Final Review

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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


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