Final Exam 2016 Flashcards
(164 cards)
1
Q
S/s liver disease/failure (RUQ)
A
Jaundice, pruritis(itchy), spider angiomas, red palms, anorexia, N/V, DULL right up quad pain, clay colored stool, fector hepaticus (sweet musty breath), portal HTN (ascites/varices), dark brown frothy urine, decrease u/o, hepatic encephalopathy, asterixis (liver flap), anasarca (fluid in skin), pleural effusion, leukopenia (NOTHING FRESH), K loss, confusion, male breasts, woman face hair, amenorrhea
2
Q
Prevent liver disease
A
Avoid raw shellfish, vent room, protect skin, limit meds, limit ETOH
3
Q
Interventions
A
Lotion, high calorie high carbs LOW PROTEIN, I&O, fluids, neuro: alarms, freq checks, elevate edema, pericentesis for ascites, respiratory: fowlers, arms out, conserve energy, nothing fresh, electrolytes
4
Q
High PT/INR means?
A
Coumadin or liver disease
5
Q
Most specific serum test for liver used to monitor tx
A
ALT
6
Q
Post liver biopsy
A
Bed rest 12 hrs, lay ON SITE (pressure)
7
Q
Portal HTN
A
Comp liver disease Ascites Peripheral edema Splenomegaly Increase venous pressure in portal circulation Varices HTN
8
Q
Ascites main s/s and intervention
A
Abd pain, impaired respiratory, low u/o, low K, bacterial peritonitis
NA restrict
Diuretics
Paracentesis
9
Q
Varices
A
Comp portal HTN (liver disease)
Bleeding/shock for esophageal varices
Gastric
Internal hemorrhoids
Caput medusae (around umbilicus)
10
Q
Esophageal varices bleed tx
A
Caused from portal HTN
contributor: STRAINING, alcohol, coarse food
Stabilize and stop bleed (fluids, blood)
Tx w/ either sclerotherapy (heat), band ligation, balloon tamponade
11
Q
Endoscopy interventions
A
Return of gag reflex, LOC, bleeding
12
Q
Balloon tamponade care
A
For bleeding esophageal varices Patency Position via X-ray Saline lovage/NG suction Semi fowlers NPO Scissors at bedside
13
Q
Shunting
A
Used after bleeding varices episode
Shunts blood out of portal vein
TIPS (non surgical)
COMPLICATION = ammonia build up
14
Q
Hepatic encephalopathy
A
Life threat complication liver disease
Ammonia (normal 15-40)
Neurotoxic
15
Q
Hepatic encephalopathy interventions
A
Limit protein Mental change Asterixis- Liver flap Hyperreflexia Fector hepaticus (musty sweet breath)
TX WITH LACTULOSE (bm to get rid ammonia)
Antibiotics
Electrolytes
Neuro asses Q2hrs
16
Q
Hepatorenal syndrome
A
Life threat complication liver disease
Renal vasoconstrict –> renal fail
Liver transplant
17
Q
Overall care liver disease
A
Rest No etoh, ASA, NSAIDS Manage s/s Prevent complication Diet
18
Q
Liver fail
A
Jaundice Coagulation defects Encephalopathy Portal HTN Cerebral edema Electrolyte disturb Cardio abnormal Renal fail
19
Q
Key w/ hepatitis management
A
Rest and nutrition
20
Q
Hep incubation phase
A
Most infectious
Flu-like (malaise, anorexia, low grade fever, N/V, arthralgia (joint aches))
RUQ pain
one month
21
Q
Acute/icteric phase hep
A
No fever
Jaundice, pruritis, dark tea urine, clay stooo
Anicteric
2-4weeks
22
Q
Convalescent/posticteric phase hep
A
Gradual improvement
Malaise, fatigue
REST
2-4 months
23
Q
Hep nutrition
A
High cal/card low fat/protein
Sm freq meals
24
Q
Hep A
A
Fecal/oral, dirty water, raw shellfish
“Newsmaker”
Acute only
25
Hep A diagnostics
Anti-HAV (antibody to hep A)
Anti-HAV IgM (immunoglobulin=acute hep)
Anti-HAV IgG= (G=gone, past infection, future immunity)
26
Tx hep A
Vaccine prophylaxis
| Immunoglobulin within 2 weeks
27
Hep B
Blood, body fluids, sex, needles ,perinatal
Lives on dry surface 7days
Carrier/infectious lifetime
