Final Review
The nurse caring for a patient with acute pancreatitis will include in the daily assessments:
-Auscultation of bowel sounds to detect paralytic ileum -amount of food eaten each meal -Effectiveness of pain control -Urine output
Which of the following symptoms would indicate that a client with chronic pancreatitis has developed secondary diabetes?
-Increased appetite -Increased thirst -Increased urination
A patient with advanced cirrhosis develops esophageal varies as a direct result of portal hypertension. The nurse anticipates that this complication will be addressed by:
-Insertion of a blakemore-sengstaken tube -administreation of IV vasopressin (pitressin) -Lactulose to empty swallowed blood in colon -Vasoconstrictors to reduce portal blood flow
The nurse is speaking with a patient who has concerns about the development of cholelithiasis. The nurse correctly includes which risk factors for the condition?
-Obesity -Diabetes mellitus -Taking cholesterol lowering drugs -Mexican american ethnicity
The nurse is discussing the impact of cirrhosis on liver function with the family of a dying patient. The nurse explains that when the damage caused by cirrhosis blocks the blood flow through the liver, the result is
-Portal hypertension -Decrease in metabolic processes of the liver -Decrease in clotting factors -Increase in ascites
Radioactive Iodine Uptake Test
-Used to observe thyroid function -Radioactive iodine is administered -Seceral scans are taken over a 24 hour period
Your bladder will have the urge to void at
100 ml to 150 ml
Serum Sickness
7-10 days after Penicillin has been injected
What percent of new cases of HIV are minorities?
73%
Causes of Gastritis:
ASA, steroids, NSAIDS (need to take food with these) Bacterial/Viral infection is another cause and s/s of that are *VOMITING, DIARRHEA, FEVER, ABDOMINAL PAIN
Hypoparathyroidism causes:
Accidental removal of parathyroids during thyroidectomy
What causes Glomerulonephritis?
Acute Post- Streptococcal
Pheochromocytoma Treatment:
Adrenalectomy
Usual treatment of chronic gastritis is the avoidance of irritating substances such s:
Alcohol NSAIDS Spicy Foods
Esophageal Cancer risk factors:
Alcohol and Tobacco Use
Would you put cotton socks on you hands with contact dermatitis?
Allow air flow No dye-use white Less scratching at night
Glucagon is released from the:
Alpha cells of the pancreas. **glucagon converts glycogen into glucose (glycongenolysis) (increasing blood glucose)
Type 1 Hypersensitivity Teaction: Anaphylactic Reaction
Anaphylaxis, Urticaria, and angioedema
Hiatal Hernia Therapeutic Interventions:
Antacids Small Meals No reclining 1 hour after eating Raise had of bed 6 to 12 inches Avoid fats because they relax the sphincter, allowing reflux
Passive Immunity
Antibodies in Breast milk
Posterior lobe of the pituitary gland stores and secretes:
Antidiuretic Hormone Oxytocin
Treatment for Nausea and Vomiting"
Antiemetics Oral care every 2 hours and PRN Environment is odor free, avoid odors and food that causes nausea Advance the diet slowly (clear liquid to full liquid to soft bland diet) (such as oatmeal, meatloaf, mash potatoes, no seasoning)
Treatment for Polycystic Kidney Disease
Antihypertensives to control HTN Epogen (stimulates body to make RBCs) AVOID NSAIDS and CEPHALOSPORIN ANTIBIOTICS
Therapeutic Interventions with skin test
Ask if allergies Stay in clinic 20-30 minutes after to make sure no delayed reaction
Nursing care after liver biopsy:
Assist client to roll on right side and place a small pillow under the costal margin for the first 2 hours
Hashimoto's Thyroiditis:
Autoantibodies for thyroid stimulating hormone Lifelong Thyroixine - levothyroxine-synthroid (take in morning on empty stomach hold if pulse >100
Morbid Obesity
BMI >40 100 lbs above recommended body weight for men. 80 lbs above recommended body weight for women
Insulin is released from the:
Beta Cells of the pancreas. **Insulin increases uptake of glucose into the cells (lowering blood glucose)
Peptic Ulcer Disease Therapeutic Medications:
Bismuth Subsalicylate -May cause aspirin toxicity
Complications of Peptic Ulcer Disease:
Bleeding Perforation Obstruction
Anaphylaxis S/S
Bronchial Narrowing: Stridor, wheezing respiratory arrest
AIDs Diagnosis:
CD4 + T Lymphocyte count below 200
(Hyperparathyroidism) An increased parathyroid hormone causes:
Calcium to leave the bones
Two mechanisms of Immunity
Cell-mediated Immunity Humoral IMmunity
Cushing's Syndrome S/S:
Central obesity with thin arms and legs Fat pads on upper back (buffalo hump) Round, moon-shaped face
Intravenous Pyelogram:
Check allergies
When taking the BP of a patient with severe acute pancreatitis, the nurse notices carpal spasm of the patient's hand. Which action should the nurse take next?
