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NUR150 > FINAL EXAM > Flashcards

FINAL EXAM Flashcards

1
Q

What is IBS?

A
  • chronic inflammation of the GI tract

- has remission and exacerbation periods

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2
Q

There are two kind of IBS, what are they and what is the difference between them?

A

Ulcerative Colitis- just the colon is involved

Crohn’s- can be anywhere in the bowel (mouth to anus)

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3
Q

Where does Crohn’s most commonly occur? How does it affect the tissue in that area?

A
  • distal ileum

- it extends through all the layers of the bowel wall causing thickened walls and narrowed intestines

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4
Q

What are the (6) risk factors for Crohn’s disease?

A
  • family history
  • Jewish
  • immune system may have a hypersensitivity reaction to normal bacteria in the intestine
  • 15-40 years old
  • urban living
  • smoking
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5
Q

What are the (5) s/sx of Crohn’s disease?

A
  • right lower quadrant abdominal pain (not relieved by defecation, aggravated by eating)
  • low grade fever
  • diarrhea
  • steatorrhea (greasy, foul-smelling stool)
  • weight loss
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6
Q

What labs and diagnostic imaging will we look at to diagnose Crohn’s?

A

Labs:

  • H/H
  • WBC

DI:
abdominal xray

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7
Q

What will the patient with Crohn’s have to change with their nutrition?

A
  • high calorie
  • high protein
  • low fiber
  • no dairy
  • possible TPN
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8
Q

What five classes of medications might we give for the client with Crohn’s?

A

Steroids
Anti-infective
Aminosalicylates
Immune modulators

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9
Q

What are some (2) examples of the steroids we would give for the client with Crohn’s? Considerations (2)?

A

ex: prednisone, hydrocortisone

what it does: reduces inflammation, pain, can induce remission, but it does slow healing and is not for long-term use

Considerations: take with food, report infections

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10
Q

What are (2) examples of the anti-infectives we would give for the client with Crohn’s?

A

ex: cipro, metronidazole

what is does: decreases inflammation, treats infection

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11
Q

What is (1) example of the aminosalicylate we would give for the client with Crohn’s?

A

ex: balsalazide, olsalazine, sulfasalazine, mesalamine

what it does: prevents and reduces reoccurences, reduces the inflammatory response

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12
Q

What is (1) example of the immunomodulator we would give for the client with Crohn’s? Considerations (3)?

A

ex: Infliximad

what it does: suppresses the immune response

considerations: can require pretreatment to reduce infusion reactions, avoid crowds, report infections

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13
Q

What surgical options are there for the patient with Crohn’s disease?

A

Bowel resection with a possible ileostomy

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14
Q

What are the big complications (5) that can result from Crohn’s disease if left untreated?

A
  • intestinal obstruction
  • perianal disease
  • F&E imbalance
  • malnutrition/malabsorption
  • fistula formation
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15
Q

Where does ulcerative colitis most commonly occur? How dies it affect the tissue in that area?

A
  • it begins in the rectum and spreads through the colon

- affects the superficial mucosa

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16
Q

What are the (6) risk factors for ulcerative colitis?

A
  • family history
  • Jewish
  • Caucasian
  • young and middle aged adults
  • emotional stress
  • low fiber diet
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17
Q

What are the s/sx of ulcerative colitis? (9)

A
  • 10-20 liquid bloody or mucous-y stools/day
  • left lower quadrant abdominal pain
  • tenesmus (urgency to empty bowel)
  • abdominal distention
  • high-pitched bowel sounds
  • weight loss (anorexia)
  • low grade fever
  • vomiting
  • dehydration
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18
Q

What are the labs (3) and diagnostic testing (3) we will look at to diagnose ulcerative colitis?

A

Labs:

  • H/H
  • WBC
  • electrolytes

DI:

  • colonoscopy- shows ulcers
  • barium enema- shows mucosal irregularities
  • CT/MRE/CTE- shows abscesses
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19
Q

How will we manage the diet of the client with ulcerative colitis?

A

-NPO during acute phase
-increase oral fluids
-low residue diet
-high calorie
-high protein
(admin multivitamins)

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20
Q

What are the 4 classes of medications we may use to treat the client with ulcerative colitis?

