Adult Health 2 Final Exam Review

Central Nervous System (CNS) consists of what?

*Spinal Cord *Brain- frontal lobe, parietal lobe, temporal lobe, and occipital lobe *Cerebrospinal Fluid (CSF)

Thyrotoxicosis/Thyrotoxic Crisis/Thyroid Storm

-Complication/Exacerbation of Graves' Disease -Excessive amounts of thyroid hormones are released into the circulation

Dementia- Diagnostic Studies

-Determining Cause -CT/MRI

MG- Nursing Interventions

-Drug Therapy (See Med Sheet)- -ABCs = Airway, Breathing, and Circulation priority! -Mobility & Activity -Thymectomy- might need to take thymus out if gets too bad -Plasmapheresis for exacerbation of MG

Post-op form Roux-en-Y

-Dumping syndrome is a complication of the RYGB

Nursing Interventions for SIADH

-Fluid/Electronic Balance- mainly want to keep Na+ in check -Monitor I&Os -Monitor Weight -Lasix ( If give this diuetic monitor for hypokalemia b/c it is a K+ wasting med) -Fluid Restrictions (800-1000mL/day)- limit their fluids to about 1 L per day! -Diet- can eat foods w/ salt! Don't want it too much though just give them a normal/proper amount, not too much fluids be careful about foods like watermelon, apples, etc . -HOB not > 10 degrees- don't want them sitting up too high b/c it enhances venous return to the heart which can make the release of ADH worse - Monitor for Hyponatremia & fix ( Give Hypertonic solutions to fix)- fix sodium imbalances slowly so don't just infuse too quickly, especially if sodium level is 120 or less

Dumping Syndrome

-Gastric contents empty too rapidly into the small intestine -Early and Late types - Tx= Tell patients to avoid foods high in sugar and carbs, watch for iron deficiency anemia b/c will have poor absorption of iron, calcium so ensure pt takes a MULTI-VITAMIN with iron and calcium supplements.Also can have cobalamin/Vit B12 deficiency.

Alzheimer's Disease-Etiology/Causes

-Genetics -Environmental causes: *Smoker, Diet, HTN, Diabetes, Obesity, High Cholesterol

Graves' Disease S&S

-Goiter -Bruits= swooshing sound on auscultation -Exophthalmos- bulging of eyes, protrusion of the eyeballs from the orbits that is usually bilateral. -Ophthalmopathy -Might be tachycardia or higher end of normal HR -Diarrhea -Might have faster than normal metabolism, lose weight more easily

Environmental Factors that Cause Obesity

-Greater access to food with poor nutritional quality -Lack of physical exercise -Low socioeconomic status (what access/availability one has to things to help with weight)

For Patients with Metabolic Syndrome, YOU as the nurse can assist with information on what?

-Healthy diets (vegetables, fruits, whole grains, etc.) - Exercise (at least 30 minutes a day is the goal!) -Positive lifestyle changes

Hiatal Hernia

-Herniation of a portion of the stomach into the esophagus through an opening, or hiatus, in the diaphragm. -AKA diaphragmatic hernia or esophageal hernia -Most common abnormality found on x-ray examination of the upper GI tract. 2 Types= Sliding and Rolling (Paraesophageal) -Won't be fixed till get surgery to fix it -As nurse will just help manage it

HYPERthyroidism

-Hyperactivity of the thyroid gland with sustained increase in synthesis and release of thyroid hormones. -Increasing of body processes -The most common form is Graves' Disease

S&S of Conn's Syndrome

-Hypertension -Hypokalemia= gets rid of K+ will be HYPERnatremic as well -Metabolic Alkalosis

Cardiovascular Changes Related to Aging: Heart & Blood Vessels

-Hypertrophy of Ventricles -Valves Degenerate -Electrical Activity Decreases -Receptors less Sensitive -Aorta Thickens and Stiffens

What causes SIADH?- Etiology

-Malignant Tumors -Drugs -CNS Disorders

Nursing Interventions for DI

-Monitor Fluid and Electrolyte Balances -Monitor I&Os -24-hour urine specimen- urinate in toilet and empty bladder then the next time is when you start it for 24 hours first thing in the morning for a full 24 hours measuring and monitoring urine, put the retained urine over ice or store in cool area (in fridge or on ice, etc.) , protect it from the light -Monitor Weight -Treat Hypernatremia (Give Hypotonic Solutions, treat S&S) -Drugs hydrochlorothiazide (HydroDIURIL)- a diuretic b/c the decrease blood flow to the ADH to help ADH work better so you can keep more fluid/fix the problem; but makes K+ go down so monitor for K+

Types of Arthritis

-Osteoarthritis (OA) -Rheumatoid Arthritis (RA) -Gout

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

-Overproduction/Oversecretion of Antidiuretic Hormone (ADH) disorder of POSTERIOR pituitary gland Overproduction/oversecretion of ADH that is stored in the posterior pituitary gland **TOO MUCH ADH**

Erythroplakia

-RBCs, red velvety mucosal lesions seen -tends to turn to cancer more often than leukoplakia -Is worse than leukoplakia

Metabolic Syndrome: Nursing and Collaborative Management-Lifestyle modifications are first-line interventions which include what???

-Reduce LDL cholesterol -Stop smoking -Lower blood pressure -Reduce glucose levels -Weight Loss You as the nurse can assist with information on......

Ascites- Nursing Interventions (NI)

-Respiratory Support (don't lie them flat b/c won't be able to tolerate it!) -Fluid and Electrolyte Imbalances (r/t to fluid shifting w/ ascites problem) -Nutrition (Low Salt Diet) -Meds (furosemide & Albumin) -Paracentesis Paracentesis- will tap them to drain off the fluid to help with ascites As liver starts to fail will have to come back 3 times a week and fluid gets loaded much sooner, and that is how you can recognize that liver is going really bad and not doing well if have ot come back more and more to get fluid pulled off **Will give Lasix and albumin together typically with ascites problem**

NI for IBD

-Rest the Bowels & NPO -Nutrition: *Low fiber diet if diarrhea present *Avoid lactose products *Avoid smoking, carbonated beverages, ETOH, caffeine, pepper, nuts, corn -No GI stimulants -Monitor Potassium (increase K+ if need!) -TPN if on NPO for long (NOT NG!) -NO raw veggies b/c have increased fiber!

Thyrotoxicosis/Thyroid Storm S&S

-Severe Tachycardia (like HR 160 or 170, very fast, need to be fixed or could die!) -Hyperthermia- high temp like 106 degrees F, very exaggerated temp -Restlessness -Irritability- brain doesn't like what is happening -Extreme high HR and extremely high TEMPs -Normally these Graves disease patients have a little bit higher than normal HR, but during crisis will be WAY HIGH!!

Pulmonary Edema Medications

-Ventilation w/ Oxygen -Loop Diuretics (Furosemide- Lasix) -Nitrate (Nitroglycerin/NGT) -Opioid (Morphine)

Reasons for getting PN???

-When GI tract cannot be used for ingestion, digestion, and absorption of essential nutrients -Used when Gi tract cannot be used for ingestion or digestion or absorption of essential nutrients such as Crohn's Disease

Hepatitis

-Widespread inflammation of liver cells. -Inflamed liver! Viral Hepatitis results from one of the following (Different Types of Hepatitis): -Hepatitis A -Hepatitis B -Hepatitis C -Hepatitis D -Hepatitis E As the nurse, you want to educate your patients on prevention and how NOT to get Hepatitis!

Left Coronary Arteries

-arises from the aorta and divides into two main branches- the Left Anterior Ascending Artery (LAD artery- AKA the Widow maker) and the Left Circumflex Artery (LCx artery) These arteries supply the left atrium, left ventricle, interventricular septum, and a portion of the right ventricle.

Liver Biopsy

2 Types of Liver Biopsies= Open and Closed Sometimes people develop nodules on liver and they will go in and biopsy it and check it for cancer Can do biopsy open or closed Open- will put a 10-12 inch incision on abdomen and go in and take part of liver out whatever they need to and go in and close them back up Closed= a needle biopsy, not being cut open, just sticking needle in there and taking out what we need Clotting huge with liver, so if going in and cutting part of liver out or needle biopsying part of the liver out will want to check H&H hematocrit and hemoglobin as well as coagulation labs (PT/INR and aPTT/PTT, etc.) Most questions come from closed, closed is more special b/c of way pt needs to be positioned, etc. Closed Biopsy= get informed consent and sedated, want the pt on the right side for 2 hours after procedure and then lay flat for 12 hours after!

Point of Maximal Impulse (PMI)

5th ICS midclavicular line AKA the Mitral Valve If in 6th ICS then that means heart has enlarged/gotten bigger, if older might not be too much concern, but the heart SHOULD be in the 5th ICS midclavicular line, so if in 6th ICS then heart might be a little bigger than it should be

A 58-year-old woman has just returned to the nursing unit after an esophagogastroduodenoscopy (EGD). Which action by unlicensed assistive personnel (UAP) requires that the registered nurse (RN) intervene? a. Offering the patient a drink of water b. Positioning the patient on the right side c. Checking the vital signs every 30 minutes d. Swabbing the patient's mouth with cold water

A

Beta Adrenergic Blocker- Metoprolol (Lopressor)

Action= blocks beta receptors therefore decreasing HR and BP, decreases renin secretion by the kidneys! Nursing Considerations: - Safe to Admin if SBP is 110 or greater, and HR 60 bpm or greater! Hold Med and contact HCP if SBP if BELOW 110 or HR is BELOW 60 -Assess for orthostatic hypotension/dizziness -Monitor BP and HR BEFORE giving med!

Ventilation-Oxygen

Actions- given via nasal cannula (NC), Non-Rebreather Mask, CPAP/BIPAP, or Intubation Nursing Implications- EVALUATE RESPONSE TO O2 supplementation

MYXEDEMA

HYPOthyroid problem; causes lots of puffiness

Sundowning

Increased confusion at night

Rheumatic Fever (RF)

Inflammation in all layers of the heart causing thickening and valvular damage

Pericarditis

Inflammation of the pericardium(the lining surrounding the heart)

Trigeminal Nerve (CN V)

Motor- jaw movement Sensory- sensation on the face and neck Normal finding= able to clench and relax the jaw, able to differentiate btwn. various stimuli to the face and neck Nursing Considerations/How to test= test with pin and wisp of cotton over each division on both sides of face; ask client to open jaw and bite down, move jaw laterally against pressure; stroke cornea w/ wisp of cotton

Epicardium

OUTER layer

Nursing Interventions for Hip Fractures

Pre-Op/Before Surgery: -Buck's Traction (before surgery)- skin traction -NPO (b/c going into surgery so don't need anything to eat or drink) -Surgery: Anterior approach to surgery- in the front, better because doesn't disrupt the muscles and more positive outcomes Posterior- done in the back,these surgeries are typically done in the back b/c easier on the surgeon to be able to do form the back, but not as many good outcomes as when doing anteriorly Post-op/AFTER Surgery: Check Neurovascular 6 Ps Cap Refill Edema Sensation Motor Function

Major Complication of CHF???

Pulmonary Edema!

Thromboangitis Obliterans (Buerger's Disease)

Recurrent inflammatory disorder of the small and medium arteries and veins of the upper and lower extremities -Happens in Men > Women, and in people Age < 45 years -Tobacco a risk factor- HUGE RISK IF SMOKING! -rare, won't be seen very often -arterial problem, arteries collapse

Smooth Tongue

Red, slick appearance Possible Etiology & Significance/Cause= Cobalamin Deficiency (Vit. B12 low)

Complications of PN

Refeeding Syndrome & Metabolic Problems

Colectomy

Removal of colon

The atria is .......

THINNER than the ventricles

Hypertensive Urgency

Urgent= BP can be very high, but NO ORGAN DAMAGE, develops more slowly (can take days or weeks to occur), caused by not adhering to med regimen or dietary restrictions, etc. puts them into a crisis URGENT= NO ORGAN DAMAGE!

Fecal Analysis

form, consistency, and color are noted. Specimen examined for mucus, blood, pus, parasites, and fat content. May test for occult blood (guaiac test, Hemoccult, Hemoccult II, Hemoccult-SENSA, Hematest) and DNA testing (preGen-plus, Colorguard) to detect colorectal cancer before= keep diet free of red meet for 24-48 hours BEFORE occult blood test During test= Observe pt's stools. Collect stool specimen. Check stools for blood!

Nutrition Considerations for CHF

if when eat then want a low sodium diet

Problems w/ Frontal Lobe

judgement, emotions and reasoning issues

When preparing a patient for a capsule endoscopy study, what should the nurse do? a. Ensure the patient understands the required bowel preparation. b. Have the patient return to the procedure room for removal of the capsule. c. Teach the patient to maintain a clear liquid diet throughout the procedure. d. Explain to the patient that conscious sedation will be used during placement of the capsule.

Correct answer: a Rationale: A capsule endoscopy study involves the patient performing a bowel prep to cleanse the bowel before swallowing the capsule. The patient will be on a clear liquid diet for 1 to 2 days before the procedure and will remain NPO for 4 to 6 hours after swallowing the capsule. The capsule is disposable and will pass naturally with the bowel movement, although the monitoring device will need to be removed.

The patient tells the nurse she had a history of abdominal pain, so she had a surgery to make an opening into the common bile duct to remove stones. The nurse knows that this surgery is called a a. colectomy b. cholecystectomy c. choledocholithotomy d. choledochojejunostomy

Correct answer: c Rationale: A choledocholithotomy is an opening into the common bile duct for the removal of stones. A colectomy is the removal of the colon. The cholecystectomy is the removal of the gallbladder. The choledochojejunostomy is an opening between the common bile duct and the jejunum.

Goiter

Enlarged Thyroid Gland which results in Hyperthyroidism or Hypothyroidism

Diverticulosis and Diverticulitis

Etiology/Cause: Lack of Fiber in Diet, Elderly S&S/Clinical Manifestations: -Sometimes no S&S -Abdominal pain (LLQ), bloating, flatulence, changes in bowel habits -People get this more as you age and because of low fiber intake in diet makes it greater risk to happening Most people don't even know they have it and some people might just have minor abdominal pain or bloating and GAS, might notice a change in bowel movements, etc. but won't usually be admitted to hospital for these things

Abdominal Distention

Excessive gas accumulation, enlarged abdomen, generalized tympany Possible Etiology/ Causes= obstruction, paralytic ileus

CT Scan

provides a rapid means of obtaining radiographic images of the brain. Computer-assisted x-ray of multiple cross sections of body parts to detect problems such as hemorrhage, tumor, cyst, edema, infarction, brain atrophy, and other abnormalities. Contrast medium may be used to enhance visualization of brain structures. Before: Assess for contraindications to contrast media, including allergy to shellfish, iodine, or dye. Explain appearance of scanner. Instruct patient to remain still during procedure.

Diastole

relaxation of the myocardium

Appendectomy

removal of appendix

Prosopagnosia

Inability to recognize oneself and other familiar faces

Apraxia

Inability to use words or objects correctly

Aphasia

Inability/Difficulty to speak or understand

Nutrition for pts w/ Esophageal Cancer

Increase calories Increase protein Soft Diet- if can swallow a bit Liquid Diet- if can't swallow thick or hard to swallow types of foods TPN- if not even able to swallow at all

Risk Factors for OA

Increase in Age Low Estrogen Obesity Sedentary Life Injury

HYPERparathyroidism

Increased secretion of the parathyroid hormone (PTH) **TOO MUCH production of PTH!**

Risk Factors for Aortic Aneurysms

Increases in Age Male > Women Tobacco HTN, CAD, PAD High Cholesterol, Obesity

Warfarin (Coumadin)

Inhibits fibrin formation Side Effect= BLEEDING! Nursing Implications= -Administered PO -Typically takes 3-4 days to become therapeutic -Antidote if overdose of warfarin= VITAMIN K!! (give it too much coumadin/warfarin) -Monitor PT/INR levels

Order of Assessment for GI System

Inspection, Auscultation, Percussion, Palpation

Addisonian Crisis

Insufficient adrenocortical hormones or a sudden sharp decrease in these hormones **Exacerbation of Adrenocortical insufficiency/Addison's Disease!**

Delirium is.......

JUST TEMPORARY, doesn't get progressively worse is just there and then once you fix it & fix the reason they have it, then it goes away

S&S of Left-Sided HF

LEFT = LUNGS!! - breathlessness, dyspnea, SOB, PIM displaced to left, crackles, wet sounding lungs, oliguria (not peeing enough) etc. , S3/S4 gallop

What causes a goiter?- Etiology

Lack of Iodine in Diet

What is the SA Node?

- Sinoatrial Node -The Pacemaker of the Heart -starts/creates the electrical impulse (action potential)

Gerontologic Considerations- GI system

Liver Size Decreased Gallbladder Disease Risk for Decreased Food Intake As you age, the liver size gets smaller (may not work as well as it used to), and typically as you age you have more gallbladder problems and get more stones and more obstructions, and also don't typically eat as much especially when reach age 85 (might be due to meds on what make food taste funny, might not have the money anymore, might live alone and can't prepare their own food, etc.)

Exercise

-An essential part of a weight control program -Biggest intervention for weight control or prevention of obesity - Need to do Daily for 30 minutes to an hour (Is most effective if done for 30 min-1 hr 5 every day!) Benefits include: - It Can diminish appetite -It Reduces waist-to-hip ratio -It Helps maintain weight loss

S&S of Osteomyelitis

Local and Systemic Local S&S: Constant bone pain, worsens with activity and unrelieved by rest Swelling Tenderness Warmth Restricted Movement Systemic S&S: Fever, Chills Night sweats Nausea Malaise Drainage

Baroreceptors

Located in the aortic arch and carotid sinus (at the origin of the internal carotid artery) - Receptors that are Sensitive to Stretch or Pressure within arterial system. -Stimulation of these receptors (volume overload) results in temporary inhibition of the sympathetic nervous system (SNS) and enhancement of the parasympathetic nervous system (PNS), causing a decrease in HR and Peripheral vasodilation. -Decreased arterial pressure causes the opposite effect (stimulates SNS and inhibits PNS)

Composition of PN

-Dextrose, Protein, Electrolytes, Vitamins, Trace Elements, Lipids -Calories are supplied by Carbohydrates Protein

Masses

Lump on palpation Possible Etiology/Causes= tumors, cysts

ALS- Nursing Interventions

-Drug Therapy (See Med Sheet)=Riluzole (rilutek), Sertraline (Zoloft), SSRIs -Education/Support -ABCs- breathing and airway problems will occur -ADLs -Safety/Fall -Manage Pain -End of Life Care (DNR) DNR= nurse needs to know what to do when stop breathing b/c with ALS stopping breathing will occur, make sure you advocate for patient, talk to the patient and find out what they want and what will happen, it is the patient's choice, talk to patient one on one so you know what is going on and get facts straight, once you get facts straight on DNR orders then doc will come in and put that in officially on order

Diagnostics to Do and Look at if Suspect CHF.......

-Electrocardiogram (EKG) -X-Ray -Echocardiography (Echo) * Done To Diagnose *Looks at the- Valves, Chambers, Ventricles, Ejection Fraction (EF)

Vegetarians

-Exclusion of Red Meat from Diet -Need well-planned diet to avoid vitamin and protein deficiencies -do NOT eat RED MEAT so concern if never getting red meat so need to work with them and plan diets with them to not fall short from not getting red meat in their diet b/c of being vegetarians

Paraplegia

-If the thoracic, lumbar, or sacral spinal cord is damaged -paralysis and loss of sensation in the legs

Classifications of SCI

-Mechanism of Injury -Level of Injury -Degree of Injury

Peptic Ulcer Disease (PUD)

-Mucosal lesion of stomach or duodenal. -GASTRITIS CAUSES ULCER -Localized erosion in stomach or duodenum partial or complete thickness -Cause= H. Pylori and NSAIDs (long-term use!) -3 Types= Gastric, Duodenal, and Stress

SCI Clinical Manifestations- GU/Urinary System

-Neurogenic Bladder -Urinary Retention & UTI Urinary dysfunction occurs in the majority of patients following an SCI. Neurogenic bladder= any type of bladder dysfunction r/t abnormal or absent bladder innervation. After spinal shock resolves, depending on the completeness of the SCI, patients usually have some degree of neurogenic bladder. Normal voiding requires nervous system coordination of urethral and pelvic floor relaxation, with simultaneous contraction of the detrusor muscle. Depending on the injury, a neurogenic bladder may have no reflex detrusor contractions (flaccid, hypotonic), have hyperactive reflex detrusor contractions (spastic), or a lack coordination between detrusor contraction and urethral relaxation (dyssynergia). Common problems w/ a neurogenic bladder include urgency, frequency, incontinence, inability to void, and high bladder pressures resulting in reflux of urine into the kidneys. Urinary Retention is a common development in acute SCI and spinal shock. While the patient is in spinal shock, the bladder is atonic, becomes overdistended, and fails to empty. In the postacute phase of SCI, the bladder may become hyperirritable. A loss of inhibition form the brain results in reflex emptying and failure to store urine (urinary incontinence)

Nervous System Structures

-Neurons -Central Nervous System (CNS) -Peripheral Nervous System (PNS)

SCI Clinical Manifestations- Pain

-Nociceptive= can develop form musculoskeletal, visceral, and/or other types of injury (ex. skin ulcerations, HAs) -Neuropathic= occurs from damage to the spinal cord or nerve roots

Nursing Implementation for Obesity

-Obesity is one of the most challenging health crises in the U.S. & is considered a Chronic disease -Regaining weight often occurs (yo yo weight loss and gain!) -Lifelong management is indicated

NI for Diarrhea

-Preventing Transmission -C-Diff= contact precautions,wash hands(soap!) -Replace Fluid -Electrolytes -Skin Integrity C. Diff= wash hands in sink only, NO ABX gels, will have lots of diarrhea that is distinctly smelly, maybe a little blood in diarrhea, need ot be put on Contact precautions Tx= replace fluids and electrolytes, and keep skin integrity intact b/c can risk for skin integrity being impaired form all that diarrhea/pooping

What causes Thyrotoxicosis/Thyroid Storm?- Etiology

-Stress -thyroidectomy

Assessing Thyroid Function/Disorder- Any issue of the thyroid shows what S&S?

-Unplanned Weight Gain or Weight Loss -Lump in throat when swallow -Goiter

Classification of SCI- Mechanisms of Injury

-how it occurred, what caused the SCI Types of Mechanisms of Injury: -Flexion -Hyperflexion -Compression/Axial Loading, -Flexion-Rotation/Excessive Loading

Anosmia

-loss of sense of smell -an early sign in Parkinson's Disease and Lewy body dementia

What is the Cardiovascular System Regulated by?

1. Autonomic Nervous System: composed of the Sympathetic Nervous System (SNS) &Parasympathetic Nervous System (PNS) 2.Baroreceptors 3.Chemoreceptors

Blood Flow Through the Heart

1. The RIGHT ATRIUM receives venous/deoxygenated blood from the Inferior and Superior Vena Cava and Coronary Sinus. The blood then passes through the tricuspid valve into the right ventricle. 2. With each contraction, the right ventricle pumps blood through the pulmonic valve into the pulmonary artery and to the lungs. 3. Oxygenated blood flows form the lungs to the left atrium by way of the pulmonary veins. 4.It then passes through the mitral valve and into the left ventricle. 5. As the heart contracts, blood is ejected through the aortic valve into the aorta and thus enters the systemic circulation.

Three areas assessed in the GCS are what?

1. The patient's ability to open eyes when a verbal or painful stimulus is applied 2. Speak 3.Obey Commands **Three indicators of response are evaluated: opening of the eyes, best verbal response, and best motor response.** Specific behaviors observed as response to the testing stimulus are given a numeric value. The higher the scores, the higher the level of brain functioning. Total GCS score is sum of numeric values assigned to each of the three areas evaluated...... -Highest total score= 15 -Lowest possible score= 3 -Score of 8 or less= indicates coma **Table 56-5, p.1323- REVIEW OVER- WILL BE ON EXAM**

Hip Fractures

95% r/t Falls in Older Adults Women > Men Will typically have Surgery -Partial and Total Hip Replacements (Fractures) - Total Hip Arthroplasty (OA) Happens a lot in older adults, usually in women more than men b/c of osteoporosis Will to have a partial or total b/c of a fracture to the hip Or will have a total hip b/c of osteoarthritis b/c that eats away at the bone.

Mechanical System of the Heart

=Involves Cardiac Output and Cardiac Index Cardiac Output (CO) CO = HR X SV CO normal range 4 - 8 L/min Cardiac Index (CI) Normal CI range 2.8 - 4.2 L/min/m2

Roux-en-Y Gastric Bypass (RYGB)

A procedure that is a combination of restrictive and malabsorptive surgery. This surgical procedure is the MOST COMMON bariatric procedure performed in the USA. IT is considered the GOLD STANDARD among bariatric procedures. Procedure involves creating a small gastric pouch and attaching it directly to the small intestine using a Y-Shaped limb from the small bowel. After the procedure, food bypassed 90% of the stomach, the duodenum, and a small segment of the jejunum. Overall, the procedure has LOW complication rates, has excellent patient tolerance, and sustains long-term weight loss. Outcomes include improved glucose control with improvement or reversal of diabetes, normalization of BP, decrease total cholesterol and triglycerides, decreased GERD symptoms, and decreased sleep apnea. One complication of RYGB = dumping syndrome **Cutting out part of the stomach and reconnects it back, re routes things** **Restriction and malabsorption properties with this type of bypass**

Arthritis

A type of Rheumatic Disease Involves the Joints Women > Men A broad term and have different types!

NI for Hemorrhage

ABC, NPO Labs, Fluids NG Tube, Gastric Lavage Flush with 200-300mL of tap water Patient positioned on left side- LAY ON LEFT SIDE! Cleans out Stomach Ng Tube Gastric Lavage= flush w/ 200-400 mL of tap water, pt is on LEFT Side, this cleans out the stomach. Irrigate 2x /day with water at room temp, YES WILL FLUSH NG. Pt is on left side so it doesn't go into the intestines and so it cleans out the stomach. Will hook NG up to SUCTION to decompress stomach. Want to suck everything out of stomach or area for a hemorrhage, do a gastric flushing/lavage (where you flush with 200-300 mLs of tap water and position the patient on their LEFT side and this will clean out the stomach ), NG tube placed in stomach and hooked up to suctioning, will do a gastric lavage and irrigate/clean/flush out into the NG tube, will get in there and then you can suck it right back out, keep chart of how much is being sucked out b/c will need to note that in I&Os for patient (on I& O sheet!) Lavage= flushing/cleaning out the stomach, can make you nauseated with al lthat blood in system so cleaning them out will help with that if all that blood is in the stomach needs to be taken out

Medications for CHF

ACE Inhibitors/ARBs (Enalapril, Captopril, Losartan) Loop Diuretics (Lasix) Positive Inotropic (Digoxin) Beta Blockers (Carvedilol or Metoprolol) ***NOTE W/ Lasix= give this as first med of choice for CHF. So if give Lasix order and Digoxin order, Lasix will fix lungs so want to fix breathing and lung issues first and then worry about heart function***

ACE Inhibitors (ACE Is) and Angiotensin II Receptor Blockers (ARBs)

ACE Is: Enalapril (Vasotec) Captopril (Capoten) Action- Prevents conversion of Angiotensin I to Angiotensin II ARBs: Losartan (Cozaar) Action- blocks the effects of Angiotensin II receptors; this will cause vasodilation decreasing BP Nursing Implications for ACE Is & ARBs: - Can cause a RAPID drop in BP -Assess for orthostatic hypotension/dizziness -Monitor for HYPERKALEMIA (makes K+ TOO HIGH!) -Avoid salt substitutes (b/c has K+ in it!) -Will cause a NAGGING COUGH ( when taking ACE Is)

Aphthous Stomatitis

AKA Canker sores Etiology/Causes: recurrent and chronic form of infection; secondary to systemic disease,trauma, stress, or unknown causes S&S/Manifestations: ulcers of mouth and lips causing extreme pain, ulcers surround by erythematous base Tx= corticosteroids (topical or systemic); tetracycline oral suspension

Nasointestinal Tube/Nasoduodenal or Nasojejunal

AKA Dobhoff or Freka Tube Length of Stay= 4 wks-months! Primary Use= for feedings and medications! Hook up to suction?= NO!! need to confirm before using, do 3 checks and definitive check with X-ray, can use immediately after x-ray confirms placement

Gastrostomy (directly from the abdomen to stomach)

AKA G-tube or PEG tube Tube Length of Stay= >4 wks- years Primary Use= feedings and medications! Hook up to suction?= NO!! Do your three checks and once confirmed by X-ray, nurse will HAVE TO WAIT 24-48 hours BEFORE USING!

Jejunostomy (directly from the abdomen to the jejunum)

AKA J-Tube -Tube Length of Stay= >4 wks- years -Primary Use= feedings and medications! -Hook up to suction?= NO!! -Do your three checks and once confirmed by X- ray, nurse will HAVE TO WAIT 24-48 hours BEFORE USING!

Appendicitis

Acute Inflammation of the Appendix Etiology/Cause : Infection or Fecaliths (hard stool!) S&S/Clinical Manifestations: -Fever -High WBC Count -RLQ Pain Nursing Interventions: Appendectomy Need to GET AN X-RAY if have S&S to rule out and then if do have it then will get an appendectomy. These pts will need to be NPO before! Infection or get a little bit of stool/fecal matter in the appendix **high WBC count, RLQ pain and a fever = suspect infection of appendix!** Interventions= goes into surgery to get appendix removed (appendectomy!)

What causes Adrenocortical Insufficiency?- Etiology

Addison's Disease r/t Autoimmune Response

Parenteral Nutrition (PN)

Administration of nutrients directly into the blood stream goes directly to the blood via centrally or peripherally IV

Disorders of Adrenal Cortex

Adrenocortical excess= Cushing Syndrome Adrenocortical insufficiency= Addison's Disease

Low Back Pain

Affects 80% of adults - most people will have this problem at some point, VERY COMMON Why is this so Common? - Because the lower back Bears most of the weight of the body - Lower back is Most flexible region of spinal cord - Lower Back Contains nerves that are vulnerable to injury and or disease

Amputation Nursing Interventions/Care of Amputation:

Amputees not supposed to use a lot of lotions and oils on that area, supposed to wash the sock that goes around the stump, and if in wheelchair and sitting a lot need to be flat b/c of sitting in that position for a long time and they don't want them to get hips locked with sitting so much in wheelchair **REVIEW OVER= Table 62-14, page 1490**

Blood Studies

Amylase & Lipase- enzymes secreted by the pancreas, deals with the pancreas, if worried about pancreas will draw these labs Liver Labs/LFTs= Aspartate Aminotransferase (AST) Alanine Aminotransferase (ALT) -(These will be drawn if we are worried about liver function!) Billirubin= deals with the liver (if worried about jaundice and liver function will get these!) Albumin= protein, protein metabolism Ammonia= deals with liver too much wastes (if this is high= THINK hepatic encephalopathy secondary to liver cirrhosis!)

Nystatin (Mycostatin)

Antifungal - like for Thrush PO liquid solution, shake it up, swish and swallow (this is tx for oral thrush!) and then afterwords do NOT eat or drink anything for 1 hour after swishing with this! **SWISH AND SWALLOW**

Delirium- Drug Therapy= What drugs do you treat Delirium with?

Antipsychotics (Haldol) Benzodiazepines (Ativan)

Auscultation of the Heart

Aortic Pulmonic Erb's Point Tricuspid Mitral **Review over Page 667- where you hear the heart the best**** -APE To Man or All Physicians Earn Too Much mnemonics -Know where each location of where to listen for exam Erb's Point= where you hear S1 and S2 equally (as far as how loud it can be heard), good place to start when you need to hear everything good Aortic and Pulmonic= hear S2 greater than S1 Tricuspid and Mitral= hear S1 greater than S2

What are the 3 main blood vessels in Vascular System?

Arteries, Veins, and Capillaries

Diagnosis of a DVT/VTE

Assessment Findings- need assessment findings to order US to find out for sure if have DVT, etc. Labs & Ultrasound- labs like D-Dimer (not talked about)- don't worry about labs for DVT/VTE

Etiology/Causes of PAD

Atherosclerosis/Arteriosclerosis

Cluster Headaches Nursing Interventions

Avoid Triggers Weather, Burst of Excitement/Anger, Inconsistent Sleep, Consistent Seasons and Emotions -Avoid extreme changes such as like extreme weather changes or a burst of excitement or anger, inconsistent sleep, and with season changes and with changes of emotions can trigger these. Like might tell someone don't want to go to amusement park because can cause a drastic change of emotion (excitement) which triggers the HA Might only last up to 30 minutes whereas migraines last a while/last longer Meds/Drugs= Adrenergic blockers, ergotamine tartrate, corticosteroids (ex. prednisone), CCBs (verapamil), Lithium Biofeedback High flow 100% O2 by non-rebreathing mask is well tolerated,safe and effective alternative treatment to meds. O2 delivered at rate of 6-8 L/min for 10 minutes to relieved HA by causing vasoconstriction and increasing synthesis of serotonin in the CNS.

Migraine Headaches Nursing Interventions

Avoid Triggers such as.... Caffeine, Red Wine, Stress, MSG, Chocolate, Fatigue, Altered Sleep, Avoid harsh Light/Glare They are caused by blood vessels dilating, so want to get them to do things that DON"T trigger vasodilation or avoid triggers that cause the migraines -Meds/Drugs= Beta blockers, Antidepressants, Antiseizure drugs, CCBs, Botulinim Toxin A (Botox), Sumatriptan (Imitrex) or Topiramate (Topamax) -Biofeedback, relaxation therapy, CBT

A 30-year-old man is being admitted to the hospital for elective knee surgery. Which assessment finding is most important to report to the health care provider? a. Tympany on percussion of the abdomen b. Liver edge 3 cm below the costal margin c. Bowel sounds of 20/minute in each quadrant d. Aortic pulsations visible in the epigastric area

B

A 62- year-old man reports chronic constipation. To promote bowel evacuation, the nurse will suggest that the patient attempt defecation a. in the mid-afternoon. b. after eating breakfast. c. right after getting up in the morning. d. immediately before the first daily meal.

B

For which patients is it most important for the nurse to refer to a dietitian for a complete nutritional assessment? A. A 38-year-old diabetic who is undergoing laser eye surgery. B. A 55-year-old with a history of alcoholism who is hospitalized with a fractured femur resulting from a fall. C. A 24-year-old who has been taking a burst of corticosteroid therapy for 1 week for treatment of an asthma exacerbation. D. A 45-year-old hospitalized with nausea and abdominal pain who has had no oral intake and has received only IV fluids of D5½NS for 6 days.

B. A 55-year-old with a history of alcoholism who is hospitalized with a fractured femur resulting from a fall. Answer is B! Alcoholics in general are risk for nutritional deficiencies- alcohol is major risk for nutritional probs! If on corticosteroids for a LONG period of time will be at risk for nutritional deficiencies but if only on it for a week, not that bad

The nurse listens to bowel sounds for 60 seconds and does not hear gurgling. Which action should the nurse take next? A. Document the bowel sounds as hypoactive. B. Continue to listen for at least 2 minutes. C. Administer the prescribed drug for constipation. D. Review the patient's dietary intake for the past 24 hours.

B. Continue to listen for at least 2 minutes.

A patient has a stage 4 pressure ulcer on their sacral area. What type of foods would the patient most benefit from? (Select all that Apply.) A. Fruit Salad B. Peanuts butter and crackers C. Legumes and Grains D. Cheese omelet E. Avocado and Tomatoes

B. Peanuts butter and crackers C. Legumes and Grains D. Cheese omelet Grains are high in protein Table p.855 lists foods high in protein! REVIEW OVER!!

A patient is scheduled for a liver biopsy. Which laboratory results would be of most concern to the nurse? A.Hemoglobin of 12 g/dL B. Prothrombin time of 32 seconds C. Serum ammonia level of 45 mcg N/dL D. White blood cell count of 14.2/µL

B. Prothrombin time of 32 seconds

Oculomotor, Trochlear, and Abducens Nerves (CN III, IV, and VI)

Because these nerves help move the eye, they are tested together. With weakness or paralysis of one of the eye muscles, the eyes do NOT move together, and the patient has a disconjugate gaze. The presence and direction of nystagmus (fine, rapid jerking movements of the eyes) are observed at this time, even though this condition most often indicates vestibulocerebellar problems. Check by PERRLA (Pupils Equal in size, Round, and Reactive to Light and Accommodation)

What causes Acromegaly?- Etiology

Benign Pituitary Tumor (adenoma), Not genetically inherited Caused from a growth tumor on the ANTERIOR pituitary gland

What causes HYPERparathyroidism?- Etiology

Benign tumor (adenoma)

Types of Vomit

Bile color= yellow/green color, what we expect to see, is normal Coffee Ground or Bright red hematemesis= think GI blood! Frank/Red Blood= BAD BAD BAD! Don't like a lot of bight red blood or blood clots b/c big GI issue

Gastritis

Break in the protective barrier and mucosal injury occurs. Can be Acute or Chronic mucosal injury, breaks in the protective barrier! Can be scattered, minimal, or all throughout

A patient is on a lacto-ovo vegetarian diet. What type of foods can the patient eat? A. Fish, milk and poached eggs B. Chicken, cheese and grilled eggplant C. Boiled eggs and chocolate milk D. Oysters, yogurt and turkey

C. Boiled eggs and chocolate milk

A patient receiving dialysis should avoid what type of foods? A. Fresh fruits and vegetable, poultry and beans B. Steamed broccoli, broiled mackerel and artificial sweeteners C. Canned soups, cold cut sandwiches and Chinese take- out D. Microwaved sweet potatoes, boiled cabbage and artichokes

C. Canned soups, cold cut sandwiches and Chinese take-out

After major surgery, a patient receives parenteral nutrition. If the patient develops refeeding syndrome, the nurse would expect which of the following findings? A.Blood glucose level of 148 mg/dL B. Serum potassium level of 5.7 mEq/L C. Serum phosphate level of 1.9 mg/dL D. White blood cell count of 15.6 x 103/μL

C. Serum phosphate level of 1.9 mg/dL Normal Phos= 2.4-4.4, so 1.9 is too low, which is a sign of refeeding syndrome

A patient was recently admitted for DVT and was started on Coumadin. During your education with the patient you would instruct the patient to avoid what food? A. Bananas B. Lettuce C. Spinach D. Processed Meats

C. Spinach Spinach b/c high in Vit K and Coumadin and Vit. K rich foods will cause a toxicity with coumadin.

The nurse is caring for a male client who is 5'8" tall and weighs 98kg. The client asks the nurse if his weight is appropriate for his height. Which is the correct response? a) Your weight is normal for someone your height. b) You are underweight. c) You are overweight. d) You are morbidly obese.

