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nclex- body systems

alterations in body systems, NCLEX

QuestionAnswer
Type 1 diabetes <30y/o; pancreatic beta cells destroyed; requires insulin injection; ketosis prone
Type 2 diabetes >30y/o; decreased sensitivity to insulin (insulin resistance) or decreased insulin production; ketosis rare, HHNKS (Hyperglycemic Hyperosmolar NonKetotic Syndrome)
Hypoglycemia <60; hypotension, tachycardia, cool & clammy; sugary drinks if conscious, Dextrose 50% IV, glucagon 1mg IM, SQ
4 - Hyperglycemia (DKA) 300-800; hypotension, tachycardia, Kussmaul's respirations, check K+ q2-4hr; EKG q2-4hr; 1L of 0.9%NaCl/hr during first 2-3 hrs then 0.45%NaCl 200-500ml/h; then D5W or D51/2NS; Regular IV insulin 5 units/hr
5 - HHNKS (Hyperglycemia Hyperosmolar NonKetotic Syndrome) >800; NS or 0.45%NaCl, Regular insulin, Potassium as soon as urine output is not satisfactory
1 - PKU (phenylketonuria) Lofenalac (specially prepared milk for infants); Low-protein diet for children (no meat, dairy products, eggs, NutraSweet)
2 - Gout low-purine diet (no fish or organ meats)
3 - Celiac disease (sprue) gluten-free diet (no wheat, oats, rye, barley)
4 - Renal failure increased protein & albumin losses in urine that leads to protein deficiency => high calorie, low-protein diet
5 - Protein allergy diarrhea => change dietary protein source
1 - Hepatobiliary disease (decreased bile leads to fat malabsorption) low-fat, high-protein diet, vitamins
2 - Cystic fibrosis (1Absence of pancreatic enzymes leads to malabsorption of fat & fat-soluble vitamins, weight loss) (2 Infection and lung disease lead to increased need for calories and protein) => pancreatic enzyme replacement (cotazym pancreas) b4 or with meals; high-pr
3 - Atherosclerosis low-saturated fat diet; cholesterol-lowering agents given b4 meals
Infxn of GI Tract s/s HA, low-grade fever; abd. discomfort, anorexia; watery diarrhea, N&V; => heat canned food 20-40 min and inspect cans for bubbles
Enterotoxigenic E. coli from undercooked beef
Salmonella poultry, eggs
Campylobacter poultry, beef, pork
Giardia lamblia from protozoan, contaminated water
Shigella from fecal contamination
HIATAL HERNIA almost like GERD, elevate HOB 4-8 in. when sleeping; small frequent feedings
PYLORIC STENOSIS (vagus nerve) palpable olive-shaped tumor in epigastrium -> epigastric fullness -> vomitting -> infant always hungry -> infant fails to gain weight -> irritability in infants => usu. don't show symptoms until the 2nd to 4th week after birth; then regurgit
GASTRITIS hiccupping; anorexia, N&v (possibly bloody); HA; uncomfortable feeling in abdomen => NPO slowly progressing to bland diet; referral to appropriate agency if ETOH abuse is verified
CHRONIC DUODENAL ULCER hypersecretion; pain relieved with food intake; rarely vomits
CHRONIC GASTRIC ULCER normal to hyposecretion; relieved by frequent vomit not with food
ULCERS gastrectomy; vagotomy; Billroth I; Billroth II; vit. B12 via parenteral route; Levin tube & Salem sump; Dumping syndrome
ESOPHAGEAL ATRESIA & TRACHEOESOPHAGEAL FISTULA excessive saliva, drooling, stomach distention, choking, coughing, sneezing, cyanosis; often occurs with anomalies of heart or the GU or musculoskeletal system; preop
You have 3 babies in the pediatric room, which baby will you assess first 1-pyloric stenosis who is a newborn 2-Esophageal atresia who is newborn 3-PKU who is a day old. 1st - Airway- Esophageal Atresia is a medical emergency 2nd- Pyloric stenosis-is important but the other is more ER 3rd- PKU patient one day old...
