1
Q
A restaurant cook has Hepatitis A. What are the immediate public health nursing priorities?
A
- Identify who ate at the restaurant.
- Identify who has symptoms.
- Determine if people have been vaccinated.
- Recommend/help facilitate vaccination
- Need to get immunoglobulin within 14 days, especially for exposed unvaccinated individuals.
- Clarify that even if already vaccinated for Hep A, immunoglobulin may still be needed depending on the situation (e.g., severe exposure).
2
Q
What is the highest risk factor for chronic pancreatitis?
A
Chronic alcoholism
3
Q
A patient in the hospital has severely edematous legs but palpable pulses. What is an initial nursing intervention?
A
Elevate the legs.
4
Q
A patient is diagnosed with Hepatitis B after a needle stick injury. What is the initial diagnostic step and subsequent interventions?
A
First, obtain a serum blood test for diagnosis.
Give the Hepatitis B vaccine.
Administer Hepatitis B immunoglobulin.
5
Q
A patient with adrenal insufficiency has low sodium levels. What indicates that treatment is effective?
A
Sodium levels starting to normalize.
6
Q
What type of insulin is typically used for meal-time coverage?
A
Humalog Lispro (Rapid-acting insulin).
7
Q
Name two types of maintenance (basal) insulin.
A
NPH, Levemir.
8
Q
What is the most appropriate diet for diverticulosis? What about during an exacerbation?
A
Diverticulosis: High-fiber, low-fat diet.
Exacerbation: Low-fiber diet.
9
Q
You have two patients, one with ulcerative colitis and another with Crohn’s disease. Which patient would you expect to see blood in the stool?
A
Ulcerative colitis.
10
Q
A patient presents with purplish-pink fingers, complaints of cold fingers and toes, and pain/pallor. What is the likely underlying issue and what is a relevant nursing diagnosis?
A
Underlying issue: Circulation (Raynaud’s phenomenon).
Nursing diagnosis: Ineffective tissue perfusion.
11
Q
A patient with venous insufficiency in the lower extremities is at risk for skin breakdown. What nursing interventions are important?
A
Elevate feet, provide significant protection around heels and feet, apply compression stockings (ensuring they are smooth and flat with no folds or wrinkles to prevent skin breakdown).
12
Q
What two daily assessments are crucial for a patient with cirrhosis?
A
Daily weights and abdominal circumference. (Due to ineffective liver function, risk for hepatomegaly, and poor circulation).
13
Q
What is a key side effect to monitor for with Spironolactone (Aldactone) and why?
A
Risk for high potassium (hyperkalemia) because it is a potassium-sparing diuretic, meaning potassium is not excreted.
14
Q
How is Hepatitis A primarily transmitted? What symptoms might be seen, and what question is important to ask?
A
Transmission: Fecal-oral route (restaurants are a significant risk).
Symptoms: Flu-like symptoms.
Question: Ask where they have eaten out recently (past few weeks).
15
Q
What is the purpose of Lactulose in a patient with hepatic encephalopathy? What is important regarding its administration?
A
Purpose: Binds to ammonia, which is then excreted via diarrhea.
Administration: Do not hold the medication unless laboratory ammonia levels are normal AND the physician has been called.
16
Q
A patient with ascites reports pain, cramping, and shortness of breath. What dietary modification is typically recommended?
A
Decrease sodium in the diet.
17
Q
List key signs and symptoms of Addison’s disease.
A
Hyperpigmentation (bronze skin), weight loss, hyperkalemia, hyponatremia, low energy, weakness, unsteadiness, postural hypotension, hypoglycemia.
18
Q
Describe the signs and symptoms of an Addisonian crisis.
A
Tachycardia, weak thready pulse, high respiratory rate, hypotension, cyanosis, darker nose, confusion/altered mental status, high intensity of circulatory shock.
19
Q
What is the main goal for a patient with Cushing’s syndrome regarding nutritional status? What foods/supplements are beneficial?
A
Goal: Maintain nutritional status.
Beneficial: High protein, Vitamin D, calcium (to decrease muscle wasting).
20
Q
List key signs and symptoms of Cushing’s syndrome.
A
High cortisol levels, moon face, fat deposition on the upper back (buffalo hump), easy bruising, hyperglycemia, personality changes.
