Exam 3 Flashcards
(123 cards)
1
Q
GERD risk factors/triggers
A
Caffeine
Alcohol
Chocolate
Spicy/fried foods
Smoking
2
Q
S/S of GERD
A
Similar to MI
Coughing/wheezing at night
Belching
Nausea
Hoarseness
3
Q
GERD occurs when
A
30-60 min after meal
Exacerbated with laying down or bending forward
4
Q
Hiatal hernia
A
Part of stomach protrudes through esophageal hiatus into chest cavity
5
Q
Hiatal hernia what to report
A
SOB
Abd pain with N/V and fever
6
Q
Hiatal hernia teaching
A
Symptoms worse after eating
Elevate HOB
No late meals- small freq meals
7
Q
Gastritis
A
Inflamed stomach
Could have edema, hemorrhage or erosion of mucosa
8
Q
Gastritis teaching/nursing interventions
A
Don’t take with NSAIDS or ASA
Priority- hydration status/ electrolytes
Daily wts, strict I&Os and VS’s
9
Q
Peptic ulcer disease causes
A
Break in mucosa lining of GI tract from continued contact with gastric juice
Smoking
10
Q
Highest risk for Peptic ulcer disease
A
H. Pylori infection
11
Q
Peptic ulcer disease tx/screening
A
Screen for H. pylori - HP breath test or endoscopy
Steroids exacerbate peptic ulcer
12
Q
S/S of Peptic ulcer disease
A
Inflammation and pain (worse after/during eating a meal)
May occur late at night
Minimal bleeding- occult blood in dark/tarry stools
N/V
Wt loss/ anorexia
Belching
Dyspepsia/ indigestion
Distended abdomen that’s painful
Peristalsis diminishes
Paralytic ileus develops
13
Q
What to report for Peptic ulcer disease
A
Tachycardia
Hypotension
Vomiting blood
Perforation is medical emergency
14
Q
Medication Tx for Peptic ulcer disease
A
Sucralfate - mucosal barrier fortifier
15
Q
Gastric cancer
A
Develops over years-changes in stomach lining
16
Q
Gastric cancer teaching
A
Administer protein & vitamins for tissue repair
Eat small, freq meals
Diet high in fiber and water but reduce fluids between meals
17
Q
Tx for gastric cancer
A
Gastrectomy- lifelong B12 shots after
18
Q
Screening for gastric cancer
A
Adults over 45
Endoscopy & sigmoidoscopy q5yrs
Colonoscopy q10yrs
19
Q
IBS
A
Abd pain and cramping- diarrhea, constipation
20
Q
Risk factors for IBS
A
Caffeine
Alcohol
Carbonated beverages
Diet high in fats & gas producing foods
Smoking
Stress
anxiety/depression
21
Q
Intestinal obstruction
A
Partial/complete blockage of bowel
22
Q
Mechanical obstruction
A
From stool, food, tumor or adhesions
23
Q
Non-mechanical obstruction
A
Paralytic ileus
24
Q
Tx of abdominal obstruction
A
Managing fluid/electrolyte imbalances
Treating cause with f obstruction
Relieving symptoms
Surgery if gastric decompression (NG tube) doesn’t relieve symptoms
25
Small bowel obstruction S/S
Distended Abd
Bloated sensation
Altered bowel sounds
Complete SBO can lead to reverse peristalsis and propel contents towards mouth
26
Resection surgery
Ileostomy/colonoscopy could be permanent or temporary for bowel onstruction
27
Stoma care
Pouch changed weekly
Empty when 1/3-1/2 full
Stoma deep pink- skin barrier AROUND stoma not on
Hot liquids help with cramping
Distention/cramping=warm compresses or lightly massage abd
NO enemas
28
Large bowel obstruction S/S
Constipation/ obstipation
Intermittent lower Abd cramping
Ribbon like stools
29
Sign of bowel perforation
Sudden sever pain
Board-like abdomen
30
Dx of bowel obstruction
Barium enema - reveals distended, air filled colon
Monitor for bowel movements after enema (barium can harden)
31
Appendicitis
Appendix inflamed and fills with pus
32
S/S of appendicitis
Severe Abd pain with guarding
Fever
High WBC
Pin at McBurney’s point (location of appendix)
Rebound tenderness
Pain relieved by bending knees
33
Peritonitis S/S
Board-like abd
34
Tx of peritonitis
NG decompression
TPN
Colloids (plasma/blood cells)
35
Gastroenteritis
“Stomach flu”
