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640 Cards in this Set
- Front
- Back
|
Normal pH
|
7.35-7.45
|
|
|
Normal PCO2 (respiratory)
|
32-45 mm Hg
|
|
|
Normal (Metabolic)
|
20-26 mEq/L
|
|
|
What determines whether a fluid is an acid or a base?
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amount of hydrogen
|
|
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An acid is a substance that:
|
releases a hydrogen ion
|
|
|
A common acid in the body is:
|
hydrochloric acid, found in the stomach
|
|
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A base is a substance that:
|
binds oxygen
|
|
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A common base in the body is:
|
bicarbonate
|
|
|
another word for base
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alkali
|
|
|
fixed acids are formed as end products of:
|
glucose, fat and protein metabolism
|
|
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bicarbonate begins as:
|
carbonic acid, a weak acid
|
|
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Maintains a delecate balance between acids and bases in the body
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ECF
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|
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Measures the strength of acids and bases
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pH
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|
|
pH range of a solution
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0 to 14
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|
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Neutral pH
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7
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Acidic range of pH
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0 - 6.99
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Alkaline range of pH
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7.01 - 14
|
|
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A pH of lower than ________ or higher than _______ is usually fatal.
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6.9 / 7.8
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|
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Name the three major mechanisms used to compensate for changes in serum pH:
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cellular buffers, lungs, kidneys
|
|
|
First line of defense against pH changes
|
cellular buffers
|
|
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The lungs respond with shallow respirations if the blood pH is too:
|
high/alkaline
|
|
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The lungs respond with rapid deep breathing if the blood pH is:
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too low/acidic
|
|
|
Slowest mechanism to respond to changes in the blood pH, taking 24 to 48 hours to respond:
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kidneys
|
|
|
Acidosis or alkalosis that is corrected for by the body is referred to as:
|
compensated
|
|
|
The laboratory tests that are used to evaluate acid base balance are called:
|
arterial blood gases (ABGs)
|
|
|
Most often used to obtain ABG samples:
|
femoral, brachial and radial arteries
|
|
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When the serum pH falls below: _________ the blood becomes too: _________
|
7.35 , acidic
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|
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When the serum pH increases above: _____________ the blood becomes: __________
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7.45, alkaline
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|
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When carbon dioxide is not adequately "blown off" during expiration, the blood becomes:
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acidic
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|
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Acid base imbalance caused by hypoventilation:
|
acute respiratory acidosis
|
|
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Acid base imbalance usually caused by chronic respiratory disease, drugs, or neurological problems that depress breathing
|
Respiratory Acidosis
|
|
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As carbon dioxide increases, mental status is altered, progressing from confusion and lethargy to stupor and coma if not treated. Respirations become more depressed and shallow as muscle weakness worsens in this acid base imbalance:
|
Respiratory Acidosis
|
|
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Uncontrolled diabetes mellitus and end stage renal failure are the two most common causes of this acid base imbalance:
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Metabolic Acidosis
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The GI tract is rich in:
|
bicarbonate
|
|
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Patients experiencing severe diarrhea or prolonged nasointestinal suction are at high risk for this acid base imbalance:
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Metabolic Acidosis
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Serum potassium tends to increase in the presence of this acid base imbalance
|
Metabolic Acidosis
|
|
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The signs and symptoms of Metabolic Acidosis are similar to Respiratory Acidosis with the exception of:
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the respiratory pattern
|
|
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To help compensate for the acidotic state, during Metabolic Acidosis, the lungs get rid of excess carbon dioxide through
|
Kussmaul's respirations
|
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Deep and rapid breathing that can only occur in patients with healthy lungs
|
Kussmaul's respirations
|
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Acid base imbalance that is a result of hyperventilation
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Respiratory Alkalosis
|
|
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Patients may hyperventilate when they are:
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severely anxious or fearful
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Mechanical ventilation, being in high altitudes, or deep breathing during a pulmonary examination can cause this acid base imbalance
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Respiratory Alkalosis
|
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Respiratory Alkalosis is treated by having patients do this, in addition to treating the underlying cause
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hold their breath or rebreathe their own carbon dioxide with a paper bag or a rebreathing mask
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|
