Shared Flashcard Set

Details

MedSurg
CW3
77
Nursing
Not Applicable
10/21/2011

Additional Nursing Flashcards

 


 

Cards

Term
Manifestations of Hyperthyroidism
Definition

 

Metabolism

 

Increased appetite, weight loss, heat intolerance

 

Cardiovascular

 

HTN, tachycardia, palpitations

 

GI

 

Hyperactive BS, increased peristalsis

 

Neuromuscular

 

Nervousness, restlessness, insomnia, tremor

 

Other

 

Fine hair, smooth/warm skin

Term
Hyperthyroidism Lab & Diagnostics
Definition

 

Thyroid antibodies

 

TSH

 

T4, T3

3

Radioactive iodine uptake test

 

Thyroid suppression test

Term
Hyperthyroidism Treatment
Definition

 

Drugs

 

Antithyroid

 

Beta-blockers

 

Radioactive Therapy

 

Damage or destroy cells

 

Surgery

 

Subtotal or total thyroidectomy

Term
Hyperthyroidism Nursing Care
Definition

 

Risk for decreased cardiac output

 

Altered Nutrition

 

Body Image Disturbance

Term
Hypothyroidism
Definition

Insufficient amount of thyroid hormone

Defect in thyroid gland

Post hyperthyroid treatment

Thyroditis (Hashimoto’s)

Iodine deficiency

Myxedema

Common in females 30-60

Term

Hypothyroidism

Manifestations

Definition

Metabolism

Cold, sleepy, weakness, fatigue

Cardiovascular

Hypotension, bradycardia

GI

Constipation, anorexia, vomiting

Neuromuscular

Slow movement and thinking

Other

Goiter, dry skin and hair

Term
Myxedema Coma
Definition

Hypothyroid crisis

Hyponatremia, hypoglycemia, lactic acidosis

Hypothermia, cardiovascular collapse

Precipitated by trauma, infection, uncontrolled hypothyroidism

Maintain airway, correct imbalances

Term
Hypothyroidism Diagnosis & Treatment
Definition

Same as hyperthyroid with opposite results

TSH- elevated

T4, T3- decreased

RAI- decreased

Medications

Replacement therapy

Surgery

For goiter that interferes with airway/swallowing

Term

Hypothyroidism

Nursing Care

Definition

Decreased cardiac output

Constipation

Risk for impaired skin integrity

Activity intolerance

Altered thought process

Term
Thyroid Cancer
Definition

Risk factor

Exposure to ionizing radiation during childhood

More common in females

Palpable firm nodule in thyroid

TH usually normal

Subtotal or total thyroidectomy

Thyroid replacement

Term

Hyperparathyroidism

Collaborative Care

Definition

May be d/t tumor or hyperplasia

Hypercalcemia & hypophosphatemia

"Bones, stones, abdominal groans"

Bone decalcification

Renal calculi

Abdominal pain, constipation

Labs

Electrolytes, Ca, Phos, Mag

Treatmemt

Decrease Ca levels

Increase fluid intake

Diuretics (Lasix)

Meds to inhibit bone reabsorption (Fosamax)

Removal of gland

Term
Hypoparathyroidism
Definition

Damage or removal of parathyroid glands

Hypocalcemia & hyperphosphatemia

Numbness, tingling around mouth, tetany

Need long term calcium supplements, Vit D

Term
Cushing’s Syndrome
Definition

Excessive production of cortisol

Primary

Benign or malignant adrenal tumor

Secondary

Increased release of ACTH

Iatrogenic

Long term glucocorticoid therapy

Term
Cushing's Manifestations
Definition

Central obesity, buffalo hump, rounded face

Hyperglycemia

Sodium retention

Hypokalemia

Thin, bruising skin

Altered immunity, risk for infection 

Depression

Changes in secondary sex characteristics

Term

Cushing's Lab & Diagnostics, Treatment,

Nursing Care

Definition

Plasma cortisol and ACTH levels

24-hour urine

Electrolytes

ACTH suppression test

 

