Mca Ii Exam 1

Front 1

Clear liquid diet

Back 1

a) Need for adequate GI function (coffee ok)
b) No orange juice
c) Listen for bowel sounds, flatulence, or BM

Front 2

Full liquid diet

Back 2

a) Difficulty chewing
b) Cannot swallow solid foods or thin liquids
c) Cream of wheat, ice cream, ensure, milkshake

Front 3

Pureed diet

Back 3

a) Smooth consistency
b) Edentulous pts
c) Pts without their dentures or no teeth
d) Pts usually hate it

Front 4

Mechanical soft diet

Back 4

a) Required only minimal chewing before swallowing

Front 5

Soft diet

Back 5

a) Transition from liquid to regular diet
b) Pt with GI problems
c) Pt with trouble swallowing

Front 6

Diet as tolerated

Back 6

a) Common Rx postop
b) Permit’s pt’s preferences
c) Situations to be taken into account
d) Allows for progression as tolerance improves (without stomach problems)

Front 7

Cardiac diet

Back 7

a) Low-fat
b) Low salt

Front 8

Renal diet

Back 8

a) Low salt
b) Low fluid
c) 3 ps:
i) Low potassium
ii) Low phosphorous
iii) Low protein

Front 9

Verification of NG tube placements

Back 9

1) Ausculate over stomach
2) X-ray to confirm placement (do not start until confirmed)
3) Check for residual (check every shift; aspirate and see how much is coming out)
a) If less than 350 mL return to pt if more than 350 mL hold TF and check in 1 hour.
4) Can be dislodged by vomiting or coughing (mark on the tube once confirmed so that if it becomes dislodged it can be noticed)
5) Can be knotted or kinked in the GI tract

Front 10

What to watch for when pts on enteral feedings?

Back 10

1) Clogged feeding tubes
a) Use warm water (DO NOT force)
b) Use smaller syringes = higher pressure
c) Use of carbonated beverages (cranberry juice or sodas)
2) Aspiration
3) Distended abdomen
4) Nausea/vomiting
5) Diarrhea
6) Abdominal pain
7) Constipation
8) Dehydration
9) HOB – 30 – 45 degrees
10) Tube patency
a) Flush with 30 mL of h2o before/after feeding, drug administration, residual checks

Front 11

Monitoring and assessment for pts on parenteral feedings

Back 11

1) Monitor VS 4-8 hours
2) Daily weights
3) Blood glucose (every 4-6 hours)
4) Electrolytes
5) CBC
6) Chem panel
7) Change solutions every 24 hours
8) Change lipids every 12 hours including tubing (lipids in glass)

Front 12

TPN

Back 12

a) 20-50% glucose
b) 60 mEq k (or more)
c) Need dedicated catheters
central line

Front 13

PPN

Back 13

a) 10-12.5% glucose
b) K is less than 60 mEq
peripheral line

Front 14

What to watch for in swallow evaluations?

Back 14

a) Collecting food under tongue or in checks:
i) Takes a long time to eat or doesn’t touch food
b) Excessive eating time
c) Coughing
d) Coking
e) Drooling
f) Wet voice (gurgling voice after eating or swallowing) (say ahhhhh)

Front 15

Starting a swallow evaluation

Back 15

a) Sit upright
b) Speech therapist
c) Ice chips to sips of water
d) Small bites only
e) Spoon vs. straw (risk for aspiration with straw is much higher)
f) Thick liquids (easier to swallow)

Front 16

Who’s at risk for aspiration? How can it be prevented?

Back 16

a) Those on TF; check residual volume; only feed when HOB is 30-45;
b) Swallow evals – change diet according to swallow eval

Front 17

Sequelaes of protein‐calorie malnutrition

Back 17

1) Generalized loss of muscle and body fat
2) Muscle wasting
3) Inability to heal
4) Decreased immune function
5) Uses carbohydrates from the liver and muscle to meet metabolic needs
6) Once stores are depleted converts protein into glucose for energy
7) Gluconeogensis occurs (formation of glucose by the liver)
8) Fat stores are used in 4-6 weeks
9) Once fat stores are depleted body proteins from internal organs are no longer spared
10) Liver function becomes impaired
11) Protein synthesis diminished
12) Plasma oncotic pressure ↓ (shift from vascular space to interstitial space)
13) Albumin leaks into interstitial space (edema present)

