherosclerosis and growth

Answer 58

- determined by size, location, and presence of symptoms - surgery is only effective in preventing AAA rupture and anuerysm related death - most commonly a resection and repair (aneurysmectomy) - risk of bleeding, infection, MI, renal failure, and graft occlusion - endovascular aneurysm repair is less invasive w/ less risk

Answer 59

aneurysm is excised and graft is applied

Answer 60

placement and attachement of sutureless aortic graft prosthesis across aneurysm

Answer 61

- caused by sudden tear in aortic intima creating a false lumen in artea - life threatening emergency due to loss of circulation to major arteries - s/s: sudden, severe, persistent pain in anterior chest or back, pain extends to shoulders, epigastric area, or abdomen, desrcibed as "ripping" or tearing, diaphoresis, n/v, faintness, tachycardia, BP different in LUE than RUE

Answer 62

- life threatening - leads to sudden and extreme blood loss - s/s similar to dissection w/ LOC and hypovolemic shock - death rate about 80%

Answer 63

- assessments - vitals specifically for hypotension and tachycardia for concern of rupture - neuro assessment - pain presence and severity - peripheral pulses, skin color, temp - peripheral sensation and motor response - gentle abdominal auscultation and palpation

Answer 64

- risk for ineffective peripheral tissue perfusion - acute pain - fear - risk for bleeding, decrease CO, and hypovolemic shock - risk for fluctuations in BP

Answer 65

- assessments - admin meds as ordered - admin stool softners - reduce stress - educate on s/s of aneurysm complications - marfan's syndrome: encoruage to do regular screening and call HCP w/ new onset of s/s - strict treatment regimen: med compliance, weight reduction, smoking cessation, regular exercise, avoid crossing or eelvating legs, reduce stress

Answer 66

- compliance w/ perscribed therapy - BP and HR WNL - strong peripheral pulses - normal skin color and texture - no complaints of abdmoinal, back, or chest pain - no complaints of wheezing or SOB - no complaints of dysphagia or hoarsness - normal neuro assessment

Answer 67

- 1/1000 per year - 0.5-7/1000 pregnancies - can detach from site of formation and become mobile in blood stream leading to PE or MI - risk increases w/ prolonged bedrest, venous stasis, surgery, increased age, active cancer w/ or w/o chemo, varicose vevins, prior VTE, pregnancy, postpartum, oral contraceptive use, hormone therapy, surgery, trauma, covid-19

Answer 68

- virchow's triad= factors implicated in formation of VTE - decreased BF rate or statsis of BF - damage to vessel wall or endothelial cell injury - increased tendency for blood to clot (hypercoaguability) - more common in lower extremities and creates environment for clotting

Answer 69

- clot can cause complete or partial blockage of circulation in vein - pain, swelling, tenderness, discoloration or redness, warmth - Homan's sign= calf pain elicited by dorsiflexion of foot - ^ can indicate presence of DVT but is not diagnostic

Answer 70

- pretest probability - d-dimer (if high, clot is present) - compression u/s (CUD) to visualize thrombi and ID if unstable or floating

Answer 71

- early ambualtion - VTE prophylaxis (LMWH, compression stokcings

Answer 72

- anticoag w/ LMWH or heparin - long term anticoags w/ warfarin or eliquis or apixiban - thrombolytic agent only used as VERY LAST resort

Answer 73

- rarely used unless massive occlusion not responding to treatment - must be recent - thrombectomy - less invasive= ballon angioplasty

Answer 74

- PE: SOB, decreased SpO2, tachycardia, hypotension, sweating, sharp chest pain, hemoptysis, increased PVR, incerased workload on heart, deceased O2 on lung - post-thrombotic syndrome: chronic disorder ranging from limb swelling and discomfort to sever leg pain, intractable edema, irreversible skin changes and leg ulcers

Answer 75

- vitals w/ o2 - extremity assessment for pain, tenderness, warmth, redness, or swelling - compare R and L calf, thigh, or arm - gentle palpation to insepction for induration - D-dimer test - lab values: INR, PT/aPTT, H/H - assess for s/s of bleeding

Answer 76

- ineffective peripheral tissue perfusion - acute pain - risk for impaired physical mobility - risk for bleeding - impaired gas exchange

Answer 77

- assessment - early ambulation - leg elevation - compression stockings - avoid use of SCDs - encourage adeuqate fluid intake - admin meds - educate of prevention: ambulation, fluids, avoid constricting clothing, avoid long periods of sitting/car rides/ planes - educate on s/s of bleeding - educate on lab compliance - safety precautions when taking anticoags

Answer 78

- compliance w/ prescribed anticoagulants - stable vs and O2 sat - decreased extremity pain, tenderness, or swelling - prevention activities and maintenance of active and healthy lifestyle

Answer 79

- obesity - smoking - sedentary lifestyle - increased age - prolonged standing - previous LE trauma or thrombosis - HTN

Answer 80

- superficial and deep veins of peripheral venous system consist of one-way bicuspid valves - most likely caused by congenital factors, hormones, prolonged standing, thrombosis, or non-thrombotic events - DVT is usually results in deep vein incompetence - valves become damaged and venous pressure increases, blood reutnr from lower extremities is obstructured leading to arterial perfusion impairment, lower extremity edema, skin ulcers

Answer 81

- lower extermity pain and edema - dilated veins - skin changes: capillary walls thicken causing breakdown of RBCs, brown skin, tissues and cells will necrose, fibrous tissue begins to develop in subq fat - ulcer formation

Answer 82

- rule out other causes - ID clinical changes, dialted vessels, skin changes, and ulcers-

Answer 83

- compression and avoiding prolonged standing - compression stockings - basic skin care - wound care - exercise w/ walking and ankle flexion increasing venous return leg elevation - adequate nutrition

Answer 84

- cellulitis development so may need antibiotics - wound care - aspirin and steroids

Answer 85

- varicose vein treatment - complicated, infected wounds may need debridement to remove necrotic tissues

Answer 86

- leg discoloration - dilated veins - edema - leg pain - ulcers - cellulitis - sepsis - limb amputation - DVT or PE

Answer 87

- clinical manifestations - vs and O2 - monitor extermities for edema, dilated vessels, skin discoloration, pain, warmth, redness, or ulcer formation

Answer 88

- risk for infection - risk for ulcer formation - impaired mobility - pain - edema of extermities

Answer 89

- provide skin care and apply dressings - compression therapy - elevation of extremities - encourage ambulation - admin meds as ordered - education on compression therapy, skin care, exercise, elevation, and nutrition - educate on importance of avoiding prolonged standing

Answer 90

- demonstrating adgerence to treatment regimen - demonstrate decreased leg swelling, vein dilation, and ulcer formation - increased exercise tolerance and elevation of legs when resting - compliant with compression therapy, skin care, and nutrition

Answer 91

- prevalent in 6.5 million people over age 20 - high mortality rate - more common in those: over 65, african americans, previous heart attacks, obesity

