Exam 2 Flashcards
(199 cards)
1
Q
which lifestyle modification should nurse recommend to client w/ GERD
A
avoid caffeine, alcohol, fatty foods
2
Q
what foods to avoid for pt with PUD?
A
avoid spicy foods and alcohol
3
Q
a pt is on metoclopramide for delayed gastric emptying, what adverse effect should the pt be monitored for?
A
tardive dyskinesia (extrapyramidal side effect like lip smacking)
4
Q
side effects of small bowel obstruction
A
abdominal distention and vomiting
5
Q
what medication increases risk for GI bleed?
A
ibuprofen
6
Q
what is good food options for Chron’s disease?
A
grilled chicken w/ mashed potatoes and applesauce
(not whole grains w/ raw veggie salad)
7
Q
important nurse caring that should be a priority after EGD?
A
assess for return of the gag reflux
8
Q
what lab needs immediate attention if abnormal (especially for a pt on TPN)
A
potassium because cardiac effects!
9
Q
what kind of pt is high risk for paralytic ileus
A
recent surgery
10
Q
pt has UC, what requires immediate attention?
A
sudden drop in blood pressure
11
Q
client has an ileostomy, what is a concern/needs further teaching?
A
pt w/ ileostomy cannot have extended release meds bc doesn’t have enough time to absorb
12
Q
what is a good diet for pt w/ diverticulosis?
A
high fiber diet w/ fresh fruits, veggies, whole grains
13
Q
pt w/ peritonitis, what is concerning?
A
board like abdominal rigidity
14
Q
pt has a hiatal hernia, what should a pt avoid?
A
carbonated beverages
15
Q
what is a concern for colorectal cancer?
A
bright red blood in stool
16
Q
pt has a SBO and is vomiting for 12 hours, what labs should you anticipate?
A
sodium being high (151) due to vomiting, he’s dehydrated !!
17
Q
pt has an AV fistula, what requires immediate attention?
A
weak or absent thrill over fistula
18
Q
Pt w/ ESRD on hemodialysis, what is concerning?
A
low bp!!!! 88/55
19
Q
A pt with AKI has UOP of 25mL, what should the nurse do first?
A
notify healthcare provider bc less than 30ml/hr
20
Q
a pt has nephrotic syndrome, what is the most common characteristic of this?
A
proteinuria and generalized edema
21
Q
pt has AV fistula, what needs additional education?
A
taking b/p on fistula arm… you cannot do this! use other arm
22
Q
client comes in w/ acute pyelonephritis, what symptom is indicative of this condition?
A
fever, chills, flank pain
23
Q
a nurse is looking at lab results w/ pt w/ AKI… what is concerning?
A
potassium of 6.5 (this is high and effects cardiac…concerning!!!)
24
Q
client w/ CKD, what kind of diet should the pt have?
A
limit intake of sodium and protein
25
what needs further teaching for a pt taking phenazopyridine for a UTI?
this med will cure the infection.... WRONG! this only treats the symptoms
26
pt presents with renal colic due to a ureteral stone. which is the nurses priority intervention?
administer prescribed opioid analgesics (bc painful!)
27
nurse is monitoring pt on peritoneal dialysis, what is concerning?
cloudy peritoneal effluent
28
nurse is teaching client w/ BPH about symptom management. what client statement requires further teaching?
"I will increase my intake of dairy to improve calcium levels" .... wrong! should do low calcium due to can cause irritation to prostate bc it regulates hormones and makes it bigger
29
what is an early symptom of bladder cancer?
painless hematuria
30
what is the #1 cause of endocarditis?
poor dental care
(also Intubation, malnutrition, poor education, vomiting, side effects of meds like chemo & radiation, lack of access to dental care)
31
this is a disorder of the oral cavity that is seen in HIV/ advancing AIDS
Kaposi sarcoma (disease in which cancer cells are found in the skin/mucous membranes that line the GI tract from mouth to anus, including stomach & intestines. These tumors appear as purple patches or nodules on the skin and/or mucous membranes and can spread to lymph nodes and lungs.
