Nutrition Flashcards
(369 cards)
1
Q
Macronutrients
A
Fats, Carbs, Protein
2
Q
Carbs
A
DRI 45-65%, 4cal/g, 130g/day
3
Q
Tell me about Simple and Complex Sugars
A
Simple are divided in to Monosaccrides (Fructose and Glucose) and Disaccarides (Lactose, Sucrose, Maltose)
Complex sugars are called polysaccrides=starches
4
Q
Fat
A
20-35%, 9cal/g
Bad fats- saturated (saturation greater than 10%) and trans fats
Good Fat-Unsaturated fats and polyfats
5
Q
Protein DRI%, grams/cal, grams/kg?
What are the building blocks?
A
10-35%, 4cal/g, 0.8g-1g/kg
Amino acids are the building blocks
6
Q
Tell me about intestine part and what they digest
A
First portion of SI Duodenum=Minerals
Second portion of SI Jejunum=Water soluble vitamins and proteins
Third portion SI Illieum= Fats and fat soluble vitamins
Colon=Draws water out of tract/colon
7
Q
Water Soluble Vitamins
A
B and C
8
Q
Fat Soluble Vitamins
A
E, A, K, D
9
Q
How is fiber digested?
Give examples of high fiber foods
What is the recommend g/day for general pop.?
A
Fiber is not digested in GI; it pulls water into GI tract
Raw fruits, vegetables, bran, oats, dried fruits, dried nuts (Evolve quiz listed raspberry)
General population should consume 25-30g/day
10
Q
What does fatty acid deficiency cause?
A
Dermatitis
11
Q
What does iron deficiency cause?
Names examples of foods high in iron.
A
Stomatitis, Cheilosis
Foods: soybeans, beef liver, pork liver, chicken liver, farina
12
Q
What is Stomatitis and Cheilosis?
Associated with what mineral deficiency?
A
Stomatitis is inflammation of lips and mouth that result in ulcers in mouth
Cheilosis is cracks at corner of mouth from painful inflammation
13
Q
Name examples of complete proteins.
A
Animal products: Milk and milk products, eggs, fish, and meats
14
Q
Symptoms of vitamin D deficiency
A
Bone pain, rickets, osteomalacia, diarrhea, muscular weakness, excess sweating
15
Q
What is tetany?
And what kind of deficiency manifest this ?
A
Intermittent muscle spasms and it’s a sign of calcium deficiency
16
Q
What is folic acid used for?
And what are the signs and symptoms of its deficiency?
A
It’s used for red blood cell formation and growth.
Signs and symptoms include: Anemia, fatigue, sore tongue, diarrhea, forgetfulness, brittle nails
17
Q
Cobalamin is also known as what?
Name example of foods high in colbalamin.
What are s&s of cobalamin deficiency?
Who is at risk for this deficiency?
A
Cobalamin is B12. Primarily absorbed in the illium of small intestines with the help of the hormone intrinsic factor (secreted from the stomach).
Foods with B12= animal protein, supplements, or foods foritfied with B12
S&S=Megaloblastic anemia (pernicious anemia), glossitis, parethesia/peripheral neuropathy
Strict Vegans that don’t take supplements.
18
Q
Normal person’s LDL should be?
A
No more than 100
19
Q
Normal person’s HDL should be?
A
Greater than 40-50
20
Q
Normal’s person Triglycerides should be?
A
No more than 150
21
Q
Total cholesterol should?
A
No more than 200
22
Q
Name long acting insulin, the appearance, and nursing consideration
A
Glargine (Lantus) and Detemir (Levemir) is a long acting insulin that is clear and colorless.
It’s good for not causing hypoglycemia because it mimics basal rate of insulin in normal bodies.
It is given once per day.
Onset is within one hour with no peak time as insulin is given steady throughout day.
Nursing consideration: NEVER mix with another insulin and NEVER give via IV and IM. Only subQ injection
23
Q
Name Rapid acting insulin and onset times.
A
Glulisine (Apidra), Aspart (Novolog) , Lispro (humalog)
Glulisine and Aspart=Onset time is 10-15 minutes, food needs to be eaten 5-10 mins after injection, and short duration of 3-5hrs.
Lispro= Onset 15-30 minutes with 3-6hours duration.
24
Q
Name intermediate acting insulin.
What is the onset, peak, and duration?
What should you know about why this type of insulin is given?
What is the appearance?
A
Isophane NPH (Humulin N)
Onset: 1-2hours, Peak: 4-12hr, Duration=:6-24hr
This insulin with typically last pt half day or through the night.
It is often given with rapid/short acting insulin
Glycemic control between meals and bedtime so it is not given for hyperglycemia after meals due to it’s longer duration and onset time.
Cloudy in appearance
25
Name short acting insulin. What is the appearance?
What is the onset, peak, duration?
How do you administer with intermediate acting insulin?
Regular Insulin (Humulin R), clear in appearance
Onset=30-60 min., Peak=2-4hr, duration=6-10hr
Must be given with food.
Administered subQ and IV. Only one that can be admin IV
When given with intermediate acting insulin, remember clear before cloudy.
26
What is calcium serum levels for hypocalcemia?
| What are Sx of hypocalcemia?
Less than 8.6mg/dL
Sx include low bone density,
frequent and painful muscle spasm (tetany),
increased DTR,
positive chvostek's sign,
positive trousseau's sign, arrhythmias =specifically prolonged QT and ST,
and seizures due to excitable nervous and skeletal system over stimulation
27
Why does calcium effect muscles?
Calcium regulates depolarization and generates action potential in muscles so low calcium causes muscle to contract more easily
28
What is Chvostek's sign?
When you tap pt's check, there will facial twitching of one side of mouth, cheek, and nose. Twitching facial muscles is a sign of hypocalcemia.
29
What is trousseau's SIgn?
Hands and fingers go into spasm when BP cuff is inflated of systolic for 1-4 minutes. This is a sign of low calcium.
30
What types of pt's require enteral feedings ?
Pt's with face injuries/surgery, throat issue, dysphagia, obstruction in GI, MS, Parkinson's Disease. These pt's have working stomach and small intestines, but something is causing a risk getting there.
31
How can you tell if pt has dysphagia?
Which side is dysphagia on ?
Watch pt swallow to see if they can form a bolus in mouth and swallow.
Sx: Excessive drooling, chest pain (acid reflux), gargling voice (fluid accumulates in oral cavity will cause this), increase clearing of throat.