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Results from excessive ingestion of bicarbonate or other bases into the body or loss of acids from the body
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Metabolic Alkalosis
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Overuse or abuse of antacids or baking soda (sodium bicarbonate) can lead to:
|
Metabolic Alkalosis
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Prolonged vomiting or nasogastric suction can cause
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Metabolic Alkalosis
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The serum potassium decreases in this acid base imbalance (and hypocalcemia may also accompany it)
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Metabolic Alkalosis
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Signs and symptoms of this acid base imbalance relate to hypokalemia and hypocalcemia rather than the state itself
|
Metabolic Alkalosis
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If the stoma is an Ileostomy the effluent is
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liquid to mushy
|
|
|
If the stoma is a cecostomy, ascending colostomy the effluent is
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liquid to mushy, foul odor
|
|
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If the stoma is a right transverse colostomy the effluent is
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mushy to semiformed
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If the stoma is a left transverse colostomy the effluent is
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semiformed, soft
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If the stoma is a descending or sigmoid colostomy the effluent is
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soft to hard formed
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|
Fluids located inside the cells
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intracellular fluid (ICF)
|
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Fluids located outside cells
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extracellular fluid (ECF)
|
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Three types of ECF
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interstitial, intravascular, transcellular
|
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Fluids that is the water that surrounds the body's cells and includes lympth
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interstitial
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Fluids and electrolytes move between the interstitial fluid and the:
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intravascular fluid
|
|
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Fluid that is the plasma of the blood
|
intravascular fluid
|
|
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Fluids that are those in specific compartments of the body, such as cerebrospinal fluid, digestive juices, and synovial fluids in joints
|
transcellular fluids
|
|
|
The primary control of water in the body is through pressure sensors in the vascular system, which stimulate or inhibit the release of:
|
ADH (antidiuretic hormone)
|
|
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ADH is released from this gland:
|
pituitary gland
|
|
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If fluid pressures within the vascular system decrease, more of this is released
|
ADH - and fluid is retained
|
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If fluid pressures within the vascular system increase, less of this is released
|
ADH - and fluid is released
|
|
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Active transport depends on the presence of adequate:
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cellular ATP
|
|
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The most common examples of active transport:
|
sodium potassium pumps
|
|
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No energy is expended specifically to move substances:
|
passive transport
|
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The three types of passive transport systems
|
diffusion, filtration and osmosis
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|
|
A process in which the substance moves from an area of higher concentration to an area of lower concentration
|
diffusion
|
|
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If you pour cream into a cup of coffee, this is an example of:
|
diffusion
|
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The movement of both water and smaller molecules through a semipermeable membrane
|
filtration
|
|
|
the force that water exerts, sometimes called water pushing pressure
|
hydrostatic pressure
|
|
|
serve as semipermeable membranes allowing water and smaller substances to move from the vascular system to the interestitial fluid, but large molecules and red blood cells remain inside the capillary walls
|
capillaries
|
|
|
the movement of water from an area of lower substance concentration to an area of higher concentration
|
osmosis
|
|
|
Refers to the concentration of the substances in body fluids
|
osmolarity
|
|
|
The normal osmolarity of the blood
|
between 270 and 300 milliosmoles per liter (mOsm/L)
|
|
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A fluid that has the same osmolarity as the blood is called
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isotonic
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A solution that has a lower osmolarity than blood is called
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hypotonic
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|
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When a hypotonic solution is given to a patient
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water leaves the blood and other ECF areas and enters the cells
|
|
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When a hypertonic solution is given to a patient
|
water leaves the cells and enters the blood stream
|
|
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This is very important to the body for cellular metabolism, blood volume, body temperature regulation, and solute transport
|
water
|
|
|
How often is water gained and lost from the body?
|
every day
|
|
|
Why are older adults more prone to fluid deficits
|
b/c they have a diminished thirst reflex and their kidneys do not function as effectively
|
|
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An adult loses as much as __________ of sensible and insensible fluid each day
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2500 ml
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Losses of which the person is aware
|
sensible
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What type of loss is urination?