32
This disorder is myofacial pain, degenerative joint disease, with pain that radiates to ears, teeth, neck, facial sinuses... restricts jaw motion; clicking or popping in jaw. causes h/a, earache, dizziness?
what is the treatment?
TMJ (temporomandibular jaw disorder)
treatment includes wear mouth guard at night to prevent clenching, botox, jaw exercises, eating soft foods while avoiding chewy tough foods
32
this pain comes in waves, cramping
colicky pain
33
these are disorders of the salivary glands
parotitis- inflammation of parotid glands (decreases produce of salvation)
sialadenitis- inflammation of salivation glands
salivary calculus- stone develops in salivary gland
neoplasms- smoking causes these
34
what are signs of neoplasms for salivary glands?
sores, non-healing ... over 2 weeks. typically non painful (open or closed) that don't heal
can bleed easy, red or white patch in mouth or throat
35
this is a high risk for causes of head/neck cancer
HPV
36
what to manage as nurse after surgical resection and radiation of neck
nutrition
written communication
airway
pain
wound care
37
this is dryness of mouth
xerostomia
38
this is inflammation of the mouth
stomatitis
39
3 exercises for rehab after neck dissection
1. turn head side to side, chin to chest, put ear on shoulder
2. place hands in front w/ elbows at right angle, rotate shoulders back brining elbows to side (then relax)
3. swing shoulder/arm in a wide circle with arm above head
40
potential complications for neck dissection
hemorrhage (low bp, low O2, tachy)
chyle fistula (lymphatic fluid draining in toracic duct)
nerve injury (paralysis, loss of sensation)
41
GT vs JT (gastrostomy vs jejunostomy)
GT goes in stomach
JT goes in jejunum
*pt gets JT if high risk of reflux
***check placement by aspirating
42
complications of G/J tubes
wound infection/ cellulitis
bleeding/leakage at site
tension on tube
43
this is when food moves too quickly through the digestive system... happens 30-60 mins after meals or late is 1-3 hrs after meals
dumping system
44
symptoms of dumping syndrome
n/v, bloating, diarrhea, abdominal cramping, dizziness, epigastric fullness, weakness, vertigo, diaphoresis, tachy
45
what is the cause of dumping syndrome? & how to manage?
Cause of this is rapid glucose absorption that can lead to hypoglycemic effects
Manage this by eating more small, frequent meals, increasing protein and fiber intake, reduce simple carbs and sugar. Avoid fluids w/ meals. Drink 35-45 mins before of after meal, not w/ the meal… increase in complex carbs and healthy fats to breakdown and maintain energy balance (lie down for 30 mins after eating to help slow down the GI process. This is the ONE time we lay down after eating to help)
46
why does dumping syndrome occur?
Can happen for many reasons such as part of digestive system being removed, can happen after cholecystecmy, pts that had weightloss surgery, sugar and carbs are a big cause too
47
this is known as esophageal spasms, pediatric pts can get this
achalasia (difficultly swallowing, get a back flow leading to aspiration, can develop chest pain not related to heart conditions – its due to esophageal spasms)
48
how to prevent achalasia
(difficultly swallowing, get a back flow leading to aspiration, can develop chest pain not related to heart conditions – its due to esophageal spasms)
encourage pt to eat slower, drink plenty of fluids, may need dilation
49
dysphagia vs odynophagia
dysphagia = difficulty swallowing
odynophagia = painful swallowing
50
a manometer (manometry) test confirms this diagnosis
...measures pressure inside esophagus
achalasia (difficultly swallowing, get a back flow leading to aspiration, can develop chest pain not related to heart conditions – its due to esophageal spasms)
51
s/s of hiatal hernia
asymptomatic or n/v, heart burn, GERD like symptoms such as midepigastric discomfort, heart burn, nausea
51
this is a hernia in stomach that pushed through diaphragm into chest cavity, many time it's asymptomatic
hiatal hernia
52
hiatal hernia diagnose
barium study (drink fluids after!!!), or EGD which requires NPO 8 hrs.. also can do X-Ray.
