Unit 2 Flashcards

Question

gastroenteritis

Answer 1

* inflammation of mucous membranes of stomach and/or small bowel * trigger: bacterial or **viral (most common)** infection * most cases self-limiting, ~ 3 days * risk for * fluid and electrolyte imbalance * impaired nutrition

Answer 2

* Hx: recent restaurant visit (24-36 hr) or travel * S/Sx * ill appearance * N/V → abd cramping, diarrhea * signs of dehydration

Answer 3

* prevent spread * handwashing * sanitizing surfaces * self-manage @ home unless severe * oral fluid replacement w/ Gatorade, Powerade, or Pedialyte * avoid antiemetics/antidiarrheals, or any drug that suppresses gastric motility * abx may be needed for bacterial infection

Answer 4

ulcerative colitis

Answer 5

most Dx @ 15-35 y/o

Answer 6

* inflammation of rectosigmoid colon, can extend to whole colon * priodic remissions and exacerbations * mucosa → * hyperemic * edematous * reddened * bleed w/ small erosions * possible abscesses → tissue necrosis * → edema, mucosal thickening → partial bowel obstruction

Answer 7

* abscesses * hemorrhage (perf) * tosic megacolon * malabsorption * nonmechanical bowel obstruction * fistulas * colorectal CA (Hx \> 10 yrs) * extraintestinal complications

Answer 8

* arthritis * hepatic and biliary dz * oral and skin lesions * ocular d/o

Answer 9

* fam Hx of IBD * nutrition Hx and habits * bowel elimination pattern * onset of Sx * VS * abd distention, pain * psychosocial assessment

Answer 10

* abd distension * blood and mucus in stool * lower abd colicky pain relieved w/ defecation * malaise * fatigue * anorexia * wt loss * extraintestinal manifestations * fever * anemia * dehydration

Answer 11

* mild: \< 4 stools/day, non-bloody * moderate: \> 4 stools/day, w/ or w/o blood * severe: \> 6 bloody stools/day * fulminant: \> 10 bloody stools/day

Answer 12

coming on suddenly and with great severity

Answer 13

* similar to those for Crohn's dz * ↓ H&H: chronic blood loss * ↓ Na⁺, K⁺, and Cl^-: diarrhea and malabsorption

Answer 14

* MRE * NPO 4-6 hr before * contrast used * colonoscopy * bowel prep very uncomfortable for UC/CD pts * frequent scopes recommended in 10+ yr Hx of UC d/t high CA risk * barium enema w/ air contrast

Answer 15

magnetic resonance enterography

Answer 16

* meds: similar to those for Crohn's * 5-ASAs * corticosteroids * antidiarrheals * BRMs (refractory, severe complications) * nutrition * bowel rest: NPO w/ TPN * avoid * caffeine * ETOH * some veggies, high-fiber foods * lactose * nuts * carbonated drinks * surgeries

Answer 17

* temp or perm ileostomy: prior abd surgery or abd scar may r/o lap * RPC-IPAA * total proctocolectomy w/ perm ileostomy

Answer 18

restorative proctocolectomy w/ ileal pouch-anal anastomosis

Answer 19

* RPC-IPAA * two-stage procedure to manage UC * Stage 1 * colon and rectum removed and temp ileostomy placed * internal pouch created from last part of small intestine and connected to anus, which remains intact * Stage 2: ileostomy reversal

Answer 20

* chronic inflammatory bowel dz * sites affected * **small intestine, usually terminal ileum** * colon * both * remission-exacerbation cycles * **severe malabsorption** by small intestine more common than in UC * inflammation → bowel wall thickening * fibrosis/scar tissue → strictures and obstruction * ulcerations → risk for fistula

Answer 21

Crohn's Disease

Answer 22

* varies by individual * diarrhea, possibly w/ * steatorrhea * bright red blood * abd pain, RLQ, constant * fever w/ abscess, inflammation, or fistula * wt loss * fluid/electrolyte imbalance * anemia (blood loss + ↓ folic acid, B₁₂)

Answer 23

* chronicity: self-management is important * requires lifestyle changes for pt and fm * level of anxiety * coping skills

Answer 24

* inflammation: ↑ C-reactive protein, ESR * blood loss: ↓ H&H, albumin * diarrhea, fistula: ↓ K⁺, Mg²⁺ * enterovesical fistula or pyuria: ↑ WBCs in urine * CMP

Answer 25

* purpose: to determine motility, bleeding, ulcerations, stenosis, fistulas * types * MRE * abd/pelvic X-ray * US * CT

Answer 26

* opening from bladder to intestine * possible w/ IBD (esp. CD) * → WBCs in urine

Answer 27

* pus in urine * → WBCs in urine (UA)

Answer 28

* 5-ASAs * BRMs/mAbs * abx as ordered * glucocorticoids

Answer 29

* aminosalicylates * used to ↓ inflammation in bowel in IBD * routes * rectal suppository or enema * PO

Answer 30

* exacerbations may require bowel rest (NPO + TPN) * avoid GI stimulants (caffeine, ETOH) * 3,000 kcal/day to promote fistula healing

Answer 31

* pts w/ **fistulas** * **pouches** to capture drainage

Answer 32

* fistula repair or resection * small bowel resection * stricturoplasty

Answer 33

* rest during periods of exacerbation * ↓ stress, esp. if it's a trigger * proper nutrition * wound/skin care w/ fistula (return demo) * S/Sx of infection * consult home health, SW, case management, dietician * support groups

Answer 34

* pain mgmt * explore nonpharm options * goal: acceptable level of comfort for pt * watch for GI bleed * stool color/consistency * H&H * VS * altered body image * home health may be necessary * psychosicial considerations

Answer 35

* healthy: pink or red, moist * unhealthy * bleeding, leaking * itching, painful * swelling/bulging * pale or purple * dry

Answer 36

* crucial to logevity of device * keep clean, dry * have properly fitting wafer * wound care team * pt teaching w/ return demo

Answer 37

* avoid foods that cause gas or are high in fiber * pt should ID well-tolerated foods * get enough salt and water in diet * find ostomy system that works best * skin and stoma care * ostomy care * S/Sx of unhealthy stoma * stoma changes * ↑/↓ in stool output * severe abd pain * meds * avoid enteric-coated or capsules * NO laxatives or enemas

Answer 38

* inflammation and infection of bowel mucosa * etiology: bacteria, food, or fecal matter become trapped in one or more diverticula

Answer 39

pouch-like herniations in intestinal wall

Answer 40

* chronic inflammation of small intestine mucosa * autoimmune w/ genetic, environmental factors * → bowel wall atrophy, malabsorption

Answer 41

* T1DM * RA

Answer 42

* (Sx vary by person) * anorexia * wt loss * abd pain, distention * diarrhea or constipation * steatorrhea

Answer 43

* malnutrition * osteoporosis * Fe-deficiency anemia * protein-calorie malnutrition * joint pain, inflammation * lactose intolerance * migraine * epilepsy * depression

Answer 44

* only Tx option is gluten-free diet * intestinal mucosa generally heal in 2 yrs

Answer 45

* avoid gluten-containing products * wheat, other grains processed in wheat facility * gluten can also be in additives, drugs, or cosmetics * supplemental nutrition needed

Answer 46

* obstruction * IBS

Answer 47

irritable bowel syndrome

Answer 48

* complete or partial * mechanical: physically blocked by object outside, inside, or in wall of intestine * nonmechanical (paralytic ileus): ↓ or absent peristalsis; neuromuscular disturbance

Answer 49

* fluid/electrolyte and acid-base imbalances * severe hypovolemia → AKI * risk for peritonitis w/ ↓ blood flow to intestine * sepsis * GI bleed

Answer 50

* adhesions * tumor * complications of appendicitis * hernias * fecal impaction * strictures d/t inflammation or radiation Tx * intussusception * volvulus * fibrosis

Answer 51

* POI * peritonitis * intestinal ischemia

Answer 52

post-op ileus

Answer 53

loop of intestine twists around itself and the mesentery that supplies it → obstruction

Answer 54

* excessive scarring in intestines → obstruction or stricture * occurs in IBD

Answer 55

* pain and/or cramping, maybe sporadic * vomiting possible * bile, mucus in vomitus * obstipation * diarrhea (diarrhea partial obstruction) * abd distention * auscultation * borborygmi above * sounds absent below

Answer 56

rumbling, gurgling bowel sounds

Answer 57

failure to pass flatus

Answer 58

* assess * VS * wt * abd * NPO until able to pass flatus, stool * NGT for decompression * disimpaction and/or enemas for lower fecal impaction * IV fluid replacement PRN * monitor electrolytes, fluid status * frequent oral care * surgery for complete mechanical obstruction

Answer 59

irritable bowel syndrome

Answer 60

* functional GI d/o * S/Sx: chronic or recurrent diarrhea, constipation, and/or abd pain and bloating * 3 types * IBS-C * IBS-D * IBS-A

Answer 61

* environmental: caffeine, carbonation, dairy * immunologic * genetic * hormonal * stress-related * infectious agents can be biomarkers for IBS

