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N308 Final Exam Flashcards (Part 1)

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When talking about treatment plan of patient with HF, Report weight gain >2lb in _1__ day, 3 lb over ___2__ days, or 3-5 lb over ___1___ week (fluid overload) o Signs of fluid overload

1. 1 2. 2

CKD progresses: oliguria (less than ___1____ ml/day)→ anuria (less than __2____ ml/day)→ uremia (symptoms of build-up of metabolic wastes; N/V, lethargy, etc). o renal function declines - develops problems in multiple organs (nausea, vomiting, lethargy, fatigue, impaired thought processes, headache) • As GFR drops, osmoreceptors stimulate production of ADH which works in the kidneys to help with water reabsorption.

1. 400 2. 40

An _____1_____ involves invasion of tissues or cells by microorganisms such as bacteria, fungi, and viruses. In contrast ___2_____ can also be caused by heat, radiation, trauma, chemicals, allergens, and an autoimmune reaction.

1. infection 2. inflammation

____1____ neutrophils (segmented neutrophils, or segs) and ___2____ neutrophils (bands)

1. mature 2. immature

With _____1_____ stimulation, the nerve endings release the neurotransmitter norepinephrine and produce: increased heart rate, increased conduction speed thru the AV node, increased contractility, peripheral vasoconstriction. With ___2_____ stimulation, nerve fibers release the neurotransmitter acetylcholine, which produces inhibitory effects. Decreases the rate of SA firing, lowering heart rate and atrial conductivity. **ANS regulation

1. sympathetic 2. parasympathetic

sodium

135-145 mEq/L

hemoglobin in men

14-18 g/dL

With an oral glucose tolerance test, there is a NORMAL result when a 2 hr post-load glucose is < _____ mg/dl. This is a normal glucose tolerance.

140

With an oral glucose tolerance test, an IGT 2 hour post-load glucose of ____-_____ = impaired glucose tolerance. This indicated prediabetes.

140-199

With nursing management of cirrhosis (acute care)--> hepatic encephalopathy: Perform neurologic assessment every ____ hours o Assess the neurologic status, including an exact description of the patient's behavior, at least every 2 hours. Plan your care of the patient with neurologic problems according to the severity of the encephalopathy.

With interprofessional care of CKD, nutrition includes: ELECTROLYTE RESTRICTION: Potassium: __-____g/day (approx. 50-75 meq/day) (39mg = 1meq) Very important when restricting sodium that a lot of salt substitutes contain potassium so need to teach patient to choose salt substitutes that do not have potassium or not high in potassium

2-3

HGB A1c

4.5-9%

hematocrit in men

45-52%

What diagnostic test of the respiratory system is described below: Description and Purpose: used to measure functional capacity and response to treatment in patients with heart or lung disease. Pulse oximetry is usually monitored during walk. Distance walked is measured and used to monitor progression of disease or improvement after rehab Nursing Responsibility: During: patient is instructed by a trained practionioner to wak as far as possible during 6 minutes, stopping when SOB and continuing when able. COntinually assess and observe patient tolerance to test.

6 min walk test

A MAP greater than _____ mmHg is needed to adequately perfuse and sustain the vital organs of an average person under most conditions. When teh MAP falls below this number for a period of time, vital organs are under perfused and will become ischemic

When talking about normal and critical values for PaO2 and SpO2: What PaO2 (mmHg) measurement is described below: SpO2%: 90 Significance: mild hypoxemia Manifestations: restlessness, tachycardia, dysrhythmias, dyspnea, HTN Management: assess patient condition as necessary, supplemental O2 may be required

60-79

With older adults, at the age of ______: Men have an additional life expectancy of 17.8 years (83 yrs) Women have an additional life expectancy of 20.4 years (85 yrs)

BUN

7-22 mg/dL

7.35-7.45

glucose

70-110 mg/dL

Fasting is no caloric intake of at least how many hours? **DM diagnostic study (Fasting PLasma Glucose)

When talking about normal and critical values for PaO2 and SpO2: What PaO2 (mmHg) measurement is described below: SpO2%: equal to or > 94 Significance: normal value Manifestations: asymptomatic Management: routine assessment

80-100

With oxygen therapy of a patient with COPD, the goal O2 sat is greater than or equal to ______% during rest, sleep, and exertion!

When talking about normal and critical values for PaO2 and SpO2: What PaO2 (mmHg) measurement is described below: SpO2%: 75 Significance: severe hypoxemia Manifestations: cyanosis, coma, respiratory and/or cardiac arrest possible Management: high FIO2, intubation, mechanical ventilation; continuous patient assessment and evaluation

< 40

bilirubin

<1.0 mg/dL

A key aspect of teaching for the patient on anticoagulant therapy includes which instructions? a. Monitor for and report any signs of bleeding. b. Do not take acetaminophen (Tylenol) for a headache. c. Decrease your dietary intake of foods containing vitamin K. d. Arrange to have blood drawn routinely to check drug levels

A patient with newly diagnosed hypertension has a BP of 158/98 mmHg after 6 months of exercise and diet modifications. Which management strategy will be a priority for this patient? a. Medication will be required because the BP is still not a goal b. BP monitoring should continue for another 3 months to confirm a diagnosis of HTN c. Lifestyle changes are less important since they were not effective and medications will be started d. More vigorous changes in the patient's lifestyle are needed for a longer time before starting medications

An appropriate care choice for an older adult who lives with an employed daughter but needs help with activities of daily living is a. adult day care b. long term care c. a retirement center d. an assisted living facility

The nurse recognizes that primary manifestations of systolic failure include: a. decreased EF and increased PAWP b. decreased PAWP and increased EF. c. decreased pulmonary hypertension associated with normal EF d. decreased afterload and decreased left ventricular end-diastolic pressure

What stage (A-D) of the ACCF/AHA Stages of HF is described below: At high risk for HF, but without structural heart disease or symptoms of HF EX: may have HTN, may have had an MI, COPD, or chronic disease that could lead to heart failure but at this time do not have heart failure

What type of hepatitis is described below: Transmission: fecal-oral Characteristics: acute; symptoms mild >>> acute liver failure; vaccination for prevention, treatment; vaccinate high-risk adults

When a person's blood pressure rises, the homeostatic mechanism to compensate for an elevation involves stimulation of a. baroreceptors that inhibit the sympathetic nervous system, causing vasodilation b. chemoreceptors that inhibit the sympathetic nervous system, causing vasodilation c. baroreceptors that inhibit the parasympathetic nervous system, causing vasodilation d. chemoreceptors that stimulate the sympathetic nervous system, causing an increased heart rate

When assessing a patient, you note a pulse deficit of 23 beats. This finding may be caused by a. dysrhythmias b. heart murmurs c. gallop rhythms d. pericardial friction rubs

When talking about diagnostic studies of hepatitis, what virus is described below: Tests: anti-HAV immunoglobulin M (IgM) and Anti-HAV immunoglobulin G (IgG) Significance: acute infection; previous infection or immunization. Not routinely done in clinical practice

With Medicare coverage is limited. Part _____ is free but only covers hospitilization.

arterial blood pressure; measure of the pressure exerted by blood against the walls of the arterial system

ABP

• Failure of the heart to maintain adequate blood circulation • Increase in pulmonary venous pressure is caused by LV failure • Manifests as Pulmonary Edema o Lung and alveoli becomes filled with sero-sanguineous fluid o Blood cannot leave lungs to got to L ventricle so backs up in the lungs • Most common cause: acute left ventricular failure secondary to CAD o People who have HF and go to a crawfish boil and overload on salt, these can lead to acute decompensated HF too • Categorized into four groups based on hemodynamic and clinical status: DO NOT NEED TO KNOW. o Dry-warm, dry-cold, wet-warm (most common), wet-cold Dry/Wet refers to volume level Warm/Cold refers to adequate perfusion • Heart is not able to maintain adequate blood circulation to support the major organs functions of the body

ADHF (acute decompensated heart failure)

• Most common cause: acute left ventricular failure secondary to CAD o People who have HF and go to a crawfish boil and overload on salt, these can lead to acute decompensated HF too

ADHF (acute decompensated heart failure)

What CV regulation mechanism is described below: • The ANS plays an important role in regulating heart rate (chronotropic effect). • Myocardial contractility (inotropic effect), AV node conduction velocity, peripheral vascular resistance (arteriole constriction and dilation) and venous return. • The 2 subdivisions of the ANS generally exert opposing influences and balance their activities to promote cardiovascular adaptation and health.

ANS Regulation

What CV regulation mechanism is described below: Sympathetic stimulation o INCREASED HR and INCREASED FORCE OF CONTRACTION o Causes VASOCONSTRICTION d/t stimulation of alpha-adrenergic receptors o Results in ↑ SVR = BP ↑ Parasympathetic stimulation o DECREASES HR (Vagus nerve)

ANS regulation

BPH

What disorder of the male urogenital tract is described below: · Complications: o Related to degree of obstruction o Acute urinary retention o UTI (from incomplete bladder emptying), sepsis o Bladder stones (urine stasis) o Hydronephrosis (distention of renal pelvis and calyces) o Pyelonephritis, renal failure

BPH

What disorder of the male urogenital tract is described below: · Develops in the inner part of prostate, gradually compresses urethra and bladder o Can lead to partial or complete obstruction of urinary outflow o Retained urine leads to infection and bladder stones o Prolonged urinary obstruction and upward reflux can cause hydronephrosis and renal failure

BPH

What disorder of the male urogenital tract is described below: · Diagnosis: o History and physical o Digital rectal exam (DRE) o Prostate Specific Antigen (PSA) - Controversial o TRUS - tansrectal ultrasound (if abnormal DRE & ↑ PSA ) o Uroflowmetry (extent of urethral blockage) o Post-void residual urine (bladder scanner) o Plasma creatinine, BUN, UA o Cystoscopy o AUA Symptom Index Tool for BPH - NOT a diagnostic tool § 0 - 7 mild § 8 - 19 moderate § 20 - 35 severe

BPH

What disorder of the male urogenital tract is described below: · Etiology: o Not completely understood o Hormonal changes related to aging o Increased proportion of estrogen to testosterone · Risk factors: o Aging o Obesity o Sedentary lifestyle o Alcohol o Erectile dysfunction o Smoking o Diabetes o Family history

BPH

What disorder of the male urogenital tract is described below: · Prostate gland increases in size - leading to disruption of urine flow · About ½ of men with BPH will have lower urinary tract symptoms o Difficulty starting a urine flow o Decreased flow o Frequency · Develops in the inner part of prostate, gradually compresses urethra and bladder o Can lead to partial or complete obstruction of urinary outflow o Retained urine leads to infection and bladder stones o Prolonged urinary obstruction and upward reflux can cause hydronephrosis and renal failure

BPH

Bypass surgery is typically not an option to treat ____ _____ because of the involvement of smaller, distal vessels but may not be used in selected patients with severe ischemia

Buerger's disease (thromboangitis obliterans)

Diagnosis of ____ _____ is based on age of onset, history, clinical symptoms, involvement of distal vessels, presence of ischemic ulcerations, and exclusions of autoimmune disease, diabetes, thrombophilia, and other sources of emboli such as atherosclerosis and aneurysm.

Buerger's disease (thromboangitis obliterans)

____ ______ is a nonatheroscleritic, segmental, recurrent inflammatory disorder of the small and medium arteries and veins of the upper and lower extremities.

Buerger's disease (thromboangitis obliterans)

Medicare Advantage Plans, sometimes called "Part ____" or "MA Plans" are offered by private companies approved by Medicare to provide Part A and B benefits

Nursing interventions directed at health promotion n the older adult are primarily focused on a. disease management b. controlling symptoms of the disease c. teaching positive health behaviors d. teaching regarding nutrition to enhance longevity

Rest pain is a manifestation of PAD that occurs due to a chronic a. vasospasm of small cutaneous arteries in the feet. b. increase in retrograde venous blood flow in the legs. c. decrease in arterial blood flow to the nerves of the feet. d. decrease in arterial blood flow to the leg muscles during exercise.

The first priority of collaborative care of a patient with a suspected acute aortic dissection is to a. reduce anxiety. b. control blood pressure. c. monitor for chest pain. d. increase myocardial contractility

The following is implementation for hepatitis ______: · No vaccine to prevent HCV · General measures to prevent HCV transmission · Screen all persons born between 1945 and 1965 · No postexposure prophylaxis; baseline and follow-up testing

What stage (A-D) of the ACCF/AHA Stages of HF is described below: Structural heart disease with prior or current symptoms of HF

What type of hepatitis is described below: Transmission: blood and body fluids Characteristics: asymptomatic in acute phase; 15-20 years from infection to symptoms; chronic >> cirrhosis, liver cancer liver failure; NO vaccine; effective treatment available

When assessing the cardiovascular system of a 79-year-old patient, you may expect to find a. a narrowed pulse pressure b. diminished carotid artery pulses c. difficulty in isolating the apical pulse d. an increased heart rate in response to stress

\A 50-year-old woman weighs 95 kg and has a history of tobacco use, high blood pressure, high sodium intake, and sedentary lifestyle. When developing an individualized care plan for her, the nurse determines that the most important risk factors for peripheral artery disease (PAD) that need to be modified are: a. weight and diet. b. activity level and diet. c. tobacco use and high blood pressure. d. sedentary lifestyle and high blood pressure.

patient with a tricuspid valve disorder will have impaired blood flow between the a. vena cava and right atrium b. left atrium and left ventricle c. right atrium and right ventricle d. right ventricle and pulmonary artery

A characteristic of a chronic illness is that it (select all that apply): a. has reversible pathologic changes b. has a consistent, predictable clinical course c. results in permanent deviation from normal d. is associated with many stable and unstable phases e. always starts with an acute illness and then progresses slowly

C,D

You are caring for a patient with ADHF who is receiving IV dobutamine (Dobutrex). You know that this drug is ordered because it (select all that apply): a. incerases SVR b. produces diuresis c. improves contractility d. dilates renal blood vessels e. works on the B1-receptors in the heart.

C,E

What diagnostic study is described below: o Marker of inflammation. May have value in predicting risk of cardiac disease and cardiac events. High sensitivity CRP assay used o Lowest risk: < 1 mg/L o Moderate risk: 1-3 mg/L o High risk: > 3 mg/L

C-reactive protein (CRP)

When performing a _______ nursing assessment look at: • Genetic components - H/PE o Run in families; polycystic kidney disease is an example • Drug/med use - NSAIDS o Frequently o NSAIDS cause body to hold on to sodium and water which can lead to chronic kidney disease • Other nephrotoxic drugs • Dietary habits o High sodium diet? • Support systems o If they will have to make significant life style changes, may need family support

CKD

With ______ planning and evaluation: • Maintenance of ideal body weight o Do not want them putting on a lot of fluid weight but do not want to be losing actual body weight • No infections • No edema • No itching or skin dryness • Slowing of bone disease o Once bone has been lost, it is very difficult to rebuild that bone • Hematocrit and hemoglobin levels in acceptable range • Acceptance of chronic disease - Lifestyle changes required as part of managing and living with that chronic disease

CKD

With interprofessional care of ______, overall goals of ______ therapy include: o #1 goal is to: Preserve existing kidney function o Reduce risk of CVD o Prevent complications o Provide for patient comfort (medication, lotion) o Early referral to a nephrologist Anyone with ____ stage 3 should be referred to a nephrologist who can look at what is going on and start treatment; at stage 4, there is not much we can do to prevent from going to stage 5 o Control of CVD

CKD

With interprofessional care of _______, some diagnostic studies include: • H&P o identify risk factors, reversible kidney disease • Lab Procedures (serum & Urine): o Albuminuria •Serum BUN/creatinine, urine creatinine clearance, GFR o Serum electrolytes (Sodium, Potassium, phosphate, Calcium, bicarb) o Lipid profile, Hematocrit & Hemoglobin (decreased) o Protein-to-creatinine ratio •Routine Urinalysis o 24 hr urine collection (creatinine clearance) Discard first urine, collect all urine for 24 hrs, keep on ice Want to discard first urine and then collect every other urine for 24 hours and keep on ice • Radiology Procedures o KUB, Renal ultrasound, renal Scan, CT scan, Retrograde Pyelogram, Cystoscopy, renal biopsy o CT Scan, Pyelogram, Renal Scan

CKD

When talking about collaborative care of leg with ______: • Other strategies - hyperbaric oxygen therapy, angiogenesis o HBO: Get oxygen under high pressure that helps give oxygen to tissue promoting healing • ______ is a condition characterized by chronic ischemic rest pain lasting longer than 2 weeks, arterial leg ulcers, and/or gangrene of the leg attributable to PAD.

CLI (critical limb ischemia)

When talking about collaborative care of leg with ______: • Protect from trauma o Should ALWAYS wearing shoes not barefoot o Can step on nail and patient would not know • Reduce vasospasm • Prevent/control infection • Maximize arterial perfusion

CLI (critical limb ischemia)

When talking about collaborative care of leg with ______: • Revascularization via bypass surgery • Meds to reduce rest pain and improve ulcer healing • Continue other meds • CVD risk factor reduction • Protect from trauma o Should ALWAYS wearing shoes not barefoot o Can step on nail and patient would not know • Reduce vasospasm • Prevent/control infection • Maximize arterial perfusion • Other strategies - hyperbaric oxygen therapy, angiogenesis o HBO: Get oxygen under high pressure that helps give oxygen to tissue promoting healing • ________ is a condition characterized by chronic ischemic rest pain lasting longer than 2 weeks, arterial leg ulcers, and/or gangrene of the leg attributable to PAD.

CLI (critical limb ischemia)

When talking about the care of leg with ________: • Avoid extremes of heat / cold • Keep heels free of pressure o Foam booties • Opioids, analgesics, reverse Trendelenburg position (!!!!!) o Keep bed flat but raise head up so they are at a slant

CLI (critical limb ischemia)

When talking about the care of leg with ________: • Avoid soaking the feet to prevent maceration (breakdown) o All bacteria on feet gets in water and if they have any cracks or fissures, bacteria can get in there • Ulcer care: o keep clean and dry o Cover with dry, sterile dressing • Soft, roomy, protective footwear

CLI (critical limb ischemia)

When talking about the care of leg with ________: • Protect extremity from trauma • Decrease ischemic pain, improve perfusion o Mostly done with medications • Prevent and control infection o Handwashing, keeping hand clean, etc. • Inspect, clean, lubricate both feet to prevent cracking • Avoid soaking the feet to prevent maceration (breakdown) o All bacteria on feet gets in water and if they have any cracks or fissures, bacteria can get in there • Ulcer care: o keep clean and dry o Cover with dry, sterile dressing • Soft, roomy, protective footwear • Avoid extremes of heat / cold • Keep heels free of pressure o Foam booties • Opioids, analgesics, reverse Trendelenburg position (!!!!!) o Keep bed flat but raise head up so they are at a slant

CLI (critical limb ischemia)

_______ (PAD end stage disease): Characteristics o chronic ischemic rest o pain lasting more than 2 weeks, o arterial leg ulcers or gangrene of the leg Risk Factors o DM, heart failure, & history of a stroke End Stage o Impending limb loss due to severe compromise in blood flow to the affected extremity. o Chronic ischemic rest pain, ulcers, or gangrene attributed to PAD

CLI (critical limb ischemia)

______ = SV x HR; SVR is regulated by constricting and dilating of arteries/arterioles/vessels - a very small change in vessels = huge change in SVR

CO (cardiac output)

is the total blood flow through the systemic or pulmonary circulation per minute. It is described as the stroke volume (SV)(amount of blood pumped out of the left ventricle per beat [approximately 70 pum]) multiplied by the heart rate (HR).

CO (cardiac output)

What diagnostic test of the respiratory system is described below: Description and Purpose: assess the level of CO2 in exhaled air. Graphically displays partial pressure of CO2. Nursing Responsibility: Before: teach patient and caregiver about purpose of capnography monitoring, emphasizing the benefit of continous monitoring. During: make sure that sensor is properly attached. Record and document data per institution policy.

CO2 monitoring (end tidal CO2 capnography)

What is the formula to calculate CO?

CO= SVxHR

The following are _______ diagnostic studies: • Arterial blood gases: o ↓ PaO2 ↑ PaCO2 ↓ pH o ↑ bicarbonate in later stages - compensating for resp acidosis

COPD

The following are _______ diagnostic studies: • Chest X-ray is not diagnostic but may show a flattened diaphragm o Lungs chronically overinflated o Characteristics from chest x-ray supports diagnosis of COPD but is not used to diagnose COPD • Echocardiogram

COPD

The following are _______ diagnostic studies: • History and physical exam • Post-Bronchodilator Spirometry - "Gold Standard" o FEV1/FVC ratio < 0.70 confirms a persistent airflow limitation & _______ o The lower the FEV1, the greater the obstruction • Chest X-ray is not diagnostic but may show a flattened diaphragm o Lungs chronically overinflated • Echocardiogram • MUGA scan (multigated acquisition scan) o Evaluates left and right sided ventricular function • Sputum for C&S • Six-minute walk test • O2 saturation at rest • AAT deficiency (α1 Antitrypsin) • Arterial blood gases: o ↓ PaO2 ↑ PaCO2 ↓ pH o ↑ bicarbonate in later stages - compensating for resp acidosis • Valid questionnaires for comprehensive assessment of symptoms: o _______ Assessment Test (CAT) The higher the score, the more worse the COPD is Aids in determination of treatment o Clinical _______ Questionnaire (CCQ)

COPD

The following are _______ diagnostic studies: • MUGA scan (multigated acquisition scan) o Evaluates left and right sided ventricular function • Sputum for C&S • Six-minute walk test • O2 saturation at rest • AAT deficiency (α1 Antitrypsin)

COPD

The following are _______ diagnostic studies: • Valid questionnaires for comprehensive assessment of symptoms: o _______ Assessment Test (CAT) o Clinical _______ Questionnaire (CCQ)

COPD

The following are clinical manifestations of _______: • Develops slowly • Chronic cough or sputum production o Coughing spasms may cause fainting or fractured ribs • Progressive dyspnea - "Air hunger" o Affects ADLS/IADLS, dyspnea at rest • Expiratory wheeze • Fatigue, unexplained weight loss and anorexia • Barrel chest • Tripod positioning • Purse-lip breathing, use of accessory muscles • Edema in ankles • Digital clubbing • Pa02 less than 60 • PaC02 over 56 • Saturation less than 88% • Bluish-red color to skin from polycythemia and cyanosis o Compensatory increase in RBCs

COPD

The following are clinical manifestations of _______: • Edema in ankles • Digital clubbing • Pa02 less than 60 • PaC02 over 56 • Saturation less than 88% • Bluish-red color to skin from polycythemia and cyanosis o Compensatory increase in RBCs

COPD

The following are clinical manifestations of _______: • Expiratory wheeze • Fatigue, unexplained weight loss and anorexia • Barrel chest (from overinflation of alveoli) • Tripod positioning • Purse-lip breathing, use of accessory muscles

COPD

The following falls under ______ etiology: • Cigarette smoking - major risk factor • Occupational chemicals & dust • Air pollution • Recurrent respiratory infections - recurrent infections in childhood • Genetics - deficiency of alpha-1 antitrypsin (AAT) linked to COPD (accounts for 1% to 2% of USA cases) • Normal levels of AAT inhibit lysis of lung tissue • Aging, asthma, gender

COPD

When maximizing food intake in _____ patients: -add skim milk powder to regular milk to add protein and calories -use milk or half and half milk instead of water to make soups cereals instant puddings, cocoa or canned soups -add grated cheese to sauces, veggies, soups, and casseroles -choose desert recipes that contain eggs

COPD

When maximizing food intake in _____ patients: -eat high calorie foods first -limit liquids at mealtimes -rest before meals -try more frequent meals and snacks -increase calories by adding margarine, better, mayo, sauces, gravies, and peanut butter to foods

COPD

When maximizing food intake in _____ patients: -keep fav foods and snacks on hand -try cold foods, which can make you feel less full than hot foods -keep ready-prepared meals available for times when you have increased SOB -avoid foods that you know cause gas (ex: cabbage, beans, cauliflower)

COPD

When talking about chest exam findings in respiratory problems, what problem is described below: Inspection: barrel chest, cyanosis, tripod position, use of accessory muscles Palpation: decreased movement Percussion: hyperresonant or dull consolidation

COPD

When talking about interprofessional care of ______, drug therapy includes: • Bronchodilators o Short-acting B2-adrenergic agonists (SABAs) - Albuterol - Rescue/relief **acute attack of dyspnea, wheezing, or coughing o Long-acting B2-adrenergic agonists (LABAs) - Salmeterot - Long-term control **once using a long acting bronchodilator, should use these every day no matter if they have symptoms or not!!!!!! (breathing fine) • Anticholinergics - Ipratropium - Open larger bronchi, promote bronchodilation in COPD • Inhaled Corticosteroids (ICS) - Reduce inflammation • Methylxanthines (theophylline) o NOT recommended for long-term unless other bronchodilators not available or unaffordable; controversial use in COPD • Combo Meds o LABA with ICS (Advair, Symbicort) **makes it easier for patient to adhere to therapy o Anticholinergic/SABA (DuoNeb, Combivent) • Antibiotics as needed for bacterial-related exacerbations • O2 Therapy o Goal O2 sat ≥ 90% during rest, sleep, & exertion

COPD

______ pathophysiology includes: • Inability to effectively expire air - small airway obstruction • Inflammatory mechanism - structural remodeling of lung tissue o Different inflammatory mechanism than asthma o Gets this scarring type appearance which is ineffective with gas exchange • May lead to Pulmonary HTN, Cor pulmonale

COPD

• > 50% of patients die within 10 years of diagnosis • More women than men have died from _______ • U.S. 12.7 million adults over the age of 18 have_________ • Number of women with ______ is on the rise (increased cigarette smoking • More prevalent in whites than African Americans • 4th leading cause of death in the U.S.

COPD

• Preventable & treatable disease o Persistent airflow limitation - usually progressive, associated with an enhanced chronic inflammatory response in airways and the lung to noxious particles or gases • Exacerbations and comorbidities contribute to the overall severity in individual patients

COPD

when talking about the diagnosis of MS, the pt will have a ____ ____ done: o ↑ IgG , lymphocytes, monocytes o Get a spinal tap and looking for an elevated igG which is an inflammatory marker.

CSF analysis

With acute pancreatitis diagnostic studies, imaging includes: · Contrast-enhanced _____ _______ o ____ ______ing is the best imaging test for pancreatitis and related complications such as pseudocysts and abscesses.

CT scan

What type of BP regulation is described below: • Nervous system responds in seconds to ↓ in BP •Baroreceptors/Chemoreceptors • SNS: peripheral vasoconstriction and cardiac response o Inotropic, chronotropic, dromotropic • PNS: vasodilation • Endothelium-derived substances o In vascular endothelium o promote vasodilation or vasoconstriction • endothelium-derived substances - nitric oxide and prostacycline are vasodilators, while endothelin is a potent vasoconstrictor • Inotropic - force of myocardial contraction, chronotropic - heart rate, dromotropic - speed of conduction

What type of BP regulation is described below: •Baroreceptors/Chemoreceptors o Baroreceptors are sensitive to stretching and when stimulated by an increase in BP, send inhibitory impulses to the sympathetic vacomotor center. Inhibition of the SNS results in decreased HR, decreased force of contraction, and vasodilation of peripheral arteries o When a fall in BP is sensed by the baroreceptors, the SNS is activated. The result is constriction of the peripheral arterioles, increased HR, and increased contractility of the heart. In long standing HTN, the baroreceptors become adjusted to elevated BP levels and recognize this level as their new "normal"

What system has the following clinical manifestations of CKD? • Fluid overload • HTN - aggravated by Na & fluid retention • arrhythmias - from hyperkalemia • vascular changes - HTN <-> CKD; pericarditis; CHF

CV system

In teaching a patient with hypertension about controlling the condition, the nurse recognizes that: a. All patients with elevated BP require medication b. Obese person must achieve a normal weigh to lower BP c. It is not necessary to limit salt in the diet if taking a diuretic d. Lifestyle modifications are indicated for all persons with elevated BP

What side effect of radiation and chemotherapy is described below: •The intestinal mucosa is highly sensitive to radiation and chemotherapy •Causes reactions r/t variety of mechanisms in the GI Tract: •Significant effect on pt's hydration, nutritional status, and state of well-being. •Possible GI Reactions: --Nausea and Vomiting --Diarrhea --Mucositis --Anorexia

GI effects

What system has the following clinical manifestations of CKD? • excessive urea irritates GI mucosa • stomatitis, nausea, vomiting, diarrhea, anorexia; diabetic gastroparesis; constipation,↓motility, ↓fluid intake o gastroparesis is when the stomach does not empty effectively causing nausea o constipation: calcium phosphate binders are given because we want the phosphate to not stay in the blood so these can worsen constipation • risk for GI bleeding due to mucosal irritation & ↓platelet aggregation o mucousal irritation

GI system

What classification of COPD severity is described below: Level of Severity: mild

GOLD 1

What classification of COPD severity is described below: Level of Severity: moderate

GOLD 2

What classification of COPD severity is described below: Level of Severity: severe

GOLD 3

What classification of COPD severity is described below: Level of Severity: very severe **bedridden on oxygen and not able to help self

GOLD 4

The following are ______ treatment goals: · Bowel rest (NPO, clear liquids) · Control inflammation · Combat infection · Correct malnutrition · Alleviate stress · Symptomatic relief · Achieve remission and prevent relapses · Improve quality of life · ******Quit smoking*****

IBD

The following are clinical manifestations of ________: · UC and Crohn's Disease are often the same: o Mild-to-severe acute exacerbations at unpredictable intervals over many years o Nonspecific complaints - fever, fatigue, abdominal pain/tenderness, weight loss, malnutrition, diarrhea, bloody stool, urgency and tenesmus § Tenesmusà feeling of incomplete bowel movement and feel like still having to go

IBD

The following are complications of _____: · Intestinal: · Hemorrhage · Perforation · Carcinoma · Toxic megacolon o Have so much fluid in the colon and the colon distends and with this distention the muscles of the colon becomes flappy, big, and balloon-like o Happens with paralytic ileus and associated with high rate of perforation o (dilation and paralysis of the colon commonly associated with perforation)

IBD

The following are diagnostic studies for _____: Diagnostic Studies · CBC, serologic markers (pANCA, ASCA), genetic tests o Of an autoimmune disease o Do not have to worry about the markers o Genetic tests can target therapy to the specific genetic marking causing disease · Inflammatory markers - ESR, C-reactive protein, TNF o TNF—tumor necrotic factor

IBD

The following are diagnostic studies for _____: Diagnostic Studies · History and physical exam · Sigmoidoscopy and colonoscopy with biopsy o Biopsy will tell if there is any chronic inflammation in the colon at the time · Virtual-reality endoscopy (capsule) · CT scan, MRE (magnetic resonance enterography) o An MRI of the lower GI tract · Barium swallow, barium enema o Barium enema helps to see how the peristalsis and movement of this fluid throughout the GI tract · CBC, serologic markers (pANCA, ASCA), genetic tests o Of an autoimmune disease o Do not have to worry about the markers o Genetic tests can target therapy to the specific genetic marking causing disease · Inflammatory markers - ESR, C-reactive protein, TNF o TNF—tumor necrotic factor · Stool cultures & type of stools: pus, blood, mucus o All signs of chronic inflammation · Plasma electrolytes o Diarrhea, losing a lot of fluids · Plasma protein level o Malabsorption syndrome that is associated with this and are not absorbing all of their nutrients

IBD

The following are diagnostic studies for _____: Diagnostic Studies · Stool cultures & type of stools: pus, blood, mucus o All signs of chronic inflammation · Plasma electrolytes o Diarrhea, losing a lot of fluids · Plasma protein level o Malabsorption syndrome that is associated with this and are not absorbing all of their nutrients

IBD

The following are indications for surgical therapy for ______: · Drainage of abdominal abscess · Inability to wean off corticosteroids · Intestinal obstruction, hemorrhage · Perforation, fistula · Severe anorectal disease · Suspicion or development of carcinoma · Failure to respond to conservative therapy · Frequent/debilitating exacerbations · For strictures, obstruction, bleeding, and/or fistula formation

IBD

The following are special considerations related to surgery for ______: · Affected segments of the intestine are removed and the remaining intestine is re-anastomosed · Disease often recurs at the anastomosis site · Can lead to short bowel syndrome - lifetime TPN is required

IBD

The following is drug therapy for _______: · Aminosalicylates · Antimicrobials · Corticosteroids · Immunosuppressants - Biologics and targeted therapy · Antidiarrheals · Iron supplements · Vitamins o Folic acid o B12 · **know the classes of drugs and nursing care of these drugs

IBD

The following is interprofessional care of _____: · Mild to moderate disease o treated as outpatient · When to admit to hospital: o No response to treatment o Dehydration o Uncontrolled pain o Uncontrolled diarrhea o Bowel obstruction or perforation

IBD

The following is the pathophysiology of ______: · Autoimmune - more than 160 gene locations identified · 70% of _______ associated with other immune diseases · Antigen initiates inflammation; tissue damage from inappropriate and sustained immune response · What are the triggers? o Diet, hygiene, stress, smoking, NSAIDs o Uncertain of what dietary habits prompt _____

IBD

When talking about ________ (Crohn's Disease or Ulcerative Colitis): o Chronic, recurrent inflammation of the intestinal tract o Exact Cause is Unknown - Autoimmune (Combination of environment, genetic predisposition, & immune system) o Periods of remission and exacerbation o Increased risk for colon and colorectal cancer o Both most commonly occur during teenage and early adulthood o Both have a second peak in the 60's o More prevalent in industrialized countries, Ashkenazi Jews, Caucasian, Middle European, or a family member with the disorder

IBD

When talking about ________ (Crohn's Disease or Ulcerative Colitis): o Increased risk for colon and colorectal cancer o Both most commonly occur during teenage and early adulthood o Both have a second peak in the 60's o More prevalent in industrialized countries, Ashkenazi Jews, Caucasian, Middle European, or a family member with the disorder

IBD

the following are gerontologic considerations for _____: · Can occur in the 50s + · Crohn's disease o Less recurrence in the elderly when treated with surgical resection o Involves colon more than small intestine · Careful assessment of fluid /electrolyte status · Age-specific considerations o skin assessment, weight loss, fecal urgency, treatment side effects, intestinal obstruction

IBD

The following is the etiology and pathophysiology of _______: · Colonic dysmotility - spasms · Visceral hypersensitivity - pain · Brain-gut dysfunction - stimulation affects areas in the brain producing emotional distress which affect bowel functioning · Etiology—Triggers o Patients report hx of GI infections - gastroenteritis o Food intolerances - role of food allergies is unclear o Stress o Psychogenic factors - depression, anxiety, sexual abuse hx, posttraumatic stress disorder · Some common triggers: o Following a meal o Complex carbohydrates o Caffeine o Fatty foods o Alcoholic drinks o Menstrual period o Emotional distress o Also, more common in women

IBS

Treatment (if ______ is symptomatic) includes the following: · Treatment is directed towards psychologic and dietary factors and medications to regulate stool o Increase water intake (constipation) o Increase fiber intake, laxatives o Avoid caffeine, alcohol, fried foods o Avoid gas forming foods o Stress reduction o Antispasmodics (dicyclomine) o Antidepressants o Psychologic treatment (cognitive behavioral Tx)

IBS

· AKA: irritable, spastic or nervous colon · Functional disorder with intermittent abdominal pain and altered bowel habits · No structural disorder and no inflammation

IBS

· Some common triggers: o Following a meal o Complex carbohydrates o Caffeine o Fatty foods o Alcoholic drinks o Menstrual period o Emotional distress o Also, more common in women

IBS

The _____ drugs used to treat hypertensive emergencies include: o Vasodilators, nicardipine, adrenergic inhibitors, labetalol o Sodium nitroprusside - most effective, direct arterial vasodilation • Antihypertensive drugs administered ____ have a rapid (within seconds to minutes) onset of action. Assess the patient's BP and HR every 2 to 3 minutes during the initial administration of these drugs. Use an intraarterial line or an automated, noninvasive BP machine to monitor BP. Titrate the drug according to MAP or BP as ordered. • Hydralazine and Nitroglycerin also used, but require additional assessment/monitoring due to other effects in myocardium

With HTN emergency treatment, you want to do a ______ measurement. This is used instead of SBP/DBP because it is more accurate. The initial goal of ______ measurement is to decrease _____ by 20-25% or to decrease _________ to 110 to 115 mmHg. You also want to gradually lower the _____ over next 24 hours IF the patient is stable.

MAP

mean arterial pressure o Refers to the average pressure within the arterial system that is felt by organs in the body. It is not the average of the SBP and DBP because the length of diastole exceeds that of systole at normal HRs o Caculated by: MAP= (SBP + 2 DBP) / 3

MAP

o -the average pressure in a patient's arteries during one cardiac cycle. o -a better indicator of organ/tissue perfusion than systolic blood pressure (SBP) o - used in hypertensive emergencies to guide/evaluate drug therapy

MAP (mean arterial pressure)

Drug therapy for _____ includes: · Corticosteroids for exacerbations o Reduces inflammation o INFECTION RISK! · Immunosuppresants for exacerbations o INFECTION RISK! · Immuno-modulators for exacerbations o Drugs that change the way the immune system works in the body o INFECTION RISK! · Cholinergics for urinary retention o Helps relax urinary sphincter · Anticholinergics for urinary frequency and urgency o Relaxes bladder muscle and control the bladder sphincter · Muscle relaxants for spasticity · CNS stimulants for fatigue · Antiviral/antiparkinsonian for fatigue

The following are clinical manifestations of ______: Motor, Sensory, Cerebellar, Emotional Manifestations: o Blurred or double vision, color distortions, blindness in one eye o Weakness in extremities, problems with coordination and balance, walking and standing o Paresthesia § lower extremity numbness, hand numbness, sensation of tingling, pricking, or numbness

The following are clinical manifestations of ______: o Lhermitte's sign § transient sensory symptom described as an electric shock radiating down the spine or into the limbs with flexion of the neck § "barber chair sign" à bend head forward and get an electric shock sensation that runs down spine and into their limbs § Pain (not the major sign of _____ but some people have pain depending on where nerve involvement is) § Dysarthria- Scanning (explosive) · Scanning speech, also known as explosive speech, is a type of ataxic dysarthria in which spoken words are broken up into separate syllables, often separated by a noticeable pause, and spoken with varying force o Talk slow and then finish out o Impulses are having trouble to get to mouth to talk and then come all at once § Tremors and Dizziness § Hearing loss is also an occasional finding · If otic nerve is affected § Fatigue aggravated by heat and humidity, deconditioning and medication side effects § Bowel and bladder function can be impaired (constipation or loss of bowel control) § Sexual dysfunction § Fatigue, emotional changes § Cognitive function may change especially as the disease progresses Some women with ______ who get pregnant experience a remission of symptoms during gestation

The following are clinical manifestations of ______: § Dysarthria- Scanning (explosive) · Scanning speech, also known as explosive speech, is a type of ataxic dysarthria in which spoken words are broken up into separate syllables, often separated by a noticeable pause, and spoken with varying force o Talk slow and then finish out o Impulses are having trouble to get to mouth to talk and then come all at once

The following are clinical manifestations of ______: § Fatigue aggravated by heat and humidity, deconditioning and medication side effects § Bowel and bladder function can be impaired (constipation or loss of bowel control) § Sexual dysfunction

The following are clinical manifestations of ______: § Fatigue, emotional changes § Cognitive function may change especially as the disease progresses Some women with ______ who get pregnant experience a remission of symptoms during gestation

The following are clinical manifestations of ______: § Pain (not the major sign of _____ but some people have pain depending on where nerve involvement is)

The following are clinical manifestations of ______: · 'Spotty' distribution in the CNS - clinical manifestations vary according to area involved · Some may experience severe and permanent manifestations early on in the disease while others may have occasional and mild symptoms for several years after onset

The following are clinical manifestations of ______: · Vague symptoms - occurring intermittently over months or years o Dragging a foot when walking, drooping eye, eye drifting to side, etc. · 'Spotty' distribution in the CNS - clinical manifestations vary according to area involved · Some may experience severe and permanent manifestations early on in the disease while others may have occasional and mild symptoms for several years after onset · Motor, Sensory, Cerebellar, Emotional Manifestations: o Blurred or double vision, color distortions, blindness in one eye o Weakness in extremities, problems with coordination and balance, walking and standing o Paresthesia § lower extremity numbness, hand numbness, sensation of tingling, pricking, or numbness o Lhermitte's sign

The following are nursing diagnoses for _______: · Impaired physical mobility o muscle weakness, paralysis, spasticity o #1 ND used · Risk for impaired skin integrity o decreased mobility · Risk for injury o weakness, visual deficits · Fatigue · Risk for impaired nutrition < body requirements o Dysphagia (Not able to swallow well) · Impaired urinary elimination pattern o sensory motor deficits · Sexual dysfunction o neuromuscular deficits · Interrupted family processes o changing family roles, potential financial problems, fluctuating physical condition

The following are nursing interventions for a pt with ______: · Triggers - infections, trauma, stress, climate · Prevent complications of immobility · Assist with grieving and anxiety · Incontinence and constipation control · ******Teaching! o Prevention of infection is very very important!*******

The following is a nursing assessment for a pt with ______: · Recent and past health history · Fatigue · Vision changes · Weight loss, dysphagia, difficulty chewing · Urinary and bowel elimination · Muscle weakness, paresthesia, ataxia, loss of balance, paralysis, · Dysarthria · Pressure sores or any other complications of immobility · Apathy, inattentiveness, depression o Depression is a very COMMON comorbidity of this disease · Sexual dysfunction · Life-style changes and adjustments · Compliance with medications

The following is nursing planning for a pt who has ______: · Maximize neuromuscular function · Maintain independence and ADLs (OT comes in) · Manage fatigue · Optimal psychosocial well-being (counselor) · Illness adjustment · Reduce exacerbations

When talking about nursing evaluation of _______: · Maintain strength and mobility · Use of assistive devices/ safety · Maintain continence · Effective decision-making and life-style adjustments

When talking about the diagnosis of _______: · No specific definitive diagnostic test · History and physical exam · CT scan, MRI - sclerotic plaques · Expanded Disability Status Scale (EDSS) · CSF analysis o ↑ IgG , lymphocytes, monocytes o Get a spinal tap and looking for an elevated igG which is an inflammatory marker. · Oligoclonal bands o Bands of Immunoglobulins in CSF, blood o By itself, not a diagnostic test · Auditory, Visual, Somatosensory o Evoked Potential Response - delayed § Send an electrical impusle to a particular nerve ending to see if it will respond or when it will respond

With interprofessional care (treatment goals) of ________: · Adjust to the illness (no cure to disease) · Use assistive devices properly to PREVENT injuries like falls o May need assistive devices to eat as well

With interprofessional care of ______, other therapies include: · Intrathechal baclophen - through pump infusion · Surgical - neurotomy · Dorsal column electrical stimulation · Physical and speech therapy - water exercises o Water exercises are great for _____ because we do not have to worry about balance and gait · Diet - balanced diet, high supplemental vitamins (especially B vitamins which are involved with nerve function) · Sexual counseling · Exercise therapy - decreases spasticity, ↑coordination, retains unaffected muscles o Supervised environment

With interprofessional care of ______, other therapies include: · Physical and speech therapy - water exercises o Water exercises are great for _____ because we do not have to worry about balance and gait · Diet - balanced diet, high supplemental vitamins (especially B vitamins which are involved with nerve function)

With interprofessional care of ______, other therapies include: · Sexual counseling · Exercise therapy - decreases spasticity, ↑coordination, retains unaffected muscles o Supervised environment

· Chronic, progressive, degenerative, inflammatory disorder of the CNS · Characterized by disseminated, de-myelination and scarring (gliosis) of nerve fibers of the brain and spinal cord o The myelin sheath in MS starts to breakdown and we call this de-myelination and it is replaced by scarred tissue which further slows nerve conduction · Onset is usually 20-50 years of age; gradual o Does not come on all the time · Periods of noticeable impairment of function altered with remission · As ongoing inflammation occurs, there is permanent loss of function o The more exacerbations you have, it does result in permanent loss of function over time · Average life expectancy after onset of symptoms is more than 25 years o Death is usually from infections related to immobility or untreated disease · Found more in northern U.S. Europe, Canada more than tropical places. o Changing location changes risk for _____ o Immigrants take on the risk of where they move to.

State employees do NOT PAY SOCIAL SECURITY so they do NOT get _________. they are eligible if they retire from the state they are eligible for the _____ ongoing insurance coverage.

Medicare

• Coverage is limited o Monthly premium for part B Part A is free but only covers hospitalization Part B , you pay a monthly premium, covers physicians visits, diagnostic services like labs and X-rays but doesn't pay for medications. Part B also comes with a copay and deductible (patient has to pay a certain amount up front each year before their insurance kicks in and they have a copay for every time they go for a visit or a diagnostic). o Copays for HCP visits, diagnostic tests, etc. o Separate plan for prescription drug coverage

Medicare

Locations found: o Iliac •Femoral •Popliteal •Peroneal • Femoral-popliteal is most common in non-diabetic patients • Below the knee PAD is most common in diabetic patients • In Advanced PAD, multiple levels of occlusions may occur

PAD (peripheral artery disease)

PAD or PVD? o Ulcers on tips of toes, foot or lateral malleolus o Minimal drainage o Intermittent claudication or rest pain o Thin, shiny, taut skin o Cool temperature

PAD (peripheral artery disease)

PAD or PVD? o Weak or absent pulse o Prolonged capillary refill o Less likely to have edema unless in dependent position o Loss of hair

PAD (peripheral artery disease)

Pathophysiology = Atherosclerosis o Gradual thickening of the intima and the media from deposits of cholesterol and lipids o The exact reasons this occurs are unknown o Inflammation and endothelial injury play a major role o Most commonly affected areas: Coronary, Carotid, Lower Extremities

PAD (peripheral artery disease)

Peripheral artery disease or peripheral venous disease? o Weak or absent pulse o Prolonged capillary refill o Less likely to have edema unless in dependent position o Loss of hair o Ulcers on tips of toes, foot or lateral malleolus o Minimal drainage o Intermittent claudication or rest pain o Thin, shiny, taut skin o Cool temperature

PAD (peripheral artery disease)

Severity of _____ - depends on: o Site o Extent of blockage o Amount of collateral circulation

PAD (peripheral artery disease)

The following are assessment findings of _____: o Reactive hyperemia of foot with dependent position o Rest Pain - aggravated with elevation - why? Why worse at night? o As PAD progresses, there is pain at rest - blood flow is insufficient to meet basic metabolic requirements of distal tissue o CO drops during sleep o The patient with rest pain, ulceration, or gangrene has critical limb ischemia

PAD (peripheral artery disease)

The following are assessment findings of _____: o Thin, shiny, and taut skin o Loss of hair on the lower legs o Diminished or absent pedal, popliteal, or femoral pulses o Pallor of foot with leg elevation o Reactive hyperemia of foot with dependent position o Rest Pain - aggravated with elevation - why? Why worse at night? o As _______ progresses, there is pain at rest - blood flow is insufficient to meet basic metabolic requirements of distal tissue o CO drops during sleep o The patient with rest pain, ulceration, or gangrene has critical limb ischemia

PAD (peripheral artery disease)

The following are complications of _______: • Atrophy of the skin and underlying muscles • Delayed wound healing and infections • Tissue necrosis • Arterial ulcers - more over bony prominences of feet, toes, lower legs • Gangrene - leading to amputations

PAD (peripheral artery disease)

The following are risk factors for ______: Similar risk factors to CAD: o Tobacco use o CKD, DM, HTN o Hypercholesterolemia o Family history o Elevated C-reactive protein o Sedentary lifestyle, stress o Obesity o Advanced Age o Stress o Hypertriglyceridemia o Hyper-homocysteinemia o Hyperuricemia • Homocysteine = non-protein amino acid - makes a person more prone to endothelial cell injury • Hyperuricemia - causes gout, kidney stones

PAD (peripheral artery disease)

The following is interprofessional care of _______: Drug Therapy: o Anti-platelet agents Critical to reduce the risk of CVD and death in _____ patients Do not want clots to form!! Makes platelets slippery so they do not clump together Oral antiplatelet therapy should include 75 to 325 mg/day of aspirin. Aspirin-tolerant patients may take 75 mg of clopidogrel daily Anticoagulants (warfarin) are NOT recommended for prevention of CVD events in ______ patients

PAD (peripheral artery disease)

The following is interprofessional care of _______: drug therapy: • Intermittent claudication treatment o Increased pain-free walking distance o Make blood vessels more flexible

PAD (peripheral artery disease)

The following is interprofessional care of _______: • Maintain B/P < 140/<90 o If DM or renal insufficiency, <130/<80 • Exercise o Promotes angiogenesis and collateral circulation o The more you move that muscle, the more likely to grow new blood vessels to supply oxygen

PAD (peripheral artery disease)

The following is interprofessional care of _______: • Reduce CVD Risk o DASH diet, weight loss - collaborate with RD o Smoking cessation • Manage diabetes o A1C <7%, or as low as attainable w/o hypoglycemia o Not all diabetes can get below 7% without having hypoglycemia • Aggressive treatment of hyperlipidemia o Major cause of PAD

PAD (peripheral artery disease)

• Thickening of the arterial wall • Progressive narrowing of arteries of upper and lower extremities • Incidence increases with age • Occurs much earlier in people with DM • Closely r/t other types of vascular disease • Prevalence is higher in ↓socioeconomic status, women, African Americans • Etiology and Pathophysiology: o Pathophysiology = Atherosclerosis o Gradual thickening of the intima and the media from deposits of cholesterol and lipids o The exact reasons this occurs are unknown o Inflammation and endothelial injury play a major role o Most commonly affected areas: Coronary, Carotid, Lower Extremities

PAD (peripheral artery disease)

The following are complications of ________: · Complications ↑ as disease progresses o Motor symptoms o Weakness o Akinesia o Neurologic problems o Neuropsychiatric problems

PD (Parkinson's disease)

The following are complications of ________: · Complications ↑ as disease progresses o Motor symptoms o Weakness o Akinesia o Neurologic problems o Neuropsychiatric problems · Dementia often results o Associated with ↑ mortality · Dysphagia à malnutrition or aspiration · General debilitation à pneumonia, UTIs, and skin breakdown · Orthostatic hypotension o ↑ Risk for falls and injuries · As the disease progresses, complications increase. · These include motor symptoms (e.g., dyskinesias [spontaneous, involuntary movements]), weakness, neurologic problems (e.g., dementia), and neuropsychiatric problems (e.g., depression, hallucinations, psychosis). · As _____ progresses, it often results in dementia, which is associated with an increase in mortality.

PD (Parkinson's disease)

The following are complications of ________: · Dementia often results o Associated with ↑ mortality · Dysphagia à malnutrition or aspiration

PD (Parkinson's disease)

The following are complications of ________: · General debilitation à pneumonia, UTIs, and skin breakdown · Orthostatic hypotension o ↑ Risk for falls and injuries · As the disease progresses, complications increase.

PD (Parkinson's disease)

The following are complications of ________: · These include motor symptoms (e.g., dyskinesias [spontaneous, involuntary movements]), weakness, neurologic problems (e.g., dementia), and neuropsychiatric problems (e.g., depression, hallucinations, psychosis). · As _____ progresses, it often results in dementia, which is associated with an increase in mortality.

PD (Parkinson's disease)

The following are diagnostic tests for _______: · Clinical diagnosis requires the presence of TRAP and asymmetric onset. (tremor, rigidity, akinesia, postural instability) · Confirmation of _____ is a positive response to antiparkinsonian drugs (levodopa or dopamine agonist).

PD (Parkinson's disease)

The following are diagnostic tests for _______: · No specific tests exist · Diagnosis based on history and clinical features o Requires presence of TRAP o Asymmetric onset o Confirmation is a positive response to antiparkinsonian drugs · Because no specific diagnostic test exists for _____, diagnosis is based on the patient's history and clinical features. · Clinical diagnosis requires the presence of TRAP and asymmetric onset. · Confirmation of _____ is a positive response to antiparkinsonian drugs (levodopa or dopamine agonist).

PD (Parkinson's disease)

The following are nursing diagnoses for a pt with ______: · Impaired physical mobility o Impaired physical mobility related to rigidity, bradykinesia, and akinesia · Imbalanced nutrition: less than body requirements o Imbalanced nutrition: less than body requirements related to inability to ingest food · Impaired swallowing o Impaired swallowing related to neuromuscular impairment (e.g., decreased or absent gag reflex) · Impaired verbal communication Impaired verbal communication related to dysarthria, tremor, and bradykinesia

PD (Parkinson's disease)

When talking about drug therapy of a pt with ______: · Aimed at correcting imbalances of neurotransmitters within the CNS · Drugs are either dopaminergic or anticholinergic in their effects. · Antiparkinsonian drugs either o Enhance or release supply of dopamine o Antagonize or block the effects of overactive cholinergic neurons in the striatum

PD (Parkinson's disease)

When talking about drug therapy of a pt with _______: · Antiviral agent - amantadine o ↑ Dopamine release; blocks reuptake · Anticholinergics o ↓ Activity of ACh · MAO-B inhibitors o ↑ Levels of dopamine o Prolong half-life of levodopa · Use of only one drug is preferred o Fewer side effects o Dosages are easier to adjust · Combination therapy is often required as disease progresses

PD (Parkinson's disease)

When talking about drug therapy of a pt with _______: · Excessive dopaminergic drugs can lead to paradoxic intoxication · Episodes of hypomobility o Often occur within 3-5 years o Off episodes o Combination carbidopa, levodopa, entacapone o Apomorphine · Needs to be taken with an antiemetic drug

PD (Parkinson's disease)

When talking about nursing management: nursing evaluation of a pt with ________: · Expected Outcomes o Perform physical exercise to deter muscle atrophy and joint contractures o Use assistive devices appropriately for ambulation and mobility o Maintain nutritional intake adequate for metabolic needs o Experience safe passage of fluids and/or solids from mouth to stomach o Use methods of communication that meet needs for interaction with others

PD (Parkinson's disease)

When talking about nursing management: nursing implementation of a pt with ______: · Focus teaching and nursing care o Maintenance of good health o Encouragement of independence o Avoidance of complications such as contractures and falls

PD (Parkinson's disease)

When talking about nursing management: nursing implementation of a pt with ______: · Manage sleep problems · Assist patients as they make adjustments to their lifestyle to accommodate symptoms · Caregivers may experience stress associated with disease progression (i.e., dementia)

PD (Parkinson's disease)

When talking about nursing management: nursing implementation of a pt with ______: · Problems secondary to bradykinesia can be alleviated by o Consciously thinking about stepping over a line on the floor o Lifting toes when stepping o One step back and . . .two steps forward · Get out of a chair by using arms and placing the back legs on small blocks

PD (Parkinson's disease)

When talking about nursing management: nursing implementation of a pt with ______: · Promote physical exercise and a well-balanced diet o Limit consequences from decreased mobility o Physical therapy o Occupational therapy

PD (Parkinson's disease)

When talking about nursing management: nursing implementation of a pt with ______: · Remove rugs and excess furniture · Simplify clothing from buttons and hooks · Use elevated toilet seats · Use an ottoman to elevate legs

PD (Parkinson's disease)

When talking about nursing management: nursing implementation of a pt with ______: · _______ is a chronic degenerative disorder with no acute exacerbations · Focus teaching and nursing care o Maintenance of good health o Encouragement of independence o Avoidance of complications such as contractures and falls · Promote physical exercise and a well-balanced diet o Limit consequences from decreased mobility o Physical therapy o Occupational therapy · Manage sleep problems · Assist patients as they make adjustments to their lifestyle to accommodate symptoms · Caregivers may experience stress associated with disease progression (i.e., dementia) · Problems secondary to bradykinesia can be alleviated by o Consciously thinking about stepping over a line on the floor o Lifting toes when stepping o One step back and . . .two steps forward · Get out of a chair by using arms and placing the back legs on small blocks · Remove rugs and excess furniture · Simplify clothing from buttons and hooks · Use elevated toilet seats · Use an ottoman to elevate legs

PD (Parkinson's disease)

When talking about nursing management: planning, goals for a pt with ______ includes: · Maximize neurologic function · Maintain independence in activities of daily living (ADLs) for as long as possible · Optimize psychosocial well-being · The overall goals are that the patient with ______ will (1) maximize neurologic function, (2) maintain independence in activities of daily living for as long as possible, and (3) optimize psychosocial well-being.

PD (Parkinson's disease)

When talking about nutritional therapy for a patient with ______: · Diet is of major importance to the patient with PD because malnutrition and constipation can be serious consequences of inadequate nutrition. · Patients who have dysphagia and bradykinesia need appetizing foods that are easily chewed and swallowed.

PD (Parkinson's disease)

When talking about nutritional therapy for a patient with ______: · Eating more numerous small meals is less exhausting than eating fewer large meals each day · Provide ample time to avoid frustration · Levodopa can be impaired by protein and vitamin B6 ingestion

PD (Parkinson's disease)

When talking about nutritional therapy for a patient with ______: · Malnutrition and constipation can be serious consequences · Patients with dysphagia and bradykinesia need food that is easily chewed and swallowed · Adequate fiber · Eating more numerous small meals is less exhausting than eating fewer large meals each day · Provide ample time to avoid frustration · Levodopa can be impaired by protein and vitamin B6 ingestion · Diet is of major importance to the patient with PD because malnutrition and constipation can be serious consequences of inadequate nutrition. · Patients who have dysphagia and bradykinesia need appetizing foods that are easily chewed and swallowed. · The diet should contain adequate fiber and fruit to avoid constipation. · Cut food into bite-sized pieces before it is served, and serve it on a warmed plate to preserve its appeal.

PD (Parkinson's disease)

When talking about nutritional therapy for a patient with ______: · The diet should contain adequate fiber and fruit to avoid constipation. · Cut food into bite-sized pieces before it is served, and serve it on a warmed plate to preserve its appeal.

PD (Parkinson's disease)

When talking about the etiology and pathophysiology of _______: · About 15% of patients with ______ have a positive family history for the disease (familial cases) that may be caused by mutations in specific genes. In other persons, risk for ______ may be increased by well water, pesticides, herbicides, industrial chemicals, and wood pulp mills. Rural residence is also considered a risk factor.

PD (Parkinson's disease)

When talking about the etiology and pathophysiology of _______: · Although _____ is not considered a hereditary condition, genetic risk factors should be evaluated for their interplay with environmental factors.

PD (Parkinson's disease)

When talking about the etiology and pathophysiology of _______: · Exact cause of ______ unknown o Possibly a result of a complex interplay between environmental factors and the person's genetic makeup § Family history in 15% of cases § Risk ↑ by well water, pesticides, herbicides, industrial chemicals, wood pulp mills, rural residence · Many forms of secondary/atypical parkinsonism exist o Exposure to chemicals o Drug-induced § Prescribed § Illicit o Others · Lack of dopamine (DA) o Degeneration of dopamine-producing neurons in substantia nigra of midbrain o Disrupts dopamine-acetylcholine balance in basal ganglia o Essential for normal functioning of extrapyramidal motor system · Although _____ is not considered a hereditary condition, genetic risk factors should be evaluated for their interplay with environmental factors. · About 15% of patients with ______ have a positive family history for the disease (familial cases) that may be caused by mutations in specific genes. In other persons, risk for ______ may be increased by well water, pesticides, herbicides, industrial chemicals, and wood pulp mills. Rural residence is also considered a risk factor.

PD (Parkinson's disease)

When talking about the etiology and pathophysiology of _______: · Lack of dopamine (DA) o Degeneration of dopamine-producing neurons in substantia nigra of midbrain o Disrupts dopamine-acetylcholine balance in basal ganglia o Essential for normal functioning of extrapyramidal motor system

PD (Parkinson's disease)

When talking about the etiology and pathophysiology of _______: · Many forms of secondary/atypical parkinsonism exist o Exposure to chemicals o Drug-induced § Prescribed § Illicit o Others

PD (Parkinson's disease)

With interprofessional care: surgical therapy for pts with ______: · DBS procedures reduce the increased neuronal activity produced by DA depletion. · It has been shown to improve motor function and reduce dyskinesia and medication usage. · DBS is most effective when candidates are carefully selected and screened.

PD (Parkinson's disease)

With interprofessional care: surgical therapy for pts with ______: · Surgical procedures fall into three categories: DBS, ablation, and transplantation of fetal neural tissue. · Surgical Therapy o Used in patients § Unresponsive to drug therapy § Have developed severe motor complications · DBS - Deep brain stimulation o Most common surgical treatment o Reversible and programmable o ↓ Increased neuronal activity produced by dopamine depletion § Improves motor function § Reduces dyskinesia and medications · Ablation - Destruction o Locate, target, destroy area of brain affected by _______ o Destroys tissue that produces abnormal chemical or electrical impulses leading to tremors or other symptoms · Transplantation o Transplantation of fetal neural tissue into the basal ganglia § Provides dopamine-producing cells in the brains of patients § Research and clinical trials are ongoing · The most common surgical treatment is DBS. · DBS is preferred to ablation procedures because it is reversible and programmable, and can be safely performed bilaterally. · DBS procedures reduce the increased neuronal activity produced by DA depletion. · It has been shown to improve motor function and reduce dyskinesia and medication usage. · DBS is most effective when candidates are carefully selected and screened.

PD (Parkinson's disease)

With interprofessional care: surgical therapy for pts with ______: · The most common surgical treatment is DBS. · DBS is preferred to ablation procedures because it is reversible and programmable, and can be safely performed bilaterally.

PD (Parkinson's disease)

· Affects up to 1 million Americans · Incidence ↑ with age o 4% diagnosed before age 50

PD (Parkinson's disease)

· Chronic, progressive neurodegenerative disorder characterized by o Bradykinesia: slowness in the intitiaton and execution of movement o Rigidity: increased muscle tone o Tremor at rest o Gait disturbance · Affects up to 1 million Americans · Incidence ↑ with age o 4% diagnosed before age 50 · More common in men by a ratio of 3:2 · It is the most common form of parkinsonism (a syndrome characterized by similar symptoms)

PD (Parkinson's disease)

· More common in men by a ratio of 3:2 · It is the most common form of parkinsonism (a syndrome characterized by similar symptoms)

PD (Parkinson's disease)

Surgical treatment for _____ is: · Partial gastrectomy o - Billroth 1 or 2 o Remove portion of stomach wehre the ulcer is o Do NOT need to memorize the difference between the 2; just know that they are partial gastrectomy procedures.

