Mistake Flashcards
(80 cards)
1
Q
Withhold medication of Barium Swallow
A
Withhold necrotic and anticholinergic for 24 hrs pretest
2
Q
Withhold medication of Oesophageal acidity test and Oseophageal manometry
A
- Antacid and H2 inhibitors
- Alcohol and corticosteroids
- Anticholinergic, adrenergic
- Cholinergic
3
Q
Side effects monitoring for OGD
A
- Vomiting of blood
- Epigastric pain, dysphagia
- black tarry stool
4
Q
Pre-test care for USG
A
- Fasting, no chewing gum and smoking for 6-8 hours
- Fat-free diet if investigate for gallbladder
- Done before barium studies
5
Q
Pre-test diet for Barium enema
A
- Low-residue diet for 1-2 days prior
- Clear liquid diet for 24hrs pretest
- Fasting for 6-8 hours
6
Q
Contradiction of Barium enema
A
Colon inflammatory disease
7
Q
Contradictions of Colonoscopy
A
- Acute infection
- Colon perforation
8
Q
Post-test care for colonoscopy
A
- Monitor vital signs every 30 mins until alert
- Resume diet when fully alert
- Monitor s/s of hemorrhage and colon perforation
- Educate the patient that fullness and abdominal cramps may present
9
Q
Withhold medication for fecal occult blood
A
NSAID, anticoagulant, aspirin
10
Q
Pre and post care of percutaneous transhepatic cholangiogram
A
Pre-test:
1. Fasting for 12 hours
2. Assess allergic history of iodine, seafood and x-ray dye
3. Administer prophylactic IV antibiotics if prescribed
Pro-test:
1. Monitor for bile leakage and hemorrhage
2. Bed rest for 6 hours
3. Lie on the right side
11
Q
Pre and post test for procedures involve contrast medium
A
Pre-test
1. Adequate hydration
2. Withhold Metformin and monitor blood glucose
3. Assess renal function
Post-test
1. Encourage fluid intake
2. Resume Metformin after 48 hours if RFT normal
12
Q
Pre and post care of endoscopy
A
Pre-test
1. Obtain signed consent
2. Fasting 6-8 hours
3. Establish IV access
4. Collect baseline vital signs
5. Administer atropine if prescribed
6. Withhold NSAID, anticoagulant and aspirin for several days before test
Post-test:
1. Monitor vital signs every 30 mins until stable
2. Encourage fluid intake
3. Resume diet until gag reflex resume
4. Monitor s/s of allergy
13
Q
Babinski’s relfex
A
Dorsiflex of big toe, small toes fan out
Indicates upper motor neuron lesion
14
Q
Purpose of EMT
A
To remove thrombus from anterior circulation large vessel occlusion
15
Q
Clinical manifestations of increased intracranial pressure
A
- Decreased LOC
- Decreased motor function
- Cushing triad: increased systolic blood pressure, widening of pulse blood pressure, bradycardia
- Headache severe in the morning and with postural changes
- Projectile vomiting
16
Q
Femoral artery care
A
- Bed rest and remain flat for 6 hours
- Assess groin area for hemorrhage and hematoma
- Assess the color, temperature, pain and paresthesia to detect early acute arterial occulsion
- Monitor the pulse of dorsal pedal and posterior tibial of the affected limbv
17
Q
Battle sign
A
- Postauricular ecchymosis
- Periorbital ecchymosis
- Rhinorrhea (CSF leak from the nose)
- Otorrhea (CSF leak from the ear)
** For CSF leakage, administer antibiotics to prevent meningitis
18
Q
Biliary colic
A
- Occur around 30 mins after meal
- RUQ pain radiates to the mid-upper back
19
Q
Clinical manifestations of acute cholecystitis
A
- Fever, chills
- Anorexia, nausea and vomiting
- RUQ pain radiates to the right shoulder and scapula, aggravated by movement and breathing
- Positive Murphy’s sign
- Jaundice, if block common bile duct
- Tea color urine
- Yellow skin discoloration
- Abdominal muscle tenderness and guarding
- Pruitus
20
Q
Complications of acute cholecystitis
A
- Gangrenous cholecystitis
- Abscess formation in gallbladder
- Biliary peritonitis due to gallbladder rupture
- Gallstone ileus
21
Q
Medication for dissolving some gallstone
A
Ursodeoxycholic acid / Chenodeoxycholic acid
22
Q
Post-op care for cholecystectomy
A
- Low fat, high protein and carbohydrate die if resume
- Encourage incentive spirometry exercise
- Monitor blood test for increased WBC, bilirubin and liver function test
23
Q
Pathophysiology of acute pancreatitis
A
Obstruction-related:
Increased pressure –> ductal rupture –> release of pancreatic enzyme (Trypsin) –> activate other pancreatic enzymes –> autodigestion –> inflammation –> pancreatitis
