med surg exam 5 Flashcards
(126 cards)
1
Q
hard, dry, small, or difficult to pass BM or less than 3 BM/week
A
constipation
2
Q
t/f constipation and diarrhea are diseases
A
false, they are symptoms
3
Q
how much fiber should you have a day
A
25-30g
4
Q
more than 3 BM/day of altered consistency
A
diarrhea
5
Q
what are the 3 types of diarrhea
A
acute (1-2 days)
persistent (2-4 weeks)
chronic (over 4 weeks)
6
Q
what 3 main things can cause diarrhea
A
meds, infection, stress hormones
7
Q
maintain skin integrity
increase fluid and decrease bulk intake
avoid alc, dairy, and fatty foods
medications
A
interventions for patients that have diarrhea
8
Q
what electrolyte imbalance can you have from throwing up or diarrhea?
A
hypokalemia
9
Q
recurrent involuntary passage of stool for at least 3 months
A
fecal incontinence
10
Q
what is another name for a fecal management system
A
butt foley
11
Q
what is a mechanical bowel obstruction
A
when something is in the way like a tumor, hernia, or abscess
12
Q
what is a nonmechanical obstruction
A
when the bowel gets paralyzed and nothing goes thru the colon
13
Q
whats another name for nonmechanical obstruction
A
paralytic ileus or adynamic
14
Q
what are the assessment findings for a small bowel obstruction
A
- pain
- visible peristaltic waves upper & middle
- nausea, perfuse vomiting, maybe fecal vomit
- obstipation
- fluid and electrolyte imbalances
- metabolic alkalosis
15
Q
obstipation
A
no stool
16
Q
what are the assessment findings for a large bowel obstruction
A
- intermittent lower abdominal cramping
- lower abdominal distention (they look pregnant)
- minimal or no vomiting
- obstipation or ribbon-like stools
- no major imbalances
17
Q
what anorectal disorder is inflammation of rectal mucosa
A
proctitis
18
Q
what is proctitis caused by and treated with
A
- infection or irritation
- antibiotics and/or antivirals
19
Q
what anorectal disorder is a tear in the anal lining
A
anal fissure
20
Q
how do you treat an anal fissure
A
topical cortisone
21
Q
what anorectal disorder is a retrograde infection caused by obstruction of the anal gland
A
anorectal abscess
22
Q
what anorectal disorder is a tract leading from anal canal to peri-anal skin
A
anal fistula
23
Q
what is an anal fistula typically caused by and what is its treatment
A
- an abscess
- surgery
24
Q
what anorectal disorder is dilated veins in the anal canal
A
hemorrhoids
25
what are hemorrhoids caused by
increased pressure
26
what anorectal disorder is an abscess on the innergluteal cleft
pilonidal sinus or cyst
27
what is pilonidal sinus or cyst caused by and treated with
- trauma or prenatal
- incision and drainage then excision of sac
28
what can you do after each BM to relax the sphincter spasms
sitz bath and clean the area (not with tp)
29
what is the 3rd most common cancer that's responsible for causing death in the US
colorectal cancer
30
what kind of diet puts you at risk for colorectal cancer
low fiber
lots of fast food
high protein
31
what are the 2 symptoms of colorectal cancer
change in bowel or bladder habits
passing blood in stool
32
what screening tests are used for colorectal cancer
fecal occult blood test or double contrast barium enema
colonoscopies
33
what happens in a colon resection surgery
removal of a tumor and regional lymph nodes
34
what surgery is a colon removal
colectomy
35
what surgery creates an opening of the colon through the abdomen
colostomy
36
what diet should a patient with colorectal cancer strive to have
increased fiber, complex carbs, and veggies
broccoli, cabbage, cauliflower, sprouts
37
what are the functions of the liver
glucose metabolism
drug metabolism
protein metabolism
fat metabolism
vitamin & iron storage
bile formation
bilirubin excretion
ammonia conversion
38
what is used to monitor hepatitis, cirrhosis, or treatment that can be toxic to the liver
ALT
39
what indicates damage to any tissue with high metabolic activity such as the heart, liver, or kidney
AST
40
what indicates biliary cholestasis or alcohol abuse
GGT/ GGTP
41
what is lower in cirrhosis, ascites, chronic hepatitis, and poor nutrition
albumin
42
what follows the same as albumin but shows up faster and is a better indicator of ACUTE malnutrition
pre-albumin
43
what is elevated in liver disease and will not respond to vit K in the presence of severe liver damage
prothrombin time (PTT)
44
the level of this rises in liver failure as the liver is responsible for converting it to urea. leads to alteration in mental status and coma
ammonia
45
what 3 things are elevated in biliary obstruction & decreased in parenchymal liver disease
HDL, LDL, and cholesterol
46
what is elevated in liver and biliary tract disease to induce jaundice
bilirubin
47
what looks at clotting time but is dependent upon liver function. therefore this level does not respond to vitamin K if the liver is severely damaged
prothrombin (PT)
48
what is the most common complication with a liver biopsy
peritonitis
49
what is caused by blocking the flow of bile or excessive destruction of red blood cells
jaundice
50
what are the 2 types of jaundice that are associated with liver disease
hepatocellular & obstructive jaundice
51
what is caused by the inability of damaged liver cells to clear normal amounts of bilirubin from the blood
hepatocellular jaundice
52
what is caused by occlusion of the bile duct, an inflammatory process, or an enlarged organ
obstructive jaundice
53
what is caused by increased destruction of red blood cells more than the liver can handle.
