Exam #3 Study Guide
Exam #3 Study Guide Nurs 3310
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This 10 page Study Guide was uploaded by Christie Kepler on Sunday February 14, 2016. The Study Guide belongs to Nurs 3310 at Western Michigan University taught by Bergman in Winter 2016. Since its upload, it has received 36 views. For similar materials see Nurs Med Surg in Nursing and Health Sciences at Western Michigan University.
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Date Created: 02/14/16
Study Guide Exam 3 Nausea & Vomiting Reasons: Pregnancy Infection Central Nervous System Disorders (e.g. Meningitis, Tumor) Cardiovascular Problems Metabolic Disorders Post Operatively after general anesthesia Side effects of Drugs Psychologic Factors Treatment Phenothiazines promethazine (Phenergan) Act in the CNS level of the CTZ Block dopamine receptors that trigger nausea and vomiting SE: Dry mouth, hypotension, sedative effects, rashes constipation Antihistamines dimenhydrinate (Dramamine) diphenhydramine (Benadryl) Block the histamine receptors that trigger nausea and vomiting SE: Dry mouth, hypotension, sedative effects, r ashes, constipation Prokinetic Agents Rnetoclopramide (Reglan) Inhibit action of dopamine ↑ Gastric motility and emptying SE: CNS side effects ranging from anxiety to hallucinations -Extrapyramidal side effects, including tremor and dyskinesia similar to Parkinson’s disease) Serotonin (5-HT) Antagonists ondansetron (Zofran) Block the action of serotonin (substance that causes nausea and vomiting) Constipation, diarrhea, headache, fatigue, malaise elevated liver function tests Dexamethasone (Decadron) is used in the management of both acute and delayed cancer chemotherapy induced emesis, usually in combination with other antiemetics Oronabinol (Marinol) is an orally active cannabinoid that is used alone or in combination with other antiemetics for the prevention of chemotherapy- induced emesis. Because of the potential for abuse, as well as drowsiness and sedation, this drug is used only when other therapies are ineffective. Nutritional Therapy. Requires IV fluid therapy with electrolyte and glucose replacement until able to tolerate oral intake. In some cases a nasogastric (N G) tube and suction are used to decompress the stomach. Start oral nutrition beginning with clear liquids once symptoms have subsided. Extremely hot or cold liquids are often difficult to tolerate. Carbonated beverages at room temperature and with the carbonation gone and warm tea are easier to tolerate. Sipping Small amounts of Fluid (5 to 15 mL) every 15-20 minutes Broth and Gatorade High in Sodium Drink fluids after meal not with to avoid over distention Lewis et al. (2014). Medical-surgical nursing: Assessment and management of clinical problems(9 thed.). St Louis: Elsevier NONdrug Therapy Accupressure Accupuncture Ginger & Peppermint Oil GERD -Results when the defenses of the esophagus are overwhelmed by the reflux of acidic gastric contents into the esophagus. Gastric HCl acid and pepsin secretions that reflux cause esophageal irritation and inflammation (esophagitis). Incompetent LES Acid moves from the stomach to the esophagus when the patient is supine or has increased abdominal pressure. Cigarette and cigar smoking can also contribute Hiatal Hernia is a common cause AVOID: Alcohol Anticholinergics Chocolate Fatty Foods Nicotine Peppermint, Spearment Tea, Coffee (Caffeine) Drugs B-Adrenergic Blockers Calcium Channel Blockers Diazepam Morphine Sulfate Nitrates Progesterone Collaborative Therapv Conservative • Elevation of head of bed on 4- to 6-in blocks • Avoid reflux-inducing foods (fatty foods, chocolate, • Avoid alcohol • Reduce or avoid acidic pH beverages (colas, red wine, orange juice) ~ • Antacids • Drug Therapy (see Table 42 … 1 0) • Proton pump inhibitors • H2-receptor blockers • Prokinetic drug therapy • Cholinergic drugs Drug Therapy: Proton Pump Inhibitors Esomeprazole (Nexium) lansoprazole (Prevacid) omeprazole (Prilosec) ↓HCL acid secretion by inhibiting the proton pump (H+-K+-ATPase) responsible for the