EXAM 3: Units 5 and 6 Flashcards by Kiana Pippin

Prevention of the initial occurrence of disease or injury

Primary prevention

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Early detection and treatment of disease with the goal of limiting severity and adverse events

Secondary prevention

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Reducing the limitations of disability and promoting rehabilitation following health alterations

Tertiary prevention

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Initial phase of care before surgery where physical and psychological preparations are made for the patient

Preoperative phase

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Time period from which patient is moved to the OR table to transfer to recovery or PACU

Intraoperative phase

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Final phase immediately after surgery

Postoperative phase

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________ are double checked as a safety consideration prior to a surgical procedure

Allergies

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2 safety considerations according to the National Patient Safety Goals for Surgery (preventing 2 things)

Preventing wrong site surgery
Preventing post-op infection

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Prevents conduction of pain impulses by affecting both the motor and sensory nerves at the surgical site

Local anesthesia

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Causes a temporary loss of feeling in an area of the body

Regional anesthesia

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The use of drugs or inhalants to suppress the nervous system

general anesthesia

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Permits thew client to remain relaxed and calm so they can follow commands without pain or anxiety

Moderate or Conscious sedation

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In the post-op phase, what is a priority?

Maintaining a patent airway

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In the post-op phase, focus is on these two things

Safety and physiologic systems

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During the post-op phase, vitals should be monitored on this frequency

Every 5-15 minutes for the first hour, then every 4 hours for the next 24 hours

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this is encouraged to promote deep breathing and coughing post-operatively

Incentive Spirometry

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Tool to assess how well a patient is recovering after anesthesia

Aldrete Scoring System

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If antibiotics are prescribed post-op, they should be given on this regimen

given 1 hour prior to procedure, then d/c within 24 hours after surgery

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Computerized pump connected to an IV line that can administer pain medications in small amounts by the press of a button

Pain Control Analgesia Pump (PCA Pump)

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In order for the patient to be eligible for discharge, they must have an aldrete scoring of

7-10

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obesity is defined as a BMI of

30 or greater

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this is a strong indicator of long-term complications associated with obesitry

waist circumference (central obesity)

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3 medications for obesity management (O, P, H)

Orlistat
Phentermine-topiramate
Hydrogel pill

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MOA Orlistat

Inhibits the digestion of fats

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MOA Phentermine-topiramate

Acts as an appetite suppressor by inducing a feeling of satiety

MOA Hydrogel pills

Expands in the stomach when in contact with water to take up space and create a feeling of fullness

Patient consideration with orlistat

Do not take the medication with foods that don't contain fats

3 AE with orlistat

Oily stools Flatulence Reduced absorption of vitamins and food

Patient consideration with phentermine-topiramate

Take in the morning to prevent insomnia

The hydrogel pill is contraindicated in this patient

Hx of a surgery that has altered GI motility

2 kinds of bariatric surgeries

Restrictive and Malabsorptive

Bariatric surgery that restricts the amount of stomach volume capacity, which limits the amount of food the patient can eat at a time

Restrictive surgery

Bariatric surgery that bypasses part of the small intestine and created a decreased capacity of food absorption

Malabsorptive Surgery

2 kinds of bariatric restrictive surgeries

Gastric band Gastric sleeve

1 kind of malabsorptive bariatric surgery

Gastric bypass

bariatric surgery that removes part of the stomach and leaves a "sleeve" to hold less food. Is this reversible?

gastric sleeve is not reversible

bariatric surgery that uses a band to reduce the size of the stomach Is this reversible?

gastric band is reversible

bariatric surgery where the upper half of the stomach is created into a small pouch and a large portion of the small intestine is bypassed, so that food will go directly from the smaller stomach to the middle part of the small intestine Is this reversible?

Gastric Bypass is not reversible

Post-surgery, if a client had an NG placed during surgery, the nurse should

NOT reposition it - it can disrupt sutures

Post-operatively (for bariatric surgeries) , should an NG tube be inserted?

Following a bariatric surgery, solid foods can be continued after this much time

6-8 weeks after surgery

3 dietary considerations following a bariatric surgery

Eat 4-6 small meals per day Do not exceed volume limitations (usually 1C) Wait 30 min after meals before drinking liquids

life-threatening complication that can occur after surgery where two hollow organs that are surgically connected become disconnected and leak fluid

Anastomotic leak

Someone experiencing an anastomotic leak may experience the following symptoms: x2

Back/shoulder/abdominal pain Reslessness/tachycardia

3 bariatric surgery complications

Anastomotic leak Dehydration Malabsorption

Greater than 50% of lower limb losses are related to complications of which two conditions

Peripheral artery disease Diabetes mellitus

amputation performed through a joint

disarticulation

level of amputation is determined by

presence of adequate blood flow needed for healing

sensation of pain in the location of the extremity following amputation

Phantom pain

Common condition characterized by gastric contents and enzyme backflow in the esophagus