C. You are Overweight

Spinal Nerves

C1-C8, Thoracic and Lumbar

Diagnostic Studies Done for AAA Aneurysm

CT EKG (to rule out MI b/c sometimes a AAA will mimic cardiac pain )

Plasmapheresis (for MG exacerbation)

Can hook them up to a machine to pull off whole blood and take away what they need to then put back what is good -done if that they think is the problem if in an exacerbation of MG Low BP because pulling off blood volume Increased HR b/c low BP and pulling volume K+ decreased- worried about dysrhythmias when pulling off blood volume Decreased Ca+= tetany, Chvostek's sign and trousseau's sign for hypocalcemia, nurse's job to watch for low Ca+ and low K+ and BP and HR

With Long Term ABX what do you worry about?

Candida albicans Clostridium difficile Long term ABX will cause yeast like in candida albicans (yeast infections which are common) or things like C. Diff (watch for this, if have C. Diff will be on contact precautions, wash hands ONLY with soap and water, C. Diff can live on things for days like pumps, door handles, etc. Treat C. Diff with Flagyl (Metronidazole)

Acute Gastritis

Causes: Helicobacter Pylori, Stress, Anxiety Alcohol, Caffeine, Corticosteroids, long term NSAIDs, radiation, ingestion of corrosive substances. -Heals in a few months not a lot of damage permanently. S&S= anorexia, N/V, dyspepsia, pyrosis, FEELS FULL, hemorrhage, and hematemesis (vomiting up blood!)

Cushing Syndrome

Chronic exposure to excess corticosteroids

Alzheimer's Disease (AD)

Chronic, progressive, degenerative disease of the brain

Butterfly Rash (of SLE Lupus)

Common S&S of Lupus Skin issues Rashes and lesions that hurt and are very painful are common with lupus- can't be in the sun at all sometimes These lesions on the skin -butterfly rash the way they look Nursing Interventions for Lupus skin lesion issues= -Might put them on prednisone, sun can cause lesions and cause infection so AVOID THE SUN espec. -Between 11am-3pm and use a sunscreen of at least 15 SPF, goal is to get less lesions and not get the lesions they have infected, etc.

Rheumatic Heart Disease (RHD)

Complication of RF Chronic with scarring and deformity of the heart valves

The Gallbladder does what?

Concentrates and collects and stores bile Can live without it

Levels of Consciousness

Consciousness- fully aware and awake Lethargy - a little more confused Obtunded- might respond w/ a couple of words then fall back asleep or pass back out (ex. someone really drunk might do this) Stupor- can be aroused by being shaken or shouted at viciously, or if do something painful/painful stimuli might respond but other than that not really responding. Coma- complete unconsciousness, not conscious at all!

decorticate posturing

Consists of internal rotation and adduction of the arms with flexion of the elbows, wrists, and fingers as a result of interruption of voluntary motor tracts in the cerebral cortex. Extension of the legs may also be seen. FLEXOR DeCORticate= to the CORE

Coronary Angiography

Contrast Medium Flushed Sensation Bleeding, Hematoma uses contrast that makes them feel flushed or like that they have to pee, will look at the artery for narrowing, can even look for aneurysms in heart this way Treatment= go in and put balloon in and do a stent, CABG, Bypass Stents are expensive being put in!! Balloons are expensive too Bypass= $50,000! WAAAY expensive CABG= need special recovery or place in ICU for CABG procedures

Lower GI Series (barium enema)

Contrast medium is ingested and films taken every 30 minutes until medium reaches terminal ileum. Fluoroscopic x-ray examination of colon using contrast medium, which is administered rectally (enema). Double contrast or air-contrast barium enema is a test of choice. Air is infused after the barium flows through the transverse colon. used to detect the presence of tumors, diverticula, and polyps. Nursing Responsibility: Before- Administer laxatives and enemas until colon is clear of stool evening before procedure. Administer clear liquid diet evening before procedure. Keep patient NPO 8 hours before test. Instruct patient about barium being given by enema. Explain that cramping and urge to defecate may occur during procedure and patient may be placed in various positions on the tilt table. After- Give fluids, laxatives, or suppositories to assist in expelling barium. Observe stool for passage of contrast medium. Tell patient that stool may be white for up to 72 hours after. -barium enema, looks at lower GI, need to be on clear liquid diet the night before, NPO for 8 hours prior to procedure, after procedure stool will be white for about 72 hours after procedure and pt will need to increase fluids for a few days afterwards.

Etiology/Cause of Metabolic Syndrome

Main risk factor is insulin resistance r/t excessive visceral fat. Insulin resistance is the the body's cells diminished ability to respond to the action of insulin. The pancreas compensates by secreting more insulin, resulting in hyperinsulinemia. Other characteristics of metabolic syndrome include HTN, increased risk for clotting, and abnormalities in cholesterol levels. The net effect of these conditions is an increased prevalence of CAD.

Restless Leg Syndrome- Nursing Interventions

Make sure pt. Avoid Caffeine/Alcohol/Smoking Hydration- get enough H2O, stay hydrated Exercise- get enough exercise for circulation Weight Loss- can help Keep Vascular patent Consistent Sleep Cycle

Nursing Interventions for Gout

Medications: -NSAID -Allopurinol (Zyloparim) *Takes 1 week to be therapeutic *Take with food *Drink 3L/water day- drink plenty to flush out! Nutrition therapy: -Avoid Alcohol -⬆ Fluids Intake -Low Purine Diet ( NO EATING = Sardines, Liver, Chicken, Salmon, Bacon, Beef, Pork, Ham)

NI for Gastritis

Medications: (same meds as for GERD) -Remove the cause and avoid irritants -Avoid these Rx: Corticosteroids, Erythromycin, NSAIDs- avoid b/c hard on stomach, ABX specifically erythromycin will be hard on stomach, and NSAIDs hard on stomach (teach to avoid!) Avoid: Caffeine, ETOH, Tobacco, Acidic, Spicy Foods (teach to avoid!) Teach a Balanced Diet, Regular Exercise, Stress Reduction (educate pt about these!) Remove the cause---if severe blood loss then may need a blood transfusion and severe fluid loss then give fluid replacement, use MEDS to decrease stomach caffiene,alcohol, tobacco acidic, seasoned and spicy foods -Balanced diet, regular exercise (increases food digestion to decrease acid in stomach), stress reduction techniques (stress increases acid)

Colorectal Cancer

Men > Women Risk Factors: Diet, Smoking, Genetics, Age > 50yrs old S&S: Hematochezia, Changes in stool consistency and shape -Men get this more than women -50 years or older puts you more at risk so start at 50 to get a colonoscopy -If get polyps then go back and get another colonoscopy sooner, etc. -Hematochezia and changes in stool is tell-tale sign meaning cancer has been hanging out a while Diets high in fats lots of meat products might cause this third most common, more common in men

MS- Drug Therapy

Methylpredinsolone (Solu-medrol)= given when having an exacerbation of MS, things to monitor when on this med are infection, hyperglycemia, don't stop taking abruptly, can cause nausea, in prednisone family just given IV, might be on oral prednisone at home as well Fingolimod (Gilenya)= taken every day to cut down on being immunosuppressant, in same family as prednisone, worry about infection -Monitor for infection, bradycardia (HR), cardiac (prolonged QT interval) Baclofen (Gablofen)= help with muscle spasms, muscle relaxer, safety an issue, can cause dizziness and drowsiness so advise patient not to drive till know how it effects them, avoid alcohol w/ med etc. -Monitor RR, drowsiness/dizziness, safety, and avoid alcohol.

A patient may have more than one what?

More than one type of HA!

Facial Nerve (CN VII)

Motor- facial muscle movement Sensory- taste on the anterior 2/3 of the tongue (sweet and salty) Normal findings= able to smile, whistle, wrinkle forehead; able to differentiate tastes among various agents Nursing Considerations/How to test= observe for facial symmetry after asking client to frown, smile, raise eyebrows, close eyelids against resistance, whistle, blow Place sweet, sour, bitter, and salty substances on tongue.

Glossopharyngeal Nerve (CN IX)

Motor- pharyngeal movement and swallowing Sensory- taste on posterior 1/3 of tongue (sour and bitter) Normal Findings= GAG REFFLEX INTACT, able to swallow; able to taste Nursing Considerations/How to Test= place sweet, sour, bitter, and salty substances on tongue; note ability to swallow and handle secretions; stimulate the pharyngeal wall to elicit a gag reflex

Hypoglossal Nerve (CN XII)

Motor- tongue movements Normal Findings= Can move tongue side to side and stick it out symmetrically and in midline Nursing Considerations/How to Test= inspect tongue in the mouth; ask client to stick out tongue and move it quickly from side to side; observe for midline, symmetry, and rhythmic movement of tongue

What is a Hypothyroidism Complication/Exacerbation?

Myxedema Coma!

Nursing Interventions of SLE Lupus

NSAIDs Avoid Sun (can lead to exacerbation) Especially between the time of 11a-3p Use Sunscreen (at least SPF 15) Renal 75% will develop kidney damage -Anemia, Thrombocytopenia -Prone to Infection How would we know someone is having renal problems? Creatinine high(#1 prob), BUN can be high, GFR will be low Anemia? = check CBC if RBCs low Thrombocytopenia?= check for LOW platelet count Prone to infection- how would you know they have infection? Check for Fever & increased white blood cell count!

Assessment of Pancreas

Cullen's Sign= bruising around the umbilical area (belly button) Grey Turner's Sign= bruising in the flank/back area behind- if have pancreatitis problems with bruising around that area Blumberg's Sign= REBOUND TENDERNESS when fluid in abdomen

The nurse teaches a patient about safe and successful weight loss. Which statement, if made by the patient, would indicate an understanding of the instructions? A.) "I will keep a diary of daily weights to chart my weight loss." B.) "I plan to lose 4 pounds a week until I have lost my goal of 60 pounds." C.) "I should not exercise more than what is required because increased activity increases the appetite." D.) "I plan to join a behavior-modification group to make permanent changes necessary for weight control."

D.) "I plan to join a behavior-modification group to make permanent changes necessary for weight control."

SIADH vs. DI

DI= too much sodium, HYPERnatremia, peeing it all out too much, hypovolemic SIADH= not enough sodium, HYPOnatremia, hypervolemic, LOTS OF FLUID ON BOARD, not peeing it out enough

Virchow's Triad

Damage (injury), Stasis, and Hypercoagulability Like with a DVT/VTE Assessment done that can tell if you have a venous thrombosis or not, usually unilateral (in one leg or another) so will have pain, warmth, tenderness

HYPOthyroidism

Deficiency of thyroid hormone that causes a general slowing of the metabolic rate and body processes EVERYTHING slows down **LOW THYROID**

GBS- Patho

Demyelination & Inflammation of the myelin sheath *Similar to MS, but MS is more gradual, GBS is more aggressive and progressive

Nursing Interventions/Considerations & Diagnostics to Consider with an Aortic Dissection

Diagnostic Studies: Similar to AAA Nursing Interventions: -Manage BP & HR- a lot of these people will have a BP parameter no greater than 90 SBP -Treat Pain: Morphine (b/c it decreases preload, helps the heart not work as hard!) -Drug Therapy -Surgery- has to go to surgery, WILL go

NI for Colorectal Cancer

Diagnostics: -Colonoscopy- The Gold Standard for Diagnosing -Fecal Occult Blood Test (FOBT) *Positive Blood in Stool *48hrs prior no red meat, ASA, NSAIDs -Surgery -Lifestyle Changes *Decrease Fat *Decrease Refined Carbs *Increase Fiber *Exercise Colonoscopy= gold standard for dx colorectal cancer, done at age of 50 or if notice a problem before then -Do a fecal occult/stool test= put stool on test/strip and drop the blue dye on it and if it is red then positive for stool -For 48 hours before doing the FOBT no red meat or ASA or NSAIDs -Normal diet changes to help with colorectal cancer and will eventually get surgery if needed

Pulse Pressure

Difference between SBP & DBP 30-40 normal Wide/Increased Pulse Pressure Narrow/Decrease Pulse Pressure PP = difference between SBP and DBP PP=SBP-DBP 120/80 pulse pressure would be 40 About 30-40 is a normal PP If PP gets narrow or less than 30, then that means the patient might be in shock or have CHF (narrow= not a lot of volume/blood volume) Wide/Increased PP= greater than 40, ex. If exercise then might make that PP go up b/c lots of volume lots of thigns going on and getting thigns moving on the heart, lots of heart working

Anomia

Difficulty finding words to name an object

Varicose Veins

Dilated, Tortuous veins! Causes of/ Etiology= Venous HTN r/t Standing, Sitting too long, Obesity, Tobacco and Pregnancy S&S/Clinical Manifestations= -Heavy, Achy feeling -Pain after prolonged Standing/Sitting Treatments= Compression Stockings, Manage/Change Diet, Standing/Sitting precautions (don't sit or stand in place for too long!), procedures like Lasix/laser surgies (not tested over procedures/surgeries)

Esophagogastroduodenoscopy (EGD)

Directly visualizes mucosal lining of esophagus, stomach, and duodenum with flexible endoscope. Test may use a video imaging to visualize stomach motility. Detects inflammation, ulcerations, tumors, varices, or Mallory-Weiss tears. Biopsies may be taken. Varices can be treated with band ligation or sclerotherapy. Before Procedure= Keep patient NPO for 8 hours. Make sure signed consent is on chart. Give preoperative medication if ordered. Explain to patient that local anesthesia may be sprayed on throat before insertion of scope and that patient will be sedated during procedure. After Procedure= Keep patient NPO until gag reflex returns. Gently tickle back of throat to determine reflex. Use warm saline gargles for relief of sore throat. Check temp q15-30 mins for 1-2 hours (b/c a sudden temp spike is a sign of perforation!) -pt. will consciously sedated (given meds and puts them in lala land a little bit, things like give them Valium!) , have back of throat sprayed to numb area so when stick tube down not gagging, pt needs to be NPO for 8 hours and have signed consent before procedure, afterwards job as nurse is to make sure gag reflex is intact before they are able to eat or drink

Heart Valve Replacement

Done w/ Prosthetic Valves= Mechanical (Anticoagulation) & Biologic (Xenograft) types! Eventually stenosis or regurgitation or prolapse problems like the mitral and aortic propblems will need to have a heart valve regurgitation Two types of Prosthetic valves Mechanical= man made, fake, tougher (if have aortic replaced this is the only valve replacement they can have) stickier, almost foreign to the body, body senses it is new thing in their body, so will put them on anticoagulants b/c makes the blood stick worse Biologic (xenograft)- more delicate, can be put in mitral valve area, not as durable and lasts about 10 years, don't have to be on anticoagulants for rest of life b/c body knows or recognizes it has normal part of body,etc.

Diagnostic Studies- Computed Tomography (CT Scan)

Done with or without contrast Need to stay still!! Contrast= hard on kidneys, so afterwords encourage lots of fluids (2-3 L/day for a few days), if on metformin need to stop med 24 hours prior to procedure and no metformin for 48 hours afterwords

MS- Nursing Interventions

Drug Therapy (See Med Sheet) Education: -Safety -Avoid Triggers *Stress, Infection, Smoking, Fatigue, Illness, Inconsistent sleep, poor diet

Parkinson's Disease- Nursing Interventions

Drug Therapy (See Med Sheet) Airway- trouble swallowing, so protect airway by giving small bites, sit pt up all the way at least 30 degrees ADL- walking, ambulating difficult Safety/Falls- precautions for falls and make sure they keep safe Psychosocial Support- cognition becomes impaired and develop dementia

Venous Disease S&S

Dull ache or heaviness in lower extremity Normal or thickened nails Bronze-Brown pigmentation varicose veins MAY be visible Skin texture= THICK, HARDENED, INDURATED Skin Temp= WARM (no temp gradient!) Dermatitis will typically occur Pruritus will typically occur Peripheral pulses are present (if edema is present MAY not be able to palpate) Cap refill= LESS than 3 seconds (<3 sec) LL Edema (lower extremities) Hair= may be present or absent Ulcers= at the MEDIAL MALLEOLUS, IRREGULAR SHAPED, Moderate to large, Granulation tissue is YELLOW SLOUGH, Dark Red "Ruddy"

Diagnostic Studies- EKG/ECG

ECG= tele box in another room and watches it EKG= put leads on chest and looks at paper that monitors it to see what is goin on with the patient's heart Bedside monitoring- gives you one view EKGs run about $1,000 each time- make sure you chart that! IT is a charge to the patient, very expensive Telebox= someone sits and watches what it is saying on there

Seizure Nursing Interventions

Education: Prevention- don't drink alcohol too much Medication -Take medication as instructed; -Do not stop medication abruptly -***STUDY MED PRINT OUT/Med Sheet!!*** Seizure Precautions: -Bed in low position -IV access or IV patent -Suction & Oxygen Ready Seizure Management: -Airway, Breathing, Circulation -Ativan (Lorazepam) IVP to stop seizure

Hypertensive Emergency

Emergent= BP elevation so high that organ damage occurs, can be like 220-250 SPB, not specific BP looking for, just know REALLY HIGH, know with emergent HTN crisis they can develop ORGAN DAMAGE EMERGENT= ORGAN DAMAGE!

Pre-Malignant/Precancerous Oral lesions

Erythroplakia Leukoplakia Screen for this, check oral mucosa and mouth area to help keep a watch over that to catch it early enough if have it

Hemorrhage

Etiology/ Cause: Gastric Ulcers S&S: -Vomiting -Hematemesis- bright/frank red blood thrown up/vomited, more serious than coffee grown, profuse bleeding -Coffee Ground Emesis- brown, has been hanging out in stomach a little longer -Melena- (bloody stool or tarry black) -Losing blood or giving blood

S&S of Fracture

External Rotation Leg Shortening (affected side) Severe Pain they have fallen and you see them, external rotation (leg flops outward, ball and joint messed up and doesn't have that structure anymore), leg shortening (one leg is shorter than the other) and have severe pain (even more severe than with OA problem, OA is chronic and will have had it a while, and fractures are a sudden issue so intense pain more so than in OA)

S3 Gallop- Third Heart Sound (S3)

Extra heart sound, low pitched, heard in early diastole. Similar to sound of a gallop Cause: LV failure. Volume overload, mitral, aortic, or tricuspid regurgitation. HTN (possible)

S4 Gallop -Fourth Heart Sound (S4)

Extra heart sound, low pitched, heard in last diastole, similar to the sound of a gallop Cause: forceful atrial contraction from resistance to ventricular filling (ex. LV hypertrophy, aortic stenosis, HTN, CAD)

Pericardium

Fibroserous sac that the heart is covered by -consists of two layers: the inner (visceral) layer and the outer (parietal) layer. -A small amount of pericardial fluid lubricates the space between the pericardial layers (pericardial space) and prevents friction between the surfaces as the heart contracts.

Refeeding Syndrome

Fluid retention and Electrolyte Imbalances Hypophosphatemia is the Hallmark LOW PHOS, Too much Fluids retained, and electrolytes imbalanced! everything gets dumped and can't handle after not having enough nutrients for such a long time

Venous Thrombosis

Formation of a thrombus and inflammation of the vein

4 Lobes of the Brain

Frontal Parietal Temporal Occipital

Cardiac Cath

Gives us information about CAD, CO, EF looks at the coronary arteries Typically goes through the femoral artery and goes all the way up to the heart to look around Uses a dye that makes them feel like they are gonna pee or feel a burning sensation throughout Area whited out= blockage found Go and put in cath and look around

Surgical Methods for Oral Cancers- Oral Surgeries

Glossectomy, Mandibulectomy, and Co-mandible procedures

Esophageal Cancer

Grows quickly and spreads quickly, if find a tumor in that area it is more than likely cancerous, at least half of these cancers will metastasize and go elsewhere b/cc it is so vascular Risks= tobacco/smoking, ETOH and untreated GERD Usually silent in the early stages and once you know it is there it has usually already metastasized Most Tumors are Cancerous Risk Factors Tobacco ETOH GERD not treated Some are benign but most are cancerous, 1/2 metastasizes, it causes GERD, tobacco, and alcohol, will have dyspahgia/trouble swallowing (early sign) and odynophagia/painful swallowing (late sign!) NI= Nutrition, soft diet, TPN, TF Tx- nonsurgical= chemo,radiation, maintain ariway Tx-surgical= Esophagogastrostomy remove part of esophagus and/or stomach NG Tube so don't throw up! Control pain- if not they won't breathe d/t pain Increase Ca+ and Protein NG Tube on suction= NEVER FLUSH, NO MEDS, Before 24 hours blood from NG is normal (just no flank, red blood), but AFTER 24 hours little to green/yellow should be the normal.

Hpertensive Crisis S&S/Clinical Manifestations

HA N/V Seizures Changes in LOC Renal/Cardiovascular/Respiratory ***Will have N/V, might cause seizures, renal output goes down (kidney UOP low) LOT OF VOLUME IN BODY= HR HIGH, trouble breathing****

Labs for Patient w/ CHF

Hct & Hgb Sodium BNP ABG UA Spec. Gravity Albumin & Protein Levels CHF patient has a lot of volume so trying to pull it off Hgb and HCt will be LOW- don't necessarily need blood transfusion unless WAY TOO LOW Sodium levels will be - HYPOnatremic give HYPERtonic fluids BNP= normal is less than 100, if higher than too much fluid in ventricle, if too high then think BNP SO if see BNP is really high then you will get an echocardiogram to confirm that and see Ejection Fraction (EF) ABG= CHF patient will typically be in respiratory ACIDOSIS UA - will get a urine and run that to the lab, urine output will be a little low Specific Gravity - HIGH (means dehydrated, b/c even though lot of volume in body, kidneys hold onto it and then when do pee out will tel lthe body they are dehydrated, kidneys aren't getting any volume so when do pee will be concentrated b/c hanging out in the body, etc.) but when giving Lasix or digoxin that number will change and be better b/c kidneys will start perfusing again,etc. Proteinuria = too much protein in urine Microalbuminuria = albumin is a protein so too much in urine, high levels of protein Albumin=protein Proteinuria= Whenever the kidneys are stressed out/not getting perfused and get damaged, so kidneys are weaker and can't hold the protein like it used to, so then protein starts spilling out in the urine

Pyrosis

Heartburn, burning in epigastric or substernal area Possible Etiology/Cause= hiatal hernia, esophagitis, incompetent lower esophageal sphincter

Treatment of Hernias

Herniorrhaphy (Laparoscopic Surgery) Hernioplasty (mesh used to enforce weakened area) Post-op Voiding, I&Os No Coughing No Heavy Lifting If strangulation or irreducible issues with hernia will send into surgery so will have a herniorrhaphy or laparoscopic surgery OR a hernioplasty to enforce the weakened area POST-OP Voiding and I&Os need to be checked strictly and enforced -NOOOO coughing b/c that mesh placed in during surg

Disorders of Thyroid Gland

Hyperthyroidism and Hypothyroidism conditions

Hypoparathyroidism S&S

Hypocalcemia

Ileostomy

opening into the ileum

Odynophagia

painful swallowing Possible etiology/cause= cancer of esophagus, esophagitis

Normal Lipid Levels- KNOW!!!! Lipid Levels should be.....

Total Cholesterol: <200mg/dL LDL (bad cholesterol): <100mg/dL HDL (good cholesterol): >40mg/dL Triglycerides: <150mg/dL

Nursing Interventions for HYPOparathyroidism

Treat HYPOcalcemia (give calcium gluconate!)

Treatment of AAID

Treatments include.... -Anticoagulant Therapy (coumadin/warfarin, heparin, lovenox?) -Remove Thrombus

Bariatric Surgical Procedures

Types Include: - Adjustable Gastric Banding (AGB) -vertical sleeve gastrectomy -Roux-en-Y Gastric Bypass Goal is to make the stomach smaller so not eating as much, restriction type of surgery

Clinical Manifestations/S&S of DVT/VTE

Unilateral Calf Pain/Tenderness Swelling/Warmth/Redness Positive Homan's Sign-dorsiflex the foot,could mean they have a clot but not for sure

What causes Bell's Palsy?- Etiology

Unknown, but evidence of Viral Infection such as HSV 1 (Other reasons, but mostly caused by HSV 1)

Two categories of Seizures

Unprovoked & Provoked

Etiology/Causes of Pericarditis

Viral and Bacterial infections!

POST- OP HIP SURGERY- TEACH THEM HOW TO WALK WITH A WALKER OR CRUTCHES!

Watch the video**** How to Use Walker: Bend in elbow needs to be 30 degrees, slide walker forward as bad leg goes forward and then bring good leg in to join it Slide walker forward with bad leg/affected leg , and the bring good leg in forward after. How to use crutches: crutches have to be 2 fingerbreadths below armpits, slight bend in elbows All pressure should go on UNAFFECTED foot, bad foot up Mood crutches forward then push off with the GOOD/UNAFFECTED LEG Going up and down stairs w/ crutches: put crutches in one hand on same side as injury, then with other hand grasp the stair railing, go UP with the good/unaffected foot and lift affected/bad foot up while doing so Going down stairs you will put crutches in one hand on the next step and go down with the bad foot keeping pressure off of it then follow with good/unaffected foot UPSTAIRS WITH THE GOOD FIRST DOWNSTAIRS WITH THE BAD FIRST

Osteomyelitis will need proper dressing of wound/infection....what type of dressing do you use for Osteomyelitis??

Wet-to-Dry Dressing- to help debris and help get rid of the drainage and soak it up

Pulse Deficit

When the apical and radial pulses are not equivalent. The difference between the two numbers is called the pulse deficit Subtract radial from apical This can indicate dysrhythmias Radial Pulse- Apical Pulse= Pulse Deficit - means both the apical and radial pulses don't match up, not equal or equivalent -Found by subtracting the radial and apical pulses you hear or feel -Might indicate dysrhythmias where the blood isn't getting out to the body like it should ,etc.

Patients with Osteomyelitis are sometimes put on BED REST, what would you need to be aware of if the patient is on BED REST??

Worry about DVT, bedsores/pressure ulcers, calcium buildup, and footdrop! sometimes are put on bed rest, but if on bed rest then the nurse should worry about DVT and bedsores/pressure ulcers, calcium buildup and out of bone (makes bones even weaker), and foot drop with being on bed rest Foot drop- foot starts to drop back, normally it stands up, damage to nerve b/c not ambulating , need to use those high top shoes like converses to help prevent foot drop (can't fix foot drop, can only help prevent it), is common and doesn't take very long for it to occur , wear the converses while in bed

Metabolic Syndrome

a group of metabolic risk factors that increase an individual's change of developing CV disease, stroke, and DM. Characterized by a cluster of problems including obesity, HTN, abnormal lipid levels, and high blood glucose levels.

SCI- Autonomic Hyperreflexia/Dysreflexia

a massive, uncompensated cardiovascular reaction mediated by the SNS. It involves stimulation of sensory receptors below the level of the SCI. -Injury T6 and higher -Exaggerated ANS ANS AND PNS are acting out of control and not calming down , so only thing to do to help this is to remove the noxious stimuli

Dyspepsia

burning or indigestion Possible Etiology/Cause= peptic ulcer disease, gallbladder disease

Stress PUD

burns major illness ICU pt. or surgery pt. Give GERD MEDS to prevent (prophylaxis in hospital against getting a stress ulcer!) Tell pt they WILL get GERD meds as prophylaxis Less common type of ulcer Occurs after acute medical crisis or trauma Less Common Etiology unclear When come to hospital will place pts on GERD medications to prevent stress ulcers as a prophylactic, especially when really sick pts like have burns the body will produce more acid and so will prophylactic be put on medications for preventing an ulcer

The nurse is caring for a male client who is 5'8" tall and weighs 98kg. The client asks the nurse if his weight is appropriate for his height. Which is the correct response? a) Your weight is normal for someone your height. b) You are underweight. c) You are overweight. d) You are morbidly obese.

c) You are overweight.

Spinal Cord Injury (SCI)

caused by trauma or damage to the spinal cord

The nurse knows her teaching has been effective when the patient responds that a low-fiber diet includes the following: a) Whole-grain bread b) Raw Carrots c) Bran and whole-grain cereals d) Steamed Broccoli

d) Steamed Broccoli Steamed foods are low in fiber! steaming foods lowers the fiber count

Capillaries

exchanges nutrients & waste

Steatorrhea

fatty,frothy, foul-smelling stool Possible Etiology/Cause= chronic pancreatitis, biliary obstruction, malabsorption problems

Nausea and Vomiting

feeling of impending vomiting, expulsion of gastric contents through mouth Possible etiology/causes= GI infections, common manifestation of many GI diseases; stress, fear, and pathologic conditions

Mass in rectum and anus

firm, nodular edge Possible Etiology/Causes= tumor, carcinoma

Acute Marginal gingivitis

friable, edematous, painful, bleeding gingivae Possible Etiology & Significance/ Cause= irritation from ill-fitting dentures or orthodontic appliances, calcium deposits in teeth, food impaction

Diarrhea

from a GI bug Take measures to PREVENT IT Worry about skin integrity If have Increased K+ do a cardiac assessment place F&E

Diagnostics/How to Diagnose RF &/or RHD

get an x-ray, Echo, and EKG to help rule out that it is RF or RHD

Bruit

humming or swishing sound heart through stethoscope over vessel Possible Etiology/causes= partial arterial obstruction (narrowing of vessel), turbulent flow (aneurysm)

MRI

imaging of brain, spinal cord, and spinal canal by means of magnetic energy. used to detect strokes, multiple sclerosis, tumors, trauma, herniation, and seizures. Provides greater detail than CT and improved resolution (detail) of intracranial structures. Takes a longer time to complete and may NOT be appropriate in life-threatening emergencies Before: screen patient for metal parts and pacemaker in body. Instruct patient on need to lie very still for up to 1 hour. Sedation may be necessary if patient is claustrophobic.

Diverticulitis

inflammation of the diverticula, pouches get inflamed or something gets caught.

Automatisms

involuntary behaviors

Problems w/ the cerebellum

issues w/ balance, RISK FOR FALLS "cerebellar ballerina"

How do you know that a person has a Vit B12 deficiency?

issues w/ neurological like tingling, start having maybe memory problems all throughout paresthesia or trouble walking, etc.

Syncope

loss of consciousness; pass out

Amnesia

loss of memory

Magnetic Resonance Imaging (MRI)

make sure no metal of any kind, worry about pacemaker if have one, etc. -don't start with this procedure first, might start with CT or x-ray first to see what we can see there then might need MRI if needed

Decerebrate posturing

may indicate more serious damage and results from disruption of motor fibers in the midbrain and brainstem. In this position, the arms are stiffly extended, adducted, and hyperextension of the legs with plantar flexion of the feet. EXTENSOR DeCEREbrate- CELEBRATE

Clubbing of nail beds

obliteration of normal angle between the base of the nail and skin Cause: endocarditis, congenital defects, prolonged O2 deficiency

Gastrostomy

opening into stomach

Pilondial cyst

opening of sinus tract, cyst in midline just above coccyx Possible Etiology/cause= probably congenital

Gastric PUD

pain 30 minutes AFTER eating in LUQ Less common than duodenal ulcers Pain located in the left epigastric Pain is aggrevataed by food! FOOD WORSENS IT! Pain in stomach!

Afterload

peripheral RESISTANCE against which the LEFT VENTRICLE (LV) must pump. -Affected by size of the ventricle, wall tension, and arterial blood pressure (BP). If the arterial BP is elevated, the ventricles meet INCREASED RESISTANCE to ejection of blood, increasing the work demand. Eventually this results in ventricular hypertrophy, an enlargement of the heart muscle without an increase in CO or the size of the chambers.

Compression or axial loading SCI

person diving into lake or pool and hits head on like a rock- compression of spinal cord, fracture vertebrae

Diverticulosis

pouch-like herniation of the mucosa of the colon

What causes Diabetes Insipidus (DI)?- Etiology

problems w/ Central, Nephrogenic (kidneys), Primary problem causes it

Gastric Outlet Obstruction

pyloric obstruction (between the stomach and duodenum) They VOMIT UNDIGESTED FOOD S&S: -N/V -abdominal bloating -Pyloric Sphincter area is smaller than should be -MUST be NPO in case of surgery -Will have NG tube to help with vomiting and decreased K+ levels

Pyorrhea

recessed gingivae, purulent pockets Possible Etiology & Significance/Cause= Periodontitis

cholecystectomy

removal of gallbladder

Mandibulectomy

removal of jaw

Mandibulectomy

removal of mandible

Esophagoenterostomy

removal of portion of the esophagus with segment of colon attached to remaining portion.

Glossectomy

removal of the tongue

Clonic

rhythmic jerking of extremities

Aortic Stenosis

risk factor for CHF Being older , 80 years of age = risk factor for CHF

Geographic Tongue

scattered red, smooth (loss of papillae) areas on dorsum (back) of tongue Possible Etiology & Significance/ Cause= Unknown

Vestibulocochlear (CN VIII)

sensory-sense of hearing and balance Normal findings= hearing intact, balance maintained while walking Nursing Considerations/How to Test= test w/ watch ticking into ear, rubbing fingers together, Rinne Test, Weber Test; test posture, standing w/ eyes closed; otoscopic exam

Cheilosis

softening, fissuring, and cracking of lips at angles of mouth Possible Etiology & Significance/Cause= Riboflavin Deficiency

Ostomy cont'd

stoma should be pink and moist all the time, veen right after. POST-OP= functions in 2-4 days, will be liquid at first but be a little bloody discharge at first; keep the skin clean around the stoma area. Ileostomy= always liquid Ascending= always liquid Transverse= pasty Descending & Sigmoid= solid The more liquid could be at risk for F&E problems!

Systemic Vascular Resistance (SVR)

the force opposing the movement of blood. Created primarily in small arteries and arterioles.

Sliding Hiatal Hernia

the junction of the stomach and esophagus is ABOVE the diaphragm, and a part of the stomach slides through the hiatal opening in the diphragm. This occurs when the patient is SUPINE. The hernia usually goes back into the abdominal cavity when the patient is standing upright. This is the MOST common type of hiatal hernia -Most common hiatal hernia -wide open, distended, larger, easy to have GERD with this type of hernia, interventions for sliding hiatal hernia is the same for GERD, typically don't go in for surgery unless becomes a big problem for these patients -Causes a lot of GERD S&S S&S similar to GERD= acid reflux, belching, regurgitation DX w/ an EGD THese people are at risk for aspiration!

Headache

the most common type of pain that humans experience. Classified as primary or secondary

Coronary Circulation

the myocardium's own blood supply system.

Systolic BP (SBP)

the peak pressure exerted against the arteries when the heart contracts

Diastolic BP (DBP)

the residual pressure in the arterial system during ventricular relaxation (or filling)

Nutrition

the sum of processes by which one takes in and uses nutrients

Leukoplakia

thickened white patches on tongue Possible Etiology & Significance/Cause= Premalignant Lesions

Endocardium

thin, INNER lining

Hemorrhoids

thrombosed veins in rectum and anus (internal or external) Possible Etiology/Causes= portal hypertension, chronic constipation, prolonged sitting or standing, pregnancy

Flexion-rotation or excessive loading SCI

turning head or neck too much and causes injury to spinal cord, usually don't live from these injuries too much- displacement of vertebrae

The LEFT ventricle is ......

two or three times THICKER than the RIGHT ventricle. -The thickness of the left ventricle is necessary to produce the force needed to pump blood into the systemic circulation.

Types of Nutritional Problems

undernutrition, normal nutrition, or overnutrition

Right Sided HF

usually caused by Left sided HF, left sided HF usually starts first so starts backing up then which causes Right Sided HF and gets the Right side of the heart too full which backs it up into the body Left Sided HF is the reason for Right Sided HF S&S of Right Sided HF= pitting edema, JVD, abdominal distention, etc

Problems w/ the occipital Lobe

vision issues

Bariatric Surgery

weight loss surgery, surgery for obesity problem that isn't being fixed by other things.

