1
Q
What is IBS?
A
- chronic inflammation of the GI tract
- has remission and exacerbation periods
2
Q
There are two kind of IBS, what are they and what is the difference between them?
A
Ulcerative Colitis- just the colon is involved
Crohn’s- can be anywhere in the bowel (mouth to anus)
3
Q
Where does Crohn’s most commonly occur? How does it affect the tissue in that area?
A
- distal ileum
- it extends through all the layers of the bowel wall causing thickened walls and narrowed intestines
4
Q
What are the (6) risk factors for Crohn’s disease?
A
- family history
- Jewish
- immune system may have a hypersensitivity reaction to normal bacteria in the intestine
- 15-40 years old
- urban living
- smoking
5
Q
What are the (5) s/sx of Crohn’s disease?
A
- right lower quadrant abdominal pain (not relieved by defecation, aggravated by eating)
- low grade fever
- diarrhea
- steatorrhea (greasy, foul-smelling stool)
- weight loss
6
Q
What labs and diagnostic imaging will we look at to diagnose Crohn’s?
A
Labs:
- H/H
- WBC
DI:
abdominal xray
7
Q
What will the patient with Crohn’s have to change with their nutrition?
A
- high calorie
- high protein
- low fiber
- no dairy
- possible TPN
8
Q
What five classes of medications might we give for the client with Crohn’s?
A
Steroids
Anti-infective
Aminosalicylates
Immune modulators
9
Q
What are some (2) examples of the steroids we would give for the client with Crohn’s? Considerations (2)?
A
ex: prednisone, hydrocortisone
what it does: reduces inflammation, pain, can induce remission, but it does slow healing and is not for long-term use
Considerations: take with food, report infections
10
Q
What are (2) examples of the anti-infectives we would give for the client with Crohn’s?
A
ex: cipro, metronidazole
what is does: decreases inflammation, treats infection
11
Q
What is (1) example of the aminosalicylate we would give for the client with Crohn’s?
A
ex: balsalazide, olsalazine, sulfasalazine, mesalamine
what it does: prevents and reduces reoccurences, reduces the inflammatory response
12
Q
What is (1) example of the immunomodulator we would give for the client with Crohn’s? Considerations (3)?
A
ex: Infliximad
what it does: suppresses the immune response
considerations: can require pretreatment to reduce infusion reactions, avoid crowds, report infections
13
Q
What surgical options are there for the patient with Crohn’s disease?
A
Bowel resection with a possible ileostomy
14
Q
What are the big complications (5) that can result from Crohn’s disease if left untreated?
A
- intestinal obstruction
- perianal disease
- F&E imbalance
- malnutrition/malabsorption
- fistula formation
15
Q
Where does ulcerative colitis most commonly occur? How dies it affect the tissue in that area?
A
- it begins in the rectum and spreads through the colon
- affects the superficial mucosa
16
Q
What are the (6) risk factors for ulcerative colitis?
A
- family history
- Jewish
- Caucasian
- young and middle aged adults
- emotional stress
- low fiber diet
17
Q
What are the s/sx of ulcerative colitis? (9)
A
- 10-20 liquid bloody or mucous-y stools/day
- left lower quadrant abdominal pain
- tenesmus (urgency to empty bowel)
- abdominal distention
- high-pitched bowel sounds
- weight loss (anorexia)
- low grade fever
- vomiting
- dehydration
18
Q
What are the labs (3) and diagnostic testing (3) we will look at to diagnose ulcerative colitis?
A
Labs:
- H/H
- WBC
- electrolytes
DI:
- colonoscopy- shows ulcers
- barium enema- shows mucosal irregularities
- CT/MRE/CTE- shows abscesses
19
Q
How will we manage the diet of the client with ulcerative colitis?
A
-NPO during acute phase
-increase oral fluids
-low residue diet
-high calorie
-high protein
(admin multivitamins)
20
Q
What are the 4 classes of medications we may use to treat the client with ulcerative colitis?
A
Antidiarrheal
Aminosalicylate
Immune modulators
Corticosteroids
21
Q
What are some examples of the antidiarrheal that we may give to the client with ulcerative colitis? Considerations?
A
Ex: diphenoxylate with atropine (lomotil) or loperamide (Imodium)
What it does: less stools
Considerations: it will decrease the risk of FVD, could lead to toxic megacolon
22
Q
What are the surgical options for the client with Ulcerative colitis?
A
Total Colectomy with ileostomy
23
Q
What are the 3 major complications that can occur if ulcerative colitis is left untreated?