21
Q
A patient is experiencing hypoglycemia. List common signs and symptoms.
A
Hunger, thirst, confusion, slurred speech, diaphoresis, high heart rate (due to compensation), tingling/numbness around lips/fingers/toes.
22
Q
What is the immediate treatment for severe hypoglycemia in a hospital setting?
A
Give Dextrose 50% in water via IV push (in a syringe).
23
Q
What is the main goal of palliative care?
A
Comfort and quality of life for the time the patient has left.
24
Q
What is the primary treatment for Hepatitis C?
A
Antiviral medications.
25
A patient in palliative care wants to stop receiving lab work. What ethical/legal considerations are relevant?
This presents an ethical issue (balancing keeping them alive vs. quality of life) and a legal issue related to advance directives.
26
What type of diet is recommended for venous leg ulcers?
High protein and high calorie (appropriate calories, not high in fat).
27
A patient with peripheral artery disease has smoked for 20 years. What is crucial education for this patient?
Nicotine constricts blood vessels, exacerbating the disease. The patient needs to quit entirely, and they should be helped to find ways to do so.
28
What are the approximate peak times for:
Rapid-acting insulin
Short-acting insulin
Intermediate insulin
Inhaled insulin
Rapid-acting: 30 min - 3 hrs
Short-acting: 2 - 5 hrs
Intermediate: 4 - 12 hrs
Inhaled: 60 min
29
According to Maslow's Hierarchy of Needs, where would a dying patient's desire to be close to family fall?
Love and belonging.
30
What lab values are important to monitor when a patient is taking Metformin? What is a life-threatening adverse effect?
Labs: BUN and Creatinine.
Life-threatening adverse effect: Nephrotoxic (kidney damage, leading to lactic acidosis).
31
For a patient in the final hours of life, what common physiological changes should the family be educated on, and what sense is often the last to go?
Changes: Cheyne-Stokes respirations, decreased perception of pain, decreased perception of touch.
Last sense to go: Hearing. Encourage family to talk to them.
32
How do heart rate and blood pressure typically change in the final hours of life?
Heart rate initially goes up, then later lowers, weakens, and diminishes.
Blood pressure continuously goes down.
33
What is intermittent claudication and what is a crucial nursing intervention related to it?
Definition: A type of peripheral vascular disease that reduces oxygen to the feet.
Nursing intervention: Ensure excellent foot care (clean, elevate, assess frequently).
34
A patient has a blood glucose of 1215 and a potassium of 3.9 (low), indicating DKA. What initial orders would you expect?
Insulin drip (Humulin R - weight-based).
ABCs (Airway, Breathing, Circulation) - Kussmaul's breathing.
Give O2.
Establish IV access.
Cardiac monitor.
IV potassium.
35
After initial DKA treatment, a patient's blood glucose is now 250. What new order would you anticipate?
Add 5% dextrose to the IV fluids.
36
Name some examples of high-fiber foods.
Peas, nuts, popcorn. (Meats and dairy are not high in fiber).
37
Describe the characteristic stools seen with ulcerative colitis.
Bloody, watery, mucus.
38
What type of support is vital for patients with ulcerative colitis to do well?
Family support (emotional support).
39
For a patient with Crohn's disease and GI bleeds, what lab values are crucial to monitor and why? What other assessments are important?
Monitor: Hematocrit and hemoglobin (if low, may need red blood cell replacement or blood transfusion).
Other assessments: Determine source of bleeding (endoscopy, scan), check stool for occult blood, monitor vital signs (at risk for hypovolemic shock).
40
A patient from the ED on glyburide (Micronase) missed a dose. What symptoms might they start to experience?
Fatigue, blurred vision, thirst (signs of hyperglycemia).
41
Give examples of microvascular complications of diabetes.
Glaucoma, retinopathy, kidney disease, increased blood pressure issues.
42
Give examples of macrovascular complications of diabetes.
Peripheral artery disease, heart attack, stroke
43
Give examples of neuropathic complications of diabetes.
Numbness, tingling, burning, neuropathy
44
Define Peripheral Artery Disease (PAD)
Involves the thickening of artery walls and progressive narrowing of arteries of upper and lower extremities
45
How do vascular disorders affect oxygenation needs at the pathophysiological level?