Front 18

Sequelaes and complications for obesity

Back 18

1) HTN
2) CAD
3) Stroke
4) Metabolic disorder (insulin resistant syndrome)
5) Obstructive sleep apnea

Front 19

Recognize tests used to dx metabolic syndrome

Back 19

1) Has 3 or more of conditions:
a) Waist circumference: men equal to or greater than 40; woman equal to or greater than 35
b) Triglycerides greater than 150
c) HDL less than 40 in men less than 50 in women
d) Bp greater than or equal to 130/85 mm Hg
e) Fasting glucose is greater than or equal to 100 mg/dL

Front 20

Patient education for discharge post‐bariatric procedures

Back 20

1) Diet should be high in protein low in carbs, fat, roughage, and consist of 6 small meals a day
2) Fluids should not be ingested with meal and in some cases fluids should be restricted to less than 1000 ml/day
3) Fluids and foods high in carbs tend to promote diarrhea and dumping syndrome
4) Diet must be understood otherwise = anemia, vitamin deficiencies, diarrhea, psychiatric problems
5) Peptic ulcer formation, dumping syndrome, and small bowel obstruction may be seen late in the recovery and rehabilitative stage.
6) Long term follow up care must be stressed
7) Massive weight loss often leaves patients with large amounts of flabby skin

Front 21

Ways to reduce dumping syndrome

Back 21

1) Small, frequent meals
2) No fluids 30-45 mins before or after meals
3) Lay down after meals (semi-folwers)
4) Avoid concentrated sweets
5) Low card moderate protein and fat

Front 22

alcohols withdrawals, DTs

Back 22

2) Alcohol hallucinosis-within 48 hrs
a) s/sx of hangover
b) > HR, B/P
c) Irritability
d) Diaphoresis
e) Oriented
f) Nighmares
3) Delirium Tremens (DTs) – 48-72 hrs
a) Sever hypertension
b) Tachycardia
c) Delirium
d) Severe tremors
e) Faulty memory
f) Rambling speech
g) Seizures
h) > hallucinations
i) Death: seizure, stroke, MIs

Front 23

Assessment for alcohol withdraws

Back 23

a) Last drink? (exact time)
b) What did you drink?
c) How much?
d) How long have you been drinking?
e) Do you feel the need to cut down drinking?
f) Are you annoyed by people who complained about your drinking?
g) Do you feel guilty about drinking?
h) Do you need an eye-opener when you wake up?

Front 24

Tx for alcohol withdraws

Back 24

1) Nitritional & fluid replacements
2) Banana bag- NS with supplemenets
3) Precautions
4) Fall
5) Seizure
6) Meds
7) Benzodiazepines-Ativan
8) May have to give in IV drip
9) CNS depressant
10) Monitor VS

Front 25

ETOH consequences/ deficiencies

Back 25

a) Alcoholic cirrhosis
b) Irreversible inflammatory disease
c) Hepatic tissue fibrosed & nodular
d) Malnutrition
e) inhibits export of proteins and alters metabolism of vitamins/minerals
f) Hypoglycemia
g) Hypomagnesemia
h) Hypokalemia
i) Folic deficiency
j) Thiamine deficiency

Front 26

What is third spacing and patient population at risk

Back 26

a) Third spacing
i) Fluid accumulation in part of body where it is not easily exchanged with ECF
ii) Interstitial spaces & connective tissues between the cells
iii) fluid is trapped
iv) unavailable for functional use.
v) Examples: ascites, burns, massive bleeding

Front 27

Hypervolemia

Back 27

i) Too much extracellular fluid
ii) Edema
iii) Peripheral
iv) Pitting
v) Fluids in lungs (crackles)
vi) > weight

Front 28

Hypovolemia

Back 28

i) Too little extracellular fluid
ii) < weight
iii) > pulse
iv) Dry skin / mucous membranes
v) < Skin turgor