Inflammation is stomach/small intestine
36
Gastroenteritis S/S
Diarrhea
Abd pain
Cramping
Low K
N/V
Fever
Distention
Rectal tenesmus (urge to go)
Excessive borborygmi (bowel sounds)
37
Tx for gastroenteritis
Replace electrolytes
IV fluids
Monitor cardiac dysrhythmias
38
Inflammatory bowel disease
Unknown etiology
Chronic-incurable
Crohns & ulcerative colitis
39
Diet for inflammatory bowel disease
Lean meats
Legumes
Water
NO corn, nuts, alcohol or gassy foods/beverages
40
Tx for inflammatory bowel disease
Monoclonal antibodies (adalimumab/humira)
Lowers immune system- protective isolation
41
Crohn’s disease
Inflammatory bowel disease
Fistulas can develop- cobblestone appearance of lumen
42
S/S of Crohn’s disease
RLQ abd pain
N/V
REPORT- cold-like symptoms/sore throat
43
Tx for Crohn’s disease
Monoclonal antibody (-mumab)
44
Teaching for Crohn’s disease
Self administer B12 injections
If sick- total bowel rest and on TPN
May have fecal matter emesis
May have frequent stools- diarrhea/mucous/bloody
45
Ulcerative colitis
Inflammatory bowel disease
Only large intestine- hemorrhages, abscess
Risk for colon cancer
46
S/S of Ulcerative colitis
Pain in LLQ
Blood/mucous/pus in stool
Urgent sensation to go
5-30 stools a day- usually bloody
Wt loss/anorexia
Fatigue/weakness
Fever
47
Dx of Ulcerative colitis
Anemia
High WBC
Fluid/electrolyte imbalances
Albumin/folic acid levels low
Stool cultures
48
Diverticulosis
Pouches that bulge from colon (aneurysms of colon)
Need adequate fluid and high fiber diet
49
Risk factors for Diverticulosis
Over 40
Obese
Smoker
Physically inactive
Diet high in animal products
NSAIDS/steroids/opiods
No specific diet triggers attacks
50
Diverticulitis
Pouches are infected/inflamed
51
Diverticulitis teaching
Liquid/low fiber diet
No greens diet- green beans, celery, fatty foods, nuts, corn
Give Tylenol - no opioids or laxatives
52
Hepatitis A
Fecal-oral route from contaminated food/water
From poor handwashing
Vaccine available
53
Hepatitis B
Spread from unprotected sex, sharing needles, hemodialysis
Can lead to liver CA
Vaccine series available
54
Hepatitis C
Transmitted via sex, sharing needles, needle sticks, unsanitary tattoo equipment, HIV, birth
Leads to cirrhosis & liver CA
55
Hepatitis D
Requires co-infection with Hep B from sexual contact with infected person
56
Hepatitis E
Spreads through contaminated food, swimming in contaminated water, crowded and unsanitary conditions
57
5 F’s of Gallbladder disease
Fat
Forty
Female
Fertile
Flatulence
58
Symptoms of Gallbladder disease
Gallstones
Severe RUQ abd pain- radiates to right shoulder/back
Pain after eating
N/V
59
Tx of Gallbladder disease
Cholecystectomy
ERCP
60
ERCP (endoscopic retrograde cholangio-pancreatography)
Used to evaluate and remove stones from common bile duct
61
ERCP teaching/nursing interventions
NPO 8hrs before
Ask if any implanted devices
Conscious sedation
Endoscope introduced using numbing gel
Stent may be placed
Post procedure- monitor for return of gag reflex (usually within 1-2 hrs)
62
Teaching for Gallbladder disease
Low fat diet
Foods not well tolerated- eggs, pork, onions, poultry, milk, coffee, oranges, corn, beans, nuts
63
S/S of malnutrition
Muscle wasting
Lethargy
Intolerance to cold
Dry skin
Poor wound healing
Infection
Possible death
64
Teaching for Gallbladder disease
Encourage 6 meals, high calorie/protein shakes
65
BMI measurements
18.5-24.9 normal
25-29.9 overweight
30-34.9 obese class 1
35-39.9 obese class 2
40-49.9 obese class 3
66
Tx for obesity
Bariatric surgery - gastroplasty, gastric bypass
67
Lap band
Surgically implanted device (laparoscopic)
Adjustable band reduces size of stomach
Not permanent
Less invasive and recovery time but less successful
