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Nurs 332 Exam 7

Bariatric & Sensory

Define obesity and the requirements to be considered obese? State of excess accumulation of body fat. BMI > 30
What are the 3 most common co-morbidities of obesity? HTN, Diabetes, Sleep apnea
When would surgical intervention be considered for an obese patient? BMI > 40; BMI > 35 with 2 or more co-morbidiites; attempted & failure of non-surgical weight loss program.
What are the restrictive surgical procedures for obesity? Gastric Band and Sleeve Gastrectomy
What are common restrictive/malabsorptive surgical procedures for obesity? Roux-n-Y and Duodenal Switch
What is used to inflate the gastric band? Saline
What is the patient asked to do after having a gastric band procedure to evaluate the tightness of the band? Patient is asked to drink fluid.
How quickly is weight lost after a gastric band procedure? Slow process: about 30-65% of body weight in about 2 years.
After Scott has a Roux-en Y procedure, how much food can he eat at one time? 1 oz
How quickly will a person loss weight after a Roux-en Y procedure? 60 - 75% in about 12 - 18 months, pretty fast
After food travels down the esophagus, where does it end up on a pt with a Roux-en Y? 1 oz proximal pouch (made from part of stomach), short intestinal roux limb, jejunum. Bile flows through the duodenum. (Intestine is Y-shaped pg 955)
How effective is the Biliopancreatic Diversion with Duodenal Switch? Very: 70 - 90% body weight loss.
What is done in a Biliopancreatic Diversion with Duodenal Switch procedure? 70% of stomach is removed, an anastomosis between stomach and intestine is made which decreases the amount of small intestine the food will pass through decreasing absorption.
What organ is commonly removed when a Biliopancreatic Diversion with Duodenal Switch is done? The gallbladder; stone formation is a common issue.
What is done pre-operatively before a patient can qualify for a bariatric procedure? Psychological evaluation, other consults prn: endocrinologist, internist, cardiologist, pulmonolgists.
How much should a patient's head be elevated after bariatric surgery? 30 degrees
Should John bring his CPAP machine for use after his Roux-en Y surgery? Nope, not unless the doctor okayed it. Can be used with Lap Band surgery with dr order.
What are some cautions a nurse should use when caring for a patient's respiratory needs post-bariatric surgery? Begin narcotics with low doses, continuous pulse ox monitoring, patient's door open, encourage IS use.
T/F: maceration can cause pressure ulcers? Absolutely, watch that moisture!
What should Jason monitor to detect DVT/PE in a patient recently back from surgery? Assess for respiratory distress, ↑ pulse, ↓ sats, ↑ resp rate, & pain.
What should Jake monitor post-op to detect hemorrhage? Hypovolemia (tachycardia, ↓ BP, low urine output, CBC)
How long should a nurse wait to ambulate a post-op bariatric patient? Within 6 - 8 hours the patient should be able to stand at the bedside.
What type of IV is used as a carrier for a post-op bariatric patient? D5W
What should a nurse monitor for after 1 - 2 days post-op with a bariatric patient? intestinal blockage
What should a patient with a gastric band be medicated with post-op to reduce complications? Antiemetics: don't want retching to make that band slip out of place. However, don't overuse causing sedation.
Scott is experiencing nausea so the nurse is about to insert a nasogastric tube after his roux-en Y procedure. What should he tell the nurse before she proceeds? Yo bitch, only doctors using fluoroscopy are allowed to insert an NG tube after a bariatric procedure.
What is an anastomotic leak and why is it bad? It's a leak of the GI suture lines. It can lead to sepsis. S/s: rapid pulse (>120), SOB, ↑ respiration, fever > 101, ↓ BP, ↓ urine output, change in JP drainage, hiccups, shoulder/chest/abd pain, sense of doom.
What is gastric remnant distention? Small bowel obstruction due to swelling or a kink at the j-j junction of bowel.
What are s/s of gastric distention? Abdominal pain &/or pressure, abdominal distention (yes, that's actually what it says in the notes-lol), signs of sepsis if gastric suture line leaks.
What are common possible complications of bariatric surgery post-op? N/V, stenosis, dehydration, adhesions, bowel obstruction, band slippage, band erosion, intussception, hernias, ulcers, GI bleed, gallstones, and dumping syndrome.
What needs to be done to oral meds to help with absorption for a pt with a RnY? Chewable and liquid are better adsorbed than pills, absorption may be rapid, large tablets need to be cut or capsules opened, verify with pharmacy as to which can be cut or crushed), may need to space times when giving large amounts of pills.