Check the calcium level on the chart
Contact Dermatitis:
Chemical comes in contact with skin PPD test Wash with brown soap
S/S for Hypothyroidism:
Cold Intolerance Dry Skin Weight Gain Myxedema Coma
With Sevver symptoms of Diverticulitis what is the drug of choice?
DEMEROL
S/S of DI
Decreased specific gravity Dehydration >increased serum osmolality
Hypophysectomy (removal of the pituitary gland) Preoperative Teaching
Deep breathing, incentive spirometry Avoid coughing, sneezing, straining post Avoid bending from waist post op (increases ICP)
Addison's Disease:
Deficient Cortisol
Growth Hormone Deficiency in children
Deficient GH in Childhood
The nurse explains to a patient with cholelithiasis that the purpose of the cholescintigraphy (HIDA scan) is to:
Diagnose abnormal contraction of the gallbladder
S/S of Crhon's Disease:
Diarrha
Hypoparathyroidism Treatment Long Term:
Dietary Calcium
Effects of Epinephrine:
Dilates bronchioles Decreases peristalsis Increases conversion of glycogen to glucose in the liver (glycogenolsis) Causes vasoconstriction in skin and viscera
Syndrome of Inappropriate Antidiuretic Hormone S/S
Dilution Hyponatremia Decreased serum osmolality
Triggers of Allergic Rhinitis:
Dust Dander Ragweed
Symptoms of UTI
Dysuria Frequency Cloudy Urine Foul-Smelling Uring
With dumping syndrome teach them :
Eat six small frequent meals Avoid fatty foods Drink fluid between meals not with meals
The Nurse is collecting data for a patient with acute pancreatitis. Which lab test result should the nurse expect?
Elevated serum amylase
Erythrocyte Sedimentation Rate (ESR)
Elevation Indicates inflammation
Lupus
Ensure pt understands importance of meds
Cushing's Syndrome
Excess adrenal cortex Hormones
With HIV you want to Wash exposure site with soap and water
FIRST
Post HIV S/S
Fatigue Diarrhea Sore Throat
Physical Assessment for Immune System:
Fever Fatigue Joint pain Weight loss Rash
S/S of Renal Calculi (Kidney Stone)
Flank Pain Renal Colic Costovertebral Hematuria Frequency
For AIDS you need to make sure they have had what three vaccines:
Flu Pneumonia Hep B
SIADH Therapeutic measures:
Fluid Restriction Hypertonic Saline IV to shrink cells Increased oral salt intake may be encouraged Loop Diuretics (furosemide) to get rid of water
What releasing and inhibiting hormones are released by the hypothalamus?
GHRH GHIH CRH GnRH TRP
Addison's Disease Treatment:
Glucocorticoids and mieralocortioids. **Two-Thirds in AM, one-Third in PM Double or triple doses in times of "stress"
A pt has reported to the clinic with concerns about contracting hepatitis A from her boyfriend. What response by the nurse is most appropriate?