Dysphagia can be on either side or both sides.
32
When do you get out the liquid nutrients for Enteral feeding pt?
Keep in refrigerated until 30 mins. before you give so it can get to room temp,, but not long enough for bacterial growth increases.
33
How much fluid does a EN pt need per day ?
1500mL/day. Give in part throughout the day,,.like Give 4 hours.
34
What pt's need to be watched more carefully and cautiously when receiving fat emulsion in parenteral feeding?
Pt's with pancreatitis, liver failure, respiratory disease
35
Fat emulsion parenteral feeding is contradicted in what pt?
Pt with hyperlipidemia
36
Pts that require central parenteral feeding are usually on what kind of diet?
Why is this type of diet done with central parenteral feeding vs parpherial parenteral feeding?
These pts need high protein and calorie intake.
It's done with central PN because high protein and calorie TPN is a hypertonic solution measuring around 1500mOsm/L with glucose content at 20-50% and can't be given through perpheiral PN.
37
What does GERD stand for?
Gastroesphageal Reflux Disease
38
What is GERD?
It's the backwards movement of gastric content into esophagus
39
What causes GERD to happen?
Either the esophageal sphincter or pylorus sphincter relaxes too much/incompetence allowing back flow, pyloric stenosis, increased gastric volume, or slowed mobility of foods
40
What are some complications if GERD is chronic?
Barrett's Esophagus/Epithelium=risk of cancer due to chronic inflammation from gastric juices, Esophagitis, dental erosion, Laryngeal and bronchial spasms
(asthma, chronic bronchitis, pneumonia)
41
What are Sx of GERD?
Pyrosis (can be felt when recumbent, bending over, or straining), Regurgitation, Hypersalivation, dyspepsia, difficulty swallowing (dysphagia), frequent nighttime coughing due to increase irritation when lying down, so coughing or wheezing or dyspena, globus
42
What is pyrosis?
Heartburn which a painful burning below or behind the breastbone
43
What is dyspepsia?
Uncomfortable and burning in upper abd/chest typically after meals
44
What are some Dx test that can be down with GERD ?
Diagnosis can be made with pH test, esphagoscopy used to rule out malignancy
45
What are some pt education a nurse can tell a pt to prevent GERD?
don't eat 2 hours before bedtime, eat smaller more frequent meals as oppose to larger less frequent meals, avoid acid and spicy foods, avoid foods that reduce lower esophageal sphincter tone, eat a low fat high fiber diet, avoid medications that decrease gastric emptying like (anticholinergics)
46
What types of food reduce lower esophageal tone?
| What types of pts should avoid these types of foods?
Peppermint, chocolate, carbonated drinks, fried, and fatty foods.
Smoking decreases tone of sphincter too.
47
What are some nursing actions when caring for GERD pt?
Keep HOB elevated, monitor I/O, monitor for N/V
48
What medications are used to treat GERD and why those types of drugs?
Antacids=prevents burning pain/chest pain
H2 receptor antagonist=decreases gastric acid secretion by blocking acid secretion
PPI (proton pump inhibitors)= decreases gastric secretion
cholinergic = Bethanechol (activates parasympathetic system)
49
What are examples H2 receptor antagonist?
What does it do?
What disease do you use this drug to treat?
What are the side effects?
-dines
Famotadine, Rantidine, Cimetidine, Nizatidine
It blocks H2 receptors in stomach to decrease acid secretion in stomach thus lowering pH.
Used to treat PUD, GERD, pancreatitis, Zollingers-Ellison syndrome
Side effects include:
Risk for pneumonia because more basic enivornment allow bacteria to colonize and possible migration to lungs
Decrease in RBD, WBD, and platelets
Gynecomastia
50
What are examples of PPI?
What does it do?
What do you use this drug to treat?
What are the side effects?
Nursing Considerations?
Proton-pump inhibitors, your -prazole
Omeprazole, Prantoprazole, Lansoprazole, Esmoprazole
This drug decreases acid secretion by irreversibly blocks the Hydrogen-Potassium ATP pump.
This drug is used treat GERD, PUD, Zollingers-Ellison's Syndrome
The side effects include nausea, diarrhea/contispation, headache, decrease in Ca+ serum (bone fractions), depression, Rhabdomylosis (breaking down of muscles=elevated creatine)
Nursing consideration: Don't' take with food, give an hour before or after meal. Also, don't give with other meds..space the time out for other meds.
51
What does PUD stand for?
Peptic Ulcer Disease
52
What does PUD do to the body?
Causes ulcers in stomach or duodenum
53
What can cause PUD?
H.pyroli or too much acid secretion
Bile Reflux and incompetent pyloric sphincter are risk factors
54
What is Zollinger-Ellison Syndrome?
Gastrin secreting tumor of the pancreas that results in gastrointestinal ulcers
55
What modifiable factors can contribute to PUD?
stressful lifestyle and certain diets like high caffeine and alcohol intake
56
What are Sx of gastric PUD?
Pyrosis, pain 30min. to 1hr. after meal, GI distress hematemesis
57
What are Sx of duodenal PUD?
Pyrosis, pain midepigastric region after 2-5 hours after eating, melena, weight loss, pain is relieved by eating
58
What foods can cause irritation to ulcers?
Coffee, alcohol, spicy food, tea, chocolate, high sodium, caffeinated drinks
59
What things should you educated the pt on to help alleviate some of the symptoms of PUD?
Smoking cessation if pt is smoker.
Eat small frequent meals
Avoid aspirin and NSAIDs (ibuprofen) because they cause GI bleeding
60
What are some nursing actions when caring for PUD pt?
Monitor Hemtocrit and hemoglobin and for bleeding, Elevate HOB
61
What are some surgical options for PUD pt?
Gastric resection, Billroth I (dueodenum) and Billroth II (jejunnum)
62
What do you need to watch for after gastric surgery?
Dumping Syndrome
63
What is Dumping Syndrome?
Rapid emptying of stomach in to small intestines, not allowing for digestion or absorption of food. Sometimes seen after removal of pylorus and stomach.
64
What are the Sx dumping Syndrome?
nausea, vomiting, feeling fullness, tachycardia, diarrhea
65
What are nursing actions when caring for pt after gastric surgery?
Keep pt in high folwer's position, assess for bowel sounds (borymi), Maintain pt NPO for three days for healing, laying down after eating
66
What are some pt education for pt after gastric surgery?
