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NURS 723 Med/Surg 1 > Test 3 > Flashcards

Test 3 Flashcards

(89 cards)

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1
Q

What are some of the pharmacological causes of GERD?

A

Calcium Channel blockers
Nitrates
Anti-cholinergic drugs
NSAIDS

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2
Q

What are some specific time related SSAs for GERD?

A

Horseness in the AM
Coughing and wheezing in PM

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3
Q

What is Odynophagia?

A

Painful swalowing and is a symptom of GERD

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4
Q

If pharmacologic treatment is not successful for GERD, what are the other 2 options?

A

Ambulatory pH Monitoring Examination
Esophagogastroduodenoscopy

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5
Q

What are the two types of Ambulatory pH Monitoring Examinations?

A

Placing a small catheter through the nose into the distal esophagus for 24 hours

Temporarily attaching a small capsule to the wall of the esophagus during an upper endoscopy (Patient is asked to keep a journal of the food they eat for 24 to 48 hours)

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6
Q

Which antacids are magnesium based?

A

Maalox and Mylanta

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7
Q

What is Gaviscon?

A

An aluminum containing antacid that is given to pts with CKD

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8
Q

What are the different side effects from aluminum and magnesium antacids?

A

Aluminum = constipation; Mag = diarrhea

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9
Q

How do H2 blockers like Famotidine work?

A

Generally decreases acid by blocking the parietal cells in the stomach

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10
Q

What is a Stretta Procedure?

A

Nonsurgical procedure that uses radiofrequency energy through an endoscope to help tighten the LES (lower esophageal sphincter).

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11
Q

What are the post procedure nursing interventions after a stretta procedure?

A

Clear Liquids for 24 hrs
After first day advance to soft diet
Avoid NSAIDs for 10 days
Use liquid medications when possible
No NG tube for 1 month

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12
Q

What is a Laparoscopic Nissan Fundoplication?

A

A procedure commonly used in hiatal hernia repair that wraps the stomach qqaround esophagus to reinforce the function of the Lower Esophageal Sphincter.

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13
Q

What are some of the factors that contribute to peptic ulcer disease (PUD)?

A

Corticosteriods (prednisone)
Caffeine
Spicy foods
NSAIDs

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14
Q

What SSAs would be observed for a gastric ulcer?

A

Pain occurs 30-60 minutes after a meal and rarely is worse at night

Pain is worse with ingestion of foods

Pain located to the left of the midline or upper epigastrium

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15
Q

What SSAs woudl be observed with a duodenal ulcer?

A

Pain occurs 1 ½ - 3 hrs after a meal

Pain often awakens the patient between 1 & 2 am

Pain relieved by ingestion of food

Melena (blood in stool) more common than hematemesis (bloody vomit)

Pain located to the right or below epigastrium (Duodenal)

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16
Q

What are signs and symptoms of both gastric and duodenal ulcers?

A

Dyspepsia

Sharp burning or gnawing pain

Bloating

Nausea

Uncomfortable feeling of fullness or hunger

Weight Loss due to changes in nutrition and intake

Anemia

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17
Q

What are the education points for Sucralfate (Carafate), Bismuth Subsalicylate (Kaopectate)?

A

Give 1 hr before and 2 hrs after meal & HS
Do not administer within 30 mins of antacids or other medications
Bismuth: avoid ASA (asprin)

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18
Q

What are the two common pairs of antibiotics given during triple therapy for H. Pylori infections?

A

Metronidazole + Tetracycline, Clarithromycin + Amoxicillin

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19
Q

What is a Gastrectomy?

A

A surgical treatment for PUD that involves all of part of the stomach removed. More common with gastric cancer than with PUD though

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20
Q

What is a Gastroduodenostomy?

A

Also known as a biliroth I, lower portion of stomach removed, remaining portion attached to duodenum

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21
Q

What is a Gastrojejunostomy?

A

Also known as a biliroth II, lower portion of stomach removed, remaining portion attached to jejunum

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22
Q

What is a Vagotomy?

A

branches of vagus nerve (fibers) that supply stomach are cut to interrupt acid production

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23
Q

What is a Pyloroplasty?

A

opening between the stomach and small intestine is enlarged to increase the rate of gastric emptying

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24
Q

What are some of the signs of a GI hemorrage?