Medications

Suppress activity of adrenal cortex

Inhibit cortisol synthesis

Surgery

Adrenalectomy

hypophysectomy

 

Fluid volume excess

Risk for injury/infection

Body image disturbance

Term
Addison’s Disease
Definition

Deficiency of cortisol, aldosterone, adrenal androgens

Autoimmune destruction most common cause

Abrupt withdrawal from steroids

 

Manifestations

Hyponatremia, hyperkalemia, hypoglycemia

Hypotension, syncope

Dizziness, confusion

N/V/D, weakness

Hyperpigmentation of skin

Term

Addison’s Disease

Lab & Diagnostics

Treatment

Nursing Care

Definition

Serum cortisol levels

Blood glucose

Electrolytes, CBC

Plasma ACTH

 

Replacement of corticosteroids

May result in Cushing-like syndrome

Increase dietary sodium

 

Fluid volume deficit

Knowledge deficit

Term
Pheochromocytoma
Definition

Tumor of adrenal medulla

Overproduction of catecholamines

Paroxysmal severe hypertension with tachycardia

Adrenalectomy

Term
Hyperaldosteronism
Definition

Causes

Tumor of the adrenal cortex

Chronic kidney disease

Manifestations

HTN, HA, muscle weakness, dysrhythmias

Adrenalectomy, aldactone

Term

Disorders of Anterior Pituitary

gigantism and acromegaly

 

Definition

Gigantism

Hypersecretion of GH prior to puberty

Results in excessively tall stature

 

Acromegaly

Hypersecretion of GH after puberty

Enlargement of face, hands, feet

Term
SIADH
Definition

High levels of ADH, suppression of aldosterone

Hyponatremia and water intoxication

Neuro symptoms

Decreased LOC, confusion, seizures

Treatment

Restrict fluids, treat underlying cause

Term
Anterior Pituitary
Definition

 

Growth Hormone

Prolactin

Thyroid-stimulating hormone (TSH)

Adrenocoricotropic hormone (ACTH)

Gonadotropin hormone

Follicle-stimulating hormone (FSH)

Luteinizing hormone (LH)

Term
Posterior Pituitary
Definition

 

Antidiuretic hormone (ADH)

Vasopressin

Oxytocin

Term
Thyroid Gland
Definition

 

Thyroid hormone

T4

T3

Calcitonin

Term
Parathyroid Gland
Definition

 

Parathyroid hormone

Term
Adrenal medulla
Definition

 

Catecholamines

Epinephrine

Norepinephrine

Term
Adrenal cortex
Definition

 

Mineralocorticoids

Aldosterone

Glucocorticoids

Cortisol & Cortisone

Term
Pancreas
Definition

 

Glucagon

Insulin

Somatostatin

Pancreatic polypeptide

Term
Gonads
Definition

 

Androgens

Estrogens

Progesterone

Term
Hormonal Control
Definition

 

Hormones regulate tissue responses

Feedback mechanisms

Negative

Sensors detect changes in hormone level and respond

Positive

Increased level of one hormone causes another gland to release a hormone

Term
Health Assessment Interview
Definition

Medical history

Family history

Changes in size or function of organs, skin, hair

Changes in thirst, appetite, weight, energy, sleep

Medications

Change in reproductive functioning

Term
Physical Assessment
Definition

Inspection of skin, hair, nails, facial appearance

Palpate thyroid

Motor function

Sensory function

Musculoskeletal structure

Assess for tetany

Term

Normal Older Adult Variations

Endocrine

Definition

Hyperpigmentation of forearms and hands

Decreased hair growth

Nails thick, brittle, yellow

Decreased sensation of touch

Decreased DTR

Term
Hyperthyroidism
Definition

Autoimmune reaction (Grave’s disease)