53
how to manage uncomplicated small hiatal hernia?
sit upright after eating, eat small more frequent meals .. Avoid spicy , acidic foods, & caffeine bc will irritate it more (so make a food diary to keep track what irritates it and to avoid those foods).. Don’t’ lay flat at night either bc acid will push up on it
Meds to use: all the “zoles” like pantoprazole (protonix) … use antacids which neutralize the acid already in the stomach , use H2 blockers and PPIs which decrease acid secretion (this decreased the production of acid) .. Can be on combination therapy like PPIs and H2 blockers and take antacids PRN in between. Some PPIs take awhile to start working.
54
this is common to occur due to peptic ulcer disease.
symptoms include sharp, sudden, severe abdominal pain.
perforation
55
s/s of shock
hypotension, tachycardia, confusion
56
most common symptoms is rebound tenderness (when you push down, it feels better & pain when you release)
also pain in RLQ, pain at McBurney's pt
appendicitis
57
how to confirm perforation
X-Ray, CT, barium swallow (not common bc barium will get into peritoneum)
58
low esophageal sphincter isn’t closing or is too weak so reflux goes back into the esophagus
GERD
59
s/s of GERD
heartburn (after they eat!!!), chest pain, regurgitation, can get oral sores and tooth decay due to acid sitting in mouth, chronic cough/clearing of throat, laryngitis
60
treatment of GERD , how to manage symptoms
antacids, H2 blockers (common med is famotidine), PPIs (common med is omeprazole), pro kinetic agents (increase motility, common med is metoclopramide aka Reglan)
-don't smoke
-wear loose fitting clothes to reduce pressure which reduces reflux
-Recommend avoiding certain foods
-do more small frequent meals
-avoid lying flat
-lose weight bc more obese is worse bc more pressure and increases risk of reflux… if you lose weight it will decrease the pressure
60
this is when squamous cells are replaced and increases risk of esophageal cancer, need to be monitored closely
Barrett’s Esophagus
61
if a pt has this, they may be on PPI indefinitely due to changes in cells in esophagus. you're diagnosed with this by EGD w/ biopsy. same s/s of GERD
**can remove partial esophagus in severe instances
Barrett's Esophagus
61
how long will GERD pts be on PPIs?
not indefinitely, just temporarily
62
3 top risk factors for esophageal cancer
1. smoking
2. GERD
3. Alcohol
63
What is more common in men where as GERD is more common in women?
esophageal cancer
64
risk factors for esophageal cancer
age (older)
gender (males!)
obesity
diets low in fruits/veggies
65
1st symptom of esophageal cancer?
dysphagia (difficulty swallowing) then chest pain/burning, then unintentional weight loss, chronic cough/hoarseness, regurgitations, black/tarry stools due to bleeding at later stages
66
what to monitor for pts with esophageal cancer
aspiration pneumonia
cardiac complications
nutritional status (bc difficulty/painful swallowing)... encourage high cal/high protein diet for healing , small/frequent meals, soft foods
avoid large amounts of fluids w/ fluids so it doesn’t overfill the stomach
67
inflammation of stomach mucosa, most common GI problem
Gastritis
68
acute vs chronic gastritis
acute- transient, self limiting, rapid onset, epigastric pain, anorexia, melena (black tarry stools), hiccups, n/v, lasts few hours to few days, shock could happen
chronic- Most common caused by h pylori, leading to peptic ulcer disease, can get fatigue, anorexia, feeling full early, sour taste in mouth, pyrosis (heartburn), asymptomatic sometimes
69
erosive vs non erosive acute gastritis (inflammation of the stomach mucosa)
erosive- caused by irritants such as aspirin, NSAID use, alcohol use..