Answer 62

* GI Hx * Sx and exacerbations, including flatulence, bloating, distention * nutrition * drugs * pain, often in LLQ * physical * usually stable wt * bowel sounds * hypo w/ C * hyper w/ D * labs normal

Answer 63

* ambulatory care mgmt * self-mgmt * ↓ stress * general health education * ↑ dietary fiber, 30-40 g/day * 64-80 oz water/day * drug therapy

Answer 64

* (depends on main Sx) * IBS-C: bulk-forming laxative (Metamucil) * IBS-D: antidiarrheal (Imodium) * others * muscarinic receptor antagonists to ↓ motility * probiotics

Answer 65

* etiology * weakness in abd muscle wall allows abd organs/structures to protrude * congenital or acquired via ↑ intra-abd pressure

Answer 66

* indirect/direct inguinal * femoral * umbilical * incisional * epigastric

Answer 67

* nonsurgical or surgical * reducible or irreducible

Answer 68

* protruding abd structure is tightly trapped → **gangrene** * requires **prompt surgery** * nonsurgical reduction **contraindicated**, will severely compromise Tx and outcome * signs * N/V * fever * sudden pain that intensifies quickly * hernia bulge that turns red, purple, or dark * inability to move bowels or pass flatus

Answer 69

* swollen or distended anorectal veins * prolapse of veins d/t ↑ intra-abd pressure * can be internal or external * common * **significant if painful d/t thrombosis and bleeding**

Answer 70

* ↑ fluids * ↑ fiber * avoid straining during BM * exercise regularly * maintain healthy wt

Answer 71

* nonpharm * cold packs * tepid sitz baths 3-4x/day * drugs * OTC topical * anesthetics * steroids * stool softeners * diet ↑ fiber and fluids * surgical: hemorrhoidectomy

Answer 72

* surgical removal of hemorrhoids * type depends on * degree of prolapse * presence of thrombi * health of pt

Answer 73

* parts * liver * gallbladder * pancreas * fxn: secrete enzymes for digestion in stomach and small intestine

Answer 74

* pear-shaped, hollow organ * in RUQ inferior to liver * holds bile * bile flow * liver common hepatic duct → gallbladder * fat digestion triggers gallbladder ctx * → cystic + common hepatic * → common bile cystic + common hepatic * → common bile duodenum

Answer 75

* inflammation of gallbladder * acute or chronic * two types * **calculous: d/t gallstones: most common** * acalculous: w/o gallstones

Answer 76

* formation of gallstones when bile salts precipitate in gallbladder * stones calcified or non * asymptomatic unless bile flow is obstructed

Answer 77

* gallstones obstruct * **cystic duct (most common)** * gallbladder neck * common bile duct * → bile backup into gallbladder * → * irritation * inflammation * impaired circulation * edema * gallbladder distension

Answer 78

* pigmented/calcified * cholesterol

Answer 79

* inflammation of gallbladder w/o calculi * etiology: changes in filling or emptying of gallbladder (biliary stasis) * ↓ blood flow to gallbladder * anatomic issues

Answer 80

* repeated episodes of gallbladder inflammation * often associated w/ calculi * outcomes * scarring, further gallbladder dysfunction * pancreatitis * cholangitis

Answer 81

* infection * ↑ bilirubin * chronic liver dz

Answer 82

* female gender * age * obesity * high-fat diet * rapid wt loss * malabsorption syndromes * HRT * contraceptives * genetics * PG * anatomical obstruction * prolonged TPN * ethnicity/race * Native American * Mexican

Answer 83

* RUQ pain, often radiating to rt shoulder * rebound tenderness * can present as general abd pain * Sx after ingesting fatty food * N/V * belching * flatulance

Answer 84

* fever * tachycardia * dehydration (fever, vomiting) * jaundice/icterus * dark urine * clay-colored stools * steatorrhea * dyspepsia * eructation * flatulence * pruritus * OA: may not have fever or pain

Answer 85

* ↑ WBCs * biliary obstruction: ↑ ALP, AST, LDH, and bilirubin * pancreatic involvement: ↑ amylas, lipase

Answer 86

* US (best intially) * abd X-ray, CT: shows only calcified stones * HIDA scan: traces bile flow to determine patency

Answer 87

* hepatobiliary iminodiacetic acid scan * used to trace flow of bile in cholecystitis Dx

Answer 88

endoscopic retrograde cholangiopancreatography

Answer 89

magnetic resonance cholangiopancreatography

Answer 90

* MRCP * oral/IV contrast used * detailed imaging of hepatobiliary and pancreatic structures * less invasive, safer that ERCP

Answer 91

* ERCP * direct visualization of liver, gallbladder, bile ducts, and pancreas * invasive * allows for therapeutic procedures * sphincterotomy * gallstone removal * stent placement * balloon dilation * Bx

Answer 92

* cholecystitis * a small cut made in papilla of Vater to enlarge opening of bile and/or pancreatic ducts * goals: improve drainage or remove stones in ducts * pancreatitis caused by gallstones * opening created in sphincter of Oddi * pacreatic duct sphincter enlarged if needed

Answer 93

* dietary * high fiber * low fat * small, frequent meals * drug therapy * ESWL * percutaneous transhepatic biliary drain w/ cholecystostomy

Answer 94

* cholecystectomy: removal of gallbladder * lap chole: gold standard Tx * open: for severe obstruction * NOTES: new MIS procedure

Answer 95

* laparoscopic cholecystectomy * process * abd insufflated using 3-4 L CO₂ * trocars puncture abd, laparoscope inserted * bile aspirated, stones crushed * gallbladder removed via umbilical port

Answer 96

blow air or gas into a cavity

Answer 97

minimally invasive surgery

Answer 98

natural orifice transluminal endoscopic surgery

Answer 99

* flexible scope passed through natural orifice to furth minimize size/number of incisions necessary * decreases post-op complications, and possibly pain * routes: mouth, vagina, anus

Answer 100

* for severe biliary obstruction * rarely done * biliary ducts explored to ensure patency * drain may be placed to reduce post-op fluid accumulation * JP * T-tube

Answer 101

* pain * opioids for acute pain * ketorolac for mild-moderate pain * N/V: antiemetics * inflammation/infection: IV abx * stones: bile acids

Answer 102

* for acute biliary pain * drugs * morphine sulfate * hydromorphone * ***may cause sphincter of Oddi spasm***

Answer 103

* for mild to moderate biliary pain * NSAID * ***risk for GI bleed***

Answer 104

* to dissolve cholesterol-based stones in pts who cannot or will not undergo surgery * compounds naturally produced in body * drugs: take w/ food or milk * ursodiol * chenodiol

Answer 105

extracorporeal shock wave lithotripsy

Answer 106

* breaks up small, cholesterol-based stones * good when surgery is contraindicated * requirements * average/normal wt * good gallbladder fxn * process * pt lays on fluid-filled pad * shock waves delivered via pad * possible results * spasms * stone movement * pain, discomfort * meds: possible UDCA to further break up fragments

Answer 107

* ursodeoxycholic acid * bile acid * sometimes used after ESWL to break up remaining fragments

Answer 108

* Jackson-Pratt * surgical drain with flexible bulb that uses gentle mechanical suction to remove accumulating fluid * expected course * diminishing amounts of serosanguineous * color: red → light pink/yellow * removal when drainage \< 25 mL/day x2 days * monitor and document output closely * abx to prevent infection

Answer 109

* expected course * sanguineous/serosanguineous → bile color * ≤ 400 mL in first 24 hr, then ↓ * *removal in 1-3 wks* * no drainage + N/V could mean obstruction * monitor * and record color, amount * insertion site for inflammation, infection, leakage * color of stools (white/clay = no bile) * VS * skin color * pain level * tolerance of diet/intake * pain meds, abx * ***report immediately*** * ***abd pain +*** ***fever*** + ***jaundice = bile peritonitis*** * ***output 500 mL/24 hr***

Answer 110

* surgical drain placed in common bile duct after surgery and exploration * prevents buildup of bile d/t postop swelling/inflammation

Answer 111

* preop/postop info baseed on procedure * dietary: avoid fatty and gas-causing foods * post-op * lap chole: early ambulation to expel CO₂ * incision/drain care * S/Sx of dehiscence or evisceration * resume activity gradually * open chole: no heavy lifting for 4-6 wks * drain: showers, not baths, until removed * S/Sx of infection, when to see provider

Answer 112

* bile duct obstruction * gallbladder rupture * peritonitis * post-cholecystectomy syndrome * hepatic CA

Answer 113

manifestations of gallbladder dz after removal

Answer 114

* shape: elongated, tapered * position * retroperitoneal, posterior to stomach * close to liver, near L1, L2 vertebrae * head on right (larger end) * in curve of duodenum * connected by pancreatic duct * tail on left (smaller), near spleen * head lies in curve of duodenum, connected by pancreatic duct * composition: 2 types of glands * 95% exocrine by mass * 1-2% endocrine

Answer 115

* makes up 95% of pancreas by mass * secrete enzymes to break down starches, proteins, and fats * activated by presence of food small intestine