Excess secretion of TSH from pituitary

Neoplasms

Thyroiditis

Excessive intake of thyroid meds

Term
Thyroid Storm
Definition

 

Extreme state of hyperthyroidism

 

Infection, trauma, manipulation of thyroid during surgery can precipitate

 

Excessive metabolic symptoms

 

Temp elevation to 102-106

 

HTN, tachycardia, psychosis, delirium, seizure

Term
Cholelithiasis
Definition

 

Formation of stones

One stone or multiple

Stone formation occurs when bile crystallizes

75% cholesterol stones

25% pigment stones

Manifestations

Epigastric pain

Heartburn

Right upper quadrant pain

Jaundice ( with obstruction of the common bile duct)

Intolerance to fat-containing foods

Term

Cholelithiasis

contributing factors/6 F's

Definition

 

Contributing Factors

Stasis of bile in gallbladder

Increased bile concentration

Family history of gallstones

Race or Ethnicity

Female Gender

The Six F’s

Fair

Fat

Female

Fertile

Forty

Flatulent

Term
Cholecystitis
Definition

 

Inflammation of gallbladder

Stones in the cystic or common bile duct

Acute or chronic

Term
Acute cholecystitis manifestations
Definition

 

Severe pain from abdominal right quadrant to midline and posteriorly to scapular region

Nausea and vomiting

Fever

Elevated WBC

Elevated serum bilirubin, alkaline phosphatase

Elevated serum amylase

Term
Chronic cholecystitis manifestations
Definition

 

Less severe symptoms

Flatulence

Complications

Infection of biliary system

Peritonitis

Perforation

Pancreatitis

Term
Cholecystits labs/diagnostics
Definition

Lab Tests

CBC: elevated WBC due to infection & inflammation

Serum amylase & lipase: to determine presence of pancreatitis

Serum bilirubin levels: to ascertain either obstruction in biliary duct system(elevated direct bilirubin) or hepatic damage (elevated indirect bilirubin)

Diagnostic Tests

X-ray study of abdomen: Flat plate to visualize stones

Oral cholecystogram: to assess the GB’s ability to concentrate and excrete bile

Cholangiogram: to detect stones in biliary duct system

Ultrasonography: to detect stones, edema, or distention of GB

GB scans: Cholescintography (HIDA): nuclear medicine techniques to assess cholecystitis

Term
Cholecystitis Treatment/Nursing care
Definition

Pharmacology

Oral bile acids: dissolvers

Ursodeoxycholic acid (UDCA); used for cholesterol stones under 20mm in diameter

Chenodeoxycholic acid (Chenodiol): decreases amount of cholesterol in bile, causing stones to be more soluble

Treatments

Surgery: Cholecystectomy: removal of GB

Laproscope

Open with bile duct exploration and T-tube insertion

Cholecystostomy: permits drainage of GB

Choledochostomy: allows for removal of stones & placement of T-tube in the common bile duct

Lithotripsy

Percutaneous stone dissolution- ERCP

Nursing Care

Pain

Altered nutrition due to N/V, & impaired fat metabolism

Risk for impaired gas exchange

Risk for infection

Term
Cancer of the Gallbladder
Definition

Rare, primarily affecting people over 65

 