Avoid taking fluids with meals to prevent dumping syndrome, avoid salt, eat small meal when you are able to eat again
67
What are some medications to treat PUD?
PPI with antibiotics
H2 receptor inhibitors
Antacids
Sucralfate (Carafate)
68
What disease is a mutation of CFTR gene?
Cystic Fibrosis
69
In CF which organs are primarily effected?
Lungs, pancreas, and liver
70
What is the main test for diagnosis CF?
What is a positive diagnosis with this test?
Sweat Chloride test
Results of above 60mEq/L on two separate days
71
What channels are blocked in CF and what are some side effects of this channel being blocked?
Sodium and Chloride Channels are blocked that are on skin, lungs, pancreas, gallbadder.
This causes the skin to be saltier because of increased salt in sweat. Since NaCl can't get into lungs to bring water, the mucus in lungs are thick and sticky causing respiratory problems. In the pancreas, the duct to the intestines can be blocked and enzymes that digest fat, proteins, and carbs can't do there jobs. This blockage in pancreas can cause damage to pancreas (pancreatitis). The gallbadder duct can get blocked too, and bile can't get out to emulsify fats.
72
What are some Sx of CF?
Chronic lung infections, Pneumonia, Bronchoilitis, Chronic hypoxemia, Nasal Polyp/Obstruction, Failure to Thrive due to malnutrition/malabsorption , Rectal Prolaspe, Salty Skin, no vas def in males, steatorrhea, DIOS, meconium lleus in neonates
More severe Sx: Hemoptysis, Bronchiectasis, Cor Pulmonale, Chronic lung infection and CF Exacerbation that can lead to respiratory failure
73
What are sx of respiratory failure?
Cyanosis, rapid breathing, and confusion
74
Why do CF pt have lung infections more than a normal person?
Which bacteria are common for the lung infections?
Thick mucus in lung make it hard for cilla to move mucus out of lung so more mucus in lung=bacteria growth
Staphylococcus and Pseudomonas like this type of environment
75
What is bronchiectasis?
Why do CF pt's get this?
Permanent widening and damage to bronchi
Chronic bronchiolitis (inflammation and bacterial infection) leads to this condition
76
What is Cor pulmonale?
Alteration in the structure and function of the right ventricle of the heart causes by primary disorder of the respiratory system
77
What is Hemoptysis?
What can cause it in CF pt ?
Coughing up blood
Bacterial infection erodes through blood vessels
78
What are the main vitamins CF pts will have deficiencies?
What are some manifestation of these deficiencies?
Fat soluble vitamins= A,k, E,D
Eye sight will effected (A), decreased prothrombotic (K), decrease bone density->ostepenia->osteoprosis (D), hemolytic anemia (E)
79
What are some ways to manage CF?
Daily chest physiotherapy (CPT), noting changes in respiration, high protein high calorie diet, fat vitamin replacement, monitoring blood glucose level, get immunizations, Pancreatic enzymes with every meal,
Medications=Bronchodilator, Albuterol with hypertonic saline through nebulizer, Antibiotic (Thobramycin and azithromycin), Dorsnase Alpha
80
What is Dorsnase Alpha?
How does this medication work?
A medication given to CF pt to thin mucus to make it easier to get out.
This medication cuts nucleic acid in mucus to thin it out
81
What is gastroenteritis?
Inflammation of mucosa of the small intestines and stomach
82
What is Celiac Disease?
An autoimmune disease where the intestines become inflamed when pt eats gluten causing damage to the villas that absorb nutrients.
83
What are some Sx of Celiac Disease?
Steatorrhea, weight loss, fat and protein malabsorption, dental enamel hypoplasia and possible decrease bone density, anemia, dermatitis Herpetiformis (rash on head), abdominal distention
84
What are some Dx test for Celiac Disease?
HLA-DQ2& HLA-DQ8 antigen, Duodenal biopsy
85
What are some nursing actions when caring for pt with Celiac Disease?
Gluten free diet= no brans, rye, wheat, products with gluten, oats (unless pure oat that's not contaminated)
86
What kind of diet should pt's with Celiac Disease eat?
High protein and high fat
87
What is Celiac Crisis?
What are the Sx? What medication used to treat?
Rare but Life-threatening complication with celiac
Watery V/D (f&e imbalance)
Decrease in Ca and Albumin
Acidosis
Infection
Treat with Corticosteriods
88
What is an objective way to tell if baby or child is FTT?
If child is below 5 percentile on growth chart in weight and height of children of that same age. Child is behind in development to stages.
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What are the normal weight gains for birth to 1 years old?
Double weight at 5 months and tripled weight at 1 year
90
At what age do babies transition to solid foods?
6-12 months
91
What things does FTT assessment needs to include?
Timing of development stages, social economics, observe feeding and family dynamics, OB Hx and how is family adjusting, family assessment (including all caregivers),
92
At what age does a baby develop fear of strangers?
6 months
93
Child with FTT will require how much caloric intake and for how long?
150% of daily intake, around 24cal/oz until child is caught up to normal for age or above 50% on growth chart
94
What should the child restrict drinking when FTT?
Juices
95
What is Pediasure?
It's high caloric milk for FTT toddlers
96
How much weight should a FTT child gain if following correct diet to increase weight?
2oz/day
97
What kind of environment will prompt eating for FTT child ?
Quiet calm environment
98
What is Type 1 diabetes and what causes it?
Little to no insulin production due to autoimmune destruction of beta cells in pancreas
99
What is type 2 diabetes and what causes it?
Pancreatic beta cells don't produce enough insulin or the body becomes immune it. Typically is caused by obesity and hyperlipidemia.
100
What is the normal, prediabetic, and Diabetic ranges for Hemglobin A1C?
Normal= 4-6%
Prediabetic=5.6-6.4%
Diabetic=over 6.5%
101
What is the only insulin that can be given IV?
Short acting insulin ( Regular Insulin)
102
What the sx of diabetes?
Polyuria, polyphagia, polydipsia
```
Elevated blood glucose
Blurred vision
non-healing wounds
neuropathy
Decreased circulation
End organ damage due to damage vessels
```
103
What are some end organ damage for diabetic pts?
Heart disease, renal failure, glaucoma
104
What instructions should you give to a patient with diabetes and numbness in the feet when teaching about diabetic foot care?
