Shared Flashcard Set

Details

Nur 112 and 114 test 4
as the title says
250
Nursing
Undergraduate 2
04/28/2012

Additional Nursing Flashcards

 


 

Cards

Term
What may happen during emergence?
Definition

- Retching, vomiting and restlessness

 

- shivering, rigidity and slight cyanosis 

 

(caused by change in body temperature)

Term
Examples of general anesthesia inhalents 
Definition

- Nitrous oxide

- Fluothane

-Ethrane

 

(Nitrous oxide is obvious, the other 2 end in "ane")

Term
Exammples of IV anesthesia 
Definition

- Pentothal

 

- Ketamine

 

-Diprivan 

Term
common side effects of general anesthesia 
Definition

- Respiratory depression

 

- Hypotension

 

- Bradycardia

 

-N/V

 

- Dry mouth

Term
Complications of general anesthesia 
Definition

- Overdose

 

-unrecognized hypoventilation

 

- complications of intubation

 

- malignant hyperthermia

Term
Manifestations of malignant hyperthermia
Definition

Early signs = tachycardia, dysrhytmias, muscle rigidity, hypotension, cyanosis, muscle protein in urine, rise in end tidal CO2 level, low O2 sats

 

Late signs = extremely high temperature up to 110 degrees F

Term
Spinal (intrathecal) anesthesia 
Definition

- local anesthesia 

 

- injecting into subarachnoid space

 

- probably want to keep HOB flat to prevent spinal headaches 

Term
Complications of local anesthesia 
Definition

- possibility of allergies and toxicity (rare)

 

- diminished sensation 

 

- diminished motor response

 

-hypotension 

Term
Insufflation 
Definition

- injecting gas or air into body cavity to seperate organs and improve visualization 

 

- may contribute to complications and pt. discomfort 

Term
Advantages of inhalation general anesthesia 
Definition

- most controllable method

 

- induction and reversal accomplished with pulmonary ventilation

 

- few side effects

Term
Disadvantages of inhalation of general anesthesia 
Definition

- must be used in combination with other agents for painful or prolonged procedures

 

- limited muscle relaxant effects

 

- post-op nausea and shivering are common

 

- explosive 

Term
advantages of IV general anesthesia 
Definition

- rapid and pleasant induction

 

- low incidence of post-op N/V

 

-requires little equipment

Term
Disadvantages of IV general anesthesia 
Definition

- must be metabolized and excreted from the body for complete reversal

 

- contraindicated with hepatic or renal disease

 

- retained by fat cells 

Term
Advantages of local anesthesia 
Definition

- gag and cough reflexes intact

- cooperation/particpation by pt.

- less disruption of physical emotional body functions

- decrased chance of sensitivity to agent

-decreased intra-op stress

Term
Disadvantages of local anesthesia 
Definition

- difficult to give to uncooroperative pt.

 

- not way to control agent after adminster

 

-absorbs rapidly into blood causing hypotension or overdose

Term
Drug to administer for malignant hyperthermia 
Definition

Dantrolene Sodium

 

(skeletal muscle relaxant)

Term
Field Block
Definition
- series of injections around operative field 
Term
Nerve Block
Definition
Injection into or around one nerve or group of nerves 
Term
Epidural 
Definition
Injection into epidural space
Term
Signs of systemic toxic reaction from local anasthesia 
Definition
CNS stimulation followed by cardiac depression 
Term
Priority Nursing Dx. for intra-op pt's 
Definition

Risk for perio-op positioning injury

 

Risk for infection 

Term
Primary collaborative problem for intra-op pt's 
Definition
Potential for hypoventilation 
Term
Most important area to assess post-op
Definition
respiratory status 
Term
Positioning for post-op pt. 
Definition
side lying or at least head turned to side to prevent aspiration 
Term
Patients at risk for respiratory complications 
Definition

- COPD

- Obese patients

-Asthmatics

- Smokers

- elderly 

Term
What should you do anytime a pt. is restless or confused?
Definition
Check O2 sats 
Term
Clinical manifestations of hypoxia (Early signs)
Definition

- Tachycardia

-Tachypnea

- Dyspnea

- increased agitation

-restlessness

-anxiety 

- Diaphoresis

-retractions

-altered LOC

- With kids: nasal flaring, grunting, stridor, feeding problems

Term
Late Clinical manifestations of Hypoxia
Definition

- increased restlessness

-somnolence

-stupor

-dyspnea

-Bradycardia

-cyanosis 

Term
If a post-op pt's O2 sat drops by 10% and you are sure it is an accurate reading you should.... ?
Definition
call rapid response team
Term
A respiratory rate of <10/min post-op may indicate
Definition
anesthetic- or opiodanalgesic-induced depression 
Term
Rapid, shallow respirations post-op may indicate 
Definition

- shock

-cardiac problems

-increased metabolic rate

-pain 

Term
Use of accessory muscles, sternal retractions and diaphramatic breathing post-op may indicate
Definition
excessive anesthetic effect, airway obstruction or paralysis 
Term
Snoring or Stridor post-op may indicate 
Definition