Vascular disorders impair oxygenation by compromising blood flow, leading to insufficient oxygen and nutrient supply to tissues.
46
Acute Arterial Ischemic Disorders
Characterized by a sudden interruption in arterial blood supply to a tissue, organ, or extremity. If untreated, this abrupt cut-off of oxygenated blood flow rapidly results in tissue death (necrosis). The most frequent cause is an embolus, often a thrombus from the heart (e.g., due to atrial fibrillation or prosthetic heart valves), that travels and lodges in a narrower vessel, blocking blood flow. Noncardiac causes include aneurysms, ulcerated atherosclerotic plaque, or complications from endovascular procedures.
47
Chronic Venous Insufficiency (CVI) and Venous Leg Ulcers
Occurs when venous valves are incompetent or vein walls are damaged, causing blood to pool in the lower extremities, leading to ambulatory venous hypertension. This high venous pressure forces fluid and red blood cells to leak into surrounding tissues, resulting in chronic edema and inflammation. The breakdown of red blood cells releases hemosiderin, causing skin discoloration, and chronic changes lead to hard, thick, and contracted skin (lipodermatosclerosis). This impaired venous return and tissue environment compromise oxygenation indirectly by hindering waste removal and nutrient delivery, leading to venous stasis dermatitis (eczema) and non-healing venous ulcers.
48
Deep Vein Thrombosis (DVT)
A blood clot forms in a deep vein, most commonly in the legs. While DVT directly impairs venous return, its most serious impact on oxygenation is the risk of a pulmonary embolism (PE). A portion of the DVT can break off (embolize), travel through the venous system to the right side of the heart, and then lodge in the pulmonary circulation, blocking blood flow to a part of the lungs, which is life-threatening.
49
What would you expect to see on an integumentary assessment for PAD, DVT, & Raynaud's phenomenon?
◦PAD: Pallor with elevation, dependent rubor (reddish-blue when dependent), coolness of affected limb, thin/shiny/taut skin, loss of hair on lower legs/feet/toes, diminished/absent nail growth (thickened/brittle). Presence, location, size, and characteristics of arterial ulcers ("punched-out" on bony prominences) or gangrene.
◦DVT: Unilateral edema (often pitting and circumferential), warmth, redness (erythema), and dilated superficial veins in the affected limb.
◦Raynaud's: Pallor, cyanosis, or rubor in fingers, toes, ears, or nose during an attack. Long-term: thick skin, brittle nails, punctate lesions, gangrenous ulcers.
50
What are common nursing diagnoses for clients with oxygenation problems secondary to ineffective vascular responses?
Ineffective Tissue Perfusion (Peripheral): Directly related to reduced blood flow to the extremities, leading to decreased tissue oxygenation and nutrient supply in conditions like PAD or acute arterial ischemia. In VTE, it relates to impaired venous return and potential complications like DVT.
*Activity Intolerance: A common consequence of intermittent claudication in PAD, where pain limits the ability to engage in physical activity, hindering adaptation. Also applies to DVT patients experiencing pain or fear of clot dislodgement.
Other Potential Nursing Diagnoses:
*Acute/Chronic Pain
*Risk for Infection
*Deficient Knowledge
*Ineffective Health Management
*Risk for Bleeding
*Risk for Falls
*Risk for Pulmonary Embolism (PE)
51
How are nursing diagnoses prioritized to address the holistic needs of clients with ineffective vascular responses?
Prioritization of nursing diagnoses for clients with ineffective vascular responses focuses on immediate threats to life or limb, followed by addressing factors that impact quality of life, prevent complications, and promote long-term well-being.
52
What are some modifiable risk factors for vascular disorders
Smoking, diabetes, hypertension, hyperlipidemia, obesity, & physical inactivity
53
Arterial Insufficiency (e.g., Peripheral Artery Disease [PAD])
- Pathophysiology
- Primary Problem
- Cause/Risk Factors
- Pathophysiology: Thickening/narrowing of arteries due to atherosclerosis (plaque buildup), reducing blood flow to limbs.
- Primary Problem: Insufficient oxygenated blood delivery to tissues.
- Cause/Risk Factors: Smoking, diabetes, hypertension, hyperlipidemia, obesity, physical inactivity, family history, advanced age.
