Study sets, textbooks, questions
Upgrade to remove ads
Med surg exam 3
Terms in this set (52)
normal hemoglobin 12-16
normal hematocrit 40-50%
AST and ALT are liver enzymes. they elevate with liver disease.
serum amylase and lipase elevate with pancreatic disorder.
elevated bilirubin indicated impaired secretion by the liver
liver detoxifies ammonia
-acute symptoms of inflammation
-gastric volume or intra-abdominal pressure is elevated
-caused by decreased or relaxed lower esophageal sphincter tone.
-dyspepsia- pain in chest
-dysphagia- difficulty swallowing.
-diet, pt education
-elevate head 6in. for sleep.
-sleep in left lateral decubitus position
-wear nonbinding clothing
-refrain from lifting heavy objects, straining, bent-over posture
-antacids- neutralize gastric acid
-histamine2 antagonist- decrease gastric acid secretions
-proton pump inhibitors-long acting inhibition of gastric acid secretion
-prokinetic (GI stimulants)- increased gastric emptying improve peristalsis.
HIATAL HERNIA-protrusion of stomach through esophageal hiatus of diaphragm into thorax.
-sliding hernia- most common.
-rolling hernia- quite rare. fundus rolls into thorax beside esophagus.
-sliding- heartburn, regurgitation, chest pain, dysphagia, belching.
-rolling- feeling of fullness, chest pain, worsening of symptoms in recumbent position.
-antacids, histamin receptor antagonists
-avoid eating in the late evening and avoid foods associated with reflux.
-remain upright after eating
GASTRITIS-inflammation of stomach lining
-acute and chronic gastritis
-etiology- H. pylori, E.coli, NSAIDS, alcohol, caffeine.
-chronic gastritis associated with risk of gastric cancer
-diagnosis- gold standard= endoscope w biopsy to detect h. pylori.
-rapid onset of epigastric pain
-pain relieved w food
-intolerance to fatty/spicy food
-neurological problems d/t lack of b12
-h. pylori infection- most common
-mucosal barrier fortifiers
-proton pump inhibitors
-triple therapy for pylori infections. proton pump inhibitor w two antibiotics.
-limit intake of food and spices that cause distress (tea, coffee, cola, chocolate, mustard, paprika, cloves, pepper, and hot spices)
-limit alcohol and tobacco
-once you're positive for pylori, you'll always be positive
PEPTIC ULCER DISEASE- mucosal lesion of the stomach or duodenum
-gastric mucosal defenses impaired- can't protect the epithelium against acid and pepsin
-acid, pepsin, and pylori play important role in development of gastric ulcers.
-epigastric tenderness located at the midline between umbilicus and xiphoid process
-sharp, burning, or gnawing pain. sensation of abdominal pressure, fullness, hunger.
duodenal ulcers- present as deep, sharply demarcated lesions that separate through the mucosa and submucosa into the muscularis propia.
stress ulcers- occur after acute medical crisis or trauma. associated w head injury, major surgery, burns, respiratory failure, shock, and sepsis.
-bleeding caused by gastric erosion.
peptic ulcer disease
drug therapy 4 goals
-provide pain relief
-eradicate pylori infection
H2 receptor antagonist
-drugs that block histamine stimulated gastric secretion
-may be used for indigestion and heartburn
-block action of H2 receptors of parietal cells.
-buffer gastric acid and prevent formation of pepsin- effective in healing of duodenal ulcers.
-aluminum hydroxide-constipates and magnesium hydroxide- laxative
-avoid bedtime snacks
-no alcohol or tobacco
Complications of ulcers
-intractable disease- pt no longer responds to conservative management. interference with ADLs
Ulcerative Colitis- widespread inflammation of the rectum/ rectosigmoid colon
-remissions and exacerbations of mucosal lining of the colon or rectum is affected.
-loose stools containing blood and mucus
-poor absorption of vital nutrients
-continuous inflammation of the colon.
-10-20 liquid bloody stools daily
-only affects inner most lining of the colon.
-barium contrast studies
-salicylate compounds- anti inflammatory effect.