Women more likely to develop

C/O of intense pain in RUQ of abdomen

A mass may be palpated in the region

Jaundice and weight loss

Metastasize via blood, lymph system, or direct extension

Poor prognosis

Term
Hepatitis
Definition

Inflammation of liver

Viral or toxic

Acute or chronic

Most common liver disorder

Endemic in underdeveloped countries

Majority are Type A or B

Most frequently affects young adults

Risk factors vary with type

Term
Hepatitis Types- nonviral
Definition

Alcoholic

Necrosis of hepatocytes and inflammation of liver tissue

Toxic

Acetaminophen most common

Hepatobiliary

Caused by cholestasis

Term
Hepatitis A
Definition

Infectious hepatitis

Transmission: fecal-oral route, contaminated food, water

Contagious through stool 2 weeks before symptoms occur

Self-limiting, symptoms last up to 2 months

Term
Hepatitis B
Definition

Transmission: blood and body fluids

Liver cells damaged by immune response

High risk populations

Health care workers

IV drug users

Person’s exposed to blood products

Term
Hepatitis C
Definition

Transmission: blood and body fluids, IV drug use most common

Primary worldwide cause of chronic hepatitis, cirrhosis, and liver cancer

Term

Acute Viral Hepatitis

phases

Definition

Incubation phase

Pre-icteric phase

"Flu-like" symptoms, malaise, fatigue

N/V/D, anorexia

HA, muscle aches, polyarthritis

Icteric Phase

Jaundice

Pruritus

Lighter-colored stool

Brown urine

Decrease in pre-icteric phase symptoms (appetite improves, no fever)

Post-icteric/Convalescent Phase

Serum bilirubin and enzymes return to normal levels

Energy level increases

Pain subsides

GI symptoms: minimal to absent

Term
Fulminant Hepatitis
Definition

Rare sequela of viral hepatitis

Hepatic encephalopathy

Widespread necrosis of the parenchyma

Liver actually shrinks

Term
Chronic Persistant Hepatitis
Definition

Benign, results from either HBV or HCV infections

Low serum transferase levels

Usually does not progress to cirrhosis

Malaise, mild fatigue, hepatomegaly

Diagnosed by liver biopsy

No specific treatment

Term
Chronic Active Hepatitis
Definition

Life threatening

Progresses to cirrhosis with liver failure

Fatigue is common

Results from hepatotoxic drug administration, HBV or HCV

Liver biopsy plus other dx and lab tests

Term

Hepatitis

Lab & Diagnostic Tests

Definition

Anti-HAV

IgM anti-HAV

HBsAG: hepatits B surface antigen

HBeAG

Anti-HBs

Anti-HBe

Anti-HBc-IgM

ADAg

Alkaline phosphatase (ALP)

Gamma-glutamyl transferase (GGT)

Alanine aminotransferase (ALT)

Aspartate aminotransferase (AST)

LDH5

Conjugated & unconjugated bilirubin levels

Prothrombin time

Term
Liver Biopsy: Your Role
Definition

Pre-biopsy preparation

Review the procedure w/ pt

Pt should be NPO for 4-6 hrs before biopsy

Have pt void before biopsy

Record baseline vital signs

Review chart for H&H, platelet count, bleeding & clotting times

Post-procedure

Right after procedure, apply direct pressure

Instruct pt to lie on the right side to keep pressure on the site for two hours

Strict bedrest for at least 6 hours

Monitor vital signs frequently for 4-6 hrs

Notify physician if BP differs markedly from baseline or if pt in severe pain

Keep pt. NPO for two hours. Then resume previous diet

Instruct pt. Not to cough hard or strain for 2-4 hr & avoid lifting or strenuous activities for 1 week

Term
Hepatitis Pharmacology
Definition

Pre-exposure Prophylaxis

Hep A clinical illness can be avoided in up to 90% of cases when immune globulin is given

Hep B prophylaxis is recommended for people at risk. Nurses & health care workers need to be vaccinated

Post-exposure Prophylaxis

Hep A: single dose of IG as soon as possible after exposure

Hep B: Hepatitis B immune globulin (HBIG) for short-term immunity. HBV vaccine given concurrently for long-term immunity

Term
Collaborative Care: Viral Hepatitis
Definition

Bedrest

Clear liquids initially then encourage a high calorie, high protein, high carb, low fat diet

Pruritus-frequent skin cleaning

Vitamin supplements (B-complex, K)

Avoid alcohol and drugs detoxified by liver

Emotional support

Home Care Teaching

During acute phase

No sharing of eating utensils, bath towels

Avoid sexual and close personal contact

Avoid hepatotoxic substances

Term
Cirrhosis
Definition

Diffuse inflammation and fibrosis

Drastic structural changes

Significant loss of function

Complications: Portal hypertension, bleeding, ascites, hepatic encephalopathy, esophageal varices, bacterial peritonitis