HIV test
28
Chronic hep b
HBsAg positive 2x
Seen in very young
Interferon and antivirala
29
Hep c
Silent killer
Asymptomatic for yrs
No vaccine
Always infectious perinatal, percutaneous, permucosal
Symptoms usually jaundice/bruising/fatigue
HIV
antibody test
30
Colorectal cancer
Change in bowel pattern
31
Polyps
All abnormal need removed
Adenomatous/neoplastic linked cancer
Risk cancer increase w polyp size increase
Gradual/insidious onset (0 symptoms until advanced)
32
Polyp risk
```
Genetics
IBD
Age > 50
Increased red meat diet
Lynch syndrome (born with hundreds polyps)
```
33
S/S polyps/colorectal cancer
```
Insidious/gradual
Non specific
Problems w/ bleed, obstruction, perforation, fistula
Recent weight loss
Iron deficient anemia
Rectal bleed
Abd tender
Bowel change
Hepatomegaly/ascites
```
34
Descending colon tumor s/s
Bleed and diarrhea
35
Ascending colon tumor
Detected later, presents as bowel obstruction
36
Cancer detect
```
Sigmoidoscopy Q5 years
Or
Colonoscopy Q10 yrs
Age 50+
Yearly feckless occult blood tests
```
37
Colorectal cancer geriatrics
Fatigue
Iron deficient
Minor bowel change/bleed
Tenesmus (feeling to have to poop)
38
colorectal cancer tx
Stage 1 hemicolectomy
Stage 2 resection w/ or w/o chemo
Stage 3 surgery and chemo
Stage 4 palliative
***bowel cleanse and antibiotics prior (ex miralax)
39
Low anterior reception (LAR)
Preserves sphincter function
| Tx colorectal cancer
40
Chemo
Affects all systems
41
Ostomy care
High fiber
| Increase fluids
42
What is celiac
Autoimmune genetic digestive disease
Malabsorption
Inflammation w/ gluten (wheat, barley, rye)
43
Celiac comp
Iron anemia, vit b/d deficient leading osteoporosis
44
Celiac s/s
```
Chronic diarrhea
Steatorrhea (pale frothy floating poop) bc impaired fat absorb
Abd pain, distention, N/V, constipation
Growth fail (lack energy/appetite)
Bruising/anemia
Tetany
Dehydration
Hair thinning
```
45
Adult celiac s/s
```
Iron anemia
Fatigue
Bone/joint pain
Depression
Tingling hands/feet
Seizures/migraines
Canker sores in mouth
Itchy dry skin rash
```
46
Celiac tx
```
Only 100% gluten free + steroids short term
Vitamins
Replace w/ corn & rice
Low fat
Compliance
```
47
Celiac crisis
Dehydration
Profuse watery diarrhea
Emotional disturb
Infection
48
Diverticulosis
Sacs in sigmoid no inflame or symptoms
Vague abd pain, bloating, flatulence, change bowel
Some bleeding
49
Diverticulitis
Inflammation w/ infection
Acute LLQ pain, mass
Infection s/s: fever, leukocytosis
Abscess
Maybe asymptomatic
50
Risk diverticular disease
Age
Low fiber/fluid
Low exercise
Congenital
51
Dx diverticular disease
Colonoscopy or rectal bleed
***Never colonoscopy w/ itis
Do CT scan with contrast ***
52
Tx diverticulitis
NPO, rest, antibiotics, NG tube, IVF
53
Tx diverticulosis
```
High fiber
Low fat/red meat
Exercise/fluids
Weight reduction
Stool soften
No straining
```
54
Acute pancreatitis
```
Life threat
Sudden severe deep piercing radiating Abd pain LUQ or midepigastrum
Decreased bowel sounds
Increase pain AFTER meals
N/V (vomit doesn't help)
Dyspnea, jaundice, cyanosis
S/S hypovolemic shock
Grey turners (flank ecchymosis)/Cullen's sign (peri umbilical ecchymosis)
Hypocalcemia (chvosteks, trousseaus)
```
55
Chronic pancreatitis
LUQ pain
Chronic heavy gnawing feelings not relieved by foods/antacids
Malabsorption: weight loss, jaundice & dark urine, steatorrhea (fatty stool), DM
Frothy urine/stool
56
Acute pancreatitis complications
```
Respiratory: effusion, ARDS (LUNG SOUNDS!!!!)