Answer 92

- CAD - HTN - DM - metabolic syndrome - obesity - smoking - high Na+ - sleep apnea

Answer 93

- valvular dysfunction - cardiomyopathies - infections and inflammatory heart disorders - dysrythmias - anemia - thyroid disease - cardiotoxic substance exposure (alcohol, chemo, drugs)

Answer 94

- respiratory conditions - pulmonary artery HTN - COPD - interstitial lung disease - obstructive sleep apnea

Answer 95

- progressive disease characterized by myocardial cell dysfunction and decreased CO - frank-starling law: increased blood in ventricles cause increased contracility of ventricle - constant demands of myocardial muscles - weakned heart muscles and inability to contract efficiently - compensatory mechanisms kick in

Answer 96

- SNS - ventricular remodeling - neurohormonal responses (RAAS, BNP) - all short term compensation

Answer 97

- causes fibrosis, cardiomyocyte loss, cardiomyocyte hypertrophy, and electrophysical changes - ^ leads to impaired contractility, LV dilation, and wall thinning leading to HF

Answer 98

- weakened heart contraction - EF 40% or less

Answer 99

- EF maintained above 50% - ventricles have impaired ability to fill

Answer 100

a- no risk factors but s/s b- no s/s but elevated heart pressures or BNP c- current or past s/s of HF d- marked signs that interfere w/ daily life

Answer 101

I: no s/s w/ physical activity II: mild s/s w/ ordinary activies III: marked limitation w/ activity but comfortable at rest IV: severe limitation

Answer 102

- acute: sudden onset and immediate interventions - chronic: basline set of symptoms, limitations are relatively stable w/ treatment and self-management - fatigue - weight gain - tachycardia - hypotension or hypertesnion - heart murmurs related to valve dysfunction - S3 may be present - S4 common in chronic heart failure

Answer 103

- fatigue - increased peripheral venous pressure - enlarged liver or spleen - distended jugular veins - anorexia or GI distress - swelling in hands and fingers - dependent edema

Answer 104

- dyspnea - orthopnea - bendopnea - edema - fatigue - crackles on auscultation - poor skin color and delayed cap refill - weak pulses - cool skin temp on extremities

Answer 105

- L HF can lead to R HF - heart may be initally affected in its entireity - s/s become less clear - can have exacerbations: hypotension, cool extremities, decreased/no output, poor decreasing mentation - +S3 and 4

Answer 106

- imaging to rule out other problems and cause - imaging: xray, echo, CT, MRI, ECG, nuclear imaging - labs: cardiac biomarkers, serum electrolytes, CBC, urinalysis, glucose levels, fasting lipids, LFTs, renal function tests - biomarkers: BNP and n-terminal pro B-type natiuretic peptides, troponins - nuclear imaging - stress test - coronary angiography - exercise testing

Answer 107

- medications most often used for HF w/ reduced EF - for HF w/o reduced EF treatment of underlying cause, BP control, diuretic and s/s management - goal: reduce risk factors, manipulation of critical component of CO- preload, afterload, and contractility - successful management: slows disease progression, prevents complications, reduces morbidity and mortality, improves QOL

Answer 108

- BP and glucose control - weight loss - optimizing serum lipids - smoking cessation

Answer 109

ACE inhibitors ARBs ARNIs

Answer 110

postive inotropic agents (digoxin)

Answer 111

- IV meds for quick and effective management - goal to decrease preload and afterload and increase contractility - vasodilators - IV inotropic and inodilators - requires VS monitoring: frequent BP/HR, cardiac monitoring and rhythm assessment

Answer 112

can cause hypotension BP monitoring frequently LOC monitoring K+ monitoring UO monitoring fall precautions CNS depression

Answer 113

- implantation of ICD for dysrhythmia control and ventricular resynchronization - intra-aortic balloon pump - ventricular assist device - valve replacement - heart transplant

Answer 114

- s/s monitoring - daily weights - med adherance - lifestyle changes (weight, Na+, prevention of cardiac cachexia) - participation in cardiac rehab

Answer 115

- more common w/ aging - often have 5+ comorbidites - reduced self-management ability - decline in renal function w/ age - potential poor nutritional status and risk of dehydration

Answer 116

- pulmonary edema - dysrhythmias r/t heart muscle enlargement and catecholamine release - renal failure r/t decreased BF to kidneys

Answer 117

- acute complication of HF - accumulation of fluid in interstitial and alveolar spaces of lungs - s/s: SOB, low spO2, pink/frothy sputum, orthopnea, bendopnea, tachycardia, chest pain, anxiety/fear

Answer 118

- supplemental O2 - initiation of higher dose or IV diuretics - respiratory support: CPAP, BiPAP, intubation w/ mechanical ventilation

Answer 119

- v/s - breath sounds for congestion - cardiac monitoring - skin color and temp changes - peripheral pulse changes and cap refill time - dry persistent cough r/t meds - activity tolerance/intolerance - changes in urine output - daily weights - lab data trends - mental health screenings - social support-

Answer 120

- impaired oxygenation r/t fluid build up in lungs - decreased CO related to altered preload, afterload, and contractility - ineffective peripheral perfusion r/t decreased CO - electrolyte imbalances - fatigue

Answer 121

- assessments - O2 therapy - HOB elevation - med administration - dietary restrictions - medication management - maintain activity as toelrated - diet teaching - daily weights - cardiac rehab - s/s of worsening HF - immunization

Answer 122

- reduce stress - fluid status and salt intake monitoring - successful implementation of treatment plan - frequent assessment, pt education, and self-management - reduced dyspnea and fatigue - ability to actively participate in ADLs - reduced hospitalizations

Answer 123

- digestion - metabolism - excretion/elimination

Answer 124

proper nutrition

Answer 125

large intestine

Answer 126

neurological

Answer 127

- liver - gallbladder - pancreas

Answer 128

- detox - metabolize and absorb - secretes and produces prothrombin

Answer 129

storing and secretion of bile (needed to digest fat)

Answer 130

- difficult digesting fats - infection - gallstones - diarrhea due to increased fats - dehydration and electrolyte loss

Answer 131

produces insulin and amylase and lipase to digest food and manage blood sugar levels

Answer 132

- hyperglycemia - diabetes - malnutrition

Answer 133

large intestine

Answer 134

malnutrition normal range: 3.7-5.1

Answer 135

1. ascending 2. transverse 3. descending 4. sigmoid

Answer 136

more specific malnutirtion <12

Answer 137

refers to how iron is transporting M= 215-365 F- 250-350 if abnormal = hepatic damage

Answer 138

- diet - nutrition - oral health - preventative health - weight changes - appetite changes - stool changes - pain - social hx - medical hx - surgical hx

Answer 139

- CBC - CMP (electrolytes, LFTs, bilirubin, albumin, total protein, glucose) - prealbumin - transferrin - lipase - prothrombin time (PT) - UA - stool culture - c-diff - ova and parasite - fecal fat analysis - fecal occult blood test (FOBT) - fecal imunochemical test (FIT-DNA)

