In pulmonary edema the medical management will often include what?
Furosemide (Lasix) IV, oxygen therapy , orthopenic position, and morphine sulfate to decrease respiratory rate.
What would the nursing interventions be for a patient with pulmonary edema, excess fluid volume, and altered tissue permeability?
Assess indicators of patient�s fluid volume status, such as breath sounds, skin turgor, and pedal/sacral/periorbital edema, mx I&O, administer diuretics as ordered, and weigh daily.
What is the most common cause of pulmonary edema?
Increased capillary pressure from left ventricular failure
What does sputum look like in pulmonary edema?
Frothy, pink sputum
What type of diet is recommended for a pt with pulmonary edema?
What is pulmonary embolism?
Foreign substance causing obstruction to the blood supply to lung tissue
What is the normal range for d-dimer?
How long is a pt on anticoagulant therapy for a pulmonary embolism?
What is the most definite method of diagnosing a pulmonary embolism?
What is pulmonary edema?
Accumulation of extravascular fluid in lung tissues and alveoli, caused by severe left ventricular dysfunction
What are the signs and symptoms of pulmonary edema?
Severe respiratory distress, frothy sputum, coughing, choking
Most pulmonary embolisms (PEs) originate from where?
deep vein thrombosis (DVT)
Chest pain from pulmonary embolism (PE) is typically what?
pleuritic and worsens upon inspiration
What is the medical management and nursing interventions of the patient with pulmonary embolism?
Bed rest, administration of IV Heparin per protocol, semi-fowlers position, and oxygen per mask or nasal cannula.
What position will the nurse instruct the pt with emphysema to enhance the effectiveness of breathing during dyspnea periods?
sitting on the side of the bed, leaning on an overbed table
A nurse is caring for a client with emphysema who is receiving oxygen. The nurse checks the oxygen flow rate to ensure that it does not exceed what?
What is the purpose of pursed lip breathing?
Promote carbon dioxide elimination
The low pressure alarm sounds on the ventilator. The nurse checks the client then attempts to determine the cause of the alarm but is unsuccessful. What initial action will the nurse take?
Ventilate the client manually
What does a pt w/emphysema become barrel chested?
Because of over inflation of the lungs
How much fluid should a pt w/emphysema consume each day?
What effective breathing technique is used for a pt w/emphysema?
What does Peak-flow monitoring measure?
how well air moves out of the lungs-during forceful exhalation
Which type of medication is used as rescue medication in acute asthma exacerbation
Asthma is best characterized as what type of disease?
an inflammatory disease
What are the nursing interventions for a pt with ineffective breathing pattern related to decreased lung expansion during an acute attack of asthma?
Administer oxygen therapy as ordered, remain with patient during acute attack to decrease fear and anxiety, incorporate rest periods into activities and interventions, and maintain semi-fowlers position to facilitate ventilation.
How is TB spread?
inhaling the TB bacteria after a person coughs, speaks, or sneezes
What is the most common etiologic factor for this diagnosis in patients with Tb who do are not compliant?
little or no motivation to adhere to a long-term drug regimen
The appropriate nursing intervention for Mr. K age 40, diagnosed with active Tb would be what?
place the patient in acid -fast bacilli (AFB) isolation precautions
What diagnostic test that will confirm TB?
What identifies the route of transmission of TB?
The airborne route
A nurse is reading the results of a Mantoux skin test on a client with no documented health problems. The site has no induration and a 1-mm area of ecchymosed. What are the results of this test?
A nurse is caring for a client who had a Mantoux skin test implantation 48 hours ago on admission to the nursing unit and reads the result of the skin test as positive. What nursing action is priority?
Report the findings
A client being discharged from the hospital to home with a diagnosis of TB is worried about the possibility of infecting the family and others. What information would help the client get the most reassurance?
The family will be treated prophylactically and the client will not be contagious after 2 to 3 consecutive weeks of medication therapy.