A
- toxic mega colon (inflammation extends into the muscles which inhibits the ability to contract)
- peritonitis- rebound tenderness
- perforation- bleeding can occur if left untreated
24
Q
What is cholelithiasis?
A
stones in the gallbladder
25
What is cholecystitis?
inflammation of the gallbladder (usually from cholelithiasis)
26
What are the (7) risk factors for cholecystitis?
- female
- high fat diet
- older adult
- estrogen therapy
- sedentary lifestyle
- obesity
- diabetes
27
What are the s/sx of cholecystitis?
- N&V after eating high fat food
- RUQ, epigastric, or shoulder pain (especially 3-6 hrs after a high fat meal or when lying down)
- positive Murphy's sign
28
What are the s/sx of cholecystitis when total obstruction occurs?
- dark amber urine
- clay-colored stools
- pruritis
- fatty food intolerance
- jaundice
- heartburn
29
What labs and diagnostic imaging will we perform to diagnose cholecystitis?
Labs:
WBC (up)
serum bilirubin (up)
urine bilirubin (up)
DI:
ultrasound
ERCP (endoscopic retrograde cholangiopancreatography)
30
What meds might we give for the patient with cholecystitis?
Analgesics (morphine)
Antiemetics (Zofran)
Anticholinergics (Atropine)(to decrease GI secretions and counteract smooth muscle spasms)
Antibiotics
31
What does an ERCP with sphincterotomy (papillotomy) entail?
- endoscope is passed to the duodenum
- visualizes the biliary system, dilates (balloon sphincteroplasty), and places stents (usually removed or changed after a few months)
- stones can be collected and removed in a basket but more often they are left to pass naturally
32
What is the nursing care for the ERCP with papillotomy postop patient?
Complications: pancreatitis, perforation, infection and bleeding
Assess: VS, abdominal pain, fever, and increasing amylase and lipase
Care: bed rest for several hours, NPO until gag reflex returns
33
What does a laparoscopic cholecystectomy entail?
- this is the treatment of choice, few complications
| - removal of the gallbladder
34
What is the nursing care following laparoscopic cholecystectomy?
- SIMS position for comfort
- clear liquids
- discharged same day and can return to work in one week!
35
What is a lithotripsy? How does it help with cholelithiasis?
it is shock wave therapy to break up small stones (non-invasive)
36
What does an open (incisional) cholecystectomy differ from the laparoscopic one?
- right subcostal incision
| - a T-tube is inserted into the common bile duct to keep it open and draining (*report drainage >1000mL/day)
37
What are the postop considerations for an incisional cholecystectomy?
- prevent respiratory complications
- maintain T-tube
- no heavy lifting for 4-6 weeks
- low-fat diet
38
What are the differences between acute and chronic pancreatitis?
Acute- lifethreatening spillage of pancreatic enzymes causing autodigestion
Chronic- characterized by remission and exacerbation, function of the pancreas decreases over time
39
What are the (5) risk factors for pancreatitis?
- gallbladder disease
- chronic alcohol use
- illegal drug use
- infection
- blunt abdominal trauma
40
What are the pain characteristics of pancreatitis?
PAIN
- LUQ or midepigastrium
- can radiate to the back
- sudden onset
- deep, piercing, continuous, or steady
- intensifies after meals
- starts when lying down
- not relieved by vomiting
41
What are the other s/sx of pancreatitis?
- N&V
- Grey Turner's spots (blue flank discoloration)
- Cullen's sign (blue around the bellybutton)
- weight loss
- abdominal tenderness/acites
- steatorrhea
- hypoactive bowel sounds
42
What labs and diagnostic imaging do we look at to diagnose pancreatitis?
Labs:
serum lipase
serum amylase
DI:
CT with contrast
43
Nursing care for the client with pancreatitis?
- NPO at first
- NG for severe vomiting
- enteral or parenteral nutrition
- when able to advance to real food it should be high carb, high protein, and low fat
- may be given fat soluble vitamins (A,D,E,K)
* NO alcohol
44
What (5) classes of meds will we try for the client with pancreatitis?
```
Analgesics
Antispasmodics
Anticholinergics
Pancreatic Enzyme (take enzymes before meals and snacks)
H2 blockers or PPI
```
45
What specific analgesics may be used or contraindicated for pancreatitis?
ex: opioid analgesics or IV morphine
| * demerol/meperidine are contraindicated
46
What specific antispasmodics may be used for pancreatitis? What do they do?
ex: dicyclomine (Bentyl)
what it does: decreases vagal stimulation, motility, and pancreatic outflow
**contraindicated in paralytic ileus
47
What will antacids do for the client with pancreatitis?
