Term
| What are the effects of fat soluble vitamin deficiencies? |
|
Definition
| A: vision; D: bone health; K: long PT/INR; E: free radical damage |
|
|
Term
| Fermentation of lactose by bacteria causes what? |
|
Definition
|
|
Term
|
Definition
| general term for diseases with malabsoption feature (ulcerative colitis and crohn's) |
|
|
Term
|
Definition
| ulceration of colon mucosa (rectum and sigmoid); frequent bloody mucous diarrhea; increased risk of colon cancer |
|
|
Term
| Describe how to prep the bowel for a flexible sigmoidoscopy |
|
Definition
| 1-2 fleets enemas; miralaax is used less often; regular or clear diet prior |
|
|
Term
| What is the best known anti-diarrheal med? |
|
Definition
|
|
Term
| What is the drug combination for lomotil? |
|
Definition
| Diphenoxylate (opioid that slows movement of intestines) and atropine |
|
|
Term
| What is given to treat Crohn's and UC if the patient has a sulfa allergy? |
|
Definition
|
|
Term
| What is a side effect of Sulfasalazine? |
|
Definition
| may cause skin or urine to turn orange-yellow, headache and photosensitivity |
|
|
Term
| Describe the dietary considerations for someone with IBD |
|
Definition
| limit dairy, low fiber, eat small meals, use supplements, drink lots of fluids |
|
|
Term
|
Definition
| continent ileostmy; patient can cath themselves to poop |
|
|
Term
| Describe post op care for an ileostomy |
|
Definition
| high stool output; assess for hemorrhage, SBO, dehydration |
|
|
Term
T/f:
Crohn's manifests with bloody diarrhea |
|
Definition
|
|
Term
| Describe short bowel syndrome |
|
Definition
| inadequate surface absorption which requires TPN supplementation |
|
|
Term
| What is a low residue diet and why is it important in diverticular disease? |
|
Definition
| low fiber; prevent increase in colon wall pressure |
|
|
Term
| What is the most common symptom of diverticulitis? |
|
Definition
|
|
Term
| Rectal bleeding is a rare emergent complication of what? |
|
Definition
|
|
Term
|
Definition
| abnormal connection of tissue between two organs or organ and skin |
|
|
Term
| How does constipation contribute to diverticular disease? |
|
Definition
| straining increases pressure in the colon which causes it to bulge out through weak spots |
|
|
Term
| What two things should not be done when treating appendicitis? |
|
Definition
| laxatives/enemas and heat too the abdomen |
|
|
Term
| Describe the function of the liver |
|
Definition
| largest metabolic organ; key in digestion, nutrition, metabolism, elimination |
|
|
Term
| What are the signs of liver dysfunction? |
|
Definition
| increased liver enzymes, n/v, fever, fatigue, pruritis (later) |
|
|
Term
| What are the meds that treat itch as a result of liver dysfunction? |
|
Definition
| cholestyramine, rifampin, narcan, zofran, eucerin |
|
|
Term
| Jaundice occurs due to what? |
|
Definition
| inflammation and edema of liver |
|
|
Term
| Describe LFTs in a dysfunctional liver |
|
Definition
| enzymes increase, proteins decrease, increase coag and bilirubin |
|
|
Term
| Describe prep for a liver biopsy |
|
Definition
| avoid that meds effect platelets and clotting, limit food or drink |
|
|
Term
| What are the needles for performing liver biopsies? |
|
Definition
|
|
Term
| What do these signs seen after a liver biopsy indicate? pain in abdomen, chest, shoulder, sob, persistent bleeding |
|
Definition
| leakage of bile into abdominal cavity |
|
|
Term
| leakage of bile into the abdominal cavity can lead to what? |
|
Definition
|
|
Term
| What are the consequences of portal hypertension? |
|
Definition
| varicose veins in esophagus, stomach and rectum; splenomegaly from increased splenic vein pressure |
|
|
Term
| What does black tarry stool indicate? |
|
Definition
|
|
Term
| What are the supportive measures for an acute bleed? |
|
Definition
| FFP, PRBC, Vitamin K, antacids (proton pump inhibitor) |
|
|
Term
| Describe the treatment of esophageal varices |