A nurse has reinforced discharge teaching with a client who was diagnosed with TB and has been on medication for 1� weeks. Which statement shows that the client has understood the teaching?
�I should not be contagious after 2 to 3 weeks of medication therapy�
A client with TB asks a nurse about precautions to take after discharge from the hospital to prevent infection of others. The nurse develops a response based on the understanding that TB is transmitted how?
By droplet nuclei
A nurse is preparing to give a bed bath to an immobilized client with TB. What should the nurse plan to wear when performing this care?
Particulate respirator, gown, and gloves.
A client with TB, whose status is being monitored in an ambulatory care clinic, asks the nurse when it is permissible to return to work. When does the nurse tell the pt he can return to work?
After three sputum cultures are negative.
What type of isolation is recommended for a patient w/TB?
What type of masks do visitors of TB pts use?
Particulate respiration mask
Which of the following statements accurately describe the disease tuberculosis (TB)? Most people who become infected with TB organism do not progress to the active disease stage.
Ms. C., age 45, is being evaluated to rule out pulmonary tuberculosis. Which finding is most closely associated with TB?
The health care workers for Ms. C., who is diagnosed with active tuberculosis, are instructed in methods of protecting themselves from contracting tuberculosis. The centers of disease controls and prevention currently recommend that health care workers who care for TB-Infected patients wear what?
a small micron fitted filtration mask
A nurse is assigned to care for a patient following a left pneumonectomy. The nurse would avoid positioning the client how?
On the side
What is the most common surgical treatment for lung cancer?
What is a pneumonectly?
Surgical removal of a lung
The primary goal for the patient with bronchiectasis is that the patient will what?
maintain removal of bronchial secretions.
What is bronchiectasis?
Irreversible chronic dilation of bronchi that destroys bronchial elastic & muscular elements
What are the signs & symptoms of bronchiectasis?
Dyspnea, cyanosis & clubbing of the fingers
What volume is O2 delivered to the pt with bronchiectasis?
What is the cure for bronchiectasis?
Surgical removal of the lung
What is a cystectomy?
Surgical removal of the bladder
What type of surgery is less invasive and less stressful for a pt with BPH?
How is tissue removed during TURP?
Through the urethra
What type of catheter is used on a pt with TURP?
Closed bladder irrigation
What type of solution is used in a closed bladder irrigation?
An isotonic solution
What should the pt expect after prostatic surgery?
Why should catheter drainage tubes be checked frequently?
For kinks that would occlude urine and cause bladder spasms
What diet is important for a pt with nephrotic syndrome?
Protein replacement, low salt
What meds are used to treat nehprotic syndrome?
Corticosteroids, loop diurectics
What is cystitis?
Inflammation of the wall of the urinary bladder
What are the signs and symptoms of cystitis?
Dysuria, urinary frequency and pyuria
Cystitis is confirmed by a u/a that reveals a bacterial count greater than what?
What is interstitial cystitis?
A chronic pain disorder in the urinary bladder and surrounding region
What statement by the client with Cushing�s syndrome indicates that the instructions related to dietary management were understood?
�I can eat foods that contain potassium.�
What is a feature of Cushing syndrome?
Increased susceptibility to infection
What causes Cushing Syndrome?
Overstimulation of ACTH
What is hypokalema?
Not enough potassium
What are the clinical manifestations of Cushing syndrome?
Moonface, buffalo hump
What is striae?
A streak or linear scar that often results from stretching of the skin
In the pt with Cushings syndrome, what results in hyperglycemia?
Impaired carbohydrate metabolism
What type of diet is indicated for a pt with Cushings syndrome?
Low sodium, reduce calories and carbs, and high potassium
When a nurse notes that a client with type 1 diabetes mellitus has lipodystrophy on both upper thights, what information should the nurse obtain from the client?
Plan of injection rotation.
Which client complaint would alert the nurse to a possible hypoglycemic reaction?
After several diagnostic tests, a client is diagnosed with diabetes insipidus. The nurse understands that which symptom is indicative of this disorder?
