MEDSURG 2 EXAM #3 Flashcards

Question

8. Describe the etiology, complications, and interprofessional and nursing management of nausea and vomiting.

Answer 1

Onset: teens to mid-30s. >60YO Abdominal pain = common, severe constant Diarrhea = common Fever = during acute attacks Malabsorption/nutritional deficiencies = minimal Rectal bleeding = common Tenesmus [gotta go, gotta poooo!] = common Weight loss = rare Location/distribution: usually starts in RECTUM and spreads in continuous pattern UP the colon; continuous areas of inflammation Cobblestoning of mucosa? NOPE, rare Depth of involvement = just mucosa Peudopolyps = common, minimal small bowel movements *Increased risk of C.diff* Perinatal abscess/fistulas = rare Strictures = occasional Toxic mega colon = more common = common perforations

Answer 2

Onset: teens to mid-30s. >60yo *Abd pain/diarrhea/fever: common w/ cramping; common* Malabsorption: common Rectal bleeding + tenesmus: sometimes/rare Weight loss = common, may be severe Location = occurs anywhere along the GI tract; most common site = distal ileum **Cobblestoning of mucosa = common** Pseudopolyps = rare Small bowel involvement = common *Increased risk of C.diff* Perforation = common (b/c inflammation involves entire bowel wall) Abscess/fistulas/strictures = common

Answer 3

— Inguinal = most common — Femoral — Umbilical — Ventral — Incisional

Answer 4

Celiac disease — AID that causes damage to small intesting Lactase deficiency — condition in which the lactase enzyme is deficient or absent Short gut syndrome — small intestestine doesn’t have enough S.A. to absorb nutrients, —> unable to meet E, F/E, nutritional needs to stay healthy on a normal diet | Tx: complex carbs (e.g. starch, white/brown rice, bread), high protein, moderate fat

Answer 5

**Cholecystitis:** inflammation of gallbladder r/t gallstones __________ **Cholethiasis:** — BMI must be WNL — Must have small, cholesterol-based stones

Answer 6

**start from RLQ in zig-zag; end at LLQ** Inspection Auscultate Percuss Palpate

Answer 7

-- Check stool to make sure they passed it -- Bowel prep to ensure intestines are cleared out — Consent!

Answer 8

Flush the tube with 30 mL of water - tell patient what you are doing - gather and dispose of all waste in the proper receptacle - lower the head of the bed to no less than 30 degrees -document the feeding, dose, solution, volume, time, and your initials - be sure to document the patients response including any adverse reactions

Answer 9

Vomiting Diarrhea Constipation Dehydration — More calorically dense, less water formula contained — Check for high protein content

Answer 10

**0.8 to 1g/kg of body weight** Example: Patient weighs 70kg x 0.8 = 56g protein DAILY

Answer 11

Liver disease patients (cannot process protein well)

Answer 12

J-tube, because it is at the furthers distance -- Located in the small intestine -- Formula: pre-digested food b/c bypassing stomach (acid contents)

Answer 13

--GERD --Esophagitis --Hemorrhage from erosion (= emergency) --S

Answer 14

**Rebound pain (pain after you release pressure)** Abdominal compartment syndrome Acute pancreatitis Appendicitis Bowel obstruction Cholecystitis Diverticulitis Gastroenteritis Pelvic inflammatory disease Perforated gastric or duodenal ulcer Peritonitis Ruptured abdominal aneurysm Internal bleeding/trauma Obstruction

Answer 15

— Infection of peritoneal area — Cause = infection r/t leaky gut; abdomen feels rigid/board-like

Answer 16

— Determined if incarcerated or not? If so —> OR b/c blood flow is not getting to intestinal wall…PROBLEM

Answer 17

Temporary colostomy and resting other part of bowels. Transverse (named b/c uses the part of the colon that goes across) or Double-loop

Answer 18

— NPO — “When was the last time you flushed the IV?”