Gastric ulcers - Pain LUQ or mid upper gastric region, sharp knawing, 30-60 minutes after meal
Duodenal ulcers Pain relieved by food. Pain in midepigastric
Alterations in body systems
ALTERATIONS IN GLUCOSE METABOLISM
1 - Type 1 diabetes <30y/o; pancreatic beta cells destroyed; requires insulin injection; ketosis prone
2 - Type 2 diabetes >30y/o; decreased sensitivity to insulin (insulin resistance) or decreased insulin production; ketosis rare, HHNKS (Hyperglycemic Hyperosmolar NonKetotic Syndrome)
3 - Hypoglycemia <60; hypotension, tachycardia, cool & clammy; sugary drinks if conscious, Dextrose 50% IV, glucagon 1mg IM, SQ
4 - Hyperglycemia (DKA) 300-800; hypotension, tachycardia, Kussmaul's respirations, check K+ q2-4hr; EKG q2-4hr; 1L of 0.9%NaCl/hr during first 2-3 hrs then 0.45%NaCl 200-500ml/h; then D5W or D51/2NS; Regular IV insulin 5 units/hr
5 - HHNKS (Hyperglycemia Hyperosmolar NonKetotic Syndrome) >800; NS or 0.45%NaCl, Regular insulin, Potassium as soon as urine output is not satisfactory
------
ALTERATIONS IN PROTEIN METABOLISM
1 - PKU (phenylketonuria) Lofenalac (specially prepared milk for infants); Low-protein diet for children (no meat, dairy products, eggs, NutraSweet)
2 - Gout low-purine diet (no fish or organ meats)
3 - Celiac disease (sprue) gluten-free diet (no wheat, oats, rye, barley)
4 - Renal failure increased protein & albumin losses in urine that leads to protein deficiency => high calorie, low-protein diet
5 - Protein allergy diarrhea => change dietary protein source
=======
ALTERATIONS IN FAT METABOLISM
1 - Hepatobiliary disease (decreased bile leads to fat malabsorption) low-fat, high-protein diet, vitamins
2 - Cystic fibrosis (1Absence of pancreatic enzymes leads to malabsorption of fat & fat-soluble vitamins, weight loss) (2 Infection and lung disease lead to increased need for calories and protein) => pancreatic enzyme replacement (cotazym pancreas) b4 or with meals; high-pr
3 - Atherosclerosis low-saturated fat diet; cholesterol-lowering agents given b4 meals
===============================
INFECTIONS OF GI TRACT s/s HA, low-grade fever; abd. discomfort, anorexia; watery diarrhea, N&V => heat canned food 20-40 min and inspect cans for bubbles
1 - Enterotoxigenic E. coli from undercooked beef
2 - Salmonella poultry, eggs
3 - Campylobacter poultry, beef, pork
4 - Giardia lamblia from protozoan, contaminated water => treated with metronidazole,
5 - Shigella from fecal contamination
================================
GI SYSTEM
1 - Hiatal hernia almost like GERD, elevate HOB 4-8 in. when sleeping; small frequent feedings
2 – Pyloric stenosis (vagus nerve) palpable olive-shaped tumor in epigastrium -> epigastric fullness -> vomitting -> infant always hungry -> infant fails to gain weight -> irritability in infants => usu. don't show symptoms until the 2nd to 4th week after birth; then regurgit
3 – Gastritis hiccupping; anorexia, N&v (possibly bloody); HA; uncomfortable feeling in abdomen => NPO slowly progressing to bland diet; referral to appropriate agency if ETOH abuse is verified
4 – Chronic duodenal ulcer hypersecretion; pain relieved with food intake; rarely vomits
5 – Chronic gastric ulcer normal to hyposecretion; relieved by frequent vomit not with food
6 – Dumping syndrome gastrectomy; vagotomy; Billroth I; Billroth II; vit. B12 via parenteral route; Levin tube & Salem sump; Dumping syndrome
7 – Esophageal atresia & tracheoesophageal fistula excessive saliva, drooling, stomach distention, choking, coughing, sneezing, cyanosis; often occurs with anomalies of heart or the GU or musculoskeletal system; preop
8 - Crohn's disease inflammation of ileum and ascending colon; fatty stool (steatorrhea); occasional rectal bleeding, abd. pain after meals; high-protein, high-calorie, low-fat, and low-fiber diet; TPN; anticholinergic
9 - Ulcerative colitis inflammation of colon with erosion; common rectal bleeding; predefecation abd. pain; high-protein, high-calorie, low-fat, and low-fiber diet; TPN; anticholinergic