A

Antidiarrheal
Aminosalicylate
Immune modulators
Corticosteroids

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21
Q

What are some examples of the antidiarrheal that we may give to the client with ulcerative colitis? Considerations?

A

Ex: diphenoxylate with atropine (lomotil) or loperamide (Imodium)

What it does: less stools

Considerations: it will decrease the risk of FVD, could lead to toxic megacolon

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22
Q

What are the surgical options for the client with Ulcerative colitis?

A

Total Colectomy with ileostomy

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23
Q

What are the 3 major complications that can occur if ulcerative colitis is left untreated?

A
  • toxic mega colon (inflammation extends into the muscles which inhibits the ability to contract)
  • peritonitis- rebound tenderness
  • perforation- bleeding can occur if left untreated
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24
Q

What is cholelithiasis?

A

stones in the gallbladder

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25
Q

What is cholecystitis?

A

inflammation of the gallbladder (usually from cholelithiasis)

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26
Q

What are the (7) risk factors for cholecystitis?

A
  • female
  • high fat diet
  • older adult
  • estrogen therapy
  • sedentary lifestyle
  • obesity
  • diabetes
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27
Q

What are the s/sx of cholecystitis?

A
  • N&V after eating high fat food
  • RUQ, epigastric, or shoulder pain (especially 3-6 hrs after a high fat meal or when lying down)
  • positive Murphy’s sign
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28
Q

What are the s/sx of cholecystitis when total obstruction occurs?

A
  • dark amber urine
  • clay-colored stools
  • pruritis
  • fatty food intolerance
  • jaundice
  • heartburn
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29
Q

What labs and diagnostic imaging will we perform to diagnose cholecystitis?

A

Labs:
WBC (up)
serum bilirubin (up)
urine bilirubin (up)

DI:
ultrasound
ERCP (endoscopic retrograde cholangiopancreatography)

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30
Q

What meds might we give for the patient with cholecystitis?

A

Analgesics (morphine)
Antiemetics (Zofran)
Anticholinergics (Atropine)(to decrease GI secretions and counteract smooth muscle spasms)
Antibiotics

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31
Q

What does an ERCP with sphincterotomy (papillotomy) entail?

A
  • endoscope is passed to the duodenum
  • visualizes the biliary system, dilates (balloon sphincteroplasty), and places stents (usually removed or changed after a few months)
  • stones can be collected and removed in a basket but more often they are left to pass naturally
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32
Q

What is the nursing care for the ERCP with papillotomy postop patient?

A

Complications: pancreatitis, perforation, infection and bleeding
Assess: VS, abdominal pain, fever, and increasing amylase and lipase
Care: bed rest for several hours, NPO until gag reflex returns

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33
Q

What does a laparoscopic cholecystectomy entail?

A
  • this is the treatment of choice, few complications

- removal of the gallbladder

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34
Q

What is the nursing care following laparoscopic cholecystectomy?

A
  • SIMS position for comfort
  • clear liquids
  • discharged same day and can return to work in one week!
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35
Q

What is a lithotripsy? How does it help with cholelithiasis?

A

it is shock wave therapy to break up small stones (non-invasive)

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36
Q

What does an open (incisional) cholecystectomy differ from the laparoscopic one?

A
  • right subcostal incision

- a T-tube is inserted into the common bile duct to keep it open and draining (*report drainage >1000mL/day)

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37
Q

What are the postop considerations for an incisional cholecystectomy?

A
  • prevent respiratory complications
  • maintain T-tube
  • no heavy lifting for 4-6 weeks
  • low-fat diet
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38
Q

What are the differences between acute and chronic pancreatitis?

A

Acute- lifethreatening spillage of pancreatic enzymes causing autodigestion

Chronic- characterized by remission and exacerbation, function of the pancreas decreases over time

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39
Q

What are the (5) risk factors for pancreatitis?

A
  • gallbladder disease
  • chronic alcohol use
  • illegal drug use
  • infection
  • blunt abdominal trauma
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40
Q

What are the pain characteristics of pancreatitis?