|
sensible
|
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Perspiration is an example of what type of loss?
|
insensible
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Feces is an example of what type of loss?
|
insensible
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At the highest risk for life threatening complications that can result from either fluid deficit or fluid excess
|
elderly people
|
|
|
Take in and excrete a large proportion of their body water each day
|
infants
|
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occurs when there is not enough fluid in the body, especially in the blood (intravascular area)
|
dehydration
|
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decreased blood volume
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hypovolemia
|
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Occurs when the patient is hemorrhaging or when fluids from other parts of the body are lost
|
hypovolemia
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Severe vomiting and diarrhea, severely draining wounds, and profuse diaphoresis (sweating) can cause
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dehydration
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Hypovolemia may occur when fluid from the intravascular space moves into the interstitial fluid space. This is called:
|
third spacing
|
|
|
common in conditions such as burns, liver cirrhosis, and extensive trauma
|
3rd spacing
|
|
|
Common causes of this are: long term NPO, hemorrhage, profuse sweating (diaphoresis, diuretic therapy, diarrhea, vomiting, gastrointestinal suction, draining fistulas, draining abcesses, severely draining wounds, systemic infection, fever, frequent enemas, ileostomy, cecostomy, diabetes insipidus
|
dehydration
|
|
|
The initial symptom of dehydration in an otherwise healthy adult
|
thirst
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|
|
Dehydration signs and symptoms include:
|
rapid, weak pulse, low bp, poor skin turgor, increased temp (may not be visable in elderly), decreased and more concentrated urine, constipation and weight loss
|
|
|
Dehydration should be considered in any adult with a urine output of less than:
|
30 ml per hour
|
|
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A pint of water weighs approximately
|
1 pound
|
|
|
Manifestations of dehydration in an older adult
|
altered mental status, light headedness, and syncope due to inadequate circulatory volume and inadequate oxygen supply to the brain
|
|
|
If dehydration is not treated, lack of sufficient blood volume causes:
|
organ function to decrease and eventually fail
|
|
|
Which diagnostic tests would suggest dehydration?
|
elevated BUN, elevated hematocrit, increased specific gravity
|
|
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What therapeutic interventions are commonly used for moderate to severe dehydration?
|
IV therapy using isotonic fluids
|
|
|
Where do you check for skin turgor
|
forehead or sternum
|
|
|
What is the impact of Ramadan on the medical needs of a Muslim?
|
though the ill are not required to participate, it is a practice of not taking fluids or meals between sunup and sundown, including medications so special precautions must be taken to avoid dehydration
|
|
|
Too much fluid in the bloodstream or from dilution of electrolytes and red blood cells causes
|
fluid excess
|
|
|
excess fluid in the intravascular space is:
|
hypervolemia
|
|
|
Poorly controlled IV therapy, excessive irrigation of wounds or body cavities and excessive ingestion of water can cause
|
hypervolemia
|
|
|
renal failure, heart failure and the syndrome of inappropriate antidiuretic hormone can cause
|
hypervolemia
|
|
|
How would you address IV therapy in at risk patients?
|
electronic infusion pump or quantity limiting devies such as a burette
|
|
|
Pitting edema, pale and cool skin, increased and diluted urine output, rapid weight gain, boudning pulse, elevated bp, increased shallow respirations, distended neck veins, and in severe cases crackles in the lungs, dyspnea, and ascites
|
hypervolemia
|
|
|
Result of acute fluid excess is typically
|
congestive heart failure
|
|
|
What test results would you expect in a patient w/ fluid excess?
|
decreased BUN and hematocrit levels, diminished specific gravity
|
|
|
How could you position the hypovolemic patient to facilitate ease of breathing?