-neutralizes gastric acid secretion, decreases production and secretion of pancreatic enzymes and bicarb
48
What specific proton pump inhibitors may be used for pancreatitis? What do they do?
ex: omeprazole (Prilosec)
| - decreases HCl acid secretion which decreases pancreatic activity
49
What is the clinical def of hypertension?
systolic >140
or
diastolic >90
50
What is primary HTN?
"essential" or "idiopathic"
- just means that the BP is elevated without an identifiable cause
* 90-95% of ppl with HTN have primary HTN
51
What is secondary HTN?
- just means that the BP is high bc of an underlying cause
- so we treat the cause
* only 5-10% of HTN cases are secondary
52
What is prehypertension?
systolic 120-139
| diastolic 80-89
53
What is HTN stage 1?
systolic 140-159
| diastolic 90-99
54
What is HTN stage 2?
systolic >160
| diastolic >100
55
What are the complications of untreated HTN? (heart, brain, vascular, kidney, eyes)
Heart: CAD, HF, left ventricular hypertrophy
Brain: TIA/stroke, encephalopathy
PVD: aortic aneurysm, aortic dissection, intermittent claudication
Kidney: CKD
Eyes: retinal damage, hemorrhage
56
What are the risk factors for HTN?
- age
- alcohol use
- tobacco use
- diabetes (obesity)
- elevated serum lipids
- excess dietary sodium
- gender
- family history
- ethnicity
- sedentary lifestyle
- socioeconomic status
- stress
57
What are the s/sx of HTN?
- increased BP
- fatigue
- dizziness
- palpitations
- angina
- dyspnea
- headache
- edema
- blurred vision
58
What diagnostics will we use to diagnose HTN?
```
Labs:
urinalysis
BUN and creatinine
Creatinine clearance
serum electrolytes
serum lipid profile
uric acid levels
```
DI:
ECG
Echocardiogram- can show left ventricular hypertrophy
59
What is the DASH diet?
Dietary Approaches to Stop HTN
- fruits
- veg
- low-fat milk
- whole grains
- fish
- poultry
- beans
- seeds
- nuts
60
What are the recommendations for sodium intake for low risk and high risk HTN?
healthy adults: <2300mg
ppl with risk factors: <1500mg
61
What are the exercise recommendations for the client with uncomplicated HTN?
moderate intensity 30mins most days of the week
vigorous intensity 20mins 3 days a week
strength building 2x/week
flexibility and balance 2x-week
62
What are some of the loop diuretics we could use to treat the client with HTN?
ex: furosemide, bumetanide
considerations: take in AM, admin K supplement, dig toxicity can happen if client is hypokalemic
63
What are some of the thiazide diuretics we could use to treat the client with HTN?
ex: HCTZ
considerations: take in AM, admin K supplement, dig toxicity can happen if client is hypokalemic
64
What are some of the potassium sparing diuretics we could use to treat the client with HTN?
ex: spironolactone, triamterene
considerations: monitor for hyperkalemia
65
What are some of the beta-blockers we could use to treat HTN?
ex: propranolol, atenolol, metoprolol
considerations: monitor for bradycardia, HF, and hypoglycemia in patients with diabetes
66
What are some of the ACE inhibitors that may be used to treat HTN?
ex: captopril, lisinopril
considerations: captopril give 1 hr before meals; lisinopril can cause a dry cough
67
What are some of the calcium channel blockers that could be used to treat HTN?
ex: nifedipine, verapramil
what it does: prevents the mvmt of calcium into the cells which increases sodium excretion and increases vasodilation
68
What is stable angina?
* exertional angina is another name. It can be relieved with rest or nitroglycerin
- it is a s/sx of MI
- 1 or more arteries are 70% blocked
- coronary artery blocked by 50%
69
What are the risk factors for stable angina?
- CAD
- family history
- older age
- hyperlipidemia
- tobacco use
- HTN
- diabetes or obesity
- sedentary lifestyle
70
What are the s/sx of stable angina?
- chest pain: intermittent occurring over a long period, usually starting from physical exertion or stress
- dyspnea
- fatigue
- pain in the arm, jaw, neck, shoulder, or back
- nausea
- diaphoresis
- dizziness
- anxiety
71
When should a 12-lead ECG be used and what could it show during angina?
- use within 10 minutes of onset
- ST elevation=injury
- T wave inversion or depression=ischemia
- Q wave enlargement=infarction
72
How do we diagnose based on cardiac enzymes and serum cardiac biomarkers?
