Med-Sure Ex 3

How do you calculate pack years?

# of years smoked x pack per day = pack years

Question: An older client is admitted to the post-anesthesia recovery unit (PACU) after having a lap cholecystectomy. Which action is the nurses priority in caring for the client? A. Assess T-tube drainage and the Cath site for signs of infection B. Teach the client to avoid fatty foods for the first 6 weeks C. Manage the pain that is caused by carbon dioxide gas D. Remind the client to deep breathe and cough every 2 hours

C. manage pain that is caused by CO2 gas

What is this: Presence of cough and sputum production for at least 3 months in each consecutive 2 years, "blue bloater"

CB

Pathophysiology of Asthma: Airway obstruction is caused by (two things):

1. Inflammation (obstructing the lumen of the airway) and 2. Airway hyperresponsiveness (obstruction by constriction of bronchial smooth muscle causing narrowing of the airway from the outside) See picture. The wall thickens and on top of it the muscle constricts *many people have both problems at the same time

The phases of wound healing include...

1. Inflammatory phase 2. Fibroblastic or connective tissue repair phase 3. Maturation or remodeling phase

What is the recommended exercise frequency for all individuals?

30-40 min/day x5 days per week

Iggy states that any oxygen saturation below what percentage is an emergency that needs rapid intervention?

91% rapid intervention 85% body tissues have hard time with perfusion 70% severely life threatening

Question: What is the difference between hypoxia and hypoxemia? Select 2 answers: A. Hypoxia is decreased tissue oxygenation B. Hypoxemia is decreased oxygen levels in the blood C. Hypoxia is decreased oxygen levels in the blood D. Hypoxemia is decreased tissue oxygenation

A & B Hypoxia- decreased tissue oxygenation Hypoxemia- decreased oxygen levels in the blood

Question: Which of the following are causes for concern following a thoracentisis? Pick two. A. Dyspnea B. Small amounts of blood drainage on the dressing C. Fever D. SaO2 of 96% E. Soreness around the insertion site

A and C

Question: Which of the following can cause a low pulse ox reading? Select more than one. A. Nail polish B. Inadequate peripheral circulation C. Hyperthermia D. Increased Hgb level E. Edema

A, B, E * Remember blood gas is most accurate

Question: A client has had an open Whipple procedure for pancreatic cancer. Which nursing interventions are appropriate for this client in the post-operative period? Select all that apply. A. Maintain IV fluids and monitor fluid imbalance B. Assess for signs and symptoms of DVT C. Connect the nasogastric tube to high intermittent suction D. Start pancreatic enzyme replacements as soon as possible E. Check finger-stick BG level regularly F. Tell the patient to lie flat to protect incision

A, B, E (no) D- must be able to consume solid meal first (no) F- semi-fowlers to reduce incisional stress

Question: Which of the following people are at risk for TB? A. Those receiving immunosuppressant drugs B. Young children C. Middle-class individuals D. Abusers of injection drugs or alcohol E. Foreign immigrants` F. Prisoners

A, B, E, F

Question: The client is a 64 year old general surgery client who was waned off mechanical ventilation this morning. Her spO2 after extubation was 97%. Despite her efforts to cough and deep breather, her SpO2 is now 88%. Which interventions should the nurse implement? Select all that apply. A. Notify rapid response team B. Assist the patient from he supine to the side-lying position C. Confirm the pulse ox reading is correct D. Assess the client for breath sounds and for SOB or dyspnea E. Administer oxygen therapy at 2 L per min via NC F. Administer oxygen therapy at 100% via non-rebreather mask

A,C, F

What acronym should be used when assessing lesions of the skin?

A- asymmetry B- border irregularity C- color variation within one lesion D- diameter > 6 mm

Question: A patient who is hypoxemia also has chronic hypercarbia. What is the appropriate flow of oxygen delivery for this patient? A. 1 L/min via NC B. 4 L/min via NC C. 6 L/min via NC D. 40% O2 via venturi mask

A. 1 L/min via NC

Question: What is CO2 narcosis? A. Loss of sensitivity to increased levels of CO2 B. Loss of sensitivity to increased levels of O2 C. Loss of sensitivity to decreased levels of CO2 D. Loss of sensitivity to decreased levels of hemoglobin

A. Loss of sensitivity to increased levels of CO2

What lab tests may you consider for a work-up on potential COPD patient?

ABG values Acid-base status Sputum sample CBC, WBC, neutrophils H&H Electrolytes Serum AAT ** CXR pulmonary function test

What treatment might be considered for a patient with the infectious respiratory problem rhinosinusitis (AKA sinusitis)?

ABX Antipyretics Decongestants Netty pot

Positive pressure ventilation device that automatically adjusts positive airway pressure minute by minute dependent upon pt need. Is usually more expensive.

APAP A (automatic)

What changes in the following labs should you expect to see with liver cirrhosis patient: AST ALT LDH (lactate dehydrogenase) Alkaline phosphate Bilirubin Albumin PT H&H Ammonia CR

AST unknown change (specific to cardiac, muscle, kidney and brain fx) ALT inc w/ hepatic inflammation LDH (lactate dehydrogenase) elevated (spec to hepatic cell destruction) Alkaline phosphate increased (cause by biliary obstruction) Bilirubin increase Albumin decrease PT prolonged, low platelet count H&H and WBC decreased Ammonia elevated CR elevated

Inappropriately high levels of O2 due to oxygen therapy can cause alveoli collapse which is called

Absorption atelectasis

COPD patients experience respiratory acidosis or alkalosis, due to retention of CO2, respiratory depression, inadequate chest expansion, airway obstruction and reduced alveolar-capillary diffusion.

Acidotic

Type of skin cancer that is a premalignant lesion that if untreated may progress to squamous cell carcinoma

Actinic Keratoses

Clinical manifestations of gastritis: Acute or Chronic Rapid onset of epigastric pain, hematemesis, anorexia, N/V, dyspepsia, gastric hemorrhage Epigastric pain relieved with food, anorexia, N/V, intolerance to fatty/spicy foods, Vit B anemia (pernicious anemia), H-pylori infection

Acute vs Chronic

Abnormal occurrence, discovered during the nail assessment and is known as inflammation of the skin surrounding the nail. Can commonly be a portal for staff infections and happens a lot with immunocompromised patients.

Acute Paronychia

Inflammation of the gallbladder and can be due to calculous (stone)* most common or calculus (inflammation).

Acute cholecystitis

Type of inflammation of the gastric mucosa that is typically bacteria (H-pylori) related or due to long-term NSAID use, caffeine use or alcohol use.

Acute gastritis

Serious and possibly life threatening inflammatory process of the pancreas caused by premature activation of excessive pancreatic enzymes that destroy ductal tissue and pancreatic cells causing autodigestion and fibrosis of the pancreas.

Acute pancreatitis

Clinical manifestations of this includes: abdominal tenderness, rigidity, guarding, general malaise, Cullen's sign (discoloration of abdomen and periumbilical region), turner's sign (flank discoloration), pancreatic ascites and changes in vital signs.

Acute pancreatitis L- cullen's R- turner's

Infectious respiratory problem that is essentially the common cold, leaving you contagious for the first 2-3 days after symptoms appear.

Acute viral rhinitis or coryza

What postoperative care considerations should we have for our post bariatric surgery patients?

Airway management Pain management

What lab values may you want to assess with a patient at risk for wound issues in regard to nutritional status?

Albumin and prealbumin to monitor nutritional status

Review: Hypo or hyperventilation with respiratory alkalosis what about respiratory acidosis?

Alkalosis- Hyperventilation Acidosis- Hypoventilation

What gene may pts posses that pre-disposes them to the development of COPD diagnosed in their 20s?

Alpha1- antitrypsin (AAT) recessive gene

When reviewing chest x-rays for suspected PNA, alveolar infiltrate indicates blank, whereas interstitial infiltration indicates blank:

Alveolar infiltrate indicates: Bacterial Interstitial infiltrate indicates: Viral

What laboratory assessment might be done on a patient with acute pancreatitis? (remember the pancreas functions to aid in digestive enzyme production)

Amylase (dig enzyme, ind pancreatic abscess) Lipase (dig enzyme) Trypsin (dig enzyme, ind pancreatic cell injury) Alkaline phosphate (elevated if biliary involvement) WBC Glucose Calcium (dec w/ fat necrosis)

The following symptoms: shoulder pain, back pain, abdominal pain, tachycardia, and low urine output; may be indicative of what for a post bariatric surgery patient?