secretion of H+ ↓Irritation of the esophageal and gastric mucosa Lewis et al. (2014). Medical-surgical nursing: Assessment and management of clinical problems(9 thed.). St Louis: Elsevier SE: Headache, abdominal pain. Nausea, diarrhea, vomiting, flatulence Histamine (H2)-Receptor Blockers F famotidine (Pepcid) ranitidine (Zantac) Blocks the action of histamine on the H2-receptors to ↓ HCL acid secretion ↓ · Conversion of pepsinogen to pepsin ↓ Irritation of the esophageal and gastric mucosa SE: Headache, abdominal pain, constipation, diarrhea Prokinetic Agents metccloprarnide (Reglan) Blocks effect of dopamine ↑Gastric motility and emptying Reduces reflux SE: CNS side effects ranging from anxiety to hallucinations extrapyramidal side effects (tremor and dyskinesias similar to Parkinson’s disease) Antacids, Acid Neutralizers calcium carbonate (Tums, Titralac, sodium bicarbonate (Alka-Seltzer), GelusiJ.. Maalox, My’anta, Aludrox aluminum/magnesium trisHicate (Gaviscon) Neutralizes HCL acid Taken 1-3 hr after meals and at bedtime SE: Calcium carbonate: Constipation or diarrhea hypercalcemia, milk-alkali syndrome, renal calculi Sodium preparations: Milk-alkali syndrome ( Used with large amounts of calcium; use caution in patients on sodium restrictions) HIATAL HERNIA Factors: Obesity Pregnancy Ascites Tumors Intense physical exertion Heavy lifting on a continual basis PEPTIC ULCER DISEASE Factors: ↑ Helicobacter Pylori Aspirin & NSAIDS Corticosteroids Anticoagulants SSRI HIGH alcohol intake Coffee Stress & Depression GI BLEED Drug Induced • Corticosteroids • Nonsteroidal anti-inflammatory drugs (NSAIDs) Lewis et al. (2014). Medical-surgical nursing: Assessment and management of clinical problems(9 ted.). St Louis: Elsevier • Salicylates Esophagus • Esophageal varices • Esophagitis • Mallory-Weiss tear Stomach and Duodenum • Stomach cancer • Hemorrhagic gastritis , Peptic ulcer disease • polyps , Stress-related mucosal disease Systemic Diseases • Blood dyscrasias (e.g .. leukemia, aplastic anemia) • Renal failure Drug Therapy Vasopressin Ditressin) Esophageal varices Causes vasoconstriction. ↓Pressure in the portal circulation and stops bleeding Causes vasoconstriction ↓ Octreotide (Sandostatin) Upper Gl bleeding, esophageal varices Somatostatin analog that ↓blood flow to GI tract ↓ HCI acid secretion ↓release of gastrin I epinephrine Bleeding from ulceration Injection during endoscopy produces hemostasis causes tissue edema and pressure on the source of bleeding Injection therapy often combined with other therapies (e.g., laser) IBS History of GI infect ions and food Psychologic stressors Treatment : Directed at psychologic and dietary factors Food/ Stress DIARY IBD Environmental Factors: DIET hygiene Stress SMOking NSAIDS HIGH INTAKE Total Fats Poly unsaturated fats Omega-6 Fatty acids MEAT HIGH FIBER AND FRUIT- ↓risk of Crohns Disease Lewis et al. (2014). Medical-surgical nursing: Assessment and management of clinical problems(9 ted.). St Louis: Elsevier VEGTABLE INTAKE ↓risk of Ulcerative Colitis Treatment: Collaborative Therapy High-calorie. High-vitamin, high-protein, low-residue I lactose-free n lactase deficiency) diet • Drug therapy (see Table 43-17) • Aminosalicytates • Annrrucrobiala • Corticosteroids • Immunosuppressants • Biologic and targeted therapy (immunomodulatory) • Elemental diet or parenteral nutrition • Physica1 and emotional rest • Referral for counseling or support group • Surgery (see Table 43-18) DRUG THERAPY : .. Aminosalicylates Decrease GI inflammation through direct contact with bowel mucosa Systemic: sulfasa\azine (Azulfidine), mesalamine (Asacol. Pentasa), olsalazine (Dipentum), balsatazide (CotazaJ) Topicat: 5-ASA enema (Rowasa) I mesalamine suppositories (Canasa) Antimicrobials Corticosteroids ‘mmunosuppressants • methotrexate, cyclosporine HEPATITIS • Types of viral hepatitis – A , Contaminated food or drinking water, not chronic – B, mucosal exposure to infectious blood, blood products, or other body fluids, acute or chronic, sexual contact – C , IV’s, workplace exposure, acute usually asymptomatic, chronic