Answer 140

- abdominal pain - prep: remove jewelry and other metal that may obscure images, assess for pregnancy, empty bladder - positioning may increase pain

Answer 141

- can detect any structural abnormalities of underlying abdominal cavity - preferred method when patient cannot receive contrast dye

Answer 142

- series of timed x rays using fluoroscopy to examine integrity and patency of GI tract after given barium (radiographic opaque liquid) - preop: explain procedure, ensure diet of clear liquids to NPO is ordered, administer laxatives or enema night before, respiratory assessment, administer barium contrast (TIMING!!!) - postop: assess for return of gag reflex (maintain NPO until it returns), monitor VS, monitor I&Os, respiratory assessment, education on resumption of diet, meds, and activity, increase fluid intake to increase elimination of barium

Answer 143

4-8hrs prior

Answer 144

gray or chalky white for 24-72hrs postop

Answer 145

- general term used to describe procedure in which a fiberoptic scope is use to visualize GI tract, patients are sedated during procedure - common tests: esophagogastroduodenoscopy (EGD), colonscopy, sigmoidoscopy

Answer 146

- perform focused physical assessment - assess mouth/oral cavity for loose teeth or dentures - ensure patient has been NPO for instructed time - ensure consent has been completed, signed, and witnessed - hold anticoagulants and aspirin as ordered - bowel prep as ordered

Answer 147

- assess for return of gag reflex (maintain NPO until return) - monitor vitals - hold anticoags and aspirin as ordered - assess for s/s of perforation

Answer 148

- informed consent - NPO 6-8 hrs before test - avoid anticoags and NSAIDs several days before - local anesthetic before scope is inserted - positioned on left side to facilitate saliva drainage and provide easy acess - airway patency is monitored and pulse ox is used - emergency equipment readily available

Answer 149

- monitor vitals - gag reflex assessment - monitor for perforation (pain, bleeding, difficulty swallowing, elevated temp) - maintain bed rest and keep side rails raised - lozenges, saline gargles, oral analgesics

Answer 150

- excruciating retrosternal pain - dysphagia - sever hypotension - surgical emergency (>24hrs increases mortality rate) - preop care: NPO, IVF, antibiotics, prepare for surgery

Answer 151

use of golytely, dulcolax, or miralax to flush out stool stool output should be yellow and clear like urine when ready

Answer 152

- do not allow pt to take anything by mouth until sedation wears off - take vitals q15-30min until alert - keep pt in left lateral position until passing of flatus - keep top side rails up until pt alert - assess for rectal bleeding or severe pain - remind pt fullness and cramping expected - assess for signs of perforation (severe abdominal pain, guarding, fever) - assess for hypovolemic shock (dizziness, light-headedness, decreased BP, tachycardia, pallor, altered LOC - refrain from activities requiring heavy focus

Answer 153

upper part of stomach protrudes through diaphragm into chest cavity caused be weakening of diaphragm muscle or increased abdominal pressure

Answer 154

- western countries residence - obesity - pregnancy - smoking

Answer 155

- often asymptomatic - bowel sounds over chest (peristalsis) - fullness, feel like food gest "stuck"

Answer 156

- birth defects - muscle weakness - trauma to diaphragm - previous abdominal surgeries - high abdominal pressure

Answer 157

- sliding - lower esophagus and stomach ascend through hiatus

Answer 158

- paraesophageal hernia - fundus migrate into throacic cavity parallel to esophagous

Answer 159

both GEJ and porition of stomach migrate into cavity

Answer 160

- stomach and other parts of GI tract protrude into chest

Answer 161

- upper GI xray - barium swallow - EGD - CT

Answer 162

- meds: avoid meds that delay gastric emptying (anticholinergics), neutralize stomach acid (antacids), treat reflux using PPI or H2RAs - surgical repair: gastropexy (pull stomach back through diaphragm and create new esophagogastric junction to prevent slipping), nissen fundoplication (recreate LES pressure by wrapping fundus of stomach around esophagus in abdomen, GOLD STANDARD)

Answer 163

- breathlessness - suffocation feeling - chest pain - palpitations - dysphagia - clinical manifestations of GERD or heartburn - n/v - belching - h/h

Answer 164

- administerd meds - HOB >30 after meals - avoid straining - small frequent meals - do not recline for 2hrs after eating - elevate HOB 4-8 in at night - lose weight - meds - refrain from tight clothes - post-op selfcare - when to seek immediate HCP attnetion

Answer 165

acid reflux from stomach into esophagous when LES is weak or relaxes inappropriately

Answer 166

- dyspepsia - regurgitation - water brash - dental caries - dysphagia - odynophagia - globus - pharyngitis - coughing - hoarseness - chest pain - heartburn (pyrosis) - epigastric pain - generalized abdominal pain - flatulence - nausea

Answer 167

- pH testing of regurgitation - PPI trial - esophageal manometry or motility testing

Answer 168

- surgery (nissen fundoplication, linx0 - avoid meds that decrease gastric emptying (anticholinergics) - meds: antiacids, H2RAs, PPIs, prokinetics

Answer 169

- dental erosion - pharynx or esophageal ulcers - laryngeal damage - esophageal strictures - adenocarcinoma - pulmonary issues

Answer 170

- assess for clinical manifestations - monitor for aspiration pneumonia, chronic cough, hoarseness, nocturnal wheezing, adult onset asthma, laryngitis, pharyngitis, bronchitis w/ regurgiation - pH of gastric aspirate

Answer 171

- meds - HOB elevated at least 6-12 inches - small, frequent meals - avoid smoking and alcohol - avoid NSAIDs and aspirin - do not recline 2hrs after eating - elevated HOB 4-8 in/night - lose weight - meds - do not wear constricting clothing

Answer 172

- inflammation of lining of stomach - can be acute occuring suddenly and often resolving quickly or it can be chronic, persisting longer periods of time

Answer 173

- abdominal discomfort - anorexia, nausea, vomtiing - headache - hiccuping - reflux or dyspepsia

Answer 174

- erosive: ASA, NSAIDs, corticosteroids, ETOH, gastric radiation - nonerosive: H. pylori - ingestion of strong acid or alkali (mucosa becomes gangrenous and perforates) - during acute illness - trigger foods - viral infection - food poisoning

Answer 175

- abomdinal xray - endoscopy - biopsy - CBC (H/H) - urea breath test - stool for occult blood

Answer 176

- treat underlying cause and symptoms - GI rest (NPO, slowly advance) - eliminate irritating foods - bland diet - small frequent meals - vomiting (fluid replacement) - PPIs, H2RAs, antacids, antibiotics, vitamin b12 - quit smoking - ensure water is clean - surgery: vagotomy, gastrectomy, pyloroplasty

Answer 177

- vitals - I&Os - key features - respiratory assessent - labs: pH of aspirate (stomach = 1.5-2.0, esophagous = 6.0-7.0), H. pylori, electrolytes