Cardiac enzymes: test for death of heart muscle tissue
Serum cardiac biomarkers:
Troponin *gold* remains elevated for 2-3 wks following MI
Creatinine phosphokinase (CK-MB): increases 4-6 hours after MI and remains elevated for 1-3 days
Myoglobin: rises in response to tissue injury, within 2 hours and gone within 7 hours
73
What is the nursing care for angina?
- assess pain
- assess heart and breath sounds
- admin O2
- monitor VS
- promote rest
- admin meds: asa, nitro, BB, statins, calcium channel blockers, ACE
74
What are some guidelines for the use of nitrogylcerin?
- take at the onset of chest pain
- take every 5 mins x3
- if pain is not relieved after the first tablet call 911
- take while sitting
considerations: headache and hypotension may be side effects, ED meds is contraindicated with the use of nitro, store ina dark, dry place and replace q 6 mos
75
What lifestyle changes should be taught to the client with stable angina?
- avoid constipation
- avoid activity in cold weather
- decrease stress
- exercise
- low salt, fat, and cholesterol
- rest after meals
- smoking cessation
76
What is the clinical definition of shock?
inadequate delivery of oxygen and nutrients to support vital organs and cellular function
77
What is cardiogenic shock? Causes?
- failure of the heart to pump adequately
| - caused by systolic or diastolic dysfunction or compromised cardiac output
78
What is hypovolemic shock? Causes?
- decreased circulating blood volume
| - caused by hemorrhage, GI loss, fistula drainage, DI, hyperglycemia, diuresis
79
What is distributive shock?
AKA circulatory shock
| -vasodilation causes blood to pool in peripheral vessels
80
What is the neurogenic cause of distributive shock? S/sx?
Cause: spinal cord injury, certain meds, hypoglycemia
| S/Sx: warm dry skin, bradycardia
81
What is the anaphylactic cause of distributive shock? S/SX?
Cause: hypersensitivity reaction that causes sudden hypotension
S/SX: can cause respiratory and cardiac arrest, swelling of the lips/tongue (angioedema), wheezing/stridor, flushing, pruritis, urticaria, cold/moist skin
**epi and benadryl are primary meds to give
82
What is the septic cause of distributive shock? S/SX?
**most common
Cause: sepsis
S/Sx: warm dry skin, bounding pulse, tachypnea
83
What are the general s/sx for shock?
- tachycardia
- hypotension
- oliguria
- pallor
- metabolic acidosis
- decreased LOC
84
What is the nursing care for the client with shock?
- modified T-Berg
- secure IV line (16-18g)
- give NS, LR, and albumin
- admin O2
- VS q 5mins
- rest
- decrease movement
- monitor I&O
85
What is the clinical definition of CAD?
Coronary Artery Disease
- progressive
- only symptomatic once its advanced
- atherosclerosis (hardening of the arteries)
86
What is the connection between CRP and CAD?
CRP is a protein produced by the liver, and is a general indicator of inflammation
-it is increased in patients with CAD
87
What are the risk factors for CAD?
- age
- gender
- ethnicity
- family history
- genetic presdisposition
- HTN
- tobacco use
- sedentary lifestyle
- obesity, diabetes
- elevated serum lipids
88
What is the nursing care for the client with CAD?
- encourage regular exercise
- weight reduction
- treat HTN
- stop smoking
- decrease sat fats and cholesterol
- decrease red meat, egg yolks, and whole milk
- increase complex carbs and fiber
- increase omega 3 fatty acids
89
What meds can we use to treat CAD?
Statins- inhibits colesterol synthesis to decrease LDL and increase HDL; monitor for liver damage and hypertrophy
Niacin- lowers LDL, raises HDL; flushing, pruritis, GI, and O.hypotension
Fibric acid derivatives- lower triglycerides and raise HDL; GI side effects
90
What are cataracts?
clouding of the lens leading to varying degrees of visual impairment
91
What are the risk factors for cataracts? (7)
- aging
- diabetes
- hereditary
- smoking
- eye trauma
- excessive sun exposure
- chronic corticosteroid use
92
What are the s/sx of cataracts?
- freq prescription changes
- reduced night vision
- abnormal color perception
- blurred vision
- diplopia (dbl vision)
- absent red reflex
- sensitivity to glare
93
What are the surgical options available to clients with cataracts?
- extracapsular cataract extraction: outpatient under local anesthesia, removal of the lens (one at a time)
- phacoemulsification: ultrasonic device breaks up the lens and a replacement is inserted (intraocular lens implantation)
94
What are mydriatics used for and some examples?