Candidiasis

white, curdlike lesions surrounded by erythematous mucosa Possible Etiology & Significance/Cause= Candida Albicans

Cranial Nerves

Nerves I-XII

Cardiovascular Problems

Neuro Skin Nails Respiratory Kidneys

What causes Dementia?- Etiology

Neurodegenerative Conditions Vascular Disorders

Treatment of Oral Cancers

Nonsurgical methods= chemo and radiation Teach: -Use NaHCO3, NO ETOH, use soft toothbrushes, avoid sun, use sunscreen, no smoking/tobacco

Etiology/Cause of RF and RHD

Occurs 2-3 weeks after having Streptococcal pharyngitis Major cause is STREP!!!

Amyotrophic Lateral Sclerosis (ALS)- Etiology/Causes

Onset 40-70 years Men > Women (happens in men more than women)

MG- Clinical Manifestations/S&S

Onset Insidious Remission & Exacerbations Muscle weakness Eyes primarily affected first (Diplopia, Ptosis) Muscles are stronger in the am and weaker in pm Rest periods can help restore strength MS= at first just a little tickled or annoyed VS. MG= will show big signs right away Muscles stronger in AM and weaker in PM, tend to be more fatigued than those w/ MS Give them rest preiods to help restore strength

Surgery Procedures for Rolling Hiatal Hernia

Open Fundoplication Incision Laparoscopic Fundoplication (Nissen)

choledochojejunostomy

Opening between common bile duct and jejunum

choledocholithotomy

Opening into common bile duct for removal of stones

Colostomy

Opening into the colon

Hip fractures most commonly happen because of what?

Osteoarthritis or Falls/Fractures from Falls

Acromegaly

Overproduction of Growth Hormone (GH)

Gastrostomy & Jejunostomy Tubes

PEG, G-tube, J-tubes! Tube feedings for extended period -Patient must have an intact and unobstructed GI tract -When need tube feedings for a long period of time, patients MUST have an intact and unobstructed GI tract to get one or use one

S&S of Osteoarthritis

Pain Decrease Function & mobility

Arterial Pulses

Presence/Absence/Equal Bilaterally Pulse Grade Scale: 0-3+, 2+ Normal Rhythm: Regular or Irregular Rate: # (how many bpm you counted) Hypo-kinetic: Weak or Narrow Pulse Hyper-kinetic: Strong or Widen Pulse What do we chart for arterial pulses?? = pulse grade, rhythm, rate, and if it is hypokinetic and hyperkinetic Grading Pulses when Palpating them: 0=Absent 1+ = Weak 2+ = Normal 3+ = Increased, full bounding Chart/note if it is a regular or irregular pulse when palpate it **Know the locations for PULSES- Figure 31-6 on pg. 666 like carotid, brachial, radial, femoral, popliteal, posterior tibial, and dosalis pedis***

Nursing Interventions for DVT/VTE

Prevention: TED Hose, SCDs, Ambulation, Anticoagulation, Education (done to prevent a DVT/VTE) Actual (if have a DVT/VTE): Rest with bathroom privileges, Elevate leg when in bed or chair, No Massage, Monitor for Complications (PE & Dysrhythmias), Surgery, Anticoagulant Therapy (see med sheet)

Difference between RF and RHD?

RF= just the inflammation RHD= that chronic scarring and deformity shown in the heart valves

4 Quadrants of the Abdomen

RUQ LUQ RLQ LLQ

Diagnostic Studies for GI System

Radiology Studies: -Upper GI series (Barium Swallow) -Lower GI series (Barium Enema) -Computed Tomography Scan (CT scan) Endoscopy: -Esophagogastroduodenoscopy (EGD) -Colonoscopy -Endoscopic Retrograde Cholangiopancreatography (ERCP) Liver Biopsy: - Open vs. Closed Fecal Tests: -Fecal Analysis -Stool Culture Blood Studies: -Amylase -Lipase -Gastrin -Liver Labs (AST & ALT aka LFTs) -Aspartate Aminotransferase (AST) -Alanine Aminotransferase (ALT) Bile Formation:- Total Bilirubin Protein Metabolism: -Albumin -Ammonia

Endoscopy cont'd.....

Refers to the direct visualization of a body structure through an endoscope. An endoscope is a fiberoptic instrument with a light and camera attached, allowing the ability to take video and still pictures. Some endoscopes contain a channel through which to pass instruments, such as biopsy forceps and cytology brushes. GI structures that can be examined by endoscopy include the esophagus, stomach, duodenum, and colon. The major complication of GI endoscopy is perforation through the structure being scoped. Many endoscopic procedures require short-acting IV sedation. All endoscopic procedures require informed, written consent. Capsule endoscopy= noninvasive approach to visualize the GI tract. Colon capsule endoscopy may be useful in monitoring inflammation in patients with IBD. Its sensitivity in detecting small lesions, colonic polyps, and colorectal cancer is under investigation.

Hemiglossectomy

Removal of half of the tongue

Diagnostic Studies for RA

Rheumatoid Factor (RF) = positive+ in 80% of RA pts!

Coronary Arteries

Right Coronary Artery (RCA) Right (acute) Marginal Artery Posterior Descending Artery Left Anterior Descending Artery (LAD) Diagonal Arteries Left (obtuse) Marginal Artery Left Circumflex Artery (LCx) Left Coronary Artery (LCA) coronary arteries originate from the aorta *For exam pruposes= Don't memorize all the coronary arteries now, just know... Right= right coronary arteries Left= Left coronary arteries

PAD Nursing Interventions/How to Treat or Prevent PAD

Risk Factor Modifications: -Check for CVD Risk Factors -Tobacco Cessation (NO SMOKING!!!) -Control Diabetes - Manage an Appropriate Weight -Manage HTN -Teach pt How to check BP correctly & What affects BP -Nutrition *Fat intake < 30% of total calories *Saturated Fat <10% *Cholesterol <300mg/day -Exercise -Position of Extremities -Promoting Vasodilation - Fix/Treat Critical Limb Ischemia- EMERGENT SURGERY -Interventional Radiology *Percutaneous Transluminal Angioplasty (PTA) *Stents *Atherectomy -Surgical *Arterial Revascularization/Peripheral Bypass Surgery *Endarterectomy *Patch Graft Angioplasty *Amputation (no questions r/t to this on exam!) Educate the patient NOT TO SMOKE, to control Diabetes, and get to/maintain appropriate weight How do you check BP correctly (Nclex world)??- make sure they rest a bit before you check it, use right cuff size, if get two BPs need to change arms or wait 5 minutes Things that can make BP high= stress, exercising, salt intake, caffeine intake so patient should have a low sodium diet (like don't have canned foods or frozen foods, Chinese foods/MSGs Want diet low in fat Diet low in salt and caffeine and saturated fats, low in cholesterol (keep cholesterol intake at less than 300 mg/day) Positioning of extremities= not supposed to elevate legs ABOVE the heart level, can elevate the legs just not above heart level, also can decrease Blood flow to the extremities if do so want to be mindful of proper positioning of extremities Promoting vasodilation= promote proper blood flow to the extremities Critical limb ischemia= need to go to surgery immediately! Medical or Surgical Interventions when NIs don't work= PTA, Stent, Artherectomy! Want to progress with least invasive then go to the most invasive - least invasive is PTA and stents and artherectomy PTA= puncture the light groing and dilate that artery in leg with a balloon and push it against the wall so blood flow can get thorugh, sometimes balloon is enough and sometimes also put a stent in PTA=BALLOON Stent= what they put in that artery to keep that area open Artherectomy= go in and scrape the plaque off the area All 3 of these procedures you have to puncture the femoral artery and puncture a big catheter with a needle and sheath around it to puncture the femoral artery in the groin and scrape off or put balloon in and do what you need to do Nurse has to put pressure on that femoral artery for at least a whole 5 minutes b/c will bleed very easily, hold pressure so it clots and doesn't bleed, usually the nurse in PACU/surgery put a big thick 4x4 after holding pressure for 5 minutes so it holds pressure for 24 hours then send them up to the floor , concern for bleeding so patient MUST BE flat for at least an hour, keep leg still, bleeding is TOP PRIORITY!! Skin color will be pale, cooler, check peripheral/pedal pulses, check stent area, check site of puncture to monitor for bleeding , Punctual wound in femoral artery if bleeding at that site= can get big like a golf ball Surgical Interventions For people with intermittent claudication even at rest, for those a little more worse off Will do a Bypass with a piece from somewhere in their body and then will replace that with the new piece from their body and so blood will be rerouted Bypass= taking a graft or another vessel from another place form the body and then put that new piece (or graft) reroute so stuff goes AROUND that clot/blockage Endarterectomy- go in to vessel, cut it open and take plaque out Patch Graft Angioplasty= go in and have an incision and open up artery and get all the plaque/stuff out and then will put a patch on that vessel b/c vessel is weak and can rupture easily so the patch gives it a little extra padding to prevent the vessel from bursting open and cause aneurysms, etc. If graft went bad= get see BP, HR go bad, pulses bad, etc. these patients can go from normal to not normal really quick, frequent vitals Remember, keep the patient's leg straight that had the graft in it b/c they shouldn't bend leg, so don't ask them to bed leg to help move up in bed, etc. Also make sure they know not to bend that leg, b/c don't want to tear off the graft, etc. If had a graft in belly or abdomen- more stuff to worry about, don't want them to vomit or regurgitate all that up and cause more problems, etc.

Clinical Manifestations/S&S of Buerger's Disease

S&S similar to PAD Intermittent Claudication As it progresses leads to Rest Pain Can be in the feet (also in hands)

Abnormal Heart Sounds

S3 Gallop S4 Gallop Murmurs Bruits Pericardial Friction Rub

Cardiovascular System Problems with RESPIRATORY include what?

SOB, resp. rate will go up/ be high, crackles, struggling to breath, holding on to CO2 (will make brain confused the more you hold on to that CO2 the more confused you get!- irritable, etc.)

Seizure Disorders

Seizure Epilepsy Status Epilepticus

Esophageal Cancer S&S/Manifestations

Silent in early stages When S&S appear, it has usually spread extensively Pain late S&S Dysphagia- difficulty swallowing but does NOT hurt, common S&S for esophageal cancer Odynophagia- PAINFUL swallowing, hurts when swallowing

Acute Arterial Ischemic Disorders (AAID)

Similar to PAD, but PAD progresses slowly, and Acute Arterial Ischemia is SUDDEN AND DRAMATIC! Causes/Etiology= Embolism r/t Atrial Fibrillation/MI Have a clot that got logged in an artery and blocked it off right away, more acute disorder Maybe have A. Fib and have clots hand out and dislodged and get caught in the lungs PAD= slow, AAID= immediate!! Different from DVT b/c this is in the artery and DVT is in the vein

Classifications of SCI- Level of Injury

Skeletal level of SCI injury= the vertebral level with the MOST damage to vertebral bones and ligaments. Neurological Level of SCI= the lowest segment of the spinal cord with normal sensory and motor function on both sides of the body. Level of Injury may be cervical, thoracic, lumbar or sacral. Cervical and Lumbar injuries= most common b/c they are associated with greatest flexibility and movement. - Types: Tetraplegia (cervical) & Paraplegia (thoracic, lumbar, and sacral)

Complication of Pericarditis= Pericardial Effusion & Cardiac Tamponade

Sometimes it gets inflamed in that area or other times fluid builds up (pericardial effusion!) in that area and causes a problem Fluid build up in that area and causes a problem= cardiac tamponade (a LOT of fluid surrounding the heart) Pericarditis= very painful, fluid can get in there and develop cardiac tamponade (more on this in advanced topics)

Oral Cancers

Squamous Cell Carcinoma Basal Cell Carcinoma

Cause/Etiology of Osteomyelitis

Staph infection- indirect entry or direct entry Indirect entry Boys < 12 years of age r/t Blunt Trauma GI & respiratory infections Direct entry - via open wound Penetrating Wounds Fractures Foreign Bodies (ex. prosthetic devices can cause infection)

What are the causes of Infective Endocarditis?- Etiology

Staphylococcus aureus and Streptococcus viridans Aging (50% have calcified aortic stenosis) Prosthetic valves IVDA (Intravenous Drug Abuse) Intravascular devices (Dialysis, Central Catheters) Two main causes of IE= staph and strep infections When you get older calcification of the aorta or valves can be seen, normal until Drug uses at risk for IE b/c of sharing needles, not being hygenic with that type of stuff, etc. Dialysis and Central Caths are at risk for IE

Mitral Valve Stenosis

Stenosis= narrowing, valves don't open fully Mitral Valve Stenosis= narrowing of the mitral valve, mitral can't opening fully , so blood cannot get from the atria into the left ventricle, so more blood into the atria and overwhelmed, so blood hanging out too long it will clot, these folks who have this are at risk for clots Valve does not open fully Difficult for blood to get from left atrium to left ventricle Left Atrium overload Left Ventricle underload S&S: Pulmonary Congestion, SOB, Decrease CO, Emboli, Diastolic Murmur

Cholelithiasis

Stones in the Gallbladder

Genetic/Biologic Basis of Obesity

Strong evidence of significant genetic/biologic susceptibility factors that are highly influenced by environmental and psychosocial factors: -Eating behavior -Energy metabolism -Body fat metabolism Genetics play a big part in obesity, environmental and psychosocial (like eat to feel better), metabolism type born with (genetically bigger bones??)

Rebound Tenderness

Sudden pain when fingers withdrawn quickly Possible etiology/Causes= peritoneal inflammation, appendicitis

Classifications of Venous Thrombosis

Superficial Vein Thrombosis (SVT) Deep Vein Thrombosis (DVT) Venous Thromboembolism (VTE)

Vagus Nerve (CN X)

Swallowing and speaking Normal finding= able to swallow and speak w/ a smooth voice Nursing Considerations/How to Test= inspect soft palate-- instruct to say "ah" and observe uvula for midline position and rate quality of voice

Drug Therapy Teaching (for Obesity)

Teach to patient ..... -Drugs will not cure obesity -Changes in food intake and exercise are essential for sustained weight loss -Proper administration, side effects, and appropriate use of drugs

Stool Culture

Tests for the presence of bacteria, including Clostridium Difficile (C. Diff) During procedure= collect stool specimen!

The Mitral Valve is also known as what?

The Bicuspid Valve

Classification of SCI- Degree of Injury

The degree of spinal cord involvement may be complete or incomplete (partial). -Complete (complete/total loss of of sensory and motor function below level of injury) -Incomplete (mixed loss of sensory and motor function/sensation and leaves some tracts intact) Degree pf sensory and motor loss depends on the level of injury and reflects specific damaged nerve tracts. -Most people have an incomplete SCI which is good, area not completely broken through. -Complete is area is completely broken through, can't feel at all, etc.

Rolling Hiatal Hernia (Paraesophageal)

The fundus and greater curvature of the stomach roll up through the diaphragm, forming a pocket alongside the esophagus. The esophagogastric junction remains in the normal position. Acute paraesophageal hernia= MEDICAL EMERGENCY! Causes a volvulus (twisting and strangulation of area- obstruction!) Monitor for this b/c it causes TISSUE NECROSIS and check for obstruction!! S&S= abdominal pain, vomiting, distended firm abdomen, VOLVULUS, feel full, difficult to breathe and worse after eatingm chest pain (NOT d/t cardiac issues), and also have S&S similar to GERD, GERD, Iron Deficiency Anemia CP (chest pain can be mistaken for heart pain b/c pushes up and makes it hard to take a deep breath), SOB Feeling very full after meals Volvulus, Obstructions, Strangulation are common If NI dont work then will do surgery! AFTER SURGICALLY FIXING AREA, NOO COUGHING AND DEEP BREATHING, NO NO NO!!!

Arterial Blood Pressure (BP)

The measure of the pressure exerted by blood against the walls of the arterial system. -Two main factors influencing this are Cardiac Output (CO) and Systemic Vascular Resistance (SVR) - is calculated by knowing the CO and Systemic Vascular Resistance (SVR) The force of blood exerted against the vessel walls Systolic BP Diastolic BP BP = CO x SVR ( aka PVR)

Adjustable Gastric Banding (AGB)

The most common restrictive procedure done Involves limiting the stomach size with an inflatable band placed around the fundus of stomach. This restrictive procedure can be done using a Lap-Band or Realize Band system. The band is connected to a subcutaneous port and can be inflated or deflated (by fluid injection in the HCP's office) to change the stoma size to meet the patient's needs as weight is lost. The restrictive effect of the band creates a sense of fullness as the upper portion of the stomach now accommodates less than the average stomach. The band then causes a delay in stomach emptying, providing patients with further satiety. The procedure can be either modified or reversed at a later date if necessary. - is the preferred option for patients who are surgical risks, b/c it is a less invasive approach AKA- Lap Band -Makes you feel fuller quicker, all about restricting what you eat

Pancreatic Cancer Tx-Whipple Procedure or Radical Pancreaticoduodenectomy

**Figure 43-13, p. 1005** This surgical procedure involves resection of the proximal pancreas, adjoining duodenum, distal portion of the stomach, and distal portion of the common bile duct. An anastomosis of the pancreatic duct, common bile duct, and stomach to the jejunum is done. -Take out part of the pancreas and reroute it!

Risk Factors for Osteoporosis

*** REVIEW OVER= Table 63-12, page 1511*** Advancing Age (>65 yr) Female and Low Body Weight White or Asian Ethnicity Cigarette Smoking Sedentary Lifestyle/Immobility Post-Menopausal Diet low in Calcium and Vitamin D Excessive Alcohol Medications As you age you will be at risk (greater risk at 65 years or older Female and lower body weights b/c have smaller body frames bad for bones White and Asian ethnicity have higher risk Smoking decreases estrogen and estrogen helps protect the bones Sedentary lifestyle (calcium pulls out of bones, less calcium in bone, bad!) Diet low in calcium and Vit. D Drink ETOH too much will cause a big risk Medications that you are on for extended/long period of time like corticosteroids, meds that pull calcium from the bone, etc.

Cushing Syndrome Nursing Interventions

**Managing Hyperglycemia** Too much steroids= causes blood sugars to go UP, so will cause HYPERglycemia so in Cushing's syndrome will have HIGH BS! So, How to manage HYPERglycemia???- give insulin! How to handle insulin/store it?- don't freeze insulin, no direct sunlight, can be stored at room temp for 4 weeks Fastest route to give/admin insulin- stomach, then arms, thighs and legs and buttocks Regular Insulin can be given IV only, not the other types of insulin Regular insulin IV= will drop the K+, so watch K+ b/c could cause a low K+ amount, so even in Cushing's Syndrome you need to watch that For Insulin subcut Mixing Insulins= Draw air into cloudy/NPH, air into clear/Regular, then draw up clear/Regular then draw up cloudy/NPH (Remember Mnemonic-Not Ready to Be an RN!)

Delirium- Patho

**REVERSIBLE** impairment of cerebral oxidative metabolism and multiple neurotransmitter abnormalities

Alzheimer's Disease-Clinical Manifestations/S&S

**REVIEW OVER p. 1406-1407** *Stages- Mild, Moderate, and Severe *Memory Loss *Retrogenesis - "back to birth"; process in AD patients in which degenerative changes occur in the reverse order in which they were acquired. Get a little angry about it, defensive then start having trouble communicating (get angry and not able to control themselves) and then in the end there is complete memory loss and then usually die r/t things like getting pneumonia or get septic Start acting like a a 10 year old then 8 year old then 6 year old- like to play with baby dolls, mind has gone back to a younger age like 10 year old, 8 year old, etc. Don't memorize all the stages of progression just know it is progressive down to childhood as it gets worse

Hyperparathyroidism Nursing Interventions

**Surgical (Total Parathyroidectomy)** - Can cause Hypocalcemia (Tetany, Chvostek's, Trousseau's S&S) - Give Calcium Gluconate to tx LOW Ca+ Treatment of choice is to remove the parathyroid by parathyroidectomy -Removing the parathyroid Might cause HYPOcalcemia b/c had too much calcium and taking it out can cause calcium to go low now, so GIVE CALCIUM GLUCONATE HYPOcalcemia S&S = tetany, Chvostek's sign, trousseau's sign So now, HYPOcalcemia causes HYPERphosphatemia, so monitor and tx for that ***Note for Exam: Questions are geared towards treating the HYPOcalcemia KNOW S&S of LOW Ca+ and HIGH Ca+ Know how to treat the calcium problem, won't go into detail on other meds you would use or what other things you would do to treat it ***

Diagnostic Studies - Chest X-Ray

**Table 31-6, p. 674*** Pregnancy??- always do a pregnancy test on a female that is in reproductive years b/c will cause harm to fetus/baby if done! NCLEX to know= can patient go for the procedure or anything worried about before sending htem? X-Rays run about $100, portables or KUBs that you can go to them or they come to you to get done Make sure patient isn't pregnant before going- check with a pregnancy test through urine test lol **Don't just ask them if they are pregnant, have them do a test before going for x-ray** Anything cardiac in nature will get a chest x-ray, a protocol Look at x-ray to determine size of heart and also review the lungs too to see if problem isn't related to lung

Gerontologic Considerations of the Nervous System

**Table 55-4, page 1302** -Mobility -Sensory -Cognition Several parts of the nervous system are affected by aging...... In the CNS, the gradual loss of neurons in certain areas of the brainstem, cerebellum, and cerebral cortex begins in early adulthood. With loss of neurons, the ventricles widen or enlarge, brain weight decreases, cerebral blood flow decreases, and CSF production declines. In the PNS, degenerative changes in the myelin cause a decrease in nerve conduction. Coordinated neuromuscular activity, such as the maintenance of BP in response to changing from a lying to a standing position, is altered with aging. As a result, older adults are more likely to experience orthostatic hypotension. Similarly, coordination of neuromuscular activity to maintain body temperature also becomes less efficient with aging. Older adults are less able to adapt to extremes in environmental temperature and are more vulnerable to both hypothermia and hyperthermia. Additional relevant changes associated with aging include decreases in memory, vision, hearing, taste, smell, vibration, position sense, muscle strength and reaction time. Sensory changes, including decreases in taste and smell perception, may result in decreased dietary intake in the older adult. Reduced hearing and vision can result in perceptual confusion. Problems with balance and coordination can put the older adult at risk for falls and subsequent fractures. Changes in assessment findings result form age-related alterations in the various components of the nervous system. Changes should NOT be attributed to aging without considering other underlying causes.

Assessment: Objective Data:

**Table 55-5, page 1308** Mental Status LOC (Level of Consciousness) A&Ox4 Remote/Long-Term Memory (ask DOB or things way back in their memory better idea of this!) Recent/Recall Memory (ask who brought you to hospital or how did you get to the hospital, etc.) Immediate/New Memory (give them 3 words then a minute later ask "what were those three words I told you to remember?")

Buerger's Disease Nursing Interventions

**Tobacco Cessation** Avoid Cold Temperatures Exercise appropriately Skin care: Ulcers, Avoid Trauma Want artery to be open and patent Ulcers will be regular/round lie ka little hole punctured NO SMOKING= BIGGEST THING TO PREVENT BUERGER'S DISEASE!! Also avoid the cold, exercise appropriately (not overly)

Autonomic Nervous System (ANS)

- helps regulated the heart -Composed of/Involves the SNS and PNS

Tension-Type Headache Nursing Interventions

*Avoid Triggers such as..... Alcohol, Caffeine, Eye Strain, Fatigue, Repetition (like look at computer for long period of time or watching TV for too long or staring at something for too long can cause this) *Drugs/Meds such as TCAs (ex. amitriptyline) and SSRIs (Fluoxetine, Paroxetine), Beta Blockers, and Antiseizure meds (Topiramate-Topamax & Divalproex-Depakote) Biofeedback, psychotherapy, muscle relaxation training

Dementia- Clinical Manifestations/S&S

-Decline in Cognitive Functions -Behavioral & Personality Changes -gradual and progressive-starts off forgetting keys or birthdays, family starts to notice then patient notices, then personality changes (once was very nice then become very mean or angry ) gets worse and worse as time goes on

Parkinson's Disease

-Decrease production of the Neurotransmitter **Dopamine** (Acetylcholine remains active) -*decreased dopamine*, not enough dopamine, genetic not sure why it occurs, either don't make enough dopamine or it doesn't get sent to right place, when not enough lose that refined voluntary movement and over time gets worse and worse

Malnutrition

-Deficit, excess, or imbalance in essential components of balanced diet -Can be either Overnutrition or Undernutrition, just means not getting in enough of what you need,etc. -Imbalance in nutrients in the body!

S&S of Acromegaly

-Enlargement/Thickening of Bony and Soft Tissues of the Face, Feet and Head -Joint Pain Secretes a lot of GH, so bones become enlarged and thickened, hands & feet and head become larger abnormally, will have joint pain because too much GH secreted.

Hyperaldosteronism - Conn's Syndrome

-Excessive aldosterone secretion Aldosterone regulates K+ and fluids *** too much aldosterone***

Aortic Aneurysms

- can enlarge 2 times its NORMAL DIAMETER - permanent and localized dilation of an artery! IT can stretch so much that it can and will rupture If in brain and ruptures= will have a stroke If in abdominal area and ruptures= very bad, people usually die from it

What influences stroke volume?

-preload, afterload, and contractility! -These three will influence the SV which in turn influences CO

Fecal Tests

-AKA Occult Blood Test -Droppers with the square piece, put stool on it and put droppers on it and if it turns blue is positive for blood; no red meat or ASA or ibuprofen for 24 hours prior to getting a fecal occult test done in order to prevent a false positive result! Also probably shouldn't do this test on a FM on their period/menstruating. -Will run it off as a culture and takes 2-3 days back after, like when have to send off stool for people who suspect C. Diff, etc.

Late Dumping Syndrome

-AKA Postprandial/Hypoglycemic Dumping - Happens 2 hours after meals - S&S= Sweating, Weakness, Confusion, Palpitations, Tachycardia -NI= Check BSG (bed side glucose), Ensure and Teach/Educate about proper Diet

What causes GBS?- Etiology

-Acute infection -Recently received Immunizations *1-3 weeks prior to onset of S&S -Caused by an acute infection or reaction to immunization shots they got (like a flu shot, etc.) 1-3 weeks prior to onset of S&S

Guillain-Barre Syndrome (GBS)

-Acute, Rapidly progressing and potentially fatal form of polyneuritis -characterized by an autoimmune process that occurs a few days or weeks following a viral or bacterial infection. -A collection of syndromes that manifest as acute inflammatory polyneuropathy an acute inflammatory demyelinating polyneuropathy (AIDP)

PAD Treatment Goals

-Adequate Tissue Perfusion -Relief of Pain -Increased Activity Tolerance -Skin Intact -Understand Knowledge of Disease and Treatments -Goals are for these patients with PAD to have no pain, have adequate tissue perfusion, and to get up and move and tolerate activity, have/keep skin intact, & that they understand what the disease is and treatments

Conn's Syndrome Nursing Interventions

-Adrenalectomy -Drug Therapy (will be on steroids for life!!) -Monitor Potassium -Monitor BP

SCI- Patho

-Compression, Inflammation -Edema leading to Hypo-Perfusion and Ischemia of the Spinal Cord Spinal cord gets hypoperfused then atrophies and dies and so anything below that area that atrophies will not be able to move or be used

Dementia

- **IRREVERSIBLE**neurocognitive disorder/syndrome characterized by dysfunction or loss of memory, orientation, attention, language, judgment and reasoning -Personality changes & behavioral problems such as agitation, delusions, and hallucinations; memory loss; continual, doesn't get any better -Tied in with Alzheimer's because a lot of people w/ Alzheimer's has dementia -Parkinson's patients can also have dementia, but mostly linked to Alzheimer's usually depending

Basal Cell Carcinoma

- Caused from tobacco, sun, and tanning beds -GO TO DENTIST every 6 months to screen for this! -Usually found on LIP -DOES NOT METASTASIZE

Difference between distended abdomen (w/ pain like in SBP) and ascites abdomen?

- In an ascites abdomen, if you press on it, it will feel like a water bed (lightly moves, like fluid waving through) -distended abdomen tends to be harder and firmer -if unsure should do a fluid weight test.

Early Dumping Syndrome

- Occurs 15-30 mins after meals - S&S= Weakness, Sweating, Palpitations, Dizziness, abd cramps, borborygmi - NI= Rest after meals (LIE DOWN!), Diet (educate on foods can & cannot eat!)

Primary Headaches

- Types include tension-type, migraine, and cluster HAs. - are NOT caused by a disease or another medical condition -type is determined by the International HA Society (IHS).

Cardiovascular Disease: Modifiable Risk Factors

- things like your diet, exercise, lifestyle habits like cigarette smoking (increases risk 4X higher for CV disease), obesity, sedentary lifestyle (not working out, sitting around a lot with job or at home ,etc.) , stress, social (income of less than $50,000), being married might make you less stressed (depends though , LOL!) -Educate patients to NOT SMOKE, get up and exercise, lose weight, eat right, stress reduction issues, make sure control Diabetes if have that (Note to self: will be more questions on the exam r/t modifiable risks- hint hint)

Nursing Interventions for Raynaud's Disease

-**Avoid Cold Environments and/or protect themselves if in a Cold Environment** -Wear loose warm clothing -Avoid Temperature Extremes -Avoid Vasoconstriction NO COLD, BIG NO NO FOR THESE PATIENTS don't want them to smoke either, but avoiding cold temps/environment more important

Amyotrophic Lateral Sclerosis (ALS)

-**Loss of lower motor neurons** in the spinal cord and brainstem -Brain remains intact -No Cure -Death typically occurs 3 yrs after diagnosis **LMN PROBLEM** **AKA= Lou Gehrig's Disease** Very rapid happening, death occurs only in about 3 years typically, no cognitive issues with this group so they know what is going on and very sad MS and MG might take months or years to develop, but ALS develops very quickly and death occurs typically within 3 years

GBS- Clinical Manifestations (S&S)

-*Ascending Symmetrical Paralysis*- symmetric meaning paralysis is seen on both sides! -Weakness -Paresthesia= numbness, tingling - Hypotonia (decrease muscle strength) -Areflexia (Absence of reflexes)

The Heart

-A four-chambered, hollow muscular organ normally about the size of a fist. -It lies within the thorax of the mediastinal space that separates the right and left pleural cavities.

Aortic Dissection

-A sudden tear in the aortic intima, blood is lost and blood flow to organs is diminished. -Tear in that lining and eventually will tear so that it bleeds out Causes/Etiology= Increased Age, HTN, Men > Women, S&S/ Clinical Manifestations= Quick onset of excruciating chest and/or back pain (S&S similar to MI) It can radiate to the neck and shoulders.

Esophageal Varices- NI

-ABCs (airway major problem b/c vomiting up blood and losing blood), VS, NPO, NGT, IVs, Labs -Meds (Inderal, Pitressin) -Endoscopic Therapies: Ligation, Esophageal Stent, Shunt, Esophagogastric Balloon (Sengstaken-Blakemore Tube) Tx= -GIVE MEDS -they can band varices and cut that area off, or do a esophagogastric balloon (generic for senstagken-blakemore tube) which is like a NGT but presses on the esophageal varices and does NOT allow them to bleed. Patient MUST be NPO, keep the HOB up, monitor for ABCs, check tube, and if in respiratory distress REMOVE IT!! Must DEFLATE the balloon BEFORE REMOVAL, you can cut to get air out or deflate w/ a syringe. HAVE THESE MATERIALS AT BEDSIDE for emergency/ER. -DO NOT Want these people to vomit, so give an antiemetic!!!

SCI- Nursing Interventions

-ABCs (check airway,breathing, circulation) -Immobilization= Prevent deterioration of neuro status -Rehab=OT and PT Encourage patient to go to PT and OT PT is to maintain function they have and prevent further disability b/c can have some movement especially if have an incomplete SCI They might think they don't need it b/c can move but really need to do prevent further issues

Nursing Interventions for Graves' Disease

-ABCs (monitor airway, breathing, circulation!) -Drug Therapy= Propylthiouracil (PTU)- drug that blocks the conversion and gets the thyroid from overproducing the thyroid hormone, slows it down, taken 3 times a day and does take about a week for person to feel better/ to take effect! -Radioactive Iodine (take weeks/months to work) = can take this to help, takes weeks or months to work so will need to be one something else when first taking this until it kicks in and starts working

GBS- Nursing Interventions

-ABCs- check airway,breathing, circulation -Assessment, VS -Plasmapheresis -Nutrition *Delayed Gastric Emptying *Tube Feeding *Paralytic Ileus *Aspiration Risk -Recovery *Can take time to recover (few months to 1 year) *Some may need PT ABCs= if can't breathe first priority to fix that first Asessment and VS Hook up to plasmapheresis- pulls out whole blood and taking out antibodies needed to take out then put back in, so will have HR and hypertension issues (just like in MS), I done for a ocuple of weeks until the antibodies are removed or felt like they are totally removed Issues w/ nutrition especially as it works its way up and gets into the gut so things won't move well Can take a few months -1 year to recover, is patient specific, no way to know how long it will take Scary b/c one day they can walk the next they are having trouble walking, etc. Will need PT to help with recovery

Skin Traction

-AKA Buck's Traction (Skin) -Used Preoperatively (before surgery!) -Weight 5lbs-10lbs -Skin Assessment to key pressure points every 2-4hours Keep a close eye on the skin and make sure not developing any pressure points issues, assess skin every 2-4 hours while patient is in a skin traction!

Gastrointestinal System (GI System)

-AKA Digestive System -consists of the GI tract and its associated organs and glands. -Includes the mouth, esophagus, stomach, small intestine, large intestine, rectum, & anus -Associated organs= liver, pancreas,& gallbladder

Vertical Sleeve Gastrectomy

-AKA Gastric Sleeve About 75% of the stomach is removed leaving a sleeve-shaped or banana-shaped stomach.Although the stomach is drastically reduced in size, its function is preserved. The removal of the majority of the stomach also results in elimination of hormones produced in the stomach that stimulate hunger such as ghrelin. -Go in an remove about 75% of the stomach to restrict intake -Most of the stomach function is preserved but does reduce ghrelin in the stomach which is a appetite stimulant

Delivery Methods of Enteral Nutrition

-Continuous infusion by pump -Intermittent by gravity -Intermittent bolus by syringe -Cyclic feedings by infusion pump Can give enteral nutrition in a variety of ways, Can hook feedings to a pump or can hold it up and by gravity it will go in or put in a syringe and bolus it in

Skeletal Traction

-Align injured bones and joints -Surgeon inserts pins and wires into the bone and weights are attached to align and immobilize the injured body part -Weight 5lbs - 45lbs -Monitor for infection at the pin insertion site Usually given POSTOP- pins and wise into bone and applies that weight to it (typically weighs more than skin traction- 5-45 lbs!) Make sure monitor for any infection and assess the pin insertion site so that area isn't getting infected

S&S of Myxedema

-Alters skin and subcutaneous tissues -Puffiness -Facial and Periorbital edema -Prominent tongue -Masklike affect (looks like you're "spaced out")

Acute Pancreatitis

-An inflammatory process where excessive pancreatic enzymes destroy ductal tissue and pancreatic cells. Etiology/Cause: Gallstones S&S/Clinical Manifestations= Abdominal Pain -Enzymes that normally get released when eat will then get trapped in that area in the pancreas, and then will start gnawing away at the pancreas b/c doesn't realize to wait until see food enzymes Acute= caused by gallstones When get gallstones, enzymes can't get out and get trapped so causes pancreatitis (Ex. Think of Grammy Bear getting this back late 90s, she also had gallstones on top of pancreatitis b/c of this reason) Amylase and lipase normally help digest food, but with this they get stuck inside the pancreas and destroy it! Cause of this is alcohol or gallstones! S&S is severe unbearable abdominal pain b/c pancreas is being digested.

Anal Disorders

-Anal Fissures -Anorectal Abscess -Anal Fistula

What are the Four Valves of the Heart?

-Aortic Valve -Pulmonic Valve -Tricuspid Valve -Mitral Valve AV valves= Atrioventricular valves, separate the atrium form the ventricles, the tricuspid and mitral/bicuspid (tricuspid on right and mitral/bicuspid on the left) SL valves= Semilunar valves, prevent blood form flowing back into the ventricles, Pulmonic and aortic, pulmonic on right and aortic on the left They open and close based on pressure and volume in that particular heart chamber **Their job is to keep blood flowing in a FORWARD direction**

Myasthenia Gravis-Etiology/Causes

-Autoimmune Disease -Correlation between hyperplasia of the thymus gland

Multiple Sclerosis (MS)

-Autoimmune disease that affects the **myelin sheath** and conduction pathway of the CNS -**De-myelination** which decrease impulses transmitted, myelin sheath damaged d/t autoimmune problem -*Myelin sheath*= deal w/ muscles, things get tired and weak

Graves' Disease

-Autoimmune disease with thyroid enlargement and excessive thyroid hormone secretion -Exacerbation and Remission periods

Criteria for Having Bariatric Surgery

-BMI ≥40 -BMI ≥35 and with one or more obesity-related complications -Hypertension, type 2 diabetes, heart failure, sleep apnea Bariatric Surgery is done ONLY if BMI greater than 40, or if less than that then they need to have another condition such as HTN, DM, etc. in order to have it done

Aortic Valve Stenosis

-Blood can't get out through the aortic valve -Will eventually need surgery for Aortic Valve Stenosis -Aorta: Main artery that carries blood out of the heart to the body -Valve does not open fully -Blood backs up causing left ventricular hypertrophy S&S: Decrease CO, Pulmonary Congestion, Narrow Pulse Pressure, CHF S&S. ***Classic Triad: Angina (chest pain relieved when resting/sitting down), Syncope, Exertional Dyspnea**** -Tx w/ Surgery: When valve is <1cm in size Angina= chest pain relieved when resting Aortic Steonisis = will have a narrowed Pulse Pressure When valve gets small enough they have to go in and have surgery to fix that

Aortic Valve Regurgitation

-Blood moves backward instead of forward -Blood can get through just comes back where it ended up -Valve does not close fully -Blood backflows from aorta to left ventricle -Blood should be moving forward instead it moves backward Left Ventricle hypertrophy -S&S: Decrease CO, Dyspnea, Widened Pulse Pressure, Murmur

Diagnostics Studies for Osteomyelitis

-Bone or Soft Tissue Biopsy -Blood and Wound Culture - Will see on CBC an ↑White Count with shift to left (too many WBCs) -Radiology (x-ray!)

