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Nurs 332 Test #3

S/s and description of Mallory-Weiss tear? s/s: bright red blood in vomit It is a tear in the mucosal lining near esophageal-gastric junction (can be caused by retching/vommiting)
What is Leukoplakia? Nickname: smoker's patch; white patch on mouth mucosa or tongue, < 15% become malignant
What is Erthroplasia? Red velverty patch on mouth or tongue, >50% lead to squamous cell carcinoma
Define Achalasia? delayed emptying of lower esphagus
What should a nurse do if using a Blakemore tube on a patient and suddenly pt can't breath? Cut end to deflate and remove. (Tx for tamponade on varices)
What is the drug Octreotide (Sandostatin) used for? reduces splanchnic blood flow and acid secretion; may be used after a procedure such as endoscopy
What does a Nissan Fundoplication treat? Hiatal hernia or GERD
What is Barrett's espophagus? Change in cells or esphogus from epithial to columnar due to constant irritation from gastric juices leaking through LES
What are the 3 inflammatory bowel diseases? Ulcerative colitis, Crohn's disease, and divertivulosis
Where is ulcerative colitis most commonly found? colon and rectum
Where is Chrohn's disease most commonly found? colon
Where is Diverticular disease most commonly found? sigmoid colon
S/s of ulcerative colitis? Bloody diarrhea, abdominal pain, high WBC, dehydration.
Diagnostic tests for ulcerative colitis? sigmoidoscopy or colonoscopy (under conscious sedation)
tx ulcerative colitis? rest bowel (high carb/low residue diet), reduce stress in life, some may have to have surgery: illiostomy
medications for ulcerative colitis? antidiarrheals: diphenoxylate (Lomotil) 5-ASA Sulfasalazine (or antibiotics if this doesn't work) Corticosteroids: last resort
Age range for ulceritive colitis? usually 15-25 year old, starts at rectum and progresses up colon
What is Chrohn's disease? Cobblestones in all layers throughout bowel, particularly in colon but also ileum and jejunum. Can lead to thickening, abscesses, fistulas and blockage.
Diet for Chrohn's disease? Low fiber, milk-free diet, high calorie/vitamin/protein, low residue
Best drug therapy for Chrohn's? Anti-TNF agent: complications include activating latent TB and must have extensive blood work before treatment.
What is diverticulosis/diverticulitis? Out-pouching and dilation of the mucosa.
S/s of diverticulosis/diverticulitis? No symptoms with diverticulosis. With diverticulitis: intermittent diarrhea or constipation, cramping/bloating, pain in LLQ, difficulty in passing stool.
Which inflammatory condition is treated with a high fiber diet? Divertivulitis
s/s of colorectal cancer? changes in bowel habits, bleeding, pain during bm, anemia, anorexia, and weight loss
What is Irritable Bowel Syndrome? very sensitive bowel syndrome that can be aggravated by stress and eating habits. Can have constipation or diarrhea.
What is Celiac disease? Can't tolerate gluten (grains), causes diarrhea, fatty stools. Can happen at any point in life.
What is the most common cause of Cirrhosis? Alcoholic Cirrhosis (can also be caused by drugs, toxins, infections like hep C, and bile duct obstructions)
What does alcohol do to the liver? Causes gradual accumulation of fat in liver cells (reversible if person stops drinking).
What is postnecrotic cirrhosis? Scarring, nodules form among normal tissue--20% from hep c
What is biliary cirrhosis? cell destruction around bile ducts so bile stays in liver, will see jaundice
Early signs of Cirrhosis? anorexia (weight loss), dyspepsia, gas, n/v, change in bowel habits, abdominal pain.
Later signs of Cirrhosis? Jaundice, skin lesions, hematologic/endocrine problems, peripheral neuropathy.
What are the test results going to be in someone with Cirrhosis for albumin and prothrombin time? Decreased albumin (poor nutrition), prolonged prothrombin time (can't make clotting factor)
Major complications of Cirrhosis? Portal Hypertension, Esophageal Varicies, Ascites, and Hepatic Encephalopathy
Why would a beta blocker like Propranolol be used to treat esophageal varicies? Lower bp--lessen stress on vessels.