PUD

Surgical treatment for _____ is: · Recommended if: o unresponsive to medical treatment o concern for gastric cancer o drug-induced ulcers (if treatment cannot be discontinued)

PUD

Surgical treatment for _____ is: · Recommended if: o unresponsive to medical treatment o concern for gastric cancer o drug-induced ulcers (if treatment cannot be discontinued) · Partial gastrectomy o - Billroth 1 or 2 o Remove portion of stomach wehre the ulcer is o Do NOT need to memorize the difference between the 2; just know that they are partial gastrectomy procedures. · Vagotomy with pyloroplasty o Vagotomy is where they snip the vagus nerve which decreases gastric stimnulation o Open up the pyloris so stomach contents can easily drain · Pyloroplasty with partial gastrectomy

PUD

Surgical treatment for _____ is: · Vagotomy with pyloroplasty o Vagotomy is where they snip the vagus nerve which decreases gastric stimnulation o Open up the pyloris so stomach contents can easily drain · Pyloroplasty with partial gastrectomy

PUD

The following is how we diagnose _____ in a patient: · Barium contrast studies o Gastric outlet obstruction (GOO) § A complication talked about later o Can see how the barium is moving through the stomach and if it does not empty then they have GOO

PUD

The following is how we diagnose _____ in a patient: · Endoscopy o Gastric and duodenal with tissue testing/biopsy (gold standard) for H. Pylori and to rule out stomach cancer o Take biopsy (gold standard for diagnosing a peptic ulcer) · Non-invasive tests for H. Pylori o Serum or whole blood antibody - IgG, stool antigen, urea breath test o Draw blood o Blow into tube and measure the amount of urea which is a breakdown product of H. pylori (urea breath test) · Barium contrast studies o Gastric outlet obstruction (GOO) § A complication talked about later o Can see how the barium is moving through the stomach and if it does not empty then they have GOO · Fasting serum gastrin level o Zollinger-Ellison syndrome · CBC (bleeding), liver enzymes, serum amylase o Liver disease can increase bleeding risk · Stool exam for occult blood · H. Pylori breath test o If it turns pink, that means there is urea meaning the presence of H.pylori

PUD

The following is how we diagnose _____ in a patient: · Fasting serum gastrin level o Zollinger-Ellison syndrome · CBC (bleeding), liver enzymes, serum amylase o Liver disease can increase bleeding risk

PUD

The following is how we diagnose _____ in a patient: · Stool exam for occult blood · H. Pylori breath test o If it turns pink, that means there is urea meaning the presence of H.pylori

PUD

The following is interprofessional care of a patient with ______: · Diagnosis - determine cause/contributing factor(s) · Generally can be treated as out-patient · Evaluate with endoscopy up to 6 months later · Pain disappears after 3-6 days · Conservative management: rest, smoking and alcohol cessation, stress management · Discontinue ulcerogenic drugs · Healing can take 3-9 weeks

PUD

The following is interprofessional care of a patient with ______: · Pain disappears after 3-6 days · Conservative management: rest, smoking and alcohol cessation, stress management · Discontinue ulcerogenic drugs · Healing can take 3-9 weeks

PUD

The following is patient teaching for _____: · Drug treatment o Give other drugs at least 1-2 hours (sucralfate, H2RBs, antacids) · Dietary modifications as needed o (especially if eating very spicy foods that can irritate stomach)

PUD

The following is patient teaching for _____: · Quit smoking, excess alcohol and caffeine · Stress management o May refer to counselor · Avoid any OTC unless approved by MD

PUD

The following is patient teaching for _____: · Report promptly ↑ nausea and vomiting, ↑ epigastric pain, bloody emesis or tarry stools · Drug treatment o Give other drugs at least 1-2 hours (sucralfate, H2RBs, antacids) · Dietary modifications as needed o (especially if eating very spicy foods that can irritate stomach) · Quit smoking, excess alcohol and caffeine · Stress management o May refer to counselor · Avoid any OTC unless approved by MD

PUD

The following is the etiology of the digestive disorder _______: · Gastric ulcers - less common · Duodenal ulcers - 80% of ulcerations o Lacks protective mechanisms that stomach lining has o The duodenum has less of that protective lining like the stomach has

PUD

The following is the etiology of the digestive disorder _______: · Zollinger-Ellison Syndrome o Rare, severe peptic ulceration and excessive secretion of HCl o Causes severe PUD related to increased secretion of HCL in the stomach o Genetic consition · Stress-related mucosal disease (SRMD) o Stress ulcers from either physical or psychological stress

PUD

The following is the etiology of the digestive disorder _______: · H. Pylori bacteria & Urease enzyme o This is what causes the ulcer · makes gastric mucosa more vulnerable · NSAIDs, ulcerogenic drugs o Corticosteroids, NSAIDS, aspirin · Lifestyle Factors - smoking, diet, alcohol, coffee, distress, stress, depression o Foods that are very spicy o Stress and distress: emotional as well as physical stress § Major injury or major surgery o Depression is a psychological stressful situation · Gastric ulcers - less common · Duodenal ulcers - 80% of ulcerations o Lacks protective mechanisms that stomach lining has o The duodenum has less of that protective lining like the stomach has · Zollinger-Ellison Syndrome o Rare, severe peptic ulceration and excessive secretion of HCl o Causes severe PUD related to increased secretion of HCL in the stomach o Genetic consition · Stress-related mucosal disease (SRMD) o Stress ulcers from either physical or psychological stress

PUD

The following is the etiology of the digestive disorder _______: · Lifestyle Factors - smoking, diet, alcohol, coffee, distress, stress, depression o Foods that are very spicy o Stress and distress: emotional as well as physical stress § Major injury or major surgery o Depression is a psychological stressful situation

PUD

What digestive disorder is described below: · Erosion of the GI mucosa o resulting from the digestive action of HCl acid and pepsin · Lower esophagus, stomach, duodenum o margin of a surgical gastrojejunal anastomosis (i.e. Roux-en-Y gastric bypass) · Acute or chronic · Gastric or duodenal · Geriatric considerations - o treatment is the same as younger persons; may manifest with frank bleeding first instead of pain o bleeding may occur before the older adult feels pain

PUD

When talking about the pathophysiology of ________: · Various agents damage the mucosal barrier · Back diffusion of HCL into gastric mucosa results in cellular destruction and inflammation · Histamine from damaged mucosa causes vasodilation, increased capillary permeability, and more secretion of acid and pepsin

PUD

PAD or PVD? o Present pulse, with edema o More normal capillary refill o Edema o Hair present or absent

PVD (peripheral venous disease)

PAD or PVD? o Present pulse, with edema o More normal capillary refill o Edema o Hair present or absent o Wounds near medial malleolus o Moderate to large amount drainage o Dull ache in calf or thigh o Ulcer often painful o Varicose veins o Thick, hardened, indurated skin o Warmth to touch

PVD (peripheral venous disease)

PAD or PVD? o Varicose veins o Thick, hardened, indurated skin o Warmth to touch

PVD (peripheral venous disease)

PAD or PVD? o Wounds near medial malleolus o Moderate to large amount drainage o Dull ache in calf or thigh o Ulcer often painful

PVD (peripheral venous disease)

The following are clinical manifestations of ______: · Joint and muscle pain - often first sign of ______ o Often mistaken for other joint diseases such as arthritis · Joints may be INFLAMED and WARM to touch o BILATERAL JOINT PAIN: wrists, hands, fingers, knees o Morning stiffness o NO PERMANENT JOINT DAMAGE!!!!!!!!!!! § When there is remission, the joints are normal and there is no permanent joint damage Low-grade fever · Light sensitivity · FATIGUE o Major defining factors or lupus · Infection (leukopenia) o ______ effects the hemotologic system · SKIN RASH over areas exposed to sunlight (nose and cheeks) o Butterfly rash: the body of the butterfly is the nose and it spreads across the cheeks · DISCOID LESIONS- coin-shaped · Oral and nasopharyngeal ULCERS o Painless ulcers · Transient ALOPECIA o When having a flare, they may lose patches of hair but it will grow back once the flare is gone · CARDIOPULMONARY - pleuresy, arrhythmias, Reynaud's, pericarditis, HTN, hyper-cholesterolemia, clots (from antiphospholipid antibody syndrome) · Renal - LUPUS NEPHRITIS

SLE

The following are clinical manifestations of ______: · SKIN RASH over areas exposed to sunlight (nose and cheeks) o Butterfly rash: the body of the butterfly is the nose and it spreads across the cheeks · DISCOID LESIONS- coin-shaped · Oral and nasopharyngeal ULCERS o Painless ulcers

SLE

The following are clinical manifestations of ______: · Transient ALOPECIA o When having a flare, they may lose patches of hair but it will grow back once the flare is gone · CARDIOPULMONARY - pleuresy, arrhythmias, Reynaud's, pericarditis, HTN, hyper-cholesterolemia, clots (from antiphospholipid antibody syndrome) · Renal - LUPUS NEPHRITIS

SLE

The following are nursing diagnoses of ______: · Fatigue (chronic inflammation, altered immunity) · Acute pain (inflammatory processes)

SLE

The following are nursing diagnoses of ______: · Fatigue (chronic inflammation, altered immunity) · Acute pain (inflammatory processes) · Risk for infection (leukopenia, immuno-suppressives) o **Should ALWAYS be included on a caremap ! · Impaired skin integrity (skin rash, photosensitivity, patchy alopecia) · Risk for injury (seizures, stroke) · R.C. Bleeding (thrombocytopenia) o High risk for thrombus formation but also high risk for bleeding from different things · Alteration in body image (skin changes, patchy alopecia)

SLE

The following are nursing diagnoses of ______: · R.C. Bleeding (thrombocytopenia) o High risk for thrombus formation but also high risk for bleeding from different things · Alteration in body image (skin changes, patchy alopecia)

SLE

The following are nursing diagnoses of ______: · Risk for infection (leukopenia, immuno-suppressives) o **Should ALWAYS be included on a caremap ! · Impaired skin integrity (skin rash, photosensitivity, patchy alopecia) · Risk for injury (seizures, stroke)

SLE

The following are nursing interventions for ______: § Hand washing, hand hygiene for everyone that enters the room (education for family members!) o Energy conservation measures o Emotional support

SLE

The following are nursing interventions for ______: o Monitor and manage pain o Monitor side-effects of meds - Teaching § Teach patient about side effects of medications especially increased risk for infection!****** o Assist with ADLs as needed

SLE

The following are nursing interventions for ______: o Monitor skin, respiratory, GI, musculoskeletal changes o Monitor and manage pain o Monitor side-effects of meds - Teaching § Teach patient about side effects of medications especially increased risk for infection!****** o Assist with ADLs as needed o Prevent infection § Hand washing, hand hygiene for everyone that enters the room (education for family members!) o Energy conservation measures o Emotional support

SLE

The following are reproductive concerns with ______: · Pregnancy class of medications o Are the medications safe for the fetus? · Pregnancy complications o Spontaneous complications, stillbirth, intrauterine growth retardation · Systemic complications o Renal, cardiovascular, pulmonary, CNS · Post-partum flares · Pregnancy should be planned! o PRECONCEPTION COUNSELING § Need to be told to NOT get accidentally pregnant and should take steps to get pregnant with health care provider ! § Very very very important!!

SLE

The following are skin lesions associated with _____: · Butterfly rash o The body of the butterfly is on the nose and then spreads over the cheeks · Discoid erythema o Looks like someone got hurt by hot coins · Skin rash from sun exposure areas o Wearing non protective clothing and develop rash · Purple rash on various parts of the body, including the face, neck, and arms. Some people also develop mouth sores · Patches of hair may fall out or become thinner. After flare-up, hair may grow back evenly. · Raynaud's Symptoms o Fingertips and toes look blue or white from no circulation

SLE

The following are skin lesions associated with _____: · Patches of hair may fall out or become thinner. After flare-up, hair may grow back evenly. · Raynaud's Symptoms o Fingertips and toes look blue or white from no circulation

SLE

The following are skin lesions associated with _____: · Skin rash from sun exposure areas o Wearing non protective clothing and develop rash · Purple rash on various parts of the body, including the face, neck, and arms. Some people also develop mouth sores

SLE

The following are the overall goals of ______: · Overall goals: o Pain management o Adhere to the therapeutic regimen to achieve symptom management o Demonstrate awareness of and avoid activities that worsen the disease § ID triggers and avoid them o Maintain optimal role function and positive self-image

SLE

The following is how ______ is diagnosed: A diagnosis of _______ is made if 4 or more of the criteria below are present either serially or simultaneously******* o Butterfly rash o Discoid rash o Photosensitivity o Oral ulcers o Nonerosive arthritis (2 or more joints) o Pleuritis or pericarditis o Renal involvement o Neurologic involvement o Hematologic disorder o Immunologic o Antinuclear antibody

SLE

The following is how ______ is diagnosed: · History and physical o COMPLETE assessment of each system · Specific test: ↑anti-Smith anti-nuclear antibody***** o Positive in most cases of Lupus but this by itself does not diagnose Lupus. · Anti-DNA antibodies · ↑ ESR, ↑CRP - not diagnostic, but used to monitor disease activity and effectiveness of treatment o Signs of systemic inflammation o Not diagnostic of disease but use these numbers to monitor progress of disease · ↓ Renal function tests · X-ray of affected joints (similar to arthritis), chest x-ray, echocardiography, CT, MRI o Inflammation in the joints o Chest x-ray may should a pleural effusion o Echocardiography may show pericarditis · A diagnosis of _______ is made if 4 or more of the criteria below are present either serially or simultaneously******* o Butterfly rash o Discoid rash o Photosensitivity o Oral ulcers o Nonerosive arthritis (2 or more joints) o Pleuritis or pericarditis o Renal involvement o Neurologic involvement o Hematologic disorder o Immunologic o Antinuclear antibody

SLE

The following is how ______ is diagnosed: · Specific test: ↑anti-Smith anti-nuclear antibody***** o Positive in most cases of Lupus but this by itself does not diagnose _______.

SLE

The following is how ______ is diagnosed: · X-ray of affected joints (similar to arthritis), chest x-ray, echocardiography, CT, MRI o Inflammation in the joints o Chest x-ray may should a pleural effusion o Echocardiography may show pericarditis

SLE

The following is how ______ is diagnosed: · ↑ ESR, ↑CRP - not diagnostic, but used to monitor disease activity and effectiveness of treatment o Signs of systemic inflammation o Not diagnostic of disease but use these numbers to monitor progress of disease · ↓ Renal function tests

SLE

The following is nursing care/teaching of _____: · Prevention of Flare Ups: o Cover up when in the sun o No smoking § Increases flares! o Regular exercise § Not high impact; walking, swimming, yoga o Improve stress management skills § Stress is a known trigger for flares o Get plenty of rest - may need up to 12 hours of night sleep § Higher risk for flares and fatigue will be very bad EVERYTHING IS IMPORTANT ON THIS CARD!!!

SLE

The following is the pathophysiology of _______: · Autoimmune reaction - various antibodies are produced · Circulating immune complexes deposited at BASEMENT MEMBRANES OF CAPILLARIES o Kidneys, heart, skin, brain and joints o Can affect any body system § Lungs, GI tract § ANY place with capillaries! · Complement system is activated and systemic INFLAMMATION occurs

SLE

When talking about nursing evaluation of ______: · Expected Outcomes - the patient will: o Use energy-conserving strategies o Adapt lifestyle o Maintain skin integrity o Prevent diseases flares

SLE

When talking about the etiology of ______: · Essentially unknown o Genes, environment, hormones, immune system o Ultraviolet light exposure, stress, chemicals, toxins o Infectious agents (viruses) may serve to trigger immune hyperactivity o May be triggered by certain drugs · Women are 6-10 times more likely to develop _____ than men o When men gets this, the diagnosis of ______ is delayed since men rarely get it

SLE

With drug therapy of _______: · Antimalarial drugs o Hydroxychloroquine—fatigue, skin, and joint problems · Corticosteroids o Flares—tapering doses o If withdrawn abruptly, they will not get enough endogenous corticosteroids

SLE

With drug therapy of _______: · Immunosuppressive drugs o INFECTION RISK!! o Used long term to prevent flares but if someone is taking a corticosteroid or steroid-sparing drugs, these increase the risk for infection! o Infection prevention Is KEY in lupus!

SLE

With drug therapy of _______: · NSAIDs o 1st line drug o Treats pain and inflammation · Steroid-sparing drugs o Methotrexate: has an immunosuppressive function and can be an alternate to steroids. It helps to decrease · Antimalarial drugs o Hydroxychloroquine—fatigue, skin, and joint problems · Corticosteroids o Flares—tapering doses o If withdrawn abruptly, they will not get enough endogenous corticosteroids · Immunosuppressive drugs o INFECTION RISK!! o Used long term to prevent flares but if someone is taking a corticosteroid or steroid-sparing drugs, these increase the risk for infection! o Infection prevention Is KEY in lupus!

SLE

With interprofessional care: treatment goals of ______: · Decrease ESR and CRP levels · Decrease exacerbation episodes, identify triggers (sun exposure, excess fatigue, emotional stress, infection, surgery) o We need to help the patient identigy triggers. They know that if they eat something or do something, they will have an attack.

SLE

With interprofessional care: treatment goals of ______: · Pain management o _______ is a painful disease. All of the inflammation contributes to the pain.

SLE

With interprofessional care: treatment goals of ______: · Prevent infections · Maintain optimal functioning and self-image o Self-image is very important. We do not want patient to become isolated and stay in their house all the time. We want to help them to still be out there.

SLE

· Chronic, multisystem, inflammatory, auto-immune disease · Multifactorial origin - genetic, environmental, hormonal, and immunologic functions · Skin, joints and serous membranes (pleura, pericardium), renal, hematologic and neurological · Unpredictable course with periods of remission and exacerbation

SLE

what compensatory mechanism of HF is described below: —(epinephrine, norepinephrine) o Increase vasoconstriction, HR, contractility o Trying to get CO up where it needs to be

SNS activation

resistance is the force opposing the movement of blood within the blood vessels. The radius of the small arteries and arterioles is the principal factor determining _____. As arteries narrow, resistance to blood flow increases. As arteries dilate, resistance to blood flow decreases. A small change in the radius of the arterioles creates a major change in the ______. If ______ is increased and CO remains constant or increases, arterial BP will increase.

SVR (systemic vascular resistance)

the force opposing blood flow through vessels) What else exerts a pull to keep blood inside vessels? The radius of the small arteries and arterioles is the principal factor in determining SVR As arteries narrow, resistance to blood flow increases As arteries dilate, resistance to blood flow decreases

SVR (systemic vascular resistance)

T or F. In MS, initially the myelin sheath is damaged, but not the nerve fiber; transmission is slowed down. The myelin can repair itself and there is remission. But this happens over and over and gliosis occurs and there is worsening of symptoms. When damage is done to the underlying axon, then permanent damage occurs

T or F. In addition... Development of classic symptoms or hyperglycemic crisis and random glucose > 200 = diabetes o Stick finger

T or F. In the presence of infection, the WBC will increase (leukocytosis)

T or F. Increase in the number of bands (immature neutrophils) indicates a high demand for WBCs to fight infection.

T or F. Increased cerebral capillary permeability - leads to cerebral edema

T or F. Infection/inflammation increases vessel dilatation and capillary permeability

T or F. Long-term management of patients who have had an episode of bleeding includes nonselective β-blockers, repeated band ligation of the varices, and portosystemic shunts in patients who develop recurrent bleeding.

T or F. Pre and post-procedure nursing care is the same as for a diagnostic angiography. Antiplatelet agents are needed postprocedure to reduce the risk of restenosis. Long term, low dose aspirin therapy or clopidogrel is recommended.

T or F. Report weight gain >2lb in 1 day, 3 lb over 2 days, or 3-5 lb over 1 week (fluid overload) o Signs of fluid overload **very important!!

T or F. Starling's law of the heart states that the greater the resting myocardial fiber length, or stretch, the greater its force of contraction. Any increase in these, will be followed by increase in the workload of the heart and increased oxygen demand.

T or F. Take every caution to try to prevent infection in these patients due to Neutropenia --Hand Hygiene for patient, family, and health care providers is important.

T or F. The drugs currently available for treating hypertension have two main actions: (1) decrease the volume of circulating blood and (2) reduce SVR.

T or F. The important distinction between promotion and initiation is that the activities of promoters are reversible. This plays a large role in cancer prevention. Reducing or avoiding cancer-promoting factors reduce the risk of developing cancer. Promoting factor examples are: cigarette smoke, dietary fat, and excessive alcohol intake.

T or F. The most common surgical treatment for a pt with PD is deep brain stimulation (DBS). o Most common surgical treatment o Reversible and programmable o ↓ Increased neuronal activity produced by dopamine depletion § Improves motor function § Reduces dyskinesia and medications

T or F. The overall goals are that the patient with PD will (1) maximize neurologic function, (2) maintain independence in activities of daily living for as long as possible, and (3) optimize psychosocial well-being.

T or F. There is NOT FDA APPROVED DIET. THEY SHOULD EAT LIKE THEY NORMALLY DO AND SHOULD NOT CHANGE THEIR DIET. THEY SHOULD EAT HEALTHY THO AND NOT EATING HONEYBUNS ALL THE TIME.

T or F. When talking about nursing interventions for a pt with MS, TEACHING is a huge thing to do because we want to teach the pt the PREVENTION OF INFECTION which is super important!!

T or F. When using the RICE method, Assess distal pulses and capillary refill before and after application of compression and immobilization.

T or F. With PD, 90% experience hypokinetic dysarthria (speech abnormalities)

T or F. With PD, there is no cure for PD. Interprofessional care is aimed at symptom management. **PD= parkinson's disease

T or F. With SLE, Pregnancy should be planned! o PRECONCEPTION COUNSELING § Need to be told to NOT get accidentally pregnant and should take steps to get pregnant with health care provider ! § Very very very important!!

T or F. With exercise therapy, Type I DM- if ketones present in urine prior to exercise, wait until no ketones present - can exacerbate ketosis

T or F. With interprofessional care of other COPD treatments, a high O2 can affect COPD patient's "drive" to breathe: ALWAYS USE THE PARAMETERS PRESCRIBED TO PATIENT WHEN TITRATING OXYGEN TO DESIRABLE O2 SAT LEVEL. • For example: if patient's prescriber wants their O2 sat to be 90%, do not titrate the prescribed regimen to get their O2 sat to 92%

T or F. With the diagnosis of MS, to be diagnosed with MS the pt must have a CT or MRI (mainly MRI) of the brain looking for sclerotic plaques in the brain. **will look like white patches on MRI

T or F. With the pathophysiology of lung cancer, it takes 8 to 10 years for a tumor to reach 1 cm which is the smallest lesion detectable on x-ray.

T or F. With the stages of CKD, The higher the stage goes, the less likely we are to stop the progression of the diseasefe. If patient gets to stage 3b, we call that the slippery slope. If we get there they are on the slippery slope to stage 4 or 5 and there is not a lot we can do to stop the progression.

T or F. Women are 6-10 times more likely to develop SLE than men

What part of the EKG is described below: repolarization of ventricles

T wave

What classification of the TNM Classification system for cancer is described below: --no primary tumor --No evidence of Primary Tumor **The T refers to the size and extent of the main tumor. The main tumor is usually called the primary tumor.

What classification of the TNM Classification system for cancer is described below: --Ascending Degrees of Increase in Tumor Size and Involvement **The T refers to the size and extent of the main tumor. The main tumor is usually called the primary tumor.

T1-4

What anticoagulant medication to treat venous thrombosis is described below: Warfarin (Coumadin) Route: PO Take a careful history before starting Warfarin. Do not give antiplatelets or NSAIDs with Warfarin since these drugs increase bleeding risk. Many other drugs, vitamins, minerals, and dietary and herbal supplements also interact with Warfarin. A diet that frequently varies in vitamin K intake can make it hard to achieve and maintain a target INR level

Vitamin K antagonists

__________ acts on the heat-regulating center in the hypothalamus. It inhibits synthesis of PGs which lowers temperature by action on heat-regulating center in hypothalamus.

acetaminophen

Acute or Chronic? --Rapid onset -- Short duration (don't last more than a couple of weeks)

acute

Acute or Chronic? o Complications infrequent o Return to previous level of functioning

acute

Acute or Chronic? o Rapid onset o Short duration (don't last more than a couple of weeks) o Self-limiting (go away without treatment over time) o Responsive to treatment (get an infection, take antibiotic, and it goes away) o Complications infrequent o Return to previous level of functioning

acute

Acute or Chronic? o Self-limiting (go away without treatment over time)

acute

what acute arterial ischemic disorder is described below: o Sudden interruption of arterial flow o 6Ps - pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia o Requires thrombus removal

acute arterial ischemia

What are the 3 acute arterial ischemic disorders?

acute arterial ischemia, Buerger's disease, and Raynaud's phenomenon

Pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia are the 6 classic clinical manifestations of ?

acute arterial ischemia/thrombotic arterial occulsion

With interprofessional care of the complication ____ ____ (complication of cirrhosis): · Fresh frozen plasma · Packed RBCs · Vitamin K · Proton pump inhibitors · Lactulose and rifaximin · Antibiotics · Supportive measures during an acute variceal bleed include: o Administration of fresh frozen plasma and packed RBCs o Vitamin K (AquaMEPHYTON) o Proton pump inhibitors (e.g., pantoprazole [Protonix]) o Lactulose (Cephulac) and rifaximin (Xifaxan) administration may be started to prevent hepatic encephalopathy from breakdown of blood and the release of ammonia in the intestine. These help to remove the excess ammonia which is a breakdown product of blood. o Antibiotics are given to prevent bacterial infection.

acute bleed

With interprofessional care of the complication ____ ____ (complication of cirrhosis): · Supportive measures during an acute variceal bleed include: o Administration of fresh frozen plasma and packed RBCs o Vitamin K (AquaMEPHYTON) o Proton pump inhibitors (e.g., pantoprazole [Protonix]) o Lactulose (Cephulac) and rifaximin (Xifaxan) administration may be started to prevent hepatic encephalopathy from breakdown of blood and the release of ammonia in the intestine. These help to remove the excess ammonia which is a breakdown product of blood. o Antibiotics are given to prevent bacterial infection.

acute bleed

With nursing management of cirrhosis (_____ ______): o Assess § Assess patient's response to altered body image § Assess the patient's response to altered body image resulting from jaundice, spider angiomas, palmar erythema, ascites, and gynecomastia. The patient may experience a great deal of anxiety and embarrassment about these changes. Explain these phenomena, and be a supportive listener. Provide nursing care with concern and encouragement to help the patient maintain his or her self-esteem.

acute care

With nursing management of cirrhosis (_____ ______): o Observe § Observe for bleeding disorders; Varices § Observe for signs of fluid and electrolyte imbalance, especially hypokalemia. Hypokalemia may be manifested by cardiac dysrhythmias, hypotension, tachycardia, and generalized muscle weakness. Water excess (hyponatremia) is manifested by muscle cramping, weakness, lethargy, and confusion. § Observe for and provide nursing care for any hematologic problems. These include bleeding tendencies, anemia, and increased susceptibility to infection.

acute care

With nursing management of cirrhosis (_____ ______): · Abdominal girth measurement o The abdomen should be marked with a permanent marker so that girth is measured at the same location each time. · Relief of dyspnea o Semi- or high Fowler's position o Dyspnea is a frequent problem for the patient with severe ascites and can lead to pleural effusions. A semi-Fowler's or high Fowler's position allows for maximal respiratory efficiency. Use pillows to support the arms and chest as they will increase the patient's comfort and ability to breathe.

acute care

With nursing management of cirrhosis (_____ ______): · Elevate lower extremities/scrotum o The lower extremities may be elevated. If scrotal edema is present, a scrotal support provides some comfort. · Monitor o Monitor for fluid and electrolytes § Hypokalemia § Water excess (hyponatremia) § When the patient is taking diuretics, monitor the serum levels of sodium, potassium, chloride, and bicarbonate. o Monitor renal function (blood urea nitrogen [BUN], serum creatinine) routinely and with any change in the diuretic dosage. o Observe § Observe for bleeding disorders; Varices § Observe for signs of fluid and electrolyte imbalance, especially hypokalemia. Hypokalemia may be manifested by cardiac dysrhythmias, hypotension, tachycardia, and generalized muscle weakness. Water excess (hyponatremia) is manifested by muscle cramping, weakness, lethargy, and confusion. § Observe for and provide nursing care for any hematologic problems. These include bleeding tendencies, anemia, and increased susceptibility to infection. o Assess § Assess patient's response to altered body image § Assess the patient's response to altered body image resulting from jaundice, spider angiomas, palmar erythema, ascites, and gynecomastia. The patient may experience a great deal of anxiety and embarrassment about these changes. Explain these phenomena, and be a supportive listener. Provide nursing care with concern and encouragement to help the patient maintain his or her self-esteem.

acute care

With nursing management of cirrhosis (_____ ______): · Measures to relieve pruritus o Cholestyramine or hydroxyzine § Cholestyramine (Questran) or hydroxyzine (Atarax) may be ordered to help relieve the pruritus. o Baking soda or Alpha Keri baths § Measures to help alleviate pruritus include baking soda or moisturizing bath oils (Alpha Keri) baths, lotions containing calamine, antihistamines, soft or old linen, and control of the temperature (not too hot and not too cold). o Lotions, soft linen o Temperature control o Short nails; rub with knuckles § Keep the patient's nails short and clean. Teach patients to rub with their knuckles rather than scratch with their nails when they cannot resist scratching.

acute care

With nursing management of cirrhosis (_____ ______): · Monitor o Monitor for fluid and electrolytes § Hypokalemia § Water excess (hyponatremia) § When the patient is taking diuretics, monitor the serum levels of sodium, potassium, chloride, and bicarbonate. o Monitor renal function (blood urea nitrogen [BUN], serum creatinine) routinely and with any change in the diuretic dosage.

acute care

With nursing management of cirrhosis (_____ ______): · Monitor color of urine and stools o Note the color of the urine and stools and assess for movement/normalization of color. When jaundice is present, the urine is often dark brown and the stool is gray or tan. · Accurate I/O o Accurate calculation and recording of intake and output, daily weights, and measurements of extremities and abdominal girth help in the ongoing assessment of the location and extent of the edema · Daily weight o Edema and ascites are frequent manifestations of cirrhosis and necessitate nursing assessments and interventions. . · Extremities measurement

acute care

With nursing management of cirrhosis (_____ ______): · ROM exercises o The patient will tend to avoid moving because of the abdominal discomfort and dyspnea. Range-of-motion exercises are helpful. · Coughing/deep breathing exercises o Implement measures such as coughing and deep breathing to prevent respiratory problems.

acute care

With nursing management of cirrhosis (_____ ______): · Rest needs o Prevent complications o Modify schedule · Nutritional needs o Oral hygiene o Between-meal nourishment o Food preferences o Explanation of dietary restrictions

acute care

With nursing management of cirrhosis (_____ ______): · Skin care o Special mattress o Turning schedule, at least every 2 hours o Meticulous skin care is essential because the edematous tissues are subject to breakdown. Use an alternating-air pressure mattress or other special mattress. A turning schedule (minimum of every 2 hours) must be adhered to rigidly. Support the abdomen with pillows. If the abdomen is taut, cleanse it gently.

acute care

Under interprofessional care: COPD complications, what COPD complication is described below: o As severity of COPD increases, exacerbations are associated with poorer outcomes o Treatment may be at home or acute care depending on severity (central cyanosis, use of accessary muscles, edema, the presence of co-morbid conditions) o SABA, oral systemic corticosteroids, antibiotics if caused by infection, oxygen, CPAP, BiPap

acute exacerbations

The following is treatment for _______ ________: • Immediate IV hydration 0.9%NS or 0.45 NS o Switch to 5% Glucose when blood glucose ↓250 o Frequent CBGs, electrolytes, ABGs including pH, osmolarity • IV regular insulin; may need to add K o Monitor V/S, cardiac status o Accurate I&O

acute hyperglycemia

• Healing occurs in 2 to 3 weeks o usually no residual damage • Neutrophils are predominant WBC type at site of inflammation

acute inflammation

Interprofessional care of ____ ____ ____ includes: • Determine/treat underlying cause o Enteral and parenteral nutrition o Restrict K+, Na, and phosphate o Dialysis/renal replacement therapy

acute kidney injury (AKI)

Interprofessional care of ____ ____ ____ includes: • Nursing Management o VS, I&O, daily weight o Patient appearance: edema, neck vein distension, bruising o Mental status, LOC o Patient education

acute kidney injury (AKI)

Interprofessional care of ____ ____ ____ includes: • Nutritional therapy o Enough nutrition but controlling sodium, potassium that is putting stress on kidneys • Restrict fluids o Do not want to overwork the kidneys • Adequate protein • Nursing Management o VS, I&O, daily weight o Patient appearance: edema, neck vein distension, bruising o Mental status, LOC o Patient education • Determine/treat underlying cause o Enteral and parenteral nutrition o Restrict K+, Na, and phosphate o Dialysis/renal replacement therapy

acute kidney injury (AKI)

____ ____ _____: • Can lead to CKD if not reversed quickly • Creatinine - byproduct of normal muscle breakdown r/t metabolism, is constant if muscle mass is constant, excreted by kidneys, o Values: 0.6-1.3 mg/L • Blood Urea Nitrogen (BUN)= 6-20 mg/dL

acute kidney injury (AKI)

____ _____ ____ is: • Rapid loss of kidney function • Range from minimal impairment to severe/ azotemia o accumulation of nitrogenous waste products urea nitrogen and creatinine in the blood • Can develop in hours-days • BUN, K+, Creatinine ↑ with or without ↓in UOP • 3 types of AKI: o Pre-renal, intrarenal, post-renal o pre or post renal can develop into intrarenal • 3 distinct phases: o Oliguric (< 400 ml/day), Diuretic (make a lot more urine than normal), Recovery (everything goes back to normal) • Can lead to CKD if not reversed quickly • Creatinine - byproduct of normal muscle breakdown r/t metabolism, is constant if muscle mass is constant, excreted by kidneys, o Values: 0.6-1.3 mg/L • Blood Urea Nitrogen (BUN)= 6-20 mg/dL

acute kidney injury (AKI)

• 3 types of AKI: o Pre-renal, intrarenal, post-renal o pre or post renal can develop into intrarenal • 3 distinct phases: o Oliguric (< 400 ml/day), Diuretic (make a lot more urine than normal), Recovery (everything goes back to normal)

acute kidney injury (AKI)

The following is talking about complications of chronic hepatitis-- ____ ____ _____: · Fulminant hepatic failure- o Encephalopathy o Gastrointestinal bleeding o Disseminated intravascular coagulation · Liver transplant - usually the cure

acute liver failure

What complication of cirrhosis is described below: · Usually due to drug/alcohol combination · Mental status changes may be the first sign, due to encephalopathy or cerebral edema · Jaundice · Renal failure · Hypoglycemia · Metabolic acidosis · Sepsis · Multi-organ failure · Liver transplant

acute liver failure

With nursing management of cirrhosis (acute care)--> ________ ________ _________: · Cerebral edema, cerebellar herniation, and brainstem compression are most common causes of death · Frequent neurological evaluation for signs of increased ICP · Assess baseline mental status and alert primary care provider for decline · Minimal use of sedation, minimal straining, minimal stimulation · HOB ↑ 30 degrees to avoid increasing ICP · Monitor for renal failure - due to dehydration, acute tubular necrosis, hepatorenal syndrome · Renal failure increases mortality risk · Monitor electrolytes, glucose, acid-base status · Coagulation studies

acute liver failure

With nursing management of cirrhosis (acute care)--> ________ ________ _________: · Minimal use of sedation, minimal straining, minimal stimulation · HOB ↑ 30 degrees to avoid increasing ICP · Monitor for renal failure - due to dehydration, acute tubular necrosis, hepatorenal syndrome

acute liver failure

With nursing management of cirrhosis (acute care)--> ________ ________ _________: · Renal failure increases mortality risk · Monitor electrolytes, glucose, acid-base status · Coagulation studies

acute liver failure

Etiology and pathophysiology of _____ ______ includes: · Etiology o Gallbladder disease (women) o Chronic alcohol intake (men) o Smoking o Hypertriglyceridemia · Pathophysiology o Acute inflammatory process of pancreas o Spillage of pancreatic enzymes into surrounding pancreatic tissue causing autodigestion and severe pain o Activation of trypsinogen to trypsin within pancreas leads to bleeding

acute pancreatitis

The following are clinical manifestations of _____ ______: · Abdominal pain predominant · Radiates to back · Left upper quadrant or midepigastrium · Sudden onset · Deep, piercing, continuous or steady · Aggravated by eating · Starts when recumbent · Not relieved with vomiting · Abdominal tenderness with muscle guarding o Abdominal tenderness with muscle guarding is common. · Decreased or absent bowel sounds o Bowel sounds may be decreased or absent. Paralytic ileus may occur and causes marked abdominal distention. · Crackles in lungs o The lungs are frequently involved, with crackles present. · Abdominal skin discoloration o Grey Turner's spots or sign o Cullen's sign o Intravascular damage from circulating trypsin (a proteolytic enzyme) may cause areas of cyanosis or greenish to yellow-brown discoloration of the abdominal wall. Other areas of ecchymoses are the flanks (Grey Turner's spots or sign, a bluish flank discoloration) and the periumbilical area (Cullen's sign, a bluish periumbilical discoloration). These result from seepage of blood-stained exudate from the pancreas and may occur in severe cases. · Shock o Shock may result from hemorrhage into the pancreas, toxemia from the activated pancreatic enzymes, or hypovolemia as a result of fluid shift into the retroperitoneal space (massive fluid shifts).

acute pancreatitis

The following are clinical manifestations of _____ ______: · Abdominal skin discoloration o Grey Turner's spots or sign o Cullen's sign o Intravascular damage from circulating trypsin (a proteolytic enzyme) may cause areas of cyanosis or greenish to yellow-brown discoloration of the abdominal wall. Other areas of ecchymoses are the flanks (Grey Turner's spots or sign, a bluish flank discoloration) and the periumbilical area (Cullen's sign, a bluish periumbilical discoloration). These result from seepage of blood-stained exudate from the pancreas and may occur in severe cases.

acute pancreatitis

The following are clinical manifestations of _____ ______: · Aggravated by eating · Starts when recumbent · Not relieved with vomiting · Abdominal tenderness with muscle guarding o Abdominal tenderness with muscle guarding is common.

acute pancreatitis

The following are clinical manifestations of _____ ______: · Decreased or absent bowel sounds o Bowel sounds may be decreased or absent. Paralytic ileus may occur and causes marked abdominal distention. · Crackles in lungs o The lungs are frequently involved, with crackles present.

acute pancreatitis

The following are clinical manifestations of _____ ______: · Shock o Shock may result from hemorrhage into the pancreas, toxemia from the activated pancreatic enzymes, or hypovolemia as a result of fluid shift into the retroperitoneal space (massive fluid shifts).

acute pancreatitis

The following are diagnostic studies for _____ _____: · Serum amylase level · Serum lipase level · Serum calcium level · Liver enzyme levels · Triglyceride levels · Glucose level · Bilirubin level · The primary diagnostic tests for ____ _________ are serum amylase and lipase measurements. o The serum amylase level is usually elevated early and remains elevated for 24 to 72 hours. o Serum lipase level, which is also elevated in acute pancreatitis, is an important test because other disorders (e.g., mumps, cerebral trauma, renal transplantation) may increase serum amylase levels. · Other serum findings include an increase in liver enzymes, triglycerides, glucose, and bilirubin levels and a decrease in calcium level.

acute pancreatitis

The following are nursing diagnoses for a patient with ____ _______: · Acute pain o Deficient fluid volume o Imbalanced nutrition: less than body requirements o Ineffective health · Nursing diagnoses for the patient with _____ ______ may include, but are not limited to, the following: · Acute pain related to distention of pancreas, peritoneal irritation, obstruction of biliary tract, and ineffective pain and comfort measures · Deficient fluid volume related to nausea, vomiting, restricted oral intake, and fluid shift into the retroperitoneal space · Imbalanced nutrition: less than body requirements related to anorexia, dietary restrictions, nausea, loss of nutrients from vomiting, and impaired digestion · Ineffective health management related to lack of knowledge of preventive measures, diet restrictions, alcohol restriction intake, and follow-up care

acute pancreatitis

The following are systemic complications of _____ ______: · Enzyme-induced inflammation of the diaphragm occurs with the result being atelectasis caused by reduced diaphragm movement. Trypsin can activate prothrombin and plasminogen, increasing the patient's risk for intravascular thrombi, pulmonary emboli, and disseminated intravascular coagulation (DIC).

acute pancreatitis

The following are systemic complications of _____ ______: · Tetany, which can be caused by hypocalcemia, is a sign of severe disease. It is due in part to the combining of calcium and fatty acids during fat necrosis. The exact mechanisms of how or why hypocalcemia occurs are not well understood.

acute pancreatitis

The following are systemic complications of _____ ______: · The pulmonary complications are probably due to the passage of exudate containing pancreatic enzymes from the peritoneal cavity through transdiaphragmatic lymph channels.

acute pancreatitis

The following are systemic complications of _____ ______: · Thrombi, pulmonary embolism, DIC o Hypocalcemia: tetany § Pleural effusion § Atelectasis · ARDS o Pneumonia · Hypotension

acute pancreatitis

The following are systemic complications of _____ ______: · Thrombi, pulmonary embolism, DIC o Hypocalcemia: tetany § Pleural effusion § Atelectasis · ARDS o Pneumonia · Hypotension · The main systemic complications of _____ ______ are pulmonary (pleural effusion, atelectasis, pneumonia, and acute respiratory distress syndrome [ARDS]) and cardiovascular (hypotension). · The pulmonary complications are probably due to the passage of exudate containing pancreatic enzymes from the peritoneal cavity through transdiaphragmatic lymph channels. · Enzyme-induced inflammation of the diaphragm occurs with the result being atelectasis caused by reduced diaphragm movement. Trypsin can activate prothrombin and plasminogen, increasing the patient's risk for intravascular thrombi, pulmonary emboli, and disseminated intravascular coagulation (DIC). · Tetany, which can be caused by hypocalcemia, is a sign of severe disease. It is due in part to the combining of calcium and fatty acids during fat necrosis. The exact mechanisms of how or why hypocalcemia occurs are not well understood.

acute pancreatitis

When evaluating a patient with ____ ______, expected outcomes include: · Have adequate pain control · Maintain adequate fluid volume · Be knowledgeable about treatment regimen · Get help for alcohol dependence and smoking cessation (if appropriate)

acute pancreatitis

When performing a nursing assessment of a patient with ___ _____, objective data includes: o Restlessness, anxiety, low-grade fever o Flushing, diaphoresis o Discoloration of abdomen/flank o Cyanosis o Jaundice o Decreased skin turgor o Dry mucous membranes o Tachypnea o Basilar crackles o Tachycardia o Hypotension o Abdominal distention/tenderness o Diminished bowel sounds

acute pancreatitis

When performing a nursing assessment of a patient with ___ _____, objective data includes: o Tachypnea o Basilar crackles o Tachycardia o Hypotension o Abdominal distention/tenderness o Diminished bowel sounds

acute pancreatitis

When performing a nursing assessment on a patient with _____ ____, possible diagnostic findings include: · ↑ Serum amylase/lipase levels o Leukocytosis · Hyperglycemia o Hypocalcemia · Abnormal findings on ultrasonography/CT scans o Abnormal findings on ERCP

acute pancreatitis

When using nursing implementation (acute care) of a patient with ____ ______: · Monitor fluid and electrolyte balance o Chloride, sodium, and potassium o Hypocalcemia - Tetany § Calcium gluconate to treat o Hypomagnesemia · Pain assessment and management: o Morphine o Positioning o TCDB, semi-Fowler's position

acute pancreatitis

When using nursing implementation (acute care) of a patient with ____ ______: · Monitor serum glucose · Post-op wound care · Frequent oral/nasal care · Observation for signs of infection · Observation for paralytic ileus, renal failure, mental changes

acute pancreatitis

When using nursing implementation (acute care) of a patient with ____ ______: · Monitoring vital signs · Monitor response to IV fluids · Assess respiratory function · Monitor fluid and electrolyte balance o Chloride, sodium, and potassium o Hypocalcemia - Tetany § Calcium gluconate to treat o Hypomagnesemia · Pain assessment and management: o Morphine o Positioning o TCDB, semi-Fowler's position · Monitor serum glucose · Post-op wound care · Frequent oral/nasal care · Observation for signs of infection · Observation for paralytic ileus, renal failure, mental changes

acute pancreatitis

When using nursing implementation (ambulatory care) of a patient with ____ ______: · Physical therapy · Assessment of opioid addiction · Counseling regarding abstinence from alcohol and smoking · Dietary teaching: o Low-fat, high-carb o No crash diets · Patient/family teaching o Signs of infection, diabetes mellitus, steatorrhea o Medications/diet

acute pancreatitis

With interprofessional care (drug therapy) of ___ _____ includes: · Antacids o Neutralization of gastric hydrochloric (HCl) acid secretion; ↓ production and secretion of pancreatic enzymes and bicarbonate · Proton pump inhibitors (omeprazole [Prilosec]) o ↓ HCl acid secretion (HCl acid stimulates pancreatic activity)

acute pancreatitis

With interprofessional care (drug therapy) of ___ _____ includes: · Antispasmodics (e.g., dicyclomine [Bentyl]) o ↓ Vagal stimulation, motility, pancreatic outflow (↓ volume and concentration of bicarbonate and enzyme secretion); contraindicated in paralytic ileus · Carbonic anhydrase inhibitors (acetazolamide [Diamox]) o ↓ Volume and bicarbonate concentration of pancreatic secretion

acute pancreatitis

With interprofessional care (drug therapy) of ___ _____ includes: · IV morphine o For pain relief · Antispasmodics (e.g., dicyclomine [Bentyl]) o ↓ Vagal stimulation, motility, pancreatic outflow (↓ volume and concentration of bicarbonate and enzyme secretion); contraindicated in paralytic ileus · Carbonic anhydrase inhibitors (acetazolamide [Diamox]) o ↓ Volume and bicarbonate concentration of pancreatic secretion · Antacids o Neutralization of gastric hydrochloric (HCl) acid secretion; ↓ production and secretion of pancreatic enzymes and bicarbonate · Proton pump inhibitors (omeprazole [Prilosec]) o ↓ HCl acid secretion (HCl acid stimulates pancreatic activity)

acute pancreatitis

With interprofessional care (nutritional therapy) of ____ ______ includes: · NPO status initially o Enteral versus parenteral nutrition · Monitor triglycerides if IV lipids given · Small, frequent feedings when able o High-carbohydrate · No alcohol · Supplemental fat-soluble vitamins

acute pancreatitis

With interprofessional care of ____ _____, goals include: · Relief of pain · Prevention or alleviation of shock · ↓ Pancreatic secretions · Correction of fluid/ · electrolyte imbalance · Prevention/ · treatment of infections · Removal of precipitating cause

acute pancreatitis

With interprofessional care, conservative therapy of ____ ______ includes: · Enteral nutrition · Antibiotics · Endoscopically or CT-guided percutaneous aspiration · Supportive care · Ongoing hypotension · Vasoactive drugs: dopamine

acute pancreatitis

With interprofessional care, conservative therapy of ____ ______ includes: · Lactated Ringer's solution · Aggressive hydration · Shock o Plasma or plasma volume expanders (dextran or albumin) · Pain management - o IV morphine, antispasmodics · Prevent infection

acute pancreatitis

With interprofessional care, conservative therapy of ____ ______ includes: · Management of metabolic complications · Oxygen, glucose levels · Minimizing pancreatic stimulation · NPO status, NG suction, decreased acid secretion, enteral nutrition if needed · Fluid/electrolyte imbalance · Lactated Ringer's solution · Aggressive hydration · Shock o Plasma or plasma volume expanders (dextran or albumin) · Pain management - o IV morphine, antispasmodics · Prevent infection · Enteral nutrition · Antibiotics · Endoscopically or CT-guided percutaneous aspiration · Supportive care · Ongoing hypotension · Vasoactive drugs: dopamine

acute pancreatitis

With interprofessional care, surgical therapy, for ___ _____ includes: · For gallstones o ERCP o Cholecystectomy · Uncertain diagnosis · Not responding to conservative therapy · Drainage of necrotic fluid collections

acute pancreatitis

· The primary diagnostic tests for ____ _________ are serum amylase and lipase measurements. o The serum amylase level is usually elevated early and remains elevated for 24 to 72 hours. o Serum lipase level, which is also elevated in acute pancreatitis, is an important test because other disorders (e.g., mumps, cerebral trauma, renal transplantation) may increase serum amylase levels. · Other serum findings include an increase in liver enzymes, triglycerides, glucose, and bilirubin levels and a decrease in calcium level.

acute pancreatitis

Under interprofessional care: COPD complications, what COPD complication is described below: o What could precipitate acute respiratory failure? o Discontinuing medications Leading cause Have to take inhaled corticosteroids and LABA even when they are feeling well When feeling well, they stop taking or or when they run out, they end up not going to get more. o Patients experiencing exacerbations o Wait too long to contact HCP Another leading cause of acute respiratory failure o PREVENTION PATIENT EDUCATION!!!!!

acute respiratory failure

What part of interprofessional care of HTN is described below: o LFT's (liver function tests) o Echo: how effectively the heart muscle is pumping as well as how well the chambers are contracting and pumping the blood o Thyroid function o 24 hour urine creatinine clearance Collect urine for 24 hours and then measure the amount of creatiine; 1. Have patient urinate and discard that urine. 2. Write down time and place bag in ice and collect for 24 hours, if you have to empty, put in fridge with patient label and time. 3. With catheters, have to tell patient to not empty or else will have to start over

additional diagnostic tests

What drug used to treat HTN is described below: act by diminishing the SNS effects that increase BP. These drugs include drugs that act centrally on the vasomotor center and peripherally to inhibit norepinephrine release or to block the adrenergic receptors on blood vessels.

adrenergic-inhibiting agents

The following are ______ of chemotherapy treatment for cancer: -Can be very effective method in the treatment of cancer -Can an option when treating cancers that have spread to more than one location. -Can be used as primary treatment or as an adjunct therapy to maximize effectiveness. -Many are tolerated well.

advantages

________ is the resistance to left ventricular pumping. It is the amount of pressure required by the left ventricle to open the aortic valve and eject or pump blood. _________ directly related to arterial blood pressure. If BP increases, the ventricles will work harder and they eventually hypertrophy. Any increase in these, will be followed by increase in the workload of the heart and increased oxygen demand.

afterload

resistance left ventricle must overcome to circulate blood **Increased in hypertension, vasoconstriction increased _______ means increased cardiac workload.

afterload

the resistance the heart has to pump against during systole (The force opposing forward movement of blood inside vessels - SVR) o Increased in HTN (more pressure in arteries) and vasoconstriction o More of the L side of the heart

afterload

What risk factor for primary HTN is described below: o SBP rises progressively with increasing age, although DBP may decrease with age o After age 50, SBP > 140 mmHg is a more important CV risk factor than DBP

age

o Discrimination against people based on age which can lead to health care disparities o EX: "they are too old to take chemo" o Negative attitude based on age **attitude toward aging

ageism

The following are effects of _____ on the CV system: • CVD - leading cause of death in adults > 85 • Most common CVD is CAD due to atherosclerosis o Arteries that supply blood to the heart muscle become narrow and stiff • Kyphosis, myocardial hypertrophy, downward displacement of heart, cellular aging, valvular rigidity, stiffening of blood vessels • Aging process, disease, environmental factors, health behaviors

aging

The following are effects of _____ on the urinary system: • 20%-30% decrease in size and weight • 30%-50% of glomeruli have lost function by the 70's • Ability to maintain body fluid homeostasis affected by diseases or physiologic stressors • Loss of elasticity of the bladder - older women more prone to bladder infections and incontinence o Can lead to urinary incontinence; bladder is not able to hold urine as well (bladder becomes flabby) o Hormonal imbalances after menopause can cause flabby bladder • Enlarged prostate may cause hesitancy, retention, slow urine stream, and bladder infections in men o Bladder infections in men: Causing retention of urine allowing for bacteria to grow

aging

Other COPD treatments include ____ ______ ______ o Typically used with other treatments, such as bronchodilators o Effective huff coughing (*Review Table 28-3) o Chest physiotherapy - percussion, vibration, postural drainage o High-frequency chest wall oscillation o Airway clearance devices - use positive expiratory pressure (PEP :

airway clearance techniques (ACTs)

what clinical manifestation of PD (Parkinson's disease) is described below: o Absence or loss of control of voluntary muscle movements o Want to pick up the fork to eat but cannot make their body do it o Want to pick their foot up and move forward but cannot get body to do it

akinesia

What risk factor for primary HTN is described below: o Excessive alcohol intake is strongly associated with HTN o Moderate intake of alcohol has cardioprotective properties; males with HTN should limit their daily intake of alcohol to 2 drinks per day and 1 drink per day for females with HTN

alcohol

With nutritional therapy of DM, what component of diet is described below: --limit to moderate amount (max i drink per day for woman and 2 drinks per day for men) --consume _____ with food to reduce risk of nocturnal hypoglycemia in those using insulin or insulin secreatogegues --moderate _____ consumption has no acute effect on glucose and insulin concentrations, but carbs taken with the _______ may raise blood glucose

alcohol

With nutritional therapy of DM, what component of diet is described below: o Do not drink ______ while taking disulfiram. Flushing, fast heartbeats, nausea, thirst, chest pain, vertigo, and low blood pressure may occur when alcohol is ingested during disulfiram therapy.

alcohol

With nutritional therapy of DM, what component of diet is described below: o High in calories, no nutritive value o Promotes hyper-triglyceridemia o Inhibits gluconeogenesis by the liver - can cause severe hypoglycemia if treated with oral hypoglycemic agents o Severe side effects when ingested with sulfonylureas o Symptoms of ______ intolerance include flushing, throbbing in the head and neck, irregular heart beat, rapid heart beat, low blood pressure, sweating, nausea, and vomiting o Do not drink ______ while taking disulfiram. Flushing, fast heartbeats, nausea, thirst, chest pain, vertigo, and low blood pressure may occur when alcohol is ingested during disulfiram therapy.

alcohol

With nutritional therapy of DM, what component of diet is described below: o Severe side effects when ingested with sulfonylureas o Symptoms of ______ intolerance include flushing, throbbing in the head and neck, irregular heart beat, rapid heart beat, low blood pressure, sweating, nausea, and vomiting

alcohol

With nursing management of cirrhosis (acute care)--> ________ ________: · Community support programs · Symptoms of complications · When to seek medical attention · Written instructions with adequate explanations for patient/family · Referral to community or home health nurse

ambulatory care

What surgical therapy to treat PAD includes the following: if tissue necrosis is extensive infectious gangrene osteomyelitis (infection in the bone) all major arteries in the limb are occluded, precluding the possibility of successful surgery **interprofessional care

amputation

• Usually due to PVD, especially r/t DM o Also trauma, thermal injuries, tumors, osteomyelitis • Requires interprofessional care o Infection prevention/control, wound healing, psychosocial adjustment, safety with mobility and ADLs, phantom limb sensations • Postop care - drains and dressing care, effective stump wraps to promote healing • Appropriateness for prosthetic device - not all patients are candidates • Long-term care needs o Potential for infection, skin breakdown, immobility, safety needs, demands of organs in geriatric patients, emotional/psychosocial concerns

amputation

The following falls under the _____ of the heart: • 4 chambers of the heart: left atrium, right atrium, left ventricle, right ventricle. • Blood is circulated by a coordinated sequence of chamber contractions and valve openings and closings o Cardiac cycle • The two phases: o Systole (contraction) o Diastole (relaxation) • Contractions of the heart propel blood through the vascular system

anatomy

what precipitating factor of HF is described below: when hemoglobin and hematocrit are low (capacity of blood being able to carry oxygen to tissue) decreased o2-carrying capacity of the blood stimulating increase in CO to meet tissue demands, leading to increased cardiac workload and increases in size of LV

anemia

What PAD diagnostic study is described below: o Delineate where and the extent of PAD o Insert catheter into arteries, inject a dye, to see how the blood is flowing

angiography and magnetic resonsance angiography (MRA)

What drug used to treat HTN is described below: prevent the conversion of angiotensin I to angiotensin II and reduce angiotensin II (A-II)-mediated vasoconstriction and sodium and water retention.

angiotension-converting enzyme (ACE) inhibitors

What PAD diagnostic study is described below: o Ankle BPs / higher of L & R brachial SBP o Only used for basic screening because results can be skewed o Not recommended immediately after revascularization surgery or on distal bypass grafts

ankle-brachial index (ABI)

What drug to treat COPD is described below: as needed for bacterial-related exacerbations

antibiotics

What drug to treat COPD is described below: Ipratropium - Open larger bronchi, promote bronchodilation in COPD

anticholinergics

Vitamin K antagonists (Warfarin), thrombin inhibitors-indirect and direct are the different ______ medications used for venous thrombosis.

anticoagulant

What treatment plan for VTE is described below: - confirmed VTE Patients with confirmed VTE should receive initial treatment with either LMWH, UH, or an oral Factor Xa drug. Oral VKA therapy may be considered.

anticoagulant therapy

With DM interprofessional care: Medications, the following are oral ______ agents: • Biguanides • Sulfonylureas*** • Meglitinides***** • Alpha-Glucosidase Inhibitors • Thiazolidinediones • Dipeptydyl Peptidase-4 Inhibitors • Glucagon-Like Peptide-1 Receptor Agonists • Amylin Analogs • Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors • Dopamine Receptor Agonists • Combinations *** are the ones that are at highest risk of causing hypoglycemia. They cause the body to secrete insulin. NEED TO KNOW THOSE !!!

antidiabetic

With chemotherapy for treatment of cancer, _______ means to reduce the # of cancer cells in the tumor site (s). It includes 2 phases: o Cell-cycle phase non-specific § Affect ALL stages of cell cycle o Cell-cycle phase specific § Cancer cells can escape death by staying in the G0 phase § Drug-resistance - challenge is to destroy the resistant resting and non-cycling cancer cells

antineoplastic

______ should be given around the clock to prevent acute swings in temperature.

antipyretics

________ should be given around the clock to prevent acute swings in temperature, which can produce chills.

antipyretics

When talking about Normal arterial and venous blood gas values the following falls under _____ blood gases: Lab Value: pH= 7.35-7.45 (both sea level BP 740 mmHg PaO2: 80-100 mmHg (sea level) SaO2: > 95% (sea level) PaCO2: 35-45 mmHg (above sea level) HCO3-: 22-26 mEq/L (sea level)

arterial

_______ ulcers most often occur over bony prominences on the toes, feet, and lower legs. Nonhealing ________ ulcers and gangrene are the most serious complications. If PAD is present for an extended period of time, collateral circulation may prevent gangrene of this extremity

arterial

The following is interprofessional care for _______, a complication of cirrhosis: · A paracentesis is a sterile procedure in which a catheter is used to withdraw fluid from the abdominal cavity. o Used to diagnose a medical condition or relieve pain, pressure, or difficulty breathing. o In the patient with cirrhosis, this procedure is reserved for the person with impaired respiration or abdominal discomfort caused by severe ________ who does not respond to diuretic therapy. o It is only a temporary measure of palliation because the fluid tends to re-accumulate rapidly. · TIPS is used to alleviate _______ that does not respond to diuretics.

ascites (abdominal)

The following is interprofessional care for _______, a complication of cirrhosis: · Accurately assess and monitor fluid and electrolyte balance. o Albumin infusion may be used to help maintain intravascular volume and adequate urinary output by increasing plasma colloid oncotic pressure.

ascites (abdominal)

The following is interprofessional care for _______, a complication of cirrhosis: · Diuretic therapy is an important part of management. o Often a combination of drugs that work at multiple sites of the nephron is more effective than a single agent. o Spironolactone (Aldactone) is an effective diuretic, even in patients with severe ascites. Spironolactone is also an antagonist of aldosterone and is potassium sparing. o A high-potency loop diuretic, such as furosemide (Lasix), is frequently used in combination with a potassium-sparing drug.

ascites (abdominal)

The following is interprofessional care for _______, a complication of cirrhosis: · Sodium restriction · Albumin · Diuretics · Medications · Paracentesis · Transjugular intrahepatic portosystemic shunt (TIPS) · Management of ascites is focused on sodium restriction, diuretics, and fluid removal.

ascites (abdominal)

The following is interprofessional care for _______, a complication of cirrhosis: · The amount of sodium restriction is based on the degree of ________. o Patients may be encouraged to limit sodium intake to 2 g/day. o Patients with severe _________ may need to restrict their sodium intake to 250 to 500 mg/day. o Very low sodium intake can result in reduced nutritional intake and subsequent problems associated with malnutrition. The patient is usually not on restricted fluids unless severe ascites develops.

ascites (abdominal)

The following is interprofessional care for _______, a complication of cirrhosis: · Tolvaptan (Samsca), a vasopressin-receptor antagonist, is used to correct hyponatremia, which is often seen in patients with cirrhosis. It causes an increase in water excretion, resulting in an increase in serum sodium concentrations.

ascites (abdominal)

What complication of cirrhosis is described below: § Accumulation of serous fluid in peritoneal or abdominal cavity § Several mechanisms · Portal hypertension · Hypoalbuminemia · Hyperaldosteronism § is the accumulation of serous fluid in the peritoneal or abdominal cavity. § Several mechanisms lead to ______. · One mechanism of _______ occurs with portal hypertension, which causes proteins to shift from the blood vessels into the lymph space (Fig. 43-7). When the lymphatic system is unable to carry off the excess proteins and water, they leak into the peritoneal cavity. The osmotic pressure of the proteins pulls additional fluid into the peritoneal cavity (Table 43-10). · A second mechanism of _______ formation is hypoalbuminemia resulting from the liver's decreased ability to synthesize albumin. The hypoalbuminemia results in decreased colloidal oncotic pressure. · A third mechanism of ascites is hyperaldosteronism, which occurs when the hormone aldosterone is metabolized by damaged hepatocytes. The increased level of aldosterone causes increased sodium reabsorption by the renal tubules. This retention of sodium, combined with an increase in antidiuretic hormone in blood, leads to additional water retention. Because of edema formation, there is decreased intravascular volume and, subsequently, decreased renal blood flow and glomerular filtration.

ascites (abdominal)

What complication of cirrhosis is described below: § Several mechanisms lead to ______. · One mechanism of _______ occurs with portal hypertension, which causes proteins to shift from the blood vessels into the lymph space (Fig. 43-7). When the lymphatic system is unable to carry off the excess proteins and water, they leak into the peritoneal cavity. The osmotic pressure of the proteins pulls additional fluid into the peritoneal cavity (Table 43-10).

ascites (abdominal)

What complication of cirrhosis is described below: · A second mechanism of _______ formation is hypoalbuminemia resulting from the liver's decreased ability to synthesize albumin. The hypoalbuminemia results in decreased colloidal oncotic pressure.

ascites (abdominal)

What complication of cirrhosis is described below: · A third mechanism of _________ is hyperaldosteronism, which occurs when the hormone aldosterone is metabolized by damaged hepatocytes. The increased level of aldosterone causes increased sodium reabsorption by the renal tubules. This retention of sodium, combined with an increase in antidiuretic hormone in blood, leads to additional water retention. Because of edema formation, there is decreased intravascular volume and, subsequently, decreased renal blood flow and glomerular filtration.

ascites (abdominal)

With nursing management of Venous thrombosis, _______ includes: o Subjective HPI: trauma, invasive procedures, medications, pregnancy, prolonged immobilization, recent travel, dehydration PMH/risk factors Current symptoms o Objective Size of extremity - compare to other Taut, shiny skin, warm, red, tender Distention, warmth of superficial veins in affected area qEdema, cyanosis of extremities, neck, back, and face if SVC involvement

assesment

1. During a nursing _____ of an older adult, attend to primary needs FIRST. Comfort, toileting, eyeglasses, hearing aids DO you need to use the bathroom? Do you have pain? Are you comfortable? 2. Place all assistive devices such as walkers within reach. 3. Assess your patient's level of fatigue and pause the interview if necessary. Allow adequate time to offer information and time for the family to respond to any questions. 4. Interview both the older adult and his or her family or caregivers. This can be done separately, unless the patient is cognitively impaired or specifically requests the caregiver's presence.

assessment

A comprehensive geriatric ________ is interprofessional, and includes the medical history, functional assessment, medication review, cognitive and mood evaluation, social resources, physical exam, followed by recommended diagnostic tests. The interprofessional team minimally includes a staff nurse, an HCP such as a physician or adult-geriatric NP and a social worker. IT may also include a PT or OT therapist, dietitian, podiatrist, dentist, etc. o medical history (all medicines) o functional assessment are they able to handle ADLs on their own such as laundry, shopping by themselves? o medication review o cognitive and mood evaluation different tools we can use such as the Mini Mental Status exam done by NP or by a home health agency nurse depression scales done by HCP o social resources do they have family close by? Frequent interactions with friends? o physical examination risk for falls thorough skin assessment meaning taking clothes off and looking. You want to look in all of skin folds, look under breasts, buttocks, knees, etc.

assessment

During a nursing ______ of an older adult, the purpose is to determine appropriate interventions to maintain and enhance the health, quality of life, function, and independence of older adults.

assessment

The following is a nursing ______ of lung cancer: o Patient and family's understanding of diagnostic tests, diagnosis, treatment options, and prognosis o Anxiety level o Respiratory assessment, assess for possible metastasis o Nutritional status, ability to perform ADLs o Level of pain, coping o Assess for complications

assessment

The following is an _____ of stomas: · Mucocutaneous junction intact, no separations, will see sutures post op · Peristomal skin intact, similar to skin on opposite side of abdomen · Stents may be in place in a urostomy · Rod may be in place with a loop stoma

assessment

The following is an _____ of stomas: · Stoma: painless, vascularized (normal to see scant blood when cleansing) · Red · Round · Moist · (like the inside of your mouth) · Budded (approximately 2.5cm) · Lumen at top of stoma · Stoma will be edematous post op, edema will decrease over several weeks and stoma size will decrease. · Mucocutaneous junction intact, no separations, will see sutures post op · Peristomal skin intact, similar to skin on opposite side of abdomen · Stents may be in place in a urostomy · Rod may be in place with a loop stoma

assessment

The following is part of a nursing ______ of SLE: · Decreased breath sounds, friction rub. · Pericardial friction rub, HTN, Raynaud's phenomenon, vasculitis · Oral and pharyngeal ulcers

assessment

The following is part of a nursing ______ of SLE: · Neurological manifestations o Confusion, parathesias, dizziness · Musculoskeletal manifestations o Inflamed joints · Proteinuria (lupus nephritis) o Protein in urine

assessment

The following is part of a nursing ______ of SLE: · What are we looking for? · Recent and past health history · Joint pain, fever, lymphadenopathy · Alopecia and skin changes. Butterfly skin rash · Decreased breath sounds, friction rub. · Pericardial friction rub, HTN, Raynaud's phenomenon, vasculitis · Oral and pharyngeal ulcers · Neurological manifestations o Confusion, parathesias, dizziness · Musculoskeletal manifestations o Inflamed joints · Proteinuria (lupus nephritis) o Protein in urine

assessment

With ______ of the urinary system, assess: • PMH o Renal or urologic disease, DM, HTN, CVD, connective tissue diseases DM is one of the leading causes of renal disease CVD: may impact blood flow to kidneys CT diseases such as lupus o Infections, trauma, congenital disorders, neurological disorders or injury • MEDICATIONS o nephrotoxic medications o meds that affect contraction/relaxation of the detrusor muscle, renal blood flow, etc • SURGERIES /TREATMENTS • CURRENT SYMPTOMS • PHYSICAL EXAMINATION o Urinary meatus o Abdomen (want to palpate; if renal arteries are obstructed may hear a bruit o Costovertebral tenderness (thump on area of lower ribs; if hurts may be something wrong with kidneys) o·Quantity, color, odor of urine • DIAGNOSTIC TEST RESULTS o BUN, creatinine, GFR, microalbumin/urine protein GFR: glomerular filtration rate; the lower, the less the kidneys will be able to filter out

assessment

With nursing management of DM, ________ includes: • PMH, weight and nutrition history, family history • other endocrine conditions, autoimmune conditions • CV, renal, hepatic disease • Vision, neurologic • Labs: A1C, BG, CMP, GFR, urinalysis, urine microalbumin • Self-health management

assessment

With nursing management of PAD, _______ includes: o Subjective: HPI, PMH, PSH, FH, medications, risk factors o Objective: VS, peripheral pulses, ABI Integumentary changes Neurologic changes Diagnostic study results

assessment

With nursing management of amputation, ______ includes: o History and PE, physical appearance of soft tissues, skin temperature, sensory function, quality of peripheral pulses, arteriography, venography, plethysmography, transcutaneous doppler recordings

assessment

Potential to increase function Can assist with rehabilitation and living with functional impairments Includes: • Canes • Walkers • Hearing aids and eye glasses • Adaptive devices: elevated toilet seats, eating utensils • Medical alert devices, electronic monitoring devices **nursing implementation

assistive devices

- expiratory airflow limitation & bronchial hyperresponsiveness **When bronchiole is stimulated by acute bronchial attack, causes bronchial airway restriction. **COPD

asthma

When talking about chest exam findings in respiratory problems, what problem is described below: Inspection: prolonged expiration, tripod position, pursed lips Palpation: decreased movement Percussion: hyperresonance

asthma with exacerbation

If the normal percentage of neutrophils is 40% and your patient has a neutrophil percentage of 47%, what is this an indication of?

