NUR 324 (quiz 2) (then add notes to make quizlet for final)
fulminant hepatic failure tx
-ICU -plasma exchanges -treat hypoglycemia -monitor cardiac/renal function -intracranial pressure monitoring for edema (mannitol) -liver assistive devices -quiet enviro -liver transplants
liver abcesses tx
-IV ABX -monitoring drainage site -skin care -VS -monitor for complications (rupture/sepsis)
acute abdomen appendicitis FVD care
-IVF (oral if not dehydrated) -monitor urine (minimum: 60ml per hour)
acute abdominal peritonitis treatment
-IVF w/ electrolytes -ABX -analgesics -antiemetics -NGT w/ suction to relieve distention -oxygen bc there could be pressure on diaphragm -peritoneal drainage and culture -surgery
chronic pyelonephritis diagnosis
-IVP -CRE/BUN/creatinine clearance
If peptic ulcer hemorrhage is suspected, immediate nursing actions would be to do which of the following:
-Insert a peripheral IV line -Call Rapid Response Team -Assess VS
kidney-diagnostic imaging
-KUB -ultrasound -MRI -nuclear scans (radioactive isotopes) -endoscopic procedures
urolithiasis/nephrolithiasis (urinary tract stones) diagnosis
-KUB xray (kidneys, ureter, bladder0 -US/IVP -bloodwork -24 hr urine -analyze stone if passed
cirrhosis diagnosis
-LFTs -albumin -bilirubin -PT -ultrasound -CT scan -liver biopsy -possibly ABGs if resp s/s
Ulcerative Colitis s/s
-LLQ pain -eye lesions -vomiting/dehydration -decreased Ca+ and H/H -arthritis -mucus, puss -fever -tenesmus -cramping -anorexia -skin lesions
endoscopic gi-upper GI -post
-LOC -VS, o2%, pain -bleeding -gag reflex -DC instructions -FIU phone call
colonoscopy post
-LOC -VS: -o2% -pain -bleeding -DC instructions -P/U phone call
longterm complications diabetes- organ
-Macrovascular -microvascular
gastric outlet obstruction (GOO) treatment
-NGT w/ suction to decompress (residual >400ml) -decrease edema -correct electrolyte imbalances -possible balloon dilation to open outlet (also done for PUD or scar tissue)
treatment of pyloric obstruction in PUD
-NGT w/ suction to decompress stomach -IVF w/ electrolytes -baloon dilation surgery may be required
acute pancreatitis nutritional support
-NPO -enteral/parenteral nutrition -H2 blockers -maybe PPI -daily weights
MRI
-NPO -no jewelry/metal -ask about: -pacemaker -defibrillator -artificial valves -metal implants -meds -insulin pumps -claustrophobia -offer ear plugs -60-90 mins -check allergy for oral contrast
perforation post op
-NPO 7 days w/ enteral feeds day 2-3 (jejunostomy tube, to bypass stomach and decrease aspiration)
when checking LFTs
-NPO after midnight
acute gastritis diet modifications
-NPO w/ IVF w/ D5/electrolytes for calories -progress fromice chips-clear liquids-solids -no caffeine, alcohol, smoking
neurogenic bladder causes
-NS -MS-spinal cord injury, ect.
rehydration tx for hyperglycemia/DKA
-NS or 1/2 NS -1L/hr -for 2-3 hrs -when BG gets to 300 may change to D5W
teporomandibular disorders non invasive treatment
-NSAIDs -PT -muscular relaxants -CBT -appliances -nur: education
CT scan for GI-post
-Na Bicarb -mucolytics -to protect kidneys from contrast
A patient's admitting history and assessment are suggestive of acute pancreatitis. Which of the following assessment criteria would the nurse expect to find? SELECT ALL THAT APPLY
-Nausea/vomiting -Respiratory distress -Abdominal distension
perforation treatment
-OR
obesity surgery post op NUR care: pain management
-PCA pump
acute kidney injury (AKI) respiratory acidosis
-PH and CO different directions
acute kidney injury (AKI) metabolic acidosis
-PH and CO in same directions -PH: 3.2 -Co2: 30 -Hco3: 18
acute kidney injury (AKI) acidosis
-PH<3.5
Crohn's Disease s/s
-RLQ pain -conjunctivitis -oral lesions -nutritional deficiencies -joint pain -steatorrhea -cramping -anorexia
acute abdomen appendicitis s/s
-RLQ pain -rebound tenderness -local tenderness at mcburney's point -Rovsing's sign (palpate LLQ=pain RLQ) -low grade fever -n/v -constipation -diarrhea -pain w/ urination
order of GI auscultation quadrants
-RLQ* -RUQ -LUQ -LLQ
microvascular
-Retinopathy: -S/S - blurry, hazy vision -Prevention: regular eye exams every year, control of BG, HTN, and smoking cessation -Tx: laser surgery to control bleeding -Blindness: Referrals for Braille education and seeing eye dogs Education of family members to assist with care Home care referrals for environmental and ADL needs -Nephropathy: (kidney) ESKD Early s/s: microalbuminaria -Tx: ACE inhibitor, low protein diet -Labs: BUN, CRE yearly HTN often develops -Neuropathy -peripheral: Numbness/tingling in feet ↓ pain/temp sensation Joint deformities ↓ in deep tendon reflexes -Tx: medications (lyrica)
proctitis causes
-STD -IBD -radiation
neuropathy-autonomic-cardiac
-Tachycardia, orthostatic hypotension, ischemic pain, MI -Tx: avoid strenuous activity, treat symptoms
UTI diagnosis
-UA -UC -STDs -x rays, CT, US for pyelonephritis
kidney diagnostics
-UA and UC -renal function tests -diagnostic imaging
gastritis diagnosis
-UGI x-ray -endoscopy + biopsy
liver abcesses diagnosis
-US, CT scan -aspiration of abcess -blood cultures
acute pyelonephritis diagnosis
-US/CT/UC -IVP
neurogenic bladder complications
-UTI -stones
neuropathy-autonomic-bladder
-Urinary retention, neurogenic bladder (↑UTI risk) -Tx: ????? Straight cath every few hrs
urinary retention complications
-UtI -renal stones -pylonephtitis -sepsis -skin breakdown -hydronephrosis
hepatic encephalopathy and coma nur
-VS -neuro status -I and O -resp. care -safe enviro -fam education -monitor electrolytes/ammonia -enteral feedings if necessary -monitor for infection
paracentesis nur
-VS (***): - Q 15x for 1 hr, Q30x for 2hrs, Q4hrs -in order to detect s/s of vascular collapse -post procedure: -label/send samples -pt in comfortable position
pyuria
-WBCs in urine
metabolic syndrome
-a combo of 3 risk factors of type 2 diabetes: -Abdominal obesity/apple shape -high cholesterol -HTN
colon/rectal polyps
-a mass that is either benign or malignant -most common in large intestines -should be removed and biopsied
peritonial dialysis complications
-abd hernias -low back pain -increased triglycerides -cardiac issues -leaking -bleeding -peritonitis -SOB -fluid doesn't drain
acute gastritis s/s
-abd. discomfort -headache -n/v -hiccuping -lassitude -melena
ascites assessment
-abd. girth -daily weight -straie/stretch marks -distended veins -umbilical hernia -percuss for shifting dullness via fluid wave -fluid/electrolyte imbalances
cholelithiasis assessment and diagnosis
-abd. x ray -ultrasonography -radionuclide imaging (cholescintigraphy) -oral cholescintigraphy w/ iodine contrast -ERCP (endoscopic retrograde cholangiopancreatography)
T7-T12
-abdomen
diarrhea NUR care
-abdominal assessment -fluids -skin assessment -rest -bland diet -monitor for lactose intolerance by restricting milk -monitor: -labs -cardiac rhythm and mental status, (dehydration), perianal skin
CN 6 (VI)
-abducens -pons -motor -abducts eye
migraine
-abnormal metabolism of serotonin -dilation of cerebral vessels
babinski reflex
-abnormal past 1 month old -fanning out feet is positive
azotemia
-abnormally high levels of nitrogen-containing compounds -such as: -urea -creatinine -various body waste compounds -other nitrogen-rich compound ( in the blood)
benign tumors nur-education
-about self care/home care -diet -positioning -meds -special equipment (suction/feeding) -meal planning -activity level -VNA -s/s to report -incision care -support groups
kayexalate (AKI tx)
-absorbs excess K+ to decrease K+ levels
intrinsic factor
-absorbs vitamin b12
CN 11 (XI)
-accessory -medulla -shoulder shrug
non toxic medications that cause non viral hepatitis
-acetaminophen -some ABX -anesthetic agents -aldomet -antidepressants -anticonvulsants -arthritis meds
motility disorders
-achalasia -spasms (can be caused by stress)
s/s of gastritis can be associated with:
-achlorhydria -hypochlorhydria -hyperchlorhydria
urolithiasis/nephrolithiasis- renal stones s/s
-achy feeling in costovertebral area -hematuria -pain -tenderness -n/v/d -fever
peritonial dialysis types
-acute intermittent -continuous ambulatory -continuous cyclic peritoneal dialysis
LE
-acute kidney injury (AKI) -Loss -ESKD -complete loss of function -will most likely progress to end stage renal failure
RIF
-acute kidney injury (AKI) -RIsk -Loss -Failure -increased Credit levels -decreased GFR -if caught in this stage can be reversed in 3 months to 1 yr
kidney failure types
-acute kidney injury (AKI) -chronic kidney failure
glomerular diseases
-acute nephritis syndrome -chronic/acute glomerulonephritis -nephrotic syndrome
upper uti's
-acute pyelonephritis -chronic pyelonephritis
upper UTI
-acute/chronic polynephritis
acute kidney injury (AKI) s/s
-affects all organ systems -lethargy -dehydration -drowsiness -headache -muscle twitching -seizures -ICU if not treated ASAP -mental status changes
injury from stroke on left side of brain
-affects right side of body
gestational diabetes risk factors
-african americans -hispanics -aisians -native americans -pacific islanders -obesity -past hx -glucosuria -fam hx
acute kidney injury (AKI) phases-diuresis
-after dialysis -gradual increase in UO -labs stabilize -increased risk dehydration
GI assessment
-age related factors -change in bowel habits -med/drug use -social/fam hx/culture -alcohol/smoking -oral cavity inspection -physical assessment of abd./rectum
chemical burns treatment
-airway -NPO -IV fluids -prep for barium swallow or esophoscopy -antinausea meds -ABX maybe -nutritional support (enteral/parenteral) -pain management -antipyretic -psych consult
priority Question if a pt starts to deteriorate
-airway -glucose
proctocolectomy
-aka "J-pouch" or IPAA -take out entire colon, make pouch at bottom of small intestines, connect to anus -if diseased anus, make ileostomy (loose diarrhea, increased risk malnutrition)
serum protein studies
-albumin and total protein -total protein: 7-7.5
post ostomy food list: gas producing
-alcohol -beans -soy -cabbage -carbonated -cauliflower -dairy, milk -gum -nuts -onions -radishes
post ostomy food list: increase stools
-alcohol -whole grains -bran cereal -cooked fruit/veggies -leafy greens -milk -prunes -raisins -spices
acute pancreatitis
-autodigestion by own enzymes (trypsin) -inflammation and edema/enzymatic digestion of itself -increased mortality w/ age -NPO and IV ABX
chronic gastritis diet modifications
-avoid caffeine and alcohol -no smoking or spicy foods -stay hydrated
parenteral nutrition nur
-daily weight initially -oral care -I and O -calorie count of oral intake -24 hr or 10-15 hr infusions -assess IV site -dressing changes -don't rapidly stop infusion-must be titrated -if solution runs out, replace with DIO and water at same rate -encourage activity
hepatic dysfunction
-damage to liver cells -acute or chronic, chronic more common
obstructive jaundice s/s
-dark brown urine -light clay colored stools -dyspepsia and fat intolerance -impaired digestion -pruritis
-nitroglycerin w/ vasopressin
-decrease coronary vasoconstriction
-vasopressin -somatostatin -ocreotide
-decrease portal HTN
acute kidney injury (AKI) Ca+
-decreased
acute kidney injury (AKI) GFR
-decreased
acute kidney injury (AKI) H/H
-decreased
acute kidney injury (AKI) specific gravity
-decreased
older adults- kidney
-decreased GFR and multiple meds = increased adverse -increased risk hypernatremia -decreased estrogen: -urinary incontinence -decreased muscle strength -increased residual volume of urine -decreased mobility -BPH (enlarged prostate sits on urethra and blocks urine flow and can back up)
kidney surgery monitor for blood loss
-decreased UO -fatigue -cool skin -flat neck veins -change in mental status
acute kidney injury (AKI) phases-oliguria
-decreased UO -increased K -increased Mg
constipation complications
-decreased cardiac output from straining -fecal impaction -hemorrhoids -rectal prolapse -fissures -megacolon
cholelithiasis nutritional/supportive for gallstones
-decreased fat -no: -gassy veggies -dairy -fried pork -alcohol
kidney-health hx
-co morbidities (HF=fluid retention=L ventricle weaker=low perfusion to kidneys) -pain -changes in voiding -GI s/s (same nerves as kidney) -anemia
post ostomy food list: constipation relief
-coffee -cooked fruits/veggies -fruit juice -water -warm/hot drinks
diverticular disease diagnosis
-colonoscopy
what does UA and UC test for
-color -clarity -odor -protein -bacteria -blood -PH -glucose -specific gravity -ketones
tips for low glycemic index
-combine starchy foods with protein and fat -raw or whole foods better than cooked/chopped -whole fruits not juices -sugary foods with foods that are more slowly absorbed
acute gastritis
-comes on quickly -hiccuping -supportive therapy -cbc, upper endoscopy, gastric resection, NPO to solids
urinary retention residual urine
-common >60yrs -50-100ml
brain death
-complete lack of EEG
kidney surgery post op
-complications -resp assessment -prevent UTI (remove cath asap) -FVE/FVD -DVT prevention -monitor for blood loss
AV graft
-connected to an artery/vein -if someone's veins/arteries are not good enough for AV fistula
diabetes meal planning
-consider food preferences, lifestyle, usual eating times, cultural/ethnic background -weight loss, gain, or maintenance -label reading -caloric requirements -non starchy veggies 50% -fat 10% -protein is important-25% -starches 25% -3 servings of fruit/dairy each per day -eat at the same times every day to keep BG more stable -skipping meals causes BG to become unstable -glycemic index
diverticular disease interventions
-constipation -pain -surgery
obesity surgery post op NUR care: diarrhea/constipation
-constipation: increase fiber in diet -diarrhea and steatorrhea: fatty stools from rapid gastric emptying
parasympathetic
-constricted pupils/blood vessels -decreased bp -increased gi secretions, thin -contracted gu/ relaxed sphincters/dilated vagina -constricted bronchioles -increased rr
Non-contrast computed tomography (NECT) remains the most available diagnostic imaging available to identify
-contraindications to fibrinolysis, thereby allowing patients with ischemic stroke to receive timely fibrinolytic therapy.
renin
-controls angiotensin I
ADH
-controls water levels in bloodstream and amount of water secreted into urine -higher ADH = higher amount of water retained
blunt renal trauma
-contusion/vascular injury -minor/major laceration/tear -from rib fractures/not wearing seatbelts
minerals stored in liver
-copper -iron
starchy foods
-corn
gastric sleeve
-cut part of stomach out to make it smaller
lower UTI
-cystitis -prostitis -urethritis
kidney endoscopic procedures
-cytoscope up through bladder -complications: -hemorrhage -infection -NUR: -pts usually awake during it -pts may report burning/pain on urination or muscle spasms
acute nephritis syndrome nur
-daily weight -increased carbs -decreased protein -decreased Na+ -I and O -calculate fluid balance -monitor labs -pt education/follow ups
UTI s/s in elderly
-decreased immune system. -cog. impairment -comorbidities (DM=sweet urine)
gerontological considerations for liver
-decreased liver size -decreased drug clearance -alcohol/drugs -increased gallstones -increased progression of Hep C -use of tylenol -lifestyle (sex/travel) -pt/fam hx -more severe complications
gerontological considerations for pancreas
-decreased rate of secretion -impaired fat absorption -no change in size (liver shrinks with age)
GI age related factors
-decreased saliva -decreased motility emptying of esophagus -decreased stomach motility/acid -atrophy/thinning of small intestine -decreased tone/elasticity of large intestine
increased aldosterone causes...