|
semi fowlers or high fowlers
|
|
|
Typically used to ensure adequate perfusion of major organs and to minimize dyspnea
|
oxygen therapy
|
|
|
A patient with COPD such as emphysema or chronic bronchitis needs what special consideration in regards to oxygen therapy
|
no more than 2 L per minute of oxygen, or they may lose the stimulus to breathe and may suffer respiratory arrest
|
|
|
Frequently administered to rapidly rid the body of excess water
|
diuretic
|
|
|
The drug of choice for fluid excess when the patient has adequately functioning kidneys
|
Lasix (furosemide)
|
|
|
Loop diuretics cause the kidneys to excrete
|
sodium and water
|
|
|
IV furosemide should be administered by:
|
RN or physician
|
|
|
In viewing I&O, how can you tell if the patient is retaining fluid?
|
drinking 1500 mL p/day or more and voiding small amts
|
|
|
Where would you check a bedbound patient for edema?
|
sacrum
|
|
|
A weight gain of what would indicate fluid retentions?
|
1-2 lbs or more per day - even if other signs and symptoms may not be present
|
|
|
what are two types of diuretics?
|
loop and thiazide
|
|
|
mEq/L means
|
milliequivalents per liter
|
|
|
mg/dL means
|
milligrams per deciliter
|
|
|
postive electrically charged electrolytes
|
cations
|
|
|
negatively electrically charged electrolytes
|
anions
|
|
|
The most important electrolytes
|
sodium, potassium, calcium and magnesium
|
|
|
Norm: serum sodium
|
135 to 145 mEq/L
|
|
|
Norm: potassium
|
3.5 to 5 mEq/L
|
|
|
Norm: calcium
|
9 to 11 mg/dL or 4.5 to 5.5 mEq/L
|
|
|
Potassium losing diuretics
|
Lasix, digitalis preparations, Lanoxin, rednisone, corticosteroids
|
|
|
Sodium imbalances are related to
|
fluid imbalances
|
|
|
Potassium is especially important for:
|
cardiac, skeletal and smooth muscle
|
|
|
Potassium is a potentially dangerous drug, especially when administered intravenously. In too high a concentration, it causes:
|
cardiac arrest
|
|
|
A potassium sparing diuretic
|
Aldactone
|
|
|
A therapeutic intervention for Hyperkalemia, a cation exchange resin is:
|
Kayexalate
|
|
|
Person most at risk for hypocalcemia and osteoporosis
|
postmenopausal thin petite caucasion woman
|
|
|
Patients with hyperphosphatemia often experience
|
hypocalcemia
|
|
|
Adequate intake of calcium for ages 19 to 50:
|
1000 mg
|
|
|
An inexpensive source of calcium for patients who do not require vitamin D supplementation
|
calcium carbonate (Tums)
|
|
|
What is the Trousseau's sign test?
|
inflate the bp cuff around the patient's upper arm for 1 to 4 minutes, in a patient w/ hypocalcemia the hand and fingers become spastic and go into palmar flexion
|
|
|
What is the Chvostek's sign?
|
tests for calcium deficit: tap the face just below and in front of the ear: facial twitching on that side of the face indicates a positive test
|
|
|
A thiazide diuretic that, in prolonged or overuse can cause Hypercalcemia, is:
|
HydroDiuril
|
|
|
Norm: Magnesium
|
1.5 to 2.5 mEq/L
|
|
|
Type of diarrhea caused by an increase in peristalsis w/out an increase in fecal volume
|
small volume diarrhea
|
|
|
Type of diarrhea caused by increased volume of feces
|
large volume diarrhea
|
|
|
The most common cause of acute diarrhea
|
bacterial or viral infection / e-coli, Campylobacter jejuni, Shigella, C-diff, Giardia and Salmonella
|
|
|
Poor tolerance or allergies to certain foods may cause
|
diarrhea
|
|
|
Foods that most commonly cause diarrhea are:
|
additives (such as nutmeg or sorbitol), caffeine, milk products, meats, wheat and potatoes
|
|
|
Acute diarrhea usually resolves in how many days:
|
7 to 14
|
|
|
Chronic diarrhea may result from
|
inflammatory disease, osmotic agents, excessive secretion of electrolytes, or increased intestinal motility
|
|
|
Inflammatory diseases such as Crohn's disease or ulcerative colitis may result in:
|
frequent watery stools
|
|
|
results from ingestion of laxatives or other agents that prevent absorption of water or nutrients in the intestine
|
osmotic diarrhea
|
|
|
Radiation therapy for cancer may induce
|
malabsorption syndrome
|
|
|
Enteral tube feedings commonly result in this, especially when malnutrition has caused edema in the gut wall, which decreases absorption
|
diarrhea
|
|
|
What is the best way to start enteral feedings?