Front 29

Hypernatremia
Nursing Implementation

Back 29

Serum sodium levels must be reduced gradually to avoid cerebral edema
Fluid balance
• Increase fluid intake
• D5W
• Diuretics
• Decrease fluid retention

Front 30

Hypernatremia

Back 30

i) Elevated serum sodium occurring with water loss or sodium gain
ii) Causes hyperosmolality leading to cellular dehydration
iii) Primary protection is thirst from hypothalamus
i) Na > 145 mEq
ii) Too much sodium
iii) concentrated (dehydration)
iv) Manifestations
(1) Thirst, lethargy, agitation
(2) Impaired LOC
(3) Dry mucous membranes

Front 31

Hyponatremia

Back 31

i) Na < 135
ii) Too little sodium
iii) Diluted (water excess)
iv) Manifestations
Fatigue, confusion, nausea, vomiting

Front 32

Hyponatremia
Nursing Management

Back 32

Treat by water excess
• Fluid restriction
Treat sodium loss
• Give NS if needed (NPO)

Front 33

Hyperkalemia

Back 33

i) K > 5.0
ii) High serum potassium caused by
(1) Massive intake
(2) Impaired renal excretion
(3) Shift from ICF to ECF
iii) Common in massive cell destruction
(1) Burn, crush injury, or tumor lysis

Front 34

Hyperkalemia Manifestations

Back 34

i) Confusion
ii) Paresthesias-numbness and tingling
iii) Weak or paralyzed skeletal muscles
iv) Abdominal cramping
v) EKG changes
vi) > T waves
vii) Widened QRS Interval

Front 35

Hypokalemia

Back 35

a) K < 3.5
b) Potassium loss
i) Use of Lasix diuretic
ii) Use of insulin-K goes into ICF-< serum K level
iii) Prolonged vomiting, diarrhea

Front 36

hypokalemia Manifestations

Back 36

i) • Most serious are cardiac
ii) • Inverted T waves
iii) • Skeletal muscle weakness
iv) • Weakness of respiratory muscles
v) • Decreased gastrointestinal motility

Front 37

Hypercalcemia

Back 37

i) High serum calcium levels caused by
(1) Hyperparathyroidism (two thirds of cases)
(2) Malignancy
(3) Vitamin D overdose
(4) Prolonged immobilization
(5) Osteoporosis
(6) Ca++ is liberated into bloodstream

Front 38

Hypercalcemia Manifestations

Back 38

(1) Confusion, disorientation
(2) Fatigue, weakness
(3) Muscle spasm
(4) Shortened QT interval

Front 39

Hypocalcemia

Back 39

i) Low serum Ca levels caused by:
(1) Decreased production of PTH
(a) Gland removal
(2) Vitamin D deficiency
(a) Hypertrophy of parathyroid (PTH) gland
(i) Demineralization
(3) Multiple blood transfusions
(4) Decreased intake

Front 40

Hypocalcemia Manifestations

Back 40

(1) Positive Trousseau’s sign
(2) Positive Chvostek’s sign
(3) Prolonged QT interval
(4) Tingling around the mouth or in the extremities-paresthesias (pins & needles)
(5) Bone pain / Fractures
(a) Demineralization
(i) Mobilization of calcium from bone

Front 41

Hyperphosphatemia

Back 41

i) Causes
(1) • Renal failure
(2) • Chemotherapy
(3) • Excessive ingestion of phosphate
(4) • In dairy products

Front 42

Hyperphosphatemia Manifestations

Back 42

iii) Calcified deposition in joints, arteries, skin, kidneys, heart, lung, blood vessels,
iv) Crystal deposits
(1) Neuromuscular irritability and tetany

Front 43

Hypophosphatemia

Back 43

(1) Low serum PO4
(a) − caused by Malnourishment/malabsorption
(ii) Alcohol withdrawal
(iii) Use of phosphate-binding agents
(iv) During parenteral nutrition with inadequate replacement

Front 44

Hypomagnesemia

Back 44

i) Causes
(1) Prolonged fasting or starvation
(2) Chronic alcoholism

Front 45

Hypomagnesemia Manifestations

Back 45

(1) Confusion
(2) Hyperactive deep tendon reflexes
(3) Involuntary twitching
(4) Seizures
(5) Cardiac dysrhythmias

