Care of Adults Test Review 2
pathogenesis, etiology and risk factors for inflammatory bowel disorder - ulcerative colitis
-inflammation and ulcerations occur in mucosal layer of bowel walls -colon is inflamed so large electrolytes and water cannot be absorbed
medical treatment of PKD
-manage HRN -watch for h/a, vision -manage pain -monitor daily weight -prevent constipation - increase fiber intake -stool softeners -vasopressors
medical treatment of acute versus chronic glomerulonephritis
-manage infection - antibiotics -fluid restriction -I&Os
drug therapy for fractures (PPT)
-methotrexate -hydroxychloriquine -biologic response modifiers -glucocorticoids -methimazole, PTU -iodine preparations -radioactive iodine -calcium gluconate
apply knowledge of A&P to assess patients with impaired kidney function from acute kidney injury or chronic kidney disease
-monitor GFR and urine output
medical treatment of hydronephrosis/hydroureter
-nephrostomy -
plan care coordination and transition management for patients with arthritis
-regular neurovascular assessment -no cast with knee -start with ice chips bc N/V
white blood cells - levels & measures?
4500 -11000 mL -amount of WBC in blood that fight off infection (increase WBC = sick)
blood urea nitrogen (BUN) - levels & measures?
6-24 mg/dL or 2.1-8.5 mmol/L -how well your kidneys are functioning
functions of the kidney...
cleanse blood of toxins and transform waste into urine
broad spectrum antibiotics to treat?
peritonitis
ABGs - interpretation of uncompensated resp. acidosis and metabolic acidosis -ROME in respiratory module
resp. acidosis = increase PCO2, increase HCO3 and decreased pH metabolic acidosis = HCO3 decrease, PCO2 decrease, and pH decrease **metabolic levels move same as pH **respiratory level move opposite of pH
class, action, side effects and nursing considerations - Antidiarrheals
slows down the movement of the gut -decrease number of bowel movements
Medications that are harmful to kidneys?
-NSAIDs -antibiotics -diuretics -PPIs -laxatives
identify community resources for families and patients recovering from inflammatory bowel and gallbladder disorders
-dietitian
a middle aged female client with diabetes mellitus is being treated for the third episode of acute pyelonephritis in the past year and asks what can be done to help prevent these infections. which is the nurse's best response?
"drink more water and empty your bladder every 203 hours during the day"
which information would the nurse include in response to a client questioning a protein restricted dietary change required for acute kidney injury?
"this diet supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys"
What is the GFR rate when a client is diagnosed with ESKD?
*end stage kidney disease -less than 15 mL/min = dialysis
Which instruction does the nurse include when teaching safety measures to a patient with rheumatoid arthritis who is receiving methotrexate therapy? -QSEN alert drug safety Ch.46
-risk for infection caused by impaired or decreased drug induced immunity -avoid crowds and people who are ill -avoid alcoholic beverages to prevent liver toxicity -observe and report other side effects including mouth sores and acute dyspnea from pneumonitis -lymphoma and pneumonitis have been associated in those who have RA and taking MTX -folic acid (B vitamin) given to those taking MTX to decrease drug's side effects
complications of inflammatory bowel disorders - Diverticulosis and Diverticulitis
-risk for peritonitis with diverticular disease especially diverticulitis -
Which finding would the nurse expect when assessing a child with acute poststreptococcal glomerulonephritis?
-skin lesions -fluid overload -changes in elimination patterns
complications of inflammatory bowel disorders - Appendicitis
-slow to develop = abscess -fast to develop = peritonitis -gangrene or sepsis can occur in 24-36 hrs
diagnostic examinations for gallbladder
-small bowel capsule endoscopy (small intestine) -colonoscopy (entire large bowel) -CT colonography or virtual colonoscopy -sigmoidoscopy (endoscopic exam of rectum and sigmoid colon) -ultrasonography
know what nurses need to do to prevent AKI and CKD
-timely intervention to remove cause of AKI may prevent CKD or renal transplant -avoid hypotension -reduce exposure to nephrotic agents (contrast media)
diagnostic examinations for appendix
-ultrasound may show enlarged appendix and then CT sed to diagnose presence of stone
a client with acute kidney injury is moved into the diuretic phase after 1 week of therapy. During this phase, which clinical indicators would the nurse assess?