Keep feet dry
Wear shoes and socks that are not tight
Walk regularly and exercise
Protect the feet from extreme heat and cold
105
What is the 15 rule with diabetics?
Admin 15g of CHO then recheck in 15 min
106
Why is feet care in diabetics so important?
Because of neuropathy and poor circulation, wounds on foot go unnoticed and don't heal.
107
How should a nurse care of diabetic foot wounds and infections?
Wounds and infections should receive meticulous care
108
When is insulin required?
Required for Type 1
Required for Type 2 when diet and exercise don't work to control BG anymore
109
What is Lipoatrophy?
Loss of fat tissue of injection site used
110
What is Lipohypertrophy?
Fatty mass at injection site
111
What causes lipoatrophy and lipohypertrophy?
| What can prevented this?
Repeated use of same injection site.
To prevent rotate site.
112
What is Dawn Phenomenon?
Reduced sensitivity to insulin between 2am and 8am resulting hyperglycemia during those times.
113
What are interventions for Dawn Phenomenon?
Avoid eating carbs before bedtime
Check blood glucose in morning
Increase insulin amount of insulin at night to help normalize the blood glucose level in the morning
114
What is Somogyi Effect ?
Rebound hyperglycemia from low BG during the night causing actions from body to release glucose into body to counteract the low BG. So in the morning pt is hyperglycemic.
115
What can prevent Somogyi effect?
Decease insulin at night or eat bedtime snack
116
How often should a sick diabetic check their blood glucose?
Every 4 hours during illness because being sick initiates counterregulatory hormones to release glucose in blood
117
What is Diabetic Ketoacidosis ?
Found only in type 1 diabetics
The breakdown of fats with the byproduct of ketones (acid)
118
What is associated with sudden onset of DKA?
Stress or infection
119
How do you know if a person is in DKA?
Ketones in urine
Dehydration
blood sugar above 250mg/dL
Kussmual's respiration
pH below 7.3
Bicarb less than 16
Orthostatic hypotension
120
What is Kussmual's respiration?
When you do see this kind of breathing?
Deep labored breathing
You see this kind of breathing in pt's in DKA
121
List treatments for DKA by priority?
1. 0.45% or 0.9% NaCl for re-hydration
2. Insulin to bring blood glucose down, correct acidosis
3. Electrolytes to correct electrolyte imbalance
122
What do you need to monitor the most when treating a DKA pt? And why?
Monitor potassium because it will rapidly decrease as insulin is administered causing cardiac dysrhymias.
123
Repaglinide and Nateglinide are what kind of medications for what kind of pts?
These medication simulate the pancreas to produce more insulin for type 2 diabetics
124
What class of medications are Repaglinide and Nateglinide?
Meglitinides
125
What can you administer to pt with severe hypoglycemia?
1 mg glucagon
126
DKA pt's blood sugar level approaching 250mg/dL, what can you add to fluid regimen?
5 to 10% dextrose
127
Posterior fontanels should be closed by how many months in babies?
8months
128
Anterior fontanels should be closed by how many months?
18 months
129
When do babies sit up?
4-7 months
130
When can babies completely roll over?
6 months
131
When can babies stand?
1 year
132
What is one sign that a baby may be malnutrition if they don't hit this developmental milestone?
Anxiety to strangers
133
When do babies start to coo, smile, and cry?
2-3 months
134
When do babies understand "no"
11 months
135
How many weight should a 1-3 year gain each year?
4-6lbs
136
When does the head circumference and chest circumference be the same in children?
1-2 years
137
Which trimester will a pt with gestational diabetes have an increase need for insulin?
Why?
2 and 3 trimester because increase insulin resistance with increase hormones in placenta
138
What diabetic sx is more likely to be seen in gestational diabetic pt in the 2 and 3 trimester?
hypoglycemia
139
What happens with insulin requirements after gestational pt gives birth? And why does this happen?
Decrease because placenta is out
140
What is the babies size from gestational diabetic mother than non-diabestic mothers?
Baby grows bigger and faster
141
What a some therapeutic management for pt's with gestational diabetes?
Check urine at every prenatal visit
Diabetic diet
Glybride
Monitor sign of diabetic complications like edema, HTN, signs of infection
Closely watch mother and newborn's glucose during labor and delivery
142
What are you checking urine for in gestational diabetes?
Glucosuria and ketonuria
143
What is glybride?
Oral hypoglycemic agent preferred over insulin in management of gestational diabetes because only small amount of this med can cross placenta
144
What happens to glycogen during labor and delivery?
Labor and delivery depletes glycogen
145
Who are a risk for gestational diabetes>
advanced maternal age
family history of diabetes
obese
146
Women with gestational diabetes have a high risk for what?
C-section
babies have increase risk for prinatal death
birth injury
neonatal complications
147
Why might pt's with gestational diabetes go into labor early?
Early labor may be due to extra stress like HTN, poor metabolic control, or uteroplacental insufficiency causing fetal growth restrictions
148
What is the recommended time of when mothers should start breast feeding ?
One hour after birth
149
What is recommend for breast feeding mothers?
Continue prenatal vitamins and increase 500 calories daily during breastfeeding
150
What is pancreatitis?
Inflammation of the pancreas from autodigestion
151
What are some common causes of acute pancreatitis?
gall stones, high alcohol consumption, obstruction of ducts
152
What are some common causes of chronic pancreatitis?
Prolonged alcohol abuse, CF, hyperlipidemia, PUD
153
What is the difference between acute and chronic pancreatitis?
Acute is sudden onset can return normal function and chronic have irreversible damage
154
What endocrine enzymes does the pancreas produce?
Amylase, lipase, trypsine, nuclease
155
What exocrine hormone does the pancreas produce?
Insulin and glucagon
156
What are some Sx of pancreatits?
Primarily acute- Extreme Midepigastric pain, LUQ pain that radiates to back, onset of pain is after eating (especially fatty foods)
Adb tenderness and distension
Ascites
Dark brown urine
Jaundice
decreased/absent bowel sounds
Leukocytosis
Cullen's and Tuner's sign
Steatorrhea
weight loss
157
What are some lab results that would be seen in pancreatitis?
Increase amylase, lipase, bilirubin, WBC, ALP
Decrease calcium
158
What is cullen's sign? When would you see this?
Bruising around umbilicus
| Serious sx of acute pancreatitis
159
What is turner's sign? When would you see this?
Flank bruising
| Serious sx of acute pancreatitis
160
What are some therapeutic management of pancreatitis?