Term
Cirrhosis Manifestations
Definition

Portal hypertension

Elevated B/P within portal vein

Blood rerouted to other veins with normally lower B/P (collateral circulation)

Veins affected become engorged & congested

Esophagus

Rectum

Abdomen

Splenomegly

Ascites

r/t increased hydrostatic pressure in vessel lumen

Hypoalbuminemia

Hyperaldosteronism

Esophageal varices

Hepatic encephalopathy

Term
Laennec’s (Alcoholic) Cirrhosis
Definition

ETOH causes fatty infiltration

Inflammatory cells cause necrosis, fibrosis and destruction

Liver shrinks and becomes nodular

Clinical symptoms: anorexia, malaise,weight loss, low-grade fever, jaundice, ascites, hemorrhage,encephalopathy

Term
Cardiac Cirrhosis
Definition

Etiology: chronic right-sided CH

Liver enlarged

Changes reversible if CHF is successfully treated

Fibrosis with long standing CHF

Term

Cirrhosis

Labs and Diagnostic Tests

Definition

 

Serum electrolytes

 

CBC w/ platelets

 

Bilirubin measurements

 

Total protein, serum albumin, and ammonia levels

 

Coagulation studies

 

Serum glucose values

 

Liver enzyme studies

 

Diagnostics

Ultrasound

Liver biopsy

Esophagoscopy

Term

Cirrhosis

pharmacology/surgical procedures

Definition

Pharmacology

Diuretics: Spironolactone (Aldactone), furosemide (Lasix)

Laxatives: Lactulose

Vitamin K

Antacids

Avoid meds metabolized by the liver

Surgical Procedures

Sclerotherapy per endoscopic procedure

Paracentesis for severe ascites

Peritoneovenous shunt: LeVeen shunt

Tranjugular intrahepatic portosytemic shunt (TIPS)

Liver transplant

Term
Cirrhosis Nutritional Considerations/Nursing Care
Definition

Sodium intake is restricted to under 2g/day

Fluid needs are calculated based on response to diruetic therapy, urinary, and serum electrolyte values

Dietary protein is adjusted to pt’s ability to handle nitrogenous load

Vitamin and mineral supplements based on lab values

Nursing Care

Fluid volume excess/deficit

Altered thought processes

Risk for injury: bleeding

Risk for impaired gas exchange

Impaired skin integrity

Term
Priorities in monitoring Cirrhosis
Definition

F&E

Ascites, edema, oliguria, hypotension

Hemorrhage

GI bleeding, hypotension, tachycardia

Infection

Fever, tachycardia, abnormal breath sounds, chills, malaise, cloudiness of body fluids

Neuro

Mental status impairment, change in sleep pattern, mood, behavior, perceptual ability, lethargy, slurred speech, poor coordination

Term
Cancer of the Liver
Definition

Linked with alcoholic cirrhosis and chronic hepatitis B and C

Mets: GI cancers, lung, breast

Poor prognosis

No early S&S

DX: Liver bx & CT scans

Treatment

Resection, Radiation, Chemotherapy

Not a candidate for liver transplant

Term
Hepatic Abscess
Definition

Often bacterial

Destroys healthy tissue leaving necrosis, inflammatory exudates, and blood

Acute onset with fever, vomiting, abd pain

CT or US

Tx: antibiotics

Term
Pancreatitis
Definition

Release of pancreatic enzymes into pancreatic tissue leading to hemorrhage and necrosis