-decreased urine output
lactose intolerance
-deficiency of lactose digestive enzyme -intolerance to milk and milk substances -risk of osteoporosis
FVD in elderly
-dehydration -change in mental status -falls -med toxicity -constipation -UTI -resp infection (can't cough up secretions) -delayed wound healing
fecal incontinence treatment
-depends on cause (diarrhea, impaction, meds) -pelvic floor training -internal/external fecal management systems -bowel training program -surgery
hemolytic jaundice
-destrcution of RBCs
post op care for increased IcP
-detect and decrease cerebral edema -releive pain -prevent seizures -monitor ICP and neuro status -pt may be intubated and have several venous lines
urea breath test
-detects H. pylori for PUD
first order thinking
-detects stimuli/sensation
chronic glomerulonephritis treatment
-determined by s/s
CT scan for GI-pre
-determined by type of test, may need IV -if using contrast, check allergies for: -iodine -shellfish -pregancy -CRE levels
fluid status
-determined by weight/how much you drink -1000mls = 2.2 pounds ***
bleeding of esophageal varices
-develops from increased pressure in veins from portal system -causes veins to be prone to rupture -1/3 of cirrhosis pts have them, 10-30% mortality
associated health risks of obesity
-diabetes -CAD -CVA -HF -PE -PVD -back pain -asthma -cancers -HTN -depression -pressure ulcers -hypercholesterolemia -obstructive sleep apnea -osteoarthritis -gallbladder disease
lactose intolerance s/s
-diarrhea -cramps
long term ostomy complications
-diarrhea -leakage -skin breakdown -stomal stenosis (from scar tissue) -urinary calculi (from loss of fluid) -cholelithiasis (from altered bile acids)
celiac disease s/s
-diarrhea -steatorrhea -abdominal pain -distention -weight loss -flatulence -others: -depression -hypothyroid -anemia -seizures -ridged teeth -itchy rash
diabetes management
-diet -exercise -blood glucose/ketones monitoring -pharmacological
celiac disease NUR care
-diet consult -label reading -products that contain gluten (meds, OTC, toothpaste, lipstick)
PUD intervention: pain relief
-diet or NPO -meds: H2RAs, PPIs, antacids
DC teaching for mouth disorders
-diet: no spicy/hot -meds -humidification if needed -pain control -incision care -s/s to report -suction equipment -follow up care
IBS education
-dietary changes: -food diary -adequate fluids -no fluids with meals -avoid smoke/alcohol -relaxation techniques -exercise -yoga
process of hemodialysis
-diffusion -osmotic -ultrafiltration
major GI functions
-digestion -absorption -elimination
sympathetic
-dilated pupils/blood vessels -constricted abd -increased BP -decreased gI secretions/thick saliva -glycogen to glucose -relaxed gu /contracted sphincters -contracted pilomotor -dilated bronchioles -increased RR
hemorrhoids
-dilated veins in the anal canal (internal and external)
pigment studies
-direct and indirect: -serum bilirubin -urine bilirubin -urine bilirubin and urobilinogen -total: 0.3-1
proctitis STD s/s
-discharge -bleeding -pain -diarrhea
PUD intervention: teaching
-disease process -meds -diet -stress reduction -smoke/alcohol cessation -s/s of complications
anoxia
-disruption of carrying capacity of oxygen to the liver -liver not getting enough blood flow
types of cerebral pathology that are best seen w/ MRA
-dissections -calcifications -aneurysms
left side of brain
-dominant -speech -math -logic
salem pump intubation tube
-double lumen, blue port vent (prevents reflux)
exchange
-drain and refill (3-4 per day)
FVD
-dry -increased BUN -increased Hct -hypo-electrolytes -hyper-electrolytes -Na+, K+, Ca+, bicarb, Mg+, phosphate defect, protein defect
PUD s/s
-dull, gnawing pain/burning in mid-epigastric area -heartburn -vomiting -melena
most frequent adverse of surgical procedures for PUD
-dumping syndrome
IVP
-dye to look at kidneys to see damage/perfusion/blockage -for acute pyelonephritis/chronic pyelonephritis diagnosis
diverticulum s/s
-dysphagia -neck fullness -belching -regurgitation -gurgling noises after eating -halitosis
other manifestations of hepatic dysfunction
-edema -bleeding -vitamin deficiency -metabolic disorders (abnormal glucose highs/lows, low estrogen levels, testicular atrophy) -pruritis -spider angiomas -reddened palms
FVE
-edema -crackles -increased weight -SOB -ascites -dyspnea -tachycardia -JVD
kidney surgery DC
-education on equiptment -home care visits -verbal/written instructions -s/s infection -prevent complications
TIPS/transjugular intrahepatic pontosystemic shunt labs
-electrolytes -ammonia levels -decreased K = increased NH4 (can cause cerebral dysfunction) (confusion/coma)
end stage renal failure
-electrolytes high bc nothing is filtered
peritonial dialysis if fluid doesn't drain
-elevate HOB -turn pt to side -check patency -kinks, clamps, air lock
hepatic encephalopathy and coma medical management
-eliminate precipitating cause -lactulose liquid enema -iv glucose -vitamins/enteral feedings -decrease ammonia from GI tract -stop sedatives/analgesics/tranquilizers -monitor/promptly treat complications/infections
amygdala
-emotional brain
small bowel obstruction treatment
-emotional support/comfort -NGT for 3 days (if not resolved, surgery) -IVF -monitor nutritional status* -monitor for return to normal*
large bowel obstruction treatment
-emotional support/comfort -NGT for 3 days (if not resolved, surgery) -rectal tube to decompress below obstruction* -IVF -colonoscopy to untwist bowel* -surgery if tumor
post contrast tests NUR
-encourage fluids to flush out contrast -monitor for allergic reactions -monitor for urine output (to make sure contrast didn't put them into kidney failure)
bleeding of esophageal varices diagnosis
-endoscopy -LFTs -x rays to see circulation
gastric outlet obstruction (GOO) diagnosis
-endoscopy -upper GI series (x-ray w/ barium)
perforation causes
-endoscopy or operative procedure -forceful vomiting -severe strain -foreign body -trauma -cancer
hiatal hernia
-enlargement of opening through diaphragm
chronic gastritis s/s
-epigastric discomfort -anorexia -n/v -belching -sour taste -heartburn -vit. b 12 deficiency -intolerance to some foods -can have no s/s
PUD
-erosion of mucus membrane forms an excavation -in stomach, pylorus, duodenum, esophagus
peripheral NS
-everything else
uremia
-excess urea and other toxins in the blood
H. pylori risk factors
-excessive gastric acid secretion -can be from: -stress -diet -chronic NSAID use -alcohol -smoking -if it runs in the family
acid
-excreted in the urine -includes phosphoric and sulfuric acid -acid is from protein breakdown/catabolism -if urine is too acidic (<4.5 ph) acid binds to buffer and excreted in urine
perforation s/s
-excruciating pain -dysphagia
urolithiasis/nephrolithiasis-ureter stones s/s
-excruciating pain radiating to thigh/genitalia -usually cannot pass urine
broca's area
-expressive aphasia -can't get words out -frontal
CN 7 (VII)
-facial -pons -sensory -motor -facial expressions/taste
right side of brain
-facial recognition -emotion -spatial relationships -music -artistic
type 1 diabetes risk factors
-familial genetic predisposition -not hereditary -immunologic/enviro viral/toxins factors
diabetes lab findings
-fasting glucose >126 -random glucose >200 -age related eval of blood glucose -A1c >7% -fasting lipids -urine test: albumin, creatinine, done together to determine kidney damage (albumin goes up while creatinine goes down -urinalysis for protein/glucose -EKG bc risk MI
protein metabolism
-fat to lipids/ketones
lassitude
-fatigued
lipase
-fats -pancreatic enzyme
dyspepsia/indigestion causes
-fatty foods -salads -course veggies -spicy food
steatorrhea
-fatty stools -float -grey/white -round
dumping syndrome
-feeds infuse too fast into small intestine
urolithiasis/nephrolithiasis-bladder stones s/s
-feels like irritation w/ bloody urine
UTI risk factors
-female -DM -pregnancy -gout -residual urine -neuro dysfunction -immunosuppresants -instruments into urinary tract -stones in ureters/kidneys -tumors
parotitis s/s
-fever -chills -swelling -pain -ear pain
acute pyelonephritis s/s
-fever/chills -pyuria -low back/flank pain -HA -n/v -malaise -uti s/s -tenderness in costoveterbral angle
kidney functions
-filtration is the main function -urine formation -excretion of waste products -electrolyte and water regulation -acid base balance -BP control -renal clearance -RBC production -vitamin D synthesis -prostaglandin secretion -Ca+ and phosphate balance
3 levels of somatic sensation
-first order direct sensation -second order spinal cord transmitted to brain -third order brain makes decision
Hep A s/s
-flu like -jaundice -dark urine -tender liver
pericardial effusion/tamponade in chronic kidney failure
-fluid build up around pericardium prevents ventricle from expanding/contracting
ascites
-fluid in peritoneal cavity
acute kidney injury (AKI) treatment
-fluid management for adequate perfusion -FVE meds -IVF -blood products/albumin infusions -hemodialysis -peritoneal dialysis -continuous renal replacement therapies -kayexalate -insulin and Ca+ -med dose adjustments -ABG treatment -nutrition -after diuretic phase
50-60 oz
-fluid management incontinence
neurogenic bladder bladder retraining
-fluid restriction 0800-2200 -void schedule -bladder scan for residual -straight cath if residual >300ml or no void after 6-8 hrs
diarrhea complications
-fluid/electrolyte imbalances -dehydration -cardiac dysrythmias from decreased K+ (give supplements)
neurogenic bladder management
-fluids -exercsie -decreased ca+ diet -bladder retraining -double voiding -meds
diverticular disease constipation interventions
-fluids 2L per day -soft foods with increased fiber and decreased fat -individualized exercise program -bulk laxatives and stool softeners -probiotics
upper GI imaging/x rays-post
-fluids to remove barium
simple partial seizure
-focal seizure w/ out alteration in awareness, aura, no EEG changes -only seizure youre aware for -it can be an aura -short
nutritional deficiencies in alcoholics
-folic acid -b12 -iron
acute gastritis causes
-food -meds -alcohol -bile reflux -radiation (erosive) -strong acid/alkali
esophageal banding
-for bleeding of esophageal varices -cuffs off circulation to area then dies/falls off
balloon tamponade
-for bleeding of esophageal varices -sengstaken-lakemore tube -stops bleeding of varices
-ERCP (endoscopic retrograde cholangiopancreatography)
-for cholelithiasis -evals ductal system and pancreas, risk of perforation/bleed)
hartman's procedure
-for diverticular disease -diseased area removed -colostomy created
1 stage resection
-for diverticular disease -diseased area removed -remaining ends reconnected
teporomandibular disorders invasive treatment
-for fractures -surgery (plates, fixation devices wire jaw shut) nur: -liquid to soft diet -maybe supplements -mouth care -suction set up at bedside for emergency -straws for liquids
sudafed
-for incontinence -causes urinary retention, not used w/ HTN
TURP
-for incontinence -transurethral resection of prostate for BPH
rouxen-Y-gastric bypass
-for morbid obesity -part of stomach is cut and connected to small intestine -food goes to small intestine earlier -less calories absorbed
pyridium
-for uti -decreases acid level, increased ph, turns urine orange, decreases burn
Barrot esophagus s/s
-frequent GERD
prevention of DKA: sick day rules
-frequent SMBG and ketones -take insulin as usual even if less hungry -eat 6-8 small meals per day -vomiting/diarrhea: liquids Q30-60 mins (broth/gatorade/cola) -report N/V/D and increased BG to HCP
hiatal hernia treatment
-frequent small feedings -upright 1 hr after eating -elevate HOB
latrogenic incontinence
-from meds
pyrogenic
-from obstruction/trauma -often in developed countries -related to liver abcesses
urea
-from protein metabolism -toxic to body tissues -excreted with creatinine, sulfates, and phosphates
functional incontinence
-function in tact -external factors prevent reaching BR on time -immobility, alzheimers
increased ICP late signs
-further deterioration of loc (stupor/coma) -hemiplegia -decortication/deceberation -flaccidity -RR alterations (cheyenne strokes) -loss of brainstem reflexes (pupil, gag, corneal, swallowing)
AV fistula
-fuses a vein and artery together -dilates vein to make big enough
liver and associated organs
-gallbladder -pancreas -biliary system -gi system
cholelithiasis
-gallstones -increases with age in women -10-25% are pigmented stones -75% are cholesterol stones
obstructive jaundice
-gallstones -tumor -bile ducts
nasogastric/nasoenteric tubes indications
-gastroparesis -severe GERD -gastrectomy -aspiration risk/stroke
surgical inserted feeding tubes
-gastrostomy tube (PEG) -jejunostomy
nocturia
-getting up in the middle of the night to pee
oral cavity disorders
-gingivitis -dental plaque -caries -periapical abcess -herpes simplex -candidiasis -leukoplakia -stomatitis -canker sore -kaposi sarcoma
oral diabetic meds for type 2
-given in addition to medical nutrition therapy (MNT) -classes: -sulfonylureas -biguinides -others
CN 9 (IX)
-glossopharyngeal -medulla -taste/gag reflex
cranial nerves in medulla
-glossopharyngeal IX -vagus X -hypoglossal XII -accessory XI
foreign bodies tx
-glucagon IV to relax esophagus
somogyi effect
-glucose goes down/hypoglycemic and then shoots up again -most dangerous bc during sleep you have hypoglycemia which can lead to coma/death -give snack before bed to help keep BG up
metabolic functions of the liver
-glucose metabolism -ammonia conversion -protein metabolism -fat metabolism -vitamin/mineral storage -bile formation -bilirubin excretion -drug metabolism
waning
-glucose starts to rise 12 am/1 am/no particular time -may need a little bit of insulin before bed
glucose metabolism
-glucose to glycogen -glucose released as needed
sulfonylureas
-glyburide/glypizide -stimulates beta cells to produce insulin
polysyctic kidney disease
-gneetic disorder w/ fluid filled cysts in kidneys -can also cause cysts in liver, blood vessels, brain, heart -no cure, treat s/s, genetic counseling, bc hereditary
gestational diabetes treatment
-goal: blood glucose < or = to 130 post prandial -diet or insulin
ventriculoustomy
-going into the ventricles
parotitis treatment
-good nutrition -increased fluids -oral hygiene -med adjustments -lithrotripsy (for stones/excision) -maybe ABX
prevention of oral cavity disorders
-good oral care -dental check ups -flouride -sealants -no smoking -moderate alcohol use -dietary choices (decrease sugar/starches) -managing diseases
NUR care for mouth disorders
-good oral care -pain releif -DC teaching
s/s of chronic kidney failure
-gradual/over time -increased cre -anemia -metabolic acidosis -unbalanced Ca+/phosphates -fluid retention -edema -HF -HTN
penetrating renal trauma
-gunshots
C8
-hands
post renal
-happens after urine is made -bladder/ureter problem -BPH -obstructed flow
intra renal
-happens inside kidney -can be: -nephron tissue obstruction -acute tubular necrosis: -damage to tubules -decreased GFR -azotemia -F/E imbalances
barium enema can cause...