Answer 116

* 1-2% of pancreas by mass * consists of islets of Langerhans * primary d/o associated w/ these glands: DM

Answer 117

* alkali: HCO₃ * enzymes * proteases * trypsinogen * chymotrypsinogen * amylase * lipase * other enzymes

Answer 118

* bicarbonate * alkaline/base

Answer 119

* secreted from pancreatic duct cells → lumen → duodenum * neutralizes HCl from stomach

Answer 120

* insulin * glucagon * somatostatin * pancreatic polypeptide

Answer 121

* inflammation of pancreas * etiology: not always known; possibilities are * obstructions * ETOH * autimmune dz * acute or chronic

Answer 122

* inflammation of pancreas → 1. ↑ duct pressure 2. → duct rupture 3. → enzymes released in pancreas 4. → autodigestion of pancreatic tissue 5. → inflammation, pain, fibrosis * untreated → NHP

Answer 123

* necrotizing hemorrhagic pancreatitis * result of untreated pancreatitis

Answer 124

* result of untreated pancreatitis * involves these processes * diffuse bleeding of pancreatic tissue * scarring * tissue death

Answer 125

* → permanent damage * almost always result of ETOH abuse * several types

Answer 126

↑ enzyme production

Answer 127

* chronic calcifying: usually r/t ETOH abuse * chronic obstructive: usually r/t cholelithiasis * autimmune * idiopathic * hereditary

Answer 128

* ETOH and drug toxicity * stones in common bile duct * genetics * cystic fibrosis * trauma * postop manipulation * OA * viral infection * autoimmunity

Answer 129

* sudden onset of pain * possible locations * LUQ radiating to back * mid-epigastric * left flank * left shoulder * descriptions * boring * gnawing * stabbing * often relieved by bending abd * worse when lying down * N/V, w/ no relief of pain * wt loss

Answer 130

* blood seeping into tissues * Cullen's sign * Turner's sign * jaundice * absent or hypoactive bowel sounds * hyperglycemia * abd guarding * tachycardia * fever * ascites * possible * palpable mass * **paralytic ileus** * **pleural effusion** * steatorrhea * dark urine * clay-colored stool * polyuria * polydipsia * polyphagia * hypocalcemia → * MSK tetany * Trousseau's sign * Chvostek's sign

Answer 131

* blood seeping into tissues → periumbilical discoloration * blue/gray * most often a sign of hemorrhagic pancreatitis

Answer 132

* blood seeps into tissues → ecchymosis on flanks * most often a sign of hemorrhagic pancreatitis

Answer 133

* hand spasm occurs when BP cuff inflated * indicates **hypocalcemia**

Answer 134

* face twitches when facial nerve is tapped * indicates **hypocalcemia**

Answer 135

* CT w/ contrast: reliable, accurate * abd X-ray and/or US: to look for gallstones * ERCP * HIDA scan

Answer 136

* pharm Tx * ERCP w/ sphincterotomy

Answer 137

* cholecystectomy * endoscopic pancreatic necrosectomy + NOTES * pancreaticojejunostomy

Answer 138

* pain: opioids * morphine * hydromorphone * NOT meperidine (sz, esp. in OA) * inflammation/infection: abx * imipenem * usu. for necrotizing * monitor for S/Sx of infection, sz * acid reduction * H2 blocker: ranitidine * PPI: omeprazole * digestive aid: pancrelipase

Answer 139

* digestive aid used for pancreatitis * give w/ every food/snack * drink full glass of water * can sprinkle capsule contents on nonprotein foods * take after antacid or H2 blocker * wipe and rinse mouth to prevent breakdown

Answer 140

for pancreatitis caused by cholecystitis and cholelithiasis

Answer 141

* reroutes pancreatic secretion drainage into the jejunum * Roux-en-Y: anastamosis technique used in LPJ

Answer 142

* anastamosis technique * used in several surgeries * pancreaticojejunostomy * pancreatic head resection * Tx of lesion in pancreatic head

Answer 143

* cholecystectomy * endoscopic pancreatic necrosectomy and NOTES * pancreaticojejunostomy

Answer 144

longitudinal pancreaticojejunostomy

Answer 145

* NPO/gut rest until pain resolves * TPN or J-tube feedings if condition not severe * J-tube contraindicated if pt has paralytic ileus * restarting solid food * bland * high-protein * low-fat * small, frequent meals * no caffeine * may need dietary consult

Answer 146

total parenteral nutrition

Answer 147

peripheral parenteral nutrition

Answer 148

* give meds as ordered: analgesics, abx, antiemetics * position for comfort * fetal * side-lying * HOB elevated * sitting leaned forward * monitor * BG, give insulin as ordered * hydration: I&O, labs, orthostatic BP * give IV fluids, electrolytes as ordered

Answer 149

* hypertonic IV solution * **only give in central line** * complete nutrition * usually * ≤ 700 kcal/day * ***↑ glucose concentration*** * can be given w/ lipids, ≤ 30% concentration

Answer 150

* ≤ 10% dextrose * given via PIV

Answer 151

* isotonic * hypotonic * hypertonic

Answer 152

* NS * osmolarity ≈ plasma * solution stays in intravasular space * expands intravascular compartment, ↑ fluid volume

Answer 153

* 1/2 NS * osmolarity lower than plasma * draws fluid out of intravascular compartment * hydrates cells and interstitial compartment

Answer 154

* TPN, 3% NS * osmolarity higher than that of plasma * draws fluid into intravascular compartment from cells, interstitial compartment

Answer 155

another RN

Answer 156

* cell injury * ↑ serum amylase * ↑ serum lipase * ↑ serum trypsin * ↑ serum elastase * cell injury/↓ insulin release: ↑ serum glucose * fat necrosis: ↓ Mg²⁺ and Ca²⁺ * hepatobiliary involvement * ↑ bilirubin (obstruction) * ↑ ALT * ↑ AST * inflammation: ↑ WBCs, ESR

Answer 157

* I&O + * daily wt * PO nutrient intake * labs * prealbumin * albumin * glucose * electrolytes * CBC * infection * fever, chills * ↑ WBCs * redness @ catheter insertion

Answer 158

* soybeans * safflower * eggs (lipid solution)

Answer 159

* use * micron filter * IV pump * strict asepsic technique * rate * start slowly * increase to goal rate gradually * **NEVER catch up** by increasing rate * **NEVER STOP SUDDENLY** * taper to D/C * if next bag unavailable, use destrose solution * change bag and tubing Q24H * **TOTAL INCOMPATIBLE**

Answer 160

distal to the filter

Answer 161

D10W or D20W

Answer 162

* hyper- or hypoglycemia * electrolyte imbalances * dehydration * fluid overload

Answer 163

* catheter misplacement * embolus

Answer 164

hyperosmolar diuresis from hyperglycemia

Answer 165

wt gain \> 1 kg/day + edema

Answer 166

* metabolic * mechanical * infectious (→ sepsis)

Answer 167

* sliding scale or IV insulin for hyperglycemia * dextrose for hypoglycemia

Answer 168

to avoid rebound hypoglycemia

Answer 169

* S/Sx * proper diet * importance of med adherence, esp. if chronic * ETOH cessation * management of complications

Answer 170

* hypovolemia * left pleural effusion → pneumonia * DIC * multi-system organ failure * T2DM or T1 if pancreas is destroyed * paralytic ileus * pancreatic abscess * pancreatic pseudocyst * pancreatic CA

Answer 171

* cause: third-spacing * → hypovolemic shock

Answer 172

too much fluid moves intravascular → interstitial

Answer 173

* restlessness * anxiety * agitation * confusion * weakness * lightheadedness * tachycardia * appearance: stable → critically ill * AMS * UOP \< 30 mL/hr * ↑ cap refill * gooseflesh

Answer 174

* may require prolonged NGT for decompression * assess for passage of flatus

Answer 175

necrotizing

Answer 176

* must be drained * abx not effective alone * ↑ mortality d/t easy spread to other organs

Answer 177

* can rupture and cause * hemorrhage * abscess * fistula * Tx * may resolve on its own * surgical removal

Answer 178

* devastating * low 5-year survival * often found late * well-developed * aggressive * very painful; pt often has vague abd pain * common Tx: Whipple

Answer 179

* pancreaticoduodenectomy * removal of * head of pancreas * parts of stomach * duodenum * gallbladder * bile duct * sometimes used as Tx for pancreatic CA

Answer 180

chronic, irreversible inflammation and scarring of liver tissue

Answer 181

* loss of normal cellular fxn * development of nodules and fibrous tissue

Answer 182

* chronic ETOH use * drugs * toxins * hepatitis * NAFLD * gallbladder dz * CV dz

Answer 183

* viral * most common: B and D * second most common: C * autoimmune

Answer 184

non-alcoholic fatty liver dz

Answer 185

* NAFLD * associated w/ * obesity * metabolic syndrome * DM

Answer 186

* post-necrotic * Laennec's (alcoholic) * biliary/cholestatic * compensated * decompensated