-corticosteroids- given w/ exacerbations
-immunosuppresive drugs- after immune response
-antidiarrheal drug- symptomatic management.
-total proctocolectomy w permanent ileostomy.
-NPO during acute phase.
-post op nutrition critical
UPPER GI BLEED
-ppl on warfarin and liver disease have prolonged PT time
-hematemesis, melena starry black stool, occult bleeding
-emergency treatment required.
-CBC, BUN, PT, ABG's liver enzymes, blood glucose, type and cross, endoscopy.
IBS IRRITABLE BOWEL SYNDROME
-chronic or recurrent diarrhea, constipation, abdominal pain and bloating.
-criteria - abd pain relieved by defecation, abd distention, sense of incomplete evacuation of stool, presence of mucus in stool.
-more common in women
-educate pt to avoid problem stimulants
-eliminate problem foods
-drugs- bulk forming laxatives, antidiarrheal agents, anticholinergic agents, tricyclic antidepressants
-weakness in the abd muscle wall through which a segment of bowel or other abd structure protrudes
-NPO day of surgery
-procedures- laparascopy, conventional open herniorrhapy.
-post op care- elevate scrotum to prevent and control swelling. address difficulties in voiding that may occur, observe for signs and symptoms of complications
-mechanical- stool, tumors, adhesions, scarring, chron's.
-nonmechanical- obstruction, paralytic ileus, anesthesia.
-strangulated- obstruction resulting from tumors, hernias, fecal impactions, strictures.
-pain and cramping
-borborygmi (high pitched bowel sounds)
-decreased to absent vowel sounds
-acute inflammation of the vermiform appendix.
-abd pain in the epigastric area migrating to Mcburmey's point.
-N/V, rebound tenderness- palpate and it hurts when you let go.
-complications include peritonitis, sepsis, perforation, abscesses.
-acute inflammation of peritoneum and lining of abd cavity
-Rigid boardlike abdomen associated w/:
Low urine output
Compromised respiratory status
-bacterial or viral disease of the intestine
-Increase in the frequency and water content of stools or vomiting as a result of inflammation of the mucous membranes of the stomach and intestinal tract
-fluid balance, electrolytes
-control of N/V
chronic inflammatory bowel disease
-ulcerative colitis and chron's disease
-widespread inflammation of the rectum colon
-remissions and exacerbations of the mucosal lining of the colon or rectum is affected
-loose stools w blood and mucus
-poor absorption of nutrients
-10-20 liquid bloody stools per day
-only in the colon
-only affects inner most lining of colon
-Total proctocolectomy w/ permanent ileostomy- removal colon, rectum, anus with anal closure
Total proctocolectomy w/ continent ileostomy
Total colectomy w/ rectal mucosal stripping and ileoanal reservoir
-NPO during acute phase
-post op nutrition critical
-all layers of the bowel involved, mostly internal ileum.
-bowel fistulas- abnormal opening
-cancer of small bowel and colon can develop
-malabsorption of vitamins and nutrients
-discontinuous lesions, not continuous
-5-6 loose stools, rarely bloody
-can occur anywhere between mouth and anus
-conservative intestinal resection w anastamosis of healthy bowel. if disease spreads, ostomy.
-cbc, esr, colonoscopy, barium contrast studies, endoscopy.
CHRONS AND COLITIS DRUG THERAPY
-salicylate compounds- antiinflammatory
-corticosteroids- given w exacerbations
-immunosuppressive drugs- after immune response
-focus on providing nutrients that are deficient
-low fiber to minimize bowel stimulation
-protein and calories to facilitate healing
-volume, color, characteristic of drainage.
-same as above
-increase fluid intake
-caused by increased pressure within intestinal lumen.
-diverticulitis occurs when diverticula become inflamed.