What should the pt avoid when taking tolbutamide (Orinase) for diabetes mellitus?
What disorder caused by secretion of insufficient amounts of antidiuretic hormone (ADH)?
What is the main problem with diabetes mellitus type 2?
Abnormal resistance to insulin action.
In caring for a patient with diabetes mellitus who is experiencing an acute hyperglycemic reaction (diabetic ketoacidosis), what interventions would be appropriate?
Insulin IV via infusion pump
What is diabetes insipidus?
A disorder of the pituitary in which ADH is deficient
How much urine can a pt with diabetes insipidus lose in an hour?
What are the characteristics of diabetes insipidus?
Polyuria and polydipsia
What is the normal serum sodium level?
What happens to urine specific gravity in a pt with diabetes insipidus?
it drops below 1.003
How much fluid should a pt with diabetes insipidus intake?
What causes polydipisa and polyuria related to diabetes?
Fluid shifts resulting from the osmotic effect of hyperglycemia
In planning care for a patient with type 2 diabetes admitted to the hospital with pneumonia, the nurse recognizes that the patient may have what?
Sufficient endogenous insulin to prevent ketosis but is at risk for development of hyperosmolar coma
At what time of day is a diabetic pt at risk for hypoglycemia?
In the late afternoon and at bedtime
What is a diabetic diet designed to do?
Help normalize blood glucose through a balanced diet
What is an appropriate instruction or the pt with diabetes related to care of the feet?
Inspect all surfaces of the feet daily
Which oral hypoglycemic works primarily by reducing hepatic glucose production and lowers fasting blood glucose levels?
What types of insulin are used in an insulin pump?
Regular and rapid-acting
How long is the onset of regular insulin (Humulin R)?
30 minutes to an hour
How long is the onset of action of Lispro (Humalog)?
How long is the onset of action of NPH (Humulin N)?
Why is caffeine restricted in a pt with diabetes insipidus?
Because it acts as a diuretic
What is deficient in a pt with diabetes insipidous?
What is diabetes mellitus?
Improper metabolism of carbs, fats, and proteins
When does insulin reach its peak level?
30 minutes after meals and returns to normal in 2-3 hours
What is the difference between type 1 and type 2 dibetes?
Type 1 is insulin dependent (IDDM) and Type 2 is non insulin dependent (NIDDM)
What causes IDDM?
Destruction of beta-cell function
What are the causes of NIDDM?
Decreased tissue, overproduction of insulin, abnormal glucose regulation
How is glucose stored?
As glycogen in the liver
What must be present for muscle cells and other body cells to utilize glucose?
What is hyperglycemia?
Excess glucose in the bloodstream
How does the body get rid of excess glucose in the bloodstream?
The kidneys will excrete it in urine, called glycosuria
Because it enters the bloodstream too quickly and can cause hypoglycemia
Which part of the body provides the fastest, least variable absorption?
What is as close a substitute to a healthy, working pancrease?
An insulin pump
What is a bolus of insulin?
A quantity of insulin delivered to cover a carbohydrate meal
What is the function of metformin (glucophage)?
It reduces hepatic glucose production and lowers fasting blood glucose levels
What must a pt have for oral hypoglycemics to be effective?
Some function insulin production
Why is calcium gluconate prescribed for a pt after a thyroidectomy?
To treat hypocalcemic tetany
What nursing action is appropriate for a pt after a thyroidectomy who has developed hoarseness and a weak voice?
Reassure the client that this is usually a temporary condition.
What would require the nurse�s immediate attention when caring for a postop thyroidectomy pt?
A nurse is caring for a client after thyroidectomy and monitoring for signs of thyroid storm. What manifestation is associated with this disorder?
What signs or symptoms should be reported immediately to the RN/MD for further evaluation in the pt who has undergone a thyroidectomy?
Numbness in the fingers, Heart rate of 160, Noticeable arm twitching when you took patient's blood pressure
How is a pt placed after a thyroidectomy?