|
slowly with full strength formula and gradually incrase the rate rather than dilute the formula
|
|
|
Diarrhea resulting from food poisoning has the following signs and symptoms:
|
explosive onset, nausea, vomiting, abdominal cramping, distention, anorexia, intestinal rumbling and thirst
|
|
|
What is the first priority in caring for a patient with diarrhea?
|
replacing fluids and electrolytes
|
|
|
If the patient has three or more watery stools per day, motility of the intestines can be decreased with the use of drugs such as:
|
Lomotil, Motofen, Imodium
|
|
|
If diarrhea is thought to be caused by antibiotics that change the normal flora of the bowel, this dietary supplement may be used to restore the normal flora
|
Lactinex
|
|
|
Occurs with the rapid entry of food into the jejunum without proper mixing of the food with digestive juices
|
dumping syndrome
|
|
|
Causes a rapid shift of fluids and as a result decreases circulating blood volume
|
dumping syndrome
|
|
|
Symptoms of Dumping Syndrome
|
dizziness, tachycardia, fainting, sweating, nausea, diarrhea, feeling of fullness and abdominal cramping, also rising blood sugar and possible symptoms of hypoglycemia
|
|
|
The treatment of dumping syndrome
|
teaching patient to eat small frequent meals high in protein and fat and low in carbs and refined sugars, avoid fluids for 1 hr before, during, and 2 hrs after meals to prevent rapid gastric emptying
|
|
|
Symptoms of Dumping Syndrome may last for how long?
|
up to 6 months after gastric surgery and may subside slowly over time
|
|
|
Bowel sounds are categorized as:
|
hyperactive, hypoactive, or absent
|
|
|
Norm: bowel sounds
|
5 to 30 times per minute
|
|
|
Also known as a barium swallow
|
Upper Gastrointestinal Series
|
|
|
an x-ray examination of the esophagus, stomach, duodenum, and jejunum using an oral liquid radiopaque contrast medium and a fluoroscope to outline the contours of the organs
|
Upper Gastrointestinal Series
|
|
|
Used to dectect strictures, ulcers, tumors, polyps, hiatal hernias and motility problems
|
Upper Gastrointestinal Series
|
|
|
Preparation for an Upper GI includes:
|
NPO 6-8 hrs prior, no smoking the morning of the procedure
|
|
|
Why is smoking discouraged prior to an Upper GI?
|
smoking can stimulate gastric motility
|
|
|
During this procedure a patient drinks thick chalky substance while standing in front of a fluoroscopic tube while x-rays are taken
|
Upper Gastrointestinal Series
|
|
|
What color is a patient's stool initially, after an Upper GI?
|
white, but should return to normal color within 3 days
|
|
|
A patient who has an Upper GI or Lower GI is at risk for what complication after procedure?
|
constipation or a barium impaction
|
|
|
Also known as a barium enema
|
Lower Gastrointestinal Series
|
|
|
performed to visualized the position, movements, and filling of the colon
|
Lower Gastrointestinal Series
|
|
|
Tumors, diverticular, stenosis, obstructions, inflammation, ulcerative colitis and polyps can be detected by this test:
|
Lower Gastrointestinal Series
|
|
|
Preparation for a Lower Gi includes:
|
Low residue or clear liquid diet for 2 days prior, laxatives, bowel cleansing solutions (such as GoLYTELY) and enemas may be administered the evening prior
|
|
|
Why is the bowel cleared prior to a Lower GI?
