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NURS 723 Med/Surg 1 > Test 3 > Flashcards

Test 3 Flashcards

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
Q

What are the early symptoms of dumping syndrome?

A

Vertigo

Diaphoresis  

Tachycardia 

Palpitations 

Nausea  

Vomiting 

Pallor
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26
Q

What are the late symptoms of dumping syndrome?

A

These are driven by hypoglycemia
Cramping
Dizziness
Diaphoresis
Confusion

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27
Q

What is the cause of pernicous anemia?

A

Lack of intrinsic factor causes a decrease in B12 absorption

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28
Q

What are the SSAs for pernicous anemia>

A

Parathesias
Pallor
Glossitis
Fatigue
Decrease H&H
Loss of appetite
Patchy tongue lesions

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29
Q

What are the characteristics of ulcerative colitis?

A

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

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30
Q

What are the characteristics of Crohn’s disease?

A

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

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31
Q

What type of diet is recommended for IBS?

A

low fiber during acute
high fiber when stable
Low residue diet (no nuts, seeds, or indigestible particles)

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32
Q

What is a dangerous complication of IBS?

A

Toxic mega colon (enlarged dilation of colon that can lead to gangrene and peridontis)

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33
Q

What are the different types of fistulas?
Enterocutaneous:
Enteroenteric:
Enterovesicular:
Enterovaginal:

A

Enterocutaneous opening between gut and skin

Enteroenteric opening between gut and gut

Enterovesicular gut and bladder

Enterovaginal gut and vagina

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34
Q

What nursing procedure should you never perform on a patient who has had a history of esophageal or gastric surgery?

A

An NG tube

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35
Q

What viruses are most commonly the causes of hepatitis?

A

Hepatitis A, B, C

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36
Q

What medications can commonly cause hepatitis?

A

Acetaminophen, NSAIDs

37
Q

What secondary infections can present themselves with hepatitis if the person has a compromised immune system>

A

Epstein Barr (mono)
Varicella Zoster
Herpes Simplex
Cytomegalovirus

38
Q

What causes pruritus during hepatitis?

A

Bile salt accumulation

39
Q

An increased AST, ALT, ALP indicates?

A

A decrease in the function of the liver

40
Q

What do we expect to see with albumin with liver impairment?

A

We expect albumin to go down

41
Q

What is fulmanating hepatitis?

A

Hepatitis that cannot be resolved->severe liver failure

42
Q

What are the different types of cirrhosis?
Post - necrotic:
Laennec’s:
Biliary:

A

Post - necrotic: result of hepatitis Laennec’s – chronic alcoholism
Biliary – chronic biliary obstruction or autoimmune disease

43
Q

What lab values increase in liver cirrhosis?

A

We see an increase in AST, ALT,LDH, Alkaline phosphatase, Bilirubin, Ammonia, Creatinine

44
Q

What labs do we see a decrease in liver cirrhosis>

A

Serum albumin
RBC, WBC

45
Q

An increase in creatinine when the liver is cirrhosed can indicate?

A

A predictor of mortality because this indicates the renal system is also starting to fail

46
Q

What is Hepatic encephalopathy?

A

deteriorating mental status due to a buildup of ammonia

47
Q

What are the nursing interventions for Hepatic encephalopathy?

A

Implement safety and fall precautions
Administer lactulose to excrete ammonia in stool

48
Q

What medication should you administer to lower the risk of esophageal varicies rupture?

A

Beta Blockers

49
Q

What is Endoscopic Variceal Ligation?

A

Small ”O” bands placed @ base of varices occludes the vessel

50
Q

What is Endoscopic Sclerotherapy?

A

Varices injected with sclerosing agent

51
Q

What is a Balloon Tamponade in regards to esophageoal varicies?

A

the balloon puts pressure on the varices until long term permanent intervention can be completed

52
Q

What is a Transjugular Intrahepatic Portal-Systemic Shunt?

A

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
Q

What are the pros and cons of a transjugular intrahepatic portal-systemic shunt?

A

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
Q

When is a Sengstaken-Blakemore Tube used?

A

Only in the ICU setting when esophageal varicies rupture, because you can easily loose the airway

55
Q

What is Hepatopulmonary syndrome?