A

PAIN

  • LUQ or midepigastrium
  • can radiate to the back
  • sudden onset
  • deep, piercing, continuous, or steady
  • intensifies after meals
  • starts when lying down
  • not relieved by vomiting
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41
Q

What are the other s/sx of pancreatitis?

A
  • N&V
  • Grey Turner’s spots (blue flank discoloration)
  • Cullen’s sign (blue around the bellybutton)
  • weight loss
  • abdominal tenderness/acites
  • steatorrhea
  • hypoactive bowel sounds
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42
Q

What labs and diagnostic imaging do we look at to diagnose pancreatitis?

A

Labs:
serum lipase
serum amylase

DI:
CT with contrast

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43
Q

Nursing care for the client with pancreatitis?

A
  • NPO at first
  • NG for severe vomiting
  • enteral or parenteral nutrition
  • when able to advance to real food it should be high carb, high protein, and low fat
  • may be given fat soluble vitamins (A,D,E,K)
  • NO alcohol
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44
Q

What (5) classes of meds will we try for the client with pancreatitis?

A 
Analgesics
Antispasmodics
Anticholinergics
Pancreatic Enzyme (take enzymes before meals and snacks)
H2 blockers or PPI
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45
Q

What specific analgesics may be used or contraindicated for pancreatitis?

A

ex: opioid analgesics or IV morphine

* demerol/meperidine are contraindicated

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46
Q

What specific antispasmodics may be used for pancreatitis? What do they do?

A

ex: dicyclomine (Bentyl)

what it does: decreases vagal stimulation, motility, and pancreatic outflow

**contraindicated in paralytic ileus

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47
Q

What will antacids do for the client with pancreatitis?

A

-neutralizes gastric acid secretion, decreases production and secretion of pancreatic enzymes and bicarb

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48
Q

What specific proton pump inhibitors may be used for pancreatitis? What do they do?

A

ex: omeprazole (Prilosec)

- decreases HCl acid secretion which decreases pancreatic activity

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49
Q

What is the clinical def of hypertension?

A

systolic >140
or
diastolic >90

50
Q

What is primary HTN?

A

“essential” or “idiopathic”

  • just means that the BP is elevated without an identifiable cause
  • 90-95% of ppl with HTN have primary HTN
51
Q

What is secondary HTN?

A
  • just means that the BP is high bc of an underlying cause
  • so we treat the cause
  • only 5-10% of HTN cases are secondary
52
Q

What is prehypertension?

A

systolic 120-139

diastolic 80-89

53
Q

What is HTN stage 1?

A

systolic 140-159

diastolic 90-99

54
Q

What is HTN stage 2?

A

systolic >160

diastolic >100

55
Q

What are the complications of untreated HTN? (heart, brain, vascular, kidney, eyes)

A

Heart: CAD, HF, left ventricular hypertrophy

Brain: TIA/stroke, encephalopathy

PVD: aortic aneurysm, aortic dissection, intermittent claudication

Kidney: CKD

Eyes: retinal damage, hemorrhage

56
Q

What are the risk factors for HTN?

A
  • age
  • alcohol use
  • tobacco use
  • diabetes (obesity)
  • elevated serum lipids
  • excess dietary sodium
  • gender
  • family history
  • ethnicity
  • sedentary lifestyle
  • socioeconomic status
  • stress
57
Q

What are the s/sx of HTN?

A
  • increased BP
  • fatigue
  • dizziness
  • palpitations
  • angina
  • dyspnea
  • headache
  • edema
  • blurred vision
58
Q

What diagnostics will we use to diagnose HTN?

A 
Labs:
urinalysis
BUN and creatinine
Creatinine clearance
serum electrolytes
serum lipid profile
uric acid levels

DI:
ECG
Echocardiogram- can show left ventricular hypertrophy

59
Q

What is the DASH diet?

A

Dietary Approaches to Stop HTN

  • fruits
  • veg
  • low-fat milk
  • whole grains
  • fish
  • poultry
  • beans
  • seeds
  • nuts
60
Q

What are the recommendations for sodium intake for low risk and high risk HTN?

A

healthy adults: <2300mg

ppl with risk factors: <1500mg

61
Q

What are the exercise recommendations for the client with uncomplicated HTN?