Alcohol related:
Pancreatic acinar cell metabolize ethanol –> generate toxic metabolites –> injury of acinar cells –> release activated enzymes
Chronic alcohol –> Formation of protein plugs in the pancreatic ducts and spasm of Oddi sphincter –> obstruction –> inflammation –> pancreatitis
24
Q
Clinical manifestations of acute pancreatitis
A
- Fever and leukocytosis
- Nausea and vomiting
- LUQ pain radiates to the back
- Hypotension and tachycardia
- Tachypnoea and hypoxia
- Abdominal distention
- Transient hyperglycemia
- Jaundice
25
Management for moderate to severe acute pancreatitis
1. Septic shock --> fluid resuscitation
2. Necrotizing pancreatitis --> antibiotics +- surgery
3. Gallstone induced --> ERCP for removal
4. Nutritional support by parenteral feeding
26
Drug therapy for urinary incontinence
1. Alpha-adrenergic agonist: relax smooth muscle of bladder neck and prostatic urethra
2. Anticholinergic drugs: relax bladder muscle and inhibit the overactive detrusor contractors
--> side effect: dry mouth and eyes, blurred vision, constipation, sleepiness
3. Botox: relax bladder to increase capacity
27
Blood test of Hepatic virus
1. IgG shows previous infection
2. IgM without anti-IgG shows past infection
28
Pre-hepatic jaundice
Increased hemolysis --> Increased serum unconjugated bilirubin
29
Intra-hepatic jaundice
Impaired liver function --> disrupted conversion and excretion of bilirubin --> Increased serum conjugated and unconjugated bilirubin --> normal colored stool and dark urine
30
Obstructive jaundice
Decreased excretion of bilirubin --> Increased conjugated bilirubin --> light colored stool and dark urine
31
Clinical manifestation of hepatic encephalopathy
(accumulation of ammonia)
1. Confusion, impaired consciousness
2. Agitation
3. Asterixis: involuntary jerking movement
32
Clinical manifestations of hepatorenal syndrome (functional liver faiure)
1. Oliguria: urine output less than 500mL/24hrs
2. Decreased urine sodium excretion; Increased urine osmolarity
3. Increased BUN and creatinine level
33
Laboratory tests for liver disorder
1. CBC
2. Clotting profile
3. Viral antigen
4. Total protein and albumin
5. Serum ammonia
34
Nursing management on diuretics (furosemide, spironolactone)
1. Monitor BP/P, ECG, serum K, BUN, creatinine and hydration status
2. Monitor I&O
3. Measure body weight daily
4. Monitor for signs of increased serum K if administer spironolactone alone
- widening QRS, spiking T, ST depression on ECG
- muscle twitching
- diarrhea
5. Monitor for signs of decreased sodium: lethargy, confusion, apprehension
35
Nursing care for Anti-infective agents
1. Monitor hearing, renal, and neurologic functions
2. Check previous hypersensitivity reaction before administer
3. Monitor I&O, BUN and creatinine level
36
Nursing care for therapeutic paracentesis
Pre-procedure care: Check blood result of CBC, LRFT, clotting profile
During procedure: administer colloid / albumin infusion in large volume paracentesis
Post-procedure care:
1. Monitor vital signs Q15mins in the first hour, Q30 mins in the second hour, then Q4H
2. Monitor I&O free flow up to 5L drainage unless adverse symptoms shown
3. If adverse symptoms present, clamp the drainage and inform medical team
4. Encourage frequent change in position to facilitate drainage
37
Clinical manifestations of GERD
1. Pyrosis (heartburn)
2. Dyspepsia (indigestion)
3. Regurgitation (may cause aspiration or bronchitis)
38
Ambulatory esophageal pH monitoring
Placed 2cm above the upper esophageal sphincter
Record the frequency and duration of stomach acid entering the tube
39
Lifestyle modification of GERD
1. Small, frequent meal (4-6)
2. Avoid ingesting within 3 hrs before bed
3. Maintain upright position for 2-3 hours after meal; Keep bed head elevated during sleep
4. Avoid food that decrease lower esophagus sphincter pressure (e.g. chocolate, fatty food)
5. Avoid food that irritate esophagus (e.g. acidic food, cola)
40
Nutrition and swallowing therapy for esophageal cancer
1. Monitor body weight, BMI and I&O
2. Assess swallowing ability
3. Remain upright for 2-3 hours after meal
4. Provide liquid supplement to increase calorie intake
