N420 Exam 2
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The rapid removal of fluid from the abdominal cavity during paracentesis leads to ________ which can cause ________ and resultant _______.
- decreased abdominal pressure
- resultant shock
Symptoms of dumping syndrome occur _____ after eating.
s/s of dumping syndrome.
- Feeling full; cramps
- palpitations & tachycardia
- sweating, weak, dizzy
Teaching pts for dumping syndrome.
- avoid sugar, salt, milk
- eat high-protein, high-fat, LOW-carb diet
- eat small meals w/o fluids
- lie down after meals
- take antispasmodic meds to delay gastric emptying
Obese pts are at increased post-op risk for ______ & _______ complications & death with bariatric surgery.
Foods rich in vitamin B-12.
- citrus fruits
- drie beans
- organ meats
- brewer's yeast
After bariatric surgery, what should the pt avoid?
- high-protein foods,
- foods high in sugar & fat
Which nutritional supplements may be prescribed following bariatric surgery?
- vitamin B12
In a pt with cirrhosis, if ascites & edema are absent & no signs of impending coma, a ________ diet supplemented with vitamins is prescribed.
In a pt with cirrhosis, which supplemental vitamins should be prescribed?
- B complex
- A, C, K
- folic acid
In a pt with cirrhosis, restrict _____ and ______ intake.
Administer _______ to treat ascites.
What is fetor hepaticus?
the fruity, musty breath odor of severe chronic liver disease
Why would you give lactulose to a cirrhosis pt?
- decreases pH of bowel
- decreases production of ammonia by bacteria
- facilitates excretion of ammonia
Which meds should be avoided in a pt with cirrhosis?
- hepatotoxic meds
What causes esophageal varices?
portal HTN, often associated with liver cirrhosis
When would esophageal varices be an emergency?
when they are bleeding
Things to assess for esophageal varices.
- hepatomegaly & splenomegaly
- dilated abdominal veins
- signs of shock
In a pt with esphageal varices, they should avoid what type of activities?
those that will initiate the vasovagal response
Precipitating factors of pancreatitis.
- alcohol use
- biliary tract disease
- viral or bacterial disease
- ischemic vascular disease
- peptic ulcer disease
Where will the pain be with acute pancreatitis?
sudden onset mid-epigastric or LUQ with radiation to the BACK
What aggravates the pain of acute pancreatitis?
- fatty meal
- lying in recumbant position
What labs will be elevated with pancreatitis?
- alkaline phosphatase
- urinary amylase
- serum lipase & amylase
What is Cullen's sign?*
discoloration of the abdomen & periumbilical area (sign of acute pancreatitis)
What is a Turner's sign?*
bluish discoloration of the flanks (sign of acute pancreatitis)
When should the HCP be notified with a pt with pancreatitis?
- acute abdominal pain
- clay-colored stools
- dark-colored urine
Why are pancreatic enzymes prescribed with chronic pancreatitis?
to aid in digestion and absorption of fat & protein
When should a pt with chronic pancreatitis notify the HCP?
- increased steatorrhea
- abdominal distention or cramping
- skin breakdown
What should you assess in a pt with possible chronic pancreatitis?
- abdominal pain & tenderness
- LUQ mass
- wt loss
- muscle wasting
- s/s DM
What should you assess in a pt with possible ACUTE pancreatitis?
- suden onset of mid-epigastric or LUQ pain radiation to BACK
- pain aggravated by fatty meal or lying in recumbant post
- abdominal tenderness & guarding
- wt loss
- absent or decreased BS
- Cullen's sign, Turner's sign
- elevated WBC, BGL, billirubin, amylase, lipase
For biopsy of bladder, withhold food _______.
after midnight the night b4 the test
For renal biopsy, withhold food and fluids _______.
4-6 hours before procedure
How long to hold pressure to renal biopsy site after procedure?
Which position should a pt be in after a renal biopsy?
- strict bed rest
- supine with a back roll for support for 2-6 hrs after biopsy
When should HCP be notified after renal biopsy?
- temp > 100
- hematuria after 24 hrs
What does prerenal mean?
OUTSIDE the kidney
What does INTRArenal mean?
WITHIN the parenchyma of the kidney
What does POSTrenal mean?
b/w the kidney and the urethral meatus
Causes of prerenal AKI?