-urine output -acid/base electrolyte -waste product (BUN & Creatinine) -mental status changes -ECG changes
know how to provide emergency care for a fracture
1. ABCs 2. Circulation, mobility and sensation check and neuro-circ checks 3. elevate extremity if able 4. monitor vitals, oxygenation and CMS 5. monitor for compartment syndrome 6. DON'T remove shoes but remove jewrely if able
what is the normal GFR?
125 mL/min -according to age, sex, body size
sodium - levels & measures?
135-145 mEq/L -sodium in blood (electrolyte) if low can indicate dehydration, CHF, liver disease or nephrotic syndrome - if high = diuretic use or addison disease (kidney/adrenal gland)
platelets - levels & measures?
150,000-450,000 mL -number of platelets in blood that help blood clot (low platelets = cancer or infection)
potassium - levels & measures?
3.6-5.2 mmol/L -potassium (electrolyte in blood) -high potassium = kidney disease
which area of the bowel is affected in UC versus Crohn's and why it is important to know?
UC = rectum and towards cecum and terminal ileum Crohn's = any place in the GI tract *able to differentiate and treat differently = importance
What does it mean when protein is found in the urine?
abnormality due to infection or stress
apply knowledge of pathophysiology of fracture to identify common assessment finding including
actual or risk for impaired sensory perception, tissue integrity and perfusion...
Pathophysiology & S/S of acute versus chronic glomerulonephritis
acute = immunity response from kidney tissues in filters of kidneys - resolves in 10 days chronic = infection from hypertension or blood blood flow (proteinuria, hematuria, fatigue, and edema)
understand how pyelonephritis, acute versus chronic glomerulonephritis, nephrotic syndrome, PKD, hydronephrosis/hydroureter, renal carcinoma and kidney trauma can lead to AKI or CKD to be able to educate clients on how to decrease the risk of kidney damage or kidney disease
all can lead to decrease function of kidney mostly due to blockage or inflammation the length of time and reversibility determines if acute or chronic
which statement below describes the pathogenesis of hyperthyroidism (graves disease)?
autoimmune disease occurs after thyroid inflammation, producing immunoglobulins (TSIs) that attach to TSH receptors, enlarging the thyroid gland, thus overproducing thyroid hormone
Pathophysiology & S/S of kidney trauma
bruising to shattering/tearing -diffuse abdominal pain -monitor urine output -hematuria -assess flanks
understand and manage injuries such as carpal tunnel and rotator cuff injury
carpal tunnel - repetitive stress injury where the synovial joint swells (NSAIDs, steroids and braces - surgery to release pressure) rotator cuff - shoulder musculotendonis - stabilizes head of humerus is abduction from the arm (unable to abduct) - tx = NSAIDs, steroids, PT and rest - full thickness tear = surgery
a nurse is teaching a client about dietary methods to manage exacerbations (flare-ups) of diverticulitis. What does the nurse advise the client?
consume a low fiber diet while your diveticulitis is active, when inflammation resolved gradually resume a high fiber diet
Does GFR increase or decrease with age?
decrease with age
complications of inflammatory bowel disorders - Peritonitis
delayed treatment caused blood vessels to dilate and blood shunts to the area of infection = hyperemia -extracellular fluid compartment into fluid cavity = decreased circulation = hypovolemic shock -bacteria into bloodstream = sepsis
metronidazole in conjunction with trimethoprim/sulfamethoxazole (TMZ) or ciprofloxacin usually prescribed for...
diverticulitis
have understanding regarding the high risk of a client with Crohn's for malnutrition
due to inability to absorb nutrient via small intestine
Pathophysiology & S/S PKD
fluid filled cysts in the nephrons -HTN -kidney stones -mitral valve prolapse -chronic diverticua -cyst bleeding
a client has the following labs: elevated T3 and elevated T4, low TSH and thyrotropin receptor antibodies (TRAbs) are present. What disease process is indicated by these labs?