bacterial infection (elevated)

what clinical manifestation of MS is described below: § bend head forward and get an electric shock sensation that runs down spine and into their limbs

barber chair sign

What surgical intervention for both type 1 and 2 DM is: o Useful for Type 2 DM to manage co-morbidities, metabolic syndrome effects

bariatric surgery

What CV regulation mechanism is described below: • Sense stretch or pressure in arteries • receptors In aortic arch and carotid sinus • Communicate with vasomotor center: o Increased "stretch" (ex. Hypervolemia) Inhibits SNS, enhances PSNS Slows HR, vasodilation o Decreased pressure (ex. Hypovolemia) Enhances SNS, inhibits PSNS Vasoconstriction, increased HR

baroreceptors

When talking about insulin administration: ____+ ____ includes: o Basal insulin long-acting or intermediate-acting o Preprandial insulin rapid-acting or short-acting

basal; bolus

Understanding CBC: Inflammation/Infection: ↑ ________ = leukemia, chronic inflammation, active allergic response, or radiation ↓ _______ = not a high concern

basophils

What tumor classification is described below: --grow slowly --well defined capsule --not invasive --well differentiated --low mitotic index --do not metastasize

benign

what are the 2 different tumor classifications?

benign and malignant

What part of the treatment plan of a patient with HF is described below: o Hold for HR < 60 and call the doctor o Monitor BP less than 120/60 hold drug and contact provider o Orthostatic hypotension Safety concerns!

beta-adrenergic antagonist drugs

What post-op complication of gastrectomy in treatment of PUD is described below: o after pyloroplasty (backwards reflux of bile causing continuous epigastric distress), increases after meals, some relief after vomiting § Treatment: cholestyramine (binds to bile acids) o They have opened up the pyloris so all of the bile in the small intestine refluxes back up into the stomach which can cause epigastric pain. o Some relief after vomiting

bile reflux gastritis

_______ causes of cirrhosis include primary _______ cirrhosis and primary sclerosing cholangitis.End result of both is liver failure.

biliary

· ________ cirrhosis o Primary _______ cirrhosis (PBC) o Primary sclerosing cholangitis (PSC) § Primary sclerosing cholangitis is a chronic inflammatory condition affecting the liver and bile ducts that is frequently found in men. § Causes the liver to become scarred and non-functioning

biliary

From a _____ view, aging reflects the changes that occur over time. ______ aging is a mutlifactorial process involving genetics, diet, and environment. In part, _____ aging can be views as a balance of positive and negative factors. Negative: stress, cancer, CV disease, diabetes, obesity Positive: exercise, good nutrition, social support, stress management, coping resources

biologic

o Both ventricles dilated and have poor filling/emptying ability o Causes: acute issues (MI) or chronic conditions (HTN, cardiomyopathy) o A lot of people with HF have this **mixed systolic/diastolic failure

biventricular failure

With interprofessional care-- longterm management for ________: · Long-term management of patients who have had an episode of ________ includes nonselective β-blockers, repeated band ligation of the varices, and portosystemic shunts in patients who develop recurrent __________.

bleeding

With interprofessional care-- longterm management for ________: · Nonsurgical and surgical methods of shunting blood away from the varices are available. · Shunting procedures tend to be used more after a second major ________ episode than an initial __________ episode.

bleeding

With interprofessional care-- longterm management for ________: · Portosystemic shunts o Used more after second major bleeding episode o Nonsurgical: transjugular intrahepatic portosystemic shunt (TIPS) o Surgical: portacaval and distal splenorenal shunt · Because there is a high incidence of recurrent ________ with each _________ episode, continued therapy is necessary.

bleeding

With interprofessional care-- longterm management for ________: · Transjugular intrahepatic portosystemic shunt (TIPS) is a nonsurgical procedure in which a tract (shunt) between the systemic and portal venous systems is created to redirect portal blood flow.

bleeding

With interprofessional care-- longterm management for ________: · Various surgical shunting procedures may be used to decrease portal hypertension by diverting some of the portal blood flow and at the same time allowing adequate liver perfusion. Currently, the surgical shunts most commonly used are the portacaval shunt and the distal splenorenal shunt.

bleeding

With interprofessional care-- longterm management for ________: · Nonselective β-adrenergic blockers · Repeated band ligation · Portosystemic shunts o Used more after second major bleeding episode o Nonsurgical: transjugular intrahepatic portosystemic shunt (TIPS) o Surgical: portacaval and distal splenorenal shunt · Because there is a high incidence of recurrent ________ with each _________ episode, continued therapy is necessary. · Long-term management of patients who have had an episode of ________ includes nonselective β-blockers, repeated band ligation of the varices, and portosystemic shunts in patients who develop recurrent __________. · Nonsurgical and surgical methods of shunting blood away from the varices are available. · Shunting procedures tend to be used more after a second major ________ episode than an initial __________ episode. · Transjugular intrahepatic portosystemic shunt (TIPS) is a nonsurgical procedure in which a tract (shunt) between the systemic and portal venous systems is created to redirect portal blood flow. · Various surgical shunting procedures may be used to decrease portal hypertension by diverting some of the portal blood flow and at the same time allowing adequate liver perfusion. Currently, the surgical shunts most commonly used are the portacaval shunt and the distal splenorenal shunt.

bleeding

what venous diagnostic study is described below: o Coagulation studies - aPTT, INR, H/H, Platelets o D-dimer - detects thromboembolism

blood

• Inferior vena cava and superior vena cava --> emptys into R atrium--> R ventricle—pulmonary artery and lungs--> picks up oxygen and flows from lungs to--> L atrium--> L ventricle--> aorta--> rest of body

blood flow through the heart

When the ____ _____ decreases it can denote HF or hypovolemia. When the ___ _____ increases, it can denote atherosclerosis or exercise.

blood pressure

• The force exerted against the walls of blood vessels • Must be adequate to maintain tissue perfusion during activity and rest • Function of: o CO: total blood flow through systemic or pulmonary circulation each minute. It is described as the stroke volume (SV) or the amount of blood pumped out of the L ventricle per beat (approximately 70 mL) multipled by the heart rate (HR). o SVR (the force opposing blood flow through vessels) What else exerts a pull to keep blood inside vessels? The radius of the small arteries and arterioles is the principal factor in determining SVR As arteries narrow, resistance to blood flow increases As arteries dilate, resistance to blood flow decreases

blood pressure

The following is nursing care of ____ ____ ____ which is a side effect of radiation and chemotherapy: Monitor: •Temperature --Routinely assess for infection •Labs: --Neutrophil, Platelet Count, and RBC Count •Take every caution to try to prevent infection in these patients due to Neutropenia •Hand Hygiene for patient, family, and health care providers is important. •Avoid invasive procedures when possible due to possible Thrombocytopenia and risk for hemorrhage

bone marrow suppression

What is an important side effect of radiation and chemotherapy treatment for cancer?

bone marrow suppression

What side effect of radiation and chemotherapy is described below: · Affects all blood cell production o Anemia, neutropenia, thrombocytopenia o NADIR - point of lowest blood cell counts; approximately 7-10 days after each treatment session (mainly chemo)

bone marrow suppression

What side effect of radiation and chemotherapy is described below: •"myelosuppression" •one of most common side effects of chemotherapy •Chemotherapy (systemic)= affects bone marrow function throughout the body •Radiation (local) = only affects bone marrow function within the treatment field. •Can be life-threatening effects in blood cell production: •Infection •Hemorrhage •Overwhelming fatigue •"Nadir": typically, blood cell counts is lowest between 7 to 10 days after initiation of therapy. •Neutropenia: could result in serious life-threatening infection and sepsis •Thrombocytopenia: could result in major hemorrhage •Anemia: Generally has a late onset: 3 to 4 months after initiation of treatment.

bone marrow suppression

The following are clinical manifestations of ___ _____ (complication of IBD): · Abdominal pain · Vomiting · Distention · Constipation

bowel obstruction

The following is treatment for ___ _____ (complication of IBD): · Depends on cause · Surgical vs Conservative · NPO · NGT to suction · IV fluids/electrolytes · Pain management

bowel obstruction

what clinical manifestation of PD (Parkinson's disease) is described below: They include blinking of the eyelids, swinging of the arms while walking, swallowing of saliva, self-expression with facial and hand movements, and minor movement of postural adjustment. · The patient with PD does not execute these movements and lacks spontaneous activity.

bradykinesia

what clinical manifestation of PD (Parkinson's disease) is described below: o Slowness of movement o Particularly evident in the loss of automatic movements o Eat slow, bath slow, walk slow, talk slow, dress slow, etc. · Loss of automatic movements occur subconsciously and result in classic characteristics of a person with PD o Stooped posture o Masked face o Drooling (loss of ability to swallow) o Festination (shuffling gait) · This occurs because of the physical and chemical alteration of the basal ganglia and related structures in the extrapyramidal portion of the CNS. · In the unaffected patient, automatic movements are involuntary and occur subconsciously. · They include blinking of the eyelids, swinging of the arms while walking, swallowing of saliva, self-expression with facial and hand movements, and minor movement of postural adjustment. · The patient with PD does not execute these movements and lacks spontaneous activity.

bradykinesia

what clinical manifestation of PD (Parkinson's disease) is described below: · Loss of automatic movements occur subconsciously and result in classic characteristics of a person with PD o Stooped posture o Masked face o Drooling (loss of ability to swallow) o Festination (shuffling gait)

bradykinesia

what clinical manifestation of PD (Parkinson's disease) is described below: · This occurs because of the physical and chemical alteration of the basal ganglia and related structures in the extrapyramidal portion of the CNS. · In the unaffected patient, automatic movements are involuntary and occur subconsciously.

bradykinesia

What cancer of the female sex organ is described below: Interprofessional Care: o Drug therapy § Chemotherapy • Hormone therapy • Immunotherapy • Targeted therapy o Radiation therapy § External radiation • Brachytherapy • Palliative radiation therapy

breast cancer

What cancer of the female sex organ is described below: o Risk factors for men § Hyperestrogenism § Family history of breast cancer § Radiation exposure § Men in BRCA-positive families should be screened and also begin prostate screening at age 40

breast cancer

What cancer of the female sex organ is described below: · Clinical Manifestations: o Lump or thickening in the breast o Nipple discharge o Nipple retraction o Peau d'orange (skin appearance) o Infiltration, induration, dimpling

breast cancer

What cancer of the female sex organ is described below: · Interprofessional Care: o Diagnosis and staging o Surgical therapy § Breast conserving · Lumpectomy with SLNB and/or axillary node dissection § Mastectomy · Simple, with SLNB and/or axillary node dissection · Modified radical mastectomy · Reconstructive surgery o Drug therapy § Chemotherapy • Hormone therapy • Immunotherapy • Targeted therapy o Radiation therapy § External radiation • Brachytherapy • Palliative radiation therapy

breast cancer

What cancer of the female sex organ is described below: · Nursing Care—Goals o Participate in the decision-making process related to treatment, o Adhere to the therapeutic plan, o Communicate about and manage the side effects of adjuvant therapy, o Access and benefit from the support provided by significant others and HCPs, o Comply with recommended follow-up and surveillance after treatment.

breast cancer

What cancer of the female sex organ is described below: · Nursing Diagnoses: o Decisional conflict related to lack of knowledge about treatment options and their effects o Fear and/or anxiety related to diagnosis of ____ _______ o Disturbed body image related to physical and emotional effects of treatment modalities o Risks r/t treatment modalities

breast cancer

What cancer of the female sex organ is described below: · Nursing Implementation: o Health promotion § TLC · Weight, nutrition, alcohol, no smoking § Screening § Genetic testing, if indicated § Prophylactic treatment, if indicated · Mastectomy, oophorectomy o Acute care § Support § Decisional support § Post-operative care § Managing drug therapy and AEs

breast cancer

What cancer of the female sex organ is described below: · Risk Factors: o Mutations in breast cancer-related genes o About 5% - 10% are hereditary - specific genetic abnormalities contribute o Most are associated with mutations in BRCA1 and BRCA2 o Breast cancer risk assessment o Genetic counseling must be considered for an individual at high risk o Risk factors for men § Hyperestrogenism § Family history of breast cancer § Radiation exposure § Men in BRCA-positive families should be screened and also begin prostate screening at age 40

breast cancer

What cancer of the female sex organ is described below: · Screening Guidelines: o Annual mammogram age 45-54 o Annual - biennial mammogram age 55+ o Continue regular mammograms until life expectancy < 10 years o Earlier initiation, additional imaging (MRI, US) in certain populations of with certain risk factors o ACS Dose not recommend clinical breast exam for screening at any age o Breast self-exam may increase breast self-awareness § Role in reducing mortality unclear

breast cancer

What cancer of the female sex organ is described below: · Types of ____ ______: o Ductal carcinoma - starts in the ducts of the gland; most common type o Lobular carcinoma - starts in lobular tissue of the mammary gland o Inflammatory ____ ______ (IBC) - grows and spreads quickly, may have already spread to nearby lymph nodes by the time symptoms appear § Later can spread to lymph nodes in the chest or distant sites o Paget's Disease § Starts in breast ducts and spreads to nipple § Rare - different from Paget's Disease of bone o Triple negative ____ ______ § Negative for all 3 receptors (estrogen, progesterone, HER-2) § Aggressive tumors - hard to treat o Phyllodes Tumor § Rare, starts in connective tissue § Tx - Mastectomy o Breast cancer may be invasive or non-invasive o Hormonal status, Genetic subtype o Non-invasive: § Ductal carcinoma in situ - DSIS § Lobular Carcinoma in situ - LCIS § Invasive (infiltrating) ductal carcinoma § Invasive (infiltrating) lobular carcinoma

breast cancer

Other COPD treatments include ____ ______: o Pursed lip breathing o Diaphragmatic breathing (not recommended in moderate-severe COPD

breathing restraining

What drug to treat COPD is described below: o Short-acting B2-adrenergic agonists (SABAs) - Albuterol - Rescue/relief o Long-acting B2-adrenergic agonists (LABAs) - Salmeterot - Long-term control

bronchodilators

What diagnostic test of the respiratory system is described below: Description and Purpose: flexible fiberoptic scope is used for diagnosis, biopsy, specimen collection, or assessment of changes. It may also be done to suction mucous plugs, lavege lungs, or remove foreign objects Nursing Responsibility: Before: obtain signed consent. INstruct patient is be NPO for 6-12 hours before the test. Give sedative (as ordered). After: keep patient NPO until gag reflex returns. Monitor for recovery from sedation. Blood tinged mucous is not abnormal if biopsy was done, monitor for hemorrhage and pneumothorax.

bronchoscopy (endoscopy)

The following are the overall goals of interprofessional care of _______: · CURE - surgery alone or extended periods of systemic therapy · CONTROL - initial treatment and maintenance therapy · PALLIATIVE- relief or control of symptoms and maintenance of quality of life

cancer

When talking about ______ development, causes are multifactorial, orderly, and in stages: o Initiation - mutation in a gene's genetic structure o Promotion - a mutation in one cell is not likely to be problematic § Promoters - dietary fat, obesity, smoking, alcohol consumption. Life-style changes can reverse risk. o Progression - increased tumor growth, angiogenesis, and metastasis

cancer

· Uncontrolled, unregulated cell proliferation and differentiation o Normally, cells maintain a state of equilibrium between cell division and loss · _______ cells don't obey these rules, there is defective cell proliferation and/or differentiation - cells continue to grow and divide · Loss of "contact inhibition"

cancer

What anatomic site classification of a tumor is described below: •Develops from Epithelial Cells (skin, glands, mucous membranes)

carcinoma

what are the 3 different anatomic site classifications?

carcinoma, sarcoma, and lymphomas, leukemias

· ________ cirrhosis o Results from long-standing severe right-sided heart failure o _________ cirrhosis includes a spectrum of hepatic derangements that result from long-standing, severe right-sided heart failure. o It causes hepatic venous congestion, parenchymal damage, necrosis of liver cells, and fibrosis over time. o The treatment is aimed at managing the patient's underlying heart failure

cardiac

what compensatory mechanism of HF is described below: o L ventricular remodeling Changes the way muscle fibers are in the heart; can either lead to being thin, stretched out, and floppy OR being thick and stiffened o All of this blood backing up into the heart leads to ventricular dilation. The ventricles get large. Think of a balloon filling, the more fluid, the bigger it will get.

cardiac dilation

What side effect of radiation and chemotherapy is described below: NURSING CARE: •Assess baseline and periodic Echocardiograms to monitor for Left Ventricular Dysfunction and Heart Failure

cardiac effects

What side effect of radiation and chemotherapy is described below: o ECG abnormalities - L sided heart failure o Pericardial effusion, pericarditis - CAD hx at high risk

cardiac effects

What side effect of radiation and chemotherapy is described below: •Patients with pre-existing coronary artery disease are especially vulnerable. •Acute Cardiotoxicities: --ECG abnormalities --Left Ventricular Dysfunction and Heart Failure (Late effects)

cardiac effects

What side effect of radiation and chemotherapy is described below: •Radiation to thorax can damage pericardium (most common), myocardium, valves, coronary blood vessels. •Pericardium Damage: --pericardial effusion --pericarditis. •Patients with pre-existing coronary artery disease are especially vulnerable. •Acute Cardiotoxicities: --ECG abnormalities --Left Ventricular Dysfunction and Heart Failure (Late effects)

cardiac effects

What primary cause of HF is : (viral, postpartum, substance abuse): where heart muscle gets weak unrelated to other causes Substance abuse is a big leading cause to HF

cardiomyopathy

Are challenging those with multiple health conditions are particularly at high risk for Rehospitalization Medicare regulations require a RN, social worker, or qualified person to develop a care transition plan for patient discharge safe and effective care transitions are most likely to occur when interprofessional team members work together with the patient and family to coordinate care **Nursing implementation of older adults

care transitions

what type of exudate is described below: (mucus - upper respiratory tract infection - aka "cold") colds, sinus infections, people with pneumonia

catarrhal

The following are the primary _____ of HF: o HTN - including hypertensive crisis Long-standing HTN can lead to HF o CAD, MI o Rheumatic heart disease o Congenital heart defects o Pulmonary hypertension: where the R ventricle is trying to push against vascular resistance in the lungs and having trouble emptying the R ventricle o Cardiomyopathy (viral, postpartum, substance abuse): where heart muscle gets weak unrelated to other causes Substance abuse is a big leading cause to HF o Hyperthyroidism Increases the metabolic demands of the body which means more oxygen resulting in more work load of heart o Valvular disorders: afterload from stiffened or weakened valves o Myocarditis: inflammation of the heart muscle which can lead to weakening of the heart muscle

causes

What part of the inflammatory response is described below: o Chemotaxis >>> leukocytes migrate to site of injury Neutrophils, monocytes (macrophages), lymphocytes (immune response) where anti-inflammatory substances migrate to the sites and they start the process of phagocytosis o Phagocytosis surround and engulf the infected tissue and start the process of destroying the infected tissue

cellular

A patient with a chronic illness has to learn about adjusting to ______ in the course of the disease. This includes: • Course may be unpredictable • May worsen over time • Prescribed treatments may change/become more intense and burdensome • Personal identity to include chronic illness and impact on life o Need to start thinking of themselves having DM for example

change

______ is the directional migration of white blood cells to the site of injury, resulting in an accumulation of neutrophils and monocytes at the site.

chemotaxis

The following is treatment (_________) for lung cancer: § Used in combination with multidrug regimen · Improved survival rate with both NSCLC and SCLC § For non-resectable tumors or adjuvant to surgery in NSCLC with distant metastases · targeted drug for NSCLC with ALK+ gene

chemotherapy

What treatment of cancer is described below: · Administration Routes o Systemic o Regional o Oral · IV Administration: o Most common route o Major Concerns § Venous access difficulties § Catheter-related infection § Extravasation (infiltration into surrounding tissue § Irritants - can cause phlebitis § Vesicant - can cause severe local tissue breakdown and necrosis if infiltrated · Regional Administration: o Delivery of the drug directly tumor site o Higher concentrations can be delivered to the tumor with reduced systemic toxicity § Intraarterial - to tumor arteries § Intraperitoneal - peritoneal cavity · (introduced in a similar way as peritoneal dialysis) § Intrathecal or intraventricular - subarachnoid space to bypass blood-brain barrier; may use ventricular reservoir § Intravesical - bladder instillation

chemotherapy

What treatment of cancer is described below: · Antineoplastic - to reduce number of cancer cells in tumor site(s) o Cell-cycle phase non-specific § Affect ALL stages of cell cycle o Cell-cycle phase specific § Cancer cells can escape death by staying in the G0 phase § Drug-resistance - challenge is to destroy the resistant resting and non-cycling cancer cells

chemotherapy

What treatment of cancer is described below: · Potential Problems o Chemotherapy doesn't distinguish between normal and cancer cells o Side effects are the result of destruction of normal cells - especially rapidly proliferating (bone marrow, GI system, integumentary system § Acute toxicity - immediate, such as hypersensitivity reaction, anaphylaxis, cardiac arrhythmias § Delayed effects - delayed reactions r/t destruction of normal cells § Chronic toxicities - r/t organ damage

chemotherapy

During a normal physical assessment of the respiratory system, what body part of the respiratory system has the following assessments: -AP (anteroposterior to lateral) diameter 1:2 -respirations nonlabored at 12-20 breaths/min -breath sounds vesicular without crackles or wheezes -excursion equal bilaterally with no increase in tachile fremitus

chest

The following are complications of ________: · Gangrenous cholecystitis · Subphrenic abscess · Pancreatitis · Cholangitis · Biliary cirrhosis · Fistulas · Gallbladder rupture → peritonitis · Choledocholithiasis

cholecystitis

The following is clinical manifestations of ______: · In addition to pain... o Indigestion o Fever, chills o Jaundice o Pain, tenderness RUQ § Referred to right shoulder, scapula o Nausea/vomiting o Restlessness o Diaphoresis · Inflammation o Leukocytosis o Fever

cholecystitis

The following is clinical manifestations of ______: · Physical examination findings o RUQ or epigastrium tenderness o Abdominal rigidity · Chronic _____________ o Fat intolerance o Dyspepsia o Heartburn o Flatulence

cholecystitis

The following is clinical manifestations of ______: · Vary from severe to none at all · Pain more severe when stones moving or obstructing o Steady, excruciating o Tachycardia, diaphoresis, prostration o May be referred to shoulder/scapula o Residual tenderness in RUQ o Occur 3-6 hours after high-fat meal or when patient lies down

cholecystitis

The following is clinical manifestations of ______: · When total obstruction occurs: o Dark amber urine o Clay-colored stools o Pruritis o Intolerance to fatty foods o Bleeding tendencies o Steatorrhea

cholecystitis

what gallbladder disease has the following etiology and pathophysiology: · Inflammation o Confined to mucous lining or entire wall o Gallbladder is edematous and hyperemic o May be distended with bile or pus o Cystic duct may become occluded o Scarring and fibrosis after attack

cholecystitis

what gallbladder disease has the following etiology and pathophysiology: · Most commonly associated with obstruction from stones or sludge · Acalculous cholecystitis o Older adults and critically ill o Prolonged immobility, fasting, prolonged parenteral nutrition, diabetes o Bacteria or chemical irritants o Adhesions, neoplasms, anesthesia, opioids · Inflammation o Confined to mucous lining or entire wall o Gallbladder is edematous and hyperemic o May be distended with bile or pus o Cystic duct may become occluded o Scarring and fibrosis after attack

cholecystitis

The following is interprofessional care of _________: · NG tube for severe nausea/vomiting · Cholecystotomy o Gallstones are not usually treated with drugs, because of the high use and success of laparoscopic cholecystectomy.

cholelithiasis

The following is interprofessional care of _________: · Opioids for pain control · Anticholinergics o Decrease GI secretions o Counteract smooth muscle spasms

cholelithiasis

The following is interprofessional care of _________: · Treatment dependent on stage of disease · Oral dissolution therapy · ERCP with sphincterotomy · Extracorporeal shock-wave lithotripsy (ESWL) · Control possible infection o Antibiotic treatment · NG tube for severe nausea/vomiting · Cholecystotomy o Gallstones are not usually treated with drugs, because of the high use and success of laparoscopic cholecystectomy. · Opioids for pain control · Anticholinergics o Decrease GI secretions o Counteract smooth muscle spasms

cholelithiasis

what gallbladder disease has the following etiology and pathophysiology: · Stasis of bile → supersaturation and changes in composition of bile (biliary sludge) · Immobility, pregnancy, and inflammatory or obstructive lesions of biliary system ↓ bile flow · Stones may remain in gallbladder or may migrate to cystic or common bile duct · Cause pain as they pass through ducts o May lodge in ducts and produce an obstruction

cholelithiasis

what gallbladder disease has the following etiology and pathophysiology: · Stones may remain in gallbladder or may migrate to cystic or common bile duct · Cause pain as they pass through ducts o May lodge in ducts and produce an obstruction

cholelithiasis

what gallbladder disease is described below: o Most common disorder of biliary system o Stones in gallbladder

cholelithiasis

What diagnostic study is described below: A blood lipid. Elevated cholesterol is considered a risk factor for CV disease Reference interval: • < 200 mg/dL (<5.18 mmol/L) (Varies with age and gender)

cholesterol

What is the treatment for bile reflux gastritis which is a complication of gastrectomy (treatment for PUD)?

cholesystramine (binds to bile acids)

Acute or Chronic? o Prolonged (lasts 3 months or more) o Do not resolve spontaneously

chronic

Acute or Chronic? o Prolonged (lasts 3 months or more) o Do not resolve spontaneously o Rarely completely cured (but can be managed) o Irreversible pathologic changes (to body systems) o Residual disability (something that impacts the patient's life and ability to function) o Special rehabilitation o Long-term nursing/medical management

chronic

Acute or Chronic? o Rarely completely cured (but can be managed)

chronic

Acute or Chronic? o Residual disability (something that impacts the patient's life and ability to function)

chronic

Acute or Chronic? o Special rehabilitation o Long-term nursing/medical management

chronic

_________ Inflammation is an underlying factor in many diseases o obesity, diabetes, long-term infections or diseases such as COPD all can lead body in _______ state of inflammation. when you look at them, you cannot look at them and see it; it is internal. o maintaining good health is very important to prevent these diseases that cause the _________ inflammation • Also ↑ in burns, transplant rejection

chronic

inflammation may be _____: An ongoing response to a chronic condition EX: autoimmune disease,

chronic

• Alzheimer's disease • Arthritis • Cancer • COPD/Asthma • CAD • Diabetes • Heart Failure • Obesity • HIV/AIDS • Kidney Disease • Many autoimmune diseases These are examples of acute or chronic disease?

chronic

presence of cough and sputum production for at least 3 months in each of 2 consecutive years, not necessarily associated with airflow limitation **Chronic airway inflammation; restricts airflow and sputum causes chronic cough **COPD

chronic bronchitis

The following is talking about complications: _____ _______: · Risk factors - Male, ETOH use, fatty liver, excess iron, metabolic syndrome, HIV · HCV infection is more likely than HBV to become chronic · Manifestations o Anemia o Coagulation problems - bruising/bleeding o Skin manifestations · May lead to ascites, cirrhosis, portal hypertension, liver cancer

chronic hepatitis

____ _______: · Manifestations o Anemia o Coagulation problems - bruising/bleeding o Skin manifestations · May lead to ascites, cirrhosis, portal hypertension, liver cancer

chronic hepatitis

____ ____ ______ progresses: oliguria (less than 400 ml/day)→ anuria (less than 40 ml/day)→ uremia (symptoms of build-up of metabolic wastes; N/V, lethargy, etc). o renal function declines - develops problems in multiple organs (nausea, vomiting, lethargy, fatigue, impaired thought processes, headache) • As GFR drops, osmoreceptors stimulate production of ADH which works in the kidneys to help with water reabsorption.

chronic kidney disease (CKD)

_____ ____ _____: • Know your risk • Over 26 million Americans; 70% are unaware • Involves progressive, irreversible destruction of the nephrons in both kidneys • End result is a systemic disease involving every organ • Up to 80% of the GFR may be lost with few changes in the functioning of the body o Asymptomatic until significant damage has been done o Very advanced before symptoms are seen

chronic kidney disease (CKD)

_______ ____ _______: o Presence of kidney damage, or o GFR< 60 ml/min for 3 months+ When GFR < 15 ml/min = ESRD • End stage renal disease • Put on dialysis We do not diagnose based on 1 urinalysis or blood test; will have come back in few weeks to check again If low for more than 3 months, then diagnosed with CKD

chronic kidney disease (CKD)

chronic pancreatitis

The following are diagnostic studies (lab tests) for ____ _____: · Stool samples for fat content · CT, MRI, MRCP, abdominal and/or endoscopic ultrasonography · Fat-soluble vitamin and cobalamin levels (↓) · Glucose tolerance/FBG/ · A1C · Secretin stimulation test

chronic pancreatitis

The following are diagnostic studies (lab tests) for ____ _____: · Serum amylase/lipase levels · May be ↑ slightly or not at all · ↑ Serum bilirubin level · ↑ Alkaline phosphatase level · Mild leukocytosis · ↑ Sedimentation rate · ERCP · Stool samples for fat content · CT, MRI, MRCP, abdominal and/or endoscopic ultrasonography · Fat-soluble vitamin and cobalamin levels (↓) · Glucose tolerance/FBG/ · A1C · Secretin stimulation test

chronic pancreatitis

The following is the pathophysiology of ___ ______: · Two major types · ________ obstructive ___________ o Inflammation of sphincter of Oddi o Cancer of ampulla of Vater, duodenum, or pancreas · ________ nonobstructive __________ o Inflammation and sclerosis in head of pancreas and around duct o Most common cause is alcohol abuse

chronic pancreatitis

With interprofessional care of a patient with _____ ______: o Choledochojejunostomy § A choledochojejunostomy diverts bile around the ampulla of Vater, where there may be spasm or hypertrophy of the sphincter. In this procedure, the common bile duct is anastomosed into the jejunum. o Roux-en-Y pancreatojejunostomy § Another type of surgical diverting procedure is the Roux-en-Y pancreatojejunostomy, in which the pancreatic duct is opened and an anastomosis is made with the jejunum.

chronic pancreatitis

With interprofessional care of a patient with _____ ______: · Analgesics for pain relief (morphine or fentanyl patch) · No alcohol or caffeine · Insulin or oral hypoglycemic agents · Acid-neutralizing and acid-inhibiting drugs · Pancreatic enzyme replacement · Bland, low-fat diet · Small, frequent meals · No smoking · Bile salts · Antidepressants · Surgery o Indicated when biliary disease is present or if obstruction or pseudocyst develops § When biliary disease is present or if obstruction or pseudocyst develops, surgery may be indicated. o Diverts bile flow or relieves ductal obstruction § Surgical procedures can divert bile flow or relieve ductal obstruction. o Choledochojejunostomy § A choledochojejunostomy diverts bile around the ampulla of Vater, where there may be spasm or hypertrophy of the sphincter. In this procedure, the common bile duct is anastomosed into the jejunum. o Roux-en-Y pancreatojejunostomy § Another type of surgical diverting procedure is the Roux-en-Y pancreatojejunostomy, in which the pancreatic duct is opened and an anastomosis is made with the jejunum. · Endoscopic procedures o Pancreatic drainage o ERCP with spincterotomy and/or stent placement

chronic pancreatitis

With interprofessional care of a patient with _____ ______: · Endoscopic procedures o Pancreatic drainage o ERCP with spincterotomy and/or stent placement

chronic pancreatitis

With interprofessional care of a patient with _____ ______: · Pancreatic enzyme replacement · Bland, low-fat diet · Small, frequent meals · No smoking · Bile salts · Antidepressants

chronic pancreatitis

With interprofessional care of a patient with _____ ______: · Surgery o Indicated when biliary disease is present or if obstruction or pseudocyst develops § When biliary disease is present or if obstruction or pseudocyst develops, surgery may be indicated. o Diverts bile flow or relieves ductal obstruction § Surgical procedures can divert bile flow or relieve ductal obstruction.

chronic pancreatitis

With nursing management of a patient with _____ ______, · Focus is on chronic care and health promotion · Patient and family teaching o Dietary control o Pancreatic enzyme with meals/snack o Observe for steatorrhea o Monitor glucose levels o Antacids after meals and at bedtime o No alcohol

chronic pancreatitis

_____ ______ includes: · Continuous, prolonged inflammatory, and fibrosing process of the pancreas · Etiology o Alcohol, gallstones, tumor, pseudocysts, trauma, systemic disease o Acute pancreatitis o Idiopathic · ______ _________ is a continuous, prolonged, inflammatory, and fibrosing process of the pancreas. o The pancreas becomes progressively destroyed as it is replaced with fibrotic tissue. o Strictures and calcifications may also occur in the pancreas. · can result from alcohol abuse; obstruction due to cholelithiasis (gallstones), tumor, pseudocysts, or trauma; and systemic diseases (e.g., systemic lupus erythematosus), autoimmune pancreatitis, and cystic fibrosis. In some patients, there may not be an identifiable risk factor (idiopathic pancreatitis). · may follow acute pancreatitis, but it may also occur in the absence of any history of an acute condition.

chronic pancreatitis

_____ ______ includes: · can result from alcohol abuse; obstruction due to cholelithiasis (gallstones), tumor, pseudocysts, or trauma; and systemic diseases (e.g., systemic lupus erythematosus), autoimmune pancreatitis, and cystic fibrosis. In some patients, there may not be an identifiable risk factor (idiopathic pancreatitis). · may follow acute pancreatitis, but it may also occur in the absence of any history of an acute condition.

chronic pancreatitis

chronic renal failure

The following are the leading causes of ____ ____ ______: • Diabetes Mellitus (nephropathy) • Hypertensive disease • Glomerulonephritis o antibody-induced inflammation of the glomerulus o an autoimmune inflammation of the glomerulus that causes scarring and destruction of glomeruli • Nephrotic Syndrome o massive proteinuria (protein loss) with edema, inflammation, hyperlipidemia, hypercoagulability (more prone to blood clots) o lots of protein loss • PolyCystic Kidney Disease o Genetic disease that causes multiple cysts in kidneys that prevent kidneys from functioning • Other Causes o rhabdomiolysis, atherosclerosis, hypotension rhabdominolysis: rapid breakdown of muscle tissue that can be caused by excessive exertion coupled with dehydration. Cross fit has kinda corrected that.

chronic renal failure

The following are the leading causes of ____ ____ ______: • Nephrotic Syndrome o massive proteinuria (protein loss) with edema, inflammation, hyperlipidemia, hypercoagulability (more prone to blood clots) o lots of protein loss • PolyCystic Kidney Disease o Genetic disease that causes multiple cysts in kidneys that prevent kidneys from functioning

chronic renal failure

The following are the leading causes of ____ ____ ______: • Other Causes o rhabdomiolysis, atherosclerosis, hypotension rhabdominolysis: rapid breakdown of muscle tissue that can be caused by excessive exertion coupled with dehydration. Cross fit has kinda corrected that.

chronic renal failure

What special population of older adults is described below: o 3x more likely to develop a chronic illness after age 45 o After 45, the chances of developing a chronic disease goes up each year

chronically ill

What risk factor for primary HTN is described below: o Smoking tobacco greatly increases risk of CV disease o People with HTN who smoke tobacco are at even greater risk for CV disease

cigarette smoking

what is the #1 reason people get COPD?

cigarette smoking

The following are clinical manifestations of _________: · Neurologic: hepatic encephalopathy, peripheral neuropathy, asterixis · GI: anorexia, dyspepsia, N/V, change in bowel habits, dull abdominal pain, fetor hepaticus, esophageal and gastric varices, gastritis, hematemesis, hemorrhoidal varices · Reproductive: amenorrhea, testicular atrophy, gynecomastia (male), impotence · Integumentary: jaundice, spider angioma, palmar erythema, purpura, petechiae, caput medusae · Hematologic: anemia, thrombocytopenia, leukopenia, coagulation disorders, splenomegaly · Metabolic: hypokalemia, hyponatremia, hypoalbuminemia · CV: fluid retention, peripheral edema, ascites

cirrhosis

The following are overall goals of a pt with _______: · Relief of discomfort · Minimal to no complications · Return to as normal a lifestyle as possible **nursing management planning: overall goals

cirrhosis

The following is clinical manifestations of _______: o Hematologic disorders o Endocrine disturbances - Gynecomastia, testicular atrophy, impotence, amenorrhea or vaginal bleeding, Hyperaldosteronism in both sexes o Peripheral neuropathies - vitamin deficiencies

cirrhosis

The following is clinical manifestations of _______: · Fatigue and enlarged liver may be early symptoms (liver is not metabolizing nutrients taken in that can be utilized in the body and toxins are building up in the body that the liver cannot filter out) · Late manifestations - liver failure and portal hypertension o Jaundice, peripheral edema, ascites § Ascites can be profound and look like they are pregnant o Skin lesions - increase in circulating estrogen caused by inability of liver to metabolize steroid hormones § Spider angiomas; Palmar erythema o Hematologic disorders o Endocrine disturbances - Gynecomastia, testicular atrophy, impotence, amenorrhea or vaginal bleeding, Hyperaldosteronism in both sexes o Peripheral neuropathies - vitamin deficiencies

cirrhosis

The following is clinical manifestations of _______: · Late manifestations - liver failure and portal hypertension o Jaundice, peripheral edema, ascites § Ascites can be profound and look like they are pregnant o Skin lesions - increase in circulating estrogen caused by inability of liver to metabolize steroid hormones § Spider angiomas; Palmar erythema

cirrhosis

The following is interprofessional care of _______: · Rest o Fatigue is the most troublesome factor for these pts · Administration of B-complex vitamins o (causing peripheral neuropathy) · Avoidance of alcohol o (including liquid OTC drugs) · Minimization or avoidance of aspirin, acetaminophen, and NSAIDs

cirrhosis

The following is pt and caregiver teaching with _____: --explain that ____ is a chronic illness and requires continual health care --teach the symptoms of complications and when to seek medical attention and to enable prompt treatment --teach the pt to avoid potentially hepatotoxic OTC drugs, because the diseased liver is unable to metabolize them. --encourage abstinence from alcohol because continues use increases the rate of liver disease progression and risk of liver complications

cirrhosis

When talking about nursing management: health promotion of _______: · Reduce or eliminate risk factors · Treat alcoholism · Maintain adequate nutrition · Identify and treat acute hepatitis · Bariatric surgery for morbidly obese

cirrhosis

With nursing management: evaluation of ______: · Maintenance of food/fluid intake to meet needs · Maintenance of skin integrity · Normalization of fluid balance · Treatment for substance abuse

cirrhosis

the following are nursing diagnoses for _________: · Imbalanced nutrition: less than body requirements · Impaired skin integrity · Excess fluid volume · Ineffective health management · Dysfunctional family processes

cirrhosis

· End-stage of diseased liver · Extensive degeneration and destruction of liver cells **Results in replacement of liver tissue by fibrous and regenerative nodules

cirrhosis

What class of the NYHA Functional Classification of Heart Disease (based on physical activity tolerance) is described below: Inability to carry on any physical activity without discomfort. Symptoms of cardiac insufficiency or of angina may be present even at rest. If any physical activity is undertaken, discomfort is increased. EX: any physical activity at all is not possible

class 4

The classic symptoms of lower extremity PAD is intermittent _________. This ischemic muscle pain is caused by exercise, resolves within 10 minutes or less with rest, and is reproductible. The ischemic pain is due to the buildup of lactic acid from anaerobic metabolism. Once the patient stops exercising, the lactic acid is cleared and the pain subsides. PAD of the iliac arteries produces _________ in the buttocks and thighs. Calf _________ indicates femoral or popliteal artery involvement.

claudication

The following are HTN ____ _____: • Frequently asymptomatic ("Silent Killer") • Increased duration and severity >>> target organ damage >>> symptoms o Fatigue o Reduced activity tolerance o Dizziness o Palpitations, angina o Dyspnea

clinical manifestations

What side effect of radiation and chemotherapy is described below: •"Chemo Brain": mental cloudiness and fog common •Possible thinking and Memory Deficits •The effects can normal school, work, or social activities

cognitive effects

What special population of older adults is described below: o EX: dementia, delirium, and depression o Trouble with synthesis of new information If you move someone to a nursing home or new home, it is difficult for them to meet and know new people because they have trouble synthesizing the new information o Problem solving EX: they go to the grocery store and they change the layout of the store, someone with cognitive impairment may not know what to do and may leave o Logical thinking

cognitively impaired

Risk factor modification, exercise therapy, nutritional therapy, complementary and alternative therapies, care of the leg with critical limb ischemia, drug therapy fall under the _______ care for a patient with PAD.

collaborative

What 2 parts of the body does ulcerative colitis affect?

colon and rectum

What type of ostomy has the following output: o approximately 600-1000ml/24hrs § ascending - similar to ileostomy § transverse - pasty to semisolid § descending - semisolid to formed

colostomy

What type of ostomy is described below: · fecal diversion in which part of the large intestines (colon) is used to create the stoma · Locations: o Ascending o Transverse o Descending/Sigmoid

colostomy

What drug to treat COPD is described below: o LABA with ICS (Advair, Symbicort) o Anticholinergic/SABA (DuoNeb, Combivent)

combo meds

What stage of chronic illness trajectory is described below: -gradual return to an acceptable way of life

comeback (4)

Patients who are cirrhotic but who have no obvious complications are considered to have _______ cirrhosis.

compensated

Neuro-Hormonal response, SNS activation, cardiac dilation, and hypertrophy are _______ mechanisms of HF.

compensatory

When providing _____ care to older adults: • Cultural competence o Same as for all clients • Ethnogeriatric described the specialty area of providing culturally competent care to older adult patients

competent

When talking about mediators of inflammation, What mediator is described below: Source: anaphylatoxic agents generated from complement pathway activation Mechanism of action: stimulate histamine release and chemotaxis

complement components (C3a, C3a, and C5a)

The ___ _____ is an enzyme cascade (C1-C9) consisting of pathways to mediate inflammation and destroy invading pathogens. Major functions of the ____ _____ are enhanced phagocytosis, increased vascular permeability, chemotaxis, and cellular lysis.

complement system

Major ________ of cirrhosis are portal hypertension with resultant esophageal and/or gastric varices, peripheral edema and ascites, hepatic encephalopathy (mental status changes, including coma), and hepatorenal syndrome.

complications

The following are HTN ______: • Hypertensive Heart disease • CAD • LVH • HF • Cerebral VD o HTN is a risk factor for atherosclerosis, which is the most common cause of cerebrovascular disease • PVD - advances atherosclerosis • Nephrosclerosis - ischemia from stenosis (HTN leading cause of renal disease) • Retinal Damage - blurring to loss of vision; retinal hemorrhage

complications

The following are _____ of urinary diversions: · Atelectasis · Paralytic ileus · Small bowel obstruction · Thrombophlebitis · Metabolic complications (with ileal conduit diversions and neobladders) · Diarrhea and malabsorption (from bowel resection)

complications

The following are _______ of cirrhosis: --portal HTN --esophageal and gastric varices --peripheral edema --abdominal ascites --hepatic encephalopathy --hepatorenal syndrome

complications

The following are post-op _______ of surgical therapy for disorders of the female urogenital tract (cystocele and rectocele): · Bleeding · Infection · Thromboembolism · Difficulty emptying the bladder · UTI (cystocele) · Constipation (rectocele) · Painful intercourse

complications

The following are potential metabolic ______ of urinary diversions: · Storage of urine in a reservoir constructed from the GI gastrointestinal system · Neobladder mucosa reabsorbs ions and fluid from urine leading to metabolic acidosis · Reservoir reabsorbs ammonium, leads to ↑ plasma urea and creatinine levels · Systemic alkalization to prevent or alleviate bone demineralization from metabolic acidosis

complications

What part of RICE serves to counter the vasodilation effects and development of edema. Immobilization promotes healing by decreasing the tissues' metabolic needs. Immobilization with a cast or splint supports fractured bones and prevents further tissue injury from sharp bone fragments that could sever nerves or blood vessels (causing hemorrhage).

compression

The electrical impulse normally begins in the SA node (pacemaker of the heart). Each impulse coming down from the SA node travels through interartrial pathways to depolarize the atria, resulting in a contraction. The electrical impulse travels from the atria to the AV node through internodal pathways. The signal then moves through the bundle of His and the L and R bundle branches. The L bundle branch has 2 fascicles (divisions): anterior and posterior. The action potential moves through the walls of both ventricles by means of Purkinje fibers. The ventricular conduction system delivers the impulse within 0.12 seconds. This triggers a synchronized R and L ventricular contraction and ejection of blood into the pulmonary and systemic circulations

conduction system of heart

With treatment of hypoglycemia: o _______ patient Below 70 with symptoms: 15g quick-acting carbohydrate wait 15 minutes Recheck CBG Repeat until CBG > 70/stable Follow with slowly absorbed carbohydrate

conscious

The following is treatment post-op nursing management for disorders of the female urogenital tract (cystocele and rectocele): · Prevent _________ early ambulation, laxatives o Adequate fluids o Adequate fiber intake o May need stool softeners because _________ and straining can press on the sutures

constipation

With nursing management of cirrhosis (acute care)--> hepatic encephalopathy: · Minimize _________: o Any GI bleeding may worsen encephalopathy. Assess the patient taking lactulose for diarrhea and excessive fluid and electrolyte losses. · Encourage fluids, if not contraindicated.

constipation

The following are nursing diagnoses for a ____ _____ (Surgery for IBD): · R.C. Electrolyte imbalance · Risk for deficient fluid volume / R.C. hypovolemia · Imbalanced nutrition: < body requirements · Risk for impaired skin integrity · Pain · Risk for infection (corticosteroids, immuno-suppressants) · Ineffective coping / Anxiety · Impaired body image · Risk for social isolation · Ineffective therapeutic regimen management

continent ileostomy

The following is evaluation for a _____ ____(surgery for IBD): · Fewer, firmer stools · Maintenance of body weight and nutrition · Maintenance of fluid and electrolyte balance · No infections · No evidence of skin breakdown · Fewer relapses · Decreased anxiety · Use of effective coping strategies

continent ileostomy

The following is nutrititonal therapy for a ____ _____ (surgery for IBD): · Dietary consult · Adequate nutrition without exacerbating symptoms · High-calorie, high-protein, low-residue diet · Correct and prevent malnutrition · Replace fluid and electrolyte losses · Vitamin and iron supplements · Parenteral nutrition (only during acute exacerbations)

continent ileostomy

The following is teaching needs for a patient with a _____ _____ (surgery for IBD): · Keep hydrated, replace electrolytes · Pain management · Importance of rest and diet management · Maintain/improve weight · Prevent infections · Perianal care · Action and side effects of drugs · Symptoms of recurrence; when to seek medical care · Use of diversional activities to reduce stress · Ostomy care if appropriate

continent ileostomy

With a _____ ______ (surgery of IBD), ileostomy postoperative care includes the following: · Chew food carefully · Change ostomy bag immediately if seeping intestinal content · Consult wound care nurse if peristomal skin is irritated · Teach ostomy care and dehydration precautions

continent ileostomy

With a _____ ______ (surgery of IBD), ileostomy postoperative care includes the following: · May have an NGT - removed when bowel function is returned · Patients with Crohn's - high risk for post-op bowel obstruction (within 30 days post-surgery) · Do not irrigate o Do not irrigate ileostomies o Dehydration risk

continent ileostomy

With a _____ ______ (surgery of IBD), ileostomy postoperative care includes the following: · assess stoma viability - mucocutaneous juncture and peri-stomal skin integrity **high risk for infection!! o Mucocutaneous juncture - where the stoma meets the skin · Monitor I&O including output from stoma - could be 1500- 2000 ml in 24 hours · Monitor F&E status · Focused abdominal assessment · Watch for bowel obstruction, hemorrhage or blood loss, abdominal abscesses · May have an NGT - removed when bowel function is returned · Patients with Crohn's - high risk for post-op bowel obstruction (within 30 days post-surgery) · Do not irrigate o Do not irrigate ileostomies o Dehydration risk · Chew food carefully · Change ostomy bag immediately if seeping intestinal content · Consult wound care nurse if peristomal skin is irritated · Teach ostomy care and dehydration precautions

continent ileostomy

What type of urinary diversion is described below: · An intra-abdominal urinary reservoir is created that is catheterized, or may have an outlet controlled by the anal sphincter · Procedure similar to ileal conduit · The bowel segment is altered to prevent peristalsis · Intermittent catheterization q 4 -6 hours (with no normal desire to void) · No need to wear an external attachment

continent urinary diversions

_________ glucose monitoring: o Can be matched with insulin pumps o Assesses interstitial glucose (in tissues) - lags behind CBG by 20min o Good for identifying trends and managing insulin needs - helpful to control hyper/hypogycemia

continuous

_________ (inotropic) state of the heart refers to the vigor of contraction generated by the myocardium regardless of its volume (preload). Any increase in these, will be followed by increase in the workload of the heart and increased oxygen demand.

contractile

To ______ symptoms of chronic illnesses the patient should adhere to: • Prescribed treatments o If they have to check blood sugar, prepare insulin, and administer insulin they need to plan that into schedule so they can manage that. • Lifestyle

control

When performing a nursing assessment on a patient with HF, what are some things you will see when looking at skin?

cool, diaphoretic skin. Cyanosis or pallor. Peripheral edema (right sided HF)

Under interprofessional care: COPD complications, what COPD complication is described below: o Caused primarily by constriction of pulmonary vessels due to alveolar hypoxia o Typically large pulmonary vessels appear on CXR with high pressures on right side of heart o BNP, echocardiogram may reflect right-sided heart failure o Treatment targets managing the COPD o Oxygen therapy if needed - low flow, long-term o Diuretics

cor pulmonale (R sided HF)

__________ are antipyretic through the dual mechanisms of preventing both cytokine production and PG synthesis.

corticosteroids

what 3 drugs with drug therapy for MS increases the risk for infection?

corticosteroids, immunosuppressants, and immunomodulators

When performing a PE on urinary system ____ _____ is when you thump on area of lower ribs and if it hurts it may be something wrong with kidneys.

costovertebral tenderness

What diagnostic study of the urinary system is described below: Nursing Responsibility: During: collect 24 hr urine specimen. Discard first urination when test is started. Save urine from all subsequent urinations for 24 hours. Instruct the patient to urinate at end of 24 hours and add specimen to collection. Ensure than serum creatine is determined during 24 hour period.

creatine clearance

Conservative management of ____ _____ ______ includes protecting the extremity from trauma, decreasing ischemic pain, preventing and controlling infection, and improving perfusion. Carefully inspect, cleanse, and lubricate feet to prevent cracking of the skin and infection. Avoid lubrication between the toes and soaking the patient's feet to prevent skin maceration (or breakdown). If ulceration is present, keep the affected foot clean and dry. Cover any ulcers with a dry, sterile dressing to maintain cleanliness. Deep ulcers can be treated with a variety of wound care products, but healing is unlikely without increased blood flow. Systemic antibiotics are used in patients with CLI, skin ulcerations, and limb infection

critical limb ischemia

_____ ______ ______ is a condition characterized by chronic ischemic rest pain lasting more than 2 weeks, arterial leg ulcers, or gangrene of the leg as a result of PAD. Patients with PAD who also have diabetes, heart failure, and a history of a stroke are at increased risk for ____ _____ ______.

critical limb ischemia

What surgical therapy to treat PAD includes PTA (percutaneous transluminal angioplasty) and cold therapy? *the cooling of smooth muscle limits cell activity **interprofessional care

cryoplasty

What are the 3 overall goals of interprofessional care of cancer?

cure, control, palliative

what type of lupus is discoid lupus and is: o Limited to the skin, no organ damage o Most common symptom is circular rash o Disc shaped rash, looks like someone got burned by hot coins

cutaneous lupus erythematosus

What assessment abnormality of the respiratory system is described below: Description: bluish color of skin best seen in lips and on the palpebral conjuctiva (inside the lower eyelid) Possible Etiology and Significance: refects 5-6 g of hemoglobin not bound with O2. decreased O2 transfer in lungs, decreased cardiac output. Nonspecific, unreliable indicator

cyanosis

What disorder of the female urogenital tract is described below: · - Protrusion of the bladder through a weakened anterior vaginal wall · Risk factors o multiple vaginal deliveries o obesity

cystocele

What disorder of the female urogenital tract is described below: · - Protrusion of the bladder through a weakened anterior vaginal wall · Risk factors o multiple vaginal deliveries o obesity · Symptoms o urine leakage with sneeze, cough, laugh o incomplete bladder emptying o feeling of pelvic pressure o bladder infections

cystocele

What disorder of the female urogenital tract is described below: · Symptoms o urine leakage with sneeze, cough, laugh o incomplete bladder emptying o feeling of pelvic pressure o bladder infections

cystocele

Pathologic conditions with similar symptoms are often confused. For example, _______ may be misdiagnosed and treated as dementia. _______ is more common; part of this has to do with changes in brain chemistry and part of this has to also do with increasing health concerns and social isolation. • They have more trouble with ADLs (more likely to have arthirits and mobility issues **atypical symptoms of older adults

depression

Insulin ______ include: Prefilled pens, reusuable pens, and jet injectors AND an insulin pump. o Dietary compliance, regular monitoring of blood glucose o Prefilled pens are prefilled with certain amount of insulin that has dial that can be turned to how many units you want to give. ALWAYS change needle after done. o Jet injectors are for people who are needlephobic. It is under a high pressure that gives a puff of air that forces insulin into skin

devices

A FPG of equal to or > 126 on 2 separate tests is? **diagnostic study for DM

diabetes

What chronic disease is described below: -affects > 29 million Americans -8.1 million do not know they have the disease -7th leading cause of death

diabetes

• Can lead to blindness, ESRD, non-traumatic lower limb amputations • Major factor r/t heart disease and stroke • Linked to one or a combination of the following factors: o Genetics—plays huge role in type 2 DM o Autoimmune problems o Environment

diabetes

• Chronic multisystem disease related to: • Abnormal insulin production - o Either too little or none at all • Very expensive disease with long term complications makes it devastating o Or both

diabetes

• Four types of diabetes recognized by the American Diabetes Association (ADA) • Most Common o Type 1 Diabetes Mellitus -5 - 10% o Type 2 Diabetes Mellitus - 90-95% • Less Common o Gestational Diabetes - risk for developing Type II Occurs in women during pregnancy Women who have had these diabetes, their offspring are at risk for developing type 2 DM o Diabetes related to other specific causes • Usually related to another disease process or medication • Resolve when treatment is begun or medication is discontinued

diabetes

• Impaired insulin utilization • 29.1 million of U.S. population • 8.1 million haven't been diagnosed and are unaware of disease • 86 million have pre-diabetes • 7th leading cause of death in the U.S • Likely to be underreported

diabetes

What acute complication of hyperglycemia is described below: • Clinical Manifestations o Lethargy, weakness - early signs • Ketonuria, ketonemia • Dehydration, dry mucous membranes, tachycardia, orthostatic hypotension, anorexia, nausea, vomiting •Kussmaul respirations - body's attempt to exhale excess CO2 •Acetone breath - sweet, fruity smelling • Metabolic acidosis o If not treated, severe electrolyte depletion, shock, renal failure, coma, death

diabetes ketoacidosis (DKA)

What acute complication of hyperglycemia is described below: • Profound deficiency of insulin - can't use glucose for energy o Hyperglycemia •Fat broken down for energy - byproduct is ketones which produce metabolic acidosis •More common in Type 1 diabetics • Clinical Manifestations o Lethargy, weakness - early signs • Ketonuria, ketonemia • Dehydration, dry mucous membranes, tachycardia, orthostatic hypotension, anorexia, nausea, vomiting •Kussmaul respirations - body's attempt to exhale excess CO2 •Acetone breath - sweet, fruity smelling • Metabolic acidosis o If not treated, severe electrolyte depletion, shock, renal failure, coma, death

diabetes ketoacidosis (DKA)

what are 2 acute complication of hyperglycemia ?

diabetes ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome

What risk factor for primary HTN is described below: o HTN is more common in patients with diabetes oWhen HTN and diabetes coexist, complications (ex: target organ disease) are more severe

diabetes mellitus

What chronic complication of DM is described below: o Loss of protective sensations (LOPS) o Neuropathic arthropathy (Charcot's Foot) o Ankle/foot changes, can lead to ulceration due to abnormal weight distribution

diabetic foot ulcers

THe following are different nursing _______ related to a patient with HF: • Anxiety o Anxiety related to dyspnea or perceived threat of death AEB restlessness, irritability, expressions of feelings of death threat, "don't leave me alone Iam afraid I might die. • Activity intolerance o Activity intolerance R/T fatigue secondary to cardiac insuffiency and pulmonary congestions AEB SOB, weakness, "I feel too weak to do anything". • Deficient knowledge o Deficient knowledge related to disease process AEB questions about the disease and patient's statements "I don't know why I keep getting sick".

diagnoses

THe following are different nursing _______ related to a patient with HF: • Excess fluid volume (edema) o Excess fluid volume related to cardiac insuffiency secondary to heart failure AEB, lower extremity pitting edema, SOB, cyanosis. • R.C. pulmonary edema • Impaired gas exchange o Impaired gas exchange related to increased preload, mechanical failure, or imobility AEB increased respiratory rate, SOB, dyspnea on exertion and patient's statement "I can't catch my breath". • R.C. electrolyte imbalance • Risk for impaired skin integrity o Risk for imapaired skin integrity related to peripheral edema secondary to heart failure.

diagnoses

The following are COPD nursing _______: • Impaired gas exchange • Ineffective airway clearance • Activity intolerance • Impaired sleep pattern • Risk for self-care deficit • Risk for impaired nutrition < body requirements • Risk for infection • Risk for impaired health-maintenance • R.C. Respiratory Acidosis

diagnoses

The following are nursing _______ for HTN: • Ineffective health management • Anxiety • Sexual dysfunction • Risk for injury (orthostatic hypotension) • Risk for fluid volume deficit (diuretics) • R.C: electrolyte imbalance (diuretics, ACEI, ARB) • Risk for decreased tissue perfusion - renal, cerebral, cardiac

diagnoses

With nursing management of PAD, nursing _______ includes: o Ineffective tissue perfusion (peripheral) o Impaired skin integrity o Activity intolerance o Ineffective self-health management

diagnoses

With nursing management of Venous thrombosis, nursing _______ includes: o Acute pain- venous congestion, inflammation o Ineffective health maintenance - knowledge deficit o Risk for impaired skin integrity - altered tissue perfusion o PC: Bleeding - treatment o PC: PE - embolization, dehydration, immobility

diagnoses

With nursing management of amputation, nursing ______ includes: o Disturbed body image R/T loss of body part and impaired mobility o Impaired skin integrity R/T immobility and improperly fitted prosthesis o Chronic pain R/T phantom limb sensation or residual limb pain o Impaired physical mobility R/T amputation of lower limb

diagnoses

the following are nursing ______ for CKD: • Excess fluid volume • Impaired skin integrity (due to pruritus and possible frost) • Risk for injury (injury to other organs) • Activity intolerance (fatigues very easily) • Imbalanced nutrition < body requirements (have some anorexia so will not be eating as much ) • Risk for infection • Grieving (losing kidneys; people grieve for things like that; losing normal way of living) • Risk for ineffective therapeutic regime mgt. (can be pretty complicated, the diet, medications, fluid restriction, fitting into lifestyle and a lot of times things get let go) • Altered body image o I they are having a lot of edema or have a vascular access or just how they feel about their body letting them down or not taking care of them like it should

diagnoses

With nursing management of DM, ________ includes: • Risk for Unstable Blood Glucose • Ineffective self health management • Risk for Injury • Risk for Peripheral Neurovascular Dysfunction

diagnosis

With the _______ of cancer: · ****PREVENTION is key!*** o Screenings · Health history - emphasis on risk factors · Physical exam · Specific studies - biopsy, tumor markers, · genetic markers, cytology (PAP smear), x-rays, CT, MRI, PET scan, endoscopy · Diagnostic studies are going to depend on the suspected primary or metastasized site.

diagnosis

Blood, Non-invasive, and invasive are the different venous?

diagnostic studies

Health history, physical exam, doppler use, doppler ultrasound with duplex imagine, segmented blood pressures, angiography and magnetic resoncance angiography, and ankle-brachial index are the different PAD?

diagnostic studies

The following are ____ ____ for cirrhosis: · Liver enzyme tests · Total protein, albumin levels · Serum bilirubin, globulin levels · Cholesterol levels · Prothrombin time · Ultrasound elastography · Liver biopsy - Gold Standard!

diagnostic studies

The following are _____ ______ on patients for HF: • History and physical examination • Chest Xray: pulmonary edema, cardiomegaly, pleural effusions • ECG: rhythm and conduction disturbances, signs of ischemia • Echocardiogram: evaluates left ventricle • Blood tests o ABGs, cardiac enzymes, BNP, electrolytes, CBC, liver function test, BUN, creatinine, lipid profile, FBG, thyroid studies ABGs: arterial blood gases Cardiac enzymes: Tell if there has been ishemic damage to heart BNP: Elevated over 100 is sign of HF Lipid profile: tells risk factors FBG: fasting blood glucose; long standing diabetes leads to HF • Nuclear imaging studies: evaluate ventricles o Function of ventricles • Cardiac catheterization: evaluate ejection fraction o To accurately measure ejection fraction • Hemodynamic studies o Blood pressure, capillary wedge pressure, etc • NYHA Classification System o places patient on a continuum of improvement or decline o guides treatment decisions/nursing care o based on symptoms patient is having now

diagnostic studies

What part of interprofessional care of HTN is described below: o H&P with ophthalmic exam o Routine UA: urinalysis; tells us function of the kidneys Looking at urine specific gravity o BMP (basic metabolic panel) BMP (glucose, Na, K, Cl, CO2, BUN, Creatinine); lipid panel -total lipids, triglycerides, HDL, LDL, cholesterol, total to HDL cholesterol ratio o Serum Calcium, magnesium, uric acid o Lipid Panel: looks at cholesterol o 12-lead EKG

diagnostic testing

The following are the general principles of ______: • Diffusion: o urea, creatinine, uric acid, K, PO4 move from the blood to the dialysate solution used to draw out these things • Osmosis: o glucose is added to the dialysate to create an osmotic gradient pulling excess fluid from the blood into the dialysate • Ultrafiltration: o the gradient to remove more fluid is created by ↑ pressure in the blood compartment (+ pressure) and ↓ pressure in the dialysate compartment (- pressure) o Fluid moves towards the dialysate due to pressure gradient

dialysis

• uremia can no longer be adequately managed conservatively with medication or conservative treatment o GFR <15 ml / min o Emphasis on clinical manifestations Two Types o Peritoneal dialysis o Hemodialysis

dialysis

Left ventricular (LV) ________ failure is also known as heart failure preserved ejection fraction or HRpEF. This type of HF is the inability of the ventricles to relax and fill during diastole Approximately 50% of patients with HF have HFpEF. Other risk factors include old age, female gender, diabetes, and obesity In _______ failure, the LV is generally stiff and noncompliant. It is characterized by high filling pressures because of stiff ventricles. Decreased filling of the ventricles results in decreased stroke volume and CO. the end result of diastolic HF is the same as systolic failure (Ex: pulmonary congestion). HFpEF is diagnosed by the following criteria: signs of _________ dysfunction , normal EF, evidence of LV ________ dysfunction by echocardiography or cardiac catheterization

diastolic

What drug used to treat HTN is described below: decrease the BP by relaxing vascular smooth muscle and reducing SVR.

direct vasodilators

When talking about drug therapy for treating HTN, what type drug has the following nursing considerations: • Nursing considerations: IV use only for hypertensive crisis in hospitalized patients. Given by continuous infusion

direct-acting vasodilators

The following are ______ of chemotherapy treatment for cancer: -Does not distinguish between normal or abnormal cells. -Acute (Immediate) Toxicity: -possible life threatening anaphylaxis or cardiac arrhythmia -Delayed Effects: -due to the destruction of normal cells Chronic Toxicities: -due to possible organ damage

disadvantages

With management of DM, what component of patient teaching has the following points that need to be taught to the patient and/or caregiver: --include an intro about the pancreas and the islets of Langerhans --describe how insulin is made and what affects it production --discuss the relationship of insulin and glucose --explain the difference between type 1 and 2 diabetes

disease process

What drug used to treat HTN is described below: promote sodium and water excretion, reduce plasma volume, and reduce the vascular response to catecholamines.

diuretics

What part of the treatment plan of a patient with HF is described below: o Accurate I & O o Daily Weights If patient came in with acute decompensated HF they have a lot of fluids so we want to see them lose the weight o Monitor electrolytes

diuretics

When talking about drug therapy for treating HTN, what type drug has the following nursing considerations: Monitor for orthostatic hypotension and electrolyte abnormalities.