often seen in transfusion reactions
hemolytic jaundice
54
what is caused by inherited disorders such as Gilbert syndrome. patients will have light/clay colored stools, puritis, and potentially orange, foamy urine
hereditary hyperbilirubinemia
55
the movement of albumin from the serum to the peritoneal cavity where it attracts more fluid is called what
ascites
56
rapid weight gain
increased abdominal girth
positive ballottement test
positive fluid wave test
^ these are all signs of what
ascites
57
what are the 3 main treatments for ascites
paracentesis
TIPS
peritoneovenous shunt
58
what is the removal of fluid from the peritoneal cavity through a puncture or small surgical incision
paracentesis
59
the treatment for ascites where a stent is placed in the portal vein is called what
transjugular intrahepatic portosystemic shunt (TIPS)
60
what is the diet for every patient with chronic liver disease
supplements of vit A,B, C,K and folic acid
61
a deficiency of what leads to eye and skin changes, night blindness
vitamin A
62
a deficiency of what leads to lesions in skin and mucous membranes
riboflavin
63
a deficiency of what leads to neurologic changes and lesions in skin and mucous membranes
pyridoxine
64
a deficiency of what leads to scurvy (hemorrhagic disease)
vitamin C
65
a deficiency of what leads to low platelets and bleeding
vitamin K
66
a deficiency of what leads to macrocytic anemia
folic acid
67
benign liver tumors typically occur in who
women who take oral contraceptives
68
primary liver tumors are caused by what
chronic liver disease
hepatitis B or C infections
cirrhosis
69
what is cirrhosis
scaring of the liver
70
liver metastases are typically from primary cancer sites in what parts of the body
digestive system
breast
lungs
71
alpha fetoprotein is elevated in what while carcinoembryonic antigen (CEA) is elevated in what
(these help to detect the presence of cancer)
alpha fetoprotein- primary liver cancer
CEA - cancers of GI tract
72
when no other treatment is available, what do you do to treat end stage liver disease
total removal/ liver transplant
73
what is used to determine the allocation of the liver t0 be transplanted
MELD score
74
what are the 3 most common complications for the recipient of the liver transplant to have?
bleeding, infection, and rejection of the organ
75
what is released when the hormone cholecystokinin is released by the intestinal wall & has a high concentration of bilirubin
bile
76
if the flow of bile is blocked, what can build up in the bloodstream?
bilirubin
77
what enzymes are included in the exocrine function of the pancreas
amylase
trypsin
lipase
78
what do the following enzymes digest:
amylase
trypsin
lipase
amylase - carb digestion
trypsin - protein digestion
lipase - fat digestion
79
what biliary diagnostic test rules out other intestinal causes of abdominal pain
an abdominal x-ray
80
what is the biliary diagnostic procedure of choice for detecting gallstones or a dilated bile duct but the pt must have a period of NPO prior to procedure for accurate results
ultrasonography
81
what biliary diagnostic test uses radioactive IV dye to track the flow through the biliary tract
HIDA scan
aka cholescintigraphy
82
what med can be given during a HIDA scan to induce sphincter contraction
morphine
83
what biliary diagnostic test uses a substance that the patient drinks followed by x-rays 12 hours later and gallbladders show up as a shadow
oral cholecystography
84
what biliary diagnostic test uses a fiberoptic scope inserted through the esophagus to the duodenum to evaluate stones
endoscopic retrograde cholangiography (ERCP)
85
what biliary diagnostic test is reserved for those whom ERCP may be unsafe due to a previous surgery
percutaneous transhepatic cholangiography (PTC)
86
t/f: fecal occult blood testing should be avoided if patient has a visibile active hemorrhoidal bleed
true
87
which of the following commonly used methods for clearing a clogged NG tube is actually NOT recommended due to recent research stating it could increase risk for future clots?