Anatomic leak

What function matches with each GI drug therapy (Histamine 2-antagonists, Proton pump inhibitors, Antacids, Prokinetic GI stimulant) Neutralizes gastric acid and bring the pH level above 3. Decreases gastric acid secretion. Ex- Pepcid, Zantac Effective, long-acting inhibition of gastric acid-secretion Ex- Prevacid, Prilosec Increases gastric emptying to improve peristalsis Ex- Reglan

Antacid: Neutralizes gastric acid and bring the pH level above 3. Histamine 2- antagonist: Decreases gastric acid secretion. Ex- Pepcid, Zantac Proton Pump Inhibitors: Effective, long-acting inhibition of gastric acid-secretion Ex- Prevacid, Prilosec Prokinetic GI stimulants: Increases gastric emptying to improve peristalsis Ex- Reglan

Common drug therapy for the Hep virus family

Antiemetics Antivirals Immunomodulators

What treatments may be provided to a patient with the infectious respiratory problem: rhinitis?

Antihistamines, decongestants, antipyretics, or CAM therapy *Rest 8-10 hrs /night Drink 2-3 L fluid/ day

Lower GI disorder with acute inflammation of the vermiform appendix- the blind pouch attached to the cecum of the colon. Associated with abdominal pain in the epigastric or periumbilical area migrating to McBurney's point, as well as low grade fever. Complications can include: peritonitis, sepsis, perforation, abscesses.

Appendicitis

During a skin assessment, where in which would color of the skin be most important to examine?

Areas of least pigmentation such as oral mucosa, sclera, and soles of the feet as they will reveal more information

Another complication of liver cirrhosis in addition to PHTN, esophageal varicies, coag defects and jaundice, where collection of free fluid within the peritoneal cavity occurs due to increased pressure.

Ascites

Intermittent noninfectious respiratory problem that is reversible airflow obstruction, includes wheezing and affects only the bronchial airways and not the alveoli.

Asthma

What is this: Reversible airflow obstruction and wheezing affecting only the bronchial airways

Asthma

Chronic airflow limitation (CAL) includes the following three chronic noninfectious lung diseases:

Asthma Chronic bronchitis Pulmonary emphysema

Common inflammatory experience that often accompanies respiratory allergies (Ex- Asthma and eczema)

Atopic dermatitis

Type of PNA that usually occurs because of chronic lung disease or congenital abnormalities.

Atypical PNA

Question: The nurse is reviewing the standing orders for a patient who was admitted for evaluation of chest pain. The patient has a history of COPD, and his laboratory results and assessment reveal that he has mild respiratory acidosis. The nurse would question which order: A. Encourage oral fluids B. Oxygen therapy at 4 L/min as needed C. Keep head of bed elevated D. Bedrest with bathroom privileges only

B

Question: What is hypercarbia? A. Elevated oxygen levels B. Elevated carbon dioxide levels C. Elevated carbon monoxide levels D. Elevated hemoglobin and hematocrit What patient usually experiences this?

B. COPD its

Question: A client has a RR of 4. Which assessment data should be obtained immediately. A. ABG's and breath sounds B. LOC and pulse ox C. Breath sounds and reflexes D. Heart sound and pulse ox

B. LOC and pulse ox

Question: While examining the results of a wound culture from a pressure ulcer on a patient's sacrum, the wound care nurse tells the nursing student that the wound is "contaminated." The contamination indicates that: A. The pressure ulcer is infected B. The pressure ulcer has organisms present but is not infected C. Sepsis may be occurring D. The culture was done improperly

B. The pressure ulcer has organisms present but is not infected

Occurs as a result of GERD, esophageal epithelium transitions from squamous epithelium to columnar epithelium and considered pre-malignant.

Barrett's esophagus or epithelium

Type of skin cancer that arrises from basal cell of epidermis and is usually caused due to excessive/unprotected sun exposure

Basal cell carcinoma

If a normal INR is below 1, why would it be positive to see an INR between 1.5-2.0 during use of Warfarin for example?

Because if it's within that range it indicates therapeutic management

Why are antacids so beneficial for gastric ulcers?

Because they buffer gastric acid and prevent pepsin formation (remember gastric ulcers are formed because increased combo of acid, pepsin and h-pylori.)

Cysts, seborrheic keratoses, keloids and nevi (moles) all fall under the grouping of:

Benign tumors

Positive pressure ventilation device that mechanically delivers set positive inspiratory pressure each time the patient begins to inspire; as the patient begins to exhale, the machine delivers a lower set end-expiratory pressure, together improve tidal volume.

BiPAP *Bi (meaning two)- positive pressure on inhalation and exhalation

Asthma inflammation is caused by allergen binding to a specific blank. These molecules contain mast cells, basophils, histamine (rapidly start inflammatory response) and leukotriene and eotaxin (for prolonged inflammatory response)

Bind to specific antibody molecule (IgE)

What type of diet may be recommended for a gastric ulcer patient?

Bland diet *Avoid bedtime snacks

Administration of tube feedings can be done three ways:

Bolus (intermittent or set intervals) Continuous Cyclic (most common, 6-10 hours of down time and disconnecting for assisted ADLs)

Most primary lung cancers are bronchogenic carcinomas and come from the blank epithelium.

Bronchial epithelium

Defined as the narrowing of the bronchial tubes through constriction of the smooth muscle around and within the bronchial wall.s Can be a result of airways hyperresponsiveness from pollutants or viruses that stimulate nerve fibers.

Bronchospasm

What organ detoxifies ammonia the in the blood and what occurs if the ammonia levels rise in the blood? Ammonia is a byproduct of what?

Byproduct of protein metabolism, the liver detoxifies it and if ammonia levels rise in the blood it can lead to brain problems.

Question: Following a thoracentisis, the patient complains of shortness of breath. The nurses first action is to: A. Adminster oxygen B. Call the rapid response team C. Place the patient in Fowler's position D. Assess vitals and O2 sat

C then D then B

Question: A patient is brought to the ED after being hit by a car while biking. He is unresponsive, has shallow breathing, and has an open femur fraction from which he has lost a significant amount of blood. The nurse anticipates which acid-base imbalance? A. Metabolic alkalosis B. Respiratory acidosis C. Metabolic alkalosis and respiratory alkalosis D. Metabolic acidosis and respiratory acidosis

D.

Question: A patient who is diagnosed with pharyngitis develops stridor. The nurse priority intervention would be: A. Monitor Vitals B. Administer oxygen C. Administer albuterol inhalation D. Notify rapid response team

D. Pt probably has swollen epiglottis indicated by the stridor which is a medical emergency

Question: A patient is in danger of respiratory arrest following administration of narcotic analgesics. Which PaCO2 value would the nurse expect? A. 15 mm Hg B. 30 mm Hg C. 40 mm Hg D. 80 mm Hg

D. This patient is in respiratory acidosis *Reminder a normal PaCO2 is 35-45 mm Hg

Abnormal occurrence, discovered during the hair assessment and is known as an accumulation of patchy or diffuse white or gray scales that appear on the surface of the scalp that results due to oil production.

Dandruff

What hair abnormality often leads to alopecia?

Dandruff

What is the most common cause of GERD?

Decreased or inappropriately relaxed lower esophageal sphincter tone

Which is hypoxia & which is hypoxemia? Decreased oxygen levels in the blood Decreased tissue oxygenation

Decreased oxygen levels in the blood is hypoxemia (less oxygen in blood) Decreased tissue oxygenation is hypoxia (less oxygen in tissues)

Review: what is a hallmark sign of respiratory acidosis?

Decreased paO2 Increased paCO2

What common breathing practices should be encouraged as an exercise for COPD patients?

Diaphragmatic breathing and pursed lip breathing *head of bed up and avoid activities with arms raised, focus on energy conservation

Caused by increased pressure within the intestinal lumen. Usually asymptomatic but can progress when inflamed. Symptoms include cramping, alternating of diarrhea and constipation, flatus, distention and low grade fever. Complications include: blood loss, iron-deficiency anemia, bowel perforation leading to peritonitis, fistula formation, bacterial overgrowth.

Diverticula and Diverticular disease diverticula inflamed = diverticulitis

Adverse effect of bariatric surgery that includes rapid gastric emptying. Ingested content moves into the intestines too fast. Symptoms include n/v, abdominal cramps and can lead to weight loss, and malnutrition.

Dumping syndrome

Abnormal occurrence, observed during the nail assessment and means abnormal nails that are not shapped right or look different. For example- clubbing.

Dystrophic nails

Skin irregularity that includes extensive bruising under the skin

Ecchymoses

What consideration is required for trach patients after they hate eaten a meal?

Elevate the head of the bed for at least 30 min to prevent aspiration

In addition to addressing urination difficulties and observing for signs and symptoms of complications of a minimally invasive inguinal hernia repair surgery, what post-op consideration must you have for patients with a scrotal sac?

Elevate the scrotum to prevent and control swelling

Lung tissue reduction surgical procedure may be used for patient's with blank. It includes removing a portion of the lung tissue due to hyperinflation.

Emphysema

What is this: CO2 retainer, destruction of the alveoli, "Pink puffer"

Emphysema

Branch of COPD in which alveoli are damaged, loss of lung tissue elasticity occurs, alveoli hyper-inflate (hyperinflation of the lung), CO2 retention occurs, and leaves patient usually in a chronic acidic state with increased RR. Known as pink puffers.

