Final Exam Flashcards

Question

Heparin Antidote

Answer 1

protamine sulfate

Answer 2

sudden onset pain

Answer 3

>60 assess 4 hemodynamic compromise treat underlying cause medications pacing

Answer 4

>100 assess s/s low cardiac output treat underlying cause medications

Answer 5

blocks the release of adrenaline and noradrenaline reduces the force of blood pumping lowers blood pressure

Answer 6

-Age -immobility -injury/surgery -smoking -cancer

Answer 7

Venous Duplex Ultrasound doppler venogram MRI

Answer 8

-early ambulation -exercise -compression stocking -well hydration

Answer 9

no vitamin k (leafy greens) cholesterol within range

Answer 10

Vomiting (Alkalosis) Diarrhea (Acidosis)

Answer 11

No metal No pregnancy tell them to hold breath

Answer 12

-obtain consent -will be sitting upright -nurse at bedside w/ ultrasound -don't remove too much (1000ml)

Answer 13

consent, anticoagulant use NPO 4-8 hrs prior montior gag reflex post

Answer 14

become unresponsive to oxygen therapy which leads to hypoxia most likely from benzocaine

Answer 15

General anesthesia can use benzocaine or lidocaine

Answer 16

determine lung function + breathing dont smoke 6-8 hrs prior no bronchodilators 4-6 hrs prior performed during exercise nose clip to prevent air escape

Answer 17

air in pleural space chest pain, SOB, deviation of midline, subcutaneous emphysema

Answer 18

medical emergency air trapped and completely collapses lungs respiratory distress, cyanosis, distended neck veins

Answer 19

blood in the pleural space simple <1000mL Massive >1000mL can have both pleural and hemothorax

Answer 20

fluid in pleural space chest xray, CT thoracentesis is treatment

Answer 21

3+ rib fractures in 2 or more places paradoxical chest movement impaired gas exchange monitor I+O, high fowlers

Answer 22

asymptomatic at first bruise to the lung tissue caused by trauma impaired gas exchange

Answer 23

ABC's ensure oxygen monitor for shock chest tube malfunction

Answer 24

Collapsed Lung -IS, Breathing exercises, ventilators, lung expansion therapy, bronchodilators

Answer 25

noninvasive support w/o intubation positive pressure keeps alveoli open ONLY for alert pt watch for skin breakdown

Answer 26

increases intrathoracic pressure 1 continuous pressure pressure in alveoli can help push fluid out

Answer 27

different level on inspiration and expiration prevent intubation

Answer 28

keeps alveoli open, doesnt allow them to close

Answer 29

consent removes air, fluid, blood restores intrapleural pressure ( lung expansion) sterile water for troubleshooting

Answer 30

2nd intercostal space

Answer 31

5th intercostal space

Answer 32

water seal, drainage collection, suction control notify if >70 mL

Answer 33

controlled suction based on amount of fluid

Answer 34

controlled by dial

Answer 35

stops air from returning to lungs gentle bubbling expected (excessive=air leak) (none=troubleshooting)

Answer 36

expected movement of water in water seal chamber

Answer 37

monitor level 24cm refill every shift check hourly sterile water at bedside

Answer 38

Air leak (continous bubbling) disconnected pulled out (cover w dry gauze and notify provider) monitor for tension pneumothorax

Answer 39

premed 30 mins prior suture removal kit deep breaths and bear down chest x ray post monitor drainage and wound for infection

Answer 40

control center makes ADH+Oxytocin

Answer 41

master gland

Answer 42

wraps around trachea regulates bodys metabolism (t3+t4)

Answer 43

regulates body calcium level

Answer 44

located above kidneys cortex(outside) steriods medulla (inside) catecholamines (fight/flight)

Answer 45

ovaries/testies

Answer 46

Family history African Americans High birth weight babies PCOS BMI >25

Answer 47

Beta Cell destruction autoimmune insulin dependent onset <30 yo thirst,hunger, increased urine, weight loss

Answer 48

Beta Cell dysfunction insulin required for 20-30% onset any age frequently no s/s: thirst, fatigue, blurred vision metabolic syndrome 60-80%

Answer 49

increases risk of type 2 DM Must Have 3 for Diagnosis 1- abdominal obesity >40 male >35 female 2- hyperglycemia 3- hypertension 4- hyperlipidemia

Answer 50

A1C 4-5.7% fasting glucose 74-100 glucose tolerance <140

Answer 51

A1C 5.7-6.4% fasting glucose 100-125 mg glucose tolerance 140-199

Answer 52

A1C >/= 6.5% fasting glucose >/= 126 glucose tolerance >/= 200

Answer 53

reduces production of glucose in liver slows carb absorption increases sensitivity to insulin contraindicated in gastroparesis take vitamin b12 and folic acid no alcohol (lactic acidosis)

Answer 54

Humalog, premeal onset: 10-30 min peak: 1-3 hrs

Answer 55

Regular Insulin, premeal onset: 30 min peak: 1-5hr

Answer 56

only admin IV U500 never admin IV

Answer 57

NPH onset: 60-120 mins peak: 6-14hr

Answer 58

insulin glargine usually 1-2 every 24hr no peak/trough onset: 60-120 min

Answer 59

abdomen 45-90 degrees (90 for obese)

Answer 60

keep glucose between 140-180 monitor BG every 2-4 hours test urine for ketones increase fluid intake

Answer 61

glucose tablets 120 mL fruit juice/ soda 5 hard candies 4 cubes/tsp of sugar 1tbs honey/syrup