Supine with pillows supporting the head and shoulders
What two conditions should the nurse monitor for after a thyroidectomy?
Tetany and edema
What is Chvotek�s sign?
An abnormal spasm of the facial muscles elicited by light taps on the facial nerve
What condition will cause a pt to have a positive Chvotek�s sign?
What is Trousseau�s sign?
A test in which a BP cuff is inflated to above systolic BP for 3 minutes.
What will happen with a positive Trousseau�s sign?
Carpal spasm in pts with hypocalcemia and hypomagnesemia
What is a thyroid storm?
A condition in which large amounts of thyroid hormones are released
What is administered for the emergency treatment of tetany?
When does a thyroid crisis generally occur?
In the first 12 hours post op
What are the signs and symptoms of a thyroid crisis?
Nausea, vomiting, severe tachycardia, hyperthermia, exaggerated symptoms of hyperthyroidism
What are the three goals of thyroid storm management?
Induce normal thyroid state, prevent cardiovascular collapse, prevent excessive hyperthermia
What is a sign that damage to the laryngeal nerve may have occurred in a pt who has had a thyroidectomy?
The pt is becoming increasingly hoarse.
What is hyperthyroidism?
Overproduction of T4 and T3
What are the clinical manifestations of hyperthyroidism?
Edema of the anterior portion of the neck, bulging eyes
What is the diet therapy for a patient with hyperthyroidism?
Foods high n calories, vitamins, minerals, and carbs
What does a radioactive iodine uptake test determine?
How is the radioactive iodine given?
By mouth to the fasting patient
What is important to obtain from a patient before a radioactive iodine uptake test?
Allergies and signed consent
What drugs are given to treat hyperthyroid?
PTU, methimazole (Tapazole)
What is the gold standard for treating hyperthyroidism?
Ablation therapy using radioactive iodine
How often is the thyroid checked during a RAIU?
2, 6 & 24 hours
What type of diet is important for a pt w/hyperthyroidism?
Foods high in calories, vitamins, minerals, and carbs
What is hypothyroidism?
A condition in which the thyroid fails to secrete sufficient hormones, resulting in a slowing of all of the body�s metabolic processes
What type of diet is important for a patient with hypothyroidism?
High-protein, high-fiber, low-calorie
Appropriate nursing care for the patient with hypothyroidism would include what?
What is severe hypothyroidism called?
What should the nurse watch for in a pt w/hypothyroidism that could indicate cardiac involvement?
Chest pain, dyspnea, changes in rate and rhythm.
Mr. A., age 71, is admitted with an exacerbation of COPD. He has dependent edema and ascites as well as dyspnea. A complication that may occur in CIPD is which some of the capillaries surrounding the alveoli are destroyed, resulting in pulmonary hypertension, blood returning to the right side of the heart, and signs and symptoms of right-sided HF is what?
A patient with COPD asks why the heart is affected by the respiratory disease. The nurse�s response to the patient is based on the knowledge that cor pulmonale is characterized by what?
right ventricular hypertrophy secondary to increased pulmonary vascular resistance
Ineffective airway clearance related to tracheobronchial obstruction and/or secretions is a nursing diagnosis for a patient with COPD. Which of the following are correct?
Offer small, frequent, high-calorie, high-protein feedings. Encourage generous fluid intake. Have patient turn and cough every 2 hours;; teach effective coughing technique.
A nurse is caring for a client hospitalized with acute exacerbation of COPD. Which of the following would the nurse expect to note in evaluating the client?
A hyper inflated chest on x-ray
Mr. F., age 52, had a laryngectomy due to cancer of the larynx. Discharge instructions are give to Mr. F. and his family. Which response, by written communication from Mr. F, or verbal response by the family, will be a signal to the nurse that the instructions need to be decalcified?
It is acceptable to take over-the-counter medications now that conditions are stable.
What is orthopnea?
A condition in which a person must sit or stand to breathe deeply or comfortably
What are the signs and symptoms of left-sided heart failure?
What are the signs and symptoms of right-sided heart failure?