68
Roux-en-Y bypass
Invasive surgical procedure to modify digestive system to consume and absorb less calories
Bypass stomach and small pouch left over
69
Roux-en-Y bypass post-op
Don’t reposition/remove NG tube without order- place safety signage above bed
Semi Fowlers position
Early ambulating and anticoagulants
70
Roux-en-Y bypass teaching
No opiods- decreases peristalsis
Leaks are most common but dangerous complication
Preven dehiscence by abd binder
Dumping syndrome
71
Dumping syndrome
Rapid gastric emptying
72
S/S of dumping syndrome
Tachycardia
N/V
Diarrhea
Hypoglycemia
Abd cramping
73
Tx of dumping syndrome
Small meals and less sugars
74
Diet after Roux-en-Y bypass
NPO after surgery until bowel sounds- then clear liquids
if tolerated - add puréed, thinned foods with broth, milk, then soft foods
Could take a month to get back to solid food
75
Nasal cannula
1-6 L/min
40% oxygen
Humidifier if over 4L
76
Venturi mask
Most precise oxygen delivery
Up to 60% oxygen
Humidifier MUST be used
77
Non-rebreather mask
60-80% oxygen
10-15 L/min
No humidifier
Reservoir bay full before placed on pt
And should NOT deflate between breaths
78
CPAP/BiPAP
Non invasive ventilation
Assist with added pressure
Increases risk for aspiration
Mask should fit tightly/snuggly
79
Bronchial breath sounds
Heard over trachea
Higher, louder pitch inspiration and expiration
Pause between inspiration and expiration
80
Bronchovesicular breath sounds
Located on sides of sternum
Moderate pitched, blowing sound with equal inspiration and expiration phase
81
Vesicular breath sounds
Heard over thorax
Lower pitched and softer than bronchial breathing
Inspiratory phase longer than expiratory phase
82
Obstructive sleep apnea
Airway can be obstructed by tongue
Lasting >10 sec increases carbon dioxide and lowers pH levels
May improve if change sleeping position, lose wt, or reduce alcohol/smoking
83
Risk factors for sleep apnea
Obesity
Short or thick neck
Smoking
Enlarged tonsils
Oropharyngeal edema
Chronic nasal congestion
Diabetics
Alcohol
Sedatives/tranquilizers
84
Symptoms of sleep apnea
Excessive snoring
Daytime sleepiness
Irritability
Headache when walking
85
Tx of sleep apnea
CPAP - opens airway to prevent alveoli from collapsing but doesn’t prevent tongue from occluding airway
86
Airway obstruction S/S
Hoarseness
Stridor
Dramatic SOB
87
Airway obstruction
No air movement
88
S/S of partial airway obstruction
Gagging
Dysarthria
Accessory muscle use with breathing
Coughing
89
Tracheostomy
Surgically inserted tube if unable to extubation within 2 weeks
90
Tracheostomy teaching/nursing interventions
Suction for 10-15 sec max on way out only with twirling motion
Never instill saline prior
Hyperoxygenate before suctioning
Suction Setting- 80-120
Shower shield when bathing
Cover opening with breathable cloth
Humidified oxygen
91
Trache care
Done every shift
Sterile procedure
Clean stoma site + trache plate (1/2 saline and 1/2 peroxide)
T-drain sponge
Place new ties before removing old ones
92
Asthma S/S
Wheezing
SOB
Chest tightness
Coughing
93
Asthma triggers
Pollen
Irritants
Pet dander
Dust mites
Smoke
94
Asthma attack
Absence of wheezing without tx may indicate complete airway obstruction
95
Tx of asthma
Bronchodilators or meter dosed inhalers
96
Bronchodilators side effects
Can cause irritability, tachycardia, headache, dry mouth, cough. Hoarseness
Thrush common- use spacer to prevent and rinse mouth after
97
Meter dosed inhaler
Breathe in slowly and deeply after releasing med into spacer and hold med in lungs for few sec
98
Teaching for bronchodilators and meter dosed inhalers
Bronchodilators- 15-30 min before exercise or after
Spacer with MDI
99
Asthma teaching