Answer 62

15-15 Rule BG <70=15g CHO BG <50=30g CHO

Answer 63

most common in type 2 DM (undiagnosed) slow onset hyperglycemia, altered mental status produce just enough to avoid DKA Glucose >600 urine ketones negative pH >7.4, HCO3 >20

Answer 64

sudden onset causes by stress,infection, or no insulin s/s: kussmaul resp, fruity breath, nausea, abd pain, dehyrdation glucose >300 postive urine ketones pH <7.35, HCO3 <15

Answer 65

cool,clammy,sweaty skin no dehydration nervous,irritable, confusion, decrease LOC weak,blurred vision, tachycardia, palpitations glucose <70 negative ketones

Answer 66

warm, dry skin dehydration kussmaul- fruity breath stuporous, obtunded, coma varies with DKA and HHS > 180mg/dL Positive ketones with DKA

Answer 67

Changes of vessels in eye vision loss

Answer 68

loss of feeling in feet

Answer 69

kidney dysfunction -control blood glucose+BP ACE/ARB's ( decrease BP) Albuminuria

Answer 70

wear shoes, lotion not between toes do not cut toenails wash in warm water

Answer 71

when a body receives signal, it either tells body to secrete more or less hormone

Answer 72

anorexia, decreased serum cortisol levels, hypoglycemia, hypoatremia, lethargy

Answer 73

selective: one hormone is deficient panhypopituitarism: two or more deficiencies of ACTH and TSH are most life threatening treatment: lifelong hormone replacement therapy risk factors: TUMORS Primary: direct problem w pituitary gland Secondary: orginaties in hypothalamus

Answer 74

decreased BP and BG

Answer 75

alopecia, cold intolerance, lethargy, menstrual abnormalities, weight gain, slow cognition

Answer 76

child: shorter height/dwarfism adults: decreased bone density, decreased muscle strength, increased serum cholesterol levels

Answer 77

male: decreased facial hair, decreased bone density, reduced muscle mass female: amenorrhea, anovulation, breast atrophy, decreased bone density, decreased estrogen

Answer 78

(increases reabsorption of water in kidneys) dehydration, increased urine, hypotension, increased thirst, increased sodium, urine output doesnt decrease when fluid decreases

Answer 79

most common: GH and ACTH caused by anterior pituitary tumor s/s: vision changes, HA, Increased intracranial pressure

Answer 80

overproduction of growth hormone and increased serum somatotropin **oral glucose test s/s: enlarged pituitary gland, visual disturbances, slanting forehead, coarse facial features, increased BP, CHF, and enlargement of bones in hands and feet

Answer 81

excess ACTH and elevated cortisol levels s/s: weight gain, trunkel obesity, moon face, loss of bone density, extremity muscle wasting, HTN, hyperglycemia

Answer 82

primary: issue w thyroid gland itself secondary: excess in thyroid hormone cardiovascular symptoms and weight loss

Answer 83

most common cause of hyperthyroidism *pretibial myxedema (dry waxy swelling), exophthalmos (eyes buldging)

Answer 84

high fever and severe HTN increased temp = worse do not palpate a goiter or thyroid tissue in pt with hyperthyroidism ( can stimulate release of hormone)

Answer 85

t3 + t4 elevated tsh: graves disease= low

Answer 86

sit down when urinating to avoid splashing close lid when you flush and flush 2-3 times males use condom catheter instead of brief avoid contact w pregnant or young children for a week avoid sleeping in bed with someone dont share drinks, tooth brush do not prepare food

Answer 87

hashimoto is most common cause iodine deficiency (needed for thyroid hormones) *goiter (neck swelling) s/s: everything decreased but weight

Answer 88

serious complication of untreated hypothyroidism medical emergency assess every 8hr (mental status)

Answer 89

increased TSH decreased t3 + t4

Answer 90

inflammation of thyroid gland chronic thyroiditis (hashimoto) most common risk: bacterial/viral infection, women s/s: dysphagia, painless enlargement, chills, fever, muscle/joint pain

Answer 91

papillary carcinoma: most common, younger women follicular carcinoma: older adults medullary carcinoma: >50 yo anaplastic carcinoma: rapid growing, aggressive

Answer 92

elevated Tg level (men .5-53) (women 0.5-43)

Answer 93

excess production of PTH increased parathyroid hormone increased calcium increased magnesium decreased phosphorus s/s: kidney stones, osteoporosis, GI issues, weight loss

Answer 94

hypocalcimia (mild tingling, severe seizures) decreased parathyroid hormone decreased calcium decreased magnesium increased phosphorus

Answer 95

nasal packing post surgery (2-3 days) (mustache dressing) don't brush teeth,cough, blow nose, bend forward ( increased ICP) monitor neuro for 24 hrs deep breathing

Answer 96

TX: graves or hyperthyroidism and goiter causing problems iodine prep to decrease thyroid size and reduce thyroid storm or hemorrhage deep breaths every 30-60 mins monitor VS q15 min until stable then q30. min quiet and limit visitors

Answer 97

minimally invasive hypocalcemic crisis: assess calcium levels post laryngeal nerve damage: assess voice post surgery

Answer 98

m- .6-1.2 f- .5-1.1

Answer 99

if passed 180 threshold check blood glucose

Answer 100

purpose: evaluate waste product from kidney measures: color, clarity, --concentration, specific gravity, pH, wbc, nitrate, bacteria, rbc, ketones, glucose -collected early in morning

Answer 101

purpose: measure creatinine clearance, urea nitrogen, sodium, chloride, calcium, and proteins -discard the first void, then collect for next 24 hours -collection restarted if any sample is discarded -samples are refrigerated or on ice