Front 46

Hypermagnesemia

Back 46

i) High serum Mg caused by
(1) Increased intake or ingestion of products containing magnesium when renal insufficiency or failure is present
(2) Milk of magnesia (MOM)
(3) Maaalox

Front 47

Hypermagnesemia Manifestations

Back 47

(1) Nausea/vomiting
(2) Impaired reflexes
(3) Loss of deep tendon reflex (DTR)
(4) Lethargy or drowsiness
(5) Respiratory and cardiac arrest

Front 48

Sodium values

Back 48

i) Na + (135-145 mEq)

Front 49

Potassium values

Back 49

i) K + (3.5-5 mEq)

Front 50

Potassium food sources

Back 50

i) Banana, sweet potato, potato, clams, plain yogurt, halibut, soybeans,

Front 51

Calcium food sources

Back 51

i) Fortified cereal, tofu, spinach, mollasus, turnip, oatmeal, soybeans, greens, yogurt, cheese, milk

Front 52

Magnesium food sources

Back 52

Pumpkin, halibut, mixed nuts (pine nuts), tuna, artichokes, brown rice

Front 53

Phosphorous food sources

Back 53

i) Garlic, wheat bran, cheese, popcorn, nuts, liver, tuna, eggs

Front 54

Hyperkalemia meds

Back 54

i) IV glucose
ii) Insulin-Regular for IV administration
iii) Calcium gluconate
iv) Kayexalate
(1) Exchanges K for Na
(2) Diarrhea-uses sorbitol for evacuation of K+
v) Needs to be on telemetry monitoring

Front 55

Hypocalcemia meds

Back 55

i) Give calcium PO
(1) Calcium carbonate (Tums)
(2) Calcitriol
(3) Sensipar
ii) Give Calcium IV
(1) A vesicant

Front 56

Hyperphosphatemia meds

Back 56

i) Phosphate binding agents
(1) PhosLO
(2) Renagel
ii) Calcium supplements

Front 57

Precautions for giving IV potassium

Back 57

Use with caution in patients with cardiac disease, severe renal impairment, hyperkalemia
Never give rapid bolus K+
Maximum adult dose is 100-200 mmol/24 hour
Do not give higher than 10 mmol in a periphal IV as it can cause pain and sclerosis
Use iv pump when giving higher signs to control rate and observe for signs of extravasation
Avoid iv potassium if pt is dehydrated or has sever renal impairment. Adequate urine flow is required before iv k+ can be administered.
K+ can leak and cause tissue damage

Front 58

Precautions for giving IV calcium

Back 58

Can cause serious tissue damage and death if leaks

Front 59

Hypotonic

Back 59

i) • More water than electrolytes
(1) • Pure water lyses RBCs
ii) • Water moves from ECF to ICF by osmosis
iii) • Usually maintenance fluids
(1) • ½ or 0.45% NS
iv) Lower osmotic pressure than the cells
v) Lowers serum osmolality, causing body
vi) fluids out of blood vessels and into the
vii) cells and interstitial space
viii) Indication: cellular dehydration
ix) Monitor: can cause shift of fluid into cells
b) • Intravascular fluid depletion and cardiovascular collapse

Front 60

Do not give Hypotonic to :

Back 60

a) Those at risk for third spacing
b) Liver pts
c) Sever malnutrition
d) Burn / trauma pts
e) Neuro patients
f) Increase in intracranial pressures

Front 61

Hypertonic

Back 61

i) • Initially expands and raises the osmolality of ECF
ii) • Require frequent monitoring of
(1) • Blood pressure
(2) • Lung sounds
(3) • Serum sodium levels
iii) Greater osmotic pressure the cell
iv) Raises serum osmolality, pulling fluids
v) from cells and interstitial tissues into the
vi) vascular space
vii) Indication: intravascular dehydration
viii) with interstitial and intracellular fluid
ix) overload
x) Infuse slowly to prevent circulatory
xi) overload
(1) • High risk IV fluids

Front 62

Do not give Hypertonic to Those with:

Back 62

a) Cardiac disease
b) Renal disease
c) Cannot tolerate extra fluid