Answer 187

* hepatitis * drugs * toxins

Answer 188

* biliary obstruction * AID

Answer 189

performs necessary fxn despite scarring

Answer 190

obvious manifestations of liver failure

Answer 191

* portal HTN * ascites * esophageal varices * coagulation problems * jaundice * encephalopathy * hepatorenal syndrome * spontaneous bacterial peritonitis

Answer 192

↑ \> 5 mm Hg in portal vein

Answer 193

* ↑ resistance of blood flow in portan vein * obstruction prevents normal blood flow

Answer 194

* (blood rerouted to nearby vessels) * esophageal varices * ascites * splenomegaly

Answer 195

* hemodynamic resuscitation * octreotide * blanding, sclerotherapy * prophylactic abx

Answer 196

* beta blockers * endoscopic variceal ligation

Answer 197

collection of free fluid in peritoneal cavity

Answer 198

* ↑ pressure from portal HTN * Na+ retention → renin-angiotensin activation

Answer 199

* plasma protein accumulates in peritoneal fluid * → ↓ plasma protein in blood + ↓ albumin production * → ↓ osmotic pressure in vessels * → fluid shift to abd * → hypovolemia + edema

Answer 200

* ↑ pressure in portal vein * → blood flow backup into esophagus * → fragile, thin-walled veins in esophagus become tortuous

Answer 201

* hematemesis * melena

Answer 202

* spontaneous * anything that ↑ pressure * damage to esophagus

Answer 203

* (blood flow backup into spleen) * portal hypertension * CHF * splenic vein obstruction * etc.

Answer 204

* spleen enlargment * → platelet destruction * → ↑ risk for bleed

Answer 205

* caused by **splenomegaly** * **liver** dysfunction

Answer 206

helps w/ absorption of fat-soluble vitamins

Answer 207

* vitamin **K** * **clotting factors**

Answer 208

* liver cells do not effectively excrete bilirubin * → excess bilirubin in circulation

Answer 209

* causes * edema * fibrous tissue * scarring of channels, ducts * interferes w/ bile and bilirubin excretion

Answer 210

* hepatocellular * intrahepatic obstructive

Answer 211

* portal-systemic encephalopathy * AKA hepatic encephalopathy

Answer 212

* AKA hepatic encephalopathy, PSE * complex cognitive syndrome

Answer 213

* AMS * speech problems * mood changes * sleep disturbances * later * altered LOC * impaired thinking * impaired neuromuscular fxn

Answer 214

* acute or insidious * etiology unknown, but unclear link to **↑ serum ammonia** * 4 stages

Answer 215

* subtle changes in * thinking * personality * behavior

Answer 216

* ↑ Sx of * confusion * disorientation * asterixis

Answer 217

* abnormal muscle tremor * involuntary **jerking** movements * esp. in **hands**, but also seen in tongue, feet

Answer 218

* marked confusion * stupor * hyperreflexia

Answer 219

* unresponsive * unarousable * + Babinski * fetor hepaticus

Answer 220

mousy odor in the breath of people with severe liver impairment

Answer 221

* dorsiflexion of the great toe when the sole of the foot is stimulated * in adults, could indicate * lesion of the pyramidal (corticospinal) tract * hepatic encephalopathy * other neurological conditions

Answer 222

* high-protein diet * infection * hypovolemia * hypokalemia * constipation * GI bleed * drugs

Answer 223

* GI bleed + clinical deterioration * onset of hepatic encephalopathy

Answer 224

* sudden ↓ of UOP: \< 500 mL/24 hr * ↑ BUN * ↑ Cr * ↓ Na⁺ excretion * ↑ urine osmolarity

Answer 225

* abnormally low protein levels * bacteria from bowels → ascitic fluid

Answer 226

* possibly none * fever * chills * abd pain/tenderness

Answer 227

* WBC count * ascitic fluid culture

Answer 228

* demographic data * lifestyle * ETOH, drug, toxin exposure * illicit drugs * OTC meds * sexual Hx * needle exposures * travel * close-quarter living

Answer 229

* vague Sx * fatigue * wt change * GI Sx * abd pain * labs * thrombocytopenia * abnormal LFTs

Answer 230

* jaundice * petechiae * ecchymoses * spider angiomas on * nose * cheeks * thorax * shoulders * ascites * edema * peripheral * sacral * vitamin deficiency, esp. K * hepatomegaly * splenomegaly * **fetor hepaticus** * asterixis * neurological dysfunction * gynecomastia

Answer 231

* abd girth * daily wt * neurological fxn

Answer 232

* may normalize w/ ↑ deterioration * AST * ALT * LDH * biliary obstruction * GGT * ALP * bilirubin * ↑ * PT/INR * ammonia * ↓ * serum protein * albumin * platelets * RBCs * H&H * *WBC*

Answer 233

* urine: ↑ urobilirubin * stool * ↓ urobilinogen conc. r/t biliary obstruction * clay-colored or light

Answer 234

* imaging: hepatomegaly, splenomegaly, ascites, lesions/masses * X-ray * CT * MRI * Bx * US: liver visualization, portal vein blood flow * EGD * visualization of esophageal varices, bleeding * ulceration * ERCP * contrast to view sphincter of Oddi, biliary tract * remove stones if necessary

Answer 235

remove excess fluid

Answer 236

Na+ restriction vitamin, electrolyte replacement IV vitamins for late-stage liver dz

Answer 237

* diuretics * abx * propranolol

Answer 238

* removal of excess ascitic fluid * at bedside or in IR

Answer 239

respiratory support for hepatopulmary syndrome

Answer 240

* ↑ abd pressure r/t ascites * prevents thoracic expansion * monitor * SpO₂ * respiratory effort * daily wt * elevate * HOB * edmatous limbs

Answer 241

* beta blockers * ↓ HR * ↓ hepatic venous pressure gradient

Answer 242

* vasopressin * ↓ blood flow * ↑ vasoconstriction * octreotide * ↓ secretion of * gastrin * serotonin * peptides * → ↓ GI blood flow

Answer 243

endoscopic variceal ligation

Answer 244

* EVL * EST * SB tube * TIPS * others

Answer 245

endoscopic sclerotherapy

Answer 246

* ↓ bleeding * ↓ blood supply to varices

Answer 247

* goal: stop bleeding * process: catheter injects sclerosing agent into vein * complications: ulceration of mucosa → further bleeding

Answer 248

* procedure * in mouth or nare → stomach * balloon inflated to apply pressure to bleeding varices * complications * aspiration * asphyxia * esophageal perf

Answer 249

* Sengstaken-Blakemore tube * used to stop esophageal bleeding

Answer 250

* transjugular intrahepatic portal-systemic shunt * Tx for bleeding esophageal varices

Answer 251

* TIPS * to treat bleeding esophageal varices * performed in IR * US-guided placement of stent in portal vein * follow-up to ensure patency

Answer 252

as needed to monitor for further bleeding

Answer 253

* pRBCs * FFP * albumin * platelets

Answer 254

* PT/INR * PTT * platelets

Answer 255

* **SERUM AMMONIA** * liver can't convert → remains in circulation → brain * also produced by GI bacteria * moderate-protein diet * drug therapy

Answer 256

* laxative: lactulose * abx: ↓ GI bacteria * rifaximin * metronidazole * vancomycin

Answer 257

* nutrition * follow diet * supplements * vitamin/electrolyte replacement * meds * avoid all OTCs * supply of lactulose * ETOH abstinence * Fm education: S/Sx of * encephalopathy * fluid shift/retention * bleeding

Answer 258

* exposure to causative source → inflammation, necrosis * causes * viral strains A-E * other viral hepatitis * toxin- and drug-induced * secondary infection * Epstein-Barr * herpes * varicella-zoster * CMV

Answer 259

* enterovirus * prognosis * generally recoverable * more severe in OA * destroyed by **bleach** and very high temps

Answer 260

* composed of antigens * circulates in blood * prognosis * most adults clear infection, become immune * others become carriers

Answer 261

* fever * anorexia * N/V * RUQ pain * dark urine * light stool * jaundice * joint pain

Answer 262

* **unprotected sex** * needles * sharing * accidental sticks * transfusions * hemodialysis * close person-person contact w/ open wound

Answer 263

* transmission: fecal-oral * hand-hand * food/water contamination * S/Sx: flu-like

Answer 264

* HCV * most common hep virus * most are unaware of infection

Answer 265

* **blood-blood** * needles * IV needle sharing * accidental sticks * tattoo equipment * blood * blood products * organ transplant

Answer 266

untreated → chronic liver inflammation/scarring → cirrhosis

Answer 267

* defective RNA → needs HBV to replicate * prognosis: usually becomes chronic dz

Answer 268

* parenteral * IV needle sharing * sexual contact

Answer 269

* geographical prevalence * Asia * Africa * Middle East * Mexico * Central and South America * ***only among international travelers in U.S.*** * prognosis: generally self-limiting, not chronic

Answer 270

similar presentation to hep A flu-like Sx

Answer 271

* fulminant hepatitis * chronic hepatitis

Answer 272

* severe acute hepatitis * failure of liver cells to regenerate * progression of necrosis * can be fatal