What can be done to treat ascites? bedrest, sodium restriction, diuretics, and paracentesis (have pt void before procedure)
What is hepatic encephalopathy? ammmonia can't convert to urea which causes confusion, agitation, slurred speech, yawning and hiccups.
What is a sign of asterixis? patient claps hands together when arms are put in front of patient. it is a sign of an impending coma used in hepatic encephalopathy.
What is Lactulose used for? Pull ammonia out of body but causes diarrhea.
Should antibiotics be used during hepatic encephalopathy? Yes, extra ammonia may cause bacteria to flourish.
What is Babinski's reflex? Fanning of toes and big toe moves forward after stroking bottom of foot--late sign of hepatic encephalopathy.
In what condition may you see petechiae, palmar erythema and spider angiomas? Cirrhosis
How is Hep A transmitted? Hep B? Hep C? Hep A: fecal oral Hep B: blood Hep C: blood (sexually and dirty needles)
What is a common early sign of Hepatitis? Flu-like symptoms
Why is itching common in hepatitis? Accumulation of bile under the skin.
Which hepatitis types are vaccines available? A and B
What is a common drug treatment for Hep C? Pegylated interferon alfa-2b (PEG-Intron) which causes ADR of profound fatigue, flu-like symptoms, insomnia and depression.
What is the greatest concern for using the drug Ribavirin to treat Hep C? Birth defects for both males and females (may also cause hemolytic anemia, and flu-like symptoms)
What is an important vitamin to take with liver disease? Vitamin K to help with clotting
What tests are used to dx acute pancreatitis? elevated serum amylase and lipase levels; also remember the insulin levels may be affected
What surgical procedure may be used to treat acute pancreatitis? Endoscopic retrograde cholangiopancreatography (ERCP) (put a stent in the bile duct to help movement of enzymes and small stones)
What are s/s of chronic pancreatitis? pain (after eating), may assume fetal postion, throwing up doesn't help pain
What may a peron with chronic pancreatitis have to take? Pancreatic enzymes: amylase, lipase, trypsin (PO)
What should the diet be of someone with chronic pancreatitis? low fat, high carbs and no ETOH
Why are vitamins A, D, and K low in a person with chronic pancreatitis? Need bile salts for absorption
What is Cullen's sign? Bruising around the abdomen--may be seen in patients with pancreatitis.
What are s/s of pancreatic cancer? abdominal pain, anorexia, possible jaundice, rapid weight loss, nausea, tumor marker CA 19-9
What is the Whipple Surgery? Taking out head of pancreas, and duodenum (they share the same blood supply) (also may remove bile duct, gall bladder, head of stomach)
What is cholelithiasis? Gall stones
What is a risk of cholelithiais? risk of stones blocking bile duct
S/s of cholelithiaisis? pain radiating from mid-sternum to lower back, worse with fatty foods
What precautions should be taken with Hep A? standard precautions
What is a diagnostic study prior to a liver biopsy? PT: prothrombine time
Is anorexia or jaundice a s/s of early stage Hep A? anorexia (jaundice is late-stage)
When is CEA (carcinoernbryonic antigen) used? A follow-up test used for pts treated for colon cancer.
What is a common diet for hepatic cirrhosis? decrease Na+, protein to tolerance, and additional vitamins (from test over-view in class.
At what angel should the head be elevated for tube-feedings? 30-45%
How often should the tubing and food be changed for tube feedings? every 24 hours
what is the goal of total parenteral nutrition? keep the pt in positive nitrogen balance and allow for growth of new body tissue
Is it common to administer insulin with TPN? yes, check BG every 4 - 6 hours; solution is hypertonic (contains high amounts of glucose)
T/F: it is important to increase the rate of flow for enteral feedings if it is interrupted for a procedure. False: never play catch-up!
Should aspectic (sterile) technique be used for TPN? Yes: two sites depending on solution: central and peripheral. Central is used for higher caloric requirements and contains more glucose).
What unit measurement is Interferon alpha-2b given in? millions/unit; admin SQ every 3 to 7 days; side-effects: flu-like symptoms so give 1 hour before bed with an anitpyretic and antiemetic)
What is the most life-threatening complication of cirrhosis? Bleeding esophageal varices
Created by: ewooda05