Keep pt NPO
Monitor blood glucose
NG tube to suction stomach content or to prevent vomiting
Pain meds as per order
ERCP
161
Why do you keep a pancreatitis pt NPO?
To decrease digestive enzymes from being released
162
Why do you monitor a pancreatitis pt's blood glucose?
because insulin may not be release due to inflammation or damage to pancreas
163
What are some things to teach pt about preventing recurring acute episodes of pancreatitis?
Avoid alcohol
Eat low fat, high protein diet
Monitor blood glucose (specifically for chronic pancreatitis pts)
Eat complex carbs (fruit, veg, grains) over refined sugars
164
What do you want to manage first in acute pancreatitis?
Pain
165
What meds are used in treatment of pancreatitis?
Analgesics
H2 blockers
Insulin
Pancreatic enzymes
Anticholinergics
166
Why do you give anticholinergics to a pancreatitis pt?
To decrease pancreatic simulation of PNS (rest, ingest)
167
What is Creon?
pancreatic enzyme supplement to be given along with meals or snacks
168
How do you know if creon, pancreatin, and panrelipase is working?
Fecal fat check, decrease of absent of staeorrhea
169
What is leukocytosis ?
Increase WBC
170
What can be given for hypovolemic shock in pancreatitis?
albumin
171
How should an acute pancreatitis pt lay to reduce pain?
On their side with knee up because supine will increase pain
172
Name an autoimmune hyperthyroid disease
Graves's Disease
173
What is hyperthyroidism?
Sympathetic overdrive
174
What are some Sx of hyperthyroidism?
Weight loss
Heat tolerance, sweaty
HTN
Tachycardia
Amenorrhea
smooth skin and silky hair
Diarrhea
Irritable
Goiter
175
Why are pts with hyperthyroidism intolerant to heat?
Increase metabolic rate
176
What is Pretibial myxedema?
Waxy discolored skin
177
When diagnosing hyperthyrodism, what is elevated?
T3 and T4
178
What are the lab values with TSH in hyperthyroidism?
Decreased or absent
179
What is the radioactive iodine uptake test?
What is a positive result and what is it positive for?
Pt ingest iodine (pill form) and thyroid scanned to for uptake. High uptake is positive result for Graves'
180
What are sx of thyroid storm?
Tachy, fever, chest pain
181
How dangerous is a thyroid storm?
Life threatening
182
What are some nursing intervention and pt teaching for hyperthyroidism?
```
Keep room quiet and dark
Never suddenly stop taking meds
Avoid foods rich in iodine
Avoid aspirin
Watch for signs of drug toxicity
```
183
What does the thyroid regulate?
Body metabolism, body temp
184
Why does normal person need to eat iodine rich food
because body cannot make T3 and T4 without iodine
185
What are iodine rich foods?
Seafood, dairy products, eggs
186
What is the function of T3 and T4?
burn calories, regulates how fast digest food, stimulates sympathetic nervous system
187
What are classic sx of Graves' disease?
Protruding eyes and pretibial myxedma
188
Why should pts with hyperthyroidism avoid aspirin?
aspirin increase thyroid hormones
189
What are some common medications for hyperthyroidism?
```
Tapzole
Methomazole
PTU
Beta Blockers
Radioactive iodine given as capsule
```
190
Name anti-thyroid hormone medication? Who is this prescribed for?
Methimazole(Tapazole)
PTU-Propylthiouracil
Prescribed for pts with hyperthyroidism
191
What is a side effect of anti-thyroid medication?
Contraindicated in what types of pts?
Liver failure and decrease WBC
Pregnant women should not take
192
Why are beta blockers prescribed to hyperthyroidism pt?
Provide rapid relief in minutes for cario sx like palpitations, arrhythmias, tremors, anxiety, and heat intolerance
193
Why is radioactive iodine given to pts with hyperthyroidism?
What are some common side effects?
What type of pt is this contraindicated in?
What pt education is needed?
it destroys thyroid gland over time
Nausea, swollen salivary gland
Pregnant women
Avoid preparing food for others, lander clothes/towels separate from others, avoid being close to pregnant women and child for one week after. Can gargle with salt and soda 3-4times/day to relieve dry mouth and irritation
194
What do post op nurse need to monitor for after pt removes thyroid?
Thyroid storm/thyrotoxicosis from leaked T3 and T4 into body
Hypocalcium
195
What are some things you need to keep in mind when caring for post op thyroid removal pt?
Keep in semi-folwers
Keep trach in room
Monitor airway closely
Splint throat when coughing
Monitor for hypocalcemia (parathyroid)
196
How many calories per kg body weight per day to maintain weight?
25-30cal/kg per body weight per day
197
How many calories per kg body weight per day to lose weight?
20-25cal/kg per body weight per day
198
How many calories per kg body weight per day to gain weight?
30-35cal/kg per day
199
What is metformin?
Oral anti-diabetic medication for type 2 diabetes
200
How does metformin work?
Decrease glucose production and increase insulin sensitivity
201
What are some side effects of metformin?
nausea, vomiting, diarrhea, metallic taste in mouth
More serious: DKA and lactic acidosis
202
What type of pt is metformin contraindicated in ?
Pts with renal insufficiency
203
What are some nursing considerations for metformin?
Hold med for 1-2 days if pt is going to have IV contrast and 2 days after to avoid renal failure and lactic acidosis
Used to manage diabetes, not cure
204
What kind of drug is Glybride and Glipizide?
Sulfonylureas 2nd generation
205
What do you use Glybride and Glipizide for?
Oral medication for type 2 diabetes
206
How does Glybride and Glipizide work?
it increases insulin production by simulating the pancreatic islets
207
What is a side effect to watch when taking sulfonylureas like Glybride and Glipizide?
Hypoglycemia
208
What are some pt education for taking Glybride and Glipizide?
Avoid alcohol
Avoid breast feeding
don't take with beta blockers
209
What is hypothyroidism?
Decrease production of T3 and T4 hormones leading to decrease metabolic rate
210
What causes hypothyroidism?
Hashimoto's disease
not eating enough iodine
tumor on anterior pituitary gland
treatment of hyperthyroidism
211
what is hasimoto's disease?
autoimmune disease where body attacks thyroid gland
212
What are sx of hypothyroidism?
weight gain
lethargy
decrease HR
decrease BP
constipation
dried skin and brittle nails
slowed thinking
myxedema on face and eyes
213
What labs would you check with hypothyroidism?