graves disease
What occurs in the lab levels such as T3, T4 and TSH in hypothyroidism versus hyperthyroidism? Which of these increase or decrease in hypothyroidism versus hyperthyroidism?
hypothyroidism = T3, T4 decrease while TSH increase hyperthyroidism = T3 and T4 increase while TSH decreases
Pathophysiology & S/S of renal carcinoma
impaired cellular regulation -anemia -erythrocytosis -edema -hypercalcimia
What is the main complication with Crohn's disease?
malabsorption -GI bleed is associated more with UC and peritonitis with diverticulitis -C. diff is related to excess antibiotic admin or passed from person to person
A 50 yr old pt with 2 day history of low grade fever ranging from 99.6-100.5 - nausea, vomiting and severe diarrhea is admitted to the med surg unit with diagnosis of Crohn's disease. Which primary HCP request does the nurse implement first?
start an IV solution of 5% dextrose in 0.45 normal saline at 125 mL/hr -fluid therapy is the focus of tx for pt with fluid loss, blood draws would be next and the lab may be drawing as the nurse is starting the IV. APAP may be administered rectally
class, action, side effects and nursing considerations - Immunosuppressants
suppress or reduce the strength of the body's immune system
common drugs that impair thyroid hormone production
-levothyroxine -synthroid
understand acute complications that occur with fractures
infections -bone infection/osteomyelitis -venus thromboembolism -DVT -PE -Fat embolisms syndrome - released from yellow bone marrow into blood within 12-48 hrs after injury - clog the small blood vessels that supply vial organs -acute compartment syndrome - excess pressure constricts the structure within a compartment and reduces circulation to muscles and nerves - fascia limited stretch = swell
prioritize evidence based care for patients with impaired urinary elimination from either acute kidney injury or chronic renal failure
*causes of AKI -pre-renal = source inside the kidney creating conditions that reduce systemic circulation thus reducing renal blood flow and perfusion causing decrease GFR (reversible) -intra-renal = damage inside the kidney directly affecting the renal cortex (often caused by adverse drug reactions -post-renal
plan transition management and care coordination for the patient who have an ileostomy - health teaching
*temporary and have stool out of rectum once heals -monitor stoma for blueish or pale look = compromised blood supply - skin care too keep enzymes and bile salts = irritate skin -avoid food that cause gas -avoid corn and nuts
when administering (TPN) the nurse should...
*total parenteral nutrition -never infuse in peripheral circulation because it can damage blood cells and the endothelial lining of the veins and decrease perfusion
collaborate with the interprofessional team to manage quality care for patients with impaired mobility caused by musculoskeletal trauma including fractures...
- PT -OT
describe the psychosocial impact for patients experiencing arthritis
-ADLs -OT -positive self image -minimize loss of joint function -acceptable pain management
which laboratory test provides evidence consistent with a client having renal impairment?
-BUN -Creatinine
use clinical judgment to analyze information from laboratory data and assessment findings in the care of clients with kidney disorders
-BUN -creatinine -urinalysis
use clinical judgement to analyze information for laboratory data and assessment findings in the care of patients with acute kidney injury and chronic kidney disease
-BUN and creatinine increase -changes in GFR decreasing -rising blood osmolarity
signs and symptoms of hypothyroidism
-T3 and T4 and free T4 decrease -TSH high -not hungry but gains weight - obesity -constipation -decreased energy - overall muscle movement is slow, muscle weakness and fatigue and increased time sleeping -intolerance to cold -pale dry skin -thick brittle nails -dry coarse brittle hair -debreased hair growth - in eyebrows common -poor wound healing -heavy menses but difficulty getting pregnant -men impotence decreased libido -may or may not produce a goiter
perforation of different area of the GI system
-UC = common bc of toxic megacolon -Crohn's = common bc of inflammation involves entire bowel wall -peritonitis = bacteria enters from perforation of the appendix, diverticulitis, peptic ulcer disease or external penetrating wound or gangrenous gallbladder or bowel segment or bowel obstruction or ascending infection through the genital tract
what are the three cardinal signs of peritonitis?
