Unit 4 Flashcards
(164 cards)
1
Q
What is the difference between ventilation, transport, and perfusion
A
Ventilation—process in inhalation 02 and exchange CO2 (BREATHING)
Transport—ability of O2 to be carried via Hg (CELLS)
Perfusion—blood volume, pump, vascular tissue which allow blood to be carried to tissues (Vessels—>Tissue)
2
Q
What is the function of elastin
A
Expand and contract lungs
3
Q
What extrinsic and intrinsic factors of restrictive respiratory disease
A
Extrinsic (Outside Lungs)—Brain, Polio, Broken ribs)
Instrinsic (Inside lungs)—Pneumonia, Covid, pulmonary fibrosis
4
Q
What are obstructive factors of respiratory disease
A
Asthma, airway collapse, less elastic tissue, poor exhale high residual volume (COPD)
5
Q
T/F 25.3% of smokers are adults who live below poverty level
A
T
6
Q
T/F largest percentage of non Hispanic American Indians of 31.8% smoke or use tobacco products
A
T
7
Q
What do you see, hear, and measure adequate gas exchange
A
Effort of breathe RR
90-100% O2
Skin, nails, and lips are appropriate
Symmetry of chest
Clear breath sounds
8
Q
What will we see if babies have impaired gas exchange
A
Poor feeding
9
Q
What are physiological signs of impaired gas exchange
A
Tripod position
Adventitious lung sounds
Tachycardia
Altered LOC
10
Q
What organ is most sensitive to oxygen deprivation
A
Brain
11
Q
What is a bronchoscopy
A
Direct endoscopic exam to look and remove blockage
12
Q
What is silent chest
A
Severe decreased breath sounds=severe obstruction
13
Q
What is status asthmaticus
A
Asthma complication
Life threatening
Without treatment: hypotension, bradycardia, and respiratory arrest
Bronchdiators and steroids are ineffective
Treatment=intubated and mechanically ventilated
14
Q
T/F with asthma, take dilator first, steroid second
A
T
15
Q
What diagnostic testing is used to diagnose asthma
A
Allergy test
Peak expectorey flow rate (PEFR) >80%
Spiromatory
Serum level of immunity cells
Oximetry, ABGs
Chest imaging
16
Q
What is a sort acting bronchodilator
A
Albuterol
“Rescue”
Take before: excerise
Side effects: tremors, tachycardia
NOT FOR LONG TERM USE
17
Q
What is a long acting bronchodilator
A
Salmeterol
“Controller”
Used once every 12 hours
Decreases need for rescue inhaler
NEVER USE FOR AN ATTACK
18
Q
What asthma drug can increase digoxin toxicity
A
Methylxanthines
19
Q
What do corticosteroids
A
Decrease hyper responsiveness, block late phase, block migration in inflammatory cells
20
Q
What is the side effects of Budesonide/fluticasone
A
Must be used on a fixed schedule
—oroparyngeal candidasis (thrush)—-rinse mouth
21
Q
What are the three types of inhaled devices
A
Metered dose inhaler
Dry powered inhaler
Nebulizers
22
Q
What is the technique for dry powder inhaler and challenges
A
Don’t shake
Rapid breath—hold 10 sec
Used when have less dexterity
Challenges: not all meds are available and cost effective
Keep out of high humidity
Rinse mouth
23
Q
What are the challenges of nebulizers
A
Bacterial growth in equipment
24
Q
What is green zone of action plans
A
Doing well: no symptoms, activity inc, PEFR >80%, med adherence
25
What is yellow zone in action plan
Asthma worse: symptomatic, PEFR 50-70%
26
What is red zone for asthma action plan
Medical emergency: meds aren’t helping
Cannot do activities
PEFR is 50% or less
Call 911 and admit to hospital
27
What are lung characteristics of COPD
Emphysema (alveoli become blebs from hyperinflation and air trapping)
Scarring
Bronchioles lose their shape and become clogged with mucus
28
What are the COPD classifications
GOLD 1: mild
GOLD 2: moderate
GOLD 3: Severe
GOLD 4: very severe
29
How is the COPD classification classified
How much air can a person exhale during forced breathing
30
What are some COPD complications
Pulmonary hypertension: constriction of vessels