Emphysema *This condition effects the alveoli, unlike CB that only effects the airways

COPD includes two lung disease processes:

Emphysema and Chronic bronchitis

Bronchodilators work for asthma by:

Encouraging smooth muscle cell relaxation

Therapy used to manage hemorrhaging in hepatic encephalopathy patients with esophageal varicies where the varicies are injected with a sclerosing agent to prevent form bleeding.

Endoscopic sclera therapy

What drug therapies might be considered for pancreatitis?

Enzyme replacement Insulin therapy

Review: Anatomy of the Skin Outer to inner layers:

Epidermis > Dermis > Subcutaneous (hypodermis)

Inflammation of the epiglottis to the point where it is so swollen it blocks the airway and entrance to the lungs. What clues should we look out for for these patients?

Epiglottittis Clue: trouble swallowing their own saliva and stridor

Type of skin biopsy that includes complete lesion removal with margin of normal skin down to adipose tissue.

Excisional Biopsy

Explosive and eruptive inflammatory form of the psoriasis disease.

Exfoliative psoriasis

Question: Which of the following statements indicates that the patient understands the plan of care for their TB infection? A. I can substitute one medication for another when I run out because they all fight the infection. B. I will wash my hands each time I cough or sneeze. C. I am glad I don't have to collect any more sputum cultures. D. I will increase my intake of citrus fruits, protein, and whole grains. E. I don't need to worry about where I go once I start taking my medication. F. I will make sure I wear a mask when I am in a public place

F is the most correct even though we don't want this pt in a public place D is also a good idea

Pulmonary function test that measures the volume of air blown out as hard and fast as possible during the first second of the most forceful exhalation/inhalation

FEV1 Forced expiratory volume in the first second

Oxygen delivery device not used often, mostly for facial injury or trauma and delivers 24-100% fiO2 with flow rate of at least 10 L/min

Face tent

T/F Tissue damage in COPD is reversible and decreases in severity, but will eventually leading to respiratory failure.

False its irreversible, increases in severity and will lead to failure

T/F T-tubes are often used for open cholecystectomy patients and require to be stored at head of patient bedside.

False, never raise it above the GB

T/F A trach patient does not require weaning

False, weaning is required. Gradual decrease in tube size, cuff deflation when secretions are managed, eventual removal.

T/F The pneumococcal vaccine has antigens for 23 types of PNA and is usually given yearly.

False- Antigens for 23 types of PNA and is usually given once but can be re-uped after 5 years.

T/F You should assess the patients skin temperature with the palm of your hand.

False- back of your hand

T/F Hep requires present symptoms to be able to infect others.

False- can infect others at any time with or without symptoms

T/F The following foods are okay to consume with gastritis... tea, coffee, cola, chocolate, mustard, paprika, cloves, pepper, and hot spices.

False- consume none of those

T/F Everyone's nail plate is relatively the same color and is independent of thickness, transparency, blood flow, or pigmentation.

False- it is dependent upon thickness, transparency, blood flow, or pigmentation.

T/F TPN requires use of a new filter, but not new tubing if it's for the same patient.

False- new tubing, new filter

T/F Lung and/or pancreatic transplantation can cure cystic fibrosis.

False- only extends life by 10-20. Not cured by this because its a genetic defect in chloride transport not failure by the organs.

T/F Cystic fibrosis is curative

False- only symptom management vitamin supplements, pancreatic enzyme replacement, weight maintenance etc

T/F You should provide mechanical ventilation as an oxygen supplementation for cystic fibrosis patients.

False- you won't be able to wean them off, use supplemental oxygen such as heliox.

Caused by the accumulation of fats in and around the hepatic cells. Causes include: DM, Obesity, elevated lipid profile, and alcohol abuse. Many patients are asymptomatic.

Fatty liver (steatosis)

Tracheostomy's tubes can be disposable or reusable. There are cuffed tubes or tubes without cuffs and the inner cannula can be disposable or reusable. Some trach tubes have blank, which is a hole in the shaft of the tube that helps pts ability to speak.

Fenestrated tube

Phase of wound healing that includes: Epithelial cells grow over granulation bed, scar tissue produced by fibrin and collagen, and new tissue is formed. Occurs 4 days to 4 weeks post trauma.

Fibroblastic or connected tissue repair phase

Lung disease that affects the alveoli, blood vessels and surrounding supporting tissues of the lungs rather than the airways. It is a restrictive disease that includes thickened lung tissue, reduced gas exchange, and "stiff" lungs that do not expand well. It has a slow onset and most pts don't know they have it until common manifestation of dyspnea occurs.

Fibrotic lung disease or interstitial pulmonary disease

Process of wound healing includes what three "intentions"?

First Intention Second Intention Third Intention

Process of wound healing- "intentions": Occurs without tissue loss, results in a thin scar

First intention

Bacterial infection involving only the upper portion of the follicle, usually as a result of staph.

Folliculitis

Pulmonary function test that measures the volume of air exhaled from full inhalation to full exhalation

Forced vital capacity (FVC)

The most accurate measures for asthma are pulmonary function tests using spirometry which include: (3)

Forced vital capacity (FVC) Forced expiratory volume in the first second (FEV1) Peak expiratory flow rate (PEFR)

For nutritional management of patients with dyspnea, what considerations should you have for meal frequency and what foods should be avoided?

Frequency- small meals with rest in-between Avoid- Milk and chocolate (may dairy additionally)

What foods should you incorporative for nonsurgical wound management- nutritional therapy?

Fruits, veggies, fats and high protein

Wound in which damage extends into the lower layers of the dermis and underlying subcutaneous tissue. Removal of damaged tissue results in a defect that must be filled with granulation tissue to heal (loss of most of epithelial cells).

Full-thickness wounds

Bacterial infection that is much deeper in the follicle, typically presents as a boil and is a result of a staph infection.

Furuncle

GI disorder that is the back flow of gastrointestinal contents into the esophagus. Characterized by acute symptoms of inflammation, dyspepsia (substernal pain) , regurgitation, hyper salivation, dysphagia, N/V, and gastric volume or intra-abdominal pressure is elevated as a result.

GERD

Part of the anatomy of the GI system and functions to store bile produced by the liver

Gallbladder

Cancer that has a poor prognosis, however is pretty rare. It will metastasize to all surrounding organs and includes symptoms such as: anorexia, weight loss, n/v, general malaise, jaundice, hepatosplenomegaly, chronic, progressively severe epigastric or RUQ pain.

Gallbladder cancer

Surgical management of obesity/overweight pt's: Malabsorption procedure. It is a common surgery where the stomach, duodenum, and part of the jejunum is bypassed. Reconnection occurs allowing for essential use of bile, however stomach is significantly smaller.

Gastric bypass (Roux-en-Y)

Inflammation of the gastric mucosa, can include two types, either acute or chronic.

Gastritis

Infectious disease of the intestine from bacterial or viral origin. Increases frequency and watery content of stool or vomiting as a result of inflammation fo the mucous membranes of the stomach and intestinal tract.

Gastroenteritis

What considerations should we have for our post Whipple or pancreatic surgery patients?

Glucose monitoring because manipulation can cause discrepancies in BG level and semi-fowler position to decrease tension on suture lines and increase oxygenation

Peak flow meter zone that indicates: patients asthma is under good control- their values reflect more than 80% of their personal best.

Green zone

What laboratory assessment might you do on a patient suspected of malnutrition?

H&H (anemic?) Albumin (determine protein in the blood) Prealbumin & Transferrin (most accurate/fast, followed by albumin) Lymphocyte (indicative of immune function, low WBC in malnutrition pts)

Common drug therapy for gastric ulcers

H2 Receptor antagonists (Zantac, Pepcid) inhibit gastric acid secretion & Antisecreatory agents also called PPI (prilosac, Prevacid) & Antacids

Herpes simplex virus: Genital herpes vs Classic recurring cold sore which type is which?

HSV2- Genital herpes HSV1- recurring cold sore

Type of infectious respiratory problem, specifically type of Pneumonia, where it is obtained in a hospital setting, it's usually more resistant to ABX and usually infects patients that are already critically ill.

Healthcare-Acquired PNA

What is the biggest surgical risk for liver cirrhosis (hepatic encephalopathy) patients undergoing shunt placement? What management interventions can be used?

Hemorrhage Management: beta blockers to control HR, esophagastric blood to put pressure on the variceis and control blood loss

Similar to that of a typical viral syndrome, often goes unrecognized and exhibits symptoms of GI illness. It is spread via fecal-oral route, by oral ingestion of fecal contaminants. It survives on human hands and is usually from food handlers. Can also be spread by oral-anal sex.

Hep A (HAV)

Spread via unprotected sexual intercourse with an infected partner, sharing needles, accidental needle sticks, blood transfusions, hemodialysis, maternal-fetal route. Symptoms occur 25-180 days post exposure and include: anorexia, n/v, fever, fatigue, RUQ pain, dark urine, light stool, joint paint, and jaundice.