Cardiac: shock
Hypocalcemia: tetany
Infection
Compartment syndrome
```
57
Pancreatitis interventions
```
Pain
NG auction
NPO (maybe ppn)
Semi fowlers
Antacids, PPI, H2RA
Slowly advance food (high carbs!)
Education (no alcohol, diet)
Pancreatic enzyme meds WITH meals
```
58
Two types of IBD
Chrons and Ulcerative colitis (UC)
Chronic inflammation; exacerbations &a remission
*no cure
59
Diff btwn chrons and UC
Chrons- all layers bowl, anywhere in GI, skip lesions, recurrence
UC- inner layer GI, starts in rectum -> continuous, pseudopolyps, cured w surgery, cancer risk, toxic mega colon more common (perforation)
60
Chrons s/s
Diarrhea
Abd pain
Weight loss (malabsorption)
61
UC s/s
Bloody stool***
Anemia, weight loss, dehydration, diarrhea
Abd pain (lower cramping)
Tenesmus
62
Toxic megacolon
```
Complication UC
SEVERE abd pain
Distention
Fever
Severe bloody diarrhea
```
Tx
NPO, rest, NG tube, IVF, steroids, antibiotics if no cure 24hrs -> colectomy
63
Systemic complication IBD
```
Finger clubbing
Erythema nodosum
Aphthous ulcers
Conjunctivitis
Thromboembolism
Gallstones
Osteoporosis
```
64
IBD dx
Colonoscopy (never w/ exacerbation)
65
Pharm tx IBD
5-ASA (reduce inflam)
Sensitive to sun w/ meds! Know bleeding s/s, orange skin/urine NORMAL
66
IBD diet
High calorie, high vitamin, high protein, low residue (no dairy)
67
Mechanical bowel obstruction
Small intestine
| Surgical, cancer, diverticular disease
68
Non mechanical bowel obstruct
```
Paralytic ileus (post op)
Neuro or vascular
```
69
Bowel Obstruction pathophysiology
Hyper bowel sounds above, absent below
Distention -> third spacing
Can lead to hypovolemic shock
Bowel ischemia -> necrosis -> perf-> septic shock
70
Small bowel obstruction
```
Rapid dehydration
Intermittent pain
Freq projectile vomit (orange, brown)
Greatly increase distention
Borborygmi (loud bowel sounds) above obstruction
Hypovolemia
```
71
Large bowel obstruct
```
Slow dehydration
Persistent cramping pain
Rare/gradual vomit
increase distention
Borborygmi (loud bowel sounds) above obstruction
Hypovolemia
```
72
Obstruction dx
Ct
| Abd X-ray
73
Tx obstruction
```
Must resolve in 24 hrs
NPO
NG tube
IVF
I & O
Pain
```
74
GERD s/s
```
Pyrosis (burning in esophagus)
Dyspepsia (indigestion)
Regurgitate
Hyper salvation
Dysphasia
Odynophagia (pain w swallow)
Globus sensation (lump in throat)
Non cardiac chest pain
```
75
Esophagitis
Common comp GERD
inflammation esophagus
Ulcers -> structures/dysphasia
Tx with sucralfate*** to coat esophagus
76
Barret's esophagus
Lining lower esophagus changes
Precursor cancer
Freq heartburn, gnawing epigastric pain, bleed, perf
Tx: endoscopic ablation therapy
77
GERD teaching
```
Low fat, small freq meals
No caffeine, beer, milk, carbonation
Don't drink/eat before bed
Normal body weight
No tight clothes
Elevate HOB
```
H2RB