HYPOthyroidism S&S

-Bradycardia -Lower BP= possibly could be hypotensive if already normal run low -Lower Temp -Cold and Tired -Intolerance to cold -Weight Gain -Constipation -MYXEDEMA Opposite symptoms of HYPERThyroid!

Gero Changes w/ Neuro System

-Brain doesn't get as perfused as well like when younger. -Might fall a little more easily w/ advanced age. -Don't feel heat as well, and might burn self more easily w/ advanced age. -Most people should be able to think normally, don't necessarily become "dumber" when you get older, but might be a little more forgetful. -Cognitive changes= meds can cause this or if supposed to be on oxygen or not and not have enough oxygen going in might be a little more c confused than normal.

Hepatitis C

-Cause/Etiology: Blood -S&S: Usually none at the beginning, RUQ pain, Malaise, Fever, Jaundice, N/V -Recovery: Life Long, Typically develop Liver Cirrhosis Transmitted via Blood form needle sticks with dirty needles needling sharing Recovery= usually don't recover typically, is usually life long and when you have it you have it and will typically develop cirrhosis of the liver! No vaccine, no cure! **Think of Cousin Erin when she was getting rehab for heroine addiction and found out she had Hep C from dirty needles

Hepatitis D

-Cause/Etiology: Blood, Unprotected Sex -Requires Hepatitis B to Replicate -S&S: Fever, Malaise, N/V, RUQ pain, Jaundice -Recovery: Life Long, Chronic Liver problems -Hep D is not typically seen often -Hep D is caused by infected blood and unprotected sex -Need to have Hep B in body in order to replicate and get Hep D -So if you have Hep B already and come in contact with someone who has Hep D you will be more risk for having both Hep B and D now Typically NO recovery, life long, can have chronic liver problems from this type. **B comes before D in Alphabet, so gotta have B before you get D in Hepatitis!**

Hepatitis B

-Cause/Etiology: Blood, Unprotected Sex -S&S: N/V, Fever, Fatigue, Jaundice, Dark Urine, Light Stool, RUQ Pain -Recovery: Some will recover and develop immunity. Others are carriers and are at risk for cirrhosis and liver cancer. -Hepatitis B Vaccine -caused by blood sharing through needle sticks or through unprotected sex -Some will fully recover and develop immunity, but others will be carriers and have a risk for cirrhosis and liver cancer down the road -There is a vaccine for Hep B

Hepatitis A

-Cause/Etiology: Fecal-Oral Route, -S&S: Flu-Like symptoms, Jaundice, Fatigue -Recovery on its own -Hepatitis A Vaccine -caused by fecal-oral route and can be in contaminated water or food as well -Vaccine available, but most people will recover on their own - will recover and won't have Hep A anymore

Hepatitis E

-Cause/Etiology: Fecal-Oral routes, Contaminated water, Travel Oversees -S&S: Flu-Like and and GI Illness -Recovery on its own fecal-oral routes and contaminated water, but typically is from TRAVELING OVERSEAS, typically get this overseas, not typically in USA ***DON'T DRINK ANYTHING IN FOUNTAIN IN FOREIGN COUNTRIES!!!*** If you travel outside of country wash hands, make sure everything is clean, *NO FRESH FRUITS OR VEGETABLES* typically, *USE BOTTLED WATER* and bottled cokes/drinks or things you can open, etc. **Hep E= OverSEAS***

Chronic Gastritis

-Causes: Type A and TYpe B, atrophic -persistent inflammmation, damages mucous membranes and goes deper and deeper. S&S= intrinsic factor can be lost causing pernicious anemia (NO Intrinsic Factor/IF) , and at risk for stomach cancer, glands are damaged.

NI for Hepatic Encephalopathy

-Check Ammonia Levels- want baseline to see if things we are doing are making things better or if it is getting worse, etc.(when checking must put it on ice and send to lab) -Neurological Assessment ( Neuro Checks q15-30 min & often!) -Nutrition: Low Protein Diet- b/c protein in body is converted into ammonia, so don't want a whole lot of protein b/c of this reason, low protein diet will help keep ammonia under control or not make it worse (*LOW PROTEIN B/C PROTEIN TURNS INTO AMMONIA!*) -Meds- (Lactulose- traps ammonia in colon causing diarrhea!) -No meds that are processed through the liver can be given (ex. lortab, Tylenol, etc.) -Educate the family, not pt b/c pt is confused!

Graft Patency w/ AAA

-Check for Stable BP- check when they go in and when they come out, will be given parameters, make sure it stays that way, SBP no more than 100 for example, keep BP low and not too high -Check for HOB not elevated > 45 ° -Check to Avoid Flexion of Graft- positioning, don't want them bending If someone has a graft put in there, make sure it doesn't come dislodged, give it time to heal!- don't want them to throw up, so even hint of nausea will give them medicine so they don't vomit, keep HOB NO GREATER THAN 45 degrees, don't' want them bending over too much, so protect the graft these ways If a graft ruptures how do you know?- decreased BP, increased HR, skin coolness, decreased skin color (bluish, white, etc.) think 6 Ps Can fix this rupture in two ways- femoral artery puncture, or other ways think hold pressure on femoral artery

NI for Esophageal Cancer

-Chemo, Radiation -Maintain Airway -Esophagogastrostomy -ABCs -Pain Control -NG Tube (No Irrigation) Whenever people have NG tubes sometimes we will irriaget it to flush out stomach, But with esophageal cancers YOU WILL NOT FLUSH OR IRRIGATE AT ALL!!!! Could break the stiches or break into something that needs to stay intact, etc. What is normal is first 24 hours after surgery, in NG you will see a little bit of blood being sucked out (NO BIG CLOTS OR OOZING FRANK BLOOD EVERYWHERE, might just be blood-tinged b/c of surgery, etc.) Blood-tinged= just pink looking, not bright or frank red blood or any clots seen lol At end of 24 hour period will be that normal green color

Liver Cirrhosis

-Cirrhosis of the liver develops slowly -Spots allover the liver develop/nodules all on the inside naturally and block blood from going in and out and doesn't allow the liver from working properly -Roadblocks in the form of nodules keep liver from doing what it is supposed to! -Causes/Etiology/Risk Factors : Hepatitis C, Alcoholism and Biliary Obstruction -Common Types: *Post-Necrotic Cirrhosis: r/t Hepatitis/Drug *Laennec's/Alcoholic Cirrhosis: r/t Chronic Alcoholism *Biliary Cirrhosis: r/t Chronic Biliary Obstruction Hep C patients and alcoholics= ppl at risk, RISK FACTORS OF GETTING CIRRHOSIS OF LIVER Biliary obstruction issues can damage liver over time but is a very small percentage of that vs. Hep C and alcoholic pts -Post-necrotic cirrhosis is from Hep C or drug use -Laennec's/Alcoholic cirrhosis= get it form chronic alcoholism/too much alcohol use -Biliary Cirrhosis- form chronic biliary obstruction

Chronic Pancreatitis

-Destructive disease of the Pancreas with periods of remission and exacerbation -Cause/Etiology: Alcoholism -Clinical Manifestations/S&S: *Abdominal Pain *Dark Urine *Diabetes caused by alcoholism , have periods of exacerbation with periods of remission, can last about 20 years or 30 years- lasts around when you are 40 years of age S&S= abdominal pain, dark urine, and can develop diabetes if pancreas is damaged enough, will also have unbearable pain that causes them to come in to get help destructive disease of pancreas w/ remission and exacerbations. From alcoholism, diet HIGH in fat, and smoking. Worse around the holidays b/c increased drinking.

Osteoarthritis (OA)

-Disorder of the diarthrodial (synovial) joints -Slowly Progressive -Caused by a known event or condition that directly damages cartilages or causes joint instability LOCALIZED, slowly progresses, caused by known event or condition that directly damages cartilages or causes joint instability over time like when playing sport and get injured in younger years damages those joints over time

Paracentesis

-Done for ascites to pull that fluid out of peritoneal cavity. During Procedure: Completed by physician, so as the nurse our responsibilities are taking care of pt and assisting the physician Physician looks with an ultrasound to find pocket with most fluid in it b/c want to do paracentesis in pocket with most fluid to get most benefit form it Physician will numb area with lidocaine and then will stick in a catheter to draw out that peritoneal fluid from the abdomen (fluid should look yellowish-clear, clear is good and cloudy bad, but when do paracentesis will send it off to lab to make sure it is not infected. Then will hook up a drain to these bottles and that will drain about 15 minutes or so, 10-15 full bottles is not uncommon to pull out Make sure BP is not lowish or too low b/c will be pulling off all this fluid SO then will take out that drain and clean it and patch It up where the needle and drain was Post-Procedure, As the nurse we will: Nurse will send them off now, sometimes use to do at bedside all the time, and then they will come back to you Worry about BP and UOP Belly has been punctured and drawn a whole bunch of fluid off (about 10 or 5 liters depends on person) BP can do down and UOP can go down typically after this NO concern if BP with 160 and come back with a BP of 130 NOT okay if BP goes all the way down to the 90s and have S&S of hypotension, don't want them to be hypotensive and blood not getting perfused and if they are pale looking 30 ml/hr or more on UOP is okay Less than 30 mL/hr is a PROBLEM and should provide interventions for this! THIS IS NOT OKAY

Alzheimer's Disease (AD)- Nursing Interventions

-Drug Therapy (See Med Sheet) -Changes in Behavior & Personality- talk normally and calmly & handle outbursts appropriately -Agitation *Consistent Sleep will decrease agitation *Frequent Walks will decrease agitation *Loud Noises will increase agitation *Restraints will increase agitation -Safety/Falls= high risk for Falls so put on Fall Precautions for these patients!!- bed and chair alarms, call light within reach, help to bathroom/ambulate, etc., ensure safety! Goal as a nurse is to make sure these patients take their meds, and know how to handle emotional outbursts with their anger, aggressiveness, do things to calm down agitation or anger Make sure they get consistent sleep, no loud noises/quiet area, restraints, make sure they are able to take frequent walks and movement to help decrease/prevent agitation/emotional outbursts No restraints b/c can make it worse to "hold them down" unless they are being a danger to others or self, if do put on restraints need to chart and assess appropriately Give them stuff to do they enjoy to keep busy- don't really just sit them down in front of the TV to keep them "preoccupied" Make sure you talk normally and calmly to these patients

Hypothyroidism Nursing Interventions

-Drugs: levothyroxine (Synthroid): Take before breakfast, Monitor HR before taking med (might have to adjust meds, reason we have to check HR) , it is taken b/c replaces what they don't have!, teach they need to get/check blood work to keep thyroid levels in check -Discharge: Provide Written Instructions/Reminders- b/c trouble with memorizing things -Safety- b/c a little more weak and lethargic in hypothyroidism

Nursing Interventions for Pericarditis- How do we Treat Peridcarditis?

-EKG (b/c valve probs can cause dysrhythmias -CT/MRI -Breathing- need to encourage cough and deep breathing, but be mindful it will be painful for them to do and hurt Medications-Antibiotics & NSAIDs- for pain! -Monitor for effusion and cardiac tamponade Job as nurse, give them meds help with inflammation , give them NSAIDS for pain, and monitor for effusion and cardiac tamponade Patient will tell you it hurts all the time whether breathing in or not, etc. and will see it on EKG.

Vegans

-Eat only plant foods -Lack of cobalamin (vitamin B12) common -Can develop megaloblastic anemia and neurologic signs of deficiency ONLY eat plant foods= NO meat or dairy products of any kind, strictly veggies/plant foods, no milk or eggs or meat of any kind - These ppl have a RISK FOR Vita B12 deficiency or megaloblastic anemia or pernicious anemia

Lacto-Ovo Vegetarians

-Eat plant foods and sometimes dairy products and eggs (eat plants primarily but will add eggs and milk and other dairy products to their diet). -Watch for vitamin and mineral deficiencies Iron deficiency

SCI Clinical Manifestations- Metabolic Needs

-Electrolyte Imbalances -Metabolic Alkalosis -Can have electrolyte imbalances= metabolic alkalosis- potassium will get low (hypokalemia!) b/c will keep hydrogen ions (very basic) and let go of the K+ in metabolic alkalosis Nasogastric suctioning may lead to metabolic alkalosis. It is especially important to monitor sodium and potassium until suctioning is d/c'd and a normal diet is resumed. The person with SCI has increased nutritional needs d/t increased metabolism and more protein breakdown. Lean body mass is lost and muscle atrophy leads to weight loss. Nutritional support should focus on a diet that addresses the person's caloric and nitrogen needs. Adequate nutrition helps to prevent skin breakdown, reduce infection, and decrease the rate of muscle atrophy.

HYPERparathyroidism S&S

-HYPERcalcemia = (HIGH Ca+) -Hypophosphatemia = (LOW phos!) PTH= helps regulate calcium and phosphate Oversecretion leads to too much calcium, and HYPOphosphatemia (inverse relationship w/ Ca+) -Too much calcium= not enough phos -Too much calcium= decreased excitability in the body

Complications of Liver Cirrhosis

-Hepatic Portal Vein HTN= Elevated Pressure in the portal vein system Elevated pressure in the portal vein, this is caused by the nodules causing the BF to back up and cause HTN in that vein, they MUST find another way to perfuse; this CAUSES ESOPHAGEAL VARICES! Portal HTN= leads to esophageal varices! Hepatic portal vein HTN= portal vein system becomes TOO HIGH in pressure, so blood comes from GI tract and goes to spleen then goes to liver and liver gets rid of toxins and sends it back out typically/normally, portal vein very important and can't live without it, So NOW HTN causes portal vein not be blocked and starts backing up which causes that portal vein HTN which makes it go places it sholdn't go (one place is esophageal varices, another place could be ascites in the belly/peritoneum/abdomen) Portal vein HTN- tries to go into the liver and can't get into and gets blocked so has to go somewhere so sometimes will go to the esophageal area and cause esophageal varices, which the esophageal area is not able to handle this

Adrenocortical Insufficiency

-Hypo-function of the Adrenal Cortex -LOW corticosteroid levels (Not producing enough corticosteroids, adrenal cortex not functioning well enough)

Corticosteroid Therapy Side Effects

-Hypokalemia -Hypocalcemia -Hyperglycemia -Susceptibility to infection -Delayed Healing -If stopped med regimen suddenly/abruptly Teach patient= Do not stop taking abruptly!! -IF not enough steroids in the body (ex. in Addison's Disease/Adrenocortical Insufficiency/Addisonian Crisis), then will give them steroid drugs/therapy to help. BUT...these meds can cause these issues if give them too much, so the nurse NEEDS to monitor for problems if giving corticosteroids to someone with an adrenal cortex problem

Nursing Interventions/NI for RA

-Ice=10-15 mins at a time -Moist Heat= 15- 20 mins at a time Apply ice for 10-15 minutes and Moist Heat for 15-20 minutes at a time (heating pad for stiffness they have and ice for inflammation they have- heat first and then ice second as far as textbook world goes by- some people in real world scenarios will maybe use ice first that helps Maybe heat helps such as jump in in a hot shower or get in a hot tub might help with the joint stiffness that occurs Medications: -NSAID -Prednisone -Anti-Rheumatic Drugs *methotrexate (Rheumatrex) *leflunomide (Arava) Will use NSAIDS, prednisone (long-term therapy, RA pts will be on prednisone maybe for 3-4 months- not taken forever but for about 3-4 months in the beginning of treatment) , and will also be on Anti-Rheumatic Drugs (Disease Modifying ANtiRheumatic Drugs) such as Methotrexate and Leflunomide- goal is to decrease inflammation and protect the joints , trying to prevent irreversible joint damage is the goal of treatment for medications for RA, first year of diagnosis very aggressive with med treatment

What does stimulation of the Sympathetic Nervous System (SNS) do?

-Increases HR -Speeds of impulse conduction through the AV node & force of atrial and ventricular contractions - Effect mediated by specific sites of the heart called Beta adrenergic receptors which are receptors for Norepi and Epi. -Dilates the pupils -Inhibits salivation -Accelerates the heartbeat -Dilates bronchi -Inhibits digestion -Stimulates glucose release -Stimulates Epi and Norepi release -Inhibits peristalsis and secretions -Relaxes the bladder

S&S/Clinical Manifestations of Infective Endocarditis (IE)

-Infection= Low Grade Fever, Chills, Fatigue, Malaise -Pain=Arthralgias, Myalgias, Headache -Cardiac and Vascular= Murmur (Systolic), Embolisms, Splinter Hemorrhages, Petechiae Will have a temp and might be tired and fatigue, but more specifically will have joint pain (arthralgia, myalgia, HAs), and murmurs, embolisms (from any time we have a lot of blood hanging out somewhere it will dislodge and float around and cause trouble elsewhere like pulmonary embolism, etc.) and splinter hemorrhages (on nailbed itself), petechiae (puplish bruising)

Bell's Palsy

-Inflammation of the Facial Nerve (CN VII) on one side of the face in the absence of any other disease (such as stroke, etc.) -an acute facial paresis of unknown cause most common facial nerve disorder

Bisphosphonates: alendronate (Fosamax)

-Inhibit bone resorption -Proper administration of Med: Take with full glass of water. Take 30 minutes before food or other meds. Remain upright for at least 30 minutes. Taken once-per-week

Nasogastric and Nasointestinal Tubes

-Inserted through the nasal cavity -Must Confirm with X-ray after insertion (once confirmed then can use it!) -Nasointestinal has a ↓ likelihood of regurgitation and aspiration than Nasogastric -Can be dislodged by vomiting or coughing -Can be knotted/kinked in GI tract

Clinical Manifestations/S&S of OA

-Joint Pain and Stiffness (especially in am) -Pain increases with joint use -Usually asymmetrically joint pain W/ STIFFNESS (in the morning especially), pain INCREASES w/ joint use and usually asymmetric (just localized at the joint that is affected) Joint not moved and gets stiff is why more pain in the morning when awakening

Osteoporosis

-Low Bone Mass with Bone Loss -Fragile Bone Disease, Porous Bone -Bones become so fragile that they cannot withstand normal mechanical stress -Chronic, Insidiously and Progressive when the bones become porous and very fragile and weak Usually chronic and insidious and progresses over time Bones become so fragile can't even withstand the day to day

Left Lower Quadrant (LLQ)

-Lower pole of left kidney -sigmoid flexure -portion of descending colon -bladder (if distended) -left ovary and salpinx -uterus (if enlarged) -left spermatic cord -left ureter

NI for GERD

-Medications -Nutrition *4-6 SMALL meals a day *Avoid: fatty foods, caffeine, chocolate, tobacco/smoking, alcohol *NO large meals -Lifestyle Changes -Lose Weight -Remain upright 2 hrs after meals -Check for: Reflux - heartburn, indigestion, things coming back up Regurgitation - partially digested food is now coming back up form stomach, worry about aspiration form this especially when lying flat at night asleep pH of Esophagus - more basic, pH around 6-7 pH of Stomach - more acidic, pH 1-3 pH of Duodenum- more basic, pH 6-7 -If put in NG tube and get a pH that it is 6-7, then not in the right place, too far or not far enough put in -If got a 1-3 pH tested then you know you put it in right place, but still GET AN X-RAY TO CONFIRM_

Epidemiology of Obesity

-More than 35% of adults in the U.S. are currently obese -68% are within the overweight-obese category -Will reach 50% by 2030 unless Americans change their ways

Systemic Lupus Erythematosus (SLE) AKA LUPUS

-Multisystem Inflammatory Autoimmune Disease -Have periods of Remission and Exacerbation Affects the Skin, joints, renal, hematologic, neuro

Mean Arterial Pressure (MAP)

-Must be at least 60 mm Hg to maintain adequate blood flow through coronary arteries and to perfuse major organs -When low vital organs are under perfused and will become ischemic - shown on the BP screen, no questions on the exam r/t on how to work it out b/c can see it on screen -MUST BE AT LEAST 60 mmHg -Less than 60= worry about perfusion, worry about brain will have confusion and lethargy, worry about kidneys= urine output will be down If heart not getting perfused= chest pain/going to hurt will have pain Note for self: On the exam-Questions will be r/t if patient has low MAP then what does that tell us about your patient?? low MAP tells us that the body isn't getting perfused well, either in brain or kidneys, etc.

Specifics of Enteral Nutrition

-Must have a functioning GI tract to recieve it -Can be easily administered -Safer than parenteral -Less expensive than parenteral (IV stuff lol!)

NI for Chronic Pancreatitis

-Non-Surgical NPO, IV Fluids, Education -Meds= (PEPs) -AA Meetings -Smoking Cessation -Insulin (b/c might not have been diabetic before but are not b/c pts can't break down glucose anymore) Again, NO EATING, LOOKING, OR SMELLING FOOD when in exacerbation, don't educate the patient until they are stable. This can cause a patient to be diabetic so need insulin. Teach pts to go to AA meetings, stop smoking, and eat a DIET LOW IN FAT NPO huge intervention= might be NPO 24 hours to a couple of days, give IV fluids and do proper education to these pts PERT OR PEPS Meds- take w/ food and w/ 8 oz of water& wipe mouth good after taking!!

AD- Nursing Interventions (cont'd....)

-Nutrition: *Dysphagia- can't swallow ( give pureed, thickened liquid) *Cannot self feed *At some point Alzheimer's patients will have trouble with swallowing and have dysphagia so might have to go with pureed or thickened liquids and then eventually can't feed self so will have to help feed them. -Infection= monitor for infection b/c can get septic easily, easy to get UTIs in this group so be mindful of this and check and monitor for them for Infections. -Skin -Elimination -Communication= may be difficult at the end, might not be able to speak or say anything except moan or grunt or point to things, so be mindful in how you communicate with these pts. Validation Therapy=recognize feelings and validate how they are feeling, will just make them more agitated, might need to redirect them when they are talking about things

Parkinson's Disease- Clinical Manifestations/S&S

-Paralysis Agitans or Shaking Palsy -Tremor, Rigidity, Bradykinesia, Postural Instability,Shuffling gait -effects the SNS- issues with SNS, focus is worrying about LOW BP w/ issues w/ SNS

Liver Transplant Cont'd....

-Patients with end-stage liver disease -Rigorous Pre-Surgery Screening -Surgery Process- lots of people in surgery room, 6 nurses, etc. surgery can last anywhere form 8 hours -28 hours long! Person who needs liver has to be compatible to donor, so need to be type-screened ABO/blood type screening should be done prior, surgery they start close and then start working way out. -Patients with end-stage liver disease are candidates for liver transplant -Controversy that they wait till deathly ill to get it and might get it and then die anyways b/c surgery is a little more rigorous -1st year Most Critical AFTER!! Monitor for Rejection: -Fever -Labs (monitor LFTs (AST & ALT) -Biopsy- get one done if think having rejection issues!) Once put new liver in the first year of liver being rejected by body is most at risk time, 1st year is most critical for liver to work or not Want to monitor for rejection- if see fever (smallest temp increase is a HUGe increase so don't ignore even like a 0.1 temp increase, so will need to keep eye on it and do something about it, temp will be done just orally- just know any increase in temp will be important to watch and do something about right away!) , labs (labs on that one side will become normal if transplanted liver is doing right, but if NOT doing right labs will be out of normal ranges, will want to get labs and get a biopsy done if any suspected issues

S&S of DI

-Polydipsia- drinking a lot -Polyuria- peeing a lot -Nocturia- excessive urination at night -Specific Gravity < 1.005 -Generalized Weakness -Hypernatremia - too much Na+ -Confusion, irritability -BP will be LOW/hypotensive, HR will be HIGH/tachycardia -Dehydration b/c peeing it all out (excessive urination)

What causes Cushing Syndrome?- Etiology

-Prednisone (taking too much corticosteroid meds for too long a time) -Adrenal Tumors

How is PN prepared??

-Prepared by Pharmacist or Trained Technician under strict Aseptic techniques -Must be refrigerated until 30 minutes before use -Ingredients labeled on Solution -Pharmacist prepares the parenteral nutrition back for the pt and then it MUST be refrigerated until 30 minutes before use -So need to keep in the fridge until you need up to 30 minutes before giving -But must be room temp to give so leave out 30 minutes before giving, but keep in fridge for up to 30 minutes prior to giving

Esophageal Varices

-r/t portal HTN -Capillaries in the esophagus are thin and fragile and were NOT made for large amounts of blood, when the liver cirrhosis/damages and backs up, the blood comes up causing HEMATEMESIS and will vomit up blood BAD!!

Why is Traction Used?- Reasons for Traction

-Prevent/Reduce Pain and Muscle Spasms -Immobilization -Prevent Soft Tissue Damage -Reduce Fracture or Dislocation (ex. Fractured hips before surgery) -Promote Active and Passive Exercise -Expand Joint Space

Post-Op Complications from Whipple Procedure

-Prognosis can be poor -Complications from this include: CP, SOB, Absent BS, No Flatus, Decrease UO, Incision care, ABCs, BSG Can do the Whipple Procedure to fix= very big surgery Complications from surgery include chest pain, SOB, absent bowel sounds (most people coming out of surgery will have HYPOactive BS) , NO gas, decreased UOP, need to make sure give good incisional care will have to stop and take a deep breath and it will hurt so proper way to make sure they cough and deep breath with splinting with pillow, monitor ABCs and monitor blood sugar levels! (get a bed side glucose or BSG) b/c might develop diabetes and so keep eye on blood sugar levels

Amyotrophic Lateral Sclerosis (ALS)- Clinical Manifestations/S&S

-Progressive Disorder -Progressive Muscle Weakness -patients have psychosocial/emotional issues b/c they know they are going to die

Nursing Interventions for Low Back Pain

-Proper Body Mechanics -Appropriate BMI -Avoid Sleeping in Prone Position -Smoking Cessation -Proper Exercise -Medications: *NSAIDs *Opioids *cyclobenzaprine (Flexeril) -Hot Compresses -Cold Compresses ***REVIEW OVER= Table 63-6, page 1504*** Ways to prevent low back pain: -use proper body mechanics (stand with feet hip width apart, don't bend at the back, bend at the knees), -need to have a normal BMI (high or overweight or obese BMI will put more pressure on back and cause that low back pain), sleep on side w/ pillows between knees (avoid sleeping prone position or flat, need to have something in between or beneath knees, etc.) - no smoking b/c decreased blood flow to the lower back area - proper exercise to help with full range of motion (use exercises to strengthen abdominal muscles and back muscles!) -People usually treat Low Back Pain with NSAIDS OTC, opioids if OTC meds don't work Use heat first, cold second -Heat is supposed to relax the lower back area - cold is supposed to help decrease inflammation & swelling (supposed to be in order if appropriate) 10 or 15 minutes on with heat then take off, not supposed to leave on more than 10-15minutes -Heat helps increase circulation, cold decreases inflammation and swelling (Cyclobenzaprine) Flexeril - for muscle spasms, can be used to help with muscles spasms with low back pain

Nursing Interventions for Osteoporosis

-Proper Nutrition= NEED High Calcium Foods! Example of High Ca+ Foods Include: Milk, Yogurt, Cheese, Ice Cream Turnips Greens Sardines Spinach Salmon Oysters Calcium Supplementation: -1000mg/day pre-menopausal -1200mg-1500mg/day post-menopausal Vitamin D Supplements -Sun - Need 800-1000 IU/day -Sometimes take both Vit. D supplement pills and encourage sun time together to get enough Vit D Exercises Weight Bearing Walking, Hiking, Weights (avoid high impact) Low impact exercises are best! Prevent Falls- sit on side of bed if need to get up and feel dizzy don't get up right straight out of bed, dangle feet, etc. Smoking Cessation- NO SMOKING!!! BAD!! Minimum Alcohol Consumption- LIMIT ETOH!! Medications/Drug Therapy: - Bisphosphonates: alendronate (Fosamax)

Bell's Palsy- Nursing Diagnosis/Nursing Considerations/Interventions

-Protection of eye on affected side -Nutrition: May be unable to chew, use a straw, control drooling, soft diet, eat and drink on unaffected side. -Recovery will be usually in a few weeks -Eye doesn't close in bell's palsy, they have lost that function so need to protect the eye on affected side can wear a patch, etc. -Eating= can't chew so make sure they don't chew on that side of the mouth and don't eat anything really big or something hard to chew so don't get choked, using straw on that side helps them out -Drooling can be embarrassing, but is kind of normal so just need to teach them how to help take care of that -Recovery usually in a few weeks

Nursing Interventions for Acromegaly

-Radiation Therapy (think back to Cancer lecture) -Transsphenoidal Hypophysectomy, post-op: *HOB raised 30 Degrees *Neuro Checks- frequent! *Mouth Care (no tooth brushing w/ reg. brush for 10 days) *Monitor for Bleeding *Monitor for CSF drainage(clear nasal drainage) *No coughing/sneezing -With Radiation therapy= skin will get really dry and like a bad sunburn so stay out of sun during treatment and a full year after completing last treatment, might be done by itself or to reduce size of tumor before surgery -Will more than likely have Surgery to remove the transsphenoidal hypophyses of the pituitary gland taken out -POST OP for surgery- make sure HOB raised at least 30 degrees, do frequent neuro checks (b/c have gone into bed and disrupted things there), proper mouth care ( no regular tooth brushing for 10 days after surgery, can use soft bristle brushes and nonalcoholic mouth wash, etc.) Monitor for bleeding and CSF drainage (will be like a clear-colored halo on the pillow darker around the edge- not just nose running, this means CSF is leaking out of brain which is not good! No coughing or sneezing after surgery!

SCI Clinical Manifestations- Respiratory System

-Respiratory complications closely correspond to the level of injury. -Cervical injuries ABOVE C4 present special problems b/c of the total loss of respiratory muscle function. Injury or fracture BELOW C4 results in diaphragmatic breathing if the phrenic nerve is functioning. -Even if the injury is below C4, spinal cord edema and hemorrhage can affect the function of the phrenic nerve and cause respiratory insufficiency. Hypoventilation and impairment of the intercostal muscles lead to a decrease in vital capacity and tidal volume. -Cervical and thoracic injuries cause paralysis of abdominal muscles and often the intercostal muscles. Thus the patient CANNOT cough effectively enough to remove secretions, increasing the risk for aspiration, atelectasis, and pneumonia. Neurogenic pulmonary edema may occur secondary to a dramatic increase in SNS activity at the time of injury, which shunts blood to the lungs. In addition, pulmonary edema may occur in response to fluid overload. To improve respiratory function for patients w/ SCI, resistive inspiratory muscle training may be effective. -C4 and above more problems because of total loss of respiratory muscle function -Below C4, results in diaphragmatic breathing if phrenic nerve is functioning -Aspiration Risk -Pneumonia -If cervical area broken (Cervical SCI) then will have respiratory problems- will have to be put on respiratory/ventilator and will have to breathe for that patient

Osteomyelitis

-Severe infection of bone, bone marrow, and surrounding soft tissue -Bone gets infected and bone gets necrotic and makes an opening in the bone there Cause= Most common microorganism is Staphylococcus aureus

Clinical Manifestations/S&S of Pericarditis

-Sharp Chest Pain worse upon Inspiration and Supine - pain is worse when take a deep breath in(upon inspiration) & while lying flat/supine -**Pericardial Friction Rub**- heard by auscultation, sounds like rubbing hair together

Pt has N/V for the past 6 hours, what will you as nurse do??

-Sit them down -Increase their fluids intake -Give antiemetic -Ask what did they eat -If FM, you MUST get a pregnancy test -Check BP (esp. if dizzy) -Check glucose levels and HR -Check K+ levels b/c they threw up!

Polyps of Large Intestine

-Small growths covered with mucosa and attach to the surface of the intestine. -Start benign but have potential to become malignant -Usually asymptomatic NI: Colonoscopy at age 50 to check and remove polyps if seen, if had a family history will check sooner!

Peripheral Nervous System (PNS) consists of what?

-Spinal Nerves (dermatomes & myotomes) -Cranial Nerves: **Table 55-4 page 1305 (Know for Exam)** -Autonomic Nervous System (ANS)

Clinical Manifestations/S&S of Osteoporosis

-Spontaneous Fractures -Fractures with Minimal Trauma -Kyphosis (major sign!- looks like a hunchback, looks like the letter K for Kyphosis!)

Delirium

-State of temporary, acute form of mental confusion. - comes and goes

Types of Oral Inflammation/Infections

-Stomatitis (inflammation of mouth) -Oral Candidiasis (thrush) -Herpes Simplex HSV-1 (cold sore) -Aphthous Stomatitis (canker sore) Thrush= white stuff that can get in the back of the tongue can be severe all over the tongue or just a little bit of white dots in mouth or tongue, usually related to HIV or cancer r/t stuff or long-term antibiotics or people with asthma if take meds that don't gargle with water to rinse out will have this as well Cold Sores AKA HSV1- contagious through saliva Canker sores= sores where you might have bit down on it r braces rubbing against the mouth, etc. NOT CONTAGIOUS take a little bit to heal back

Clinical Manifestations- GI/Gastrointestinal System

-Stress Ulcers -Constipation Decreased GI motor activity contributes to gastric distention and development of paralytic ileus. Gastric emptying may be delayed, especially in patients w/ higher level SCI. Excessive release of HCl acid in the stomach may cause stress ulcers. dysphagia may also be present in patients who require mechanical ventilation, tracheostomy, and anterior spine surgery. Intraabdominal bleeding may be difficult to diagnose b/c the person with SCI may not experience pain or tenderness. Continued hypotension and decreases in Hgb and Hct may indicate bleeding. Expanding abdominal girth may also be noted. Loss of voluntary control of bowel following SCI= neurogenic bowel Peristalsis= impaired, and stool propulsion is slow. The defecation reflex may be damaged and anal sphincter tone relaxed (retention). This leads to constipation, increased risk of incontinence, and possible impaction, ileus, or toxic megacolon. Hemorrhoids can occur over time.

S&S of Myxedema Coma

-Subnormal temp- extremely low body temp! -Hypotension- extremely low BP, like maybe normally run 100 SBP, might run in the 60s or 70s now -Hypoglycemia- VERY LOW BS! -Changes in LOC-Trouble with Memory

Leptin

-Suppresses appetite -Increases physical activity -Increases fat metabolism **Appetite Suppressor!**

Disorders of Posterior Pituitary Gland

-Syndrome of Inappropriate Antidiuretic Hormone (SIADH) -Diabetes Insipidus (DI)

Rheumatoid Arthritis (RA)

-Systemic Autoimmune Disease characterized by inflammation of connective tissue in the diarthrodial (synovial) joints - Periods of Remission and Exacerbation - Smoking ↑ Risk -caused by inflamed synovial joints, SYSTEMIC (can have pain not just in joints but can go up the arm, other places, travels)

The Pulmonic and Aortic Valves are also known as what?

-The Semilunar Valves -They prevent blood from regurgitating into the ventricles at the end of each ventricular contraction.

Preload

-The VOLUME of blood in the ventricles at the end of diastole (heart relaxing) BEFORE the next contraction. -It determines the amount of STRETCH placed on the myocardial fibers.... so, a lot of stretch will have a bigger contraction. Can be increased by a number of conditions such as HTN, aortic valve disease, and hypervolemia.

Etiology/Causes of Osteoporosis

-This is determined by Heredity, Nutrition, Exercise and Hormone Function -Peak Bone Mass is primarily achieved by the age of 20 years -Occurs most commonly in the spine, hips and wrists Some people get it because it is hereditary, might be caused by nutrition and hormones Bones peak in mass at 20 years of age (when you can store up bone mass at that point) Occurs mostly in the spine, hips, and wrists

Hepatic Encephalopathy

-Too much ammonia floating around! The liver processes ammonia and rids normally, and the brain does NOT like it when it is increased! -Patient will start getting confused and as cirrhosis advances the more the pt. will experience -First a little confused and lethargic then will go all the way into coma! - Educate the family and NOT the pt b/c patient will be confused Stages: 1: mild confusion, agitation, irritability, sleep disturbances, and decreased attention 2: lethargy, disorientation, inappropriate behavior, drowsiness 3: somnolent but arousable, slurred speech, confused, aggressive 4: coma- can happen fast!

Endoscopies

-Types= EGD, colonscopy, and ERCP -Common endoscopy dx studies are used for pancreatitis and gallbladder problem patients and can also be used to look at tumors and lesions , not using contrast just visualizing -Allows videos and still pictures, taking video or picture while scope/tube is down with light, can be seen right inside the body Can look for perforations/tears

Gout

-Uric Acid Crystals in the Joints - Will Have Periods of Remission and Exacerbation -Inflammation, Swollen, Painful Joints -Great Toe (podagra) most common initial location Too much uric acid built up in the joints Great toe is most common location In those joints and causes inflammation and swollen painful joints r/t kidneys not excreting uric acid like it should or because of having increased foods that produce uric acid

Raynaud's Disease

-Vasospastic disorder of small cutaneous arteries. -Imbalance between Vasodilation & Vasoconstriction -Involves Fingers and Toes -Happens in Women > Men & in younger Age 15-40 years -Vessels very spasmy -Go from vasodilation to vasoconstriction -Because spasming some circulation can't get through -Seen in fingers and toes!