-hardening of stools -impactions -***increase fluids to prevent
C1-C5
-head/face
fecal incontinence NUR care
-health Hx -assess for impaction -bowel training/biofeedback -therapeutic diets (applesauce, fiber) -perianal skin care -external collection devices (drainable pouches)
kidney assessment
-health hx -social and fam hx -head to toe
hiatal hernia s/s
-heartburn/pyrosis -GERD -dysphagia -fullness in chest after eating -can have no s/s
bleeding of esophageal varices s/s
-hematemesis -melena -general deterioration/shock -hx ETOH
acute nephritis syndrome s/s
-hematuria -edema -azotemia -proteinuria -HTN -headache -flank pain -malaise -can be mild or progress to acute kidney disease/death
polysyctic kidney disease s/s
-hematuria -polyuria -enlarged kidneys -renal calculi -Uti -proteinuria
renal replacement therapies
-hemodialysis
jaundice types
-hemolytic -hepatocellular -obstructive -hereditary
complications of obesity surgeries
-hemorrhage -DVT/PE -bile reflux -dumping syndrome -dysphagia -bowel/gastric outlet obstruction
PUD complications
-hemorrhage -perforation/penetration -pyloric obstruction
kidney surgery post op complications
-hemorrhage/shock (increased HR, decreased bP, late is decreased HR) -abd. distention can indicate bleeding -infection -theomboembolism -resp (pain on inspiration)
FOTB-fecal occult blood testing false positives
-hemorrhoids -red meats -ASA -NSAIDs -turnips -horeseradish within 72 hrs
streaking on stool
-hemorrhoids, rectal area
IBS factors/triggers
-heredity -psychological stress -depression -anxiety -high fat diet -irritating foods -alcohol, smoking
GERD causes
-hiatal hernia -pyloric stenosis -obstructive airway diseases -peptic ulcers -angina -IBS
ADH level with decreased water
-high ADH level to hold onto more water -ex: dehydrated pts have high ADH
Hep C prevalence
-high prevalence in adults 40-59 yrs
if pt needs prilosec today and has urea breath test tomorrow...
-hold and call HCP
craniotomy
-hole in brain
dwell time
-how long fluid stays in pt (5 hrs)
infusion time
-how long it takes to go in (15-20 mins)
fast acting insulins
-humalog/humalin
headache causes
-hx and description and phys exam -multisystem review for: -etiologies -med hx -stress
stomach acid, secretion,enzymes
-hydrochloric acid breaks down food and destroys bacteria -intrinsic factor -pepsin
kidney transplant post op nur-assess for rejection
-hyperacute reaction: kindeyse removed immediately -acute reaction: kidneys removed after a few days/weeks -s/s: -tenderness -fever -malaise -oliguria -CRE changes -increased weight/BP tx: -immunosuppresants every day for rest of life
hyperglycemia (HSS)
-hyperglycemic hyperosmolar syndrome in type 2 diabetes -its low insulin -happens slowly -insulin deficiency caused by illness, meds, dialysis -no ketosis/acisosis
complications of chronic kidney failure
-hyperkalemia -pericarditis -pericardial effusion/tamponade -Htn -anemia -bone disease/metastatic calcifications
causes of increased ca+ in blood
-hyperparathyroidism -blood cancer/bone marrow diseases -dehydration -increased vitamin d/milk -meds: -antacids -vitamin c -laxatives -ASA
nephrotic syndrome s/s
-hypoalbuminemia -generalized edema -ascites -proteinuria -malaise -headache
CN 12 (XII)
-hypoglossal -medulla -swallowing
type 1 duping syndrome
-hypoglycemia -can happen to anyone -prevent by eating less sugary foods less fast
diabetes complications
-hypoglycemia -hyperglycemia -DKA -HHS -organ
acute kidney injury (AKI) causes
-hypovolemia (not enough perfusion to kidney) -hypotension (not enough pressure for perfusion) -decreased CO/HF -obstructions of kidney/lower urinary tract/renal arteries/veins -sclerosis -meds/toxic materials
bleeding of esophageal varices surgery complications
-hypovolemia/hemorrhagic shock -electrolyte imbalance -heart/liver failure -etoh withdrawls -seizures -sepsis -hepatic encephalopathy -metabolic resp/acidosis
kidney transplant post op nur-monitor urine function
-if related donor will produce urine imediately -if cadaver: urine produced after a few weeks, alters fluid/electrolytes, may need hemodialysis
what to ask if a pt is trying to stop smoking before having an MRI
-if they're wearing a patch
diabetes from other illnesses
-illnesses/infections increase glucose levels, esp IV steroids
cranial arteritis headache
-immune initiated vasculitis
cerebral aqueduct
-in 3rd ventricle -drains into 4th ventricle
jejunostomy
-in jejunum* -foods -fluids -meds -low profile vs tubing
gastrostomy tube (PEG)
-in stomach* -stoma formation -replaced/reinserted every 3-6 months -feeds -fluids -meds -decompression* -low profile vs tubing
parenteral nutrition indications
-inability to digest foods/fluids for 7-10 days -to correct nitrogen balance from protein/electrolyte breakdown
urinary retention
-inability to empty bladder
dysarthria
-inability to get mouth to move
acute abdomen appendicitis respiratory care
-incentive spirometer -hgh fowlers to reduce strain
diverticulum post op
-incision/dressing assessment -NPO until no leakage at incision site -liquids at first -maybe NGT
monroe kellie hypothesis
-increase in any component will cause a change in volume of others -brain is compliant and can adjust -theres a point of max ability to adjust to stressors -after that point, brain can deteriorate -if brain pressure goes above 10-15 might it causes issues
after diuretic phase (AKI tx)
-increase protein and calories for energy to heal
acute kidney injury (AKI) BUN labs
-increased
acute kidney injury (AKI) CRE labs
-increased
acute kidney injury (AKI) K+
-increased
acute kidney injury (AKI) phosphate labs
-increased
s/s of shock
-increased HR -decreased BP
increased systolic pressure with unknown cause
-increased ICP most likely
amylase/lipase
-increased can cause pancreas damage
nutrition(AKI tx)
-increased carbs -spares protein for growth/healing bc protein would break down -K+ and phosphate restriction (no bananas, citrus, cantaloupes, coffee)
how is digoxin affected by low K+?
-increased digoxin can cause cardiac arrest and feels like you have the flu -need k+ to be slightly elevated at around 4
diarrhea
-increased frequency of bowel movements >3 per day -increased amount of stool >200g per day -altered consistency/looseness
diverticular disease gerontological considerations
-increased incidence with age -may delay seeking help -impaired vision- may not see blood -may be in patient instead of outpatient
decreased BP causes...
-increased renin to cause angiotensin I into angiotensin II to increase aldosterone
elderly acute kidney injury (AKI)
-increased risk bc: -dehydration -polypharmacy/toxic meds -surgery
Hep C outcomes
-increased risk chronic state -liver disease -cancer
kidney-social and fam hx
-increased risk with trauma occupation
acute pancreatitis diagnosis
-increased serum amylase and lipase -increased WBC and glucose -hypocalcemia -ultrasound studies -H and H
cushing's triad
-increased systolic pressure -decreased HR -decreased irregular RR
constipation
-increases with older age
kidney transplant complications
-infection -bleeding -GI ulcers -rejection -adrenal insufficiency if steroid use
IBD complications of surgery
-infection -bowel obstruction (nausea, abdominal distention)
kidney surgery pre op
-infection -coags -fluid if appropriate
surgical inserted feeding tubes-complications of insertion
-infection at site -skin irritation -cellulitis -bleeding -pain -dislodgement
dialysis at hospital-care
-infection control -protect access device/assess -monitor iv fluids/labs -resp/cardio assesment -VS -s/s pericarditis -blood transfusions can be done during dialysis -diet -pain -meds -support
diarrhea treatment
-infection control measures to rule out c-diff first -meds: -ABX Lomotil w/ atropine -antiinflammatories -antidiarrheals (immodium/Loperamide) -probiotics to replace good bacteria
liver abcesses
-infection that destroys liver cells
diarrhea causes
-infections -meds (ABX) -tube feeds -metabolic/endocrine disorders -other diseases
acute abdomen appendicitis
-inflammation of appendix (peritonitis) due to an obstruction or kinking that fills with puss -if not treated, becomes ischemic; overgrown with bacteria and gangrenous -common between 10-30 years
cystitis
-inflammation of bladder
cholecystitis
-inflammation of gallbladder
enteritis
-inflammation of most of descending colon
stomatitis
-inflammation of mucus, mostly in cancer -prophylactic tx is NSAIDS, mouth wash, mix of benedryl, maalox, xylocaine (magic mouth wash/BMX)
parotitis
-inflammation of parotid gland (below ear)
proctocolitis
-inflammation of rectum and part of descending colon
sialadartitis
-inflammation of salivary glands (lip, tongue, cheeks, mouth)
acute abdominal peritonitis
-inflammation of the peritoneum -can happen with a ruptured appendix, or post abdominal surgery/ c-section
proctitis
-inflammation of the rectal mucosa
acute nephritic syndrome
-inflammation of the renal capillaries -may be caused by a virus or bacteria from a previous illness and includes acute glomerulonephritis (which has as s/s hematuria, azotemia, and protenuria, and edema - cola-colored urine)
gastritis
-inflammation of the stomach -can be erosive or non erosive
IBD
-inflammation or ulceration of the bowel -crohns disease -ulcerative colitis
blood, mucus, pus stools are indicative of?
-inflammatory process
intragastric balloon for obesity
-inflated balloon into stomach to take up space -increases satiety, decreases gastric emptying
endoscopic gi-upper GI - pre
-informed consent -NPO for 8 hrs -iv sedation -left lateral position (to clear secretions and smooth scope entry) -transport home
colonoscopy pre
-informed consent -clear liquids -bowel clensing -NPO after midnight -transport home -IV sedation -left lateral position -check for pacemakers, defibrillator (may go off if electrocavlery for polyps) -side effects of prep: -n/v -dehydration -diarrhea -cramps -bloating -electrolyte imbalances (bc diarrhea)
pharmacotherapy for obesity
-inhibit absorption of fats -alter central brain receptors -increase s/s to make you feel sick after a fatty meal
acute kidney injury (AKI) phases-initiation
-initial insult/toxin/injury and oliguria -decreased urine, increased K, increased Mg begins
type 2 diabetes treatment
-initially with diet/exercise -oral hypoglycemic agents increase production/sensitivity of cells
acute kidney injury (AKI) phases
-initiation -oliguria -diuresis -recovery
nasal/oral care for intubation tubes
-inspect skin daily -change tape every 2-3 days -decrease talking -lozenges -steam/cool air -ice collar -gum/candy to moisten mouth
order of GI exam
-inspection -auscultation -percussion -palpation
order of abdominal assessment
-inspection -auscultation -percussion -palpation
parenteral nutrition
-insulin can be added -peripheral or central -if formula is >10% dextrose, increased risk irritating vein
hyperglycemia/DKA causes
-insulin deficiency -illness -missed insulin doses
pharmacological tx for type 1 diabetes
-insulin for life: -rapid (before meals, make sure tray is there) -short -intermediate (2x/day, good for 8-12 hrs, milky color) -long (@ night, good for 24 hrs) -delivery methods (pen, SQ, pumps, pancreatic transplant) -conventional regimen: 4 glucose checks a day
gestational diabetes
-insulin resistance during pregnancy from placental hormones that cause cells to resist insulin -increases risk for HTN in pregnancy
type 2 diabetes differences
-insulin resistance or impaired beta cell function -slow progressive glucose intolerance ->30 yrs
Hep B route
-intimate contact -parenteral (blood, body fluid) -oral/oral -perinatal (to baby)
types of hemorrhagic strokes
-intracranial hemmorhage -subarachnoid hemmorhage -other causes
IVFE formulas
-intravenous fat emulsion (lipids) -250-500ml -no filter needed -don't piggy back PN into IVFE (run separately at another port on primary line)
chronic kidney failure
-irreversible kidney damage, results in azotemia -will progress to end stage -will need dialysis
bariatric surgery pre op care
-is pt aware of risks/benefits? -dietary counseling (restrictions, pt should expect 10-35% weight loss over 2-3 years) -labs -mental status -life long follow ups -special screenings (sleep study.....ect)
endocrine unctions of the pancreas
-islets of langerhans -alpha cells (glucagon) -beta cells (insulin) -delta cells (somatostatin-lowers blood glucose)
hemorrhoids s/s
-itching -burning -pain -bleeding
others (oral diabetic meds for type 2)
-januvia/victoza/trulicity -stimulates pancreas to produce more insulin -given once a day
fulminant hepatic failure s/s
-jaundice -anorexia -coag. defects (bleed easily) -renal failure -electrolyte imbalances -hypoglycemia -cardiac problems -cerebral edema -infection
hepatic dysfunction s/s
-jaundice -portal HTN -ascites -varicies -hepatic encephalopathy -coma -nutritional deficiencies
teporomandibular disorders s/s
-jaw disorders-non trauma- -dull ache or throbbing pain radiating to ears, teeth, neck, face -restricted movement -change in way teeth fit together -clicking/popping sounds -headache -earaches -diziness -hearing problems -lock jaw
what to do for ICP/cerebral oxygenation
-keep BP slightly elevated to perfuse the brain -also diuretics like mannitol
15 mins
-kegal exercises
adult voiding dysfunction (urinary incontinence) behavioral therapy
-kegel exercises-15 mins -fluid managent-50-60oz -times voiding-every 2 hrs -electrical stimulation (causes contractions of pelvic muscles) -toilet 1st thing in AM
KUB
-kidney diagnostic imaging -x-ray of kidneys, ureters, bladder -sees if there are any obstructions
RBC production
-kidney releases erythropoietin which stimulates bone marrow to produce more RBCs -why renal failure pts are anemic
vitamin D and kidneys
-kidney's convert inactive vitamin D to active vitamin D -active vitamin d helps calcium get into bones
bicarb
-kidneys reabsorb bicarb from urine and return it to bloodstream -any lost bicarb can be generated from the kidney
kidney transplant post op nur-prevent infection
-labs -urine cultures -visitors -hand hygeine -major cause of death
chronic kidney failure diagnosis
-labs: -GFR -CRE over 24 hrs
functional obstruction
-lack of peristalsis due to illness -muscular dystrophy -parkinsons -diabetes
lactose intolerance treatment
-lactose tablets -yogurt -calcium and vitamin d -avoid milk and milk products
surgical management of gallstones
-laproscopic cholecystectomy -cholecystectomy -choledochostomy
liver biopsy
-laproscopic through skin
loose, semi-solid stools are from?
-large intestines
FVE meds (AKI tx)
-lasix -mannitol
urinary retention assessment
-last void -amount -dribbling -pain -distention -residual urine -restless/agitation -UTI
where is css produced
-lateral and 3rd ventricles in choroid plexus
L1-L5
-legs
central parenteral nutrition
-length of time depends on type -tunneled, non tunneled, PICC, implant port -100% nutritious -dextrose >10%* -lipids given simultaneously to prevent vein irritations -infused at higher rate*
decorticate
-lesion above brainstem -above corticospinal -responds to sternal rub by flexion of elbows, wrists, and fingers -plantar flexes feet w/ extension and internal rotation of legs
non starchy veggies
-lettuce -tomatoes
neurogenic bladder treatment
-liberal fluids -bladder retraining -meds (urecholine) -surgery -cath: continuous, intermittent, indwelling, suprapubic, condom
liver biopsy post
-lie on right side -pillow against right side (bc liver is on right, helps stop bleeding) -no coughing/straining for several hrs -vs: -10-15 mins 1 hr -30 mins 1-2 hrs until stable -no lifting/strenuous activity for 1 week
hepatic encephalopathy and coma
-life threatening complication (high ammonia levels) -accumulation of ammonia/other toxic metabolites in blood -can improve as liver function improves
management of obesity
-lifestyle modifications -pharmacotherapy -non surgical -intragastric balloon
adult voiding dysfunction (urinary incontinence) surgery
-lift/stabilize pelvic organs -periurethral bulking -TURP
pancreatic enzymes
-lipase -amylase -trypsin
pain releif for mouth disorders
-liquid/soft diet -soft toothbrush -analgesic
hepatic dysfunction-hypersensitivity states
-liver becomes allergic to itself
other liver diagnostic studies
-liver biopsy -ultrasonography -CT -MRI
hepatocellular jaundice
-liver disease
cirrhosis s/s
-liver enlargement -ascites -edema -indigestion -anemia -apider angiomas -jaundice -infection/peritonitis -varices throughout GI tract -vitamin A/C/K deficiency -mental deterioration
LFT's
-liver function tests: -serum protein studies -pigment studies -prothrombin time (PT) -serum alkaline phosphatase -serum ammonia -cholesterol
dementia
-longterm -progressive
anorectal manometry
-looks at how stool moves through colon and the pressure against it
general tonic clonic seizure
-loss of consciousness -cyanosis -foaming -incontinence
ADH level with increased water
-low ADH level to let go of water
gallstones diet
-low fat (until 4-6 weeks) -high carbs -protein
GERD tx-diet
-low fat, spicy ok -avoid: -caffine -smoking -beer -milk -mints -soda -eating/drinking 2 hrs before bed -tight clothes
urolithiasis/nephrolithiasis risk factors
-low fluid intake -infection -decreased mobility -increased Ca+ in blood/urine -IBD -antacids -vitamin c -laxatives -ASA
ascites treatment
-low sodium diet -diuretics (aldactone to decrease sodium) -bed rest/low fowlers -paracentesis -salt poor albumin -TIPS (trans jugular intrahepatic portosystemic shunt)
bright red/dark red stool
-lower gi
exercise for diabetics
-lowers blood sugar over time -hypoglycemia if blood sugar is >250 + ketones present before you exercise -check blood glucose before, during, and after -always have glucose tablets with you -have a snack after -aids in weight loss -lowers cardio risks -3x week w/ resistance training, same time of day each time at peak glucose levels -proper footwear -if BG <100 have 15g carb snack before moderate exercise to prevent hypoglycemia -older adults need physical before exercising/start slow and gradually work up to 30 mins
zollinger-ellison syndrom (ZES)
-luminal disorder -associated w/ severe cases of PUD -can lead to stomach cancer and benign/malignant pancreas tumors -excessive gastrin -cause may be related to genetics
nasogastric/nasoenteric tubes preventing pulm complications
-lung sounds -monitor for: -cough -difficulty clearing airway -proper tube placement -VS, o2% -prevent aspiration
treatment goal of diabetes
-maintain normal glucose levels -A1c <7% -no complications
dietary management of diabetes
-maintain the pleasure of eating; include personal and cultural preferences -BMI<25 -prevent glucose fluctuations -normal BP -decrease serum lipids/cholesterol/triglycerides if elevated
greasy stools are from?
