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