Answer 19

— Should be considered infectious until proven otherwise

Answer 20

— Decreases secretions and has weak antibacterial activity — Purpose: prevent traveler’s diarrhea

Answer 21

— Bulk-forming agent that absorbs excess fluid from diarrhea to form a gel — Purpose: when intestinal mucosa cannot absorb fluid

Answer 22

— Opioid and anticholinergic — Purpose: decreases peristalsis and intestinal motility

Answer 23

Inhibits peristalsis, delays transit, increases absorption of fluid from stools

Answer 24

Suppresses serotonin secretion, stimulates fluid absorption from GI tract, decreases intestinal motility

Answer 25

— Opioid — Purpose: decreases peristalsis and intestinal motility

Answer 26

Involuntary passage of stool Tx: bowel training program

Answer 27

Decrease in the frequency of BM from what is a patient’s “normal” — Teach patient importance of dietary + activity measures to prevent

Answer 28

- Cessation and return of normal BM - Normal fluid and electrolyte and acid-base balance - Normalize nutritional status - Prevent skin breakdown

Answer 29

— Life-threatening dehydration if severe enough — Electrolyte problems (e.g. HYPOkalemia)

Answer 30

— Fever (no-to-low grade) — N/V — Frequent bloody diarrhea w/ small volume *Examples: Shigella, Salmonella, C.difficile*

Answer 31

— Preventing transmission, replacing F/E, and protecting the skin — Depends on the cause to determine Tx — Acute = self-limiting

Answer 32

— Appendicitis = inflammation of appendix — Peritonitis = hole/infection in the bowel, penetrating the peritoneal — Diverticulitis = cramping/bloating, tenderness — Gastroenteritis = inflammation of stomach + intestines, usually from bacterial toxins/viral infections; N/V/D, cramps, low-grade temp

Answer 33

— _Ileostomy:_ >1000mL/day, bile-colored, liquid — _Transverse colostomy:_ small semi-liquid w/ some mucus 2-3 days post surgery (with some blood) — _Sigmoid colostomy:_

Answer 34

Fish, eggs, asparagus, garlic, beans, dark leafy veggies Tx: buttermilk, cranberry juice, parsley, yogurt DECREASES odor

Answer 35

— Consistency: liquid-semiliquid — Fluid requirement: increased — Bowel regulation: NOPE — Pouch + skin barriers: YES — Indications for surgery: UC, Crohn’s, or injured colon, familial polyposis, trauma, cancer

Answer 36

— Dark leafy greens, beer, carbonated beverages, dairy products, and corn — Chewing gum, skipping meals, smoking Tx: yogurt, crackers, toast DECREASE gas

Answer 37

— Stool consistency: semi-liquid — Fluid req.: INCREASED — Bowel regulation: NO — Pouch + skin barriers: YES — Indications for surgery: Perforating diverticulum in lower colon, trauma, recto signal fistula, inoperable t muros of colon/rectum/pelvis

Answer 38

— Avoid high-fiber foods for the first 2 months postoperative — Chew food well — Increase fluid intake — Evaluate for evidence of blockage when slowing adding high-fiber foods to diet

Answer 39

— Stool consistency: semi-liquid to semi-formed — Fluid req.: perhaps increased — Bowel regulation: NO — Pouch + skin barriers: YES — Indications for surgery: same for ascending

Answer 40

Viable/healthy: — pink/red, beefy-looking, and moist May indicate anemia: — pale Inadequate blood supply to stoma/bowel — blanching, dark red-purple

Answer 41

— Stool consistency: formed — Fluid req: NO ∆ — Bowel regulation: YES, if there is a hx of a regular bowel pattern — Pouch + skin barriers: dependent on regulation — Indications for surgery: cancer of rectum/rectosigmoid area; perforating diverticula, trauma

Answer 42

— Expected color: pale pink or blueish purple, ry — Unexpected color = If stoma is BLACK/PURPLE = serious impairment of blood flow and requires immediate attention