diuretics

Diverticulosis or Diverticulitis? o Surgery: § Partial colectomy with end-to-end anastomosis § Partial colectomy with temporary colostomy · Post-Operative Care: o Focused abdominal assessment o Respiratory assessment o Incentive spirometry; cough/deep breathing o Monitor dressing and incision o Manage pain o NGT for post op gastric decompression: check patency, suctioning o Foley: amount of urine, patency, infection o Monitor K, Na, Cl levels (NG suction) o Ostomy care (if present) and teaching as appropriate

diverticulitis

Diverticulosis or Diverticulitis? · Clinical Manifestations: o LLQ cramping pain relieved by passage of flatus or bowel movement o Abdomen distended and tender o Palpable mass LLQ o Thin or pellet shaped stools o Alternating constipation and diarrhea o May have rectal bleeding o Fever

diverticulitis

Diverticulosis or Diverticulitis? · Complications: o abscess formation o bleeding o perforation o peritonitis o bowel obstruction o fistula formation

diverticulitis

Diverticulosis or Diverticulitis? · Inflammation of a diverticula caused by bacteria and fecal material trapped in the diverticula · Bacteria seeps through the thin wall of the diverticula · When inflammation subsides, healing occurs · Can lead to scaring and stenosis of intestinal wall (intestinal obstruction)

diverticulitis

Diverticulosis or Diverticulitis? · Nursing Diagnoses: o Acute pain (abdominal) o R.C. of GI bleeding (perforated diverticula) o R.C. hypovolemia (diarrhea, bleeding) o R.C. electrolyte imbalance (diarrhea) o R.C. peritonitis o Risk for impaired body image (if ostomy is needed)

diverticulitis

Diverticulosis or Diverticulitis? · Treatment: o Only fluids or NPO - progress as tolerated o IV fluids o Broad spectrum antibiotics o Bedrest o Treat pain o Surgery: § Partial colectomy with end-to-end anastomosis § Partial colectomy with temporary colostomy

diverticulitis

The following is postoperative care of ______: o Focused abdominal assessment o Respiratory assessment o Incentive spirometry; cough/deep breathing o Monitor dressing and incision o Manage pain

diverticulitis

The following is postoperative care of ______: o Focused abdominal assessment o Respiratory assessment o Incentive spirometry; cough/deep breathing o Monitor dressing and incision o Manage pain o NGT for post op gastric decompression: check patency, suctioning o Foley: amount of urine, patency, infection o Monitor K, Na, Cl levels (NG suction) o Ostomy care (if present) and teaching as appropriate

diverticulitis

The following is postoperative care of ______: o Manage pain o NGT for post op gastric decompression: check patency, suctioning o Foley: amount of urine, patency, infection o Monitor K, Na, Cl levels (NG suction) o Ostomy care (if present) and teaching as appropriate

diverticulitis

Diverticulosis or Diverticulitis? · Clinical Manifestations: o Most are asymptomatic · Complications: o Diverticulitis · Diagnosis: o History and physical o CBC, urinalysis o Abdominal Xray o CT scan with oral contrast o Barium enema o Colonoscopy

diverticulosis

Diverticulosis or Diverticulitis? · Etiology: o Appears later in life o 30 million middle aged adults and elderly in the USA o 1/3 of the population by age 50 o More common in Western society o Equally prevalent for men and women o Contributing factors: chronic constipation, dietary fiber deficiency, stress

diverticulosis

Diverticulosis or Diverticulitis? · Pathophysiology: o Outpouchings of intestinal mucosa at weak points in the bowel wall o Due to weakened muscle tone of intestinal wall (structural factor) and increased colon pressure (intraluminal factor) § results in sac-like outpouchings o Most common site is the sigmoid colon

diverticulosis

Diverticulosis or Diverticulitis? · Treatment: o Goal: regular bowel movements and prevent constipation § High fiber diet - 20 grams/day § Bulk agents § Stool softeners § Increase fluid intake

diverticulosis

What PAD diagnostic study is described below: o When palpation of a peripheral pulse is difficult due to severe PAD

doppler use

What type of stoma is described below: o two stomas (proximal is functional, distal is a mucous fistula), used for venting of distal bowel due to infection, obstruction

double barrel

What stage of chronic illness trajectory is described below: -gradual and progressive deterioration in physical or mental status -accompanied by increasing disability and symptoms -continuous alterations in everyday life activities

downward (7)

WIth interprofessional care of CKD, _____ therapy includes: • Anemia o Erythropoietin (stimulates production of RBCs; injection) • Dyslipidemia o Statin drugs • Do not need to know specific details; just know what they are used for.

drug

WIth interprofessional care of CKD, _____ therapy includes: • CKD-MBD o Phosphate binders; calcium acetate, calcium carbonate Can bind to phosphate and promote calcium being moved into the bones Calcium carbonate is a good antacid, can be given for GI problems o Vitamin D Promotes reabsorption of phosphate into the bones

drug

WIth interprofessional care of CKD, _____ therapy includes: • Hyperkalemia o _____ therapy to remove excess K+ o Emergency Treatments: IV Regular insulin & glucose - moves K into cells; Potential hypoglycemia • Insulin pushes glucose into cells and when glucose moves into cells, potassium goes with it • Problem is potential for hypoglycemia IV 10 % calcium gluconate - K binding; Stabilizes Myocardium • Prevents arrhythmias associated with hyperkalemia When doing either of these, want aour patient on a continuous EKG monitor o K Xalet (oral); binds to potassium before can be absorbed into blood stream

drug

What part of interprofessional care of HTN is described below: o Age > 60 - start BP meds for SBP > 150 and/or DBP > 90 and treat to SBP < 150 and/or DBP < 90 o Age < 60 - treatment initiation and goals for 140/90 mm Hg Meds: diuretics, direct-acting vasodilators, calcium channel blockers, ACE inhibitors, A-2 receptor blockers (ARBs)

drug therapy

what type of lupus is described below: o Temporary lupus symptoms o When you discontinue the medication that is used to treat lupus, it will go away

drug-induced systemic lupus

what percussion sound is described below: sound with medium-intensity, pitch, and duration heard over areas of "mixed" solid and lung tissue, such as top area of liver, partially consolidated lung tissue (pneumonia) or fluid-filled pleural space

dull

What post-op complication of gastrectomy in treatment of PUD is described below: o with surgical removal of a large part of the stomach and the pyloric sphincter o Hyperosmolar fluid dumped into bowel o Occurs 15-20 min post meal o Treatment dry foods with low CHO content, small amount of food, rest after meals, no fluids with meals § Should drink fluids before or a couple of hours after the meal but NOT WITH the meal.

dumping syndrome

With PUD, ______ ulcers have the following clinical manifestations: o Pain***** § burning, cramplike § Mid epigastrium, below xiphoid § 2-5 hours after a meal (waiting on the food and secretions to move from the stomach to the duodenum) o Pain relief with antacids and food § Takes up some of the HCL diminishing irritation to duodenum o Occurs underneath the sternum

duodenal

When talking about the etiology of PUD, ______ _____ are 80% of the ulcerations. o Lacks protective mechanisms that stomach lining has o The duodenum has less of that protective lining like the stomach has

duodenal ulcers

What type of ostomy is described below: · not frequently done; both created in LUQ; high volumes of liquid output; effluent contains activated digestive enzymes causing peristomal moisture associated skin damage; high risk for dehydration and electrolyte imbalance.

duodenostomy and jejunostomy

What stage of chronic illness trajectory is described below: -patient has to relinquish everyday life interests and activities, let go, and die peacefully -immediate weeks, days, hours preceding death

dying (8)

what clinical manifestation of MS is described below: § Scanning (explosive) · Scanning speech, also known as explosive speech, is a type of ataxic dysarthria in which spoken words are broken up into separate syllables, often separated by a noticeable pause, and spoken with varying force o Talk slow and then finish out o Impulses are having trouble to get to mouth to talk and then come all at once

dysarthria

what precipitating factor of HF is described below: May decrease CO and increase workload and oxygen requirments of myocardial tissue

dysrhythmias

The following falls under patient _______ for COPD: • Controlled breathing techniques • Airway clearance techniques • Energy conservation • Medications o Correct use of inhalers or nebulizer o TEACHING POINT: have patient SHOW you how to properly use an inhaler!! • Home oxygen o safety • F/U care o Need to go even when feeling well! • S/S to report

education

With HTN patient ______, teach the following: • Identify, report, and minimize side effects such as: orthostatic hypotension, sexual dysfunction, dry mouth, frequent urination • Hypokalemia (with thiazides, loop diuretics) • Hyperkalemia (K-sparing diuretics, ACE inhibitors) • Use caution with OTC drugs • Lifestyle modification, decrease Na+ intake, CV risk factor modification • Beta blockers - caution with lung disease and DM • Rebound HTN if meds discontinued abruptly • BP monitoring, telehealth • Explain therapy controls HTN, is not a cure • Long-term therapy and follow up are crucial to achieving BP goals

education

With patient _____ about HF, teach: • F/U care and labs • S/S of decompensation o They need to know when they are decompensating so they can get to ER before getting worse • Physical activity ad exercise • Immunizations: o Flu o Pneumonia o VERY VERY VERY IMPORTANT TO EDUCATE PATIENT ABOUT. • Risk factor reduction

education

With patient _____ about HF, teach: • Weigh daily - report gain of > 3# in 24 hours or 5 # in 1 week o Need to weigh self under same circumstances such as either having no clothes on or having clothes on each time weighing theirselves • Medication compliance o Teach importance of each medication • Home pulse and B/P monitoring o Best way is to get a BP home monitor that gives pulse • Nutrition - o Need dietician to come in and teach about dash diet, etc. • Na restriction, high K+ foods

education

With patient ______ about HF and their activity program, teach: -increase walking and other activities gradually, provided they do not cause fatigue or dysnpea -consider a cardiac rehabilitation program -avoid extremes of heat and cold

education

With patient ______ about HF and their dietary therapy, teach: - consult the diet plan and list of permitted and restricted foods -examine labels to determine sodium content. also examine the labels of the OTC drugs such as laxatives, cough medicines, and antacids for sodium content - avoid using salt when preparing foods or adding salt to foods -weight yourself at the same time each day, preferably in the morning, using the same scale and wearing similar clothes -eat small, frequent meals

education

With patient ______ about HF and their drug therapy, teach: -take each drug as ordered -develop a system (ex: daily chart weekly pillbox) to ensure all drugs have been taken - count pulse rate each day before taking drugs (if appropriate). know the limits that your HCP wants for your pulse rate -take BP at determined intervals (if appropriate). Know your target BP limits - know signs and symptoms of orthostatic hypotension and how to prevent them -if taking anticoagulants, know signs and symptoms of internal bleeding (bleeding gums, increased bruises, blood in stool or urine) and what to do -know your INR and target range if taking warfarin (Coumadin) and how often to have blood checked

education

With patient ______ about HF and their health promotion, teach: -obtain annual flu vaccination ** -obtain pneumococcal vaccine ** -develop plan to reduce risk factors (Ex: blood pressure control, tobacco cessation, weight reduction)

education

With patient ______ about HF and their monitoring program, teach: -know the signs and symptoms of worsening HF (Think FACES: fatigue, limitation of activities, chest congestion/cough, edema, and SOB) -recall the symptoms experiened when illness began. Reappearance of previous symptoms may indicate a recurrence -Report immediately any of the following to the HCP: 1. weight gain of 3 lbs in 2 days or 3-5 lbs in a week 2. difficulty breathing, especially with activity or when lying flat 3. waking up breathless at night 4. frequent dry, hacking cough, especially when lying down 5. fatigue, weakness 6. swelling of ankles, feet, or abdomen. Swelling of face or difficulty breathing (if taking ACE inhibitors) 7. nausea with abdominal swelling, pain, and tenderness 8. dizziness or fainting -folllow up with HCP on regular basis -consider joining a local support group with your family members of caregivers

education

With patient ______ about HF and their rest, teach: -plan a regular daily rest and activity program -after exertion, such as exercise and ADLs, plan a rest period -consider shorter working hours or schedule rest period during working hours -avoid emotional upsets. share any concerns, fears, feelings, or depression, etc with HCP

education

With patient and caregiver ______ following lower extremity amputation, teach: • Do not use lotions, alcohol, powders, or oil on resisdual limb unless prescribed by the HCP • Wear only a residual limb sock in good condition and supplied by the prosthesist • Change residual sock daily. Launder in mild soap, squeeze, lay flat to dry • Use prescribed pain management technqiues

education

With patient and caregiver ______ following lower extremity amputation, teach: • Inspect the residual limb daily for signs of skin irritation, especially redness, abrasion, and odor. Pay particular attention to areas prone to pressure • Discontinue use of prosthesis if irritation develops. Have the area checked before resuming use of the prosthesis • Wash the residual limb thoroughly each night with warm water and bacteriostatic soap. Rinse thoroughly and dry gently. Expose the residual limb to air for 20 minutes

education

With patient and caregiver ______ following lower extremity amputation, teach: • Perform ROM in all joints daily. Perform general strengthening exercises daily • Do not elevate residual limb on pillow • Lay prone with hip in extension for 30 minutes 3-4 times daily

education

With patient and caregiver _______, teach the following: • Medication administration • S/S and treatment of hypoglycemia o Lifestyle (TLC) o Safety - medical ID • Disease process o SMBG

education

Amount (%) of blood pumped (ejected) from the left ventricle with each contraction

ejection fraction

The following are Common disease among ________: o Hypertension, renal insufficiency, etc. Arteries stiffen up Renal insufficiency stimulates RAAS system to hold onto water

elders

What category of BP is described below: SBP: 120-129 mmHg and DBP: < 80 mmHg

elevated

A sustained ______ of BP: o SBP ≥ 130 mm Hg or o DBP ≥ 80 mm Hg or o Current use of antihypertensive medication

elevation

When treating a hypertensive _______: • Monitor the ECG for dysrhythmias and signs of ischemia or MI. Measure urine output hourly to assess renal perfusion. Patients receiving IV antihypertensive drugs may be restricted to bed. Getting up (e.g., to use the commode) may cause severe cerebral ischemia and fainting. • Ongoing assessment is essential to evaluate the effectiveness of these drugs and the patient's response to therapy. • Frequent neurologic checks, including level of consciousness, pupillary size and reaction, and movement of extremities, help detect any changes in the patient's condition. • Once the hypertensive crisis is resolved, it is important to determine the cause. • The patient will need appropriate management and teaching to avoid future crises.

emergency

With treatment of a hypertensive _____, BP level alone is a poor marker of the seriousness of the patient's condition. It is not the major factor in deciding the treatment for a hypertensive crisis. The link between elevated BP and signs of new or progressive target organ disease determines the seriousness of the situation.

emergency

destruction of the alveoli, can also be found in patients with normal lung function **Have destruction of alveoli. The walls of alveoli have broken down and makes one big sac that does not really participate in gas exchange. **COPD

emphysema

What type of stoma is described below: o ______ (fecal) - one , one opening, 100% diverting § All stool is diverted through the ostomy o ______ (urinary) - one stoma, one opening, 100% diverting

end

The following are risk factors for venous thrombosis: _____ ______: o Abdominal/pelvic surgery (ex: gynecologic or urologic surgery) o Caustic or hypertonic IV medications o Fractures of the pelvis, hip, leg o Trauma o Hx indwelling PICC, IV drug use o History of previous venous thromboembolism

endothelial damage

endothelium dysfunction

What genetic consideration of HTN is described below: o Prolonged vasoconstriction may be caused by high levels of endothelin (ET). o Vasodilation effects can be altered by oxygen free radicals, which impair the bioavailability of nitric oxide (NO). o This leads to cellular dysfunction and an imbalance of the vasodilation and vasoconstriction mechanisms in the endothelium.

endothelium dysfunction

Understanding CBC: Inflammation/Infection: ↑ _________ = allergies, skin inflammation, parasitic infections, or bone marrow disorders ↓ _________ = may indicate infection, not a high concern

eosinophil

What are the clinical manifestations of the local response to inflammation? **EWPEEL **NEED to know what you see when you assess your patient

erythema, warmth, pain, edema, exudate, loss of function

The following is interprofessional care for _______ ____ _____ ______, a complication of cirrhosis: · All patients with cirrhosis should have upper endoscopy (EGD) to screen for the presence of varices. The diagnosis of esophageal or gastric variceal bleeding needs to be made by endoscopic examination as soon as possible.

esophageal and gastric varices

The following is interprofessional care for _______ ____ _____ ______, a complication of cirrhosis: · Drug therapy - Octreotide, Vasopressin · Endoscopic therapy - Band ligation, Sclerotherapy · Balloon tamponade - Mechanical compression of varices o Sengstaken-Blakemore tube, Minnesota tube

esophageal and gastric varices

The following is interprofessional care for _______ ____ _____ ______, a complication of cirrhosis: · Patients with varices at risk of bleeding and are generally started on a nonselective β-blocker (nadolol [Corgard] or propranolol [Inderal]) to reduce the incidence of hemorrhage. β-blockers decrease high portal pressure, which decreases the risk for rupture.

esophageal and gastric varices

The following is interprofessional care for _______ ____ _____ ______, a complication of cirrhosis: · Prevent bleeding/hemorrhage o Avoid alcohol, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs) o Screen for presence with endoscopy o Nonselective β-blocker · If bleeding occurs, stabilize patient, manage airway, provide IV therapy and blood products · Drug therapy - Octreotide, Vasopressin · Endoscopic therapy - Band ligation, Sclerotherapy · Balloon tamponade - Mechanical compression of varices o Sengstaken-Blakemore tube, Minnesota tube · The main therapeutic goal for ____ ____ _____ ______ is to prevent bleeding and variceal rupture by reducing portal pressure. The patient who has ____ ____ ____ _____ should avoid ingesting alcohol, aspirin, and nonsteroidal antiinflammatory drugs (NSAIDs). · All patients with cirrhosis should have upper endoscopy (EGD) to screen for the presence of varices. The diagnosis of esophageal or gastric variceal bleeding needs to be made by endoscopic examination as soon as possible. · Patients with varices at risk of bleeding and are generally started on a nonselective β-blocker (nadolol [Corgard] or propranolol [Inderal]) to reduce the incidence of hemorrhage. β-blockers decrease high portal pressure, which decreases the risk for rupture.

esophageal and gastric varices

The following is interprofessional care for _______ ____ _____ ______, a complication of cirrhosis: · The main therapeutic goal for ____ ____ _____ ______ is to prevent bleeding and variceal rupture by reducing portal pressure. The patient who has ____ ____ ____ _____ should avoid ingesting alcohol, aspirin, and nonsteroidal antiinflammatory drugs (NSAIDs).

esophageal and gastric varices

What complication of cirrhosis is described below: § Complex of tortuous, enlarged veins at lower end of esophagus § Gastric varices: Upper portion of stomach § Both are very fragile, bleed easily; MOST LIFE-THREATENING COMPLICATION***** · If they eat something sharp that goes down esophagus, it can cause a rupture of the varices! · No hot or cold substances § Esophageal varices are a complex of tortuous, enlarged veins at the lower end of the esophagus. · These varices are fragile and do not tolerate high pressure, thus they can bleed easily. · Large varices are more likely to bleed · Esophageal varices are responsible for approximately 80% of variceal hemorrhages. · Ruptured esophageal varices are the most life-threatening complication of cirrhosis and considered a medical emergency. o Bleeding to death from hemorrhage · Gastric varices are located in the upper portion of the stomach. o These account for 20% of all varices.

esophageal and gastric varices

What complication of cirrhosis is described below: § Esophageal varices are a complex of tortuous, enlarged veins at the lower end of the esophagus. · These varices are fragile and do not tolerate high pressure, thus they can bleed easily.

esophageal and gastric varices

What complication of cirrhosis is described below: · Large varices are more likely to bleed · Esophageal varices are responsible for approximately 80% of variceal hemorrhages.

esophageal and gastric varices

What complication of cirrhosis is described below: · Ruptured esophageal varices are the most life-threatening complication of cirrhosis and considered a medical emergency. o Bleeding to death from hemorrhage · Gastric varices are located in the upper portion of the stomach. o These account for 20% of all varices.

esophageal and gastric varices

The following falls under the legal and _____ issues with older adults: • Complex • Difficult decisions • Role of the nurse: o Stay informed about concerns with patient as well as family concerns o Be knowledgeable about resources available in the community o The REAL RULE is to be--> Advocate for patients and resolution

ethical

________ issues related to end-of-life care include decisions about resuscitation, treatment of infections, nutrient and dehydration, and transfer to more intensive treatment units

ethical

What risk factor for primary HTN is described below: higher in African-American males o Incidence of HTN is 2 times higher in African Americans than in whites

ethnicity

After implementation is _______. • Change in condition o ADLs, IADLs, mental status, or signs and symptoms of the disease • Perception of improved health o Does the client feel health has improved • Perception of the plan o Do the client and caregivers feel the plan is worth the time/effort/expense • Document positive changes to support the plan o Or indications to revise the plan

evaluation

With nursing management of Venous thrombosis, overall goals/ ________ includes: o Pain relief o Decreased edema o Intact skin - no ulceration o No bleeding complications o No Evidence of P.E.

evaluation

With nursing management of amputation, ______ includes: The expected outcomes are that the patient with an amputation will: Accept changed body image and integrate changes into lifestyle No evidence of skin breakdown Have reduction or absence of pain Become mobile within limitations imposed by amputation

evaluation

when talking about the diagnosis of MS, an _____ ____ ____ is delayed. § Send an electrical impulse to a particular nerve ending to see if it will respond or when it will respond **auditory, visual, somatosensory

evoked potential response

what part of the diagnosis of MS is described below: · Measures electrical activity in areas of the brain in response to stimulation of certain groups of nerves

evoked potential response test

Name 8 different nursing diagnosis that can be used for a patient with HF.

excess fluid volume (edema), R.C pulmonary edema, impaired gas exchange, R.C. electrolyte imbalance, RIsk for impaired skin integrity, Anxiety, Activity Intolerance, Deficient Knowledge

When talking about the overall treatment of both type 1 and 2 DM, _______ therapy includes: • Increases insulin sensitivity / decreases insulin resistance • Decreases blood glucose level • Lowers LDL and BP • Type I DM- if ketones present in urine prior to exercise, wait until no ketones present - can exacerbate ketosis

exercise

What diagnostic test of the respiratory system is described below: Description and Purpose: used in diagnosis and determining exercise capacity. A complete test involves walking on a treadmill while expired O2 and CO2 resp rate, HR, and heart rhythm are monitored. In a modified test, only SpO2 is monitored. Nursing Responsibility: Before: instruct patient to wear comfortable shoes DUring: encourage patient to hold handlebars on treadmill and walk as quickly as possible.

exercise testing

With interprofessional care of patients with PAD, ____ ______: o Recommended as an initial treatment for all patients with intermittent claudication o Walking is the most effective exercise for individuals with claudication. 30 to 45 minutes daily, 3 times weekly supervised for at least 3 months PT, OT, Cardiac rehab o A supervised, hospital-based PAD rehabilitation program is an effective means of improving exercise performance. Such programs typically include exercise for 30 to 60 minutes/day, 3 to 5 times/week, for 3 to 6 months. Supervised treadmill exercise training improves walking performance and quality of life in PAD patients, whether or not they have claudication.

exercise therapy

What form of elder mistreatment and abuse is described below: move patient in the home for the purpose of getting access to social security check and spend it on themselves and not on the patient Or patient has a significant amount of savings Manifestations: living situation below level of personal resources, sudden change in personal finances, sudden transfer of assets

exploitation

What type of radiation therapy treatment for cancer is described below: -(most common) -aims high-energy rays (or beams) from outside the body into the tumor. -does less damage to normal tissues, so allows higher doses of radiation for better efficacy.

external radiation therapy (external beam radiation)

• Fluid and leukocytes that move from circulation to site of injury o Nature and quantity depend on type and severity of injury and tissues involved

exudate

The following are other ______ with lung cancer: o Pollution o Radiation - especially radon o Asbestos exposure o Second-hand smoking o Radiotherapy to breast or chest o Other carcinogens § Nickel § Coal Dust § Uranium § Chromium § Arsenic § Air pollution

factors

With nursing management of cirrhosis (acute care)--> hepatic encephalopathy: · Prevent ______ _____ _______: o Institute measures to prevent ____ ____ ______. In addition, measures to minimize constipation are important to reduce ammonia production. Give drugs, laxatives, and enemas as ordered

falls and injuries

What risk factor for primary HTN is described below: o History of a close blood relative (ex: parents, siblings) with HTN is associated with increased risk for developing HTN

family history

What diagnostic study for DM is described below: o FPG less than 100 - normal o FPG 100-125 - prediabetes o FPG > 126 on 2 separate tests - diabetes • *Fasting= no caloric intake for at least 8 hours

fasting plasma glucose (FPG)

What are the 3 DM diagnostic studies?

fasting plasma glucose (FPG), hemoglobin A1C, and oral glucose tolerance test

With nutritional therapy of DM, what component of diet is described below: --individualize goals --minimize trans fat --dietary cholesterol < 200 mg/day --equal to or > 2 servings of fish per week to provide polyunsaturated fatty acids

fat

fatigue

What side effect of radiation and chemotherapy is described below: NURSING CARE: •Assess for reversible causes of fatigue, such as: --Anemia, Hypothyroidism, ----Depression, Anxiety, Insomnia, Dehydration, or Infection •Inform patient fatigue is common side effect. •Encourage energy conservation strategies. •Help the patient to Identify parts of the day when fatigue is minimal; Encourage pt to remain active during that period of time during the day. •Rest before activities •Encourage the patient to ask for assistance for tasks at home management or work. •Educate pt the importance of maintaining exercise (within their limits)

fatigue

What side effect of radiation and chemotherapy is described below: NURSING CARE: •Help the patient to Identify parts of the day when fatigue is minimal; Encourage pt to remain active during that period of time during the day. •Rest before activities •Encourage the patient to ask for assistance for tasks at home management or work. •Educate pt the importance of maintaining exercise (within their limits)

fatigue

What side effect of radiation and chemotherapy is described below: o Identify times of day when feeling better to plan activity o Rest before activity o Get assistance with activity o Maintain nutritional and hydrational status

fatigue

What side effect of radiation and chemotherapy is described below: •May persist long after treatment has ended. •Common causes: --Anemia --Toxic Substance Accumulation --Increased Demand on the Body for Tissue Repair/Healing --Lack of Sleep due to some chemotherapy drugs

fatigue

What side effect of radiation and chemotherapy is described below: •sense of tiredness associated with cancer and its treatment. •Interferes with day-to-day functioning. •Universal symptom to most of cancer patients •Commonly reported as the most distressful of treatment-related side effects. •May persist long after treatment has ended. •Common causes: --Anemia --Toxic Substance Accumulation --Increased Demand on the Body for Tissue Repair/Healing --Lack of Sleep due to some chemotherapy drugs

fatigue

The following is talking about the output of what type of stoma? - will start to function in 1-3 days post op, gas first then liquid stool

fecal stoma

To treat ________, a high ______ greater than 104F may damage cells. As a nurse YOU WILL ALWAYS TREAT A HIGH ________.

fever

What special population of older adults is described below: • is when they are no longer able to fully care for themselves • Clinical manifestations o Unintentional weight loss o Fatigue, exhaustion o Weakness o Slow walking speed o Low physical activity level o Poor nutrition SCALES nutritional assessment • Sadness or mood change • Cholesterol higher • Albumin lower • Loss or gain of weight • Eating problems (ex: mechanical problems such as impaired swallowing, poor dentition) • Shopping (food prep) problems

frail

the following are the major _____ of the renal system: • Water balance • Acid-base balance • Excrete waste • Production of hormones • Activation of vitamin D o What causes the bones to uptake calcium

functions

what type of biliary cancer is described below: · Diagnosis and staging o EUS o Transabdominal ultrasonography o CT o MRI o MRCP

gallbladder cancer

what type of biliary cancer is described below: · Poor prognosis overall · Nursing Management - Palliative care o Nutrition o Hydration o Skin care o Pain relief

gallbladder cancer

what type of biliary cancer is described below: · Primary uncommon · Adenocarcinomas · Relationship with chronic cholecystitis and cholelithiasis · More common in women · Early symptoms o Insidious o Similar to those of cholecystitis and cholelithiasis · Late symptoms o Usually those of biliary obstruction

gallbladder cancer

what type of biliary cancer is described below: · Usually not detected until advanced · Can be cured if found early · Endoscopic stent placement in biliary tract to reduce jaundice · Adjuvant therapies o Radiation therapy o Chemotherapy

gallbladder cancer

Risk factors for _____ ______ includes: o Female o Multiparity o Age older than 40 years o Estrogen therapy o Sedentary lifestyle o Genetics/ethnicity o Obesity o **Fat, Fertile, and Forty**

gallbladder disease

The following are diagnostic studies used for ______ _______: · Ultrasound o Ultrasound is commonly used to diagnose gallstones. o It is especially useful for patients with jaundice (because it does not depend on liver function) and for patients who are allergic to contrast medium · ERCP - endoscopy and fluoroscopy o ERCP allows for visualization of the gallbladder, cystic duct, common hepatic duct, and common bile duct. Bile taken during ERCP is sent for culture to identify possible infecting organisms. · Percutaneous transhepatic cholangiography o Percutaneous transhepatic cholangiography is the insertion of a needle directly into the gallbladder duct, followed by injection of contrast materials. It is generally done after ultrasonography indicates a bile duct blockage. · Laboratory tests o ↑ WBC count o ↑ Serum bilirubin level o ↑ Urinary bilirubin level o ↑ Liver enzyme levels o ↑ Serum amylase level

gallbladder disease

The following is clinical manifestations of ______ ________: · Vary from severe to none at all · Pain more severe when stones moving or obstructing o Steady, excruciating o Tachycardia, diaphoresis, prostration o May be referred to shoulder/scapula o Residual tenderness in RUQ o Occur 3-6 hours after high-fat meal or when patient lies down · When total obstruction occurs: o Dark amber urine o Clay-colored stools o Pruritis o Intolerance to fatty foods o Bleeding tendencies o Steatorrhea · In addition to pain... o Indigestion o Fever, chills o Jaundice o Pain, tenderness RUQ § Referred to right shoulder, scapula o Nausea/vomiting o Restlessness o Diaphoresis · Inflammation o Leukocytosis o Fever · Physical examination findings o RUQ or epigastrium tenderness o Abdominal rigidity · Chronic _____________ o Fat intolerance o Dyspepsia o Heartburn o Flatulence

gallbladder disease

The following is interprofessional care: drug therapy for ____ ____: · Anticholinergics o Atropine o Anticholinergics such as atropine and other antispasmodics may be used to relax the smooth muscle and decrease ductal tone.

gallbladder disease

The following is interprofessional care: drug therapy for ____ ____: · Bile salts o Bile salts may be administered to facilitate digestion and vitamin absorption. · Cholestyramine

gallbladder disease

The following is interprofessional care: drug therapy for ____ ____: · Fat-soluble vitamins o If the patient has chronic ____ ________ or any biliary tract obstruction, fat-soluble vitamins (A, D, E, and K) may need to be given.

gallbladder disease

The following is interprofessional care: drug therapy for ____ ____: · The most common drugs used in the treatment of _____ ________ are analgesics, anticholinergics (antispasmodics), fat-soluble vitamins, and bile salts. · Analgesics o Morphine § Morphine may be used initially for pain management. · Anticholinergics o Atropine o Anticholinergics such as atropine and other antispasmodics may be used to relax the smooth muscle and decrease ductal tone. · Fat-soluble vitamins o If the patient has chronic ____ ________ or any biliary tract obstruction, fat-soluble vitamins (A, D, E, and K) may need to be given. · Bile salts o Bile salts may be administered to facilitate digestion and vitamin absorption. · Cholestyramine

gallbladder disease

The following is interprofessional care: surgical therapy for ______ _____: · Laparoscopic cholecystectomy o Resume normal activities, including work, within 1 week o Few complications · Open (incisional) cholecystectomy o Removal of gallbladder through right subcostal incision o T-tube inserted into common bile duct § Ensures patency of duct § Allows excess bile to drain

gallbladder disease

The following is nursing management: nursing assessment of a patient with _____ ______ (objective data): · Fever · Restlessness · Jaundice, icteric sclera · Diaphoresis · Tachypnea · Splinting · Tachycardia · Palpable gallbladder · Abdominal guarding and distention

gallbladder disease

When performing a nursing assessment on a patient with _____ _____, the following are abnormal diagnostic findings: · ↑ Serum liver enzymes · ↑ Alkaline phosphatase · ↑ Bilirubin · Absence of urobilinogen in urine · ↑ Urinary bilirubin · Leukocytosis · Abnormal gallbladder ultrasound findings

gallbladder disease

When planning for a patient with ____ ______, the following are overall goals for the patient: · Relief of pain and discomfort · No complications postoperatively · No recurrent attacks of cholecystitis or cholelithiasis

gallbladder disease

When talking about nursing management: ambulatory care of a patient with _____ _______ includes: · Dietary teaching o Low-fat diet o Weight reduction if needed o Fat-soluble vitamin supplements · Teach what to report · Follow-up care · Laparoscopic cholecystectomy o Remove bandages day after surgery and then can shower o Report signs of infection o Gradually resume activities o Return to work in 1 week o May need low-fat diet for several weeks · Open-incision cholecystectomy o No heavy lifting for 4-6 weeks o Usual activities when feeling ready o May need low-fat diet for 4-6 weeks · Include the following instructions in the patient's postoperative teaching plan. o Remove the bandages on the puncture site the day after surgery, and then you can shower. o Notify your surgeon if any of the following signs and symptoms occur: o Redness, swelling, bile-colored drainage or pus from any incision o Severe abdominal pain, nausea, vomiting, fever, chills o You can gradually resume normal activities. o You can return to work within 1 week of surgery. o You can resume your usual diet, but a low-fat diet is usually better tolerated for several weeks following surgery.

gallbladder disease

When talking about nursing management: ambulatory care of a patient with _____ _______ includes: · Include the following instructions in the patient's postoperative teaching plan. o Remove the bandages on the puncture site the day after surgery, and then you can shower. o Notify your surgeon if any of the following signs and symptoms occur: o Redness, swelling, bile-colored drainage or pus from any incision o Severe abdominal pain, nausea, vomiting, fever, chills o You can gradually resume normal activities. o You can return to work within 1 week of surgery. o You can resume your usual diet, but a low-fat diet is usually better tolerated for several weeks following surgery.

gallbladder disease

When talking about nursing management: ambulatory care of a patient with _____ _______ includes: · Laparoscopic cholecystectomy o Remove bandages day after surgery and then can shower o Report signs of infection o Gradually resume activities o Return to work in 1 week o May need low-fat diet for several weeks

gallbladder disease

When talking about nursing management: ambulatory care of a patient with _____ _______ includes: · Open-incision cholecystectomy o No heavy lifting for 4-6 weeks o Usual activities when feeling ready o May need low-fat diet for 4-6 weeks

gallbladder disease

When using implementation (acute care) of a patient with ____ ______: · Incisional cholecystectomy o Maintain adequate ventilation o Prevent respiratory complications o General postoperative nursing care o Maintain drainage tubes (T-tube, Penrose tube, or Jackson-Pratt tube), if present o Replace fluids and electrolytes

gallbladder disease

When using implementation (acute care) of a patient with ____ ______: · Manage nausea and vomiting o NG tube, gastric decompression § Oral hygiene, care of nares § Accurate intake and output § Maintenance of suction o Antiemetics o Comfort measures

gallbladder disease

When using implementation (acute care) of a patient with ____ ______: · Monitor for complications o Obstruction o Bleeding o Infection

gallbladder disease

When using implementation (acute care) of a patient with ____ ______: · Pain management o Administer medications o Assess effectiveness · Comfort measures o Clean bed o Positioning o Oral care

gallbladder disease

When using implementation (acute care) of a patient with ____ ______: · Post-ERCP care o Assessment for complications o Bed rest o NPO until return of gag reflex o Patient teaching o Your care of the patient after ERCP with papillotomy includes § Assessment to detect complications such as pancreatitis, perforation, infection, and bleeding. Monitor the patient's vital signs. Abdominal pain, fever, and increasing amylase and lipase may indicate pancreatitis. § The patient should be on bed rest for several hours and should be on NPO status until the gag reflex returns. § Teach the patient the need for follow-up if the stent is to be removed or changed.

gallbladder disease

When using implementation (acute care) of a patient with ____ ______: · Post-ERCP care o Your care of the patient after ERCP with papillotomy includes § Assessment to detect complications such as pancreatitis, perforation, infection, and bleeding. Monitor the patient's vital signs. Abdominal pain, fever, and increasing amylase and lipase may indicate pancreatitis. § The patient should be on bed rest for several hours and should be on NPO status until the gag reflex returns. § Teach the patient the need for follow-up if the stent is to be removed or changed.

gallbladder disease

When using implementation (acute care) of a patient with ____ ______: · Postoperative care o Laparoscopic cholecystectomy § Monitor for complications § Patient comfort · Referred pain to shoulder pain from CO2 · Sims' position · Deep breathing, ambulation, analgesia § Clear liquids § Discharged same day

gallbladder disease

When using implementation (acute care) of a patient with ____ ______: · Pruritus relief measures o Antihistamines o Baking soda or Alpha Keri baths o Lotions o Soft linen o Control of temperature o Short, clean nails o Scratch with knuckles rather than nails

gallbladder disease

When using implementation (acute care) of a patient with ____ ______: · Nursing goals o Treat pain o Relieve nausea and vomiting o Provide comfort and emotional support o Maintain fluid and electrolyte balance/nutrition o Accurate assessments o Monitor for complications

gallbladder disease

With nursing management of a patient with ______ _______, evaluation includes the following expected outcomes: · Appear comfortable and verbalize pain relief · Verbalize knowledge of activity level and dietary restrictions

gallbladder disease

_______ ______ includes: · Cholelithiasis o Most common disorder of biliary system o Stones in gallbladder · Cholecystitis o Inflammation of gallbladder o Usually associated with cholelithiasis · Common health problem · Risk factors o Female o Multiparity o Age older than 40 years o Estrogen therapy o Sedentary lifestyle o Genetics/ethnicity o Obesity o **Fat, Fertile, and Forty**

gallbladder disease

The following are post-op complications of _______ in treatment of PUD: · Bile reflux gastritis o after pyloroplasty (backwards reflux of bile causing continuous epigastric distress), increases after meals, some relief after vomiting § Treatment: cholestyramine (binds to bile acids) o They have opened up the pyloris so all of the bile in the small intestine refluxes back up into the stomach which can cause epigastric pain. o Some relief after vomiting

gastrectomy

The following are post-op complications of _______ in treatment of PUD: · Dumping Syndrome o with surgical removal of a large part of the stomach and the pyloric sphincter o Hyperosmolar fluid dumped into bowel o Occurs 15-20 min post meal o Treatment dry foods with low CHO content, small amount of food, rest after meals, no fluids with meals § Should drink fluids before or a couple of hours after the meal but NOT WITH the meal. · Post-prandial hypoglycemia o may be part of dumping syndrome § Bolus of fluid high in CHO results in hyperglycemia -> the release of excessive insulin causes hypoglycemia · When you eat in the stomach, the stomach gets converted to a liquidy, high carb fluid that enters very rapidly into the small intestine causing hyperglycemia which signals the pancreas to release insulin causing hypoglycemia o When all of the foods gets dumped in the small intestine, that signals the pancreas to produce insulin which can lead to hypoglycemia · Bile reflux gastritis o after pyloroplasty (backwards reflux of bile causing continuous epigastric distress), increases after meals, some relief after vomiting § Treatment: cholestyramine (binds to bile acids) o They have opened up the pyloris so all of the bile in the small intestine refluxes back up into the stomach which can cause epigastric pain. o Some relief after vomiting

gastrectomy

The following are post-op complications of _______ in treatment of PUD: · Post-prandial hypoglycemia o may be part of dumping syndrome § Bolus of fluid high in CHO results in hyperglycemia -> the release of excessive insulin causes hypoglycemia · When you eat in the stomach, the stomach gets converted to a liquidy, high carb fluid that enters very rapidly into the small intestine causing hyperglycemia which signals the pancreas to release insulin causing hypoglycemia o When all of the foods gets dumped in the small intestine, that signals the pancreas to produce insulin which can lead to hypoglycemia

gastrectomy

With post-op are of ________ for treatment of PUD: · NG suction/care o To avoid gastric distention (rupture of sutures, leak of gastric contents into peritoneal cavity, hemorrhage, abscess formation) o NG tube on suction · Monitor for intestinal obstruction o Listen to bowel sounds o Look at characteristics of the stool · Manage pain · Accurate I&O

gastrectomy

With post-op are of ________ for treatment of PUD: · Prevent pernicious anemia o loss of intrinsic factor → inability to absorb vit. B12 o the inability to absorb vitamin B12 through the stomach o when we remove a portion of the stomach we remove intrinsic factor which allows the absorption of vitamin B12 o need to supplement vitamin B12 but not orally so subQ

gastrectomy

With post-op are of ________ for treatment of PUD: · Replace fluids and electrolytes (gastric suction) o Patients will at least be on Normal Saline but quite frequently on Lactated Ringer's solution · Prevent respiratory complications o early ambulation o unhook suction and allow pt to walk

gastrectomy

With post-op are of ________ for treatment of PUD: · Similar to care of the Gastric Bypass patient · NG suction/care o To avoid gastric distention (rupture of sutures, leak of gastric contents into peritoneal cavity, hemorrhage, abscess formation) o NG tube on suction · Monitor for intestinal obstruction o Listen to bowel sounds o Look at characteristics of the stool · Manage pain · Accurate I&O · Replace fluids and electrolytes (gastric suction) o Patients will at least be on Normal Saline but quite frequently on Lactated Ringer's solution · Prevent respiratory complications o early ambulation o unhook suction and allow pt to walk · Prevent pernicious anemia o loss of intrinsic factor → inability to absorb vit. B12 o the inability to absorb vitamin B12 through the stomach o when we remove a portion of the stomach we remove intrinsic factor which allows the absorption of vitamin B12 o need to supplement vitamin B12 but not orally so subQ

gastrectomy

With PUD, ______ ulcers have the following clinical manifestations: o Discomfort high in epigastrium - § burning, gaseous', 1-2 hours after meals § right up underneath the xiphoid process o **Eating does not relieve pain** o When you eat your body starts to produce more Hcl which aggravates the mucosa causing the pain (why pain occurs after meals)

gastric

What complication of PUD is described below: · Obstruction o from edema, inflammation o pylorospasm o scar tissue formation that leads to o pyloric stenosis · Leads to o gastric hypertrophy (stomach is large and distended) o gastric atony (stomach does not completely contract during peristalsis)

gastric outlet obstruction/ syndrome

When talking about the etiology of PUD, ______ _____ are less common.

gastric ulcers

The following is treatment post-op nursing management for disorders of the female urogenital tract (cystocele and rectocele): · Monitor vaginal bleeding: _____ _____ o ____ ______ up in the vagina o Surgeon removes normally 24 hours after surgery o Need to monitoring for enough bleeding that leaks in the vagina

gauze pack

What risk factor for primary HTN is described below: o HTN is more prevalent in men in young adulthood and early middle age o After age 64, HTN is more prevalent in women

gender

The following are ____ risks for CV disease: • CAD • Cardiomyopathy (heart muscle is weak and cannot pump blood out) • Hypertension

genetic

The following falls under ______ considerations of HTN: • More research is needed • Genetics may influence: o Water/sodium retention o Altered renin-aldosterone-angiotensin mechanism o Stress and SNS activity o Insulin resistance o Endothelial dysfunction

genetic

The following are _____ considerations of the respiratory system: • Chest wall stiffening • Decreased alveolar elasticity • Decreased respiratory muscle strength • Decreased immune function • Decreased ciliary function • Decreased cough force • Decreased response to hypoxia • Decreased response to hypercapnia

gerontologic

The following are _____ considerations with COPD: • Co-morbidities o CVD, infections, osteoporosis, psychologic changes, problems with cognition, lung cancer • Weakness • Medications - inhalers, O2, meds • Impaired quality of life • End of life considerations - hospice, palliative care

gerontologic

The following are _____ considerations with COPD: • Normal physiologic changes o Higher incidence of exacerbation and hospitalizations o Gradual loss of lung's elastic recoil o Changes in lung structure (smaller and rounded) o Decreased number of functional alveoli Similar changes as emphysema Some degree of emphysema even in non-smokers • Co-morbidities o CVD, infections, osteoporosis, psychologic changes, problems with cognition, lung cancer • Weakness • Medications - inhalers, O2, meds • Impaired quality of life • End of life considerations - hospice, palliative care

gerontologic

The following are _______ considerations of HTN: • Incidence increases with age • "White coat HTN" • Pathology o arterial elasticity, myocardial stiffness, peripheral vascular resistance, receptor sensitivity, renal function, renin - Na - H2O functions • Orthostatic hypotension o Impaired baroreceptors, volume depletion, chronic renal or hepatic diseases • Insulin Resistance and Hyperinsulinemia o Defects in glucose, insulin, and lipoprotein metabolism are common in primary hypertension. These defects are not present in secondary hypertension and do not improve when primary hypertension is treated. Insulin resistance is a risk factor in the development of hypertension and CVD. High insulin levels stimulate SNS activity and impair Nitric Oxide-mediated vasodilation. Additional pressor effects of insulin include vascular hypertrophy and increased renal sodium reabsorption. • Endothelium Dysfunction o Endothelial dysfunction is recognized as a marker for CVD including primary hypertension. o Hypertension can present as a prolonged vasoconstriction response or as a reduced vasodilator response. o Prolonged vasoconstriction may be caused by high levels of endothelin (ET). o Vasodilation effects can be altered by oxygen free radicals, which impair the bioavailability of nitric oxide (NO). o This leads to cellular dysfunction and an imbalance of the vasodilation and vasoconstriction mechanisms in the endothelium.

gerontologic

The speciality of ______ nursing is: o Complex, skilled, creative care for older patients o Care of older adults based on the specialty body of knowledge of gerontology and nursing o Provide care for older adults using a whole person (physical, psychological, cultural, socioeconomic, functional, developmental) perspective

gerontologic

The following are the overall _____ for a patient with HTN: • Achieve and maintain BP goal • Follow plan including follow up • Experience minimal side effects • Manage to cope with condition

goals

With COPD planning and evaluation ______ include: o Prevention of disease progression **we can NOT cure COPD but can PREVENT disease progression o Improved ability to perform ADLs o Relief from symptoms o No complications related to COPD (R sided HR, pulmonary embolus) o Knowledge and ability to implement long-term regimen o Overall improved quality of life o PaCO2 and PaO2 return to levels normal for that patient **individualized thing O2= 90% or better!

goals

What grade of histological analysis is described below: · - differ slightly from normal, well differentiated •Mild Dysplasia: Cells differ slightly from normal cells •Undifferentiated (Low Grade)

grade 1

What grade of histological analysis is described below: - more abnormal, moderately differentiated •Moderate Dysplasia: Cells are more abnormal •Moderately Differentiated (Intermediate Grade)

grade 2

What grade of histological analysis is described below: - very abnormal, poorly differentiated •Severe Dysplasia: Cells are very abnormal •Poorly Differentiated (High Grade)

grade 3

What grade of histological analysis is described below: · - immature, primitive and undifferentiated; cell of origin difficult to determine •Anaplasia: Cells are immature and primitive •Undifferentiated (High Grade); Cell of Origin is Hard to Determine

grade 4

What grade of histological analysis is described below: •Cell can not be assessed

grade X

What diagnostic test of the respiratory system is described below: Description and Purpose: staining of sputum permits classification of bacteria into gram - or gram + types. Nursing Responsibility: Before: instruct patient to expectorate sputum into container after coughing deeply. During: obtain sputum in early morning after mouth care because secretions collect during night. If unsuccessful, try increasing oral intake unless fluids are restricted. Collect sputum in sterile container during suctioning of endotracheal tube or by aspirating secretions from the tube. After: send specime to lab

gram stain (sputum study)

When talking about nursing management: nursing assessment of a pt with Parkinson's disease, ____ _____ includes: o CNS trauma, Cerebrovascular disorders, Exposure to metals and CO2, Encephalitis o Medications o Fatigue, Excessive salivation, Dysphagia, Weight loss, Constipation, Incontinence o Difficulty initiating movements, falls, Loss of dexterity o Diffuse pain in head, shoulders, neck, back, legs, and hips o Insomnia, Depression, Mood swings

health history

What PAD diagnostic study is described below: - including palpating peripheral pulses o Not just radial and dosalis pedis pulses o Femoral, popliteal, antecubital, brachial arteries, etc.

health history, physical exam

What chronic disease is described below: -most common reason older adults are hospitalized

heart failure

is a complex clinical syndrome that resuts in the inability of the heart to provide sufficient blood to meet the O2 needs of tissues and organs o A defect in either ventricular filling (diastolic function) or ventricular ejection (systolic function) are the key manifestations of HF.

heart failure

• A syndrome that results in the heart being unable to provide enough blood to meet 02 needs of tissues and organs • Associated with long-standing HTN, CAD and acute MI o CAD: Where heart muscle is not getting enough oxygen supply • Incidence and prevalence of HF are increasing • AHA - more than 650,000 new cases each year • Most common reason for hospitalization over age 65 • About 25% of HF admissions are readmitted within 30 days

heart failure

HFpEF stands for?? ***diastolic left sided HF

heart failure preserved ejection fraction

HFrEF stands for? ***systolic left sided HF

heart failure reduced ejection fraction

What diagnostic test of the respiratory system is described below: Description and Purpose: test reflects ration of RBCs to plasma. Increased hematocrit (polycythermia) found in chronic hypoxemia. Venous blood sample obtained. Nursing Responsibility: Before: explain procedure and its purpose

hematocrit

the following are clinical manifestations of cirrhosis: · anemia, thrombocytopenia, leukopenia, coagulation disorders, splenomegaly

hematologic

What system has the following clinical manifestations of CKD? • anemia - due to ↓ production of erythropoietin • bleeding tendencies - due to thrombocytopenia; defect in Platelet aggregation & Clotting factors • infection - changes in leukocyte function, impaired immune response

hematologic system

With interprofessional care of CKD, nutrition includes: FLUID RESTRICTION: receiving _________ - Based on daily urine output if they have no urine output, they will be more fluid restricted than if they produced 300 mL/day

hemodialysis

With interprofessional care of CKD, nutrition includes: PROTEIN RESTICTION: o in _______- - restricting protein isn't necessary

hemodialysis

what type of dialysis is described below: Complications: o Hepatitis B and C Hep b vaccination indicated Hep c now more common cause; no vaccine available • Not contraindicated for people on dialysis to be treated for hepatitis C Less common now since we are testing blood products and using all sterile stuff but used to be common o Sepsis Accessing blood from external environment

hemodialysis

what type of dialysis is described below: Complications: o Hypotension - give fluid bolus if indicated (removing too much fluid) light-headedness, nausea /vomiting, seizures, visual changes, chest pain, mental status changes o Muscle cramps Common; rapid fluid loss and shift in electrolytes o Loss of blood / Thrombocytopenia Too much anticoagulation during dialysis possible

hemodialysis

what type of dialysis is described below: No BP, IV site, or blood draw from the arm with a fistula or graft is. o POST A SIGN!! o Want to remain patent o No flushing a fistula, no drawing back aspirate to see if patent.

hemodialysis

what type of dialysis is described below: Points to Consider: o Before treatment, assess fluid status (weight, BP, edema, lung and heart sounds) Need to know what baseline is to see if successfully removing enough o pre-dialysis weight determines the amount of weight (from fluid) to be removed weight is one of best indicators of fluid status goal is to get to dry weight o After treatment, re-assess thoroughly - especially V/S, fluid status, cramping, dysrhythmias, s/s blood loss Cramping can be a symptom of excess electrolyte and fluid loss Anticoagulant is given in access site which increases risk for blood loss

hemodialysis

what type of dialysis is described below: Treatment Plan: o 3 to 5 hours, 3 times a week Can do at home overnight or at a center to stay overnight Medicare will pay for home _______ but have to have a place to accommodate the machine which is huge and have to have a partner that will be with them overnight AND have to learn how to do the procedure o Requires subcutaneous arterio-venous access o AVF, AVG, temporary AV access (graft or fistula) o Blood removed from arterial side and returned to the AV access through the venous side Machine does all of that o Can also be done at home—overnight, every night

hemodialysis

what type of dialysis is described below: • Arteriovenous Fistula - preferred access for HD o AV fistula o Hook artery and vein together creating opening o NEEDS to be Placed at least 3 months prior to need to initiate HD o To assess: Normally a thrill can be palpated & a bruit can be auscultated 2 assessments you must do when someone has an AV fistula or AV graft. A lot of turbulent blood flow going on

hemodialysis

What diagnostic test of the respiratory system is described below: Description and Purpose: test reflects amount of hemoglobin available for combination with O2. Venous blood sample obtained. Nursing Responsibility: Before: explain procedure and its purpose

hemoglobin

What complication of PUD is described below: o Erosion of granulation tissue or major blood vessel · Hematemesis, melena o → anemia →Hypovolemia → shock · Treatment o NPO, NG suction, IV fluids, blood replacement

hemorrhage

What complication of PUD is described below: · Treatment o NPO, NG suction, IV fluids, blood replacement

hemorrhage

what type of exudate is described below: (blood vessel rupture or necrosis - hematoma, post-op bleeding pure blood patient will develop a hematoma which is a pocket of blood developed and post-op bleeding

hemorrhagic

The following are factors precipitating _____ _____: --GI hemorrhage --constipation --hypokalemia --hypovolemia --infection --cerebral depressants (ex: opioids) --metabolic alkalosis --paracentesis --dehydration --increased metabolism --uremia (renal failure)

hepatic encephalopathy

What complication of cirrhosis is described below: § A major source of ammonia is the bacterial and enzymatic deamination of amino acids in the intestines. § The ammonia that results from this deamination process normally goes to the liver via the portal circulation and is converted to urea, which is then excreted by the kidneys. § When blood is shunted past the liver via the collateral vessels or the liver is so damaged that it is unable to convert ammonia to urea, the levels of ammonia in the systemic circulation increase. § The ammonia crosses the blood-brain barrier and produces neurologic toxic manifestations. § apraxia (inability to construct simple figures

hepatic encephalopathy

What complication of cirrhosis is described below: § Liver unable to convert increased ammonia; crosses blood-brain barrier · Changes in neurologic and mental responsiveness · Impaired consciousness and/or inappropriate behavior · Sleep disturbances, trouble concentrating, coma · Asterixis- Flapping tremors; common in arms and hands · Impairment in writing; difficulty in moving pen left to right; apraxia · Fetor hepaticus - Musty, sweet odor of patient's breath o True sign of this disorder! § is a neuropsychiatric manifestation of liver disease. § The pathogenesis of ______ ________ is multifactorial and includes the neurotoxic effects of ammonia, abnormal neurotransmission, astrocyte swelling, and inflammatory cytokines. § A major source of ammonia is the bacterial and enzymatic deamination of amino acids in the intestines. § The ammonia that results from this deamination process normally goes to the liver via the portal circulation and is converted to urea, which is then excreted by the kidneys. § When blood is shunted past the liver via the collateral vessels or the liver is so damaged that it is unable to convert ammonia to urea, the levels of ammonia in the systemic circulation increase. § The ammonia crosses the blood-brain barrier and produces neurologic toxic manifestations. § apraxia (inability to construct simple figures

hepatic encephalopathy

What complication of cirrhosis is described below: § is a neuropsychiatric manifestation of liver disease. § The pathogenesis of ______ ________ is multifactorial and includes the neurotoxic effects of ammonia, abnormal neurotransmission, astrocyte swelling, and inflammatory cytokines.

hepatic encephalopathy

When talking about interprofessional care of _____ _____ (complication of cirrhosis): · Reduce ammonia formation o Lactulose, which traps ammonia in gut o Rifaximin antibiotic o Prevent constipation · Treatment of precipitating cause o Lower dietary protein intake o Control GI bleeding o Remove blood from GI tract

hepatic encephalopathy

When talking about interprofessional care of _____ _____ (complication of cirrhosis): · Treatment of precipitating cause o Lower dietary protein intake o Control GI bleeding o Remove blood from GI tract

hepatic encephalopathy

With nursing management of cirrhosis (acute care)--> ________ ________: · Control factors known to precipitate ____ _________ o Control factors known to precipitate ____ ________ as much as possible, including anything that may cause constipation (e.g., dehydration, opioid medications). o In patients with altered levels of consciousness or whose airway may become compromised, have safety measures and emergency equipment readily available.

hepatic encephalopathy

With nursing management of cirrhosis (acute care)--> ________ ________: · Minimize constipation o Any GI bleeding may worsen ____ ________. Assess the patient taking lactulose for diarrhea and excessive fluid and electrolyte losses. · Encourage fluids, if not contraindicated.

hepatic encephalopathy

With nursing management of cirrhosis (acute care)--> ________ ________: · Perform neurologic assessment every 2 hours o Assess the neurologic status, including an exact description of the patient's behavior, at least every 2 hours. Plan your care of the patient with neurologic problems according to the severity of the _____ ________. · Prevent falls and injuries o Institute measures to prevent falls and injuries. In addition, measures to minimize constipation are important to reduce ammonia production. Give drugs, laxatives, and enemas as ordered . · Minimize constipation o Any GI bleeding may worsen ____ ________. Assess the patient taking lactulose for diarrhea and excessive fluid and electrolyte losses. · Encourage fluids, if not contraindicated. · Control factors known to precipitate ____ _________ o Control factors known to precipitate ____ ________ as much as possible, including anything that may cause constipation (e.g., dehydration, opioid medications). o In patients with altered levels of consciousness or whose airway may become compromised, have safety measures and emergency equipment readily available.

hepatic encephalopathy

With nursing management of cirrhosis (acute care)--> ________ ________: · Prevent falls and injuries o Institute measures to prevent falls and injuries. In addition, measures to minimize constipation are important to reduce ammonia production. Give drugs, laxatives, and enemas as ordered

hepatic encephalopathy

The following are clinical manifestations of ________: o If conjugated bilirubin cannot flow out of the liver because of obstruction or inflammation of the bile ducts, the stools will be light or clay-colored. o Pruritus (intense chronic itching) sometimes accompanies jaundice. The pruritus occurs as a result of the accumulation of bile salts beneath the skin.

hepatitis

The following are clinical manifestations of ________: o Jaundice, a yellowish discoloration of body tissues, results from an alteration in normal bilirubin metabolism or flow of bile into the hepatic or biliary duct systems. o The urine may darken because of excess bilirubin being excreted by the kidneys.

hepatitis

The following are clinical manifestations of ________: · Acute phase - PHYSICAL EXAM o Hepatomegaly o Lymphadenopathy o Splenomegaly o Icteric (jaundice) or anicteric § If icteric, may have: · Dark urine · Light or clay-colored stools · Pruritus o Jaundice, a yellowish discoloration of body tissues, results from an alteration in normal bilirubin metabolism or flow of bile into the hepatic or biliary duct systems. o The urine may darken because of excess bilirubin being excreted by the kidneys. o If conjugated bilirubin cannot flow out of the liver because of obstruction or inflammation of the bile ducts, the stools will be light or clay-colored. o Pruritus (intense chronic itching) sometimes accompanies jaundice. The pruritus occurs as a result of the accumulation of bile salts beneath the skin.

hepatitis

The following are clinical manifestations of ________: · Acute phase - SYMPTOMS o Maximal infectivity; lasts 1-6 months o Anorexia o Lethargy o Weight loss o Fatigue o Nausea/vomiting o RUQ tenderness o Distaste for cigarettes

hepatitis

The following are clinical manifestations of ________: · Classified as acute or chronic · Many patients: asymptomatic · Symptoms intermittent or ongoing o Malaise o Fatigue o Myalgias/arthalgias o Right upper quadrant tenderness

hepatitis

The following are clinical manifestations of ________: · Convalescent Phase: o Begins as jaundice disappears o Lasts weeks to months o Major complaints § Malaise § Easy fatigability o Hepatomegaly persists o Splenomegaly subsides

hepatitis

The following are clinical manifestations of ________: · ↓ Sense of smell · Low-grade fever · Skin rashes · Myalgias · Arthralgias

hepatitis

The following are diagnostic studies used for _________: **liver function tests and other tests · aspartate aminotransferase (AST) ↑ · alanine aminotransferase (ALT) ↑ · g-Glutamyl transpeptidase (GGT) ↑ · alkaline phosphatase ↑ · plasma protein ↓ · plasma bilirubin ↑ · urinary urobilinogen · PT · Physical assessment · Liver biopsy · ultrasound · serum enzymes

hepatitis

The following are nursing diagnoses for _______: · Imbalanced nutrition: less than body requirements · Activity intolerance · Risk for impaired liver function

hepatitis

The following is implementation for acute care hospitalization for a patient with ______: · Adequate nutrition o Small, frequent meals o Measures to stimulate appetite o Carbonated beverages o Adequate fluid intake

hepatitis

The following is implementation for acute care hospitalization for a patient with ______: · Assess for jaundice · Comfort measures o Diversion activities o REST! · Adequate nutrition o Small, frequent meals o Measures to stimulate appetite o Carbonated beverages o Adequate fluid intake

hepatitis

The following is implementation of ambulatory self-care for a pt with ________: · Dietary teaching · Plan activities after periods of rest · Teach how to prevent transmission · What to report · Assessment for complications · Regular follow-ups for at least 1 year after diagnosis · No alcohol · Medication education o Dosing and administration o Adverse effects · No blood donation by HBsAg- or HCV-positive patients

hepatitis

The following is implementation of ambulatory self-care for a pt with ________: · Regular follow-ups for at least 1 year after diagnosis · No alcohol · Medication education o Dosing and administration o Adverse effects · No blood donation by HBsAg- or HCV-positive patients

hepatitis

The following is interprofessional care: drug therapy for _______: · Acute HBV infection: treat only if severe; suppress virus replication · Acute HCV infection o Pegylated interferon o Direct Acting Antivirals (DAAs) § *****> 98% cure rate!!!***** · Supportive drug therapy o Antihistamines o Antiemetics

hepatitis

When performing a nursing assessment of a patient with ________, objective data includes: · Low-grade fever · Jaundice · Rash · Hepatomegaly · Splenomegaly · Abnormal lab values

hepatitis

With evaluation of a patient with ______, expected outcomes include: · Maintain food and fluid intake adequate to meet nutritional needs · Avoid alcohol and other hepatotoxic agents · Demonstrate gradual increase in activity tolerance · Perform daily activities with scheduled rest periods · Ability to explain methods of transmission and methods of preventing transmission

hepatitis

With nursing planning of a patient with _______: · OC: the patient will: o Have relief of discomfort · The patient will: o Return to normal liver function without complications o Resume normal activities

hepatitis

the following is pathophysiology of ______: · Acute infection o Large numbers of hepatocytes destroyed o Liver cells regenerate in normal form after infection resolved · Chronic infection - fibrosis and cirrhosis

hepatitis

· Inflammation of the liver · Causes o Viral (most common) - A,B,C,D, E § Specific antigen and/or antibody for each type of viral hepatitis - o Alcohol o Medications o Chemicals o Autoimmune diseases o Metabolic abnormalities

hepatitis

hepatorenal syndrome

What complication of cirrhosis is described below: § Renal failure with azotemia, oliguria, and intractable ascites § No structural abnormality of kidneys § Portal hypertension → vasodilation → renal vasoconstriction § Treat with liver transplantation § is a type of renal failure with azotemia, oliguria, and intractable ascites. In this syndrome, the kidneys have no structural abnormality. § The etiology is complex, but the final common pathway is likely to be portal hypertension along with liver decompensation that results in splanchnic and systemic vasodilation and decreased arterial blood volume. As a result, renal vasoconstriction occurs, and renal failure follows. § This renal failure can be reversed by liver transplantation. In the patient with cirrhosis, hepatorenal syndrome frequently follows diuretic therapy, GI hemorrhage, or paracentesis.

hepatorenal syndrome

What complication of cirrhosis is described below: § The etiology is complex, but the final common pathway is likely to be portal hypertension along with liver decompensation that results in splanchnic and systemic vasodilation and decreased arterial blood volume. As a result, renal vasoconstriction occurs, and renal failure follows.

hepatorenal syndrome

What complication of cirrhosis is described below: § This renal failure can be reversed by liver transplantation. In the patient with cirrhosis, hepatorenal syndrome frequently follows diuretic therapy, GI hemorrhage, or paracentesis.

hepatorenal syndrome

What complication of cirrhosis is described below: § is a type of renal failure with azotemia, oliguria, and intractable ascites. In this syndrome, the kidneys have no structural abnormality.

hepatorenal syndrome

When talking about mediators of inflammation, What mediator is described below: Source: stored in granules of basophils, mast cells, and platelets Mechanism of action: cause vasodilation and increased capillary permeability

histamine

The following is the different grades of ____ ____: · Cell evaluation appearance, degree of differentiation · Grade 1 - differ slightly from normal, well differentiated · Grade 2 - more abnormal, moderately differentiated · Grade 3 - very abnormal, poorly differentiated · Grade 4 - immature, primitive and undifferentiated; cell of origin difficult to determine

histologic analysis

· Cell evaluation appearance, degree of differentiation **pathological evaluation of abnormal cancer cells and tissue under a microscope

histologic analysis

With DM, ambulatory and ____ _____ includes: • Insulin therapy and oral agents • Medical identification at all times • Travel precautions - requires planning: • Snacks, meds, syringes, CBG checks, general skin care, DVT prevention • Acute illness and surgeries • Patient and family teaching: o Always carry source of CHO o Foot care and hygienic practices o When to call health care practitioner o Develop plan when traveling, "sick days"

home care

• Caregiver involvement • Does not provide 24 hour care or supervision • Requires HCP orders and a need for skilled nursing care o Not just patient needs help bathing, ambulation, etc. is not covered by home health care o Skilled nursing care is care provided by someone with a license

home health care

• Homebound--> cannot easily leave home without assistance from at least 1 other person • Provides for Intermittent or acute health care needs o Generally someone gets discharged from hospital and have a wound that needs care for so home health may come to perform wound care for patient • Caregiver involvement • Does not provide 24 hour care or supervision • Requires HCP orders and a need for skilled nursing care o Not just patient needs help bathing, ambulation, etc. is not covered by home health care o Skilled nursing care is care provided by someone with a license

home health care

What special population of older adults is described below: o person is _______ if they don't have a permanent place to stay such as a shelter, staying with a relative, living on the street, etc. and you would want to contact social services o Increasing numbers o High mortality rate o More health problems that are more difficult to treat o Interprofessional approach

homeless

What diagnostic study is described below: o Amino acid produced during protein catabolism that has been identified as a risk factor for CV disease. Homocysteine may cause damage to the endothelium or have a role in formation of thrombi o Reference interval: Male: 5.2-12.9 umol/L Female: 3.7-10.4 umol/L

homocysteine

What complication of lung cancer is described below: § Cancers of top part of lung may damage nerve pathways from the brain § Drooping or weakness of one eyelid § Myosis in the same eye § Reduced or absent sweating on the same side of the face § Can cause SEVERE SHOULDER PAIN

horner syndrome

The following are factors that precipitate HF _______: • Noncompliance***** o Financially cannot pay for medications o Increases rate of readmission rate within 30 days of last visit • Uncorrected high blood pressure • Atrial fibrillation and other arrhythmias • Pulmonary embolus • NSAID use***** o Should not be using NSAID with exception of low dose aspirin o Will cause sodium and water retention • Excessive alcohol or illegal drugs • DM, thyroid disorders • Concurrent infections o Teach patient infection prevention cautions

hospitalization

what part of health promotion is the following: Want to make sure that the patient is hydrated because a lot of fluids are going to the site of inflammation and are being drawn from other places (intravascular system, intracellular)

hydration

What oncologic emergency is described below Description: - Occurs in metastatic disease of bone or multiple myeloma, or when a parathyroid hormone-like substance is secreted by cancer cells. - Immobility and dehydration can contribute to or exacerbate hypercalcemia

hypercalcemia

What oncologic emergency is described below Management: - Treat primary disease. - Hydration (3 L/d) and bisphosphonate therapy. - Diuretics (particularly loop diuretics) used to prevent heart failure or edema.