54
Arterial Insufficiency (e.g., Peripheral Artery Disease [PAD])
- Key Symptoms
- Physical Findings
- Pulses
- Key Symptoms: Intermittent Claudication: Ischemic muscle pain with exercise, relieved by rest; reproducible. Rest Pain: Severe, burning pain in foot/toes at rest, aggravated by elevation, relieved by dependent position. Paresthesia/neuropathy.
- Physical Findings: Skin: Pallor with elevation, dependent rubor when lowered. Coolness. Thin, shiny, taut, atrophic skin. Hair loss on lower legs/toes. Thickened, brittle nails.
- Pulses: Diminished or absent peripheral pulses (femoral, popliteal, pedal).
55
Arterial Insufficiency (e.g., Peripheral Artery Disease [PAD])
- Ulcers
- Complications
- Management Focus
- Ulcers: Arterial Ulcers: Typically on bony prominences, toes, heels. "Punched-out" appearance, pale/necrotic base, minimal bleeding, very painful
- Complications: Critical limb ischemia (rest pain, non-healing ulcers, gangrene), amputation, heart attack, stroke, death.
- Management Focus: Restore arterial blood flow (revascularization), aggressive risk factor modification (smoking cessation, BP, glucose, cholesterol control), exercise therapy, meticulous foot care, antiplatelet therapy.
56
Venous Insufficiency (e.g., Chronic Venous Insufficiency [CVI], DVT)
- Key Symptoms
- Physical Findings
- Pulses
- Key Symptoms: Aching pain, heaviness, fatigue in legs, especially after prolonged standing. Swelling (edema). Itching/burning, muscle cramps.
- Physical Findings: Skin: Brownish discoloration (hemosiderin staining). Thick, hardened, leathery skin (lipodermatosclerosis). Eczema/stasis dermatitis.
- Pulses: Usually present and often normal. May be difficult to palpate due to edema.
57
Venous Insufficiency (e.g., Chronic Venous Insufficiency [CVI], DVT)
- Pathophysiology
- Primary Problem
- Cause/Risk Factors
- Pathophysiology: Incompetent venous valves or damaged vein walls lead to blood pooling (venous hypertension). DVT is clot in deep vein.
- Primary Problem: Inadequate deoxygenated blood return to the heart, leading to venous congestion.
- Cause/Risk Factors: Genetic predisposition, prolonged standing/sitting, obesity, pregnancy, previous DVT, leg trauma, history of phlebitis.
58
Venous Insufficiency (e.g., Chronic Venous Insufficiency [CVI], DVT)
- Ulcers
- Complications
- Management Focus
- Ulcers: Venous Leg Ulcers: Typically around ankle, above medial malleolus. Irregular shape, moist, ruddy base, often with significant exudate, variable pain.
- Complications: Pulmonary embolism (from DVT). Post-thrombotic syndrome (PTS). Varicose veins, superficial thrombophlebitis, chronic venous insufficiency, skin changes, venous ulcers.
- Management Focus: Manage symptoms, prevent DVT/PE, promote venous return (compression therapy, leg elevation, exercise), meticulous wound care for ulcers, weight management. Anticoagulation for DVT.
59
Palliative Care
Care involves assessment and management of pain and other symptoms, support of caregiver needs, and care coordination.
Goals:
Reduce the burden of health-related suffering
Improve quality of life for patients with serious life-limiting illnesses
60
Hospice Care
Provides compassion, concern, and support for those in the last phases of a terminal disease
Goals:
Live fully and comfortably
Die with dignity
61
Hospice 2 admission criteria?
1. Patient must desire services
- Agree to hospice care only; in writing
2. Patient must be medically eligible for services
- Two physicians certify terminal illness with
- Less than 6 months to live
62
What is the last sense to go before death?
Hearing
63
Cheyne-Stokes Respiration
A specific breathing pattern at the end of life characterized by alternating periods of apnea and progressively deeper, sometimes faster, breaths.
64
What are the characteristics of a normal bowel elimination?
Normal Bowel Elimination: Formed stools, often described as Type 3 (sausage-shaped with cracks) or Type 4 (smooth, soft, snake-like) on the Bristol Stool Scale.Typically involves comfortable defecation without excessive straining, incomplete evacuation, or the need for manual assistance
65
What are the characteristics of diarrhea?