Avoid physical activity during extreme weather
Wash bedding in hot water to reduce dust mites
Obstain from MSG (monosodium glutamate
100
COPD
Leading cause of death
Bronchitis/emphysema
101
S/S of COPD
Chronic hypoxemia/ hypercapnea (too much CO2)
Fatigue
Respiratory acidosis
Wheezing/rhonchi
SOB
Expiratory>inspiratory
Progressive dyspnea on exertion (end stage- dyspnea at rest)
JVD
Pitting peripheral edema
Barrel chest
Accessory muscle use, retractions, asymmetrical chest expansion- REPORT
102
COPD interventions/teaching
Pursed lip breathing (smell flowers, blow out candle)
High protein/calorie diet
Minimum 2L of fluids/day
Encourage sitting in a chair
103
Lung cancer common symptoms
New/change in cough
dyspnea
wheezing
excessive sputum production
chest pain
malaise
fever
wt loss
fatigue
anorexia
104
Pulmonary resection
Removal of part or entire lung (pneumonectomy)
Treatment for lung cancer
May develop adhesions and serious fluid buildup
105
Thoracic surgery nursing interventions
Pulse ox and ABGs
TCDB q1-2hrs with splinting
Pursed lip breathing
Lung sounds - look for crackles/rales (BAD)
Absent breath sounds/unequal rise and fall of chest=pneumothorax
106
Pneumonectomy
Phrenic nerve may be severed to paralyze diaphragm in elevated position
Bronchus severed and sutured
Place pt on non operative side after surgery for
107
Chest tube
Re-expand a collapsed lung and remove air/blood
108
Chest tube teaching/nursing interventions
Sterile procedure
If drainage stops suddenly- call DR
109
Compartments of chest tube
Collection chamber- monitors volume, rate and nature of drainage
Water-seal chamber- one way valve- air can come out but can’t go in (shouldn’t have continuous bubbles)
Suction-control chamber- promotes drainage from pleural space (dial)
110
Chest tube management
Dressing tight and intact
Check for difficulty breathing, breath sounds, chest rise, and alignment of trachea
Don’t strip tube - hand over hand is okay to get clot out
Drainage system lower than pts chest
Can use 20 gauge needle to obtain pleural sample culture from tubing
111
If tube disconnected from drainage system
Insert chest tube into container of sterile water below level of insertion and notify MD
112
Thoracentesis
Needle inserted into pleural space between lungs and chest wall
After procedure- CXR
Monitor for signs of pneumothorax
113
S/S of Influenza
chills
body aches
coughing and sneezing
extreme fever
fatigue
headache
nasal congestion
114
High risk for complications of influenza
individuals over 65 years of age
residents of nursing homes
patients with chronic pulmonary or cardiovascular disorders including asthma
115
Pts who should receive a killed virus vaccine every year (Fluviron)
Patients with chronic metabolic diseases, renal dysfunction, or immunosuppression
116
Pneumonia
Caused by bacteria, viruses, fungi, or parasites
May lead to empyema (pleural effusion)
117
Community acquired pneumonia usually caused by
Streptococcus
118
S/S of pneumonia
Coughing
fatigue/weakness/lethargy
dehydration
confusion
poor appetite
119
Pneumonia vaccine
recommended for patient 65 years of age or older
120
TB precautions
Airborne
Private room
Health care workers wear N95
Visitors and patient wear surgical mask
PAPR- powered air-purifying respirator
121
S/S of TB
persistent cough with weight loss
anorexia
night sweats
hemoptysis
shortness of breath
fever
chills
pleuritic chest pain
crackles
Fatigue
122
TB teaching
Transmission reduced after drug therapy for 2-3 weeks
Off isolation if negative AFB cultures on 3 consecutive days
123
TB tx
isoniazid (INH) for 6 - 12 months- empty stomach, avoid alcohol and multivitamin (B6)
Rifampin can cause secretions to turn orange
Pyrazinamide- photosensitive