Black tarry stools or melena, bright red blood in stool, bloody vomit
non erosive- caused by infections such as H pylori (50% of ppl have H pylori)
70
how to manage acute vs chronic gastritis
manage acute- resolve on its own, no alc., bland diet, may need NG tube or electrolytes, PPIs temporarily
manage chronic- modify diet, reduce stress, avoid NSAIDs, no alc., may need antbx due to h. pylori, PPIs (asnomeprazole, lansoprazole aka Prevacid, pantoprazole aka Protonix), H2 blockers (famotidine) , surgery
71
nurse care for gastritis
reduce anxiety
nutrition - may be NPO shortly then advance diet like CL then solid bland foods, avoid caffeine, avoid spicy foods, avoid alc
fluid balance
relieve pain
monitor for hemorrhaging aka increased pain, hypotension, tachycardia)
72
what causes peptic ulcer disease (ulcer in mucosa of stomach)
h. pylori, use of NSAIDs, stress, alcohol
also has fam hx, COPD, cirrhosis, auto immune disease disorders
73
PUD occurs mostly where?
duodenum
74
s/s of PUD
bloody vomit, burning pain, constipation, diarrhea, sour burping especially when stomach is empty, midepigastric pain that radiates into middle upper back, can happen after eating or 2-3 hours after eating, can wake you up in middle of night
75
what to expect if there is a perforation from PUD
expect sudden ONSET SEVERE PAIN, distended abdomen, n/v, bloating, hypotension, tachy
76
what med for PUD should not be taken by pregnant women as it softens cervix and results in miscarriage or premature labor
misoprostol (prophylactic agent for NSAID ulcers)
77
most common cause of
PUD
h. pylori
78
how to treat h. pylori PUD
Antibiotics, proton pump inhibitors, bismuth salts..
10-14 days triple therapy or quadruple therapy
(Amoxicillin, clarithromycin, + a PPI OR adding bismuth salts for quad therapy)
79
what meds end in "idine" and "azole"
H2 blockers end in "idine"
PPIs end in "azole"
80
area distal to sphincter become scarred or edema .. Constipation, weight loss, epigastric fullness
(this can be complication from PUD)
Gastric Outlet Obstruction
81
s/s of hemorrhage , this can be complication from PUD
hypotension, tachycardia, bloody stools (black or bright red or tarr or melena aka dark stools ), emesis that looks like coffee grounds
82
5th most common cancer in the world!!!!
Risk factors include smoking, alcohol, obesity, diet low in fruits & veggies, diet high in smoked, salted or pickled foods, h. pylori, gastric ulcers, AA or Spanish Americans, Asian pacific islanders
Poor prognosis due to symptoms being caught late
Usually asymptomatic at early stages then progresses and get weight loss, feel full quicker, pain around umbilicus, fatigue, n/v
gastric cancer
83
this is straining to go, small, dry, difficult to pass bowels ... less than 3 per week
constipation
84
causes of dehydration
low fiber, dehydration , opioid use, alcohol, de-mobility
85
how to treat constipation
first would be increase fluids and fiber then ambulation, then stool softeners, THEN laxatives (atomic bomb)
86
this is the treatment for cdiff
vancomycin
87
what is the #1 complication of diarrhea
dehydration
88
this med reduces diarrhea
loperamide (Imodium)
89
IBS vs IBD
IBD = inflammatory bowel disease
IBS = irritable bowel syndrome
90
causes of IBS (irritable bowel syndrome)
this can be constipation or diarrhea
causes = being female (2x more likely), stress is a trigger, diet, bacterial overgrowth, sleep deprived
91
how to treat IBS
find your trigger!
increase fiber, low fermentable foods, low lactose and fructose, low sweeteners
**Use dicyclomine for spasms or antidepressants for serotonin levels (90% receptors of serotonin are in the gut)
92
this is inflammation of the peritoneum ... can be caused by bacteria, perforation, trauma
s/s = constant, localized, more intense pain .. Rigid or board like abdomen
peritonitis
DO NOT PALPATE abdomen if you suspect peritonitis bc you can worsen it!
93
diverticulosis vs diverticulitis
Diverticulosis = pouch in colon
Diverticulitis = inflammation of acute condition
94
s/s include Bowel irregularity, nausea, anorexia, bloating, cramps, narrow stools, constipation, pain in LLQ, N/V, fever, chills
diverticular disease
95
Wavelike cramping pain, may pass blood and mucus, not stool or flatus
Vomiting, eventually will vomit stool bc small intestine
Abdominal distention
what does the pt have?