-malabsorption
celiac disease
-malabsorption of products containing gluten -can happen at any time
hepatic dysfunction causes
-malnutrition from alcoholism -infection -anoxia -metabolic disorders -hypersensitivity states -nutritional deficiencies
chronic pyelonephritis s/s
-may be asymptomatic unless exaserbation -progressive kidney scarring
constipation gerontologic considerations
-may eat foods with decreased fiber because of dentures -decreased food/liquid intake -depression -multiple illnesses -bedrest -overuse of laxatives
acute abdomen appendicitis gerontological considerations
-may have no pain until perforation -s/s suggest a bowel obstruction (RLQ) -need EKG and chest x-ray to rule out pneumonia
chronic glomerulonephritis s/s
-may have none -peripheral neuropathy -neuro changes -pericarditis later on -same as chronic kidney disease
increase exercise for obesity
-may need a stress test first
types of intestinal obstructions
-mechanical -functional -small bowel -large bowel
IBS treatment/NUR care
-med management -complimentary medicine -education
perforation
-medical emergency
constipation causes
-meds -chronic laxative use -weakness -immobility -fatigue -diet -ignoring urge -lack of regular exercise
GERD tx
-meds -diet -maintain normal weight -increased HOB and upper body at least 30 degrees
PUD treatment
-meds -lifestyle changes -occasional surgery (interventions) -pain relief -decrease anxiety -promote optimal nutrition -promote fluid balance -teaching
nephrotic syndrome treatment
-meds (diuretics, antilipidemia) -diet -albumin
cholelithiasis pharmacologic therapy for gallstones
-meds to dissolve gallstones
respiratory centers
-medulla oblongata and pons, brainstem
black/tarry stool
-melena/upper gi
obesity
-metabolic disease -fat accumulation that may impair health
biguinides
-metformin/glucophage -decreases glucose production from liver -monitor kidney function -no alcohol -stop 48 hrs before contrast
primary headaches
-migraine -tension -cluster -cranial arteritis
acute pancreatitis range of presentation
-mild, self limiting, severe -fatal w/ organ failure/shock
hepatocellular jaundice s/s
-mildly/severly ill -decreased appetite -n -decreased weight -malaise -fatigue -weakness -headache -chills -fever
fecal incontinence s/s
-minor soiling -occasional urgency -loss of control -complete incontinence
UTI gerontological considerations
-mobility -incontinence -decreased muscle/bladder tone (bc estrogen) -BPH -decreased estrogen -unclean living -bacteremia
chronic gastritis treatment
-modify diet -promote rest -reduce stress -avoid alcohol/NSAIDs -antacids -H2RAs (pepcid, zantac) -PPIs (protonix, prilosec)
PUD intervention: promote fluid balance
-monitor I&O -look for s/s of dehydration -monitor for electrolyte imbalance -monitor for hemorrhage
neurogenic bladder suprapubic cath
-monitor UO, color, clarity, odor -i and O -increase fluids -assess site for s/s infection -monitor for fever, increased wbc, chills -make sure cath= secure -cover site w/ dressing/maintain closed system -can stay for several weeks -weaning
chronic glomerulonephritis nur
-monitor fluids/electrolytes -assess cardio and neuro -emotional support -educate on self care
adult voiding dysfunction (urinary incontinence) gerontological concerns
-not a usual part of aging -transient episodes -decreased estrogen -comorbidities -decreased bladder tone -meds -assess home enviro
hypochlorhydria
-not enough hydrochloric acid
7 contributing factors to dental plaque and caries
-nutrition -soft drinks -genetics -plaque -time acids are in contact -strength of acid/saliva ability to neutralize -susceptibility
cholelithiasis medical management of gallstones
-nutritional/supportive -pharmacologic -nonsurgical
sweeteners for diabetics
-nutritive/non nutritive
acute pancreatitis resp care
-o2 -ABGs -position changes -cough and deep breathing
type 2 diabetes risk factors
-obesity ->45 yrs -family hx -race -previous id of impaired fasting glucose tolerance -HTN >140/90 -HDL <35 -triglycerides >250 -hx of gestational diabetes or babies >9 lbs -metabolic syndrome
urolithiasis/nephrolithiasis (urinary tract stones) post lithotripsy care
-observe for obstruction of urine flow -infection -hematuria common for several days -strain all urine and send to lab -education (diet, strain, blood in urine)
portal HTN
-obstructed blood flow through liver that causes increased pressure throughout portal venous system
Crohn's Disease complications
-obstruction -perianal disease -malnutrition -fistulas -abscesses -fluid/electrolyte imbalances
anorectal abscess
-obstruction of anal gland resulting in infection
gastric outlet obstruction (GOO)
-obstruction of the pylorus and duodenum
ketones
-occcur from breakdown of fats/fatty acids -urine/blood test (trace/small/large, +/-) -check with any sign of illness -tx: fluids -check 2 times a day -can put you into metabolic acidosis -greater risk for type 1 diabetic
diverticular disease
-occurs anywhere in the intestines but common in the sigmoid colon -little pockets form -increases with age -associated with decreased fiber diet
CN 3 (III)
-oculomotor -midbrain -motor -eye movement
cranial nerves in midbrain
-oculomotor III -trochlear IV
parotitis at risk
-older -ill (bc decreased saliva from meds)
CN 1 (I)
-olfactory -midbrain -sensory -smell
bariatric surgery
-only after non surgical methods failed -its permenent/life long commitment
pyloroplasty
-open pylorus and clean/reshape, then close
acute pancreatitis pain management
-opioids
CN 2 (II)
-optic -midbrain -sensory -vision
loss of direct pupillary light reflex/vision cranial nerve
-optic II
cranial nerves in cerebral hemisphere
-optic II -olfactory II
Hep A route
-oral/fecal -oral/anal
amebic
-organism from developing countries in tropics -related to liver abcesses
GI intubation tubes
-orgogastric -nasogastric -levin -nasoenteric -salem pump
IBD surgery treatment
-ostomy (ileostomy or colostomy)
how csf moves
-out of capillaries -below cerebellum -circulates in brain/spinal cord -through arachnoid villi -into blood in dural sinuses to heart
GI common symptoms
-pain -dyspepsia/indigestion -intestinal gas -blood in stool
cholecystitis s/s
-pain -ragidity of RUQ -right shoulder pain -n/v
majority of renal trauma are in shock
-pain -renal colic from clots/fragments -hematuria -swelling -flesh wounds -hypovolemia -bleeding
ESRD-end stage renal disease s/s
-pain -restless leg syndrome -burning feet -increased BUN/CRE -Na+/water retention -acidosis -anemia -Ca+ and phosphate imbalance
sialadartitis s/s
-pain -swelling -purulent drainage*
cholelithiasis s/s
-pain (binary colic, n/v, hrs after eating) -RUQ pain radiating to right shoulder -fever -reselessness -jaundice -change in urine (dark) -change in stool (grey/clay) -vitamin ADEK deficiency
UTI nur
-pain (heating pad, analgesics, antispasmodics) -fluids -frequent voiding -diet (no sugary foods) -monitor WBC/temp
acute abdominal peritonitis s/s
-pain aggravated by movement -tenderness/rebound tenderness -distention -paralytic ileus -anorexia, n/v -fever -increased HR -may become hypotensive
acute abdomen appendicitis discharge instructions
-pain control -activity level (no heavy lifting) -incision care -s/s to report -follow up -meds -diet
obesity surgery post op NUR care
-pain management -IVF advanced to clear liquids -psychosocial support -pt diet teaching -diarrhea/constipation
acute pancreatitis medical/surgical care
-pain management -critical care modalities -resp care -nutritional support -billiary drainage/skin assessment -surgical procedures
urolithiasis/nephrolithiasis (urinary tract stones) key things
-pain management -strainer
urolithiasis/nephrolithiasis (urinary tract stones) treatment
-pain management: -opioids -NSAIDS -heat -strainer -fluids 3L/day -UO of >L/day is good -lithotripsy -surgery -endoscopic procedure
meds you can give for hemodialysis
-pain meds -insulin
diverticular disease pain interventions
-pain meds: -analgesics (opioids) -antispasmotics -ABX -IVF -NGT to reset bowel
PUD planning
-pain relief -decrease anxiety -avoid irritating foods -adequate nutrient intake -fluid balance maintenance -aware of disease process and dietary management
tenesmus
-painful straining -feeling like you have to poop but nothing comes out
dysuria
-painful urination
Rovsing's sign
-palpate LLQ=pain RLQ
central processing center
-parietal lobe -primary sensory cortex
salivary gland disorders
-parotitis -sialadartitis
dialysate
-part of mixture that passes through membrane and goes into blood
chyme
-partially digested food mixed w/ gastric secretions
IBS complimentary medicine
-peppermint oil -probiotics
-major complication to monitor for after a colonoscopy
-perforation
preventing CAUTIs
-perineal care -clea/new cath if not in on 1st try -cath in <= 3 days -WBC labs -closed system
acute abdomen appendicitis complications
-peritonitis: -usually 24 hrs after onset of pain -s/s: -toxic look -pain -found supine and motionless
nasogastric/nasoenteric tubes preventing FVD
-I and O of all fluids/drainage -monitor for: -dry skin/mucous membranes -hypotension -lethargy -decreased CO -increased HR -lightheadedness
The nurse is caring for a client who had an intragastric balloon placed 5 months ago for the treatment of obesity. The client's abdominal girth has increased over the past 48 hours and the last bowel movement was 72 hours ago. What is the nurse's best action?
Report the possibility of balloon rupture to the primary provider
The nurse is caring for an acutely ill client. What assessment finding should prompt the nurse to inform the physician that the client may be exhibiting signs of acute kidney injury (AKI)?
The client's average urine output has been 10 mL/hr for several hours.
A nurse is caring for a newly admitted client with a suspected GI bleed. The nurse assesses the client's stool after a bowel movement and notes it to be a tarry-black color. This finding is suggestive of bleeding from what location?
Upper GI tract
The nurse is caring for a client whose acute kidney injury has a post-renal cause. What most likely caused this client's health problem?
Ureterolithiasis
nur-diabetes
VS I+O Telemetry/EKG Labs Skin assessment Oral care Cardiac/Resp /Bowel assessment Mental status check/cerebral edema
clinical characteristics of diabetes
-polyuria -polydipsia -polyphagia -fatigue -weakness -vision changes -tingling/numbness in hands/feet -dry skin -skin lesions/wounds that are slow to heal -recurrent infections -type 1 can have sudden weight loss/are thin
hepatic encephalopathy and coma causes
-portal HTN -too much shunting of blood from portal to systemic (liver failure)
paracentesis
-removal of fluid from abdomen to send to lab for analysis -can be done for ascites -5-6L = safe to remove -used w/ albumin infusions
orgogastric intubation tube
-removal of gastric contents
antrectomy
-remove antrum of stomach
craniectomy
-remove brain
sclerosis
-renal artery/vein gets blocked w/ plaque and inhibits perfusion
UTI complications
-renal failure -sepsis/urosepsis -strictures/obstructions w/ BPH -CAUTI (catheter associated UTi)
urolithiasis/nephrolithiasis s/s
-renal stones -ureter stones -bladder stones
chronic glomerulonephritis causes
-repeated acute glomerularnephritis -HTN nehrosclerosis -hyperlipidemia -glomerular damage
cirrhosis
-replacement of normal tissue w/ fibrosis -alcoholic cirrhosis is most common but can occur in non alcoholics
acute abdomen appendicitis post op NUR care
-resp -pain -FVD -anxiety -infection -skin -nutrition
NUR management of obesity
-respect -courteous -empathetic -get rid of biases -IV insertion may be difficult -may need increased med doses -may need special equipment (beds, lifts, commodes)
diarrhea pt teaching
-rest -diet and fluid intake -no irritating foods (caffeine, carbonated drinks, v hot/cold) -avoid milk, fat, whole grains, fresh fruit/veggies -perianal skin care -meds -lactose intolerance
Hep A tx
-rest -fluids -increased nutrition if decreased weight -avoid etoh -hand hygiene
Ca+ stones diet
-restrict Na+ -2mg/day -Na+ increases Ca+
hemodialysis diet
-restrict protein and Na+ -fluid restriction (500ml + output for day) -K+ restriction -<1.5 kg weight gain per day
bariatric surgery exclusion criteria
-reversible causes (thyroid issue) -drugs/alcohol -psychiatric illness -lack of comprehension of risks, benefits, post op care
acute pancreatitis assessment
-review hx of abd pain -risk factors -phys exam
rapid insulin
-right before meals -make sure tray is there
parkinsonism gait
-rigid/bradykinesia -head stooping, neck forward
chronic kidney failure elderly
-risk factors: -polypharmacy -OTC -dehydration -comorbidities
diverticular disease complications
-rupture -perforation -bleeding -peritonitis if ruptured -abscess (steroids/ABX)
subarachnoid hemorrhage
-ruptured cerebral aneurysm or ruptures AVM
diverticulum
-sac like herniation of bowel lining that extends through a defect in the muscle layer -outpouching of mucosa
agents that breakdown barrier in bladder
-saccharin -aspirtame -tryptophan
PUD intervention: promote optimal nutrition
-same as gastritis + 3 regular meals and avoid too hot/cold food/drinks
lower GI imaging/ barium enema x rays
-same as upper pre and post -possible frequent BMs from barium -possible cramping from air
glucose tolerance test
-see how much sugar it takes to raise blood sugar to a high level
angiography
-sees buldging/narrowing -takes longer -not done for emergencies -occlusions -stenosis -aneurysm -DVT/PE
liver abcesses s/s
-sepsis -fever -chills -malaise -n/v -jaundice -abd.pain RUQ -enlarged liver -anemia -pleural effusion
acute abdominal peritonitis complications
-sepsis -intestinal obstruction
celiac disease diagnosis
-serologic tests for immunoglobulin A -biopsies
vagotomy
-sever vagus nerve to decrease acid secretion
acute pancreatitis s/s
-severe abd. pain, back pain, tenderness -pain after meals/alcohol -abd. distention -n/v -decreased peristalsis -hypotension -hypovolemia from shock -resp distress
s/s penetration/perforation in PUD
-severe upper abdominal pain -can refer to shoulder -vomiting and collapse -tender, board like abdomen -s/s of shock/ impending shock
insulin and Ca+ (AKI tx)
-shifts K+ back into cells to decrease K+ levels
UTI prevention
-shower no baths -front to back wipe -pee after sex -avoid coffee/tea/alcohol -void every 2-3 hrs -limit cath use
Hep C s/s
-similar but less severe than hep B
levin intubation tube
-single lumen, no vent
spastic paraplegia
-sissers gait -crossing legs -cerebral palsy/MS
anorectal abscess treatment
-sitz baths -analgesics -surgery
kidney surgery circulation
-skin color -temp -UO -incision -drains/tubes
nasogastric/nasoenteric tubes contraindications
-skull fractures -transphenoidal/maxillofacial surgery -facial trauma -coag. impairment -esophageal varices w/ caution
special screenings for obesity
-sleep study (to ensure airway before anesthesia) -UGI series -EKG -vitamin levels -LFTs -glucose -CBC -electrolytes
dumping syndrome prevention
-slow the feed -feed at room temp -continuous drip -1 hr semi fowlers -minimal flushing amount
30mins-4 hrs after meal
-small intestine does further breakdown w/: -pancreatic enzymes -bile -peristalsis: segmentation and contractions (churning)
watery stool is from?