Answer 273

* inflammation \> 6 mo * etiology * generally HBV or HCV * also w/ combo infections and HIV * → cirrhosis, liver CA

Answer 274

* vaccines * HAV * HBV * HAV * proper handwashing * avoid contaminated food/water * HBV * avoid unprotected, risky sexual contact * exposure to blood or bodily fluids

Answer 275

* ↑ ALT * ↑ AST

Answer 276

* OTC * prescribed * illicit

Answer 277

* LFTs * drug usage * ingestion of shellfish or contaminated water * sexual activity * living quarters * travel Hx

Answer 278

* malaise * N/V * pruritis * abd pain * jaundice * arthralgia * myalgia * stool and urine changes

Answer 279

* emotions/coping * depression * fm involvement * cost * fear of infecting others

Answer 280

* current inflammation: ImM * previous infection: IgG

Answer 281

* + HBSAB: antibody present * recovery and immunity * vaccinated

Answer 282

+delta-antigen

Answer 283

characteristics and changes to liver

Answer 284

* liver rest, recovery * small, frequent meals * drugs (HBV and HCV) * antivirals * immunomodulators * prevent spread

Answer 285

* ↑ carb and kcal * moderate fat and protein * vitamin supplements * no ETOH, drugs

Answer 286

* accumulation of fats in and around hepatic cells * NAFLD * non-alcoholic steatohepatitis

Answer 287

fatty liver dz

Answer 288

* DM * obesity * ↑ lipids

Answer 289

* fatty liver dz * degenerative changes in liver cells 2/2 fat deposits in hepatocytes * generally asymptomatic * may be found in liver Bx or imaging

Answer 290

* Tx of underlying cause * monitor LFTs * meds: lipid-lowering agents

Answer 291

* injury or assault to liver * common cause: steering wheel in MVA * complication: blood loss, hypovolemic shock * Tx: blood products * monitor coags

Answer 292

* primary or metastatic * main cause: cirrhosis 2/2 chronic HBV and HCV

Answer 293

asymptomatic

Answer 294

* wt loss * anorexia * RUQ pain

Answer 295

AFP tumor marker

Answer 296

* alpha-fetoprotein tumor marker * indication of liver CA

Answer 297

* tumor resection * hepatic artery embolization * radiofrequency ablation * chemo * transplant * palliative care (late stages)

Answer 298

* only available long-term Tx * most tumors not resectable

Answer 299

* causes cell death by ischemia in hepatic artery, which feeds most tumors * most hepatic cells fed by portal vein * IR procedure * catheter guided by angiogram injects blocking agent into artery feeding tumor

Answer 300

* indication: end-stage dz w/o response to conventional Tx * exclusions * severe cardiac or respiratory dz * metastatic tumors * inability to follow instructions/self-manage

Answer 301

* most donors trauma victims * liver preserved ≤ 8 hr

Answer 302

* acute graft rejection * infection

Answer 303

* usually POD 4-10 * S/Sx * tachycardia * fever * RUQ pain * ↑ jaundice * → multi-organ failure * prophylaxis: immunosuppressants

Answer 304

* common * pneumonia * wound infection * UTI * opportunistic * in month after surgery * S/Sx * fever * foul-smelling drainage

Answer 305

* medium to dark brown * strong-smelling * pain-free to pass * passed 1-2x daily * consistent in characteristics

Answer 306

* smell * frequency * firmness * color

Answer 307

bilirubin from breakdown of RBCs

Answer 308

* foods ingested * meds * amount of bile * presence of blood

Answer 309

* brown * green * yellow * grey/clay * red * black

Answer 310

* green foods * diarrhea: ↓ time for chemical changes to bilirubin

Answer 311

* (undigested fat) * d/o of * liver * pancreas * gallbladder * celiac dz * giardiasis * *stress* * *diet*

Answer 312

* (↓ bile) * hepatobiliary dz

Answer 313

* also dark red, maroon * diet: red veggies or food dye * lower GI bleed

Answer 314

* not sticky + odorless * bismuth * Fe supplements * tarry + sticky + foul-smelling * AKA melena * upper GI bleed

Answer 315

* basic metabolic panel * glucose * electrolytes * Ca²⁺ * Na⁺ * K⁺ * Cl^- * CO₂ * BUN * Cr

Answer 316

* comprehensive metabolic panel * BMP+ * total bilirubin * total protein * albumin * liver enzymes * ALT * AST * ALP

Answer 317

false positive

Answer 318

* red meat * raw fruits and veggies

Answer 319

* x7 days before * NSAIDs * anticoagulants

Answer 320

fecal immunochemical test

Answer 321

* FIT, iFOBT * type of FOBT that does not require pt prep * also screening for colon CA * detects blood from lower GI

Answer 322

small intestine

Answer 323

* steatorrhea * fatty stools * yellow

Answer 324

* instilled air → colicky abd pain + flatulence * severe * bleeding * perf * sepsis * pancreatitis

Answer 325

* medazolam * fentanyl * propofol

Answer 326

* Dx and Tx of conditions of pancreas or bile ducts * indications * abd pain * wt loss * jaundice * CT or US showing stones or massess

Answer 327

**before** or **after**

Answer 328

* **ERCP** helps * best **procedure**

Answer 329

* solution is best chilled * watery stool starts ~1 hr after starting * do not give to OA

Answer 330

* 50 yo * Q10yrs

Answer 331

* fm Hx of CA * polyps

Answer 332

* nutritional deficits * altered bowel elimination * infection * pain * fluid/electrolyte imbalances

Answer 333

appendicitis

Answer 334

peritonitis

Answer 335

anywhere in abd, esp. periumbilical or epigastric → more severe → McBurney's point

Answer 336

* presentation **inconsistent** * Dx **challenging** * **severe** abd conditions

Answer 337

intestinal obstruction

Answer 338

* lying down * hips flexed * knees drawn up * keeping still

Answer 339

* \< 48 hr in ~80% of adults * \> 48 hr w/ perf or in OA

Answer 340

* may need * wound drain * wound vac * NGT (decompression) * meds * abx * opioids * prevent complications: early ambulation * VTE * atelectasis * pneumonia

Answer 341

* OA * chronic dz

Answer 342

surgical opening of abd

Answer 343

* **largest** * most **complex**

Answer 344

* outer layer of peritoneum * attached to abd wall

Answer 345

* inner layer of peritoneum * wrapped around organs in intraperitoneal cavity

Answer 346

* double layer of visceral peritoneum * encloses the peritoneal cavity

Answer 347

* enclosed by mesentery * serous fluid-filled * ~ 50 mL * prevents friction during peristalsis

Answer 348

life-threatening

Answer 349

* transmission * fecal-oral * person-person * contaminated food/water * airborne via vomiting * incubation: 1-2 days

Answer 350

oral rehydration therapy

Answer 351

* often develop in teens and young adults, but possible at any age * affect the sexes equally * Sx are similar * unknown causes * similar contributing factors * both AIDs

Answer 352

* UC affects innermost lining of colon * Crohn's occurs in all layers of bowel

Answer 353

* ~10% of IBD * has features of UC and Crohn's

Answer 354

* fat wrapping bowel * fissures into mucosa and muscle * muscle hypertrophy * cobblestone appearance of mucosa

Answer 355

ulceration within mucosa

Answer 356

* fluid/electrolyte imbalance * dehydration * **hypokalemia → dysrhythmias** * cellular changes → **↑ risk of colon CA**

Answer 357

* exact cause unknown * factors * **genetic** * immunologic (AID) * environmental

Answer 358

* rectum * rectosigmoid colon * may also spread to entire colon

Answer 359

about halfway between umbilicus and anterior iliac spine

Answer 360

paralysis of colon → dilation → colonic ileus + possible perf → peritonitis and/or gangrene

Answer 361

* anemia * malnutrition * bone loss

Answer 362

* pyuria * fecaluria

Answer 363

feces in the urine

Answer 364

* \> 10 WBCs per high-powered microscopic urinary field * detected in UA

Answer 365

* polyarthritis * episcleritis * uveitis * aphthae * renal calculi * gallstones * vitamin-deficiency anemia * erythema nodosum * Sweet's syndrome

Answer 366

inflammation of \> 1 joint, and usually \> 4

Answer 367

extraintestinal manifestations

Answer 368

conditions in other parts of the body that IBD patients can develop during active dz

Answer 369

tender, red nodular rash on the shins that typically occurs with another illness

Answer 370

inflammation of the subconjunctival layers of the sclera

Answer 371

* nonspecific term for any intraocular inflammatory d/o * uveal tract (iris, ciliary body, and choroid) usually involved * other parts of the eye, including retina and cornea, may be involved

Answer 372

* AKA acute febrile neutrophilic dermatosis * distinctive eruption of tiny bumps that enlarge * often tender to the touch * on back, neck, arms or face

Answer 373

* urgent sensation to defecate, even though bowels already empty * may involve straining, pain, and cramping