A

When the liver fails, you begin to see the respiratory system fail too

56
Q

What is Nephritic syndrome?

A

chronic, progressive destruction of glomeruli

57
Q

What is Nephrotic syndrome?

A

Massive damage to glomeruli that is immunologic in nature

58
Q

What will you see in the urine during nephritic syndrome?

A

A little protein and a LOT of red blood cells

59
Q

What will you see in the urine during nephrotic syndrome?

A

Lots of protein, little rbcs

60
Q

What are SSAs are you going to see with nephritic syndrome?

A

Oligura
Proteinura
Hematuria
HTN
Fatigue
Edema
Crackles in lungs
increased BUN and Creatinine

61
Q

What are SSAs are you going to see with nephrotic syndrome?

A

significant loss of protein (proteinuria)
generalized edema (anasarca), hypotension (losing volume)
RAAS activation leading to fluid retention and worsening edema, HTN
hyperlipidemia
hypoalbuminemia

62
Q

What is chronic kidney disease?

A

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
Q

What are the greatest risk factors for chronic kidney disease?

A

Diabetes and HTN

64
Q

What are the early stage symptoms of CKD?

A

Azotemia, mild acidosis, anemia, F&E imbalances, HTN, polyuria

65
Q

What are the late stage symptoms of CKD?

A

Uremia
encephalopathy
neuropathy
osteodystrophy
oliguria/anuria
skin disorders
CV disorders
GI disorders
Metabolic derangements

66
Q

What is diverticulitis?

A

The impaction and infection of pouches in the intestine

67
Q

What is diverticulosis?

A

presence of pouch like herniations protruding through the intestinal wall

68
Q

Where are divertiuli most likely to form?

A

In the sigmoid colon

69
Q

What diet does someone with diverticultis need to eat?

A

Low fiber during acute phase
high fiber once pain resides
low residue diet

70
Q

What kind of fruits and vegtables should be avoided?

A

strawberries,cucumbers, tomatoes, figs, popcorn

71
Q

Should a client with diverticultis use laxatives?

A

No, because it can increase peristalsis and increase outpouching of the lumen

72
Q

An Irreducible hernia is one that?

A

Cannot be moved back by gentle palpation

73
Q

What is bowel intusseption?

A

A telescoping of bowel

74
Q

What is a bowel volvus?

A

180 twist of bowel

75
Q

What is a truss?

A

A pad that can be worn after the provider has reduced the hernia

76
Q

What type of obstruction would symptoms of abdominal discomfort with epigastric abd distention, nausea & profuse projectile vomiting, obstipation and metabolic alkalosis indicate?

A

A small bowel obstruction

77
Q

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?

A

Bowel perforation

78
Q

What are the different types of urinary incontienence?

A

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
Q

What are the surgical interventions for BPH?

A

Transurethral needle ablation
Prostatic stent
Transurethral microwave therapy
Prostate artery embolization
Transurethral resection of prostate

80
Q

What electrolytes do we limit in CKD?

A

Na, Phos, Mag

81
Q

What is the first step if someone comes in with CKD?

A

Place them on a cardiac monitor

82
Q

In CKD, what is platlet malfunction caused by?

A

Uremia

83
Q

What are the nutritional recommendations for CKD?

A

Carbs for energy
Limited sodium/potassium/phosphate
Restrict protein
Cold/frozen food for stomatitis

*Educate on metallic taste in mouth from uremia

84
Q

What is odium Polystyrene Sulfonate (Kayexalate) used to treat?

A

Hyperkalemia

Pt will poop ALOT

85
Q

How long does Epoetin alpha (Epogen) take to work, and what is it used for?

A

3 weeks
Used to treat anemia by raising H &H

86
Q

What is
continuous Renal Replacement Therapy (CRRT)?

A

A type of dialysis used in critically ill patients in the ICU–more gentle processes for those who can’t handle sudden shifts

87
Q

What are the indicators for hemodialysis?

A

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
Q

What are the components of hemodialysis?

A

Dialyzer (machine)
Dialysate (fluid; NEVER GOES INTO PATIENT)
Vascular Access– emergent or long-term (Fistula)

89
Q

What are the risks of peritoneal dialysis?

A

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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