|
Definition
| manage bleeding with volume replacement, vasoconstrictive drugs, norepi |
|
|
Term
| Why has ER shunt surgery been abandoned to treat esophageal varices? |
|
Definition
| high mortality rate; esophageal transection is best choice (esophageal ring is removed and ends stapled together) |
|
|
Term
| Describe TIPS in treating liver issues |
|
Definition
| creates shunt so blood flows from high pressure hepatic vein to lower pressure hepatic vein; reduces formation of ascites |
|
|
Term
| What are the names of two beta blockers that can reduce variceal bleeding? |
|
Definition
| propranolol and nadolol; reduce portal pressure to allow adrenergic constriction |
|
|
Term
| What medication treats ascites? |
|
Definition
| aldactone (K sparing diuretic); may be used in combo with lasix |
|
|
Term
| What are the contraindications of abdominal paracentesis? |
|
Definition
| disseminated intravascular coagulation |
|
|
Term
| Describe Spontaneous Bacterial Peritonitis |
|
Definition
| common fatal complication of cirrhosis;fever, abdominal pain; claforin used to treat it |
|
|
Term
| Describe refractory ascites |
|
Definition
| not successfully managed by meds; can use TIPS, transplant, or laveen shunt as Tx |
|
|
Term
| Describe the laveen shunt |
|
Definition
| moves ascites fluid to SVC; last resort b/c of outcomes |
|
|
Term
| Describe hepatic encephalopathy |
|
Definition
| CNS disturbance from high Ammonia (protein digestion byproduct) |
|
|
Term
|
Definition
| flapping tremor of wrist upon extension r/t ammonia |
|
|
Term
| What are some meds used to treat hepatic encphalopathy and how do they work? |
|
Definition
| lactulose, flagyl (antibiotic reduces ammonia from bacteria) |
|
|
Term
| Someone with low bilirubin will have what color stools? |
|
Definition
|
|
Term
| Liver dysfunction inhibits the body's ability to metabolize what? |
|
Definition
|
|
Term
| Describe hepatorenal syndrome |
|
Definition
| oliguric hepatic failure w/ decrease in blood volume r/t GI bleed, hypotension |
|
|
Term
| Hyperglycemia is a common manifestation of ___ while hypoglycemia is a manifestation of ____ |
|
Definition
| chronic liver disease; liver failure |
|
|
Term
| What are the pancreatic enzymes? |
|
Definition
| lipase, amylase, protease |
|
|
Term
| Describe acute pancreatitis |
|
Definition
| inflammation leads to enzymes leak with edema, vascular damage, Ca deposition in areas of fat necrosis |
|
|
Term
| Ca in acute pancreatis is what? |
|
Definition
| sequestered to areas of fat necrosis |
|
|
Term
| What are the clinical manifestations of acute pancreatitis? |
|
Definition
| epigastric pain radiating to back, fevver, paralytic ileus, hypotension, jaundice |
|
|
Term
|
Definition
|
|
Term
| Describe the treatment plan for acute pancreatitis |
|
Definition
| pain, antacids, NPO, Ca, Rest GI tract, Electrolytes, Antibiotics, Suction |
|
|
Term
| What are the complications of chronic pancreatitis? |
|
Definition
| abdominal pain, malabsorption syndromes, DM, abcesses, pseudocysts |
|
|
Term
| What are the diagnostic results for chronic pancreatitis? |
|
Definition
| elevated amylase, lipase, hyperglycemia, low Ca |
|
|
Term
| Describe pancreatic cancer pain |
|
Definition
| significant later on, worse when laying down, no relation to food |
|
|
Term
| What are two ADH antagonists? |
|
Definition
| lithium carbonate and demeclocycline (corrects low Na) |
|
|
Term
| What med inhibits ADH release? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Describe diabetes insipidus |
|
Definition
| low ADH or lack of response; neurogenic (primary), nephrogenic (kidney doesn't respond to ADH), psychogenic (excessive water intake) |
|
|
Term
|
Definition
| antidiuretic replacement therapy to control DI |
|
|
Term
| What is the most common cause of hyperpituitarism? |
|
Definition
|
|
Term
| What is a classic sign of acromegaly? |
|
Definition
|
|
Term
| How do you confirm diagnosis of acromegaly? |