And what woud they show?
Decrease in T4
Increase in TSH
214
What should you monitor when caring for a hypothyroidism pt?
Vitals signs
Monitor for signs that can lead to myxedema coma
Monitor for hyperthyroidism with medication
215
What kind of diet is recommended for hypothyroidism
Low fat and calories, high fiber and fluid
216
What are signs of myxedema coma?
Pt is unconscious with severely low BP, HR, RR, hypothermia, hyponatrimia, hypoglycemia
217
What are common medications prescribed for hypothyroidism?
Lionthyronine (Cytomel)
Levothyroxine (synthyroid)
218
What do you need to educate pt on in regards to medication for hypothyroidism?
Lifelong hormone therapy with routine blood work to see if medication is effective and no adjustments needed
Do not switch brands, discuss with MD before you do anything
Do not suddenly stop taking meds
219
How does Levothyroxine work?
Who is it prescribe for?
It's a synthetic T4 prescribed for hypothyroidism
220
When should pt take Levothyroxine?
In the morning on empty stomach at the same time everyday
221
What should labs you monitor when pt is on Levothyroxine?
Monitor TSH and T4
222
About when does Levothyroxine start to show effectiveness?
6-7weeks
223
What medication should be taken separately from levothyroxine?
And by how many hours?
Gastric meds like antacids by at least 4 hours
224
What kind of side effects should you monitor for with Levothyroxine?
Hyperthyroidism like thyrotoxicosis, tremors, increase HR, palpation, chest pain
225
What should a pt do if they miss a dose of levothyroxine meds?
Take a soon possible
226
What can happen if a pt suddenly stops taking Levothyroxine meds?
Myxedema coma
227
What interventions are needed with myxedma coma?
STAT IV fluid NS or hypertonic solution
| STATE IV thyroid hormone
228
What is Addison's Disease?
Chronic Adrenal Insufficiency
| Hyposecretion of the adrenal cortex hormones that sits on top of kidney
229
What hormones do the adrenal cortex secrete?
Cortisol (glucocorticoid) and Aldosterone (mineralcorticoid)
230
What does cortisol do?
decrease swelling and inflammation
| increase blood glucose
231
What does aldosterone do?
Retains sodium and excretes potassium
232
What causes Addison's disease?
Autoimmune
Infarction or trauma
TB
Fungal infection
Lack of ACTH (pituitary adrenocoticotropic hormone)
233
What are sx of Addision's disease?
```
decrease BP
increase HR
weight loss
muscle weakness
hyperpigmentation (bronze)
Hypercalcemia
Hyperkalemia
hypoglycemia
hyponatremia
dehydration
Salt cravings
```
234
Where do you see hyperpigmentation first in Addision's disease?
hands, elbows, mouth
235
What are some therapeutic managements?
Replacement of adrenal hormones
Steroid and electrolyte replacement
Lifelong medication
236
what are some labs you need to monitor in Addison's Disease?
K+
Na+
Ca+
Blood glucose (hypoglycemia)
237
What are some pt education with Addision's Disease?
Life long medication requirements
Wear a medical alert bracelet
Salt additives needed especially after exercising/sweaty a lot
During stress or infection steroid medication may need to be increased
238
Name what you need to think of with the following imbalances:
Potassium
Sodium
Potassium=Cardiac
| Sodium=Fluid, BP
239
What are some medications prescribed for Addison's disease?
Predisone(coriticorsteriod)
Glucose for hypoglycemia
Fludrocortisone acetate (mineralocorticoid)
240
What are sx of hypercalcemia?
shorten QT interval on EKG
Loss of calcium from bones= risk for fractures
Confusion and Lethargy from decrease neuromuscular excitability
Kidney stones
Constipation due to weakness in muscles
Hypercoaglation
241
What are sx of hyperkalemia?
Tall T wave in EKG
Muscle weakness
Abdominal cramps
Diarrhea
Arrhythmia
Decrease cardiac contractility so weak pulse and low BP
242
What is the normal range for calcium serum?
8.6-10.2 mg/dL
243
What is the normal range for potassium serum?
3.5-5 mEq/L
244
What is the normal range for sodium?
135-145 mEq/L
245
Why would a pt with Addison's disease have hyponatremia?
Deficiency of aldosterone leads to inability to reabsorb sodium into kidney causing low sodium
246
What are sx of hyponatremia?
N/V
Confusion
Lethargy
Seizures
hypovolemia and orthostatic hypotension
247
What is Addisonian Crisis?
Life threatening acute exacerbation of Addison's disease
248
What clinical manifestation can Addisonian Crisis present as?
Hypovolemic shock
249
What can cause Addisonian Crisis?
severe infection
trauma
dramatic decrease of glucocorticoid
not taking medication
250
How can glucocorticoid medication be taken?
2/3 in morning and 1/3 late afternoon
251
What is Cushing's disease?
Hypersecretion of adrenal cortex hormone leading to elevated cortisol levels
252
What are sx of Cushing's Disease?
Hypertension with sign of CHF
```
Swollen face (moon face)
Buffalo hump
```
Excessive weight gain
Truncal obesity
Striae on abd and thighs
Muscle wasting
Hypocalcemia
Hypernatremia
Hypertension
hyperglycemia
Decrease immunity
253
What is buffalo hump?
Hump on back of neck from fat deposits
254
Why is there a decrease in immunity with Cushing's disease?
Steriods decrease immune system
255
Name calcium rich foods.
Milk, cheese, sardines, spinach, yogurt, collard greens,
| rhubarb, tofu
256
What can cause Cushing's ?
Tumor on adrenal gland or pituitary gland
| long term steroid use
257
What do you need to monitor when monitor pt with Cushing's?
Monitor vitals and electrolytes
Protect pt from infection
Skin assessment due to fragile skin
Provide meticulous would care
258
What is a hemophilia?
Genetic blood clotting disorder X-link recessive from mother
259
What organ produces clotting factor proteins?
Liver
260
What is classic hemophilia?
Type A
261
Which type of hemophilia is the most common?
Type A
262
Which clotting factor is type A hemophilia missing?
8 VIIII
263
What medication is used to treat type A hemophilia ?
DDAVP (Desmopressin)
264
What does DDAVP do?
Stimulates vWF (stabilize VIII)
265
What clotting factor is type B hemophilia missing?
9 IX
266
What is the treatment for type B hemophilia?