Hep B (HBV) *healthcare workers

Spread by sharing needles, blood, blood products, or organ transplants (before 1992), needle stick injury, tattoos, intranasal cocaine use. Inc period 21-140 days. Most individuals are asymptomatic with damage occurring over decades. It is the leading cause of liver transplantation need in the US and usually causes liver cirrhosis.

Hep C (HCV) carrier and chronic *

Viral inflammation of liver cells that is transmitted primary by parenteral routes, not as common as others in this virus family and has inc period of 14-56 days.

Hep D

Present in endemic areas where waterborne epidemic occur and in travelers to those areas. Transmitted via fecal-oral route, resembles Hep A and has an inc period of 15-64 days. Seen most in Asia, Africa, and Middle East.

Hep E (HEV)

Liver is invaded by bacteria or protozoa causing abscess. Has a high mortality rate because of potential for rupture and usually is caused by pts with cholelithiasis. Treatment usually involves: drainage and abx.

Hepatic abscess

Another extreme complication of liver cirrhosis that results from the shunting of the portal venous blood into the central circulation and the liver is bypassed. It is seen in patients with end-stage liver disease presenting with ALOC, impaired thought process and elevated ammonia levels.

Hepatic encephalopathy or portal systemic encephalopathy

Widespread viral inflammation of the liver cells by one of the following viruses: Hep A, B, C, D, E and can occur as a secondary problem to other infections.

Hepatitis

What is the leading cause of liver disease among the other causes: hep B, alcohol, drugs, toxins, GB disease, genetic causes, cvd?

Hepatitis C

Liver cirrhosis complication that is the cause of death in most liver failure pts. Includes decrease urinary flow less than 50 ml in 24 hours, increased BUN and Cr levels and decreased sodium excretion.

Hepatorenal syndrome

Weakness in the abdominal muscle wall through which a segment of bowel or other abdominal structure protrudes. Can be indirect, direct, femoral, umbilical, incisional or ventral.

Hernia or herniation

Part of the herpes family that is caused by reactivation of the dormant varicella zoster virus in pt's who have previously had chickenpox. Includes multiple lesions occurring in a segmental distribution on the skin area innervated by the infected nerve.

Herpes Zoster/shingles

Form of herpes simplex infection that occurs on the fingertips of medical personnel who have come in contact with viral secretions.

Herpetic whitlow

Protrusion of the stomach through the esophageal hiatus of the diaphragm into the thorax. Can be either sliding classification or rolling classification.

Hiatal Hernia

What nutrition consideration should be had for diverticular disease patients?

High-fiber! Acid nuts, seeds and popcorn

Abnormal occurrence, discovered during the hair assessment and is known as excessive growth of body hair, which os one manifestation of hormonal imbalance (commonly seen in Cushing's Disease).

Hirsutism

What intervention should be considered with all oxygen delivery devices to prevent irritation or drying of the mucosa?

Humidifier

Part of non-surgical wound management that includes absorbent material that draws exudate away from the surface.

Hydrophilic material

Part of non-surgical wound management that includes protecting dry wound from being contaminated with nonabsorbent, waterproof material.

Hydrophobic material

What considerations/techniques must be utilized when performing trach suctioning?

Hyper-oxygenate the patient only suction for 10-15 seconds Sterile procedure

Often seen in COPD patients and defined as elevated CO2 levels

Hypercarbia

What are some progressive complications of COPD?

Hypoxemia and acidosis Respiratory infections Cardiac failure, especially cor pulmonale (R sided HF) Cardiac dysrhythmias

Question: Why is it important to maintain oxygen liter flow at the lowest level needed to treat hypoxemia?

Hypoxemia is having decreased levels of oxygen in the blood, therefor if you hyper-oxygenate the pt you can eliminate their drive to breathe because an increase in CO2 *a like COPD pt's

Common restrictive lung disease. Usually occurs in older person with a history of smoking or exposure to irritants of some kind. Disease of excessive wound healing, where inflammation continues beyond normal healing time causing extensive fibrosis and scaring. Survival rate is quite poor, 5 years approximately if early intervention.

Idiopathic pulmonary fibrosis (fibrosis think scaring)

What type of nutrient considerations must we have with acute pancreatitis patients?

If eating: consume small, frequent, moderate to high carb, high protein, low fat meals.

Type of skin biopsy that includes cross-section wedge of tissue removed through center of lesion.

Incisional Biopsy

When comparing your parents pulmonary function to the pulmonary function tests (FVC, FEV1, PEFR), what is indicative of asthma? what confirms asthma?

Indicative: 15-20% decrease in ability compared to ideal Confirmative: give bronchodilator and increase of about 12%

Types of hernias: (Indirect inguinal, direct inguinal, umbilical, ventral, reducible, irreducible) Scrotal sac into inguinal canal Passes through area of muscle weakness Born with it or acquired, through congenital defect in muscle Usually in older men Content can be replaced back into cavity with gentle pressure Can't be replaced back into abdomen and requires surgery

Indirect Inguinal Direct inguinal Umbilical Ventral Reducible Irreducible

What are some common signs and symptoms of organ transplant rejection?

Infection Hemorrhage F& E imbalance Organ failure

Inflammatory disorder of the GI tract with unknown etiology. Characterized by loose stools possibly containing blood and mucus, poor absorption of vital nutrients and is split into two disease processes:

Inflammatory bowel disease (different from IBS)

Phase of wound healing that includes: Vasodilation and clot formation, occurs right after trauma.

Inflammatory phase

Complication of ulcers along with hemorrhage, perforation, and pyloric obstruction, in which the pt no longer responds to conservative management or recurrences of symptoms interfering with ADL's

Intractable disease

Lower GI disorder characterized by chronic or recurrent diarrhea, constipation, and/or abdominal pain and bloating (can have all together). Criteria includes; abdominal pain relieved with defecation, distention, sense of incomplete evacuation of stool and presence of mucous of stool. Is two times more likely in women and often has concurrent mental health disorder.

Irritable bowel syndrome (IBS) otherwise called spastic colon

What interventions may you use for managing hypoxemia?

Keep spO2 greater than 95% Incentive spirometry Cough, deep breathe

Type of malnutrition where the pt is getting enough calories but not enough protein. Most often body weight is closer to normal, but the serum protein is low. Presents as protuberant belly with possible itchy rash and poor wound healing.

Kwashiorkor malnutrition

With Urticaria, what in particular could worsen symptoms?

Lack of removal of triggering substance, overexertion, warm environments, and alcohol consumption.

What drug therapy combination (2 drugs) in particular can be used in the treatment of hepatic encephalopathy to help control the amount of ammonia in circulation?

Lactulose- promotes secretion of ammonia in stool & Metronidazole- eliminates natural flora which decrease amount of ammonia absorption in the bowel

Surgical management of obesity/overweight pt's: Gastric restriction that can be reversed, a band is tightened via saline injection and restricts the amount of food you can eat before feeling full. Normal digestion occurs and no nutritional deficiencies are experienced. Overeating may cause n/v.

Laparoscopic adjustable gastric band

Surgical management of obesity/overweight pt's: Allows for normal digestion without risk of nutritional deficiencies. A portion of the stomach is removed and reduces consumption from 4 cups to 1 oz. Pt will experience fullness earlier. This is the most common intervention. The hunger hormone Grelin is reduced as a result of the removal of stomach portion.

Laparoscopic sleve gastrectomy

What nutrition and lifestyle considerations are important for a GERD patient? Hint: What to eat/ meal consumption consideration, how to sleep

Limit chocolate and alcohol Eat meals slowly Sleep in L lateral decubitus position and elevate head 6 in

Surgical management of obesity/overweight pt's that reduces the amount of adipose tissue in the body and is more of a cosmetic rather than long term procedure/fix

Liposuction

Part of the anatomy of the GI system and functions to: store: glycogen, vitamins, minerals excretes: bilirubin, cholesterol, hormones, and drugs metabolize: fats, proteins, and carbs

Liver

One of the most common tumors in the world with the most common complain of abdominal discomfort. Those with Hep B or C carry the highest risk for developing this cancer. Treatment can include chemo orally or through the artery that is feeding the tumor, artery embolization to block blood supply to the tumor, or surgery.

Liver cancer

Which disorder includes the following signs and symptoms at its early stage: fatigue, significant change in weight, GI symptoms (n/v/anorexia), abdominal pain and liver tenderness, and pruritus.

Liver cirrhosis

Only organ that can be preserved for up to 8 hours prior to transfer. This organ is hard to come by as donors are obtained only from trauma or those who don't have damage to the organ. In order to receive you must be in end-stage, have no advanced cardiac disease, rep disease, issue with alcohol or substance abuse and ability to follow drug therapy instructions.

Liver transplant

What is a large differing factor between emphysema and chronic bronchitis?

Location emphysema- alveoli CB- bronchi and bronchioles

Bronchodilator that is long acting, is taken over a period of time to build a longer lasting effect and is usually usedin prevention with asthma patients

Long-acting beta 2 agonists

What three key signs should you evaluate when inspecting a patient skin?