|
Definition
| high GH, increased insulin-like growth factor, glucose tolerance test |
|
|
Term
| What are the risks of pituitary surgery? |
|
Definition
| DI, CSF leak, visual impairment, incomplete tumor removal |
|
|
Term
| What is the sign of a CSF leak? |
|
Definition
|
|
Term
| Why should post pit surgery patients not brush their teeth? |
|
Definition
|
|
Term
| What are some patient expectations post pit surgery? |
|
Definition
| work 2 wks later; clots/mucous out of nose or down throat |
|
|
Term
| Describe the use of sandostatin |
|
Definition
|
|
Term
| What is the result of too much PTH? |
|
Definition
| increase Ca, low Ph and bone weakness |
|
|
Term
| What is the most common cause of primary hyperparathyroidism? |
|
Definition
|
|
Term
| What two conditions cause secondary hyperparathyroidism? |
|
Definition
| kidney failure and malabsorption |
|
|
Term
| What is the most common cause of hypoparathyroidism? |
|
Definition
| thyroid surgery where some parathyroid tissue was removed |
|
|
Term
| What are the clinical manifestations of hypoparathyroid? |
|
Definition
| trousseau's sign and muscle spasticity |
|
|
Term
| Describe the cortisol levels in someone with Cushing's |
|
Definition
| normal in the morning; higher at night |
|
|
Term
| Describe the decadron test in adrenal disease |
|
Definition
| decadron given at night and cortisol measured in the morning; normal= low, cushings= high |
|
|
Term
| Describe the use of and cautions related to Nizoral |
|
Definition
| block corticosteroid secretion; hepatotoxic |
|
|
Term
| What is the purpose of a high protein diet in someone with cushing's? |
|
Definition
| helps heal friable "steroid skin" |
|
|
Term
| What are the signs of hypocortisolism? |
|
Definition
| vomiting, dehydration, hypotension |
|
|
Term
| What are some normal complaints of the patient after adrenal Sx? |
|
Definition
| painful joints, pruritis, peeling skin |
|
|
Term
| What is another name for primary adrenal insufficiency? |
|
Definition
|
|
Term
| Describe mineralcorticoid deficiency |
|
Definition
| Na deficiency and K toxicity |
|
|
Term
| Which is the more dangerous of Cushing's and Addison's? |
|
Definition
| Addison's; Cushing's is more common |
|
|
Term
| Describe Pheochromocytoma |
|
Definition
| caused by tumor on adrenal medulla that causes severe HTN; increased catecholamines (epi and norepi) |
|
|
Term
| What is the function of the thyroid? |
|
Definition
| convert iodine to T3 and T4 to control metabolism |
|
|
Term
| The thyroid gland and production of TSH is under the control of what? |
|
Definition
|
|
Term
| TSH releasing hormone and the pituitary gland are controlled by what? |
|
Definition
|
|
Term
| What do T3 and T4 tests tell you? |
|
Definition
T4: overall function of thyroid
T3: diseased if high |
|
|
Term
|
Definition
| autoimmune toxic diffuse goiter; most common cause of hyperthyroidism; clinical manifestations: goiter, exopthalmos; low TSH |
|
|
Term
| Describe the secondary cause for hyperthyroidism |
|
Definition
| TSH secreting pituitary adenoma |
|
|
Term
| Describe infiltrative dermopathy |
|
Definition
| non pitting proteinaceous edema in pretibial area; associated with Grave's |
|
|
Term
| What are the conservative measures for treating exopthalmos? |
|
Definition
| elevate head at night, glasses, eyedrops, cool compress |
|
|
Term
| What are 3 meds used to treat hyperthyroidism? |
|
Definition
| PTU, methimazole and iodine |
|
|
Term
| What is the main drug used to treat hypothyroidism? |
|
Definition
|
|
Term
| What is the purpose of using beta blockers and Ca blockers to treat hyperthyroidism? |
|
Definition
| reduce tachycardia; Ca for those who can't tolerate beta blockers (lung effects) |
|
|
Term
| What can lead to an episode of thyroid storm? |
|
Definition
| infection, trauma, surgery DKA, pre-eclampsia |
|
|
Term
| What are the symptoms of a thyroid storm? |
|
Definition