-abdominal pain -tenderness -distension
teach the client about common drugs and other management strategies used for kidney disorders including pain control
-acetaminophem
medical treatment of pyelonephritis
-acetaminophen and antibiotics -catheter care and replacement
Pathophysiology & S/S of pyelonphritis
-acute bacteria infection in kidney and renal pelvis -reflux of urine -recurrent UTI, diabetes, stone disease? -inspect flanks -tissue inflammation -CVA tenderness, enlargement, asymmetry, edema or redness? -confusion in older adults
How do you collect 24 - hour urine?
-add all losses from the previous 24 hrs plus 500-600 mL for insensible losses (evaporative water loss through breathing and through the skin - solute free) = volume needed to be replace loss during restriction
the nurse is reviewing the history, physical exam, and diagnostic test results of a client with colitis. Which clinical finding would the nurse associate with this disorder? (SATA)
-anemia -diarrhea -abdominal cramps -ulceration of the colon causing blood loss and anemia - the inflammation usually increased peristalsis causing diarrhea and abdominal cramps
class, action, side effects and nursing considerations - Aminosalicylates 5 - ASA
-anti-inflammatory -block cyclooxygenase and lipoxygenase reducing production prostaglandins
Which assessment data would be a major concern for the nurse when caring for a patient admitted to the emergency department with pelvic fractures?
-arterial bleeding -abdominal rigidity -blood in stool or urine
Which action would the nurse take when a client has returned from surgery with a nephrostomy tube?
-asses the amount of drainage in the collection bag
chronic complications of fractures
-avascular necrosis -delayed union -long to heal -non-union - failure of bone to heal -mal-union - heal in abnormal position -complex regional pain syndrome (CRPS) - unrelating pain (ANS changes) - desensitize area by rubbing different textured objects
teach clients how to deacrease the risk of acute kidney injury or chronic kidney injury
-complication associated with shock, heart conditions and surgery -continued exposure to antibiotics or NSAIDs -untreated hypertension or diabetes mellitus -age -obesity -urinary track abnormalities (UTIs)
Which S/S is constant with diagnosis of appendicitis? (SATA)
-cramping pain in the epigastric or periumbilical area -RLQ pain -anorexia -N/V -rebound tenderness
medical treatment of renal carcinoma
-curable if local -target therapies to block new growth -surgical removal (watch blood loss_ -pain manament
prioritize evidence based nursing interventions for patient's with inflammatory bowel and gallbladder disorders to promote nutrition, maintain fluid and electrolyte balance, manage pain, infection and inflammation
-diet -monitor stools -keep skin clean and drt -monitor H&H -monitor VS -surgury
Safe administration of IV fluid and electrolytes -pg.254 QSEN drug chart
-dilution no greater than 1 mEq of potassium to 10 mL of solution for IV administration -maximum recommended infusion rate is 5-10 mEq/hr - never exceed 20 mEq/hr -potassium is not given by IV push to avoid cardiac arrest
teach the patient and caregivers about common drugs and other strategies used for acute kidney injury and chronic kidney disease
-diuretics (loop and osmotic)
medications used for treatment of AKI -slide 33
-diuretics increasing urine output
collaborate with intraprofessional team to manage quality care for patients with impaired elimination caused by chronic inflammatory bowel and gallbladder disorders
-dr -nurses -nutritionist -surgeons
medical treatment of kidney trauma
-drugs -fluid replacement -immobilize clot -place a stent
which finding would the nurse assess in a pt with acute peritonitis? (SATA)
-fever -vomiting -tachycardia -rigid abdomen
understand glomerular filtration rate (GFR)... -what does it mean if GFR increases or decreases?