-small intestines
neuro deficits from stroke
-visual loss/peripheral visual loss/diplopia -homonymous hemoplegia -motor (hemiparesis, hemoplagia, ataxia, dysarthria, dysphasia) -sensory(paresthesias opposite of lesion) -expressive/receptive/global aphasia -cognitive (memory loss, decreased attention/concentration/reasoning/judgement) -emotional (disinhibition, liability, decreased stress tolerance, depression, withdrawal, fear, hostility, anger, isolation)
FOTB-fecal occult blood testing false negatives
-vitamin c
what reverses coumadin/warfarin
-vitamin k
adult voiding dysfunction (urinary incontinence) assessment
-voiding hx -UA/UC -residual check -maybe transient/reversible
cholelithiasis nur-post op
-vs -gag reflexes -s/s perforation/infection -effects of meds
mcburney's point
-w/ appendicitis -local tenderness occurs there
factors that increase obesity morbidity
-waist circumference -apple shape (fat accumulation around heart)
steppage gait
-weak dorsiflexion so foot doesnt drag on floor
indicator of fluid loss/gain
-weight (main)* -1L= 2.2 lbs -FVD -FVE
lifestyle modifications for obesity
-weight loss -increase exercise -behavioral modification
constipation pt teaching
-whats normal -establish normal pattern -dietary fiber and fluid intake -respond to urge -exercise and activity -do not use laxatives
anaerobic respiration
-when briain stops doing aerobic respiration -happens in neuron issues -lactic acid is byproduct
cerebellar gait
-wide base -falls to one side
sensory ataxia gait
-wide base -high steps
how to treat bile reflux
-with cholestyramine -it binds w/ bild acid
deceberate
-worse -lesion below brainstem -below corticospinal -brainstem affected -mechanical ventilation -flex wrists -clench jaw -arch back -plantar flex and extend neck
C6
-wrist
nasogastric/nasoenteric tubes confirmation of placment
-x ray*** -placment is confirmed before feeds, meds, 1x per shift done by: -measureing tube length -assessing aspirate -PH testing -air auscultation -end tidal CO2 detector
small bowel obstruction diagnosis
-x-ray -CT -labs
large bowel obstruction diagnosis
-x-ray -CT -labs -MRI -colonoscopy
jaundice
-yellow/green tinges body tissues -sclera and skin -from increased bilirubin levels
hypo reflex
1
diarrhea gerontological considerations
-they are at increased risk for: -dehydration -low K+ -muscle weakness -paralytic ileus -dysrythmias -teach s/s of hypokalemia -digoxin affected by low K+
types of ischemic strokes
-thrombotic -embolic -lacunar -cryptogenic
perforation/penetration in PUD
-through stomach wall -can cause peritonitis -requires immediate surgery
self monitoring blood glucose (SMBG)
-tight control: 2-4 times per day if on insulin -70-130 pre meals -<180 2 hrs post meal -A1c7% -low levels of insulin all the time, extra with meals -long lasting insulin at night -complications: weight gain/hypoglycemia
every 2 hrs
-times voiding
acute pancreatitis surgical procedures
-to detect or decried necrotic tissue -lef topen to drain -removes bad part and attaches rest to small intestine to drain
chronic kidney failure treatment
-to prevent complications -treat cause -follow ups -control cardio risk factors (HTN. CAD) -monitor glucose and labs -stop smoking -restrict Na+ and alcohol
fulminant hepatic failure plasma exchanges
-to treat coag issues and decrease ammonia levels
behavioral modification for obesity
-to work on not always focusing on food
hyperchlorhydria
-too much hydrochloric acid (eats away at stomach lining)
hypoglycemia causes
-too much insulin w/ too little food -excess exercise -elderly: -decreased kidney function -took insulin but skipped meals -eyesight/can dose wrong -knowledge of s/s
polyuria
-too much urine output -common w/ diabetes
chronic pancreatitis
-perminent irreversible damage to pancreas -progressive dysfunction of pancreas -increased pressure within pancreas causes: -obstruction of pancreatic bile ducts -destruction of recreating pancreatic cells
headache medical management
-pharmacological therapy -select meds best for each type -interventions focused on pain relief
toxic chemicals that cause non viral hepatitis
-phosphorus -carbon tetrachloride -gold compounds
parenteral nutrition complications
-pneumothorax -air embolism -clotted catheter -displacement/contamination -sepsis -hyperglycemia -fluid overload -rebound hypoglycemia
TNA formulas
-total nutrient admixture -3 in 1 solution -IVFE and components of PN -cost effective (1 bag , 1 line) -requires filter and inspection of bag
Ulcerative Colitis complications
-toxic megacolon (if unresponsive after 72 hours need surgery) -perforation -bleeding
anal fistula
-tract that forms into the anal canal from an opening outside the anus in the perianal skin -requires surgery
TIPS/transjugular intrahepatic pontosystemic shunt
-transjugular intrahepatic pontosystemic shunt -put btwn portal circulation and hepatic vein -done to reduce portal HTN -extremly effective for ascites
Role of Insulin
-transports/metabolizes glucose for energy -stimulates glucose storage in liver/muscle as glycogen -signals liver to stop releasing glucose -enhances storage of fat in adipose -accelerates amino acid transport into cells -inhibits breakdown of stored glucose/protein/fat
routes of infection uti
-transurethral -bloodstream -intestinal fistula
fecal incontinence causes
-trauma -neurologic disorder -inflammation/infection -chemo -fecal impaction -pelvic floor relaxation -laxative abuse -meds -increased age
flaccid neurogenic bladder
-trauma to lower spine -DM -bladder is overdistended w/ overflow incontinence -sensory loss -weak bladder contractions
bleeding of esophageal varices treatment
-treat shock -oxygen -IV electrolytes/volume expanders -blood/blood products -foley -vasopressin, somatostatin, ocreotide, nitroglycerin, vasopressin -prophylactic treatment -endoscopic sclerotherapy -tips procedure
C7
-triceps
CN 5 (V)
-trigeminal -pons -sensory -motor -face sensation/chewing
cranial nerves in pons
-trigeminal V -abducens VI -agoustic/vestibulocochlear VIII
CN 4 (IV)
-trochlear -midbrain -motor -moves eye
choledochostomy
-tube placed after stones are removed -for drainage
assessments for feedings for intubation tubes
-tube placement -formula tolerance (residual checks, N/v/d) -labs -s/s FVD -I and O -glucose levels -weekly weight -infection control -bowel elimination
nasogastric/nasoenteric tubes preventing aspiration
-tubes placed below pyloric valve are lower risk -semi fowlers 30-45 degrees for 1 hr post bolus (all the time if continuous feeds) -meds to decrease regurgitation
mechanical obstruction
-tumors -abscesses -foreign objects -intusseption -adhesions
celiac disease: those at risk
-type 1 diabetes -downs syndrome -turner syndrome -familial risk
acute kidney injury (AKI) diagnosis
-ultrasound -labs: -BUN, CRE, phosphate, GFR, Ca+, H/H, specific gravity -hyperkalemia -metabolic acidosis, acidosis, resp acidosis
GI interventions
-ultrasound -upper GI imaging/x rays -lower GI imaging/barium enema x rays -CT scan -MRI -endoscopic interventions (upper GI, colonoscopy)
chronic pancreatitis medical management
-understand etiology -focus on preventing acute episodes -pain relief (non opioid, yoga, antioxidants) -manage endocrine and exocrine insufficiencies (DM, gallstones, ect)
chemical burns causes/s/s
-undissolved meds -ingested material -may also have burns of: -lips -mouth -throat -airway -swelling of airway -shock -fever
hemiplegic gait
-unilateral weakness -swings leg around -strokes/brain tumors
cryptogenic stroke
-unknown mechanism
pancreas
-upper abdomen -enzymes go through pancreatic duct to common bile duct to duodenum -exocrine and endocrine functions
waste products
-urea -creatinine -sulfates -phosphates
what waste products do the kidneys excrete
-urea -drug metabolites -uric acid -creatinine -phosphates -sulfites
diarrhea s/s
-urgency -perianal discomfort -incontinence -a combo of above -increased frequency and fluid contents -watery, loose, semi solid, greasy, blood, mucus, pus -abdominal cramps -distention -borborygmus (bowel noises/rumbling) -painful spasmodic contractions of anus -tenesmus
UA
-urine analysis -not sterile
UC
-urine culture -sterile
chronic glomerulonephritis diagnosis
-urine w/ fixed specific gravity/casts -proteinuria -hyperkalemia -metabolic acidosis -anemia -hypocalcemia -hyoalbuminemia -enlarged heart -pulm. edema
defecography and colonic transit studies
-use fluoroscopy to watch process of defecation through colon and rectum
diverticular disease s/s
-usually chronic constipation -often asymptomatic -may have bowel irregularities: -nausea -anorexia -bloating -abdominal distention -mild to severe pain in LLQ -n/v -fever -chills -leukocytosis
non surgical for obesity
-vagal blocking -decreases cravings, increases satiety
surgical procedures for PUD
-vagotomy -pyloroplasty -anastomosis -antrectomy
CN 10 (X)
-vagus -medulla -gag reflex/ns innervation
toxic meds for acute kidney injury (AKI)
-vancomycin -gentamicin -cyclosporin -amphotericin B -NSAIDs -radiocontrast
BP regulation
-vasa recta vessels sense changes to release/suppress renin
prostaglandins
-vasodilators and vasoconstrictors help control renal blood flow
lateral ventricles
-ventricles 1 and 2
bile
-very concentrated -composed of: -water -electrolytes -fatty acids -cholesterol -bilirubin -bile salts
lacunar ischemic stroke
-very small vessel of brain progressively narrows until its completely occluded
thrill
-vibration
diagnosis for crohn's and UC
-video capsule -proctosigmoidoscopy -colonoscopy -x-rays, CT, ultrasound, MRI -stool study -barium enema -CBC for electrolytes -albumin protein (indicated nutritional status, keeps fluid in bloodstream) -ESR
fulminant hepatic failure causes
-viral hepatitis -meds -chemicals
A patient is diagnosed with viral hepatitis and complaining of 'no appetite' and 'losing my taste for food'. What instruction should the nurse give the patient to provide adequate nutrition?
Increase intake of fluids, including juices
A nurse is caring for an older adult who has been experiencing severe Clostridium difficile-related diarrhea. When reviewing the client's most recent lab tests, the nurse should prioritize what finding?
Potassium level
A nurse is caring for an older adult who has been experiencing severe Clostridium difficile-related diarrhea. When reviewing the client's most recent laboratory tests, the nurse should prioritize what finding?
Potassium level
Which of the following components of a UA would be above the normal level if a person had a fever, exercised too much, or was standing in one position for a prolonged period of time?
Protein
where is pain in Crohn's Disease
RLQ
where is the pain in acute abdomen appendicitis
RLQ
A client with liver disease has developed ascites; the nurse is collaborating with the client to develop a nutritional plan. The nurse should prioritize which of the following in the client's plan?
Reduction in sodium intake
cirrhosis education
-AA -counseling -lifestyle changes -home care -s/s progression
acute pancreatitis critical care modalities
-ABGs -insulin -i and o -cough and deep breathing
proctitis treatment
-ABX -antivirals -antiamebics
constipation diagnosis
-Hx and phys exam -barium enema w/ pics -sigmoidoscopy -stool testing -defecography and colonic transit studies -MRI
status epilepticus
-associated w/ neuron death -seizures >5 mins
cycling
-at night
PUD assessment
-Hx and presenting s/s -smoking/alcohol use -NSAID use -dietary Hx and association w/ s/s (72 hr diet) -abdominal assessment
long insulin
-at night -good for 24 hrs
gallstone surgery complications
-atelectasis -skin breakdown -bleeding -abdominal rigidity -n/v -infection
CN 8 (VIII)
-auditory -pons -sensory -hearing/balance
renal trauma types
-blunt -penetrating
stroke management
-<10 mins from door to evaluation -<15 mins to stroke team notified -<25 mins to CT -<45 mins to read CT -<60 mins from door to needle -<3 mins to monitored bed
H/H
-<12/37 (females) -<14/42 (males) - considered anemia and abnormal.
normal brain pressure
-<15
stage 4 end stage kidney disease urine amount
-<15 mls
constipation s/s
-<3 BMs per week -abdominal distention -decreased appetite -headache -fatigue -indigestion -sensation of incomplete BM -straining -elimination of small volume, har, dry, stools
oliguria
-<30mls per HOUR -not enough urine output
anuria
-<50 mls in 24 hours (1 DAY) -not enough urine -often in dialysis patients
bacteriuria uti
->100,000 bacteria in urine -e. coli most common
fasting glucose diabetes
->126 mg
embolic ischemic stroke
-clot within heart or major vessel -dislodges and becomes lodged in vessel in brain
nasogastric intubation tube
-nose to stomach -decompression -lavage -drainage/suction -meds -feedings/fluids
fecal incontinence diagnosis
-Hx to determine etiology -rectal exam -endoscopic exam -radiography studies -barium enema -CT/MRI -anorectal manometry
benign tumors nur
-assessment -adequate nutrition -no aspiration -releive pain -education
intracranial hemmorage
-associated w/ HTN
A client has been admitted to the hospital after diagnostic imaging revealed the presence of a gastric outlet obstruction (GOO). What is the nurse's priority intervention?
- Insertion of an NG tube for decompression
paracentesis VS
- Q 15x for 1 hr -Q30x for 2hrs -Q4hrs
kidney transplant
->99,000 on list -donor can be dead or alive, related or not -damaged kidney left in -new kidney put in pelvic ilium -dialysis the day before -urine right after blood supply is established -psychosocial eval -care of donor/fam
chronic pyelonephritis tx/nur
(if hospitalized) -prophylactic ABX -3-4 L fluid/day -VS Q4 hrs -antipyretics -frequent bladder emptying -perineal hygiene
A nurse is caring for a client who has been admitted to the hospital with diverticulitis. What would be appropriate nursing diagnoses for this client? SELECT ALL THAT APPLY.
