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Med Surge 3 > Week 3 (exam 1) > Flashcards

Week 3 (exam 1) Flashcards

1
Q

Methotrexate

A

DMARDs (disease modifying antirhumatic drug)

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2
Q

Rheumatoid arthritis

A

autoimmune reaction that effects the synovial tissue causing loss of articular surfaces and joint motion

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3
Q

Symptoms of rheumatoid arthritis

A

Symmetric joint pain/morning stiffness
Swelling
Warmth
Erythema
Low grade fever
Lack of function

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4
Q

Stages of RA

A

Stage 1
- the body mistakenly attacks its own joint tissue
Stage 2
- the body make the antibodies and the joints start swelling up
Stage 3
- the joints start becoming bent and deformed, the fingers become crooked. These misshapen joints can press on nerves and cause sever pain
Stage 4
- if not treated the disease will progress into the last stage, in which there’s not joint remaining at all and the joint is essentially fused

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5
Q

Extra Articular features of RA

A

Weight loss
Fatigue
Anemia
Lymph node enlargement
Raynaud’s phenomenon
Arteritis (inflammation of the arteries)
Neuropathy
Pericarditis
Sjogren’s syndrome (dryness throught the body)

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6
Q

Sjogren’s syndrome

A

a chronic autoimmune disorder that primarily affects the glands that produce moisture, such as the salivary and lacrimal glands

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7
Q

Assessment findings of RA

A

Joint inflammation
Tenderness
Temperature changes in joints
Extra articular changes

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8
Q

Lab findings in RA

A

Rheumatoid factor
Anti-CCP (cyclic citrullinated peptide antibodies)
ESR and CRP
CBC – (baseline)
arthrocentesis
X- ray

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9
Q

Medical management of early RA

A

Balance of rest and exercise
NSAIDs
DMARDs
Biologic DMARDs

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10
Q

DMARDs

A

a class of medication used to treat inflammatory and autoimmune diseases

Ex: methotrexate
leflunomide hydroxychloroquine
sulfasalazine

can cause N/V, diarrhea, hair loss, fever, increased risk of infection, lymphoma, kidney damage, and can cause bone marrow suppression

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11
Q

Biologic DMARDs

A

Rituximab
Etanercept
Adalimumab
Sarilumab

can increase risk of infection

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12
Q

Established RA

A

Formal occupational and physical therapy program
Addition of an immunosuppressant
Reconstructive surgery
Corticosteroids
Anti depressants
Nutrition

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13
Q

Assessment of pt with a Rheumatic disease

A

current and past symptoms
patient’s psychological and mental status
social support systems,
ability to participate in daily activities,
compliance with treatment regimen
management of self-care

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14
Q

systemic lupus erythematosus

A

chronic inflammatory disorder of the connective tissue and it caused wide spread inflammation as well as tissue damage

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15
Q

systemic lupus erythematosus symptoms

A

Arthralgias (joint pain) and arthritis
Skin manifestations
Pericarditis
Renal involvement
CNS involvement
impacts females more than males

see grid in notes

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16
Q

Dx for systemic lupus erythematosus

A
  • labs will reveal moderate to severe anemia, thrombocytopenia, leukopenia, and positive antinuclear antibodies
  • classic sign is the butterfly rash
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17
Q

Medical management of lupus is

A

Pharmacologic therapy
Corticosteroids
Antimalarials (hydroxychloroquine)
NSAIDs
Immunosuppressants
Monoclonal antibodies

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18
Q

Nursing management of lupus is

A
  • educate pt to avoid sun exposure
  • due to the involvement of multiple organ systems, educate pts about the importance of periodic health screenings
  • provide support groups
  • educate on the importance of sticking to their medication regimen
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19
Q

Causes of thyroid cancer

A

radiation exposure
3/4 of cases are female

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20
Q

Dx of thyroid cancer

A

Large or palpable thyroid
Ultrasound, MRI, CT
Thyroid function test
Serum Ca and phosphorous levels
Biopsy once ultrasound confirms mass
Radioactive iodine uptake studies

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21
Q

Signs and symptoms of thyroid cancer

A
  • lesions on thyroid
  • recurrent nodules on thyroid
  • dysphagia
  • hoarseness
  • dyspnea
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22
Q

Tx of thyroid cancer

A

Thyroidectomy
Radioactive Iodine (no chemo)

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23
Q

Thyroidectomy

A

Depending on where it is, if its to the side it could be a partial

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24
Q

Radioactive iodine

A

Prior to taking this pill pt will go on a low iodine diet for two weeks (no red meat)
This will cause the thyroid to be craving iodine so that when the pt takes the radioactive iodine pill the thyroid will soak it all up.

Pts taking this pill should…
- flush toilet twice
- no pregnant visitors
- no bed sharing
- wash clothes separate