Answer 102

purpose: 3 dimensional imaging of organ system, can assess kidney size, cyst, or mass prep:assess for iodine or shellfish allergy post: assess kidney function

Answer 103

purpose: detects urethral or bladder injury after instillation of contrast to provide imaging of bladder and ureters. pre: informed consent, may require anesthesia procedure: insert catheter, instill contrast, obtain x ray, remove catheter post: monitor for UTI first 72 hours, increase fluids, monitor output

Answer 104

Purpose: removal of a sample of tissue by excision or needle aspiration for histological examination. * Pre-procedure: informed consent, coagulation studies, NPO for at least 4 hours, typically local anesthesia, pt must lay prone (procedure is contraindicated if they cannot lay in this position for extended periods) * Post-procedure: monitor for bleeding--> high risk b/c kidney is highly vascularized--> hematuria, H&H, bruising at puncture site

Answer 105

Purpose: used to discover bladder wall abnormalities or occlusions of ureter or urethra * Pre-procedure: NPO, informed consent, laxative or enema for bowel prep night before. May require anesthesia (not always) * Intra-procedure: Lithotomy position, vitals monitoring * Post-procedure: monitor urine output and characteristics (may be pink tinged), irrigation may be necessary if blood clots are present, encourage increased fluid intake

Answer 106

Purpose: to break a stone into smaller fragments * Pre-procedure: pt must be able to lie flat, assess for dysrhythmia (as this procedure can cause or worsen existing) * Intra-procedure: monitor ECG * Post-procedure: strain urine for stone passage, bruising may occur at site (expected finding), assist with pain management r/t stone passage

Answer 107

Percutaneous: * Purpose: removal of stone through the skin. * Pre-procedure: NPO, Informed consent, pt must lie prone (contraindicated if they cannot do so for extended periods) * Post-Procedure: monitor nephrostomy for drainage and presence of blood Open: * Purpose: for large or impacted stones * Pre-procedure: NPO, Bowel prep, Informed consent * Post-procedure: monitor for excess bleeding, maintain fluid intake, strain urine for passage of additional fragments, teach prevention measures

Answer 108

Monitory amount of drainage and type hourly within the 1st 24 hours * A decrease in drainage amount and back pain can indicate tube obstruction or dislodgement Monitor for nephrostomy leaking Sterile dressing changes Tube flushing--> to check patency and dislodge clots

Answer 109

S/S: pain, fatigue, fever, confusion, frequency, urgency, dysuria, nocturia, hematuria, retention, feeling of incomplete bladder emptying * Diagnosis: history, physical exam, urinalysis, CBC, cystoscopy if recurrent * Tx: antibiotic therapy, phenazopyridine (urinary analgesic), antipyretic, increased fluid intake, warm sitz bath 2-3 times a week can relieve pain * Education: full abx course, drink 2-3 L/day, wipe front to back, do not hold urine, phenazopyridine (urinary analgesic) will turn urine orange * Labs: urinalysis-->expect positive WBCs, Nitrite, bacteria, leukocyte esterase, casts; Urine culture and sensitivity; CBC-> elevated WBCs

Answer 110

S/S: flank pain, fluctuating pain (depending on location of stone), oliguria, anuria, dysuria, hematuria, bladder distention. * Diagnosis: x-ray KUB, CT KUB, Ultrasound KUB * Tx: NSAIDs, Antiemetics, Antibiotics, increase fluid intake (to aid in passing stone and prevent further stone formation), watchful waiting (for stones to pass), straining of urine * Education: once stone type has been determined, patient may need to alter intake of certain foods. * Calcium: avoid milk and other dairy products * Oxalate: avoid spinach, black tea, and rhubarb * Uric Acid: decrease purine intake--> poultry, fish, gravies, red wines, sardines * Struvite: typically results after a bacterial infection. Avoid high phosphate foods (dairy, red or organ meats, whole grains) * Labs: urinalysis--> rule out infections, may be positive for RBCs, Hyperkalemia, Hyperphosphatemia

Answer 111

S/S: weight gain (due to cyst formation and increased kidney size), flank pain, headache (stroke risk r/t hypertension), hematuria, hypertension (r/t decreased kidney perfusion and initiation of the RAAS system), dysuria, nocturia, constipation (enlarged kidney compresses bowels), enlarged abdominal girth (r/t enlargement of kidneys), kidney stones * Diagnosis: ultrasound, family history/genetic testing * Tx: blood pressure control (typically with ACEs or ARBs because they work directly on the RAAS system), pain management (typically acetaminophen and nonpharmacologic interventions), interventions to slow progression of kidney damage (surgical cyst drainage, dialysis, smoking cessation), infection prevention, Pt will inevitably need a kidney transplant (if they live that long) * Education: importance of diet (decrease sodium intake), importance of smoking cessation (hypertension risk), * Labs: urinalysis: + proteinuria, + hematuria; decreased GFR; elevated BUN and creatinine levels, fluctuation in sodium level (can be wasted or retained)

Answer 112

S/S: flank pain, anuria, abdominal asymmetry (may indicate kidney mass), abdominal tenderness * Diagnosis: renal ultrasonography (1st choice), UA, CBC, CT or X-Ray KUB * Tx: removal or treatment of obstruction--> nephrolithotomy/ureterolithotomy, cystoscopy, stent placement; Nephrostomy placement * Labs: depend on severity and related kidney damage--> if left untreated kidney damage will result in low GFR, elevated BUN, elevated Creatinine