Diarrhea: Defined as an increased frequency of bowel movements (more than 3 per day) with altered consistency, specifically increased liquidity of stool. On the Bristol Stool Scale, this would be Type 6 (mushy, fluffy pieces with ragged edges) or Type 7 (watery, entirely liquid).
66
What are the characteristics of constipation?
Constipation: Defined as fewer than 3 stools per week, often accompanied by straining, a sensation of incomplete evacuation, the need for digital assistance, bloating, and hard or lumpy stools (Bristol Stool Scale Type 1 or 2).
67
What are the characteristics of fecal incontinence?
Fecal Incontinence: Characterized by the involuntary loss of stool related to motor and/or sensory dysfunction of the anal sphincters or pelvic floor muscles. It can be worsened by chronic straining or fecal impaction (leading to "overflow incontinence").
68
Pathophysiology of Inflammatory Bowel Disease (IBD)
An autoimmune disease where an environmental or bacterial trigger causes an overactive, inappropriate, and sustained immune response in a genetically susceptible person, leading to widespread tissue destruction in the gastrointestinal (GI) tract. Over 200 genes are associated with IBD susceptibility, and lifestyle factors (diet, smoking, stress) can alter microbial flora, increasing risk.
69
Crohn's Disease (CD)
- Alterations in elimination
Characterized by "skip" lesions (normal tissue between inflamed areas), inflammation affecting all layers of the bowel wall (transmural), and can occur anywhere from the mouth to the anus (most common in distal ileum and proximal colon). It presents with a "cobblestone appearance" from deep ulcerations.
Alterations in Elimination: Causes frequent diarrhea, cramping, and abdominal pain. Malabsorption due to inflammation (especially in the small intestine) leads to weight loss and nutritional deficiencies. Some rectal bleeding may also occur.
70
Ulcerative Colitis (UC)
- Alterations in elimination
Involves continuous inflammation confined to the colon and rectum, typically starting in the rectum and spreading proximally to the cecum. The inflammation primarily affects the innermost mucosal layer of the bowel wall. Pseudopolyps (tongue-like projections of regenerating tissue) can form.
Alterations in Elimination: Leads to diarrhea and significant electrolyte loss because the inflamed tissue cannot absorb water and electrolytes properly. Protein can also be lost in the stool. Cardinal symptoms include bloody diarrhea with mucus and abdominal pain.
71
Diverticulosis vs. Dierticulitis
Alterations in Elimination
Diverticulosis: The presence of sac-like herniations (diverticula) of the bowel lining that extend through defects in the muscle layer.
Diverticulitis: Occurs when diverticula become obstructed by stool, leading to bacterial overgrowth, inflammation, and potentially complications like an abscess or perforation.
Alterations in Elimination: Presents with classic symptoms including left lower quadrant (LLQ) abdominal pain, fever, chills, nausea and vomiting, and altered bowel habits (either constipation or diarrhea). Bowel sounds may be decreased or absent in severe cases
72
IBD medications
Antibiotics: (e.g., ciprofloxacin, metronidazole)
Biologic Therapies: (e.g., ustekinumab, risankizumab)
Corticosteroids
Aminosalicylates (5-ASAs): (e.g., mesalamine)
Janus Kinase (JAK) Inhibitors
73
Pharmacological Management for Diverticulitis
Acute Flare (Home Care): Analgesia (e.g., acetaminophen, avoiding NSAIDs due to GI bleeding risk).
Acute Flare (Hospitalization): IV antibiotics for systemic infection.
Long-term/Prevention: Bulk laxatives may supplement a high-fiber diet to ensure soft, regular stools.
74
What are realistic client-centered outcomes of care for someone experiencing chronic alterations in elimination needs?
Focus on symptom management, improved quality of life, patient self-management, and prevention of complications. Ex: reduction in frequency, stool consistency within an acceptable range
75
Explain the rationale for altering fiber in diets for various bowel elimination needs.
High-Fiber Diet: Primarily used for constipation, fecal incontinence (to bulk up stool for better control), and for the prevention of diverticulitis (in diverticulosis).
Low-Fiber/Low-Residue Diet: Primarily used during acute episodes of diarrhea, acute diverticulitis flares, or active inflammatory bowel disease (IBD) flares.