|
for adequate visualization during the procedure, inadequate prep may result in poor test results or test cancellation
|
|
|
During this procedure barium is instilled rectally and xray films are taken with or without fluoroscopy, patient may experience some abdominal cramping and an urge to have a bowel movement during the procedure
|
Lower Gastrointestinal Series
|
|
|
Normal pH
|
7.35-7.45
|
|
|
Normal PCO2 (respiratory)
|
32-45 mm Hg
|
|
|
Normal (Metabolic)
|
20-26 mEq/L
|
|
|
What determines whether a fluid is an acid or a base?
|
amount of hydrogen
|
|
|
An acid is a substance that:
|
releases a hydrogen ion
|
|
|
A common acid in the body is:
|
hydrochloric acid, found in the stomach
|
|
|
A base is a substance that:
|
binds oxygen
|
|
|
A common base in the body is:
|
bicarbonate
|
|
|
another word for base
|
alkali
|
|
|
fixed acids are formed as end products of:
|
glucose, fat and protein metabolism
|
|
|
bicarbonate begins as:
|
carbonic acid, a weak acid
|
|
|
Maintains a delecate balance between acids and bases in the body
|
ECF
|
|
|
Measures the strength of acids and bases
|
pH
|
|
|
pH range of a solution
|
0 to 14
|
|
|
Neutral pH
|
7
|
|
|
Acidic range of pH
|
0 - 6.99
|
|
|
Alkaline range of pH
|
7.01 - 14
|
|
|
A pH of lower than ________ or higher than _______ is usually fatal.
|
6.9 / 7.8
|
|
|
Name the three major mechanisms used to compensate for changes in serum pH:
|
cellular buffers, lungs, kidneys
|
|
|
First line of defense against pH changes
|
cellular buffers
|
|
|
The lungs respond with shallow respirations if the blood pH is too:
|
high/alkaline
|
|
|
The lungs respond with rapid deep breathing if the blood pH is:
|
too low/acidic
|
|
|
Slowest mechanism to respond to changes in the blood pH, taking 24 to 48 hours to respond:
|
kidneys
|
|
|
Acidosis or alkalosis that is corrected for by the body is referred to as:
|
compensated
|
|
|
The laboratory tests that are used to evaluate acid base banalce are called:
|
arterial blood gases (ABGs)
|
|
|
Most often used to obtain ABG samples:
|
femoral, brachial and radial arteries
|
|
|
When the serum pH falls below: _________ the blood becomes too: _________
|
7.35 , acidic
|
|
|
When the serum pH increases above: _____________ the blood becomes: __________
|
7.45, alkaline
|
|
|
When carbon dioxide is not adequately "blown off" during expiration, the blood becomes:
|
acidic
|
|
|
Acid base imbalance caused by hypoventilation:
|
acute respiratory acidosis
|
|
|
Acid base imbalance usually caused by chronic respiratory disease, drugs, or neurological problems that depress breathing
|
Respiratory Acidosis
|
|
|
As carbon dioxide increases, mental status is altered, progressing from confusion and lethargy to stupor and coma if not treated. Respirations become more depressed and shallow as muscle weakness worsens in this acid base imbalance:
|
Respiratory Acidosis
|
|
|
Uncontrolled diabetes mellitus and end stage renal failure are the two most common causes of this acid base imbalance:
|
Metabolic Acidosis
|
|
|
The GI tract is rich in:
|
bicarbonate
|
|
|
Patients experiencing severe diarrhea or prolonged nasointestinal suction are at high risk for this acid base imbalance:
|
Metabolic Acidosis
|
|
|
Serum potassium tends to increase in the presence of this acid base imbalance
|
Metabolic Acidosis
|
|
|
The signs and symptoms of Metabolic Acidosis are similar to Respiratory Acidosis with the exception of:
|
the respiratory pattern
|
|
|
To help compensate for the acidotic state, during Metabolic Acidosis, the lungs get rid of excess carbon dioxide through
|
Kussmaul's respirations
|
|
|
Deep and rapid breathing that can only occur in patients with healthy lungs
|
Kussmaul's respirations
|
|
|
Acid base imbalance that is a result of hyperventilation
|
Respiratory Alkalosis
|
|
|
Patients may hyperventilate when they are:
|
severely anxious or fearful
|
|
|
Mechanical ventilation, being in high altitudes, or deep breathing during a pulmonary examination can cause this acid base imbalance
|
Respiratory Alkalosis
|
|
|