hypercalcemia

What oncologic emergency is described below Manifestations: - Serum Calcium in excess of 10.9 mg/dL. - Apathy, depression, fatigue, muscle weakness, ECG changes, poyluria and nocturne, anorexia, nausea, and vomiting - High calcium elevations can be life threatening. - Chronic hypercalcemia can result in nephrocalcinosis and irreversible renal failure.

hypercalcemia

What oncologic emergency is described below: Description: - Occurs in metastatic disease of bone or multiple myeloma, or when a parathyroid hormone-like substance is secreted by cancer cells. - Immobility and dehydration can contribute to or exacerbate hypercalcemia Manifestations: - Serum Calcium in excess of 10.9 mg/dL. - Apathy, depression, fatigue, muscle weakness, ECG changes, poyluria and nocturne, anorexia, nausea, and vomiting - High calcium elevations can be life threatening. - Chronic hypercalcemia can result in nephrocalcinosis and irreversible renal failure. Management: - Treat primary disease. - Hydration (3 L/d) and bisphosphonate therapy. - Diuretics (particularly loop diuretics) used to prevent heart failure or edema.

hypercalcemia

What oncologic emergency is described below: o Can be life-threatening o Acute (look for other factors - hydration, diuretic, bisphosphonate) o Manifestations § Apathy/depression, fatigue, muscle weakness, polyuria/nocturia, anorexia, nausea, vomiting

hypercalcemia

What oncologic emergency is described below: o PTH-like substance secreted from cancer cells (in absence of bone metastasis) o Immobility and dehydration can contribute to or exacerbate _______ o Can be life-threatening o Acute (look for other factors - hydration, diuretic, bisphosphonate) o Manifestations § Apathy/depression, fatigue, muscle weakness, polyuria/nocturia, anorexia, nausea, vomiting

hypercalcemia

The following are risk factors for venous thrombosis: ________: o Anti-thrombin III deficiency o Antiphospholipid antibody syndrome o Malnutrition/ dehydration o Elevated clotting factors VIII or lipoprotein o Erythropoiesis stimulating drugs o High altitudes o Hormone therapy o Cancer (especially breast, brain, hepatic, pancreatic, and GI) o Nephrotoxic syndrome o Polycythemia vera o Hyperhormocysteinemia o Severe anemias o Tobacco use o Malignancies o Oral contraceptives (especially women > 35 years who uses tobacco), pregnancy and postpartum period o Sepsis o Protein C and S deficiencies

hypercoagulability

Hyperglycemia or hypoglycemia? Manifestations: elevated blood glucose, increase in urination, increase in appetite followed by lack of appetite, weakness, fatigue, blurred vision, headahce, N/V, glycosuria, abdominal cramps, progression to DKA or HHS Causes: illness, infection, corticosteroids, too much food, too little or no diabetes medication, emotional, physical stress, poor asborption of insulin

hyperglycemia

What acute DM complication is described below: Diabetes Ketoacidosis (DKA) Hyperosmolar, Hyperglycemic Non-ketotic Syndrome (HHNK)

hyperglycemia

dry mouth, extreme thirst, frequent urge to urinate, drowsiness, frequent bed wetting, and stomach pain are signs and symptoms of hypoglycemia or hyperglycemia?

hyperglycemia

What acute complication of hyperglycemia is described below: • Also known as HHS • Enough insulin to prevent DKA; hyperglycemia & osmotic diuresis occurs • Blood glucose levels > 600mg/dl and ↑ serum osmolality • Absent or minimal ketones • No acidosis • More common in Type 2 DM and over 60 y/o • Severe fluid and electrolyte imbalance • Dehydration and hyper-osmolarity (thrombus) • More severe neurologic symptoms • Common causes: o Infection, new onset DM, dehydration, depression

hyperosmolar hyperglycemic syndrome

What acute complication of hyperglycemia is described below: • Blood glucose levels > 600mg/dl and ↑ serum osmolality • Absent or minimal ketones • No acidosis • More common in Type 2 DM and over 60 y/o

hyperosmolar hyperglycemic syndrome

What acute complication of hyperglycemia is described below: • Common causes: o Infection, new onset DM, dehydration, depression

hyperosmolar hyperglycemic syndrome

What acute complication of hyperglycemia is described below: • Severe fluid and electrolyte imbalance • Dehydration and hyper-osmolarity (thrombus) • More severe neurologic symptoms

hyperosmolar hyperglycemic syndrome

what percussion sound is described below: loud, lower-pitched sound than normal resonance heard over hyperinflated lungs, such as in COPD and acute asthma

hyperresonance

The following are causes of ____ ____: o Exacerbation of chronic HTN o Renovascular HTN o Preclampsia, eclampsia o Pheochromocytoma o Drugs (cocaine, amphetamines) o Monoamine oxidase inhibitors taken with tyramine-containing foods o Rebound HTN (from abrupt withdrawal of some antihypertensive drugs such as clonidine or beta blockers o Head injury o Acute aortic dissection

hypertensive crisis

• Occurs more frequently in patients who: • have not adhered to drug regimen • have been under-treated • Can lead to endothelial damage due to turbulent blood flow

hypertensive crisis

what type of hypertensive crisis is described below: o Develops over hours to days o Severe elevation - often above 220/140 o Evidence of target organ disease (encephalopathy, intracranial or subarachnoid bleeding, HF, MI, RF, dissecting aortic aneurysm, retinopathy) o Clinical manifestations: Severe headache N/V Seizures, Confusion, Coma Chest pain, dyspnea, pulmonary edema

hypertensive emergency

what type of hypertensive crisis is described below: o Develops over days to weeks o BP elevated - >180/110 o No clinical evidence of target organ disease o May not require hospitalization o Treatment - Oral anti-hypertensives Captopril, labetalol, clonidine, amlodipine Monitor closely for proper regulation

hypertensive urgency

What primary cause of HF is : Increases the metabolic demands of the body which means more oxygen resulting in more work load of heart

hyperthyroidism

what compensatory mechanism of HF is described below: o Increase in cardiac muscle mass/thickness o Makes the heart muscle larger, decreasing capacity of blood being able to go through chambers of heart

hypertrophy

what precipitating factor of HF is described below: too much fluid volume; heart cannot manage it all increased preload causing volume overload on the RV

hypervolemia

Hyperglycemia or hypoglycemia? Manifestations: blood glucose of < 70 mg/dL, cold clammy skin, numbness of fingers, toes, and mouth, rapid heartbeat, emotional changes, HA, nervousness tremors, faintness, dizziness, unsteady gait, slurred speech, hunger, changes in vision, seizures, coma Causes: alcohol intake without food, too little food (delayed, omitted, inadequate intake), too much diabetes medications, too much exercise, without adequate food intake, diabetes medicaiton or food taken at wrong time, loss of weight without change in medicaiton

hypoglycemia

The following is treatment of _______: o Conscious patient Below 70 with symptoms: 15g quick-acting carbohydrate wait 15 minutes Recheck CBG Repeat until CBG > 70/stable Follow with slowly absorbed carbohydrate o Unconsious patient With IV access: • 25 - 50 ml D50 IVP • look for other cause of unconsciousness With no IV access: • 1mg glucagon IM or SQ • Place IV access

hypoglycemia

What acute DM complication is described below: - _________ unawareness Repeated episodes, elderly, B-adrenergic blockers Manage with high glucose range

hypoglycemia

What acute complication of DM is described below: • Blood glucose drops ↓70 mg/dl • ANS activated • Clinical manifestations of epinephrine release: nervous, shaky, anxious, hungry, diaphoresis

hypoglycemia

What acute complication of DM is described below: • Not enough glucose to the brain - difficulty speaking, visual impairment, stupor, coma - can mimic alcohol intoxication • Counter-regulatory hormones released - cause suppression of insulin release, production of glucagon and epinephrine

hypoglycemia

What acute complication of DM is described below: • Too much insulin in proportion to blood glucose available • Blood glucose drops ↓70 mg/dl • ANS activated • Clinical manifestations of epinephrine release: nervous, shaky, anxious, hungry, diaphoresis • Not enough glucose to the brain - difficulty speaking, visual impairment, stupor, coma - can mimic alcohol intoxication • Counter-regulatory hormones released - cause suppression of insulin release, production of glucagon and epinephrine

hypoglycemia

sweating, trembling, dizziness, mood changes, hunger, headaches, blurred vision, and extreme tiredness and paleness are the signs and symptoms of hypoglycemia or hyperglycemia?

hypoglycemia

what precipitating factor of HF is described below: muscle weakness can occur including heart muscle indirectly predisposes to increase atherosclerosis. Severe hypothyroidism decreases myocardial contractility

hypothyroidism

The following are clinical manifestations of ______: Neuro o Apprehension, restlessness, irritability, confusion, lethargy, combativeness, coma Respiratory o Tachypnea, dyspnea, accessory muscles, retractions, pauses for breath between words Cardiac o Tachycardia, B/P abnormalities, dysrhythmia, cyanosis, cool, clammy skin Why cold, clammy skin? Other o Diaphoresis, oliguria, fatigue Why oliguria?

hypoxemia

means health that worsens as a result of being in the health care center **nursing implementation under acute and ambulatory care

iatrogenesis

What type of ostomy has the following output: · thick liquid to semi-pasty, approximately 1200ml/24hrs, contains digestive enzymes (will digest skin too!)

ileostomy

What type of ostomy is described below: · Fecal diversion in which part of the small intestines (ileum) is used to create the stoma · Location: o Typically RLQ of abdomen

ileostomy

With acute pancreatitis diagnostic studies, _______ includes: · Abdominal ultrasonography o Abdominal ultrasonography, x-ray, or contrast-enhanced CT scanning can be used to identify pancreatic problems. · Endoscopic retrograde cholangiopancreatography (ERCP) o ERCP is can be used, although ERCP can cause acute pancreatitis in some cases. · May cause pancreatitis - irritation/damage · Magnetic resonance cholangiopancreatography · (MRCP) · Endoscopic ultrasonography (EUS) · X-ray · Contrast-enhanced CT scan o CT scanning is the best imaging test for pancreatitis and related complications such as pseudocysts and abscesses. · Angiography · Chest x-ray · Diagnostic evaluation of acute pancreatitis is also directed at determining the cause.

imaging

With acute pancreatitis diagnostic studies, _______ includes: · Contrast-enhanced CT scan o CT scanning is the best imaging test for pancreatitis and related complications such as pseudocysts and abscesses. · Angiography · Chest x-ray · Diagnostic evaluation of acute pancreatitis is also directed at determining the cause.

imaging

With a patient with CKD, they will have electrolyte and acid-base _______ which includes: • Calcium and phosphate o ↓Ca, ↑Phosphorous • Magnesium o Hypermagnesemia - watch antacid use! o Will be elevated o People with chronic kidney disease have indigestion and GI effects so they are likely to take OTC antacids which contain magnesium. So, we need to educate out patients about NOT taking a magnesium based antacid. (TEACHING POINT)

imbalance

With a patient with CKD, they will have electrolyte and acid-base _______ which includes: • Potassium (Hyperkalemia) o most serious electrolyte disorder because of fatal arrhythmias not uncommon for people on dialysis to have heart attack while on dialysis because of this build-up of potassium o not able to pull potassium out • Sodium - may be elevated, normal or low o Dietary restriction may be 2g/day (if elevated) • Calcium and phosphate o ↓Ca, ↑Phosphorous • Magnesium o Hypermagnesemia - watch antacid use! o Will be elevated o People with chronic kidney disease have indigestion and GI effects so they are likely to take OTC antacids which contain magnesium. So, we need to educate out patients about NOT taking a magnesium based antacid. (TEACHING POINT) • Metabolic acidosis o inability to excrete H ions o ↓ reabsorption/regeneration of bicarbonate • ↓ kidney function -> less vitamin D being converted to it's active form -> ↓ Calcium absorption from GI tract -> ↓ serum calcium levels -> bone demineralization -> ↑ phosphorous levels

imbalance

With a patient with CKD, they will have electrolyte and acid-base _______ which includes: • ↓ kidney function -> less vitamin D being converted to it's active form -> ↓ Calcium absorption from GI tract -> ↓ serum calcium levels -> bone demineralization -> ↑ phosphorous levels

imbalance

The following is the role of the _____ ____ in cancer: · The _____ ______ has the ability to distinguish 'self' from 'non-self' o Because cancer cells arise from one's own cells, it may or may not be recognized as 'non-self', so the immune response may be absent or inadequate · Immunologic surveillance - destroy "non" cells · Immunologic escape - cancer cells' ability to avoid detection · Oncofetal antigens - found on surfaces and inside of cancer cells and fetal cells o Examples: AFP, CEA, CA-125, CA-19-9, can be used as tumor markers

immune system

You always want to treat fever in an __________ patient. A patient who has an immune suppressant disease or who takes _________ drugs always should be treated if they have a fever. and for sure always if it is about 104 F

immunocompromised

What role of the immune system is described below: · cancer cells' ability to avoid detection

immunologic escape

What role of the immune system is described below: · destroy "non" cells

immunologic surveillance

If the normal percentage of lymphocytes is 25-40% in the body and your patient has only 7%, what is this an indication of?

immunosuppression (low)

The following is treatment (_________) for lung cancer: · Prophylactic cranial radiation · Bronchoscopic laser therapy · Photodynamic therapy o photosensitive drug in combination with specific wavelength of light · Airway stenting to support airway wall · Bronchoscopic cryotherapy

immunotherapy

After planning, you will use nursing _______ which includes: o Modify approach based on the older adult's physical, functional, and mental status o Safety first! o Health Promotion and Disease Prevention Increase participation in health promotion and disease prevention activities Reduce diseases and health-related issues Increase use of services to decrease health hazards (risk for falls) o Nurse's role: Know about available resources Educate and refer them to those services

implementation

Also, with nursing _______ you want to look at acute and ambulatory care avaliable. Identify those at risk for iatrogenesis • Iatrogenesis means health that worsens as a result of being in the health care center o EX: people spending all their time in bed, muscles weaken, and they go home and never get out of bed Early discharge planning Interprofessional teams (not just the nurse!) Standard protocols to screen for at-risk conditions • Falls, UTIs, cognition, skin o Indwelling catheter risk for UTI • Available in hospital Maintain function/prevent functional decline • "the bed is not your friend" • Get them out of bed! The longer in bed, the less likely to recover to previous state. SAFETY! Referral to community-based services

implementation

With nursing management of PAD , nursing _______ (acute intervention after surgery) includes: • Ambulatory and Home Care o Management of risk factors o Daily inspection of the feet meticulous foot care o Importance of gradual physical activity after surgery o Comfortable shoes with rounded toes and soft insoles lightly laced

implementation

With nursing management of PAD , nursing _______ (acute intervention after surgery) includes: • Early ambulation o Walking even short distances is desirable o Use of a walker may be helpful especially in frail, elderly patients • Discourage prolonged sitting with leg dependency - may cause pain and edema, increase the risk of venous thrombosis, place stress on the suture lines • Check the operative extremity q 15 minutes initially, then hourly: o color, temperature, capillary refill, peripheral pulses, sensation, and movement • Monitor perfusion to the extremities • If edema develops, position the patient supine and elevate the edematous leg above heart level • Assess for complications: bleeding, hematoma, thrombosis, embolization, and compartment syndrome • Ambulatory and Home Care o Management of risk factors o Daily inspection of the feet meticulous foot care o Importance of gradual physical activity after surgery o Comfortable shoes with rounded toes and soft insoles lightly laced

implementation

With nursing management of PAD , nursing _______ (acute intervention after surgery) includes: • Monitor perfusion to the extremities • If edema develops, position the patient supine and elevate the edematous leg above heart level • Assess for complications: bleeding, hematoma, thrombosis, embolization, and compartment syndrome

implementation

With nursing management of Venous thrombosis, nursing _______ includes: o Focus on prevention of emboli formation & inflammation o Monitor labs, administer anticoagulants o Drug Alert: anticoagulant therapy o Injection safety o Skin care o Patient teaching

implementation

With nursing management of amputation, ______ includes: o Health promotion o Acute care o Preoperative care o Postoperative care o Ambulatory care o Special considerations In upper limb amputation

implementation

What type of urinary diversion is described below: · Diversion to the skin requiring an appliance: o Ureterostomy o Ileal conduit - a 6-8 inch (15-20cm) segment of ileum is converted into a conduit for urine drainage - through the abdominal wall / urostomy o Nephrostomy - a catheter is inserted into the pelvis of the kidney o Cystostomy with suprapubic catheter · No valve and no voluntary control over the stoma output · Urine flows from the stoma requiring a permanent external collecting device · Lifelong need to care for and deal with the stoma and collection devices

incontinent urinary diversions

the drug half-life is ________ in older adults as compared with younger adults o Can led to greater risk for drug toxicity and adverse drug events

increased

What are the SYSTEMIC clinical manifestations of inflammation?

increased WBC count with a shift to the left, malaise, nausea, anorexia, increased pulse and respiratory rate, and fever

Understanding CBC: Inflammation/Infection: ____ ______ = leukemia, chronic inflammation, active allergic response, or radiation

increased basophils

What risk factor for primary HTN is described below: o High sodium intake can contribute to HTN in salt-sensitive patients and decrease the effectiveness of certain antihypertensive medications

increased dietary sodium

Understanding CBC: Inflammation/Infection: ______ ________ = allergies, skin inflammation, parasitic infections, or bone marrow disorders

increased eosinophils

Understanding CBC: Inflammation/Infection: ___ _______ = viral infection, leukemia, lymphoma

increased lymphocytes

Understanding CBC: Inflammation/Infection: ____ _______ = chronic infection, autoimmune disorders, leukemia

increased monocytes

Understanding CBC: Inflammation/Infection: ____ __________ = bacterial infection, vasculitis and inflammatory conditions e.g. rheumatoid arthritis, lupus and vasculitis

increased neutrophils

What risk factor for primary HTN is described below: o Increased levels of cholesterol and triglycerides are primary risk factors in atherosclerosis o Hyperlipidemia is more common in people with HTN

increased serum lipids

Confusion may be a sign of an ________. UTIs are notorious for doing this. A patient will get a UTI and acute delirium and when the ________ is gone, the patient goes back to their fully cognitive function like they were before **atypical symptoms

infection

What side effect of radiation and chemotherapy is described below: o Primary cause of cancer death o lungs, GU system, mouth, rectum, peritoneal cavity, and blood (septicemia) o Causes: ulceration and necrosis, neutropenia o Patient education: s/s neutropenia, when to call

infection

what complication of cancer is described below: •Primary cause of death in cancer patients. •Usual sites of ______: Lungs, GU System, Mouth, Rectum, Peritoneal Cavity, Blood (Septicemia) • Causes of ______: --Ulceration and Necrosis caused by the Tumor --Compression of Vital Organs caused by the Tumor --Neutropenia from the Disease or its Treatment

infection

what precipitating factor of HF is described below: increases metabolic demand resulting in need for more oxygen increased oxygen demand of tissues stimulating increased CO

infection

If the normal WBC is 5,000-10,000 in the body and your patient has a WBC of 18,000 that is an indication of?

infection (elevated)

What chronic complication of DM is described below: o Impaired phagocytosis o Leads to UTIs, diabetic foot infections, yeast infections

infections

What category of oncologic emergencies is described below: **Malignant tumor, or the result of secondary cancer treatment, infiltrate major organs. - Cardiac Tamponade - Carotid Artery Rupture

infiltrative emergency

The ability to recognize the clinical manifestations of __________ is important. In the individual who is immunosuppressed (e.g., taking corticosteroids or receiving chemotherapy), the classic manifestations of _________ may be masked, and early symptoms of __________ may be malaise or "just not feeling well."

inflammation

may be: o Acute Immediate response to injury or infection Resolves spontaneously or with treatment EX: a mosquito bite; it turns red, gets fluid in it, but after a few days it goes away EX: cut finger with knife while cooking and it gets red and swollen with some fluid but eventually it heals and goes away o Subacute EX: pneumonia; has to be hospitalized and it may take 6-8 week to get it out of system EX: broken bone; will take a long o similar to acute but lingers for weeks or months o Chronic An ongoing response to a chronic condition EX: autoimmune disease,

inflammation

• A physical reaction to injury or infection • A protective mechanism o The body is fighting something harmful and attempting to heal itself

inflammation

The following are the different ______ _______: CRP and hsCRP - Normal under 1mg/L ESR - Normal 15-20mm/hr Plasma viscosity (PV) - Normal 1.10-1.30 mPa s TNF (tumor necrosis factor) Interleukin 1, 6 Omega 3 tissue concentration - Normal 60%

inflammation markers

_______ insulin: • Take right before meal o or up to 20 minutes into the meal • May be used in combination with long-acting • Not for people who smoke • Not used in DKA • Not for people with asthma or COPD • Common reactions - cough, throat pain, hypoglycemia • The most common adverse effect to insulin is hypoglycemia

inhaled

________ insulin is not used in DKA and is not for people with asthma or COPD. Common reactions of _______ insulin include cough, throat pain, and hypoglycemia. It is also not for people who smoke.

inhaled

________ insulin should be taken right before meal or up to 20 minutes into the meal.

inhaled

What drug to treat COPD is described below: - Reduce inflammation

inhaled corticosteroids (ICS)

What insulin prep is described below: **Afrezza Onset: 12-15 min Peak: 60 min Duration: 2.5-3 hr

inhaled insulin

What stage of cancer development is described below: o mutation in a gene's genetic structure

initiation

What stage of cancer is described below: •Arise from Normal Cells •Gene mutation in DNA sequence •Spontaneous or induced by carcinogen **Cancer cells arise from normal cells as a result of a mutation in DNA, or genes. This can occur spontaneously or is induced by exposure to a carcinogenic agent. A carcinogenic agents can be chemical agent, radiation, or a viral carcinogen.

initiation

A normal ______ of a physical assessment of CV system includes: Skin warm, normal color. PMI not visible. No JVD with patient at 45 degree angle

inspection

The following are ______ problems and risk: • Hypoglycemia-- the MOST common adverse effect of insulin use!!! • Lipodystrophy - hypertrophy or atrophy of subcutaneous tissue at injection site **Rotate injection sites to avoid • Somogyi Effect: • Dawn Phenomenon • Allergic Reactions - true systemic reactions are rare; usually localized

insulin

With ______ administration: • Given subcutaneously o Rotate injection sites • May be given IV for immediate action o Don't give IM - unpredictable action o Regular insulin is the ONLY insulin that can be given IV *** • NOT GIVEN ORALLY; rendered inactive in the digestive process • Short or rapid acting can be mixed in syringe with intermediate acting

insulin

What genetic consideration of HTN is described below: o Defects in glucose, insulin, and lipoprotein metabolism are common in primary hypertension. These defects are not present in secondary hypertension and do not improve when primary hypertension is treated. Insulin resistance is a risk factor in the development of hypertension and CVD. High insulin levels stimulate SNS activity and impair Nitric Oxide-mediated vasodilation. Additional pressor effects of insulin include vascular hypertrophy and increased renal sodium reabsorption.

insulin resistance and hyperinsulinemia

The following are the different ____ ______: • Rapid acting - lispro, aspart, glulisine • Short acting - novolin R, humulin R ***regular insulin • Intermediate - NPH • Long-acting - Glarine, Detemir • Combination/premixed • Inhaled insulin - Afrezza **DO NOT NEED TO KNOW BRAND NAMES. FOR SURE NOW THE FIRST 3.

insulin types

What are the 3 major types of glucose-lowering agents when talking about medications for DM?

insulin, non-insulin injectable agents, and oral agents

the following are clinical manifestations of cirrhosis: · jaundice, spider angioma, palmar erythema, purpura, petechiae, caput medusae

integumentary

What system has the following clinical manifestations of CKD? • pruritus from dry skin • calcium-phosphate deposition in the skin o have little lumps in skin where calcium has deposited • uremic frost o when BUN levels are extremely high (>200mg/dL), urea crystalizes on the skin

integumentary system

Potential drug ______ with oral antidiabetic agents include: • Beta blockers o Can mask symptoms of hypoglycemia • Diuretics o Can potentiate Hyperglycemia through K+ loss • Be aware of potential _______ with other meds/treatments

interactions

What type of radiation therapy treatment for cancer is described below: -allows a higher dose of radiation in a smaller area -radiation source usually sealed in a small holder (implant). Various implants: - pellets, seeds, ribbons, wires, needles, capsules, balloons, or tubes. -placed close to or inside the tumor. -harms as few normal cells as possible.

internal radiation therapy (brachytherapy)

With radiation therapy treatment of cancer, ______ ______- _______ involves placing radioactive material inside the body. •Radiation source usually sealed in a small holder (implant). •Various implants: • pellets, seeds, ribbons, wires, needles, capsules, balloons, or tubes. •placed close to or inside the tumor.

internal radiation- brachytherapy

With interprofessional care of patients with PAD, ____ ______ _______ includes: o Percutaneous transluminal balloon angioplasty (PTCA) Insertion of a balloon catheter through the femoral artery Balloon is inflated, dilating the vessel by cracking the confining atherosclerotic intimal shell Stent is placed to keep the artery open

interventional radiologic procedure

The following are nursing ______ for COPD patients: • Assess breath sounds frequently • Monitor respiratory pattern • Monitor blood gases or pulse ox levels as prescribed • Position for optimal respiratory effort (elevating HOB; if having acute exacerbation, put in tripod position or pursed breathing) • Encourage use of incentive spirometry (IS) • Assist with coughing techniques • Encourage activity/ambulation as possible • Encourage adequate hydration: 2500ml/day (if not contraindicated) o To loosen and liquify secretions so they can cough it up • Monitor effectiveness of medications and O2 treatment • Assess nutritional status • 30 min resting before/after eating a meal

interventions

The following are nursing ______ for a patient with HF: • Daily weights • Administer meds as prescribed • Diet (2-3g Na)*** • Exercise*** o Do not want patient just sitting in bed all day long; will make them overall deconditioned o Need to get patient out of bed but want to sit them in nice comfortable chair o Ambulation is important ! o Individualized to what patient is capable of ***are highlighted bold in notes

interventions

The following are nursing ______ for a patient with HF: • Energy conservation, promote rest, pace activities *** • Relaxation techniques o Teach these o Stress increases SNS; teach deep breathing exercises, reading a book, etc. • Smoking cessation ** o If smoking, needs to quit! • Monitor intake and output

interventions

The following are nursing ______ for a patient with HF: • Fluid restriction as needed/prescribed • Semi to high Fowler's position • Avoid valsalva maneuver o Increases thoracic pressure and increases cardiac demand o Do not want patient to be constipated, be aware of bowel movements

interventions

The following are nursing ______ for patients taking anticoagulants: Injections: -avoid IM injections -minimize venipuncture -use small-gauge needles for venipuncture unless therapy requires a larger gauge -apply manual pressure for at least 10 minutes (for longer if need) on venipuncture sites

interventions

The following are nursing ______ for patients taking anticoagulants: Patient Care: -sue soft toothbrushes or foam swabs for oral care -reposition the patient carefully at regular intervals -limit tape application. use paper tape as appropriate -give stool softeners to avoid hard stools and straining -lubricate tubes adequately before insertion -use support pads, mattresses, bed cradles, and therapeutic beds as indicated -apply graduated compression stockings or intermittent pneumatic compression devices (if ordered) and with attention to proper size, application and use -perform risk for fall and skin breakdown assessments per agency policy and implement safety and preventive measures as needed

interventions

The following are nursing ______ for patients taking anticoagulants: Patient Care: -avoid restrictive clothing -apply moisturizing lotion to skin -use electric razors, not straight razors -perform physical care in a gentle manner -avoid removing or disrupting established clots -humidify O2 source if supplemental O2 is ordered

interventions

The following are nursing ______ for patients taking anticoagulants: assessment: -monitor V/S as indicated -examine urine and stool for overt and occult signs of blood -inspect skin frequently, especially under any splinting devices -evaluate platelet count for signs of heparin-induced thrombocytopenia (HIT) -evaluate appropriate lab coagulation tests for target therapeutic levels -evaluate lower extremity for ecchymosis or hematoma development if intermittent pneumatic compression device used -perform assessments frequently to observe for signs and symptoms of bleeding (ex: hypotension, tachycardia) or clotthing -notify the provider of any abnormalities in assessments, vital signs, or lab values

interventions

the following are nursing ______ of CKD: • Daily weight, monitor trends in weight • I&O • Monitor BP, apical pulse o Not just counting pulse rate, identify irregular pulse for arrhythmias

interventions

the following are nursing ______ of CKD: • Daily weight, monitor trends in weight • I&O • Monitor BP, apical pulse o Not just counting pulse rate, identify irregular pulse for arrhythmias • Identify signs and symptoms of fluid overload o Not just edema, bounding pulses, pulmonary crackles • Monitor electrolytes: BUN, creatinine, PO4, Ca, • Mg, PH, Hct, Hb, protein, Na, K, phosphate • Dietary adherence, fluid restriction o (RD referral) o Family members will be bringing food; tell patient to not eat anything before checking with nurse first. Need to tell family member that they cannot eat high sodium, high protein diets. Should not be eating food from outside • Teaching o weight gain > 4lbs within 2 days; increasing BP; SOb; increasing edema; increasing fatigue or weakness; confusion or lethargy signs of decompensating kidney function o different from CHF!!

interventions

the following are nursing ______ of CKD: • Dietary adherence, fluid restriction o (RD referral) o Family members will be bringing food; tell patient to not eat anything before checking with nurse first. Need to tell family member that they cannot eat high sodium, high protein diets. Should not be eating food from outside

interventions

the following are nursing ______ of CKD: • Identify signs and symptoms of fluid overload o Not just edema, bounding pulses, pulmonary crackles • Monitor electrolytes: BUN, creatinine, PO4, Ca, • Mg, PH, Hct, Hb, protein, Na, K, phosphate

interventions

What complication of IBD is described below: · Intestinal contents can't pass through the GI tract - occlusion of the lumen of small intestine and/or colon o Partial (usually resolves w/o surgery) vs Complete (usually requires surgery) o Simple (blood supply intact) vs Strangulated (loses blood supply) · Small intestines: o Surgical adhesions most common cause - can occur within days, or years after surgery o Other causes: hernia, strictures from Crohn's disease, intussusception after bariatric surgery · Colon: Most common cause is cancer or diverticular disease · Types: o Mechanical - detectable occlusion o Non-mechanical - from a neuromuscular or vascular disorder (i.e. paralytic (adynamic) ileus)

intestinal obstruction

Nephrotoxic injury, interstitial nephritis, and other causes are all the common causes of what type of acute kidney injury? Nephrotoxic injury (drugs such as aminoglycosides and amphotericin B, contrast media, hemolytic blood transfusion reaction , severe crush injury, chemical exposure: ethylen glycol, lead, etc) Interstitial Nephritis (allergies: antibiotics, NSAIDs, ACE inhibitors, viral drugs, fungal drugs, and infections: bacterial, viral, or fungal) OTher causes (prolonged prerenal ischemia, acute glomerulonephritis, thrombotic disorders, toxemia of pregnancy, malignant HTN, systemic lupus erythematosus)

intrarenal

______ AKI is something that is going on inside the kidneys. This is where nephrotoxic drugs come in. they are actually causing damage to the structures of the kidneys themselves. Other causes of ________ AKI could be infection that causes scarring if not treated scarring can cause chronic kidney disease. It can also be growths or tumors in kidneys or polycystic kidney disease where a bunch of cysts develop in the kidneys and it is hereditary. ****THINGS happening INSIDE the kidneys.

intrarenal

what venous diagnostic study is described below: o Venography, phlebogram - contrast media studies to find filing defects, presence of clots

invasive

• When conservative therapy is no longer effective, • dialysis and transplantation are treatment options • leave the old kidneys, and place donor kidney in place

kidney transplant

When talking about mediators of inflammation, What mediator is described below: Source: produced from precursors factor kiniogen as a result of activation of Hageman factor (XII) of clotting system Mechanism of action: causes contraction of smooth muscle and vasodilation. result in stimulation of pain

kinins (ex: Bradykinin)

What diagnostic study for gallbladder disease is described below: o ↑ WBC count o ↑ Serum bilirubin level o ↑ Urinary bilirubin level o ↑ Liver enzyme levels o ↑ Serum amylase level

laboratory tests

The following are _____ effects of radiation and chemotherapy: -Cardiotoxicity, Cataracts, Arthralgias, Endocrine Alterations, Renal Insufficiency, Hepatitis, Osteoporosis, Neurocognitive Dysfunction

late

The following is talking about the _____ effects of radiation and chemotherapy: · Risk for leukemia and skin cancers · Secondary malignancies (other than leukemia) o Breast, ovarian, uterine, thyroid, and lung cancers o Usually resistant to therapy o *Risk for other malignancies does not contraindicate use of chemotherapy

late

CBC: "shift to the ____" o More immature neutrophils (bands) - >10% o Indicates ACUTE BACTERIAL INFECTION

left

Pathophysiology—Classification • According to phase of cardiac contraction o _____ ventricular Systolic (LVS) or ejection fraction disorder o ______ ventricular Diastolic (LVD) or filling disorder

left

What side of heart failure has the following symptoms: Symptoms: - Weakness, fatigue - Depression, anxiety - Dyspnea - Shallow respirations up to 32-40/min - Paroxysmal nocturnal dypnea - Orthopnea - Dry, hacking cough - Nocturia - Frothy, pink tinged sputum (advanced pulmonary edema)

left sided HF

What side of heart and type of HF is described below: (about 50% of patients with left heart failure) - inability of the L ventricle to fill properly during diastole o HFpEF - EF not reduced (preserved) but: decreased filling of ventricle = ↓ SV and ↓CO o LV is stiff and noncompliant o HTN is the most important cause of this HF o Diagnosed by s/s: EF normal, LV dysfunction on echocardiogram, or cardiac catheterization o Heart muscle has become thick making chamber size small leading to not being able to hold as much blood o Thick heart muscle and smaller chambers!

left sided diastolic HF

What side of heart and type of HF is described below: failure (about 50% of patients with left heart failure) - inability of the L ventricle to FILL properly during diastole o HFpEF - EF not reduced (preserved) but: decreased filling of ventricle = ↓ SV and ↓CO

left sided diastolic HF

What part of interprofessional care of HTN is described below: o Weight reduction o 1 mm Hg for every 1 kg weight loss o DASH diet o Restrict sodium <1500 mg/day, or at least 1000 mg/day reduction o Moderate alcohol 1/day for women, 2/day for men o Activity Aerobic and resistance, structured program o Tobacco o Manage psychosocial risk factors Stress, social isolation, socioeconomic status, depression, hostility

lifestyle changes

When talking about activities that affect caloric expenditure: ________ activity includes: --100-200 kcal/hr --includes: fishing, light housework, secretarial work, teaching, walking casually

light

What part of the pouching system of an ostomy is described below: · - protects skin from stripping with removal of barrier, seals in powder

liquid skin prep

what type of biliary cancer is described below: · Clinical manifestations o Can be subtle or absent at the early stages o Most often the result of the underlying cirrhosis or failure

liver cancer

what type of biliary cancer is described below: · Diagnostic and screening for ____ _____ o Ultrasound, CT scan and MRI o Biopsy - only if absolutely necessary due to risks o Serum ἀ-protein level (AFP)

liver cancer

what type of biliary cancer is described below: · Nursing and Interprofessional Care: o Nursing Care § Keep the patient comfortable § Treat the same as any patient with advanced liver disease § Prognosis is poor but improving with early screening for high risk groups (chronic hepatitis and/or cirrhosis) § Death may occur in 6-12 months without treatment § Provide emotional support

liver cancer

what type of biliary cancer is described below: · Nursing and Interprofessional Care: o Prevention § Screening and treating patients with chronic hepatitis B and C, cirrhosis § Treat persons with chronic alcohol abuse § Screening usually involves a combination of AFP, CT, and MRI or ultrasound imaging of the liver o Treatment § Depends on stage of the disease § Age and overall health § Underlying liver disease § Surgical liver resection offers the best chance for cure - requires enough healthy liver tissue for this option § Liver transplant - for early stage and impaired liver function § Non-surgical Treatment · Percutaneous ablation, chemoembolization, radioembolization, chemotherapy o Nursing Care § Keep the patient comfortable § Treat the same as any patient with advanced liver disease § Prognosis is poor but improving with early screening for high risk groups (chronic hepatitis and/or cirrhosis) § Death may occur in 6-12 months without treatment § Provide emotional support

liver cancer

what type of biliary cancer is described below: · Nursing and Interprofessional Care: o Treatment § Depends on stage of the disease § Age and overall health § Underlying liver disease § Surgical liver resection offers the best chance for cure - requires enough healthy liver tissue for this option § Liver transplant - for early stage and impaired liver function § Non-surgical Treatment · Percutaneous ablation, chemoembolization, radioembolization, chemotherapy

liver cancer

what type of biliary cancer is described below: · Starts in the liver - may metastasize to the gallbladder, peritoneum or diaphragm, or most commonly to the lungs · 75% are hepatocellular carcinoma (HCC) · 25% are cholangiocarcinoma (bile duct) · Hepatitis C is the most common cause of HCC · is the most common cause of death in patients with cirrhosis

liver cancer

redness, edema in surrounding areas, little bit of serous and purulent drainage

local response

What insulin prep is described below: *glargine (Lantus), detemir (Levemir), degludec (Tresiba) Onset: 0.8-4 hr Peak: less defined or no pronounced peak Duration: 16-24 hr

long acting

(nursing home) o Rapid patient deterioration or function o Caregiver stress and burnout o Alteration in or loss of family support system Transition may be difficult Relocation stress syndrome--> if a patient moves into a long-term care facility, the transition is very difficult for them. They will go into depression, malnutrition, and will have an increased risk of fractures

long-term care facilities

What type of stoma is described below: o - one stoma, two openings (proximal & distal), not 100% diverting

loop

What part of the pouching system of an ostomy is described below: · - facilitates pouch emptying as stool slides out of pouch easier, deodorizes stool

lubricating deodorizer

What diagnostic test of the respiratory system is described below: Description and Purpose: specimens may be obtained by transbronchial or percutaneous biopsy via transthoracic needle aspiration (TTNA) , video assisted thorascopic surgery (VATS), or open lung biopsy. Nursing Responsibility: Before: obtain signed consent. Same as bronchoscopy if procedure done with bronchoscope and same as thoracotomy if only lung biopsy done. After TTNA: Check breath sounds q4hr for 24 hours and report any respiratory distresss. Check incision site for bleeding. a chest x-ray should be done after TTNA After VATS: a chest tube may be placed postoperative until lung has reexpanded. MOnitor breath sounds to follow chest reexpansion

lung biopsy

The following are clincial manifestations what type of cancer? o Non-specific, appear late in disease process, may be masked by chronic cough attributed to smoking o Frequently a pneumonia that does not respond to treatment o Persistent cough, blood tinged sputum, dyspnea, wheezing, chest pain o Anorexia, weight loss, fatigue, n/v, hoarseness, unilateral paralysis of the diaphragm, dysphagia , SVC syndrome

lung cancer

The following are clincial manifestations what type of cancer? o Persistent cough, blood tinged sputum, dyspnea, wheezing, chest pain o Anorexia, weight loss, fatigue, n/v, hoarseness, unilateral paralysis of the diaphragm, dysphagia , SVC syndrome

lung cancer

The following are diagnostic studies for what type of cancer? · Diagnostic Studies: o Chest x-ray o Sputum cytologic studies o CT scan, CT guided biopsy, bronchoscopy, mediastinoscopy, video-assisted thoracoscopic surgery (VATS) o Bone scans and CT scan of brain, pelvis, abdomen o CBC, Chemistries, LFT, pulmonary function tests, MRI and/or PET

lung cancer

The following are nursing diagnoses for what type of cancer? o Ineffective airway clearance o Impaired gas exchange o Ineffective breathing pattern o Anxiety o Acute pain o Imbalanced nutrition: < body requirements o Self-care deficit o Ineffective health maintenance (smoking)

lung cancer

The following are overall goals of a patient with what type of cancer? o Improved/effective breathing patterns o Adequate airway clearance o Improved/adequate oxygenation of tissue o Improved nutritional status o Minimal to no pain o Realistic attitude toward treatment and prognosis

lung cancer

The following are the different types of ____ ____: o Non-small cell ___ ______ (NSCLC) - 80% of all lung cancers § Squamous cell carcinoma - slow § Adenocarcinoma - moderate § Large-cell undifferentiated carcinoma - rapid o Small cell _____ ______ (SCLC) - very rapid, most malignant, 20% of all lung cancers

lung cancer

The following is nursing care (surgery patients) of what type of cancer? o Post-op: § Pain control - PCA § Respiratory status § Chest tube § Wound assessment and care

lung cancer

The following is nursing care (surgery patients) of what type of cancer? o Pre-op: § Baseline pulmonary status § ABGs, ECG, PFT, CBC, Chemistries, glucose, coagulation studies § Smoking cessation § Support o Post-op: § Pain control - PCA § Respiratory status § Chest tube § Wound assessment and care · Ambulatory and Home Care: o Follow up carefully for manifestations of metastasis o Educate patient on S/S to report: § hemoptysis § dysphagia § chest pain § hoarseness o

lung cancer

The following is nursing care (surgery patients) of what type of cancer? · Ambulatory and Home Care: o Follow up carefully for manifestations of metastasis o Educate patient on S/S to report: § hemoptysis § dysphagia § chest pain § hoarseness o

lung cancer

The following is nursing care for what type of cancer? o Support and reassurance during diagnostic evaluation o Oxygenation, oxygenation, oxygenation o Assist with ADLs o Nutrition o Airway clearance o Pain management

lung cancer

The following is treatment (Surgery) for what type of cancer? o Surgery § Contraindicated for small cell carcinomas (most malignant, fast metastasis) § Squamous cell carcinomas likely to be treated with surgery § Surgical resection is the treatment of choice · pneumonectomy, lobectomy, segmental or wedge resection § 50% of NSCLCs are not resectable at the time of diagnosis

lung cancer

What type of cancer is described below: · Leading cause of cancer-related deaths · Associated with high mortality rates · Smoking is responsible for 80 to 90% of all ____ ______ · Cigarette smoke causes changes in bronchial epithelium - in the person who is smoking, and whoever is exposed · Risk of lung cancer gradually decreases with smoking cessation - in 10-15 years = same as non-smokers

lung cancer

o Remove the most diseased portion of the lung so the remaining portion can work better o Improves lung and chest wall mechanics, allows the diaphragm to return to its normal shape o Helps the patient breathe more efficiently **interprofessional care: surgical therapy

lung volume reduction surgery (LVRS)

Understanding CBC: Inflammation/Infection: ↑ ___________ = viral infection, leukemia, lymphoma ↓ ___________ = immune system/ bone marrow diseases (i.e. lupus, HIV infection, immunosuppression, chemo)

lymphocytes

What anatomic site classification of a tumor is described below: •Develops from Hematopoietic System

lymphomas and leukemias

What chronic complication of DM is described below: o CAD, PVD, CVA

macrovascular

What are the 2 chronic complications of DM?

macrovascular and microvascular

What diagnostic test of the respiratory system is described below: Description and Purpose: used in depth diagnosis of lesions difficult to assess by CT scan (ex: lung apex) and for differentiating vascular from nonvascular structures Nursing Responsibility: same as for chest x-ray and CT scan exepct medium is NOT iodine based. Before: explain MRI unit will be close to patient's body. IF patient has claustrophobia, provide relaxation suggestions to help cope. Patient must remove all metal before test. Patients with pacemakers and implantable cardioverter-defibrillators may not have an MRI.

magnetic resonance imaging (MRI)

To plan to ______ a crisis: o Treatments and medications they need to take EX: someone with asthma: if they need a treatment, they know they have an inhaler to help o Dietary and lifestyle changes EX: someone with high blood sugar levels; what dietary and lifestyle changes will they need to adapt to? o When to contact the HCP

manage

As a nurse, you play an important role in the _____ of patients with chronic illness. This includes conducting a comprehensive history and physical assessment, participating in interventions and plan of care, teaching the patient and caregiver regarding the treatment plan, implementing strategies for symptom management, and evaluating patient outcomes.

management

What part of interprofessional care of HTN is described below: o Periodic monitoring of BP Home BP monitoring Ambulatory BP monitoring Every 3-6 months by a HCP once goal BP is achieved and stabilized USE CORRECT TECHNIQUE!!! o Nutritional therapy Restrict salt and sodium Restrict cholesterol and saturated fats Maintain adequate intake of potassium, calcium, and magnesium Weight management o Regular moderate physical activity o Tobacco cessation o Moderation of alcohol intake o Stress management techniques o Antihypertensive drugs o Patient and caregiver teaching

management

• ______ ______ --> HCP, anyone who is in social service sector, it is mandated that we report elder abuse o Mandated to report to elder abuse o In Louisiana, _______ _______ starts at age 60; any person 60 or over that you suspect to be abused or neglected or exploited, you are mandated to report to Adult Protective Services o For younger people, there is no _______ _________ unless they are physically or psychologically okay but their children are stealing from them • Organizational protocols for screening and intervention **elder mistreatment and abuse

mandatory reporting

The following are specific _______ related to urinary system disorders: -edema -pain -patterns of urination -urine output -urine composition 1. edema (facial, ankles, ascites, anasarca, sacral) 2. pain (dysuria, flank or costovertebral angle, groin, suprapubic) 3. patterns of urination (frequency, urgency, hesitancy of stream, change in stream, retention, dysuria, nocturia, incontinence, stress incontinence, dribbling) 4. urine output (anuria, oliguria, polyuria) 5. urine composition (concentrated, dilute, hematuria, pyuria, color such as red, brown, yellowish green)

manifestations

The following are inflammatory ______: • Histamine • Serotonin • Kinins • Complement components • Prostaglandins • Leukotrines • Cytokines

mediators

With management of DM, what component of patient teaching has the following points that need to be taught to the patient and/or caregiver: --ensure that the patient understands the proper use of prescribed medications (Ex: insulin) ==account for a patient's physical limitations or inabilies for self medication. If necessary, involve the family and caregiver in proper use of medicatoin --discuss all side effects in proper use of medication.

medication

1. Decreased vision 2. Forgetting to take drugs 3. Use of nonprescription over the counter drugs 4. Use of medications prescribed ot someone else 5. Lack of financial resources to obtain prescribed medication 6. Failure to understand instructions or importance of drug treatment 7. Refusal to take medication because of undesirable side effects These are the causes of ______ _____ by older adults

medication errors

With _______ _____, errors are common. They are common cause of hospitilization and a common cause of disability and death.

medication use

with DM interprofessional care, _______ include: Three Major Types of Glucose-Lowering Agents o Insulin o Non-insulin injectable agents o Oral agents Insulin • Type 1 DM o need exogenous insulin for life to prevent ketoacidosis o REQUIRED FOR TYPE 1 DIABETICS!!! • Type 2 DM o prescribed for patients who cannot control blood glucose by other means o The need varies with exercise, stress, illness, food intake o requires self-monitoring of blood glucose. (NEED TO KNOW THIS!)

medications

With management of DM, what component of patient teaching has the following points that need to be taught to the patient and/or caregiver: --stress the importance of a well-balanced diet as part of a DM management plan --explain the impact of carbohydrates on blood glucose levels

menu planning

the following are clinical manifestations of cirrhosis: · hypokalemia, hyponatremia, hypoalbuminemia

metabolic

When taking about a patient with CKD, ____ _____ Include: o Hyperglycemia may also occur because body is not able to metabolize carbohydrates o If they are on insulin in the later stages of CKD, their insulin needs may be deprived because the kidneys are what excrete the insulin from the body so if the insulin is not being excreted, then insulin is hanging around longer. People think that their diabetes are getting better since insulin is staying around however they are making their kidneys worse.

metabolic disturbances

When taking about a patient with CKD, ____ _____ Include: • Elevated triglycerides o hyperinsulinemia stimulates hepatic production of triglycerides o hyperlipidemia with ↑LDL and VLDL, ↓HDL This accelerates atherosclerosis. Increased bad cholesterols Decreased good cholesterol o Most patients with CKD die from CV disease as a result Most people do not die from CV disease but by kidney disease

metabolic disturbances

When taking about a patient with CKD, ____ _____ Include: • Waste product accumulation o BUN ↑, creatinine ↑ • Altered CHO metabolism o Decreased insulin sensitivity- mild to moderate hyperglycemia and hyperinsulinemia may occur o Later: insulin requirements may decrease due to endogenous insulin staying in circulation longer o Will cause excess insulin to be produced and hyperinsulemia can lead to elevated triyglycerides and fat storage in the body o Hyperglycemia may also occur because body is not able to metabolize carbohydrates o If they are on insulin in the later stages of CKD, their insulin needs may be deprived because the kidneys are what excrete the insulin from the body so if the insulin is not being excreted, then insulin is hanging around longer. People think that their diabetes are getting better since insulin is staying around however they are making their kidneys worse. • Elevated triglycerides o hyperinsulinemia stimulates hepatic production of triglycerides o hyperlipidemia with ↑LDL and VLDL, ↓HDL This accelerates atherosclerosis. Increased bad cholesterols Decreased good cholesterol o Most patients with CKD die from CV disease as a result Most people do not die from CV disease but by kidney disease

metabolic disturbances

What category of oncologic emergencies is described below: **Tumor, or the secondary metabolic changes from the tumor/treatment, causes the production of ectopic hormones - Inappropriate Antidiuretic Hormone Secretion - Hypercalcemia - Tumor Lysis Syndrome - Septic Shock - Disseminated Intravascular Coagulation

metabolic emergency

_______ of lung cancer: o Direct extension, blood circulation, lymphatic system o Common sites for _______ § Liver § Brain § Bones § Scalene lymph nodes § Adrenal glands

metastasis

________ or cancer spread is: · Most cancer cells do not metastasize · It must detach and migrate from its primary location (primary tumor) · Need to survive multiple body deterrents · Invade through: o vascular system o lymphatic system o natural tissue walls

metastasis

What type of cancer is described below: --The spread of malignant cancer other parts of the body --Locally •by moving into nearby normal tissue --Regionally •Lymph Nodes •Tissues •Organs --Once spread, the _______ cancer has the same name as the primary cancer. For instance, colon cancer that spreads to the liver is not liver cancer, it's stage IV colon cancer with liver metastasis. The cancer cells in the liver look like the cancer cells in the colon and are treated like colon cancer.

metastatic

The following are problems using a ____ ____ ____ (MDI): --failing to coordinate activation with inspiration --activating MDI in the mouth while breathing through nose --inspiring too rapidly --not holding the breath for 10 seconds (or as close to 10 sec as possible) --holding MDI upside down before use --inhaling more than 1 puff with each inspiration --not waiting a sufficient amount of time between each puff --not opening mouth wide enough (if using open mouth technique), causing medication to bounce off teeth, tongue, or palate --not having adequate strength to activate MDI --being unable to understand and follow directions

metered-dose inhaler

The following are problems using a ____ ____ ____ (MDI): --not waiting a sufficient amount of time between each puff --not opening mouth wide enough (if using open mouth technique), causing medication to bounce off teeth, tongue, or palate --not having adequate strength to activate MDI --being unable to understand and follow directions

metered-dose inhaler

What drug to treat COPD is described below: (theophylline) o NOT recommended for long-term unless other bronchodilators not available or unaffordable; controversial use in COPD

methylxanthines

What chronic complication of DM is described below: o Retinopathy, neuropathy, nephropathy

microvascular

What category of the elderly is from the age of 75-84? **nearly 25% of individuals age 75-84 live in nursing homes

middle-old

What are 3 manifestations of the early stages of PD?

mild tremor, slight limp, and decrease arm swing

Elder _______ and abuse affects 2-10% of community-dwelling older adults. There is a 3x mortality risk of other adults with elderly ______ and abuse. When elderly _____ and abuse is seen, mandatory reporting is required. • Mandatory reporting: HCP, anyone who is in social service sector, it is mandated that we report elder abuse o Mandated to report to elder abuse o In Louisiana, mandatory report starts at age 60; any person 60 or over that you suspect to be abused or neglected or exploited, you are mandated to report to Adult Protective Services o For younger people, there is no mandatory reporting unless they are physically or psychologically okay but their children are stealing from them • Organizational protocols for screening and intervention

mistreatment

Manifestations - o Low EF (ejection fraction) o Low BP o Low CO o Impaired renal perfusion o Low exercise tolerance Not enough oxygen to tissues o Dysrhythmias Stretching or thickening of heart muscles impedes electrical pathways sending them in different directions causing these

mixed systolic/diastolic HF

When talking about activities that affect caloric expenditure: ________ activity includes: --200-350 kcal/hr --Includes: active housework, bicycling (light), bowling, dancing, gardening, golf, roller skating, walking briskly

moderate

With management of DM, what component of patient teaching has the following points that need to be taught to the patient and/or caregiver: --teach correct blood glucose monitoring --include when to check blood glucose levels, how to record them, and how to adjust insulin levels if necessary

monitoring blood glucose

Understanding CBC: Inflammation/Infection: ↑ _________ = chronic infection, autoimmune disorders, leukemia ↓ __________ = bone marrow disorders, immunosuppression

monocytes

What system has the following clinical manifestations of CKD? • osteomalacia due to demineralization • bone fractures, muscle pain

musculoskeletal system

What primary cause of HF is : : inflammation of the heart muscle which can lead to weakening of the heart muscle

myocarditis

What method of2 administration is described below: Description: most commonly used device, O2 delivered via plastic nasal prongs; safe and simply method that allows some freedom of movement. Patient can eat talk or cough while wearing. useful for patient requiring low O2 concentrations; O2 concentrations of 24% (at 1 L/min) to 44% (at 6 L/min) can be obtained. Nursing Interventions: stabilize nasal cannula when caring for a restless patient; amount of O2 inhaled depends on room air and patient's breathing pattern; most patients with COPD can tolerate 2 L/min via cannula; assess patient's nares and ears for skin breakdown.May need to pad cannula where it sits on ears.;

nasal cannula

what counter-regulatory mechanism of HF is described below: o B-Type Natriuretic Peptide (BNP) increases Na excretion, cause diuresis → decreased fluid overload and ↓ preload o Natural diuretics in the body that when there is fluid volume overload and increases stretch in heart, heart released these peptides to help get rid of sodium and water decreasing fluid overload

natriuretic peptides

During a normal physical assessment of the respiratory system, what body part of the respiratory system has the following assessments: trachea midline

neck

What form of elder mistreatment and abuse is described below: not providing hygiene or nutritional needs or leaving them alone in house with no interaction Manifestations: Older adult's report of being neglected. Untreated or infected pressure ulcers on sacral area, heels. Loss of body weight. Laboratory values showing dehydration. Poor personal hygiene and lack of adherence with medical treatment. Depression, withdrawn behavior, agitation. Ambivalenet attitude toward caregiver or family member

neglect

With interprofessional care of chronic complications of DM, what microvascular complication is described below: • Proteinuria - first sign of renal damage • Annual screening for micro-albuminuria

nephropathy

What microvascular complication of DM is described below: • delayed gastric emptying (gastric stasis) • constipation • atonic bladder • erectile dysfunction o - Crede Manuver to assist emptying • silent MI • loss of warning signs of hypoglycemia/hypoglycemia unawareness • decreased perspiration, dry skin • Sensory neuropathy and autonomic neuropathy

neuropathy

What microvascular complication of DM is described below: • silent MI • loss of warning signs of hypoglycemia/hypoglycemia unawareness • decreased perspiration, dry skin • Sensory neuropathy and autonomic neuropathy

neuropathy

What part of bone marrow suppression (side effect of radiation and chemotherapy) is described below: : could result in serious life-threatening infection and sepsis

neutropenia

As the body "uses up" existing WBCs, the bone marrow produces new cells called?

neutrophils

Understanding CBC: Inflammation/Infection: ↑ ________ = bacterial infection, vasculitis and inflammatory conditions e.g. rheumatoid arthritis, lupus and vasculitis ↓ __________ = serious infection or meds (e.g. chemotherapy)

neutrophils

what counter-regulatory mechanism of HF is described below: from vascular endothelium, vasodilation to ↓ afterload o A vasodilator that decreases afterload

nitric oxide

With treatment of hypoglycemia: With ____ IV access: • 1mg glucagon IM or SQ • Place IV access

With interprofessional care of CKD, nutrition includes: FLUID RESTRICTION: ____ _____ (Stages 1-5) - water isn't restricted diuretics may be used to reduce fluid restriction need

no dialysis

With interprofessional care of CKD, nutrition includes: PROTEIN RESTICTION: ____ ______ (stages 1-4) - may have a normal protein intake but no high-protein or protein supplements to prevent additional renal stress These are not patients you want to drink protein shakes or meal bars

no dialysis

what venous diagnostic study is described below: o Ultrasound - assess blood flow and venous collapse

non-invasive

what does NSCLC stand for?

non-small cell lung cancer

what clinical manifestation of PD (Parkinson's disease) is described below: **In addition to the motor signs of PD, many ____ _______ are common. **They include depression, anxiety, apathy, fatigue, pain, urinary retention and constipation, erectile dysfunction, and memory changes.

nonmotor symptoms

what clinical manifestation of PD (Parkinson's disease) is described below: -The posture is that of a slowed "old man" image, with the head and trunk bent forward and the legs constantly flexed. -Postural instability is common. -Patients may complain of being unable to stop themselves from going forward (propulsion) or backward (retropulsion). -Assessment of postural instability includes the "pull test." The examiner stands behind the patient and gives a tug backwards on the shoulder, which causes patients to lose their balance and fall backward.

nonmotor symptoms

what clinical manifestation of PD (Parkinson's disease) is described below: o Depression and anxiety - Apathy - Fatigue - Pain o Urinary retention and constipation o Erectile dysfunction - Memory changes o Sleep disturbances § Difficulty staying asleep - Restless sleep - Nightmares § Drowsiness during the day § REM behavior disorder · Violent dreams · Potentially dangerous motor activity during REM sleep **In addition to the motor signs of PD, many ____ _______ are common. **They include depression, anxiety, apathy, fatigue, pain, urinary retention and constipation, erectile dysfunction, and memory changes.

nonmotor symptoms

what clinical manifestation of PD (Parkinson's disease) is described below: o Sleep disturbances § Difficulty staying asleep - Restless sleep - Nightmares § Drowsiness during the day § REM behavior disorder · Violent dreams · Potentially dangerous motor activity during REM sleep

nonmotor symptoms

A ______ physical assessment of urinary system includes: • No costovertebral angle tenderness • Nonpalpable kidney and bladder • No palpable masses

normal

IF the normal percentage of monocytes is 3-7% in the body and your patient has a percentage of 4%, what is this considered?

normal

What category of BP is described below: SBP: < 120 mmHg and DBP < 80 mmHg

normal

During a normal physical assessment of the respiratory system, what body part of the respiratory system has the following assessments: -symmetric with no deformities -nasal mucosa pink, moist with no edema, exudate, blood, or polyps -nasal septum straight (slight nasal deviation possible). Nares patent bilaterally

nose

What diagnostic study done for a patient with HF is described below: evaluate ventricles o Function of ventricles

nuclear imaging studies

What part of the treatment plan of a patient with HF is described below: o Provide Rest (physical, emotional) Decreases demand on the heart With emotional rest, pay attention to what the visitors are doing such as fighting about where their parent is going after this (for example); short visits of 10-15 minutes o Life-style changes Low sodium diet, spacing out activities o High Fowler's position o O2 therapy

nursing care

The following are ____ ____ for disorders of the female urogenital tract (cystocele and rectocele): · Pain · R.C. Bleeding · R.C. Thromboembolism · Risk for infection · Risk for constipation · Impaired body image o Usually be a pre-op ND but also too can have this ND after the surgery if there is significant internal scarring that prevents them from engaging in normal sexual functions · Risk for impaired sexual pattern

nursing diagnoses

Under ____ _____ of a chronic illness/disease, you need to perform a comprehensive health and physical assessment, plan of care, patient and caregiver education, symptom management, and evaluating outcomes of treatments so you can play role in adjusting treatments to achieve the best results. o History: when did this disease start? Has this disease gotten worse or better? Has any treatment helped? Children can begin taking precautions in order to not develop same disease

nursing management

With interprofessinal care of COPD, _______ includes: Avoid : o Foods that require a great deal of chewing o Exercises and treatments 1 hour before and after eating o Gas-forming foods

nutrition

With interprofessinal care of COPD, _______ includes: Malnutrition caused by: o Increased inflammatory mediators o Increased metabolic rate o Increased metabolic rate o Lack of appetite o Weight loss - predictor of poor prognosis To decrease dyspnea and conserve energy: o Rest at least 30 minutes before eating o Avoid exercise for 1 hour before and after eating o Use bronchodilator o Supplemental O2 may be helpful o High-calorie, high-protein diet is recommended o Eat five to six small meals to avoid bloating and early satiety Avoid : o Foods that require a great deal of chewing (such as as steak) o Exercises and treatments 1 hour before and after eating o Gas-forming foods Want to avoid bloating that will further decrease intrathoracic space

nutrition

With interprofessinal care of COPD, _______ includes: To decrease dyspnea and conserve energy: o Rest at least 30 minutes before eating o Avoid exercise for 1 hour before and after eating o Use bronchodilator o Supplemental O2 may be helpful o High-calorie, high-protein diet is recommended o Eat five to six small meals to avoid bloating and early satiety

nutrition

With interprofessional care of CKD, ________ includes: • Electrolyte Restriction o Sodium: 2-4g/day Depending on elevated sodium or not o Potassium: 2-3g/day (approx. 50-75 meq/day) (39mg = 1meq) Very important when restricting sodium that a lot of salt substitutes contain potassium so need to teach patient to choose salt substitutes that do not have potassium or not high in potassium o Phosphate: 1g/day Foods high in protein may be high in phosphates May need phosphate binders

nutrition

With interprofessional care of CKD, ________ includes: • Fluid Restriction o No dialysis (Stages 1-5) - water isn't restricted diuretics may be used to reduce fluid restriction need o receiving hemodialysis - Based on daily urine output if they have no urine output, they will be more fluid restricted than if they produced 300 mL/day

nutrition

With interprofessional care of CKD, ________ includes: • Protein Restriction o Hemodialysis - restricting protein isn't necessary o No dialysis (stages 1-4) - may have a normal protein intake but no high-protein or protein supplements to prevent additional renal stress These are not patients you want to drink protein shakes or meal bars o peritoneal dialysis - additional protein may compensate for that losses in PD draws more protein out of blood than hemodialysis patients lead to dietician to decide o **once on dialysis, can have protein again

nutrition

what part of health promotion is the following: If they do have an inflammatory process, we want to make sure the patient is getting the proper _______ in order to heal

nutrition

Cirrhosis _________ therapy includes: · Diet for patient WITHOUT complications o High in calories (3000 cal/day) o ↑ Carbohydrate o Moderate to low fat · Protein supplements for protein-calorie malnutrition · Low-sodium diet with ascites and edema · Seasonings to make food more palatable · Collaborate with a dietitian

nutritional

what precipitating factor of HF is described below: May decrease cardiac function by increased myocardial muscle mass and myocardial contractility

nutritional deficiencies

nutritional therapy

With interprofessional care of patients with PAD, ____ ______: includes: o Weight loss, o reduced cholesterol and triglycerides o lower blood glucose o reduce Na+ to < 2 gm daily

nutritional therapy

what clinical manifestation of MS is the involuntary, rhythmic movement or oscillation of the eye **Can occur if the ocular motor nerve is affected. In remission the nystagmus can go away. Brain tumors, strokes, can all cause nystagmus. This is not a specific factor of MS.

nystagmus

What chronic disease is described below: -affects about 34% of adults -major contributor to other health problems

obesity

What risk factor for primary HTN is described below: - visceral adiposity o Weight gain is associated with increased frequency of HTN o Risk increases with central abdominal obesity

obesity

When talking about the CV assessment ______: assess, • distended neck veins • central cyanosis • peripheral cyanosis • splinter hemorrhages o pinkish lines underneath nails; sign of poor circulation • clubbing of nail beds o swollen embolus appearance at end of fingers • color changes in extremities with postural change • ulcers

objective

With nursing management of COPD, assessment includes assessing _______ data which includes: o General: debility, restlessness, cognition, upright position o Color, edema, digital clubbing o Respiratory effort, breath sounds, AP chest diameter (barrel chest) o Heart rate and rhythm, heart tones, JVD, S3 heart sound o Ascites, hepatomegaly o Muscle atrophy o Diagnostic studies: ABG, H&H (compensatory ), oximetry, PFT, CXR,

objective

When talking about nursing management: nursing assessment of a pt with Parkinson's disease, ____ _____ includes: o Blank faces, infrequent blinking o Seborrhea, Dandruff, Ankle edema o Postural hypotension o Tremor at rest o Aggravated with anxiety; absent in sleep o "Pill rolling", Poor coordination o Cognitive impairment and dementia o Impaired postural reflexes o Cogwheel rigidity, Dysarthria, Bradykinesia o Contractures, Stooped posture, Shuffling gait

objective data

What category of oncologic emergencies is described below: **Tumor causes obstruction of an organ or blood vessel - Superior Vena Cava Syndrome - Spinal Cord Compression Syndrome - Third Space Syndrome - Intestinal Obstruction

obstructive

what precipitating factor of HF is described below: Frequent nighttime apnea results in increased afterload, intermittent hypoxia, and increased sympathetic nervous system activity

obstructive sleep apnea

What are the 3 categories of oncologic emergencies?