10% mortality rate

Acute or Chronic

Term
Acute Pancreatitis
Definition

Autodigestion of the pancreas

Obstruction by gallstone

Obstruction of bile ducts

Back up of duodenal contents into pancreatic duct

Excess HCL causing sphincter spasm

Term

Acute Pancreatitis

Assessment Findings

Definition

Sudden severe pain in middle upper abdominal region that radiates to back

N/V, fever

Abdominal distension and tenderness

Diminished bowel sounds

Shallow, rapid breathing

Tachycardia, hypotension

Restlessness, confusion

Jaundice

Discoloration of abdomen and flanks

Elevated serum amylase and lipase levels

Elevated WBC and serum bilirubin level

Transient elevation in blood and urine glucose levels

AST/ALT may be elevated

In severe cases, serum calcium levels may drop

Abnormal ultrasound & CT of pancreas

Term
Complications of Acute Pancreatitis
Definition

Local

Pseudocyst

Abscess

Fistulas

Systemic

Diabetes

Hemorrhage, DIC

Hypovolemic shock

Sepsis

Renal failure

ARDS

Term

Acute pancreatitis

Collaborative Care

Definition

Relief of pain

Meperidine

Prevention or alleviation of shock

Albumin

Reduction of pancreatic secretions

NPO w/ NG tube to suction

Cimetidine (Tagamet) or ranitidine (Zantac) IV

Control of fluid and electrolyte imbalance

Lactated Ringer’s Solution

Prevention or treatment of infection

Peritoneal lavage

Antibiotics

Removal of precipitating cause, if possible

Surgery: Cholescystectomy to remove gallstones

Surgical resection of all or part of pancreas to remove necrotic tissue

For pseudocyst or abscess, percutaneous insertion of tubes placed for external drainage

Term
Acute Pancreatitis Nursing Care
Definition

Monitor vital signs

Observe fluid & electrolyte imbalances

Assess respiratory function

Observe for symptoms of tetany

Measures to relieve pain

Maintain hydration/nutrition

Observe for fever & other signs of infection

Term
Chronic Pancreatitis
Definition

Progressive, destructive disease of pancreas

Characterized by remissions & recurrences

Inflammation & fibrosis contribute to pancreatic insufficiency & diminished function

Chronic Pancreatitis

Two major types:

Chronic obstructive pancreatitis

Associated with biliary disease

Chronic calcifying pancreatitis

Also called alcohol-induced pancreatitis

Term

Chronic Pancreatitis

Assessment Findings

Definition

Upper abdominal pain radiating to the back

N/V with weight loss

Flatulence

Constipation

Steatorrhea

Manifestations of DM

Elevated serum & urinary amylase levels

Elevated serum bilirubin w/ jaundice

Term

Chronic Pancreatitis

Collaborative Care/Nursing Care 

Definition

Prevention of further attacks

Relief of pain

Control of pancreatic exocrine & endocrine insufficiency

Diet

Pancreatic enzyme replacement

Control of diabetes

Surgery

Nursing Care

After pancreatitis

Prevention of further attacks

Avoid alcohol, narcotics

Reporting symptoms

Pain, N/V, abdominal distention, steatorrhea, polyuria, polydipsia, polyphagia, weight loss, fever

Low-fat,low protein, high carbohydrate bland diet

Several small meals, vitamin supplements

Continuing medications

Pancreatic enzymes, bile salts, oral hypoglycemic agents or insulin

Need for continued medical follow up

Seek medical care when ill

Term
Cancer of the Pancreas
Definition

Usual site at head of pancreas at ampulla of Vater

Risk factors: Smoking, diabetes, high fat diets

S&S: anorexia, nausea, dull epigastric pain

Poor prognosis, usually mets before diagnosis

Term

Cancer of the Pancreas

Collaborative Care

Definition

Whipple procedure

Chemotherapy and radiation

Postoperative Care

Same as for any intestinal surgery

NG tube and suction

Pain management

TCDB

F&E

I&O (IV fluids/blood and monitor drains/tubes, etc)

Assess skin, color, temperature, moisture, turgor

Assess LOC

Vital signs

Monitor labs

Assess for hemorrhage, hyovolemic shock, hepatorenal failure

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