| fever, weakness, restlessness, mood swings, n/v/d |
|
|
Term
| How do you treat hypothyroidism? |
|
Definition
| address cause, give thyroxine |
|
|
Term
| Describe primary hypothyroidism |
|
Definition
| commonly caused by Hashimoto's thyroiditis, due to disease in thyroid, increased TSH |
|
|
Term
| Describe secondary hypothyroidism |
|
Definition
| hypothalamus does not make enough TRH |
|
|
Term
| Describe hypothyroidism in the elderly |
|
Definition
| non-specific geriatric symptoms; confusion, anorexia, muscular aches and weaknesses; may mimic dementia or parkinsons |
|
|
Term
|
Definition
| life threatening; coma with extreme hypothermia, seizures and respiratory depression |
|
|
Term
| What are the dietary considerations for someone with hypothyroidism? |
|
Definition
| High fiber and stool softeners |
|
|
Term
| Describe the treatment plan for myxedema coma |
|
Definition
| IV fluids, thyroxine, corticosteroids |
|
|
Term
| What is the classic triad of PE? |
|
Definition
| dyspnea, chest pain and hemoptysis |
|
|
Term
| Describe the labs seen in someone with PE |
|
Definition
| hypoxemia and uncompensated respiratory alkalosis or acidosis (large) with positive D dimer |
|
|
Term
| Describe contrast induced nephropathy |
|
Definition
| increase >25% or .5mg in creatinine |
|
|
Term
| What is the widely accepted indication for fibrinolytic therapy? |
|
Definition
| persistent hypotension due to acute PE |
|
|
Term
|
Definition
| ventilatory failure; PaCO2>48 and pH>7.35 |
|
|
Term
| Describe paradoxic breathing |
|
Definition
| abs and chest move in opposite manner from max effort of accessory muscles |
|
|
Term
| Describe the use of the end tidal CO monitor |
|
Definition
| sensor that changes color when exposed to CO2; purple= low, tan= some, yellow= normal used to verify ETT placement |
|
|
Term
| If a patient is breathing on their own but need a humidified airway what do you use? |
|
Definition
|
|
Term
| Inhalation occurs due to what? |
|
Definition
| negative intra-thoracic pressure |
|
|
Term
|
Definition
| damage to pulmonary tissue from positive pressure ventilation |
|
|
Term
|
Definition
| similar to iron lung; creates negative pressure to the external chest, used in patients with muscular disorders |
|
|
Term
|
Definition
| positive end expiratory pressure; postive pressure in airway after expiration; helps facilitate gas exchange in alveoli |
|
|
Term
| Volume cycled PPV is often used with what population? |
|
Definition
| adults and older children |
|
|
Term
| What is the normal range for PEEP? |
|
Definition
|
|
Term
| DEscribe synchronized intermittent mandatory ventilation |
|
Definition
| SIMV; ventilator breathes in synchrony with patient at prescribed rate. Patient can breathe independent of ventilator |
|
|
Term
|
Definition
| used to prevent pressure at end of exhalation from being 0; used on patients breathing on their own |
|
|
Term
|
Definition
| acute respiratory distress syndrome; hypoxic despite O2 therapy, dyspnea, decreased pulmonary compliance, respiratory acidosis |
|
|
Term
|
Definition
| anything that injures the lungs; septic shock is the most common |
|
|
Term
| After checking the patient, what do you check if there's an abnormal heart rhythm? |
|
Definition
|
|
Term
| How do you know if a dysrhythmia is supraventricular or ventricular? |
|
Definition
| QRS width; narrow= above ventricles, wide= ventricles |
|
|
Term
| What meds treat fast supraventricular rhythms? |
|
Definition
| Ca channel blockers (diltiazem), beta blockers, amiodorone (long term) |
|
|
Term
| What vagal maneuvers can be used to treat fast supraventricular rhythms? |
|
Definition
| cough, carotid massage, diving reflex |
|
|
Term
| What is the function of digoxin? |
|
Definition
| slows and strengthens the heart |
|
|
Term
| What med for fast supraventricular rhythms is pushed quickly? |
|
Definition
|
|
Term
| define ventricular ectopy |
|
Definition
|
|
Term
