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Nurs 332 Test #3
| Question | Answer |
|---|---|
| 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
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