Cor pulmonale (right sided heart failure)—pulmonary hypertension
Acute exacerbations-infections
31
What are some complications of oxygen therapy
Combustion: cannot smoke
CO2 narcosis: lost drive to stimulate breathing
O2 toxicity: severe inflammatory response in alveolar-capillary membranes
Infection: particularly when humidifiers used to prevent dryness
32
What are COPD medications
Bronchodilators given first
Corticosteroids first line for inflammation
Anticholineric-decreased spasm
Antibiotics-after sputum culture
Expectorants-help get rid of mucus
33
What kind of meals should COPD patients need
High protein and high calories, small frequent meals (flat diaphragm)
34
What are the three causes of pathogens in pneumonia
Aspirations, inhalation of microbes, hematogenous spread from primary infection in body
35
What are the two classification of pneumonia
Community acquired—treat from home—antibiotics and often due not need sputum culture
Hospital acquired—48 hours after admission, collect sputum cultures, start empirical antibiotics, drug resistance is common, ventilator associate
36
What are some diagnostics for pneumonia
CBC, CMP, blood cultures, Blood gases, pulse oximetry, chest x ray
37
what are complication of pneumonia
Atelectasis—fluid in the alveoli
Pleurisy—inflammation of pleura
Pleural effusion—fluid connects in pleural space
Bacteremia—gets in the blood
Pneumothorax—are collects in plural space (can make lung collapse)
Sepsis/septic shock: systemic failure
38
What is some preventions of pneumonia
>30 degrees
Sit up for meals and meds
Assess for s/s of dysphasia
Monitor for reflux or gastric residual
Vaccines
Incentive spirometer
39
What is akinesia
Loss of ability to move muscles voluntarily
40
What are the neurotransmitters involves in Parkinson’s
Deficit in DA creates imbalance between DA and ACh result in movement disturbance
Levy bodies are clumps of protein found in pts w PD which leads to Lewis body dementia
41
Is there specific diagnostic tests for Parkinson’s
No
42
What are the manifestation of Parkinson’s
Tremor—first sign, pill rolling motion, lessens with movement
Rigidity— increased resistance to ROM, tired achy muscles
Bradykinesia—slowness of movement, dead pan expression
Postural instability—propulsion/retropulsion
NURSING HINT: planning should include maximizing function, maintain independence, and prevent injuries (fall risk)
43
What are risks of Parkinson’s
Traumatic brain injury
Environmental exposures (pesticides, insecticides,etc)
Genetics (20-25% inc risk of sibling/parent
NURSING HINT—obtain a thorough patient history
44
What are the 5 stages of Parkinson’s disease
Stage 1: develop mild symptoms but able to go about day-to-day life
Stage 2: symptoms such as tremors and stiffness be worse, poor posture (Cain)
Stage 3: movement begins to slow down, loss of balance (walker)
Stage 4: symptoms are severe, issues with day to say living, unable to live alone
Stage 5: walking or standing impossible (wheelchair)
45
How do you accomplish the four goals of Parkinson’s
Promote exercise
Attending physical therapy
Environmental changes
Diet
Management of sleeping problems
Assist with psychological well being
Recognize caregiver burden
Dementia education
—-finger foods, weakened utensils, satin night gowns
NURSE HINT- sense of smell dec, dec food intake
46
T/F with dementia, manifestation depends on the cause
T
47
What is the pathophysiology of Alzheimer’s disease
Changes in brain structure and function, amyloid plaques, neurofibrillary tangles, loss of connections between neurons, neuron death
48
What are the diagnostic test
No definitive test exists. Definitive diagnosis requires examination of brain tissue after death
49
What is delirium