Before meal PPI
Antacid
Prokinetic
78
PPI side effect
Osteoporosis
79
IBS s/s
```
Alter bowel pattern
Abd pain/distention
Bloating
Constipation/diarrhea/both
Excessive flatulence
```
* no fluids with meals
80
Cholecystitis
```
Obstruction gallbladder from stones
Emergency
S/s:
Indigestion
Pain RUQ radiate shoulder
Abd rigidity
Fever
Jaundice
Increased labs
```
81
Cholecystitis care
```
NPO
rest
Fluids
NG tube
Dressing
```
82
Cholelithiasis
```
Intolerance fatty food
Severe pain (biliary colic)
Obstructive jaundice
Dark amber urine
Clay stool
```
Tx
Surgery
ERCP
ESWL (shock wave)
83
ERCP
Pt left side
| Gag/cough reflex post procedure
84
Peripheral artery disease
```
Intermit claudication (pain/cramps)
Paresthesia
Pallor when legs up (no blood)
Rubor when legs down (blood pooling)
Rest pain
No periph pulses
```
Dx: ankle brachial index
85
Percutaneous transluminal balloon angioplasty
Balloon tipped cath in stenotic vessel, inflates to compress plaque and stretch vessel --> stent
(PAD tx)
86
Post surgical PAD nsg care
Avoid knee flexed position and prolonged sitting (cuts circulation)
ABI
pulses
87
6 Ps of acute arterial ischemia
```
Pain
Pallor
Pulsessness
Paresthesia
Poikilothermia (coldness)
Paralysis (advanced stage)
```
* caused from clot that cuts off blood supply
88
Care for arterial embolism
SUPINE
89
Venous leg ulcer
```
Near medial malleolus
Edema
Exudate
Superficial IRREGULAR shape
Red/yellow color
Pain worsens when dangling legs
```
90
venous insufficiency
```
Aching/crampy
Present pulses
Stasis dermatitis
Warm
Thick/tough skin
Brown/leathery skin
```
91
Arterial ulcer
```
In feet areas
Very painful or no pain
Deep CIRCULAR shape
Ulcer pale black
No edema or drainage
```
92
PQRST assessment for angina
```
Pain
Quality
Radiating
Severity
Timing
```
93
Acute coronary syndrome
Is an MI just different types (stemi/nonstemi)
94
Most cardiac specific biomarker
Troponin
95
Tx ACS
Acute coronary syndrome (MI)
Oxygen, ASA, NTG, Morphine
"M-A-N-O"
PCI within 90 min
96
#1 complication MI
Dysrhythmias
97
Post PCI care
SUPINE, leg straight, insertion site, pressure when sheath removed, distal extremity
98
PDA
Patent ductus arteriosus
Widening pulse pressure
Bounding pulse
Acyanotic
99
Aortic stenosis
Limit activity
| Acyanotic
100
Tetralogy of fallot
Pulmonary stenosis
Right ventricular hypertrophy
Ventrical septal defect
Overriding of aorta
Dx: cyanosis, Tet spells
101
Tet spells
With activity that increases O2 demand
| Tachypnea, tachycardia, irritable, crying, cyanosis, KNEE TO CHEST POSITION to compensate (calm the child down)
102
Normal CO, MAP, and EF
CO: 5-7
MAP > 60
EF > 60
103
Normal K
3.5-5
104
Normal pH
Normal CO2
Normal bicarbonate
PH 7.35-7.45
CO2 35-45
Bicarbonate 22-26
105
Left HF
PND
| Pulmonary
106
2 ACE inhibitor examples
Captopril
Lisinopril
HF !!!!!