Answer 43

Small amount = NORMAL — when small amount is oozing form stoma mucosa when touched b/c of high vascular it’s Moderate/large amount = NOT GOOD — lower GI bleed, coagulation factor deficiency, stomal varices 2nd army to portal HTN

Answer 44

— Erosion of GI mucosa resulting from digestive action of HCl acid and pepsin — Develops only in the presence of an acid environment

Answer 45

Acute — superficial erosion — minimal inflammation; resolves quickly when cause is ID’d and removed _________________ Chronic — muscular wall erosion w/ formation of fibrous tissue — continuous for many months/intermittently throughout life; more common

Answer 46

— Assess wound, record bleeding, XS drainage, unusual odor — Monitor for edema erythema, drainage around suture line — Fever, HIGH WBC count

Answer 47

Fecal-oral: Hep A, Hep E Blood: Hep B, Hep C, Hep D

Answer 48

— board-like abdomen — severe abdominal/back pain that radiates to R shoulder IF HEMORRHAGING: vomiting of blood + shock (^HR/RR, decr BP)

Answer 49

*Inflammation of the liver* Causes: — Viral (most common) — Drugs (alcohol) — Chemicals — Autoimmune diseases — Metabolic abnormalities

Answer 50

Elevated: ALT, AST, ALP (can also be WNL), total bilirubin, Hepatits A virus antibodies (anti-HAV)

Answer 51

— Not chronic & incidence decreased w/ vaccination — RNA virus transmitted via fecal-oral (e.g. contaminated food/water — Vaccinate children @ 1yo *NOTE: the greatest risk of transmission occurs before clinical S/Sx are apparent*

Answer 52

Elevated: ALT, AST, ALP (also can be WNL), total bilirubin, HBsAG

Answer 53

— Transmission: percutaneous, parenteral (concurrent w/ HBV); sexual, shared needles, blood, birth canal — Dx: liver biopsy (intensity and degree of liver damage) — S/Sx: N/V, fever, fatigue, RUQ pain, dark urine/clay stools, joint pain, jaundice — Labs: Elevated AST, ALT, bilirubin, HBV PCR DNA, HBsAg — Tx: Tenofovir, adenovirus dip I odio, interferon alfa-2b, peginterferon alfa-2a, lamivudine, entecavir, & telbivudine (for chronic infxn) — Vaccine?: YES — Prevention: Engerix-b

Answer 54

Men who have sex with men Household contact of chronically infected Patients undergoing hemodialysis Health care and public safety workers Transplant recipients HBsAg in the serum for 6 months or longer after infection indicates chronic HBV infection. **NOTE: HBV can live on a dry surface for at least 7 days. HBV is much more infectious than HIV.

Answer 55

Alanine aminotransferase (ALT) = 4-36u/L Aspartate aminotransferase (AST) = 0-35u/L Alkaline phophatase (ALP) = 30-120u/L Total bilirubin level = 0.3-1.0mg/dL Presence of antibodies for Hepatitis infection Enzyme immunoassay (EIA) HCV RNA polymerase chain reaction (PCR)

Answer 56

Elevated = ALT, AST, ALP (or WNL), total bilirubin, anti-HCV, EIA, PCR

Answer 57

Acute: asymptomatic Chronic: liver damage RNA virus transmitted percutaneously IV drug use High-risk sexual behaviors Occupational exposure Dialysis Perinatal exposure Blood transfusions before 1992 NOTE: majority of patients are unaware of their infection and usually develop chronic infection.