Answer 178

- diet mod - NPO than advance - no caffeine, aclohol, spicy, irritating, or highly seasoned foods - administer IVF - monitor I&Os - admin meds as ordered - reduce stress - no NSAIDs - no smoking - releve pain

Answer 179

call doctor if: - s/s don't improve in 24-72hrs, - unable to keep food or meds down - blood in stool or vomit - take all meds as prescribed - follow up with HCP

Answer 180

- condition characterized by inflammation of stomach and intestines - commonly called the stomach flu - commonly caused by viral or bacterial infections, parasitic infections, ingestion of toxins, adverse effects of antibiotics - inflammatory response leads to increased permeability of intestinal lining allowing fluid to leak in intestinal lumen causing diarrhea - usually self-limiting

Answer 181

- good hygeine - hand hygeine - avoid contaminated food and water

Answer 182

- diarrhea - nausea - vomiting - anorexia - abdominal distention - discomfort - dehydration - hyperactive bowel sounds - decreased BP

Answer 183

- stool testing to find caustive organism (acute watery diarrhea = viral, subacute or chronic watery diarrhea = parasitic, acute inflammatory diarrhea w.o blood or wbcs = bacterial, acute inflammatory diarrhea w./ blood.= c. diff, diarrhea w/ gross blood = dysentery, shigellosis, e. coli, r/o UC) - blood cultures - stool for ova and parasite

Answer 184

- supportive treatment - oral or IV rehydration - antidiarrheal agents except c. diff - oral bismuth subsalicylate - antibiotics - antiemetics - diet (clear liquids, slowly introduce bland and easy to digest foods)

Answer 185

- patient hx (severity of diarrhea, dehydration, onset, frequency, quantity, duration of diarrhea, vomiting) - recent travel hx, eating hx - I&Os - weight loss - VS w/ orthostatic - abdominal distention - bowel sounds and elimination patterns - labs: electrolytes, BUN/CR - perineal skin - s/s of dehydration - pain

Answer 186

- hand hygeine - IVF - admin medications - clear liquids oral rehydrations - promote rest - VTE prophylaxis - perineal care - oral care - diet mods - preventative measure (sanitation of food and water when traveling, proper food prep)

Answer 187

- ulceractions and erosions in lower esophagous, stomach or duodenum - results from imbalance between protective factors that line GI tract and damging effects of stomach acid and digestive enzymes

Answer 188

- gastric ulcers - duodenal ulers

Answer 189

- dull gnawing pain or burning in epigastric area or back - n/v - constipation - diarrhea - bleeding - gastric: pain after eating, hematemesis (fresh blood in stool) - duodenal: pain 2-3hrs after eating, melena (black tarry stool) - perforation: sudden onset of sever sharp pain that travels to shoulder, extreme abomdinal tenderness, rigid abdomen, n/v, hypotension, tachycardia

Answer 190

- physical exam - upper GI study - endoscopy w/ biopsy - h. pylori testing - CBC - stool for occult blood

Answer 191

- meds - avoidance of NSAIDs and ASA - smoking cessation - diet mod (NPO if GI bleed) - surgery

Answer 192

- PPI - antiulcer (misoprostol) - antacids - antibiotics

Answer 193

- GI bleed: sudden severe pain w/o warning, sudden weakness, dizziness, cold, pale mosit skin, passage of loose tarry stool or coffee ground emesis - penetration: intense persistent pain - perforation: peritonitis causes sudden intense epigastric pain, release of GI content into peritoneum - obstruction: early satiety, epigastric fullness, gastric reflux, weight loss, abomdinal pain

Answer 194

- rapid emptying of gastric contents into small intestine occuring after gastric resection - 30 minutes after eating - nausea - vomiting - feelings of fullness and cramping - diarrhea - palpitations and tachycardia - perspiration - weakness and dizzines - borborygmi (loud gurgling)

Answer 195

- hx: risk factors, use of NSAIDs or ASA, alcohol, tobacco, diet, and eating pattern - general appearance - vitals - weight - abdominal exam including shape and contour - bowel sounds and tenderness to palpations - presence of obvious or occult blood in emesis and stool - inspection of skin turgor and oral mucous mebmranes - pain - labs: emesis and feces for occult blood, electrolytes, BUN/Cr, CBC, peritoneal fluid culture

Answer 196

- maintain IV infusions - admin blood - admin meds - assist w/ gastric lavage for bleeding, irrigate NG tube with room temp water as rodered - prep for endoscopy or surgery - document and report anorexia,fullness, nausea, vomiting, or s/s of dumping syndrome - take meds as ordered - avoid eating within 2hrs of bed - avoid risks

Answer 197

- symptom, not a disease - fewer than 3 BM/wk or hard, dry, small and difficult to pass stools - complications: vasovagal, impaction, hemorrhoids, fissures, rectal prolapse, perforation (surgery w/ colostomy) - treatment: underlying cause, exercise, increase fiber and fluid, laxatives and/or enema, assess for impaction, privacy to use bathroom, NPO until n/v resolves and has BM, education on diet, fluids, exercise, and importance of defecating when urge is felt

Answer 198

- swollen or dilated veins in anorectal area - can be internal or external - medical treatment is symptom management and surgical removal

Answer 199

- assess for prescence of hemorrhoids and s/s of bleeding - risk for altered bowel elimination due to pain - local analgesics/anesthetics - astringents - corticosteroids - protectants/emollients - provide cold packs and sitz baths - avoid straining (administer laxatives and increase fiber and fluids) - apply local moist heat - education

Answer 200

- ingunial, femoral, umbilical, or ventral - intestine protrudes through abdominal opening - reducible, incarcerated, or strangulated - cause: pressure on abdomen, weakened structures post-op, straining, lifting heavy objects, sudden twists, pulls or muscle strain, weight gain, chronic cough - s/s: buldge in abdomen or groin - tx: reduction or surgical repair (hernia repair or bowel resection) - AVOID COUGHING, STRAINING, AND LIFTING POST-OP

Answer 201

- identify presence of hernia - preop and post op - treat pain - assess for complications (strangulation, surgical site infection, bowel obstruction) - education

Answer 202

- inflammation of peritoneum - bacterial infection from leakage of GI tract contents from a perforation, surgery, trauma, or peritoneal dialysis

Answer 203

- rigid board like abdomen - abdominal pain (can refer to shoulder or chest) - distended abdomen - n/v - anorexia - diminished bowel sounds - inability to pass gas or stool - high fever - tachycardia - dehydration - rebound tenderness - decreased urine output - hiccups - possible compromised respiratory status

Answer 204

- blockage that prevents normal flow of intestinal contents through intestinal tract - SBO - most common - LBO - causes: surgery, hernia volvulus, intussusception, tumor/mass, adhesions, strictures, diverticular disease, paralytic ileus

Answer 205

- dysfunction of nervous system affecting peristalsis (i.e., paralytic ileus, spinal cord injury/paralysis, multiple sclerosis) - paralytic ileus: temporary paralysis of normal intestineal movement commonly from surgery taht involves intestine manipulation