Airway obstruction:

- tracheal or laryngeal spasm

-mucus in airway

-blockage from edema or tongue relaxation 

Term
When should you report B/P changes post-op
Definition

- when changes are 25% higher or lower than baseline

 

- report to anesthesia provider or surgeon 

Term
Bradycardia post-op may indicate
Definition

- an anesthesia effect

-hypothermia 

Term
Increased heart rate post-op could indicate
Definition

- hemorrhage

-shock

-pain 

Term
Order of return to consciousness after general anesthesia 
Definition

- muscular irritability 

- restlessness and delirium

-recognition of pain

-ability to reason and control behavior 

Term
Order of return of motor and sensory functioning after local anesthesia 
Definition

- sense of touch

-sense of pain

-sense of warmth

-sense of cold

-ability to move

Term
Decreased urine output post-op may indicate
Definition

- hypovolemia 

-renal complications 

Term
Manifestations of paralytic ileus 
Definition

-few or absent bowel sounds

-distended abdomen

-abdominal discomfort

-vomiting

- no passage of flatus or stool 

 

Term
Color of Normal NG tube drainage 
Definition
greenish-yellow
Term
Red NG tube drainage = 
Definition
active bleeding 
Term
Brown with coffee ground NG tube fluid or drainage = 
Definition
old bleeding 
Term
Priority nursing Dx's for post-op patient 
Definition

- impaired gas exchange

-impaired skin integrity

-acute pain 

Term
Common collaborative problem for post-op pt. 
Definition
potential for hypoxemia (low blood oxygen)
Term
What to do should an Evisceration occur
Definition

- call for help (help should call doctor)

-cover with sterile saline soaked gauze

-assess for shock

-pt. in supine w/ hips and knees bent

-HOB 15-20 

-vital signs

-prep for surgery 

Term
Common drugs given by PCA
Definition

- morphine

-meperidine

-hydromorphone 

Term
Drugs given by epidural cath. include
Definition

- Fentanyl (sublimaze)

- Duramorph

-bupivacaine (Marcaine)

Term
Emergency care of pt. with Benzo overdose
Definition

- secure airway and IV access

-preapre to administer flumazenil

-repeat drug q 2-3 min

-give O2 if hypoxic or below 10/min

-have suction ready 

Term
Side effects of flumazenil 
Definition

-skin rash

-hot flashes

-dizziness

-headache

-sweating

-dry mouth

-blurred vision 

Term
the inital obstruction of appendicitis is caused by 
Definition
fecaliths (very hard pieces of stool)
Term
Nausea and vomiting before abdominal pain may indicate 
Definition
gastroenteritis 
Term
Nausea and vomiting before abdominal pain may indicate 
Definition
appendicitis 
Term
What kind of pain is classically felt with appendicitis 
Definition
cramplike pain in the epigastric or periumbilical area
Term
McBuney's point 
Definition

RLQ between iliac crest and umbilus 

 

(where pain usually is as inflammation and infectin progress in appendicitis)

Term
Abdominal pain that increases with coughor movement and is relieved by bending the right hip or knee may indicate 
Definition
perforation and peritonitis 
Term

WBC count greater than 20K may indicate

 

 

(r/t appendicitis)

Definition
perforated appendix 
Term
Care of pt. with suspected appendicitis 
Definition

- NPO

-IV fluids

-Semi-fowlers

-Once confirmed admin. opiod analgesics and antibiotics 

Term
Appendectomy 
Definition
removal of appendix 
Term
Anesthetics 
Definition
drugs that reduce or eliminate pain by depressing nerve function in the CNS and/or PNS
Term
Normal PSA level 
Definition
< 4 ng/mL
Term
Observation without immediate active treatment 
Definition
watchful waiting or expectant therapy 
Term
Local thearpies for prostate cancer
Definition
surgery and radiation 
Term
systemic therapies for prostate cancer
Definition
a variety of drugs 
Term
Strongest risk factor for prostate cancer
Definition
Age
Term
Signs and symptoms of prostate cancer
Definition

-typicall none in early stages 

-urinary frequency

-impotence

-pain

-weakness/numbness

-loss of bladder and bowel control

-Hematuria (later sign)

Term
Side effects of Androgen Deprivation Therapy 
Definition

- reduced/loss of libido

-breast tendernes and growth

-elevated cholesterol

-decreased mental acuity

-impotence 

-anemia

- decreased muscle mass

-osteoporosis 

-hot flashes

-weight gain

-fatigue 

-depression 

Term
Chemotherapy side effects 
Definition

-fatigue

-loss of appetite

-N/V

-Hair loss

-mouth sores

-anemia

-decreased WBC count (risk for infection)

-low platelets (easy brusing and bleeding)

Term
What is Biphosponates (Zometa) used for in the treatment of prostate cancer
Definition
to decrease bone pain 
Term
Priority assessment for post-op prostatectomy is
Definition
hemorrhage
Term
After treatment for prostate cancer, what does an elevated PSA most likely indicate?
Definition
A recurrence of the prostate cancer
Term
Most common signs of colorectal cancer
Definition