A

moderate intensity 30mins most days of the week

vigorous intensity 20mins 3 days a week

strength building 2x/week

flexibility and balance 2x-week

62
Q

What are some of the loop diuretics we could use to treat the client with HTN?

A

ex: furosemide, bumetanide
considerations: take in AM, admin K supplement, dig toxicity can happen if client is hypokalemic

63
Q

What are some of the thiazide diuretics we could use to treat the client with HTN?

A

ex: HCTZ
considerations: take in AM, admin K supplement, dig toxicity can happen if client is hypokalemic

64
Q

What are some of the potassium sparing diuretics we could use to treat the client with HTN?

A

ex: spironolactone, triamterene
considerations: monitor for hyperkalemia

65
Q

What are some of the beta-blockers we could use to treat HTN?

A

ex: propranolol, atenolol, metoprolol
considerations: monitor for bradycardia, HF, and hypoglycemia in patients with diabetes

66
Q

What are some of the ACE inhibitors that may be used to treat HTN?

A

ex: captopril, lisinopril
considerations: captopril give 1 hr before meals; lisinopril can cause a dry cough

67
Q

What are some of the calcium channel blockers that could be used to treat HTN?

A

ex: nifedipine, verapramil

what it does: prevents the mvmt of calcium into the cells which increases sodium excretion and increases vasodilation

68
Q

What is stable angina?

A
  • exertional angina is another name. It can be relieved with rest or nitroglycerin
  • it is a s/sx of MI
  • 1 or more arteries are 70% blocked
  • coronary artery blocked by 50%
69
Q

What are the risk factors for stable angina?

A
  • CAD
  • family history
  • older age
  • hyperlipidemia
  • tobacco use
  • HTN
  • diabetes or obesity
  • sedentary lifestyle
70
Q

What are the s/sx of stable angina?

A
  • chest pain: intermittent occurring over a long period, usually starting from physical exertion or stress
  • dyspnea
  • fatigue
  • pain in the arm, jaw, neck, shoulder, or back
  • nausea
  • diaphoresis
  • dizziness
  • anxiety
71
Q

When should a 12-lead ECG be used and what could it show during angina?

A
  • use within 10 minutes of onset
  • ST elevation=injury
  • T wave inversion or depression=ischemia
  • Q wave enlargement=infarction
72
Q

How do we diagnose based on cardiac enzymes and serum cardiac biomarkers?

A

Cardiac enzymes: test for death of heart muscle tissue

Serum cardiac biomarkers:
Troponin gold remains elevated for 2-3 wks following MI

Creatinine phosphokinase (CK-MB): increases 4-6 hours after MI and remains elevated for 1-3 days

Myoglobin: rises in response to tissue injury, within 2 hours and gone within 7 hours

73
Q

What is the nursing care for angina?

A
  • assess pain
  • assess heart and breath sounds
  • admin O2
  • monitor VS
  • promote rest
  • admin meds: asa, nitro, BB, statins, calcium channel blockers, ACE
74
Q

What are some guidelines for the use of nitrogylcerin?

A
  • take at the onset of chest pain
  • take every 5 mins x3
  • if pain is not relieved after the first tablet call 911
  • take while sitting

considerations: headache and hypotension may be side effects, ED meds is contraindicated with the use of nitro, store ina dark, dry place and replace q 6 mos

75
Q

What lifestyle changes should be taught to the client with stable angina?

A
  • avoid constipation
  • avoid activity in cold weather
  • decrease stress
  • exercise
  • low salt, fat, and cholesterol
  • rest after meals
  • smoking cessation
76
Q

What is the clinical definition of shock?

A

inadequate delivery of oxygen and nutrients to support vital organs and cellular function

77
Q

What is cardiogenic shock? Causes?

A
  • failure of the heart to pump adequately

- caused by systolic or diastolic dysfunction or compromised cardiac output

78
Q

What is hypovolemic shock? Causes?

A
  • decreased circulating blood volume

- caused by hemorrhage, GI loss, fistula drainage, DI, hyperglycemia, diuresis

79
Q

What is distributive shock?

A

AKA circulatory shock

-vasodilation causes blood to pool in peripheral vessels

80
Q

What is the neurogenic cause of distributive shock? S/sx?

