Med surg 1 Flashcards
(120 cards)
1
Q
GERD
A
symptom of esophageal damage, no single cause, related to weakened sphincter and back flow of contents
2
Q
Barrett’ Esophagus(metaplasia), Esophagitis, aspiration, dental erosion
A
GERD
3
Q
Antacids
A
increase gastric pH by neutralizing HCL (TUMS, Maalox, Alka-seltzer)
4
Q
H2-receptor blocker
A
block conversion of pepsinogen to pepsin (Pepcid, Zantac)
5
Q
PPI
A
Block secretion of HCL (Prevacid(effective at healing esophagitis), Protonix, Prilosec)
6
Q
Primary cause of hiatus hernia
A
increased intraabdominal pressure and weakened diaphragm muscles
7
Q
2 types of hernias
A
Sliding, peraesophageal
8
Q
PUD risk factors
A
gastritis, H. pylori , NSAID, corticosteroid, lifestyle factors (etoh, coffee, stress, smoking)
9
Q
Types of PUD
A
Acute, chronic, duodenal, gastric
10
Q
Complications of PUD
A
hemmorhage, perforation, gastric outlet obstruction
11
Q
CC for PUD
A
NPO w/NG, pain, IV electrolyte, transfusions, lavage, surgery (billroth I, II) REST, DRUG THERAPY, DIET and FOLLOW UP
12
Q
Dumping syndrome
A
more chyme produced, more fluid being drawn into the bowel, causes bowel distention, nutrients don’t get absorbed
13
Q
IBD
A
autoimmune, chronic inflammation, exacerbation and remission
14
Q
UC
A
rectal bleeding, superficial mucosa, only in colon, around 20’s, fever during exacerbation, weight loss rare,
15
Q
Crohn’s
A
weight loss, malabsorption, full thickness wound, fistulas, common fever, occurs anywhere in GI, fistulas common,
16
Q
Drug therapy for IBD- to induce and maintain remission
A
Anti-inflammatory (corticosteroids), antimicrobial (cipro), immunosuppressant (imuran, MTX), antidiarrheal (lomotil), and biologic therapy (suppress tumor factor, mabs)
17
Q
Total proctocolectomy
A
curative surgery for UC
18
Q
removal of parts of intestines
A
surgery for crohn’s
19
Q
SBS
A
too little small intestine surface area to absorb nutrients, causes lifetime TPN
20
Q
SI obstruction
A
rapid, onset, frequent emesis, cramp like, feces for short time, dehydration, distention
21
Q
LI obstruction
A
gradual onset, low grade cramping, absolute constipation, distention
22
Q
diverticulosis
A
increase in number of diverticuli
23
Q
diverticulitis
A
inflammation of diverticuli
24
Q
Care for diver-problems
A
high fiber, stool softeners, weight reduction
25
Malabsorption syndrome
sbs and dumping
26
Celiac
autoimmune, ingestion of wheat barely and rye, high genetic link
27
Treatment of celiac
elimination of gluten, symptom support
28
Care of surgical client
raise HOB, SFF, early ambulation, F&E management, NG care, clear liquids, wound care, pain management, respiratory toilet
29
Assessment for surgical client
Last BM, bowel sounds, palpation, swelling, asymmetry, pain, I and O, diet, EtOH, meds
30
Functions of the liver
coagulation, detox, form bile, fat CHO and steroid metabolism, protein synthesis, endocrine hormone control, glucose storage
31
4 causes of cirrhosis
alcohol, post-necrotic, cardiac, biliary
32
Alcohol cirrhosis
most common cause, risk for hepatocellular cancer
33
post-necrotic
chemicals, hepatitis, drugs
34
cardiac cirrhosis
ride sided heart failure (portal vein backs up)
35
Biliary
primary-obsturction or inflammation of bile ducts
| Secondary-intraheptaic bile status (bile becomes concert)
36
portal hypertension
increase in pressure of vessels of liver from increased resistance
37
Esophageal varices
from increase pressure in vessels, engorged veins
38
coagulation defects
can't conjugate fats or vit. k for clotting
39
ascites
related to PH, increase in system HTM causing edema
| -protein level in blood decreases and water follows
40
jaundice
increase bilirubin (2.5 or higher) inability to conjugate bilirubin
41
encephalopathy
inability of liver to digest protein causing formation of ammonia
42
liver damage and cirrhosis labs
increase in AST, ALT, increase bilirubin, increase PT time, decrease albumin, increase LDH, increase ammonia, decrease BUN creat., increase Na, decrease K, increase WB, decrease, H and H, increase all, increase IGg
43
Integument exam for cirrhosis
look for jaundice, bruising, edema, petechiae
44
gastro exam for cirrhosis
hernia, decrease bowel sounds, increase liver border, palpable spleen
45
respiratory exam for cirrho.