Is dumping syndrome a complication? Nope, just happens when eating too many carbs. The jejunum fills too quickly drawing fluid into the bowel... and the rest is history.
What are other s/s of dumping syndrome other than dumping? Fast HR, sweating, nausea, vomiting.
What will a post-op Bariatric pt be given 1st to drink? One dixie cup (3 oz) of water an hour for 3 hrs.
What is included in a bariatric clear liquid diet? Sugar-free popsicles, sugar-free jello, crystal light, broth. (All given at 60 mL increments.)
What are non-approved bariatric liquids? No carbonation, caffeine, concentrated sugars, regular juice, jello or popsicles.
What did Jason eat after his lap-band procedure? Same as bariatric diet except no limit on liquids (as tolerated) but must sip not gulp. Also no risk of dumping syndrome, just use sugar-free liquids to ↓ caloric intake.
What is a gastrograffin swallow? Gastrograffin is a contrast medium used with w-ray to detect the outline of the stomach lining. Shows up as white on the x-ray.
What are the bariatric surgery lifetime dietary guidelines? Eat slow, small bites, chew well, stop when full, protein 1st, low carb/fat, no grazing or nibbling, no liquid with meals, sip liquid in between meals, take vitamin/minerals.
Which vitamins and minerals are likely to be deficient in a pt whose had a restrictive/malabsorptive surgery? Vitamins A, B12, D, E, K, folic acid; calcium, iron, K+
Jake has a BMI of over 60. Will he be able to have a RnY immediately? Nope, poor Jake has to lose weight 1st. Also, his insurance isn't going to cover removing all that extra skin left over after lossing weight... having surgery... and losing more weight.
What is intusseception? The telescoping of the bowel into itself.
Why is gallstone formation common in post-op bariatric patients? ↑ fat metabolism = ↑ secretion of cholesterol into bile forming stones.
What are functions of the skin? protection, heat regualtion, sensory perseption, excretion, synthesis of vitamin D, expression and body image.
What is the largest organ of the body? Skin
What 3 conditions are optimal for healthy skin? Dry, supple, acidic.
What is a macule? No elevation or depression, just a change in color.
What is a macule patch? Patch greater than 1 cm, no elevation or depression.
What is a papule? A bump with no pus. Also called acne, comedone, folliculitis, or insect bite.
What is plaque? A rash. Elevated but flat overall. Think of psoriasis or eczema or a plateau.
What is a vesicle? Cell or cyst containing fluid, breaks easily. Yellow crusts form on skin after drying.
What is a bulla? Raised lesion > .5 which contains water not pus. A blister.
What is a fissure? Sharply defined linear or wedge-shaped tears in the epiderms with abrupt walls.
What is a scale? Flaking of skin cells.
What is an ulcer? Disintegration of tissues.
What is excoriation? A loss of the top layer of the skin caused by scratching. Usually linear. May have scab.
What is alopecia? Hair loss.
What is an angioma? A benign tumor of blood vessels at the skin surface.
What is comedone? A closed comedone is a whitehead. May rupture, cause low grade inflammation. An open comedone is a blackhead.
What is hirsutism? Excessive hair on women, where usually only seen on men.
What is a keloid? An abnormal scar that grows beyond the boundary of the original site of the skin injury.
What is a nevus? A birthmark or mole.
What is spider telandiectasia? A group of dilated capillary blood vessels forming a spider-like image on the skin.
What are diagnostic studies performed on the skin? Punch biopsy, excisional biopsy, incisional biopsy, culture, patch test (allergy).
When a patch test is performed what does the grading 0 to 3+ mean? 0 is no reaction and 3+ is the greatest reaction
What does ultraviolet A (UVA) do to the skin? Effects elastic tissue, contributes to skin cancer.
What does ultraviolet B (UVB) do to the skin? Sunburn, sun damage, major factor in skin cancer.
What happens to ultraviolet C? It's blocked by the atmosphere in most areas.
What should you teach clients about protecting skin from the sun? Worst exposure time is midday, wear a hat and sunglasses, wear broad spectrum (UVA & UVB) sunscreen with benzophenones, apply every 2 -3 hours even if it says all day of waterproof.
What are common irritants in allergic contact dermatitis? Gloves, adhesives, metal, etc.
What are risk factors for skin cancer? Fair skin (blonde, red hair, blue or green eyes), family history, outdoor occupations/recreation, tanning, smoking.
What type of skin cancer has irregularly shaped, flat scales or a horn? Actinic Keratosis: treat with cryosurgery, surgery, retin-A, chemical peel, etc.