Respiratory Alkalosis is treated by having patients do this, in addition to treating the underlying cause
|
hold their breath or rebreathe their own carbon dioxide with a paper bag or a rebreathing mask
|
|
|
Results from excessive ingestion of bicarbonate or other bases into the body or loss of acids from the body
|
Metabolic Alkalosis
|
|
|
Overuse or abuse of antacids or baking soda (sodium bicarbonate) can lead to:
|
Metabolic Alkalosis
|
|
|
Prolonged vomiting or nasogastric suction can cause
|
Metabolic Alkalosis
|
|
|
The serum potassium decreases in this acid base imbalance (and hypocalcemia may also accompany it)
|
Metabolic Alkalosis
|
|
|
Signs and symptoms of this acid base imbalance relate to hypokalemia and hypocalcemia rather than the state itself
|
Metabolic Alkalosis
|
|
|
If the stoma is an Ileostomy the effluent is
|
liquid to mushy
|
|
|
If the stoma is a cecostomy, ascending colostomy the effluent is
|
liquid to mushy, foul odor
|
|
|
If the stoma is a right transverse colostomy the effluent is
|
mushy to semiformed
|
|
|
If the stoma is a left transverse colostomy the effluent is
|
semiformed, soft
|
|
|
If the stoma is a descending or sigmoid colostomy the effluent is
|
soft to hard formed
|
|
|
Fluids located inside the cells
|
intracellular fluid (ICF)
|
|
|
Fluids located outside cells
|
extracellular fluid (ECF)
|
|
|
Three types of ECF
|
interstitial, intravascular, transcellular
|
|
|
Fluids that is the water that surrounds the body's cells and includes lympth
|
interstitial
|
|
|
Fluids and electrolytes move between the interstitial fluid and the:
|
intravascular fluid
|
|
|
Fluid that is the plasma of the blood
|
intravascular fluid
|
|
|
Fluids that are those in specific compartments of the body, such as cerebrospinal fluid, digestive juices, and synovial fluids in joints
|
transcellular fluids
|
|
|
The primary control of water in the body is through pressure sensors in the vascular system, which stimulate or inhibit the release of:
|
ADH (antidiuretic hormone)
|
|
|
ADH is released from this gland:
|
pituitary gland
|
|
|
If fluid pressures within the vascular system decrease, more of this is released
|
ADH - and fluid is retained
|
|
|
If fluid pressures within the vascular system increase, less of this is released
|
ADH - and fluid is released
|
|
|
Active transport depends on the presence of adequate:
|
cellular ATP
|
|
|
The most common examples of active transport:
|
sodium potassium pumps
|
|
|
No energy is expended specifically to move substances:
|
passive transport
|
|
|
The three types of passive transport systems
|
diffusion, filtration and osmosis
|
|
|
A process in which the substance moves from an area of higher concentration to an area of lower concentration
|
diffusion
|
|
|
If you pour cream into a cup of coffee, this is an example of:
|
diffusion
|
|
|
The movement of both water and smaller molecules through a semipermeable membrane
|
filtration
|
|
|
the force that water exerts, sometimes called water pushing pressure
|
hydrostatic pressure
|
|
|
serve as semipermeable membranes allowing water and smaller substances to move from the vascular system to the interestitial fluid, but large molecules and red blood cells remain inside the capillary walls
|
capillaries
|
|
|
the movement of water from an area of lower substance concentration to an area of higher concentration
|
osmosis
|
|
|
Refers to the concentration of the substances in body fluids
|
osmolarity
|
|
|
The normal osmolarity of the blood
|
between 270 and 300 milliosmoles per liter (mOsm/L)
|
|
|
A fluid that has the same osmolarity as the blood is called
|
isotonic
|
|
|
A solution that has a lower osmolarity than blood is called
|
hypotonic
|
|
|
When a hypotonic solution is given to a patient
|
water leaves the blood and other ECF areas and enters the cells
|
|
|
When a hypertonic solution is given to a patient
|
water leaves the cells and enters the blood stream
|
|
|
This is very important to the body for cellular metabolism, blood volume, body temperature regulation, and solute transport
|
water
|
|
|
How often is water gained and lost from the body?