Answer 113

S/S: UTI symptoms, N/V, recent cystitis or other UTI * Diagnosis: urinalysis, culture and sensitivity, Imaging (X-ray KUB, CT) * Tx: antibiotics, increase fluid intake, pain interventions, antipyretic, * Education: do not hold urine, drink plenty of fluids, wipe front to back, take full course of abx, * Labs: BUN may be elevated (but creatinine will not), urinalysis- + WBC, + nitrite, + bacteria, cloudy, foul odor

Answer 114

Acute: results from excess immune response within the kidney tissues --> onset about 10 days after time of infection Chronic: do not know cause S/S: Proteinuria, hematuria, hypertension, edema (especially in the face and hands), Pulmonary edema (dyspnea, shortness of breath, crackles), neck vein distension, weight gain Diagnosis: can only be officially diagnosed by kidney biopsy Tx: r/t fluid overload--> diuretics, sodium restriction, water restriction; Antihypertensives, Dialysis, antibiotic therapy Education: educate on medication, if dialysis is required--> educate on vascular access care and dialysis schedule/routine Labs: Elevated BUN and creatinine, electrolyte imbalances r/t ineffective filtration, urinalysis: + RBC and protein, decreased GFR (normal: greater than 125 mL/min)

Answer 115

Hematoma formation within 24-72 hours of fracture  Granulation tissue invades hematoma to form fibrocartilage within 3 days- 2 weeks  Fracture site is surrounded by new vascular tissue known as a callus within 3-6 weeks  Callus is gradually resorbed and transformed into bone within 3-8 weeks Consolidation and remodeling of bone can continue for up to 1 year after

Answer 116

breaks through skin

Answer 117

break remains in skin

Answer 118

bends enough to snap but only cracks on one side more common in children

Answer 119

created from twisting motion; fracture line goes around

Answer 120

complete fracture that runs horizontally across bone

Answer 121

diagnoally complete break that runs horizontally across bone

Answer 122

from loading force (even gravity can cause these) ex) trauma, osteoporsis, tumors

Answer 123

broken bone that is in multiple pieces -usually three or more

Answer 124

single line fracture with no other damage

Answer 125

occurs when bone structure is weakened by disease

Answer 126

fracture caused by repeated stress over time most common in athletes

Answer 127

type of fracture that occurs when pressure is at boths sides of the bones causing it to split and broken ends jam together

Answer 128

used to maintain alignment of the bone fragments/pieces. Used to decrease muscle spasm

Answer 129

a short-term treatment that uses weights and a pulley system to help realign broken bones in the lower limb

Answer 130

pins placed into bone

Answer 131

Weights are not touching anything (I.e. bed or floor) Ropes are intact (not fraying or thinning) Pulley systems are intact Cleanliness of pins: sterile cotton swab with approved antiseptic--> clean from pin base up the pin, use different swab for each pin--> pin care should be completed at least once a shift Foot pedal is not touching the bed

Answer 132

ORIF (open reduction internal fixation): Hardware is inside bone  External Fixation: Hardware is outside--> assess pin sites every 8- 12 hours for s/s of infection

Answer 133

May be Elective or traumatic  Elective: surgical removal r/t chronic disease --> more commonly the lower extremities  Traumatic: result of an injury/trauma --> more commonly the upper extremities  Nursing Care:  Physical assessment: Neurovascular assessment  Psychosocial assessment: altered body image, depressed mood, financial concerns (connect with proper resources including social worker), denial, self-esteem issues  “Assessing ability to cope, identify and acknowledge feelings, help connect with resources”  Medication: pain management, IV CALICTONIN  Post-amputation Tx:  Pain management: especially for phantom limb pain  Phantom limb pain: REAL PAIN!!!! More likely to occur if they had chronic pain in that limb prior to amputation (ex: diabetic neuropathy)  Proper stretching of area (flexion contracture prevention)  Neuroma removal (tumor of damaged nerve cells typically at the end of a limb) can reoccur after removal

Answer 134

Compression of the median nerve from inflammation (can occur in both hands, but more likely in the dominant hand)  Inflammation=swelling --> increased fluid in space--> fluid compresses nerve S/S: dull ache/discomfort, paresthesia that may extend up the arm, muscle weakness (may have difficulty holding small objects, turning knobs/keys, and doing other fine motor tasks)  Risk factors: repetitive stress (typing, crocheting, tennis, etc.), obesity, pregnancy, joint inflammation  Dx: Phalen’s maneuver: wrist flexion for 1 minute (numbness in hands indicates positive test), Tinel’s sign: repetitive tapping of the transverse ligament (results in paresthesia indicates positive test)  Tx: wrist immobilization and NSAIDs, behavior modification (ergonomic typing: hands parallel to each other at table, wrist support), physical therapy, corticosteroid injection, median nerve decompression surgery  Median nerve decompression surgery: post-op wrist immobilizer for 4-6 weeks, no heavy lifting

Answer 135

tear or stress on ligament (bone to bone)

Answer 136

tear or stress to tendon ( muscle to bone)

Answer 137

REST ICE COMPRESS ELEVATE

Answer 138

Rapid increase in pressure within a muscle compartment (compresses muscle, blood vessels, and nerves)  S/S: 6 P’s--> Pain (out of proportion to injury), Paresthesia, Pallor, Pulselessness, Poikilothermic (decreased temperature in one area--> r/t decreased circulation and swelling), Paralysis  Intervention: immediately notify provider, if cause is known remove it (ex: cast), emergency fasciotomy

Answer 139

S/S: similar to DVT/PE, if in lung, a petechial rash may appear on the chest (usually the last sign to develop)  Intervention: ABC Maintenace while waiting for fat to be reabsorbed by the body. (Intubation may be required), hydration, fracture immobilization, bedrest