SBO
-treatment NG tube to decompress bowels, may prevent surgery (monitor fluid/electrolytes due to being NPO)
96
how to know if bowel sounds returned
ask pt it they are passing gas!!
97
Symptoms slower/less severe than SBO but more constant
Constipation, weakness, weight loss, anorexia
lower abdominal cramps
bowel sounds diminished
**no vomiting bc too far down
LBO
97
if pt is NPO, what to monitor?
electrolytes/fluids!! pt will most likely be dehydrated
98
how to know if pt had a perforation
sudden rapid intense ONSET pain
99
type of IBD that causes ulcerations in patches
Chron's disease
100
UC vs Chron's
**both cause inflammation and are types of IBD
Chron’s = patchy ulcerations, no consistent section that is inflamed… cobblestone. RLQ pain.
UC = one section of continuous inflammation. LLQ pain. more blood. tons of loose stools. more severe, can end up w/ colostomy. can also get toxic megacolon
101
More common in males, late teens to early 20s.
Can develop joint disorders, skin lesions, ocular disorders, oral ulcers, ulcers throughout esophagus as well.
s/s = RLQ pain and diarrhea, cramping after meals, Wt loss, malnutrition, anemia, chronic diarrhea, steatorrhea
cobble stone patches
Chron's Disease
102
Inflammation and ulcerations of the lining of the colon and rectum.
Lesions are in sequence, occurring one after the other
s/s = Exacerbation & remission, diarrhea, mucus, pus, blood LLQ pain, anorexia, wt loss, fever, vomiting, dehydration, 6 or more liq stools per day (up to 20)
UC
103
type of IBD that has lesions in one sequence... complication is toxic megacolon. bloody purulent diarrhea. tons of loose stools.
UC
104
treatment for Chron's and UC
Sedatives, antidiarrheal, antiperistaltic meds
Aminosalicylates such as sulfasalazine (Azulfidine) for mild/moderate … first line treatment for IBD!!
Corticosteroids-severe (for short term due to side effects such as lowering immune system, decrease bone density, weight gain)
Biologic therapies-infliximab (Remicade) for maintenance
Abx for complications
105
what to avoid for pts w/ Chron's and UC?
what to add?
avoid cold foods and smoking bc increases motility of intestines
add iron supplements (If not constipated).. take w/ OJ be helps absorbs iron better
106
red flag for an ostomy
purulent discharge, pale stoma, blue/black stoma (necrosis!)
107
this is the 3rd most common cause of cancer in US, 2nd leading cause of cancer deaths
colorectal cancer
108
risk factors for colorectal cancer
smoking, fam hx, alcohol, high fats diets, low fiber diet, hx of IBD (males), hx of genital cancers, DM
109
s/s of colorectal cancer
change in bowel habits, bloody stool … most common early symptom is change in bowel habits!!!! Then weightloss, fatigue, anorexia can come
110
how to prevent colorectal cancer
Prevent w/ high fiber diet, early screenings, avoid alcohol / tobacco use, staying active
111
this is inflammation of rectum, celiac can cause it or IBD.. Treat w/ antbx. s/s = discharge, rectal pain, ghonnera is most common cause
proctitis
112
this is tiny tubular results from abscess .. Purulent drainage, itch are symptoms
anal fistula
113
this is the obstruction of anal glands, can get infection.. Itching, discomfort.. Need I&D bc abscess infection
anorectal abscess
114
this is a tear or ulceration in anal lining, burning, bleeding, needs diet modifications, stool softeners
anal fissure
115
this is on the surface of lower sacrum caused by trauma usually, needs surgically removed bc if you drain it, it will just refill
Pilonidal Sinus or Cyst
116
TPN goes through which line
Central line
117
what to monitor if pt is on PN
Nutrition and fluid balance!