Answer 374

may be asymptomatic

Answer 375

* mild abd pain * nausea * possibly ↑ CRP and ESR

Answer 376

* fever * tachycardia * anemia * abd pain * ↑ CRP and ESR

Answer 377

* ↑ Sx of severe * may need transfusion * possible colonic distention

Answer 378

C-reactive protein

Answer 379

* protein made by liver * sent into bloodstream as response to inflammation * interpretation * low levels expected * ↑ levels can mean * serious infection * other d/o

Answer 380

erythrocyte sedimentation rate

Answer 381

* measures how quickly RBCs settle to bottom of test tube of blood * normal: slowly * ↑ rate: inflammation

Answer 382

* shows * differences between UC and Crohn's * complications * depth of dz involvement

Answer 383

* ↓ systemic exposure * targets colon

Answer 384

* sulfasalazine * mesalazine * olsalazine * balsalazide

Answer 385

* drugs that alter a pt's immune response * not effective alone * synergistic effect w/ corticosteroids: ↓ steroids needed

Answer 386

certified wound, ostomy, and continence nurse

Answer 387

* ACS * any circumstance that suddenly impairs blood flow through the coronary arteries

Answer 388

acute coronary syndromes

Answer 389

* CAD * narrowing of the coronary arteries, usually as a result of atherosclerosis

Answer 390

coronary artery disease

Answer 391

* most common form of arteriosclerosis * marked by cholesterol-lipid-calcium deposits in walls of arteries that may restrict blood flow

Answer 392

* disease of the arterial vessels marked by thickening and loss of elasticity in the arterial walls * “hardening of the arteries"

Answer 393

* ↓ blood flow and O₂ to heart muscle → oppressive chest pain or pressure * usually precipitated by exercise

Answer 394

death of myocardial tissue d/t ischemia

Answer 395

* end-diastolic stretch of a heart muscle fiber * at bedside: estimated by measuring CVP or pulmonary capillary wedge pressure

Answer 396

* force that impedes the flow of blood out of the heart * primarily composed of * peripheral vasculature pressure * aortic compliance * mass and viscosity of blood

Answer 397

inability of the heart to circulate blood effectively enough to meet the body's metabolic needs

Answer 398

* percentage of the blood emptied from the ventricle during systole * **normal: 50-70%**

Answer 399

infection or inflammation of the heart valves or of the lining of the heart

Answer 400

valvular inflammation and dysfunction (esp. mitral insufficiency) occurring during acute rheumatic fever

Answer 401

* blood thinners * antihypertensives * heart medication

Answer 402

agent that destroys or inactivates platelets, preventing them from forming blood clots

Answer 403

agent that prevents or delays blood coagulation

Answer 404

interfering with or preventing thrombosis

Answer 405

* class * anticoagulant * antithrombotic * factor Xa inhibitor * action: inactivates cascade of coagulation by blocking active site on factor Xa

Answer 406

blocks action of epinephrine on CV system

Answer 407

* antihypertensive * action * blocks conversion of precursor angiotensin I to vasoconstrictor angiotensin II * systemic vasodilation

Answer 408

angiotensin II receptor antagonist

Answer 409

* antihypertensive * action * blocks aldosterone-secreting and vasoconstrictor effects of angiotensin II * ↓ BP, ↓ risk of death from CV dz

Answer 410

* tricuspid * mitral

Answer 411

* pulmonic * aortic

Answer 412

* "lub" * corresponds with * closure of AV valves (mitral) * ventricular ctx * beginning of systole * loudest at apex

Answer 413

* "dub" * corresponds with * closure of semilunar valves (aortic) * beginning of diastole * loudest at base

Answer 414

* rate, rhythm * high-pitched/normal sounds * w/ diaphragm * S1, S2 * low-pitched/extra sounds * w/ bell * S3, S4 * murmurs

Answer 415

* color * temp * hair * edema * nailbeds

Answer 416

* cap refill * palpate pulses * feel w/ fingertips * compare bilaterally * note * rate * rhythm * amplitude/intensity * quality

Answer 417

* (0-4+) * 0: no palpable pulse * 1+: faint * 2+: diminished * **3+: normal** * 4+: bounding

Answer 418

* chronic ischemic heart dz * acute coronary syndromes

Answer 419

* stable angina * variant (Prinzmetal's) angina

Answer 420

* unstable angina * myocardial infarction

Answer 421

* NSTEMI * STEMI

Answer 422

non-ST segment elevation myocardial infarction

Answer 423

ST segment elevation myocardial infarction

Answer 424

* HF * valvular dz/dysfunction

Answer 425

heart failure

Answer 426

coronary heart dz

Answer 427

* CAD * atherosclerosis in coronary artery → ↓ blood flow to area it supplies * untreated → * angina * MI

Answer 428

* progressive * endothelial damage → deposits → vessel narrowing * can → thrombus formation * blockage grows → occlusion → tissue death * begins early in life

Answer 429

atherosclerosis → CAD → angina → MI

Answer 430

* low-density lipoproteins * less desirable lipoproteins

Answer 431

* high-density lipoproteins * highly desirable lipoproteins

Answer 432

* genetics: gene variation can → extremely ↑ LDL * ↑ age * sex: male \> female * T1DM

Answer 433

* smoking * diet * obesity * T2DM * HTN * physical inactivity * hyperlipidemia * hypertriglyceridemia * metabolic syndrome

Answer 434

blood flow ↓ → ischemia in affected myocardium

Answer 435

partial or total occlusion of coronary arteries

Answer 436

* description * tightness * heaviness * vise-like * "elephant on chest" * S/Sx * pain radiating to left * arm * hand * jaw * shoulder * nausea * fatigue * lightheadedness

Answer 437

* partially occluded coronary arteries → * ↑ in myocardial O₂ demand * ↓ in myocardial O₂ supply

Answer 438

pattern, signs, and symptoms

Answer 439

predictable degree of exertion or emotion

Answer 440

* onset * duration * severity * relieving factors

Answer 441

* begins gradually and peaks over a period of minutes as activity continues * activity → CP * rest → relief

Answer 442

* rest * nitro * both

Answer 443

* occurs during periods of rest, often at night * not related to * physical activity * HR

Answer 444

coronary artery spasm

Answer 445

* nausea * dizziness * SOB * anxiety * feeling of impending doom

Answer 446

* unusual fatigue * sleep disturbance * SOB * indigestion * anxiety * chest discomfort: aching, tightness, pressure

Answer 447

* wt * VS * all signs

Answer 448

* hypo- or hypertension * peripheral edema * cyanosis or pallor * diaphoresis * dyspnea * vomiting * EKG changes * abnormal heart sounds, rate, and/or rhythm

Answer 449

Sx suggesting cardiac ischemia w/o CP

Answer 450

* women * diabetics * OA

Answer 451

* jaw * arm * upper back

Answer 452

* dyspnea * fatigue * lightheadedness * dizziness * pain in jaw, arm, upper back * women: upper arm weakness

Answer 453

* unstable angina * MI * NSTEMI * STEMI

Answer 454

* unpredictable CP * w/ rest or minimal activity, possibly at night * occurs with ↑ frequency and severity * nitro doesn't help * **requires immediate medical attention**

Answer 455

myocardial infarction

Answer 456

complete or near-complete occlusion of coronary artery

Answer 457

occlusion of coronary artery → ↓ O₂ delivery → cell death

Answer 458

* **leading** cause of death * **ineffectively** treated **CAD**

Answer 459

* cardiac-specific: troponin I * non-specific * CK-MB * myoglobin

Answer 460

* Q6H * multiple draws show trends

Answer 461

* **negative** on arrival * then **increase**

Answer 462

cardiac-specific muscle protein useful in lab Dx of heart attack

Answer 463

* ↑ injury = ↑ numbers * Normal: \< 0.04 ng/mL * Elevated: 0.04 – 0.39 * Probable MI: ≥ 0.40 * *↑ after heart cath* * ↑ 7-14 hrs after Sx onset**

Answer 464

creatinine kinase-muscle/brain

Answer 465

more cardiac-specific than myoglobin and other forms of CK

Answer 466

* normal: 5-25 IU/L * MI * ↑ 3-6 hrs after CP onset * peak: 12-18 hrs

Answer 467

* O₂-binding protein * released after damage to heart or any skeletal muscle

Answer 468

* normal: 25-72 ng/mL * MI * detected within 2 hrs after * sensitive indicator: second sample is x2 if drawn within 2 hrs of first sample

Answer 469

* EKG * EST * TEE * transthoracic echo * heart cath and angio

Answer 470

electrocardiogram

Answer 471

* 12-lead * easiest and most effective test * **for every pt w/ CP**

Answer 472

* heart rhythm * blood flow or ischemia * heart attack * thickened heart muscle

Answer 473

* ↓ blood flow → depolarization changes * manifests as abnormal changes in ST segment and T wave * ischemia/injury to different regions show on different leads

Answer 474

exercise stress test

Answer 475

* exercise + EKG * evaluates myocardial perfusion

Answer 476

* don't eat, smoke, or drink caffeine for several hrs * hold CV meds for 24 hrs * wear comfy clothes, shoes

Answer 477

* normal ECG at rest * abnormalities w/ ↑ O₂ demand (activity)

Answer 478

* pt exercises * per strict protocol * w/ continuous EKG * if myocardial ischemia suspected * test immediately stopped * Tx administered

Answer 479

* angina * ST segment depression ≥ 1 mm * BP * failure to ↑ systolic BP to ≥ 120 mm Hg * sustained ↓ of ≥ 10 mm Hg with progressive ↑ in exercise

Answer 480

induces CV stress with meds that dilate coronary vessels

Answer 481

exercise contraindicated d/t arthritis, amputation, etc.