76
How do you differentiate Irritable Bowel Syndrome (IBS) from chronic Inflammatory Bowel Disorders (IBD)?
IBS:
No inflammation or structural damage to the bowel.
Symptoms are primarily functional (disruption in bowel motility and sensation).
Diagnosis is based on symptoms and the exclusion of other conditions.
Does not increase risk of colorectal cancer.
Typically does not cause weight loss, fever, or anemia.
IBD (Crohn's Disease & Ulcerative Colitis):
Characterized by chronic inflammation and structural changes/damage to the bowel lining.
Diagnosed via objective evidence of inflammation
Increases risk of colorectal cancer
Can cause systemic symptoms like weight loss, fever, anemia, and other extra-intestinal manifestations.
77
Health Promotion & Maintenance (General Principles applicable to many GI conditions):
A balanced diet, incorporating appropriate fiber
Hydration
Physical activity
Hand hygiene
Avoid irritants
Stress management
78
Health Restoration (Specific Interventions for Altered Elimination)
Bowel training
Medication adherence
Symptom monitoring
Red-flag symptoms (sudden/persistent change, severe unremitting pain, high fever, significant weight loss, or signs of perforation/severe bleeding)
Nutritional support (supplements if needed)
Perianal care
Follow-up care
79
Describe the types of stool (1-7)
Type 1: Hard lumps, like stones or nuts (severe constipation)
Type 2: Sausage-shaped, lumpy (mild constipation)
Type 3: Sausage-shaped with cracks (normal)
Type 4: Smooth, soft snake-like (normal)
Type 5: Feces in the form of soft lumps (lacking fiber) (still good/normal)
Type 6: Porous and soft feces (mild diarrhea)
Type 7: Watery stool (severe diarrhea)
80
What medications are used to treat C-diff, E.coli, cholera, and non-invasive E.coli
Metronidazole or Vancomycin: C-Diff
Ciprofloxacin or Azithromycin: E. coli
Doxycycline: cholera
Rifaximin: non-invasive E. coli
81
What are 2 chronic diarrhea complications?
Malabsorption syndromes: anemia from iron or vitamin B12 deficiency
Osteoporosis from chronic calcium or vitamin D loss
82
Obstipation
Refers to severe constipation where there is a complete inability to pass stool or gas.
83
What is an example of a laxative osmotic agent?
Bisacodyl (Dulcolax)
Dioctyl sodium sulfosuccinate (Colace)
Magnesium hydroxide (Milk of Magnesia)
Polyethylene glycol and electrolytes (Colyte)
Magnesium hydroxide (Milk of Magnesia)
84
Examples of High-FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) Foods
Oligosaccharides: Garlic, onions, wheat, legumes.
Disaccharides: Dairy products containing lactose (e.g., milk, cheese).
Monosaccharides: High-fructose fruits (e.g., apples, mangoes, honey).
Polyols: Sugar-free sweeteners (e.g., sorbitol, mannitol), certain fruits (e.g., cherries, stone fruits).
85
What is the Rome IV criteria (IBS)?
Presence of abdominal pain and/or discomfort at least 1 day/wk for 3 months and associated with two or more of the following defecation changes:
Change in stool frequency
Change in stool form
Other S/S:
Pain
Distention
Guarding
Nausea
Fever
Hypovolemic shock
86
What is the main difference between ulcerative colitis & Crohn's disease?
Ulcerative colitis is in the colon, constant severe abd pain
Crohn’s disease is anywhere in GI tract; mouth to anus, abdominal cramping
87
What disease is the acronym CHRISTMAS for, what does is it stand for?
Crohn's Disease
Cobblestoning
High temperature
Reduced appetite
Intestinal fistulae
Skip lesions
Transmural involvement
Malabsorption
Abdominal pain
Strictures
88
What disease is the acronym EASTER for, what does is it stand for?
Ulcerative colitis
Electrolyte imbalances
Abdominal pain LLQ/ Anorexia
Severe diarrhea 10-20x pre day
Tongue-like projection
Excessive mucus
Rectal bleeding
89
What are the essential metabolic functions performed by the liver?
Metabolism of Glucose, Protein, and Fat
Direct Blood Exchange with Aorta and GI Tract
Manufactures and Secretes Bile
Removes Wastes
Storage
Drug Metabolism
90
How is Hep A spread?