State of confusion that develops over days to hours
Represents a change in baseline
Exact cause in unknown
Rarely caused by a single factor
50
What is the deliriu, pneumonic
Dementia
Electrolyte imbalance, emotional stress
Lung, liver, heart, kidney, brain
Infection
RX drugs
Injury, immobility
Untreated pain, unfamiliar environment
Metabolic disorders
51
What is type 1 diabetes
Characterized by autoimmune destruction of the pancreatic beta cells
Child often
52
What is diabetic ketoacidosis
DKA is the second most common form of present for T1DM in most populations
53
What is type 2 diabetes
Characterized by hyperglycemia usually due to progressive loss of insulin secretion form beta cells superimposed on a background of insulin resistance, resisting in insulin deficiency
54
What is A1C scale
5.6-6.4 pre diabetic
6.5+ diabetic
55
What is some dietary modification
Women 25-60g/meal
Men 60-75g/meal
56
What does metformin
Reduces glucose absorption from the intestines
Lowers liver glucose production
Improves insulin sensitivity
Low risk of low blood sugar
Side effects- nausea, upset stomach diarrhea
57
What do SGLT-2 do
SFLT-2 inhibitors shown to lower A1C, improve weight loss, and lower blood pressure
Cardiac and renal benefit
Side effects-bladder infections, UTI, yeast inflections, hypotension
58
What do GLP-1 do
They increase insulin secretion, suppress glucagon release, slow gastric emptying, and reduce appetite. These effects lead to decreased caloric intake and improved satiety
Cardiac and renal benefit
Side effects—nausea, vomiting, diarrhea, constipation, abdominal pain
59
What do sulfonylureas
Stimulate the pancreas to release insulin, which lowers blood sugar levels
Side effects—hypoglycemia
60
What is considered hypoglycemia
<70
61
What is DKA
Characterized by the triad of hyperglycemia, anion gap metabolic acidosis, and ketonemia
62
What are DKA treatments
Assess vital signs
Treat volume depletion and electrolyte abnormalities
Administer insulin
63
What are some maifesetations of anemia
Increased HR, inc pulse pressure, systolic murmurs, claudication, angina, HF, MI
Icteric conjunctiva, retinal hemorrhage, blurred vision
Anorexia, hepatomegaly, splenomegaly, dysphasia, weight loss, glossitis, smooth tongue, bone pain, techpnea, orthopnea, Dyspnea, vertigo, irritability, depression, pallor, jaundice, itching
64
What are the three problems lead to decreased RBC production
Dec HBG synthesis from iron deficiency anemia, thalassemia, and sideroblastic anemia, defective DNA synthesis, megaloblastic anemia, diminished availability of RBC precursors
65
T/F glossitis is the 2nd most common manifestation
T
66
What is the most common manifestion of anemia
Pallor
67
What kind of medication do you avoid with anemia patients
Avoid enteric coated or system release capsules
68
What are some teachings you do for anemic patients
Best absorbed in acidic environment—take an hour before meals with orange juice
Dilute liquid iron to prevent tooth staining
Sit upright for 30 min after taking oral iron
High risk for allergic reaction with IV and IM iron preparations
69
What is thalassemia
Group of diseases involving inadequate production of normal HGB
Decreased RBC production
Due to absent or reduced globulin protein
Autosomal recessive genetic basis
70
What is thalassemia minor
Often asymptomatic
Mild to moderate anemia
Microcytosis
Hypochromia
Mild splenomegaly
Bronzed skin color
Bone marrow hyperplasia
71
What is thalassemia major
Life threatening disease
Symptoms by age 2–can cause growth and development deficits
Pale, jaundice
Pronounced splenomegaly
Hepatomegaly, cardiomyopathy
Cardiac complications
Bone marrow
72
What are cares for thalassemia major
Blood transfusion/exchange transfusions
Chelating agents—reduce iron overloading