Answer 482

* dobutamine * adenosine * dipyridamole

Answer 483

* EKG + * echo * nuclear testing (tracer injection)

Answer 484

nuclear testing (tracer injection) often used during pharm stress test to detect CAD

Answer 485

myocardial perfusion imaging

Answer 486

US used to assess functional structures of heart

Answer 487

* structural valve abnormalities * atrial and ventricular chamber size * diameter of great vessels * heart wall motion

Answer 488

transesophageal echocardiogram

Answer 489

transducer is guided down esophagus to allow for visualization of heart w/o ribs or lungs in the way

Answer 490

* thin catheter inserted into artery and threaded into coronary arteries * +angio: visualize presence/degree of blockage

Answer 491

* catheter threaded into coronary arteries * radiopaque contrast injected * fluoroscopy used to visualize presence/degree of blockage

Answer 492

* **invasive** procedure * IV **contrast**

Answer 493

* iodine or shellfish allergies * previous rxn to contrast

Answer 494

* Q15Min x4 * Q30Min x2 * Q1H x4 * Q4H

Answer 495

* monitor VS frequently (per protocol) * ensure pt lies flat w/ extremity straight for prescribed time * neurovascular checks as prescribed; assess affected limbs together * continuous telemetry, pulse ox * antiplatelet/antithrombotic or thrombolytic therapy * monitor UOP * administer IVF * sheath removal

Answer 496

* **4-6** hrs * **shorter**

Answer 497

* body area: distal to catheter insertion site * purpose: to ensure sensation and pulse are present

Answer 498

* pulses * parethesias * pain * pallor * paralysis

Answer 499

* based on Hx and Sx patterns * ECG changes only during EST * no ↑ cardiac enzymes

Answer 500

* Hx * presence of unstable angina * Sx consistent w/ partially occluded arteries * no ↑ serum biomarkers * possible, but not necessary: ST segment depression, T wave inversion

Answer 501

* ST segment and/or T wave changes, depending on type * ↑ enzymes * cell necrosis and infarction distal to occlusion

Answer 502

* NSTEMI * **partial** coronary artery blockage * **less** damaging to heart * **depressed** ST segment or **T wave inversion** * ↑ serum cardiac enzymes

Answer 503

* STEMI * **complete** coronary artery blockage * **more** damaging to heart * **elevated** ST segment of ≥ 1 mm * ↑ serum cardiac enzymes

Answer 504

* healthy, balanced diet * ↓ in BP * ↓ in fat intake * wt loss

Answer 505

* antiplatelet/antithrombotic therapy * ASA * heparin * enoxaparin

Answer 506

* all **chest pain** * like **myocardial infarction**

Answer 507

* general * pain * N/V * focused cardiopumonary * VS * heart and lung sounds * peripheral pulses * skin color, temp, and moisture * look for * SOB * diaphoresis during pain

Answer 508

* immediate 12-lead EKG (10 min) * continuous tele + pulse ox * start IV * HOB @ 30° * MONA meds as ordered * additional Tx dictated by * EKG * labs * risk to pt

Answer 509

* immediate: ~325 mg nonenteric-coated ASA * O₂ * nitroglycerin * morphine

Answer 510

* vasodilator * prevents coronary artery spasm * ↓ preload and afterload to **↓ O₂ demand**

Answer 511

* routes * **sublingual (tab or spray)** * TD * dosage: 0.4 mg * Q5Min ≤ 3x until CP relieved * if no relief, explore other options

Answer 512

* orthostatic hypotension * **HA**

Answer 513

↓ CP where nitro is not successful

Answer 514

* hypotension, esp. w/ vasodilator * respiratory depression

Answer 515

* metoprolol and others * action * ↓ HR and afterload (↓ BP) * → ↓ myocardial O2 demand * **can ↓ infarct size in acute MI**

Answer 516

* orthostatic hypotention * severe bradycardia

Answer 517

* diltiazem, verapamil, and others * **NOT nifedipine** * action * dilates coronary arteries * ↑ O₂ supply to myocardium

Answer 518

* ASA, clopidogrel * action * inhibits platelet aggregation * ↓ risk of clot formation

Answer 519

* chronic: teach about lifestyle changes * acute: considered acute MI until proven otherwise

Answer 520

* draw cardiac enzymes * anticoagulation therapy * ↓ workload of heart * monitor pt closely * may need surgical Tx

Answer 521

* heparin + ASA or clopidogrel * rationale * heparin prevents new clots * ASA or clopidogrel ↓ platelet aggregation

Answer 522

* continuous tele and pulse ox: dysrhythmias * S/Sx of cardiogenic shock

Answer 523

* + signs of HF * v-tach * hemodynamic instability * persistent CP * persistent/recurrent ST deviation

Answer 524

* optimal * activate cath lab (≤ 90 min) * IV access, x2 if done quickly * nitro 0.4 mg * IV nitrates * IV morphine * not near cath lab * transfer within 120 min? * if not, tPA (≤ 30 min) * other possible meds * beta blocker * Ca channel blocker

Answer 525

* door → balloon inflation in **≤ 90 min** * ≤ 60 min even better

Answer 526

* restores blood flow to affected myocardium * won't reverse damage * stops or limits future damage

Answer 527

* get x2 if possible, but don't delay Tx * draw blood for enzymes now if possible

Answer 528

* usually starts at 5-10 mcg/min * gradually increase until CP relieved

Answer 529

* for refractory or severe pain * dosage * 2-4 mg IV push * repeat Q5-10Min

Answer 530

given for STEMI if within 12 hrs after Sx onset

Answer 531

door to needle in **30 min**

Answer 532

* can re-occlude * will begin to c/o CP again * small pieces travel distal, occlude smaller vessel * compared to heart cath * ↑ reperfusion outcomes * ↓ complications and death

Answer 533

* beta blockers * Ca channel blockers

Answer 534

restore blood flow to prevent further damage

Answer 535

* percutaneous transluminal coronary angioplasty (PTCA) * directional coronary atherectomy (DCA) * intracoronary stents * transcatheter aortic valve replacement (TAVR) * coronary artery bypass graft (CABG)

Answer 536

percutaneous transluminal coronary angioplasty

Answer 537

directional coronary atherectomy

Answer 538

transcatheter aortic valve replacement

Answer 539

coronary artery bypass graft

Answer 540

* done during heart cath w/ coronary angiogram * balloon-tipped catheter * inserted into blocked artery * inflated several times to open vessel

Answer 541

* done during heart cath * excises and removes plaque in blocked artery * rotating blade shaves blockage material and stores it in cone

Answer 542

medium- to large-sized

Answer 543

* done during heart cath * inserted on tip of balloon cath * balloon inflated, then deflated to leave stent in place

Answer 544

longer-term

Answer 545

* artery dissection * **cardiac tamponade** * hematoma * allergic rxn * external bleed at insertion site * **retroperitoneal bleed** * embolism * restenosis of vessel * AKI

Answer 546

* palpate thoroughly all around insertion site * feels like hard knot under skin * intervention: pressure x15 min

Answer 547

* possible complication of heart cath procedure * happens with femoral insertion * blood pools in posterior abd cavity

Answer 548

* to treat symptomatic aortic valve stenosis * via cardiac cath * new valve expands, pushes old valve leaflets aside * new valve takes over blood flow regulation

Answer 549

pt not candidate for open-heart surgery because of dz, comorbidities, etc.