Edema in legs, jugular vein distention, liver enlargement, ascites
What are the signs and symptoms of right-sided heart failure?
Edema in legs, jugular vein distention, liver enlargement, ascites
What should a postmyocardial patient being prepared for discharge be instructed to do?
Begin a cardiac rehab program
What is the primary function of patient teaching following a myocardial infarction?
To assist the patient to develop a healthy lifestyle
What is an important nursing intervention when caring for a patient with remote telemetry?
Never remove telemetry and allow patient to shower unless physician has written the order to allow a shower
What is the name of the neurohormone released from the left ventricle in response to volume expansion and pressure overload that has emerged as the blood marker for the identification of individuals with CHF?
B-type natriuretic peptide (BNP)
What is the normal range for B-type natriuretic peptide (BNP)?
0 to 100 pg/ml
What is a myocardial muscle protein released into circulation after myocardial injury and is useful in diagnosing a myocardial infarction?
What typical vital signs will display in a patient presenting with a myocardial infarction?
Hypertension, tachycardia, weakened pulse, temperature elevation
What cardiac markers is specific to the heart, not influenced by skeletal muscle trauma or renal failure, and rises 3 hours following a myocardial infarction?
What nursing care is followed for a patient with myocardial infarction?
Bedrest with commode privileges for 24 to 48 hours.
What breath sounds would a nurse expect to hear in a patient with myocardial infarction who suddenly becomes tachycardic and shows signs of air hunger?
What is a myocardial infarction?
An occlusion of a major coronary artery
How long does it take myocardial cells to die?
Jaundice results when there is an excess amount of what in the bloodstream?
What is the preferred diagnostic test for visualizing the biliary tree in a pt with jaundice?
What is multiple myeloma?
Bone marrow cancer that metastasizes to the bone
What labs should the nurse monitor in a pt with multiple myeloma?
Calcium�watch for hypercalcemia
What is the best food item to administer with oral iron supplements?
What nursing intervention should be incorporated into the plan of care for a child with aplastic anemia with WBC of 6000 and platelet of 27,000/mm?
Encourage quiet play activities
What test is used to detect pernicious anemia?
What would a nurse expect to specifically note with in a pt with a diagnosis of multiple myeloma?
Increased calcium level
What is a priority nursing intervention for the client with multiple myeloma?
What intervention is a priority in the nursing plan of care for a pt with thrombocytopenia?
Monitor the client for bleeding
What medication is given to the patients with sickle cell anemia?
What does anemia cause?
Delivery of insufficient amounts of oxygen to tissues and cells
What is pernicious anemia?
The absence of a glycoprotein intrinsic factor secreted by the gastric mucosa
What is thrombocytopenia?
Blood platelets below 150,000
What is sickle cell anemia?
An illness in which the blood cells shape in crescents and get stuck to one another and occlude vessels
What would the nurse expect to find during the physical assessment of a pt with thrombocytopenia?
Petechiae and purpura
What is an important nursing intervention goal to establish for a person who has iron deficiency anemia?
Alternate periods of rest and activity to balance oxygen supply and demand
What is a nursing intervention for a pt during a sickle cell crisis?
Administration of large doses of continuous opioid analgesics
What foods should be included in the diet of a pt with iron deficiency anemia?
Dark green leafy veggies ad organ meats
In addition to the general symptoms of anemia, the pt with pernicious anemia also manifests what?
What statement by the pt with pernicious anemia would indicate the she has understood the teaching?
�I�ll have to take B12 shots for the rest of m life.�
What type of data indicates that iron deficiency anemia is not currently managed effectively?
In a pt with sickle cell anemia, why does the sickling crisis not stop when oxygen therapy is started?
when red cells sickle, they occlude small vessels, which causes more local hypoxia and more sickling
How is a pt positioned during a needle liver biopsy?
Supine with the right arm over the head
What is the most common form of hepatitis, having an incubation period of 10-40 days.
What snack choices would be appropriate for a pt suffering from acute pancreatitis?