Reblozyl—improves hbg levels and reduces transfusion needs
73
What is cobalamin deficiency
Most common cause of pernicious anemia
Caused by absence of intrinsic factor
Middle or later years >60 years
Manifestations—develop from tissue hypoxia
Beefy red tongue, paresthesias of feet’s and hands
74
What are megaloblastic anemias
Folic acid needed for DNA synthesis leading to RBC formation and maturation
Develops insidiously
Treat with high diet of folic acid
75
How do you teat aplastic anemia
Diagnosis of Hgb, wbc, platelet deceased
Normocytic
Low reticulocytes
Serum iron and TIBC may be high
Confirmed with bone marrow biopsy and patho exam
Management- identify and remove causative agent
76
What is gout
Recurrent arthritis flares due to excess urine acid over production or under elimination
Irate crystals form in synovial tissues
Rapid inflammatory process
Chronic
77
What are signs of gout
Acute onset of severe joint pain
Swollen joints
Joint return to normal in a few weeks
Drainage, joint deformity, kidney stones
Middle aged male—hyper lipidemia, glycemic
78
What medicine do you use
Stop acute attack—colchicine—antinflammatory
Prevent further attacks—probenecid-increases urinary secretion
Allopurinol—blocks production
79
What are some common triggers of gout
Purine rich—shellfish, liver, wine/beer
80
What is the difference between primary headaches and secondary headaches
Primary headaches are not caused by disease or another medical condition (tension type, migraine, cluster)
Secondary are caused by another condition or disorder (sinus infections, neck injury, brain tumor)
81
What is a tension headache
Stress headache,most common type of headache
Bilateral location
Mild to moderate intensity
82
What is a migraine
Usually unilateral throbbing pain
25-55 years old
Premonitory symptoms or trigger (giving premonition serving to warn)
83
What are risk factors to migraines
Age (female)
Obesity
Depression
Stressful life events
two categories (without aura-common migraine with aura (classic migraine
84
What are Clincal manifestations of migraine
Premonitory symptoms-sensory sensitivity to light and sound, sleep changes, mood changes, hemeostatic changes, nausea and vomiting
Aura—visual symptoms and distortions, sensory and motor phenomena
Throbbing or pulsating headache
85
What are cluster headaches
Most severe primary headaches caused
Repeated headaches generally occur at same time of day or night
20-50 years
Affect men more than women
86
What is pathology of cluster headaches
Unilateral pain
Pattern suggests dysfunction of hypothalamic
Triggers can include alcohol, strong odors
87
What are the clinical manifestations of cluster headaches
Sharp stabbing intense pain
Duration of 15 to 3 hours
Presence of autonomic symptoms as mitosis and runny nose
Frequent a day and may last 2 weeks to 3 months then remission
88
What are some inter professional care of headaches
Medication
Yoga
Biofeedback
Cognitive behavioral therapy
Relaxation therapy
89
What are drugs for tension headaches
Mild to moderate
Aspirin, acetaminophen, NSAID with caffeine, a sedative or muscle relaxant
preventative- antidepressants or anti seizure medication
90
What drugs help migraine headaches
Mild to severe Analgesics (NSAIDs, aspirin, caffeine)
Moderate to severe (Tristans—-first line, affect selcted serotonin receptors reduce neurogenic inflammation)
91
What are preventative drugs for migraine headaches
Antiseizure
B blockers
Botox
92
What are drug therapies for cluster headaches
Symtomatic—Tristan’s (contraindicated for vascular risk factors), 100% o2 at 6-8L for 10 minutes, repeated after 5 min rest
Preventative— high dose veramil, invasive nerve blocks, deep brain stimulation, and ablative neurosurgical procedures
93
What is a MOH