-rectal bleeding

-anemia

-change in stool 

Term
Most common site for colon cancer to metastasize to
Definition
the liver
Term
Lab assessment for colon cancer
Definition

- H&H usually decreased

-fecal occult blood test postive

**a negative does NOT mean colon cancer is not present**

- possible elevation of carcinoembryonic antigen

Term
Stage 1 cancer
Definition
tumor invades up to muscle layer 
Term
Stage II cancer
Definition
tumor invades up to other organs or perforates perioteneum 
Term
Stage III cancer
Definition
any level of tumor invasion and up to 4 regional lymph nodes
Term
Stage IV cancer
Definition
any level of tumor invasion; many lymph nodes affected with distant metastasis 
Term
Mechanical intestinal obstruction 
Definition

-Intussuception

-Volvolus 

Term
Non-mechanical intestinal obstruction 
Definition

- paralytic ileus

-adynamic ileus 

Term
Manifestations of mechanical obstruction 
Definition

- midabdominbal pain/cramping

-vomiting

-obstipation (no stool)

-Diarrhea

-alteration in bowel pattern

-abdominal distention

-Borborygmi (rumbling or gurgling sounds)

-abdominal tenderness 

Term
Clinical manifestations of non-mechanical obstruction 
Definition

- constant, diffuse discomfort

-abdominal distention

-decreased/absent bowel sounds

-vomiting

-obstipation ( no stool)

-electrolyte imabalance 

Term
What is dronabinol (marinol) used for
Definition
stimulate appetite 
Term
Best diagnostic test for cholecystitis 
Definition
ultrasound of RUQ
Term
Cholangitis 
Definition

- inflammation of common bile duct

 

-complication of cholecystitis 

Term
Nursing Dx's for pt. with Cholecystitis 
Definition

-acute pain

-risk for infection

-impaired gas exchange

-nausea

-imbalanced nutrition

-fluid and electrolyte imbalances

-activity intolerance

-risk for anxiety 

Term
Risk factors for pyelonephritis 
Definition

- pregnancy

-structural defects (reflux)

-obstruction

-diabetes 

Term
Manifestations of actue pyelonephritis 
Definition

-fever

-chills

-flank, back, loin pain

-burning, urgency, frequency, dysuria

-general malaise

-fatigue 

Term
Advantages of Ambulating after surgery 
Definition

- gets rid of CO2

-motility 

-peristalsis 

-increase circulation 

Term
Labs/Diagnostics for Nephritis 
Definition

-Urinalysis (WBCs, protein, bacteria, RBCs)

-urine culture

-KUB

Term
complications of Nephritis 
Definition

-kidney failure

-sepsis 

Term
Nursing Dx's for Nephritis 
Definition

- acute pain

- infection/risk for infection

-imbalanced nutrition

-risk for fluid volume excess/deficit

-deficient knowledge 

Term
Non-surgical interventions for Nephritis
Definition

-IV antibiotics

-hydration

-nutrition

-cranberry juice 

Term
pyelolithotomy 
Definition
getting rid of stones 
Term
Cholecystitis 
Definition
inflammation of the gallbladder
Term
calculous cholecystitis 
Definition

When you have stones and inflammation

 

(most common type)

Term
Acalculous Cholecystitis 
Definition
inflammation without stones 
Term
clinical manifestations of acute cholecystitis 
Definition

-RUQ pain (usually severe and comes and goes)

-Murphys sign (pain with deep breath)

-Bloomburgs sign (rebound pain)

-pain after eating (food not being digested)

-N/V

-Dyspepsia 

-Flatulence

-fever (because of inflammation)

Term
Clinical manifestations of chronic cholecystitis 
Definition

-Jaundice (obstructive)

-itching or burning of skin due to toxic accumulatio of bile salts

-clay colored stools

-dark urine

-steatorrhea (fatty stools)

Term
The person who is most at risk for cholecystitis 
Definition

-female

-fertile

-fat

-forty 

Term
Risk factors for cholecystitis 
Definition

- women (20-60 yrs)

-multiple pregnancies 

-estrogen

- >60 years

-obesity

-family hx (eat same foods)

- Diabetes (increased triglycerides)

-The four F's

-American indian, Mexican, caucasian 

Term
Manifestations of chronic pyelonephritis 
Definition

-HTN

-Nocturia

-fluid and electrolyte imbalance

-possible hyperkalemia 

Term
Labs/diagnostic tests for glomerulonephritis 
Definition

-BUN and Creatinine are elevated

(normal BUN = 6-20, normal creatinine = 0.6-1.1)

-Urinalysis (bacteria, protein, blood)

-GFR (normal is 90-120mL/min)

anything < 60 is r/t kidney disease

anything < 15 is kidney failure 

-Biopsy 

Term
Risk factors for Glomerulonephritis 
Definition

-steptococcal infection

-systemic lupus erythematosus

-diabetic nephropathy (nephrons get hard and don't function properly)

Term
Nursing Dx's for glomerulonephritis 
Definition

-fluid volume excess

-acute/chronic pain

-risk for imbalanced nutrition (less than)

-anxiety

-infection/risk for infection 

Term

Prostate cancer is ____1_____ growing and _______2_____ in a _________3_________

pattern.