5. Provide semisoft food and thickened liquid
6. Enteral feeding, gastrotomy or jejunostomy may be needed
41
Pre-op care for esophageal surgery
1. Nutrition support (high calorie and protein)
2. Avoid smoking for 2-4 weeks before surgery
3. Oral care 4 times per day
4. Bowel preparation for colon interposition
42
Post-op care for esophageal surgery
1. Keep NPO and IV fluid
2. Administer antacid and metoclopramide (treat slow gastric emptying)
3. Educate incentive spirometry
4. After excubate, perform coughing, turning and breathing exercise Q1-2H
5. NG tube aspiration; Oral suction
6. If NG tube displacement occurs, do not re-insert
7. If anastomotic leak (diagnosed by barium swallowing), discontinue all oral intake and do not resume
8. Report if s/s of fever, inflammation, fluid accumulation, early shock (tachycardia, tachypnea)
43
s/s of colorectal cancer
1. Weight loss
2. Constipation, diarrhea, ribbon-like stool
3. Pressure in lower abdomen or rectum
44
Complications of ostomy
1. Hemorrhage, infection, lesions
2. Necrosis
3. Anastomotic leakage (abdomen distention, fever, drainage of fecal matter via drains)
4. Paralytic ileus (abdominal distention, absence of bowel sound, vomiting)
45
Medications of haemorrhoids
1. Local anesthetic ointment
2. Hydrocortisone ointment
46
Purpose of continuous feeding
To reduce risk of aspiration, nausea and vomiting, diarrhea, and distention in patients with poor gastric emptying
47
Nursing care for enteral feeding
1. Ensure the tube in place before feeding (marking and pH)
2. Monitor fullness, nausea and vomiting during feeding (gastric retention)
3. Remain upright position for 30-60 mins after feeding
4. Flush the tubing with warm water Q4H, between bolus feeding, between medication
5. Grind only the immediate-acting medication, and mix with 30-60 mL water
6. Change the feeding bag daily
7. Check the integrity of tube after removal
48
Medications of OA
1. Acetaminophen, NSAID, Intra-articular corticosteroids (treat inflammation)
2. COX-2 inhibitors
3. Opioid anesthetic
4. Intra-articular hyaluronic acid
49
Primary GA
Error of purine metabolism
50
Acute GA
Sudden onset, 2-10 days
swelling and pain for several hours, accompanied by low grade fever
51
Chronic GA
Visible sodium urate crystal
Chronic inflammation --> joint deformity and cartilage destruction
52
Medications of RA
1. Intra-articular corticosteroids
2. Corticosteroids
3. NSAID
4. Allopurinol
5. Colchicine (side effect: diarrhea)
53
Clinical manifestations of RA:
1. Symmetrical small joint
2. Morning stiffness
3. Sign of inflammation: heat, swelling, tenderness
4. Deformities: ulnar deviation of fingers; swan neck fingers
54
Diagnostic test of RA
1. Erythrocyte sedimentation rate and CRP
2. Anti-citrullinated protein antibody
3. CBC
4. Rheumatic factor
5. X-ray
6. Synovial fluid anaylsis
55
Clinical manifestations of ankylosing spondylitis
1. Spine pain, low back pain
2. Limited motion, improved by mild activity
3. Risk of spinal fracture
4. Ventilation impairment due to chest restriction
56
Treatments of ankylosing spondylitits
1. NSAID
2. Disease modifying anti-rheumatic drugs
3. Local injection of corticosteroids
4. Salicylates
5. Biological response modifier
6. Therapeutic exercise for chest stretching
7. Hydrotherapy for spinal extension
8. Use firm mattress to avoid postural with spinal flexion
9. Heat applications
57
Treatment of phantom pain
1. Mirror therapy
2. Tricyclic antidepressant
3. Anti-seizure
4. Opioid anesthesia
58
Post-op care of total knee replacement
1. Encourage active flexion of the foot hourly when the patient is awake
2. Avoid putting pillow under the knee to avoid knee contracture
3. Continuous passive motion device:
- flexion from 10 to 0 degree
- extension from 50 to 90 degree
59
Post-op care of the total hip replacement
1. Place the abduction pillow between the legs
2. Bed head elevation no more than 60 degree to prevent hip dislocation
3. Encourage active leg exercise and breathing exercise daily
4. Measure the calf circumference daily
5. Administer low molecular heparin (anti-coagulant)
6. Use of compression stockings
60
s/s of dislocation of prosthesis
1. Acute pain in the surgical site and groin area, swelling and immobilization