- intravascular volume depletion
- decreased CO
- decreased PVR
- decreased renovascular BF
- rerenal infection or obstruction
Causes of intrarenal AKI?
- tubular necrosis
- prolonged prerenal ischemia
- intrarenal infection or obstruction
Causes of postrenal AKI?
- bladder neck obstruction
- bladder cancer
- postrenal infection
Duration of oliguria in AKI?
- 8-15 days
- (longer duration = less chance of recovery)
What is the UOP in the oliguric phase of AKI?
less than 400 mL/day
What signs are seen in the oliguric phase of AKI?
- excess FV, edema
- pleural & pericardial effusions
- dysrhythmias, HF, pulmonary edema
- metabolic acidosis
- neuro changes
What are signs of pericarditis (which is also a sign of AKI)?
- friction rub,
- chest pain with inspiration
- low-grade fever
Kussmaul's respirations are indicative of?
metabolic acidosis (sign of AKI)
Interventions for oliguric phase of AKI.
- restrict fluid intake
- if HTN, 400-1000mL may be allowed plus UOP
- diuretics to increase renal BF & diuresis
What is a primary concern in a pt having a liver biopsy?
- Bleeding b/c of high vascularity of liver
- *check risk for bleeding
Normal prothrombin time.
What is important to note with daily weights in a pt with AKI?
- *an increase of 1/2 to 1 lb/day = fluid retention
- also weigh at same time, same scale, same clothes
How often to monitor I&Os with AKI?
What is azotemia?
the retention of nitrogenous wastes in the blood
What is CKD?
- slow, progressive, IRREVERSIBLE loss in kidney fxn
- GFR < or = 60m>/minute for THREE mos or longer
What does CKD result in?
uremia or ESKD
Primary causes of CKD.
- DM, HTN
- chronic urinary obstruction
- recurrent infections
- renal artery occlusion
- autoimmune DO
What physiological changes could occur in a pt with CKD?
- emotional lability
- depression, anxiety, suicidal behavior
- dependence-independence conflict
- body image changes
Typical diet for CKD pt.
- moderate protein
- low-K+, low-phosphorous
In a pt with CKD, provide _____ and _____ care.
- oral (prevent stomatitis, reduce discomfort from mouth sores)
- skin (prevent pruritus)
Why do CKD pts develop fatigue?
from anemia & buildup of wastes
In pts with CKD, avoid administration of _______.
- aspirin b/c it's excreted by kidneys.
- could cause toxicity & prolong bleeding time
CKD pts should avoid foods high in ______.
In CKD pts, what can be administered to lower the serum potassium level?
- oral or rectal Kayexalate
- (electrolyte-binding & electrolyte-excreting)
Why should a CKD pt avoid laxatives, antacids & enemas?
- they contain magnesium
- CKD pts have hypermagnesemia from decreased renal excretion of Mg++
Why should (CKD) pts avoid the use of aluminum hydroxide preparations to bind phosphates?
they are associated with dementia and osteomalacia
Why are CKD pts at risk for bone demineralization?
- decreased renal excretion of phosphorous (hyperphosphatemia) = hypocalcemia =
- stimulation of parathyroid hormone = bone demineralization
Why would a CKD pt need stool softeners & laxatives?
phosphate binders are administered to increase excretion of phosphorous and they are constipating
Why should urinary catheters be avoided in CKD pts?
they are at increased risk for infection due to a suppressed immune system (& poss malnutrition)
Interventions to control muscle cramps with CKD pts.
- heat & massage
- electrolyte replacements
Earliest indication of increased ICP.
- altered LOC
- –incrsd BP & RR and a slow/bounding pulse
Late signs of increased ICP
- *increased SBP
- *widened pulse pressure
- *slowed HR
- changes in motor fxn from weak to hemiplegia
- positive Babinski reflex
- decorticate or decerebrate posture
In pts with increased ICP, avoid which med and why?
morphine to prevent hypoxia
What should you maintain the PaCo2 at for a pt with increased ICP? Why?
- will result in vasoconstriction, decreased BF, & decreased ICP
Extremely late sign of increased ICP
- Cushing's triad:
- Bradycardia, hypertension, and bradypnea
- Cheyne-Stokes breathing
Complications in a pt with a TBI (craniotomy) r/t fluid & electrolyte imbalance.