Answer 140

S/S: Fever (typically greater than 101 Fahrenheit), chills, sweats, elevated WBC, Bone pain (constant, localized, pulsating, worse with movement), swelling and tenderness Intervention: intense antimicrobial therapy via IV (for up to 3 months or until infection is eliminated), oral drug therapy may be required after IV, pain management  Complication: loss of function, persistent pain, amputation, death r/t sepsis

Answer 141

More lightweight, strong, dries quickly (within 30 minutes), can be made water-resistant

Answer 142

Heavy, can take up to 3 days to fully dry, cannot get wet

Answer 143

Pain, Pulse, Pallor, Paresthesia, Paralysis

Answer 144

Weight bearing exercises for bone strengthening--> slows bone loss  Maintenance of adequate calcium and vitamin D intake (diet or supplementation)  Smoking cessation--> nicotine has been shown to negatively impact musculoskeletal and immune systems  Maintain regular exercise--> muscle fibers decrease in size and number with age and can atrophy if unused  Osteopenia (decreased bone density) --> safety through fall prevention is top priority  Kyphosis (hump-back) --> teach proper body mechanics

Answer 145

bone strength and muscles-->maintain adequate intake--> (9.0-10.5)

Answer 146

calcium balance and bone strength--> maintain intake--> inverse relationship with Ca (Ca increases; P decreases) --> (3.0-4.5)

Answer 147

r/t calcium and phosphorous absorption--> maintain intake--> deficiency can result in calcium deficiency

Answer 148

can indicate muscle trauma--> recall rhabdomyolysis

Answer 149

stimulates osteoblastic activity--> deficient estrogen=weakened bones

Answer 150

can indicate skeletal muscle trauma

Answer 151

creatinine clearance, urea nitrogen, sodium, chloride, calcium, and proteins

Answer 152

breaks stone into smaller pieces

Answer 153

a surgical procedure to remove kidney stones that are too large to pass on their own or don't respond to other treatments go in through the skin

Answer 154

Removes a stone from the ureter

Answer 155

Removes a stone from within the kidney

Answer 156

a thin, flexible tube that drains urine directly from the kidney into a bag outside the body.

Answer 157

urinalysis–>expect positive WBCs, Nitrite, bacteria, leukocyte esterase, casts; Urine culture and sensitivity; CBC-> elevated WBCs

Answer 158

flank pain, fluctuating pain (depending on location of stone), oliguria, anuria, dysuria, hematuria, bladder distention.

Answer 159

avoid milk and other dairy products

Answer 160

avoid spinach, black tea, and rhubarb

Answer 161

decrease purine intake–> poultry, fish, gravies, red wines, sardines

Answer 162

results after a bacterial infection. Avoid high phosphate foods (dairy, red or organ meats, whole grains)

Answer 163

urinalysis–> rule out infections, may be positive for RBCs, Hyperkalemia, Hyperphosphatemia

Answer 164

blood pressure control (typically with ACEs or ARBs because they work directly on the RAAS system), pain management (typically acetaminophen and nonpharmacologic interventions), interventions to slow progression of kidney damage (surgical cyst drainage, dialysis, smoking cessation), infection prevention, Pt will inevitably need a kidney transplant (if they live that long)

Answer 165

importance of diet (decrease sodium intake), importance of smoking cessation (hypertension risk),

Answer 166

urinalysis: + proteinuria, + hematuria; decreased GFR; elevated BUN and creatinine levels, fluctuation in sodium level (can be wasted or retained)

Answer 167

The dilation of the renal pelvis and calyces, which can affect one or both kidneys.

Answer 168

The dilation of the ureter

Answer 169

kidney infection

Answer 170

an X-ray exam that uses a contrast material to image the bladder, urethra, and kidneys while the bladder is filling and emptying

Answer 171

a term for a group of kidney diseases that damage the glomeruli, the tiny filters in the kidneys acute: strep infection after 10 days chronic: occurs 20-30 year

Answer 172

Proteinuria, hematuria, hypertension, edema (especially in the face and hands), Pulmonary edema (dyspnea, shortness of breath, crackles), neck vein distension, weight gain

Answer 173

surgical removal r/t chronic disease –> more commonly the lower extremities

Answer 174

result of an injury/trauma –> more commonly the upper extremities

Answer 175

wrist flexion for 1 minute (numbness in hands indicates positive test),

Answer 176

repetitive tapping of the transverse ligament (results in paresthesia indicates positive test)

Answer 177

Peristalsis slows with age--> maintain physical activity which promotes peristalsis Abdominal muscle weakens with age--> increased hernia risk and increased straining with defecation (fiber and fluid intake can assist with straining)

Answer 178

pt drinks barium--> X-ray while drinking and post drinking--> allows for visualization of anatomical structures and the flow of contents Pre: NPO @ midnight, avoid smoking and chewing gum Post procedure: ensure barium leaves the system by encouraging fluid intake. --> stool will be chalky white--> if no bowel movement within 24 hours a laxative may be administered to promote defecation

Answer 179

provides ultrasound image from within the body--> can be used to measure size of esophageal tumor

Answer 180

Pre: NPO, informed consent, remove dentures and other oral inserts, assess for anticoagulant therapy, moderate sedation Intra: pt positioned left side lying with HOB elevated, biopsy and ultrasound can be performed during the procedure using the EGD scope Post: verify gag reflex (withhold fluids until verified), monitor for s/s of perforation (fever, pain, dyspnea, bleeding), use throat lozenges if sore throat or hoarseness persists

Answer 181

-visualizes biliary tree Pre: NPO, anticoagulant cessation, removal of dentures and other oral inserts Intra: pt will be semi-prone initially and will reposition during procedure Post: monitor ABCs, verify gag reflex, monitor for infection, throat lozenge for sore throat and hoarseness