Reduced fat cheese and whole wheat crackers
What is the preferred diagnostic test for visualizing the biliary tree in a pt with jaundice?
How is the pt instructed to breathe during a needle liver biopsy?
Exhale fully and not breathe while the needle is inserted
What causes jaundice in a pt?
An excess of bilirubin
What is a needle liver biopsy?
A test in which a needle is inserted into the liver between the 6 & 7 or 7 & 8 intercostal spaces
After a cholesysectomy, why would a pt complain about shoulder pain?
Diaphragmatic irritation secondary to residual carbon dioxide
What is jaundice?
The appearance of yellowish skin, discoloration of the sclera and mucous membranes
What is the best form of preventing hepatitis A & B?
What is a critical aspect nursing interventions following a liver transplantation?
Monitor for infection
What vitamins are given intravenously with fluids for the dehydrated hepatitis pt?
C (healing), B (assists liver to absorb vit), K (blood clotter)
What can happen to a pt after a liver transplant, who has liver disease secondary to viral hepatitis?
They often experience reinfection of the transplanted liver with hepatitis B or C
What are the signs and symptoms of hepatitis?
General malaise, aching muscles, headaches, chills, abdominal pain, dyspepsia, nausea, diarrhea and constipation.
What would be an appropriate nursing intervention in a pt with viral hepatitis and no appetite?
Offer small, frequent meals
What immunosuppressant drug is utilized in the success of a liver transplant?
What are the major postop complications of a liver transplant?
Rejection and infection
How is hepatitis diagnosed?
A normal lab test will be negative for the presence of the antigen
How is hepatitis G spread?
Unsafe tattooing or piercing; coinfection of Hepatitis C
How is hepatitis B spread?
Through contaminated blood transfusion, direct contact with body fluids, sexual contact
What are the nursing interventions following a liver biopsy?
Ensure that platelet, clotting or bleeding time or okay and report any abnormal lab values to the doc; observe for the symptoms of bleeding
How is hepatitis A spread?
Through the fecal-oral route, usually by contaminated food
How is hepatitis E spread?
Oral-fecal route; spreads through fecal contamination of water
Following a liver biopsy, how long is a pt to lay on their right side?
A minimum of 2 hours to splint the puncture site
How is hepatitis D spread?
Coinfection of hepatitis B
What infection control method would be priority to include in the plan of care to prevent hepatitis B in a pt considered to be at high risk for exposure?
Hepatitis B vaccine
What type of hepatitis is contracted from contaminated food?
What should the nurse encourage in order to provide adequate nutrition to a pt with viral hepatitis, who is complaining of loss of apetite?
Increase intake of fluids
What signs or symptoms would a nurse expect to note in a pt with acute viral hepatitis?
What physician order would a nurse verify on the chart of a pt with acute pancreatitis?
Morphine sulfate for pain
What position will aggravate the pain in a pt with acute pancreatitis?
What foods are allowed for a pt with hepatic encephalopathy?
Toast, cereal, rice, tea, fruit, juice, and hard candies
What nursing interventions are included in planning care for a pt with metastatic cancer of the liver?
Focus primarily on symptomatic and comfort measures
What is the treatment for cancer of the liver?
What do most pts already have when diagnosed with cancer of the liver?
What are the signs and symptoms of cirrhosis?
Dyspepsia, changes in bowel habits, gradual weight loss, ascites, enlarged spleen and spider telangiectases
What causes ascites?
Portal hypertension and hypoalbumin
What is the number one drug of choice for alieving pain of pancreatitis?
What is cirrhosis?
A chronic, degenerative disease of the liver in which the lobes are covered with fibrous tissue and the lobules are infiltrated with fat
What are the signs and symptoms of cholecystitis and cholelithiasis?
Low grade fever, elevated leukocyte count, clay-colored stools that contain fat, dark amber urine
What is hepatic encephalopathy?
Brain damage caused by liver disease where there is ammonia intoxication
What type of diet is prescribed for a pt with hepatic encephalopathy?