-first process in urine formation -water, electrolytes, and other small particles (creatinine, urea nitrogen, glucose) are all filtered across the glomerular membrane into bowman's capsule to form glomerular filtrate -prerenal decrease GFR -post renal increase GFR
complications of inflammatory bowel disorders - gallbladder disorders
-gallstones -peritonitis /preforation
Pathophysiology & S/S nephrotic syndrome
-glomerular dysfunction from damaged kidney glomerular permeability due to kidney blood vessels thickening resulting in narrowed lumens and decreased kidney blood flow -edema -HTN -protein in urine
medications for glomerulonephritis and nephrotic syndrome -slide 13
-glomerulonephritis = erythromycin for strep -nephrotic syndrome = suppressive therapy (steroid, cytotoxic, immuno-suppressive agents, rituximab) and mild diuretics, cholesterol reducing agents, heparin and NS
complications of inflammatory bowel disorders - ulcerative colitis
-hemorrhage/perforation -abscess formation -toxic mega-colon -intestinal malabsorption -non-mechanical bowel obstruction (mega-colon or cancer) -colorectal cancer -extraintestinal complications (skin lesion, arthritis, biliary disease)
complications of inflammatory bowel disorders - Crohn's
-hemorrhage/perforation -abscess formation -toxic mega-colon -intestinal malabsorption -non-mechanical bowel obstruction (mega-colon or cancer) -fistulas -osteoporosis -extraintestinal complications (skin lesion, arthritis, biliary disease)
medical treatment of nephrotic syndrome
-hydration status -I&Os -increase protein in diet -diuretics -hypertension meds
which problems occur with myxedema? (SATA)
-hypothermia -hypoglycemia -respiratory failure -greatly reduced level of conciousness
class, action, side effects and nursing considerations - Biologic Response Modifiers
-immunomodulatores -target disease causing mechanisms
signs and symptoms of hyperthyroidism
-increase sympathetic nervous system activity (increase HR, increase systolic BP, rapid shallow resp.) -diaphoresis in temp comfortable to others -muscle weakness -hyperactive deep tendon reflexes , tremors - increased appetite -unplanned weight loss -diarrhea -increase edema in extraocular muscles and fatty tissue behind the eyes pressure on optic nerve may cause problems with visions blurring and double vision. tired eyelids (Graves) -eyelid or eyeball lag -photophobia -decreased attention span, restlessness, emotional instability, manic until fatigued -thinning scalp hair -thyroid gland 4X size - goiter common (graves -affect women mentrual problems and men fertillity issues -increase libido in men and women -T3, T4 and free T4 increase -TSH decrease -TSI and TRAbs are measured to diagnose graves disease
Health promotion and maintenance - health teaching on risks for musculoskeletal injury
-infection (osteomyelitis) -impaired skin integrity -constipation -impaired mobility -reducing circulation = compartment syndrome -fat embolism syndrome -good nutrition promotes healing
pathogenesis, etiology and risk factors for inflammatory bowel disorder - gallbladder disorders
-inflammation and blockage can occur from gallstones, edema, stricture or tumors -moderate to severe abdominal pain -cholecystis - gallstones or cholelithiasis (common bile duct calculi) that obstruct the cystic duct = tissue sloughing or necrosis within gallbladder may perforate
class, action, side effects and nursing considerations - Antimicrobials
-inhibit cell wall synthesis -depolarize the cell membrane -inhibit protein synthesis
Why are NSAIDs and ASA avoided in clients with kidney problems?