- used preop for lens removal to dilate the pupil and constrict vessels
- examples: phynelephrine hydrochloride, atropine
95
How do we care for the postop cataract surgery client?
- keep the operative eye covered for 24 hours, sunglasses outside
- HOB 30-45
- do not turn pt on the operative side
- avoid IOP such as bending at the waist, coughing, straining (give antiemetic to avoid emesis)
- vision should stabilize in 6-12 weeks
96
What is glaucoma?
- vision changes/blindness from optic nerve damage
| - usually occurs due to increased IOP (RR 10-21 mmHg)
97
What are the risk factors for glaucoma?
- age >40
- men
- infection
- tumors
- diabetes
- genetic predisposition
- HTN
- eye trauma
98
What is closed angle glaucoma?
- obstruction to the outflow of aqueous humor increases IOP suddenly
* *ocular emergency
99
What is open angle glaucoma?
- aqueous humor outflow is decreased causing a gradual increase in IOP
- most common
100
What are the s/sx of closed angle glaucoma?
- rapid onset of IOP >30
- blurred vision
- dilated pupils
- N&V
- sudden severe eye pain
101
What are the s/sx of open angle glaucoma?
- headache
- mild eye pain
- loss of peripheral vision
- halos around lights
- fluctuating IOP 22-32
102
What does tonometry measure?
IOP (noninvasive, painless)
103
What is a miotic medication given for in the client with glaucoma?
example: pilocarpine
- constricts the pupil, improves outflow, improves circulation
Consider: can cause blurred vision
104
What is a beta blocker given for in the client with glaucoma?
* *first choice defense for glaucoma**
example: timolol
- decreases IOP, reduces aqueous humor production
Consider: can cause bronchoconstriction or hypoglycemia (use caution with asthma, DM, COPD)
105
What is a carbonic anhydrase inhibitor used for in the client with glaucoma?
example: acetazolamide, dorzolamide, brinzolamide
- decreases IOP, reduces aqueous humor production
Consider: ask about Sulfa allergy
106
What is IV mannitol used for in the client with glaucoma?
* *this is the emergency treatment for closed angle glaucoma**
- osmotic diuretic quickly decreases IOP
107
What do glaucoma surgical interventions looks like?
Laser trabeculectomy, iridotomy, placement of a shunt all improve the flow of aqueous humor
-4-6 weeks for vision to stabilize
108
What is AMD?
Age-related Macular Degeneration
- tiny, yellow spots (drusen) beneath the retina
- shadow-y areas in field of vision
109
What is dry macular degeneration?
- more common
- no exudate
- atrophy of the macular cells
- gradual blockage in the retinal capillary arteries
- painless, slow onset
110
What is wet macular degeneration?
- less common
- exudate
- new growth of blood vessels that have thin walls and leak blood and fluid
- rapid onset
111
What are the risk factors for macular degeneration?
- female
- short body stature
- smoking
- HTN
- family history
- lack of carotene and Vit E
112
What are the s/sx of AMD?
- lack of depth perception
- objects appear distorted
- blurred vision
- loss of central vision
- blindness
113
How can we treat wet macular degeneration?
- laser therapy seals leaking vessels
| - ocular injections inhibit blood vessel growth
114
What does the tympanic membrane look like normally?
- pearly gray, shiny, translucent
| - flat, slightly pulled in at the center
115
What is the Weber test?
strike a tuning fork and put it on the skull, the tone should be heard equally bilaterally
*bone conduction
116
What is the Rinne test?
- strike a tuning fork and put it on the mastoid process
- instruct the client to signal when the sound stops
* air conduction
117
What is Meniere's Disease?
- abnormal inner ear fluid balance, progressive
- age 30-60
- more common in women
118
What are the s/sx of Meniere's disease?
- episodic vertigo (can lead to N/V, sweating, being pulled to the ground)
- tinnitus
- fluctuating hearing loss
- pressure in the ear
**vertigo attacks can last hours to days and may happen several times a year
119
What is the nursing care for the client with Meniere's disease?
- teach fall precautions
- quiet environment
- avoid aspirin (may increase symptoms)
- small freq meals low in sodium, no caffeine or alcohol, no MSG
120
What are antihistamines used for in the client with Meniere's disease?
example: meclizine
- treats vertigo
Consider: avoid driving or heavy machinery due to sedative effects
example: diphenhydramine
- treats vertigo
Consider: avoid driving, etc..., dry mouth is expected
121
What are tranquilizers used for in the client with Meniere's disease?
example: diazepam
- anti-vertigo effects
Consider: assess for sedation and safety, restrict use in clients with closed angle glaucoma!
NUR150
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