A

Cause: spinal cord injury, certain meds, hypoglycemia

S/Sx: warm dry skin, bradycardia

81
Q

What is the anaphylactic cause of distributive shock? S/SX?

A

Cause: hypersensitivity reaction that causes sudden hypotension
S/SX: can cause respiratory and cardiac arrest, swelling of the lips/tongue (angioedema), wheezing/stridor, flushing, pruritis, urticaria, cold/moist skin
**epi and benadryl are primary meds to give

82
Q

What is the septic cause of distributive shock? S/SX?

A

**most common
Cause: sepsis
S/Sx: warm dry skin, bounding pulse, tachypnea

83
Q

What are the general s/sx for shock?

A
  • tachycardia
  • hypotension
  • oliguria
  • pallor
  • metabolic acidosis
  • decreased LOC
84
Q

What is the nursing care for the client with shock?

A
  • modified T-Berg
  • secure IV line (16-18g)
  • give NS, LR, and albumin
  • admin O2
  • VS q 5mins
  • rest
  • decrease movement
  • monitor I&O
85
Q

What is the clinical definition of CAD?

A

Coronary Artery Disease

  • progressive
  • only symptomatic once its advanced
  • atherosclerosis (hardening of the arteries)
86
Q

What is the connection between CRP and CAD?

A

CRP is a protein produced by the liver, and is a general indicator of inflammation
-it is increased in patients with CAD

87
Q

What are the risk factors for CAD?

A
  • age
  • gender
  • ethnicity
  • family history
  • genetic presdisposition
  • HTN
  • tobacco use
  • sedentary lifestyle
  • obesity, diabetes
  • elevated serum lipids
88
Q

What is the nursing care for the client with CAD?

A
  • encourage regular exercise
  • weight reduction
  • treat HTN
  • stop smoking
  • decrease sat fats and cholesterol
  • decrease red meat, egg yolks, and whole milk
  • increase complex carbs and fiber
  • increase omega 3 fatty acids
89
Q

What meds can we use to treat CAD?

A

Statins- inhibits colesterol synthesis to decrease LDL and increase HDL; monitor for liver damage and hypertrophy

Niacin- lowers LDL, raises HDL; flushing, pruritis, GI, and O.hypotension

Fibric acid derivatives- lower triglycerides and raise HDL; GI side effects

90
Q

What are cataracts?

A

clouding of the lens leading to varying degrees of visual impairment

91
Q

What are the risk factors for cataracts? (7)

A
  • aging
  • diabetes
  • hereditary
  • smoking
  • eye trauma
  • excessive sun exposure
  • chronic corticosteroid use
92
Q

What are the s/sx of cataracts?

A
  • freq prescription changes
  • reduced night vision
  • abnormal color perception
  • blurred vision
  • diplopia (dbl vision)
  • absent red reflex
  • sensitivity to glare
93
Q

What are the surgical options available to clients with cataracts?

A
  • extracapsular cataract extraction: outpatient under local anesthesia, removal of the lens (one at a time)
  • phacoemulsification: ultrasonic device breaks up the lens and a replacement is inserted (intraocular lens implantation)
94
Q

What are mydriatics used for and some examples?

A
  • used preop for lens removal to dilate the pupil and constrict vessels
  • examples: phynelephrine hydrochloride, atropine
95
Q

How do we care for the postop cataract surgery client?

A
  • keep the operative eye covered for 24 hours, sunglasses outside
  • HOB 30-45
  • do not turn pt on the operative side
  • avoid IOP such as bending at the waist, coughing, straining (give antiemetic to avoid emesis)
  • vision should stabilize in 6-12 weeks
96
Q

What is glaucoma?

A
  • vision changes/blindness from optic nerve damage

- usually occurs due to increased IOP (RR 10-21 mmHg)

97
Q

What are the risk factors for glaucoma?

A
  • age >40
  • men
  • infection
  • tumors
  • diabetes
  • genetic predisposition
  • HTN
  • eye trauma
98
Q

What is closed angle glaucoma?

A
  • obstruction to the outflow of aqueous humor increases IOP suddenly
  • *ocular emergency
99
Q

What is open angle glaucoma?