* Acute pain related to increased peristalsis and GI inflammation * Deficient fluid volume related to anorexia, nausea, and diarrhea * Activity intolerance related to generalized weakness
hep vaccine available
-A -B
transient ischemic attack (tia)
- a small clot blocking a brain artery that resolves itself usually within an hour -there is no evidence of it on a CT scan because it dissolves quickly. - It can take longer to regain whatever function was effected (speech, mobility, etc). -It can be a warning sign of a stroke or CVA to come. -A brief stroke-like attack that, despite resolving within minutes to hours, still requires immediate medical attention to distinguish from an actual stroke.
hypoglycemia s/s
-(adrenergic s/s): -sweating -tremors -tachycardia -hunger -headache -lightheadedness -confusion -decreased LOC -numbness of lips/tongue -slurred speech -double vision -drowsiness
chronic gastritis causes
-*stomach ulcers (benign/malignant/H. pylori) -*autoimmune diseases -diet (coffee) -meds (NSAIDs, steroids)(erosive) -alcohol (erosive) -*smoking -*chronic pancreatic secretion/bile reflux -radiation
alcohol for diabetics
-1 per day women -2 per day men -always eat something -major side effects: hypoglycemia -weight gain -increases BG
diverticular disease surgery interventions
-1 stage resection -hartman's procedure
uti ABX short term
-1,3,7 days
hepatic encephalopathy and coma stage 1
-1-normal LOC w/some lethargy/euphoria
hepatic encephalopathy and coma stages
-1-normal LOC w/some lethargy/euphoria -2-increased drowsiness/disorientation -3-stupor/difficult to arouse -4-comatose
normal specific gravity
-1.010-1.025
liver biopsy vs
-10-15 mins 1 hr -30 mins 1-2 hrs until stable
BUN to creatinine ratio
-10:1 -should have 10x more BUN than creatinine
prothrombin time (PT)
-12-16 seconds
insulin to correct acidosis tx for hyperglycemia/DKA
-12-24 hrs continuous insulin drip -IV 100 units regular/short acting w/ 100ml NS -puts K+ back into cells/decreases K+ levels -hourly BG -special priming instructions (prime line then prime out 20-50 mrs bc insulin can stick to tubing)
Hep C incubation
-15-160 day incubation
15/15 rule if pt cant swallow/is in hospital:
-1mg glucagon SQ/IM -25-50ml D50W IV push as fast as possible
4 ventricles in brain
-2 lateral ventricles -3rd and 4th ventricles
epilepsy diagnosis
-2 or more seizures w/ out a known cause
hepatic encephalopathy and coma stage 2
-2-increased drowsiness/disorientation
renal function tests
-24 hour creatinine clearance -CRE (creatinine) -BUN (blood urea nitrogen) -GFR -BUN to creatinine ratio
how to measure creatinine clearance
-24 hour urine: -discard 1st void -pee into jug on ice for 24 hours -blood tested at 12 hours
stroke risk factors
-2x as likely after 55 yrs old -african americans -hispanics -whites -hereditary -phys. inactivity -obesity -oral contraceptives -alcohol/drug abuse -hypercoaguable -infection/inflammation -hyperthrombocytopenia
intermediate insulin
-2x/day -good for 8-12 hrs -milky color
hepatic encephalopathy and coma stage 3
-3-stupor/difficult to arouse
timing of food journey
-30 mins/several hrs after meal stomach breaks down food w/acids/secretions/enzymes -30 mins/4 hrs after meal small intestine does further breakdown w/ pancreatic enzymes, bile, peristalsis, segmentation and contractions (churning) -4 hrs after meal ascending colon mixes food w/ bacteria for more breakdown via slow peristalsis and absorbs major nutrients, fluids/electrolytes -after next large meal theres strong intermittent peristalsis that moves waste and continues absorption -12 hrs after it goes into rectum and stimulates deflation -3 days after there may be 25% left in colon
hyperglycemia/DKA s/s
-300-1000BG -dehydration from polyuria -metabolic acidosis from ketones -acetone breath -poor appetite -n/v -abdominal pain -increased RR (Kussmaul's-rapid/deep) -decreased BP bc dehydration -change in mental status from dehydration
when does food reach stomach
-30mins-several hrs after meal
water flushes for intubation tubes
-30ml -before and after meds or bolus feeds -after residual check -every 4 hrs w/ continuous feeding -min: 1x day if not being used
obesity surgery post op NUR care: IVF advanced to clear liquids
-30ml every 15 mins
Hep A incubation
-4-6 wks until s/s
hepatic encephalopathy and coma stage 4
-4-comatose
acute kidney injury (AKI)
-40-90% mortality -rapid loss of renal function due to damage -comes on suddenly ->50% increase in creatinine -urine output/volume changes -oliguria -anuria
acute kidney injury (AKI) classifications: RIFLE
-5 categories -Risk -Injury -Failure -Loss -ESKD
paracentesis amount removed
-5-6L is safe amount
peripheral parenteral nutrition-PPN
-5-7 days* -less nutritious -dextrose <10%* -lipids given simultaneously to prevent vein irritations
uti ABX long term
-6-7 months
normal urine output
-60ml/kg/hr
what should BG be before meals for a diabetic
-70-130
acute pancreatitis risk factors
-80% of pts have: -gallstones -alcoholsim -mumps -bacteria
acceptable weight gain to allow for dialysis
-<1.5 kg/day
intracranial hemorrhage
-associated w/ HTN
medical surgical care for increased ICP
-ABX -diazepam -CT, MRI, angiography, transcranial doppler -antiseizure meds -corticosteroids -fluid restriction -hyperosmotic agent (mannitol) -diuretics to decrease cerebral edema -baseline neuro assessment -assess pt/fam understanding of surgery -info, reassurance, support
sialadartitis treatment
-ABX -warm compress -hard candy/leon juice to stimulate saliva
UTI tx
-ABX (short/longterm) -vitamin c to acidify urine -unsweetened cranberry juice -probiotics -analgesics, antispasmodics -pyridium (decreases acid level, increased ph, turns urine orange, decreases burn)
acute pyelonephritis tx
-ABX >= 2 wks -iv ABX if in patient -increased fluids -follow up UC
A nurse is caring for a client who has been admitted to the hospital with diverticulitis. What would be appropriate nursing diagnoses for this client? Select all that apply.
-Acute Pain Related to Increased Peristalsis and GI Inflammation -Activity Intolerance Related to Generalized Weakness -Deficient Fluid Volume Related to Anorexia, Nausea, and Diarrhea
hypoglycemia
-BG<70
when diabetics cant exercise
-BG>250 -ketones in urine
bariatric surgery selection factors
-BMI -failed non surgical methods -post op care compliance -ability to perform ADLs -support system
no hep vaccine available
-C -D -E
acute gastritis labs/tests
-CBC -stool analysis -H. pylori test -upper endoscopy -gastric resection surgery (to remove a pyloric obstruction/diseased tissue)
GI cancer markers
-CEA -alpha fecal protein
cholelithiasis risk factors
-CF -DM -frequent weight changes -estrogen therapy -obesity -rapid weight loss -multiple pregnancies
ESRD-end stage renal disease treatment
-Ca+ and phosphate binders -antihypertensives -anticonvulsants -erythropoetin w/ dialysis -diet
urolithiasis/nephrolithiasis (urinary tract stones) diet
-Ca+ stones -oxalate stones -uric acid stones -fluids 1-2 hrs
anorectal abscess most at risk
-Crohn's Disease -AIDS
weight loss for obesity
-DASH diet (for HTN) -Mediterranean diet (fish/veggies) -cut carbs, red meat -eat fruits/veggies/olive oil
hyperglycemia
-DKA happens quickly -absence/inadequate amount of insulin -increase in breakdown of fats/fatty acids into ketones
causes of chronic kidney failure
-DM -HTN -chronic glomerularnephritis -pyleonephritis -other infections -urinary obstruction -hereditary lesions -vascular disorders -meds/toxic agents
A client with ESKD is scheduled to begin hemodialysis. The nurse is working with the client to adapt the client's diet to maximize the therapeutic effect and minimize the risks of complications. The client's diet should include what modifications? Select All That Apply.
-Decreased protein intake -Decreased sodium intake -Fluid restriction
neuropathy-autonomic-GI
-Delayed emptying, N/V, bloating, diarrhea/constipation -Tx: low fat diet, frequent small meals, medications
hepatic encephalopathy and coma assessment
-EEG -LOC changes/frequent neuro checks -asterixis (flapping tremor of hands) -constructional apraxia -deep tendon reflexes -potential seizures -fetor hepaticus (fecal breath odor) -fluid/electrolytes/ammonia level
chronic pancreatitis assessment and diagnosis
-ERCP -MRI -CT -ultrasound studies -glucose tolerance test
chronic pyelonephritis complications
-ESRD -HTN -kidney stones
neuropathy-autonomic-sexual dysfunction
-Erectile dysfunction, ↓libido, vaginal itching, impotence -Tx: medications
nasogastric/nasoenteric tubes complications
-FVD -pulmonary (impaired cough, aspiration) -tube irritations
Diabetics and Surgery
-Frequent BG monitoring pre-op and post-op (hypo/hyperglycemia) -AM insulin dose is Held unless BG > 200 -Hold metformin for 48 hours before -IV D5W -Insulin may be needed for a poorly controlled Type 2 -NPO -Clear liquids -Monitor for complications (cardiac (MI), infection, skin breakdown)
stage 4 chronic kidney failure
-GFR 15-29
stage 3 chronic kidney failure
-GFR 30-59
stage 2 chronic kidney failure
-GFR 60-89
stage 5 chronic kidney failure
-GFR <15 -ESKD -once GFR <15 you need dialysis
ESRD-end stage renal disease
-GFR <15% -affects every body system -desn't go away
stage 1 chronic kidney failure
-GFR >90
cholesterol levels
-HDL -LDL
kidney transplant contraindications
-HTN -malignancy -peripheral vascular disease -COPD -DM -HIV active infection -obesity -substance abuse
acute nephritis syndrome complications
-HTN encephalopathy -HF -pulm. edema
If the patient were a Type 2 Diabetic scheduled for an IVP, which of the following would be important interventions for the nurse to perform? Select All That Apply
-Hold glucophage -Check kidney function tests -Check for allergies -Administer fluids after the test
acute abdomen appendicitis diagnosis
-Hx and phys -CBC -UA -abd. x-ray -if female, pregnancy test to rule out ectopic pregnancy (similar s/s)
malabsorption diagnosis
-all we need to know is that these are tests that check for malabsorption: -fat analysis of stool -D-xylose absorption tests -hydrogen breath test for carb absorption -schilling test for B12 -lactose intolerance test -CBC -pancreatic function tests -endoscopy w/ biopsy -ultrasound -CT -radiography
insulin complications
-allergic -lipodystrophy (scar tissue) -resistance to insulin -hyperglycemia (waning, dawn phenomenon, somogyi effect)(tx: adjust insulin/snacks before bedtime)
obesity surgery post op NUR care: psychosocial support
-allow pt to express fear of concerns/greif -allow pt to participate in decisions -include fam/sig others -referrals
IBS s/s
-alteration in bowel patterns -pain -bloating -abdominal distention -possibly: -backaches -lethargy -urinary frequency
Barrot esophagus
-altered lining, precursor to cancer
chemical burns priority
-always manage airway first
ammonia conversion
-ammonia to urea -increased ammonia affects brain
ESRD-end stage renal disease complications
-anemia -bone disease -hyperkalemia -Htn -pericarditis
urinary retention causes
-anesthesia -DM -BPH -pregnancy -tumors -spinal cord injuries -meds
things that cause brain to exceed 10-15mm/hg pressure
-aneurysms -hydrocephalus -status epilecticus -intraventricular hemorrhage
anorectal conditions
-anorectal abscess -anal fistula -anal fissure -hemorrhoids -proctitis -pilonidal sinus/cyst
peritonial dialysis
-another type of renal replacement therpay -removes toxic substances and metabolic waste and replaces with new -re establishes normal fluid/electrolye balance -peritoneal membrane is semi permeable (ultrafiltration and perineal cath)
cirrhosis tx
-antacids -vitamins A/C/K -nutritional supplements -folic acid/iron -meds (diuretics, H2 blockers, statins, ACE inhibitors, immunosuppressants) -thistle milk (herbal that treats jaundice) -SAM-E (an antioxidant)
GERD tx-meds
-antacids (tums, maalox) -PPIs (prilosec, protonix) -H2RA (pepcid)
adult voiding dysfunction (urinary incontinence) pharmacological
-anticholinergics -tricyclic antidepressants -sudafed
meds that affect oral conditions
-antidepressants -antihypertensives -antiinflammatories -diuretics -all cause dry mouth from decreased saliva
Hep C tx
-antivirals (Harvoni)
nephrotic syndrome
-any condition that seriously damages glomerular membrane and results in high permeability to plasma proteins
benign tumors nur- assessment
-appetite -dysphagia -aggrevating factors/releiving factors -emotional upsets -belching, n/v -pain -pyrosis -infections -meds -hx -regurgitation and nocturnal -alcohol/tobacco use
post ostomy food list: stoma obstruction
-apple peels -raw cabbage -celery -Chinese veggies -whole kernel corn, popcorn -coconuts -dried fruits -mushrooms -nuts -oranges, pineapple -seeds
post ostomy food list: diarrhea control
-applesauce -bananas -boiled rice -PB -pectin (fiber) -tapioca -toast
ischemic penumbra
-area of hypo perfused brain tissue -will become necrotic if stroke pt not treated well (4.5 hour window) -ischemic tissues progress to necrotic tissue if not treated properly -need quiet, dark, enviro. and enough blood to area
2 most important indicators of a neuro change
-arousal -awareness
Hep B s/s
-arthralgias -rash -loss of appetite -flu like -possible jaundice
4 hrs after meal
-ascending colon mixes food w/ bacteria for more breakdown via: -slow peristalsis -absorbs major nutrients, fluids/electrolytes
acute pancreatitis complications
-ascites -hypovolemic shock -hemorrhage -septic shock -MODS -infection -necrosis
portal HTN s/s
-ascites (can be from decreased albumin) -esophageal varicose (hemorrhoids/polyps that can bleed) -enlarged spleen (can be from RBC destruction)
post ostomy food list: odor producing
-asparagus -baked beans -broccoli -cabbage -cod liver oil -eggs -fish -garlic -onions -PB -strong cheese
post ostomy food list: color changes
-asparagus -beets -food coloring -iron pills -licorice -red jello -strawberries -tomato sauce
acute abdomen appendicitis nutrition
-assess bowel sounds/flatus -advance diet as tolerated
kidney transplant post op nur
-assess for rejection -prevent infection -monitor urine function -psychological concerns -pain relief/meds -promote airway clearance (breathing/turn/cough/deep breathing/incentive spirometer) -strict asepsis w/ cath -monitor s/s of bleeding -sncourage exercises (early ambulation/monitor s/s Dvt)
treatment of hemorrhage in PUD
-assess for: bleeding, hematemesis, melena -s/s of shock/impending shock -IVF -NGT w/ saline/water lavage -oxygen -treatment for potential shock (VS, UO) -may require endoscopic coagulation or surgery
acute abdomen appendicitis skin integrity
-assess incision site and drains -dressing changes
IBD NUR care post op ostomy
-assess stoma/skin -ostomy site care/pt education -IVF -I&O -ambulation -Na+ and K+ labs -rectal packing -emotional support -irrigation (regulates BM, removes gas, feces, mucus) -diet education (post ostomy food lists)
renal trauma nur
-assess swelling, pain, tenderness, muscle apses -fluid intake -BP, labs, monitoring -restrict activities for 1 month w/ gradual increase -ID bracelet if kidney is removed -s/s to report -folow ups -incision care if surgery
acute gastritis treatment
-avoid causes until s/s go away -can take 1-3 days -supportive therapy -IVF -NGT w/ suction to keep stomach empty -antacids -H2RAs (pepcid, zantac) -PPIs (protonix, prilosec) -avoid emetics/lavage (could burn on way up) -reduce anxiety -monitor for: -bleeding -tachycardia -hypotension -dehydration (I&O)
hemorrhoids treatment
-avoid straining -good hygiene -high residue diet -increase fluids -sitz baths -analgesics -suppositories -witch hazel -surgery (rubberband ligation) -non surgical (sclerotherapy, lasers, staples)
adult voiding dysfunction (urinary incontinence) education
-avoid: stimulants/caffine/etoh/nutrasweet -diuretics before 1600 -pelvic floor exercises -no smoking -avoid constipation -void 5-8x/day
GERD
-backflow of gastric or duodenal contents into esophagus
bacteriuria
-bacteria in urine
colon/rectal polyps diagnosis
-barium enema -colonoscopy -sigmoidoscopy
stages of chronic kidney failure
-based on GFR (N= >125) -stage 1 (higher GFR) -stage 2 -stage 3 -stage 4 -stage 5 (lower GFR)
hemodialysis nur
-baseline VS -weight -fluid balance -IV therapy/administration pump -accurate I and Os -a/a of uremia/electrolyte imbalance -check labs regularly -monitor cardio/resp status -assess access site (infection, thrill/bruit) -fistulas need 2-3 months to mature (subclavian in meantime) -address pain/discomfort -infection control -skin care (can have pruritus) -don't touch caths -emotional support bc fistulas can be disfigureing -pt education
why do we do a ct right away
-bc blood looks white so you can see bleeds -can't see clot stroke for up to 72 hrs
angiotensin I
-becomes angiotensin II
enuresis
-bedwetting
pre renal
-before kidney is perfused -perfusion problem -before blood gets to kidneys -HF causes less blood to kidney
Foot and leg ulcers
-begins with soft tissue injury -daily foot assessment and at every clinic visit foot care: Inspect Washed/clean Trim toenails No bare feet Cotton socks Elevate the legs
adult voiding dysfunction (urinary incontinence) treatment
-behavioral therapy -verbal instruction -PT -diary -pharmacological -surgery
bleeding of esophageal varices prophylactic treatment
-beta blockers (propanolol, nadolol to decrease portal pres) -in combo w/ other treatment
type 1 diabetes differences
-beta cell destruction -<30 yrs -rare- 5% of diabetics
acid base balance
-bicarb from urine reabsorbed into bloodstream -lost bicarb generated by kidneys -phosphoric and sulfuric acid excreted in urine -if urine too acidic <4.5 acid binds to buffers and excreted in urine
how bile travels
-bile -cystic duct -common bile duct -duodenum
bile peritonitis
-bile leaks out from hole they make -can leak into abdomen to cause peritonitis
lactulose liquid enema
-binds w/ ammonia and comes out in BM
melena
-black, tarry stools -can be from swallowing blood
important thing about ultrasounds of bladder
-bladder must be full to ID organ
liver biopsy complications
-bleeding -bile peritonitis
s/s of perforation after colonoscopy
-bleeding -pain -distention -fever -focal peritoneal signs: -n/v -bloating -fever -decreased appetite -diarhea -thirst -low UO
other causes of hemorrhagic strokes
-bleeding disorders -bleeding into tumor -infection -trauma -drugs
hemorrhagic stroke
-bleeding into brain tissue -more dangerous -16% -perforated blood vessel that cuts off circulation -'brain bleed'. -Depending on where in the brain the cirrculation was cut off, the defects will be different.