Can by hyperglycemic due to amt of glucose in it .. Can also be hypoglycemia when insulin is added to it.. SO MONITOR CLOSELY!
always ween pt off this, do not stop abruptly
118
1lb is equivalent to how many mL
1lb = 500mL
119
s/s of potassium deficit and potassium excess?
s/s of potassium deficit – muscle cramps, arrythmias, abdominal distention, paralytic ileus
s/s of potassium of excessive – arrythmias/EKG changes, diarrhea
119
s/s of sodium excess and sodium deficit?
s/s of sodium excess (too much Na aka too much salt like eat a whole bag of salty chips) = dehydration so thirsty and dry mouth, some swelling, change in mental status
s/s of sodium deficit – nausea, abdominal cramps, lethargy, seizures
120
what is the criteria for CKD?
pt has to have decrease GFR for at least 3 months .... if left untreated, can end up w/ ESRD
121
most common cause of CKD?
DM and HTN
122
this is a new bladder made from part of the intestine.
it's contraindicated for AKI.
Strict post op voiding regimens.
No impaired liver.
Have to self cath.
Will have indwelling or SP catheter
Orthotopic neobladder
123
pt presents with intense flank pain, fever, chills.
Early signs are nausea, vomiting
pyelonephritis (UTI won't have fever usually)
usually full week of antbx compared to 3 days w/ UTI. need repeat UA after treatment.
124
symptom of CKD?
Fluid retention bc kidneys aren’t excreting anything … will come in very edema with pitting !!!
125
how to treat CKD
Treat underlying causes aka get b/p controlled and DM controlled
Encourage low sodium diet, avoid alcohol
Manage their anemia
126
Hardening of the renal arteries caused by uncontrolled DM or prolonged htn
Neprhosclerosis
Few symptoms early, maybe protein in urine.. Will treat with ace inhibitors
127
This is inherited, genetic in nature
You get numerous cysts on kidneys … everyone in family needs to be tested for it
S/s = polyuria, hematuria, frequent kidney stones
Diagnosed through US, sometimes you can even palpate the cysts … no cure for this .. Just treat symptoms but eventually kidneys will fail
polycystic kidney disease
127
risk factors for renal cancer
increased BMI
smokers
AA
genetics
htn
males
certain meds like diuretics and other meds for htn
128
s/s of renal cancer?
no symptoms to painless hematuria is common, lower back pain.
129
what causes AKI
it's sudden on set of kidney damage due to dehydration, kidney stones, meds like vancomycin
Limited blood flow to kidneys causes acute kidney injury such as hypovolemia, hypotension, reduced cardiac output/HF, instruction to kidney or renal arteries/veins
can be reversed if caught early
130
3 types of AKI
Prerenal- hypoperfusion (this isn’t due to kidney problem… hypovolemic, MI, heart failure., dehydration. Something that causes problem to kidney .. Kidney isn’t causing the issue, something else)
Intrarenal- actual damage to kidney tissue (anything happening in the kidney itself! Kidney is causing the injury)
Postrenal- obstruction to urine flow (kidney is fine, blood flow is filtering, but it doesn’t flow out of kidney – something is blocking like kidney stones and causing back flow)
131
phases of AKI
1. Initiation – something insults the kidney, not functioning as well as it should
2. Oliguria – no urine, potassium elevates
3.Diuresis – increase in urine output, GFR starts to recover
4. Recovery – kidney fully recovers in 3-12 months
132
assessment of AKI
UOP – scant to normal
Hematuria/specific gravity low
BUN/Creatinine elevated
GFR decreased
Hyperkalemia
Metabolic acidosis
133
how to treat / manage AKI
Hyperkalemia – kayexalate is given to help reduce the potassium, also known as sodium polystyrene (helps reduce the potassium)
Elevated phosphate levels – give calcium to help bind to the phosphorus
Will be restricted on diets, limited on potassium & phosphorus foods .. limited on dairy products as well b/c dairy is high in phosphorus .. Limit sodium.. Will be more of a blander diet.. Monitor protein intake as well as fluid/electrolyte imbalance
134
diet for AKI
limited phosphorus, potassium, dairy, sodium
more bland diet
high carbs
135
CVD is the #1 death for what pts?