Medication overuse headache is a analgesic rebound headache
Acetaminophen, aspirin, NSAIDS, buralbiral, Tristan’s, ergotomaine, opioids
94
What do you teach a patient about headaches
Teach about preventative treatment
Teach to avoid triggers
95
What is fibromyalgia
Fibromyalgia is known as chronic centeral pain syndrome with widespread musculoskeletal pain and fatigue. It is believed that repeated nerve stimulation causes the brains of people with fibromyalgia to change causing an abnormal increase in neurotransmitters
Research is still being done
96
What are risk factors of Fibromyalgia
Increased levels of substance P in spinal fluid
Low blood flow to thalamus
Dysfunction of hypothalamic pituitary adrenal axis
Low serotonin and tryptophan
Abnormal cytokine function
Genetic component
Women>men (10:1)
CLIENTS W OSTEOARTHRITIS, RA OR LUPUD ARE MORE LIKLEY TO DEVELP FIBROMYALGIA
97
T/f a recent stressful or traumatic event or illness is often seen to occur prior to the client experiencing symptoms of fibromyalgia. For others, it may occur spontaneously
T
98
What are manifestation of fibromyalgia
Muscle pain—not weakness or inflammatory response
Trouble determining if pain is in muscle, joint, or tissue
Paresthesia
Burning pain
Numbness tingling in hands and feet
Restless leg syndrome
99
What are cognitive effects of fibromyalgia
Range in difficulty concentrating to memory lapses
Feelings of being overwhelmed when dealing with multiple tasks
Migraine headaches
Depression and anxiety
100
What are GI symptoms of fibromyalgia
IBS
Difficulty swallowing
Greater urinating requency and urgency
101
What are drug therapies for fibromyalgia
Pregabalin
Duloxetine
Milnacipin
Low dose tricyclic antidepressants, SSRIs, benzodiazepines
Muscle relaxants
Analgesics
Zolpidem
102
What are nursing managements of fibromyalgia
Supportive care
Massage combined with ultrasound
Application of alternating heat/cold packs
PT (gentle stretching)
Yoga, tai chi
Low impact aerobic exercise
103
What are nutritional management of fibromyalgia
Limite sugar, caffeine, alcohol (may be muscle irritants)
Vitamin/mineral supplements
Avid miracle diets and supplements
Relaxation strategies (meditation, counseling, biofeedback, imagery, cognitive behavioral therapy)
104
pathophysiology of mobility altering disorders
Slowly progressive disorder
Not inflammatory
Primary or secondary
Cartilage degenerates
Bone pull together
105
What are complimentary therapies of mobility issues
Tai chi
Stem cell injections show some benefit but small sample sizes
106
T/F glucosamine, chondroitin have demonstrated benefits
F
These have not demonstrated benefits
107
T/F of all the age related changes, osteoporosis is the one that is most likely to cause serous negative functional consequences even in the absence of additional risk factors
T
108
What are risk factors of osteoporosis
Smoking
Diet low in calcium and vitamin D deficiency
Low body weight
Sedentary lifestyle
109
What disease is the silent thief
Osteoporosis
110
What are early and late manifestations of osteoporosis
Early—bone pain, spontaneous fractures
Late—dowager’s hump, hypnosis, loss of height, spinal deformities, stooped posture
111
What are focus of care measures
Proper nutrition
Calcium/ vitamin d supplements
Exercise daily
Prevention of falls
Drug therapies —NSAIDs recommended over Tylenol
(Surgical options exist)
112
T/F recommended to take calcium in divided doses with food for osteoporosis
T
113
What is the first line drug for osteoporosis calcium deficiency
Biphosphonates
114
What is MOA of biphosphonates and side effects
The mechanism of action (MOA) of bisphosphonates in the treatment of osteoporosis involves inhibiting osteoclast-mediated bone resorption, which helps increase bone density and reduce the risk of fractures.
