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95 Cards in this Set

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Abdominal sounds should sound _____.
tympanic
When inspecting we look for ____.
symmetry
Use the ____ of the stethoscope to auscultate.
diaphragm
Percussion is used to
look for fluid levels.
Palpation is only light and can indicate _____.
peritonitis
Lab studies used during GI assessment are
-visceral proteins
-nitrogen balance
Visceral proteins are
albumin
prealbumin
____ is a major carrier protein and indicator for malnutrition.
Albumin
When a patient is in the hospital and we are monitoring nutritional status we look at their ____ levels.
prealbumin
Protein deficiency can lead to
anemia and immunosuppression.
3 major types of malnutrition are
-obesity
-protein-calorie
-protein
____ malnutrition occurs when there is an excess of adipose or fat tissue d/t consuming empty calories.
Obesity
____ malnutrition is what most hospital patients suffer from.
Protein-calorie malnutrition
____ malnutrition is a chronic protein deficiency with adequate calories.
Protein (kwashiorkor)
_____ is inadequate intake of calories.
Malnutrition
Risk factors for malnutrition include:
-age (older)
-poor
-oral/GI/functional problems
-meds or treatments that affect appetite
-chronic illness
-pain
-depression
Malnutrition results in _____.
immunosuppression
Complications of malnutrition include:
-impaired mobility
-skin/tissue breakdown with delayed healing
-increased infection (low lymphocytes)
-decreased cardiac output
Tx of malnutrition includes:
-correct fluid and electrolyte imbalances
-re-introduce proteins/calories (gradual refeeding)
-add fats and lactose last
____ contributes to breast cancer for women and colon cancer for the general population.
Obesity
Obesity results from _____.
excess energy intake (consumption>expenditure)
The appetite is regulated by the ____ and emotional factors.
hypothalamus
Obesity is a BMI>___ or 30lbs overweight.
30
Hormones that regulate obesity are:
thyroid, insulin, leptin
____ is a peptide produced by fat tissue that suppresses appetite and increases energy expenditure.
Leptin
Risk factors for obesity include
-heredity
-inactivity
-environment
-psychological factors
Obesity related problems include:
-cardiovascular (HTN, CVA)
-sleep apnea
-GI (gallstones, colon cancer)
-osteoarthritis
-insulin resistance, T2DM
-polycystic ovary disease, endometrial cancer, low androgen levels
-stress incontinence
-depression, eating d/o
Tx of obesity is aimed at
diet, exercise and behavior modification
1lb body fat= ____ kcal.
3500
Medications that can help promote weight loss are
-appetite suppressants (prob w/ heart)
-lipase inhibitors (Alli)
-bulk forming agents
Surgical Tx for obesity is limited to
the morbidly obese.
Morbidly obese is defined as
____ over IBW
BMI>__ for women
BMI>__ for men
100%
35
40
The most dramatic, irreversible, but definite results weight loss surgery is _____.
Roux-en-Y
____ is a weight loss surgery that involves placement of an adjustable band around the top part of the stomach.
Lap banding
_____ is weight loss surgery done through endoscopy where the stomach is stapled off to create a smaller one.
Vertical banding gastroplasty
The major problem with a Roux-en-Y is
dumping syndrome
The problem with lap banding is that it can
come lose, slide, or cause erosion in the stomach.
All weight loss surgeries have the potential complication of ____.
B12 anemia
A major complication of bariatric surgery is ____ which causes vomiting which then causes Mallory Weiss tears (Upper GI bleed).
overeating
Other complications of bariatric surgery include:
-vomiting
-leaking from staple lines
-bleeding
-dumping syndrome
-DVT risk
-hernias
-nutritional deficiencies (Fe, Ca, B-12)
-avoid pregnancy 1 year
4 strategies to increase oral intake when patients can't meet daily caloric needs include:
-calculate a 3 day calorie count
-offer high calorie and high protein foods
-offer oral supplements
-add modular products
____ is administration of liquid formula via a tube into the GI tract.
Enteral nutrition
Benefits of enteral nutrition are
it uses the gut so that it doesn't atrophy and it is cheaper than parenteral.
Indications for enteral nutrition-
the patient must have a working gut
Enteral nutrition is contraindicated for
acute/chronic pancreatitis, SBO, NVD, short gut syndrome
Gastric formulas are fed
into the stomach.