Answer 182

Probe inserted from nose to end of esophagus to measure pH and changes of a certain period (typically 48h) Keep food diary for time while monitor is in place, keep a record of symptoms, when they occur, and how they were positioned

Answer 183

S/S: pyrosis, dyspepsia, regurgitation, chest pain, water brash (hypersalivation to compensate for the increased acidity in the lower esophagus), Globus (feeling of something stuck in the throat), coughing at night complications- ´ esophageal erosion, Barret's esophagus (premalignant)--> increased risk for esophageal adenoma

Answer 184

Education: Avoid acidic and spicy foods, avoid chocolate/caffeine/carbonated drinks, do not lay down after eating, do not wear tight clothing or lift heavy weights (increase abdominal pressure), eat multiple small meals per day, sleep with HOB elevated Tx: Lifestyle changes--> diet, medication therapy--> PPI (Pantoprazole, omeprazole)

Answer 185

S/S: Type I/sliding type: GERD Symptoms; Type II/rolling type (herniation of the upper portion of the stomach but the gastroesophageal junction remains in normal position): fullness after eating, sense of suffocation, worsening of symptoms when reclined complications: perforation, ischemia/necrosis

Answer 186

Dx: EGD (visualize esophagus and gastric lining), Barium Swallow Education: GERD teaching Tx: lifestyle changes--> diet, surgery if severe

Answer 187

S/S: Dysphagia (most common symptoms), odynophagia, regurgitation, globulus (feeling of something stuck in the throat), halitosis, change in bowel habits, chronic hiccups (r/t diaphragmatic irritation), voice changes Complications: metastasis, airway obstruction, surgical complications (discussed in esophageal tumor surgery section)

Answer 188

(EGD) esophagogastroduodenoscopy

Answer 189

endoscopic resection--> high risk of cardiac and respiratory complications (fluid overload and post-op A fib.), esophagectomy with lymphadenectomy, combo chemo and radiation, consult with registered dietician (nutrition) and speech language pathology (swallowing study and techniques)

Answer 190

S/S: dyspepsia, gastric pain, N/V, bloating, weight loss, hiccupping, evidence of GI bleed Complications: GI bleed, Ulcer formation

Answer 191

endoscopy with biopsy, H pylori (blood and stool test or urea breath test)

Answer 192

Education: eat small frequent meals, smoking and alcohol cessation, medication education (PPI, Sucralfate, Antacids) Tx: identify and avoid cause of gastric irritation, H pylori--> triple therapy with clarithromycin, amoxicillin, and PPI

Answer 193

S/S: Abdominal pain, hematemesis, increased pain with eating (gastric ulcer), bloating, belching, decreased pain while eating (duodenal ulcer) Complications: Bleeding (most common), Pyloric obstruction (long standing ulcers cause edema and swelling), perforation, peritonitis

Answer 194

Dx: EGD and H. pylori test Tx: PPI, H-2 blockers, sucralfate or misoprostol, surgery depending on severity (Gastrectomy, pyloroplasty, vagotomy)

Answer 195

S/S: Early--> dyspepsia, abdominal discomfort, abdominal fullness. Late--> N/V, palpable mass, weight loss, enlarged lymph nodes, weakness Complications: dumping syndrome, malabsorption

Answer 196

Dx: EGD with biopsy Tx: chemotherapy and radiation combo therapy, surgical--> total or subtotal gastrectomy

Answer 197

S/S: full sensation, diaphoresis, palpitations, dizziness, diarrhea, pallor, H/A, drowsiness Complications: fluid and electrolyte imbalance r/t rapid gastric emptying, hypoglycemia r/t rapid release of insulin from the pancreas as food quickly enters the small intestine

Answer 198

do not drink with meals but between meals, small/freq meals, low-fiber and low-carb foods, high-protein, lie down after eating to slow gastric movement

Answer 199

constipation/diarrhea depending on IBS type, Abdominal bloating and cramping, passage of mucous, distension, nausea with meals or passing stool, belching, sensation of incomplete defecation

Answer 200

dx hydrogen breath test--> can indicate s/s being r/t bacterial overgrowth in gut, malabsorption, or impaired digestion tx diet changes, stress reduction, avoiding triggers

Answer 201

Diet- avoid irritating foods (caffeine, lactose, gluten), increase physical activity, stress reduction techniques

Answer 202

S/S: visible lump or a lump that emerges with increased intrabdominal pressure (ex: coughing), heavy discomfort around gut, pain with palpation, constipation ´ Complications: strangulation of bowel--> surgical emergency

Answer 203

turn/deep breath post-surgery (do not cough), avoid increasing intra-abdominal pressure (coughing, straining, heavy lifting), constipation prevention

Answer 204

may require surgery (especially if irreducible) --> herniorrhaphy/ hernioplasty--> men may require catheterization post-op due to swelling ´ Reducible--> can be manipulated back into the abdominal wall--> application of a truss post-reduction to keep in place and provide support

Answer 205

S/S: melena/visible clots/rectal bleeding, weight loss, fatigue, palpable mass, increased bowel frequency, abdominal pain, passage of mucous, hematochezia Complications: obstruction from polyp or tumor, metastasis

Answer 206

colonoscopy (used for screening every 10 years starting at age 45 unless at increased risk due to presence of polyps or an inflammatory bowel disease), fecal occult blood test/guaiac (done yearly), sigmoidoscopy (not recommended as it only visualizes one section of the colon) Carcinoembryonic antigen is released in colon cancer