Side effects—osteonecrosis of jaw, renal toxicity, femur fractures
115
What are other medications for osteoporosis
Monoclonal antibodies
Selective estrogen receptor modulator
Recombinant parathyroid hormone
116
What is osteoarthritis
Shows damage to cartilage within joints, with visible wear and tear, bone spurs, and joint space narrowing, causing pain and stiffness during movement
117
What is pathophysiology of osteomyelitis
Swelling and warmth
Decreased movement
Constant bone pain
118
How are fractures classified
Direction of fracture line
119
What do you do if you have a patient with a fracture
Elevate above heart,do not place in dependent or below heart position, observe for increased pressure or compartment syndrome, immobilize if suspected fracture
120
What is closed and open reduction
Closed—non surgical, manual realignment, traction, cast, splint, brace
Open—surgical, wires, screws, rods, nails. Facilitates early ambulating, reduced risks related to immobility. Problem—risk for infection.
121
What do you do before putting on a cast
Ice for first 24 hours??
122
What do casts allow you to do
Allows for ADLs while maintaining fractures immobilization (plaster of Paris or fiberglass)
Elevate above heart first 48 hours
Need permission to shower with cover
Report increasing pain, swelling, tingling, or foul odor
NEVER: insert object into cast, bear weight for first 48 hours, cover for prolonged periods
123
What are the don’t for casts
DO NOT:
Elevate if compartment syndrome
Get plaster cast wet
Remove padding
Insert objects
Bear weight for 48 hours
Cover cast with plastic for prolonged periods
124
What are the DOs of casts
Use hair dryer on cool setting for itching, check with healthcare provider before getting wet
Dry thoroughly after getting wet
Report burning or tingling under cast
Report sores or foul odor under
125
What is traction with fractures
Purpose, prevent or decrease pain and muscle spasm
Immbolize joints
Reduce fracture or dislocation
Treat a pathologic joint condition
126
What is the neuromuscular assessment in fractures
Color and temperature
Capillary refill
Pulse rate and quality
Edema
Motor function
Sensory function
127
What is fat embolism syndrome
Fat globules transported to lungs cause a hemorrhagic interstitial pneumonitis
Symptoms 24-48hours after injury
Petechiae- neck, chest wall, axilla, buccal membrane, conjunctiva
128
What is fat embolism syndrome
Serious manifestation of fat embolism occasionally causes multi system dysfunction, the lungs are always involved and next is bran
129
How do you manage compartment syndrome
No elevation above heart
No ice
Loosen bandage and split gast
Reduce traction weight
Surgical decompression
130
What is arthroplasty
Reconstruction or replacement of a joint
131
What is key for hip arthroplasty nursing care
Maintain limb alignment to prevent dislocation
Cannot flex or cross legs. Ankles
Toilet raising, no putting on shoes or reach for items, sleep with pillow or foam pad between legs
132
What is different between Caron’s disease and ulcerative colitis
Chron’s—spotty in large intestines
Ulcerative colitis— LLQ continuous, grows upward in intestinal tract as progressive
133
What are nutritional considerations when a pt has inflammatory bowel disease
Water and electrolytes, and vitamin absorption is impaired.
Small intestine absorbs most essential nutrients from food
Jejunium—middle part of small intestine, does most of work
134
T/F exact cause of inflammatory bowel disease is unknown
T
Etiology: autoimmune, genetic, environmental, teens to early adulthood, 2nd peak in incidence after age 60, smoking
135
Where in the intestine in Crohn’s disease more common
Terminal ileum and colon (LRQ)
Effects entire thickness of bowel wall
Common perforations
136
What are manifestations of Crohn’s disease
Crumpling abdominal pain
Diarrhea
Rectal bleeding (not often)
Systemic symptoms
Small intestine involved >>weight loss
137
What are corhn’s complicatoins
Hemorrhage
Perineal abscess
Strictures—inflammatory and scarring in intestine
Fistulas
Small intestine cancer
Nutritional deficits
Perforation
138
What is patho of ulcerative colitis
Starts in rectum and spreads in continuous pattern up the colon
Mucosa and sub mucosa involvement
Pseudo polyps common
139
What are UC manifestations
Bloody diarrhea (more likely)
Abdominal pain
Exacerbations
Fever!!!