Definition

1. slow

2. metastasizes

3. predictable 

Term
Men older than ________ years have the greatest risk for prostate cancer
Definition
65
Term
First symptoms that may be reported with prostate cancer
Definition

-difficulty in starting urination

-frequent bladder infections

-urinary retention 

Term
Bone pain is a symptom associated with ___________ prostate cancer
Definition
advanced
Term
Most common manifestation of late prostate cancer
Definition
Gross blood in urine (hematuria)
Term
Manifestations of glomerulonephritis 
Definition

-edema (especially periorbital and facial)

-dark and cloudy urine

-increased B/P

-fatigue

-flank pain, back pain

-proteinuria

-hematuria

-decreased glomerular filtration 

Term
TURP
Definition

Transurethral resection of the prostate

 

(not curative treatment)

Term
laparoscopic radical prostatectomy 
Definition

- MIS

-patients must have PSA <10 ng/mL and no previous hormone therapy

-is a curative treatment

-may experience temporary ED

Term
Complications of external beam radiation for prostate cancer
Definition

-ED

-persistant pain

-hematuria 

Term
Three Lutenizing hormone releasing hormone agonists 
Definition

-leuprolide (Lupron)

-goserelin (Zoladex)

-triptorelin (Trelstar)

Term
Side effects of LH-RH agonists 
Definition

-hot flashes

-ED

-decreased libido

-gynecomastia (breast tenderness and growth)

Term
Three anti-androgen drugs
Definition

-flutamide (Eulexin)(Euflex)

-bicalutamide (casodex)

-nilutamide (nilandron)

Term
cryotherapy 
Definition

-MIS

-reserved for those whose cancer is confined to prostate gland

-liquid nitro freezes the gland causing cell death

-high risk for urinary incontinence and ED

Term
complications r/t increase growth of colorectal tumor 
Definition

-bowel obstruction

-perforation w/ peritonitis

-abcess formation

-fistulas 

Term

Normal PSA level 

 

(prostate-specific antigen)

Definition
< 4 ng/mL
Term
Foods that may increase the risk of colorectal cancer
Definition

- high fat like red meats

-friend and grilled meats and fish

-excess of refined carbs

-decreased fiber 

Term
What a pt. with colorectal cancer may report 
Definition

-fatigue r/t anemia

-abdominal fullness

-vague abdominal pain

-unintentional weight loss

Term
common signs of colorectal cancer 
Definition

-rectal bleeding

-anemia 

-change in stool

Term
Definitive test for dx. of colorectal cancer 
Definition
colonoscopy 
Term
Priority nursing Dx. for pt. with colorectal cancer 
Definition
Anticipatory grieving 
Term
priority collaborative problem for pt. with colorectal cancer
Definition
potential for metastasis 
Term
Intussusception 
Definition
telescoping of a segment of the intestine within itself
Term
Volvulus 
Definition
twisiting of intestine 
Term
Manifestations of mechanical obstruction in small intestine 
Definition

-mid-abdominal pain or cramping

-pain can be sporadic 

-vomiting

-diarrhea (partial obstruction)

-obstipation (complete obstruction)

Term
Labs for intestinal obstruction 
Definition

-WBC normal unless strangulated obstruction

-H&H, creatinine and BUN are elevated indicating dehydration

-serum Na, Cl and K are decreased

-high obstruction mayhave metabolic alkalosis 

-low obstruction may have metabolic acidosis 

-

Term
Cholecystitis 
Definition
inflammation of the gallbladder
Term
icterus
Definition
yellow discoloration of the sclerae 
Term
Steatorrhea 
Definition
fatty stools due to lack of bile 
Term
Key features of cholecystitis 
Definition

-episodic or vaque increased abdominal pain or discomfort that can radiate to right shoulder

-pain triggered by fatty or high volume meal

-anorexia

-N/V 

-dyspepsia

-Eructation (belching)

-gas

-fullness

-rebound tenderness

-fever

-jaundice, clay colored stools and dark urine are most common with chronic 

Term
Cholecystectomy 
Definition
surgical removal of gallbladder 
Term
Pyelonephritis 
Definition
Bacterial infection in the kidney and renal pelvis 
Term
Key features of acute pyelonephritis 
Definition

-fever

-chills

-N/V

-tachycardia and tachypnea

-flank, back or loin pain

-tender costal vertebral angle

-abdominal, often colicky discomfort

-general malaise or fatigue

-burning, urgency or frequency

-nocturia 

Term
key features of chronic pyelonephritis 
Definition

-HTN

-inability to conserve Na

-decreased urine concentrating ability 

-tendency to develop hyperkalemia and acidosis 

Term
priority nursing Dx. for pt. with pyelonephritis 
Definition
Acute pain
Term
common collaborative problem for pt. with pyelonephritis 
Definition
potential for kidney failure 
Term
Pyelolithotomy 
Definition
stone removal from kidney 
Term
Nephrectomy 
Definition
removal of kidney
Term
Ureteroplasty 
Definition

ureter repair or revision

 