hemorrhage in PUD
-bleeding peptic ulcers are deadly
cirrhosis complications
-bleeding/tamponade -hepatic encephalopathy -FVE (pulm/cardio/ascites, nocturia then oliguria)
dumping syndrome s/s
-bloating -cramping -sweating -diarhea -diziness -weakness
large bowel obstruction s/s
-blood -altered stool shape -flatus -abdominal distention -dehydration -slower onset***
Hep C route
-blood (needles/transfusions/needlesticks) -sexual contact
continuous renal replacement therapies (AKI tx)
-blood circulates through chemo filter
thrombotic ischemic stroke
-blood clot forms within blood vessel in brain
urine formation
-blood filtered through glomeruli, 99% back into bloodstream, 2% becomes urine (1-2L) -180 L/day of blood filtered through kidneys -ADH and fluid status -ADH controls water levels in bloodstream and amount of water secreted into urine
hematuria
-blood in urine
CT scan
-blood looks white -bleed can be seen -if no bleed seen, tpa should be given for ischemic stroke
hemodialysis system
-blood out of artery so that pressure is enough to let blood out -then blood filtered (takes 3 hrs) -then blood put back in vein (decreased pressure to let blood in) -need every 2-3 days -if cath on chest, its short term from ED
small bowel obstruction s/s
-blood, mucus -no BM -no flatus -fast onset of s/s*** -abdominal distention -dehydration -vomiting
GI diagnostics
-bloodwork (best if npo) -CBC -CMP -PT/PTT -triglycerides -LFTs -amylase/lipase -CEA -alpha fecal protein
constipation treatment/ NUR care
-bowel training -increase fiber to 25-30g/day -abdominal toning exercises 4x a day -bulk agents -probiotics -alternative therapies (abd. massage, aromatherapy, ect) -cholinergic meds to increase peristalsis -laxative meds
third order thinking
-brain makes decisions
cranial vault
-brain tissue -blood -csf
cerebral auto regulation
-brain trying to remain homeostasis before it starts to deteriorate
secondary headaches
-brain tumor -aneurysm -HTN -meningitis
liver biopsy intra
-breathing instructions (hold breath during insertion) -emotional support
anterior carotid
-brings 80% of blood to brain -affects frontal parts of brain
ABG treatment (AKI tx)
-buffers/bicarbs
aneurysm
-buldging/herniation -can cause dissection/tear which causes blood to increase ICP
IBS med management
-bulk agents -antidiarrheals -probiotics -antidepressants -antispasmodics
constipation laxative meds
-bulk forming (fiber) -saline (milk of magnesia) -lubricant (mineral oil) -softener (colace) -stimulant (ducolax) -osmotic (for colonoscopies) -chloride channel
post ostomy food list: odor control
-buttermilk -cranberry juice -OJ -parsley -tomato juice -yogurt
bleeding of esophageal varices-surgery
-bypass -shunts -transection (to separate bleeding site from portal htn) -many complications
bone disease/metastatic calcifications in chronic kidney disease
-ca+ doesn't get into bone
fluid management for adequate perfusion (AKI tx)
-calculated by: -weight -central venous pressure -fluid losses -BP -clinical status -parenteral/oral intake -serum urine concentrations -all output including insensible loss
PUD intervention: decrease anxiety
-calm approach to explain all procedures/treatments -relaxation methods: -biofeedback -hypnosis -behavior modification
too high/low K and Mg
-can cause dysrhythmias
fluent aphasia
-can say the words but order gets mixed up
locked in
-can't communicate in or out
neuropathy-autonomic
-cardiac -GI -bladder -sexual dysfunction
megacolon
-cardiac emergency from fecal mass (fecatoma) -dilation w/ no peristalsis means there could be a perforation
meds you can't* give for hemodialysis
-cardiac meds -antihyertensives -hold all once a day meds until after
hemodialysis complications
-cardio: -HF -stroke -angina -Pvd -increased triglycerides -chest pain -anemia -gastric ulcers from stress -SOB -hypotension -muscle cramping -n/v -dysrythmias -air embolism -disequilibrium from fluid shift
type 2 duping syndrome
-caused by eating lots of foods that expand in stomach (hot dogs) -can be caused by gastric bypass surgery
non viral hepatitis
-caused by toxic chemicals and non toxic medications
angiotensin II
-causes increased aldosterone
bacterial invasion UTI
-certain agents breakdown barrier in bladder -reflux when urine backs up (from urethra to bladder/from bladder to ureter)
increased ICP early s/s
-changes in LOC -any change in condition -restlessness -confusion -increased drowsiness -increased resp effort -pourposeless movements -pupillary changes -impaired ocular movements -weakness in extremity or 1 side -headache (constant, increase in intensity, aggravated by movement/straining)
liver biopsy pre
-check coag studies -check consent -VS -pt education
kidney-head to toe
-check for mental confusion, fatigue/malaise (from toxin build up) -check for residual urine -check for edema -check deep tendon reflexes (same nerves as kidney)
sialadartitis causes
-chemo -radiation -leukopenia -dehydration -stress -malnutrition -poor oral care -infection -calculi
T1-T6
-chest
s/s pericarditis
-chest pain -fever -friction rub
nephrotic syndrome causes
-chronic glomerular nephritis -DM -amyloidosis -lupus -multiple myeloma -renal vein thrombosis
roux-en-y
-chronic pancreatitis surgical management -joins pancreatic duct to jejunum -drains pancreatic secretions into jejunum
neurogenic bladder weaning
-clamp for 4 hrs -after pt attempts to void, check residual -if <100 on 2 occasions, cath is removed
neurogenic bladder intermittent/self cath
-clean technique at home -antibacterial soap/ bedadine -keep in plastic bag -every 4-6 hrs -fowlers -female may need mirror
upper GI imaging/x rays-pre
-clear liquids -NPO after midnight -enema -no smoking, gum, mints -check allergy to barium -insulin adjustment to NPO
hemodialysis
-clinic or home -acutely ill until kidneys resume function -long term in CKD/ESKD -extracts toxic nitrogenous substances from blood -removes excess fluid -vascular access (AV fistula/graft) -need a weight before -can or cant give certain meds
treating something based on CT
-clinical diagnosis -not confirmed by a diagnostic
ischemic stroke
-clot -stops blood flow into brain tissue - 84% -a clot that blocks an artery, usually a bigger clot than the TIA
acute kidney injury (AKI) nur
-monitor fluids/electrolytes -decrease fluids -monitor labs -strict I and O -assess for FVE, FVD -decrease activity/rest -promote good resp function (turn/position/cough/deep breathing) -prevent infection (hand hygiene/no indwelling catheters/monitor IV sits) -skin care(cool water baths bc hot water dries skin/moisterizer/file nails) -psychosocial support (pt/fam education on tx plan)
periapical abscess nur
-monitor for bleeding post treatments -warm saline/water rinses -review meds -liquid to soft diet -address facial swelling
gallstone surgery post op care
-monitor for complications -improve resp status -skin/drain site/incision site care -monitor bile drainage -pain control -diet -education: -drain site care -s/s to report -follow up -diet -activity restriction (no lifting for 1 wk)
TIPS/transjugular intrahepatic pontosystemic shunt education
-monitor for fever -salt poop albumin transfusions -no strenuous lifting/exercise -change positions slowly
hiatal hernia post op
-monitor for: -belching -vomiting -gagging -abd. distention -epigastric pain
cirrhosis nur
-monitor labs -bedrest -nutrition -small frequent meals (increased vitamin A(carrots),C(fruits),K(spinach/greens) -probiotics -increased protein decreased Na+ -skin care -measure ABD. girth*** -weight*** -I and O***
TIPS/transjugular intrahepatic pontosystemic shunt nur
-monitor labs -bleeding/tamponade -too much shunting can cause encephalopathy
acute abdomen appendicitis infection prevention
-monitor labs -wash hands
Barrot esophagus tx
-monitor over time -PPI -resection -ablation
acute abdomen appendicitis pain care
-morphine -high fowlers to reduce strain
complex partial seizure
-most common -focal seizure -alteration in awareness -starting off w/ automatisms -often occur in sleep
esophageal disorders
-motility disorders -hiatal hernia -diverticulum -perforation -foreign bodies -chemical burns -GERD -Barrot esophagus -benign tumors
malabsorption conditions
-mucosal transport of minerals -disorders (celiac disease) -luminal disorders (zollinger-ellison) -lymphatic obstruction (transport of fat byproducts) -surgical trauma -neoplasms
diverticulitis
-multiple diverticula -with inflammation
diverticulosis
-multiple diverticula -without inflammation
Ulcerative Colitis
-multiple ulcerations -diffuse inflammation -shedding of colonic epithelium -usually begins with rectum -recurrent -systemic complications
tension headaches
-muscle contraction -neck/scalp
s/s of hypokalemia
-muscle cramps -leg spasms
gastric outlet obstruction (GOO) s/s
-n/v -constipation -epigastric fullness -anorexia -weight loss
complications of feedings for intubation tubes
-n/v/d/constipation -gas/bloating/cramps -aspiration -tube placement/obstruction -irritations -hyperglycemia -dehydration -azotemia (increased nitrogen in blood- indicates kidney dysfunction) -dumping syndrome
assessing speech
-naming -fluency -comprehension -repitition
achalasia
-narrowing of lower esophagus
tube that nurses cannot insert
-nasoenteric bc increased risk perforation at bedside w/ stylet steel pin tubing
nasogastric/nasoenteric tubes insertion/measureing
-nasogastric is inserted by nurse -may stay for up to 4 wks -vent must stay above stomach -measure to earlobe to diploid process to nose -+6 inches for nasogastric tube -+8-10 inches for nasoenteric tube
s/s pyloric obstruction in PUD
-nausea -vomiting -constipation -epigastric fullness -anorexia -weight loss
viral hepatitis
-necrosis and inflammation of liver cells -highly contagious
bleeding of esophageal varices nur
-neuro checks VS -nasal care -frequent monitoring -ensure pt doesn't pull out/displace tube -suctioning maybe parenteral nutrition -tube care/gi suction -oral care/NPO (moist sponge if thirsty) -vit. K/blood transfusions -quiet/calm enviro/reassuring manner esp for etoh withdrawl -decreased anxiety/agitation -etoh withdrawl -teaching/support for pt/fam
exocrine functions of the pancreas
-neutralizes gastric acids -secretes digestive enzymes: -amylase (carbs) -trypsin (proteins) -lipase (fats) -bicarb (acid/base balance)
insulin pen
-never use on other pts
if an obese pt gets a bowel/gastric outlet obstruction
-no NGT -endoscopy required
what is the NUR bland diet for diarrhea
-no caffeine, soda, hot/cold -restrict milk -restrict high fat foods, high fiber foods, fruits/veggies for several days
Neuropathic Foot Ulcer
-no drainage or bleeding -if goes into bone causes osteomyelitis which causes amputations
achlorhydria
-no hydrochloric acid
uric acid stones diet
-no purines: -shellfish -asparagus -mushrooms -organ meats
oxalate stones diet
-no: -spinach -strawberries -tea -peanuts -chocolate -wheat bran
gold standard to diagnose ischemic stroke
-non contrast ct
dawn phenomenon
-normal glucose before bed (110), then shoots up around 2-3 am until morning -in morning becomes 200-230 -may need to adjust the snack or give it earlier
nasoenteric intubation tube
-nose to small intestine -decompression -lavage -drainage/suction -meds -feedings/fluids
ascites causes
-portal HTN (increased capillary pressure and obstruction of venous blood flow) -vasodilation of blood flow to major abd. organs -changes in aldosterone (fluid retention) -decreased albumin (decreased serum osmotic pressure causes leaked albumin to abdomen)
kidney surgery peri op
-position during surgery (on side) -arms out/away to help circulate
UA uti
-positive for esterase and nitrite
acute nephritis syndrome
-post infectious glomerulonephritis: -occurs after strep A, URI, impetigo, HIV, eaten barr, Hep B -progressive glomerulonephritis -membranous glomerulonephritis
acute kidney injury (AKI) categories
-pre renal -intra renal -post renal
types of diabetes
-prediabetes -type 1 diabetes -type 2 diabetes -gestational diabetes -diabetes from other illnesses
good oral care
-prevention: -xerostomia (dry mouth) -halitosis -stomatitis -adequate nutrition/fluids -encourage positive self image
urinary retention nur
-privacy -BR/commode -warmth -water faucet -stroke inner thigh -analesics on perineum after childbirth -bladder scan -cath -lights on -clothing easy to remove
frontal lesions cause what
-problems with leg
adult voiding dysfunction (urinary incontinence)-mictruition
-process of voiding
Hep B tx
-prolonged convalescence -infection -antivirals -decreased protein diet -decreased activity
chronic gastritis
-prolonged inflammation -belching -sour taste -vit. b 12 deficiency -modify diet
1st priority Question
-protect airway -perfusion
CEA
-protein in blood -carcinoembryonic antigen -19-9 -elevated in: -advanced cancers -gallstones -liver disease -CF
proteinuria
-protein in urine
ESRD-end stage renal disease diet
-protein restriction -fluid restriction (500-600ml more than previous day, calculated via output) -vitamin supplements: Ca+, vitamin D, folic acid
PN formulas
-proteins -carbs -fats -electrolytes -vitamins -minerals -sterile water -dextrose added for caloric requirements and positive nitrogen balance -must be inspected
trypsin
-proteins -pancreatic enzyme
kidney transplant pt education
-pt and fam -med id bracelet -follow ups for life -diet -prevent infections -meds (use the same pharmacy) -daily weight and I and O -no contact sports -labs -CVD is leading cause of death -increased risk cancer (promotion/screening) -support groups
cholelithiasis nur- pre op
-pt education -NPO
celiac disease treatment
-pt education -correction of s/s
pre contrast tests NUR
-pt education (no metformin within 48 hours or kidneys could shut down) -illness/med hx -check labs (creatinine clearance to see if theres already kidney damage, if 6/7 no contrast it can make it worse) -start IV before hand -side effects: flushing, seafood flavor, warm feeling -no contrast if pt has shellfish allergy
acute abdomen appendicitis anxiety care
-pt education: -incision care -s/s to report -no heavy lifting -follow ups -drain care
constipation: how to know laxative is working
-pt has soft, formed stool
gallstones assessment
-pt hx -knowledge/education -resp status/risk factors for post op resp complications -smoking/coughing -meds to avoid (ASA, NSAIDS, herbals) -labs
mannitol
-pulls off some cellular fluid to make room for brain
cranioplasty
-putting a piece of brain back on
GERD s/s
-pyrosis -dyspepsia -regurgitation -MI s/s -increased salvation -inflammation of esophagus
chronic pancreatitis surgical management
-rare -roux-en-y
wernike's area
-receptive aphasia -can't understand others talking -temporal
anastomosis
-reconnect parts (ex: duodenum to stomach)
Hep B outcome
-recovers in about 6 months (> 6 months = carrier) -may be severe -increased risk chronic state/cirhosis -can lead to cancer
treatment for non viral hepatitis caused by toxic chemicals
-recovery if id early -death/liver transplant if prolonged -no antidotes
Hep A outcome
-recovery w/ no increased risk liver damage
colon/rectal polyps s/s
-rectal bleeding -obstruction
rectal prolapse
-rectum through anal canal
chronic pancreatitis s/s
-recurring episodes of severe upper abdominal pain -pain management becomes challanging -vomiting -weight loss -malabsorption
anorectal abscess s/s
-redness -swelling -pus -tenderness -foul smelling
Crohn's Disease
-regional enteritis -inflammation of the bowel through all layers -remission and exacerbation -bowel thickens and narrows -abscesses, fistulas, fissures -rare bleeding