Fluid and electrolyte loss
140
What are complications of UC
Perforation
Toxic megacolon
Colorectal cancer
Fistula formation
141
What are diagnostics of UC
Stool culture
CBC
Inc WBC
Dec electrolytes
Sigmoidoscopy
Colonoscopy
Barium enema
142
T/F steroids increase glucose
T
143
What are drug therapies
Aminosalicylates
Antimicrobials
Corticosteroids
Immunosuppressants
Biological and target therapy
144
What are the two surgical modalities
Total proctocolectomy —with ideal pouch/anal anastomosis, with permanent ileostomy
Strictureplasty
145
What are nutritional therapies of UC
Individualized
Balanced diet
Diarrhea—anorexia, iron deficiency, reduced absorption of cobalamin
Food diarrhea
Avoid certain foods
146
What is an expected color of stoma
Rosy to brick red
147
Why would there be edema and bleeding in a stoma
Edema—mild to moderate—normal, moderate to severe—obstruction, inflammed, allergic reacation
Bleeding—small is normal, moderate to large—lower Gi bleed, stomach varies from portal hypertension
148
What are peptic ulcers
Erosion of the GI mucosa from HCL acid and pepsin
149
What are the types of peptic ulcer diseases
Acute—superficial erosion
Chronic—stress related
Gastric—pain right away after eating
Duodenal—pain after food digested
150
How is h pylori involved in PUD
Produces enzyme urease—release inflammatory cytokines
151
What are duodenal ulcers
80% of peptic ulcers
Can get at any age
H pylori is found in 90-95% of patients
Associated with increased HCl acid secretions
152
What are manifestations if duodenal ulcers
Back pain 2-5 hours after meals
Burning and cramp like
Disappear and occur again
Gastric secretions increased
153
What drugs considerations are taken with duodenal PUD
Aspirin and NSAIDs are discontinued for 4-6 weeks
Avoid and restrict alcohol
PPIs are first line ( pronotix) proton pump inhibitors
154
T/F one antibiotic agent is effective in eliminating H pylori
F
No single agent has been effective in eliminating H pylori
Antibiotics prescribed concurrently with PPI for 7 to 14 days
155
What is the difference between diverticulosis and diverticulitis
Diverticulosis—lack of dietary fiber
Diverticulitis— infection from retention of stool
156
What is nurse management for diverticulosis
High fiber diet
High levels of physical activity
Fluids
Weight reduction
Avoid increase intra-abdominal pressure
157
What is the nurse management of diverticulitis
Acute inpatient—rest colon, NPO, IV fluids, IV antibiotics, monitor wbcs, bed rest initially, NG if obstruction
Acute outpatient—rest colon, oral antibiotics, clear liquid diet
158
What is choleliathiasis
Stones in gallbladder
Most frequent biliary system
159
What are risk factors in choleliathiasis
Women
Obesity
Multiparity
Sedentary
Over 40
Birth control increase risk
Native Americans and African Americans
160
What is pathophysiology
Supersaturation with cholesterol and stasis of bile
Most are cholesterol stones
Stuck in bile ducts
Movement=opportunity for obstruction
161
When is an attack most common in choleliathiasis
3-6 hours post high fat meal or patient lies down
Pain in RUQ
Chronic—history of fat intolerance, dyspepsia, heartburn, flatulence
162
What are the drug therapies for gall stones
Anticholinergics
Fat soluble vitamins
Bile salts
Cholestryamine—powder mixed with milk that binds bile salts to be excreted in stools
163
What is the difference between restrictive, malabsorptive bariatric surgery
Restrictive—reduce size of stomach to less foot eaten
Malabsorptive—small bowel shorten or bypassed
164
What is an example of restrictive surgery
Adjustable gastric band—inflatable bad around fundus of stomach—creates a sense of fullness
Sleeve gastrectomy—no reversible stomach removed (removes horned produced to stimulate hunger)