Leukoplakia

-WBCs, thick white patches seen -will turn to cancer if not taken care of -not as bad as erythroplakia

Metabolic Syndrome is Diagnosed with three or more of the following......

-Waist circumference ≥40 inches (men) or ≥35 inches (women) -Active treatment for *Triglycerides >150 mg/dL *HDL cholesterol <40 men, <50 women *Blood pressure ≥ 130 mm Hg systolic or ≥ 85 mm Hg diastolic *Fasting glucose ≥ 100 mg/dL ***Have to have at least three of these listed above to be diagnosed: waist circumference >= 40 in men and >= 35 for women, trigylcerides >150 mg/dL, HDL <40 men and <50 women, BP >=130 systolic or >= 85 diastolic, and fasting blood glucose >= 100 mg/dL**

Adrenocortical Insufficiency S&S

-Weakness, Fatigue -Poor Skin Turgor -Orthostatic Hypotension and/or Low BP -Hyponatremia (low sodium levels!) -Hyperkalemia (too much K+!)

What causes an Addisonian Crisis?- Etiology

-Withdrawal of Corticosteroid Hormones -Adrenal Surgery -Destruction of Pituitary Gland

Epilepsy

-a disease marked by a continuing predisposition to seizures, with neurobiologic, cognitive, psychologic, and social consequences. -when someone has 2 or more unprovoked seizures

What causes Conn's Syndrome/Hyperaldosteronism?- Etiology

-adrenocortical adenoma - CKD

Open Fundoplication

-an incision -more complicated and will go inside and fix the hernia that way -Pts at risk for respiratory complications - NI= Check ABCs, chest tube, NG tube, will put pt on NPO status, monitor the incision! -check ABCs, will have a chest tube to manage, want to have a NG tube placed to keep stomach empty at first, keep them NPO b/c have NG tube, and will monitor incision For first 14 hours the liquid in NG intermittent suction will be brown/light brown colored which is normal, Not normal = BIG CLOTS OF BLOOD

Inflammatory Bowel Disease (IBD)

-autoimmune disease ivolving an immune reaction to a person's own intestinal tract. -Autoimmune Disease that attacks the GI tract! -Types= Ulcerative Colitis and Crohn's Disease -Happens in Teens and early adulthood -can have exacerbations and remission (Crohn's Disease is worse) S&S= -Tenesmus (urge to defecate all the sudden), -diarrhea - abdominal pain. -Hurts worse when they eat!

Primary SCI Injury

-can result form cord compression by bone displacement, interruption of blood supply to the cord, or traction from pulling on the cord. Penetrating trauma, such as gunshot wound or stab wounds, can cause tearing and transection. -The initial mechanical disruption of axons as a result of stretch or laceration. -Ex. Trauma= fell, dove into rock, injury

Secondary Headaches

-caused by another condition or disorder, such as sinus infection, neck injury, and brain tumor.

Squamous Cell Carcinoma

-caused from tobacco and ETOH/alcohol -Happens in 40 yo and older -METASTASIZES EASY -No S&S so not noticed. can go undetected -90% of oral cancers is this type -usually metastasizes -most people with oral cancer is this type -EARLY DETECTION IS KEY

Tetraplegia

-formerly called Quadriplegia -If cervical cord is involved, paralysis of all four extremities occurs -Degree of impairment in the arms following cervical injury depends on the level of injury. The lower the level, the more function is retained in the arms.

Glasgow Coma Scale (GCS)

-gold-standard for assessing LOC! -quick, practical, and standardized system for assessing LOC

Diet

-have 6 small meals throughout the day, NO fluids with meals, and avoid concentrated/high sugar foods, increase protein, & decrease the amount of carbs you eat -Divide meals into 6 small feedings to avoid overloading the stomach and intestine at mealtimes -Do NOT take fluids with meals but at least 30-45 min BEFORE OR AFTER meals. This helps prevent distention or a feeling of fullness - Avoid concentrated sweets (hone, sugar, jelly, jam, candies, sweet pastries, sweetened fruit) b/c they sometimes cause dizziness, diarrhea, and sense of fullness. - Increase protein and fats to promote rebuilding of body tissues and to meet energy needs. Meat, cheese, eggs, are specific foods to increase in the diet. -Amount of time these restrictions should be followed varies. The HCP decides the proper amount of time to remain on this prescribed diet according to the patient's clinical condition and progress.

Bell's Palsy- Clinical Manifestations/ S&S

-inability to wrinkle brow -drooping eyelid; inability to close eye -inability to puff cheeks, no muscle tone -drooping mouth, inability to smile or pucker

What does stimulation of the Parasympathetic Nervous System (PNS) do?

-is mediated by the vagus nerve -slows the HR by decreasing impulses from the SA node and thus conduction through the AV node. -constrict pupils -stimulates salivary glands -Slows the heartbeat -constricts bronchi -stimulates digestion -Stimulates bile release -Stimulates peristalsis and secretions -constricts the bladder

Liver Transplantations

-scores based on how urgent they need it. More sick they are the higher on the list they are to get one, usually have to wait 1 year -Surgery is 10-20 hours (very long) and liver can only stay on ice for 12-20 hours -The people on the wait list have a phone and if called MUST come in 1 hour and it is done nationally. -These pts will be in the ICU after!

S&S of SIADH

-⬆Extracellular Fluid Volume -⬆ Weight Gain -⬇Sodium Levels -⬇UO (< 30mL/hr) Normally volume is controlled, but with SIADH and when too much ADH then will hold on to that fluid/water so TOO MUCH VOLUME ON BOARD. So b/c SIADH will have increased ECF volume, these patients have weight gain, decreased sodium levels and a decreased urinary output (which means <30 mL/hr of output) So BP will be INCREASED/GO UP b/c of too much volume, will give HYPERtonic solutions

Cardiovascular System Problems with KIDNEYS include what?

-kidneys don't get perfused then don't produce urine so UOP goes down (less than 30 mL/hr) which can lead to other more serious issues with the kidneys, etc.

Left Upper Quadrant (LUQ)

-left lobe of liver -spleen -stomach -body of pancreas -left adrenal gland -portion of left kidney -splenic flexure of colon -portion of transverse and descending colon

Right Upper Quadrant (RUQ)

-liver and gallbladder -pylorus -duodenum -Head of the pancreas -right adrenal gland -portion of the right kidney -hepatic flexure of colon -portion of ascending and transverse colon

Chemoreceptors

-located in the aortic and carotid bodies and the medulla. They are capable of causing changes in respiratory rate (RR) and BP in response to increased arterial CO2 pressure (hypercapnia) and, to a lesser degree, decreased plasma pH (acidosis) and arterial O2 pressure (hypoxia). When the chemoreceptors in the medulla are triggered they stimulate the vasomotor center to increase BP. **Can cause changes in the RR and BP in response to hypercapnia, acidosis and hypoxia** -have central receptors in the brain and peripheral around the heart, sensitive to hypoxemia (when not enough O2 it wakes up and tries to help out in that area) -Ones in brain are sensitive to CO2 so when body has too much CO2 (hypercapnia) then it will sense that and wake up and help out to reduce the CO2 in the body

NI for DIverticulosis & Diverticulitis

-low fiber when in exacerbation -NO corn, seeds, popcorn, NOTHING to get caught in pockets -Teach what can eat/what to eat! -Educate on diet and nutrition, what to eat and not to eat -Make sure start them on clear liquid diet, then AVOID corn, seeds, and popcorn (think of MY MOTHER-IN-LAW! She can't have popcorn with seeds and no corn to eat things that can get in the pockets)

Right Lower Quadrant (RLQ)

-lower pole of right kidney -cecum and appendix -portion of ascending colon -bladder (if distended) -right ovary and salpinx -uterus (if enlarged) -right spermatic cord -right ureter

Provoked Seizures

-the patient did something to cause it Caused by: ETOH Withdrawal Drug Abuse High Fever Stroke Head Injury Infection Stop Medications abruptly

Cushing Syndrome S&S

-thinning of hair -**moon face** -acne -**buffalo hump** -**supraclavicular fat pad** -**INCREASED body and facial hair** -**weight gain** - purple striae -thin extremities w/ muscle atrophy -ecchymosis resulting from easy bruising -thin skin and subcut tissue -slow wound healing -INCREASED BS b/c of increased corticosteroids

Seizure

-transient, uncontrolled electrical discharge of neurons in the brain that interrupts normal function. - may accompany a variety of disorders, or they may occur spontaneously without any apparent cause. -Not considered epilepsy if they result form systemic and metabolic disturbances such as acidosis, electrolyte imbalances, hypoglycemia, hypoxia, alcohol and barbiturate withdrawal, dehydration, and water intoxication. Extracranial disorders that can cause seizures are heart, lung, liver, or kidney diseases; systemic lupus erythematosus, DM, HTN, and septicemia. -neuron discharge in the brain

Migraine Headaches

-unilateral (in 60%), may switch sides, commonly anterior location -throbbing, synchronous w/ pulse -periodic, cycles of several months & years -duration: 4-72 hours -May be preceded by premonitory symptoms or aura, onset AFTER awakening, improves w/ sleep -Associated S&S= irritability, sweating, N/V, photophobia, phonophobia, premonitory symptoms (sensory, motor, or psychic phenomena), and family history ( in 65% of cases)

Cluster Headaches

-unilateral, radiating up or down from one eye -severe, bone crushing pain (quality of HA) -may have months or years between attacks, attacks occur in clusters over a period of 2-12 weeks -nocturnal, commonly awakens person from sleep= onset -Associated Symptoms= facial flushing or pallor, unilateral lacrimation, ptosis, rhinitis

Endoscopic Retrograde Cholangiopancreatography (ERCP)

-used to visualize the pancreatic, hepatic, and common bile ducts. Endoscopy is often combined with diagnostic procedures, including biopsy and cytologic studies and invasive therapeutic procedures. Examples include polypectomy, sclerosis or banding of varices, laser treatment, cauterization of bleeding sites, papillotomy, common bile duct stone removal, and balloon dilation. -interventions are same as EGD, NPO 8 hours, conscious sedate

A patient is being scheduled for endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which actions from the agency policy for ERCP should the nurse take first? a. Place the patient on NPO status. b. Administer sedative medications. c. Ensure the consent form is signed. d. Teach the patient about the procedure.

A

Pitting Edema

1+ = mild pitting, slight brief indentation 2+ = 3+ = 4+ = deep pitting, indentation that lasts a long time 4+ is worse than 1+ 1+ might take a minute or so to come back and keeps getting worse -Sometimes pitting edema gets so bad that you have to use a doppler to palpate pulses b/c so much edema. Not allowed to chart no pulse, get the doppler out and DOUBLE CHECK Checked by depressing the skin over the tibia or medial malleolus for 5 seconds. Normally there is no depression after releasing pressure. IF present, you should grade it from 1+-4+

Preventing Food Poisoning (Table 41-25, p.926)

1. Cook ALL ground beef and hamburger thoroughly- use a digital instant-read meat thermometer to ensure thorough cooking (ground beef can turn brown before disease causing bacteria are killed!) 2. If you are served undercooked hamburger or otehr ground beef products in a restaurant, send it back for further cooking. ALso ask for a new bun and a clean plate 3. Avoid spreading harmful bacteria. Keep raw meat separate from read-to-eat foods. Wash hands, counters, and utensils with hot soapy water after they touch raw meat. Never palce cooked hamburgers or ground beef on the unwashed plate that held raw patties. Wash meat thermometers in between tests of patties taht require further cooking 4. Drink ONLY pasteurized milk,juice, or cider. Commercial juice with an extended shelf-life that is sodl at room temp (ex. juice in cardboard boxes, vaccuum-sealed juice in glass containers) has been pasteurized. Juice concentrates are heated sufficiently to kill pathogens 5. Wash fruis and vegetables thoroughly, especially those that will NOT be cooked. 6. Do NOT eat raw food products that are supposed to be cooked. Follow package directiosn for cooking at proper temp. 7. People who are immunocompromised should avoid eating alfalfa sprouts until the safety of the sprouts can be ensured.

What are the three layers of the heart?

1. Endocardium 2. Myocardium 3. Epicardium

Types and Routes of PN

1. Total/Central Parenteral Nutrition (TPN) or (CPN) 2. Partial Parenteral Nutrition (PPN) TPN is given through a central line or port, longer term PPN= given through just an IV, shorter term or gor a special condition where they need it for just a little bit TPN= goes right into the subclavian or SVC PPN= goes through an intravenous area/IV ****Both TPN and PPN have to be confirmed by x-ray before being able to use it, can be used right after****

To palpate the liver during a head-to-toe physical assessment, the nurse a. places one hand on the patient's back and presses upward and inward with the other hand below the patient's right costal margin. b. places one hand on top of the other and uses the upper fingers to apply pressure and the bottom fingers to feel for the liver edge. c. presses slowly and firmly over the right costal margin with one hand and withdraws the fingers quickly after the liver edge is felt. d. places one hand under the patient's lower ribs and presses the left lower rib cage forward, palpating below the costal margin with the other hand.

A

Restless Leg Syndrome

A common condition characterized by unpleasant sensory (paresthesia) and motor abnormalities of one or both legs. Two types: primary (idiopathic) and secondary ( can occur w/ metabolic abnormalities associated w/ iron deficiency, renal failure, HTN, DM, spinal disorders, or rheumatoid arthritis Conditions such as anemia, pregnancy, and certain medications can worsen symptoms. S&S- ranges form infrequent minor discomfort (paresthesia, including numbness, tingling and "pins and needles" sensation) to severe pain. Sensory symptoms appear first and patients describe as "annoying and uncomfortable" but usually not painful sensation in the leg. Pain at night can disrupt sleep. physical activity such as walking, stretching, rocking or kicking often relieves the pain. -Patho= deficiency of dopamine - Clinical S&S= Leg paresthesia with the irresistible urge to move one or both legs Pain can be absent, minor or severe Occurs typically in the evening or night

While interviewing a 30-year-old man, the nurse learns that the patient has a family history of familial adenomatous polyposis (FAP). The nurse will plan to assess the patient's knowledge about a. preventing noninfectious hepatitis. b. treating inflammatory bowel disease. c. risk for developing colorectal cancer. d. using antacids and proton pump inhibitors.

C

Beta Adrenergic Blocker and Diuretic (Combined med)- Metoprolol/Hydrochlorothiazide (Lopressor HCT)

Action- Blocks salt and fluid reabsorption form the urine in the kidneys causing diuresis Metoprolol (Lopressor)= Beta Blocker Hydrochlorothiazide= Thiazide Diuretic Nursing Implications= -Monitor for HYPOKALEMIA (thiazide diuretic= potassium wasting med, so will make K+ LOW!!!) -Monitor for ALKALOSIS -Give dietary Sodium restrictions (b/c causes Na+ to build up in body!) -Assess for orthostatic hypotension/dizziness -Monitor BP and HR

Risk Factors for HF

HTN CAD Aortic Stenosis MI Diabetes, Tobacco use, Obesity, Increase in Age People at risk are those with HTN, CAD, Aortic Stenosis, people with an MI in the past, etc and those with Diabetes and smokers and those who are obese And increases your risk with older age (elderly are more at risk!)

Autonomic Hyperreflexia/Dysreflexia- Clinical Manifestations/S&S

HTN (very hypertensive- like in the 220s, etc.), Bradycardia, Headache, Diaphoresis, Blurry Vision, Flushed Face

Nasogastric/Orogastric Tubes

AKA Salem Sump or NG tube Tube Length of Stay= 1 wk-weeks Primary Use= DECOMPRESS THE STOMACH Hooked up to suction?= YES!! need to confirm prior to use - aspirate and check pH, inject 20-30 mL of air bolus into tube and listen w/ steth for swoosh, and definitive way to know is confirm w/ an X-RAY immediately after x-ray confirms can use

Herpes Simplex

AKA cold core, fever blister Etiology/Causes: HSV Type 1 or 2, predisposing factors of upper respiratory tract infections (URIs), excessive exposure to sunlight, food allergies, emotional tension, onset of menstruation in women S&S/Manifestations: lip lesions, mouth lesions, vesicle formation (single or clustered), shallow and painful ulcers Tx: spirits of camphor, corticosteroid cream, mild antiseptic mouthwash, viscous lidocaine, removal or control of predisposing factors, antiviral agents (ex. Acyclovir, famiciclovir, etc.)

Oral Candidiasis

AKA monoiliasis or THRUSH Cause/Etiology: candida albicans (a yeast-like fungus), debilitation, prolonged high-dose ABX or corticosteroid therapy S&S/Manifestations: pearly, bluish white "milk-curd" membranous lesions on mucosa or mouth and larynx, sore mouth, yeasty halitosis (yeasty smelling breath!) Tx= Miconazole buccal tablets (Oravig) Nystatin or amphotericin B as oral suspension or buccal tablets -Good oral hygiene

SCI Clinical Manifestations- Cardiovascular

ANY cord injury above T6 leads to dysfunction of the SNS. The result may be bradycardia, peripheral vasodilation, and hypotension (neurogenic shock). Peripheral vasodilation causes a relative hypovolemia b/c of the increase in the capacity of the dilated veins. It also reduces venous return of blood to the heart. Cardiac output then decreases, leading to hypotension. Other injuries can also cause hemorrhagic shock and further reduce BP. It is important to identify ALL causes of hypotension in the person w/ SCI. Above T6 leads to dysfunction of SNS Results, Bradycardia, Hypotensive, Peripheral Vasodilation -Want to Keep SBP 90 and > -T6 and above on the body will have more trouble (with walking, ambulating, peeing, going to bathroom, any ADLs, etc.) than people below those levels b/c that is where the nerves crosses and interfaces and exchanges at T6 or above before goes anywhere else T6= dysfunction of SNS Will have more trouble with CV problems Will have bradycardia, hypotension, and peripheral vasodilation Make sure to keep SBP at 90 and above!!!! Make sure systolic pressure is nothing less than 90 to make sure getting perfused and heart/blood/body getting oxygen it needs, etc.

Triple A (AAA)

Abdominal Aortic Aneurysm

Pulmonary Edema

Abnormal of buildup of fluid in alveoli of lungs, with CHF more fluid in lungs Alveoli get so filled up with fluid that EVERYTHING gets exacerbated Pulmonary Edema= CHF exacerbated!! If patient comes in with CHF and you treat it they should start showing improvement and get better, but if you see that ****pink frothy sputum*** then know that they are experiencing pulmonary edema. Tx with oxygen first and then Lasix Check O2 sats before giving oxygen/O2- know O2 sats, implications w/ O2 and how to give it and what to give, etc. before giving any O2!!

Anal Fistula

Abnormal tunnel leading from rectum Causes/Etiology: Abscess NI: -Perineal Care -Diet -Fistulotomy abnormal tunnel leading from rectum, from an ABSCESS, cut area to heal from the inside out, teach PERI care and diet DON'T allow CONSTIPATION , and teach strict cleaning Fistulotomy

Ascites

Accumulated fluid within the abdominal cavity, eversion of umbilicus (usually) Possible Etiology/Causes= peritoneal inflammation, heart failure (HF), metastatic carcinoma, cirrhosis

Diagnostic Studies for MG

Acetylcholine Receptor (AChR) Antibodies Increase with MG Tensilon Testing: -Cholinesterase Inhibitor -Monitor patient during procedure -Acetylcholine receptor antibodies will be INCREASED w/ MG -Tensilon test= a medication that you give a patient (a cholinesterase inhibitor) can be injected in IV and will improve muscle strength and lasts about 5 minutes to test to see if they have it, so if it helps them then they have MG if it isn't any better than might be something else, can cause a patient to go into V. Fib so might just draw blood first to check for antibodies, so nurse must monitor for V.Fib and EKG and so need to have crash cart and an IV ready if something happens.

Disorders of the Anterior Pituitary Gland

Acromegaly

Opioid-Morphine

Action- Acts on CNS to DECREASE PAIN and DECREASES PRELOAD Nursing Implications- GIven IV Push (IVP) 2 mg over 2 minutes! -Monitor RR and BP (b/c slows RR and lowers BP) -Monitor for localized reaction (hypersensitivity) -Monitor for constipation and treat accordingly w/ stool softener or laxative -will cause CNS depression and relaxes the GI causing constipation issues

Disorders of Parathyroid Glands

HYPERparathyroidism and HYPOparathyroidism

Calcium Channel Blocker (CCB)- Diltiazem (Cardizem) Extended Release

Action- Inhibits movement of Ca2+ across the cell membrane, resulting in vasodilation; cardioselective resulting in a decrease in HR and slowing AV conduction! Nursing Implications/Considerations: - USE WITH CAUTION in patients w/ HF! -Serum concentration and toxicity MAY be increased while eating grapefruit and drinking grapefruit juice ( ***NO grapefruit or grapefruit juice!***) -Monitor HR and BP

Loop Diuretic- Lasix

Action- Inhibits the reabsorption of Na+ and Chloride from the Loop of Henle and distal renal tubule; this will INCREASE renal excretion of water, Na+, Chloride, Mag, K+, and Ca+ Nursing Implications= -Assess for orthostatic hypotension/dizziness -Assess for dehydration -Monitor for HYPOkalemia (makes K+ LOW!!) -Check BP= if SBP is 100 or more than okay to give, if LESS than 100 then HOLD MED

Beta Blockers- Carvedilol (Coreg) and Metoprolol (Lopressor)

Action- blocks beta receptors therefore decreasing HR and BP Nursing Implications= -Assess for orthostatic hypotension/dizziness -Monitor HR and BP These meds won't fix HF immediately, it takes time, need to take ALL THE TIME to help with BP and HR, will typically give these meds to patient to go home with to try to see if it helps with HR and BP

Angiotensin II Receptor Blocker (ARB)- Losartan (Cozaar)

Action- prevent action of Angiotensin II and produces vasodilation and increased Na+ and Water excretion Nursing Implications/Considerations: -Assess for orthostatic hypotension -Monitor for hyperkalemia (K+ increased!!!) -Avoid salt substitutes -Should NOT be used w/ potassium sparing diuretics -***May take up to 3-6 weeks to become fully effective and show results on the BP***

Loop Diuretic- Furosemide (Lasix)

Action: inhibits the reabsorption of Na+ and Chloride form the Loop of Henle and DIstal Renal Tubule; this will increase renal excretion of water, Na+, Chloride, Mag, K+, and Ca+ Nursing Implications= -Given IV Push (IVP) 20 mg over 1-2 minutes! -Assess for orthostatic hypotension/dizziness -Assess BP PRIOR to administering! Can give if SBP is 100 or MORE, hold if less than 100 SBP -Assess for dehydration -Monitor for HYPOKALEMIA (makes K+ low b/c potassium wasting!)

Mixed Alpha and Beta Adrenergic Blocker- Carvedilol (Coreg)

Action= Alpha 1, Beta 1 and Beta 2 adrenergic blocking properties producing peripheral vasodilation and decreased HR; reduces CO, SVR, and BP! Nursing Implications/Considerations: -Assess for orthostatic hypotension - Monitor BP and HR - BP must be 110 or GREATER and HR 60 bpm or GREATER to administer; hold if less!!

Positive Inotropic - Digoxin (Lanoxin)

Action= INCREASES myocardial contractility, INCREASES CO, DECREASES HR, helps w/ contractility of the heart, helps the heart beat with more force and so you get more CO out to the body Nursing Implications= -Monitor for DIGOXIN TOXICITY (check Dig Levels!) -Monitor HR (always check HR before giving- you CAN GIVE Digoxin if HR is 60 bpm or greater! If less than 60 then HOLD -Avoid taking with Antacids (doesn't mix well!)

Loop Diuretic- Furosemide (Lasix)

Action= inhibits the reabsorption of Na+ and Chloride from the Loop of Henle and distal renal tubule. This will INCREASE renal excretion and water, Na+, chloride, mag, K+, and Ca+ Nursing Implications/Considerations= -Assess for orthostatic hypotension (dizziness! might be dizzy when trying to stand from lying position (take BP lying,sitting, standing) -Assess for any dehydration -Monitor for HYPOkalemia (K+ low)= lasix causes K+ to decrease! -Monitor BP

Angiotensin Inhibitor/ACE Inhibitor- Captopril (Capoten)

Action= prevents conversion of Angiotensin I to Angiotensin II; inhibits the breakdown of Bradykinin and can cause a dry, hacking cough! Nursing Implications/Considerations= -Assess for orthostatic hypotension (might have w/ 1st dose dizziness and low BP -Monitor for HYPERkalemia (can cause K+ to INCREASE!) -Avoid salt substitutes (b/c have K+ in them!) -Should NOT be used with potassium sparing diuretics -Can cause a nagging cough -Severe reactions can cause angioedema (swelling around the face and lips, etc.)

Nitrate- Nitroglycerin (NTG)

Actions= causes vasodilation of blood vessels, and decreases preload and afterload Nursing Implications= -Assess BP PRIOR to administration! Can give if SBP is 100 or greater! Less than 100 need to hold med! VERY IMPORTANT to check BP -GIVE MED sublingual (SL) and do NOT chew or Swallow _ can give 1 tab every 5 minutes up to 3 times for 15 minutes total (3 tabs total in 15 minutes) *** GIVEN 1 tab Q5 minutes up to 3 times*** -Causes HA and dizziness b/c will drop BP

Delirium- Clinical Manifestations/S&S

Acute onset Lethargic Hallucinations Agitation

Cultural/Gender Related Risks for HTN

African Americans- highest risk for HTN Mexican Americans- lowest rate of BP control, don't typically seek tx or follow tx protocol, has to do w/ language barrier and $$$ Men before 45 yrs Women after 64 yrs- highest risk at this point in age in girls b/c of estrogen loss, estrogen helps relax/fix HTN but when go through menopause don't have that protective factor of estrogen to help out so higest risk then Oral Contraceptives- makes blood thicker and clot more easily and can give you a little HTN **REVIEW OVER pg. 682**

Risk Factors for HTN

Age, Gender, Genetics = nonmodifiable risks Modifiable Risks: ETOH and Tobacco Diet high in Fat, Na Diabetes, CAD Obesity ***REVIEW OVER Table 32-4, page 685***

NI for Esophagogastroduodenoscopy (EGD)

Airway Breathing Ability to swallow Gag reflex After coming back from an EGD= focus is airway, nothing to eat or drink till gag reflex returns and is checked ABCs, MUST check gag reflex after so they can eat d/t them numbing the throat and conscious sedation. Progresses from water to meals and also worry about/ check for them vomiting.

Right Coronary Artery

Also arises from the aorta and its branches supply the RIGHT atrium. RIGHT ventricle, and a portion of the poterior wall of the LEFT ventricle. Blockage of this artery often causes serious defects in cardiac conduction.

SCI Clinical Manifestations - Motor and Sensory Effects

American Spinal Injury Association (ASIA) Impairment Scale is recommended for classifying the severity of impairment from SCI. It combines assessments of motor and sensory function to determine neurologic level and completeness of injury. **REVIEW OVER- Figure 60-4, p.1422**

Alzheimer's Disease- Patho

Amyloid Plaques Neurofibrillary Tangles Loss of connection between Neurons Neuron Death -Lot of memory loss, personality changes, progressive and will destroy the brain as time goes on. -Plaque builds up on neurons and causes it not to work right, get tangled, end result is neurons not working right or communicating right and then get smaller and atrophy and die -Starts out in temporal lobe- emotion, seeing new things, storing new memories- so tend to see that first w/ changes in personality and emotions, etc.

Which information about an 80-year-old man at the senior center is of most concern to the nurse? a. Decreased appetite b. Unintended weight loss c. Difficulty chewing food d. Complaints of indigestion

B

Your patient is diagnosed with right-sided heart failure. Which assessment findings will the nurse expect the client to have? Select all that apply. (Table 35-4, page 771) A) Peripheral Edema B) JVD C)Noturnal Polyuria (b/c fluid in body flows up to kidneys and makes htem pee a lot) D) S3/S4 Gallop E) Breathlessness/Dyspnea/SOB F) PMI displaced to the left

Answers= A,B, & C

You are taking care of a patient with left-sided heart failure. Which assessment findings will the nurse expect the client to have? Select all that apply. A) Confusion B) Ascites C)Oliguria D) Increased Thirst E) Crackles in lungs F) Nausea/Anorexia

Answers= A,C, & E

The nurse is assessing an alert and independent 78-year-old woman for malnutrition risk. The most appropriate initial question is which of the following? a. "How do you get to the store to buy your food?" b. "Can you tell me the food that you ate yesterday?" c. "Do you have any difficulty in preparing or eating food?" d. "Are you taking any medications that alter your taste for food?"

B

The nurse will plan to monitor a patient with an obstructed common bile duct for a. melena. b. steatorrhea. c. decreased serum cholesterol levels. d. increased serum indirect bilirubin levels.

B

Which area of the abdomen will the nurse palpate to assess for splenomegaly? a. Right Upper Quadrant b. Left Upper Quadrant c. Right Lower Quadrant d. Left Lower Quadrant

B

Which finding by the nurse during abdominal auscultation indicates a need for a focused abdominal assessment? a. Loud gurgles b. High-pitched gurgles c. Absent bowel sounds d. Frequent clicking sounds

C

Which statement to the nurse from a patient with jaundice indicates a need for teaching? a. "I used cough syrup several times a day last week." b. "I take a baby aspirin every day to prevent strokes." c. "I use acetaminophen (Tylenol) every 4 hours for back pain." d. "I need to take an antacid for indigestion several times a week"

C

A patient became dizzy when changing from a position form sitting to standing. What is the nurses priority intervention? A.)Assess RR B.) Assess BP C.) Assess O2 D.) Assess medication list

B.) Assess BP B/C pt is experiencing symptom of dizziness with sitting to standing which should alert to orthostatic hypotension issues.

Clinical Manifestations/S&S of PAD

Based on location, extent of blockage and collateral circulation Claudication Table 37-1, page 804 (also see EXTRA HANDOUT!) Claudication= think arterial!!! W/ PAD, that blockage starts to impair circulation, and the size of the blockage determines type of impairment they have Claudication= term used to determine how bad the blockage is, S&S of PAD Claudication= determines how far they can walk before they have pain, if can walk 20 blocks before have pain better than someone who can walk 8 blocks before having pain so that determines how much blockage they have Definition of Claudication= impairment of walk r/t pain relieved by rest! extremity needs oxygen so claudication determines how much it is blocked The longer they can walk without pain the more blood flow that is getting through and more oxygenated those extremities are, etc. If hurt all the time and doesn't matter if they rest or not or if waking up hurting at night then there is a BIG CONCERN for MAJOR BLOCKAGE to that area so area not getting perfused= think cutting off blood flow, start to become necrotic if don't do anything about it quickly. S&S= intermittent claudication, or rest pain, critical limb ischemia, paresthesia, thickened or brittle nails,dependent rubor (black coloring!) , reactive hyperemia, elevation pallor (cyanotic, pale!) , delayed healing, skin texture is THIN, SHINY, TAUT, Skin temp is COOL w/ temp gradient b/c arterial problem!, dermatitis RARELY OCCURS, pruritus RARELY OCCURS, PERIPHERAL PULSES will be DECREASED, cap refil is >3 seconds (SLOW!), hair is absent on lower extremities, Ulcers= on the bony prominences of toes, feet, and LATERAL MALLEOLUS and are rounded and smooth, and have minimal drainage, granulation tissue w/ black eschar or can be pale/pink color

Nursing Interventions/How do we Treat Infective Endocarditis (IE)?

Blood Cultures (BC) x3 over 1 hour from 3 different sites Echo, TEE Xray EKG IV antibiotics Treat fever and pain Subsequent BC x2 Teaching Oral Hygiene! Avoid sick people Prophylactic Antibiotics Blood cultures ( BCs are usually in two bottles= 1 set, one anaerobic and one is aerobic and we put 10 mL in each bottle, 2 sets which is 4 bottles, but these people will get 3 BCs over 1 hour form 3 different sites in order to make sure we know what is causing the infection, etc. so if they are all the same did a good job drawing it up without contaminating the bottles and can treat accordingly BCs take a few days to grow then will tell us what is growing in there Patients w/ IE need an echo or TEE (taking look at valve and seeing how bad it is) , xray (takes a look to see how bad it is, looks at how the heart is getting bigger, etc.), and EKG (if valve problems will have a dysrhythmia so need an EKG for that) If anyone has an infection they are given IV ABX for about 6 weeks (a while) so might go home with a PICC or port in place, so home health will come to check on it and help take care of it or if older might go to nursing home for a while, etc. Will go through 6 weeks of IV ABX then will check a BC again. Want to teach them to have proper oral care (brushing teeth good b/c it is linked to heart health), avoid being around sick people/crowded areas b/c will be at risk for picking up infections, will be on prophylactic ABX if having invasive procedures or dental work done prior in order to fight off whatever might get introduced into their bodies, etc. People will almost deal with IE for about a year- have to be on longterm ABX and recheck BCs , hard to get rid of

Classification of Body Weight and Obesity

Body mass index (BMI) BMI= Weight (kg)/Height (m2) Underweight = BMI <18.5 Normal = BMI 18.5-24.9 Overweight = BMI 25-29.9 Obese = BMI >30 Severely obese = BMI > 40

Diagnostic Studies for Osteoporosis

Bone Mineral Density (BMD) Measurements -Measures bone density - Will do a (QUS) Quantitative Ultrasound & (DXA) Dual-Energy X-ray Absorptiometry **BMD= consists of QUS and DXA scan to measure bone density! -Osteopenia= Bone Loss, if have bone loss then can diagnose as having osteoporosis typically

Hernia

Bulge or nodule in abdomen, usually appearing on straining Possible Etiology/Causes= inguinal (in inguinal canal), femoral (in femoral canal), umbilical (herniation of umbilicus), or incisional (defect in muscles after surgery)

Accommodation and Convergences are tested how?

By having the patient focus on the examiner's finger as it moves toward the patient's nose.

A 54-year-old man has just arrived in the recovery area after an upper endoscopy. Which information collected by the nurse is most important to communicate to the health care provider? a. The patient is very drowsy. b. The patient reports a sore throat. c. The oral temperature is 101.6° F. d. The apical pulse is 104 beats/minute.

C

After assisting with a needle biopsy of the liver at a patient's bedside, the nurse should a. put pressure on the biopsy site using a sandbag. b. elevate the head of the bed to facilitate breathing. c. place the patient on the right side with the bed flat. d. check the patient's postbiopsy coagulation studies.

C

After discharge instructions for a patient who has had bariatric surgery for treatment of obesity, the nurse determines that additional teaching is needed when the patient says: A.) "I shouldn't eat concentrated sweets." B.) "I can eat small, frequent meals throughout the day." C.) "I should drink several glasses of fluids with my meals." D.) "I will need to have a cobalamin injection once a month."

C.) "I should drink several glasses of fluids with my meals."

An important factor associated with both short-term and long-term weight-loss success is: A.) Higher initial body mass index. B.) Simultaneous smoking cessation. C.) A strong desire to improve appearance. D.) Fewer dieting attempts in the past year.

C.) A strong desire to improve appearance. B/C Have to want to lose the weight in order to be successful with weight loss!

A patient with persistent vomiting of 3 days' duration is seen at the urgent care center because of increasing weakness. IV therapy with lactated Ringer's solution is started, and arterial blood gases (ABGs) are measured. Which ABG result would the nurse expect? A.) pH 7.4; PaCO2 40; HCO3− 25 B.) pH 7.3; PaCO2 50; HCO3− 20 C.) pH 7.6; PaCO2 30; HCO3− 40 D.) pH 7.48; PaCO2 40; HCO3− 30

C.) pH 7.6; PaCO2 30; HCO3− 40 Answer: c Rationale: Vomiting is a cause of metabolic alkalosis; the arterial blood gases indicate partially compensated metabolic alkalosis. The pH is greater than 7.45 (alkalosis); the HCO3− is above 26 mEq/L (metabolic); and the PaCO2 is less than 35 mm Hg (partially compensated). Vomiting= getting rid of acid so will be basic, so can mark off all the acidic answers, so the most basic is 7.6 and metabolic alkalosis=vomiting,ahk ahkk ahkolosis! Lol

A patient with anemia would benefit form which diet? A.Vegetables, fish and pasta B. Nuts and seeds, fruits and soy products C.Legumes, organ meat and dark green leafy vegetables D. Grains, berries and organic vegetables

C.Legumes, organ meat and dark green leafy vegetables

What can occur if any of the Coronary Arteries are blocked/clogged?

CAD (Coronary Artery Disease)= plaque buildup, blockage and blood can't get through, this is when people start having chest pain/angina, etc

Cardiac Index (CI)

CI= CO/ BSA -CI adjusts the CO to the body size. -CI is more specific than CO, is based on body size, so if people are more sick we can measure their CI more closely to make sure their CO is okay for them. Normal CI range in adult = 2.8 - 4.2 L/min/m2

Cranial Nerves Mnemonic To Remember...