DI & SIADH
Injury at C2-C3
Spinal cord injury at C4.
causes respiratory difficulty & paralysis of all 4 extremities.
Spinal cord injury at C5-C8.
- may have shoulder movement
- may have decreased respiratory reserve
_______ occurs with lesions or injuries above T6 and in cervical lesions.
Spinal cord injury at S2 or S3.
the bladder will contract but not empty (neurogenic bladder)
Spinal cord injury above S2 in males.
can have erection, but unable to ejaculate
Spinal cord injury b/w S2-S4.
prevents erection or ejaculation
Spinal cord injury at C4
paralysis of intercostal & abdominal muscles (assess respiratory status)
Signs of spinal shock.
- flaccid paralysis
- loss of reflex below level of injury
- paralytic ileus
Signs of autonomic dysreflexia.
- sudden severe throbbing H/A
- severe HTN & bradycardia
- flushing above injury
- pale blow injury
- nasal stuffiness, nausea, sweating, piloerection
- dilated pupils/blurred vision
Something to avoid when caring for pts with cerebral aneurysm.
taking rectal temp
Highest incidence of all cancer.
Highest cancer incidence in males in order of frequency.
Highest cancer incidence in females in order of frequency.
Cancers with a familial relationship.
Infections associated with cancer.
- genital herpes
- hyman cytomegalovirus
Alcohol promotes which cancers?
liver & esophagus
Women ages _______ should have a breast exam by HCP every 3 yrs.
A tumor that arises from epithelial tissue.
A tumor arising from supportive tissues.
Hormones that may be used as tumor markers.
- calcitonin, catecholamines
Used to kill a tumor, reduce the tumor size, relieve obstruction, or decrease pain.
Causes lethal injury to DNA, so it can destroy rapidly multiplying cancer cells, as well as normal cells.
Time & distance for a nurse caring for a pt receiving internal radiation.
- limit contact time to 30 min per 8-hr shift
- min distance of 6 ft
Visitors of internal radiation pts should limit their visits to _______ (time).
SE of EXTERNAL radiation.
- tissue damage to tgt area
- ulers of mouth
- radiation pneumonia
Wash marked area of external radiation with what?
plain water ONLY; pat dry skin
How long to protect skin from sun exposure after external radiation?
at least one year
Type of diet for chemo pts.
- avoid undercooked meat, spicy, fatty, & hot foods, & raw fruits & veggies
- frequent small, low-fat meals
High risk of spontaneous hemorrhage when platelet level is < ________.
Interventions for extravasation (leaking chemo againts into surrounding tissue).
- antidote injection
- cold or warm compress
Four oncologic emergencies.
- Spinal cord compression
- SVC syndrome
- Cardiac tamponade
Early symptom of spinal cord compression (oncological emergency).
- back & leg pain
- coldness, numbness, tingling, paresthesias
- (progression to bowel & bladder dysfunction, weakness, & paralysis)
S/S of SVC syndrome (oncological emergency).
- perorbital edema & facial edema
- (results from blockage of venous circulation of head, neck, & upper trunk)
Symptoms of SVC syndrome (oncological emergency) progress to....?
- edema of neck, arms, hands
- difficulty swallowing, SOB
Late s/s of SVC syndrome (oncological emergency).
- cyanosis, altered mental status
- HA, HTN
Nursing interventions for SVC syndrome (oncological emergency).
- prepare for tracheostomy
- seizure precautions
- corticosteroids to reduce edema
S/S of DIC (oncological emergency).
- r/t decreased BF to major organs:
- AND depleted clotting factors:
- abnormal bleeding
What foods does it include?
- meat, fish, poultry, cheese, eggs
- cranberries, prunes, plums,
- corn, lentils, grains
- foods high in:
- cholorine, phosphorous, & sulfur
What foods does it avoid?
- milk & milk products
- all veggies except corn & lentils
- all fruits except cranberries, plums, & prunes
- all foods high in Na+, K+, Ca+, Mg++
What is an acid-ash diet?
lowers pH (to reduce bacteria growth)
Normal UOP in 24 hrs.
The ONLY cause of significant elevation of Cr.
severe renal damage
Normal serum Cr levels
- Males: 0.6 - 1.5
- Females: 0.6 - 1.1
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