Hepatitis A is not transmitted as result of close contact with an infected individual
Irritable Bowel Syndrome Therapeutic Interventions:
High fiber and bran diet Avoid trigger foods Smaller , Frequent meals
Renal Calculi Food prevention:
High in calcium: Coco Spinach Nuts
Therapeutic interventions of Constipation:
High-Fiber Diet Set a time each day for dedication Exercise Bulk-forming agents Stool softeners
Celiac Disease Therapeutic Intervention:
High-calorie, high-protein, gluten-free diet!!
Polycystic Kidney Disease S/S
Hypertension (classic symptom)
Endocrine Disorders occur from:
Hypo function of an endocrine gland or hyperactive gland
AIDS nursing Diagnosis:
Imbalanced Nutrition: less than body requirements
Ankylosing Spondylitis: (chronic progressive inflammatory disease)
Important to include activity every 2 hours to decrease stiffness and joint pain
Treatment for Diverticulitis:
Increase fluids, stop softeners, NSAIDS for pain, bulk laxatives High fiber- Prunes raisins and peas
Parathyroid Hormone Functions:
Increases the resorption (release) of calcium and phosphate from bones Activates Vitamin D
Pyelonephritis
Infection of the kidneys
Peritonitis:
Inflammation of the peritoneum
Central Diabetes Insipidus
Insufficient ADH production form pituitary (not producing enough)
Stress-Induced Gastritis: The critically Ill are at risk:
Ischemia damaging mucous barrier
Stress Incontinence:
Legal exercises! happens with coughing, laughing, sneexing
Acromegaly Treatment:
Lifelong Thyroid Hormone, Steroid and sex hormone replacement is necessary after pituitary removal
Adrenalectomy postoperative care
Lifelong hormone replacement may be necessary (glucocorticoids and mineralocorticoids)
Nursing Management for Crohn's Disease:
Low fat, low fiber for IBS like Crohn's and Ulcerative Colitis
The nurse is caring for a patient with chronic liver failure. Which lab values should the nurse expect to be as a late sign of liver failure?
Low serum albumin
A client has undergone surgery to create a sigmoid colostomy. when inspecting the abdomen, the nurse would expect tho find the stoma located in which of the following areas of the abdomen?
Lower Left
Nursing Care for Anaphylaxis:
Maintain Airway (#1 priority) Education: Medical alert bracelet Epi Pin
Therapeutic Interventions for HIV
Make sure pt will comply with treatment
Gastric Cancer
Malignant lesion in stomach *Second most common cancer
S/S of Constipation:
May pass liquid stool around an obstructed stool mass (impaction)
Myxedema Coma
Metabolic Rate drops so low.
Adrenal Cortex secretes three steroid hormones:
Mineralocorticoids (salt) Glucocorticoids (sugar) Gonadocorticoids (Sex)
Thyroidectomy for hyperthyroidism Considerations Postoperatively:
Monitor for thyrotoxic crisis and hypothyroidism
Gastrojejunostomy (billroth II)
More distal stomach removed. Anastomosed to jejunum treats duodenal problems
Addison's Crisis Prevention
NEVER ABRUPTLY DISCONTINUES STEROIDS! QUESTION ANY ORDER FOR DISCONTINUING FOR LONG-TERM USE STEROIDS
With GERD question patients taking ___ that are on digoxin
NEXIUM
With an Upper GI pre procedure care:
NPO 6-8 hours before the test
Neutropenic Precautions and standard:
No fresh fruits No plants Wera Mask Change AC filters Assess for: Age Alcoholism Family History Exposure to HIV
Client Teaching with Hemodialysis:
No heavy lifting on access side Do not wear constrictive clothing Do not sleep on access side NO BP OR STICKS to access arm Assess for bruit or thrill daily
Causes of Peptic Ulcer Disease:
No more than 2000 mg of tylenol per day
Acromegaly S/S
Nose, Jaw, Brow enlargement
S/S of Glomerulonephritis?