ESKD pts or CRF
136
protein accumulates in blood during this disease , uremia develops and affects every body system
ESRD (GRF less than 15)
kidneys can't excrete!!!
137
assessment of ESRD
GFR decrease < 15ml/min
Creatinine and BUN rise
NA and water retention /loss
Acidosis
Anemia
CA/Phosphorus imbalance
138
this med is for ESRD , it binds to phosphorus dietary intake so order before meals
sevelamer
139
restrict Na , K , and phosphorus (dairy) for these pts
ESRD
also restrict fluids
140
this is a complication of renal replacement therapy (RRT), pt will develop this due to build up of phosphorus and not being able to excrete the toxins as well (pt will be itchy!!!)
pruritus
141
what should a nurse do for pt on dialysis
Hold meds prior to dialysis bc they wont be absorbed, they will get cleared immediately during dialysis .. Hold b/p meds as well because we don’t want to bottom them out
141
this type of dialysis a pt can do at home to live more normal life, but there is criteria for this
peritoneal dialysis
142
what color should the drainage be for pt on peritoneal dialysis at home?
clear to light straw color
143
big complication of PD (peritoneal dialysis)
pt could get peritonitis !!! Aka infection. s/s include board like rigid abdomen, rebound tenderness , abdominal pain .. Uncomfortable
144
what's important for pt on PD
check leakage around catheter
can have glucose in it so will show high triglycerides
don't want to fluid overload them so monitor intake
place on cardiac monitors
high risk for infections
monitor b/p
145
sign you might be rejecting kidney
Rejection is always a possibility following transplant… days or years after
Will notice decreased urine output if rejecting as well as fever, chills, edema
146
what med for UTI can rupture tendon if pt goes out running on this
Ciproflaxin
147
what can cause upper UTI
Tumors, BPH, stones= obstruction
Systemic infections such as TB cx abscesses
148
what to ask if pt has distended abdomen
when was your last BM?
149
diets for kidney stones
Uric stones - Low purine diet (shellfish, asparagus, organ meats)
Low protein diet for cysteine stones
Oxalate stones –limit pecans, nuts, spinach
150
what's important to monitor after neck dissection?
airway! bc lots of swelling
-HOB should be elevated so gravity helps w/ swelling/draining .. NEVER lay flat.
151
some pts will come back from neck dissection with a trach, what to monitor?
assess trach, oxygen, and LUNG SOUNDS to make sure it's effective prior to suctioning.
check their secretions, suction!
(line suction is ideal bc it's sterile all the time)
152
why to let tube feeding become room temp prior to administering?
prevent spasms
153
what does a pt need to heal
protein
154
what are the most common foods that contribute to dumping syndrome (goes through too quickly)
sugar and simple carbs
155
what 4 ways to test for h. pylori
breath test
stool test
blood test
tissues form scope
156
how it TPN given and why
central line!!!!! bc we can't use the gut and pt needs nutrients
157
what to monitor if pt is on TPN
blood glucose q4 hrs (insulin can be added to TPN if needed)
electrolytes (bc it's pt specific)
I&Os
158
what can cause peritonitis (inflammation of the peritoneum)
ruptured appendix or ulcers that are perforated
**never palpate!!!!!
159
what not to palpate?
if you suspect appendicitis or abscess
160
this has mild symptoms like heart burn / GERD symptoms and is treated with PPIs, H2 blockers, small frequent meals, sit upright for 2 hrs after meal, avoiding food triggers like spicy/greasy foods. Sleep w/ extra pillow.
hiatal hernia
161
treatment for UC (first line treatment)
**UC is where one whole segment is affected (intestines!), up to 20 stools a day, bloody
aminosalicylates such as sulfasalazine (Azulfidine) or steroids for acute flare ups
162
treatment for Chron's disease
**cobblestoning throughout the entire digestive system (oral-skin)
immunosuppressants and IV infusions
(antipyretics or acetaminophen prior to infusions to prevent effects)
163
medication for hyperkalemia for pt w/ kidney disease
kayexalate aka sodium polycytosine (can take up to 6 hrs to work to decrease potassium)
164
risk factor for oral cancer
Age, gender (men are more susceptible), weakened immune system, and nutritional deficiencies, starts as leukoplakia and erythoplakia .