_____ are already broken down enough that the bowel can just suck it right up.
Small bowel formulas
Diseases that have specific enteral formulas include
renal, hepatic, pulmonary, critical care/trauma, glucose intolerant, HIV/AIDS
A renal enteral formula should consist of
low potassium with complete proteins.
If tube feeding is going to be longer than 3 months, use a
PEG tube or j jeunostomy tube
If tube feeding is going to be less than 3 months, use a
tube thru the nose and into the stomach.
Never push air down a tube to verify _____. All tube fed patients can aspirate.
placement
____ are small bore tubes that should be x-rayed for placement, are susceptible to clogging and collapse.
Nasoenteric tubes (NET)
Nasoenteric tubes can be placed in the _____ or ____.
gastric or small bowel
Use at least a ___cc syringe with NET tubes.
30
2 types of post pyloric NET tubes are
jejunostomy and duodenal
With NET tubes, use ____mL of sterile H2O before, between, and after meds.
30
A _____ tube is a large bore tube usually placed percutaneous endoscopically or radiologically (PEG) into the stomach.
gastrostomy
Gastric feedings can be...
continuous, intermittent or bolus.
_____ feedings are NEVER bolus. They are only continuous.
Post-pyloric
Only ____ tubes can be aspirated.
gastrostomy
Always check for ____ prior to tube feeding.
residual
Mechanical complications with tube feedings include:
-tube obstruction- flush
-respiratory placement
-aspiration pneumonia (HOB>45)
GI complications with tube feedings are:
-diarrhea (fiber, rate)
-delayed gastric emptying (increase HOB, give meds- Reglan)
-constipation- (fiber, water)
Metabolic complications with tube feedings are:
hyperglycemia
hyponatremia d/t diarrhea and low Na formulas
dehydration
Parenteral nutrition is delivered via ___ into the ____.
IV, blood stream
Parenteral nutrition is IV administration of ___, ____, ____ and ____.
dextrose, amino acids, fats, vitamins/minerals
Benefits of TPN are
can be tailored to individual needs and does not use the gut.
TPN is indicated for people who can't use their gut
short gut syndrome, SBO, NV
TPN is contraindicated for people with
a functioning gut.
A central line is used for delivery of
TPN/hyperalimentation
___ is parenteral nutrition through a regular IV cannula.
PPN
TPN access can be
non-tunneled catheters
tunneled catheters
implanted ports
PICC line
Continuous TPN is delivered ____.
24 hours per day
Cyclic TPN is delivered
less than 24 hours per day. It is tapered on and off at one half the maintenance rate.
If patient is on TPN, check ____ and use ____.
BG q6h and use sliding scale insulin prn.
Infections during TPN are predominately with the _____.
central line
Redness, swelling, and drainage indicate a _____.
local infection
High fever, chills, and general malaise indicate a ______.
systemic infection
The most common catheter colonization is _____.
yeast
If a patient has a central line the nurse should observe the _____, ___, and ____.
arm, shoulder, and neck
Chronic catheter colonization may result in a systemic ____.
yeast infection
____ is a collapsed lung d/t escaped air into the pleural cavity that can occur when the physician is trying to place a central line in the subclavian vein.
Pneumothorax
____ is blood bleeding from the lung causing it to collapse.
Hemothorax
____ is the most common complication with central line placement therefore we always want to do a chest xray to confirm placement.
Pneumothorax
A central line that ends up in the R atria can cause _____.
arrhythmias
Occlusion of a central line can be due to
drug precipitate, fibrin sheath, intraluminal blood occlusion, and thrombosis.
Redness, warmth and tenderness at the site of central line insertion is _____.
phlebitis
___cc of air in an artery can kill a person.
5
____ cc of air in a vein can kill someone.
30
Central line placement is always checked with ____ to confirm placement.
chest x-ray
Metabolic complications of TPN include:
hyperglycemia and hypoglycemia.
If pt is hyperglycemic,
cover with sliding scale insulin- Regular or Humalog
After coming of TPN, pt often becomes
hypoglycemic.
S/Sx of hypoglycemia are:
-hunger, nausea, anxiety, shaky
-pale, cool skin and sweating
-irritable
-rapid pulse
-hypotension
-h/a, poor concentration
-slurred speech, blurred vision
-decreased LOC, seizures, coma