Oliguria (pee too little) Hypertension Electrolyte Imbalances Edema (periorbital aka in the face) Flank Pain
Major complication after a liver biopsy is BLEEDING so you want to monitor their
PT/INR
Early S/S of cancer of the bladder:
Painless Hematuria
Palpation of the thyroid:
Palpated while patient swallows. LVN may assist, do not palpate on your own.
Which hormone raises serum calcium levels?
Parathyroid hormone
Prevention for Health-Care Workers
Personal Protective Equipment Standard Precautions
B Cells
Plasma cells produce antibodies to specific foreign antigen Memory cells
Kidney function:
Production of erythropoietin
Causes of Cushing's:
Prolonged use of exogenous glucocorticoids (too much steroids)
Nuclear Scanning - Thyroid Scan
Radioactive material is administered (oral or IV) Scan will show: >Hot spots (not malignant) >Cold Spots (malignant)
Dumping syndrom
Rapid emptying of stomach contents into duodenum.
Cell-Mediated Immunity
Recognition of Foreign Antigen by helper T cells (CD4) Killer T cells lyse cells (CD8) Memory T cells remember specific foreign antigens Suppressor T cells limit immune response
Adrenal Medulla
Releases catecholamines (epinephrine and norepinephrine)
What is the cardinal sign for peritonitis:
Rigid abdomen
Nursing Dx for Hypoparathyroidism:
Risk for injury related to Hypocalcemia and tetany
Corticotropin-Releasing Hormone
Secreted during stress (injury, disease, exercise, or hypoglycemia)
Mallory-Weiss Tear therapeutic Interventions"
Self-healing
Syndrome of Inappropriate Antidiuretic Hormone Diagnostic Test:
Serum sodium and osmolality are low Urine sodium and osmolality are high
Viral Load Testing:
Shows response to antiretroviral therapy
Cause of Bladder Cancer
Smoking. >the primary tumor location is the lungs.
Thyroidectomy Post Op Care Positioning:
Support neck using hands
Cushing's Syndrome Treatment:
Symptom control: Weight is the best measurement for fluid balance management
HIV attracted to CD4+
T -lymphocytes
Thyroid Gland secretes three hormones
T3 T4 Calcitonin
Thyrotoxic Crisis (thyroid storm)
Tachycardia High fever, dehydration Hypertension, Heart failure Coma, Death
Hyperthyroidism S/S:
Tachycardia, Palpitations Nervousness, Insomnia Increased appetite with weight loss Heat intolerance Exophthalmos (bulging eyes)(Grave's Disease)
HIV Testing ELISA test aka EIA (enzyme immunoassay)
Takes 3 days Test for HIV antibodies Repeat if positive After 2 positive ELISA test they do Wester Blot
Drinks that worsen UTI
Tea Soda Coffee Alcohol
Older adults need to get their
Tetanus every ten years
Ulcerative Colitis:
The chronic inflammation usually is limited to the mucosal and submucosal layers of the colon and rectum
Syndrome of Inappropriate Antidiuretic Hormone
They have too much ADH in body and a Decreased urine output. Resulting in **DECREASED SERUM OSMOLALITY AND INCREASED URINE OSMOLALITY ( concentrated urine)
Artificially Acquired
This can help prevent disease after exposure to a pathogen such as the hep B virus (vaccines)
Pre-Exposure Prophylaxis (prEP)
This is effective prevention for those at high risk. Saquinavir, Inverse is an ART drug that stops the virus from replicating
Feel the
Thrill
A patient with liver failure and esophageal varies is prescribed to receive vasopressin. What should the nurse realize is the purpose for this medication?