Answer 206

- perfusion to intestinal segment can be compromised causing: ischmemia leading to necrosis, or rupture or perforation causing peritonitis and septic shock/death

Answer 207

- abdominal discomfort or pain accompained by visible peristaltic waves in upper and middle abdomen - upper or epigastric abdominal distention - nasuea and early vomiting (may contain fecal material) - obstipation - severe fluid and electrolyte imbalances - metabolic aklakosis (not always)

Answer 208

- intermittent lower abdominal cramping - lower abdominal distention - minimal or no vomiting - obstipation or ribbon-like stools - no major fluid and electrolyte imbalances - metabolic acidosis (not always)

Answer 209

bowel decompression w/ NGT up to 3 days - NPO w/ IVF - antiemetics - electrolyte replacement - TPN gastrografin - GI contrast media to dislodge, break up, and flush out partial obstruction - administer via NGT, clamp for 2-4hrs, then abdominal xrays- if dye is in large intestine, obstruction should resolve w/o surgical intervention surgery: hernia repair, lysis of adhesions, bowel resection

Answer 210

- monitor vitals (BP and HR!) for fluid balance monitoring - assess abdomen 2x/day for bowel sounds, distention, and passage of flatus - monitor fluid and electrolyte balance status include lab values - manage NGT: monitor drainage, ensure tube patency, check tube placement, irrigate tube as perscribed, maintain NPO, provide frequent mouth and nares care, maintain pt in semi-fowlers position - give analgesics for pain - maintain IV therapy for fluid and electrolyte replacement - give alvimopan as prescribed for patients w/ post-op ileus - maintain parenteral nutrition if prescribed

Answer 211

- assess placement, suction, patency, and output - assess for presence of bowel sounds and flatus - assess for nasal pressure injury

Answer 212

- exact cause unknown - inflammatory condition impacting GI tract causing chronic inflammation and intestinal mucosal damage - exacerbations and remissions - impaired ability to absorb nutrients due to diarrhea leading to weight loss - umbrella term for 2 disease: crohn's and ulcerative colitis

Answer 213

- inflammation of GI tract wall that extends through all layers, most commonly distal ileum and ascending colon - crypt inflammation and abscesses will develop into ulcers taht deeped and become separated by edematous patches creating cobble stone apperance - fistuals, fissures, and abscesses form leading to postential perforation and peritonitis - diseased segments of bowel are adjoined by areas of normal bowel tissue

Answer 214

- inflammation and ulceration of colon and rectal mucosa - begins in rectum and progresses through colon (continuous pattern)

Answer 215

- begins in rectum an proceeds in a continuous manner toward cecum - 15-25 and 55-65 age of diagnosis - 10-20 liquid bloody stools per day - complications: hemorrhage, nutritional deficiencies - 20-40% need surgery

Answer 216

- most often in terminal ileum with patchy involvement through all layers of bowel - 15-40 yr age of onset - 5-6 soft, loose stools per day, non bloody - fistuals and nutritional deficiencies common - 75% need surgery

Answer 217

- abdominal cramping, LLQ pain - severe bloody, purulent, mucousy diarrhea - tenesmus (painful and constant need to empty bowel) - bleeding causing anemia (pallor, fatigue) - anorexia (malnutrition, weight loss) - vomiting (dehydration, electrolyte imbalances) - fever

Answer 218

- <4 stools/day w/ or w/o blood - asymptomatic

Answer 219

>4 stools/day w/ or w/o blood mild abdominal pain mild intermittent nausea increased CRP or ESR

Answer 220

>6 bloody stools/day fever tachycardia anemia abdominal pain increased CSR and/or ESR

Answer 221

>10 bloody stools/day increasing symptoms anemia may need transfusion colonic distention

Answer 222

- hemorrhage/perforation: lower GI bleeding results from erosion of bowel wall - abscess formation: localized pockets of infection develop in ulcerated bowel lining - toxic megacolon: massive dilation of colon and colonic ileus that can lead to gangrene and peritonitis - intestinal malabsorption - non mechanical bowel obstruction: obstruction results from toxic megacolon or cancer - fistulas: in chron's, inflammation is transmural, fistuals can occur anywhere but usually track between the bowel and bladder, resulting in pyuria and fecaluria - colorectal cancer: patients w/ UC w/ a hx of longer than 10 years have high risk for colorectal cancer - extraintestinal complications: arthritis, hepatic and biliary disease (especially cholelithiasis), oral and skin lesions and ocular disorders such as iritis - osteoporosis: common in chron's

Answer 223

- physical rest - treat inflammation - treat infection - correct malnutrition (bowel rest and TPN, fluid and electrolyte management, nutrition) - alleviate stress - symptom relief - complementary and alternative therapies to improve QOL (stress reduction, fear, self-esteem, depression, anxiety) - surgery: colectomy w/ ostomy temp or permanent

Answer 224

- vitals - daily weights - I&Os - fluid and electrolyte status (IVF, electrolyte replacement) - nutritional intake (NPO during flare, TPN, advance from NPO to clear to low fiber) - assess bowel sounds - monitor for tenderness, cramping, s/s of perforation, peritonitis, hemorrhage, obstruction - stool frequency and characteristics - rest - skin care - administer meds as perscribed (salicylate compounds, corticosteroids, immunosuppresants, antidiarrheals, pain meds) - education: low fiber, high protein, vitamin and iron supplements, small frequent meals, foods to avoid, smoking cessation, meds, followups, colonscopy

Answer 225

- small bulging pouches that form in lining of colon - susceptible to complications like inflammation (diverticulitis), bleeding, or perforation - diverticulosis: presence of non-inflammed diverticula - diverticulitis: inflammation and infection of diverticula

Answer 226

- none - hx: chronic constipation, bowel irregularity, nausea, anorexia, bloating, distentions

Answer 227

- acute onsent of abdominal cramping LLQ - constipation or diarrhea - bloating, distention - anorexia - flatulence - n/v - fever - leukocytosis - rectal bleeding - if abscess present: tenderness, palpable mass

Answer 228

- hemorrhage - fistula - inflammaiton - abcess - perforation - bowel obstruction - bleeding

Answer 229

- outpt - rest - diet (oral fluids, low fiber and low fat) - anitbiotics - pain meds

Answer 230

- hospitalization - NPO - IVF - NGT - antibiotics - pain meds - antiemetics - surgery: colon resection, ostomy - discharge education

Answer 231

- surgically created fecal diversion to abdominal wall via stoma - permanent or temporary - ileostomy (small intestine) - colostomy (colon)

Answer 232

- stoma ischemia and necrosis (dark red, purplish, or black color, dry) - continuous heavy bleeding - mucocutaneous separation (breakdown of suture line securing stoma to abdominal wall)

Answer 233

ileostomy - liquid to semi-liquid ascending colostomy - semiliquid transverse colostomy - semiliquid to semiformed descending colostomy - semiformed sigmoid colostomy - formed stool