A
  • aqueous humor outflow is decreased causing a gradual increase in IOP
  • most common
100
Q

What are the s/sx of closed angle glaucoma?

A
  • rapid onset of IOP >30
  • blurred vision
  • dilated pupils
  • N&V
  • sudden severe eye pain
101
Q

What are the s/sx of open angle glaucoma?

A
  • headache
  • mild eye pain
  • loss of peripheral vision
  • halos around lights
  • fluctuating IOP 22-32
102
Q

What does tonometry measure?

A

IOP (noninvasive, painless)

103
Q

What is a miotic medication given for in the client with glaucoma?

A

example: pilocarpine
- constricts the pupil, improves outflow, improves circulation

Consider: can cause blurred vision

104
Q

What is a beta blocker given for in the client with glaucoma?

A
  • *first choice defense for glaucoma**
    example: timolol
  • decreases IOP, reduces aqueous humor production

Consider: can cause bronchoconstriction or hypoglycemia (use caution with asthma, DM, COPD)

105
Q

What is a carbonic anhydrase inhibitor used for in the client with glaucoma?

A

example: acetazolamide, dorzolamide, brinzolamide
- decreases IOP, reduces aqueous humor production

Consider: ask about Sulfa allergy

106
Q

What is IV mannitol used for in the client with glaucoma?

A
  • *this is the emergency treatment for closed angle glaucoma**
  • osmotic diuretic quickly decreases IOP
107
Q

What do glaucoma surgical interventions looks like?

A

Laser trabeculectomy, iridotomy, placement of a shunt all improve the flow of aqueous humor

-4-6 weeks for vision to stabilize

108
Q

What is AMD?

A

Age-related Macular Degeneration

  • tiny, yellow spots (drusen) beneath the retina
  • shadow-y areas in field of vision
109
Q

What is dry macular degeneration?

A
  • more common
  • no exudate
  • atrophy of the macular cells
  • gradual blockage in the retinal capillary arteries
  • painless, slow onset
110
Q

What is wet macular degeneration?

A
  • less common
  • exudate
  • new growth of blood vessels that have thin walls and leak blood and fluid
  • rapid onset
111
Q

What are the risk factors for macular degeneration?

A
  • female
  • short body stature
  • smoking
  • HTN
  • family history
  • lack of carotene and Vit E
112
Q

What are the s/sx of AMD?

A
  • lack of depth perception
  • objects appear distorted
  • blurred vision
  • loss of central vision
  • blindness
113
Q

How can we treat wet macular degeneration?

A
  • laser therapy seals leaking vessels

- ocular injections inhibit blood vessel growth

114
Q

What does the tympanic membrane look like normally?

A
  • pearly gray, shiny, translucent

- flat, slightly pulled in at the center

115
Q

What is the Weber test?

A

strike a tuning fork and put it on the skull, the tone should be heard equally bilaterally
*bone conduction

116
Q

What is the Rinne test?

A
  • strike a tuning fork and put it on the mastoid process
  • instruct the client to signal when the sound stops
  • air conduction
117
Q

What is Meniere’s Disease?

A
  • abnormal inner ear fluid balance, progressive
  • age 30-60
  • more common in women
118
Q

What are the s/sx of Meniere’s disease?

A
  • episodic vertigo (can lead to N/V, sweating, being pulled to the ground)
  • tinnitus
  • fluctuating hearing loss
  • pressure in the ear

**vertigo attacks can last hours to days and may happen several times a year

119
Q

What is the nursing care for the client with Meniere’s disease?

A
  • teach fall precautions
  • quiet environment
  • avoid aspirin (may increase symptoms)
  • small freq meals low in sodium, no caffeine or alcohol, no MSG
120
Q

What are antihistamines used for in the client with Meniere’s disease?

A

example: meclizine
- treats vertigo

Consider: avoid driving or heavy machinery due to sedative effects

example: diphenhydramine
- treats vertigo

Consider: avoid driving, etc…, dry mouth is expected

121
Q

What are tranquilizers used for in the client with Meniere’s disease?

A

example: diazepam
- anti-vertigo effects

Consider: assess for sedation and safety, restrict use in clients with closed angle glaucoma!

NUR150 (8 decks)

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