Look for: Edema Moisture Vascular changes

IBD diet should be high or low in fiber?

Low b/c loose stools

What surgical management is performed for end-stage lung patients that is not commonly used due to donor availability and cost?

Lung transplant

Term for redness of the skin due to pressure

Maceration

Palpation of the skin confirms the size of lesions and determines whether or not they are flat or slightly raised. What is the term for flat rash?

Macular

Type of malnutrition where body fat and proteins are lost, but the body tries to preserve what it can. Most often seen in third world countries. Pt presents with prominent bones, decreased subcutaneous fat and loose skin.

Marasmus-caloric malnutrition

Phase of wound healing that includes: Collagen is reorganized providing greater strength to the wound. Occurs as early as 3 weeks up to 1 year post trauma.

Maturation

Area on the abdomen (RLQ) in which rebound tenderness occurs and is the initial symptom of appendicitis.

McBurney's point

Obstruction usually due to adhesions in the intestine, IBD, or tumors. Obstruction usually due to decreased peristalsis, otherwise known as paralytic Ileus Obstruction resulting from tumors, hernias, fecal impaction, strictures, insussitation (bowel folds on itself), volvulus (looped intestine), fibrosis, vascular disorders, or adhesions.

Mechanical Obstruction usually due to adhesions in the intestine, IBD, or tumors. Nonmechanical Obstruction usually due to decreased peristalsis, otherwise known as paralytic Ileus Strangulated Obstruction resulting from tumors, hernias, fecal impaction, strictures, insussitation (bowel folds on itself), volvulus (looped intestine), fibrosis, vascular disorders, or adhesions.

Which obstruction is associated with a physiological problem and the dead giveaway symptom: borborygmi (high pitched bowel sounds) Which obstruction is associated with decreased peristalsis and the dead giveaway symptom of: decreased to absent bowel sounds

Mechanical Physiologic problem & borborygmi Nonmechanical Decreased peristalsis & decreased/absent BS

Part of non-surgical wound management that includes entrapment of tissue and exudate and removal of it.

Mechanical debridement

Type of skin cancer that is highly metastatic, survival depends on early diagnosis and treatment is from melanin produced in the epidermal cells

Melanoma

What patients are at high risk for pressure ulcers?

Mental status change Dependent mobility Nutritional deficits Incontinence

Defined as severe negative effect on health and usually more than 100% above IBW

Morbid obesity

What drug therapy must be avoided for patients who are suspected of gastroenteritis?

NO IMMODIUM or stool softners

Defined as an irreversible state of CNS depression

Narcosis

Oxygen delivery system that is often used for COPD pt's starting at 1 to 3 max, but also can be used for many other pt's receiving 1-6 L of oxygen at 20-40% fiO2.

Nasal cannula

What methods may be used to administer total enteral nutrition?

Nasoenteric tube via nasogastric tube Nasoduodenal tube Enterostomal (gastrostomy PED)

Part of non-surgical wound management that includes enzyme prep that promotes self digestion of dead tissue

Natural chemical debridement

Acute pancreatitis can lead to this once diffuse bleeding of the pancreatic tissues occur with fibrosis and tissue death.

Necrotizing hemorrhagic pancreatitis.

Oxygen delivery device that has flaps over one-way ports, delivers 10-15 L/min at greater than 90% fiO2.

Non-rebreather

Technique that uses positive pressure to keep the alveoli open and improve gas exchange without airway intubation.

Noninvasive positive pressure ventilation

When should you start enzyme replacement therapy for your post-surgical pancreatic disorder patient? (Ex- Whipple surgery)

Not until the patient can consume a solid meal

TB Tests: Time in which to receive results & most common/reliable Nucleic acid amplification test (NAAT) Purified Protein Derivative (PPD) or Tuberculin (Mantoux) Test QuantiFERON- TB Gold Sputum culture

Nucleic acid amplification test (NAAT)- fast results (2 hours) Purified Protein Derivative (PPD) or Tuberculin (Mantoux) Test Most common and reliable, results within 24 hours QuantiFERON- TB Gold 24 hours, hospital setting Sputum culture takes days

Defined as excess amount of body fat when compared with lean body mass, at least 20% above upper limit of normal range for IBW

Obesity

Disease that can be caused by exposure to occupational or environmental fumes, dust, vapors, gases, bacterial or fungal antigens, or allergens. It is worsened by cigarette smoke and is preventable by use of respirators with adequate ventilation on the job. Dependent upon degree of exposure, it can grow to progressive lung diseases.

Occupational pulmonary disease

Defined as increase in body weight for height compared with standard, or up to 10% greater than ideal body weight (IBW)

Overweight

Oxygen levels that are greater than 50% that are given for more than 24-48 hours can cause what?

Oxygen toxicity

O2 delivery device that is similar to a nasal cannula. It delivers concentrated oxygen when the pt breathes in and allows for higher saturations at a lower flow rate.

Oxymizer

Pulmonary function test that measures the fastest airflow rate reached at any time during exhalation.

PERF Peak expiratory flow rate

Cholecystectomy post-op patients can return to activities in 1-3 weeks, but may experience free air pain- what is free air pain?

Pain from CO2 retention in the abdomen from air being blown into belly to enable sight during surgery

Skin assessment term commonly known as paleness.

Palor

Part of the anatomy of the GI system and functions to provide exocrine functions (secrete digestive enzymes) and endocrine functions (produce glucagon/insulin)

Pancreas

Serious complication of necrotizing pancreatitis, always fatal if untreated. Includes high fever up to 104 F, requires drainage in addition to abx treatment since abx alone isn't enough.

Pancreatic abscess

Encapsulated or false cysts in that pancreases that may present with epigastric pain that radiates to the back. Complications include: rupture then hemorrhage, bowl obstruction, fistula, pancreatic ascites. Requires surgical intervention after 6 weeks by percutaneous, endoscopic, or surgical drainage.

Pancreatic pseudocyst

Palpation of the skin confirms the size of lesions and determines whether or not they are flat or slightly raised. What is the term for raised rash?

Papular

Fluid volume excess (acisites specifically) from liver cirrhosis treatment- insertion of a trocar catheter into the abdomen to remove and drain ascitic fluid from the peritoneal cavity What should you look out for post-procedure?

Paracentesis Look out for impending shock

What might you think if you hear hypoactive bowl sounds upon auscultation?

Paralytic Ileus

Syndrome that occurs accompanying small lung cancer tumors where the tumor cells secrete hormones created hormone imbalance (like cushings and gynecomastia)

Paraneoplastic syndrome

Skin disorders such as lice, mites, bedbugs, etc., that most often occur in patients with poor hygiene and is treated with eradication:

Parasitic disorders

Abnormal occurrence, discovered during the nail assessment and is known as inflammation of the skin surrounding the nail- can be acute or chronic.

Paronychia

Oxygen delivery device that requires the bag to be 2/3 full to prevent from inhaling CO2, contains exhalation points to blow out CO2 and delivers 40-70% fiO2 with suggested use of 6-10 L/min.

Partial rebreather mask

Wound that involves damage into the epidermis and upper layers of the dermis. Usually heals by re-epithelialization within 5-7 days.

Partial-thickness wounds

Parasitic disorder that includes infestation by human lice of any or all of the following: Head lice Body lice Pubic or crab lice it is commonly associated with pruritus and can be transferred via bedding or other items.

Pediculosis Pediculosis capitis Pediculosis corporis Pediculosis pubis

Mucosal lesion of the stomach or duodenum. Gastric mucosal defenses are impaired making them no longer able to protect the epithelium from effects of acid and pepsin. Developed from the combo of acid, pepsin, and h-pylori. Symptoms include dyspepsia, sharp, burning, or gnawing pain, epigastric tenderness located at the midline, abnormal pressure, sensation of fullness and hunger.

Peptic ulcer disease (PUD)

Catheter insertion for cholecystitis patients that opens the bile duct and allows bile to drain into the duodenum through the catheter. Can be internal or external.

Percutaneous transhepatic biliary catheter

What flow meter use considerations/tips must be considered/conveyed to your patient when performing peak flow meter use?

Performed three times total and use highest reading of the three, should be used twice daily

Surgical intervention to divert ascites from the venous system in liver disease (hepatic encephalopathy) patients by creation of a shunt

Peritoneovenous shunt or portovenal shunt

Problem that may occur from appendix rupture. It is life threatening and is acute inflammation of visceral/parietal peritoneum and endothelium lining of the abdominal cavity. Symptoms include rigid boardlike abdomen, pain, distention, fever, tachy, dehydration, hiccups, compromised respiratory status etc.

Peritonitis

What are some telling signs that a patient may have TB?

Persistant cough Night sweats Hemoptysis (bloody sputum)

Skin irregularity that includes rupture of the capillaries

Petechiae

Infectious respiratory problem that commonly includes a sore throat and inflammation of pharyngeal mucous membranes. Can be caused by bacteria, viral, or even trauma, however most commonly caused by group a beta strep. Manifestations include pain odynophagia (pain with swallowing), dysphagia, and fever.