Tobacco / (Alcohol consumption
Human Papillomavirus (HPV) infection
Hx of head and neck cancer
Poor oral hygiene
Betel quid
UV Radiation
165
#1 priority for oral cancer
airway!!!
166
what meds are used for neutralizing acids
Risk: Can cause gastric acid suppression and loss of protective flora.
Antacids - Calcium Carbonate, Aluminum hydroxide, Magnesium Hydroxide, and Simethicone Alginate.
167
what is the only med that accelerates gastric emptying
Metoclopramide ( Prokinetic agent )
168
these meds decrease gastric acid production, ends in "tidine"
H2 receptor antagonists
(Famotidine , Cimetidine)
169
these meds decrease gastric production , end in "prazoles"
PPIs (omeprazole,
lansoprazole)
170
what to assess for immediate post op neck dissection
the nurse assesses for STRIDOR (coarse, high-pitched sound on inspiration) by listening frequently over the trachea with a stethoscope.
**must be reported immediately because it indicates obstruction of the airway.
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causes of erosive (acute) vs non-erosive (Chronic) gastritis
Non erosive (chronic) is most often caused by H.plyori
Erosive (acute) is most often caused by NSAIDS, Corticosteroids, Alcohol consumption, kidney disease .
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this is another term for indigestion
Dyspepsia
173
this is another term for black tarry stools
Melena
174
this is another term for bright red stools
Hematochezia
175
this med is used for gastritis but should NOT be used in pregnant woman , Will cause miscarriage or premature labor .
Misoprostol
176
pt w/ chronic gastritis can't absorb what?
vit B 12
177
this syndrome can happen after surgery and can cause weight loss
dumping syndrome
178
this is a chronic functional disorder characterized by recurrent abdominal pain associated with disordered bowel movements, which may include diarrhea, constipation, or both, without an identifiable cause
IBS (irritable bowel syndrome)
179
IBS-C , prescribe what meds
Prescribe antispasmodic agents like propantheline
(Pro-Banthine)
180
IBS-D , prescribe what meds
Prescribe antidiarrheal agents like loperamide (imodium)
181
IBS-M (mixed), prescribe what med
prescribe probiotics
182
Diagnosis and treatment for perforation
Tx: Surgical intervention, antibiotics, bowel rest NPO for 7 days
Dx: X-ray , barium Swallow , CT scan
183
what cancer can be prevented if the pt gets regular screenings, weight loss and increased activity.
colorectal cancer
184
this is inflammation of a small, finger-shaped pouch attached to the large intestine in the lower right abdomen (pt vomits bile)
Appendicitis
185
what conditions often presents with vague periumbilical pain that later localizes to the right lower quadrant
Appendicitis
186
complication of appendicitis
gangrene or perforation can occur in 6-24 hours which can lead to sepsis.
187
laboratory tests such as elevated white blood cell count and C-reactive protein levels indicate what
appendicitis
188
Hemodialysis vs Peritoneal Dialysis
Hemodialysis: Blood is circulated outside the body to a machine that filters waste and
excess fluid.
Peritoneal Dialysis: Dialysis solution is introduced into the abdominal cavity to draw waste and excess fluid.
189
Pharmacological therapy for acute kidney injury is:
Sodium polystyrene sulfonate
190
Stages of Chronic Kidney Disease?
**normal gfr = 125ml/min
* Stage 1: ≥ 90 ml/min = Kidney damage with normal or increased Gfr
* Sage 2: 60- 89 ml/min = Mild decrease in Gfr
* Stage 3: 30 – 59 = Moderate decrease in Gfr
* Sage 4: 15- 29 = Severe decrease in GFr
* Stage 5: < 15 ml = End-Stage kidney disease
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Labs to know for every exam :
Sodium range : 135- 145
Potassium 3.5- 5.2
WBC : 4,500 – 11000