obstructive, metabolic emergency, and infiltrative emergency

What category of the elderly is from the age over 85? *often a widowed, divorced, or single woman dependent on family for support of care *many OA this age outlived children, spouses, or partners, and siblings

old-old

The following is characteristics of ___ ____: • The population of the world is aging! o Surviving acute illnesses o Living longer with chronic illnesses o More educated and resourceful o More ethnically diverse

older adults

when talking about the diagnosis of MS, ____ _____ are bands of Immunoglobulins in CSF, blood o By itself, not a diagnostic test

oligoclonal bands

When talking about insulin administration: ______ a day includes: o Intermediate acting at bedtime o Long acting in a.m. or bedtime

once

What role of the immune system is described below: · found on surfaces and inside of cancer cells and fetal cells o Examples: AFP, CEA, CA-125, CA-19-9, can be used as tumor markers

oncofetal antigens

The following are _____ _____: 1. superior vena cava syndrome 2. Spinal cord compression 3. Third space syndrome 4. Syndrome of inappropraite antidiuretic hormone release 5. Hypercalcemia

oncologic emergencies

_______ pressure pulls blood into vessels.

oncotic

What part of the pouching system of an ostomy is described below: · skin barrier and pouch are made together, can't be separated

one-piece

What stage of chronic illness trajectory is described below: -signs and symptoms are present -disease diagnoses

onset (1)

What are the 8 stages of Chronic illness trajectory?

onset, stable, acute, comeback, crisis, unstable, downward, and dying

What surgical therapy for gallbladder disease is described below: o Removal of gallbladder through right subcostal incision o T-tube inserted into common bile duct § Ensures patency of duct § Allows excess bile to drain

open (incisional) cholecystectomy

What diagnostic study for DM is described below: • IGT o 2-hr post-load glucose 140-199 = impaired glucose tolerance o Indicates pre-diabetes • DM o 2-h post-load glucose ≥200 mg/dl = Diabetes mellitus • normal o 2-h post-load glucose <140 mg/dl = Normal Glucose Tolerance • Test procedure: NPO for 8 hours; ingest 75 gm glucose; check blood glucose after 2 hours • When you suspect someone has DM but their fasting glucose is fine.

oral glucose tolerance test

what diagnostic study for DM is described below: Test procedure: NPO for 8 hours; ingest 75 gm glucose; check blood glucose after 2 hours

oral glucose tolerance test

During a normal physical assessment of the respiratory system, what body part of the respiratory system has the following assessments: -light pink, moist, no exudate, or ulcerations

oral mucosa

What side effect of radiation and chemotherapy is described below: NURSING CARE: o Teach to examine oral cavity o Dental work done before treatment o Saliva substitutes, Oral care, Pain relief o Frequent feedings of soft, nonirritating, high-protein, high-calorie foods o Avoid extremes in temperature, spices, alcohol, tobacco

oral, oropharynx, esophageal reactions

What type of urinary diversion is described below: · Created with small intestine to store and remove urine o Total cystectomy o Ureters and urethra sutured to neobladder o Patient urinates through urethra o Need to void q 2 - 4 hours (no normal desire to void) o Takes ~ 6 months for bladder control

orthotopic bladder or "neobladder"

The following are the different types of _______: · Colostomy · Ileostomy · Urostomy · Other: o Duodenostomy o Jejunostomy o Ureterostomy o Vesicostomy

ostomies

The following is patient education for _______ care: · Empty pouch when it is 1/3 -1/2 full · For fecal stoma - wipe tail of pouch (inside & outside) with toilet paper or wipe prior to closing pouch, may add lubricating deodorizer after emptying · Pouching system change - goal is a predictable wear time, usually change twice per week (every 3-4 days), at least weekly, not advised to wear pouching system longer than 7 days, need to be able to assess peristomal skin at least weekly

ostomy

The following is patient education for _______ care: · Remove old pouching system using the push pull method to protect peristomal skin · Clean peristomal skin with water · Remeasure stoma on a weekly basis for 6-8 weeks

ostomy

The following are _______ treatments for cancer: -Targeted Therapy: (works by targeting the cancer's specific genes related to cancer growth) -Hormone Therapy: seeks to prevent production and effects of hormones that are vital for the cancer (such as breast cancer). -Gene Therapy: a new treatment modality that introduces new genes into a cancerous cell or the surrounding tissue to cause cell death or slow the growth of the cancer.

other

With HF patients, patient ______ include: • Maintains weight within 1-2 lbs of baseline • Notifies primary care provider with weight gain of >3 lbs over 2 days • No hospital admissions with ADHF • No peripheral edema • able to walk 25 feet without complaints of dyspnea o or improvement relevant to baseline o individual thing

outcomes

Other COPD treatments include ____ ______: o use with caution o COPD pts breathe based on CO2 level, not O2 level o Reversed "hypoxic" drive - breathing stimulated by dropping CO2 level o High O2 flow can affect COPD pt's "drive" to breathe ALWAYS USE THE PARAMETERS PRESCRIBED TO PATIENT WHEN TITRATING OXYGEN TO DESIRABLE O2 SAT LEVEL. • For example: if patient's prescriber wants their O2 sat to be 90%, do not titrate the prescribed regimen to get their O2 sat to 92%

oxygen therapy

What method of2 administration is described below: Description: generally indicated for long term O2 therapy at home vs during hospitalization (ex: pulmonary fibrosis, pulmonary HTN); may be "moustache" (Oxymizer) or "pendant type"; cannula has a built in reservoir that increases O2 concentrations and allows patients to use lower flow, usually 30-50% which increases comfort, lowers cost, and can be increased with activities. Nursing Interventions: may cause necrosis over tops of ears but can be padded; cannula cannot be cleaned. Manufacturer recommened changing cannula every week. If it more expensive than standard cannulas and requires evaluation with ABGs and oximetry to determine correct flow for patient. Connula is highly visible

oxygen-conserving cannula

A normal ______ of a physical assessment of CV system includes: Capillary refill < 2 sec. PMI palpable in 4th ICS at left MCL. No thrills or heaves. Slight palpable pulsations of abdominal aorta in epigastric area. Carotid and extremity pulses 2+ or equal bilaterally. No pedal edema.

palpation

What surgical intervention for both type 1 and 2 DM is: o Option for Type 1 Dm with severe and consistent complications/treatment failurse o Usually due to end-stage renal disease/kidney transplant

pancreas transplant

what complication of acute pancreatitis is described below: o Infected pseudocyst o Results from extensive necrosis o May rupture or perforate o Upper abdominal pain, mass, high fever, leukocytosis o Requires prompt surgical drainage

pancreatic abcess

what complication of chronic pancreatitis is described below: o Pleural effusion

pancreatic cancer

what type of biliary cancer is described below: · Cause is unknown; risk factors include: o Smoking o Diabetes o Chronic Pancreatitis o Family history of pancreatic cancer o High-fat diet o Age o Exposure to chemicals - most firmly established environmental risk is smoking

pancreatic cancer

what type of biliary cancer is described below: · Clinical Manifestations o Pain o Jaundice o Anorexia, nausea, and rapid/progressive weight loss o Extreme pain is related to extension of the cancer

pancreatic cancer

what type of biliary cancer is described below: · Diagnosis o Abdominal ultrasound, endoscopic ultrasound o CT scan, ERCP, MRI, MRCPPET/CT scan o Tumor marker § Cancer-associated antigen 19-9 (CA 19-9)

pancreatic cancer

what type of biliary cancer is described below: · More than ½ of pancreatic cancer tumors are in the head of the pancreas o Those in the body or the tail often remain silent until growth is advanced o Majority have metastasized at the time of diagnosis o Prognosis is poor (5-12 months) - Less than 5% survive 5 years

pancreatic cancer

what type of biliary cancer is described below: · Nursing and Interprofessional Care: o Surgery - most effective treatment o Only 15%-20% have tumors that can be resected at the time of diagnosis o Neoadjuvant chemotherapy (treatment before surgery) - more patients become surgical candidates o Radiation may be used as part of palliative care o Treatment: § Surgery (only 20% of patients) · Whipple procedure (pancreatoduodenectomy) o Head of the pancreas, portion of the bile duct, gallbladder and duodenum are removed; portion of the stomach may also be removed o Remaining structures sutured back to the intestine to direct gastrointestinal secretions back into gut · Distal pancreatectomy · Total pancreatectomy § Chemotherapy § Radiotherapy: intensity modulated radiation Tx · external radiation · Brachytherapy

pancreatic cancer

what type of biliary cancer is described below: · Nursing and Interprofessional Care: o Treatment: § Surgery (only 20% of patients) · Whipple procedure (pancreatoduodenectomy) o Head of the pancreas, portion of the bile duct, gallbladder and duodenum are removed; portion of the stomach may also be removed o Remaining structures sutured back to the intestine to direct gastrointestinal secretions back into gut · Distal pancreatectomy · Total pancreatectomy

pancreatic cancer

With nursing management of cirrhosis (acute care)--> ________: · Patient voids immediately before o Immediately before a __________, have the patient void to prevent a puncturing of the bladder during the procedure. · High Fowler's position or sitting on side of bed o When the ___________ is completed, have the patient sit on the side of the bed or place him/her in high Fowler's position. · Monitor for hypovolemia and electrolyte imbalances · Monitor BP and heart rate o Check and monitor BP and heart rate following the procedure. · Monitor dressing for bleeding/leakage o Check the dressing for bleeding and/or leakage of ascetic fluid.

paracentesis

What are the 3 complications of lung cancer?

paraneoplastic syndrome, horner syndrome, and superior vena cava syndrome

paresthesias

What clinical manifestation of PAD is described below: o Numbness or tingling in the toes or feet Or distal to the affected area o Produces loss of pressure and deep pain sensations Increased risk for injury!!!! o Injuries often go unnoticed by patient o Results from nerve tissue ischemia o The ischemic pain is a result of the accumulation of end products of anaerobic cellular metabolism, such as lactic acid. Once the patient stops exercising, the metabolites are cleared and the pain subsides. o PAD of the aortoiliac arteries produces claudication in the buttocks and thighs, whereas calf claudication indicates femoral or popliteal artery involvement. o PATIENT NEEDS TO CHECK THEIR FEET EVERY DAY.

paresthesias

What clinical manifestation of PAD is described below: o The ischemic pain is a result of the accumulation of end products of anaerobic cellular metabolism, such as lactic acid. Once the patient stops exercising, the metabolites are cleared and the pain subsides. o PAD of the aortoiliac arteries produces claudication in the buttocks and thighs, whereas calf claudication indicates femoral or popliteal artery involvement. o PATIENT NEEDS TO CHECK THEIR FEET EVERY DAY.

paresthesias

What method of2 administration is described below: Description: useful for short term therapy for patients needing higher O2 concentrations (60-90% at 10-15 L/min); O2 flows into reservoir bag and mask during inhalation; this bag allows patient to rebreate about first third of exhaled air; vents remain open on partial mask only; some facilities prefer this over non-rebreather as a safety issue Nursing Interventions: O2 flow rate must be sufficient to keep bag from collapsing during inspiration to avoid CO2 buildup; if deflation occurs, increase liter flow to keep bag inflated; mask should fit snugly; with non-rebreather masks, make sure valves are open during expiration and closed during inspiration to prevent drastic decrease in FIO2; monitor patient closely since more advanced interventions may be required such as CPAP, BiPAP, or intubation with mechanical ventilation

partial and non-rebreather masks

What part of the pouching system of an ostomy is described below: · "caulk" to fill in uneven areas, around edge of barrier next to stoma, contains alcohol, will sting when applied to denuded skin

paste

What surgical therapy to treat PAD includes the opening of an artery, removing plaque, and sewing a patch to the opening to widen the lumen? **interprofessional care

patch graft angioplasty

The following is the _______ of lung cancer: o Most primary lung originate from mutated epithelial cells o Development of mutations caused by carcinogens is influenced by genetic factors o Tumor development is promoted by epidermal growth factor o Takes 8 to 10 years for a tumor to reach 1 cm which is the smallest lesion detectable on x-ray

pathophysiology

The primary focus of nursing management of Raynaud's disease is ____ ______. Focus your instructions on preventing recurrent episodes. Tell patients to wear loose, warm clothing as protection from the cold, including gloves when handling cold objects. At all times, patients should avoid temperature extremes. Immersing hands in warm water often decreases the vasospasm. The patient should stop using all tobacco products and avoid caffeine and other drugs that have vasoconstrictive effects (ex: cocaine, amphetamine). Finally, provide patients with stress management strategies as appropriate.

patient teaching

The heart is covered by a fibrouserous sac called the ______. This sac consists of 2 layers: visceral, inner layer, and parietal, outer layer.

pericardium

What complication of cirrhosis is described below: § ↓ colloidal oncotic pressure from impaired synthesis of albumin § ↑ portacaval pressure from portal hypertension Lower extremities/presacral edema

peripheral edema

right sided heart failure results in?

peripheral edema, abdominal ascites, hepatomegaly, jugular venous distention

With interprofessional care of CKD, nutrition includes: PROTEIN RESTICTION: ______ dialysis - additional protein may compensate for that losses in PD draws more protein out of blood than hemodialysis patients lead to dietician to decide

peritoneal

what type of dialysis is described below: Complications: o Exit site/catheter infection o Peritonitis (infection of peritoneal cavity) o Abdominal pain o Hernias - ↑ intra-abdominal pressure o Protein loss - Encourage protein intake Dialysis used for peritoneal dialysis removes more protein May need protein supplements

peritoneal dialysis

what type of dialysis is described below: Complications: o Hyperinsulinism & hepatic production of tryglycerides glucose added to dialyzer we are adding so much glucose that they can absorb that and have problems o Sclerosing peritonitis & loss of ultrafiltration Scarring in peritoneal cavity and loss ultrafiltration and this dialysis no longer works for them

peritoneal dialysis

what type of dialysis is described below: Complications: o Lower back problems - ↑ intraabdominal pressure Pushes their posture o Bleeding problems o Pulmonary complications - atelectasis, pneumonia Excess absorption of this fluid into lungs Also from amount of fluid in abdomen preventing full expansion of lungs

peritoneal dialysis

what type of dialysis is described below: Treatment Plan: o Electrolyte composition of dialysis solution similar to plasma o Three phases for each cycle ("exchange") Inflow (fill) +- 2L over 10min • Fill peritoneal cavity and instill 2 L over 10 minutes Dwell (equilibration) - 20-30min (or up to 8+ hours depending on type of PD) Drain 15-30min Looking at about an 1 hour each cycle; may need to do 4 times a day; very time consuming o Patient can receive up to 4 exchanges/day

peritoneal dialysis

what type of dialysis is described below: • Fluid removal o ultrafiltration depends on osmosis, with dextrose being the most commonly used osmotic agent in PD solution • Relatively inexpensive and safe o Mean it costs less than hemodialysis • may cause complications o peritoneal glucose absorption -> hypertriglyceridemia, hyperglycemia

peritoneal dialysis

what type of dialysis is described below: • Primary advantage is simplicity and that it is done at home o Disadvantage: where to store those huge bags of dialysate? Have to have a room in house for dialysate solution o Patients do not have to go spend 3-4 hours at a time at a dialysis center • A catheter is inserted through the anterior wall of the peritoneal membrane into the peritoneal cavity • May be used once placed for low-volume exchanges or delayed for up to 2 weeks pending healing and sealing of the exit site • Dialysis is done daily, Different modalities

peritoneal dialysis

Some diseases, such as multiple sclerosis, have unpredictable courses that make planning activities difficult. Part of the individual's tasks is to develop a _____ ______ that includes the chronic illness and adjust to the lifestyle changes it necessitates. For example, an individual taking warfarin due to a mechanical heart valve may need to avoid extreme physical sports that have a high potential for injury. ***adjusting to changes in the course of the disease

personal identity

During a normal physical assessment of the respiratory system, what body part of the respiratory system has the following assessments: -smooth, moist, and pink

pharynx

When talking about pathophysiology or classification of HF, is is according to _______ of cardiac contraction and according to the ______ of the heart.

phase; side

What venous disorder is acute and is the inflammation of small cannulated veins?

phlebitis

What are 2 venous disorders?

phlebitis and venous thrombosis

With management of DM, what component of patient teaching has the following points that need to be taught to the patient and/or caregiver: --discuss the effect of regular exercise on the management of blood glucose. Improvement of CV function and general health

physical activity

Devices, materials, and equipment that physically prevent individuals from moving freely, such as walking, standing, lying, transferring, and sitting Used ONLY to ensure safety Least restrictive approach Last resort with the care of older adults Determine unmet physiologic or psychosocial needs Highly regulated

physical restraints

After the assessment of an older adult, you will now start _______. This includes: o Identify strengths and abilities Want them to maintain as much independence as possible o Priority goals Gain a sense of control: want them to feel like they have control over care Feel safe Reduce stress as much as possible by telling patient upfront on how the day is going to do, what the plan is, what you will be doing, etc.

planning

When planning for a patient with acute pancreatitis, ______ includes: · Patient will have: o Normal fluid and electrolyte balance o Minimal to no complications o No recurrent attacks · Relief of pain

planning

With nursing management of DM, ________ and evaluation includes: • Self-care engagement • Few hypo/hyper-glycemic episodes • Prevent/reduce chronic complications • Adjust to new lifestyle needs

planning

With nursing management of amputation, ______ includes: The overall goals are that the patient with an amputation will: Have adequate relief from the underlying health problem Have satisfactory pain management Reach max rehabilitation potential (with the use of prosthesis, if indicated) Cope with the body image changes and Make satisfying lifestyle adjustments

planning

When talking about chest exam findings in respiratory problems, what problem is described below: Inspection: tacypnea, use of accessory muscles Palpation: increased movement, increased fremitus above effusion, absent fremitus over effusion Percussion: dull

pleural effusion

When talking about chest exam findings in respiratory problems, what problem is described below: Inspection: tachypnea, use of acessory muscles, duskiness or cyanosis Palpation: increased fremitus over affected area Percussion: dull over affected area

pneumonia

• Rx'd and OTCs • Use of multiple medications by a person who has more than one health problem *nursing implementation

polypharmacy

What complication of cirrhosis is described below: Increased venous pressure in portal circulation · Splenomegaly · Large collateral veins · Ascites · Gastric and esophageal varices

portal HTN

What complication of cirrhosis is described below: · In patients with cirrhosis, the liver undergoes structural changes. These changes lead to obstruction of blood flow in and out of the liver. Ultimately this results in increased pressure within the liver's circulatory system (____ ______).

portal HTN

What complication of cirrhosis is described below: · Increased venous pressure in portal circulation · Splenomegaly · Large collateral veins · Ascites · Gastric and esophageal varices · In patients with cirrhosis, the liver undergoes structural changes. These changes lead to obstruction of blood flow in and out of the liver. Ultimately this results in increased pressure within the liver's circulatory system (____ ______). · is characterized by increased venous pressure in the portal circulation, splenomegaly, large collateral veins, ascites, and gastric and esophageal varices.

portal HTN

What complication of cirrhosis is described below: · is characterized by increased venous pressure in the portal circulation, splenomegaly, large collateral veins, ascites, and gastric and esophageal varices.

portal HTN

What part of the treatment plan of a patient with HF is described below: (drugs that increase the force of myocardial infraction) o Monitor HR o Monitor for S&S of toxicity o Monitor K levels

positive inotropic drugs

What diagnostic test of the respiratory system is described below: Description and Purpose: used to distinguish benign from malignant pulmonary nodules. Because malignant lung cells have an incrased uptake of glucose, the PET scan, which used an IV radioactive glucose prep, can demonstrate increased uptake of glucose in malignant lung cells. Nursing Responsibility: Before: patient is NPO at least 4-6 hours preprocedure. Check the blood glucose levels at high levels may interfere with test. After: encourage fluids to excrete radioactive substances.

positron emission tomography (PET) scan

What is the "gold standard" for diagnosing COPD?

post-bronchodilator spirometry

What post-op complication of gastrectomy in treatment of PUD is described below: o may be part of dumping syndrome § Bolus of fluid high in CHO results in hyperglycemia -> the release of excessive insulin causes hypoglycemia · When you eat in the stomach, the stomach gets converted to a liquidy, high carb fluid that enters very rapidly into the small intestine causing hyperglycemia which signals the pancreas to release insulin causing hypoglycemia o When all of the foods gets dumped in the small intestine, that signals the pancreas to produce insulin which can lead to hypoglycemia

post-prandial hypoglycemia

Benign prostatic hyperplasia, bladder cancer, calculi formation, neuromuscular disorders, prostate cancer, spinal cord disease, strictures, and trauma of the back, pelvis, or perineum are all common causes of what type of acute kidney injury?

postrenal

_______ AKI is something that happens beyond the level of the kidney that obstructs flow of urine out of the kidney causes the urine to back up in the kidney leading to a condition called hydronephrosis which is excess fluid in the kidney that can lead to scarring and build-up of nitrogenous waste products.

postrenal

The following are ____ _____ for chemotherapy treatment of cancer: o Chemotherapy doesn't distinguish between normal and cancer cells o Side effects are the result of destruction of normal cells - especially rapidly proliferating (bone marrow, GI system, integumentary system § Acute toxicity - immediate, such as hypersensitivity reaction, anaphylaxis, cardiac arrhythmias § Delayed effects - delayed reactions r/t destruction of normal cells § Chronic toxicities - r/t organ damage

potential problems

What part of the pouching system of an ostomy is described below: · collects effluent, contains odor; can be drainable or non-drainable; can be transparent or opaque; may contain filter

pouch

The following is the ____ ____ of an ostomy: · Stoma measuring guide - measure at base of the stoma, no peristomal skin exposed · Skin barrier- (commonly referred to as the flange) - protects peristomal skin from effluent; cut-to-fit, pre-cut, moldable; flat or convex · Pouch - collects effluent, contains odor; can be drainable or non-drainable; can be transparent or opaque; may contain filter · One-piece - skin barrier and pouch are made together, can't be separated · Two-piece - skin barrier and pouch are two separate pieces that are put together upon application of system · Ring - enhances seal of skin barrier, can be used in place of paste on denuded skin, does not contain alcohol · Paste - "caulk" to fill in uneven areas, around edge of barrier next to stoma, contains alcohol, will sting when applied to denuded skin · Powder- applied to denuded peristomal skin to absorb moisture · Liquid skin prep - protects skin from stripping with removal of barrier, seals in powder · Lubricating deodorizer - facilitates pouch emptying as stool slides out of pouch easier, deodorizes stool

pouching system

What part of the pouching system of an ostomy is described below: · applied to denuded peristomal skin to absorb moisture

powder

anemia, infection, thyrotoxicosis, hypothyroidism, dysrhythmias, bacterial endocarditis, obstructive sleep apnea, pulmonary embolism, Paget's disease, hypervolemia, and nutritional deficiences are all _______ causes of HF.

precipitating

the following are _______ factors for MS: · Exact etiology is unknown - not likely a single cause - probably genetic disposition plus triggering event or illness · First, second, and third degree relatives of people with MS are considered to be at higher risk for developing this disease · Possible _______ factors o Infection, physical injury, emotional stress, excessive fatigue, smoking, pregnancy, poor health status

precipitating

With type 2 DM, the disease onset includes: • ________ - intermediate stage between normal glucose metabolism and diabetes o IFG - impaired fasting glucose (100-125 mg/dl) o IGT - impaired glucose tolerance (140-199 mg/dl) 2 hours post bolus during OGTT (oral glucose tolerance test) o No symptoms but damage is being done

prediabetes

the amount of blood in the ventricle at the end of diastole (end diastolic pressure) o More of the R side of heart

preload

volume of blood in ventricles at end of diastole (end diastolic pressure) **increased in hypervolemia, regurgitation of cardiac valves

preload

What influences SV?

preload, contractility, afterload

Hypovolemia, decreased CO, decreased peripheral vascular resistance, and decreased renovascular blood flow are the common causes of what type of acute kidney injury? Hypovolemia (dehydration, hemorrhage, GI losses through diarrhea and vomiting, excessive diuresis, hypoalbuminemia, burns) Decreased CO (cardiac dysrhythmias, cardiogenic shock, HF, MI) Decreased Peripheral Vascular Resistance (anaphylaxis, neurologic injury, septic shock) Decreased Renovascular Blood Flow (bilateral renal vein thrombosis, embolism, hepatorenal syndrome, renal artery thrombosis)

prerenal

______ acute kidney injury: is caused by something that happens above the level of the kidneys. Usually it is something that obstructs or diminishes the blood flow to the kidneys. So, it can be renal artery stenosis which is the arteries that supply blood to the kidneys and if they become narrow or blocked, that can reduce blood flow to kidneys and cause AKI. If they have Hypotension or fluid volume deficient or any other reason for decreased cardiac output like decompensated HF that can cause prerenal AKI. If those conditions, are not corrected permanent damage to the kidneys can occur and become a chronic condition

prerenal

When patients with chronic illnesses have to carry out a _____ _____ _______, the ____ ____ _____: • Vary in degree of difficulty • Impact on lifestyle EX: Someone who has HTN and takes 1 pill a day, that is not a big deal but compare to someone who has DM and has to take 4 shots of insulin and check sugar level 4 times a day; that has more of an effect on their lifestyle

prescribed treatment regimen

To _______ a crisis: • Understand the potential for exacerbation/crisis • Adhere to prescribed treatment regimen on a regular basis to prevent that crisis • Know s/s of onset of crisis o May be sudden, or slow/insidious (little minor changes that over time become a crisis)

prevent

What part of health promotion is when you want to prevent things that are going to cause inflammation?

prevention

When talking about ______ of chronic illness, preventive health behaviors in patient has to be voluntary meaning that the patient undertakes these on own free will. **have primary, secondary, and tertiary interventions

prevention

Under nursing management of inflammation and healing, health promotion includes what 4 things?

prevention, nutrition, hydration, and early recognition

Chronic illnesses are most often preventable. ______ intervention refers to measures such as a nutritious diet, proper exercise, and immunizations that prevent the occurrence of a specific disease. *Appropriate immunizations for OAs include influenza, pneumococcal, herpes zoster, tetanus/diptheria/pertussis (Td/Tdap), and hepatitis A and B

primary

What prevention measure to prevent chronic illness is described below: o Measures to prevent specific disease o Diet, exercise, lifestyle, immunizations are primary intervention method examples.

primary

What type of HTN is described below: o Elevated BP without an identified cause o 90% to 95% of all cases o Associated with many risk factors **also known as essential HTN

primary

What type of HTN is described below: risk factors include: age, alcohol, cigarette smoking, diabetes mellitus, increased serum lipids, increased dietary sodium, stress, gender, family history, obesity (visceral adiposity), ethnicity, sedentary lifestyle, and socioecomonic status

primary

What are the 2 types of HTN?

primary and secondary

what type of MS is a steady increase in disability without attacks?

primary progressive MS

What stage of cancer development is described below: o - increased tumor growth, angiogenesis, and metastasis

progression

What stage of cancer is described below: •Final Stage •Fast increase in tumor Size •Increased cell mutation •Increased invasiveness •Metastatic This is the final stage of neoplastic transformation. -Increased Growth Rate -Fast increase in the tumor size, where the cells may undergo further mutations with invasive -Metastatic potential

progression

what type of MS is when there is a steady decline since onset with superimposed attacks?

progressive-relapsing MS

What stage of cancer development is described below: o a mutation in one cell is not likely to be problematic § Promoters - dietary fat, obesity, smoking, alcohol consumption. Life-style changes can reverse risk.

promotion

What stage of cancer is described below: •Preneoplastic Cells accumulate, but not yet problematic •"Promoters" increase risk: •Ex: cigarette smoking, ETOH, dietary fat •Can REVERSE risk with lifestyle changes **This is a relatively lengthy process in which actively proliferating preneoplastic cells accumulate. During this stage, the process can be altered by chemo-preventative agents and affect growth rates. This stage is the phase between a premalignant lesion and the development of invasive cancer.

promotion

With VTE prevention and ________: • A core measure of high quality care in hospitalized surgical patients (TJC) • Early and frequent mobilization/ambulation • Graduated compression stockings (limited mobility) • Thromboembolic deterrent (TED) hose • Intermittent pneumatic compression devices • Sequential compression devices (SCD) • Anticoagulant medications

prophylaxis

When talking about mediators of inflammation, What mediator is described below: Source: produced from arachidonic acid Mechanism of action: PGs cause vasodilation and Its stimulate chemotaxis.

prostaglandins (PGs) and leukotriene (Lts)

Enlarged ______ may cause hesitancy, retention, slow urine stream, and bladder infections in men o Bladder infections in men: Causing retention of urine allowing for bacteria to grow **effects of aging on urinary system

prostate

The following are nursing care--> goals of ____ _____: (cancer of male sex organ) o Be an active participant in the treatment plan o Have satisfactory pain control o Follow the therapeutic plan o Understand the effect of the therapeutic plan on sexual function o Find a satisfactory way to manage the impact on bladder and bowel function

prostate cancer

The following are nursing diagnoses for _____ _____: (cancer of male sex organ) o Decisional conflict o Pain o Urinary retention o Sexual dysfunction o Anxiety

prostate cancer

What cancer of the male sex organ is described below: · Clinical Manifestations: o Usually asymptomatic in early stages o Symptoms similar to BPH § Need to urinate frequently, especially at night § Difficulty starting urination or holding back urine § Weak or interrupted flow of urine o Pain - can be severe especially in the back and legs due to spinal cord compression and bone destruction

prostate cancer

What cancer of the male sex organ is described below: · Diagnosis: o DRE o PSA (controversy) o PAP (prostatic acid phosphatase) o Elevated alkaline phosphatase (bone metastasis) o Biopsy of the prostate - using trans-rectal ultrasound and biopsy needles o Bone scan o CT scan o MRI using an endo-rectal probe o Staging of tumor - see Table 54-5

prostate cancer

What cancer of the male sex organ is described below: · Interprofessional Care—Treatment: o Depends on stage of cancer and patient's overall health o Active surveillance - digital rectal exams, PSA § Active surveillance includes annual PSA and DRE o Surgical therapy § Radical prostatectomy - prostate gland, seminal vesicles, part of the bladder neck are removed; retroperitoneal lymph node dissection is performed if high risk for metastasis § Bilateral orchiectomy is the gold standard for androgen deprivation - can lead to weight gain, loss of muscle mass, changes in physical appearance; also can lead to grief, loss of self-esteem, depression o Radiation therapy § External beam radiation § Brachytherapy o Chemotherapy

prostate cancer

What cancer of the male sex organ is described below: · Interprofessional Care—Treatment: o Surgical therapy § Radical prostatectomy - prostate gland, seminal vesicles, part of the bladder neck are removed; retroperitoneal lymph node dissection is performed if high risk for metastasis § Bilateral orchiectomy is the gold standard for androgen deprivation - can lead to weight gain, loss of muscle mass, changes in physical appearance; also can lead to grief, loss of self-esteem, depression

prostate cancer

What cancer of the male sex organ is described below: · Malignant tumor of the prostate gland · Slow growing, it usually spreads through lymph system, bloodstream, or direct extension · Risk factors include age, ethnicity, and family history · Incidence rises after age 50, however some cases occur in younger men o Higher in African American men than any other ethnic group · Dietary factors and obesity may be related · Environmental connection - chemicals found in pesticides

prostate cancer

What cancer of the male sex organ is described below: · Nursing Implementation: o Health Promotion o Screening § PSA, DRE o High risk groups § AA, family history o Acute Care § Pre- and post-operative care § Support o Ambulatory Care § Catheter care § Bladder training, Kegels, incontinence products § Palliative care § Pain managment

prostate cancer

With nursing management of cirrhosis (acute care): · Measures to relieve __________ o Cholestyramine or hydroxyzine § Cholestyramine (Questran) or hydroxyzine (Atarax) may be ordered to help relieve the __________. o Baking soda or Alpha Keri baths § Measures to help alleviate _________ include baking soda or moisturizing bath oils (Alpha Keri) baths, lotions containing calamine, antihistamines, soft or old linen, and control of the temperature (not too hot and not too cold). o Lotions, soft linen o Temperature control o Short nails; rub with knuckles § Keep the patient's nails short and clean. Teach patients to rub with their knuckles rather than scratch with their nails when they cannot resist scratching.

pruritus

what complication of chronic pancreatitis is described below: o Splenic vein thrombosis § Pseudocyst formation § Bile duct or duodenal obstruction § Pancreatic ascites

pseudoaneurysm

what are the 2 complications of chronic pancreatitis?

pseudoaneurysm and pancreatic cancer

what complication of acute pancreatitis is described below: o Fluid, enzyme, debris, and exudates surrounded by wall o Abdominal pain, palpable mass, nausea/vomiting, anorexia o Detected with imaging o Resolves spontaneously or may perforate and cause peritonitis o Surgical or endoscopic drainage

pseudocyst

What are the 2 acute pancreatitis complications?

pseudocyst and pancreatic abcess

psychological

With cancer, as a nurse you will experience coping and ______ support: · Planning for transportation, nutrition, emotional support · Teach symptom management to improve quality of life · Emphasis on maintaining optimal quality of life · Positive attitude has significant positive impact on quality of life and may also influence prognosis · Relationship based on trust and confidence · Be available, caring attitude, therapeutic touch · Set realistic short- term goals · Adjust lifestyle pattern · Maintain hope and positive view o Provides control over what is occurring · Consider self - help groups

psychological

With cancer, as a nurse you will experience coping and ______ support: · Relationship based on trust and confidence · Be available, caring attitude, therapeutic touch · Set realistic short- term goals · Adjust lifestyle pattern · Maintain hope and positive view o Provides control over what is occurring · Consider self - help groups

psychological

What system has the following clinical manifestations of CKD? • emotional lability, anxiety, withdrawal, depression (Body Image)

psychological system

With management of DM, what component of patient teaching has the following points that need to be taught to the patient and/or caregiver: --help the pt identify resources that are available to faciliate the adjustment and answer questions about living with a chronic condition such as diabetes

psychosocial

What primary cause of HF is : where the R ventricle is trying to push against vascular resistance in the lungs and having trouble emptying the R ventricle

pulmonary HTN

What diagnostic test of the respiratory system is described below: Description and Purpose: used to visualize vasculature and locate obstruction or pathologic conditions (ex: pulmonary embolus). Contrast medium is injected through a catheter threaded into pulmonary artery or right side of heart. Series of x-rays are taken after contrast medium is injected into pulmonary artery. Chest CT is replacing angiography, since is it less invasive. Nursing Responsibility: Same as for chest x-ray. After: check pressure dressing site after procedure monitor BP, pulse, and circulation distal to injection site. Report and record any significant changes.

pulmonary angiogram

left sided heart failure results in?

pulmonary congestion and edema

When talking about chest exam findings in respiratory problems, what problem is described below: Inspection: tachypnea, labored respirations, cyanosis, blood-tinged sputum Palpation: decreased movement or normal movement Percussion: dull or normal depending on amunt of fluid

pulmonary edema

What side effect of radiation and chemotherapy is described below: NURSING CARE: •Possible Medications: --Bronchodilators may be needed --Expectorants and Cough Suppressants •Oxygen Therapy may be indicated. •Bed Rest

pulmonary effects

What side effect of radiation and chemotherapy is described below: o Bronchodilators o Expectorants/cough suppressants o Bed rest o Oxygen

pulmonary effects

What side effect of radiation and chemotherapy is described below: •Acute and Late Reactions: --Pulmonary Fibrosis: Late effect of therapy. --Pneumonitis: delayed acute inflammatory reaction. *May occur 1 to 3 months after thoracic radiation. •Common pulmonary toxicities r/t Chemotherapy: --Pulmonary Edema (r/t Capillary Leak Syndrome or Fluid Retention) --Hypersensitivity Pneumonitis --Interstitial Fibrosis --Pneumonitis (produced by inflammatory reaction or destruction of alveolar-capillary endothelium.

pulmonary effects

What side effect of radiation and chemotherapy is described below: •Common pulmonary toxicities r/t Chemotherapy: --Pulmonary Edema (r/t Capillary Leak Syndrome or Fluid Retention) --Hypersensitivity Pneumonitis --Interstitial Fibrosis --Pneumonitis (produced by inflammatory reaction or destruction of alveolar-capillary endothelium.

pulmonary effects

When talking about chest exam findings in respiratory problems, what problem is described below: Inspection: tachypnea Palpation: decreased movement Percussion: normal

pulmonary fibrosis

What diagnostic test of the respiratory system is described below: Description and Purpose: used to evalutate lung function. Involves use of spirometer to assess air movement as patient performs prescribed respiratory manuevers. Nursing Responsibility: BEfore: avoid sceduling immediately after mealtime. avoid administration of inhaled bronchdilators 6 hours before procedure. explain procedure to patient and assess for resp distress During: assess for resp distress After: assess for resp distress; provide rest after procedure **measures how much air patient can get out of lung in certain amount of time

pulmonary function tests

difference between the systolic and diastolic pressures o e.g. 120/60 = pulse pressure is 60. • ↓ = HF or hypovolemia • ↑ = atherosclerosis or exercise (stiffening or hardening of the arteries and are not able to relax properly)

pulse pressure

o - Difference between the systolic and diastolic BP o Example: BP 120/60 = ____ _____ is 60 (120-60 = 60)

pulse pressure

What assessment abnormality of the respiratory system is described below: Description: exhalation through mouth with lips pursed together in slow exhalation Possible Etiology and Significance: COPD, asthma, suggests increased breathlessness, strategy taught to slow expiration, decrease dyspnea

pursed-lip breathing

what type of exudate is described below: o Purulent [pus (leukocytes, microorganisms, cellular debris] - boils, abscesses, cellulitis) Correct term: purulent, not pussy! infected cuts, surgical wounds

purulent

The following are late effects of ______: -Occur Months to Years after treatment. -Usually in Liver, Kidney, Lung, Heart, Muscle, Bone (post-mitotic cells). -Damage is usually permanent once it occurs.

radiation

The following is nursing management of a patient having _____ _____ as treatment for cancer: •Common Side Effects of Radiation: •Bone Marrow Suppression •Fatigue •GI Disturbances •Integumentary and Mucosal Reactions •Pulmonary and Reproductive Effects •Patient Education: •Side Effects of Radiation Therapy •Plan of Care

radiation therapy

The following is treatment (____ _____) for lung cancer: § Curative approach for resectable tumors, poor surgical risk § Some cancer cells are more radio-sensitive than others § In combination with chemotherapy and/or surgery

radiation therapy

What treatment of cancer is described below: --Involves the use of high-energy, ionizing radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. --It damages and breaks the chemical bonds in DNA , resulting in cell death. •-Used to shrink tumors "locally" •Allows a higher dose of radiation in a smaller area •Can be administered alone or in combination with another form of treatment.

radiation therapy

What treatment of cancer is described below: · Can be used in conjunction with surgery and chemotherapy or alone · Can be used to treat primary tumors or for palliation of metastatic lesions · Technically, all cancer cells could be killed with enough radiation

radiation therapy

What treatment of cancer is described below: · Radiation to surrounding healthy tissue must be limited to the maximal tolerated dose for that specific tissue · External Beam Radiation - teletherapy · Internal radiation - brachytherapy - involves placing radioactive material inside the body.

radiation therapy

What treatment of cancer is described below: · Emission and distribution of energy causes ionization and generation of free radicals that break DNA bonds - causing loss of cell proliferative capacity · Normal tissue can recover · Can be used in conjunction with surgery and chemotherapy or alone · Can be used to treat primary tumors or for palliation of metastatic lesions · Technically, all cancer cells could be killed with enough radiation · Radiation to surrounding healthy tissue must be limited to the maximal tolerated dose for that specific tissue · External Beam Radiation - teletherapy · Internal radiation - brachytherapy - involves placing radioactive material inside the body.

radiation therapy

What type of procedure for urinary diversion is described below: o Removal of the bladder, prostate & seminal vessels in men and bladder, uterus, cervix, urethra, & ovaries in women (extensive bladder cancer) o After this procedure, a urinary diversion must be created because they no longer have a bladder to hold and eliminate urine from the body*******

radical (total) cystectomy

What insulin prep is described below: **lispro (Humalog), aspart (NovoLOg), and glulisine (Aprida) Onset: 10-30 min Peak: 30 min-3 hr Duration: 3-5 hr

rapid acting

What disorder of the female urogenital tract is described below: · Protrusion of the rectum through the o posterior vaginal wall · Risk factors o multiple vaginal deliveries o obesity o repetitive bearing down or heavy lifting o chronic constipation, coughing

rectocele

What disorder of the female urogenital tract is described below: · Symptoms o difficulty initiating bowel movement, constipation o feeling of rectal pressure

rectocele

What are the LOCAL clinical manifestations of inflammation? (RHPSL)

redness, heat, pain, swelling, loss of function

What major component of the inflammation healing process is the replacement of cells of same type? Ex: liver can regenerate liver cells

regeneration

_________ is the replacement of lost cells and tissues with cells of the same type. The ability of cells to regenerate depends on the cell type (Table 11-5). ** major component of the inflammation healing process

regeneration

What are the 2 major components of the inflammation healing process?

regeneration and repair

What administration route for chemotherapy treatment of cancer is described below: o Delivery of the drug directly tumor site o Higher concentrations can be delivered to the tumor with reduced systemic toxicity § Intraarterial - to tumor arteries § Intraperitoneal - peritoneal cavity · (introduced in a similar way as peritoneal dialysis) § Intrathecal or intraventricular - subarachnoid space to bypass blood-brain barrier; may use ventricular reservoir § Intravesical - bladder instillation

regional

What type of insulin is the ONLY insulin that can be given IV?

regular insulin

Autonomic nervous system, baroreceptors, and chemoreceptors fall under CV?

regulation

CV system and renal system are the 2 types of BP?

regulation

o Goal is to help older adults adapt to or recover from disability or an acute functional decline o may occur in an acute Inpatient, long-term care, home o Interprofessional team **nursing implementation

rehabilitation

What are the 4 types of MS?

relapsing remitting MS, primary progressive MS, secondary progressive MS, and progressive relapsing MS

what type of MS includes unpredictable attacks which may or may not leave permanent deficits followed by periods of remission?

relapsing-remitting MS

if a patient moves into a long-term care facility, the transition is very difficult for them. They will go into depression, malnutrition, and will have an increased risk of fractures • A nursing diagnosis that is associated with the disruption, confusion, and challenges that older adults face when moving from one environment to a new environment **long-term care facilites

relocation stress syndrome

What type of BP regulation is described below: • Na and H2O Retention or Excretion: o RAAS - renin converts A - A1; ACE converts A1 - A2 o A2 - potent vasoconstrictor and also tells the adrenal cortex to release aldosterone o Renal medulla also secretes prostaglandins which have a vasodilator effect o Natriuretic peptides - antagonize ADH and aldosterone; promotes natriuresis (Na loss in urine) and diuresis (reduces circulating blood volume)

renal system

With a chronic illness, the patient has to participate in _____ _____ which is when they adjust their schedule to accomodate treatments and limitations.

reordering time

What major component of the inflammation healing process is when connective tissue goes in and fills in the space and hooks everything back together resulting in a scar?

repair

________ is healing as a result of lost cells being replaced by connective tissue. _______ is the more common type of healing and usually results in scar formation. ** major component of the inflammation healing process

repair

the following are clinical manifestations of cirrhosis: · amenorrhea, testicular atrophy, gynecomastia (male), impotence

reproductive

What side effect of radiation and chemotherapy is described below: •Educate patient about expected reproductive and sexual side effects •Educate women of child-bearing age for the need of contraception •Counseling referrals may be indicated

reproductive effects

What system has the following clinical manifestations of CKD? • Infertility - irregular menstrual cycles, ↓ libido

reproductive system

During assessment of the _______ system: assess the following: o PMH, smoking, chemical exposure, immunizations, freq. _______ infections or problems o Physical exam: nose, thorax, lungs (inspect, palpate, percuss, auscultate);

respiratory

The following are diagnostic tests for the ______ system: • H&H • ABGs • Oximetry, • End-tidal Co2 • Sputum: culture, gram stain, acid-fast bacteria, cytology • Imaging: Xray, CT, MRI, VQ scan, pulmonary angiogram, PET scan • Bronchoscopy, lung biopsy • PFT • Exercise testing • 6 minute walk test

respiratory

What system has the following clinical manifestations of CKD? • pulmonary edema, pleural effusion, infections, pneumonia

respiratory system

What part of RICE helps the body to use nutrients and oxygen for the healing process.

rest

What does RICE stand for?

rest, ice, compression, elevation

When performing a nursing assessment on a patient with HF, what are some things you will see when looking at their neuro function?

restlessness, confusion, decreased attention or memory

With interprofessional care of chronic complications of DM, what microvascular complication is described below: • 80% of diabetics • Can lead to blindness • Annual eye exam

retinopathy

CBC: "shift to the _______" Absence of immature neutrophils (bands) o More mature neutrophils (segs) o Indicates VIRAL INFECTIONS

right

With _____ sided HF: • ______ ventricle doesn't pump efficiently enough to pump out all of the blood returning to it • Fluid backs up to venous system - peripheral edema, ascities, hepatomegaly, JVD o Fluid is backing up into venous system (peripheral edema) o Ascities because fluid is accumulating in abdomen; leaking out from vascular o Hepatomegaly: High pressures in portal circulation system that feeds the liver causing liver to swell, enlarge, and be pushed down into the abdominal cavity o JVD: When sitting patient up at 45 degrees, they will have a big jugular vein because fluid is backed up into systemic circulation • Primarily caused by left heart failure • Also can be caused by o Pulmonary embolism o Cor pulmonale - RV dilation and hypertrophy secondary to lung disease High pressures in lungs, the R ventricular cannot pump against that resistance and cannot empty the RV up into the lung which then causes R sided heart failure to back up systemically

right

what clinical manifestation of PD (Parkinson's disease) is described below: o Elicits the following § Complaint of soreness § Feeling tired and achy § Pain in the head, upper body, spine, or legs o Slowness of movement

rigidity

what clinical manifestation of PD (Parkinson's disease) is described below: o is the increased resistance to passive motion when the limbs are moved through their range of motion. o Parkinsonian _______ is typified by a jerky quality (cogwheel rigidity), as if there were intermittent catches in the passive movement of a joint.

rigidity

what clinical manifestation of PD (Parkinson's disease) is described below: o ↑ Resistance to passive motion when limbs are moved through their ROM

rigidity

what clinical manifestation of PD (Parkinson's disease) is described below: o ↑ Resistance to passive motion when limbs are moved through their ROM o Cogwheel _______ § Jerky quality § Like intermittent catches in passive movement of a joint o Sustained muscle contraction o Elicits the following § Complaint of soreness § Feeling tired and achy § Pain in the head, upper body, spine, or legs o Slowness of movement o is the increased resistance to passive motion when the limbs are moved through their range of motion. o Parkinsonian _______ is typified by a jerky quality (cogwheel rigidity), as if there were intermittent catches in the passive movement of a joint.

rigidity

What part of the pouching system of an ostomy is described below: · enhances seal of skin barrier, can be used in place of paste on denuded skin, does not contain alcohol

ring

Important ____ _______ for PAD are tobacco use (most important), chronic kidney disease, diabetes, HTN, and hypercholesterolemia. Other ____ _______ include elevated CRP, family history, high levels of triglycerides, increasing age, hyperhomocysteinemia, hyperuricemia, obesity, sedentary lifestyle, and stress

risk factors

The following are ___ _____ for CV disease: • Family history • Obesity o Increases workload of the heart • Dietary habits and Vit D deficit o High in saturated fats, people who eat a lot of processed foods o Vitamin D deficit is an ongoing study; it is a fat soluble vitamin so you can overdose on that. POINT OF EDUCATION for patient. • Tobacco use • DM o Causes microvascular damage to small vessels and macrovascular damage to large vessels

risk factors

The following are ___ _____ for CV disease: • Increased plasma lipids o High cholesterol builds fatty plaques which causes narrow vessels causing HTN and could also unclog and cause obstruction leading to heart attack • Metabolic Syndrome (obesity, dislipidemia, diabetes glucose intolerance (insulin resistance), HTN) o Risk factor NOT disease • Sedentary lifestyle o The more we sit and do nothing, the more at risk for CV disease

risk factors

The following are ___ _____ for CV disease: • Stressful lifestyle o Stress stimulate ANS which elevates HR and BP putting on more workload • LDL should be less than 100mg/dl HDL higher than 40 for men, 50 for women Triglycerides less than 150

risk factors

With management of DM, what component of patient teaching has the following points that need to be taught to the patient and/or caregiver: --ensure that the pt understands and appropriately responds to teh signs and symptoms of hypclygemia and hyperglycemia --stress the importance of proper foot care, regular eye exams, and consistent glucose monitoring --inform the patient about the effect that stress can have on blood glucose

risk reduction

o Increased risk for accidents Most occur in or around the home o Declining thermoregulation higher rate of deaths during severe cold spells and heat waves o Carefully orient older adults on admission Confusion common in a new environment **nursing implementation of older adults

safety

What anatomic site classification of a tumor is described below: --Develops from Connective Tissue (bone, muscle, fat)

sarcoma

The ankle-brachial index is a PAD ______ tool. It is performed using a hand-held Doppler. The ABI is calculated by dividing the ankle systolic BPs by the higher of the left and right brachial systolic. o PAD guidelines recommend uniform reporting of ABI results. In older patients and those with diabetes, the arteries are often calcified and non-compressible. This results in a falsely elevated ABI.

screening

______ for lung cancer: o U.S. Preventive Services Task Force (USPSTF) recommends screening: § Annually for adults 55 - 80 years old with a history of smoking (30-pack year smoking, or currently smoke, or quit less than 15 years ago Screen using low-dose CT scan

screening

The following are causes of what type of HTN? • Coarctation or congenital narrowing of the aorta • Renal disease (ex: renal artery stenosis, glomerulonephritis) • Endocrine disorders - hyperaldosteronism, Cushings, pheochromocytoma • Neurologic disorders - brain tumors, trauma to brain, quadriplegia • Pre-eclampsia • Obstructive sleep disorders -apnea • Medications: corticosteroids, estrogen, amphetamines, NSAIDs o Drug related: estrogen replacement therapy, oral contraceptives, corticosteroids, NSAIDs, sympathetic stimulants (ex: cocaine, monoamine oxidase) • Cirrhosis • Pregnancy induced HTN

secondary

What type of HTN is described below: o Elevated BP with a specific cause Identify and treat underlying cause to reverse HTN o 5% to 10% in adults o Contributing factor to HTN Crisis o Suspect if suddenly develop high BP, especially if severe

secondary

______ prevention refers to actions aimed at early detection of disease that can lead to interventions to prevent disease progression. **chronic illness

secondary

what type of MS is the initial relapsing-remitting MS that suddenly begins to have decline without periods of remission ?

secondary progressive MS

What risk factor for primary HTN is described below: o Regular physical activity can help control weight and reduce CV risk o Physical activity may lower BP

sedentary lifestyle

_______ blood pressures are obtained (using dopplar ultrasound and a sphygomomanometer) at the thigh, below the knee, and at ankle level while the patient is supine. o A drop in ________ BP of greater than 30 mmHg suggests PAD. Angiography and magnetic resonance angiography delineate the location and extent of PAD.

segmental

What type of procedure for urinary diversion is described below: o A portion of the bladder wall containing a tumor is removed o Patient has a malignant tumor in the bladder; can take that portion of the bladder out and keep the rest of the bladder intact

segmented (partial) cystectomy

What PAD diagnostic study is described below: o using Doppler and sphygmomanometer at thigh, below knee, and ankle (with patient supine) o A drop in BP greater than 30 mm Hg indicates PAD

segmented blood pressures

With ___-_____ of blood glucose: • Frequency varies o up to 4 times a day • Offers a tool for helping with glycemic control • Continuous glucose monitoring o Can be matched with insulin pumps o Assesses interstitial glucose (in tissues) - lags behind CBG by 20min o Good for identifying trends and managing insulin needs - helpful to control hyper/hypogycemia

self-monitoring

With ___-______ BP: • Teach how to monitor BP at home • Provide information on: o Response to antihypertensive therapy o Improving adherence with therapy o Evaluating "white-coat HTN" in clinical setting - compare to self-monitored results • **Home measurement devices should be checked regularly for accuracy

self-monitoring

_____-_____ in older adults results when the older adult is: • Unable to meet basic needs and Refuse help o Seen living in standard homes and don't clean their homes like they need to, don't go grocery shopping, etc. • Untreated medical/psychiatric conditions • Live alone o Substandard housing o Often in squalor • Increased mortality

self-neglect

what type of exudate is described below: (serous fluid + RBCs - surgical healing - drains/dressings) pinkish reddish ting to it with spots or streaks of blood in it seen in cuts with a surgical wound, you will see this drainage on the dressing and on the drains

serosanguinous

When talking about mediators of inflammation, What mediator is described below: Source: stored in platelets, mast cells, enterochromaffin cells of GI tract Mechanism of action: causes vasodilation and increased capillary permeability; stimulates smooth muscle contraction

serotonin

what type of exudate is described below: (Early stage, mild injury: blister, pleural effusion) clear yellowish fluid seen in blisters or a cut that weeps contains plasma

serous

What insulin prep is described below: **regular (Humulin R, Novolin R) Onset: 30 min-1 hr Peak: 2-5 hr Duration: 5-8 hr

short acting

What are 3 manifestations of later stages of PD?

shuffling, propulsive gait with arms flexed, and loss of postural reflexes

Pathophysiology—Classification • According to _____ of the heart o Left-sided heart failure Systolic or diastolic o Right-sided heart failure Systolic or diastolic

side

What method of2 administration is described below: Description: covers patients nose and mouth; used only for short periods of time, especially when transporting patients; longer use is typically not toelrated becoase of tight seal and heat generated around nose and mouth from mask; O2 concentrations of 35-60% can be achieved with flow rates of 6-12 L/min; ;mask provides adequate humidification of inspired air Nursing Interventions: wash and dry under mask q2hr; mask must fit snugly; nasal cannula may be provided while patient is eating; watch for pressure necrosis at top of ears from elastic straps if patient wears for a longer time.

simple face mask

With nursing management of cirrhosis (acute care)--> ________ ________: · Pad the bedrails to avoid injury from possible seizures · Monitor I & O closely · Nutrition · Supportive care

skin care

What side effect of radiation and chemotherapy is described below: NURSING CARE: •Nursing care for Chemo Treatments: --Assess the emotional status of patients with Alopecia --Refer to additional outside resources and support, Ex: Miles Perret Center Cancer Services

skin reactions

What side effect of radiation and chemotherapy is described below: NURSING CARE: •Main goal in all Skin Care of Cancer Patients: Prevent Infections and Facilitate Wound Healing

skin reactions

What side effect of radiation and chemotherapy is described below: NURSING CARE: •Main goal in all Skin Care of Cancer Patients: Prevent Infections and Facilitate Wound Healing •Nursing care for Radiation treatments: --Protect skin from extreme temperatures *Do Not use heating pads, ice packs, or hot water --Avoid constricting garments, deodorants, or harsh chemicals --Lubricate dry skin •Nursing care for Chemo Treatments: --Assess the emotional status of patients with Alopecia --Refer to additional outside resources and support, Ex: Miles Perret Center Cancer Services

skin reactions

What side effect of radiation and chemotherapy is described below: NURSING CARE: •Nursing care for Radiation treatments: --Protect skin from extreme temperatures *Do Not use heating pads, ice packs, or hot water --Avoid constricting garments, deodorants, or harsh chemicals --Lubricate dry skin

skin reactions

What side effect of radiation and chemotherapy is described below: o Mild erythema and/or hyperpigmetation o Erythrodysesthesis syndrome § redness and tingling of the palms of the hands and soles of the feet. It may also cause severe symptoms of painful moist desquamation, ulceration, blistering, and pain o Alopecia § Usually reversible § Is also considered a skin reaction o Avoid constricting garments, harsh chemicals, deodorants

skin reactions

What side effect of radiation and chemotherapy is described below: •Chemotherapy Skin Changes: •ranges from mild erythema and hyperpigmentation to "Erythrodysesthia Syndrome" (Hand-Foot Syndrome): •redness and tingling of the palms of the hands and soles of the feet. May cause severe symptoms of painful, moist desquamation, ulceration, and blistering.

skin reactions

What side effect of radiation and chemotherapy is described below: •Radiation Skin Changes: •local; can be acute or chronic •Erythema: occurs 1 to 24 hours after single treatment; worsens as progress through the plan of care. Particularly evident in skin folds. •Chemotherapy Skin Changes: •ranges from mild erythema and hyperpigmentation to "Erythrodysesthia Syndrome" (Hand-Foot Syndrome): •redness and tingling of the palms of the hands and soles of the feet. May cause severe symptoms of painful, moist desquamation, ulceration, and blistering.

skin reactions

• _____ ______ alone are not effective for in-patient glycemic control o associated with ↑ mortality • _____ ______ do not allow for basal or mealtime insulin requirements o may underestimate total daily insulin requirements • Respond to hyperglycemia after it happens rather than preventing it o Reactive instead of Proactive ***Diabetes Mellitus Insulin Evidence Based Practice (EBP)

sliding scales

Lower extremity PAD progresses _______. Prolonged ischemia leads to atrophy of the skin and underlying muscles. Even minor trauma to the feet (ex: stubbing one's toe, blister from shoes) can result in delayed healing, wound infection, and tissue necrosis, especially in the patient with diabetes. **complication of PAD

slowly

what does SCLC stand for?

small cell lung cancer

When preventing ____ ____ in a chronically ill person: • Ill person withdraws from others • Others withdraw from the ill person • Very important that we remain active with a group of peers but especially with someone with a chronic illness because they tend to believe that those around them don't want to be around them anymore

social isolation

____ ______ may occur with chronic illness because that individual chooses to withdraw from pervious activities or because others withdraw from the chronically ill person. For example: a woman has aphasia secondary to a stroke may be unwilling to go out in public because of embarrassment related to communication issues

social isolation

Administration on Aging (AoA), Area Agency on Aging, Medicare, and Medicaid are all different types of ____ ____ for older adults.

social support

When providing ______ _______ for older adults occurs at 3 levels. First, family members are the primary and preferred providers of ___ ____. Second, a semiformal level of support is found in clubs, religious organizations, neighborhoods, adult day care, and senior citizen centers. Third, older adults may be linked to formal systems of social welfare agencies, health facilities, and government support. Generally, you as a nurse are part of the formal support system.

social support

o Family caregivers (most prevalent means of social support for older patients) o Semiformal Religious organizations, social groups Churches will have people visit elderly people in their homes o Formal In-home professional caregivers Adult day health centers Assisted living centers Nursing homes This falls under the 3 levels of ____ _____ for an older adult.

social support

What risk factor for primary HTN is described below: o HTN is more prevalent in lower socioeconomic groups and among the less educated

socioeconomic status

Chronically ill, cognitively impaired, homeless, and frail are the ___ ____ of older adults.

special populations

spinal cord compression

What oncologic emergency is described below: Description: - Neurologic Emergency caused by cancer in epidural space of spinal cord. - Common causes: - Breast Cancer - Lung Cancer - Prostate Cancer - GI Cancer - Renal Cancer - Melanoma - Non-Hodgkin Lymphoma Manifestations: - Intense, localized, persistent back pain with vertebral tenderness - Motor Weakness - Sensory Loss and Paresthesia - Autonomic Dysfunction (Change is Bladder or Bowl) Management: - Radiation Therapy and Corticosteroids - Surgical Decompression Laminectomy - Activity Limitations and Pain Management

spinal cord compression

What oncologic emergency is described below: Management: - Radiation Therapy and Corticosteroids - Surgical Decompression Laminectomy - Activity Limitations and Pain Management

spinal cord compression

What oncologic emergency is described below: Manifestations: - Intense, localized, persistent back pain with vertebral tenderness - Motor Weakness - Sensory Loss and Paresthesia - Autonomic Dysfunction (Change is Bladder or Bowl)

spinal cord compression

What oncologic emergency is described below: o Malignant tumor in epidural space o Sensory paresthesia and loss o Autonomic dysfunction o Intense, localized, persistent back pain o Motor weakness and dysfunction o Change in bowel or bladder function

spinal cord compression

What stage of chronic illness trajectory is described below: v -illness course and symptoms controlled by treatment regimen -person maintains everyday activities

stable (2)

What stage of the clinical staging classification system for cancer is described below: o cancer in situ -Carcinoma in situ is considered pre-malignant or pre-cancer

stage 0

What stage of the clinical staging classification system for cancer is described below: o limited to tissue of origin --Cancer is only in the cells where it first started and the area is small. Localized. This is considered early stage and most curable.

stage 1

What stage of CKD is described below: GFR: 60-89

stage 2

What stage of the clinical staging classification system for cancer is described below: o limited local spread

stage 2

What stage of the clinical staging classification system for cancer is described below: o extensive local and regional spread

stage 3

What stage of CKD is described below: GFR: 30-44

stage 3b

What stage of CKD is described below: GFR: 15-29 **start to have symptoms **start thinking to have a dialysis access put in them (do not want to wait until patient is in ESRD)

stage 4

What stage of the clinical staging classification system for cancer is described below: o metastasis --Cancer has spread to organs in other parts of the body (metastasized)

stage 4

What stage of CKD is described below: GFR: < 15 or dialysis (ESRD) **End stage renal disease (edema, mental confusion, anemia, nausea, headache, all the symptoms of uremia)

stage 5

When talking about ______ of lung cancer: o SCLC § _______ not useful because metastasizes before diagnosis is made - poor prognosis o NSCLC - staged according to TNM system: § T : tumor size, location, and degree of invasion § N : regional lymph node involvement § M : presence/absence of distant metastasis

staging

What chronic complication of DM is described below: o Slow impulse transmission, sensory deficits o Numbness or tingling, pain, extreme sensitivity to touch, insensitive to pain and temperature, loss of balance

stocking-glove neuropathy

What part of the pouching system of an ostomy is described below: · measure at base of the stoma, no peristomal skin exposed

stoma measuring guide

The following are the different types of ______: · End Stoma o End (fecal) - one stoma, one opening, 100% diverting § All stool is diverted through the ostomy o End (urinary) - one stoma, one opening, 100% diverting · Loop Stoma o Loop - one stoma, two openings (proximal & distal), not 100% diverting · Double-barrel o Double-barrel - two stomas (proximal is functional, distal is a mucous fistula), used for venting of distal bowel due to infection, obstruction

stomas

With insulin _______: Room temperature o up to 4 weeks o between 33o and 86o F May use pre-filled syringes o Pre-filled syringes containing 2 type of insulin o stable in refrigerator for up to 1 week anytime drawing up syringe you are opening up pathway for bacteria to enter Store in vertical position o needle pointing up o Rotate several times before injecting ****THIS IS GOOD INFO TO PROVIDE PATIENT ABOUT STORING THEIR INSULIN.

storage

For older adults, the _____ of an illness may lead to: o fear and anxiety about health problems and institutions of care o fearful that someone will prescribe a treatment they cannot afford o they may view health care personnel as helpful but perceive institutions as negative and potentially harmful places

stress

What risk factor for primary HTN is described below: o People exposed to repeated stress may develop HTN more frequently than others o People who develop HTN may respond differently to stress than those who do not develop HTN

stress

What chronic disease is described below: -affects about 7 million adults. 15%-30% disables -leading cause of serious disability -5th leading cause of death

stroke

amount of blood ejected by the left ventricle with each contraction.

stroke volume (SV)

inflammation may be _____: EX: pneumonia; has to be hospitalized and it may take 6-8 week to get it out of system EX: broken bone; will take a long o similar to acute but lingers for weeks or months

subacute

When talking about the CV assessment ______: assess, • HPI • PMH • Medications • Surgeries and other treatments • Self-health management • Family history of cardiac disease

subjective

With nursing management of COPD, assessment includes assessing _______ data which includes: o PMH: smoking, environmental exposure, infections, hospitalizations o FH of COPD or other chronic lung disease o Changes in appetite or weight o Activity tolerance, ADLS, IADLs o Current symptoms (SOB, coughing, orthopneic, etc.)