Answer 207

Education: Increase fiber intake, decrease smoking and alcohol use, increased exercise, decrease processed food intake, need for screening, avoid NSAIDS/red meat 1 week prior to FOBT Tx: Combination of chemotherapy and radiation, surgical intervention--> partial or total colectomy and lymphadenectomy then anastomosis(may require temporary or permanent ostomy)

Answer 208

Physical blockage Adhesion, tumor, intussusception (telescoping aka going inside itself), hernia, volvulus (180 twisted), stool

Answer 209

- "Functional obstruction" - Myopathy or neuropathy -Most common in post-op abdominal surgery pt's

Answer 210

- Vomiting is more likely and begins earlier (more likely to be undigested contents) - if high in small intestine ****Metabolic alkalosis risk, lower in small intestine duodenum or lower metabolic acidosis***** - Pain is more centrally located in the abdomen and a cramping sensation Visible peristaltic waves

Answer 211

- Vomiting is less likely to occur until later stages of obstruction - Typically, fewer fluid and electrolyte issues--> Metabolic acidosis risk - Pain/spasm in lower quadrants - Diarrhea or ribbon-like stools

Answer 212

S/S: Obstipation (inability to pass flatus or stool), fever, tachycardia, N/V, abdomen tender to palpation, hyperactive bowel sounds above obstruction site, hypoactive or absent bowel sounds below obstruction complications: Perforation of bowel, peritonitis, dysrhythmia (r/t fluid and electrolytes), bowel ischemia, sepsis, acid-base imbalances, hypovolemia/shock, increased peristalsis

Answer 213

Imaging--> CT abdomen and pelvis with contrast, Abd X-ray, endoscopy - Labs--> CBC (elevated H&H r/t fluid and electrolyte changes and fluid shift), Urinalysis (BUN elevates r/t dehydration, creatinine elevates in later stages r/t decreased renal perfusion), CMP for electrolyte monitoring, Lactate level r/t sepsis risk

Answer 214

Non-surgical: digital disimpaction (perforation risk), enema (perforation risk), laxatives (increased fluid imbalance risk), NPO (especially for paralytic ileus), NG tube decompression, cardiac monitoring/ I&O (r/t fluid and electrolyte imbalances), alvimopan (stimulates peristalsis in post-op paralytic ileus) Surgical: type of surgery is dependent upon cause--> Exploratory laparotomy may be indicated when cause is unknown--> more invasive than other surgeries--> extended recovery time and increased risk for complications

Answer 215

pain with defecation, small amounts of frank blood in stool, mucus discharge, sudden perianal pain, perianal mass (s/s depend on if the hemorrhoids are internal or external (prolapsed or not)

Answer 216

high fiber diet, sitz bath (comfort) steroid cream (can be bought OTC), rubber band ligation/hemorrhoidectomy (if conservative measures are unsuccessful

Answer 217

esophageal hug surgery" --> for hiatal hernia Pre: NPO, informed consent, general anesthesia, Intra: laparoscopic or open Post: nasogastric decompression--> do not touch unless ordered

Answer 218

Pre: NPO, general anesthesia, informed consent, oral care--> very important b/c poor oral care increases post-op infection risk Post: monitor EKG as post-op A fib is more likely with this procedure, monitor ABCs--> increased risk for respiratory complications especially r/t fluid overload, assess for anastomosis leak--> infection S/S (presence of anastomosis depends on type of surgery), pt will remain intubated for extended period--> freq oral care, turning, suctioning

Answer 219

Pre: NG tube will typically be placed prior and left in place post-surgery, educate on possible complications--> especially dumping syndrome--> other complications include malabsorption (may require nutrient supplementation Post: keep HOB elevated, monitor for manifestations of dumping syndrome and hypoglycemia related to dumping syndrome (pancreas "slams" body with insulin as food rapidly enters the small intestine)

Answer 220

Pre: informed consent, men may require catheterization post-op due to swelling Post: can be outpatient surgery--> quicker recovery time, use of truss pad post hernia reduction (truss can be removed at night)

Answer 221

colon resection (removal of a portion of the colon) or colectomy and lymphadenectomy (removal of all the colon)

Answer 222

Pre: general anesthesia, NPO, informed consent, education on increased risk of complication and prolonged recovery time Post: surgical management similar for other abdominal surgeries

Answer 223

metabolic alkalosis with obstruction/emesis, and overuse of calcium carbonate

Answer 224

barium enema Pre: NPO, avoid smoking or chewing gum (increases peristalsis), assess for contraindication for bowel prep (increased perforation or obstruction risk, inflammatory disease) Post: Post procedure: ensure barium leaves the system b

Answer 225

Pre: moderate sedation, NPO, avoid red liquids as they can indicate false bleeding to the physician, bowel prep day before (risk for fluid and electrolyte imbalance especially with older adults) Intra: pt positioned left side with knees to chest Post: monitor for rectal bleeding, monitor for s/s of perforation, encourage fluid intake, may experience increased flatulence post-procedure

Answer 226

S/S: RLQ pain/ McBurney's point (typically first sign/ #1 cause of acute RLQ pain), N/V, fever, tachycardia, rebound tenderness Complications: Appendix rupture--> peritonitis--> sepsis

Answer 227

Dx: abdominal ultrasound--> then CT for confirmation, CBC may show elevated WBCs Tx: Appendectomy (laparoscopic or open) pre and post op similar to other abdominal surgery with general anesthesia--> may start as laparoscopic but can quickly turn into open ´ Non-surgical: abx and pain management (no heat--> causes vasodilation--> increases swelling--> increases risk of rupture), NPO, IV fluids, semi-fowlers position (pools fluid in lower abdomen)