a- use of digestive enzymes
b- use of commercial digestive enzymes
c- milking the tube
d- cranberry juice flushes
D
88
t/f: although commonly used in practice, measuring gastric residual volumes has not been validated by research and is no longer recommended by the SCCM nor the American society for parenteral and enteral nutrition
true
89
which body organ serves as the storage depot for bile
gallbladder
90
which of the following is NOT a factor that increases risk for liver cancer
a- male gender
b-taking oral contraceptives
c- previous hepatitis B or C
d- chronic liver disease or cirrhosis
A
91
what lab combinations are used to determine if a patient is protein deficient
albumin and pre-albumin
92
which of the following IV accesses can NOT be used for TPN?
a- left internal jugular triple lumen catheter
b- right subclavian port-a-cath
c- left antecubital INT
d- right upper arm PICC line
c
93
what is the most effective nursing action to prevent respiratory complications during post-procedure care of a patient after an EGD (esophogstroduodenoscopy)?
assess for gag reflex before offering anything to eat or drink
94
glucagon is administered during a routine EGD. the purpose of this medication during the procedure is to:
a- slow gastric motility
b- decrease the patients BS
c- relax the muscles in the GI tract
d- provide sedation
C
95
how often does the tubing need to be changed in a closed gastric feeding system
every 24 hours
96
how does the liver receive blood
via the portal vein & hepatic artery
97
palmar erythema
red hands
98
what is asterixis
inability to maintain posture
99
what is verices
overgrown blood vessels
(this increases the risk for bleeding)
100
what is pruritis
itching from bile salts under the skin
101
what is steatorrhea
dark urine/clay-colored stool
102
what is caused by obstructed blood flow through the liver resulting in increased pressure throughout the portal venous system
portal hypertension
103
what 2 main things can portal hypertension cause
ascites & esophageal varices
104
what is the ballottement test
when you push the stomach and feel the fluid hit your hand that is touching the other side of the stomach
105
what diuretics will the MD order for ascites
1st- aldosterone
2nd - lasix (furosemide)
NOT diamox
106
what is a paracentesis
sticking a needle in the abdomen to drain the fluid
107
what shunt pulls blood from the abdomen back into the blood vessels
peritoneovenous
108
why do pts with ascites need to monitor their mental status
bc they can become confused from toxic metabolites like ammonia building up
109
what is the most significant source of bleeding in cirrhosis
esophageal varices
110
the inability of patients to copy accurately drawings or three-dimensional constructions (all the numbers on a clock only go half way around)
constructional apraxia
111
the breath of a patient that smells like sweet poop
fetor hepaticus
112
what are the types of viral hepatitis & their characteristics
hep A - from food
hep B - from blood & fluids & sex
hep C - from sex and drugs
hep D - continuation of B
hep E - continuation of A
113
what mediation do you give to treat a tylenol OD
acetylcysteine (mucomyst)
114
what are the functions of the gallbladder and exocrine pancreas
gallbladder- store bile
exocrine pancreas - release digestive enzymes
115
what is cholecystitis
inflammation of gallbladder
116
what is cholelithiasis
gallbladder stones
117
what kind of gallstone is the coalescence of multiple small stones
pigment stones
118
what kind of gallstone is composed of calcium bilirubinate and the most common type
cholesterol stones
119
what are the 6 f's for cholelithiasis risk factors
fair - white
fat- obese
female
fertile - had over 1 baby
forty
familial - fam hx
120
what is known for causing progressive destruction of the pancreas during which the normal tissue is replaced by fibrous tissue & the bile and secreting ducts are damaged
chronic pancreatitis
121
t/f: the majority of blood supply to the liver, which is poor in nutrients, comes from the portal vein
f
122
which diuretic medication would most often be used for a patient with ascites
a- actazolamide (diamox)
b- ammonium chloride
c- furosemide (lasix)
d- spironolactone (aldactone)
D
123
what is Candida Albicans
thrush
124
what is the procedure called where you removal of gallbladder
cholecystectomy
125
what is the procedure called where you send shock waves to break up stones so they get naturally passed thru body
lithotripsy
126
what is the procedure called where you drain the fluids from the gallbladder
percutaneous cholecystostomy