CN Names: Old- Olfactory, CN I Operators- Optic, CN II Occasionally- Oculomotor, CN III Troubleshoot- Trochlear, CN IV Tricky- Trigeminal, CN V Abducted- Abducens, CN VI Family- Facial, CN VII Veterans- Vestibulocochlear, CN VIII Galloping- Glossopharyngeal, CN IX Valiantly- Vagus, CN X Across- Accessory, CN XI History- Hypoglossal, CN XII CN Functions: Some Some Marry Money, But My Brother Says Big Brains Matter More

Lumbar Puncture

CSF is aspirated by needle insertion in L3-4 or L4-5 interspace. Manometer is attached to needle to obtain CSF pressure. CSF is withdrawn in a series of tubes and sent for analysis (Table 55-8). Contraindicated in the presence of increased intracranial pressure (b/c risk of downward herniation from CSF removal) or infection at site of puncture. Before: Have patient void. Inform the patient that he/she may feel temporary, sharp pain or tingling radiating down the leg as a sterile needle is passed between 2 lumbar vertebrae During: Most commonly,the patient is side lying. Seated position may also be used. Ensure labeling of CSF specimens in proper sequence. After: Encourage fluids. Monitor neurologic signs and VS. Monitor for HA intensity, meningeal irritation (nuchal rigidity), or signs and symptoms of local trauma (ex. hematoma, pain). Administer analgesia as needed.

What is Cardiac Output (CO)?

Cardiac Output= HR X Stroke Volume - amount of blood pumped out of the ventricle each minute CO= HR X Stroke Volume -Normal CO range for adult at rest= 4-8 L/min Preload= stretch, a lot of stretch will have a bigger contraction Afterload= resistance it needs to get out into the body Contractility= the force of contraction of the heart -CO involves the HR, stretch of the ventricle, how hard it works to get blood out to the body and the force it uses to contract/pump the heart -Increasing preload, afterload, and contractility increases the workload of the heart which results in an increased O2/oxygen demand.

Assessment of Obese Patient

Cardiovascular Respiratory Diabetes GI Musculoskeletal Cancer Women have more risk for obesity more than men (b/c the way they carry everything and can lose weight faster, etc.) Cardiovascular= risk for HTN, CAD, atherosclerosis, increased lipids, easier to caused heart attacks and clots, causes body to be more at an inflammatory state Respiratory= can cause sleep apnea (lot of people with sleep apnea are overweight and increased weight is a factor Diabetes= huge risk factor of being obese, insulin becomes more resistant, inflammation not good for body so causes DM, weight huge for helping those with DM Musculoskeletal= knee problems b/c all that weight being bared down on the knees and legs can cause osteoarthritis, etc . Cancer= obesity causes a greater risk of cancers! Has to do with inflammation, increase in hormone levels that body wasn't meant to have, too much insulin floating around can create risks for cancer developing

NI for Gastric Outlet Obstruction

Check ABCs, Ensure pt is NPO Check Labs, monitor Fluids NG Tube- decompress stomach to suck everything out so nothing affects, so will need to be NPO w/ this -Surgery to fix if can't fix on own! Sometimes can fix that area itself and might just need rest and to help with F&E problem, but might go into surgery if can't fix it on its own If someone is vomiting a lot, worry about K+ level!!! K+ might be low b/c of vomiting

Electrical Conduction System of the Heart

Consists of specialized tissue responsible for creating and transporting the electrical impulse ( AKA action potential). This impulse or action potential starts depolarization of the heart cells and subsequently heart contraction.

PUD Ulcer complications

Hemorrhage Perforation of bowel Gastric Outlet Obstruction (in the stomach!) With a hemorrhage can have hematemesis or coffee ground emesis...... hematemesis- bright/frank red blood, when vomit comes right back up, is active bleeding or throwing up, BRIGHT RED, profuse bleeding, more serious than that coffee ground emesis, Coffe ground emesis- has hung out in stomach a little bit longer and then is thrown up/vomited, slower than hematemesis, not as much blood thrown up)

What problem should the nurse assess the patient for if the patient was on prolonged antibiotic therapy? a. Coagulation problems b. Elevated serum ammonia levels c. Impaired absorption of amino acids d. Increased mucus and bicarbonate secretion

Correct answer: a Rationale: Bacteria int he colon (1) synthesize vitamin K, which is needed for the production of prothrombin by the liver and (2) deaminate undigested or non absorbed proteins, producing ammonia, which is converted to urea by the liver. A reduction in normal flora bacteria by antibiotic therapy can lead to decreased vitamin K, resulting in decreased prothrombin and coagulation problems. Bowel bacteria do not influence protein absorption or the secretion of mucus.

A patient is jaundiced and her stools are clay colored (gray). This is most likely related to a. decreased bile flow into the intestine. b. increase production of urobilinogen. c. increased production of cholecystokinin. d. increased bile and bilirubin in the blood.

Correct answer: a Rationale: Bile is produced by the hepatocytes and is stored and concentrated in the gallbladder. When bile is released from the common bile duct, it enters the duodenum. In the intestines, bilirubin is reduced to stercobilinogen and urobilinogen by bacterial action. Stercobilinogen accounts for the brown color of stool. Stools may be clay-colored if bile is not released from the common bile duct into the duodenum. Jaundice may result if the bilirubin level in the blood is elevated.

What characterizes auscultation of the abdomen? a. The presence of borborygmi indicates hyper peristalsis. b. The bell of the stethoscope is used to auscultate high-pitched sounds. c. High-pitched, rushing, and tinkling bowel sounds are heard after eating. d. Absence of bowel sounds for 1 minute in each quadrant is reported as abnormal.

Correct answer: a Rationale: Borborygmi are loud gurgles (stomach growling) that indicate hyper peristalsis. Normal bowel sounds are relatively high-pitched and are heard best with the diaphragm of the stethoscope. High-pitched, tinkling bowel sounds occur when the intestines are under tension, as in bowel obstructions. Absent bowel sounds may be reported when no sounds are heard for 2 to 3 minutes in each quadrant.

A patient had a stomach resection for stomach cancer. The nurse should teach the patient about the loss of the hormone that stimulates gastric acid secretion and motility and maintains lower esophageal sphincter tone. Which hormone will be decreased with a gastric resection? a. Gastrin b. Secretin c. Cholecystokinin d. Gastric inhibitory peptide

Correct answer: a Rationale: Gastrin is the hormone activated in the stomach (and duodenal mucosa) by stomach distention that stimulates gastric acid secretion and motility and maintains lower esophageal sphincter tone. Secretin inhibits gastric motility and acid secretion and stimulates pancreatic bicarbonate secretion. Cholecystokinin allows increased flow of bile into the duodenum and release of pancreatic digestive enzymes. Gastric inhibitory peptide inhibits gastric acid secretion and motility.

Priority Decision: Following auscultation of the abdomen, what should the nurse's next action be? a. Lightly percuss over all four quadrants b. Have the patient empty his or her bladder c. Inspect perianal and anal areas for color, masses, rashes, and scars d. Perform deep palpation to delineate abdominal organs and masses

Correct answer: a Rationale: The abdomen should be assessed in the following sequence: inspection, auscultation, percussion, palpation. The patient should empty his or her bladder before assessment begins.

Checking for the return of the gag reflex and monitoring for LUQ pain, nausea and vomiting are necessary nursing actions after which diagnostic procedure? a. ERCP b. Colonoscopy c. Barium swallow d. Esophagogastroduodenoscopy (EGD)

Correct answer: a Rationale: The left upper quadrant (LUQ) pain and nausea and vomiting could occur from perforation. The return of gag reflex is essential to prevent aspiration after an ERCP. The gag reflex is also assessed with an EGD. These are not relevant assessments for the colonoscopy and barium swallow.

A 35-year-old man with a family history of adenomatous polyposis had a colonoscopy with removal of multiple polyps. Which signs and symptoms should the nurse teach the patient to report immediately? a. Fever and abdominal pain b. Flatulence and liquid stool c. Loudly audible bowel sounds d. Sleepiness and abdominal cramps

Correct answer: a Rationale: The patient should be taught to observe for signs of rectal bleeding and peritonitis. Fever, malaise, and abdominal pain and distention could indicate a perforated bowel with peritonitis.

A 90-year-old healthy man is suffering from dysphagia. The nurse explains what age-related change of the GI tract is the most likely cause of his difficulty? a. Xerostomia b. Esophageal cancer c. Decreased taste buds d. Thinner abdominal wall

Correct answer: a Rationale: Xerostomia, decreased volume of saliva, leads to dry oral mucosa and dysphagia. Esophageal cancer is not an age-related change. Decreased taste buds and a thinner abdominal wall do not contribute to difficulty swallowing.

A patient has an elevated blood level of indirect (unconjugated) bilirubin. One cause of this finding is that a. the gallbladder is unable to contract to release stored bile. b. bilirubin is not being conjugated and excreted into the bile by the liver. c. the Kupffer cells in the liver are unable to remove bilirubin from the blood. d. there is an obstruction in the biliary tract preventing flow of bile into the small intestine.

Correct answer: b Rationale: Bilirubin is a pigment derived from the breakdown of hemoglobin and is insoluble in water. Bilirubin is bound to albumin for transport to the liver and is referred to as unconjugated. An indirect bilirubin determination is a measurement of unconjugated bilirubin, and the level may be elevated in hepatocellular and hemolytic conditions.

An 80-year-old man states that, although be adds a lot of salt to his food, it still does not have much taste. The nurse's response is based on the knowledge that the older adult a. should not experience changes in taste. b. has a loss of taste buds, especially for sweet and salty. c. has some loss of taste but no difficulty chewing food. d. loses the sense of taste because the ability to smell is decreased.

Correct answer: b Rationale: Older adults have decreased numbers of taste buds and a decreased sense of smell. These age-related changes diminish the sense of taste (especially of salty and sweet substances).

In preparing a patient for a colonoscopy, the nurse explains that a. a signed permit is not necessary. b. sedation may be used during the procedure. c. only one cleansing enema is necessary for preparation. d. a light meal should be eaten the day before the procedure.

Correct answer: b Rationale: Sedation is induced during a colonoscopy. A signed consent form is necessary for a colonoscopy. A cathartic or enema is administered the night before the procedure, and more than one enema may be necessary. Patients may need to be kept on clear liquids 1 to 2 days before the procedure.

The patient had a car accident and was "scared to death." The patient is now reporting constipation. What affecting the gastrointestinal (GI) tract does the nurse know could be contributing to the constipation? a. The patient is too nervous to eat or drink, so there is no stool. b. The sympathetic nervous system was activated, so the GI tract was slowed. c. The parasympathetic nervous system is now functioning to slow the GI tract. d. The circulation in the GI system has been increased, so less waste is removed.

Correct answer: b Rationale: The constipation is most likely related to the sympathetic nervous system activation from the stress related to the accident. SNS activation can decrease peristalsis. Even without oral intake for a short time, stool will be formed. The parasympathetic system stimulates peristalsis. The circulation to the GI system is decreased with stress.

As gastric contents move into the small intestine, the bowel is normally protected from the acidity of gastric contents by the a. inhibition of secretin release. b. release of bicarbonate by the pancreas. c. release of pancreatic digestive enzymes. d. release of gastrin by the duodenal mucosa.

Correct answer: b Rationale: The hormone secretin stimulates the pancreas to secrete fluid with a high concentration of bicarbonate. This alkaline secretion enters the duodenum and neutralizes acid in the chyme.

A patient who is scheduled for surgery with general anesthesia in 1 hour is observed with a moist, but empty water glass in his hand. Which assessment finding may indicate that the patient drank a glass of water? a. Flat abdomen without movement upon inspection b. Tenderness at left upper quadrant upon palpation c. Easily heard, loud gurgling in the right upper quadrant d. High-pitched, hollow sounds in the left upper quadrant

Correct answer: c Rationale: If the patient drank water on an empty stomach, gurgling can be assessed without a stethoscope or assessed with auscultation. High-pitched, hollow sounds are tympanic and indicate an empty cavity. A flat abdomen and tenderness do not indicate that the patient drank a glass of water.

During an examination of the abdomen the nurse should a. position the patient in the supine position with the head of the bed flat and knees straight. b. listen in the epigastrium and all four quadrants for 2 minutes for bowel sounds. c. use the following order of techniques: inspection, palpation, percussion, auscultation. d. describe bowel sounds as absent if no sound is heard in the lower right quadrant after 2 minutes.

Correct answer: b Rationale: The nurse should listen in the epigastrium and all four quadrants for bowel sounds for at least 2 minutes. The patient should be in the supine position and should slightly flex the knees; the head of the bed should be raised slightly. During examination of the abdomen, the nurse auscultates before performing percussion and palpation because the latter procedures may alter the bowel sounds. Bowel sounds cannot be described as absent until no sound is heard for 5 minutes in each quadrant.

A patient is admitted to the hospital with left upper quadrant (LUQ) pain. What may be a possible source of the pain? a. Liver b. Pancreas c. Appendix d. Gallbladder

Correct answer: b Rationale: The pancreas is located in the left upper quadrant, the liver is in the right upper quadrant, the appendix is in the right lower quadrant, and the gallbladder is in the right upper quadrant.

A 62-year-old woman patient is scheduled for a percutaneous transhepatic cholangiography to restore biliary drainage. The nurse discusses the patient's health history and is most concerned if the patient makes which statement? a."I am allergic to bee stings." b. "My tongue swells when I eat shrimp." c. "I have had epigastric pain for 2 months." d. "I have a pacemaker because my heart rate was slow."

Correct answer: b Rationale: The percutaneous transhepatic cholangiography procedure will include the use of radiopaque contrast medium. Patients allergic to shellfish and iodine are also allergic to contrast medium. Having a pacemaker will not affect the patient during this procedure. It would be expected that the patient would have some epigastric pain given the patient's condition.

What is a normal finding on physical examination of the abdomen? a. Auscultation of bruits b. Observation of visible pulsations c. Percussion of liver dullness in the left midclavicular line d. Palpation of the spleen 1 to 2 cm below the left costal margin

Correct answer: b Rationale: The pulsation of the aorta in the epigastric area is a normal finding. Bruits indicate that blood flow is abnormal, the liver is percussed in the right midclavicular line, and a normal spleen cannot be palpated.

Inspection of an older patient's mouth reveals the presence of white, curd-like lesions on the patient's tongue. What is the most likely etiology for this abnormal assessment finding? a. Herpesvirus b. Candida albicans c. Vitamin deficiency d. Irritation from ill-fitting dentures

Correct answer: b Rationale: White, curd-like lesions surrounded by erythematous mucosa are associated with oral candidiasis. Herpesvirus causes benign vesicular lesions in the mouth. Vitamin deficiencies may cause a reddened, ulcerated, swollen tongue. Irritation from ill-fitting dentures will cause friable, edematous, painful, bleeding gingivae.

An 85-year-old woman seen in the primary care provider's office for a well check complains of difficulty swallowing. What common effect of aging should the nurse assess for as a possible cause? a. Anosmia b. Xerostomia c. Hypochlorhydria d. Salivary gland tumor

Correct answer: b Rationale: Xerostomia (decreased saliva production), or dry mouth, affects many older adults and may be associated with difficulty swallowing (dysphagia). Anosmia is loss of sense of smell. Hypochlorhydria, a decrease in stomach acid, does not affect swallowing. Salivary gland tumors are not common.

Which digestive substances are active or activated in the stomach (select all that apply)? a. Bile b. Pepsin c. Gastrin d. Maltase e. Secretin f. Amylase

Correct answer: b, c Rationale: Pepsinogen is changed to pepsin by acidity of the stomach, where it begins to break down proteins. Gastrin stimulates gastric acid secretion and motility and maintains lower esophageal sphincter tone. The stomach also secretes lipase for fat digestion.Bile is secreted by the liver and stored in the gallbladder for emulsifying fats. Maltase is secreted in the small intestine and converts maltose to glucose. Secretin is secreted y the duodenal mucosa and inhibits gastric motility and acid secretion. Amylase is secured in the small intestine and by the pancreas for carbohydrate digestion.

The nurse should recognize that the liver performs which functions (select all that apply) a. Bile storage b. Detoxification c. Protein metabolism d. Steroid metabolism e. Red blood cell (RBC) destruction

Correct answer: b, c, d Rationale: The liver performs multiple major functions that aid in the maintenance of homeostasis. These include metabolism of proteins and steroids as well as detoxification of drugs and metabolic waste products. The Kupffer cells of the liver participate in the breakdown of old RBCs. The liver produces bile, but storage occurs in the gall bladder.

What is a normal finding during physical assessment of the mouth? a. A red, slick appearance of the tongue b. Uvular deviation to the side on saying "Ahh" c. A thin, white coating of the dorsum of the tongue d. Scattered red, smooth areas on the dorsum of the tongue

Correct answer: c Rationale: A thin white coating of the dorsum (top) of the tongue is normal. A red, slick appearance is characteristic of cobalamin deficiency and scattered red, smooth areas on the tongue are known as geographic tongue. The uvula should remain in the midline while the patient is saying "Ahh"

When assessing a patient's abdomen, what would be most appropriate for the nurse to do? a. Palpate the abdomen before auscultation. b. Percuss the abdomen before auscultation. c. Auscultate the abdomen before palpation. d. Perform deep palpation before light palpation.

Correct answer: c Rationale: During examination of the abdomen, auscultation is done before percussion and palpation because these latter procedures may alter the bowel sounds.

The health care team is assessing a male patient for acute pancreatitis after he presented to the emergency department with severe abdominal pain. Which laboratory value is the best diagnostic indicator of acute pancreatitis? a. Gastric pH b. Blood glucose c. Serum amylase d. Serum potassium

Correct answer: c Rationale: Elevated serum amylase levels indicate early pancreatic dysfunction and are used to diagnose acute pancreatitis. Serum lipase levels stay elevated longer than serum amylase in acute pancreatitis. Blood glucose, gastric pH, and potassium levels are not direct indicators of acute pancreatic dysfunction.

When caring for the patient with heart failure, the nurse knows that which gastrointestinal process is most dependent on cardiac output and may affect the patient's nutritional status? a. Ingestion b. Digestion c. Absorption d. Elimination

Correct answer: c Rationale: Substances that interface with the absorptive surfaces of the GI tract (primarily in the small intestine) diffuse across the intestinal membranes into intestinal capillaries and are then carried to other parts of the body for use in energy production. The cardiac output provides the blood flow for this absorption of nutrients to occur.

How will an obstruction at the ampulla of Vater affect the digestion of all nutrients? a. Bile is responsible for emulsification of all nutrients and vitamins. b. Intestinal digestive enzymes are released through the ampulla of Vater. c. Both bile and pancreatic enzymes enter the duodenum at the ampulla of Vater. d. Gastric contents can ply pass to the duodenum when the ampulla of Vater is open.

Correct answer: c Rationale: The ampulla of Vater is the site where the pancreatic duct and common bile duct enter the duodenum and the opening and closing of the ampulla is controlled by the sphincter of Oddi. Because bile from the common bile duct is needed for emulsification of fat to promote digestion and pancreatic enzymes from the pancreas are needed for digestion of all nutrients, a blockage at this point would affect the digestion of all nutrients. Gastric contents pass into the duodenum through the pylorus or pyloric valve.

A patient's serum liver enzyme tests reveal an elevated aspartate aminotransferase (AST). The nurse recognizes what about the elevated AST? a. It eliminates infection as a cause of liver damage. b. It is diagnostic for liver inflammation and damage. c. Tissue damage in organs other than the liver may be identified. d. Nervous system symptoms related to hepatic encephalopathy may be the cause.

Correct answer: c Rationale: The aspartate aminotransferase (AST) level is elevated in liver disease but it is important to note that it is also elevated in damage to the heart and lungs and is not a specific test for liver function. Measurements of most of the transaminases involves nonspecific tests unless isoenzyme fractions are determined. Hepatic encephalopathy is related to elevated ammonia levels.

The nurse is assessing a 50-year-old woman admitted with a possible bowel obstruction. Which assessment finding would be expected in this patient? a. Tympany to abdominal percussion b. Aortic pulsation visible in epigastric region c. High-pitched sounds on abdominal auscultation d. Liver border palpable 1 cm below the right costal margin

Correct answer: c Rationale: The bowel sounds are more high pitched (rushes and tinkling) when the intestines are under tension, as in intestinal obstruction. Bowel sounds may also be diminished or absent with an intestinal obstruction. Normal findings include aortic pulsations on inspection and tympany with percussion, and the liver may be palpable 1 to 2 cm along the right costal margin.

A patient receives atropine, an anticholinergic drug, in preparation for surgery. The nurse expects this drug to affect the GI tract by doing what? a. Increasing gastric emptying b. Relaxing pyloric and ileocecal sphincters c. Decreasing secretions and peristaltic action d. Stimulation the nervous system of the GI tract

Correct answer: c Rationale: The parasympathetic nervous system stimulates activity of the gastrointestinal (GI) tract, increasing motility and secretions and relaxing sphincters to promote movement of contents. A drug that blocks this activity decreases secretions and peristalsis, slows gastric emptying, and contracts sphincters. The enteric nervous system of the GI tract is modulated by sympathetic and parasympathetic influence.

Priority Decision: When caring for a patient who has had most of the stomach surgically removed, what is important for the nurse to teach the patient? a. Extra iron will need to be taken to prevent anemia. b. Avoid foods with lactose to prevent bloating and diarrhea. c. Lifelong supplementation of cobalamin (vitamin B12) will be needed. d. Because of the absence of digestive enzymes, protein malnutrition is likely.

Correct answer: c Rationale: The stomach secretes intrinsic factor, necessary for cobalamin (vitamin B12) absorption in the intestine. When part or all of the stomach is removed, cobalamin must be supplemented for life. The other options will not be a problem.

When the nurse is assessing the health perception-health maintenance pattern as related to GI function, an appropriate question to ask is a. "What is your usual bowel elimination pattern?" b. "What percentage of your income is spent on food?" c. "Have you traveled to a foreign country in the last year?" d. "Do you have diarrhea when you are under a lot of stress?"

Correct answer: c Rationale: When assessing gastrointestinal function in relation to the health perception-health management pattern, the nurse should ask the patient about recent foreign travel with possible exposure to hepatitis, parasitic infestation, or bacterial infection.

Which nursing actions are indicated for a liver biopsy (select all that apply)? a. Observe for white stools b. Monitor for rectal bleeding c. Monitor for internal bleeding d. Position to right side after test e. Ensure bowel preparation was done f. Check coagulation status before test

Correct answer: c, d, f Rationale: Because the liver is a vascular organ, vital signs are monitored to assess for internal bleeding. Prevention of bleeding is the reason for positioning on the right side for at least 2 hours and for splinting the puncture site. Again, because of the vasculature of the liver, coagulation status is checked before the biopsy is done. White stools occur with upper gastrointestinal (UGI) or barium swallow tests. No smoking is to be done after midnight before the study with an UGI. The bowel must be cleared before a lower GI or barium enema, a virtual colonoscopy, or a colonoscopy. Rectal bleeding may occur with a sigmoidoscopy or colonoscopy. A perforation may occur with an esophagogastroduodenoscopy (EGD), ERCP, or peritoneoscopy.

The nurse is performing a focused abdominal assessment of a patient who has been recently admitted. In order to palpate the patient's liver, where should the nurse palpate the patient's abdomen? a. Left lower quadrant b. Left upper quadrant c. Right lower quadrant d. Right upper quadrant

Correct answer: d Rationale: Although the left lobe of the liver is located in the left upper quadrant of the abdomen, the bulk of the liver is located in the right upper quadrant.

The nurse obtains a drug history from a patient with ascites and elevated aspartate and alanine aminotransferase levels. The nurse is most concerned if the patient makes which statement? A. "Occasionally I will use Benadryl for my allergies." B. "Sometimes probiotics can make me feel bloated." C. "I add flaxseed powder to my cereal every morning." D. "I take acetaminophen 4 to 5 times a day for back pain."

D. "I take acetaminophen 4 to 5 times a day for back pain."

After eating, a patient with an inflamed gallbladder experiences pain caused by contraction of the gallbladder. What is the mechanism responsible for this action? a. Production of bile by the liver b. Production of secretin by the duodenum c. Release of gastrin from the stomach antrum d. Production of cholecystokinin by the duodenum

Correct answer: d Rationale: Cholecystokinin is secreted by the duodenal mucosa when fats and amino acids enter the duodenum and stimulate the gallbladder to release bile to emulsify the fats for digestion. The bile is produced by the liver but stored in the gallbladder. Secretin is responsible for stimulating pancreatic bicarbonate secretion and gastrin increases gastric motility and acid secretion.

The nurse is reviewing the home medication list for a 44-year-old man admitted with suspected hepatic failure. Which medication could cause hepatotoxicity? a. Nitroglycerin b. Digoxin (Lanoxin) c. Ciprofloxacin (Cipro) d. Acetaminophen (Tylenol)

Correct answer: d Rationale: Many chemicals and drugs are potentially hepatotoxic (see Table 39-6) and result in significant patient harm unless monitored closely. For example, chronic high doses of acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs) may be hepatotoxic.

A patient is admitted to the hospital with a diagnosis of diarrhea with dehydration. The nurse recognizes that increased peristalsis resulting in diarrhea can be related to a. sympathetic inhibition. b. mixing and propulsion. c. sympathetic stimulation. d. parasympathetic stimulation.

Correct answer: d Rationale: Peristalsis is increased by parasympathetic stimulation.

What is a clinical manifestation of age-related changes in the GI system that the nurse may find in an older patient? a. Gastric hyperacidity b. Intolerance to fatty foods c. Yellowish tinge to the skin d. Reflux of gastric contents into the esophagus

Correct answer: d Rationale: There is decreased tone of the lower esophageal sphincter with again and regurgitation of gastric contents back into the esophagus occurs, causing heartburn and belching. There is a decrease in hydrochloric acid secretion with aging. Jaundice and intolerance to fatty foods are symptoms of liver or gallbladder disease and are not normal age-related findings.

A 68-year-old patient is in the office for a physical. She notes that she no longer has regular bowel movements. Which suggestion by the nurse would be most helpful to the patient? a. Take an additional laxative to stimulate defecation. b. Eat less acidic foods to enable the gastrointestinal system to increase peristalsis. c. Eat less food at each meal to prevent feces from backing up related to slowed peristalsis. d. Attempt defecation after breakfast because gastrocolic reflexes increase colon peristalsis at that time.

Correct answer: d Rationale: When food inters the stomach and duodenum, the gastrocolic and duodenocolic reflexes are initiated and are more active after the first daily meal. Additional laxatives or laxative abuse contribute to constipation in older adults. Decreasing food intake is not recommended, as many older adults have a decreased appetite. Fibre and fluids should be increased.

The ED nurse has inspected, auscultated, and palpated the abdomen with no obvious abnormalities, except pain. When the nurse palpates the abdomen for rebound tenderness, there is severe pain. The nurse should know that this could indicate what problem? a. Hepatic cirrhosis b. Hypersplenomegaly c. Gall bladder distention d. Peritoneal inflammation

Correct answer: d Rationale: When palpating for rebound tenderness, the problem area of the abdomen will produce pain and severe muscle spasm when there is peritoneal inflammation. Hepatic cirrhosis, hypersplenomegaly, and gall bladder distention do not manifest with rebound tenderness.

A normal physical assessment finding of the GI system is/are (select all that apply) a. nonpalpable liver and spleen. b. borborygmi in upper right quadrant. c. tympany on percussion of the abdomen. d. liver edge 2 to 4 cm below the costal margin. e. finding of a firm, nodular edge on the rectal examination.

Correct answers: a, c Rationale: Normal assessment findings for the gastrointestinal system include a nonpalpable liver and spleen and generalized tympany on percussion. Normally, bowel sounds are high pitched and gurgling; loud gurgles indicate hyperperistalsis and are called borborygmi (stomach growling). If the patient has chronic obstructive pulmonary disease, large lungs, or a low-set diaphragm, the liver may be palpated 0.4 to 0.8 inch (1 to 2 cm) below the right costal margin. On palpation, the rectal wall should be soft and smooth and should have no nodules.

Cranial Nerve Function

Cranial Nerve Function: -Ex. When dealing with pupils, what cranial nerve is that?- Oculomotor Nerve or CN III Motor function?- equal gait, equilibrium Sensory Function?- should be able to feel you touch them, touch their forehead and ask if they can feel that & where you are touching them at on their head, etc. Reflexes= triceps reflex, brachioradialis reflex, patellar reflex, achilles tendon reflex, etc. *review in book*

A 42-year-old woman is admitted to the outpatient testing area for an ultrasound of the gallbladder. Which information obtained by the nurse indicates that the ultrasound may need to be rescheduled? a. The patient took a laxative the previous evening. b. The patient had a high-fat meal the previous evening. c. The patient has a permanent gastrostomy tube in place. d. The patient ate a low-fat bagel 4 hours ago for breakfast.

D

The nurse receives the following information about a 51-year-old woman who is scheduled for a colonoscopy. Which information should be communicated to the health care provider before sending the patient for the procedure? a. The patient has a permanent pacemaker to prevent bradycardia. b. The patient is worried about discomfort during the examination. c. The patient has had an allergic reaction to shellfish and iodine in the past. d. The patient refused to drink the ordered polyethylene glycol (GoLYTELY).

D

When caring for a patient with a history of a total gastrectomy, the nurse will monitor for a. constipation. b. dehydration. c. elevated total serum cholesterol. d. cobalamin (vitamin B12) deficiency.

D

Colonoscopy

Directly visualizes entire colon up to ileocecal valve with flexible fiberoptic scope. Patient's position is changed frequently during procedure to assist with advancement of scope to cecum. Used to diagnose or detect inflammatory bowel disease, polyps, tumors, and diverticulosis, and to dilate strictures. Procedure allows for biopsy and removal of polyps without laparotomy. Before Procedure = -Bowel prep PRIOR varies depending on HCP preference/order. For example, patient follows either a low-residue or full-liquid diet the day before until bowel cleaning begins. -Bowel cleansing follows a split-dose regiment. The evening before the procedure the patient drinks 2 L of oral polyethylene glycol (PEG) lavage solution. The second 2 L dose begins 4-6 hours BEFORE procedure. -Explain to patient that a flexible scope will be inserted while patient is in side-lying position and sedation will be given. After Procedure= -Patient may experience abdominal cramps caused by stimulation of peristalsis b/c the bowel is constantly inflated with air during procedure. Observe for rectal bleeding and manifestations of perforation (ex. malaise, abdominal distention, tenesmus). Check Vital Signs. -need to take prep (like Go Lytely prep) need to take about 2 liters and then in evening take another 2 liters before procedure, during procedure side lying and conscious sedated, afterwards nothing airway or traumatic to worry about, but afterwards will put a lot of air in there from tubing to blow up and so pt will after have a lot of gas and cramping and feel uncomfortable for a bit ( lol like Bradley when he had to get colonoscopy and he had lot of gas in car and nothing but a shake helped with his cramping pain)

Common Nursing Diagnoses for Amputation Patients

Disturbed Body Image= - be open ended and honest w/ them (ask them how they are feeling in open ended questions) -Psychological and Social Implications (think will have these when have an amputation!) - Use Therapeutic Communication Impaired Skin Integrity= -Monitor for Skin Breakdown -Monitor for Infection -Use Ace Wraps- take off to do skin assessments as nurse, take off during showers?? Phantom Limb Sensation= -can have pain in extremity they don't have anymore, pain can be anywhere from mild to severe, typically goes away for most people but can be chronic (brain maybe gets confused, etc. not sure why) -S&S= Pain, Cramping, Burning, Heaviness -TX will use Mirror Therapy- decreases use of opioids and baclofen, supposed to put good leg in front of mirror and move it and make it seems like they have two legs and tricks the brain into thinking they have two legs Impaired Physical Mobility= -Crutches -Prosthetics -Elderly will use wheelchair b/c not a lot of upper body strength to use crutches and prosthetics.

What causes Delirium?- Etiology

Drugs, Surgery (b/c of meds given during surgeries, etc.), Sleep deprivation, Stroke, Electrolyte disturbances, Malnutrition

Blood flow into the two main coronary arteries occurs primarily during when?

During Diastole

Safety Alert- Seizures:

During a seizure, you should do the following: - Maintain a patent airway for the patient -Protect the patient's head, turn the patient to the side, and loosen constrictive clothing, ease patient to the floor (if seated) -Do NOT restrain the patient! -Do NOT place any objects in the patient's mouth After seizure, the patient may require repositioning (to open and maintain airway), suctioning, and O2/oxygen.

Seizure Precautions & Management-KNOW!!

During or after a seizure or if worried going to have one....what do you do? PUT THEM ON PRECAUTIONS IF THINK THEY WILL HAVE ONE, set room up for potential seizure SO make sure bed is in lowest position, side rails up, when people have seizures they foam at mouth so check airway b/c could effect breathing (get suction and oxygen ready if needed) Make sure have IV access or a patent IV If just had a seizure, they won't get to have a big meal after words so might put them on NPO for a couple of hours or at appropriate times and THEN they can have something- wait at least an hour before they have meal to make sure they are okay after they have actively had a seizure SO to manage a seizure during a seizure if they are actively having a seizure..... Make sure siderails are up, bed in lowest position, want them a little lower (don't' want them in high-fowlers necessarily but at least back enough to maintain airway- put jaw up, DON"T PUT ANYTHING IN MOUTH IF HAVING A SEIZURE, but maybe want them side-lying to help prevent airway being blocked y the foaming at the mouth, etc.) check ABCs and give Ativan (Lorazepam)- can use Valium (Diazepam) as well, but Ativan is go to med IV Push to stop the seizure When a patient is having a seizure, lips might turn a little blue , and the longer they have the seizure might get bluer, etc. Turn them on side, suction out mouth best you can, make sure nothing in mouth during seizure, keep airway open, monitor ABCs, have oxygen and suctioning ready to use in case and have IV access and patent IV ready to use, make sure bed in lowest position, and give Lorazepam iV push

How do you diagnose Gastritis?

Dx w/ esophagogastroduodenoscopy (EGD)

How does an electrical impulse (action potential) start in the heart? - Pathway of Electrical Conduction of the Heart

Electical Impulse normally starts in the SA Node. Each impulse coming from the SA NODE travels through the interarterial pathways to depolarize the atria, resulting in a contraction. The electrical impulse travels from the atria to the AV NODE through the internodal pathways. The signal then moves through the BUNDLE OF HIS and branch off into the LEFT BUNDLE BRANCH (LBB) & RIGHT BUNDLE BRANCH (RBB). The LBB has two divisions :anterior and posterior. The action potential moves through the walls of both ventricles by means of PURKINJE FIBERS. The ventricular conduction system delivers the impulse within 0.12 seconds. This triggers a synchronized R & L ventricular contraction and ejection of blood into the pulmonary and systemic circulations. Last, repolarization occurs when the contractile fiber cells and the conduction pathway cells regain their resting polarized condition. heart muscle cells regain their resting polarized condition. heart muscle cells have a compensatory mechanism that makes them unresponsive or refractory to restimulation during the action potential. During ventricular contraction, there is an ABSOLUTE REFRACTORY PERIOD during which heart muscle does NOT respond to any stimuli. After this period, heart muscle gradually recovers its excitability and a RELATIVE REFRACTORY PERIOD occurs by early diastole.

Splenomegaly

Enlarged spleen Possible Etiology/Causes= chronic leukemia, hemolytic states, portal hypertension, some infections

Pyloroplasty

Enlargement and repair of pyloric sphincter area

Botulism- Food Borne Illness

Etiology: Improperly canned or preserved food S&S: N/V, abd pain, delirium, coma and breathing difficulties Onset: 12 - 36 hrs Toxin from Clostridium Botulinum; ingested toxin absorbed from the gut and blocks acetylcholine at neuromuscular junction Sources: improperly canned or preserved foods, home-preserved vegetables (most common), preserved fruits and fish, canned commercial products Manifestations= Onset: 12-36 hours S&S= GI- N/V, abdominal pain, constipation, and distention CNS- HA, dizziness, muscular incoordination, weakness, inability to talk or swallow, diplopia, breathing difficulties, paralysis, delirium, coma Tx and Prevention= Treat: Maintenance ventilation, polyvalent antitoxin, guandidine hydrocholroci acid (enhances acetylcholine release) Prevent: correct processing of canned foods, boiling of suspected canned foods for 15 min BEFORE serving *ONSET 12-36 HOURS* RESP & NEURO/CNS effects, caused from canned foods that are damaged or is resistant to heat. Will have trouble breathing b/c neurotoxins LISTEN TO LUNGS, GET O2 SATS, GIve O2 and fluids! NG lavage to get out stomach and antitoxins! Special b/c does have respiratory problems with this one! HAVE breathing and GI problems both Caused by improperly canned or preserved foods Releases a toxin that makes it difficult for people to breathe Not only have N/V and abdominal pain, people get confused and have trouble breathing PRIORITY is ABCs with breathing, Takes long to kick in- from 12-36 horus to kick in an see symptoms, etc. Will give meds to help IF trouble breathing, asses them and make sure HOB is up, put oxygen on them, might get NG tube and need to do gastric lavage to irrigate out toxins to help with breathing and GI issues

Salmonella- Food Borne Illness

Etiology: Improperly cooked meat, eggs S&S: N/V/D, abd pain/cramps, fever, chills Onset: 8 hrs to several days From Salmonella typhimurium (grows in the gut!) Sources: improperly cooked poultry, pork, beef, lamb, and eggs Manifestations= Onset: 8 hours - several days S&S= N/V/D, abdominal cramps/apin, fever and chills Tx & Prevention= Treat: symptomatic, fluid and electrolyte replacement Prevent: correct prep of food! Takes longer than Clostridium, 8 hours or longer up to several days to kick in Usually will be placed on Cipro if have salmonella for a couple of weeks PTs who get this will be Carriers up to 1 year!!!- make sure have good proper hand washing after going to bathroom and before preparing foods or eating, etc. *ONSET 8 HOURS TO SEVERAL DAYS* S&S take longer to appear, 5 Fs (feces, flies, fingers, food, fomaties). Meat or dairy products usually. They can carry this up to ONE YEAR and be contagious Need Stool sample to Dx!!