2. Abnormal internal or external rotation
3. Popping sensation in the hip
4. Shortening of limb
61
Treatment of acute low back pain
1. NSAID
2. Muscle relaxant
3. Massage
4. Spinal manipulation
5. Acupuncture
6. Cold/heat pad
62
Treatment of chronic low back pain
1. NSAID
2. Anti-seizure drugs
3. Weight reduction
4. Adequate exercise to maintain mobility
5. Physiotherapy
6. Local heat/cold pad
7. Surgery
63
Sciatica
Leg pain from a pinched nerve (sciatic nerve) from the nerve roots of L4-5, S1-3
Symptoms:
1. Tingling
2. Numbness
3. Weakness
4. Originate from the lower back, travels through the buttock, down the large sciatic nerve to the back of the leg
64
Cauda equina syndrome
1. Bladder and bowel syndrome (urinary retention and constipation)
2. Tingling or loss of sensation to the lower pelvic area and legs (bilateral)
65
Straight leg raise test
1. Test the L4, L5 and S1 nerve root irritation
2. Stretch the sciatic nerve and hamstring
3. Herniation: cannot raise more than 30 degree without pain
66
Medical treatment of lumbar herniated disc
1. Maintain bed rest for 2-4 days on a firm mattress
2. Change position: supine and lateral
3. Apply ice in the first 48hrs; apply heat in the next 48hrs
4. Administer analgesic Sand muscle relaxant
67
Surgical complications of discectomy and laminectomy
1. Infection/inflammation/injury of the nerve roots
2. Herniation relapse
3. Dual tears: CSF leak and meningitis
4. Cauda Equina Syndrome
5. Hematomas
68
Complications of spinal cord injry
1. Injury at C1-3: apnea, inability to cough
2. Injury at C4: poor cough, diaphragmatic breathing, hypoventilation
3. Injury at C5-T6: decreased respiratory reserve
4. Injury above T5: bradycardia, hypotension, postural hypotension, absence of vasomotor tone
69
Diagnostic test for osteoporosis
1. Blood test:
- serum calcium
- phosphorus
- alkaline phosphatase
- vitamin D level
2. Bone mineral densitometry
- dual-energy x-ray absorptiometry
- quantitative ultrasound
70
Osteoporosis-related fracture prevention
1. Diet and supplement rich in calcium and vitamin D
2. Bisphosphonates: inhibit osteoclast-mediated bone reabsorption
- take 30 mins before meal and other medications
- remain upright 30 mins after taking
3. Estrogen therapy: increase risk of cardiac, breast and uterine cancer
71
s/s of acute gastritis
1. Rapid onset of epigastric pain
2. Nausea and vomiting
3. Hematemesis
4. Gastric hemorrhage
5. Dyspepsia
6. Anorexia
72
s/s of chronic epigasitis
1. Nausea and vomiting
2. Anorexia
3. Relieved by ingestion of food
4. Intolerance of fatty and spicy food
5. Pernicious anemia
73
Clinical manifestations of duodenal ulcer
Hypersecretion of HCl
1. Occur in the mid epigastrium after 2-3 hours of meal
2. Relieved after ingesting
3. Weight gain
4. Melena (black stool)
5. Often awake with pain at night
74
Clinical manifestations of gastric ulcer
1. Occur in the left epigastrium after 30 mins of meal
2. Does not relieve after ingesting, or may even aggravate
3. Weight loss
4. Hematemesis; may relieved after vomiting
75
s/s of acute GI bleeding
1. Faint, nausea and vomiting
2. Hematemesis (coffee ground)
3. Diarrhea (black or bright red)
4. Decrease Hb
76
s/s of perforated peptic ulcer
1. Sudden and severe upper abdominal pain
2. Cannot be relieved by antacid or food
3. Respiration become swallow and slow
4. Increased heart rate and weak pulse
5. Nausea and vomiting
6. Absence of bowel sound
77
Investigations of peptic ulcer disease
1. Blood test for H. pylori and CBC
2. OGD
3. Stool test for fecal occult blood
4. Urea breathing test
5. Physical examination: pain, epigastric tenderness, abdominal distention
78
s/s of acute dumping syndrome (30 mins after eating)
1. Nausea and vomiting
2. Abdominal fullness and cramps
3. Diarrhea
4. Palpitation and tachycardia
5. Perspiration
6. Weakness and dizziness
79
s/s of late dumping syndrome (90mins to 3 hours after eating)
1. Dizziness
2. Confusion
3. Palpitations
4. Diaphoresis
80
Nursing care to prevent dumping syndrome
1. Separate the meal into 6 small feedings
2. Do not take fluids 30 mins before or after, or during the meal
3. Avoid concentrated sweets
4. Provide meal with high protein and fats