What is the most common type of skin cancer? Basal Cell Carcinoma
Name the type of cancer that is from the epidermal basal cells, usually doesn't spread beyond the skin and can destroy tissue if left untreated? Basal Cell Carcinoma
Name the type of skin cancer that originates as malignant neoplasms of keratinizing epidermal cells, is due to sun exposure and can metastasize leading to death if untreated? Squamous Cell Carcinoma
Where is squamous cell carcinoma often found on the body? The mouth and lips.
What is common treatment for squamous cell carcinoma? Curettage, excision, radiation, intralesional injection of 5-FU r methotrexate, or Moh's surgery (microscopic to lessen deformity from surgery).
What type of skin cancer arises from the melanocytes and is able to metastasize to any organ making it the deadliest skin cancer? Malignant Melanoma
What are common sites for malignant melanoma to form? 1/3 found in nevi (moles), also common on lower legs and backs of women and trunk, head and neck of men.
What do the stages 0 to IV mean for melanoma? 0: in situ (one place in epidermis); I & II: moved out a bit more; III: regional lymph nodes; IV: metastasis to other organs.
What are treatment options for malignant melanoma? Surgery, Chemotherapy, and Radiation Therapy
What does the mnemonic ABCDE stand for? Asymmetry, Border irregular, Color change, Diameter 6mm+, Evolving or changing.
What is the most common cause of a skin infection? Staphylococcus aureus: risks includes moisture, obesity, skin disease, systemic steroid use, antibiotics, diabetes.
What complications can a skin infection lead to? Starts out looking like a pimple or boil which can lead to pneumonia, bloodstream infections, or surgical wound infections.
What is cellulitis? A skin infection. It will be warm, red, swollen and tender and as it spreads the pt may have fever, chills and swollen glands. It is infectious.
What is folliculitis and how is it treated? An infected hair follicle from bacteria. Can be due to an ingrown hair or tight fitting clothing. Treat with Domeboro solution or Burow's astringent.
What causes a furuncle (boil) and how is it treated? a single infected hair follicle; can be either staph or another bacteris. Treat with a warm compress, triple antibiotic cream and may have to open up.
What is the difference between a furuncle and a carbuncle? A furuncle is one infected hair follicle and a carbuncle is multiple infected hair follicles. It is generally a deep infection.
Which age group most often gets impetigo? Children: it is a staph infection of the skin treated with bactroban ointment
What is herpes zoster and how is it treated? Shingles: usually unilateral viral infection that travels via the nerve tract causing severe pain and skin vesicles on the trunk, thorax and face. Treated with Acyclovir, Valtrex, or Famvir. May also give pt analgesics and antipruritics.
When is herpes zoster most contagious? When it's weeping.
Medical term for excessively dry skin? Atopic dermatitis, more common in elderly.
Define uticaria Hives: red spot, itchy
What is vitiligo? Melanocytes are destroyed causing depigmentation. Think MJ.
What is a lipoma and what is treatment? A fatty tumor. It is harmless but may be removed for cosmetic purposes.
What does psoriasis look like? Red lesions with pustules that look silver or white when they dry up.
What is common treatment for psoriasis? Antipsoriatic: Dononex, Anthra-Derm, corticosteriod ointments, UV light.
What are some common cosmetic topical procedures? Retinoin (Retin-A), Chemical Peels, Microdermabrasion, and Alpha hydroxy acids. Also injections like Neurotoxin (Botox) and Fillers like Collagen.
Name the 4 categories for the Braden Scale Assessment? Nutrition, Moiture, Mobility and LOC. The lower the score the higher the risk.
What are risk factors for skin breakdown? Age, time, shearing/tearing, moisture, nutrition, blood glucose (Diabetics).
__________ pads are for bed protection, _________ pads are for patients Chuck, Dryflow
Maintain __________ wound surface; a ______ cell is a dead cell. moist, dry
What does a type II pressure ulcer look like? Partial-thickness skin loss. Looks like a blister or abrasion. A shallow crater.
What does a type IV pressure ulcer look like? Full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (tendon, etc).
When should a pt call the doctor about their wound? A temp above 100 F for > 4 hrs, drainage is coming from or around incision/wound and it doesn't decrease after 3 - 5 days, is increasing in amount, or becomes thick, tan, yellow or smells bad.
Define Myopia and Hyperopia: Myopia: nearsightedness Hyperopia: farsightedness
What are diseases states that can lead to blindness or decreased vision? Diabetes, HTN, CVA, Atherosclerotic disease, infection (cytomegalovirus).