107
BB example
Metoprolol
108
Digoxin and digoxin toxicity
Increase force contraction and slows conduction in HF
toxicity: nausea, blurred vision, halos, dysrhythmias
109
HF symptom recognition teaching
FACES:
```
Fatigue
Activity limitation
Cough
Edema
SOB
```
110
Reasons why went into HF exacerbation (acronym)
A3 I3 E
Arrhythmia
Angina
Anemia
Indiscretion of meds
Infarction
Infection
Endocrine
111
Another name for ADHF
Pulmonary edema
112
Early sx ADHF
Tachypnea
| Decrease O2 sat
113
"Donkey and cart up hill" interventions (3) for ADHF
Can either unload cart to get uphill (diuretics)
Have donkey go around hill (vasodilators)
Push donkey to go uphill (inotropes)
114
Takotsubo
Stress related syndrome in women that mimics cardiomyopathy until cath
115
Weird teaching about mouth to prevent IE
Prevent gum infections/tooth decay
| Prophylactic antibiotics for dental cleanings
116
IE s/s
```
Flu
Murmur
HF
Splinter hemorrhages
Petechiae
Olsers nodes
Janeways lesion
```
117
PTBV
Percutaneous transluminal balloon valvuloplasty
Cath lab
Balloon prevents stenosis in valve
Extremity CMS, pressure dressing
118
INR range onnnnnn Coumadin
2.5-3.5
| Takes longer to work
119
Immediate post op for heart replacement
Lethal arrhythmias and rejection
120
Cor pulmonale
From copd (pulmonary artery HTN) -> increase work of R side heart -> right sided HF
121
S/s COPD
Weight loss
Chronic cough
Dyspnea
Sputum
122
Bacterial pneumonia sputum color
Purulent
123
HAP
More virulent pneumonia
| Onset 48hrs or longer after admission
124
IHI ventilator bundle
```
Sedation vacation
Chlorhexidine rinse
Elevate HOB
Ulcer prophylaxis
DVT prophylactic
```
125
S/s lung cancer
```
Silent
Persist cough
Sputum volume/blood
Pneumonitis sx
Chest shoulder back pain
Dyspnea wheezing strider
```
```
Systemic (late)
Bone/joint pain
Weight loss
Anorexia
Fatigue
N/V
Hoarseness
```
126
2 main issues w/ end stage lung cancer
Dyspnea (air hunger)
| Pain
127
TB manifestations
DRY cough -> productive
Fatigue, weight loss, night sweats, fever (flu like)
Dyspnea
Hemoptysis (cough blood)
128
Tuberculin skin test
Screening if infected
| PPD objected read 48-72 hrs
129
Positive TB skin test
Redness NOT positive, hardness (induration) is
If it's over 15 induration = low risk
5 = immunosuppressed, recent exposure
10 = immigrant, high risk setting, IV drug users
Doesn't mean disease present (exposed or vaccinated)
Should have CXR***
130
Dx TB
Sputum culture (8 weeks) (and H&P and CXR)
131
Positive TB sputum smear infection time
2 weeks
| Avoid public
132
TB meds
```
Rifampin
INH (causes hepatitis--> avoid alcohol)
```
133
Main reason for TB tx fail and how to solve
Non-adherence
| DOT (direct observed therapy)- watch them swallow meds
134
ARDS
Severe dyspnea/hypoxemia UNRESPONSIVE to O2
| Infiltrates on CXR
135
ARDS tx
```
O2 + PEEP (positive end expiratory pressure to open alveoli)
Manage underlying cause
Lateral rotation therapy
PRONE position (tummy)
Nutrition
```
136
Acute respiratory failure
50/50
o2 50
CO2 50
137
When is trach tube consider for pt on vent
If on vent longer than 10-14 days (damage)
138
Flail chest
Floating seg ribs from fractures
| Paradoxical chest movement
139
Croup s/s
Harsh barking cough
Hoarseness
Inspiratory strider
LTB most common type
(Epiglottitis = emergency!)