-period of diarrhea and constipation
Occult blood loss and acute rectal bleeding leading to iron-deficiency anemia
Abscesses and bowel perforation leading to peritonitis
Fistula formation causing bowel obstruction
Bacterial overgrowth (in small-bowel diverticula) that leads to malabsorption of fat and vitamin B12
-high fiber intake may prevent and improve symptoms. and prevent diverticulitis
-avoid nuts, seeds, and popcorn
during acute diverticulitis
-Patients are NPO until bleeding and diarrhea subside
-Oral intake resumes with clear liquids and progresses to a low-fiber diet until inflammation and bleeding are no longer a risk
-A high-fiber diet is recommended unless symptoms of diverticulitis recur
GERD- common in middle aged adults. Relaxation of lower esophageal sphincters. Belching, pain, reflux, difficulty swallowing.
Hernias- sliding- hiatal. Rolling hernia.
Acute gastritis- bacterial, H. pylori. Chronic- autoimmune, but can be H. pylori
Appendicitis- low grade fever, rebound tenderness of right side, mcburney's sign
A-asymmetry of shape
C- color variation
look for signs of edema, moisture, vascular changes
-petechiaie- small circular red spots on skin due to internal bleeding.
-ecchymosis- bleeding under the skin due to bruising
-use palpation to confirm size of lesions and determine if they are raised or flat.
-hirsutism- excessive growth of body hair, which is a manifestation of hormonal imbalance.
nail clubbing- indicative of hypoxia
paronychia- inflammation of skin around nail
for pt's with dark skin, assess for
-Bacterial growths over 100,000= positive for infection
Less than 10,000= you're okay
-cultures for fungi, unroofing bacterial infections by puncturing outer surface and getting fluid, viruses by putting them on ice after they've been obtained.
-flaking of the stratum corneum
-scratching may results in secondary skin lesions, excoriations, lichenification, and infection
-water softens outer skin layer. lotions seal the moisture.
-scratching can cause more itchiness
-cool sleeping environment is helpful
-antibiotic ointments for blistering and infected skin
-topical corticosteroids for pain
-presence of papules or plaque of varying sizes
-removal of triggering substances
-avoid alcohol, warm environment.
phases of wound healing
2. fibroblastic or connected tissue repair phase
3. maturation or remodeling phase
-first intention resulting in a thin scar
-second intention(granulation) and contraction-a deeper tissue injury or wound
-third intention(delayed closure)- high risk for infection with a resultant scar
partial thickness wounds
-damage to epidermis and upper dermis
-heal by re-epithelialization within 5 to 7 days .
-skin injury followed by inflammation
full thickness wound
-damage extends to lower layers of dermis and subcutaneous tissue
-damaged tissue healed with granulation
-contraction develops in healing process
-tissue damage caused when skin and soft tissue are compressed between a bony prominence and external surface for a long time.
-pressure, friction, shear
high risk pts
-mental status changes
-capillary closing pressure
-pressure relief products and devices
Stage 1: non blanching, red
Stage 2: Open blister
Stage 3: Fat, subcutaneous tissue
Stage 4: Bone, tendon
-a wound that is exposed is always contaminated, but not always infected. contamination is the presence of organisms.
-infection is contamination with pathogenic organisms tot he degree that growth and spread cannot be controlled.
-high protein diet for wounds
-electrical stimulation increases perfusion
-hyperbaric oxygen therapy
-topical growth factors-stimulate cell growth and movement
-folliculitis- superficial infection involving only the upper portion of the follicle. Staph infection
-Furuncle (boil)—much deeper infection in the follicle. apply heat twice a day
-Cellulitis—generalized infection with either Staphylococcus or Streptococcus involving deeper connective tissue
HERPES SIMPLEX VIRUS
-Type 1 herpes simplex virus (HSV-1)—classic recurring cold sore. Contact precaution
-Type 2 herpes simplex virus (HSV-2)—genital herpes. Contact precaution
-Herpes zoster (shingles)
-Herpetic whitlow—a form of herpes simplex infection occurring on the fingertips of medical personnel who have come in contact with viral secretions
Caused by reactivation of the dormant varicella-zoster virus in patients who have previously had chickenpox.
Multiple lesions occur in a segmental distribution on the skin area innervated by the infected nerve.
Eruption lasts several weeks.
Postherpetic neuralgia occurs
after lesions have resolved.