hyperglycemia DKA tx
-rehydration -electrolytes -insulin to correct acidosis
kidney transplant post op nur-psychological concerns
-rejection -immunosupresant complications (bushings syndrome, DM, osteoporosis, glaucoma, acne, nephrotoxicity) -guilt of fam donor -stress
erythropoietin
-released by kidneys -stimulates bone marrow to produce RBCs
obesity surgery post op NUR care: pt diet teaching
-smaller more frequent meals (6 per day with protein/fiber) -decrease carbs/concentrated carbs i.e. candy -low fowlers 20-30 mins after eating (delays stomach emptying to decrease risk of dumping syndrome) -antispasmodic agents (to delay gastric emptying) -no fluids with meals (fluids 30-60 mins before meals or between meals) -b12 injections, vitamins, medium chain triglycerides -more dry items than liquid items -eat foods high in calories, vitamins A and C, and high in iron -diet/teaching to prevent dumping syndrome
stress incontinence
-sneezing, coughing, changing position
regulation of electrolytes and water
-sodium controlled through renin which controls angiotensin I which becomes angiotensin II which controls aldosterone which decreased urine output -amount of electrolytes is equal to the amount you excrete in urine
cholelithiasis nonsurgical removal of gallstones
-solvent to dissolve stones -removal via instrument -lithrotipsy
lithotripsy
-sonic waves break up the stones then you pass them -only if theres a few stones -extracorpeal shock waves (ESWL)
neurogenic bladder types
-spastic -flaccid
IBS
-spastic colon -more common in women -motility disorder
spastic neurogenic bladder
-spinal cord lesion -no control of voiding
second order thinking
-spinal cord transmits message to brain
hematemesis
-spit up blood
gallstone surgery pain control
-splinting -sitting up right -heated pad -walking
laproscopic cholecystectomy
-standard approach -rapid recovery -same day surgery
amylase
-starches -pancreatic enzyme
peritonial dialysis process
-sterile*** -otheriwse they can get peritonitis -mask/gown/ect -cap end of cath and replace w/ new one after -2000ml in bag (check w/ scale) -takes 15-20 mins to drain/fill bag -fill bag -weigh bag -calculate output/diuretic if needed -open valve and drain bag
30mins-several hrs after meal
-stomach breaks down food w/acids/secretions/enzymes
urolithiasis/nephrolithiasis
-stones of urinary tract/kidney -from: -Ca+ oxalate -Ca+ phosphate -uric acid
IBS diagnosis
-stool studies -contrast radiography studies -proctoscopy -barium enema -colonoscopy -manometry -electromyography*
treatment for non viral hepatitis caused by non toxic medications
-stop drug -death if severe/liver transplant
gallbladder
-stores bile -3x4 inches -lies on inferior surface of liver -holds 30-50ml of bile -food enters duodenum, CCK/cholecystokinin hormone secreted to stimulate gallbladder to contract, sphincter of oddi relaxes, bile enters duodenum
hemorrhoids causes
-straining -pregnancy
adult voiding dysfunction (urinary incontinence) types
-stress incontinence -urge incontinence -functional incontinence -latrogenic incontinence -mixed
after next large meal
-strong intermittent peristalsis -moves waste -continues absorption
urge incontinence
-strong urge to void that cannot be controlled -elderly
perceived constipation
-subjective problem where pt's elimination pattern is not consistent with what he/she believes is normal
fulminant hepatic failure
-sudden acute liver failure in a healthy person -liver shuts down -usually within 8 wks after jaundice appears -progresses from jaundice to encephalopathy
3rd ventricle
-superior to brainstem -produces CSF and drains it into 4th ventricle via cerebral aqueduct
acute nephritis syndrome treatment
-supportive care for s/s -Na+/protein restriction -treat cause if able -ABX -steroids -immunosuppresants
acute abdomen appendicitis treatment
-surgery
periapical abscess tx
-surgery to drain -ABX -analgesics
cholecystectomy
-surgical incision
gerontological considerations for gallstones
-surgical intervention is common -increased risk complications/death -comorbidities
periapical abscess s/s
-swelling -pain -fever
hydronephrosis
-swelling of kidney from urine backup
bruit
-swoosh
billiary system
-system of ducts -substances excreted/moves through ducts
hypoglycemia treatment: 15/15 rule
-take 15 g of carbs then recheck BG in 15 mins, can repeat if needed -3 glucose tablets -4 oz OJ/soda -1 cup skim milk/1% milk -follow each snack with a starch and a protein (sandwich)
acute kidney injury (AKI) phases-recovery
-takes 3-12 months
anal fissure
-tear
delirium
-temporary -an emergency
renal clearance
-the ability of the kidney's to clear solutes from blood -an indicator of kidney disease progression -creatinine is the most important solute to measure in renal clearance ( 1.8) -GFR = >125
malabsorption
-the inability of the digestive system to absorb 1 or more of the major vitamins, minerals, or nutrients
vasa recta
-the vessels sense BP changes to release or suppress renin -damage to vessels can cause secondary HTN
normal creatinine clearance
1.8
% of fat for diabetes
10%
BUN
10-20
serum ammonia
15-45
normal reflex
2
1000ml is how many pounds
2.2 (1kg)
A CT should be performed within x mins of discovery of a change in patient neurological status , and should be resulted within x mins.
25 mins, resulted in 45 mins
% of protein for diabetes
25%
% of starches for diabetes
25%
how much food is left after 3 days
25%
hyper reflex
3
dairy per day for diabetes
3 servings/day
fruit per day for diabetes
3 servings/day
when does food reach small intestine
30mins-4 hrs after meal
HDL
35-85
when does food reach ascending colon
4 hrs after meal
the brain imaging study should be interpreted within x minutes of arrival by a physician with expertise in reading computed tomography (CT) and magnetic resonance imaging (MRI) studies of the brain parenchyma.
45 mins
recommended times to void per day
5-8x/day
The nurse is monitoring the I+O status of a patient. The patient has voided 3600 cc of urine after taking Lasix and taken in orally 1000 cc of fluid. How many lbs has the patient lost?
5.7 lbs
% of non starchy veggies for diabetes
50%
An ESRD patient has a urinary output of 100 mL for today. How many mLs of fluid will the patient be allowed as intake tomorrow?
600 mL
LDL
<130
what should BG be 2 hrs post meal for a diabetic
<180
acidic urine PH
<4.5
BMI
= weight (lbs) X 703 (height (in))²
normal GFR
>125
diabetes lab diagnosis
>126
HTN
>140/90
random glucose diabetes
>200 mg/ml
obesity BMI
>30kg/m
normal urine PH
>4.5
very severe obesity BMI
>40kg/m
diabetes A1c
>7%, goal is to get below 7%
vitamins stored in liver
A, B, B complex, D
A 24-hour urine collection is scheduled to start at 0100. When should the nurse start the procedure?
After discarding the 0100 specimen
A client's health history is suggestive of inflammatory bowel disease. Which of the following would suggest Crohn's disease rather than ulcerative colitis, as the cause of the client's signs and symptoms?
An absence of blood in stool
A client's health history is suggestive of inflammatory bowel disease. Which of the following would suggest Crohn's disease, rather that ulcerative colitis, as the cause of the client's signs and symptoms?
An absence of blood in stool
Tube feedings/TPN for diabetics
BG monitoring and insulin at regular intervals Special formulas (gluserna has a low glycemic index) Hypoglycemia if tube feeding stopped for an extended period of time
What lab value will indicate a high uremic level in the blood stream?
BUN
my plate protein
Beans and lentils Nuts and seeds Fish Seafood Eggs Cheese Chicken Turkey Beef Pork Hummus Soy nuggets or burgers
Which of the following meals would indicate a good understanding of meal selection by a diabetic patient?
Brown rice with grilled chicken and string beans
macrovascular
CAD/MI TIAS/CVA PAD Prevention: Proper diet Exercise Tight control Smoking cessation Medications
my plate starches/grains
Calabaza Chayote squash Green peas Corn Yucca Yams Sweet potato Plantain Quinoa Rice Brown rice Tortillas Potatoes Pasta
my plate non starchy veggies
Chilies Nopales Jalapeños Carrots Cabbage Eggplant Cauliflower Broccoli Jicama Tomatoes Spinach Peppers
The nurse is performing an admission assessment on a patient scheduled for a colonoscopy. The patient has reported to the nurse that they have been NPO since midnight and completed the bowel preparation. Which of the following are possible side effects the nurse should monitor for related to the bowel preparation? SELECT ALL THAT APPLY
Cramping Low potassium level Nausea
A nurse is performing an abdominal assessment of an older adult client. When collecting and analyzing data, the nurse should be cognizant of what age-related change in gastrointestinal structure and function?
Decreased mucus secretion
Gerontological Considerations diabetics
Decreased sensory perception (vision, hearing, feeling) Forgetfulness Hypoglycemia - can result in falls Dehydration - from chronic high glucose levels Depression Mobility Disabilities Finances Polypharmacy
diabetes definition
Dysfunction of insulin resulting in an increase in blood glucose ↓Secretion ↓Action Both
Bleeding esophageal varices result in an increase in renal perfusion. (true or false)
False
The exocrine function of the pancreas is to excrete insulin.
False
hyperglycemia (HSS) tx
Fluid replacement - same as DKA Correction of electrolytes/ K+ IV Insulin - same as DKA
Which of the following orders would the nurse anticipate to be written for a patient with bleeding esophageal varices? SELECT ALL THAT APPLY
Foley catheter insertion Oxygen Somatostatin IV fluids
A nurse is assisting with serving dinner trays on the unit. Upon receiving the dinner tray for a client admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray?
Fried zucchini
high cholesterol
HDL <35/triglycerides>250
A client is scheduled for the creation of a continent ileostomy. What dietary guidelines should the nurse encourage during the weeks following surgery?
High intake of strained fruits and vegetables
The nurse is caring for a client in acute kidney injury. Which of the following complications would most clearly warrant the administration of polystyrene sulfonate (Kayexalate)?
Hyperkalemia
The nurse is preparing to perform a client's abdominal assessment. What examination sequence should the nurse follow?
Inspection, auscultation, percussion, and palpation
where is pain in Ulcerative colitis
LLQ
where is pain in diverticular disease
LLQ
what side is colostomy on?
Left side
A nurse is promoting increased protein intake to enhance a client's wound healing. What is the enzyme that will initiate the digestion of the protein that the client consumes?
Pepsin
The nurse is admitting a client who has class III obesity. Inspection reveals that the client's neck and chest have a much larger than usual circumference. What is the nurse's best action?
Perform a focused respiratory assessment
A nurse is assessing a client who has been diagnosed with cholecystitis, and is experiencing localized abdominal pain. When assessing the characteristics of the client's pain, the nurse should anticipate that it may radiate to what region?
Right shoulder
what side is ileostomy on?
Right side
A client who had surgery for gallbladder disease has just returned to the postsurgical unit from postanesthetic recovery. The nurse caring for this client knows to immediately report what assessment finding to the health care provider?
Rigidity of the abdomen
A 16-year-old presents at the emergency department reporting right lower quadrant pain and is subsequently diagnosed with appendicitis. When planning this client's nursing care, the nurse should prioritize what nursing diagnosis?
Risk for Infection Related to Possible Rupture of Appendix
A 16y/o presents at the emergency department reporting right lower quadrant pain and is subsequently diagnosed with appendicitis. When planning this client's nursing care, the nurse should prioritize what nursing diagnosis?
Risk for infection related to possible rupture of appendix
pt education DKA/HHS
S/S of hypoglycemia/DKA/HHS Sick Day Rules
A nurse is completing a health history on a client whose diagnosis is chronic gastritis. Which of the data should the nurse consider most significantly related to the etiology of the client's health problem?
Smokes one pack of cigarettes daily.
A client has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based on this GFR, the nurse interprets that the client's chronic kidney disease is at what stage?
Stage 3
A nurse is caring for a client with hepatic encephalopathy. The nurse's assessment reveals that the client exhibits episodes of confusion, is difficult to arouse from sleep and has rigid extremities. Based on these clinical findings, the nurse should document what stage of hepatic encephalopathy?
Stage 3
The nurse is providing health education to a client with a gastrointestinal disorder. What should the nurse describe as a major function of the GI tract?
The breakdown of food particles into cell form for digestion
>50% increase in creatinine
acute kidney injury (AKI)
when does food reach rectum/whe do you defecate it
after 12 hrs
frontal stroke
behavioral changes, memory issues
albumin goes up in the...
blood
proctoscopy
bottom part
what has ragidity of RUQ, and right shoulder pain
cholecystitis and cholelithiasis
if you have high albumin you'll have low...
creatinine
tricyclic antidepressants
decrease bladder contraction
cluster headache
dilation of orbital arteries
pepsin
enzyme that digests protein
fetor hepaticus
fecal breath odor
overflow incontinence
flaccid neurogenic bladder
asterixis
flapping tremor of hands
electromyography
follows nerve endings
where is urinary incontinence in the brain
frontal lobe
prediabetes lab diagnosis
glucose btwn 110-126
GCS<8 (glasgow coma scale)
greater risk of mortality
if BG <100 before exercising
have a 15 g carb snack
glycemic index
how much a food increases glucose levels as compared to an equal amount of glucose or white bread
polyphagia
hungry
when does exercise cause hypoglycemia
if blood sugar is >250 + ketones present before you exercise or if you exercise too much/intense
straight cath if
if residual >300ml if no void after 6-8 hrs
paracentesis why vs are important during procedure
in order to detect s/s of vascular collapse
renal threshold
kidney only filters 180-200 mg/dL of glucose, otherwise the glucose goes into the urine
high fowlers can cause
na retention
why is A lean grilled beef burger (no bun) with a mix of vegetables on the side bad for a diabetic
no carbs
why is Egg salad with reduced fat mayonnaise on a bed of lettuce with tomatoes bad for a diabetic
no carbs
why is Pasta salad with low calorie dressing, tomatoes, and cucumbers bad for a diabetic
no protein or fat
left sided stroke
paralysis, weakness, on right side, right visual field deficit, altered intellectual capacity, slow and cautious, expressive, receptive and global aphasia
megacolon and dilation w/ no peristalsis could mean...
perforation
0.3-1
pigment studies
pump care
prevent infection
7-7.5
serum protein studies
normal BUN
should be under 20
CSF/brain is...
sterile
anticholinergics
stop bladder contraction
polydipsia
thirst
creatinine goes down in the...
urine
parietal stroke
wernickes aphasia, trouble with spacial perception,
The goal timeframe for obtaining a NECT is
within 25 minutes of the patient's arrival in the emergency department
hyperglycemia (HSS) s/s
↓BP Dehydration Altered LOC/hallucinations Hemiparesis BG 600-1200