(for pt's with poor ureter valve closure or dilated ureters)

Term
Effects of glomerulonephritis 
Definition

-proteinuria

-hematuria

-decreased GFR

-edema

-HTN

Term
Manifestations of glomerulonephritis 
Definition

-edema in face, eyelids, hands and other parts of body

-fluid overload

-SOB

-crackles, neck vein distention

-hematuria

-fatigue, anorexia, N/V

(may be confused with congestive heart failure, especially in older adults)

Term
Ulcerative Colitis 
Definition

-widespread inflammation of mainly the rectum and rectosigmoid colon, but can spread to entire colon

-In mild cases the intestinal mucosa is hyperemic (increased blood flow), edematous and reddened 

-In severe cases the lining can bleed and small ulcers can occur 

Term
Manifestations of Ulcerative Colitis 
Definition

-stool contains blood and mucus

-tenesmus (unpleasant and urgent sensation to defecate)

-abdominal colicky pain (relieved with defecation)

-malaise, anorexia, weight loss 

Term
Incidence/prevalence of Ulcerative colitis 
Definition

- risk is 10 times greater when first degree relative has it

-peak age @ 20-40 and again at 55-65

- women more often in younger years, but same as men in older years

-those who don't smoke have increased risk 

Term
Complications of U.C. and Crohn's disease
Definition

-hemorrhage/perforation

-abcess formation

-toxic megacolon

-malabsorption

-non-mechanical obstruction

-fistulas

-colorectal cancer

-extraintestinal complications

-osteoporosis 

Term
Manifestations of U.C.
Definition

-vital signs usually WNLs with mild disease

-with severe disease there may be a low grade fever

-physical assessmet findings are usually non-specific and in milder cases the exam may be normal 

Term
Priority nursing Dx's for pt's with U.C.
Definition

-Diarrhea

-Acute/Chronic pain 

Term
Primary collaborative prob. for pt. with U.C.
Definition
potential for lower GI bleeding with possible anemia 
Term
Drug therapy for U.C.
Definition

-aminosalicylates

-glucocorticoids

-immunomodulators

-anti-diarrheal drugs 

Term
Surgical management of U.C. 
Definition

-colectomy (colon removal) and ileostomy

 

indications for surgery include, perforation, toxic megacolon, hemorrhage, dysplastic biopsy results, failure of conventional treatment and colon cancer

Term
Crohn's disease 
Definition

-inflammatory of small intestine, colon or both

-skip lesions

-all layers are affected

-severe diarrhea and malabsorption

-fistula formation

-occurs in adolescents or young adults 

Term
Symptoms of Appendicitis 
Definition

-N/V

-abdominal pain

-anorexia

-rebound pain

-with perforation there is an increase in pain with coughing or movement and relieved by bending right hip or knee and increased temperature 

Term
Interventions for appendicitis 
Definition

-NPO

-IVF

-semi-fowlers

-no smoking or gum

- never use enemas, laxatives or heat

Term
Electrolyte that MUST be controlled before surgery and why.
Definition

Potassium

 

-hyperkalemia increases the risk for dysrhytmias

 

-Hypokalemia increases cardiac irritability and increases recovery time from anesthesia 

Term
Potassium normal level and why it may be decreased or increased 
Definition

Normal = 3.5-5

Increased in - dehydration, renal failure, acidiosis, cellular tissue damage

 

decreased in - NPO status when K supplement isn't adequate, excessive use of diuretics, vomiting, malnutrition, diarrhea and alkalosis 

Term
Sodium normal levels and why it would increased or decreased
Definition

Normal = 135-145

increased in - cardiac or renal failure, HTN, increased use of normal saline, edema, dehydration 

 

decreased in - NG drainage, vomiting or diarrhea, excessive use of laxatives or diuretics, increased IVF using water 

Term
Chloride normal levels and why it would be decreased or increased 
Definition

normal = 98-106

increased in - respiratory alkalosis, dehydration, renal failure, increased use of IVF using NaCl

 

decreased in - increased NG drainage, vomiting, excessive use of diuretics, diarrhea 

Term
CO2 normal levels and why it would be increased or decreased 
Definition

normal = 23-30

increased in - chronic pulmonary disease, intestinal obstruction, vomiting, or NG suction, metabolic alkalosis

 

decreased in - hyperventilation, diabetic ketoacidosis, diarrhea 

Term
Glucose (fasting) normal levels and why it would be increased or decreased
Definition

normal = 70-110

increased in - hyperglycemia, increased IVF using glucose, stress, steriod use, pancreatic or hepatic disease

 

decreased in - hypoglycemia, excessive insulin 

Term
Creatinine normal levels and why it would be increased or decreased 
Definition

normal = 0.5-1.2

increased in - renal damage, renal insufficiency, acute renal failure, chronic kidney disease and end stage kidney disease

 

decreased in - atrophy of muscle 

Term
BUN normal levels and why it would be decreased or increased 
Definition

normal = 10-20

increased in - dehydration, renal failure, increased protein in diet, liver failure

 

decreased in - overhydration, malnutrition 

Term

Increased surgical risk or post-op complications 

(age)

Definition
65 yrs +
Term

Increased surgical risk or post-op complications

(meds)

Definition

-antihypertensive drugs

-tricyclic antidepressants

-anticoagulants

-NSAIDs

Term
Vital signs that require reporting pre-op
Definition

- elevated temp.