FUNGAL INFECTIONS - dermatophyte
Tinea pedis- foot
Tinea manus- hand
Tinea cruris- groin
Tinea capitis- head
Tinea corporis- whole body
Tzanck smear- look for viral infection.
Swab culture- bacterial test
Potassium hydroxide (KOH) test- test for fungal infection. Look at sample under microscope.
-pediculosis- human lice
-Head lice—pediculosis capitis
Body lice—pediculosis corporis
Pubic or crab lice—pediculosis pubis
-pruritus most common symptom
-launder clothing and linens
SCABIES- caused by mite infestation
-transmitted by close and prolonged contact or infested bedding.
-examine skin between fingers and palms.
-infestation confirmed by examination of a scraping of a lesion under a microscope.
-lifelong disorder w exacerbations and remissions
-Scaling disorder with underlying dermal inflammation; possibly an autoimmune reaction
-Exfoliative psoriasis—an explosively eruptive and inflammatory form of the disease
-Corticosteroids- suppress inflammation/ cell division
Tar preparations- reduce inflammation
Other topical therapies
Ultraviolet light therapy
Keloids-overgrowth of scar
-actinic keratoses- premalignant lesions. exposure to sun.
-squamous cell carcinoma.
-basal cell carcinoma
-melanomas- highly metastatic, survival depends on early diagnosis and treatment
Cryosurgery- liquid nitrogen on lesions
Curettage and electrodesiccation- cut lesion off and use electro to kill anything that's left
TOTAL ENTERAL NUTRITION
-pts who can eat but cannot eat orally
-pts who have permanent neuromuscular impairment and cannot swallow.
-abd distention, N/V
-start slow when you first feed someone
-Bring it to room temperature and leave it for 1 hour. Check electrolyte panel. Put it on a filter. Blood glucose check twice a day. Hang dextrose 10% if you run out of parenteral nutrition.
-partial parenteral- pt is also eating food.
-diet high in fat and cholesterol
-drugs- hypertension drugs can make ppl sleepier
-familiar and genetic factors
Diet programs- low calorie diet
Drug therapy—Xenical (BMI 27 w/comorbidities)
Complementary and alternative therapies—acupuncture, acupressure, ayurvedic therapy hypnosis
BARIATRICS- deals w/ treating obesity
restrictive procedure- interferes w capacity of volume stomach.
malabsorption procedure- deals w absorption
laparascopic adjustable gastric band- creates two compartments of the stomach. (restrictive)
laparascopic sleeve gastrectomy- excising part of the stomach. (restrictive)
gastric bypass- roux en Y- small pouch of stomach connected to small intestine. High success rate. Will maintain weight loss after 20 years.
Can have leakage or bleeding.
-pt and staff safety
-assess for anastomic leaks
-semi fowlers position
-remove urinary catheter within 24 hrs
-assist pt out of bed
-monitor abdo girth
-6 small feedings and prevent dehydration
-observe for signs of dumping syndrome- rapid gastric emptying. A feeling of fullness, even after eating just a small amount.
Abdominal cramping or pain.
Nausea or vomiting.
Sweating, flushing, or light-headedness.
-scarring of the liver due to inflammation and necrosis
-nodular tissue can develop and block bile ducts and blood flow
-postnecrotic- viral hepatitis C or drugs
-biliary- caused by biliary obstruction GB
-Cirrhosis- blocks perfusion. Circulation is bad, loss of functionality. Then shrinks.
-ascites- fluid buildup in belly
-jaundice- liver can't remove bilirubin
-hepatic encephalopathy- loss of brain function when liver doesn't remove toxins from blood. elevated ammonia levels.
-hepatorenal syndrome- decreased urinary output. increased BUN and creatinine.