Answer 228

rigid/board-like abdomen (classic sign), fever, tachycardia, hypotension, increased RR, hypoactive bowel sounds (peristalsis slows/stops), hypovolemia (dehydration and decreased urine output), dyspnea (r/t increased intrabdominal pressure/fluid shift), hiccups (pressure on diaphragm causes diaphragmatic spasm)

Answer 229

Increased H&H r/t hypovolemia, elevated BUN and creatinine, elevate WBCs, blood cultures + for gut bacteria, X-ray can be done to visualize air and fluid

Answer 230

Non-surgical: O2 therapy, sepsis monitoring (vitals, urine output, neuro status), broad-spectrum Abx, fluid replacement, semi-fowlers (decreases diaphragmatic pressure and pulls fluid to lower abdomen) Surgical: dependent upon cause--> exploratory laparotomy if cause unknown

Answer 231

S/S: N/V (typically first), abdominal pain, diarrhea, fever, tachycardia, electrolyte imbalance Complications: fluid and electrolyte imbalance--> especially in children and older adults

Answer 232

S/S, elevated inflammatory markers--> ESR and CRP, elevated WBCs, Hx (where they've eaten, what they've eaten, have they traveled recently), stool sample can be done to determine pathogen, CBC to assess for dehydration

Answer 233

ed- FLUIDS tx-´ oral rehydration therapy, IV fluids, potentially abx depending on the cause (not typically used because it can also destroy good bacteria), practice good hygiene, skin care (avoid using toilet paper--> use absorbent wipes or soap and water)

Answer 234

s/s only in the large intestine (key difference from Crohn's), LLQ pain, bloating, cramping, more severe and frequent diarrhea, tenesmus, weight loss, blood in stool (depending on severity and presence of ulceration), periods of remission and exacerbation Complication: colorectal cancer, bowel obstruction, perforation

Answer 235

Stool consistency/color/frequency/presence of blood, family history, medication use (PPI, antacids, H2 blockers), colonoscopy, decreased albumin (r/t diarrhea), elevated inflammatory markers (WBCs, ESR, CRP), colonoscopy, barium enema

Answer 236

diet--> avoid caffeine, spicy foods, fiber as they worsen s/s, record color/volume/freq/consistency of stool, record weight 1-2 times per week

Answer 237

Non-surgical; anti-inflammatory (aminosalycilates), corticosteroids, antidiarrheals, immunosuppressors Surgical: total colectomy--> generally curative--> may require permanent ostomy

Answer 238

Cobblestone appearance to GI tract (areas of raised tissue (strictures) and areas of indentation (fissures)--> fissures increase risk for fistulas), can be located anywhere along the GI tract, periods of exacerbation and remission, multiple stools a day, may have diarrhea, RLQ pain or other abdominal pain (most often Crohn's occurs in the ileum), steatorrhea (fatty stools r/t decreased fat absorption in the small intestine), nutrient deficiencies (if it's affecting the small intestine)

Answer 239

fistula formation--> perforation risk or fistula formation btwn organs or skin, bowel obstruction, colorectal cancer, osteoporosis (poor calcium and vitamin D absorption)

Answer 240

M2A/pill camera, H&H remains WNL (bleeding is less likely with Crohn's), decreased albumin (r/t diarrhea), decreased folic acid and vitamin B12 (decreased intestinal absorption), WBC/ESR/CRP elevated, MRE (magnetic resonance enterography)

Answer 241

Non-surgical: Same medication regimen as UC Surgical: Fistula repair--> can heal without intervention if small or Tissue removal--> not curative--> unlikely unless very severe

Answer 242

S/S: may be asymptomatic--> unless diverticulitis occurs (LLQ pain--> diverticula are more common in the sigmoid colon, bleeding, N/V, Fever, chills, diarrhea) Complications: perforation or diverticula, peritonitis, bowel obstruction, fluid and electrolyte imbalance

Answer 243

colonoscopy, elevated WBC--> in diverticulitis, CT, Barium enema-> less likely because it increases perforation risk of diverticula

Answer 244

Education: avoid nuts, seeds, corn, and other indigestible foods, increase fiber and fluids Tx: Non-surgical: Diet changes, IV abx/ antiemetics/bowel rest--> for diverticulitis ´ Surgical: resection--> used when they have many episodes of diverticulitis

Answer 245

S/S: absent or decreased bowel sounds r/t diminished peristalsis, diffuse constant pain, abdominal distension, frequent vomiting, obstipation

Answer 246

Tx: intestinal obstruction tx--> alvimopan can stimulate return of peristalsis post-surgery

Answer 247

Pre: education will likely be limited due to pain, general anesthesia Post: Same as other abdominal surgery

Answer 248

Pre: WOCN consult for ostomy education, general anesthesia Intra: may perform an ileostomy/ileoanal pull through--> 2-part surgery that does not result in a permanent ostomy, or an abdominoperineal resection--> removal of entire colon and rectum--> permanent colostomy Post: Stoma monitoring, reinforcing of teaching for ostomy care, do not sit on bottom or use donut pillow (reduces blood flow and delays healing)

Answer 249

Pre: may require ostomy--> education and WOCN consult may be required Post: monitoring for complications--> anastomosis leakage, infection, bleeding, general post-op abdominal care

Answer 250

Consult with wound ostomy care nurse for placement marking and client education Empty when 1/3 to 1/2 full Stoma should be pink and moist Assess surrounding skin for maceration Change the pouch system every 2 weeks Monitor stoma output for consistency and pH--> more liquid and more acidic the higher up it is

Answer 251

RLQ, McBurneys point

Final Exam Flashcards

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