Clostridial- Food Borne Illness

Etiology: Meat dishes not cooked properly, Improper canned vegetables S&S: N/D, abd pain/cramps Onset: 8 - 24 hrs AKA C.Diff or also Clostridium Perfinigens Might be caused by foods/meats that are not cooked very well thoroughly PROFUSE/DISTINCT SMELLY DIARRHEA and abdominal cramping bad Takes a little longer about 8-24 hours to kick in Sources= meat or poultry dishes cooked at lower temp (stew, pot pie), rewarmed meat dishes, gravies, improperly canned foods Manifestations: Onset- 8-24 hours! S&S= N/D, vomiting (RARE), abdominal cramps, MIDEPIGASTRIC PAIN Tx & Prevention= Treat: symptomatic, fluid replacment Prevent:Correct prep of meat dishes, serving food immediately after cooking or rapid cooling of foods *ONSET 8-24 HOURS* undercooked, RAW meat

Staphylococcal - Food Borne Illness

Etiology: Meat, Salad Dressings, Milk, Skin/Respiratory Tract S&S: N/V/D, abd pain/cramps Onset: 30 mins - 7 hrs Staph- doesn't take very long to kick in AKA a 24-hour stomach bug/GI bug might last a little longer sometimes but for most part staph food born illness lasts 24 hours Might be gotten if food sits out at a picnic or party (like church picnic that leaves it out long, etc.) Sources: meat, bakery products, cream fillings, salad dressings, milk, skin and respiratory tract or food handlers Manifestations: Onset 30 min-7 hrs S&S = N/V/D, abdominal cramping TX & Prevention= Treat: symptomatic, fluid and electrolyte replacement and antiemetics Prevent: immediate refrigeration of ffoods, monitoring of food handlers *ONSET 30 min-7 hours* from leaving food out (picnics and church gatherings), starts QUICK, must dx w/ stool. Tx the vomiting!!

Escherichia Coli (E. Coli)- Food Borne Illness

Etiology: Undercooked Meat, Diary S&S: Bloody Stools, abd cramps, profuse diarrhea Onset: 8 hrs - 1 week -Cause from E. Coli 0157:H7 Sources: contaminated beef, pork, milk, cheese, fish, cookie dough Manifestations= Onset- 8 hours- 1 week! S&S= BLOODY STOOLS, hemolytic uremic syndrome (HUS), abdominal cramping, profuse diarrhea Treatment and Prevention: Treat: Symptomatic, fluid and electrolytes prevent: correct prep of food!! *ONSET 8 HOURS- 1 WEEK** beef, pork, and cookie dough sources; NI- replace electrolytes! They will have BLOODY STOOL!!!

Enteral Nutrition

Feeds Administered through a tube inserted into the patients: Stomach,Duodenum, or Jejunum

NI for Vomiting

Fix Dehydration ( give fluids!) Monitor and Fix Electrolyte Imbalances -Monitor for Aspiration Risk - GIve Medications (Zofran & Phenergan) -Will be HYPOKALEMIC if vomiting -If vomiting getting rid of acid so will be basic= METABOLIC ALKALOSIS -Worry about aspiration risks -Give meds like Zofran and phenergan to help!

Ascites

Fluid in the Abdomen Problem with Cirrhosis of Liver Pts typically will al have ascites at some point with cirrhosis Accumulation of fluid in peritoneal fluid and fluid starts to shift and more keeps going in there (fluid keeps shifting out) -Ascites can also cause the kidneys to vasoconstrict b/c kidneys think not a lot of volume there so will hold on to Na+ and H20 to help out which actually makes the problem worse (AKA BP is low which tells kidneys they should help out but actually makes it worse!) Ascites in the stomach is typically not infected, shouldn't hurt, shouldn't be infected, no pain typically. Fluid should be clear, but if fluid is cloudy then know it probably is infected so that is when problems start occurring So when that fluid is infected = SBP (Spontaneous Bacterial Peritonitis) So typically, ascites shouldn't hurt when press on belly, shouldn't be infected but when it is infected is known as SBP

Upper GI Series (barium swallow)

Fluroscopic x-ray study using contrast medium. Used to diagnose structural abnormalities of esophagus, stomach, and duodenum Nursing responsibility= Before: Explain procedure including the need to drink contrast medium and assume various positions on x-ray table. Keep patient NPO for at least 8 hours before procedure. Tell patient to avoid smoking after midnight before procedure After: Take Measures to prevent contrast medium impaction (fluids, laxatives). Tell patient that stool may be white for up to 72 hours after. -barium swallow, looking at the upper GI (esophagus and stomach), will have them swallow a contrast medium (barium!) and can look for things such as eosphageal strictures, polyps, hiatal hernias, tumors, foreign bodies and peptic ulcers to see what is going on in the upper GI -Rules for this are that they are NPO 8 hours prior to doing procedure, NOT ALLOWED TO SMOKE 8 hours before procedure, and afterwards (after procedure) the barium swallow MAY turn their stool white for about 72 hours after, so want them to drink lots of water/increase fluid in take for a few days

Decreasing Enteral Feeding Miconnections (Table 39-13, p.869)

Following tips can help you decrease your risk of making enteral tube feeding misconnections. 1. Teach visitors, LPN/LVNs, and UAPs to notify RN if an enteral feeding line becomes disconnected and not to reconnect any line. 2. Do NOT modify or adapt IV or feeding devices, because you MAY compromise the safety features incorporated into their design. 3.Do NOT use an IV pump or IV tubing to deliver an enteral feeding. 4.When making a reconnection or connecting any new device or infusion, trace lines back to their origins and ensure connections are secure. 5. When patient arrives on a new unit or setting or during shift handoff, recheck connections and trace all tubes. 6. Route tubes and catheters that have different purposes in unique and standardized directions (ex. route IV lines toward the patient's head and enteral liens toward the feet). 7. package together all parts needed for enteral feeding and reduce the availability of additional adapters and connectors. This will minimize the availability of dissimilar tubes or catheters that could be improperly connected. 8. Label or color-code feeding tubes and connectors. Teach staff about the labeling or color-coding process in the institution's enteral feeding system. 9. When there are several access points and/or several bags hanging, place proximal and distal labels on all tubings. 10. Check the pt's VS after making any connection. 11. Identify and confirm a solution's label, since a three-in-one parenteral nutrition solution can appear similar in an enteral nutrition formulation bag. Label the bags with large, bold statements such as "WARNING! For Enteral Use Only- NOT for IV use." 12. Make all connections under proper lighting conditions!

Tube Feedings Info

For Nasogastric/Orogastric, Nasointestinal, Gastrostomy, and Jejunostomy tubes! Patient Position= up 30-45 degrees AT ALL TIMES for continuous feeds If intermittent feedings HOB should remain elevated at 30-45 degrees for 30-60 minutes after feeding. Residual Volumes= -Done Every 4 hours (for the first 48 hours) -THEN done every 6-8 hours after (in non-critically ill patients) Preventing Aspiration Risk= -Check placement prior to use - Ensure HOB 30-45 degrees - Ensure HOB remains elevated 30-60 minutes for intermittent delivery -Check Residual (might hold feeds if too much!) - Check/Auscultate Lung sounds (if crackles might hold!) - Check Temperature Tube Position/Checking Placement= -Confirm with X-RAY prior to use -Re-Confirm with X-RAY whenever movement is suspected -Mark insertion location and Monitor -Check placement prior to use (medications, feedings, flushing) Flush with Water(to ensure/check Patency) & Flush with Water (Free Water Order)= -Flush with 20-30mL of water for patency (prn, meds, feedings, residual) -Flush every 4 hrs with continual feedings -Chart Input on Patient's I&O Chart= what goes in goes in the chart! Feedings= -Check BS levels (b/c feeds have a lot of sugar in it, so whether diabetic or not will need a bedside BS/ accucheck checked on them!) -Change feedings/tubing every 24 hours (tubes should be changed EVERY morning usually at 8am!) -Room Temperature ( feeds should be served at room temp!) -Assess Bowel Sounds -Daily Weights- to see if getting too much, too little, or just enough of what they need out of the feedings! Skin Care with Feeding Tubes= -Check for Redness and Maceration -Clean with mild soap and water -Protective ointments and barriers -Drainage Sponge Complications Of Tube Feedings= -Vomiting -Aspiration -Diarrhea (common problem w/ tube feeds, will make stool very loose b/c formula) -Dehydration -Accidental tube Removal

Optic Nerve (CN II)

Function- sensory from retina of eyes (vision) Examine each eye independently Visual Fields test: position yourself opposite the patient. Ask him or her to look directly at the bridge of your nose and indicate when an object (finger, pencil tip) presented from the periphery of each of the visual fields is seen. Visual Acuity: ask patient to read a Snellen chart. Record the number on the lowest line the patient can read with 50% accuracy. The patient who wears glasses should wear them during testing unless they are used only for close reading. If a Snellen chart is not available, ask the patient to read newsprint for gross assessment of acuity. Record the distance from patient to newsprint required for accurate reading. Visual field defects may arise from lesions of the optic nerve, optic chiasm, or tracts that extend through the temporal, parietal, or occipital lobes. Visual field changes resulting from brain lesions include hemianopsia (one half of the visual field is affected), quadrantanopsia (one fourth of the visual field is affected), bitemporal hemianopsia (bilateral peripheral vision is affected), or monocular vision. IT may be difficult to test acuity if patient does not read English or is aphasic.

Olfactory Nerve (CN I)

Function- sensory from smell Assessment- ask patient to close one nostril at a time and identify easily recognized odors (ex. coffee). Any asymmetry in sense of smell is important to note. Chronic rhinitis, sinusitis, and heavy smoking may decrease the sense of smell. Disturbance in ability to smell may be associated w/ a tumor involving the olfactory bulb or may be the result of a basilar skull fracture that has damaged the olfactory fibers as they pass through the delicate cribriform plate of the skull.

OA Nursing Interventions/NI

Goal -Managing pain, and Inflammation -Maintaining and Improving Joint Function -Preventing Disability NI Include: -Modify activities to ↓ joint stress -Exercise- low impact exercises!! Good to exercise just be careful what you do -Ice for Inflammation -Heat for Stiffness -Weight Control, Diet -Smoking Cessation -Assistive Device, prn (canes, walker, crutches)- use those devices if needed Don't want you to sit around either, good to exercise but also need rest periods as needed Medications: -acetaminophen (Tylenol) -NSAID -OTC (BenGay, Nutritional Supplements) Surgery- will usually be needed at some point

Metabolic Problems

Hyperglycemia Hypoglycemia Hyperlipidemia Check blood sugars every day and maybe several times a day if needed, b/c parenteral nutrition can cause too much sugar if you keep put that in Hypoglycemia- when you accidentally or just decrease parenteral nutrition too quickly will cause hypoglycemia, drop blood sugar too fast, so need to wean the person off of parenteral nutrition and not take them off of it too quickly for that reason

Addisonian Crisis S&S

Hypotension- severely low BP Hypothermia- severely low body temp Tachycardia- severely high HR Hyponatremia- severely low sodium levels <120 Hyperkalemia- severely HIGH K+ levels Hypoglycemia- very very low BS

Nursing Interventions for Osteomyelitis- Medication Treatments

IV Antibiotic Therapy (for Acute infection ) - 4 to 6 weeks (possibly 6months) - gentamicin (Garamycin) - CVAD (PICC) -Need to check Peak and Trough PO Antibiotics Therapy ( for Chronic infection) - 6-8 weeks - ciprofloxacin (Cipro) IV ABX lasting 6 weeks or loonger (ex. Gentamicin), need a PICC LINE, check peaks and troughs (for acute infection) -Peak- draw 30 minutes AFTER completion of ABX infusion (b/c supposed ot be highest concentration in the body!) -Trough- draw RIGHT BEFORE ADMINISTERING THE ABX infusion (supposed to be the LOWEST concentration in the body!) Will go ahead and draw and then hang it and then get results from there with the trough levels -Sometimes with chronic, will have to be on PO ABX for 6-8 more weeks (ex. Ciprofloxacin) if it gets cleared up but comes back again, etc.

Hypoparathyroidism

Inadequate circulating PTH

Heart Failure (HF)

Inadequate pumping and/or filling of the heart Results in accumulation of fluid in the lungs and other body tissues. Body does not provide sufficient blood to meet the oxygen needs of the tissues S&S Might See w/ HF= Edema in lungs and legs, JVD, poor cardiac output (kidneys and brain not getting perfused)

Infective Endocarditis (IE)

Infection of the Endocardium effecting the inner layer and valve

Cheilitis

Inflammation of lips (usually lower) with fissuring, scaling, crusting Possible Etiology & Significance/Cause= Often Unknown

Cholecystitis

Inflammation of the Gallbladder Risk Factors for Cholecystitis= 4 Fs: Female, Forty, Fat, Fertile S&S/ Clinical Manifestations -Light/Clay/tan colored Stool and/or Dark Amber colored urine (from too much bilirubin!) -Obstructive Jaundice- b/c issue with bile can build up on skin and causes pruritus or itching AKA obstructive jaundice; (bile salts build up on the skin causing itching!) -Abdominal Pain- can be VERY painful (RUQ to midline!)

Peritonitis

Inflammation of the Peritoneum Cause/Etiology: Appendicitis, PUD, Obstruction S&S/Clinical Manifestations: -Abdominal Pain -Rebound Tenderness -Rigidity - Abdomen very HARD AND STIFF inflammation of the peritoneum Caused from if appendix ruptures/appendicitis, or PUD causes it to leak through, or anything that causes fluid to leak into the peritoneal cavity. S&S= abdominal pain, rebound tenderness and rigidity, abdomen distended and decreased bowel sounds NI/Tx= NPO ASAP for surgery and NG tube to suction everything out, rest the bowels, IV fluids, and give ABX

Bell's Palsy- Patho

Inflammation, edema, ischemia and demyelination of the nerve

Functions of the GI System

Ingestion Digestion Absorption Elimination

Overnutrition

Ingestion of more food than required

MS- Clinical Manifestations/S&S

Insidious and Gradual with vague symptoms Early- Eye problems and Muscles fatigue Periods of Remission and Exacerbation might spend years going to doctors and dealing with symptoms until actually diagnosed b/c it is gradual and insidious and vague in symptoms One of the first places MS shows up is in the eyes, might have diplopia or double vision, issues with cardinal gazes being a little weak

Clinical Manifestations/S&S of SLE Lupus

Integumentary: -Alopecia -Butterfly Rash -Discoid erythema -Palmar erythema -Mucosal ulcers Cardiopulmonary: -Endocarditis -Myocarditis -Pleural Effusion -Pneumonitis -Raynaud's Phenomenon Urinary: -Glomerulonephritis -Hematuria -Proteinuria Musculoskeletal: -Arthritis -Myositis -Synovitis Neuro: -Stroke -Seizures -Peripheral neuropathy -Psychosis -Cognitive impairment Hematologic: -Anemia -Leukopenia -Lymphadenopathy -Splenomegaly -Thrombocytopenia Gastrointestinal (GI): -Abdominal pain -Diarrhea -Nausea and vomiting -Dysphagia Reproductive: FM menstrual abnormalities Can have cardiac and renal problems very common Renals= almost 50% of people with lupus have renal/kidney problems , some have milder and some people have so severe that it damages their kidnesy so bad they have to get a kidney transplant Cardiac= small murmur or severe dysrhythmia, etc.

What causes HYPOthyroidism?- Etiology

Iodine deficiency, atrophy of thyroid gland

Types of Heart Failure

Left Sided HF & Right Sided HF

Physiologic Regulatory Mechanisms that Cause Obesity

Leptin & Ghrelin

Nursing Interventions (NI) for HTN

Lifestyle Modifications Lose Weight Diet (DASH)- p. 688 in book, (fruits, veggies, lean meats, etc.) Low Sodium- diet shold be low Na+ ETOH in moderation or none Increase in Physical Activity Avoid Tobacco Decrease Volume of Circulating Blood Reduce SVR Medications: page 690 Diuretics Adrenergic-Inhibiting Agents Direct Vasodilation Vasodilators Calcium Channel Blockers ACE Inhibitors ARBs Goals of NI and BP meds are to Decrease volume of circulating blood and reduce SVR (systemic vascular resistance) ***KNOW MEDS AND WHAT TO EDUCATE OR DO FOR PATIENTS ON THESE MEDS!!! ***

Functions of the Liver

Liver has over 500 functions, but just focusing on a few What can go wrong with the liver?: Fatigue Don't eat a lot b/c don't feel good Develop HTN specifically portal HTN - high BP Develop confusion r/t ammonia Issues with clotting and bruising or not being able to clot, bruise easily and bleed easily Ascites (belly enlarged) Jaundice (yellowing color) Pruritus (intense itching! On the skin Functions: Liver metabolizes ammonia and when it can't break it down it goes to the body and when you have too much built up you can get seizures, coma, and eventually die! BAD! Liver metabolizes albumin and when it can't metabolize the albumin will have swelling typically in the abdomen (ascites) and that will effect specifics with breathing issues, etc.

Anal Abscess

Localized area of induration and pus Causes/Etiology: Infection NI: -I&D (incision & drainage) -Perineal Care -Hygiene localized area of induration and pus from an infection. NI= I&D incison and drainage where they cut open to push out pus, then pack it and get culture. Teach pts how to clean it. COULD BE MRSA! get a culture!

Dementia-Patho= Why does Dementia occur?

Loss of Nerve Cells Shrinkage of Brain

Agnosia

Loss of sensory comprehension

Diagnostic Studies

Lumbar Puncture X-ray CT MRI

Myocardium

MIDDLE layer of MUSCLE

MEDS for GERD

Maalox and Mylanta= OTC, doesn't work well with other medications, causes that med to not be as effective (ex. Cipro- Maalox and Mylanta doesn't work well with cipro at all, makes Cipro less effective!) , don't take other meds at the same time you take this, it is hard on kidneys (assess renal function!) Sodium Bicarbonate- not really prescribed, people take it b/c it is cheap and helps with acid, problem is that it causes fluid retention, tell people with HF NOT TO TAKE THIS MED to take something else to help, elderly will more likely take this than other age groups b/c that is what they did to help treat stomach acid issue back in the day H2 Antagonists Proton Pump Inhibitors (PPIs) = know which med goes with which classification! H2 Antagonists= not as strong as PPIs, will start people off with these and then if that doesn't help then will start pts on PPIs Zantac and Pepcid= same as far as nursing implications, main thing is DO NOT CRUSH THESE MEDS and these meds increases the excretion of Vit B12 so if already Vit B12 deficient then will keep an eye on that if taking these meds Nizatidine= Not as prescribed as much b/c causesm roe issues like dysrthymias and renal problems Reglan= helps decrease acid by getting food to move along (b/c some people with issues with acid the food just stays in there too long so this med helps that), take before you eat, may cause dizziness so be careful getting up from lying or sitting position, no ETOH while on this med b/c may make dizziness worse PPIs= end in -ole like omeprazole, DO NOT CRUSH, increased absorption of Vitamin B12 Bone fractures?? PPIs can pull calcium out of the bone so will sell OTC and it says to only take for 2 weeks, but people will be on this med long term so can be a SE of this med Metoprostol (Cytotec) = People who take NSAIDs all the time like with RA and need to keep pain down everyday, so PPIs will decrease acid secretions and keeps acid down but don't want them to be on it for a long time if it will increase issues with NSAIDs on the stomach

Nervous System Functions

Mobility, Sensation, Cognition

Spinal Accessory Nerve (CN XI)

Motor- flexion and rotation of head; shrugging of shoulders Normal Findings= able to flex and rotate head; able to shrug shoulders Nursing Considerations/How to Test= Inspect and palpate sternocleidomastoid and trapezius muscles for size, contour, tone; ask client to move head side to side against resistance and shrug shoulders against resistance.

Irritable Bowel Syndrome (IBS)

Mucosal Inflammation & Abdominal Intestinal Motility S&S= -Pain -Bloating -Cramping -Diarrhea NI= Teach pts to avoid caffeine, alcohol, eggs, wheat, or any GI stimulant; teach to make sure drink PLENTY OF WATER (2-3 L/day) MEDS= Probiotics (increased GOOD bacteria and provides stress reduction

Nursing Interventions for MG

Myasthenic Crisis ↓ Ach Tensilon test will improve S&S Cholinergic Crisis ↑ Ach Tensilon test will NOT improve S&S Sometimes they take too much of their medication or not enough, so can go into different types of crises for MG Myasthenic Crisis= not enough acetylcholine (didn't take meds) , Tensilon test will help improve S&S Cholinergic Crisis= too much acetylcholine, maybe forgot and then took too much after, Tesilon test won't improve S&S, too much acethylcholine makes muscles rigid and not work Body needs just right amount of Acetylcholine not too much and not too little When patient with MG or Cholinergic crisis, might not be able to breathe, not feeling well, so ....goal is not giving meds first, assess them first and maintain airway, and figure out which crisis they are in and THEN YOU CAN TREAT THEM

Types of Enteral Tubes

Nasogastric Tubes= ex brands- Salem Sump (NG) & Flexiflo- use the NG tube (salem sump tube) , tube ends up in the stomach and doesn't go any further than the stomach Salem sumps are used to DECOMPRESS thE STOMACH, bigger and put down pts when needing to intubate them or if they have a perforation somewhere and don't want anything else going through and will be NPO, typically NG tubes are NOT FOR FEEDINGS!!! Used for decompressing the stomach, NOT for feedings IS SHORT-TERM (don't have in for more than a week or so) Hooked up to wall suction (like low-intermittent wall suctioning, stay away from continuous suctioning!) and making sure keeps stomach empty for a while, large and the shorter it is left in the better for the patient White/Clear looks up to the wall suction- WHITE TO THE WALL Blue will leak gastric entire time b/c broken the seal if you hooked it up to the wall accidentally, but not for hooking up to suction, no no no Flexiflo- brand name for another nasogastric tube, also ends in the stomach, yellow is for feeding, Flexiflo can be used for gastric feedings, not as big, smaller, not as harmful Nasoduodenal/Nasojejunal- examples are Dobhoff and Freka- brand names Dobhoff- ends up in the duodenal or jejunal areas, harder to put in through the duodenal, ask the previous nurse/look at chart to know what type of tube it is, Freka= brand name, goes longer and further, similar to Dobhoff Gastrostomy tube= most common type of gastrostomy tube is the PEG tube PEG tube= inserted into the stomach and has a balloon inflated on the end and have the plug sticking out of the abdomen, kept in for years as long as working right J-tube- jejunostomy tube type, inserted into the jejunum and has ballon inflated on the end to keep in and have a plug sticking out of abdomen, is kept in for years as long as functioning Correctly

Treatment for Gallbladder Issues (Stones or Inflammation)

Non-Surgical: -Nutrition: Avoid Fatty foods -Fluids, IV and or PO -Medications: Pain and Nausea Surgical: Laparoscopic -Cholecystectomy- Watch for Free Air Pain Might go home and might just have follow-up if get it under control Surgery= typically laparoscopic (4 incisions in abdomen and go in and take out the gallbladder), keep eye on the area as nurse and watch for CO2 being pumped up/Air put in during surgery to get those stones out, etc. so during that time after this type of surgery can have this free air pain So intervention for this free air pain is to have early ambulation to promote that absorption of that air/CO2 in the body Diet w/ NO FATTY FOODS IV fluids or PO fluids Medicate for pain and nausea Laparoscopic surgery (fill up with CO2 and it gets trapped!) Cholecystectomy- watch for free air pain! - If get gallbladder ultrasound---> NPO before!

NI for Acute Pancreatitis

Non-Surgical: NPO, IV Fluids, Medications Surgical: ERCP, Cholecystectomy NPO most important thing we need to make sure these patients do b/c if we keep letting them eat that will keep making the enzymes stay blocked in that area and gnaw at the pancreas and make it work, so being NPO will help fix that problem and then will go into surgery and do a cholescystectomy and ERCP to get those stones out, etc. MUST BE NPO b/c amylase and lipase will be worse if eat DON'T EVEN NEED TO SMELL or SEE ANY FOOD! NO GUM or CANDY or anything! Give meds for pain and N/V and give IV fluids. Rest pancreas and remove the gallbladder (cholecystectomy) NGT w/ suction will stop the abdominal pain b/c it takes out the food and decreases enzymes

Computed Tomography (CT) Scan

Noninvasive, radiologic examination allows for exposure at different depths. Can be with or without contrast medium. Using oral and Iv contrast medium accentuates density differences. Detects biliary tract, liver, and pancreatic disorders. Nursing responsibility: Before- explain procedure. Determine sensitivity/allergy to iodine or shellfish or contrast medium if contrast material is used. NO METFORMIN 24 hours before and 48 hrs after, lots of fluids after to flush contrast out (2-3 L/day for several days after!)

Reading an EKG

Normal heartbeat= 1 EKG rhythm, when it is normal it is a normal sinus rhythm so each heartbeat is represented by this EKG strip Normal HR= 60-100 bpm lower than 60 bpm HR = bradycardia higher than 100 bpm HR= is tachycardia Each little rhythm of that heartbeat means something **P wave**= initiated the SA node, electrical impulse came/originated from there, starts the electrical conduction of the heart, means the SA node is working, means **depolarization of the atria** activation of the atria **QRS complex**= initiated by the AV node, **depolarization of the ventricles** activation of the ventricles **T wave**= where the heart is resting, **repolarization of the ventricles** resting of the ventricles Note to self: Won't have any rhythms on the exam, will build on that in advanced topics, just memorize the waves and what they do right now

Classifications for HTN

Normal- <120 SBP and <80 DBP Pre-HTN- considered 120-139 SPB OR 80-89 DPB HTN Stage 1- 140-159 SPB OR 90-99 DPB HTN Stage 2- > or = 160 SPB or > = 100 DPB

Assessment of AAA/ S&S Noted w/ AAA

Normal: Flank, Back and/or Abdominal Pain Expansion S&S: Pain icnreased, Radiation to LE Rupture S&S: Hypotension, Decreased LOC & UOP, Absent or Diminished Pedal Pulses, Dysrhythmias, Diaphoresis One assessment that will find it and one assessment that will monitor a AAA if found to have one Monitoring Assessment= normal w/ AAA will have flank, back, and/or abdominal pain Worsening AAA/getting bigger= pain increasing and radiates to the lower extremities (usually need to get CT again to see how much it has grown and if need to go into surgery to fix it, etc.) If ruptured, S&S would be what?- low BP/hypotension, decreased level of consciousness and decreased UOP, HR will be INCREASED/ up, absent or diminished pedal pulses (DP & PT- may not be able to feel these pulses) , dysrhythmias, diaphoresis (sweating) GOAL as the nurse is to keep the aneurysm form bursting b/c very low chances for survival of patient - usually minutes given to take care of the problem, can't get them there fast enough if it bursts

Echocardiography (Echo)

Not invasive, don't need consent, don't care if you ate or drank, but need patient to be still and if need to turn left then have patient turn left Needs to have a tech that is trained to do that An ultrasound, helps us look at the heart valves and how the blood flows through the heart and valves, More expensive to do Can tell us if heart is enlarged or not, see any valve problems/issues, gets us our ejection fraction Ejection fraction= measure of the percentage of the blood leaving the heart each time it contracts Normal EF= 50-70! If EF is 30 (low) then heart is not pumping, not getting a lot of blood or CO(cardiac output) out We like the Echo b/c it helps us take a better look at the heart, lets us see the EF and ensures heart is working okay/normal

Autonomic Hyperreflexia/Dysreflexia Etiology/Causes

Noxious stimulus such as constipation, distended bladder, pregnancy Patients with an SCI that have autonomic hyperreflexia/Dysreflexia will have an noxious stimulus that causes it such as anything tight (tight clothing) that constricts such as having constipation, distended bladder, or being pregnant might cause the body to sense a tightness or constriction b/c of an exaggerated ANS

Nursing Interventions for ANY Oral Inflammation/Infections

Nutrition: -Soft Bland Diet -Avoid Acidic and Spicy foods Medication: Anti-Fungal= Nystatin (Mycostatin) Mouth Care: -Rinse Mouth with NaHCO3 or Saline -Rinse every 2-3 hours, after meals -No Mouthwashes with alcohol -No lemon glycerin swabs- DON"T USE! -Avoid acidic and spicy foods -Use soft bristled toothbrush

Malnutrition Nursing Assessment

Nutritional Screening - Has to be performed within 24 hours of hospital admission EVERYBODY GETS A Nutritional Screening within 24 hours of admission, floor has 24 hours to get the screening done -Looks at to screen them and looks at weight and height and if the person is at risk for malnutrition or need nutritional support, etc. -Key to know= just know they have 24 hours within admission to the hospital (not just admitted to the specific floor, etc.) but admitted to the hospital to get the nutritional screening done!

Venous Insufficiency

Occurs when veins are stretched and valves are damaged Varicose Veins: Dilated, Tortuous veins can be related to weight gain, etc. Things such as varicose veins, valve problem with varicose veins

Clinical Manifestations/S&S of AAA

Often Asymptomatic Pulsatile Mass in the peri-umbilical area (around the belly button) left of midline Bruit noted over the aneurysm Pain can mimic abdominal and/or back pain A lot of times people don't' even know they have one b/c it has to get big enough to cause a problem Can sometimes feel a mass, will hear a bruit (which is not a normal thing unless we are dealing with a fistula or graft) , and patient will or can have pain that mimics regular abdominal and/or back pain (the bigger it gets the more they will have pain!) Triple A= if feeling a mass, hear a bruit, and patient having pain in that area or in back= THINK AAA!

Left or Right Sided HF ????

Orthopnea, Paroxysmal Nocturnal Dyspnea (PND)- LEFT SIDED HF Weight Gain- RIGHT SIDED HF Oliguria- LEFT SIDED HF Shoes fit Tight/Edema- RIGHT SIDED HF Syncope or Near Syncope Episodes/ Dizziness- LEFT SIDED HF Fatigue/Weakness- LEFT SIDED HF Chest Pain- LEFT SIDED HF

Ostomy Surgeries

Ostomy- surgical procedure where they pull intestines out and can see that stoma peaking out Stoma- are they pull out that is pink and red and moist- don't want it to be black or dusty gray b/c could mean necrosis, stoma will be in ileostomy area or colostomy area! Types: Ileostomy Colostomy Colostomy Care Ileostomy Care Stoma should be: -Pink and moist -Will begin to function in 2-4 days -Will be liquid at first, then change depending on stoma location -Keep skin around stoma clean without redness Ileostomy and colostomy care is the same at first -Stoma should be pink and moist, if getting dry and gray and dusky or black then problem -Will begin to function in 2-4 days and will have liquid stools at first regardless of where the ostomy is located, make sure to keep skin around stoma very clean and without any redness to prevent skin breakdown or infection or other issues -Stoma care, skin care, check effluent going into ostomy bag

Lab Values for if on Anticoagulant Therapy

PT/INR (for coumadin/warfarin) Therapeutic level 2-3 x's normal level aPTT (for heparin) Therapeutic level 1.5-2 x's normal level PT normal levels= 11-16 seconds INR normal levels= 0.75-1.25 seconds PTT normal levels= 20-30 seconds aPTT normal levels= 25-35 seconds Titration of Heparin= means you can fix/change the dose according to level results; check aPTT levels, and if at normal/therapeutic levels then won't need to titrate but if lower or higher then might need to titrate according to hospital protocol/levels Higher than therapeutic/normal= think THINNER blood LOWER than therapeutic/normal= think THICKER blood

Patients with Osteomyelitis will have pain and muscle spasms..... How do you treat those issues??

Pain- patients will have a lot of pain, bone pain bad, so give opioids and nsaids( watch for bleeding), opioids (watch for breathing/resp. depression and BP) Muscle Spasms- give baclofen to treat muscle spasms, watch for respirations, can get a little dizzy with taking baclofen

Peripheral Arterial Disease (PAD)

Partial/Total arterial occlusion Thickening of Artery walls: Results in progressive narrowing of the arteries including upper and lower extremities. People can have partial or total arterial occlusions, can be anywhere in body but a lot of times in lower extremities/legs The arterial walls get thicker and plaque builds up (arteriosclerosis and atherosclerosis occurs) and narrowing

Diagnostic Studies for Malnutrition to look at

Pre-Albumin (PAB) ↓ C-Reactive Protein (CRP) ↑ ( shows inflammation only, general, not specific) Electrolyte levels (Hyperkalemia) RBC, H&H ↓ Liver Enzymes ↑ Cholesterol Level ↓ Erythrocyte Sedimentation Rate(ESR) ↑ (inflammation marker, not specific!)

Liver Biopsy cont'd- Closed Liver Biopsy

Percutaneous procedure uses needle inserted between the 6th and 7th or 8th & 9th ICS on the right side to obtain specimen of hepatic tissue. Often done with ultrasound or CT guidance. Before Procedure= -Check pt's coagulation status (PTT, clotting, or bleeding time). -Ensure pt's blood is typed and crossmatched. -Take baseline VS -Explain to pt the need ot hold breath after expiration when needle is inserted. -Ensure informed consent has been signed. After Procedure= -Check Vs to detect internal bleeding q15min x 2, q30min x4, q1hr x4. -Keep pt lying on right side for minimum of 2 hours to splint puncture site. -Keep pt in bed in flat position for 12-14 hours after that. -Assess pt for any complications such as bile peritonitis, shock, pneumothorax

Undernutrition

Poor nourishment due to inadequate diet or disease

Post-Op Care of Hip Surgery:

Positioning to prevent dislocation Do not cross legs or feet Do not bend and touch toes Do not flex hip > 90 degrees Do not sit on low seats, toilets Do not twist or reach behind DO NOT CROSS LEGS OR FEET AND DO NOT BEND/FLEX HIP MORE THAN 90 DEGREES!!- don't try to bend over and tie shoes or pick stuff up, NO LOW SEATS OR TOILET SEATS, and DO NOT TWIST OR REACH FROM BEHIND YOU! HAVE TO START TEACHING THESE THIGNS TO YOUR PATIENT AS SOON AS THEY WAKE UP FROM SURGERY TO ENSURE GOOD OUTCOMES Trapeze Bar- helps pull themselves into position in bed and transfer if need to Abduction Wedge- special pillow that goes between leg to help them remember not to cross legs, etc. if don't have it can put aregular pillow between leg PT (first postoperative day) Walker and Crutches= typically use walkers for hips Xray- always get an xray after surgery/postop or xray if fell again, and might get another one down the road to see how it is healing, etc. Monitor for Dislocation of Hip- teach proper positioning with hip, what not allowed to do and monitor proper position and ambulation.

Nursing Interventions for Oral Surgery

Pre-op: Accepting Diagnosis & therapeutic- use therapeutic communication b/c pts can be very upset and this can be a very emotional issue for them Post-op: ABCs- airway #1 priority! Make sure sitting them up, use ice, get VS, definitely let doc know but need to do something before call doc! NPO, will have NG Tubes, monitor and intervene/tx/ prophylactic measures against N/V Communication DVT Prevention Incision Care Patient will usually be in ICU- AIRWAY< HOB elevated, check for swelling in neck, vent, monitor for N/V and GIVE MEDS FOR IT b/c DON"T WANT HTEM THROWING UP) Give lovenox Get them up to ambulate Use TED hose and SCDs as needed, etc. Discharging Home: -Palpate lymph nodes for Metastasis -Xerostomia (Dry mouth!) -Before go home, teach them how to check for if cancer has spread, so teach them how to palpate their lymph nodes (teach them if it is hard and movable that could mean cancer again, etc.) Teach about good stomatitis care and treat dry mouth(xerostomia) so no alcoholic mouthwashes, good mouth/oral care frequently, no spicy foods, no ETOH -Teach S&S of metastasis- pain,fever, lymph nodes hardening/change, dry mouth/xerostomia NI for stomatitis

Etiology/Causes of Malnutrition

Primary (Anorexia Nervosa)= Starvation-Related Malnutrition Secondary (Cancer)= Chronic Disease-Related Malnutrition Acute Disease/Injury Related Malnutrition (Trauma) =Acute Disease or Injury such as trauma or burns

Liver Cancer

Primary Tumors or Metastatic Cancer Causes/Etiology/Risk Factors: Hepatitis B & C S&S/Clinical Manifestations: RUQ Pain, Jaundice, Bleeding, Ascites Nursing Interventions: End of Life (use supportive care measures!) -Is a Metastatic form of cancer or primary tumors -Metastatic form= where end of life care comes into play- so supportive care measures take with these folks! -Causes= Hx of cirrhosis, primary tumor or metastasized cancer -risk factors are if had Hep B or C -S&S= RUQ pain, jaundice, bleeding ascites NI= EOL care, not a candidate for transplant if cancer has metastasized!