-spontaneous bacterial peritonitis
-increased ammonia levels
-esophageal varices- enlarged veins. Esophageal varices develop when normal blood flow to the liver is blocked by a clot or scar tissue in the liver.
liver disease early stages
-change in weight
-abd pain and liver tenderness
-hepatomegaly- enlarged liver
during hepatic inflammation
-ALT increased- specific to liver
-AST increased- cardiac, muscle, kidney, and brain
-alkaline phosphatase increased
-serum bilirubin and urobilinogen increased
-serum protein and albumin DECREASED
-PT time prolonged- low platelets
-hemoglobin and hematocrit are DECREASED
excess fluid volume
-low sodium diet
-paracentesis- insertion of catheter into abd to remove ascitic fluid from peritoneal cavity.
-for dyspnea, elevate head.
-supine position can aggravate dyspnea.
potential for hemorrhage
-blakemore tube to stop bleeding
-reduce ammonia levels because they're too high
-small meals and protein packed
-drugs- lactulose, neomycin sulfate, metronidazole
-fecal oral route by oral ingestion of fecal contaminants
-contaminated water, food, shellfish
-oral anal sexual activity
-incubation period 15-50days
-not life threatening unless older than 40
-symptoms don't rly show
-unprotected sex w infected partner, sharing needles, transfusion, hemodialysis. healthcare workers needle stick
-symptoms occur 25-180 days after exposure.
-anorexia, nausea, fatigue, dark urine, joint pain, jaundice
-spread by needles, blood, tattoo, cocaine use
-incubation period 21-140 days.
-asymptomatic. damage occurs over decades.
-hep c is the leading cause for liver transplants
hep b and c can infect others, even if they're without symptoms
-transmitted primarily thru parenteral routes
-incubation 14-56 days
-endemic in areas where waterborne epidemics occur.
-fecal oral route
-resembles hep A
-incubation 15-64 days
-high carbs and calories
-antiemetics, antiviral meds, immunomodulators
-use drugs sparingly because liver is damaged.
FATTY LIVER (steatosis)- accumulation of fats around hepatic cells
-caused by DM, obesity, elevated lipid profile, alcohol abuse.
-liver invaded by bacteria
-treatment- drainage w ultrasound guidance. antibiotic therapy
-used in treatment of end-stage liver disease
-transported in a cooled saline solution that preserves the organ for 8 hrs.
Acute, chronic graft rejection
Hepatic artery thrombosis
Fluid and electrolyte imbalances
Acute renal failure
-inflammation of the GALLBLADDER
-cholethiasis(gallstones) usually accompanies cholecystitis
-repeated episodes of cystic duct obstruction result result in chronic inflammation, with calculi always present.
Flatulence, dyspepsia, eructation, anorexia, nausea and vomiting, abdominal pain
Biliary colic- obstruction of bile duct.
MURPHY'S SIGN- right side pain increases when breathing.
Blumberg's sign (Rebound tenderness)
Steatorrhea- fatty stool
-low fat diet, bile salts
-opioid analgesics, anticholinergics, antiemetic
-shock wave lithotripsy
-percutaneous transhepatic biliary catheter insertion
-laparascopic cholecystectomy- gold standard. removes the gallbladder. gall bladder stores bile, which breaks down fats, so limit fat intake.
-post op care- free air pain result of carbon dioxide retention in the abdomen. ambulation. return to activities in 1-3 weeks.
-traditional cholecystectomy- assess t tube after surgery
CANCER OF GALLBLADDER
-right upper quadrant pain
-surgery, radiation, chemotherapy
-life threatening inflammatory process of the pancreas caused by premature activation of excessive pancreatic enzymes that destroy pancreatic cells causing autodigestion and fibrosis of the pancreas.
-necrotizing hemorrhagic pancreatitis- diffusely bleeding pancreatic tissue w fibrosis and tissue death.
-acute renal failure
-paralytic ileus- no perfusion so bowel mvmt slows down
-multisystem organ failure
-DM- destruction of islet cells
right sided- appendicitis and gallbladder
left sided- pancrease
-abd tenderness left side
-cullen's sign- edema and bruising around belly button
-turner's sign-bruising of the lower sides
-bowel sounds decreased
-vital sign changes
-amylase elevated- digests starch
-lipase elevated- digests fat
-Alkaline phosphatase- elevated if process accompanied by biliary involvement.