Pharyngitis

Therapy used for lung cancer for example that includes injection of an agent that sensitizes cells to light, then medication is administered that attacks all the cells and destroys them. Leaves patients at risk because it attacks healthy cells too however it attacks cancerous cells at a faster rate.

Photodynamic therapy

Infectious respiratory problem that includes excess fluid in the lungs resulting from an inflammatory process. Inflammation triggered by infectious organisms or maybe inhalation of irritants.

Pneumonia

Major complication of liver cirrhosis, occurs from persistent increase in pressure within the portal vein, the pressure is high and meets resistance, so it will seek other venous channels to go through, which dilates other vessels resulting in for example esophageal varicies.

Portal hypertension

Types of liver cirrhosis Caused from viral hepatitis or drugs Caused by chronic alcohol abuse Caused by biliary obstruction GB or autoimmune disorders

Postnecrotic cirrhosis: Caused from viral hepatitis or drugs Laennec's cirrhosis: Caused by chronic alcohol abuse Billiary cirrhosis: Caused by biliary obstruction GB or autoimmune disorders

What are the common complications of obesity?

Practically everything (HTN, hyperlipidemia, CAD, stroke, PAD, obstructive sleep apnea, depression, decreased wound healing, etc) *Primarily cardiovascular and respiratory related

Damage caused when skin and underlying soft tissue are compressed between a bony prominence and an external surface for an extended period. Can be created with mechanical forces such as: pressure, friction, or shear.

Pressure ulcer

What is the number one nursing priority of open nissen fundoplication surgery (fix rolling hernia)?

Prevention of post-op respiratory complications

In regard to skin lesions, characterized as an initial reaction to a problem that alters the structural component of the skin.

Primary Lesion

Skin problem that may occur due to lack of blood flow to an area. It is caused by stimulation of itch-specific nerve fibers at the dermal-epidermal junction.

Pruritus (itchiness)

Lifelong skin disorder with experiences of exacerbations and remissions. Considered a scaling disorder with underlying dermal inflammation, possibly of autoimmune reaction.

Psoriasis

Infectious respiratory problem that includes collection of pus in the pleural space, often caused by pulmonary infection, PNA, lung abscess, chest surgery or trauma.

Pulmonary Empyema

Respiratory problem with manifestations that include: recent febrile illness, chest pain, cough, diminished and rale breath sounds, fever, chills and even blood pressure changes (see picture).

Pulmonary Empyema

Disorder that occurs in the presence of other lung disorders, cause is unknown. Includes the pathologic problem, blood vessel constriction with increasing vascular resistance in the lung. Cor pulmonale is often experienced as a result and the disorder commonly effects women between 20-40 and if untreated will lead to death in 2 years.

Pulmonary arterial hypertension (PAH)

Test that functions to evaluate lung volume and capacity. Requires pt not to smoke 6-8 hours prior and hold rx of bronchodilators 4-6 hours prior to test.

Pulmonary fx test

Type of skin biopsy that includes sampling of possible cancers, tumors and inflammatory conditions but punch removal of tissue.

Punch Biopsy

How is the infectious respiratory problem, pharyngitis, often diagnosed?

RAT rapid antigen test (called Genaprob or immunoassay) *screens for group A beta strep antigen

Frank blood means

Red blood

Peak flow meter zone that indicates: medical alert whereas the patient should be instructed to take their rescue medication and seek medical attention from their provider or the ED.

Red zone

Complication of total enteral nutrition: when enteral feeding isn't done the correct way, sodium shift will occur and other major electrolytes will change due to change in insulin within the body. You can avoid by starting the feeding off slow and weaning the patient.

Refeeding syndrome

Surgical management of lung cancer: Removal of one of the lobes Removal of entire lung and sever the bronchus Removal of bronchus, pulmonary artery and vein, and other tissue segments involved Removal of peripheral portion

Removal of one of the lobes Lobectomy Removal of entire lung and sever the bronchus Pneumonectomy Removal of bronchus, pulmonary artery and vein, and other tissue segments involved Segmentectomy Removal of peripheral portion Wide resection

Review: System more sensitive to acid-base imbalances, can begin compensation in seconds to minutes System more powerful, but less sensitive and begins compensation several hours to days later.

Respiratory: more sensitive, faster compensation Metabolic: less sensitive, less fast, more powerful

Bariatric procedures are split into two categories: Trying to decrease volume capacity of the stomach to illicit weight loss vs Interfering with absorption of food and nutrients from the GI tract to illicit weight loss

Restrictive procedure vs Malabsorption procedure

Infectious respiratory problem that includes inflammation of the nasal mucosa from an allergy, viral or bacterial infection and is spread through direct contact or droplet. Manifests as nasal irritation, h/a, sneezing, drainage, watery eyes, etc.

Rhinitis

Infectious respiratory problem that is inflammation of the mucous membranes of one or more of the sinuses. It usually follows rhinitis and is commonly caused by Strep and can have predisposing factors such as structural effects, deviated septum, nasal polyps, facial trauma, etc. Symptoms include facial pressure, tenderness over infected sinus area, and presents typically like a cold.

Rhinosinusitis (otherwise known as Sinusitis)

What does Tinea mean?

Ring worm

Common symptoms of sliding hernia vs rolling hernia: Feeling of fullness/breathlessness after eating, chest pain, worsening symptoms with recumbent position. Heart burn, regurgitation, chest pain, dysphagia, belching.

Rolling Sliding *however rolling can have symptoms of sliding too

Hernia that puts the patient at risk for strangulation and venous obstruction. Requires surgical fixation. Where the funds rolls into the thorax beside the esophagus.

Rolling hernia

Granulomatous (granuloma formation) disorder of unknown cause that affects the lungs most often. It is an autoimmune response in which the normally protective T-lymphocytes increase and damage healthy lung tissue. Cxr will reveal no abnormalities which doesn't usually match with clinical presentation of cough and SOB. Usually treated with corticosteroids.

Sarcoidosis

Parasitic disorder that is a contagious skin disease caused by mite manifestation. It is transmitted by close and prolonged contact or infested bedding. Requires examination between fingers and on palms as this is usually site of markings and infestation must be confirmed by examination of a scraping of a lesion under a microscope.

Scabies

Process of wound healing- "intentions": Granulation and contraction, a deeper tissue injury or wound with loss of tissue and dead space (Ex- pressure ulcers, stasis ulcers)

Second Intention

In regard to skin lesions, characterized as changes in appearance over time versus an initial reaction altering structural components of the skin.

Secondary Lesion

Infectious respiratory problem that includes a virus infection of the respiratory tract cells, triggering an inflammatory response. There is no effective treatment and it is airborne. It is a new family of virus types called "coronaviruses."

Severe Acute Respiratory Syndrome (SARS)

Type of skin biopsy that includes horizontal shaving of the skin lesion with only superficial portion of the dermis.

Shave Biopsy

Bronchodilator that is short acting but has a rapid response, and can be used for pre-medicating asthma patients

Short-acting beta 2 agonists

Oxygen delivery device used for mouth breathers that delivers 6-12 L/min at 40-60 L fio2

Simple facemask

Sensory organ that functions as protective barrier and regulates homeostasis through water balance and permeability.

Skin

What may be revealed upon Wood's Light examination?

Skin infections appear different looking colors such as blue or green.

The most common type of hernia where the esophagastric junction and a portion of the fundus of the stomach slide upward though the esophageal hiatus into the thorax. Treated with antacids, histamine receptor antagonists, avoidance of late night meals or foods associated with reflux and upright position for several hours along with sleeping with head 6 in elevated.

Sliding hernia

Type of infectious respiratory problem that is virally induced. It is inflammation of the terminal or smaller airways versus Inflammation of the larger airways

Smaller airways - bronchiolitis Larger airways- Bronchitis

Liver cirrhosis complication that includes migration of bacterial through the bowel wall into the lymphatic system diagnosed by culture of acetic fluid.

Spontaneous bacterial peritonitis

What testing may be done for a suspected infectious respiratory problem patient?

Sputum C&S CBC, WBC, leukocytes ABG Blood culture (for elevated temp) BUN Electrolytes Imaging: chest xray

Skin cancer of the epidermis that is most likely to metastasize and can happen in odd areas such as the ear.

Squamous cell carcinoma

Review- Pressure ulcer assessment stages: Stage 1: Stage 2: Stage 3: Stage 4:

Stage 1: Redness, nonblanchable Stage 2: partial thickness loss, blister or superficial ulcer Stage 3: full thickness loss, subq tissue injured and may be necrotic Stage 4: full thickness with muscle, tendon, or bone visible, including eschar, slough, or tunneling

Severe, life-threatening, acute episode of airway obstruction that intensifies once it begins and often does not respond to common therapy. If the condition is not reversed, the patient may develop pneumothorax and cardiac or respiratory arrest. Treated with IV fluids, potent systemic bronchodilator, steroids, EPI and oxygen.