Answer 58

Presence of: identification of intrahepatic delta antigen, anti-HDV, co-infected with HBV

Answer 59

*also called delta virus* Transmission: percutaneous, parenteral (concurrent w/ HBV); sexual, shared needles, blood, birth canal Dx: HBV PCR DNA, HBsAG S/Sx: anorexia, N/V, fever, RUQ pain, dark urine/light stool, joint pain, jaundice (icteric) Lab results: elevated ALT, AST, bilirubin, Tx: NONE Vaccine?: NONE, but vaccination against HBV reduces risk of HDV co-infection Prevention:

Answer 60

Presence of: anti-HEV

Answer 61

*primarily in developing countries (Inda, Asia, Mexico, Africa)* Transmission: fecal-oral, H20-borne Labs: elevated ALT, AST, bilirubin, S/Sx: flu-like (2wk-2mos) Tx: Prevention?: HH, lifestyle, BLEACH

Answer 62

Hydrocodone w/ acetaminophen because can acetaminophen can impair liver function.

Answer 63

**Aspirin** to the kidneys and cause elevated aminotransferase levels **Acetaminophen** to liver

Answer 64

Acute infection — Liver damage: lysis of infected cells — Cholestasis — Liver cells can regenerate in normal form after resolution of infection Chronic infection — Can cause fibrosis and progress to cirrhosis

Answer 65

Active: Rash, Angioedema, Arthritis, Fever, Malaise, Cryoglobulinemia, Glomerulonephritis, Vasculitis Intermittent/On-going: Malaise, fatigue, myalgias/arthralgias, hepatomegaly

Answer 66

Malaise, anorexia, weight loss, fatigue, N/V, abd discomfort, distantes for cigarettes, ↓ Sense of smell, H/A, low-grade fever, arthralgias, skin rashes

Answer 67

— Incubation period — Acute S/Sx: elevated ALT, jaudice (icteric) — Convalescence: begins as jaundice is disappearing, lasts weeks-months — Recovery: homologous immunity to HAV or HBV, but can become reinfected w/ other types and different strains (HCV)

Answer 68

Cirrhosis: extensive scarring of the liver caused by necrotic injury or a chronic Tx to inflammation over a prolonged period of time Types: — Postnecrotic: viral hepatitis/mixed medications or toxins — Laennec’s: chronic EtOH d/o — Biliary: caused by chronic biliary obstruction/Autoimmune disease

Answer 69

_Chronic hepatitis:_ — ongoing inflammation of liver — results from HBV, HCV, or HDV — increases risk for liver cancer ___________ _Fulminant hepatitis:_ — XS severe + fatal form of viral hepatitis — Patient goes from viral hep w/in hrs —> severe liver failure — No meds, simply supportive care _______ — Cirrhosis of the liver — Liver cancer/failure — Hepatic encephalopathy: NH3 elevated causing neurological S/Sx (stupor, asterixis [hand-flapping], fetor hepaticus [fruity musty breath], seizures, and coma)

Answer 70

— Portal HTN: increased portal venous pressure, s pleno metals, large collateral veins, ASCITES, gastric (upper)/esophageal varices (very fragile) — Coagulation defects — Jaundice — Portal-systemic encephalopathy (PSE) w/ hepatic coma (inability to detoxify protein byproducts = elevated NH3

Answer 71

EtOH, chronic HBV, HCV, or HCD, AID (hepatic), Steatohepatitis (causing chronic inflammation), biliary cirrhosis, — — Cardiac cirrhosis —> RHF inducing necrosis/fibrosis d/t lack of blood flow

Answer 72

(1) — (2) — (3) (4)

Answer 73

MEN: gynecomastia (benign growth of the glandular tissue of the male breast), loss of axillary and pubic hair, testicular atrophy, and impotence with loss of libido may occur because of increased estrogen levels. WOMEN: Young = amenorrhea Older = vaginal bleeding. NOTE: liver fails to metabolize aldosterone adequately —> hyperaldosteronism w/ Na+/H2O retention & K+ loss

Answer 74

Fatigue, weight loss, abdominal pain/distention, pruritis, confusion

Answer 75

LDH ALT/AST: elevated —> WNL b/c Elevated (initially): LDH, ALT, AST (d/t hepatic inflammation) THEN ALT/AST —> normal (b/c liver unable to create inflammatory response) ALP — elevated b/c of intrahepatic biliary obstruction NH3 =