-calcium decreased w fat necrosis
-relieve symptoms, decrease inflammation.
-fasting and drug therapy. give TPN and iv fluids
-NPO in early stages
-Antiemetics for nausea and vomiting
-Total parenteral nutrition
-Small, frequent, moderate- to high-carbohydrate, high-protein, low-fat meals
-Avoidance of foods that cause GI stimulation
chronic pancreatitis- remissions and exacerbations
-most serious complication of necrotizing pancreatitis, fatal if untreated
-high fever up to 104
-antibiotic treatment alone does not resolve abscess
-hemorrhage from rupture
-may resolve on its own
-surgical intervention after 6 weeks.
-one of the leading cause of cancer deaths
-metastasis spreads rapidly.
-radiation therapy to decrease size so they can eat better
-biliary stent insertion to help keep biliary duct open
-TPN usually begins
-whipple procedure- remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct. treats cancer
post op care
-observe for hemorrhage
-GI drain monitoring
NEVER PUT ANYTHING ON HIGH SUCTION
increased eosinophils- asthmatic
hypercarbia- increased levels of CO2. pts with COPD
C02 narcosis- loss of sensitivity to increased levels of C02
oxygen toxicity- not good for tissue, it becomes damaged
apply humidifier for greater than 4L/min
when giving oxygen therapy, always start LOW
high oxygen delivery
-venturi- most accurate
-T piece- pts with tracheostomy
POSITIVE AIRWAY PRESSURE TO KEEP ALVEOLI OPEN
BiPAP- inspiration and expiration are set at different setting by the machine
aPAP-automatic adjusting postivie airway pressure
cPAP- continuous positive airway pressure
-potential for infection
-damaged oral mucosa
post op- assess every 2 hrs for airway patency, tube obstruction, dislodgment.
complications- pneumothorax, emphysema, bleeding, infection
Tracheostomy bypasses nose and mouth, which normally humidify. warm hair
-air must be humidified
-maintain proper temp
-ensure adequate hydration
complications of suctioning
-cardiac dyysrhythmias from induced hypoxia
-do it only for 10-15 secs
-turn/reposition every 2 hrs
-promote coughing and deep breathing
-avoid mouthwash that has alcohol
-elevate had of bed for at least 30 mins after eating to prevent aspiration
-inflammation of nasal mucosa
-direct or droplet
-inflammation of mucous membranes
-similar to cold
-sore throat, inflammation of pharyngeal mucous membranes
-strep throat can lead to serious medical complications
odynophagia- pain swallowing
RAT test- rapid antigen test
-screening for group A beta- hemolyric streptococcal antigen
-results available in 15 mins
when there's stridor, notify rapid response team
-excess fluid in the lungs resulting from inflammatory process
-community acquired- easier to treat.
-healthcare associated- more resistant to antibiotics. difficult to treat.
BACTERIAL PNEUMONIA-streptococcal/ staph
VIRAL PNEUMONIA- most common
ATYPICAL PNEUMONIA- chlamidophila pneumoniae
bronchiolitis- inflammation of the lower, small end of brochioles. terminal ends
bronchitis- larger airways.
SEVERE ACUTE RESPIRATORY SYNDROME
-virus infection of respiratory cells, triggering inflammatory response.
-new family of viruses- coronaviruses
-highly communicable diseases
-most acquired virus
-persistent cough, night sweats, hemoptysis
-treatment for TB
-therapy lasts 6 months if protocol followed.
-3 consecutive negative sputums
thoracentesis- invasive procedure to remove fluid or air from the pleural space for diagnostic or therapeutic purposes.
Sets with similar terms
Digestive System Disorders
GI- GERD, gastritis, Inflammatory bowel disease
Iggy ch 60
Liver, Gallbladder, Pancreas and Ostomies
Other sets by this creator
316 exam 2
Pharm exam 2
med surg exam 2
Psych exam 1
Other Quizlet sets
CSAD 236: EXAM 1 (module 1)
S.S test topic 8 lessons 3-5
Career Prep Exam Study Guide: 1st Semester
CSE 12 - Quiz 3