subjective

what are the 2 oral antidiabetic agents that are the ones that cause the highest risk of causing hypoglycemia? *they cause the body to secrete insulin

sulfonylureas and meglitinides

What complication of lung cancer is described below: § Chest tumors may push on the superior vena cava causing blood to back up into the veins § Can lead to facial, neck, arms, upper chest swelling (sometimes with a bluish-red skin color) § Headaches, dizziness, changes in LOC (if it affects the brain) § Can develop gradually, life-threatening

superior vena cava syndrome

What oncologic emergency is described below: Description: - Obstructed Vena Cava - Common causes: - Lung Cancer - Non-Hodgkin Lymphoma - Metastatic Breast Cancer Manifestations: - Facial Edema - Distention of Veins in head, neck and chest - Headaches, Seizures - Mediastinal Mass on Chest X-Ray Management: - Considered a serious Medical Problem - Radiation Therapy to site of Obstruction - Chemotherapy for Tumors More Sensitive to This Therapy

superior vena cava syndrome

What oncologic emergency is described below: Management: - Considered a serious Medical Problem - Radiation Therapy to site of Obstruction - Chemotherapy for Tumors More Sensitive to This Therapy

superior vena cava syndrome

What oncologic emergency is described below: Manifestations: - Facial Edema - Distention of Veins in head, neck and chest - Headaches, Seizures - Mediastinal Mass on Chest X-Ray

superior vena cava syndrome

What oncologic emergency is described below: o Due to tumor obstruction § Facial edema § Distention of neck and chest veins § Seizures § Headache

superior vena cava syndrome

The following are ______ interventions for both type 1 and 2 DM: • Bariatric Surgery o Useful for Type 2 DM to manage co-morbidities, metabolic syndrome effects • Pancreas Transplant: o Option for Type 1 Dm with severe and consistent complications/treatment failurse o Usually due to end-stage renal disease/kidney transplant • Pancreatic islet cells transplant o experimental only

surgical

The following are indications for ______ repair for disorders of the female urogenital tract (cystocele and rectocele): · Chronic discomfort from bulging vagina o Will feel like something is "down there" · Difficulty emptying the bladder · Surgical Treatment: Colporrhaphy · Surgical repair of a defect in the vaginal wall, including cystocele and rectocele o Cystocele § Anterior colporrhaphy - "anterior repair" o Rectocele § Posterior colporrhaphy -"posterior repair" o Rectocele + Cystocele - A & P repair

surgical

With interprofessional care of _______ therapy: • Lung volume reduction surgery (LVRS) o Remove the most diseased portion of the lung so the remaining portion can work better o Improves lung and chest wall mechanics, allows the diaphragm to return to its normal shape o Helps the patient breathe more efficiently • Bronchoscopic LVRS - similar to LVRS o Air goes out, can't get back in - through implanted one-way valves • Bullectomy o Bullae (large sacks that form when alveoli are destroyed) removed surgically • Lung Transplant

surgical

What treatment of cancer is described below: · Prevention o Example: prophylactic mastectomy for + mutation of BRCA-1 or BRCA-2 with strong family history of early onset of breast cancer · Cure or control of cancer · Palliation to maximize bodily function or facilitate cancer treatment · The goal is to remove as much resectable tumor as possible while sparing normal tissue · If a tumor can't be removed completely (attached to a vital organ), may remove as much as possible and then use chemotherapy and/or radiation therapy

surgical therapy

What treatment of cancer is described below: · The goal is to remove as much resectable tumor as possible while sparing normal tissue · If a tumor can't be removed completely (attached to a vital organ), may remove as much as possible and then use chemotherapy and/or radiation therapy

surgical therapy

What treatment plan for VTE is described below: thrombectomy, vena cava interruption devices (filters) Venous thrombectomy involves the removal of a thrombus through an incision in the vein. Anticoagulant therapy is recommended after venous thrombectomy Vena cava interruption devices (EX: Greenfield Filter) can be placed percutaneously through the R femoral or R internal jugular veins. The filter device is opened and the spokes penetrate the vessel walls. The filter acts as a "sieve-type" device, permitting filtration of clots without interruption of blood flow. Complications aftr the insertion are rare but include air embolism, improper placement, migration of the filter, and perforation of the vena cava. Over time, clots can clog the filter and completely block the vena cava, requiring filter removal and replacement.

surgical therapy

With interprofessional care of patients with PAD, ____ ______ _______ includes: o Atherectomy Removal of the obstructing plaque o Cryoplasty PTA with cold therapy - the cooling of smooth muscle limits cell activity o Peripheral artery bypass operation Most common approach with autogenous vein or synthetic graft material to bypass blood around the lesion o Endarterectomy o Patch graft angioplasty o Amputation: if tissue necrosis is extensive infectious gangrene osteomyelitis (infection in the bone) all major arteries in the limb are occluded, precluding the possibility of successful surgery

surgical therapy

_______ response to inflammation is when inflammation begins to affect the entire body. o Increased WBC count with a shift to the left Increased # of immature neutrophils (bands), monocytes, lymphocytes NEED TO KNOW: what is a normal WBC count and what indicates the WBC count? o Malaise o Nausea and anorexia o Increased pulse and respiratory rate o Fever (usually not seen with the local response) Cytokines: • Hypothalamus: thermoregulation • Adrenal medulla--> epinephrine--> ^ metabolic rate o Leukocytosis results from the increased release of WBCs from the bone marrow.

systemic

What administration route for chemotherapy treatment of cancer is described below: o Most common route o Major Concerns § Venous access difficulties § Catheter-related infection § Extravasation (infiltration into surrounding tissue § Irritants - can cause phlebitis § Vesicant - can cause severe local tissue breakdown and necrosis if infiltrated

systemic (IV)

what are the 3 administration routes for chemotherapy treatment for cancer?

systemic (IV), regional, and oral

What are the 3 types of lupus?

systemic lupus erythematosus, cutaneous lupus erythematosus (discoid lupus), and drug-induced systemic lupus

SVR): force opposing the movement of blood; created in small arteries and arterioles o BP= CO x SVR

systemic vascular resistance (SVR)

left ventricular (LV) ______ failure is also known as heart failure reduced ejection fraction or HRrEF this type of HF results from an inability of the heart to pump blood effectively the hallmark of _______ failure is a decrease in the EF, Normal EF is 55-60%. Patients with HRrEF generally have an EF less than 45%. It can be as low as 5-10%. HRrEF is caused by impaired contractile function (EX: MI), increased overload (Ex: hypertension), cardiomyopathy, and mechanical abnormalities (EX: valvular heart disease) The LV in systolic failure loses its ability to generate enough pressure to eject blood forward through the aorta. Over time, the LV becomes dilated and hypertrophied. The weakened heart muscle cannot generate adequate stroke volume, which affects CO. Because the LV cannot adequately push blood forward, end diastolic volumes and pressures in the LV increase. When the LV fails, blood backs up into the left atrium. This causes fluid accumulation in the lungs. The increased pulmonary hydrostatic pressure causes fluid leakage from the pulmonary capillary bed into the interstitium and then the alveoli. This results in pulmonary congestion and edema.

systolic

• Prevent/manage crisis • Prescribed treatment regimen • Control symptoms • Reorder time • Adjust to changes in course of disease • Prevent social isolation • Normalize interactions with others These are _____ of people with chronic illnesses.

tasks

What prevention measure to prevent chronic illness is described below: o Limit disease progression and maintain optimal functioning o Examples: treatment, rehabilitation

tertiary

When monitoring for ______ in acute pancreatitis: · Tests for hypocalcemia. o A, Chvostek's sign is contraction of facial muscles in response to a light tap over the facial nerve in front of the ear. o B, Trousseau's sign is a carpal spasm induced by (C) inflating a blood pressure cuff above the systolic pressure for a few minutes.

tetany

What oncologic emergency is described below: Management: - Fluid, Electrolyte, and Plasma Protein Replacement - During recovery hypovolemia can occur, result in hypotension, elevated central venous pressure, weight gain, and shortness of breath

third space syndrome

What oncologic emergency is described below: Manifestations: - Signs of Hypovolemia: - Hypotension - Tachycardia - Low Central Venous Pressure - Decreased Urine Output

third space syndrome

What oncologic emergency is described below: Description: - Shifting of fluid from vascular space to interstitial space. - Occurs secondary to extensive - Surgical Procedures - Immunotherapy - Septic Shock Manifestations: - Signs of Hypovolemia: - Hypotension - Tachycardia - Low Central Venous Pressure - Decreased Urine Output Management: - Fluid, Electrolyte, and Plasma Protein Replacement - During recovery hypovolemia can occur, result in hypotension, elevated central venous pressure, weight gain, and shortness of breath

third space syndrome

What oncologic emergency is described below: o Fluid shift from vascular to interstitial space o Signs of hypovolemia o Treatment - F&E replacement and plasma proteins § *****Hypervolemia can occur during recovery tx*****

third space syndrome

What diagnostic test of the respiratory system is described below: Description and Purpose: used to obtain specimen of pleural fluid for diagnosis, remove pleural fluid, or instill medication. Chest x-ray always obtained after procedure to check for pneumothorax. Nursing Responsibility: Before: explain procedure to patient and obtain signed consent before procedure. DUring: usually performed in patient's room. Position patient upright with elbows on an overbed table and feet supported. INstruct patient not to talk or cough during procedure. After: observe for signs and symptoms of hypoxia and pneumothorax and verify breath sounds in all fields. Encourage deep breaths to expand lungs. Send specimens to lab.

thoracentesis

What anticoagulant medication to treat venous thrombosis is described below: Synthetics • Dabigatran (Pradaxa) Factor Xa inhibitors • Rivaroxaban (Xarelto), Apixaban (Eliquis)

thrombin inhibitors-direct

What anticoagulant medication to treat venous thrombosis is described below: Heparin: • Can be given subcutaneously for VTE prophylaxis or by continuous IV infusion for VTE treatment. When given IV, heparin requires frequent monitoring of clotting status as measured by activated partial thromboplastin time (aPTT). • One serious side effect of heparin is heparin-induced thrombocytopenia (HIT). HIT is an immune reaction to heparin. It causes a severe sudden reduction in the platelet count along with a paradoxical increase in venous or arterial thrombosis. HIT is diagnosed by measuring the presence of heparin antibodies in the blood. Treatment requires immediately stopping heparin therapy, and if further anticoagulation is required, using a non-heparin anticoagulant. • Another side effect of heparin use is osteoporosis

thrombin inhibitors-indirect

What anticoagulant medication to treat venous thrombosis is described below: Low molecular weight - Lovenox (LMWH) • LWMH have more bioavailability, more predictable dose response, longer half-life, and fewer bleeding complications. It is less likely to cause HIT and osteoporosis. It typically does not require ongoing anticoagulant monitoring and dose adjustment and their anti-inflammatory properties may help prevent PTS and venous ulcer development.

thrombin inhibitors-indirect

The following is treatment post-op nursing management for disorders of the female urogenital tract (cystocele and rectocele): · Prevent ________ early ambulation, TED hose, ICDs o Want them up and get them into a chair the first afternoon after surgery

thromboembolism

What treatment plan for VTE is described below: Another treatment option for patients with a thrombus is catheter-directed administration of a thrombolytic drug. It dissolves the clot, reduces the acute symptoms, improves venous flow, reduces valvular reflux, and may help to decrease the incidence of PTS. Catheter-directed thrombolysis is recommend for select patients who are at a low bleeding risk and present with an acute, extensive, symptomatic, proximal VTE

thrombolytic therapy

what precipitating factor of HF is described below: excess of thyroid hormone changes the tissue metabolic rate, increased HR and workload of the heart

thyrotoxicosis

- muscle protein o Part of heart muscle o Mutations in the _____ gene: most common known genetic cause of dilated cardiomyopathy (heart muscle gets thin, weak, and floppy)

titin

With nutritional therapy of DM, what component of diet is described below: --include carbohydrate from fruits, veggies, grains, legumes, and low fat milk --monitor by carbohydrate counting, exchange lists or use of appropriate proportions --sucrose-containing food can be substitutied for other carbohydrates in meal plan --fiber intake at 25-30 g/day --nonnutritive sweeteners are safe when consumed within FDA daily intake levels

total carbohydrate

What surgery for IBD has the following special considerations R/T surgery: o Two procedures 8 to 12 weeks apart o GI adaptation over 3-6 months o Anal sphincter is preserved o For the first procedure they go in and remove the colon and rectum and then take a portion of the small intestine and make a J pouch and make a temporary ileostomy. Once healed, they hook up the J pouch to the ileum and close up that stoma site. Since they left the anus, they are continent and can control their bowel movements.

total colorectomy with ileoanal reservoir (J-pouch)

What surgery for IBD has the following special considerations R/T surgery: o One-stage surgery o Removal of colon, rectum, and anus with closure o No continence o Incontinent stoma**

total proctocolectomy with PERMANENT ileostomy

What surgery for IBD has the following special considerations R/T surgery: o Pouch reservoir, drained at regular intervals o Rarely used today—risk from SBS and disease recurrence (Crohn's) o Problems include: d § Valve failure § Leakage § Pouchitis (inflammation of the ileal reservoir Pouch)

total proctolectomy with CONTINENT ileostomy pouch

What complication of IBD is described below: Complications · Extraintestinal (more common with Crohn's) o Sclerosing cholangitis o Skin lesions o Arthritis o Ankylosing spondylitis (lose normal curvature of the Spine; can get crusty looking lesions develop on the Skin o Osteoporosis o Liver disease o Thromboembolism o Eye inflammation o Kidney stones o **more common in Crohn's than in ulcerative colitis

toxic megacolon

What complication of IBD is described below: Complications · Strictures and obstruction from scar tissue · Fistulas · Abscess · Peritonitis · Extraintestinal (more common with Crohn's) o Sclerosing cholangitis o Skin lesions o Arthritis o Ankylosing spondylitis (lose normal curvature of the Spine; can get crusty looking lesions develop on the Skin o Osteoporosis o Liver disease o Thromboembolism o Eye inflammation o Kidney stones o **more common in Crohn's than in ulcerative colitis

toxic megacolon

what complication of IBD is described below: o Have so much fluid in the colon and the colon distends and with this distention the muscles of the colon becomes flappy, big, and balloon-like o Happens with paralytic ileus and associated with high rate of perforation o (dilation and paralysis of the colon commonly associated with perforation)

toxic megacolon

What assessment abnormality of the respiratory system is described below: Description: leftward or rightward movement of trachea from normal midline position Possible Etiology and Significance: nonspecific indicator of change in position of mediastinal structures. Medical emergency if caused by tension pneumothorax. (trachea deviates to side opposite collapsed lung).

tracheal deviation

what surgical therapy procedure for a pt with PD is described below: o __________ of fetal neural tissue into the basal ganglia § Provides dopamine-producing cells in the brains of patients § Research and clinical trials are ongoing

transplantation

What is the main treatment goal of a patient with HF?

treat underlying cause and contributing factors

The following are the different types of cancer ________: · Surgical · Radiation · Chemotherapy · Targeted therapy · Biologic therapy · Hormone therapy · Gene therapy

treatment

The following is overall ______ for both type 1 and 2 DM: • Nutritional therapy • Exercise • Self-monitoring of blood glucose • Bariatric surgery • Pancreas transplant

treatment

The following are _____ _____ of HF: • Treat underlying cause and contributing factors • Maximize cardiac output and improve ventricular function • Provide treatment to alleviate symptoms o If patient is FVO, give diuretics o If patient is SOB, put on oxygen • Improve quality of life Decrease mortality and morbidity

treatment goals

what clinical manifestation of PD (Parkinson's disease) is described below: o More prominent at rest o Aggravated by Emotional stress and ↑ Concentration o is often the first sign and may be minimal initially, so the patient is the only one who notices it.

tremor

what clinical manifestation of PD (Parkinson's disease) is described below: o Often first sign o Initially minimal o More prominent at rest o Aggravated by Emotional stress and ↑ Concentration o is often the first sign and may be minimal initially, so the patient is the only one who notices it. o can affect handwriting, causing it to trail off, particularly toward the ends of words. o Parkinsonian ________ is more prominent at rest and is aggravated by emotional stress or increased concentration. · Pill rolling hand ________ · Diaphragm, tongue, lips, jaw may be involved · Essential _______r is not associated with PD o Occurs during voluntary movement, has more rapid frequency, is familial

tremor

what clinical manifestation of PD (Parkinson's disease) is described below: o can affect handwriting, causing it to trail off, particularly toward the ends of words. o Parkinsonian ________ is more prominent at rest and is aggravated by emotional stress or increased concentration.

tremor

what clinical manifestation of PD (Parkinson's disease) is described below: · Pill rolling hand ________ · Diaphragm, tongue, lips, jaw may be involved · Essential _______r is not associated with PD o Occurs during voluntary movement, has more rapid frequency, is familial

tremor

Name as many clinical manifestations of PD (Parkinson's disease) as you can.

tremor, pill rolling hand tremor, essential tremor, rigiditity, akinesia, bradykinesia, stooped posture, masked face, drooling, festination, short, shuffling gait, forward tilt to posture, blank facial expression, slow monotonous slurred speech, erectily dysfunction, sleep disturbances, urinary retention and constipation, depression and anxiety, fatigue, pain, memory changes

When talking about the etiology and pathophysiology of Parkinsons's disease/Parkinsonism, what does TRAP stand for?

tremor, rigidity, akinesia, and postural instability

What diagnostic study is described below: • mixtures of fatty acids. Elevations are associated with CV disease and diabetes • Reference interval: o < 150 mg/dL (< 1.7 mmol/L) (varies with age)

triglycerides

What assessment abnormality of the respiratory system is described below: Description: leaning forward with arms and elbows supported on overbed table Possible Etiology and Significance: COPD, asthma exacerbation, pulmonary edema; indicated moderate to severe respiratory distress

tripod position, inability to lie flat

The following is another classification system of _____ (NOT benign or malignant): 1. Anatomic Site Classification o Carcinoma - skin, glands, mucous membranes o Sarcoma - Connective tissue, muscle bone, fat o Lymphomas, leukemias - hematopoietic system · 2. Histological - Grades 1-4 · 3. Extent of disease · Clinical Staging Stages 0-4 · TNM Classification T-N-M

tumors

what percussion sound is described below: drum-like, loud, empty quality sound heard over pneumothorax

tympany

Insulin for _____ ____ DM: need exogenous insulin for life to prevent ketoacidosis o REQUIRED FOR ____ _____ DIABETICS!!!

type 1

What type of DM has the following etiology and pathophysiology: • Autoimmune disorder o the body develops antibodies against insulin and/or pancreatic β-cells • Genetic and environmental o exposure to a virus that ignites the immune system

type 1

What type of DM has the following etiology and pathophysiology: • Autoimmune disorder o the body develops antibodies against insulin and/or pancreatic β-cells (insulin producing cells) • Genetic and environmental o exposure to a virus that ignites the immune system • Idiopathic o strongly inherited but not autoimmune o not an autoimmune process but for some reason, their beta cells stop making insulin o not common • LADA - latent autoimmune diabetes o appears like Type 2 because it progresses slowly instead of all beta cells being destroyed in a few days or weeks, it can take years to destroy the beta cells • Pancreas can't produce sufficient insulin - Production Deficit o Islet cell autoantibodies destroy pancreatic β-cells • Requires exogenous insulin o They MUST inject insulin to survive • May experience a "honeymoon" period of 3-12 months o TEACHING POINT: Need to educate patient that the honeymoon period will end at some point

type 1

What type of DM has the following etiology and pathophysiology: • Pancreas can't produce sufficient insulin - Production Deficit o Islet cell autoantibodies destroy pancreatic β-cells • Requires exogenous insulin • May experience a "honeymoon" period of 3-12 months o TEACHING POINT: Need to educate patient that the honeymoon period will end at some point

type 1

When talking about nutritional support: ____ _____ DM includes the following: o Plan meals based on usual food intake and preferences o Balance intake with exercise and insulin o Day-to-day consistency -may be able to adjust insulin dose based on BG & carbohydrate content of meals/snacks

type 1

what type of DM has the following clinical manifestations: • Polyuria, polydipsia, polyphagia o Due to osmotic effect of glucose - polyuria and polydipsia o Body cannot correctly uptake glucose - cannot enter cells due to insulin deficiency - leads to cellular malnourishment - polyphagia (patient is hungry) • Weight loss, weakness, fatigue • Diabetic Ketoacidosis (DKA) o Without insulin the body can't use glucose, so it breaks down fat for fuel o Causes a buildup of ketones in blood - ketoacidosis

type 1

what type of DM has the following clinical manifestations: • Weight loss, weakness, fatigue • Diabetic Ketoacidosis (DKA) o Without insulin the body can't use glucose, so it breaks down fat for fuel o Causes a buildup of ketones in blood - ketoacidosis

type 1

Insulin for ___ ___ DM: o prescribed for patients who cannot control blood glucose by other means o The need varies with exercise, stress, illness, food intake o requires self-monitoring of blood glucose. (NEED TO KNOW THIS!)

type 2

What type of DM has the following etiology and pathophysiology: • Inadequate production along with resistance • Pancreas produces some endogenous insulin • Strong genetic link o First degree relative with diabetes are more at risk for developing diabetes • Many risk factors associated • Beta cells have stopped functioning fully • Cells are not sensitive to insulin and do not use insulin well

type 2

What type of DM has the following risk factors: • Family history of diabetes (#1 RISK OF TYPE 2 DM) • Increasing age • Overweight, unhealthy diet • Impaired glucose tolerance (IGT) o Body is not able to take care of large amount of glucose coming into the body by producing enough insulin • History of gestational diabetes • Poor nutrition during pregnancy o Even if they did not have gestational diabetes and they gain a lot of weight from poor diet, can develop type 2 DM • Physical inactivity, hypertension, ethnicity o Hispanic or Latin American, pacific islanders, African Americans, American Indians, native Americans are at higher risk of developing diabetes

type 2

When talking about nutritional support: ____ _____ DM includes the following: o Emphasize glucose, lipid, and BP control o Balance energy from food intake with energy expenditure from activities o Involve family in diet teaching

type 2

what type of DM has the following clinical manifestations: • Polyuria, polydipsia, polyphagia • Fatigue • Poor wound healing o A lot of times that is one of the things that clue us in on DM • Visual changes o Reporting of blurred vision from damage of blood vessels in eye • Recurrent infections - yeast o Yeast LOVES sugar

type 2

what type of DM has the following way of disease onset: • Onset is gradual • 50-80% of β-cell malfunction prior to onset of clinical manifestations • Many go undiagnosed or are diagnosed with routine lab work • Glycosylated hemoglobin - (A1C) o Usually discovered during routine assessment/labs o Common method to diagnose DM • Prediabetes - intermediate stage between normal glucose metabolism and diabetes o IFG - impaired fasting glucose (100-125 mg/dl) Fasting for 8 hours Less than 100 is normal in fasting o IGT - impaired glucose tolerance (140-199 mg/dl) 2 hours post bolus during OGTT (oral glucose tolerance test) 75 gram of glucose load o No symptoms but damage is being done

type 2

The following is treatment and care of an _____ in PUD: · H.Pylori Treatment****** o PPI +clarithromycin (or metronidazole) + amoxicillin for 10 to 14 days o 20% FAILURE to eradicate H.pylori

ulcer

The following is treatment and care of an _____ in PUD: · NGT placement, if indicated - decompression o Put to suction · Dietary modifications: avoid irritants, NPO o High spicy foods, black pepper, etc. o NPO—decreases gastric stimulation

ulcer

The following is treatment and care of an _____ in PUD: · Quit smoking · Avoid or restrict alcohol intake · Monitor for bleeding, shock, and complications · Health promotion · Drug therapy***** o H2 receptor blockers, PPIs, antacids, antisecretory and cytoprotectives, anti-cholinergics, ABX

ulcer

The following is treatment and care of an _____ in PUD: · Rest o Increased basal metabolic rate, leads to irritation · NGT placement, if indicated - decompression o Put to suction · Dietary modifications: avoid irritants, NPO o High spicy foods, black pepper, etc. o NPO—decreases gastric stimulation · Quit smoking · Avoid or restrict alcohol intake · Monitor for bleeding, shock, and complications · Health promotion · Drug therapy***** o H2 receptor blockers, PPIs, antacids, antisecretory and cytoprotectives, anti-cholinergics, ABX · H.Pylori Treatment****** o PPI +clarithromycin (or metronidazole) + amoxicillin for 10 to 14 days o 20% FAILURE to eradicate H.pylori

ulcer

Crohn's disease or ulcerative colitis? · Limited to the colon and rectum · Proctocolectomy is curative o Ileal pouch/anal anastomosis (J pouch) o Permanent ileostomy o Have an anal sphincter to have bowel movement but sometimes are not able to do this and will have a permanent ileostomy. Both will cure ulcerative colitis.

ulcerative colitis

What diagnostic study for gallbladder disease is described below: is commonly used to diagnose gallstones. o It is especially useful for patients with jaundice (because it does not depend on liver function) and for patients who are allergic to contrast medium

ultrasound

What stage of chronic illness trajectory is described below: -unable to keep symptoms or disease course under control -life becomes disrupted while patient works to regain stability -hospitalization not required

unstable (6)

What type of ostomy is described below: · ureters brought to abdomen or flank area; stomas reflux and can lead to UTI's and hydronephrosis; done when patient is not able to have an intestinal diversion.

ureterostomy

What diagnostic study of the urinary system is described below: Nursing Responsibility: Before: wash perineal area before collecting specimen. During: try to obtain first urinated morning specimen. After ensure specimen is examined within 1 hour of urinating.

urinalysis

The following are indications for ___ _____: · Bladder cancer requiring total cystectomy · Neurogenic bladder conditions that threaten renal function · Congenital anomalies · Chronic UTIs with renal deterioration · Strictures (stenosis) · Severe radiation injury or trauma to bladder · Intractable incontinence in females · Enlarged prostate

urinary diversions

The following are the different types of ____ ____: · 1- Incontinent ____ _____ o A stoma that is produced and the patient has no control on the flow of urine and have to wear a pouch · 2- Continent _____ ______ o The urine does not automatically drain from the catheter · 3- Orthotopic Bladder Reconstruction o Use a segment of the bowel and clip the nerves that cuase peristalsis to the bowel and hook this to the urinary sphincter

urinary diversions

The following is nursing care pre-op for ___ ____: · Consult WOCN (wound, ostomy, continence nurse) · Patient teaching: stoma care, complications, increase fluid intake, self catheterization as appropriate · Assess peristomal skin (non-continent urinary deviations); provide skin care; assess stoma. · Monitor quality of urine (frequent UTIs)

urinary diversions

The following is nursing care pre-op for ___ ____: · Increase fluid intake · Manage early post-op NG tube · Prevent post-op respiratory complications · Monitor for metabolic complications · Monitor for diarrhea and weight loss

urinary diversions

The following is nursing care pre-op for ___ ____: · Provide information - reduce anxiety and fear - address psychosocial issues (clothing, body image, sexuality, exercise, odor) · Keep in mind that anxiety and fear can interfere with learning · Bowel prep and ABx before surgery · Consult WOCN (wound, ostomy, continence nurse) · Patient teaching: stoma care, complications, increase fluid intake, self catheterization as appropriate · Assess peristomal skin (non-continent urinary deviations); provide skin care; assess stoma. · Monitor quality of urine (frequent UTIs) · Increase fluid intake · Manage early post-op NG tube · Prevent post-op respiratory complications · Monitor for metabolic complications · Monitor for diarrhea and weight loss

urinary diversions

_____ _______ include: · Urinary Surgical Therapy · Segmented (Partial) Cystectomy o A portion of the bladder wall containing a tumor is removed o Patient has a malignant tumor in the bladder; can take that portion of the bladder out and keep the rest of the bladder intact · Radical (Total) Cystectomy o Removal of the bladder, prostate & seminal vessels in men and bladder, uterus, cervix, urethra, & ovaries in women (extensive bladder cancer) o After a radical cystectomy, a urinary diversion must be created because they no longer have a bladder to hold and eliminate urine from the body · ____ _____ o Surgical procedure that reroutes the normal flow of urine out of the body

urinary diversions

the following are nursing diagnoses for ___ ____: · Risk for infection · R.C. Electrolyte imbalance (ileal conduits, neo-bladder) · R.C. malnutrition (ileal conduits, neo-bladder) · R.C. metabolic acidosis (ileal conduits, neo-bladder) o Will not absorb as many nutrients through GI tract · Risk for impaired skin integrity o Urine can leak from pouch onto the skin · Disturbed body image · Risk for ineffective sexuality pattern o Primarily in males with total prostatectomy or neobladder · Anxiety · Knowledge deficit

urinary diversions

What system has the following clinical manifestations of CKD? • As CKD progresses, ↑ fluid retention; may require diuretics • Anuria: UOP < 40ml / 24 hours - may develop with ESRD/Dialysis

urinary system

What system has the following clinical manifestations of CKD? • Polyuria (early stage) from inability of kidneys to concentrate urine - may or may not be present o Kidneys are not able to concentrate urine o Higher urine output but will look clear

urinary system

What system has the following clinical manifestations of CKD? • Uremia: systemic signs and symptoms of renal failure o Itchy dry skin, nausea, vomiting, lethargy, confusion, headaches, and progress to edema, heart failure, liver problems, ascites, etc. • Polyuria (early stage) from inability of kidneys to concentrate urine - may or may not be present o Kidneys are not able to concentrate urine o Higher urine output but will look clear • As CKD progresses, ↑ fluid retention; may require diuretics • Anuria: UOP < 40ml / 24 hours - may develop with ESRD/Dialysis

urinary system

The following is treatment post-op nursing management for disorders of the female urogenital tract (cystocele and rectocele): · Monitor quality of _______: Foley removed after 2 days o We do not want bladder distention to press on the sutures for a few days o Look for bleeding and S/S of infection

urine

What diagnostic study of the urinary system is described below: Nursing Responsibility: During: use sterile container for collection of urine. Touch only outside of container. For women: seperate labia with one hand and clean meatus with other hand, using at least 3 sponges (saturated with cleaning solution) in a front to back motion. For men: retract foreskin and cleanse glands with at least 3 cleansing sponges. (replace foreskin after cleaning). After cleaning, instruct patient to start urinating and then continue voiding in sterile container. (the initial voided urine flushes out most contaminants in the urethra and perineal area). Catheterization may be needed if patient is unable to cooperate with procedure.

urine culture ("clean catch" or "midstream")

What type of ostomy has the following output: · will function immediately post op, minimal 800ml/24hrs o immediately post op blood-tinged urine with mucous that progresses to amber/yellow urine with mucous

urostomy

What type of ostomy is described below: · Urinary diversion, usually an ileal conduit, in which part of the ileum is used to create a stoma and conduit for urine · Location: o Typically RLQ of abdomen

urostomy

The following is treatment post-op nursing management for disorders of the female urogenital tract (cystocele and rectocele): · Encourage fluid intake · Avoid _______ ______ o That is the bearing down maneuver that can increase pressure on the suture lines and cause more bleeding

valsalva maneuver

The following describes the _______ response to inflammation: After cell injury, arterioles briefly undergo transient vasoconstriction. After release of histamine and other chemicals by the injured cells, the vessels dilate. Chemical mediators cause increased capillary permeability and facilitate fluid movement from capillaries into tissues spaces. Initially composed of serous fluid, this inflammatory exudate later contains plasma proteins, primarily albumin. These proteins exert oncotic pressure that further draws fluid from blood vessels. Both vasodilation and increased capillary permeability are responsible for redness, heat, and swelling at the site of injury and the surrounding area. As the plasma protein fibrinogen leaves the blood, it is activated to fibrin by the products of the injured cells. fibrin strengthens a blood clot formed by platelets. in tissues, the clot functions to trap bacteria, prevent their spread, and serve as a framework for the healing process. Platelets release growth factors that start the healing process.

vascular

What part of the inflammatory response is described below: o Increased capillary permeability (fluid is able to get out of blood and into surrounding tissues which leads to edema) o Localized edema o Fibrin clot to trap bacteria

vascular

What part of the inflammatory response is described below: o Release of chemical mediators Histamine, kinins, prostaglandins o Local vasodilation, hyperemia

vascular

What part of the inflammatory response is described below: o Release of chemical mediators Histamine, kinins, prostaglandins o Local vasodilation, hyperemia o Increased capillary permeability (fluid is able to get out of blood and into surrounding tissues which leads to edema) o Localized edema o Fibrin clot to trap bacteria

vascular

what are the 2 parts of the inflammatory response?

vascular and cellular

What type of surgical therapy to treat VTE is described below: _____ _____ _____ ____ (EX: Greenfield Filter) can be placed percutaneously through the R femoral or R internal jugular veins. The filter device is opened and the spokes penetrate the vessel walls. The filter acts as a "sieve-type" device, permitting filtration of clots without interruption of blood flow. Complications aftr the insertion are rare but include air embolism, improper placement, migration of the filter, and perforation of the vena cava. Over time, clots can clog the filter and completely block the vena cava, requiring filter removal and replacement.

vena cava interruption devices

When talking about Normal arterial and venous blood gas values the following falls under _____ blood gases: Mixed ____ Blood gases: pH: 7.32-7.43 PvO2: 38-42 mmHg SvO2: 60-80% PvCO2: 38-55 mmHg HCO3-: 22-26 mEq/L

venous

The following are risk factors for venous thrombosis: _____ ______: Age A-fib, CHF, CVA Obese Varicose veins Orthopedic surgery Prolonged immobility Pregnancy and postpartum Long trips w/o movement

venous stasis

What type of surgical therapy to treat VTE is described below: ______ ______ involves the removal of a thrombus through an incision in the vein. Anticoagulant therapy is recommended after venous thrombectomy

venous thrombectomy

What venous disorder includes SVT (superficial vein thrombosis) and VTE (venous thromboembolism)/DVT? Virchow's triad Venous stasis, damage of endothelium, hypercoagulability

venous thrombosis

What type of ostomy is described below: · opening from bladder to abdomen, just below belly button; temporary urinary diversion to prevent UTI's or damage to the kidneys; kids with spina bifida; usually closed before toilet training age.

vesicostomy

When talking about activities that affect caloric expenditure: ________ activity includes: --400-900 kcal/hr --includes: aerobic exercise, bicycling (vigorous), hard labor, ice skating, outdoor sports, running, soccer, tennis, wood chopping

vigorous

______ _______ are important to note with any inflammation, especially when an infectious process is present. When infection is present, the temperature may rise, and pulse and respiration rates may increase.

vital signs

With nursing management of cirrhosis (acute care)--> paracentesis: · Patient ______s immediately before o Immediately before a paracentesis, have the patient _____ to prevent a puncturing of the bladder during the procedure.

void

what are some abnormal diagnostic findings of gallbladder disease? **what lab values are increased?

· ↑ Serum liver enzymes · ↑ Alkaline phosphatase · ↑ Bilirubin · Absence of urobilinogen in urine · ↑ Urinary bilirubin · Leukocytosis · Abnormal gallbladder ultrasound findings

With the classification of cancer (extent of disease classification or "staging"), The TNM classification system is used to determine the anatomic extent of cancer according to 3 parameters: TNM. What does TNM stand for?

•T = TUMOR SIZE AND INVASIVENESS •N = PRESENCE OR ABSENCE OR REGIONAL SPREAD TO LYMPH NODES •M = METASTASIS TO DISTANT ORGAN SITES

What is the final phase of the inflammation process?

healing

Acute or Chronic? o Responsive to treatment (get an infection, take antibiotic, and it goes away)

acute

Nursing care in the _____ setting includes: observation and vital signs, treating a fever, and drug therapy.

acute

When talking about nursing and inter professional management of inflammation, _____ intervention includes: o Observation Looking for the s/s inflammation • improvement • worsening: Need to contact provider o Vital signs Temp (needs to come down) B/P, pulse (expect to be high in ______ phase, should come down as patient improves) o Fever management Prescribed medications (fever, parameters for when to given it such as "Give for fever over 101 F")

acute

________ arterial ischemia is a sudden interruption in the arterial blood supply to a tissue, an organ, or an extremity that, if left untreated, can result in tissue death. It is caused by embolism thrombosis of a preexisting atherosclerotic artery, or trauma

acute

inflammation may be _____: Immediate response to injury or infection Resolves spontaneously or with treatment EX: a mosquito bite; it turns red, gets fluid in it, but after a few days it goes away EX: cut finger with knife while cooking and it gets red and swollen with some fluid but eventually it heals and goes away

acute

What stage of chronic illness trajectory is described below: -active illness with severe and unrelieved symptoms or complications -hospitalization may be required for management

acute (3)

The _____-_______ mechanisms oppose the action of the compensatory mechanisms (SNS activation, Neuro-hormonal response, cardiac dilation, hypertrophy).

counter-regulatory

what 2 stages of CKD are endocrine, metabolic, fluid and electrolyte manifestations?

stages 4 and 5

total blood flow through systemic or pulmonary circulation each minute. It is described as the stroke volume (SV) or the amount of blood pumped out of the L ventricle per beat (approximately 70 mL) multipled by the heart rate (HR).

CO (Cardiac output)

Nitric oxide and natriuretic peptides fall under what kind of mechanisms of heart failure?

counter-regulatory mechanisms

What stage of chronic illness trajectory is described below: -life-threatening situation occurs -emergency services are necessary

crisis (5)

If the normal percentage of eosinophils is 0-3% in the body and your patient has a percentage of 2%, that is?

normal

What part of the pouching system of an ostomy is described below: · commonly referred to as the flange) - protects peristomal skin from effluent; cut-to-fit, pre-cut, moldable; flat or convex

skin barrier

Understanding CBC: Inflammation/Infection: ___ ________ = immune system/ bone marrow diseases (i.e. lupus, HIV infection, immunosuppression, chemo)

decreased lymphocytes

11.0-12.5 seconds

hemoglobin in women

12-16 g/dL

o measures general levels of inflammation in the body o something we often check in people who are at risk for CV disease

C-reactive protein (CRP)

What chronic disease is described below: -affects many older adults -3rd leading cause of death

COPD (chronic obstructive pulmonary disease)

What are the 2 subcategories of IBD?

Crohn's disease and ulcerative colitis

What type of hepatitis is described below: Transmission: fecal-oral Characteristics: occurs primarily in developing countries

· Chronic, progressive, degenerative, inflammatory disorder of the CNS

Intermittent claudication and paresthesia are the 2 main clinical manifestations of?

PAD (peripheral artery disease)

Is inflammation always present with infection?

Yes; inflammation is ALWAYS present with infection!!!!!

Where does Crohn's disease affect in the body with IBD?

anywhere in the GI tract (from the mouth to the anus)

What is a very COMMON comorbidity of MS?

depression

what is a big complication of cancer?

infection

A FPG of 100-125 is? **diagnostic study for DM

prediabetes

With treatment of hypoglycemia: o ________ patient With IV access: • 25 - 50 ml D50 IVP • look for other cause of unconsciousness

unconcious

Pre-filled syringes are stable in refridgerator for up to ____ week. o Pre-filled syringes containing 2 type of insulin anytime drawing up syringe you are opening up pathway for bacteria to enter

triglyceride

40-50 mg/dL

· In _____ 1_______ ______1______, there are healthy parts of the intestine mixed in between inflamed areas. ____2____ _____2______, on the other hand, is continuous inflammation of the colon. _____2____ ____2______ only affects the inner most lining of the colon while _____1_____ ____1______ can occur in all the layers of the bowel walls.

1. Crohn's disease 2. Ulcerative colitis

In __1____ inflammation, the healing occurs in 2 to 3 weeks and usually leaves no residual damage. Neutrophils are the predominant cell types at the site of inflammation. A ___2____ inflammation has the features of the acute process but lasts longer. For example, infective endocarditis is a smoldering infection with acute inflammation but it persists for weeks or months. ___3___ inflammation lasts for weeks, months, or even years. Examples include rheumatoid arthritis and osteomylitis.

1. acute 2. subacute 3. chronic

What is the 3 different classifications of a tumor (NOT benign or malignant)?

1. anatomic site classification 2. Histological 3. Extent of Disease

The __1___ is the thin inner layer of the heart, __2____ is a muscle layer, and ___3_____ is the outer layer of the heart.

1. endocardium 2. myocardium 3. epicardium

___1____ Is always present with ___2___ but ___2_____ is not always present with ___1_____.

1. inflammation 2. infection

In the ____1__ position, the patient's BP will have an increased SBP and a decreased DBP. In the __2_____ position, the patient's BP will have a decreased SBP and an increased DBP. ALWAYS DOCUMENT PATIENT POSITION AND LOCATION OF CUFF.

1. supine 2. sitting

Normal GFR = _____ml/min o -how much blood passes through the glomeruli each minute o ______ ml/min is how much blood should be flowing through kidneys per minute **Falls under chronic kidney disease

125

phosphorus

2.5-4.5 mg/dl

With an oral gluocse tolerance test, DM is present when a 2 hr post-load glucose is equal to or > ______ mg/dl.

200

platelets

200,000-400,000

CPK

21-232 U/L

When talking about normal and critical values for PaO2 and SpO2: What PaO2 (mmHg) measurement is described below: SpO2%: 88 Significance: moderate hypoxemia Manifestations: confusion, lethargy, dysrhythmias, hypotension, respiratory distress, accessory muscle use Management: O2 required, escalate level of care. Obtain critical care consult. Monitor frequently for sudden deterioration in condition

40-59

WBC

5,000-10,000

What is the normal value for WBCs?

5,000-10,000

Protein

6.2-8.1 g/dL

SaO2

95-100%

Chloride

98-107

With interprofessional care of patients with PAD, ____ ______: o ↓ Cardiovascular morbidity o ↓ Mortality o ↑ Peripheral blood flow o ↑ ABI o ↑ Walking distance o Type of medication given for BP and for patients with PAD

Ace inhibitors

_____ prevention refers to activities that limit disease progression such as rehabilitation. **chronic illness

tertiary

• Community environment • Supervision/safety • Socialization (games, music, gets in groups to talk) • Assistance with ADLs • Meals • State regulations and standards • Delay institutional placement o Adult day care and adult day care can delay institutional placement o It can help with patients staying in their home or a family member in home for a longer period of time before going to a nursing home • Difference between _____ _____ ____ ___ ____ ___ ___ ____: Adult day health care provides some services like medication administration;

Adult Day Care and Adult Day Health Care

• Federal agency o Department of Health and Hospitals o Provides funding and services for social support for the elderly

Administration on Aging (AoA)

With CKD therapy, what is the #1 overall goal of treatment?

to preserve existing kidney function

What chronic disease is described below: -affects 5.4 million people -6th leading cause of death

Alzheimer's disease

What is the surgery for repair of a cystocele?

Anterior colporrhaphy - "anterior repair"

• Aka Council on Aging • State and local agencies funded thru AOA o Provide home making services where they send someone to do housekeeping, prepare meals, etc.

Area Agency on Aging

What chronic disease is described below: -affects 1 in 5 people -one of most common chronic illnesses

Arthritis

__________ blocks PG synthesis in the hypothalamus and elsewhere in the body. This lowers temperature by action on heat-regulating center in hypothalamus resulting in peripheral vasodilation and heat loss

Aspirin

The following is interprofessional care (treatment--> Surgery) of _______: o Choice of treatment depends on the size of the prostate, location of enlargement, patient factors such as age and surgical risk § Transurethral Resection of the Prostate (TURP) § Transurethral Incision of the Prostate (TUIP)

BPH

When talking about insulin administration: ______ a day includes: o Intermediate-acting or pre-mixed o Before breakfast and dinner

twice

What part of the pouching system of an ostomy is described below: skin barrier and pouch are two separate pieces that are put together upon application of system

two-piece

what acute arterial ischemic disorder is described below: o Recurrent inflammatory thrombus disorder of upper/lower extremity arteries/veins o Young men - history of smoking, periodontal disease o Smoking cessation, vasodilator meds, possible surgery/amputation

Buerger's disease

In the acute phase of _____ _____, an inflammatory thrombus forms and blocks the vessel. Over time the thrombus becomes more organized and the inflammation in the vessel wall subsides. During the chronic phase, thrombosis and fibrosis occurs in the vessel, causing tissue ischemia. The symptoms of _____ ____ often are confused with PAD and other autoimmune diseases. Patients may have intermittent claudication of the feet, hands, or arms. As the disease progresses, rest pain and ischemic ulcerations develop.

Buerger's disease (thromboangitis obliterans)

The primary treatment of ___ ______ is the complete cessation of tobacco and marijuana use in any form. Use of nicotine replacement products is contraindicated. Patients must choose between their tobaccor or marijuana and their affected limb, or both.

Buerger's disease (thromboangitis obliterans)

amount of blood pumped from each ventricle each minute. o CO= SV x HR o Normal range is 4-8 L/min

Cardiac output (CO)

What CV regulation mechanism is described below: • Sense O2, CO2 and PH changes in blood o Reside in aortic arch & carotid arteries • Cause change in respiratory rate & BP in response

Chemoreceptors

What diagnostic test of the respiratory system is described below: Description and Purpose: used to screen, diagnose, and evaluate changes in respiratory system. Most common views are AP and lateral Nursing Responsibility: Instruct patient to undress to waist, put on gown, and remove any metal between neck and waist

Chest X-ray

What class of the NYHA Functional Classification of Heart Disease (based on physical activity tolerance) is described below: No limitation of physical activity. Ordinary physical activity does not cause fatigue, dyspnea, palpitations, or anginal pain.

Class 1

What class of the NYHA Functional Classification of Heart Disease (based on physical activity tolerance) is described below: Slight limitation of physical activity. No symptoms at rest. Ordinary physical activity results in fatigue, dyspnea, palpitations, or anginal pain. EX: goes grocery shop for a few things and come home and exhausted but cannot got and get $300 worth of groceries because would need to bring to car and cannot do that

Class 2

What class of the NYHA Functional Classification of Heart Disease (based on physical activity tolerance) is described below: Marked limitation of physical activity. Usually comfortable at rest. Lees than ordinary physical activity (ADLs) causes fatigue, dyspnea, palpitations, or anginal pain EX: get up to take a shower, they are exhausted, cannot eat large meal because get exhausted, no way of going to grocery store

Class 3

What diagnostic study of the urinary system is described below: Nursing Responsibility: During: instruct the patient to urinate and discard this first urine specimen. Note this time as the start of teh test. Save all urine from subsequent urinations in a container for designated period. At end of period, ask patient to urinate, and this urine is added to container. Remind patient to save all urine during study period. Specimens may have to be refrigerated or preservatives added to container used for collecting urine.

Composite Urine collection

What diagnostic test of the respiratory system is described below: Description and Purpose: performed for diagnosis of suspicious lesions difficult to asses by conventional x-ray. Common types are helical or spiral CT (contrast medium is usually used) and high resolution CT scan (contrast medium is not used). Spiral CT used to diagnose a pulmonary embolism. Nursing Responsibility: Same as for chest x-ray. Contrast medium may be given IV. Before: before contrast medium used evaluate BUN and serum creatinine to assess renal function. assess if patinet is allergic to shellfish (iodine) since the contrast is iodine based. Be sure the patient is well hydrated before and after procedure to excrete contrast. DUring: warn patient that contrast injection may cause a feeling of warm and flushed. Instruct patient it lie still on a hard table and that scanner will revolve around body with clicking noises.

Computed tomography (CT) scan

What diagnostic study is described below: o Substitute for arginine vasopression (AVP) that directly reflects AVP concentration. Can be used as a cardiac biomarker for detecting acute MI. higher in men than women, increased after exercise and stress and influencd by fasting and water load o Reference interval: < 10 pmol/L

Copeptin

Part ___ is available to Medicare enrollees and provides a prescription drug benefit

what surgical therapy procedure for a pt with PD is described below: o Most common surgical treatment o Reversible and programmable o ↓ Increased neuronal activity produced by dopamine depletion § Improves motor function § Reduces dyskinesia and medications

Deep brain stimulation (DBS)

What are the diagnostic studies that a patient with PAD? Who is suspected of having PAD may expect?

Doppler ultrasound, segmental blood pressures BPs), and ankle-brachial index (ABI)

What diagnostic study for gallbladder disease is described below: endoscopy and fluoroscopy o allows for visualization of the gallbladder, cystic duct, common hepatic duct, and common bile duct. Bile taken during _______ is sent for culture to identify possible infecting organisms.

ERCP

When using implementation (acute care) of a patient with gallbladder disease: · Post-________ care o Assessment for complications o Bed rest o NPO until return of gag reflex o Patient teaching o Your care of the patient after ________ with papillotomy includes § Assessment to detect complications such as pancreatitis, perforation, infection, and bleeding. Monitor the patient's vital signs. Abdominal pain, fever, and increasing amylase and lipase may indicate pancreatitis. § The patient should be on bed rest for several hours and should be on NPO status until the gag reflex returns. § Teach the patient the need for follow-up if the stent is to be removed or changed.

ERCP

What genetic consideration of HTN is described below: o Endothelial dysfunction is recognized as a marker for CVD including primary hypertension. o Hypertension can present as a prolonged vasoconstriction response or as a reduced vasodilator response. o Prolonged vasoconstriction may be caused by high levels of endothelin (ET). o Vasodilation effects can be altered by oxygen free radicals, which impair the bioavailability of nitric oxide (NO). o This leads to cellular dysfunction and an imbalance of the vasodilation and vasoconstriction mechanisms in the endothelium.

Endothelium dysfunction

what is a true sign of hepatic encephalopathy which is a complication of cirrhosis?

Fetor hepaticus (musty, sweet odor of patient's breath)

What side effect of radiation and chemotherapy is described below: NURSING CARE: Mucositis: •Irritation, Inflammation, and/or Ulceration of the Mucosa •Almost all pts receiving head and neck radiation therapy will experience mucositis •Encourage Meticulous Oral Care; Implement Standard Oral Protocol •Promote Regular Dental Visits •Routinely Assess Oral Cavity, Mucous Membranes, Characteristics of Saliva, and Ability to Swallow •Monitor for Candidiasis (which occurs often in those with mucositis).

GI effects

the following are clinical manifestations of cirrhosis: · anorexia, dyspepsia, N/V, change in bowel habits, dull abdominal pain, fetor hepaticus, esophageal and gastric varices, gastritis, hematemesis, hemorrhoidal varices

What side effect of radiation and chemotherapy is described below: NURSING CARE: Anorexia: •Tends to Peak at Week 4 of treatment; Resolves quicker than fatigue after treatment ends. •Monitor during and after treatment to ensure excessive weight loss does not occur. •Small, Frequent, High Protein, High Calorie Meals are better tolerated than large meals. •Consult with Dietician: Assess need for Nutritional Supplements •Assess need for Enteral or Parenteral Nutrition

GI effects

The following are clinical manifestations of ______: § Tremors and Dizziness § Hearing loss is also an occasional finding · If otic nerve is affected

What bacteria and enzyme is what causes the ulcers in PUD?

H. pylori and Urease enzyme

What chronic disease is described below: -50,000 new cases each year -affects > 1 million Americans

HIV/AID

What influences Cardiac Output?

HR and SV

What category of BP is described below: SBP: 130-139 mmHg or DBP: 80-89 mmHg

HTN Stage 1

What category of BP is described below: SBP: equal to or > 140 mmHg or equal to or > 90 mmHg

HTN Stage 2

associated with severe HA, N/V, seizures, confusion, coma

HTN encephalopathy

What are the primary causes of HF?

HTN, CAD, MI, rheumatic heart disease, congenital heart defects, pulmonary HTN, cardiomyopathy, hyperthyroidism, valvular disorders, myocarditis

When talking about genetics, there are specific gene mutations for what 3 conditions?

HTN, CAD, cardiomyopathy

What are the risk factors? Which are modifiable and which are non-modifiable?

Hypertension and CAD are the primary risk factors for HF. Hypertension is a modifiable risk factor that should be aggressively treated and managed

ADLs or IADLS: using a phone, shopping, handling finances, preparing food, housekeeping, doing laundry, arranging transportation, and taking medications

IADLs

What part of RICE is described below: Cold application is usually appropriate at the time of the initial trauma to promote vasoconstriction and decrease swelling, pain, and congestion from increased metabolism in the area of inflammation. Heat may be used later (e.g., after 24 to 48 hours) to promote healing by increasing the circulation to the inflamed site and subsequent removal of debris.

Ice

When using implementation (acute care) of a patient with gallbladder disease: · __________ _____________: o Maintain adequate ventilation o Prevent respiratory complications o General postoperative nursing care o Maintain drainage tubes (T-tube, Penrose tube, or Jackson-Pratt tube), if present o Replace fluids and electrolytes

Incisional cholecystectomy

What insulin prep is described below: *NPH (Humulin N, Novolin H) Onset: 1.5-4 hr Peak: 4-12 hr Duration: 12-18 hr

Intermediate acting

the following is talking about the pathophysiology of ______: · Antigen-antibody reaction o Within the CNS - activates an inflammatory response that leads to demyelination of neuronal axons

What assessment abnormality of the respiratory system is described below: Description: regular, rapid, deep respirations Possible Etiology and Significance: metabolic acidosis, increases CO2 secretion

Kussmaul respirations

what type of bronchodilator is described below: Salmeterot - Long-term control **once using a long acting bronchodilator, should use these every day no matter if they have symptoms or not!!!!!! (breathing fine) TEACHING POINT!

LABA (long acting B2 adrenergic agonists)

When talking about nursing management: ambulatory care of a patient with gallbladder disease includes: · _________ __________ o Remove bandages day after surgery and then can shower o Report signs of infection o Gradually resume activities o Return to work in 1 week o May need low-fat diet for several weeks

Laparoscopic cholecystectomy

When using implementation (acute care) of a patient with gallbladder disease: · Postoperative care o ________ __________ § Monitor for complications § Patient comfort · Referred pain to shoulder pain from CO2 · Sims' position · Deep breathing, ambulation, analgesia § Clear liquids § Discharged same day

Laparoscopic cholecystectomy

What classification of the TNM Classification system for cancer is described below: --Ascending degrees of metastatic involvement, including distant nodes **The M refers to whether the cancer has metastasized. This means that the cancer has spread from the primary tumor to other parts of the body. **distant metastases (M)

M1-4

: average pressure within arterial system felt by organs o Require a MAP Greater than 60mmHg is needed to perfuse organs adequately • MAP = (SBP + 2DBP) / 3

MAP

What classification of the TNM Classification system for cancer is described below: --No evidence of metastases **The M refers to whether the cancer has metastasized. This means that the cancer has spread from the primary tumor to other parts of the body. **distant metastases (M)

the following is talking about the pathophysiology of ______: · Autoimmune process: o Antigens activate T cells (lymphocytes) → migrate to CNS from systemic circulation disrupting blood-brain barrier · Antigen-antibody reaction o Within the CNS - activates an inflammatory response that leads to demyelination of neuronal axons · Myelin replaced by glial scar tissue forms hard, sclerotic plaques scattered throughout white matter of CNS: nerve impulses slow down

the following is talking about the pathophysiology of ______: · Myelin replaced by glial scar tissue forms hard, sclerotic plaques scattered throughout white matter of CNS: nerve impulses slow down

· Average life expectancy after onset of symptoms is more than 25 years o Death is usually from infections related to immobility or untreated disease · Found more in northern U.S. Europe, Canada more than tropical places. o Changing location changes risk for _____ o Immigrants take on the risk of where they move to.

· Characterized by disseminated, de-myelination and scarring (gliosis) of nerve fibers of the brain and spinal cord o The myelin sheath in MS starts to breakdown and we call this de-myelination and it is replaced by scarred tissue which further slows nerve conduction

· Onset is usually 20-50 years of age; gradual o Does not come on all the time

· Periods of noticeable impairment of function altered with remission · As ongoing inflammation occurs, there is permanent loss of function o The more exacerbations you have, it does result in permanent loss of function over time

· To be diagnosed with _____, the patient must have: o Evidence of at least two inflammatory demyelinating lesions in at least two different locations within the CNS § CT or MRI of brain looking for sclerotic plaques in brain o Damage or an attack occurring at different times (usually 1 or more months apart) o All other diagnoses ruled out

What diagnostic test of the respiratory system is described below: Description and Purpose: scope is inserted through a small incision in suprasternal notch and advanced into mediastinum to inspect and biopsy lymph nodes. used to diagnose lung cancer, non-Hodgkin's lymphoma, granulomatous infections Nursing Responsibility: Before: obtain signed consent. Prepare patient for surgical intervention. Performed in OR using general anesthetic After: monitor as for bronchoscopy

Mediastinoscopy

• Individuals who qualify for both _______ and Medicaid are referred to as dual-eligible. Eligibility and coverage vary by state. For qualified Medicare beneficiaries, __________ pays Medicare premiums, deductibles, and co-insurance as well as long-term care and home health expenses. • In the US, the majority of long-term care is paid for by ________ or private pay

Medicaid

• State-administered, • Needs-based program o eligible low-income people with medical expenses o Program expanded in Louisiana in 2016 (under Affordable Care Act) to include more low-income citizens Medicare or Medicaid?

Medicaid

Only those who PAY SOCIAL SECURITY are eligible for ?

Medicare

• Federally funded insurance for people > 65 o And those < 65 with disabilities or end-stage kidney disease o Funded through Social Security taxes o Only those who pay social security are eligible for Medicare o State employees do not pay social security so they DO NOT get Medicare but they are eligible if they retire from the state they are eligible for the state's ongoing insurance coverage. o People younger than 65 who have disabilities can also be eligible for Medicare • Coverage is limited o Monthly premium for part B Part A is free but only covers hospitalization Part B , you pay a monthly premium, covers physicians visits, diagnostic services like labs and X-rays but doesn't pay for medications. Part B also comes with a copay and deductible (patient has to pay a certain amount up front each year before their insurance kicks in and they have a copay for every time they go for a visit or a diagnostic). o Copays for HCP visits, diagnostic tests, etc. o Separate plan for prescription drug coverage • Out-of-pocket expenditures continue to rise

Medicare

The following are diagnostic tests for _______: · Because no specific diagnostic test exists for _____, diagnosis is based on the patient's history and clinical features.

PD (Parkinson's disease)

What classification of the TNM Classification system for cancer is described below: --Cannot be determined **The M refers to whether the cancer has metastasized. This means that the cancer has spread from the primary tumor to other parts of the body. **distant metastases (M)

What diagnostic study is described below: o Serum concentrations rise 30-60 minutes after MI and rapidly cleared from circulation. Limited use in the diagnsos of cardiac injury/infarction o Reference interval: Male: 15.2-91.2 mcg/L Female: 1.1-57.5 mch/L

Myoglobin

What classification of the TNM Classification system for cancer is described below: --No evidence of disease in lymph nodes **The N refers to the the number of nearby lymph nodes that have cancer.

What classification of the TNM Classification system for cancer is described below: --Ascending degress of nodal involvement **The N refers to the the number of nearby lymph nodes that have cancer.

N1-4

Is infection always present with inflammation?

Some nonsteroidal antiinflammatory drugs (________) (e.g., ibuprofen [Motrin, Advil]) have antipyretic effects. These also inhibit the synthesis of PGs.

NSAIDs

What diagnostic study is described below: o Aids in assessing the severity of HF in symptomatic and asymptomatic patients. In patients with renal insufficiency concentrations may increase and may not correlate with New York Heart Association functional classification of heart failure o Reference interval: Equal to or < 74 year: 124 pg/mL > 75 year: 449 pg/mL

NT-Pro-BNP

What diagnostic study done for a patient with HF is described below: o places patient on a continuum of improvement or decline o guides treatment decisions/nursing care o based on symptoms patient is having now

NYHA Classification System

what compensatory mechanism of HF is described below: o RAAS-Renin-angiotension-aldosterone system o ADH o Endothelin-1 Released from vascular endothelium o Proinflammatory cytokines o Poor CO leads to poor renal perfusion. When we have poor renal perfusion that signals the kidneys to activate the RAAS system and to also activate ADH. The kidneys interpret that as "not enough fluid volume" so that is causing the body to hold on to fluid and water which will increase the preload which has the effect of making the HR worse.

Neuro-Hormonal Response

What system has the following clinical manifestations of CKD? • CNS depression due to ↑ level of urea o Drowsiness and lethargy • metabolic acidosis & electrolyte imbalance • headaches, nausea/vomiting, seizures, coma, peripheral neuropathy

Neurological system

What type of lung cancer is described below: o - 80% of all lung cancers § Squamous cell carcinoma - slow § Adenocarcinoma - moderate § Large-cell undifferentiated carcinoma - rapid

Non-small cell lung cancer (NSCLC)

What classification of the TNM Classification system for cancer is described below: --Regional lymph nodes unable to be assessed clinically **The N refers to the the number of nearby lymph nodes that have cancer.

What diagnostic test of the respiratory system is described below: Description and Purpose: monitors arterial or venous O2 saturation. probe attaches to finger, toe, earlobe, bridge of the nose for SpO2 monitoring or is contained in a pulmonary artery catheter for Sv)2 monitoring. Oximetry is used for intermittent or continuous monitoring and exercise testing. Nursing Responsibility: During: apply probe. when interpreting SpO2 and SvO2 values, first assess patient status and presence of factors that can alter accuracy of pulse oximeter reading. For SpO2, these include motion, low perfusion, cold extremities, bright lights, acrylic nails, dark skin color, carbon monoxide, and anemia. For SvO2, these include change in O2 delivery and O2 consumption.

O2 monitoring (oximetry)

What drug to treat COPD is described below: o Goal O2 sat ≥ 90% during rest, sleep, & exertion

O2 therapy

With an ostomy, you need to read the ____ notes! · Do not assume ostomy type based on location of stoma. · Read the surgeon's ____ note · Typical locations: o Colostomy - left side o Ileostomy - right side o Urostomy - right side

When talking about nursing management: ambulatory care of a patient with gallbladder disease includes: · _______-________ __________ o No heavy lifting for 4-6 weeks o Usual activities when feeling ready o May need low-fat diet for 4-6 weeks

Open-incision cholecystectomy

PAD (peripheral artery disease)

What part of the EKG is described below: atrial contraction o Begins with the firing of the SA node o Represents atrial depolarization

P wave

A person who has Medicaid will not have to pay a monthly premium for the long-term portion of the ______ benefit. A person who does not qualify for Medicaid but has Medicare will be charged a monthly premium to cover the long-term care portion. **Programs for All-Inclusive Care for the Elderly

PACE

_______ (Programs for All-Inclusive Care for the Elderly) services include primary care including prescription medications and wound care; physical, occupational, recreational, and speech therapy; adult day care; dental; podiatry; social services; and home health care.

PACE

• Programs for All-Inclusive Care for the Elderly o Care for adults age 55 and older who meet certain financial and health criteria o Allows those who need skilled nursing home level care to stay in community

PACE

Interventional radiology catheter based procedures for _____ include: percutaneous transluminal angioplasty (PTA), stents, atherectomy, cryoplasty

PAD

Surgical procedures for _____ include: synthetic grafts, endarterectomy (opening the artery and removing the obstructing plaque) and patch graft angioplasty (opening the artery, removing the plaque, and sewing patch to the opening to widen the lumen) and amputation

PAD

what precipitating factor of HF is described below: Increased worklad of the heart by increased vascular bed in the skeletal muscle

Paget's disease

What are the 6 classic clinical manifestations of acute arterial ischemia/thrombotic arterial occlusion?

Pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia

The following is talking about the etiology and pathophysiology of _______: · Onset is gradual and insidious with ongoing progression · TRAP o Tremor o Rigidity o Akinesia (abnormalities in movement) o Postural instability · Beginning stages o Mild tremor, slight limp, ↓ arm swing · Later stages o Shuffling, propulsive gait with arms flexed, loss of postural reflexes · 90% experience hypokinetic dysarthria (speech abnormalities)

Parkinsonism

What is more common artery area in diabetic patients? Why?

Patients with diabetes tend to develop PAD in the arteries below the knee. In advanced PAD, multiple levels of occulsions are found.

What diagnostic study for gallbladder disease is described below: is the insertion of a needle directly into the gallbladder duct, followed by injection of contrast materials. It is generally done after ultrasonography indicates a bile duct blockage.

Percutaneous transhepatic cholangiography

What interventional radiologic procedure to treat PAD is described below: Insertion of a balloon catheter through the femoral artery Balloon is inflated, dilating the vessel by cracking the confining atherosclerotic intimal shell Stent is placed to keep the artery open **interprofessional care

Percutaneous transluminal balloon angioplasty (PTCA)

What surgical therapy to treat PAD includes the following: Most common approach with autogenous vein or synthetic graft material to bypass blood around the lesion **interprofessional care

Peripheral artery bypass operation

what is the surgery for repair of a rectocele?

Posterior colporrhaphy -"posterior repair"

What part of the EKG is described below: ventricular contraction o Depolarization from the AV node throughout the ventricles

QRS Complex

What part of the EKG is described below: : where P wave starts and where T wave ends; of prolonged puts patient at risk for cardiac arrest o Sets patient up for dysrhythmias

QT interval

Rest, ice, compression, and elevation (______) is a key concept in treating soft tissue injuries and related inflammation.

RICE

_____ _______ is an episodic vasopastic disorder of small cutaneous arteries, most often involving the fingers and toes. It occurs primarily in young women (typically between 15 and 40) and it is more common in women than men. _____ _____ is characterized by vasospasminduced color changes of fingers, toes, ears, and nose (white, blue, red). Decreased perfusion results in pallor (white). The digits then appear cyanotic (bluish purple). These changes are followed by rubor (red) caused by the hyperemic response that occurs when blood flow is restored.

Raynaud's disease

what acute arterial ischemic disorder is described below: o Episodic vasospasms of small cutaneous arteries o Young women; may occur with other diseases (lupus, RA) or alone o Symptoms for 2 yrs to dx - pallor/cyanosis in digits, ears, nose o Vasodilator meds, conservative treatments

Raynaud's phenomenon

What side of heart failure has the following signs: Signs: - RV heaves - Murmurs - Jugular venous distention - Edema (ex: pedal, scrotum, sacrum) - Weight gain - Increased HR - Ascites - Anasarca (massive generalized body edema) - Hepatomegaly (liver enlargement)

Right sided HF

What is the collaborative care for a patient with PAD?

Risk factor modification, exercise therapy, nutritional therapy, complementary and alternative therapies, care of the leg with critical limb ischemia, drug therapy

systolic blood pressure; is the peak pressure exerted against the arteries when the heart contracts

SBP

"Kentucky" o 3rd Heart Sound FVE, left heart failure o Cause of too much fluid coming in (hypervolemia); sounds like slushy sounds

) "Tennessee" o 4th heart sound stiff ventricles, LVH, aortic stenosis o When ventricles have become stiffen and do not expand or contract as well o Aortic stenosis is when the aortic valve does not open easily

what type of bronchodilator is described below: Albuterol - Rescue/relief **acute attack of dyspnea, wheezing, or coughing

SABA (short acting B2 adrenergic agonists)

What type of lupus is the most common and serious type?