140
Epiglottitis
```
Type of croup: EMERGENT!
strider at rest
Cyanosis
Severe agitation
Retractions
CANT DRINK FLUIDS
```
141
Croup (LTB) management
```
Patent airway (home care usually)
Moist air
Room temp oral fluids
Cool mist
Steroids
```
142
Cardinal signs of Epiglottitis (4 D)
Drooling
Dysphasia
Dysphonia
Distressed inspiration
(Never examine epiglottis until intubation equipment available- NPO)
143
Bronchiolitis
Commonly from RSV
Most common ped. Respiratory infection
No cough but trouble breathing s/s
CONTACT/droplet precautions
144
Cystic fibrosis
Inherited
Mucus in bronchioles, intestine, pancreatic/bile ducts)
Increase Cl and Na in sweat !
No cure
145
S/s cystic fibrosis
```
Poor growth
Bulky greasy stool or STEATORRHEA (difficulty absorbing)
Freq colds/cough
Thick sticky secretions
Cor pulmonale
Diabetes
```
146
Cystic fibrosis tx
Airway clearance therapy
| Mucolytics
147
Pancreatic enzyme capsule
WITH meals to breakdown high fat foods in CF
148
Adrenal cortex
Cortisol (metabolism and stress)
| Aldosterone (k/na for bp regulation)
149
Addisons
```
Adrenal cortex insufficiency
Hyper pigment
Low Na, low glucose
High K
Muscle weakness
Neuro
```
Steroids (increase in times of stress)
*** increase Na intake ***
150
Cushings
```
Excessive ACTH (from pituitary to adrenal cortex->cortisol)
From long term steroids; can be hypothalamus, pituitary, or adrenal
```
```
High Na, high glucose
Low K
Moon face
Muscle atrophy(low K)
HTN
buffalo humo
Facial hair
Na and water retention
Thin fragile skin, acne
Fat tummy
Facial hair
```
Taped down steroids
151
Primary hyper aldosteronism
```
Excess aldosterone (adrenal cortex)
Tumor
HTN
Low k
Low Ca (tetany, paresthesia, weakness, cramps, dysrhythmias)
High Na (sodium retention, K excretion)
```
K sparing diuretic
Na restrict, K supplements
152
Adrenal medulla
Epi/norepi
| Vasoconstrict; "fight or flight"
153
Pheochromocytoma
```
Adrenal medulla tumor
EXCESSIVE catecholemines (epi/norepi)
Pounding headache
Tachycardia
HTN
Diaphoresis
Flushing
Hyperglycemia
Tremor
Anxious
```
Give antiHTN
Don't palp abd
154
Anterior pituitary
ACTH, TSH, GH
155
Acromegaly
```
Excess GH
Sweat
Mood disorders
Enlarged hands/feet
Deep voice
Thick facial features
Hyperglycemia
Thick leathery skin
Large lips
```
156
Pituitary tumor
Gland bear face/eyes
Headache
Visual disturb
Hypo or hyper secretion s/s
Tx transphenoidal hypophysectomy
157
Transphenoidal hypophysectomy
Removal of pituitary (secretes ADH so at risk for DI) need lifelong hormones
Neuro assess
CSF drainage
Nasal packing
HOB up
Avoid straining *** (sneeze, lift, blow nose)
158
Posterior pituitary
ADH (water balance)and vasopressin
| Low osmolality=more dilute
159
SIADH
```
Excess ADH
increase H2O absorb, dilute Na (low osmality)
Water retention low Na
Weight gain
Muscle weakness
Lethargy
Low u/o
Headache
Confusion
THIRST
```
Tx fluid restrict (<1000), diuretics, IV hypertonic
160
DI
```
Deficient ADH
LARGE amounts dilute urine, increasing serum osmolality, hypernatremia
Low sp gravity (<1)
Polydipsia
Polyuria
U/o > 20L
Weakness
Dehydration
```
Tx fluid replace, vasopressin
161
Dignostic for thyroid disease
TSH
high= hypoactive thyroid
Low= hyperactive
162
Thyroid hormone needs what
Iodine (in salt)
163
Goiter
Enlarged thyroid gland
| Swallowing/airway problems
164
Hashimoto's thyroiditis
Autoimmune
High TSH
hypothyroid