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25
Pre operative education for pts having thyroidectomy
- educate how they should support the neck with their hands after surgery to prevent stress on the incision typical post op care (monitor for any complications, assess airway and stay on top of pain meds)
26
Potential complications to monitor after thyroidectomy
hematoma injury to laryngeal nerve hypocalcemia *life long thyroid hormone replacement (thyroxine) (Synthroid levothyroxine) *
27
Gastric cancer risk factors
Diet - smoked, salted, and pickled foods Poor prognosis - asymptomatic in early stages Typically adenocarcinomas - a type of cancer that arises from mucus producing cells of inner-most lining of stomach
28
Gastric cancer manifestations
Few symptoms early stages Indigestion Early satiety (feeling of fullness) Weight loss Abdominal pain Bloating after meals Decrease appetite N/V
29
Gastric cancer assessments
Palpable mass (late) Ascites (metastasis) Palpable lymphnodes around the umbilicus
30
Diagnostics of gastric cancer
Esophagogastroduodenoscopy (EGD) Barium x-ray CBC Tumor marker - CEA
31
Tx of gastric cancer
Billroth I- Gastroduodenostomy Billroth II- gastrojejunostomy
32
Priority problems w gastric cancer
Anxiety Impaired nutritional intake Acute pain Grief Lack of knowledge
33
Potential complications of bilroth
Hemorrhage Dietary deficiencies - B12 deficiency (pernicious anemia) Bile reflux Dumping syndrome (review chart in notes)
34
Dumping syndrome symptoms
- occurs 15-30 min after eating - epigastric fullness - weakness - dizziness, vertigo - diaphoresis - tachycardia - abdominal cramping - self limiting
35
Dumping syndrome management
- no fluids w meals - no high carbs - no high sugars
36
Colorectal cancer (the third most common cause of cancer death) Risk factors
Smoking family Hx Lynch syndrome (hereditary disorder that increases the risk of cancer) Alcohol consumption High fat, Low fiber diet Sally Has Lunch After Highs & Lows Ross **Lynch ** has colorectal cancer *should have colonoscopy once a year once you turn 50*
37
Manifestation of colorectal caner
change in bowel habits; blood in stool - tarry - bleeding - tenesmus (feeling of needing to have a bowl movement even when there is little to no stool present) symptoms of obstruction; - pain, either abdominal or rectal - feeling of incomplete evacuation
38
Dx of colon cancer
- colo guard - conoloscopy - biopsy - CEA (tumor marker) - contrast CT scans
39
Tx of colorectal cancer
surgery, aka colectomy (remove portion where cancer is) they will either reconnect the bowl, or the pt will get an ostomy radiation and chemo
40
Patho of pancreatitis
the digestive enzymes produce by the pancreas specifically trypsin starts to digest itself
41
causes of pancreatitis
typically alcohol abuse bacterial or viral infections gall stones
42
Dx of pancreatitis
Lab values (serum amylase and lipase levels are most indicative) Scans (CT, MRI, Ultrasound) ERCP (Endoscopic Retrograde Cholangiopancreatography)
43
Tx of pancreatitis
- NPO (monitor their fluid and electrolyte balances) (monitor their glucose) - NG suction - Medications such as opioids for pain, PPIs, and H2 receptor blockers to decrease hydrocloric acid secretion - ERCP- can remove gallstones, blockages, and help treat infection
44
Cullens sign
bruising or swelling around the belly button or umbilicus indicating sever pancreatitis symptoms. Can be a sign of internal bleeding.
45
Grey turner sign
a rare bruise-like discoloration of the lower abdomen and **flanks** that can indicate serious abdominal issues. It's often a sign of acute pancreatitis and can indicate hemorrhage
46
Inflammatory bowl disease
a group of chronic disorders: Crohn’s disease and ulcerative colitis that result in inflammation or ulceration (or both) of the bowel.
47
Ulcerative colitis
Immune system dysfunction that results in inflammation of the mucosa of the colon and the formation of continuous ulcerations throughout the colon
48
Ulcerative colitis S&S
Diarrhea (10-20 liquid stools per day) Fever Abdominal pain Fecal urgency Weright loss Anemia Dehydration Hypokalemia Labs increase in WBC, ESR, and CRP
49
Ulcerative colitis Dx
Colonoscopy w biopsy
50
Tx of ulcerative colitis
sulfasalazine (GI anti inflammatory medication) Corticosteroids – prednisone Immunosuppressant- Cyclosporine Antidiarrheals Surgical tx: Proctocholectomy – removing entire colon and rectum
51
Pt teaching w ulcerative colitis
NPO during exacerbations High calorie diet w low fiber Pt should avoid caffeine, alcohol, and lactose eat smaller more frequent meals
52
Crohn's disease
autoimmune disorder that is characterized by periods of exacerbation and remission. inflammation of the GI tract through all layers. the entire GI tract can be involved, with ulcerative colitis it is just the colon
53
S&S of Crohn's disease
Formation of patchy ulcerations or skip lesions (ulcerations will be sporadic) formation of fistulas diarrhea (5-6 loose stools a day) Steatorrhea (high content in the stool) RLQ plain Weight loss Anemia Fever Fatigue
54
Abnormal labs in Crohn's disease
Elevation of WBCs, ESR, and CRPs
55
Dx of Crohn's disease
Endoscopy (can include colonoscopy, and an EGD)
56
Medications for Crohn's disease
sulfa sulfasalazine (GI anti inflammatory medication) Immunosuppressant- Cyclosporine Antidiarrheals
57
Surgical interventions for Crohn's disease
Small bowel resection colectomy ileostomy
58
Pt education w Crohn's disease
- during exacerbations pts should be NPO - if they have a serious exacerbation they may require TPN - high calorie low fiber diet - smaller more frequent meals
59
Ileana Anastomosis
a surgical procedure that involves connecting the ileum (the last part of the small intestine) to the anus
60
stoma appearance
should look beefy and red if it looks dusty and pale we are concerned that there is not enough blood flow to the site
61
Ostomy education
1/8th inch around the stoma stool should not be on the abdomen at all bc that can cause skin breakdown empty ostomy when 1/3 to 1/2 full first goal is to have them acknowledge the stoma then they will learn how to take care of it

Med Surge 3 (11 decks)

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