Answer 234

- inflammation of appendix - when appendix becomes inflammed or infected - can cause perforation or rupture within 24 hrs, gangrene after 24-36hrs, peritonitis and/or sepsis

Answer 235

- vague periumbilical pain progressing to RLQ - rebound tenderness, abdominal rigidity - anorexia - n/v - fever - abdominal distention - leukocytosis - constipation or diarrhea

Answer 236

- clinical presentation - u/s - CT scan

Answer 237

7-10 day antibiotics but may still need surgery

Answer 238

appendectomy

Answer 239

- vitals - intake and output - pain - rebound tenderness - WBCs

Answer 240

- keep NPO - admin IVF - prepare pt for OR - provide comfort - position supine w. HOB elevated - advance diet as tolerated - NO LAXATIVES OR ENEMAs - NO APPLICATION OF HEAT

Answer 241

- TCDB - incentive spirometer - early ambulation - take full course of antibiotics - wound care

Answer 242

- blunt or pentrating trauma between diaphragm and pelvis - spleen and liver most common - causes: MVA, stabbing, GSW, fall, asault, contact sports - complications: peritonitis, hemorrhage, shock - diagnosis: lab studies, xray, CT scan, diagnostic peritoneal lavage, FAST exam

Answer 243

- bruising - penetrating injuries - abrasions - lacerations - discolorations - asymmetry - cullen's sign: ecchymosis around umbilicus - turner's sign: ecchymosis around flank

Answer 244

- dependent on nature of injury - large bore IV - fluid resuscitation - NG tube - surgery: exploratory laparotomy

Answer 245

- ABCDE (airway, breathing, circulation, disability (neuro), exposure - vitals: tachycardia and tachypnea - LOC - area of injury - clinical manifestations - bowel sounds - CBC - serum electrolytes - urinarlysis (hematuria)

Answer 246

- restlessness - anxiety - cool clammy skin - confusion - weakness - pale color - tachypnea - tachycardia - hypotension

Answer 247

- admin o2 - insert large bore IVs - draw labs - collect UA - insert catheter - do not remove object protruding from wound - control bleeding - admin antibiotics - keep family informed about pt condition

Answer 248

- ALT - AST - alkaline phosphatase - GGT - LDH - bilirubin direct and indirect - albumin - amonnia - coags - platelets

Answer 249

- used to diagnosis conditions - tissue samples are removed from liver and checked under a microscope fro signs of damage or disease, cancer cells or other abnormal cells in liver - can tell how liver is functioning

Answer 250

- informed consent - withhold fluid and food for 8-12hrs before procedure - perform baseline assessment - assess results of coags and blood type and x - teach about postop care and need to hold breath after expiration when needle is isnerted - administer sedative as prescribed - note client is placed in supine or left lateral during procedure to allow right side exposure

Answer 251

- must notify HCP - you may admin platelets, vitamin K, FFP, thrombopoietin agonists, prothrombin complex, and cryoprecipitate

Answer 252

- assess vitals - monitor site for bleeding - monitor for peritonitis - maintain bed rest for 12-14hrs - place client on right side w/ pillow under costal margin for 2 hrs to decrease the risk of bleeding, and instruct the client to avoid coughing and straining - instruct client to avoid havy lifting and strenous exercise for 1wk and to avoid coughing or straining which may cause increased intra-abdominal pressure - notify the HCP if dyspnea, cyanosis, or restlessness occurs as these are signs of pneumothorax

Answer 253

- blood storage - blood filtration - production of bile - synthesis of clotting factors (prothrombin and factors II, VII, IX, and X) - removal of clotting factors to prevent clotting - metabolism of carbs, fats, protein - detox blood - storage area for vitamins A,D, E, K, and iron

Answer 254

occurs when liver is no longer able to perform usual function caused by: hepatitis, cirrhosis, trauma, or cancer

Answer 255

- thrombocytopenia causing bleeding gums, tachycardia, petechiae, 150k> platelets - distended, large abdomen feeling tight w/ abdominal discomfort, lack of appetite, and SOB - jaundice: yellowing of skin due to high levels of bilirubin in blood caused by bile duct obstruction, liver dysfunction, and colecystisis - esophageal varicies: dilated veins in lining of lower esophagous caused by portal HTN from cirrhosis, portal vein thrombosis, right-sided HF, and schistosmiasis - hepatic encephalopathy

Answer 256

- monitor vs - elevated HOB - monitor orthostatic hypotension - monitor lung sounds for signs of distress - administer o2 as prescribed - monitor LOC - maintain NPO - admin fluids IV as prescribed to restore fluid volume and electrolyte imbalances - monitor I&Os - monitor h/h and coags - administer blood transfusions or clotting factors - assist NGT insertion or balloon tamponade - prepare to assist with meds to induce vasoconstriction and reduce bleeding - instruct patient to avoid activites causing vasovagal responses - prepare client for endoscopic procedures or surgical procedures as prescribed

Answer 257

- life threatening condition - liver dysfunction causes impaired ability to metabolize toxic substances like ammonia causing brain dysfunction - s/s: insomnia, hypersomnia, mood changes, confusion, coma, asterixis

Answer 258

- inflammation of liver leading to dysfunction - impairs liver's ability to fxn in detoxifying body of substances production of proteins and clotting factors ability to store vitamins, fats, and sugars - results in jaundice, fatigue, nausea, vomiting, abdominal pain, fever, dark urine, light colored stool - caused by a virus, bacteria, or exposure to meds, chronic alcohol use or toxins - vital: A,B, and C - transmission: blood, body fluid exposure (sex, needles, etc.), stool, fecal-oral contamination

Answer 259

- fecal-oral contaminated water or food - sources include feces and contaminated water or food - 2-7wk incubation epriod - acute ilness - vaccine available - symptom management is treatment

Answer 260

- percutaneous or mucosal blood, body fluids, needles, and sharps is how disease is transmitted - 2-5mo incubation period - acute and chronic - vaccine available - interferon and antivirals for treatment

Answer 261

- percutaneous or mucosal blood, body fluids, needles, and sharps is form of transmission - 1wk-several months for incubation period - acute and chronic condition - no vaccine - interferon and antivirals

Answer 262

- direct acting antivirals - interferon

Answer 263

- preicteric stage: jaundice, flu-like symptoms, anorexia, n/v, diarrhea, pain, elevated bilirubin and enzyme levels - icteric stage: jaundice, elevated bilirubin, dark urine, clay colored stools, pruritis, decrease in preicteric phase, fatigue, abdominal pain - posticteric: resolution of jaundice, urine and stool return to normal, energy increases,p ain subsides, minimal GI s/s, bilirubin and enzymes WNL

Answer 264

- avoid contaminated food - treat municipal water supplies - screening of food handlers - preexposure prophylaxis w/ immune globulin for travelers - vaccine

Answer 265

- hand hygeine - HBV vaccine - needle precautions - avoiding unprotected contact with body fluids of infected persons - blood donor screening - testing on women who are pregnant