Very low protein to no protein diet
What is ascites?
An accumulation of fluid and albumin in the peritoneal cavity
What is cholecystitis?
An inflammation of the gallbladder
How can pain from pancreatitis be alleviated?
By flexing the trunk, leaning forward from a sitting position, or by assuming the fetal position
Why is it especially important for the pt to cough and deep breathe postoperatively following an open cholecystectomy?
The pt tends to take shallow breaths due to the placement of the incision
What will the administration of analgesic morphine cause in pts with acute pancreatitis?
Spasms of the sphincter of Oddi
Hepatitis types B,C,D, & G are spread mainly through which routes?
Blood transfusions, contaminated needles and instruments, direct contact with body fluids from infected people
What nursing diagnoses could be related to a liver needle biopsy?
Pain, related to leakage of blood and bile into the peritoneal cavity
When caring for a pt with hepatic encephalopathy the nurse may give enemas, provide a low-protein diet, and limit physical activity. Why are these measures taken?
To decrease the production of ammonia
In hepatic encephalopathy, what is the nurse assessing for when she requests the pt stretch out the arm and hyperextend the wrist with the fingers separated, relaxed, and extended to see whether rapid, irregular flexion and extension (flapping) of the wrist occur?
Which types of hepatitis now have vaccines for prevention?
A & B
Why is a T-tube inserted during a cholecystectomy?
To keep the duct open and allow drainage
What type of food is limited in a pt with advanced cirrhosis of the liver?
Following a laparoscopic cholecystecomty, what should the pt report?
Bile-colored drainage or pus from any incision
Why is lactulose given to a pt with hepatic encephalopathy?
It decreases the bowel�s pH thus decreasing the production of bacteria within the bowel
What is the stool and urine color of a pt who is jaundiced?
Dark tea-colored urine and clay-colored stools
When caring for a pt with acute pancreatitis, what lab reports may be anticipated?
Hypoalbuminemia, hyperglycemia, and elevated hematocrit and leykocytosis
What is the nurses response to a pt with advanced cirrhosis who asks why his abdomen is so swollen?
Portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space
What labs are taken for cirrhosis?
What is the post op care for an open cholecystectomy?
Monitor vital signs and observe dressing for exudates or hemorrhage
What is hepatitis?
An inflammation of the liver resulting from several types of viral agents or exposure to toxic substances
How is hepatitis C spread?
Needle sticks, contaminated blood transfusions
Why is neomycin given to a pt with hepatic encephalopathy?
To reduce the bacterial flora of the colon
What is pancreatitis?
Inflammation of the pancreas and may be acute or chronic
What types of drugs are avoided until the liver regains adequate function?
Drugs that are normally detoxified in the liver
What is a cholesystectomy?
A procedure to remove the gallbladder
What two major factors are most commonly associated with pancreatitis?
Alcoholism and biliary tract disease
What are the signs and symptoms of pancreatitis?
Severe abdominal pain radiating to the back; low-grade fever, vomiting, jaundice, weight loss, steatorrhea, and tachycardia
What is the primary use of nonabsorbable antibiotics as preparation for bowel surgery?
To reduce the bacterial flora in the colon
What is the most important nursing intervention to decrease post op edema and pain in a male pt following an inguinal herniorraphy?
Elevation of the scrotum with a support or small pillow
How is hernia reduced?
Returned to its original position by manipulation
When can a temp colostomy be closed?
6 weeks to 3 months after the initial procedure
What is the treatment of diverticulus disease when muscle atrophy is responsible?
Low-residue diet, stool softeners, and bed rest
How can dumping syndrome be relieved?
Eating 6 small meals without fluids and by lying down after eating to slow the movement of food
What are the types of hernias?
Ventral, femoral, inguinal and umbilical
What is a hernia?
A protrusion of a viscus through an abnormal opening or a weakened area in the wall of a cavity
What is an incarcerate hernia?