| What is the first choice drug for symptomatic bradycardia? |
|
Definition
|
|
Term
| What are the causes of treatment for Premature Atrial Contractions (PACs)? |
|
Definition
| caffeine, COPD; remove cause/nothing |
|
|
Term
| What can cause atrial flutter? |
|
Definition
|
|
Term
| Describe the treatments for types of AV block? |
|
Definition
| 1st: monitor patient 2nd1: likely caused by digoxin, monitor, 2nd2: pacemaker, 3rd: pacemaker |
|
|
Term
| What is the treatment for ventricular dysrhythmias (PVCs)? |
|
Definition
| monitor if lasting less than 6 mins; lidocaine, amiodarone |
|
|
Term
| What electrolyte replacements are made for someone with PVCs? |
|
Definition
|
|
Term
| What is the front line drug for ventricular dysrhythmias? |
|
Definition
| lidocaine; bolus followed by drip |
|
|
Term
| Describe the use of amiodarone to treat ventricular dysrhythmias |
|
Definition
| daily use can treat asymptomatic patients; bolus followed by infusion |
|
|
Term
| Describe the care plan for pulseless V tach/ V fib |
|
Definition
| call code, CPR, use defibrillator asap, epi is used 1st for vasoconstirction (blood flow to heart and brain). Vasopressin is alternate |
|
|
Term
| What are two common causes of torsades de pointes? |
|
Definition
| hypomagnesemia and hypokalemia; special v tach |
|
|
Term
| What is the treatment plan for asystole? |
|
Definition
|
|
Term
| What are the 6 Hs the cause pulseless electrical activity? |
|
Definition
| Hypoxia, hypovolemia, hypothermia, H+ ions, hypokalemia, hyperkalemia |
|
|
Term
| What are the 5 Ts that cause pulseless electrical activity? |
|
Definition
| Tablets (overdose), tamponade, tension pneumo, thrombosis (coronary and pulmonary) |
|
|
Term
| a prolonged PR interval indicates what? |
|
Definition
|
|
Term
| How does adenosine work in treatings SVT? |
|
Definition
| causes transient heart block in the AV node |
|
|
Term
| Administration of what are considered priority in treating tachycardia? |
|
Definition
|
|
Term
| Adenosine does not work for what kind of tachycardia? |
|
Definition
|
|
Term
| Describe obstructive shock and its causes |
|
Definition
| obstructions reduces CO; pericardial tamponade, tension pneumo, SVC syndrome, PE |
|
|
Term
| Describe hypoadrenal shock |
|
Definition
| water and Na loss from adrenal issues causes hypovolemia |
|
|
Term
| What are the signs of obstructive shock? |
|
Definition
| JVD, hepatomegaly, peripheral edema |
|
|
Term
| Lactic acid is created in what stage of shock? |
|
Definition
|
|
Term
| At what point is a patient less likely to recover from shock? |
|
Definition
| stage 4; failure of one organ system effects others |
|
|
Term
| Describe the clinical manifestations of shock |
|
Definition
| BP, urine output and CO decrease, increase HR and RR, vasoconstriction |
|
|
Term
| Describe the treatment plan for cardiogenic shock |
|
Definition
| restrict fluids, give diuretics, give vasoactive meds |
|
|
Term
| What are the fluid resuscitation guidelines for hypotension and shock? |
|
Definition
| 10ml/kg hypotension; 20ml/kg shock (high LA) |
|
|
Term
| What is the function of low dopamine doses? |
|
Definition
| help restore blood flow to low priority areas |
|
|
Term
| What is the dosage range for dopamine to treat shock? |
|
Definition
|
|
Term
| What is the purpose of dobutamine? |
|
Definition
| inotropic; causes heart to pump more efficienctly |
|
|
Term
| What is the function of nipride? |
|
Definition
| vasodilator; reduces afterload so make it easier for the heart to empty |
|
|
Term
| Describe central venous pressure |
|
Definition
| pressure of blood as it returns to the heart |
|
|
Term
| What are the goals for central venous pressure? |
|
Definition
|
|
Term
| Describe pulmonary artery wedge pressure and give the normal range |
|
Definition
| preload/filling pressure (volume); 7-12 |
|
|
Term
| Describe LV and normal ranges |
|
Definition
| preload of left heart; 7-12 |
|
|
