alterations in body systems, NCLEX
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| Type 1 diabetes | <30y/o; pancreatic beta cells destroyed; requires insulin injection; ketosis prone
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| Type 2 diabetes | >30y/o; decreased sensitivity to insulin (insulin resistance) or decreased insulin production; ketosis rare, HHNKS (Hyperglycemic Hyperosmolar NonKetotic Syndrome)
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| Hypoglycemia | <60; hypotension, tachycardia, cool & clammy; sugary drinks if conscious, Dextrose 50% IV, glucagon 1mg IM, SQ
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| 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
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| 5 - HHNKS (Hyperglycemia Hyperosmolar NonKetotic Syndrome) | >800; NS or 0.45%NaCl, Regular insulin, Potassium as soon as urine output is not satisfactory
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| 1 - PKU (phenylketonuria) | Lofenalac (specially prepared milk for infants); Low-protein diet for children (no meat, dairy products, eggs, NutraSweet)
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| 2 - Gout | low-purine diet (no fish or organ meats)
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| 3 - Celiac disease (sprue) | gluten-free diet (no wheat, oats, rye, barley)
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| 4 - Renal failure | increased protein & albumin losses in urine that leads to protein deficiency => high calorie, low-protein diet
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| 5 - Protein allergy | diarrhea => change dietary protein source
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| 1 - Hepatobiliary disease | (decreased bile leads to fat malabsorption) low-fat, high-protein diet, vitamins
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| 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
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| 3 - Atherosclerosis | low-saturated fat diet; cholesterol-lowering agents given b4 meals
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| 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
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| Enterotoxigenic E. coli | from undercooked beef
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| Salmonella | poultry, eggs
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| Campylobacter | poultry, beef, pork
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| Giardia lamblia | from protozoan, contaminated water
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| Shigella | from fecal contamination
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| HIATAL HERNIA | almost like GERD, elevate HOB 4-8 in. when sleeping; small frequent feedings
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| 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
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| 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
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| CHRONIC DUODENAL ULCER | hypersecretion; pain relieved with food intake; rarely vomits
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| CHRONIC GASTRIC ULCER | normal to hyposecretion; relieved by frequent vomit not with food
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| ULCERS | gastrectomy; vagotomy; Billroth I; Billroth II; vit. B12 via parenteral route; Levin tube & Salem sump; Dumping syndrome
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| 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
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| 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...
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| Gastric ulcers | - Pain LUQ or mid upper gastric region, sharp knawing, 30-60 minutes after meal
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| Duodenal ulcers | Pain relieved by food. Pain in midepigastric
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| Alterations in body systems |
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| ALTERATIONS IN GLUCOSE METABOLISM |
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| 1 - Type 1 diabetes | <30y/o; pancreatic beta cells destroyed; requires insulin injection; ketosis prone
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| 2 - Type 2 diabetes | >30y/o; decreased sensitivity to insulin (insulin resistance) or decreased insulin production; ketosis rare, HHNKS (Hyperglycemic Hyperosmolar NonKetotic Syndrome)
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| 3 - Hypoglycemia | <60; hypotension, tachycardia, cool & clammy; sugary drinks if conscious, Dextrose 50% IV, glucagon 1mg IM, SQ
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| 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
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| 5 - HHNKS (Hyperglycemia Hyperosmolar NonKetotic Syndrome) | >800; NS or 0.45%NaCl, Regular insulin, Potassium as soon as urine output is not satisfactory
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| ALTERATIONS IN PROTEIN METABOLISM |
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| 1 - PKU (phenylketonuria) | Lofenalac (specially prepared milk for infants); Low-protein diet for children (no meat, dairy products, eggs, NutraSweet)
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| 2 - Gout | low-purine diet (no fish or organ meats)
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| 3 - Celiac disease (sprue) | gluten-free diet (no wheat, oats, rye, barley)
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| 4 - Renal failure | increased protein & albumin losses in urine that leads to protein deficiency => high calorie, low-protein diet
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| 5 - Protein allergy | diarrhea => change dietary protein source
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| ======= |
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| ALTERATIONS IN FAT METABOLISM |
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| 1 - Hepatobiliary disease | (decreased bile leads to fat malabsorption) low-fat, high-protein diet, vitamins
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| 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
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| 3 - Atherosclerosis | low-saturated fat diet; cholesterol-lowering agents given b4 meals
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| =============================== |
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| 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
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| 1 - Enterotoxigenic E. coli | from undercooked beef
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| 2 - Salmonella | poultry, eggs
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| 3 - Campylobacter | poultry, beef, pork
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| 4 - Giardia lamblia | from protozoan, contaminated water => treated with metronidazole,
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| 5 - Shigella | from fecal contamination
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| ================================ |
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| GI SYSTEM |
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| 1 - Hiatal hernia | almost like GERD, elevate HOB 4-8 in. when sleeping; small frequent feedings
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| 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
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| 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
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| 4 – Chronic duodenal ulcer | hypersecretion; pain relieved with food intake; rarely vomits
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| 5 – Chronic gastric ulcer | normal to hyposecretion; relieved by frequent vomit not with food
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| 6 – Dumping syndrome | gastrectomy; vagotomy; Billroth I; Billroth II; vit. B12 via parenteral route; Levin tube & Salem sump; Dumping syndrome
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| 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
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| 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
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| 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
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| 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
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| 11 - Peritonitis | rebound tenderness; symptoms may be masked in elderly persons or those receiving corticosteroids
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| 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
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| 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
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| 14 – Meckel’s diverticulum | hematochezia; s/s of appendicitis; painless rectal bleeding; surgery
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| 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 &
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| 15 - Intestinal ostomies for fecal diversion | colostomy irrigation; Koch pouch
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| Cirrhosis | esophageal varices; reduce ascites; balloon amponade; edoscopic sclerotherapy; administer vasopressin or propanolol
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| 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
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| 17 - Reye's syndrome | fever, increased ICP, coma, heaptic function from acute metabolic encephalopathy of childhood; neuro checks, monitor CVP or Swan-Ganz catheter
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| 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
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| 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
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| 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
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| 1 - Impetigo | skin isolation; monitor for glomerulonephritis
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| 2 - Herpes simplex virus type I | antiviral
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| 3 - Herpes zoster | antiviral; wet compresses; analgesics
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| 4 - Scabies | antipruritus (permethrin, Elimite, Eurax), scabicide (Kwell, Eurax); treat all family members;
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| 5 - Pediculosis (lice) | Kwell, Nix
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| 6 - Tinea | Pedis (athlete’s foot) – vesicular; Capitis (ringworm); Corporis (ringworm of the body) => antifungal ; fluoresces green with Wood’s lamp
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| 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
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| 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
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| 9 - Eczema (atopic dermatitis) | lotions to affected areas – Eucerin/Alpha-Keri
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| SKIN INFECTIONS | VCHIPS
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| V - varicella zoster |
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| C - cutaneous diphtheria |
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| H - herpes simplex |
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| I - impetigo |
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| P - pediculosis |
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| S - scabies |
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| ---- |
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