Answer 266

- antivirals - interferon - vaccine required for some - mild: rest, adequate fluids and nutrition - chronic: monitor liver function

Answer 267

- good handwashing - blood donor screening - needle precautions - avoid unprotected sex w. infected persons

Answer 268

direct acting antivirals for 8-24wks, ongoing monitoring viral load and LFTs interferon transplant

Answer 269

- pain in right side of abdomen - fever - jaundice - digestion problems - dark urine - feeling weak - vomiting - nausea

Answer 270

- jaundice - encephalopathy - ascites - palmar erythema - violation of blood clotting - edema - bleeding from esophagus and stomach - itching of skin

Answer 271

- jaundice - ascites - nausea - bruising and bleeding - intoxication - asthenia - joint pain - lack of appeitie

Answer 272

- rest and low level exercise - diet: low fat, high fruits veggies, and grains, small frequent meals, alcohol reduction, vitamin A, D, E, and K supplements - fluids - avoid acetaminophen - med: direct acting antivirals, antiemetics, sofosbuvir, nucleoside and nucleotide analogs

Answer 273

- vs - labs- LFTs, bilirubin, ammonia - skin- color and sclera - nutritional intake, daily weight, I&Os - observe stools for color, consistency, amount and frequency - s/s of complications: change in LOC, ascites, edema, dehydration, respiratory problems, myalgia, arthralgia, s/p transplant (assess for rejection)

Answer 274

- allow client to rest - administer antipruritic meds - admin antiemetics - admin meds for HBV suppression - administer direct acting antivirals - provide balanced diet as tolerated - encourage small, frequent meals, admin IV nutrition if needed - provide adeuqate fluids - monitor I&Os and electrolyte balance - private room for HAV if client exhibits poor hygeine or has bowel incontinence - provide range of motion exercises to minimize risk of blood clots - standard precautions!!!!

Answer 275

- handwashing - do not share bathrooms - individual washcloths, towels, drinking and eating utensils, toothbrushes, razors, etc. - cannot prep food for family - client should avoid alcohol and OTCs - increase activity gradually - small frequent high carb low fat meals - cannot donate blood - crowds should be avoided - medicalert bracelet - inform HCP - med adherance

Answer 276

- condition where healthy liver tissue is replaced by scar tissue affecting liver ability to function - liver damage: over time from various factors like alcohol, viral hepatitis infections, fatty liver disease, or other causes the liver to be damaged - scar tissue formation: in response to damage, liver tries to heal itself by forming scar tissue which gradually replaces healthy liver tissue - impaired liver fxn: as more scar tissue forms, livers ability to perform its vital fxn's, like detox, protein synthesis, and bile production is impaired

Answer 277

- US - CT - EGD - biliary tract obstruction (percutaneous transhepatic portal angiography, or perc. transhepatic cholangiography

Answer 278

- SOB - jaundice - pruritis - increased risk of bleeding: nosebleeds, easy bruising, bleeding gums, thrombocytopenia, PTT - changes in LOC (elevated ammonia levels, hyponatremia) - chanegs in motor fxn (asterixis) - increased abdominal girth - abdominal pain and bloating - hemorrhids - fatigue - weight loss

Answer 279

- ascites - GI varicies - bleeding - vitamin K deficiency causing poor clotting ability - hepatic encephalopathy - infection and peritonitis

Answer 280

- portal HTN - hepatic encephalopathy - spontaneous bacterial peritonitis - heptorenal syndrome - liver cancer - coagulopathy - malnutrition - liver failure

Answer 281

- increase Na+ and water excetion (restrct <2g/day of sodium) - admin diuretics - treat ascites: routine paracentesis, peritoneovenous shunt - treat portal HTN (vasoactives) - treat hepatic encephalopathy: eat small meals to prevent protein loading, rifaximin, or neomycin, lactulose - manage bleeding (banding of varicies, beta blockers, baloon tamponade - correct fluid and electrolyte imbalances - tranjuglar intrahepatic protosystemic shunt - liver transplant

Answer 282

- assess for anorexia, n/v, ascites - measure girth - assess for muscle wasting and poor nutrition - assess color of urine - assess stools - assess respiratory status - complete physical - assess for prescence of jaundice - ask client about itching - assess for melean or hematemeis - assess client for bleeding and esophageal and GI varicies - assess symptoms of hepatorenal syndrome: decrease UO and decreased urine sodium and increased levels of BUN/CR - monitor for hepatic encephalopathy - assess for a sweet musty odor on client's breath - VS -petechiae, bruising, bleeding gums, nosebleeds - I&Os, daily weights - spider angiomas - palmar erythema

Answer 283

- nutritional/fluid and electrolytes (diet, high cal low protein, restrict sodium intake and fluid intake, enteral or parenteral nutrition, IVF) - meds: antipruritic, diuretics, beta blockers, lactulose, antibiotics, vitamin supplements: K, A, C, B, complex, folic acid, thiamine - electrolyte replacements - octreotide - treat pruritis - elevate HOB breathing - promote rest - test stool for occult blood - reorient as needed - safety measures to prevent injury - administer blood products - avoid meds like opioids or sedatives, barbiutrates, any hepatotoxic meds - assist with paracentesis, prep for shunting or TIPS procedure

Answer 284

- teach client experiencing pruitis to sue knuckles to rub itchy areas - teach client ot not drink alcohol - avoid straining for bowel movements, sneezing, vomiting - assist client to quit alcohol - sodium restriction - read foods labels - instruct client on intake of high cals and nutritional supplement - instruct client on when to call HCP - need for care with hygeine, soft toothbrushes, careful flossing, electric razors

Answer 285

- ensure understanding of procedure - obtain vs - obtain weight - assist client to void and empty bladder - measure abdominal girth - position client upright

Answer 286

- assess HCP in comfort and support - apply dressing to puncture site for bleeding - monitor for hematuria, caused by bladder trauma - monitor vs for BP and HR - monitor for LOC - measure abdominal girth and weight - monitor for hypovolemia and electrolyte loss - measure amount of fluid removed and description of it - label and send fluid to lab - document event and client response - instruct HCP if urine becomes bloody, pink or red

Answer 287

- prescence of stones in gallbladder or common bile duct - cholelithiasis - coldedocolithiasis

Answer 288

- supersaturation of bile with cholesterol occurs causing colesterol to precipitate into stones - protein, bile salts, and calcium precipitate into stones - conditions like pregnancy, obstructive lesions, or inflammation of biliary system and immobility decrease flow increasing risk - gallstones frequently stay in gallbladder but may move to ducts causing obstruciton and pain

Answer 289

- biliary colic - severe rapidly intensifying pain - localized to upper right or central abdomen - triggered at night after fatty meal

Answer 290

- abdominal ultrasound - endoscopic ultrasound - endoscopic retrograde cholangiopancreatography