Define Miosis and Mydriasis: Miosis: constriction of the pupil (stimulate muscarinic receptors). Mydriasis: dilated pupil (block muscarinic receptors)
Recite the mnemonic for Miosis and Mydriasis: MIosis: makes the pupil "Itty bitty" MyDriasis: makes the pupil "Dialate"
What are 2 visual diagnostic studies? Retinoscopy: scans retina to determine visual acquity. Refractory: checks myopia v. hyperopia through subjectivity. Visual field perimetry: peripheral vision eval. Ultrasonography: id foreign objects. Fluorescein angioagraphy: uses dyes in vessel
What type of vision loss does someone with glaucoma experience? Tunnel vision: caused by an increase in intraocular pressure.
What types of medications will someone with glaucoma be treated with? Adrenergic: ↓ fluid production; Beta Blockers: ↓ intraocular fluid (Timolol); Cholinergic: ↑ fluid drainage (Pilocarpine); Prostaglandin Analogs: ↑ drainage.
What does a Laser Trabeculoplasty do? Opens up site to ↑ drainage and ↓ intraocular pressure.
What type of medications should patients with Glaucoma avoid? Cold medicines: ↑ intraocular pressure.
What are the possible causes of conjunctivitis? Bacterial (pink eye), viral (herpes, shingles, Chlamydia (bacterial).
What causes a Hordeolum (Sty)? Infection of sebaceous gland. Treat with a warm moist compress 4 times a day.
Name some topical Antibiotics, Antifungals and antivirals used for the eyes. Antibiotic: Bacitracin, Erythromycin, Toramycin. Antifungals: Natamycin. Antivirals: Cidofovir, Ganciclovir.
What are 2 anti-inflammatory drugs for the eyes? Dexamethasone, Flurbiprofen
What are risk factors for developing cataracts? Aging & UV light
What would vision look like to a person with cataracts? Blurred
What is the focus of cataract surgery? To replace the lens or to remove the lens.
What causes Macular Degeneration? Dry: deposits of yellow plaques collect on the macula. Wet: new vessels grow and leak.
What test is used to detect Macular Degeneration? Amsler Grid
What treatment is used for Macular Degeneration? No cure: ↑ doses antioxidants, Zine, Vit C & E, Beta Carotene, Zinc Oxide.
How is vision affected in Macular Degeneration? Center of vision loss, have to rely on periphery.
What are risk factors for retinal detachement? Aging, Cataract Extraction, Degeneration, Trauma, Severe Myopia, & Diabetes.
What vision changes would a person experiencing retinal detachement notice? shadows or black areas
What are 2 common surgeries for retinal detachment? Scleral buckling & laser treatment with a gas bubble.
What vision changes would a person with Diabetic Retinopathy experience? Photopsia (light flashes), cobwebs, floaters, a curtain effect.
What does it mean to have conductive hearing loss? Interference of sound transmission through external and middle ear.
What is sensorineural hearing loss? Impairment of function of the inner ear or 8th cranial nerve.
What causes conductive hearing loss? Ear obstruction (like earwax), infection, otosclerosis (damage to inner bone), typmanosclerosis (hardening or tym. mem), trauma to tympanic membrane.
What causes sensorial hearing loss? Presbycusis (old ears), congenital hearing loss, noise-inducing hearing loss, benign and malignant tumors, Meniere's disease.
What type of hearing loss may be treated with cochlear implants? Profound hearing loss that is sensorineural.
Symptoms of Meniere's Disease (Endolymphatic Hydrops)? Vertigo, tinnitus, ans regressive unilateral hearing loss. Effects men and women between 35-60 yrs, often precipitated by a viral infection. Onset gradual or sudden.
What treatment options are available for Meniere's disease? Sedatives, Anticholinergics, Vasodilators, Antihistamines, diuretics, low salt diet. Restrict caffeine, nicotine and alcohol intake. Surgery: Endolymphatic shunt, vestibular nerve section.
What is Otalagia? An earache: can be causes by infection, external ear trauma, foreign bodies, and eustachian tube disorders.
Define Hyposmia? ↓ sense of smell
Define Anosmia? Can't detect odor
What eye disease is referred to as the silent thief of sight? Glaucoma
T/F: a detached retina should be taken care of with a month of occurrence? False: medical emergency requiring immediate treatment.
What are causes of vertigo? Trauma, meds, inner ear issues, ↓ blood flow to brain, Meniere's and migraines.
Created by: ewooda05