A

Increased HR, RR
BP drop
Boardlike abdomen
Rebound tenderness
Fetal position

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25
What are the early symptoms of dumping syndrome?
Vertigo Diaphoresis Tachycardia Palpitations Nausea Vomiting Pallor
26
What are the late symptoms of dumping syndrome?
These are driven by hypoglycemia Cramping Dizziness Diaphoresis Confusion
27
What is the cause of pernicous anemia?
Lack of intrinsic factor causes a decrease in B12 absorption
28
What are the SSAs for pernicous anemia>
Parathesias Pallor Glossitis Fatigue Decrease H&H Loss of appetite Patchy tongue lesions
29
What are the characteristics of ulcerative colitis?
10-20 bloody stools per day Location: begins in the rectum and proceeds in a continuous manner towards the cecum Complications: Hemorrage and nutritional deficiences Less frequent need for surgery
30
What are the characteristics of Crohn's disease?
5-6 loose stools per day (not bloody with steatorrhea) Location: Most often occurs in the terminal ileum with patchy involvement through all layer of the bowel Complications: Fistula, nutritional deficencies, anemia common Frequent need for surgery Unintentional Weight loss
31
What type of diet is recommended for IBS?
low fiber during acute high fiber when stable Low residue diet (no nuts, seeds, or indigestible particles)
32
What is a dangerous complication of IBS?
Toxic mega colon (enlarged dilation of colon that can lead to gangrene and peridontis)
33
What are the different types of fistulas? Enterocutaneous: Enteroenteric: Enterovesicular: Enterovaginal:
Enterocutaneous opening between gut and skin Enteroenteric opening between gut and gut Enterovesicular gut and bladder Enterovaginal gut and vagina
34
What nursing procedure should you never perform on a patient who has had a history of esophageal or gastric surgery?
An NG tube
35
What viruses are most commonly the causes of hepatitis?
Hepatitis A, B, C
36
What medications can commonly cause hepatitis?
Acetaminophen, NSAIDs
37
What secondary infections can present themselves with hepatitis if the person has a compromised immune system>
Epstein Barr (mono) Varicella Zoster Herpes Simplex Cytomegalovirus
38
What causes pruritus during hepatitis?
Bile salt accumulation
39
An increased AST, ALT, ALP indicates?
A decrease in the function of the liver
40
What do we expect to see with albumin with liver impairment?
We expect albumin to go down
41
What is fulmanating hepatitis?
Hepatitis that cannot be resolved->severe liver failure
42
What are the different types of cirrhosis? Post - necrotic: Laennec’s: Biliary:
Post - necrotic: result of hepatitis Laennec’s – chronic alcoholism Biliary – chronic biliary obstruction or autoimmune disease
43
What lab values increase in liver cirrhosis?
We see an increase in AST, ALT,LDH, Alkaline phosphatase, Bilirubin, Ammonia, Creatinine
44
What labs do we see a decrease in liver cirrhosis>
Serum albumin RBC, WBC
45
An increase in creatinine when the liver is cirrhosed can indicate?
A predictor of mortality because this indicates the renal system is also starting to fail
46
What is Hepatic encephalopathy?
deteriorating mental status due to a buildup of ammonia
47
What are the nursing interventions for Hepatic encephalopathy?
Implement safety and fall precautions Administer lactulose to excrete ammonia in stool
48
What medication should you administer to lower the risk of esophageal varicies rupture?
Beta Blockers
49
What is Endoscopic Variceal Ligation?
Small ”O” bands placed @ base of varices occludes the vessel
50
What is Endoscopic Sclerotherapy?
Varices injected with sclerosing agent
51
What is a Balloon Tamponade in regards to esophageoal varicies?
the balloon puts pressure on the varices until long term permanent intervention can be completed
52
What is a Transjugular Intrahepatic Portal-Systemic Shunt?
A nonsurgical procedure performed in IR where a sheath introduced in jugular and advanced to portal vein where stent is placed Stent is expanded using balloon inflation Stent forms a shunt between portal vein and hepatic vein that bypasses the liver to reduce pressure in hepatic vasculature
53
What are the pros and cons of a transjugular intrahepatic portal-systemic shunt?
The pros are that it is used when other interventions aren't successful The cons are that it bypasses the liver's filtration and metabolizing processes
54
When is a Sengstaken-Blakemore Tube used?
Only in the ICU setting when esophageal varicies rupture, because you can easily loose the airway
55
What is Hepatopulmonary syndrome?
When the liver fails, you begin to see the respiratory system fail too