Blood transfusion until they stop bleeding (sometimes can be take BT)
267
What clotting factor is type C hemophilia missing?
11 XII
268
what is the treatment for type C hemophilia ?
plasma
269
Which gender is usually effected by hemophilia?
boys
270
How can a person acquired hemophilia?
Liver failure, vit K deficiency, autoimmune against clotting factors, disseminated intravascular coagulation
271
What is disseminated intravasular coagulation?
consumes clotting factors
272
What are sx of hemophilia?
```
Epistaxis
spontaneous bleeding
hemarthrosis
Ecchymosis
Swelling of the joints, soft tissue, and muscles
Hematuria
```
273
What is epistaxis?
nosebleeds
274
What is hemarthrosis?
bleeding into the joint space
275
What is ecchymosis?
bruising
276
What labs test should be done for hemophilia?
Platelets
Prothrombin time (PT)
Partial Thromboplastic time (PTT)
Genetic testing: Electrophoreisis
277
What results do hemophilia get on PT, PTT, and platelets?
```
Platelets=normal
Prothrombin time (PT)=normal
Partial Thromboplastic time (PTT)=prolonged
```
278
Why is PTT abnormal while PT and platelets are normal in hemophilia?
PTT test intrinsic and common pathways (factors 7, 11, 9, 8, 10, 5, 2, 1) which include the clotting factors effected in hemophilia A, B, C
PT test extrinsic and common pathways (factor 7, 10, 5, 2, 1) does not include clotting factors for hemophilia
Platelets are not effected in hemophilia
279
What should a nurse monitor when caring for hemophilic?
```
Monitor neuro status that would indicate brain bleeding lead to a stroke or increase intracranial pressure
Monitor for drooling, parenthesis
Monitor for blood from any orifice
melena
Petechia
Pressure on joints
Pain from swollen joints
```
280
what is melena?
Black tarry stool associated with upper GI bleed
281
what is petechia?
a small red or purple spot caused by bleeding into the skin.
282
What are some generalized treatment and drugs of hemophilia?
Prophylaxis
Aminocaproic Acid (Amicar)
Antifibrinolytic agents
Injuries should rest, ice, compression, and elevated
283
What is prophylaxis?
Clotting factor replacement therapy
| Supplementing missing factor by injecting missing or nonfunctional clotting factor
284
What is aminocaproic acid?
Drug that help hold clot in place once it's formed
285
What are some pt education for hemophilia?
```
Avoid contact sports
Preventive dental care
Do not give aspirin or ibprophen for pain
Give tylenol or codeine for pain
Delayed growth in hemophiliac babies
```
286
What does aspirin and ibprophen do to blood?
thins blood
287
What is Deep Vein Thrombosis?
Blood clot in deep veins
288
What part of body is DVT common?
Lower extremities
289
What is primary hemostasis ?
Platelet plug
290
What is secondary hemostasis?
Hard clot from fibrin on top of platelet plug from coagulation cascade
291
what is thromboembolism?
A clot that is free flowing in body
292
What are some risk for thromboembolism?
Stroke or pulmonary embolism
293
Name the components of Virchow's Triad?
Slowed blood flow or venous stasis
Hyper coagulation
Damage to blood vessel
294
What is venous stasis caused by
Inactivity of skeletal muscle pump
295
What can cause venous stasis?
Long periods of inactivity like bed rest
296
What can cause hypercoagulation?
Genetics
Surgery that that damaged blood vessel initiating coagulation cascade
Birth control
Exogenous hormones (hormone therapy)
297
What are some things that can cause damage to blood vessel causing DVT?
Infection
Chronic inflammation
toxins from smoking
298
What types of pts are at risk for DVT?
```
Bedrest
Post op
Obesity
Pregnant women
Women on birth control or hormone therapy
```
299
What are sx of DVT?
```
Pain Swelling
redness
tenderness
warmth
Edema /pitting edema
Distal toes bluish
Homan's sign
```
300
what is Homan's sign
calf pain on doriflexion
301
What are some Dx test for DVT?
D-dimer blood test
Venography
Ultrasound
302
What is D-dimer blood test used for?
| Why is D-dimer blood test used?
To dx DVT
D-dimer detects fibrin break down which is high when there is a clot
303
What are some treatments for DVT?
Anticoagulation meds and therapy
if too large then thrombectomy or thrombolytic enzymes
ICV filter
304
What kind of anticoagulant meds used for DVT?
Low molecular weight heparin
305
If pt is on heparin drip IV what labs do you need to monitor ?
Moinitor PTT q6hr
306
What is Lovenox and how is it admin?
Anticoagulant
| SubQ
307
If pt is on Coumadin/Warfarin, what labs need to be monitor and how often?
How is this med admin.?
What does the lab result need to be?
PT and INR
PO
INR needs to between 2.5-3.0
308
What is IVC filter and what is it used for?
Filter in inferior vena cava to prevent pulmonary embolism?
309
What are ways to prevent DVT?
Compression stockings and calf exercises during sitting still to prevent stasis
SCD (sequential compression device)
Early mobilization of post op pt or for people in general
310
What are some nursing actions for DVT?>
Elevate affected limb
| Educate pt to take meds a prescribed and be aware of vit K high foods (increase clotting)
311
What are some nursing actions when it comes to compression socks?
measure limb and apply correct compression stocking that isn't too tight or too loose
312
What are compression sock used for
Prevent DVT
313
What is PAD?
Peripheral artery disease caused by blockage (organic PAD)
314
What a typically the blockage in PAD?
Atherosclerosis or embolus
315
What is the disease process of PAD?
Occulsion in artery-> decrease O2->ischemia->pain (claudication) ->necrosis
316
What is stage 1 in PAD?
small occlusion or narrowed artery. Pt typically asymptomatic. Maybe pallor and cold in affected limb but no pain
317
What is stage 2 in PAD?
Pain with pressure like walking on affected limb because of ischemia pain (claudication)
318
What is stage 3 in PAD?
Resting pain
319
What is stage 4 in PAD?
gangrene, necrosis from lack of O2
hairless an shiny in affected limb
sensation issues, increase bp
320
What is claudication?
ischemic pain ( typically caused by obstruction of the arteries)
321
What are sx of PAD?
ulcers that don't heal
color changes:elevation pallor and dependent rubor
increased BP
sensation issue
322
What is dependent rubor?
dusky red color when limb lowered usually seen with arterial occlusion
323
What are nursing actions with PAD?