Answer 550

reperfusion by other methods not viable options

Answer 551

* open-heart surgery * uses veins from other parts of body to replace blocked artery or arteries

Answer 552

* **saphenous vein** * internal mammary/thoracic veins * radial artery * gastroepiploic artery

Answer 553

* pt → ICU * monitor VS closely and meet surgeon's parameters * measure chest tube output closely * frequent labs * extubate ASAP * after stable/extubated, walk and move as much as possible * many pts D/C home within 4 days

Answer 554

* dysrhythmias * cardiogenic shock * HF + pulmonary edema

Answer 555

* SVT * frequent PVCs * v-tach * v-fib

Answer 556

supraventricular tachycardia

Answer 557

premature ventricular contraction

Answer 558

* cause: ↓ functionality of myocardium * usually manifests wks later * pt education: warning signs, importance of follow-up

Answer 559

not common COD, but possible

Answer 560

* hypotension * diaphoresis * tachycardia

Answer 561

* vasopressors * O₂ * other Tx as ordered * until heart recovers

Answer 562

* stabilize pt during acute phase * monitor for complications * promote energy conservation * educate pt on lifestyle changes * prep for rehab

Answer 563

changes in heart fxn due to intrinsic or extrinsic factors

Answer 564

* chronic * exacerbations

Answer 565

* progressive dz → cardiac remodeling * left ventricle dilates, hypertrophies, and becomes more spherical

Answer 566

* left-sided * right-sided * high-output

Answer 567

* systolic * diastolic

Answer 568

* **left ventricular failure** * less common * right ventricular MI * COPD * pulmonary HTN

Answer 569

* heart can't contract hard enough * ↑ * preload * afterload (d/t peripheral resistance) * ↓ * contractility * ejection fraction * cardiac output * BP * UOP

Answer 570

* no S/Sx of ↓ cardiac output * ejection fraction \> 40%

Answer 571

* ventricle can't empty completely * ↑ venous volume + pressure → peripheral edema

Answer 572

ventricle can't relax enough to fill completely during diastole

Answer 573

cardiac output remains ≥ normal

Answer 574

* ↑ metabolic needs * usually in hyperkinetic conditions * septicemia * high fever * anemia * hyperthyroidism

Answer 575

* HTN * CAD * cardiomyopathy * substance abuse * valvular dz * congenital defects * cardiac infections and inflammatory states * dysrhythmias * DM * smoking/tobacco use * family Hx * obesity * severe lung dz * sleep apnea * hyperkinetic conditions

Answer 576

* stenosis * regurgitation

Answer 577

* valve leaflets thicken, stiffen, or fuse together * → ↓ blood flow and ↑ resistance * → pressure backup

Answer 578

* mitral * aortic

Answer 579

* valves don't close completely * → backflow into chamber * → pressure backup

Answer 580

* mitral * aortic * valvular prolapse

Answer 581

* narrowing of valve between LA and LV * → slow LA filling time

Answer 582

* pulmonary problems first * crackles * SOB * ↑ HR can → CO drop

Answer 583

* rheumatic fever * female sex

Answer 584

* valve hardens * → restricted flow to aorta * → pressure backup to LV * → LV hypertrophy * → cannot ↑ CO for ↑ demand

Answer 585

* rheumatic fever * aging

Answer 586

* mitral valve can't close completely * → blood flows back into LA → ↓ SV * → LA works hard, hypertrophies * can → * left-sided HF * right-sided HF

Answer 587

stroke volume

Answer 588

volume of blood pumped from LV per beat

Answer 589

* aging * infective endocarditis * rheumatic fever

Answer 590

* difficulty breathing * dyspnea * orthopnea * paroxysmal nocturnal dyspnea * non-productive cough * fatigue, weakness * dizziness * angina

Answer 591

* fatigue * tight feeling in extremities * nausea d/t liver congestion

Answer 592

severe SOB and coughing that occur at night

Answer 593

* respiratory * wheezes * crackles * tachypnea * **pink, frothy sputum** * CV * tachycardia * palpitations * weak peripheral pulses * cool extremities * S3, S4 * pallor * other * oliguria, nocturia * ↓ LOC

Answer 594

* CV * JVD * dependent edema (esp. hands) * enlarged liver, spleen * ↑ LFTs * ascites * anorexia * GU * nighttime polyuria * wt gain

Answer 595

abnormally small amounts of urine

Answer 596

* chem panel * CBC * BNP * ABGs * LFTs

Answer 597

* severe anemia and/or infection * **anemia can cause or aggravate HF**

Answer 598

brain natriuretic peptide

Answer 599

* can show any acid-base imbalances or hypoxemia * usually only done for resp. distress

Answer 600

* AKA B-type, BNP * hormone secreted by left ventricular cardiomyocytes 2/2 stretching and hard work w/ ↑ blood volume * most specific test for HF * level indicates severity * abnormal: \> 100 pg/mL

Answer 601

* ECG * CSR * echo * CVP

Answer 602

* heart dz * MI * enlarged heart * dysrhythmias

Answer 603

* most useful diagnostic * can differentiate HF w/ or w/o preserved left ventricular systolic fxn

Answer 604

central venous pressure

Answer 605

* pressure in vena cava near RA * estimates RA pressure

Answer 606

* preload of RV, which regulates SV * volume status

Answer 607

fluid resuscitation

Answer 608

right-sided HF

Answer 609

* ↑ in venous blood volume * ↓ in venous compliance

Answer 610

* O₂ * diuretics * ACE inhibitors * beta blockers * digoxin * vasodilators (nitro) * morphine

Answer 611

* elevate HOB * Na⁺ restriction * ↓ activity level, stress * VAD

Answer 612

ventricular assist device

Answer 613

* requires open-heart surgery * for right, **left (LVAD)**, or both ventricles * indication: ventricular dysfunction * end Tx for those who are not transplant candidates * *rarely: temporary unti heart recovers*

Answer 614

* for ↓ of FVE * often w/ ACE inhibitor and beta blocker * types * thiazide: for mild Sx * loop: for more severe Sx * multiples used together if necessary

Answer 615

* captopril, lisinopril * relaxes blood vessels to ↓ BP * often used w/ beta blocker and diuretic

Answer 616

* carvedilol, atenolol, propranolol * block effects of epinephrine: ↓ HR + ↓ force + vasodilation → **↓ BP** * usually used w/ ACE inhibitor and diuretics * may not work as well in OA or those of African descent

Answer 617

\> 2 ng/mL

Answer 618

0.5-2 ng/mL

Answer 619

* fatigue * dysrhythmias * **visual disturbances**

Answer 620

* brady: hold for apical pulse \< 60/min * hypokalemia: check K⁺ before admin * toxicity: check drug levels and hold per protocol

Answer 621

* affects Na⁺ and K⁺ inside heart cells to ↓ strain * ↓ ventricular rate + improved strength → better filling

Answer 622

* admin oxygen per order or protocol * maintain SpO₂ ≥ 90% (except in advanced COPD)

Answer 623

* oxygenation * O₂ therapy (≥ 90%) * high Fowler's or on pillows * arms on pillows (chest expansion) * reposition, cough, and deep breathe Q2H * check ABGs * help pt group activities to conserve energy * fluid/electrolyte balance * monitor I&O, daily wt * **report wt gain of \> 3 lbs** * may require ↑ diuretic dosage * maintain Na⁺ restriction * check electrolytes

Answer 624

* pericarditis * myocarditis * rheumatic endocarditis * infective endocarditis

Answer 625

extended inflammatory response often → destruction of healthy tissue

Answer 626

inflammation of pericardium

Answer 627

* commonly follows resp. infection * MI

Answer 628

* CV * chest pressure/pain * relieved when sitting, leaning forward * worse on inspiration * pericardial friction rub * ↑ cardiac enzymes * resp. * coughing * SOB

Answer 629

inflammation of myocardium

Answer 630

* virus * fungus * bacteria * inflammatory dz, e.g. Crohn's

Answer 631

* tachycardia * murmur * friction rub * cardiomegaly * CP * dysrhythmias

Answer 632

* complication of rheumatic fever → **lesions in heart** * preceded by Group A betahemolytic streptococcal pharyngitis

Answer 633

* CV * CP * tachycardia * friction rub * murmur * SOB * **joint pain** * **rash on trunk, extremities** * **fever**

Answer 634

* organisms * staphylococci * streptococci * fungi * other * most common in * structural malformation * cardiac devices * prosthetic heart valves * IV substance use * other causes → bacteremia → endocarditis * dental procedures, * body piercing * tattooing

Answer 635

* **fever** * **flu-like manifestations** * murmur * **petechiae** * **splinter hemorrhages** * **+ blood culture**

Answer 636

* non-modifiable * congenital defects * heart valve replacement * immune suppression * rheumatic fever, other infections * school-age children w/ long duration of strep * modifiable * malnutrition * overcrowding * lower socioeconomic status

Answer 637

* ECG * rheumatic fever: heart block * pericarditis: ST elevation in almost all leads * echo * inflamed heart layers * pericardial effusion

Answer 638

1. cultures: blood, throat 2. CBC: WBC count 3. cardiac enzymes: ↑ in pericarditis 4. ESR, CRP: ↑ inflammation

Answer 639

* assess * heart sounds for murmur, friction rub, or muffle * pain * review labs * ABGs * SaO₂ * CXR * monitor * VS for fever * ECG * meds * abx * antipyretics * bed rest

Answer 640

* infective endocarditis * rheumatic endocarditis

Answer 641

rheumatic endocarditis

Answer 642

* pericarditis * myocarditis * rheumatic endocarditis

Answer 643

* flu-like manifestations * petechiae * splinter hemorrhages * + blood cultures

Answer 644

* joint pain * rash on trunk and extremities * recent infection w/ Group A betahemolytic strep pharyngitis

Answer 645

friction rub

Answer 646

pericarditis

Answer 647

* relief: sitting, leaning forward * worsening: on inspiration

Answer 648

myocarditis

Answer 649

* pericarditis * rheumatic endocarditis

Answer 650

* myocarditis * rheumatic endocarditis