Answer 76

EARLY: fatigue (many unaware of liver condition) Vs. LATE: jaundice, peripheral edema, ascites, skin, hematologic , endocrine, and neurologic disorders — Advanced —> liver becomes small and nodular

Answer 77

1. Clotting factors 2. Thrombin 3. Bruising, bleeding gums, PETECHIAE on skin, spider angiomas (telangiectasia/spider nevi), heavy menstrual periods, palmar erythema (red area that blanches w/ pressure) on palms of hands

Answer 78

— ultrasound — abdominal x-ray/CT scan — MRI — liver biopsy — esophagagogastroduodenoscopy — endoscopic retrograde cholangiopancreatography

Answer 79

— RR status — Skin integrity — Fluid balance — VS + pain level — Neurological status: r/t hepatic encephalopathy —> Lactulose — Nutritional status: HIGH carb & protein, moderate fat, and LOW Na+ diet — GI status

Answer 80

— Paracentesis — Endoscopic varicela ligation/endoscopic sclerotherapy — Transjugular intrahepatic portosystemic shunt — Surgical bypass shunting procedures = LAST RESORT for portal HTN/esophageal varices — Liver transplantation

Answer 81

— Renal failure w/ azotemia (^Nitrogen levels) — Suddenly decrease in urinary flow (<500mL/24hr) — ^BUN/Cr — Intractable ascites — Spontaneous bacterial peritonitis ››› IV Cefotaxime

Answer 82

ELEVATED: AST, ALT, LDH, ALK, GGT, bilirubin, PT/INR DECREASED: platelets, albumin

Answer 83

GOAL: slow progress of cirrhosis, prevent, tx any complications — Rest — B-complex vitamins (d/t insufficiency) — AVOID EtOH, ASA, acetaminophen, NSAIDs

Answer 84

— Na+ restriction + fluid removal — Albumin — Diuretics (Spironolactone WITH Furosemide (Lasix)) — Tolvaptan (Samsca): correct HYPONa+ by ^ H20 excretion — Paracentesis — Transjugular intrahepatic portosystemic shunt (TIPS): if doesn’t respond well to Diuretics

Answer 85

GOAL: Prevent bleeding/hemorrhage — Avoid alcohol, aspirin, and irritating foods — Screen for presence with endoscopy — Nonselective β-blocker (Decrease high portal pressure)

Answer 86

B, C, E RATIONALE: A & D is present for liver dysƒ(x),

Answer 87

Opioid analgesics, sedatives, & NSAIDs (acetaminophen) are metabolized in the liver and should be AVOIDED for anyone w/ a viral hepatitis

Answer 88

Amylase RATIONALE: Pancreatitis is the most common diagnosis for marked elevations in serum amylase. Serum amylase begins to increase about 3 to 6 hr following the onset of acute pancreatitis. The amylase level peaks in 20 to 30 hr and returns to the expected reference range within 2 to 3 days. — Lipase stays elevated for up to 14days — Aldolase = inflammation of muscles = myositis — LDH = anemia, leukemia, or liver damage

Answer 89

B. To detect an ulceration in the stomach RATIONALE: EGDs visualize the esophagus, stomach, and duodenum w/ light to ID a tumor, ulcer, or obstruction A. ID polyps = sigmoidoscopy/barium enema in lower GI C. ERCP is performed D. Free air = gas = fluoroscopy/x-ray

Answer 90

-Rectal bleeding is most common -Alternating constipation and diarrhea -Change in stool caliber -Narrow, ribbon-like -Sensation of incomplete evacuation -Obstruction

Answer 91

— Insidious onset — Symptoms often appear in advanced stages — Change in bowel habits — Unexplained weight loss — Vague abdominal pain — Weakness and fatigue — Iron-deficiency anemia and occult bleeding