can lead to liver failure • D, Requires HBV to replicate, transmitted same as B, no vaccine but vaccine to B helps. Can be asymptomatic or progress to liver fail • E, Transmitted via fecal-oral route- contaminated water supply in developing countries MANIFESTATIONS • Dark urine – Bilirubinuria • Light stools • Fatigue I • Acute Hepatitis Continued hepatomegaly with tenderness • Anorexia • Weight loss • Nausea, vomiting • Right upper quadrant discomfort • Constipation or diarrhea Chronic Hepatitis • Decreased sense of taste and smel\ • Malaise • Malaise • Headache • Easy fatigability • Fever • Hepatomegaly • Myalgias and/or arthralglas • Arthralgias • Urticaria • Elevated liver enzymes (aspartatse aminotransferase • Hepatomegaly (AST} and alanine aminotransferase (ALT) • Splenomegaly Collaborative Therapv Acute and Chronic • Weight loss • Well-balanced diet • Vitamin supplements • Rest • Jaundice (degree of strictness varies) , • Avoidance of alcohol • Pruritus intake and drugs detoxified by the live-r Lewis et al. (2014). Medical-surgical nursing: Assessment and management of clinical problems(9 ted.). St Louis: Elsevier Chronic HBV entecavir (Baraclude) • telbivudine (Tvzeka) • tenofovir • Standard interferon (Intron Al • Pegylated interferon (Viread) (Peglntron, Pegasys) • Nucleoside and nucleotide Chronic HCV analogs • lamivudine (Eoivir) • adefovir (Hepsera) • • PeQylated interferon ribavirn (Rebetol. Copegus) • Protease inhibitors tetaprevir (lncivek) CIRRHOSIS Excessive alcohol intake and NAFLD Most common cause is Hepatitis C infection Nutrition-related Cirrhosis Extreme Dieting Malabsorption Obesity Environmental Factors Genetic Factors Manifestations Early Alkaline Fatigue Phosphate Later AST Jaundice ALT Peripheral Edema o DECREASED Ascities Total Protein Skin Lesions Albumin Hematologic disorders o Increased Endocrine Disorders Serum Bilirubin Peripheral neuropathy Globulin Levels Lab o ELEVATED Collaborative Therapy Conservative Therapy • Rest • Administration of B-complex vitamins • Avoidance of alcohol • Minimization or avoidance of aspirin, acetaminophen, and NSAIDs Ascites • Low-sodium diet food • Diuretics • Paracentesis (if indicated) Esophageal and Gastric Varices • Drug therapy • Nonselective J3-blocker (e.g., oropranolol [lndera’l) • vasopressin (Pitressin) • Endoscopic band ligation or sclerotherapy • Balloon tamponade , -. Transjugular intrahepatic portosystemic shunt (T\PS) Hepatic EncephalopathY • Antibiotics (rifaximin [Xifaxan1) , • lactufose (Cephulac) S&S of LIVER FAILURE Encephalopathy Jaundice Acute Coagulation abnormalities Changes in mentation Lewis et al. (2014). Medical-surgical nursing: Assessment and management of clinical problems(9 ted.). St Louis: Elsevier LABS Abnormal neurotransmission Serum Bilirubin = elevated Astrocyte swelling Prothrombin time= elevated Inflammatory cytokines AST- ALT =elevated Flapping Tremor Treatment Hepatic Encephalopathy Lactulose- traps ammonia in GI, expels -Neuropsychiatric Manifestation of liver disease ammonia from the colon Neurotoxic effects of ammonia Varices - Low grade fever -Accumulation of serous fluid in the peritoneal or - Leukocytosis abdominal cavity - Hypotension Common manifestation of cirrhosis - Tachycardia Second Mechanism – hypoalbuminemia - Jaundice Third Mechanism – hyperaldosteronism - Decreased or absent bowel Sounds Manifestation - Guarding of abdomen Abdominal Distention w/ weight gain Dehydration- ↓urine output Treatment Treatment -Pain control – IV Morphine, don’t combine with anticholinergics in order to not decrease GI mobility NA restriction- 2g/day (WORSE CASE, 250-500 mg/day) -O2 > 95 % Diuretics- Aldactone, Spironolactone COMBO -Watch for Hyperglycemia Lasix -NPO with NG tube for suction -IV calcium gluconate Fluid removal- paracentesis (removal of fluid from abdomen -Lactated Ringer Solution AVOID NSAIDS, Alcohol -Proton Pump Inhibitor Sandostatin – Vasopressin, for bleeding varices -Antibiotics LABS Pancreatitis -↑Serum Amylase - Common in middle aged people and African Americans -↑ Serum Lipase Manifestations - ↑Urine Amylase - ABD pain ↑ Blood glucose o ULQ , radiates to the back (severe, ↓ Serum calcium deep, piercing, and continuous or ↑Serum Triglycerides steady) - N/V Gallbladder Disease -Cholelithiasis, stones in the gall bladder -Cholecystitis, inflammation of the gallbladder OCCUR TOGETHER Manifestations Gallbladder Spasms -Tenderness RUQ , occur 3-6 hours after high-fat meal or when patient lies down. - Severe Pain, fever, and Jaundice - N/V restlessness, diaphoresis Complications: - Gangrenous cholecystits - Subphrenic abscess - Pancreatitis - Cholangitis Lewis et al. (2014). Medical-surgical nursing: Assessment and management of clinical problems(9 thed.). St Louis: Elsevier - Biliary Cirrhosis - Fistulas - Rupture of the gallbladder - Choledocholithiasis Glomerular Filtration Rate (GFR) -RATE: 90- 125 ml/min/1.73m 2 2 Closely related to Creatinine clearance, 70- 135mL/min/1.73 m Normal UA: - Color: Amber yellow - Odor: Aromatic - Protein: Random, 0-Trace - Glucose: None - Ketones: None - Bilirubin: None - Specific Gravity: 1.003-1.030 - Osmolality: 300-1300 mOsm/kg - pH: 4.0-8.0 ,avg6.0 - RBC: 0-4/hpf - WBC: 0-5/hpf 4 - Bacteria: <10 /mL BUN: 6-20 mg/dl Creatinine: 0.6-1.3mg/dL Urinary Tract Infections Infection defined by location- upper or lower tract Upper - Renal parenchyma, pelvis, and ureters - Fever, chills, and flank pain Lower - No systemic manifestations - Related to bladder storage or emptying o Dysuria, urgency, frequent urination Treatment - Uncomplicated, Short-term antibiotics 1-3 days - Complicated, require longer treatment 7-14 days longer Glomerulonephritis S&S: - Protein & hematuria - Hx- of strep and sore throat Treatment: - Underlying disease, ACE, Dietary restrictions- NA ↓& ↓fluid intake Nephrotic Syndrome S&S: - Proteinuria 3+ Treatment: - Corticosteriods, NSAIDS, Salt restriction Pyelonephritis -inflammation of the renal parenchyma - Due to bacterial infection Lewis et al. (2014). Medical-surgical nursing: Assessment and management of clinical problems(9 ted.). St Louis: Elsevier S&S: - Fever, Vomiting, chills, malaise, flank pain, Costovertebral pain Treatment: - Antibiotics 14-21 days - Resolve in 48-72H Polycystic Kidney Disease - Life threatening genetic disease - Diet Modification, fluid restriction, drugs(Antihypertensives) Acute Kidney Injury Prerenal - Causative factors external to the kidneys o ↓systemic circulation o Oliguria- ↓ BV- severe dehydration, HF, ↓CO - Treatment: o ↑ BV, ↑ CO, ↑BP Intrarenal - Conditions that cause direct damage to the kidneys , impaired nephron function - Due to prolonged ischemia, nephrotonxins, hemoglobin, myoglobins o Acute Tubular Necrosis Most common - Risks: Major Surgery, shock, sepsis, blood transfusion, muscle injury from trauma, prolonged hypotension, and nephrotoxic agents – contrast media Postrenal - Mechanical Obstruction of urine - Cause: benign hyperplasia, prostate cancer, calculi, trauma, extrarenal tumors - IF relieved in 48 H, complete recovery is likely - After 12 Weeks , recovery is unlikely Oliguric Phase - Reduction of Urine output < 400 mL - Occurs within 7-10 days of injury - Lasts avg 10-14 days - UA will show specific gravity around 1.010 - Hypovolemia causes fluid retention- neck vein distention and bounding pulse, edema and hypertension - Overloads- HF, pulmonary edema, pericardial, and pleural effusion - Metabolic Acidosis- Bicarbonate decrease - ↓sodium balance - ↑ Potassium - Waste accumulation- ↑ BUN - Neurologic Disorders o Fatigue, coma, seizures, Asterixis (flapping tremor) Diuretic Phase - Daily urine output 1-3 L and will slowly increase - ↑ urine volume is from osmotic diuresis - Hypovolemia and Hypotension can occur - Last 1-3 weeks - Monitor UA and Electrolytes Recovery Phase - GFR ↑ - Occur in 1-2 weeks Lewis et al. (2014). Medical-surgical nursing: Assessment and management of clinical problems(9 thed.). St Louis: Elsevier - Kidney function 12 months to stablilize Lewis et al. (2014). Medical-surgical nursing: Assessment and management of clinical problems(9 ted.). St Louis: Elsevier
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