SLE

With interprofessional care: treatment goals of ______: · Pain management o _______ is a painful disease. All of the inflammation contributes to the pain. · Decrease ESR and CRP levels · Decrease exacerbation episodes, identify triggers (sun exposure, excess fatigue, emotional stress, infection, surgery) o We need to help the patient identigy triggers. They know that if they eat something or do something, they will have an attack. · Prevent infections · Maintain optimal functioning and self-image o Self-image is very important. We do not want patient to become isolated and stay in their house all the time. We want to help them to still be out there.

SLE

· Skin, joints and serous membranes (pleura, pericardium), renal, hematologic and neurological · Unpredictable course with periods of remission and exacerbation

SLE

With interprofessional care of esophageal and gastric varices (complication of cirrhosis), the _______-______ ______ includes the following: · LABEL YOUR PORTS! · A, ______-______ _______. · B, Tube inserted into esophagus and stomach. · SAFETY ALERT: o Label each lumen to avoid confusion. o Secure the tube to prevent movement of the tube which could result in occlusion of the airway. o Deflate balloons for 5 minutes every 8 to 12 hours per institutional policy to prevent tissue necrosis.

Sengstaken-Blakemore tube

With interprofessional care of esophageal and gastric varices (complication of cirrhosis), the _______-______ ______ includes the following: · SAFETY ALERT: o Label each lumen to avoid confusion. o Secure the tube to prevent movement of the tube which could result in occlusion of the airway. o Deflate balloons for 5 minutes every 8 to 12 hours per institutional policy to prevent tissue necrosis.

Sengstaken-Blakemore tube

T or F. The main systemic complications of acute pancreatitis are pulmonary (pleural effusion, atelectasis, pneumonia, and acute respiratory distress syndrome [ARDS]) and cardiovascular (hypotension).

What insulin problem or risk is described below: o How to avoid this? Check blood glucose a 2:00 and 4:00 a.m. - may be low due to insulin-induced hypoglycemia during sleep Patient needs a PM snack, or a decrease in dose of PM insulin

Somogyi effect

What diagnostic test of the respiratory system is described below: Description and Purpose: purpose is to diagnose bacterial infection, select antibiotic and evaluate treatment. Sputum specimen is collected in a sterile container. Takes 48-72 hours for result. Nursing Responsibility: Before: instruct patient on how to produce a good specimen. If patient cannot produce specimen, bronchoscopy may be used. After: send specimen to lab promplty for analysis.

Sputum studies (Culture and Sensitivity)

What stage of CKD is described below: GFR: 45-59

Stage 3a

what stages of CKD are asymptomatic?

Stages 2-3b

What oncologic emergency is described below: Management: -Treat underlying malignancy. -Take measures to correct fluid and electrolyte imbalances. -Monitor sodium level because correcting SIADH rapidly may result in seizures or death. Activity Limitations and Pain Managemen

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

What oncologic emergency is described below: Description: - Tumor cells can produce abnormal or sustained production of antidiuretic hormone (ADH). - Many chemotherapy agents may also contribute to ectopic ADH production or potentiate ADH effects. Manifestations: - Water Retention and Hyponatremia - Weight gain without edema, weakness, anorexia, nausea, vomiting, personality changes, seizures, oliguria, decrease in reflexes, and coma. Management: -Treat underlying malignancy. -Take measures to correct fluid and electrolyte imbalances. -Monitor sodium level because correcting SIADH rapidly may result in seizures or death. Activity Limitations and Pain Managemen

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

What oncologic emergency is described below: Manifestations: - Water Retention and Hyponatremia - Weight gain without edema, weakness, anorexia, nausea, vomiting, personality changes, seizures, oliguria, decrease in reflexes, and coma.

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

What oncologic emergency is described below: o Abnormal production of ADH o Cancer cells can produce, store, and release ADH o Chemo drugs can stimulate ADH release o Treatment - fluid restrictions, IV 3% NaCl

Syndrome of inappropriate antidiuretic hormone (SIADH) release

T or F. A drop in segmental BP of greater than 30 mmHg suggests PAD. Angiography and magnetic resonance angiography delineate the location and extent of PAD.

T or F. A small change in the radius of arterioles creates a major change in SVR (systemic vascular resistant)

What classification of the TNM Classification system for cancer is described below: --Carcinoma in Situ **The T refers to the size and extent of the main tumor. The main tumor is usually called the primary tumor.

Tis

What classification of the TNM Classification system for cancer is described below: --Tumor cannot be measured or found **The T refers to the size and extent of the main tumor. The main tumor is usually called the primary tumor.

The following are risk factors for a ______: • Functional disorders o Neurogenic bladder, constipation Common in spinal or brain injuries; bladder does not get signals to empty Caue pressure on urethra preveting flow of urine out of bladder

UTI

The following are risk factors for a ______: • Other o Menopause, STIs/multiple partners, pregnancy, hygiene Menopause: Causes tissue in urinary tract to become thin and friable being prone to infection Pregnancy: pressure on organs in pelvis which can blow exit of urine Hygiene: Wiping from back to front leads to UTIs or not retracting foreskin to clean

UTI

Name an infectious and inflammatory urinary system disorder.

UTI

The following are clinical manifestations of a _______: • Dysuria • Urgency • Frequency • Fever o Depends on how serious infection is • Disorientation, confusion, delirium in older adults o An older adult admitted to hospital for confusion and UTI is very common to be seen o When UTI clears up, cognition returns back to normal • Urinalysis o + nitrites, WBC, leukocyte esterase, sometimes +blood Nitrites are a breakdown product of dying bacteria Leukocyte esterase: enzyme responsible for breaking down WBCs Blood: reddish color urine • Urine culture o Collect via clean catch mid-stream method or collect a catheterized specimen o Looking for specific causative pathogens Give 3 cleaning wipes (clean from front to back for women and to retract foreskin to clean for men) Specimen cup Urinate in toilet for first little bit then caught remainder in the cup

UTI

The following are clinical manifestations of a _______: • Urinalysis o + nitrites, WBC, leukocyte esterase, sometimes +blood Nitrites are a breakdown product of dying bacteria Leukocyte esterase: enzyme responsible for breaking down WBCs Blood: reddish color urine

UTI

The following are clinical manifestations of a _______: • Urine culture o Collect via clean catch mid-stream method or collect a catheterized specimen o Looking for specific causative pathogens Give 3 cleaning wipes (clean from front to back for women and to retract foreskin to clean for men) Specimen cup Urinate in toilet for first little bit then caught remainder in the cup

UTI

The following are risk factors for a ______: • Urine stasis from: o Obstruction (enlarged prostate gland, strictors, scarring) o **Neurological (where there is some type of neurological damage that prevents sphincter form relaxing or detrusor muscle from pushing urine out) • Foreign objects: catheters! o #1 reason for infection • Anatomic factors: congential abnormalies o Shape or location of bladder • Immunocompromised states: Age, HIV, DM o More likely to become immunocompromised with age, someone with HIV or DM • Functional disorders o Neurogenic bladder, constipation Common in spinal or brain injuries; bladder does not get signals to empty Caue pressure on urethra preveting flow of urine out of bladder • Other o Menopause, STIs/multiple partners, pregnancy, hygiene Menopause: Causes tissue in urinary tract to become thin and friable being prone to infection Pregnancy: pressure on organs in pelvis which can blow exit of urine Hygiene: Wiping from back to front leads to UTIs or not retracting foreskin to clean

UTI

What infectious and inflammatory disorder of urinary system is described below: o Most common cause of urinary tract inflammation o More common in women than in men o Most commonly caused by bacteria E. coli is the most common bacteria o Can be treated as outpatient o Untreated infection can lead to bacteria going up into kidneys

UTI

Anticoagulant therapy, thrombolytic therapy, and surgical therapy are the 3 different treatment plans of?

VTE

What type of venous thrombosis is described below: o Deep veins of arms, legs, and pulmonary system o Tender, induration of overlying muscle, venous distention, edema, mild to moderate pain, deep reddish color to area, may have no objective changes o Embolization to lungs, pulmonary HTN, post-thrombotic syndrome with or w/o venous leg ulceration can develop

VTE( venous thromboembolism)

What diagnostic test of the respiratory system is described below: Description and Purpose: used to assess ventilation and perfusion of lungs. IV radiosotrope given to assess perfusion. FOr the ventilation portion, patient inhales a radioactive gas that outlines alveoli. Normal scans show homogenous radioactivity. Diminished or absent radioactivity suggests lack of perfusion or airflow. Ventilation without perfusion suggests a pulmonary embolus Nursing Responsibility: same as for chest x-ray. NO precautions needed afterward because the gas and isotrope transmit radioactivity for only a brief interval. Not useful for patients in critical care who are intubated and mechanically ventilated. **How blood is flowing through the lungs

Ventilation-perfusion (V/Q) scan

What method of2 administration is described below: Description: mask can deliver precise, high flow rates of O2; lightweight, plastic, cone shaped device is fitted to face; mask are available for delivery of 24,28, 31,35, 40, and 50% O2; method is especially helpful for administering low constatnt O2 concentrations to patients with COPD; adapters can be applied to increase humidification Nursing Interventions: entrainment device on mask must be changed to deliver higher concentrations of O2; air entrainment ports must not be occluded; mask is uncomfortable so remove when patient eats; patient can tak but voice may be muffled

Venturi Mask

What are the 2 nursing diagnoses for a patient with gallbladder disease?

acute pain and ineffective health management

What medications are used for patients with PAD?

antiplatelet therapy and aspirin therapy

What drug used to treat HTN is described below: increase sodium excretion and cause arteriolar vasodilation by preventing the movement of extracellular calcium into cells.

calcium channel blockers

What chronic disease is described below: -2nd leading cause of death

cancer

- the force of myocardial contraction o How strong the heart can pump

contractility

Understanding CBC: Inflammation/Infection: ____ _______ = bone marrow disorders, immunosuppression

decreased monocytes

Understanding CBC: Inflammation/Infection: ____ ________ = serious infection or meds (e.g. chemotherapy)

decreased neutrophils

Not a normal part of aging More common in institutionalized older adults Second highest rate of suicide occurs in those over 75 Occurs together with medical conditions Caregivers also at risk **nursing implementation of older adults

depression

What are the 2 acute DM complications?

hypoglycemia and hyperglycemia

A FPG less than 100 is? **diagnostic study for DM

normal

ostomy

what percussion sound is described below: low-pitched sound heard over normal lungs

resonance

What stage of CKD is described below: GFR: Equal to or > 90

stage 1

Those who have one or more complications of their liver disease have __________ cirrhosis.

decompensated

What are the 3 categories of surgical procedures/therapy for a pt with Parkinson's disease?

DBS, ablation, and transplantation of fetal neural tissue

When talking about ______ consider treatment for the very young, very old, and also consider the patient's discomfort.

fever

isolated _______ HNT (ISH): o Increased risk of CVA, HF, death o Avg SBP >140 mm Hg with DBP less than 90 mm Hg

systolic

Dawn Phenomenon

What insulin problem or risk is described below: o Also characterized by early morning hyperglycemia o Due to release of counter-regulatory hormones Cortisol and Growth Hormone - highest in early am Affects most diabetics, but most common in adolescence and young adulthood due to growth hormone surges o May need to ↑ PM insulin or adjust administration time o If between 2:00am and 4:00am glucose is increased, patient may need a higher dose of insulin at bedtime and an appropriate snack

Dawn Phenomenon

What insulin problem or risk is described below: o May need to ↑ PM insulin or adjust administration time o If between 2:00am and 4:00am glucose is increased, patient may need a higher dose of insulin at bedtime and an appropriate snack

Dawn Phenomenon

______ (usually not seen with the local response) Cytokines: • Hypothalamus: thermoregulation • Adrenal medulla--> epinephrine-->^ metabolic rate

fever

When normalizing ______ with others manage symptoms and treatments to hide/minimize disability/differences/disfigurement in chronically ill people.

interactions

intermittent claudication

What clinical manifestation of PAD is described below: o Ischemic muscle ache or pain precipitated by a constant level of exercise o Resolves within 10 minutes or less with rest o Reproducible o 1/3 patients have classic symptom o Others may have no symptoms or atypical (soreness, tightness, weakness, burning, heaviness) o The ischemic pain is a result of the accumulation of end products of anaerobic cellular metabolism, such as lactic acid. Once the patient stops exercising, the metabolites are cleared and the pain subsides. o PAD of the aortoiliac arteries produces claudication in the buttocks and thighs, whereas calf claudication indicates femoral or popliteal artery involvement.

intermittent claudication

What is the most classic clinical manifestations?

intermittent claudication

If the normal percentage of bands (immature neutrophils) is 3-6% and your patient has a band percentage of 16%, what is this an indication of?

acute bacterial infection (elevated)

When talking about chest exam findings in respiratory problems, what problem is described below: Inspection: normal Palpation: normal Percussion: normal

asthma with no exacerbation

what clinical manifestation of MS is the lack of coordination of muscle movement? **gait and ability to walk

ataxia

What are 2 other clinical manifestations that are talked about separately and are important?

ataxia and nystagmus

What clinical manifestations could you expect to find in a person with heart failure?

A defect in either ventricular filling (diastolic function) or ventricular ejection (systolic function) are the key manifestations of HF.

the force exerted by the blood against the walls of the blood vessel, is primarily a function of cardiac output (CO) and systemic vascular resistance.

blood pressure

serum creatine

0.6-1.35 mg/dL (< 2 in older adults)

INR

0.8-1.11 (> 1.5-2.0 times control for full anticoagulant therapy)

With interprofessional care of CKD, nutrition includes: ELECTROLYTE RESTRICTION: ___g/day Foods high in protein may be high in phosphates May need phosphate binders

when using a metered dose inhaler, the patient needs to be taught to wait ____ minute between puffs!

Other options for long-term care of older adults includes ___1___ living facilities and ____2___ living facilities. --____1______ living facilities includes housekeeping and meals being available. --______2_____ living facilities is for people who can somewhat do their own things but still need help. They offer assistance with ADLS, medications, transportation, etc. but the patient is okay to be in their room by themselves and can pretty much move around freely and don't need as much help as those in nursing homes

1) independent 2) assisted

With interprofessional care of CKD, nutrition includes: ELECTROLYTE RESTRICTION: Sodium: ____-____g/day Depending on elevated sodium or not

2-4

The LV in ___1____ failure loses its ability to generate enough pressure to eject blood forward through the aorta. Over time, the LV becomes dilated and hypertrophied. The weakened heart muscle cannot generate adequate stroke volume, which affects CO. Because the LV cannot adequately push blood forward, end diastolic volumes and pressures in the LV ___2___. When the LV fails, blood backs up into the left atrium. This causes fluid accumulation in the lungs. The increased pulmonary hydrostatic pressure causes fluid leakage from the pulmonary capillary bed into the interstitium and then the alveoli. This results in pulmonary congestion and ___3____.

1. systolic 2. increases 3. edema

specific gravity

1.010-1.030

magnesium

1.6-2.6 mg/dl

The B/P is 100/70. What is the MAP?

100 + 140/3 = 80

LDH

100-190 U/L

A mild-moderate fever up to _____ may be beneficial.

103

Because mild to moderate fever usually does little harm, imposes no great discomfort, and may benefit host defense mechanisms, antipyretic drugs are rarely essential to patient welfare. Moderate fevers (up to ______°F [39.5°C]) usually produce few problems in most patients. However, if the patient is very young or very old, is extremely uncomfortable, or has a significant medical problem (e.g., severe cardiopulmonary disease, brain injury), the use of antipyretics should be considered.

103

Fever (especially if greater than _____°F [40°C]) can be damaging to body cells, and delirium and seizures can occur. At temperatures greater than 105.8°F (41°C), regulation by the hypothalamic temperature control center becomes impaired. Damage can occur to many cells, including those in the brain.

104

total cholesterol

130-200 mg/dL

HCO3

24-26 mEq/L

When talking about insulin administration: ______ _____ a day includes: o Before breakfast and dinner, and at bedtime o AC & HS

3 times

albumin

3.4-5.0 g/dL

potassium

3.5-5.1

Uric acid

3.5-7.5 mg/dL

pCO2

35-45 mmHg

hematocrit in women

37-48%

RBC

4.5-5.0 million

PTT

60-70 seconds

Calcium

8.5-10.9 mg/L

pO2

80-100 mmHg

A patient with chronic HF and atrial fibrillation is treated with a digitalis glycoside and a loop diuretic. To prevent possible complications of this combination of drugs, what does the nurse need to do (select all that apply)? a. Monitor serum potassium levels b. teach the patient how to take a pulse rate. c. keep an accurate measure of intake and output d. Teach the patient about dietary restriction or potassium e. Withhold digitalis and notify health care provider if heart rate is irregular

A,B

Which nursing responsibilities are priorities when caring for a patient returning from a cardiac catheterization (select all that apply)? a. Monitoring vital signs and ECG b. Checking the catheter insertion site and distal pulses c. Assisting the patient to ambulate to the bathroom to void d. Informing the patient that he will be sleepy from the general anesthesia e. Instructing the patient about the risks of the radioactive isotope injection

A,B

A patient has a severe blockage in his right coronary artery. Which heart structures are most likely to be affected by this blockage (select all that apply)? a. AV node b. Left ventricle c. Coronary sinus d. Right ventricle e. Pulmonic valve

A,B,D

A patient is admitted to the hospital in hypertensive crisis (BP 243/124 mmHg). Sodium nitroprusside is started to treat the elevated BP. Which management strategy (ies) would be appropriate for this patient (select all that apply)? a. Measuring hourly urine output b. Decreasing MAP by 50% within the first hour c. Continuous BP monitoring with an arterial line d. Maintaining bed rest and providing tranquilizers to lower the BP e. Assessing the patient for signs and symptoms of heart failure and changes in mental status

A,C,E

Which BP regulating mechanism(s) an result in the development of hypertension if defective (select all that apply)? a. Release of norepinephine b. Secretion of prostaglandins c. Stimulation of the SNS d. Stimulation of the PSNS e. Activation of the renin-angiotension-aldosterone system

A,C,E

An ethnic older adult may feel a loss of self worth when the nurse: (select all that apply) a. prohibits visits from a faith healer b. informs the patient about ethnic support services c. allows a patient to rely on ethnic health beliefs and practices d. emphasizes that a therapeutic diet does not allow ethnic foods e. has to use an interpreter to provide explanations and teaching

A,D

What drug used to treat HTN is described below: prevent angiotensin II from binding to its receptors in the walls of the blood vessels.

A-2 receptor blockers (ARBs)

When talking about drug therapy for treating HTN, what type drug has the following nursing considerations: • Nursing considerations: Full effect on BP may not be seen for 3-6 weeks. Do not affect bradykinin levels, therefore acceptable alternative to ACE inhibitors in people who develop dry cough. In patients with kidney disease, ACE inhibitors and ARBs should not be used together due to adverse renal effects

A-2 receptor blockers (ARBs)

In prediabetes: - intermediate stage between normal glucose metabolism and diabetes o IGF - impaired fasting glucose (___A_-__A___ mg/dl) o IGT - impaired glucose tolerance (__B-___B_ mg/dl) 2 hours post bolus during OGTT (oral glucose tolerance test) o No symptoms but damage is being done **type 2 DM disease onset

A. 100-125 B. 140-199

With interprofessional care of the complication ____ ____ (complication of cirrhosis): Fresh frozen plasma · Packed RBCs · Vitamin K · Proton pump inhibitors · Lactulose and rifaximin · Antibiotics

acute bleed

What diagnostic test of the respiratory system is described below: Description and Purpose: arterial blood is obtained through puncture of radial or femoral artery or through arterial catheter. Performed to assess acid-base balance, oxygenation/ventilation status, need for and/or change in O2 therapy, or change in ventilator settings. Nursing Responsibility: Before: indicate whether patient is using O2 (flow rate in L/min). avoid hange in O2 therapy or interventions (ex: suctioning, position change) for 15 minutes before obtaining sample. During: assist with positioning (ex: palm up, wrist slightly hyperextended if radial artery is used). COllect blood in heparinized syringe. to ensure accurate results, expell all air bubbles. After: apply pressure to radial artery for at least 5 min after specimen is obtained to prevent hematoma at the arterial puncture sute. send sample to lab promptly for analysis.

ABGs (arterial blood gases)

Defined as the sudden onset of signs and symptoms of HR, requiring urgent care

ADHF (acute decompensated heart failure)

In ________, an increase in pulmonary venous pressure is caused by failure of the LV. This results in engorgement of the pulmonary vascular system. As a result, the lungs become less compliant and there Is increased resistance in the small airways. To help compensate, the lymphatic system increases its flow to maintain a constant volume of the pulmonary extravascular fluid. This early stage is critically associated with mild increase in the respiratory rate and a decrease in partial pressure of oxygen in arterial blood.

ADHF (acute decompensated heart failure)

The universal finding of ______ is pulmonary and systemic congestion due to elevated left sided and right sided filling pressures

ADHF (acute decompensated heart failure)

ADLs or IADLS: bathing, dressing, eating, toileting, and transferring

ADLs

A P wave on an ECG represents an impulse arising at the a. SA node and repolarizing the atria b. SA node and depolarizing the atria c. AV node and depolarizing the atria d. AV node and spreading to the bundle of His

Examples of primary prevention strategies include: a. colonscopy at age 50 b. avoidance of tobacco products c. teaching the importance of exercise to a patient with HTN d. intake of a diet low in saturated fat in a patient with high cholesterol

The auscultatory area in the left midclavicular line at the level of the fifth ICS is the best location to hear sounds from which heart valve? a. Aortic b. Mitral c. Tricuspid d. Pulmonic

The following is implementation for hepatitis ______: · General measures - prevent transmission · Immunization o Recombivax HB, Engerix-____ § Series of three IM injections o All children and at-risk adults · Postexposure prophylaxis: vaccine and hepatitis ____ immune globulin (HBIG)

The patient at highest risk for venous thromboembolism (VTE) is a. a 62-year-old man with spider veins who is having arthroscopic knee surgery. b. a 32-year-old woman who smokes, takes oral contraceptives, and is planning a trip to Europe. c. a 26-year-old woman who is 3 days postpartum and received maintenance IV fluids for 12 hours during her labor. d. an active 72-year-old man at home recovering from transurethral resection of the prostate for benign prostatic hyperplasia

The portion of the vascular system responsible for hemostasis is the a. thin capillary vessels b. endothelial layer of the arteries c. elastic middle layer of the veins d. smooth muscle of the arterial wall

What stage (A-D) of the ACCF/AHA Stages of HF is described below: Structural heart disease, but without signs or symptoms of HF

What type of hepatitis is described below: Transmission: blood and body fluids Characteristics: acute or chronic; may lead to permanent liver damage; vaccination available-- all children, high risk adults

While obtaining subjective assessment data from a patient with hypertension, the nurse recognizes that a modifiable risk factor for the development of hypertension is A. hyperlipidemia. B. excessive alcohol intake. C. a family history of hypertension. D. consumption of a high-carbohydrate, high-calcium diet

With medicare coverage is limited. Part _____ you pay a monthly premium, covers physicians visits, diagnostic services like labs and X-rays but doesn't pay for medications. Part ____ also comes with a copay and deductible (patient has to pay a certain amount up front each year before their insurance kicks in and they have a copay for every time they go for a visit or a diagnostic).

When collecting subjective data related to the CV system, which info should be obtained from the patient (select all that apply) a. Annual income b. Smoking history c. Religious preference d. Number of pillows used to sleep e. Blood for basic lab studies

B,C,D

Which clinical manifestations are seen in patients with either Buerger's disease or Raynaud's phenomenon (select all that apply)? a. Intermittent fevers b. Sensitivity to cold temperatures c. Gangrenous ulcers on fingertips d. Color changes of fingers and toes e. Episodes of superficial vein thrombosis

B,C,D

Patients with a heart transplantation are at risk for which complications in the first year after transplantation (select all that apply)? a. cancer b. infection c. rejection d. vasculopathy e. sudden cardiac death

B,C,E

Which are probable clinical findings in a person with an acute lower extremity VTE (select all that apply)? a. Pallor and coolness of foot and calf b. Mild to moderate calf pain and tenderness c. Grossly diminished or absent pedal pulses d. Unilateral edema and induration of the thigh e. Palpable cord along a superficial varicose vein

B,D

What diagnostic study is described below: o Peptide that causes natriuresis. Elevation helps to distinguish cardiac vs. respiratory cuase of dyspnea. Infusion of nesiritide elevated levels temporarily o Reference interval: BNP > 100 picograms/mL

B-type natriuretic peptide (BNP)

What diagnostic study is described below: o Cardiospecific osoenzyme that is released from cells when myocardial tissue is injured. Concentrations > 4-6% of total creatine kinase (CK) are highly indicative of MI. serum levels increase within 4-6 hr after MI

CK-MB

Older adults who become ill are more likely than younger adults to: a. complain about the symptoms of their disease b. refuse to carry out lifestyle changes to promote recovery c. seek medical attention because of limitations on their lifestyle d. alter their daily living activities to accommodate new symptoms

The following are nursing diagnoses for _____: o Risk for infection - Sepsis o Risk for fluid volume deficit (voluntary fluid restriction) o Impaired urinary elimination (urinary frequency, urgency, dysuria) o Urge urinary incontinence o Pain (bladder distention) o Sleep pattern disturbance (nocturia) o Risk for sexual dysfunction (post-op) o Impaired body image o Risk for social isolation

BPH

The following is interprofessional care (treatment) of _______: o Goals § Restore bladder drainage § Relieve symptoms § Prevent complications

BPH

The following is interprofessional care (treatment) of _______: o Treatment § Based on degree of symptoms bothering the patient or presence of complications § Active surveillance § Dietary changes - decrease caffeine, artificial sweeteners, and spicy or acidic foods § Avoid drugs such as decongestants and anticholinergics § Restrict evening fluid intake § Timed voiding schedule

BPH

The following is nursing care of _____: o Acute Care (TURP) - Preoperative: § ABX therapy § 2-3 liters fluid a day unless contraindicated § Provide opportunity to discuss sexual concerns § Monitor for: hemorrhage, bladder spasms, urinary incontinence, infection § May have a standard urinary catheter or a triple-lumen urinary catheter · Catheter needed to restore flow - probably a curved tip catheter (Coude) · Bladder irrigation - either manually or continuous (CBI - continuous bladder irrigation) · Blood clots expected in the first 24-36 hours, but not large amounts of bright blood

BPH

The following is nursing care of _____: § May have a standard urinary catheter or a triple-lumen urinary catheter · Catheter needed to restore flow - probably a curved tip catheter (Coude) · Bladder irrigation - either manually or continuous (CBI - continuous bladder irrigation) · Blood clots expected in the first 24-36 hours, but not large amounts of bright blood

BPH

What disorder of the male urogenital tract is described below: · Clinical Manifestations: o Gradual onset o Symptoms result from urinary obstruction, infection (UTI), inflammation o Obstructive - decreased caliber and force of urinary stream, difficulty initiating voiding, intermittency, dribbling o Irritative - urinary frequency, urgency, dysuria, bladder pain, nocturia, incontinence

BPH

A compensatory mechanism involved in HF that leads to inappropriate fluid retention and additional workload of the heart is: a. ventricular dilation b. ventricular hypertrophy c. neurohormonal response d. sympathetic nervous system activation

A patient with infective endocarditis develops sudden left leg pain with pallor, paresthesia, and a loss of peripheral pulses. The nurse's initial action should be to a. elevate the leg to promote venous return. b. start anticoagulant therapy with IV heparin. c. notify the physician of the change in peripheral perfusion. d. place the bed in reverse Trendelenburg to promote perfusion.

Ageism is characterized by: a. denial of negative stereotypes regarding aging b. positive attitudes toward the elderly based on age c. negative attitudes toward the elderly based on age d. negative attitudes toward the elderly based on physical disability

An important nursing action to help a chronically ill older adult is to a. avoid discussing future lifestyle changes b. ensure the patient that the condition is stable c. treat the patient as a competent manager of the disease d. encourage the patient to "fight" the disease as long as possible

What chronic disease is described below: -affects about 17 million adults -leading cause of death

CAD (coronary artery disease)

What chronic disease is described below: leading cause of death

CAD (coronary artery disease)

acute pancreatitis

With PAD, what is the end stage disease called?

CLI (critical limb ischemia)

With interprofessional care of _____, stable ______ treatment plan includes: • Smoking cessation • Step-wise drug therapy: o SABA, LABA, ICS Short acting beta agonist: stimulate beta receptors in lung to cause bronchodilation in the lungs (used early on) Long acting beta agonist: have continuous long term function to keep bronchioles dilated all the time Inhaled corticosteroids: used in combo with LABA to keep inflammation down and bronchodilation • Nutrition therapy, increase fluid intake • Physical activity • Annual Flu vaccine • Pneumonia vaccine every five years, no more than 2 in a life-time • Alpha-1 Antitrypsin Augmentation Therapy

COPD

______ pathophysiology includes: • Chronic inflammation of the airways, lung parenchyma (bronchioles and alveoli), & pulmonary blood vessels • Airflow limitation, air trapping, gas exchange dysfunction, mucus hypersecretion • Inflammatory process - starts with inhalation of noxious particles and gases o Would be an exacerbation o Have low inflammation at all times, then get exposed to a household chemical such as pollen, molds, perfumes which enhances inflammatory response resulting in an acute exacerbation resulting in trouble breathing • Enhanced inflammatory response may be genetically influenced

COPD

______ pathophysiology includes: • Excess secretion of mucous • Cilia destruction & dysfunction • Alveolar destruction, loss of elastic recoil, gas exchange abnormalities, airflow limitations - "Overinflated" o When looking at X-ray alveoli are big and balloony looking

COPD

the following are clinical manifestations of cirrhosis: : fluid retention, peripheral edema, ascites

How many classes does the NYHA FUnctional Classification of Heart disease have?

Classes 1-4

Crohn's disease or ulcerative colitis? · Chronic, nonspecific inflammatory bowel disorder · Can affect any part of the GI tract from the mouth to the anus · Most often seen in the terminal ileum and colon · NOD2 gene - associated with Crohn's · Surgery is not curative - high % recurrence o We cannot remove the whole GI tract. Even though we can take out the colon, there is a high risk for recurrence

Crohn's disease

A major consideration in the management of the older adult with hypertension is to: a. Prevent primary HTN from converting to secondary HTN b. Recognize that the older adult is less likely to adhere to the drug therapy regimen than a younger adult c. Ensure that the patient receives larger initial doses of antihypertensive drugs because of impaired absorption d. Use careful technique in assessing the BP of the patient because of the possible presence of auscultatory gap

In planning care and patient teaching for the patient with venous leg ulcers, the nurse recognizes that the most important intervention in healing and control of this condition is a. discussing activity guidelines b. using moist environment dressings. c. taking horse chestnut seed extract daily. d. applying elastic compression stockings

The recommended treatment for an initial VTE in an otherwise healthy person with no significant co-morbidities would include a. IV argatroban (Acova) as an inpatient. b. IV unfractionated heparin as an inpatient. c. subcutaneous unfractionated heparin as an outpatient. d. subcutaneous low-molecular-weight heparin as an outpatient

What stage (A-D) of the ACCF/AHA Stages of HF is described below: Refractory HF requiring specialized intervention EX: structural damage not responsive to treatment; can do a pacemaker but only a heart transplant is the only way to fix completely

What type of hepatitis is described below: Transmission: co-infection with Hepatitis B Characteristics: cannot infect on its owne--can only occur as coinfection with Hep B; NO vaccine

what part of health promotion is the following: want our patients to be able to recognize when they are having an inflammatory response and when it is bad enough to seek treatment for it

early recognition

Lowest level of arterial pressure during diastole (relaxation) • Major determinant is SVR ***(vasomotor tone) o How much pressure remains in the arteries when the left ventricle is relaxed. o Vasoconstriction or narrowing of arteries is the major determinant of diastolic • Amount of pressure remaining

DBP

diastolic blood pressure; residual pressure in the arterial system during ventricular relaxation (or filling)

DBP

Adult ____ care provides social, recreational, and health-related services to individuals in a safe, community-based environment. This includes daily supervision, social activities, opportunities for social interaction, and ADLs assistance for 2 major groups of adults: 1) those who are cognitively impaired and 2) those who have problems independently performing ADLs.

Day

Adult ____ care services are individualized based on need. Programs designed for adults who are cognitively impaired offer therapeutic recreation, support for family, family counseling, and social involvement.

Day

Adult ____ ____ Care centers are similar to adult day care but are designed to meet the needs of older adults and people with disabilities who need a higher level of care. This might include health monitoring, therapeutic activities, one on one ADLs training, and personal services.

Day Health

What side effect of radiation and chemotherapy is described below: NURSING CARE: Anorexia: •Small, Frequent, High Protein, High Calorie Meals are better tolerated than large meals. •Consult with Dietician: Assess need for Nutritional Supplements •Assess need for Enteral or Parenteral Nutrition

GI effects

What side effect of radiation and chemotherapy is described below: NURSING CARE: Mucositis: •Encourage Meticulous Oral Care; Implement Standard Oral Protocol •Promote Regular Dental Visits •Routinely Assess Oral Cavity, Mucous Membranes, Characteristics of Saliva, and Ability to Swallow •Monitor for Candidiasis (which occurs often in those with mucositis).

GI effects

What side effect of radiation and chemotherapy is described below: NURSING CARE: •Diarrhea: •Administer ordered PRN meds (Anti-Diarrheal Meds); or as Prophylaxis to Treatments •Recommend Diet: Consult Dietician •Assess the need for Dietary Supplements •Prevent Excessive Weight Loss

GI effects

What side effect of radiation and chemotherapy is described below: NURSING CARE: •Monitor hydration (I & O's) •Assess the need for Electrolyte Supplementation •Lukewarm Sitz Baths to Alleviate Rectal Discomfort •Perianal care if needed for skin breakdown •Note the frequency, volume, and consistency of stools per day

GI effects

What side effect of radiation and chemotherapy is described below: NURSING CARE: •Nausea and Vomiting: •Administer ordered PRN medications as needed; or as Prophylaxis to Treatments •Assess pt for signs and symptoms: ￭Dehydration ￭Metabolic Alkalosis •Diarrhea: •Administer ordered PRN meds (Anti-Diarrheal Meds); or as Prophylaxis to Treatments •Recommend Diet: Consult Dietician •Assess the need for Dietary Supplements •Prevent Excessive Weight Loss

GI effects

What side effect of radiation and chemotherapy is described below: o Anorexia, nausea, vomiting, diarrhea § Prophylactic antiemetics § Assess S/S of alkalosis, dehydration, o electrolyte losses § I&O § Non-irritating diet § Antidiarrheal meds § Prevent weight loss § Small, frequent, high-protein, high-calorie meals § Dietary supplements

GI effects

what is the first step in nursing care regarding infection and inflammation?

Health promotion

what diagnostic test for DM is described below: • Evaluates long-term glycemic control o 90-120 days o Amount of glucose attached to hemoglobin molecules over cellular life • 5.7 - 6.4% = Pre- diabetes o > 6.5 = DM • Does not require fasting o Unreliable in patients with hemoglobinopathies (sickle cell anemia) • Another advantage is that it looks at 3 months instead of 1 day. Some people will drink alcohol to lower blood sugar the day before the exam since it lowers blood sugar but will this diagnostic test they cannot do that because this tests looks at around the last 3 months.

Hemoglobin A1C (HB A1C)

With nursing management of cirrhosis (acute care)--> paracentesis: · _____ ______ position or sitting on side of bed o When the paracentesis is completed, have the patient sit on the side of the bed or place him/her in _____ ______ position.

High Fowler's

The diagnosis of _____ includes the following: · No specific way to diagnose _____ · Key is reported history / clinical manifestations · Rule out other causes o Colorectal cancer, endometriosis, IBD, malabsorption disorders · Diagnostic Test/Procedures o FOB, CBC, C-reactive protein, ESR o Sigmoidoscopy or colonoscopy § Sigmoidoscopy goes only into the distal third of the colon o Small Bowel Series - uses barium sulfate and x-rays to get a clear picture of the small bowel o **all of these should be negative/normal in order for the patient to be diagnosed with ______!**

IBS

The following are clinical manifestations of ______: · Diffuse, lower abdominal pain (RLQ) o Meals can precipitate the pain, defecation improves it · Constipation (women), diarrhea (men), or both · Post-prandial urgency o Abnormal stool consistency · Mucous stools o Abdominal bloating o Excessive flatulence o Sensation of incomplete bowel evacuation

IBS

The following are clinical manifestations of ______: · Post-prandial urgency o Abnormal stool consistency · Mucous stools o Abdominal bloating o Excessive flatulence o Sensation of incomplete bowel evacuation

IBS

The following are extra-intestinal clinical manifestations of ______: · Migraines*** · Insomnia · Fibromyalgia · Fatigue · Altered sleep patterns

IBS

The following are nursing diagnoses for ______: · Constipation r/t altered GI motility · Diarrhea r/t altered GI motility · Pain · Ineffective coping r/t effects of disorder on lifestyle · Risk for impaired nutrition less than body requirements (anorexia, bloating)

IBS

The following are nursing interventions for ______: · Help identify triggers of _______ o Encourage patient to keep diary of symptoms, diet, and episodes of stress to identify triggers · Abdominal assessment · Pain assessment · Check bowel movements · Meds - individualized basis o Antispasmodics, antidiarrheals, antidepressants

IBS

What side of heart failure has the following signs: Signs: - LV heaves - Pulsus alternans (alternating pulses, strong and weak) - Increased HR - PMI displaced inferiorly and left of the midclavicular line (LV hypertrophy) - Decreased PaO2, slight increase PaCO2, (poor O2 exchange) - Crackles (pulmonary edema) - S3 and S4 heart sounds - Pleural effusion - Changes in mental status - Restlessness, confusion

Left sided HF

What side of heart and type of HF is described below: - inability of the left ventricle to empty adequately during systole o EF 45% or lower, can be as low as 5-10% EF: Ejection fraction o Impaired contractility of heart o Increased afterload due to peripheral vascular resistance Heart is not strong to pump against that resistance o (Remember... Normal EF = 55% - 60%) o Thin, weak heart muscle!

Left sided systolic HF

When talking about drug therapy of a pt with PD: · Effectiveness of _____-_______ could wear off after a few years of therapy o Some HCPs initiate therapy with a dopamine receptor agonist § Directly stimulates dopamine receptors o ____-______ is added when moderate to severe symptoms develop

Levodopa - carbidopa

When talking about drug therapy of a pt with PD: · ________-_______ is the primary treatment o Precursor of dopamine o Can cross blood-brain barrier o Converted to dopamine in the basal ganglia o Carbidopa inhibits an enzyme that breaks down levodopa before it reaches brain o Levodopa with carbidopa (Sinemet) is the primary treatment for symptomatic patients. o The net result of the combination of levodopa and carbidopa is that more levodopa reaches the brain, and therefore less drug is needed. o However, levodopa has many side effects and drug interactions. Prolonged use often results in dyskinesia (abnormal or impaired voluntary movement) and "off/on" periods when the medication will unpredictably start or stop working.

Levodopa - carbidopa

With HTN emergency treatment, if you decrease the _____ too quickly, can decrease cerebral, renal, coronary perfusion o Exceptions - aortic dissection, acute ischemic stroke (TPA use)

MAP

With interprofessional care (treatment goals) of ________: · Maintain independence in ADLs as long as possible o PT and OT especially OT involved to help maintain independence · Maintain muscle strength (PT comes in here and maybe outpatient expert physiologist) · Manage disabling fatigue · Optimize psychological well-being o A chronic progressive debilitating disease so patients will need some psycho-social support through social worker, spiritual leader, etc. · Adjust to the illness (no cure to disease) · Use assistive devices properly to PREVENT injuries like falls o May need assistive devices to eat as well · Maintain/manage urinary continence (bladder training where they go empty bladder on a 2 hour schedule or just teach about incontinence products such as pads) · Reduce factors that precipitate relapsing o Ask patient to keep a diary so when they have an exacerbation they can look at diary and look to see what was going on that could have caused it · Participate in care, make decisions about lifestyle modifications

With interprofessional care (treatment goals) of ________: · Maintain/manage urinary continence (bladder training where they go empty bladder on a 2 hour schedule or just teach about incontinence products such as pads)

With interprofessional care (treatment goals) of ________: · Manage disabling fatigue · Optimize psychological well-being o A chronic progressive debilitating disease so patients will need some psycho-social support through social worker, spiritual leader, etc.

With interprofessional care (treatment goals) of ________: · Reduce factors that precipitate relapsing o Ask patient to keep a diary so when they have an exacerbation they can look at diary and look to see what was going on that could have caused it · Participate in care, make decisions about lifestyle modifications

_____ does not cover long-term care, custodial ADLs or IADLs care, dental care or dentures, hearing aids, or eyeglasses.

Medicare

What part of bone marrow suppression (side effect of radiation and chemotherapy) is described below: •": typically, blood cell counts is lowest between 7 to 10 days after initiation of therapy. --point of lowest blood cell counts; approximately 7-10 days after each treatment session (mainly chemo)

Nadir

The following are the different arteries commonly involved in _______: o Superior mesenteric artery o Abdominal aorta o Internal iliac artery o Superficial femoral artery o Popliteal artery o Celiac artery o Renal artery o Common iliac artery o External iliac artery o Deep femoral artery o Anterior tibial artery o Peroneal artery o Posterior tibial artery

PAD

The following is how we diagnose _____ in a patient: · Non-invasive tests for H. Pylori o Serum or whole blood antibody - IgG, stool antigen, urea breath test o Draw blood o Blow into tube and measure the amount of urea which is a breakdown product of H. pylori (urea breath test)

PUD

• Force generated by the left ventricle with each contraction • Major determinant is CO*** o The amount of blood being pushed through the arteries o An elevated systolic BP may be an indicator of hypervolemia

SBP

The following are clinical manifestations of ______: · GI - abdominal pain, nausea, vomiting, dysphagia, hepatitis, pancreatitis · Neurological - headaches, seizures, peripheral neuropathy, stroke · Hematologic - anemia, leukopenia, thrombocytopenia

SLE

What type of venous thrombosis is described below: o Typically superficial leg veins, occasionally arms o Tender, itching, red, warm, pain, inflammation, induration along the course of the vein, palpable cord, rarely edema o Clot may extend to deeper veins and VTE may form

SVT (superficial venous thrombosis)

The following are clinical manifestations of ______: · Low-grade fever · Light sensitivity · FATIGUE o Major defining factors or lupus · Infection (leukopenia) o ______ effects the hemotologic system

SLE

Somogyi effect

What insulin problem or risk is described below: o Hyperglycemia on awakening in am High dose of insulin causes hypoglycemia during night Rebound glucose release (gluconeogenesis); hyperglycemia in am on awakening May result in unnecessary change in insulin dosing by Provider May report headaches, nightmares, sweating during night o How to avoid this? Check blood glucose a 2:00 and 4:00 a.m. - may be low due to insulin-induced hypoglycemia during sleep Patient needs a PM snack, or a decrease in dose of PM insulin

Somogyi effect

T or F. Amputation may be needed if adequate blood flow is not restored or if severe infection occurs.

T or F. As many as 1/3 of patients with PAD report classic claudication symptoms. The remaining either have no symptoms or present with atypical leg symptoms (Ex: burning, heaviness, pressure, soreness, tightness, weakness) in atypical locations (Ex: foot, ankle, hamstring, hip, knee, skin).

T or F. BP must be adequate to maintain tissue perfusion during activity and rest. The maintenance of normal BP and tissue perfusion requires the integration of both systemic factors and local peripheral vascular effects.

T or F. Hypertensive emergencies require hospitalization, IV administration of antihypertensive drugs, and intensive care monitoring

What is most common artery area for non-diabetic patients?

The femoral popliteal area is the most common site of PAD in non-diabetic patients.

What diagnostic study is described below: o Contractile proteins that are released after an MI. both troponin T and troponin I are highly specific to cardiac tissue o Reference intervals: Troponin I (cTnl) • Negative: < 0.5 ng.mL (< 0.5 mcg/L) • Indeterminate or suspicious for injury to myocardium: 0.5-2.3 ng/mL (0.5-2.3 mcg/L) • Positive for myocardial injury > 2.3 ng/mL (> 2.3 mcg/L) Troponin T (cTnT) • < 0.1 ng/mL (<0.1 mcg/L)

Troponin

The following are risk factors for a ______: • Anatomic factors: congential abnormalies o Shape or location of bladder • Immunocompromised states: Age, HIV, DM o More likely to become immunocompromised with age, someone with HIV or DM

UTI

With interprofessional care of a _______: • Adequate fluid intake o More fluid means more dilute urine which leads to less discomfort • Patient education o Hygiene Wiping from front to back Women need to teach little girls this o Fluid intake o Voiding frequency o Limit sexual partners More partners, more at risk for UTIs o Cranberry juice, tablets Good evidence that cranberries can decrease risk for UTIs Unsweetened cranberry juice Problems with tablets, these are not drugs so are not controlled by FDA so we do not know what it in the pill • Medications as ordered o Antibiotics • Medications to treat symptoms o Bladder anesthetics (for example)

UTI

With patient and caregiver teaching of prevention of a ______, teach: 1. take all antibiotics as prescribed. symptoms may improve over 1-2 days of therapy but organisms may still be present. 2. practice appropriate hygiene, including the following: -carefully clean the perineal region by separating the labia when cleansing -wipe from front to back after urinating -cleanse with warm soapy water after each bowel movement 3. empty the bladder before and after sexual intercourse 4. urinate regulary, approximately every 3-4 hours per day 5. maintain adequate fluid intake 6. avoid vaginal douches and harsh soaps, bubble baths, powders, and sprays in the perineal area 7. report to the HCP symptoms or signs of recurrent _____ (ex: fever, cloudy urine, pain on urination, urgency, frequency) 8. Consider drinking unsweetened cranberry juice (8 oz 3x a day) or taking cranberry extract tablets 300-400 mg/day for ____ prevention. (This practice may not be effective with every patient).

UTI

With patient and caregiver teaching of prevention of a ______, teach: 3. empty the bladder before and after sexual intercourse 4. urinate regulary, approximately every 3-4 hours per day 5. maintain adequate fluid intake 6. avoid vaginal douches and harsh soaps, bubble baths, powders, and sprays in the perineal area

UTI

With patient and caregiver teaching of prevention of a ______, teach: 7. report to the HCP symptoms or signs of recurrent _____ (ex: fever, cloudy urine, pain on urination, urgency, frequency) 8. Consider drinking unsweetened cranberry juice (8 oz 3x a day) or taking cranberry extract tablets 300-400 mg/day for ____ prevention. (This practice may not be effective with every patient).

UTI

When talking about the etiology of PUD, ____ _______ ____ is: o Rare, severe peptic ulceration and excessive secretion of HCl o Causes severe PUD related to increased secretion of HCL in the stomach o Genetic consition

Zollinger Ellison Syndrome

When performing a nursing assessment on a patient with HF, what are some things you will see when looking at their GI function?

abdominal distention, hepatosplenomegaly, ascites

What assessment abnormality of the respiratory system is described below: Description: inward (rather than normal outward) movement of abdomen during inspiration Possible Etiology and Significance: inefficient and ineffective breathing patterns. NOnspecific indicator of severe resp. distress.

abdominal paradox

what surgical therapy procedure for a pt with PD is described below: · Destruction o Locate, target, destroy area of brain affected by PD o Destroys tissue that produces abnormal chemical or electrical impulses leading to tremors or other symptoms

ablation

The following are _____ assessment findings when doing a PE on urinary system: • Polyuria (drinking excessive amount of fluids) • Dysuria (pain with urination) • Oligouria/Anuria (decreased urine output) (anuria: no urine output) • Hematuria (blood in urine) • Hesitancy (need to urinate but takes a while to) • Retention (bladder will not empty) • Urgency (need to go now) • Incontinence (leaking of urine) • Pain

abnormal

The following are ______ CV assessments when palpating: • Pulse: bounding, thready, irregular, pulsus alternans, o absent, thrill, rigidity, ↑, ↓ o Thrill is turbulence going on in the artery creating a vibration type pulse • Extremities: unusually warm, cold, pitting edema, abnormal capillary filling time, asymmetry in limb circumference

abnormal

What assessment abnormality of the respiratory system is described below: Description: neck and should muscles used to assist breathing; muscles between ribs pull in during inspiration Possible Etiology and Significance: COPD, asthma exacerbation, secretion retention; indicates severe respiratory distress/failure, hypoxemai

accessory muscle use, intercostal retractions

making it harder for blood to pump out

afterload

With nutritional therapy of DM, what component of diet is described below: o Promotes hyper-triglyceridemia o Inhibits gluconeogenesis by the liver - can cause severe hypoglycemia if treated with oral hypoglycemic agents

alcohol

What part of bone marrow suppression (side effect of radiation and chemotherapy) is described below: --Generally has a late onset: 3 to 4 months after initiation of treatment.

anemia

When talking about chest exam findings in respiratory problems, what problem is described below: Inspection: no change unless involves entire segment, lobe Palpation: if small, no change; if large, decreased movement and decreased fremitus Percussion: dull over affected area

atelectasis

What surgical therapy to treat PAD includes the removal of the obstructing plaque? **interprofessional care

atherectomy

The leading cause of PAD is ________, a gradual thickening of the intima (the innermost layer of the arterial wall) and media (middle layer of the arterial wall). This results from the deposit of cholesterol and lipids within the vessel walls and leads to progressive narrowing of the artery

atherosclerosis

The following is _____ toward aging: • Aging is normal and is not an illness o Only 1 way to avoid getting older • Diverse o People age differently and have diverse characteristics • Care should be based not on age alone • Myths and stereotypes o Can lead to poor care • Ageism o Discrimination against people based on age which can lead to health care disparities o EX: "they are too old to take chemo"

attitudes

In older adults, disease symptoms are often _______ meaning the older adults do not feel same symptoms as younger patients would. They may underreport symptoms and "treat" these symptoms by altering their functional status. They fear of losing their independence and do not want to talk about their health problems.

atypical

the most common ________ illness presentations are 'delirium" or "acute change in mental status" and change in functional status. A caregiver may say that their relative is "acting differently," "doesnt appear as him/herself," or is no longer participating in usual activities or self-care. Sometimes the family member will come and say they are "not acting right" that should be a red flag; something is wrong

atypical

A normal ______ of a physical assessment of CV system includes: S1 and S2 heard. Apical-radial pulse rate equal. 72 and regular, no murmurs or extra heart sound

auscultation

what precipitating factor of HF is described below: inflammation of heart muscle and weakness infection increases metabolic demands and oxygen requirements valvular dysfunction causes stenosis or regurgitation

bacterial endocarditis

What diagnostic study done for a patient with HF is described below: o ABGs, cardiac enzymes, BNP, electrolytes, CBC, liver function test, BUN, creatinine, lipid profile, FBG, thyroid studies ABGs: arterial blood gases Cardiac enzymes: Tell if there has been ishemic damage to heart BNP: Elevated over 100 is sign of HF Lipid profile: tells risk factors FBG: fasting blood glucose; long standing diabetes leads to HF

blood tests

What cancer of the female sex organ is described below: · Diagnosis: o Radiologic studies § Mammogram, ultrasound, MRI o Biopsy § Fine needle aspiration § Core needle biopsy § Excisional biopsy o Axillary lymph node analysis § To detect spread and calculate risk for recurrence o Tumor size o Hormone receptor status § Estrogen and/or progesterone positive or negative § To assist in treatment selection o Cell proliferation indices § Risk for recurrence and death o Genomic assay § HER-2 positive or negative § Prognostic, assist with treatment selection

breast cancer

What cancer of the female sex organ is described below: · Second leading cause of cancer-related death of women in the USA, second only to lung cancer · Can also occur in men, although it is rare · 1 of every 8 women will develop breast cancer at some point during her life

breast cancer

When talking about drug therapy for treating HTN, what type drug has the following nursing considerations: • Nursing considerations: use with caution in patients with HF. Serum concentrations and toxicity of certain calcium channel blockers may be increased by grapefruit juice, avoid concurrent use. Used for supraventricular tachydysrhythmias. Avoid in patients with second or third degree AV block or left ventricular systolic dysfunction

calcium channel blockers

The following are the 7 warning signs of _______: · Changes in bowel or bladder habit · A sore that doesn't heal · Unusual bleeding or discharge from any body orifice · Thickening of a lump in the breast or elsewhere · Indigestion or difficulty swallowing · Obvious change in a wart or mole · Nagging cough or hoarseness

cancer

What is metastasis?

cancer spread

cellular

Drugs used to restrict the freedom or movement of a patient or in some cases to sedate a patient Used ONLY to ensure safety Least restrictive approach Last resort with the care of older adults Determine unmet physiologic or psychosocial needs Highly regulated

chemical restraints

what gallbladder disease is described below: o Inflammation of gallbladder o Usually associated with cholelithiasis

cholecystitis

Acute or Chronic? o Irreversible pathologic changes (to body systems)

chronic

The following are clinical manifestations of ______ ______: · Abdominal pain o Located in same areas as in acute pancreatitis o Heavy, gnawing feeling; burning and cramplike · Malabsorption with weight loss · Mild jaundice with dark urine · Steatorrhea · Constipation · Diabetes mellitus

chronic pancreatitis

_____ ______ includes: · ______ _________ is a continuous, prolonged, inflammatory, and fibrosing process of the pancreas. o The pancreas becomes progressively destroyed as it is replaced with fibrotic tissue. o Strictures and calcifications may also occur in the pancreas.

chronic pancreatitis

The following is pt and caregiver teaching with _____: --instruct the pt with esophageal and gastric varices to avoid aspirin and NSAIDs to prevent hemorrhage --teach the pt with portal HTN and varices that straining at stool, coughing, sneezing, and retching and vomiting may increase the risk of variceal hemorrhage.

cirrhosis

The following are _______ of HF: • Pleural effusion • Dysrhythmias - atrial fibrillation • Left ventricular thrombus • Hepatomegaly- may lead to cirrhosis due to fibrosis • Renal failure

complications

when talking about the etiology of HR, Interference with the normal mechanisms regulating CO which lead to ______ ventricular function: o Preload: too much blood trying to get into the ventricles o Afterload: making it harder for blood to pump out o Myocardial contractility: how hard can the heart contract o Heart rate o Metabolic state: things like thyroid disease, diabetes, etc can all contribute to HF

decreased

Understanding CBC: Inflammation/Infection: ____ _______ = not a high concern

decreased basophils

Understanding CBC: Inflammation/Infection: _____ ______ = may indicate infection, not a high concern

decreased eosinophils

With ______ in an older adult, the nurses role is to assess, report, and refer.

depression

When talking about ventricular dysfunction, a problem with ventricular FILLING is considered _______ failure while a problem with ventricular EMPTYING is considered ______ failure.

diastolic; systolic

Diverticulosis or Diverticulitis? · Nursing Interventions: o Measures to prevent constipation o Teach foods high in fiber o Avoid foods not well tolerated o Avoid activities that increase intra-abdominal pressure o Teach to identify signs and symptoms of diverticulitis and when to notify physician

diverticulosis

What PAD diagnostic study is described below: o Maps blood flow throughout the entire region of an artery

doppler ultrasound with duplex imagine

What part of RICE is described below: o Elevating the injured extremity above the level of the heart will reduce the edema at the inflammatory site by increasing venous and lymphatic return and also helps reduce pain associated with blood engorgement at the injury site.

elevation

When treating a hypertensive _____, The initial goal is to decrease MAP by no more than 20% to 25%, or to decrease MAP to 110 to 115 mm Hg. If the patient is clinically stable, drugs can be titrated to gradually lower BP over the next 24 hours. Lowering the BP too quickly or too much may decrease cerebral, coronary, or renal perfusion. This could cause a stroke, MI, or renal failure.

emergency

What surgical therapy to treat PAD includes the opening of an artery and removing the obstructing plaque? **interprofessional care

endarterectomy

what is the most life-threatening complication of cirrhosis?

esophageal and gastric varices

what type of exudate is described below: (surface coating - venous ulcers, adhesions) coating that forms on top of injury to protect form external sources adhesions is a fibrous material that forms internally between organs can cause intestinal obstruction adhesions take a while to develop (weeks to months after surgery)

fibrinous

What assessment abnormality of the respiratory system is described below: Description: increased depth, bulk, sponginess of distal portion of finger Possible Etiology and Significance: chronic hypoxemia, cystic fibrosis, lung cancer, bronchiectasis,

finger clubbing

what percussion sound is described below: soft, high-pitched sound of short duration heard over very dense tissue where air is not present, such as posterior chest below level of diaphragm

flat

What category of the elderly has chronic conditions and are not independent with ADLs? * usually over age of 75 and has physical, cognitive, and/or mental conditions that may interfere with independently performing ADLs

frail old

with interprofessional care of DM, the following are treatment _____: • Prevent hyperglycemic/hypoglycemic emergencies • Maintain 'normal' glucose levels o Normal in a diabetic is a little higher than for a non-diabetic o 80-130 g/mL is normal for diabetic patients o 80-180 for post something • Prevent infections • Delay onset and progression of complications • Active patient participation and lifestyle adjustment with minimal stress

goals

With interprofessional care: acute and chronic _______: · Adequate nutrition o Well-balanced diet - reduce fats o Vit B-complex, Vit K · Rest · Avoid alcohol intake and drugs - metabolized by liver · Notification of possible contacts

hepatitis

• Modifiable • Major risk factor for CVD • As BP ↑, so does risk for MI, HF, CVA, CKD • "The silent killer" • Nearly 1 in 3 Adults • Heart and blood vessels under strain o ↑ afterload, increased cardiac workload • HP2020 lists HTN as a high priority health indicators

hypertension

What are the 2 types of hypertensive crisis?

hypertensive urgency and hypertensive emergency

With a patient with CKD, they will have electrolyte and acid-base _______ which includes: • Metabolic acidosis o inability to excrete H ions o ↓ reabsorption/regeneration of bicarbonate

imbalance

When using the nursing process of HTN, _______ includes: • Primary prevention is cost effective • Early screening and individual patient evaluation o Risk factors for other diseases • Ambulatory care - compliance and self-monitoring • Accurate BP measurement

implementation

Drug therapy of ______ includes: o Aspirin o Acetaminophen o NSAIDs o Corticosteroids o Vitamins A, B complex, C, D wound healing o Drugs are used to decrease the inflammatory response and lower the body temperature

inflammation

Erythrocyte Sedimentation Rate (ESR) is often elevated with?

inflammation

the following are nursing ______ of CKD: • Teaching o weight gain > 4lbs within 2 days; increasing BP; SOb; increasing edema; increasing fatigue or weakness; confusion or lethargy signs of decompensating kidney function o different from CHF!!

interventions

What complication of IBD is described below: · Small intestines: o Surgical adhesions most common cause - can occur within days, or years after surgery o Other causes: hernia, strictures from Crohn's disease, intussusception after bariatric surgery · Colon: Most common cause is cancer or diverticular disease

intestinal obstruction

What complication of IBD is described below: · Types: o Mechanical - detectable occlusion o Non-mechanical - from a neuromuscular or vascular disorder (i.e. paralytic (adynamic) ileus)

intestinal obstruction

What side of heart and type of HF is described below: o Heart muscle has become thick making chamber size small leading to not being able to hold as much blood o Thick heart muscle and smaller chambers!

left sided diastolic failure

What side of heart and type of HF is described below: o Thin, weak heart muscle!

left sided systolic HF

______ issues include advance directives, estate planning, taxation issues, appeals for denied services (EX: disability), financial decisions, or exploitation by strangers or "trusted others". o Advanced directives are written statements of a person's wishes regarding medical care

legal

what is the GOLD STANDARD diagnostic study for cirrhosis?

liver biopsy

What tumor classification is described below: --grow rapidly --not encapsulated --invasive --poorly differentiated --high mitotic index --can spread distantly (metastasis)

malignant

The following are general _____ of urinary system disorders: -fatigue -headaches -blurred vision -elevated BP -anorexia -N/V -chills -itching -excessive thirst -change in body weight -cognitive changes

manifestations

the following are clinical manifestations of cirrhosis: · hepatic encephalopathy, peripheral neuropathy, asterixis

neurologic

What part of the treatment plan of a patient with HF is described below: • Collaborate with registered dietician o Na restriction (2-3g daily) o Increase K through food- monitor with med use Helps support heart rhythm and strength of muscle contraction o Dash diet Low in sodium, high in whole grains, omega 3 fatty acids, fruits, and vegetables o Fluid restriction May be ordered to restrict to 1 liter per day for example Measure I&O and educate family o Daily weights • Report weight gain >2lb in 1 day, 3 lb over 2 days, or 3-5 lb over 1 week (fluid overload) o Signs of fluid overload • * Discharge Instructions o Excellent, adequate discharge instructions

nutritional therapy

What complication of lung cancer is described below: § Associated with SCLC § Systemic manifestations caused by hormone-like substances produced by tumor cells · Hypercalcemia · SIADH · Adrenal hypersecretion · Hematologic disorders · Neurologic syndromes

paraneoplastic syndrome

What complication of PUD is described below: · *****Most lethal complication***** o greater mortality with gastric ulcers · Ulcer penetrates serosal surface o spillage of gastric or duodenal contents into peritoneal cavity · Small ________s can seal themselves · Larger ________s require emergency surgery o Can cause peritonitis, acute abdomen § Will not be able to press down on the abdomen · Treatment o fluid replacement, ABX, open or lap surgery to repair

perforation

What complication of PUD is described below: · Treatment o fluid replacement, ABX, open or lap surgery to repair

perforation

What is the most LETHAL complication of PUD?

perforation

With nursing management of PAD, _______ includes: o Goals: Adequate tissue perfusion Relief of pain Increased exercise tolerance Intact, healthy skin on extremities

planning

The following is the ____ ____ of an ostomy: · Powder- applied to denuded peristomal skin to absorb moisture · Liquid skin prep - protects skin from stripping with removal of barrier, seals in powder · Lubricating deodorizer - facilitates pouch emptying as stool slides out of pouch easier, deodorizes stool

pouching system

The following is the ____ ____ of an ostomy: · Two-piece - skin barrier and pouch are two separate pieces that are put together upon application of system · Ring - enhances seal of skin barrier, can be used in place of paste on denuded skin, does not contain alcohol · Paste - "caulk" to fill in uneven areas, around edge of barrier next to stoma, contains alcohol, will sting when applied to denuded skin

pouching system

too much blood trying to get into the ventricles

preload

With nutritional therapy of DM, what component of diet is described below: --individualize goals --high-______ diets are not recommended for weight loss

protein

what precipitating factor of HF is described below: Increased pulmonary pressure resulting from obstruction leads to pulmonary hypertension, decreasing CO

pulmonary embolism

rectocele

What side of heart failure has the following symptoms: Symptoms: - Fatigue - Depression, anxiety - Dependent, bilateral edema - Right upper quadrant pain - Anorexia and GI bloating - Nausea

right sided HF

what clinical manifestation of PD (Parkinson's disease) is described below: o Cogwheel _______ § Jerky quality § Like intermittent catches in passive movement of a joint o Sustained muscle contraction

rigidity

What prevention measure to prevent chronic illness is described below: o Early detection of disease o EX: screening o Facilitate interventions to prevent disease progression

secondary

o Assess pattern, duration o Assess quality o Does the person feel "refreshed" after sleep o Sleep hygiene measures **nursing implementation

sleep

What are the 6 stages of CKD?

stage 1, stage 2, stage 3a, stage 3b, stage 4, and stage 5

When performing a nursing assessment on a patient with HF, what are some things you will see when looking at their CV function?

tachycardia, S3 and S4 heart sounds, pulsus alternans, PMI displaced inferiorly and posteriorly, lifts and heaves, jugular venous distention

What assessment abnormality of the respiratory system is described below: Description: rate of more than 20 breaths per min Possible Etiology and Significance: fever, anxiety, hypoxemia, restrictive lung disease; magnitude of increased above normal rate refletcts increased work of breathing

tachypnea

When performing a nursing assessment on a patient with HF, what are some things you will see when looking at their respiratory function?

tachypnea, crackles, wheezes, frothy blood tinged sputum

What part of bone marrow suppression (side effect of radiation and chemotherapy) is described below: •could result in major hemorrhage

thrombocytopenia

Mutations in the ______ gene: most common known genetic cause of dilated cardiomyopathy (heart muscle gets thin, weak, and floppy)

titin

evidence-based and innovate care coordination and management model A transitional care nurse delivers and coordinates care by nurses and other team members throughout potential and acute episodes of illness Those most likely to benefit from transitional care nursing include those of older adult and those with functional deficits, behavioral or psychiatric issues, multiple chronic conditons, a need for polypharmacy, a recent hospitalization, lack of a support system, low health literacy, and history of nonadherence to treatment **nursing implementation of older adults

transitional care model

What type of DM has the following etiology and pathophysiology: • Idiopathic o strongly inherited but not autoimmune • LADA - latent autoimmune diabetes o appears like Type 2 because it progresses slowly

type 1

What primary cause of HF is : afterload from stiffened or weakened valves

valvular disorders

Loss of elasticity of the bladder - older _______ more prone to bladder infections and incontinence o Can lead to urinary incontinence; bladder is not able to hold urine as well (bladder becomes flabby) o Hormonal imbalances after menopause can cause flabby bladder **effects of aging on urinary system

women

does patient position affect BP?

yes

What category of the elderly is from the age of 65-74? **nearly 6% of individuals age 65-74 live in nursing homes

young-old

What are the 4 categories of the elderly?

young-old, middle-old, old-old, and frail old

What are the 7 warning signs of cancer? **acyronym= CAUTION

· Changes in bowel or bladder habit · A sore that doesn't heal · Unusual bleeding or discharge from any body orifice · Thickening of a lump in the breast or elsewhere · Indigestion or difficulty swallowing · Obvious change in a wart or mole · Nagging cough or hoarseness

When performing a nursing assessment of a patient with gallbladder disease, what is some objective data that would be collected?

· Fever · Restlessness · Jaundice, icteric sclera · Diaphoresis · Tachypnea · Splinting · Tachycardia · Palpable gallbladder · Abdominal guarding and distention

N308 Final Exam Flashcards (Part 1)

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