Answer 92

ROUTE: IV — Chronic/severe D/V — Complicated surgery/trauma — Gi obstruction — Intractable diarrhea — Severe anorexia nerviosa/malabsorption — Short bowel/gut syndrome — GI tract anomalies + fistulae — No more than 170 calories/L for Dextrose in H2O or dextrose in LRs

Answer 93

CARBS — PROTEIN — 45-65g daily

Answer 94

Vital signs every 4 to 8 hours Daily weights Blood glucose Check initially every 4 to 6 hours Electrolytes BUN CBC

Answer 95

Local: erythema, tenderness, exudate at catheter site Systemic: fever, chills, N/V, malaise

Answer 96

— Continuous infusion by pump — Intermittent by gravity — Intermittent bolus by syringe — Cyclic feedings by infusion pump

Answer 97

Nasogastric = NG-tube Esophagostomy = E-tube Nasoduodenal/nasojejunal = NJ-tube = nose —> small bowels for children *Gastrostomy = G-tube *Jejunostomy = J-tube Percutaneous endoscopic gastrostomy = PEG-tube *= used extended periods

Answer 98

*most commonly used for ST feeding problems* — Inserted through the nasal cavity Radiopaque: Allowing visualization from x-ray ↓ likelihood of regurgitation and aspiration when placed in intestine

Answer 99

May be used in those needing tube feedings for extended period Patient must have intact, unobstructed GI tract Can be placed surgically, radiologically, or endoscopically *NOTE: Failure to flush the tubing after both drug administration and residual volume determinations can result in tube clogging; small amount of cola can help restore patency*

Answer 100

BMI (kg/m2) = (weight in lbs.) x 703/ (height in inches)^2 Underweight: ≤18.5 WNL: 18.5-24.9kg/m^2 Overweight: 25-29.9 Obesity: 30-34.9 Extremely obesity: ≥40 __________ MEN: ≤40 inches WOMEN: ≤35 inches

Answer 101

— Requires esophageal lumen wide enough for endoscope — Can start feedings when bowel sounds are present (~24hr after placement) DO NOT PLACE DRESSINGS BENEATH BUMPER

Answer 102

*Complete:* eggs, fish, meats, milk + milk products, poultry *Incomplete:* legumes, grain, nuts, seeds

Answer 103

*Major minerals:* Ca, Cl, Mg, P, K, Na, S *Trace elements:* Cr, Cu, F, I Fe, Mn, Mo (Molybdenum) Se, Zn

Answer 104

Cachexia — complicated metabolic syndrome related to underlying illness and characterized by muscle mass loss with or without fat mass loss that is often associated with anorexia; scaphoid appearance Kwashiorkor — seen in children in places w/ limited food resources (e.g. swollen bellies, freq infxns) | Tx: SLOWLY increase calories then protein Marasmus — form of severe malnutrition d/t E deficiency; a child will look emaciated + BW will be ≤60% weight fo r age

Answer 105

C. Seizures RATIONALE: s a life-threatening metabolic complication resulting from hypophosphatemia, hypokalemia, hypomagnesemia which manifests with seizures, weakness, acute confusion, shallow respirations, and increased bleeding tendency. Patients receiving total enteral nutrition are generally at risk for diarrhea, vomiting, and abdominal distention due to overfeeding.

Answer 106

*aka tube feeding* May be ordered for the patient who has a functioning GI tract but is unable to take any or enough oral nourishment. — Stomach — Duodenum — Jejunum

Answer 107

Anorexia Orofacial fractures Head/neck cancer Burns Nutritional deficiencies Neurologic conditions Psychiatric conditions Chemotherapy Radiation therapy

Answer 108

Continuous infusion by pump (for critically ill patients) Intermittent by gravity Intermittent bolus by syringe Cyclic feedings by infusion pump

MEDSURG 2 EXAM #3 Flashcards

Weeks 5, 6, & 7 (173 cards)