Answer 291

- can occur as acute or chronic - acute is inflammation resulting from obstruction from biliary sludge or gallstones - chronic disease is caused when wall of gallbladder becomes scarred and itssues become fibrotic, causing a shrunken gallbladder and decreased function - gallbladder becomes swollen and contains pus - can occur in absence of gallstones

Answer 292

- indigestions, belching, flatulence after high fat foods - pain in RUQ, epigastric pain radiating to right shoulder, between shoulder blades - gaurding, rigidity, bebound tenderness - hypoactive bowels - tachycardia - s/s of dehydration

Answer 293

- NPO - manage pain - antibiotics - maintain fluids and electrolytes - IVF - antiemetics - NGT if n/v severe - transhepatic biliary catheter - lithotripsy - ERCP - cholecystectomy - gallstone dissolution therapy (bile acids (ursodiol) - low fat diet - fat soluble vitamins

Answer 294

- monitor vs - abdominal assessment: distention, bowel sounds, murphy's sign (taking a deep breath and palpating, if pain occurs on inspiration and palpation it is +) - maintain NPO - I&Os - administer antibiotics, antiemetics, analgesics - NGT if ordered - prep client for nonsurgical and surgical procedures as ordered

Answer 295

- keep dressing on for 24hrs after procedure - don't take shower for 48hrs or get incision wet - pain meds instruction, constipation, prevention - activity level; walk w/i a week, driving, working, light lifting <10lbs, no driving while on narcotics - s/s of infection or jaundice - postop care of t-tube (monitor drainage - clincial manifestations of infection, obstruction, jaundice, color of urine and stool

Answer 296

acute: occurs suddenly as one attack or can be recurrent with resolutions chronic: continual inflammation and destruction of pancreas with scar tissue replacing pancreatic tissue

Answer 297

- trauma - pancreatic obstruction (tumors, cysts, abscess) - metabolic problems - renal involvement - familial inherited pancreatitis - penetrating gastric or duodenal ulcers causing peritonitis - viral infections such as coxsckievirus B and HIV - alcoholism - toxicities of drugs like opiates, sulfonamides, thiaxides, steroids, and oral contraceptives - cigarette smoking and tobacco use - CF - gallstones

Answer 298

- low grade fever - hypovolemia (tachycarida, hypotension) - hypoxia (restlessness, anxiety) - abdominal pain (sudden onset, midepigastric or LUQ, radiation to back, aggravated by fatty meal, alcohol, or lying flat) - abdominal distention - n/v - hiccups - indigestions - absent or decerased bowel sounds - jaundice - cullen's sign: bruising around umbilical site - turner's sign: bruising around flank - eleavted WBC, lipase, and amylase - monitor for hypocalcemia (Chvostek's sign (hyperexcittability of masseter muscle/cheek), Trousseau's sign (hand pulls inward), tetany, and laryngospasm) - pleural effusion - ARDS - MODS

Answer 299

- pancreatic infection leading to shock - hemorrhage (necrotizing hemorrhagic pancreatitis) - acute kidney failure - paralytic ileus - hypovolemic shock - pleural effusion - ARDs - atelectasis - penumonia - multiorgan system failure - disseminated ivtravascular coagulation (DIC) - type 2 diabetes mellitus

Answer 300

- vitals (tachycardia, hypotension, increased RR, decreased O2, fever) - NPO - monitor lipase and amylase levels - abdominal assessment - monitor stool color - daily weight I&Os - assess for s/s of hypocalcemia, tetany - NG tube if vomiting, has biliary obstruction or paralytic ileus - administer parenteral nutrition for severe nutritional deficiency - prolonged NPO status remains - NJ tube - admin opiod analgesics for pain - admin anticholinergics to decrease secretions - histamin blocks, pancreatic enzymes, and antibiotics - observe for changes in LOC related to alcohol withdrawal, hypoxia, or sepsis

Answer 301

- diet mods - avoid alcohol and smoking - follow ups - notify HCP if acute abdominal pain, jaundice, clay-colored stools, or dark-colored urine develops

Answer 302

- constant severe upper abdominal and back pain - vomiting - steatorrhea, foul smelling stools - clay colored stools - malnutrition - anorexia - weight loss - jaundice - ascites - elevated serum glucose - elevated amylase, lipase, serum bilirubin, and alkaline phosphatase

Answer 303

- VS: pain increasing HR, RR, BP - abdominal assessment, look for cullen or turner signs - assess sclera - assess stool - monitor labs - pain management - IVF - electrolyte replacement - pancreatic enzyme replacement. (PERT- do not chew) - nutritional support - glucose management - GI prophylaxis - avoid alcohol and irritating food/beverages, limit fat, avoid heavy meals, small high calorie snacks, follow up

Answer 304

- underweight <18.5 - normal 18.5-24.9 - overweight 25.0-29.9 - obesity (class 1) 30-34.9 - obesity (class 2) 35-39.9 - extreme obesity (class 3) >40

Answer 305

- type 2 DM - CVD - stroke - OSA - cancer - end stage renal disease - psych episodes - incerased prescriptions for pain

Answer 306

medical specialty that focuses on causes, prevntion, and treatment of obesity

Answer 307

- weight loss therapy - diet therapy - physical activity - behavioral therapy - medications - bariatric surgery

Answer 308

inhibits pancreatic lipase reducing dietary fat absorption

Answer 309

affects chemicals in brain regulating appetite and increase feeling of fullness after eating

Answer 310

phentermine supressess appetite causing weight loss, decreased appetitie, an enhanced satiety

Answer 311

can raise BP, antidepressant

Answer 312

glucagon like peptide reception agonist to slow gastric emptying dosage titrated up weekly

Answer 313

weight loss by reduced gastric capcity adjustable gastric banding, sleeve gastrectomy

Answer 314

no longer commonly preformed induces weight loss through decreased nutrient absorption, jejunoileal bypass and biliopancreatic diversion

Answer 315

induces weight loss through restriction also creating component of malabsorption Roux-en-Y gatric bypass

Answer 316

- mortality rates steadily declined - PE -infection -anastomosis leak - band slippage - obstruction - hernia - esophageal erosion - ulcers - acid reflux - vitamin deficiency - osteoporosis - anemia - dumping syndrome

Answer 317

- impaired breathing - atelectasis and pneumonia - increased risk VTE - increased risk pressure injury - risk for skin infetions - immobility - anastomosis leak (life threatening complication causing tachycardia, fever, hypotension, and abdominal pain) - bleeding - peritonitis - intestinal obstruction - dehydration - electrolyte imbalance related to vomiting - malnutrition

Answer 318

- VS - o2 sat - electrolytes - daily weight - skin assessment - incisions and drains - pain

Answer 319

- obtain appropriate sized equipments - elevate HOB - VTE prevention - use mobility devices - turn and position - skin care - do not reposition NG tube - monitor NG tube for patency - introduce clear liquids as ordered - emotional support - teaching: post op lifting restrictions, diet (clear liquids advancing to pureed and then solid foods, PROTEIN!!!), signs to report to HCP, follow up

exam 2 Flashcards

(351 cards)