56
What is Nephritic syndrome?
chronic, progressive destruction of glomeruli
57
What is Nephrotic syndrome?
Massive damage to glomeruli that is immunologic in nature
58
What will you see in the urine during nephritic syndrome?
A little protein and a LOT of red blood cells
59
What will you see in the urine during nephrotic syndrome?
Lots of protein, little rbcs
60
What are SSAs are you going to see with nephritic syndrome?
Oligura Proteinura Hematuria HTN Fatigue Edema Crackles in lungs increased BUN and Creatinine
61
What are SSAs are you going to see with nephrotic syndrome?
significant loss of protein (proteinuria) generalized edema (anasarca), hypotension (losing volume) RAAS activation leading to fluid retention and worsening edema, HTN hyperlipidemia hypoalbuminemia
62
What is chronic kidney disease?
Involves progressive, irreversible loss of kidney function defined by pathological abnormalities (over 50% of nephrons are damaged before symptoms appear), biomarkers of damage in laboratory values and an under 60 mL/min GFR for more than 3 months
63
What are the greatest risk factors for chronic kidney disease?
Diabetes and HTN
64
What are the early stage symptoms of CKD?
Azotemia, mild acidosis, anemia, F&E imbalances, HTN, polyuria
65
What are the late stage symptoms of CKD?
Uremia encephalopathy neuropathy osteodystrophy oliguria/anuria skin disorders CV disorders GI disorders Metabolic derangements
66
What is diverticulitis?
The impaction and infection of pouches in the intestine
67
What is diverticulosis?
presence of pouch like herniations protruding through the intestinal wall
68
Where are divertiuli most likely to form?
In the sigmoid colon
69
What diet does someone with diverticultis need to eat?
Low fiber during acute phase high fiber once pain resides low residue diet
70
What kind of fruits and vegtables should be avoided?
strawberries,cucumbers, tomatoes, figs, popcorn
71
Should a client with diverticultis use laxatives?
No, because it can increase peristalsis and increase outpouching of the lumen
72
An Irreducible hernia is one that?
Cannot be moved back by gentle palpation
73
What is bowel intusseption?
A telescoping of bowel
74
What is a bowel volvus?
180 twist of bowel
75
What is a truss?
A pad that can be worn after the provider has reduced the hernia
76
What type of obstruction would symptoms of abdominal discomfort with epigastric abd distention, nausea & profuse projectile vomiting, obstipation and metabolic alkalosis indicate?
A small bowel obstruction
77
Pain in the chest or abd that radiates to the back or right shoulder, abdominal distention, vomiting, board like abdomen, rebound tenderness, hemodynamci instability all are indicators of a?
Bowel perforation
78
What are the different types of urinary incontienence?
Stress: precipitated by increased abd pressure Urge: Strong urge to void followed by leakage Overflow: Overditended bladder, incomplete emptying Functional: Barriers to get to bathroom
79
What are the surgical interventions for BPH?
Transurethral needle ablation Prostatic stent Transurethral microwave therapy Prostate artery embolization Transurethral resection of prostate
80
What electrolytes do we limit in CKD?
Na, Phos, Mag
81
What is the first step if someone comes in with CKD?
Place them on a cardiac monitor
82
In CKD, what is platlet malfunction caused by?
Uremia
83
What are the nutritional recommendations for CKD?
Carbs for energy Limited sodium/potassium/phosphate Restrict protein Cold/frozen food for stomatitis *Educate on metallic taste in mouth from uremia
84
What is odium Polystyrene Sulfonate (Kayexalate) used to treat?
Hyperkalemia Pt will poop ALOT
85
How long does Epoetin alpha (Epogen) take to work, and what is it used for?
3 weeks Used to treat anemia by raising H &H
86
What is continuous Renal Replacement Therapy (CRRT)?
A type of dialysis used in critically ill patients in the ICU–more gentle processes for those who can’t handle sudden shifts
87
What are the indicators for hemodialysis?
BUN > 75-120 mg/dL (Uremia) Uncontrolled hypertension Metabolic acidosi GFR < 15mL/min Serum potassium > 6mEq/L Fluid volume overloa Thrombosis False Aneurysm Formation, Infection
88
What are the components of hemodialysis?
Dialyzer (machine) Dialysate (fluid; NEVER GOES INTO PATIENT) Vascular Access– emergent or long-term (Fistula)
89
What are the risks of peritoneal dialysis?
Infection (peritonitis) Weight gain (because fluid has a lot of glucose that can be absorbed by the body causing hyperglycemia) Weakening of the abdominal muscles

NURS 723 Med/Surg 1 (6 decks)

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