Don't elevate
324
What are some risk factor for developing PAD?
smoking
diabetes
dyslipidemia
HTN
325
What are some treatment for PAD?
Quit smoking
Exercise and healthy diet
medication to reduce clotting
angioplasty and bypass
326
What are some dx test for PAD?
Ankle-Branchial Index (ABI)=best way
Whoosing bruit
Doppler ultrasound(dependent on person's skill)
327
What is ABI and what are the ranges for PAD?
Bp comparsion of arm and ankle
Positive result is when systolic BP in ankle divided over systolic BP in arm= less than 0.9
claudication=0.9-0.4
rest pain=0.4 to 0.2
tissue loss=0.2 to 0.0
328
Name interventions for myxedema coma?
```
O2 via mechanical ventilator
Monitor cardiac VS
low pressure mattress to prevent skin breakdown
IV fluids
IV thyroid hormones
```
329
What is sickle cell anemia?
Autosomal recessive trait where the RBCs sickles when it does get enough O2 (irreversible)
330
What demographic typically have SCA?
African Americans
331
What is sickle RBC?
Rigid, stiff, crescent shaped RBCs with short life
332
What's the worse disease process that can happen with SCA pt?
Sickle cell crisis
333
What is sickle cell crisis ?
Vaso-occlusion to organs causing severe pain and ischemia
334
What can cause sicke cell crisis?
Hypoxia, exercise, high altitude, and fever
335
What are sx of sickle cell crisis?
Severe pain (typically adb. hands, and feet), fever, stroke, changes in vision, jaundice, hematuria, and priapism
336
What are some sx of SCA?
```
Pain
Pallor
Fatigue
Jaundice
Gallstones
Priapism
Hepatomegaly
Infant dactylitis
Bones pain
Infarction of spleen
Splenic sequestration = Splenomegaly
Acute Chest syndrome
```
337
what is SCA pain due to ?
decrease in blood flow and clots in vessel (vaso-occlusion) causes pain
338
Why does SCA cause jaundice?
Rapid breadown of RBS cause increase bilirubin=jaundice
339
What is Priapism?
Sickled RBCs may prevent blood from leaving penis during a sickle cell crisis causing painful prolonged erection
340
What is dactylitis?
Why do SCA infants get this?
Swelling of hands and feet
seen in SCA infant due to vaso-occlusion in capillaries of bones of hands and feet=swelling
341
Why do SCA pt get bone pain?
vaco-occlusion in bones causing avasular necrosis
342
What is avascular necrosis?
death of bones tissues due to lack of blood supply
343
What is infarction?
tissue death due to inadequate blood supply
344
Why do SCA pt get infarction of spleen?
Vaso-occlusion of spleen from sickled RBCs blockage
345
what is splenic sequestration?
What kind of pt do you see this in?
Seen in SCA pt where blood is backed up in spleen causing splenomegaly
346
Without properly function spleen what can happen ?
```
Without spleen=more susceptible to encapsulated bacteria like:
Streotoccous pneumoniae
Influenza
Salmonella
Meningitidis
```
347
What is acute chest syndrome ? Commonly seenin what type of pt?
occurs in vaso-occlusive crisis when sickle cells occlude blood vessels of lungs
348
What are some Dx test for SCA?
Newborn blood spot screen after 3 months from birth
Blood smear for sickled cells
Protein electrophoresis
349
What are some tx for SCA?
Supplemental O2
Increase fluid intake/IV fluid for sickle cell crisis
Analgesia (opiods) for severe pain
Anti-inflammatory
Antibiotics for bacterial infection
prophylactic antibiotics for young children
Vaccinations
Blood transfusion
Hydroxyurea
Bone marrow transplant (Hematopoietic stem cell transplantation)
350
Why given O2 to SCA pt?
To treat hypoxia and prevent further sickling of RBCs
351
What is the most common cause of death in SCA pt?
Pneumonia
352
What is hyroxyurea?
Medication for SCA that increase production of Hgb F to increase RBC volume and hydration
353
What are some SCA pt education?
```
Avoid high altitudes
Avoid strenuous exercise
Avoid dehydration
get vaccinations
warm compression for pain=vasodilation
don't use cold compression=vasoconstriction
```
354
Explain what high altitudes, strenuous exercise, and dehydration does to SCA pt?
high altitude=less O2 in high elevation->sickle cell crisis
Strenuous exercise=dehydration and increase O2 demand=sickle cell crisis
hydration=decrease sickle cells from sticking together causing clots
355
what is albumin range?
3.5 to 5.0
356
what is renal calculi ?
Stones that form in the urinary tract-- in kidney or down ureter
357
wath causes kidney stones?
```
diet high in calcium (hypercalcemia), vit D, or purines
Dehyration
increase uric acid
infections
obstruction somewhere in urinary tract
```
358
what is the most common renal calculi?
Calcium oxalates (hypercalcemia)
359
What are sx of renal calculi?
Flank pain which radiates from lumbar to side to testicles or bladder (pain can be severe or dull)
Renal Colic
Sign of UTI
Acute urinary retention
Hemauria
360
What is renal colic
Sharp wavelike rhythmic constant pain causing pt to have hard time staying still
pt will walk around, sit down, get up lay down
361
what are signs of UTI?
mild shock with cool, moist skin, dysuria, fever, and chills
362
What are some Dx for renal calculi?
Ultrasound
| Identify type CT-KUB
363
What are some nursing actions when caring for renal calculi pt?
```
Monitor VS looking for infection
Monitor I/O
Increase fluid intake to 3000ml/day for urine output of 2000ml/day
Admin analgesia (opioids and NSAIDs)
Promote ambulation
Strain urine to catch stone
```
364
What are signs of infection ?
fever, tachy, increase WBC
365
What are some treatment options of renal caculi?
EWSL (eletracorporeal shock-wave lithotripsy)
| lithotomy
366
What is EWSL? What does it do?
Electracorporeal shock-wave lithotripsy
| shock wave that polarize kidney stone to powder to get out
367
What is lithotomy?
surgical method for removal of calculi
368
What are some renal calculi pt teaching?
Diet low in sodium during kidney stone
increase fluid intake during and after kidney stone(after to prevent reoccurence)
Avoid food like colas, coffee, and teas to prevent recurrence
369
In diabetic pts albumin in urine indicates what disorder?
Nephropathy