labored shallow breathing, tripod position, fluid, decrease cough, secretions, orthopnea
46
Neuro for cirrho.
asterixis, clonus,
47
reproductive for cirrho.
decrease testes size, enlarged breast tissue, bearded lady
48
Diet management for cirrho.
0 protein if encephalopathy, if no encel then high calorie high protein low fat, eliminate spicy, acidic foods
49
Meds for cirrho
K sparing diuretic (spiralactone), vassopressin, antihypertensive, PPI, pain management, albumin, lacatalose-pulls fluid into bowel, dose until diarrhea
50
TIPS
redirect portal blood flow
51
Blakemore tube and balloon
push walls to prevent bleeding
52
Parencentesis
reserved for clients with respiratory impatient, tube inserted into abdomen to remove ascites fluid, monitor for dehydration and excess fluid volume loss
53
Nursing interventions for cirrhosis
Skin, assessments, F/E monitoring, comfort management, tube management, meds, special precautions, education and planning
54
Hepatitis A
foodborne
55
Hep B
Blood borne and sex
56
Hep C
blood borne and sex
57
Prodromal phase of hep
first 1-21 days, exposure and vague symptoms, flu-like, fatigue, pain, D/C, dark urine, fever, N/V
58
Icteric (acute phase) of hep
2-4 weeks, jaundice, fever resolves but GI remain, weight loss, parities, clay colored stool
59
convalescent phase of hep
2-4 mos, persistent fatigue, and eventual recovery
60
Gastro Physical assess of hep.
hepatomegaly, tenderness, spleenomegaly
61
Skin asses of hep.
rash, jaundice, iteric sclera, injection sites
62
General assess of hep.
fever, lethargy, lymph nodes
63
Labs for hep.
viral level, antibodies, IGg
64
Nursing interven. for hep
bedrest, diversion activities, meds, comfort, patient education
65
Causes of pancreatitis
alcohol, biliary disease, blocked bile duct
66
Acute pancreatitis
life threatening, sharp stabbing pain in LUQ
67
Chronic pancreatitis
> 6 months, dull nagging flank pain
68
Electrolyte complications with pancreatitis
hyperglycemia (pancreas cannot produce insulin), hypocalcemia (binding of fat to Ca, Tetany)
69
exam of gastro for pancreatitis
LUQ pain, radiate pain to flank and shoulder, rigidity
70
exam of resp. for pancreas.
crackles
71
circulatory exam for pancreas.
hypotension, tachycardia, hemmorage
72
ecchymosis is seen in patients with
pancreatitis
73
Lab values for pancreatitis
increased-glucose, WBC, amylase, lipase
| decreased-Ca
74
Diet for pancreatitis
NPO, increase calories and SFF, gibe amylase and lipase, accu checks for glucose, oral care for NG tube
75
Meds for pancreatitis
narcotic, antibiotic, Ca
76
where does pancreatic cancer usually occur
on head of pancreas
77
Whipple procedure
resection of proximal pancreas and bile duct
78
Cholecystitis
inflammation of gallbladder
79
cholelithiasis
gall stones (made of bile salt, bilirubin, calcium, protein, fat)
80
4 F's associated with gall bladder problems
Fair (caucasian), 40, female, fat
81
Diet for gallbladder
low in fat, high in fiber, SFF, NPO
82
Meds for gallbladder
bilirubin if liver disease, antispasmodic, antiemetic, analgesic
83
What causes diabetes?