-inhibit the mechanism and can lead to AKI -long term NSAID use = CKD
Medications used to decrease serum potassium -slide 34
-insulin and sodium bicarbonate (temporary treatment that shifts potassium into cells) -calcium gluconate (temporarily stabilized myocardium and prevents dysrhythmia) -dialysis (removed potassium from body) -sodium polystyrene sulfonate (removes potassium from body)
pathogenesis, etiology and risk factors for inflammatory bowel disorder - Diverticulosis and Diverticulitis
-losis = abnormal pouchlike herniations in wall of intestine due to aging or decrease fiber intake -litis = inflammation or infection of diverticula due to undigested food or bacteria trapped -can lead to perforation or GI
pathogenesis, etiology and risk factors for inflammatory bowel disorder - Appendicitis
-lumun is blocked and the mucosa secretes fluid increasing the internal pressure and restricting blood flow which results in pain -initial obstruction caused by fecal lith (hard piece of feces -severe pain shifts to RLQ & rebound tenderness
diagnostic examinations for bowel
-magnetic resonance enterography (MRE) = main exam to view bowels contrast or glucagon may be given to slow the bowels activity -CT scan -sigmoidoscopy or colonoscopy with biopsy -esophagogastroduodenoscopy (NPO for 6-8 hrs) -small bowel capsule endoscopy (view small intestine) -barium enema with air contrast differentiates between UC and Crohn's -ultrasound for diverticulitis
treatment of myxedema
-maintain patent airway and oxygenation -hypertonic or normal saline -glucose to increase blood glucose -monitor mental status -IV levothyroxine -check VS -provide blankets -turn every 2 hrs -aspiration precautions
teach the patient and caregivers about common drugs used for rheumatoid arthritis including those used for immunity suppression
-methotrexate = slows progression and decreases risk of joint deformity -Auranofin or Gold sodium thiomalate = alters immune response and inhibits oxidative enzymes and reduces apoptosis -hydroxychloroquine = suppresses antigen formation and increases photosensitivity -immunosuppressants = inhibits DNA/RNA synthesis -biological response modifiers &glucocorticoids = decrease inflammatory response and immune response
collaborate with the interprofessional team to coordination high-quality care and promote urinary elimination in patients who have acute kidney injury or chronic kidney disease
-nutritionist calculates pt's protein and caloric needs -nephrologist -nephrology nurse -pharmacist -dialysis technician
Pathophysiology & S/S of hydronephrosis/hydroureter
-obstruction of renal pelvis = hydroephrosis -hydroureter = obstruction of ureter -urinary flow obstructed -pain -kidney can burst
pathogenesis, etiology and risk factors for inflammatory bowel disorder - Crohn's
-occur anywhere in the GI tract (most common in distal ileum and proximal colon) -segments of normal bowel = skip lesions -commonly results in bowel obstruction, paratenitis and the formation of accesses and fistulas
pathogenesis, etiology and risk factors for inflammatory bowel disorder - Peritonitis
-s/s = abdominal pain, tenderness and distention -life threatening acute infection and inflammation of the visceral/parietal peritoneum and endothelial lining of the abdominal cavity -peritoneum extremely inflamed -peritoneal cavity is contaminated by bacteria -at risk for sepsis
implement evidence based nursing interventions to help patients and families cope with the psychosocial impact caused by acute kidney injury or chronic kidney disease
chronicity of kidney disease and long term treatment affects virtually ever area of person's life including... -family relationships -social and work activities -self-image -emotional states *utilize conciling
hemoglobin - levels & measures?
men - 13.2-16.6g women - 11.6 - 15g -amount of protein in red blood cells that carries oxygen to organs and CO2 from organs to lungs
creatinine - levels & measures?
men = 0.74-1.35 mg/dL women = 0.59-1.09 -measure how well kidneys are filtering waste from blood (creatinine is chemical left for energy producing process in muscles)
manage the care of patients with fractures and dislocations - prioritize evidence based nursing interventions for patients with musculoskeletal trauma to promote
mobility, maintain perfusion, manage pain and protect tissue integrity
Which statement below is true regarding hyperthyroidism?
most body systems are stimulated causing hyper-metabolism
a client has undergone a thyroidectomy. The client reports numbness and tingling around the mouth and a little bit of numbness and tingling in their fingers and toes. What does the nurse suspect and what precaution should be taken?
the nurse suspects parathyroid gland damage causing hypocalcemia -calcium glyconate or calcium chloride IV need to be readily available to treat an emergency situation of hypocalcemia
a patient who is obese is discharged 10 days after being hospitalized for peritonitis, which resulted in exploratory laboratomy. Which assessment finding by the patient's home health nurse requires immediate intervention?
the pt states, "I feel like the incision is splitting open" -the pt who feels that the incision is splitting open is at risk for poor wound healing and possible wound dehiscence -the nurse should immediately assess the would and notify the HCP
which assessment finding made by the nurse may indicate the onset of hypoparathyroidism?
tingling around the mouth
What is the main cause of myxedema?
tissues affected by low metabolic rate in hypothyroidism cause protein and sugar buildup inside cells caused by glycosaminoglycans (CAGs). CAG buildup increases mucus and water forming cellular edema