Type?
Prevention?
Immunization?
Treatment?
Spread: Fecal-oral (Contaminated food/drink)
Type: RNA
Prevention: Good hygiene & vaccine
Immunization: Passive: Immunoglobulin serum
Active: Vaccine
Treatment: No treatment
Self-resolving/limiting
91
How is Hep B spread?
Type?
Prevention?
Immunization?
Treatment?
Spread: Blood (Childbirth
Contact with infected body fluid
Sexual contact)
Type: DNA
Prevention: Practicing good hygiene, Blood Screening, & Vaccine
Immunization: Passive: Hepatitis B immunoglobulin Active: Vaccine
Treatment: Interferon
92
How is Hep C spread?
Type?
Prevention?
Immunization?
Treatment?
Spread: Percutaneously/Blood (Contact with infected body fluid Sexual contact)
Type: RNA
Prevention: Practicing good hygiene. Avoid sharing needles, toothbrush, and shavers
Immunization: NONE
Treatment: Direct-acting antiviral drugs
93
How is Hep D spread?
Type?
Prevention?
Immunization?
Treatment?
Spread: Percutaneously/Blood (Contact with infected body fluid (only occurs in people who are infected with Hep B), Sexual contact)
Type: RNA (cannot survive on own) (must have B to get D)
Prevention: Avoid sharing needles, toothbrush, and shavers. Vaccine
Immunization: Hepatitis B vaccination prevents infection
Treatment: Interferon
94
How is Hep E spread?
Type?
Prevention?
Immunization?
Treatment?
Spread: Fecal-oral (Contaminated food/drink (Contaminated water most common))
Type: RNA
Prevention: Practicing good hygiene. Avoid drinking water that has come from a potentially unsafe source
Immunization: NONE
Treatment: No treatment. Self-resolving/limiting
95
What are the common clinical manifestations of liver dysfunction, and how do they relate to nutritional needs?
Common Symptoms: Anorexia, nausea, vomiting, malaise, fatigue, lethargy, muscle & joint pain, & right upper quadrant tenderness.
Nutritional Impact: Anorexia & N//V can directly disrupt dietary intake, leading to inadequate caloric & nutrient consumption. Malaise & fatigue can reduce energy for food preparation and eating. Disrupted digestion d/t altered bile production (e.g., cholestasis) can lead to fat malabsorption, affecting overall nutrient uptake & requiring fat content reduction in the diet.
96
What are common safety and nutritional problems encountered in clients with hepatitis, and how might a nurse prioritize them?
Safety: risk of bleeding, impaired neurological function, infection, & falls/injury
Nutritional: imbalance, fluid volume excess, & deficient knowledge
Prioritization: life-threatening complications
97
What are the current risk factors leading to the development of cirrhosis and non-alcoholic fatty liver disease (NAFLD)/non-alcoholic steatohepatitis (NASH)?
Cirrhosis: Cirrhosis is the end-stage of liver disease, typically developing after decades of chronic liver disease.
- Most Common Causes in the United States: Chronic Hepatitis C (HCV) and alcohol-induced liver disease are the leading culprits
NAFLD is characterized by fat in the liver without inflammation or damage, affecting 10-20% of Americans.
NASH resembles alcoholic liver disease but occurs in people who drink little or no alcohol. Its major feature is fat in the liver along with inflammation and damage, affecting 2-5% of Americans.
- Primary Risk Factor: Both NAFLD and NASH are becoming more common, strongly linked to the global obesity epidemic, affecting both children and adults
98
Interprofessional care for ascites
Sodium restriction
Diuretics, fluid removal
Albumin
Paracentesis
Transjugular intrahepatic portosystemic shunt (TIPS)
Peritoneovenous shunt
99
Interprofessional care for esophageal and gastric varices
Prevent bleeding/hemorrhage
Avoid alcohol, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs)
Screen for presence with endoscopy
Drug therapy
- Nonselective β-blocker
100
Interprofessional care for hepatic encephalopathy
Reduce ammonia formation
- Lactulose (Cephulac), which traps ammonia in gut (ammonia excreted in diarrhea) (DO NOT STOP UNTIL AMONIA LEVELS ARE NORMAL/MD SAYS TO)
Treatment of precipitating cause
101
Acute Pancreatitis Clinical Manifestations
Abdominal pain predominant
- Left upper quadrant or mid-epigastric & Radiates to back
- Sudden onset
- Deep, piercing, continuous, or steady
- Eating worsens pain
- Starts when recumbent
- Not relieved with vomiting
102
What disease is the acronym I GET SMASHED for? What does it stand for?