increase in insulin resistance
decrease in insulin production
decrease in insulin receptors
84
alpha cells
secrete glucagon in response to decreased glucose
85
beta cells
secrete insulin and amylin in response to increased glucose
86
delta cells
somatostatin to inhibit glucagon and insulin
| Regulate alpha and beta cells
87
Type I diabetes
autoimmune,> 6 mos and
88
Type II diabetes
most prevalent, obesity high fat, race, age, sedentary life, environmental, defective beta cells
89
3 Ps symptoms for diabetes
more likely to have in type 1 but still might have in type 2
polyuria- get rid of sugar and ketones
polydipsia-due to dehydration
polyphagia-increase in eating because glucose is not circulating in good for energy
90
DKA
more likely in type 1, fruity odor, exhibits 3 Ps, metabolic acidosis, Kussmauls, hyperglycemia, dehydration, altered mental status (from dehydration), dry mucous membranes
91
HHNS/HHS
Very high glucose levels usually > 600, 3 Ps, more likely in type 2 because they produce just enough insulin to keep from DKA, common in elderly, predisposed by dehydration
92
Treatment for HHNS and DKA
IV R insulin, .9% NaCl for hydration, cardiac monitoring( arrhythmia from hypokalemia, K follows glucose out of cells)
93
Macrovascular
alteration in blood viscosity(thick blood from fat and triglycerides), more common in TYPE 2
CAD-MI
PVD- decrease circulation
Cerebrovascular disease-stroke
94
Microvascular
alteration in structure of vessels, more common in TYPE 1
Retinopathy- increase viscosity causes detachments
Nephropathy-decrease in circulation to kidneys
Neuropathy-sensory and autonominc
95
3 parts of Management for Diabetes
Diet, Exercise, Medications
96
Diet for Diabetes
avoid complex CHO, protein 15-20%, fat 10%, the rest CHO, high fiber, alternative sweeteners, eating with ETOH
97
Exercise for Diabetes
increase risk for hypoglycemia, monitor glucose, sufficient fluids, proper shoes, warm up and cool down, measure ketones,
98
Meds for Diabetes
Regular insulin, NPH, Lente, 70/30
99
Somogyi Effect
hyperglycemia in the morning caused by high doses of insulin at night leading to rebound hyperglycemia
100
Dawn Phenomenon
GH and cortisol excreted in high amounts in the morning causing hyperglycemia,
101
Endocrine system is composed of:
hypothalamus, A/P pituitary, thyroid and parathyroid, adrenal glands
sometimes pancreas, ovaries and testes, pineal glands
102
All hormones have three things in common
Released continuously, neg. feedback, bind to target cell receptors
103
anterior pituitary gland- GH changes
acromegaly, dwarfism
104
Acromegaly
high GH, enlarged bones, IC pressure, thickened tissues, alteration in protein CHO metabolism, increase risk for diabetes, protruding jaw
105
Dwarfism
low GH, small stature, delayed puberty, may cause Na/K retention
106
posterior pituitary-ADH problems
SIADH, Diabetes insipidus
107
SIADH
Too much fluid, too little Na, confusion, cramps, seizures, fluid retention, hyponatremia
108
SIADH treatment
FLUID RESTRICTION, solution high in Na, diuretic, vassopressin, supplement Na/K,
109
Nursing care for SIADH
monitor I and O, weight, VS (crackles, arrhythmias), hyponatremia, seizure precautions, HOB flat or
110
DI
increased diuresis, F/E imbalances from large urine output, too little fluid, too much Na, hypernatremia
111
DI treatment
HYDRATION, nasal spray for hormone replacement, low Na diet, indocin
112
Nursing care DI
monitor for weight, specific gravity, VS (heart sounds), signs of hypernatremia, skin care, signs of rebound retention
113
Cushing Disease/Syndrome
overproduction of ACTH
Disease (primary)-problem with adrenal
Syndrome (secondary)-problem with pituitary
114
Symptoms of Cushings
moon face, striae, weight gain, HTN, delayed wound healing, gynecomastia, fluid retention, thin skin, osteoporosis
hypernatremia and -glycemia
hypokalemia and -calcemia
115
Addisions disease
too little ACTH
primary-adrenal glands
secondary-decreased ACTH by pituitary
116
Addisons symptoms
weakness, bronze skin (primary only), weight loss, changes in body hair distribution, fatigue
Hypercalcemia and -kalemia
hyponatremia and -glycemia
117
Graves disease
hyperthyroidism, autoimmune, excessive thyroid hormone secretion
118
Diet for Graves
high calorie, high protein/CHO with supplements, avoid spicy high fiber, caffeine and ETOH
119
Hypothyroidism
too little thyroid hormone (TSH), iodine deficiency
primary-destruction of thyroid
secondary-pitrutary(decreased TSH)
120
Myxedema
hypothyroidism