10 - Appendicits periumbilical pain to McBurney's pain; anorexia, N&V; localized tenderness; muscle guarding; low-grade fever; highest incidence 11-30 yo; no heating pads, enemas, or laxatives preop; NPO until blood lab received, IVF to prevent dehydration; no analgesic u
11 - Peritonitis rebound tenderness; symptoms may be masked in elderly persons or those receiving corticosteroids
12 - Hirschsprung's disease newborn - failure to pass meconium, refusal to suck; child - failure to gain weight, delayed growth, constipation alternating with diarrhea, foul-smelling stools, abd. distention; low-fiber, high-calorie, high-protein diet; colostomy is temporary, closed
13 - Abdominal hernias strangulated hernia is ER; truss-pad placed under hernia, held in place with belt; surgery is postponed until resp. conditions are controlled; provide ice packs for swollen scrotum; sexual function is not affected
14 – Meckel’s diverticulum hematochezia; s/s of appendicitis; painless rectal bleeding; surgery
Intestinal obstruction NV; high-pitched bowel sounds above area of obstruction, decreased or absent bowel sounds below the area of obstruction; colicky pain; obstipation (absence of stool & gas) => NGT, Miller-Abbot & Cantor (intestinal tubes); surgery (exploratory, resection &
15 - Intestinal ostomies for fecal diversion colostomy irrigation; Koch pouch
Cirrhosis esophageal varices; reduce ascites; balloon amponade; edoscopic sclerotherapy; administer vasopressin or propanolol
16 - Jaundice dark-colored urine, clay-colored stools, pruritus; extrahepatic (due to obstructed flow of bile thru liver or biliary duct system); keep nails trimmed and clean; teach to rub with knuckles rather than nails
17 - Reye's syndrome fever, increased ICP, coma, heaptic function from acute metabolic encephalopathy of childhood; neuro checks, monitor CVP or Swan-Ganz catheter
18 - Cholecystitis, cholelithiasis intolerance to fatty foods, indigestion; severe pain in upper right quadrant of abd. radiating to back and right shoulder (biliary colic); fever; dark urine & clay-colored stools; keep T-tube drainage bag below level of gallbladder
19 - Pancreatitis abd. pain relief with position change; NV 24-48 hrs after heavy meal or alcohol ingestion; grey-blue discoloration in flank and around umbilicus; hypotension; acute renal failure => dietary restrictions
-------------------------
Systemic Lupus erythematosus (SLE) butterfly rash across bridge of nose and cheeks caused by chronic, systemic inflammatory disease of connective tissue; exaggerated production of autoantibodies; antimalarial therapy; corticosteroids for exacerbations; plasmapheresis
------------
1 - Impetigo skin isolation; monitor for glomerulonephritis
2 - Herpes simplex virus type I antiviral
3 - Herpes zoster antiviral; wet compresses; analgesics
4 - Scabies antipruritus (permethrin, Elimite, Eurax), scabicide (Kwell, Eurax); treat all family members;
5 - Pediculosis (lice) Kwell, Nix
6 - Tinea Pedis (athlete’s foot) – vesicular; Capitis (ringworm); Corporis (ringworm of the body) => antifungal ; fluoresces green with Wood’s lamp
7 - Psoriasis (vảy nến) coal-tar prep. – protect from direct sunlight for 24 hrs; UV light (wear goggles to protect eyes); anthralin prep; steroids followed by warm, moist dressings with occlusive outer wrapping (enhances penetration); antimetabolites(methotrexate) – c
8 - Acne vulgaris PO tetracycline (with sunscreen with factor of 15); antibacterial agents; drying preparations – benzoyl peroxide; Isotretinoin (Accutane) – risk of elevated LFT, dry skin, and fetal damage
9 - Eczema (atopic dermatitis) lotions to affected areas – Eucerin/Alpha-Keri
----
SKIN INFECTIONS VCHIPS
V - varicella zoster
C - cutaneous diphtheria
H - herpes simplex
I - impetigo
P - pediculosis
S - scabies
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Created by: qtprep