Status asthmaticus

Lung cancer stages are dependent upon what acronym?

T where is primary tumor N involvement of lymph nodes M metastasized?

Oxygen delivery device used with trach's that delivers 24-100% fiO2, at least 10 L/min and needs humidification because of direct delivery of oxygen bypassing the nose and mouth.

T-tube

Highly communicable respiratory problem that is the most common bacterial infection worldwide and is airborne.

TB

Shunt used to control long term ascites and hemorrhage in hepatic encephalopathy patients and to reduce variceal bleeding. In through jugular vein and then insert a stent to keep the portal vein open.

TIPS transjugular intrahepatic portosystemic shunt

The following airway infections share what in common: Bacterial tracheitis Retropharnygeal abscess Tonsillar infections (tonsilitis) Peritonsillar abscess

They are acute upper airway infections that share common cause of strep

Process of wound healing- "intentions": Delayed closure. High risk for infection with a resultant scar, delayed primary closure of the wound (wound was closed and then re-opened taking a long time to heal) Ex- abdominal wounds post bariatric surgery.

Third intention

Defined as fluid removal by suction after placement of a large needle or catheter into the intrapleural space, usually done for patients with pulmonary empyema

Thoracentesis

Incision into pleural space in order to remove cancerous lung tissue. Requires respiratory management every 2 hours assessing for adequate ventilation, gas change, and trachea alignment. Different from thoracentesis in which excess fluid is removed.

Thoracotomy

Where are the following ring worm fungal infections occurring? Tinea pedis Tinea manus Tinea cruris Tinea capitis Tinea corporis

Tinea pedis FEET Tinea manus HANDS Tinea cruris PERINEAL Tinea capitis HEAD Tinea corporis BODY

Wound management that includes biologically active substances that stimulate cell growth and movement vs Wound management that provides temporary or permanent wound closure

Topical growth factor vs Skin substitutes

Bilirubin panel: Indicative of hemolysis, biliary obstruction, liver damage Increased numbers, indicating biliary obstruction Increased numbers, indicative of hepatic damage

Total bili: Indicative of hemolysis, biliary obstruction, liver damage Conjugated bili: Increased numbers, indicating biliary obstruction Unconjugated bili: Increased numbers, indicative of hepatic damage or hemolysis

Malnutrition intervention that requires functional GI tract. Used with patients who can eat but cannot maintain adequate nutrition by oral intake alone, includes neuromuscular impairment pts, pts that can't swallow, critically ill (cancer) etc.

Total enteral nutrition (TEN)

Oxygen delivery device that delivers 24-100% fiO2, started at at least 10 L/min and is specifically for tracheostomy pt's. Different from T-tube because it allows space between the patients internal body and oxygen delivery.

Tracheostomy collar

Surgical incision into the trachea for the purpose of establishing an airway, may be temporary or permanent.

Tracheotomy Tracheostomy (in reference to the stoma /opening)

Oxygen delivery device that is used for long-term delivery of oxygen directly into the lungs. Avoids irritation that nasal prongs cause and is more comfortable. Placed surgically between the second and third tracheal ring and is not very common.

Transtracheal oxygen delivery

Asthma is classified into different types dependent upon

Triggering events such as: cold air, dry air, aspirin, NSAIDS, GERD, URI

What is the most common drug therapy combination for gastritis patients in the presence of h-pylori infection?

Triple therapy (PPI triple) Two types ABX + protein pump inhibitor

T/F Abdominal distention, digestive disorders, GERD, rectal prolapse, and steatorrhea may accompany Cystic fibrosis due to its thick mucous production effecting the GI tract.

True

T/F Antihypertensives and antidepressants put an individual at risk for diabetes because they cause fatigue

True

T/F Dermatitis whether contact or atopic is often resolved by use of steroids, avoidance of oils, antihistamines, and compression & bathes.

True

T/F Exercise and activity is recommended to promote ventilation and perfusion in asthma patients

True

T/F Lung cancer can have pulmonary manifestations such as displaced trachea dependent upon tumor size and location as well as secondary problems such as muffled heart tones or thin bones.

True

T/F Open wounds are always contaminated

True

T/F TPN should be considered like a med and needs to be compared to ordered electrolyte panel int he patient's chart prior to administration.

True

T/F Acute pain is commonly associated with acute pancreatitis. Pain reduction occurs with drug therapy and fasting.

True *Fasting

T/F Lesions positive for bacterial growth and infection typically reveal 100,000 colonies in their culture versus lesions negative for bacterial growth revealing 10,000 or less.

True 100,000 = positive for bacterial infection <10,000= negative for bacterial infection

T/F Liver disease patients experience decrease in production of prothrombin which puts them at risk for clotting issues

True PT will decrease with liver disease

T/F Skin changes can occur as a result of GI disorders

True Ex- colon's sign, jaundice

T/F The act of itching (experienced with Pruritus) illicit more itchiness.

True this phenomena is called itch-scratch-itch cycle

T/F TB pt is non-contagious after using meds for 2-3 weeks

True typically, however they need 3 negative sputum's to be officially considered non-contagious

T/F Sunburns are often first-degree, superficial burns.

True, but can be more extensive

Other complications of total enteral nutrition: (specifically physical complications)

Tube misplacement or dislodgment Abdominal distention with n/v (check residual and report if >60 mL Fluid and electrolyte imbalance

In addition to assessment of skin temperature via palpation, what method should you use in order to determine hydration status?

Turgor assessment- tenting= dehydration

Upon abdominal auscultation, what could tympani indicate? What about bruits or swooshing sound?

Tympani- gas Bruit/swoosh- cardiovascular problem

What does dermatophyte mean?

Type of fungal infection

The following laboratory assessments are utilized for what type of infections? Tzanck smear Swab culture Potassium hydroxide (KOH) test

Tzanck smear VIRAL Swab culture BACTERIAL Potassium hydroxide (KOH) test FUNGAL

For which lower GI disorder are the following surgeries considered: Total proctocolectomy w/ permanent ileostomy (colon removal, rectum, anus with anal closure) Total proctocolectomy w/ continent ileostomy Total colectomy w/ rectal mucosal stripping and ileoanal reservoir

Ulcerative colitis

Branch of IBD affecting the colon & rectum, multiple abscesses present, 10-12 liquid, bloody, stools daily and potential perforation. Branch of IBD affecting the Ileum & all bowel tissue layers, discontinuous lesions, 5-6 loose stools, that are rarely bloody, and potential fistulas. Drug therapy for both: Salicylate compounds, corticosteroids, immumnosuppresives, antidiarrheal

Ulcerative colitis: Colon & rectum Abscesses 10-12 bloody stools perforation Crohn's Ileum & all bowel layers Lesions 5-6 non bloody stools fistulas

Skin diagnostic testing often includes cultures for fungal, bacterial, and viral infections. Bacterial infections in particular includes a technique called blank, in which you lift up the lesion or puncture the outer surface with a needle to express or squeeze out exudate for culture rather than scrapping off cells for culture.

Unroofing *for bacterial infections

Skin problem that includes presence of white or red edematous papule or plaques of varying sizes due to exposure to allergen and is often treated with antihistamines.

Urticaria (Hives)

What is important to ask your patient to do prior to performing a physical assessment of their abdomen? What pattern should you assess the abdomen in?

Use the restroom and assess L to R

What are the five processes of respiration?

Ventilation Distribution Diffusion Perfusion Circulation

Oxygen delivery device that is said to be specific and most accurate in delivery of oxygen, it is commonly used with COPD patients.

Venturi Mask

In addition to community and healthcare acquired PNA, PNA has three types: Bacterial Viral Atypical Which is the most common?

Viral PNA

What pharmacologic interventions might you use for a pulmonary arterial hypertension patient?

Warfarin to decrease chances of clotting Calcium channel blockers to dilate vessels Dig and diuretics

Surgical procedure to remove pancreatic cancer, includes removal of tumor, proximal head of pancreas, duodenum, portion of the stomach and small intestine as well as the GB.

Whipple

Nonsurgical wound management that is considered physical therapy and includes cleaning of the wound and promotion of circulation and healing through warm water.

Whirlpool therapy or hydrotherapy

Defined as contamination with pathogenic organisms to the degree that growth and spread cannot be controlled by the body's immune defenses.

Wound infection

Skin problem that is common among older patients that includes fine flaking of the stratum corner. Accompanied by pruritus (itching) and can result in secondary skin lesions, excoriation (reddens), lichenification (thickening) and eventual infection if scratching is excessive.

Xerosis (dryness)

What interventions might you see used for Xerosis?

Xerosis= dry skin - rehydration to relieve itching - bathing and moisturizing soaps, oils, etc *water softens outer skin layer while cream and lotion seals in moisture

Peak flow meter zone that indicates: caution and airway narrowing is present- usually indicating that the patient should administer a rescue medication and may need to be seen by their provider to adjust medications.