To constrict vessels causing bleeding in esophageal varices
Oral Cancer risk factors:
Tobacco or alcohol use of any kind
Pheochromocytoma:
Tumor secretes excessive catecholamines such as *EPINEPHRINE and norepinephrine
Treatment for GERD:
Upright with and 30 minutes to 1 hour after meals Avoiding foods 2-3 hours before bedtime, HOB up while sleeping
Diagnostic Tests for DI:
Urine Specific Gravity < 1.001 If specific gravity remains low notify RN or PCP that therapy is ineffective
Post op Nursing Care for Hypophysectomy
Urine for Specific Gravity (risk for DI)
Lithotripsy
Use of sound, laser, or dry shockwave energies to break the stone into small fragments (for larger stones)
Pernicious Anemia:
Vitamin B12 Deficieny RBC Production Decreased But size of RBC increased
Peptic Ulcer Disease S/S:
Vomiting of old blood looks like coffee grounds
Therapeutic Interventions for Obesity:
Weight Loss through exercise and calorie restriction Stress reduction Support groups Change in concepts about food
A pt with acute pancreatitis has a NG tube to suction and is NPO . which information obtained by the nurse indicates that these therapies have been effective?
abdominal pain is decreased
Safer sex practices:
abstinence monogamous sexual relationships (*GET TESTED BEFORE RELATIONSHIP AND AGAIN IN 6 MONTHS) condoms
Angioedema:
affects SQ tissue rather than skin Painless, dermal erythematous/SQ eruptions, Skin/ mucous membrane edema Check for swelling of lips and tongue
To minimize a reaction with the immunotherapy in a clinic, use an
antihistamine before being given the vaccine
Assessment findings with Appendicitis:
attack of abdominal pain in RLQ Positive Rovsing Sign ( Palpating LLW and pt has pain in RLQ Supine with legs bent helps relieve pain
You may have to use TPN with gastric cancer and you want to monitor their
blood sugar.
How can we help with dysphagia?
chew thoroughly, Sit up Tuck chin
With Ulcerative Colitis you are at an increased risk for
colon cancer
Post test counseling by trained personnel will assist with informing sexual partners and
drug needle sharers
_____ glands secrete hormones directly into the bloodstream
endocrine glands
Acromegaly is an
excess growth hormone in adults bones grow in width not length
Urge Incontinence:
have to go right then
Constipation Prevention:
high fiber diet, fluids, exercise Obstipation (prolonged constipation)
Serum Creatinine:
if serum creatinine is elevated, the kidneys aren't functioning properly
Transplant Rejection is prevented by
immunosuppression therapy. for life
Adrenal glands are located:
int he abdomen on the top of each kidney
Overflow Incontinence:
involuntary loss of urine associated with bladder over distention
Hypersensitivity reactions to seafood, including shellfish, are not caused by
iodine in the seafood
Antibodies
label antigens for destruction by attaching to them
Why are they minorities?
lack of high quality care cultural beliefs about sex decrease access to healthcare cultural sensitivity information cost of HIV prevention meds
The nurse is caring for a patient recovering from an incisional cholecystectomy. Which activities should the nurse identify as having the highest priority for this patient
managing pain ambulating early & frequently coughing and deep breathing Encouraging use of an incentive spirometer
Thyroid Test (thyroid panel)
measurement of blood hormone levels.
With SCIT (subcut injection) its important that the patient not..
miss dose, if this happens verify with doctor dosage to be administered (may need to give a smaller dose)
Gigantism
occurs before puberty has ended
Acromegaly
occurs in adults
Parathyroid gland is located:
on the back of the thyroid gland
Appendicitis:
pain to RLQ- McBurney's point
Arteriovenous Fistula (sites used for dialysis)
preferred over AV grafts related to decreased complications. (AV graft has more THROMBOSIS and infection complications
HIV prevention
prevention/eduation is best
To protect AIDS patients from Pneumocystic air...Pneumonia they will take
prophylactic Sulfa meds such as Bactrim and septra
Glomerulonephritis causes:
proteins, WBCs, RBCs to leak into urine
Pygidium turns urine
red orange
Hyperparathyroidism nursining Diagnosis:
risk for injury: fracture, complications of hypercalcemia
Age is an important factor when
testing for HIV
With thyroidectomy:
tetany can occur from hypocalcemia related to removal of parathyroid glands
Primary Hyperthyroidism:
too much thyroid hormone from thyroid