Chronic pancreatitis (causes)
Idiopathic
Gallstones/Genetic
Ethanol
Trauma (penetrating)
Steroids
Mumps
Autoimmune
Scorpion sting
Hyperlipidemia/Hypercalcemia
ERCP
Drugs
103
What is ERCP?
Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas
104
Pathophysiology of Addison's Disease
A rare endocrine disorder characterized by the hyposecretion (insufficient production) of cortical hormones, primarily cortisol and often aldosterone, by the adrenal glands. When these hormones are produced in inadequate amounts, it leads to a wide range of symptoms.
105
Pathophysiology of Cushing's Syndrome
Cushing's syndrome is a hormonal disorder caused by prolonged exposure of the body's tissues to high levels of the hormone cortisol.
106
Addison's disease S/S
Bronze pigmentation of skin
Changes in the distribution of body hair
GI disturbances
Weakness
Hypoglycemia
Postural hypotension
Weight loss
107
Addisonian crisis S/S
Progressive and acute hypotension
Tachycardia
Cyanosis
Circulatory Shock
Headache
Nausea/Vomiting/Diarrhea/Abdominal Pain
Altered Mental Status
108
Cushing's Syndrome S/S
Moon face
Buffalo hump
Personality changes
Increase susceptibility to infection
Gynecomastia (males)
Fat deposits on face & back of shoulders
Osteoporosis
Hyperglycemia
CNS irritability
NA & fluid retention (edema)
Thin extremities
GI distress - Increased acid
Amenorrhea, hirsutism (females)
Thin skin
Purple striea
Bruises & petechia
109
Clinical manifestations Type 1 diabetes
Classic symptoms
Polyuria (frequent urination)
Polydipsia (excessive thirst)
Polyphagia (excessive hunger)
Weight loss
Weakness
Fatigue
Ketoacidosis
110
Clinical manifestations Type 2 diabetes
Nonspecific symptoms
Classic symptoms of type 1 may manifest
Fatigue
Recurrent infection
Recurrent vaginal yeast or candida infection
Prolonged wound healing
Visual problems
111
If glucose greater than _____, check urine for ketones every 3 to 4 hours
240 mg/dL
112
Hypoglycemia S/S
Cold, clammy skin
Numbness fingers, toes, mouth
Tachycardia
Emotional changes
Untreated hypoglycemia can progress to loss of consciousness, seizures, coma, and death
113
Diabetic ketoacidosis (DKA) is characterized by what?
Hyperglycemia
Ketosis
Acidosis
Dehydration
Most likely to occur in Type 1
114
DKA clinical mainfestations
Polydipsia
Headache
N/V
Abd pain
Polyuria
Leg cramps
Low GCS
Confusion
Ketotic breath
Kussmaul breathing
Tachycardia
Hypotension
Dehydration
115
Macrovascular complications of diabetes
Microvascular
Neuropathic
Macro: Stroke, Heart attack, & Peripheral artery disease
Micro: Diabetic retinopathy, Diabetic nephropathy, Cataracts, & Glaucoma
Neuro: Peripheral neuropathy, Diabetic foot
116
What are the pH ranges?
Acidosis: <7.35
Normal: 7.35-7.45 (perfect: 7.4)
Alkalosis: >7.45
117
What are the CO2 ranges?
Acidosis: >45
Normal: 35-45
Alkalosis: <35
118
What are the HCO3 ranges?
Acidosis: <22
Normal: 22-26
Alkalosis: >26
119
What does R.O.M.E. stand for?
Respiratory
Opposite
(CO2 up & pH down = Resp. Acidosis or CO2 down & pH up = Resp. Alkalosis)
Metabolic
Equal
(Both HCO3 and pH down = Metabolic Acidosis or Both HCO3 and pH up = Metabolic Alkalosis)
120
What are the normal values for PaO2 & SaO2
PaO2 = > 80% mmHg
SaO2 = > 95%
Chronic NUR 150
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