Mitral Valve Prolapse

Prolapse= leaflets prolapse back INTO the atria, is opening and closing right just going back into the atria (not a lot of problems), kind of a precursor for regurgitation Leaflets get stretched and flow back into the atrium. A lot of people don't know they have it without getting an echocardiogram -Valves are stretched and do not close properly & Collapse backward into the left atrium -Blood can backflow from left ventricle to left atrium to lungs -Causes Mitral Regurgitation S&S: Sometimes no S&S, Murmur, heart palpitations

Hernias

Protrusion of the viscus through a weakened area in the wall of the cavity in which it is normally contained Risk Factors: -Obesity, Pregnancy -Heavy Lifting -Genetics -Men > Women -Abdominal wall gets weak and protrudes out -Men get more than women and genetics affects If you'll get it -Pregnant women risk for it or being obese/overweight, doing lots of heavy lifting can cause this! S&S and Types -Lump, Protrusion -Inguinal -Femoral -Umbilical -Ventral or Incisional Will see a lump or feel it and protrusion Locations= inguinal (down low), femoral, umbilical (belly button), ventral or incisional (risk for heavy lifting) Reducible- GOOD, OKAY Reduced manually or when patient lies supine Irreducible or Incarcerated- BAD! CONCERN! Not reducible Intestinal flow and blood supply are obstructed and hernia is Strangulated Hernias are not a big deal unless they get STRANGULATED!! If getting strangulated then worry about not oxygen to that area and will cause necrosis to that area and die off and will have to have bowel ostomy rest of life, issues, etc. Reducable= if push it and it moves then good, just chart and your good If NOT reducable= assess and push on it and it is not moving so worry about strangulation of hernia, and only definitive way to know if strangulated is to run a CT scan, if not moving and not reducible, see if have any pain and auscultate bowel sounds and get VS and then call the doctor to let them know your concern for strangulation, etc.

What causes an SCI?- Etiology

Usually result of trauma Most common causes are MVC, falls, violence, sports injuries Types of Injuries= Primary or Secondary

Health Risks of Obesity

Psychosocial- Depression, low self esteem, risk of suicide, discrimination, social isolation Endocrine/Metabolic- Type 2 DM, Metabolic Syndrome, PCOS Respiratory- obesity hypoventilation syndrome, sleep apnea, asthma, pulmonary HTN, exercise intolerance Reproductive- For Women: menstrual irregularities, infertility, gestational diabetes; For Men: Hypogonadism, gynecomastia, sexual dysfunction Musculoskeletal- osteoarthritis, impaired mobility & flexibility, gout, lumbar disk disease, chronic low back pain Cardiovascular- Hyperlipidemia, sudden cardiac death, right sided HF, LV hypertrophy, CAD, DVT, A. Fib, HTN, cardiomyopathy, venous stasis, varicose veins Gastrointestinal- nonalcoholic steatohepatitits (NASH), gallstones, GERD Genitourinary- kidney cancer, CKD, stress incontinence Cancer issues- esophagus, pancreas, thyroid, colorectal and gallbladder; endometrial, breast and ovarian cancers for women -80% of Type 2 Diabetics are obese! -Obesity can CAUSE MULTI-SYSTEM RISKS!

Traction

Pulling force to an injured extremity Apply a pulling force on a fractured extremity to attain realignment Uses a pulling force to the injured extremity Two types of Traction -Skin: Short Term (48-72 hours)- used b4 surgery -Skeletal: Long Term (> 72 hours)= used AFTER surgery

Ghrelin

Regulates appetite through inhibition of leptin -Gut hormone -when in a fasting state, it increases **Appetite Regulator**

Mitral Valve Regurgitation

Regurgitation= cannot close fully, too relaxed open Blood that gets through can get back from the atria to the ventricles fully but won't close so then will leak back up into the atria Blood moving backwards Valve does not close fully Blood backflows from left ventricle to left atrial Blood should be moving forward instead it moves backward Blood can back up from left ventricle to left atrium to lungs S&S: Fatigue, Dyspnea, Decrease CO, Thready, Pulse, Murmur, Cool and Clammy Skin, pulmonary congestion

Esophagogastrostomy

Removal of esophagus and anastomosis of remaining portion to stomach

Treatment/Nursing Interventions of RF and RHD

Remove Infection: Antibiotics Prevent Cardiac Complications Pain management, Fever control Steroids NSAIDs Antibiotics Education- good oral care, don't be around sick people/ crowded areas

Autonomic Hyperreflexia/Dysreflexia- Nursing Interventions

Remove Noxious Stimulus -Remove tight clothes -I&O cath and/or remove fecal impaction -Fix distended bladder= cath them! -Constipation= if impacted fix that, give them some meds to get the system unclogged -No tight clothes

S&S of Right Sided HF

Right, think SYSTEMI!! - peripheral edema, JVD, nocturnal polyuria, ascites, (pee a lot at night), abdominal distention (SYSTEMIC), increased thirst r/t to Sodium retention, Nausea (r/t to fluid retention in systemic/body- liver gets engorged and makes them nauseated) **REVIEW OVER= Table 35-4, page 771!

Nursing Interventions w/ AAA

Risk Factor Modification- no smoking, etc. Monitoring- BP monitoring (want it low no more than 110 SBP, will be given parameters, b/c high BP can cause aneurysm to burst/pop!) Drug Therapy Surgery 5.5cm of > sooner if symptomatic Graft Patency - Check Peripheral Perfusion Status *Check Pulses & 6 Ps 2 Types of Surgery for AAA= -Open Aneurysm Repair (OAR) -Endovascular Graft Procedure (EVAR) **NI = get them to surgery STAT Two types of procedures Open Aneurysm repair= will go in and cut open that aneurysm and put a graft in there to stabilize the vessel and close it back up/sew it back up, so vessels more stable and won't rupture Endovascular Graft Procedure (EVAR)= insert an actual graft inside the vessel and bifurcates and stabilizes that weak,floppy vessel that has gotten to big and enlarged, etc.

MG- Drug Therapy

Rivastigmine (Exelon)- a cholinesterase inhibitor, helps acetylcholine get absorbed, helps to get more acetylcholine in the body and make it normal since low in body so will help increase muscle strength, only lasts for 24 hours and then starts wearing off so make sure you give on time so it's always in body, better to give early than late , make sure take on an empty stomach (1 hour before meals or 3 hours after a meal) Pednisone ( a corticosteroid) - immunosuppressant to help with exacerbations

Clinical Manifestations/S&S of Raynaud's Disease

Vasospasm induced color changes - from White to Blue to Red Pain Episode can last for minutes to a few hours - color changes from White to blue then opens back up to Red (b/c change from vasodilation to vasoconstriction- spasming! Opens closes opens closes, etc.) -Will have pain and the episodes can last for minutes or to hours depending on how bad it is

Parkinson's Disease- Drug Therapy

Ropinirole (Requip)- stimulates the receptors to intake the dopamine, can cause orthostatic hypotension so sit up slowly on side of bed for a minute, take BPs lying, sitting, standing, watch for falls, can take with or without food (doesn't matter what you do) just DON"T CRUSH MED, admin on time because if don't then it could wear off and they could have trouble swallowing it, etc. ***early on when someone has Parkinson's can control them with meds, but as time goes on they start having receptor and conduction problems so meds are only good for a certain length of time (for a few years) then you got to put them on something else stronger, etc. So that's where Requip comes in, so it is most effective during first 3-5 years of use (Sinemet) Carbidopa-Levodopa- two meds in one, Carbidopa allows the dopamine get past that BBB and then once it gets past it turns it on and gets dopamine going Orthostatic dizziness, admin w/ or w/out food but don't crush and make sure it gets taken on time

Normal Heart Sounds

S1 S2 S1 and S2 are normal heart sounds you hear = lub dub S2- closes up the SL valves S1= closes up the AV valves, you hear those valves being closed

Pathway of Electrical Conduction of the Heart

SA Node --> AV Node--> Bundle of His---> LBB & RBB---> Purkinje Fibers

Reading an EKG- TO KNOW!!

ST Elevation= STEMI= NOT GOOD, DO SOMETHING ABOUT THAT! ST depression= NON-STEMI ST segment is elevated, then that means a STEMI (ST elevated MI) ST segment is depressed/low then that means a NON-STEMI (non ST elevation MI) means ST segment is NOT elevated Either that ST segment is too high (elevation) or too low (depression) HIGH AND LOW= MI, HIGH IS WORSE! so STEMI is worse than NON-STEMI STEMI= tombstone MI BOTH ARE BAD, need to do something about it STEMI= ST Segment elevated HEART ATTACK NON STEMI= ST segment depressed HEART ATTACK If you need to give patient/ or have patient an EKG (hooked up on 10 leads) Need to know how to hook patient up to leads NO CONSENT NEEDED FOR EKG, doesn't matter if ate or drank or not, DOES MATTER FOR PATIENT TO REMAIN STILL (book world, kind of hard in real world to keep patient still but need to to be able to read the EKG correctly) When to get an EKG ordered for patient?- chest pain/angina, syncopal episode (passed out, etc.), and if SOB w/ chest pain or hurting a little in chest need an EKG too, and if patient has indigestion Patient = don't need to get consent signed doesn't matter if ate or drank, but DO need to be still (if wiggling moving around harder to read the EKG strip) If patient just passed out or having indigestion, having a hard time catching breath and hurts when trying to catch breath= NEED EKG If get one and didn't need one after all, can delete it and undo it in chart to not get charged for it. Syncope= if passed out b/c heart had dysrthymia, want to know why they passaedo ut, might be heart dysrhythmia Have 10 minutes between time patient tells you they are having a heart issue to get an EKG ordered and done, need to call down for it to be ordered and bring the machine up to hook them up to it, etc. Needs to be done within 10 minutes to check for that ** KNOW THE EKG rules !!** White on Right, Snow over Grass, Smoke over Fire, and Brown/Dirt in the mIddle ( how you put on a lead!)

Special Diets

Vegetarians Vegans Lacto-Ovo Vegetarians

SCI Clinical Manifestations- Peripheral Vascular Problems

Venous thromboembolism (VTE) is a common problem accompanying SCI during the first 3 months. Detecting a deep venous thrombosis (DVT) may be difficult in a person w/ a SCI b/c usual signs and symptoms, such as pain and tenderness, are not present. Pulmonary embolism is a leading cause of death in patients w/ SCI. -Thrombo-Embolisms, especially in first 3 months -Detecting DVT (hard to detect in SCI pts.) Nursing Interventions/Considerations: -Risk for clots in SCI -Know how to detect a DVT- leg will be red, swollen, might be painful/hurt, etc.

SCI Clinical Manifestations- Integument & Thermoregulation/Temperature

Skin & Muscle -Skin Breakdown -Muscle Atrophy -Take on Temperature of Environment Integument= The risk for skin breakdown over bony prominences in areas of decreased or absent sensation is a major consequence of immobility r/t SCI. Pressure ulcers can occur QUICKLY and lead to major infection and sepsis. Thermoregulation/Temperature: Poikilothermism=adjustment of the body temp to room temp. It occurs in SCI b/c of interruption of the SNS prevents peripheral temp sensations from reaching the hypothalamus. Spinal cord disruption is also marked by decreased ability to sweat or shiver below the level of injury, which affects the ability to regulate body temperature. The degree of poikilothermism depends on the level of injury. High cervical injuries are associated with a greater loss of ability to regulate temp than are thoracic or lumbar injuries.

Urine and Stool Colors in The Liver

Stool will be clay colored if Liver Function is Decreased= Normally bilirubin is filtered in the liver, then kidneys filter out the rest and they really aren't made to do that, so many times the reason people with liver problems have clay colored stool b/c kidneys trying to filter out bilirubin that it wasn't made to do. Normal Urine VS. Bilirubinuria: -Kidneys filter out the dead RBC, leaving the reddish or Dark Amber urine color. -Urine color= now that kidneys are trying to breakdown the bilirubin when liver isn't working right, the kidneys will filter out things it isn't used to so urine will be changed from a normal yellowish-clear color to an AMBER RED color (bilirubinuria)

Diagnostic Studies- Transesophageal Echocardiography (TEE)

TEE= step up from an echo A little more complicated echo Sticks a tube down the throat and looks at the heart, better view of the heart Has to knock patient out/sedate them in order to take a look at the heart TEEs= runs about a $1,000, endo team performs this, RN only takes care of the patient NO eating or drink 8 hours prior to procedure, b/c it is invasive need to sign a consent, patient will be sedated Conscious sedation done, tube stuck down throat and look around the heart, similar what you can see on echo you will find but just more specifc b/c you can see a little closer After TEE= expect the nurse to make sure the patient doesn't eat or drink until gag reflex returns (airway monitoring after the procedure) Before procedure= need consent, no eating or drinking 8 hours prior, etc. After= worry about gag reflex b/c sedated the throat, etc. Before you give them anything to eat or drink make sure gag reflex is intact, then one it is intact then you progress slowly by giving small sips of liquid and start with ice chips so don't throw up or make them nausea, then progress to sprite and jello, then to more solid foods If going home after procedure, patient MUST NOT DRIVE for 24 hours after procedure, sedation still in system at this point so worry about safety on that

Anal FIssure

Tear/Skin Ulcer Etiology/Causes: Trauma, Straining to have BM NI: -Medications -Nutrition (Diet, increase fluid and fiber!) -Perineal Care

AAID Nursing Interventions/Considerations

Way to remember what to chart if they have AAID Pain= not getting enough circulation or oxygenation Pallor= pale Pulselessness= no pulse Paresthesia= tingling, numbness Paralysis= not having feeling in extremity Poikliothermic= coolness to the touch of extremities Assess the 6 Ps!!! 1.pain 2.Pallor 3.Pulselessness 4.Paresthesia 5.Paralysis 6. Poikilothermia

Diagnostic Studies- Cardiac Markers

Troponin T (cTnT) < 0.1 ng/mL Troponin I (cTnI) <0.5 ng/mL Creatine Kinase-MB < 4%-6% Myoglobin < 91mcg/dL **KNOW THESE CARDIAC MARKERS/LAB VALUES THAT CORRELATE WITH CHEST PAIN** When you draw blood and send it to lab you run a cardiac marker test Troponin, CK-MB, and Myoglobin= Cardiac Markers IF you think patient is having an MI/heart attack, run the cardiac marker labs and get an EKG and you can determine if they are having an MI or not Troponin I= MORE SPECIFIC TO CARDIAC, measures more specific cardiac tissue, less than or equal to 0.5 then normal, if 0.6 or above then having an MI Troponin T= not as specific to cardiac , cardiac and other tissue both If Troponin I is high, then that patient is having an MI along with if pale, diaphoretic, etc. CK= enzyme specifc to cells in a lot of palces like brain, myocardium and muscles CK-MB= more specific to the heart muscles! Myoglobin= found in cardiac & skeletal muscle Might have to keep patient in order to wait and see those levels show up Troponin might take 5 hours to show up on lab values to see if high or not or if having an Mi or not IF those are low, then keep those in mind and then rerun levels after a little while longer Myoglobin= ms. Windmiller's patient was having lots of falls over and over, but myoglobin was high, doesn't necessarily mean having an MI or anything but other thigns going on sometimes Troponin High= having an MI KNOW VALUES Troponin = gold standard to see if patient is having an MI or not

Hypertensive Crisis

Two Categories= Emergency and Urgency Happens when a patient doesn't take meds like they should or eat a proper diet like they should or take care of themselves and let their HTN get out of hand can go into this. Nursing Considerations= Need to not only look at BP number but look at if have any organ issues

Oral Cancer

Types: Pre-Cancerous Cancerous Causes/Etiology: Sun, Tobacco, ETOH

Diabetes Insipidus (DI)

Underproduction/Undersecretion of ADH **NOT ENOUGH ADH**

Obesity Assessment

Use these assessment tools to determine or classify the body weight....... BMI- weight divided by height Waist circumference- just measure the waist, greater than 40 for men and greater than 35 for women is overweight and increases your risk Waist-to-Hip Ratio= 0.8 or less is optimal waist to hip ratio! Body shape- apple gained more in abdominal/more risk for cardiovascular problems, pear shaped gained more in the hip and thighs *NOTE TO SELF= Will have Exam Question on how to get the patient's BMI by having their height and weight*

CVAD Care (Care of PICC Line)

X-ray- get RIGHT AFTER insertion of PICC to clear to use it to make sure it is in right spot 10mL Syringe- only thing you can hook up to it! Flushing- flush 10 mL normal and then 20 mL if you draw blood. If flushing like normal protocol flush 10 mL of NS, if draw blood then will flush with 20 mL

Melena

abnormal, black, tarry stool containing digested blood Possible etiology/causes= cancer, bleeding in upper GI tract from ulcers, varices

Myasthenia Gravis (MG)

an autoimmune disease of the neuromuscular junction characterized by the fluctuating weakness of certain skeletal muscle groups. Patho= Body attacks the **acetylcholine receptors** (ACh Rs), decrease in Ach receptor sites MG worse than MS Think problem with acetylcholine in MG Acetylcholine is the neurotransmitter that activates muscles so things aren't moving right with MG

Pancreas

an endocrine gland located right next to gallbladder Labs that tell you something is going wrong with pancreas= Amylase and Lipase So if Amylase and Lipase are ELEVATED= something going on with the pancreas Norm Amylase= 30-122 Norm Lipase= 31-186 * if these are INCREASE then something is wrong with pancrease Amylase: 30-122 u/L (Normal ranges for Amylase) Lipase: 31-186 u/L (normal ranges for Lipase) Hypocalcemia -glucagon causes Ca+ to go down Hyperglycemia- can cause BS to go up! HYPOcalcemia= Ca+ LOW= sign of pancreas issues! S&S of Hypocalcemia= tetany, numbness, tingling Hyperglycemia= HIGH BS, sign of pancreas issues! S&S of hyperglycemia= HOT AND DRY SUGAR HIGH, 3 Ps (polyuria, polydipsia, polyphagia)

Vomiting

at risk for aspiration remove the cause Give Meds- antiemetics Zofran and Phenergan Projectile vomiting is from a spinal cord injury or kids! Emesis types= coffee ground, coagulated blood, or GI bleed

Meds for IBD

atropine (Lomotil)- SE= Dizziness, stops diarrhea, causes dizziness corticosteroids (Prednisone)-Immunosuppressant, can cause BS to go up, just taken during exacerbations; avoid crowds and being around people who are sick, wash hands, etc. (decreased GI inflammation, take during exacerbation in AM w/ food!) adalimumab (Humira)-SQ every 1-2weeks, no regards to food/can take with or w/out food, rotate sites, Immunosuppressant, taken all the time to decrease/minimize attacks or inflammation! Avoid crowds, being around people being sick, wash hands, etc. VERY EXPENSIVE DRUG!! ( SubQ, rotate sites, painful injection, take it all the time, it decreased inflammatoin and is a IMMUNOSUPPRESSANT!)

Preictal & Postictal

before & after a seizure

Eructation

belching Possible etiology/cause= gallbladder disease

Herpes Simplex

benign vesicular lesion Possible Etiology & Significance/Cause= Herpesvirus

Tension-Type Headache

bilateral, band-like pressure at base of skull Constant, squeezing tightness cycles for many years Duration= 30 min.-7 days! Not related to particular time Associated S&S= palpable neck and shoulder muscle tension, stiff neck, tenderness

tan stool means what??

biliary obstruction!!!

Central Cyanosis

bluish or purplish tinge in central areas such as tongue, conjunctivae, inner surface of lips Cause: inadequate O2 saturation of arterial blood b/c of pulmonary or cardiac disorders (congenital defects, etc.)

Peripheral Cyanosis

bluish or purplish tinge in extremities or in nose and ears. Cause: reduced blood flow b/c of HF, vasoconstriction, or cold environment

Left-Sided HF

can have Systolic and Diastolic Systolic Left sided HF= means the blood can NOT move forward (b/c maybe the heart doesn't contract forcefully enough, maybe not enough volume, etc.), blood doesn't eject enough to more the blood out to the body Diastolic Left HF= the heart doesn't hold enough blood to push out, ventricle is not relaxing enough to fill up appropriately so not enough blood to eject out to the body Both Systolic or Diastolic have a decreased CO - either way it is a problem! Left Sided HF= The Reason for Right Sided HF

Constipation

can't go regularly! lol! NI: Nutrition Exercise Discourage the use of Laxatives and Enemas increase fiber in diet, increase fluids and EXERCISE!! HIGH FIBER, LOTS OF WATER, exercise helps move things along Laxatives and Enemas= NO NO NO DO NOT use daily or often b/c body will get used to it and cause rebound constipation or issues, maybe good to use every once in a while like if after having a baby or for serious constipation issues or for impactions, etc.

Veins

carry deoxygenated blood TOWARDS the heart (except pulmonary vein)

Arteries

carry oxygenated blood AWAY from the heart (except pulmonary artery)

Ascites cont'd

cause of it is low albumin levels and fluid shifts causing a decreased BP and FVO. Pts have edema and hypervolemia Respiratory support is needed b/c they cannot breathe good, and F& E imbalanced, need a LOW Na+ diet. Give lasix and albumin Do a paracentesis (tap) Kidneys think they AREN'T being perfused so they vasoconstrict and increase fluid and reabsorb more Na+ and can worsen!

Cardiovascular system problems with NEURO include what?

confusion, changes in LOC, memory loss

Interatrial septum

creates the right and left atrium

Interventricular septum

creates the right and left ventricle

Cardiovascular System Problems with SKIN & NAILS include what?

cyanotic, cool pale, cap refill greater than 3, clubbing (takes time to develop so cyanosis is more priority b/c haven't had that as long as clubbing, etc.), peripheral cyanosis (skin, periphery, will be noticed first) central cyanosis (kidneys, heart, etc... if mouth and tongue inside gets blue then that is MORE serious issues, really worried in mouth is blue )

Pericardial Friction Rub

high-pitched, scratchy sound heard during S1 and S3, at the apex. Heard best with patient sitting and leaning forward and while holding breath at the end of expiration Cause: pericarditis Sounds Like rubbing pieces of your hair together -If hear it then worry about peridcarditis - It is heard over the pericardium -Pericardium is INFLAMED and makes that rubbing sound (like rubbing pieces of hair together, bristling sound)

Unprovoked Seizures

didn't do anything to cause it Caused by: primary-genetics or idiopathic, or secondary- tumor caused it or trauma caused it

Dysphagia

difficulty swallowing, sensation of food sticking in esophagus Possible Etiology/Cause= Esophageal problems, cancer of esophagus

Jugular Venous Distention (JVD)

distended neck (jugular) veins with patient sitting at 30-45 degree angle. Cause: elevated right atrial pressure or Right Sided HF -Note to self: Not quizzed over how to set them up to assess for JVD, but what it means if they have it. JVD on the right= right side of heart being backed up into the body= think Right sided HF If JVD then think Right ventricle/valve is NOT working right and too much blood getting backed up into the BODY JVD= RIGHT SIDE

Laparoscopic Fundoplication (Nissen)

easier post-op/ recovery Post-Op= check for bleeding, keep pt on soft diet and NO carbonated beverages for 1 month after, check for infection, causes referred pain d/t CO2 being trapped NO heavy lifting! Go in there and try to restore it and take it back to what it should be= nissen Postop care for this= put pt on soft diet for about a week, check for bleeding issues, NO carbonation beverages like cokes or even sprites, NO heavy lifting, monitor the incision sites (usually will be covered with dermabond- tell pts to not pick at it and it will come off in a week or two, want it to stay in place for at least a week, it will dissolve on its own though!)

Nodular Liver

enlarged, hard liver w/ irregular edge or surface Possible Etiology/Causes= cirrhosis, carcinoma

Hepatomegaly

enlargement of liver, liver edge >1-2 cm below costal margin Possible Etiology/Causes= metastatic carcinoma, hepatitis, venous congestion

Foodborne Illnesses

food poisoning w/ S&S of GI symptoms of N/V/D and abdominal pain and cramping. Best to prevent by..... -HAND WASHING -CORRECT FOOD PREP and REFRIGERATION AND CLEANLINESS -DON"T MIX FOODS and check the TEMP OF FOODS. Rare steak and egges over easy are a risk -PUT FOODS BACK IN FRIDGE & DON"T LET THEM SIT OUT LONG! Hand Washing- wash your hands before meal prep! Correct food preparation and cooking Refrigeration Canned foods= is a botulism risk Fluid and Electrolyte Replacement Medications- proper storage and usage, etc.

Contractility

force of contraction of the heart Can be increased by Epi and Norepi released by the SNS. Increasing contractility raises the Stroke Volume (SV) by increasing ventricular emptying.

Hyperflexion SCI

head moves WAY forward and then breaks- ruptured anterior ligament, compressed ligament (like bump chin against table, etc.)

Flexion SCI

head moves forward and at an accelerated rate, breaks and then problems occur- forward dislocation, damage to spinal cord, ruptured posterior ligaments (like in MVC accident)

Compartment Syndrome

if after surgery want to assess the Six Ps b/c sometimes there can be swelling in fascia (compartments in there) and decrease circulation, area can get inflamed and gets so big and swollen and inflamed that it causes that area to not get perfused (not enough blood flow) if you DON"T do something about it then they WILL LOSE THAT LIMB, only a few hours before you notice it and they lose that limb, call doc immediately to get it fixed!! 4 words to remember compartment syndrome= increased pain from procedure (shouldn't get worse after surgery should get better), increased swelling (gets REALLY SWOLLEN AND TIGHT FEELING to the patient), tenderness (hurts to touch), and tension (whenever get increased pain, swelling tenderness that the tension is so built up that it makes them feel like they are gonna burst!) If you see that and patient say they have too much pain or pressure and it's gotten worse, then CALL THE DOCTOR!! TX= If have compartment syndrome then go in for a procedure called a fasciotomy Fasciotomy= where they go in and cut open the area and relieve that pressure to the extremity

Risk Factors for getting PAD

increased Age, Diabetics, Women > Men, Tobacco use, Hyperlipidemia, HTN, BMI > 30, CVD elderly, diabetics, women more than men, smoking makes vessels smaller!, high cholesterol (too much fat or lipids floating around) , HTN, BMI over 30, and those w/ Cardiovascular disease

Herniorrhpahy

repair of hernia

Stomatitis

inflammation of the mouth Causes/Etiology: trauma, pathogens, irritants (tobacco, ETOH); renal, liver, and hematological diseases; side effects of chemo & radiation S&S/Manifestations= excessive salivation, halitosis (BAD BREATH), and sore mouth Tx= -ABX, mouthwashes, warm compresses; -preventative measures such as chewing gum, sucking on hard candy (lemon drops, etc.) -Adequate fluid intake -Removal or tx of cause -Oral hygiene w/ soothing solutions, topical meds -intake of soft, bland diet

Enoxaparin (Lovenox) = low molecular weight heparin (LMWH)

inhibits fibrin formation Side Effects= BLEEDING!! Nursing Implications= -Administer Subcut ONLY -ONLY given in Abdomen -No aspiration of needle -NO massage after giving med! -Dosage us 1 mg/kg (dose is weight based!)

Heparin Sodium (Heparin)- aka unfractionated heparin (UFH)

inhibits fibrin formation Side Effects= BLEEDING!! nosebleeds, dark tarry stool, petechiae noted Nursing Implications= - Administer IV or Subcut ( can be given IV or subcut!) -Antidote for overdose= Protamine! If have too much Heparin give Protamine -Monitor for HIT (Heparin Induced Thrombocytopenia!- platelets too low) -Monitor aPTT & PTT levels - aPTT more specific to being on heparin therapy and PTT is not specific to being on heparin therapy

Vagotomy

resection of branch of vagus nerve

Hyperresonance

loud, tinkling sounds Possible etiology/cause= intestinal obstruction

Nursing Interventions for CHF Patient

major problem is respiratory in CHF because of backup issues, etc. TO help them breathe better= give 02, O2 sats= 85%, can put htem on oxygen, if don't get this result then need to check O2 sats and then put them on O2 IF laying flat then need to elevate HOB (raise HOB up) Meds= give Lasix to pull fluid off, diuretics Foley cath because need ot keep track of how much peeing out after diuretic/Lasix, get I&Os and weights If feeling fatigued and weak and chest hurts then do a EKG and a chest x-ray (look at lungs and heart- PMI might be a little longer, displaced a bit like in 6th ICS instead of normal 5th ICS) If getting up not staying in bed whole time, need TED hose and SCDs Heart not pumping right so have a CO problem, things we can fix that= give CHF meds (like digoxin-helps heart contract better), do an echocardiogram (gold standard to dx CHF to look at the ejection fraction to see how heart is pumping/if pumping right, etc.) , do labs, IV DON"T GIVE BOLUS FLUIDS B?C MIGHT SUFFOCATE B/C ALREADY TOO MUCH FLUID IN LUNGS w/ crackles, etc.

Duodenal PUD

more common RUQ pain 90 min-3 hours AFTER eating Food empties from stomach to duodenal too quickly. Makes pt WAKE UP AT NIGHT Melena occurs with this! Duodenal ulcers= further down past the stomach When the body constantly empties gastric contents will get dumped into the duodenum and ulcers can develop easily there pain located to the RIGHT of the epigastric area Pain starts 90 min-3 hours AFTER eating, takes a little longer for pain to start after eating b/c further down in the GI Also pain will wake pt up in middle of night b/c when lying flat easy to take that acid to that area

Clinical Manifestations/S&S of RF & RHD

murmur, monoarthritis/polyarthritis (infection gets in the synovial joints, synovial fluids in the joints)

Absent Bowel Sounds

no bowel sounds heard on auscultation Possible Etiology/causes= peritonitis, paralytic ileus, obstruction

Tenesmus

painful and ineffective straining at stool. Sense of incomplete evacuation (incomplete BM!) Possible Etiology/Cause= Inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), diarrhea secondary to GI infection (ex. food poisoning)

Glossectomy

partial or total removal of the tongue

Glossitis

reddened, ulcerated, swollen tongue Possible Etiology & Significance/ Cause= Exposure to streptococci, irritation, injury, vitamin B deficiencies, anemia

Secondary SCI Injury

refers to the ongoing, progressive damage that occurs after the primary injury. Possible causes include= vascular changes d/t hemorrhage, vasospasm, thrombosis, loss of autoregulation, breakdown of BBB, and infiltration of inflammatory cells that cause ischemia, edema, and cellular necrosis. - Ex.Hemorrhage= A gunshot wound that didn't get perfused to the area shot at and causes Ischemia

Gastroesophageal Reflux Disease (GERD)

reflux from GI into the esophagus Result of Reflux (backward flow) of GI contents into the Esophagus via Cardiac Sphincter Causes: fatty foods, caffeine, tobacco/smoking, alcohol, chocolate, NG tube placed (which causes a relaxed LES), obesity (increases intra-abdominal pressure!) S&S: -*Pyrosis*= heartburn,more bloating discomforting feeling -*Dyspepsia*= indigestion,burning feeling when it comes back up

Gastrectomy

removal of stomach

Co-mandible procedure

removes jaw and lymph nodes

Skull and Spine X-rays

simple x-ray of skull and spinal column is done to detect fractures, bone erosion, calcifications, abnormal vascularity. Before: explain procedure is noninvasive

mouth ulcer, plaque on lips or in mouth

sore or lesion Possible etiology/significance/cause= carcinoma, viral infections

Types of Food Borne Illnesses

staphylococcal, clostridial , salmonella, and botulism

Status Epilepticus (SE)

state of continuous seizure activity or a condition in which siezures recur in rapid succession without return to consciousness between seizures. Defined as any seizure lasting longer than 5 minutes. The longer a seizure lasts, the less likely it is to stop without drug therapy. A NEUROLOGIC EMERGENCY that can occur with any type of seizure. when seizure last longer than about 5 minutes, goes on and on for a long time.

Tonic

stiffness of muscles

Hemorrhoids

swollen or distended veins in the anorectal region. S&S: - constipation -straining -portal HTN -pregnancy -Teach to prevent! NI: - warm sitz bath -pericare -lidocaine spray -stool softener during times when worse only (dn't want dependent on laxatives or stool softeners) Tx: rubber band, cryotherapy (burn or freeze off), try to manage with DIET or surgery hemorrhoidectomy

Chordae Tendinae

thin strands of fibrous tissue that the cusps of the Mitral and Triscupid Valves are connected to. -Anchored in papillary muscles of the ventricles. This support system prevents the eversion of the leaflets into the atria during ventricular contraction.

Cardiovascular Disease: Non-Modifiable Risk Factors

things such as being male gender, your age, etc., Type 1 DM is non-modifiable but can branch into modifiable if you don't do things you can help with

Colorectal Cancer con'td....

third most common, more common in men, S&S- diet, smoking, genetics, age over 50, hematochezia (bright red blood in stool), CHANGE in stool consistency and shape. Do a colonoscopy, and fecal occult blood test (FOBT), FOBT positive means blood in stool and at risk for cancer, could also mean hemorrhoids ate meat, or took NSAIDs, not for sure have cancer. Don't eat meat or take NSAIDs 48 hours before. Colonscopy is hte only way to dx for sure. Decrease fat, increase fiber, decrease refined fat (chips, white pasta/bread)

Bruits (arterial bruits)

turbulent flow sound in peripheral artery Cause: Arterial obstruction or aneurysm heard over vessels -vessels, specifically arteries -Sounds the same as a murmur, but heard over vessels not the heart -Makes blowing, whooshing, rushing sound -Turbulent blood flow -Abnormal if heard over a carotid artery and hear that turbulent blood flow (hear a blowing, rushing, whooshing sound) If 50% or greater blocked, then can hear the bruit If heard over a fistula or graft= NORMAL, good to hear a bruit over that, the ONLY reason hearing a bruit would be good to hear it

Heart Murmurs

turbulent sounds occuring between normal heart sounds. Characterized by loudness, pitch, shape, quality, duration, timing Cause: heart valve disorder, abnormal blood flow patterns -reflects turbulent blood flow in the heart valves - if you hear one then that means the blood flow is turbulent (hard to get into the valves, valves narrow, too much calcium) Described as/makes a blowing, whooshing sound Heard over the heart (NOT vessels) If you hear a murmur as a student= just chart you heard a murmur, but with more experience you will chart whether it is systolic or diastolic (some are not as loud and some are very loud, won't be quizzed over this!) Heard over the Aortic, Pulmonic, Tricuspid, and Mitral valves

Absence of Liver Dullness

tympany on percussion Possible Etiology/Causes= Air from viscus (ex. perforated ulcer)

Fissure in anus/rectum

ulceration in anal canal Possible Etiology/Cause= straining, irritation

Aura

unusual sensation, happens preitcal

Gastric/Stomach Cancer

usally begins in the glands of the stomach mucosa Risk Factors/Causes: Chronic gastritis untreated GERD H. Pylori PICKLED AND NITRATE FOODS (hotdogs, bacon, pickles, etc.) can change into the cancer cells Educate on the causes and prevent! These pts might end up needing surgery!!! Surgery will reroute to the jejunum and body gets confused, Post op issue= dumping syndrome Gastrectomy pts Postop will have same issues with dumping syndrome Might have dumping issues b/c will have a gastric bypass to take out part of stomach and restructure them if have surgery for gastric/stomach cancers Dumping Syndrome= Early- happens in 30 minutes AFTER EATING, will feel sick and need to LIE DOWN Late- happens 90 min-3 hrs AFTER EATING, will have HYPERGLYCEMIA. Teach how to minimize occurence by DECREASING CARBS, DECREASE FLUIDS, INCREASE PROTEIN, and have 6 SMALL FREQUENT MEALS and NO FLUIDS W/MEMALS

Gero Changes r/t Cardiovascular (cont'd...)

ventricles get enlarged, preload/stretch more than it should, valves will degenerate, aorta thickens and stiffens, not too worried about it unless it interferes with life, so....Ventricles can tend to get a little too large with age! Valves start not working as well or close as well so blood can't get through as well or gets backed up- valves degenerate Electrical activity not as sensitive, number of cells decrease so that is why many elderly folks develop A. Fib, so that SA Node and AV node doesn't work as well Baroreceptors and Chemoreceptors are a little "lazy" don't work as well, elderly might fall a lot at night when trying to get up to go to bathroom so worry about FALLS at night, etc. (teach them to sit on side of bed and take time to get up before getting up to go to bathroom, etc. b/c causes orthostatic hypotension issues in elderly) Aorta starts getting thicker and more stiff with age

Hematemesis

vomiting of blood Possible Etiology/Cause= esophageal varices, bleeding peptic ulcer

Paroxysmal Nocturnal Dyspnea (PND)

wakes up in middle of night and can't catch breath, feeling like they are suffocating

Borborygmi

waves of loud, gurgling sounds in abdomen Possible etiology/causes= hyperactive bowel as result of eating

Spontaneous Bacterial Peritonitis (SBP)

when fluid in the peritoneal area is infected when someone has ascites from liver cirrhosis, etc. S&S=fever, abdominal tenderness, rebound tenderness, fluid gets harder, blumberg's sign -impaired albumin causes ascites that can get infected d/t bacteria and decreased albumin, if have ascites it SHOULD NOT hurt and the fluid should be clear. If they have SBP they will have abdominal pain, fever, and CLOUDY tap/fluid!!

Fasciotomy

where they go in and cut open the area and relieve that pressure to the extremity

Labs to Review for Liver Cirrhosis

↑ ALT: 10-40units/L and AST: 10-30units/L ↓ Albumin: 3.5-5.0g/dL ↑ Ammonia:15-45mg/dL ↑ Total Bilirubin: 0.2-1.2 mg/dL ↑ PT: 11-16 seconds ↑ INR: 0.75-1.25 seconds ↑ PTT: 20-30 seconds EVERYTHING GOES UP EXCEPT ALBUMIN GOES DOWN!!! ALT and AST= Liver Labs specific to the liver= LFTs Ammonia goes up b/c liver processes and filters it and b/ cirrhosis can't filter that so it just hangs out in body and builds up PTT and INR & aPPT and PTT will go up as well because liver cannot clot as well when have cirrhosis **With liver issues ALL these labs will INCREASE except for albumin will DECREASE (b/c liver produces albumin!) The liver will typically rid of ammonia and bilirubin so with liver problems those will INCREASE!**