Gastroesophageal Reflux Disease (GERD)

4 kinds of medications that can be used to treat GERD

Antacids Proton pump inhibitors H2-receptor blockers Prokinetics (increase motility)

condition where the lower lining of the esophagus changes from one cell type to another (similar to that of the small intestine)

Barrett's esophagus

erosion of the mucosal lining of the stomach, esophagus, and/or duodenum

Peptic Ulcer Disease (PUD)

PUD is mostly caused by

H. pylori infection

PUD may be caused also by this class of medication

NSAIDs

discomfort in the upper abdomen characterized by heartburn, bloating, and nausea

Dyspepsia

black tarry stool that can indicate bleeding in the upper GI tract

melena

Bloody emesis

hematemesis

this testing provides a definitive diagnosis of ulcers

Esophagogastroduodenoscopy (EGD)

5 medications that can be used for PUD

PPIs Antacids Antibiotics (H. pylori) H2 receptor blockers Mucosal protectants (sucralfate)

All or part of the stomach is removed

Gastrectomy

Lower portion of the stomach is removed

Antrectomy

Lower portion of the stomach is excised and then anastomosed to the jejunum, and the remainig duodenum is surgically closed

Gastrojejunostomy

Vagus nerve is cut to decrease gastric acid production

Vagotomy

The opening between the stomach and small intestine is enlarged to increase the rate of gastric emptying

Pyloroplasty

condition where a hole or tear develops in the GI tract characterized by severe epigastric pain spreading across the abdomen, rebound tenderness, and shock

Perforation

immune-mediated inflammatory disease of the small intestine (gluten sensitive)

Celiac Disease

gluten is found in these three things

Wheat Barley Rye

treatment for celiac disease is

a lifelong gluten-free diet

some celiac patients may present with this skin finding

a rash called dermatitis herpetiformis

disease where small pouches (diverticula) form int he wall of the large intestine

Diverticular disease

sac-like herniation of the bowel lining

diverticulum

the presence of multiple diverticula without inflammation or symptoms

diverticulosis

inflammation and infection of the bowel mucosa caused by bacteria, food, or fecal matter trapped in one or more diverticula

diverticulitis

patient should avoid this while treating diverticulitis

seeds or indigestible material

Inflammation primarily in the rectum and rectosigmoid colon

Ulcerative colitis

Inflammation and ulceration of the GI tract often at the distal ileum

Crohn's Disease

Ulcerative colitis can involve the

entire length of the colon

Crohn's Disease can involve the

entire length of the GI tract

In Crohn's Disease, which bowel layers are involved and how do these lesions characterized?

ALL layers of the bowel are involved and lesions are sporadic

Abdominal pain/cramping will often reside in this abdominal quadrant with Ulcerative Colitis

LLQ

Difference between stool presentation in Ulcerative Colitis and Crohn's Disease

Blood can be in the stool with ulcerative colitis, whereas in Crohn's, there normally isn't blood

4 common findings with both ulcerative colitis and crohn's disease

-Anorexia/weight loss -Fever -Abdominal distention/firmess -High pitched bowel sounds

There are about this many loose stools per day in ulcerative colitis

~15-20 loose stools per day (diarrhea)

There are about this many loose stools per day in Crohn's

~5 loose stools per day (diarhhea)

In lab findings for Ulcerative Colitis, which components of the blood will be elevated?

ESR WBC CRP

In lab findings for Ulcerative Colitis, which components of the blood will be low?

Hct Albumin

Would occult blood be positive or negative in a patient with Ulcerative Colitis?

Positive

Why would corticosteroids be used to treat UC and CD?

To induce remission (NOT for long-term therapy)

4 classes of medications that can be used to treat UC and CD

-Corticosteroids -Immunosuppressants -Antidiarrheals -Sulfonamides

Surgical treatment option for UC

Colectomy with or w/o ileostomy

How often should a patient be weighed if they have UC or CD

1-2 times weekly

Educate a patient with UC or CD to eat this kind of dietq

High-protein High-calorie Low-fiber

Patients with UC or CD should avoid these two drinks

Caffeine and alcohol

Occurs when the entire colon must be removed due to disease (CD, UC)

Ileostomy

Occurs when a portion of the bowel must be removed due to disease or just requires rest for healing

Colostomy

a stoma should appear

pink and moist

empty the ostomy bag when it is this full

1/3-1/2 full

assess a patient for these 2 imbalances if they have an ileostomy or colostomy

fluid and electrolyte imbalances

Abdominal cramping with Crohn's Disease will typically present in this abdominal quadrant

RLQ

EXAM 3: Units 5 and 6 Flashcards

(100 cards)