Yellow zone

What changes in the following may you expect to see in a patient with an asthma attack: ABG and O2 PaCO2 Eosinophils and IgE

assess ABG, PaO2 may decrease PaCO2 may decrease early and then increase later (indicative of poor gas exchange) Elevated eosinophil and IgE levels

Asthma inflammation usually occurs in response to specific allergies, general irritants, microorganisms, and aspirin, while hyperresponsiveness occurs with:

exercise URI other unknowns

The home oxygen therapy device, 'oxygen concentrator' functions to:

extract oxygen from room air to deliver to the pt

What is the most commonly injured organ in patients with abdominal trauma with manifestations including abdominal tenderness, rigidity, guarding and distention. Requires surgery dependent upon extent.

liver trauma

Nutritional therapy of cholecystitis includes:

low-fat diet, fat-soluble vitamins and bile salts

Review: ABG interpretation pH range: PaO2 range: PaCO2 range: HCO3 range:

pH range: A 7.35- B 7.45 PaO2 range: 80-100 PaCO2 range: B 35- A 45 HCO3 range: A 22- B 26

Review: When chemical buffers alone cannot prevent blood pH changes, what is the second like of defense? What is the third?

respiratory changes (i.e. hyperventilation and hypoventilation) metabolic changes

Complication of tracheotomy where there is a tear in the trachea leading to air escaping into the tissues, face and neck.

subcutaneous emphysema

What would be the suspected treatment of pulmonary empyema?

thoracotomy or thoracentesis

Which oxygen delivery system/airway management system must have humidified air?

trach

The following lab tests may be performed on a suspected GI problem pt, what do they indicate? CBC Clotting factors (PT) Electrolytes Assays of enzymes : AST (aspartate) and ALT (alanine aminotransferease) Serum amylase and lipase Bilirubin Ammonia Urinalysis- urobillinogen

CBC (infection, anemia?) Electrolytes (malnutrition?) Liver function: Clotting factors (PT) Assays of liver enzymes : AST (aspartate) and ALT (alanine aminotransferease) *elevated with liver disease Bilirubin (byproduct during RBC breakdown, *elevated indicate poor liver fx Ammonia *elevated indicate poor liver fx Serum amylase and lipase *elevated with pancreatic disorders ex-pancreatitis Urobillinogen *elevated indicates hepatic or biliary obstruction

Increased level of PaCO2 over prolonged period of time that eventually damages the drive to breathe & ability to function and incurs loss of sensitivity to levels of CO2

CO2 narcosis

What pt's may experience hypoventilation by providing too much oxygen therapy?

COPD & hypercarbia pt's

Positive pressure ventilation device that provides continuous positive airway pressure.

CPAP C (continuous)

Fungal infection that grows well in moist environments such as skin folds or pubic areas.

Candida albicans

What are the following three symptoms that are associated with only liver cirrhosis? Caput medusae Fector hepaticas Asterixis

Caput medusae dilated abdominal veins Fector hepaticas fruity or musty breathe odor Asterixis type of tumor in wrists and fingers

Device that measures the CO2 exhaled by the patient as well as O2.

Capynography

Bacterial infection that is a generalized infection with either Staph or Strep involving deeper connective tissue.

Cellulitis

Chest tube chambers: Chamber 1: Chamber 2: Chamber 3:

Chamber 1: Collects fluid draining from the patient Chamber 2: Water seal that prevents air from entering the patient's pleural space Chamber 3: suction control system

Therapy used for cystic fibrosis patients that can be considered either preventative or maintenance therapy, includes postural drainage, loosened secretions enabling the patient to cough out mucous. Usually done on a daily basis.

Chest physiotherapy

A drain placed in the pleural space to restore intrapleural pressure, allowing the re-expansion of the lung.

Chest tube

Surgical management of cholecystitis including surgical removal of the gallbladder either laparoscopically or open (typically lap).

Cholecystectomy

The following clinical manifestations are indicative of what: Flatulence, dyspepsia, belching, biliary colic, murphy's sign, blumbergs sign (rebound tenderness), steatorrhea (fatty, clay colored stool)

Cholecystitis

What usually accompanies acute cholecystitis?

Cholelithiasis (gall stones) abnormal formation of cholesterol

Abnormal occurrence, discovered during the nail assessment and is known as inflammation of the skin surrounding the nail. Common condition with patients that have an inflammatory condition that is present for months, also common with people who have frequent exposures to water.

Chronic Paronychia

Branch of COPD that includes inflammation of bronchi and bronchioles, more thick mucous, chronic cough, bronchospasm, problems occur at least 3 months each 2 consecutive years prior to diagnosis. Known as blue bloaters.

Chronic bronchitis *this condition only affects the airways, not the alveoli (like emphysema)

Characterized by repeated episodes of cystic duct obstruction resulting in chronic inflammation, with calculi almost always presenting. Is accompanied by: pancreatitis, cholangitis, jaundice, icterus, or pruritus

Chronic cholecystitis

Type of inflammation of the gastric mucosa that occurs due to the presence of antibodies as an autoimmune response and is also referred to as type A gastritis. Can be associated with risk for gastric cancer.

Chronic gastritis

Chronic airflow limitation (CAL) disease that is characterized by airflow limitation, bronchospasm and dyspnea, is progressive, and associated with an abnormal inflammatory response to noxious particles or gases.

Chronic obstructive pulmonary disease COPD

Progressively destructive disease of the pancreas, characterized by remissions and exacerbations. Pain is the most prominent manifestation. It's related to acute episodes of pancreatitis or obstructive chronic bile duct.

Chronic pancreatitis

What is the most important risk factor for COPD?

Cigarette smoking

Extensive, irreversible scaring of the liver, usually caused by chronic reaction to hepatic inflammation and necrosis. Complications are dependent upon the amount of damage sustained by the liver. Nodular tissue may develop, blocking bile ducts and blood flow, making tissue nonfunctional.

Cirrhosis

What disorder presents with the following in its later stage: jaundice and icterus (jaundice sclera), dry skin, rashes, petechiae, ecchymoses, warm and bright red palms of the hands, spider angiomas and peripheral dependent edema of the extremities and sacrum.

Cirrhosis

Bruising in the belly button region due to GI problem, indicative of abdominal bleeding.

Colon's sign

Type of infectious respiratory problem, specifically type of Pneumonia, that is easier to treat and usually infects patients who are not up to date on immunizations

Community-Acquired PNA

What is usually the first sign of PNA in the elderly population?

Confusion

Common inflammatory experience that may be acute or chronic presenting as a rash caused by contact with a direct irritant

Contact dermatitis

A wound that is exposed is always blank, but not always infected. This indicates the presence of organisms without manifestation of infection.

Contaminated Always contaminated, but not necessarily always infected.

Positive pressure device/technique in which delivers a set positive airway pressure throughout each cycle of inhalation and exhalation via the nasal passage way.

Continuous Nasal positive pressure

What interventions may be used to aid with pruritus?

Cool environment Trimming of fingernails Antihistamines Topical steroids

Cardiac complication experienced by progressive chronic lung disease (COPD, emphysema, CB) patients; an enlargement of the right ventricle due to high blood pressure in the arteries of the lungs

Cor pulmonale (Right sided HF)

What treatment might you give a pt with psoriasis?

Corticosteroids Tar preparations or other topical therapy Immunosuppressants

Functions to check for mucosal ischemia in patient's with tracheostomy's, ideal measurement is 14-20 mm mercury.

Cuff pressures

Surgical management of skin cancer: (Moh's, Excision, Curettage & electrodesiccation, and wide excision) Cutting and burning of the lesion Biopsy of small lesions Excision of lesion by layers Excision used for deeper lesions like melanomas

Cutting and burning of the lesion Curettage and electrodesiccation Biopsy of small lesions Excision Excision of lesion by layers Moh's surgery Excision used for deeper lesions like melanomas Wide excision

Disease that includes error of chloride transport, producing thick mucous. Contains pulmonary involvement, leads to frequent respiratory infections, pancreatic insufficiency therefor GI tract effected and Diabetes dx, intestinal obstructions, stunted growth due to malnutrition, cirrhosis, and death usually due to respiratory failure.

Cystic Fibrosis

Genetic disease that affects many organs, lethally impairing pulmonary function. It's present from birth, first seen in dx in early childhood. Error of chloride transport, producing thick mucous with low water content. Mucous plugs up glands, causing atrophy and organ dysfunction in the lungs, pancreas, liver, salivary glands, and testes. How is it diagnosed?

Cystic fibrosis Diagnosed: sweat chloride analysis and genetic testing (normal is usually 35 mEq/L, infected would be between 60-100 mEq/L)

Question: The nurse is evaluation the laboratory work of a patient who has uncontrolled metabolic acidosis. Which outcome would result from this condition? A. pH 7.4 B. Bicarb 38 mEq/L C. PaO2 98 mm Hg D. Serum potassium 5.7 mEq/L

D