One that cannot be returned to its original position
What is the difference between ulcerative colitis and Crohn�s disease?
Ulcerative colitis is curable with a colectomy; Chrohn�s often recurs after surgery
How would a stoma appear if a prolapse occurred?
Protruding and swollen
Dumping syndrome is a disorder associated with what condition?
Following gastric resection or peptic ulcer surgery
What is a nursing diagnosis for a pt with ulcerative colitis?
Imbalanced nutrition, less than body related to bowel hyper
What is diverticulitis?
The inflammation of one or more diverticula
What are the sings and symptoms of dumping syndrome?
Diphoresis, nausea, vomiting, explosive diarrhea, borborygmi and dyspepsia
Which nursing measure will the nurse instruct the pt to follow to help prevent dumping syndrome?
Limit the fluids taken with meals
What recommendations for food choices would you give a pt who has been diagnosed with diverticulosis as a result of muscle thickening and increased intracolonic pressure?
Bran, fruits and vegetables
What are the difficulties of the hiatal hernia pt?
Gastroesophageal reflux, heartburn, strangulation, infarction and ulceration
What is diverticulosis?
The presence of pouchlike herniations
What is a hiatal hernia?
A protrusion of the stomach through the diaphragm
What symptoms will indicate the occurrence of dumping syndrome?
Sweating and pallor
What is ulcerative colitis?
Abcessess in the rectum and up through the large intestine
What is dumping syndrome?
A condition of weakness and sweating following eating related to rapid emptying of the stomach
What is the treatment for diverticulus when muscle thickening is responsible?
High-fiber diet of bran, fruits and veggies
What lab values are decreased as a sign of a fat embolism?
Hemoglobin and hematocrit
What are the signs and symptoms of a fat embolism?
Chest pain, localized muscle weakness, spasticity and rigidity, all especially if a pt has multiple broken bones
What medications are used to control RA?
Antiinflammatory drugs and aspirin
When may a prothesis be fitted?
2 or 3 weeks post op
Besides joints, what other systems can RA affect?
Lung, heart, blood vessels, muscles, eyes and skin
Why is it necessary to warp an amputated extremity?
To facilitate proper fit and use of a prothesis
What type of disease is RA?
A chronic, systemic disease that�s also though of as an autoimmune disorder
How are flexion hip contractures prevented postoperatively?
By raising the foot of the bed slightly
How much sleep is recommended for a pt with RA?
8-10 hours a nig and a 2 hour nap during the day
What is the most common type of fracture treated in the hospital?
How is a fat embolism formed?
When a bone breaks, the fat deposits in the marrow are released into the bloodstream
What is an extracapsular fracture?
When a fracture occurs outside of the hip joint capsule
What is an impacted fracture?
Where one bone fragment is forcibly impacted into another bone fragment
What is compartment syndrome?
The progressive development of arterial vessel compression and reduced blood supply to an extremity
What are signs of a hip fracture?
Inability to move the leg voluntarily, and shortening or external rotation of the leg
What is a transverse fracture?
A break that runs directly across the bone
What are the signs of compartment syndrome?
inability to flex the fingers or toes, coolness of the extremity and absence of a pulse
What is an oblique fracture?
A break along the slant of the bone at a 45 degree angle
What is an intrascapular fracture?
When the femur is broken inside the joint
What is a comminuted fracture?
The bone is splintered into three or more fragments at the site of the break
What is the maximum elevation for the head of bed on a hip fracture patient?
How high can a limb with compartment syndrome be elevated?
No higher than the heart
What is a complete fracture?
A fracture entirely through the bone
Why does phantom pain occur?
Because the nerve tracks that register pain in the amputated area continue to send a message to the brain
What diagnostic tests are performed prior to an amputation?
CBC, BUN, potassium levels, urinalysis
In a pt with gout, what is the fluid intake increased to?
What is gout?
A metabolic disease resulting from an accumulation of uric acid in the blood
What is a greenstick fracture?
An incomplete fracture; the bone is only broken on one side