-very high or very low B/P

-increased HR

Term
Risk factors for DVT/PE
Definition

-obese

-40+

-have cancer

-immobility 

-spinal cord injury

-Hx of DVT/PE, varicose veins or edema

-oral contraceptives

-smokers

-decreased cardiac ouput

-ortho surgery 

Term
Cardiac problems that increase surgical risks 
Definition

-CAD

-angina

-MI within 6 months

-heart failure

-HTN

-dysrythmias 

Term
Depleted protein stores increases risk for ... 
Definition

-skin breakdown

-delayed wound healing

-possible dehiscence or evisceration 

-dehydration

-sepsis 

Term
Priority nursing Dx. for pre-op pt's 
Definition

-Deficient knowledge

-anxiety 

Term
Largest risk of anesthesia 
Definition

Cardiopulmonary depression

 

**monitor airway mangement**

Term
Non-surgical treatment of fistulas 
Definition

-adequate nutrition and fluid and electrolyte balance

-monitor urinary output

*a decrease indicates possible dehydration

- at least 3000 calories daily to promote healing

-prevent skin irritation from drains 

Term
Peptic ulcer
Definition
a mucosal lesion of the stomach or duodenum 
Term

Peptic ulcer disease 

 

(PUD)

Definition
results when mucosal defenses become impaired and no longer protect the epithelium from acid and pepsin 
Term
Three types of ulcers 
Definition

- gastric

-duodenal

-stress 

Term
Three things that play an important role in the development of a gastric ulcer 
Definition

-acid

-pepsin

-H. pylori infection 

Term
Duodenal ulcers 
Definition

- upper portion of duodenum (most often)

-high gastric acid secretion 

-pH levels are low (excess acid) in duodenum

-protein rich meals and calcium and vagus nerve excitation stimulate acid secretion 

Term
Stress ulcer 
Definition
acute gastric mucosal lesions occuring after an acute medical crisis or trauma such as head injury and sepsis 
Term
Key features of a peptic ulcer 
Definition

-upper GI bleed

-bright red or coffee ground vomit

-tarry stools or frank blood in stool

-melena

- decreased B/P

-increased, weak, and thready pulse

-decreased H&H

-vertigo

-acute confusion

-dizziness

-syncope

Term
complications of peptic ulcers 
Definition

-hemorrhage

-perforation 

-pyloric obstruction

-intractable disease 

Term
Coffee-ground blood (hematemesis) vomit usually indicates 
Definition

bleeding at or above the duodenoljejunal junction 

 

(upper GI bleeding)

Term
Peptic ulcer formation is associated primarily with 
Definition
NSAID use and H. pylori infection 
Term
Manifestations of peptic ulcer 
Definition

-epigastric tenderness

-initially hyperactive bowel sounds that may diminish with progression

-dyspepsia (most common reported sign)

-abdominal pressure or fullness or hunger

-gastric ulcer pain = upper epigastric and aggravated by food

-duodenal pain = right of epigastric pain and occuring 90min to 3 hrs after eating

Term
Labs for PUD
Definition

- decreased H&H

-positive occult blood 

Term
Major diagnostic test for PUD
Definition

esophagogastroduodenoscopy

 

EGD

Term
Priority nursing Dx. for pt. with PUD
Definition
Acute or chronic pain 
Term
most important collaborative problem wtih PUD
Definition

potential for GI bleeding 

 

Others: 

potential for shock

potential for metabolic alkalosis 

Term
primary purposes of drug therapy for PUD
Definition

- provide pain relief 

-eliminate H. pylori infection

-heal ulcerations

-prevent recurrence 

Term
Common drug regimen for H. pylori infection 
Definition
a proton pump inhibitor (lansoprazole (Prevacid)) and 2 antibiotics such as metronidazole (Flagyl, Novonidazol) and tetracycline or clarithromycin and amoxicillin 
Term
Three classes of drugs that are hyposecretory drugs 
Definition

- proton pump inhibitors

-H2-receptor antagonists

-prostaglandin analogues 

Term
PPI's 
Definition

- drug class of choice for treating acid r/t disorders

 

examples: Prilosec, Prevacid, Acipnex, protonix, Nexium 

Term
H2 - receptor antagonists 
Definition

-block histamine-stimulated gastric secretions

 

examples: Zantac, Pepcid, Axid 

Term
Prostaglandin analogues 
Definition

-effective with duodenal ulcers

-reduce gastric acid secretion 

example: Cytotec 

adverse effect is uterine contraction 

Term

Nutrition therapy for PUD

 

Definition

-bland diets

-avoid caffeine

-avoid all coffee

-avoid bedtime snacks

-avoid alcohol and tobacco 

Term
Antacids 
Definition

-buffer gastric acid

-mylanta and Maalox

-take 2 hrs. after meals

-TUMs triggers gastrin release so it's not recommened 

-those with past or present heart failure need to avoid aluminum hydroxide, magnesium hydroxide, sodium bicarbonate, and simethicone combons (Gelusil and Mylanta)

Term
symptoms and treatment of pyloric obstruction 
Definition

-feeling of fullness, distention, nausea after eating, vomiting undigested food

 

-restoring fluid and electrolyte balance and decompressing the dilated stomach 

Term

PPI's

 

 

 

 

 

 

(from Lilley book)

Definition

-Prevacid, Prilosec, Aciptlex, Protonix and Nexium

 

- may increase serum levels of diazepam and phenytoin

 

-take on empty stomach

Term

H-2 receptor antagonists

 

 

 

 

 

 

(from lilley book)

Definition

- most popular

-cimetidine, ranitidine, famotidine and nizatidine

(all end in dine)

-should be taken 1-2 hours before antacids

-smoking decreases the effects 

Term
Ulcerative colitis 
Definition

-ulcers in colon and/or rectum

-usually starts in rectum and moves up

-rarely affects small intestine

-only affects mucosa lining

-15-25 yrs of age and 55-65 years of age

Term
Manifestations of U.C.
Definition

-Diarrhea (liquid, runny, bloody) - 20+ stools daily

-lower abdominal pain

-constant need to defecate and pain and burning in rectal area

-blood stools

-malaise

-anorexia

-mild weight loss

Term
Labs and diagnostics for U.C.
Definition

- decreased H&H (bloody stools)

- increased WBC (inflammation)

- increased ESR (indicates inflammation)

- decreased electrolytes (diarrhea)

-hypoalbuminemia (undigested food)

 

-colonscopy = best diagnostic tool 

Term
Most common complications of U.C.
Definition

- hemorrhage (lower GI bleed)

-perforation

-abscess

-colon cancer

**1/3 die of colon cancer

Term
Less common complications of U.C.
Definition

-toxic megacolon

-bowel obstruction

-malabsorption

-extraintestinal problems

*eye disorders, arthritis, etc. 

Term
Nursing Dx's for U.C.
Definition

-diarrhea

-risk for deficient fluid volume

-acute pain/chronic pain

risk for imbalanced nutrition (less than)

-disturbed body image

-electrolyte imbalances

-impaired skin integrity 

Term
Nutritional therapy for U.C.
Definition

-NPO

-TPN

-low fiber diet

Term
Drug therapy for U.C.
Definition

-aminosalicylates

(sulfasalazine, mesalamie (ROWASA = enema or supp, ), balsolazide)

-glucocorticoids (predinisone) (need to be on calcium, not for long term use, increases glucose)

-antidiarrheal (Lomotil and Immodium) (for short term use, when used long term = bowel dilation)

 

Term
Crohn's disease 
Definition

-affects usually small intestine but can affect the colon

-affects all layers (transmural)

-skip leasions

-causes bowel to be thick

- 15-40 yrs of age

Term
Manifestations of Crohn's 
Definition

-severe weight loss

-diarrhea (losse, soft stool, 5-6 stools per day)

-abdominal pain

-fever

Term
Labs and diagnostics for Crohn's 
Definition

-anemia r/t malnutrition 

-decreased folic acid and B12

-decreased albumin

-increased ESR 

Term
complications of Crohns 
Definition

-sever malabsorption

-fistulas

-obstructions

-hemorrhage

-peritonitis r/t perforation 

Term
Nursing Dx. for Crohn's 
Definition

-impaired nutrition (less than)

-acute/chronic pain

-fluid and electrolyte imbalances

-risk for infection

-ineffective coping 

Term
Nutritional interventions for Crohns
Definition

-TPN

-supplements

-low residue (low fiber)

Term
Manifestations of PUD
Definition

-dyspepsia

-epigastric tenderness

-pain (gastric = 20-30 min after eating, Duodenum = 1-3 hr after eating)

-N/V

**most people ignore symptoms until pain is severe or bleeding occurs**

Term
Complications of PUD
Definition

-hemorrhage

-perforation

-peritonitis 

-fluid/volume loss

-obstruction (rare)

-intractable pain (pain that will not go away)

Term
Signs and symptoms of upper GI bleed 
Definition

-bright red (acute) or coffee ground (chronic) vomit

-melena (black tarry stools)

occult blood

-decreased B/P (fluid loss)

-increased pulse (compensation for B/P)

-vertigo

-light headed

-confusion 

Term
Nursing Dx. for PUD
Definition

-acute pain

-fluid volume deficit (during bleeding)

-N/V

-imbalanced nutrition 

Term
Managing GI bleed
Definition

-prevent hypovolemia and shock

-ABC's

-monitor VS

-monitor fluid status

-adminster fluid or blood

-heme test all excretions

-monitor labs

-acid suppression

-antibiotics

-EGD

=insert NGT/GI lavage 

Term
Urolithiasis 
Definition

kidney stones

 

presence of calculi in urinary tract 

Term
Nephrolithiasis 
Definition
stones in kidney 
Term
Ureterolithiasis 
Definition
stones in ureter
Term
risk factors for kidney stones
Definition

- young and middle aged caucasian males

-personal or family hx

-gout

-hyperparathyroidism

-urinary stasis and repeated infections

-loop diuretics, calcium antacids

-colo ingestions or other dark drinks 

Term
Causes of kidney stones
Definition

-urinary stasis

-urinary retention

-immobility 

-dehydration 

Term
Manifestations of kidney stones
Definition

-renal colic

-unbearable pain

-nausea

-vomiting

-pallor

-diaphoresis 

Term
Drug therapy for kidney stones
Definition

-morphine

-toradol (NSAID)

-antispasmodics (ditropan)

Term
Lithotripsy 
Definition

-shock waves

-conscious sedation

-continuous EKG monitoring 

Term
complications of kidney stones 
Definition

-hydrourter

-shock

-hematuria

-infection

-hydronephrosis

-permanent kidney damage 

Term
Nursing Dx. for kidney stones
Definition

-acute pain

-risk for infection

-knowledge deficit

-impaired urinary elimination

-risk for fluid volume deficit

-nausea

Term

BPH

 

Benign prostatic hyperplasia 

Definition

-glandular units in prostate undergo and increase in number of cells, resulting in elargement of prostate gland

 

-presents around 40 years but some don't show symptoms until about 60 or older 

Term
Potential complications of BPH
Definition

-hydronephrosis 

-hydroureter

-dilated renal pelvis

-hyperirritability, hypertrophy and development of cellules and diverticula

-urinary retention and reflux 

-impeded outflow of urine 

Term
Drug therapy for BPH
Definition

-5-Alpha reductase inhibitors (Proscar, Advodart)

-Alpha-1-Adrengic blocking agents (Flomax, Uroxatrol)

-alpha blockers (cardura, Hytrin)

Term
Other non-surgical measures for BPH
Definition

-saw palmetto and lycopene (watermelon)

-thermotherapy

-balloon urethroplasty

-intraurethral stents

-frequent sexual intercourse

-avoiding large quantities of fluid in a short period of time

-void as soon as you have the urge 

Term
TURP
Definition

-enlarged portion of prostate gland is removed

-pt. will have indwelling cath for at least a day

-CBI (continuous bladder irrigation)

Term
CBI
Definition

-3 way cath with 30-45 mL retention balloon

-traction via taping to abdomen or thigh

-uncomfortable urge to void continuously 

*teach them not to try and void because it will cause spasms*

-antispasmodic and pain meds

-small clots = normal 

Term
complications of TURP
Definition

-infection

-urinary incontinence

-ED

-post-op bleeding 

Term
ED
Definition
inability to achieve or maintain an erection for sexual intercourse 
Term
organic ED
Definition

-gradual deterioration of function

-may have decrease in firmness of penis and frequency of erections

-may be due to medical reasons 

Term
Functional ED
Definition
psychological reasons 
Term
causes of ED
Definition

-inflammation of prostate, urethra or seminal vesicles

-prostatectomy

-pelvic fractures

-lumbar sacral injuries

-parkinson or multiple sclerosis

-diabetes (major cause)

-smoking, alcohol

-antihypertensive drugs 

Term
Drugs for ED
Definition

-sukdebafil  (Viagra)

-vardenafil (Levitra)

-tadalafil (cialis)

 

(all end in fil)

Term
Pt. education for ED drugs 
Definition

-avoid alcohol before sexual intercourse

-common side effects include headaches, facial flushing and stuffy nose

-nitrates + ED drugs = HTN and decreased blood flow to vital organs 

Term
Vasodilating drugs for ED
Definition

-caverject

-paverine

-regitine

Term
Intraurethral ED drugs 
Definition
Alprostadil (MUSE)
Term
Nursing Dx. for ED
Definition

-disturbed body image

-sexual dysfunction

-risk for injury

risk for situational low self-esteem

-deficient knowledge 

Term
Drugs to treat hypercalciuria 
Definition

-thiazide diurectics (Diuril or HydroDIURIL)

-orthophosphate

-sodium cellulose phosphate 

Term
Signs and symptoms of hypovolemic shock 
Definition

-First sign may be restlessness

-increased B/P and anxiety are early signs

- difficult to arouse

- decreased B/P

-little urine output

-labored respirations 

Term
Populations at risk for N/V post-op
Definition

-Hx of motion sickness

-obese (fat cells retain anesthesia)

-Pt's with abdominal surgeries 

Term
What to do for evisceration 
Definition

*usually happens around 5-10 days post-op*

1. call for help (they call doctor)

2. cover with sterile saline soaked gauze

3. HOB 10-15 degrees with hips and kneeds bent

4. assess for shock

5. vital signs

6. do not attempt to put organs back inside

7. prep for surgery

8. document 

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