|
every day
|
|
|
Why are older adults more prone to fluid deficits
|
b/c they have a diminished thirst reflex and their kidneys do not function as effectively
|
|
|
An adult loses as much as __________ of sensible and insensible fluid each day
|
2500 ml
|
|
|
Losses of which the person is aware
|
sensible
|
|
|
What type of loss is urination?
|
sensible
|
|
|
Perspiration is an example of what type of loss?
|
insensible
|
|
|
Feces is an example of what type of loss?
|
insensible
|
|
|
At the highest risk for life threatening complications that can result from either fluid deficit or fluid excess
|
elderly people
|
|
|
Take in and excrete a large proportion of their body water each day
|
infants
|
|
|
occurs when there is not enough fluid in the body, especially in the blood (intravascular area)
|
dehydration
|
|
|
decreased blood volume
|
hypovolemia
|
|
|
Occurs when the patient is hemorrhaging or when fluids from other parts of the body are lost
|
hypovolemia
|
|
|
Severe vomiting and diarrhea, severely draining wounds, and profuse diaphoresis (sweating) can cause
|
dehydration
|
|
|
Hypovolemia may occur when fluid from the intravascular space moves into the interstitial fluid space. This is called:
|
third spacing
|
|
|
common in conditions such as burns, liver cirrhosis, and extensive trauma
|
3rd spacing
|
|
|
Common causes of this are: long term NPO, hemorrhage, profuse sweating (diaphoresis, diuretic therapy, diarrhea, vomiting, gastrointestinal suction, draining fistulas, draining abcesses, severely draining wounds, systemic infection, fever, frequent enemas, ileostomy, cecostomy, diabetes insipidus
|
dehydration
|
|
|
The initial symptom of dehydration in an otherwise healthy adult
|
thirst
|
|
|
Dehydration signs and symptoms include:
|
rapid, weak pulse, low bp, poor skin turgor, increased temp (may not be visable in elderly), decreased and more concentrated urine, constipation and weight loss
|
|
|
Dehydration should be considered in any adult with a urine output of less than:
|
30 ml per hour
|
|
|
A pint of water weighs approximately
|
1 pound
|
|
|
Manifestations of dehydration in an older adult
|
altered mental status, light headedness, and syncope due to inadequate circulatory volume and inadequate oxygen supply to the brain
|
|
|
If dehydration is not treated, lack of sufficient blood volume causes:
|
organ function to decrease and eventually fail
|
|
|
Which diagnostic tests would suggest dehydration?
|
elevated BUN, elevated hematocrit, increased specific gravity
|
|
|
What therapeutic interventions are commonly used for moderate to severe dehydration?
|
IV therapy using isotonic fluids
|
|
|
Where do you check for skin turgor
|
forehead or sternum
|
|
|
What is the impact of Ramadan on the medical needs of a Muslim?
|
though the ill are not required to participate, it is a practice of not taking fluids or meals between sunup and sundown, including medications so special precautions must be taken to avoid dehydration
|
|
|
Too much fluid in the bloodstream or from dilution of electrolytes and red blood cells causes
|
fluid excess
|
|
|
excess fluid in the intravascular space is:
|
hypervolemia
|
|
|
Poorly controlled IV therapy, excessive irrigation of wounds or body cavities and excessive ingestion of water can cause
|
hypervolemia
|
|
|
renal failure, heart failure and the syndrome of inappropriate antidiuretic hormone can cause
|
hypervolemia
|
|
|
How would you address IV therapy in at risk patients?
|
electronic infusion pump or quantity limiting devies such as a burette
|
|
|
Pitting edema, pale and cool skin, increased and diluted urine output, rapid weight gain, bounding pulse, elevated bp, increased shallow respirations, distended neck veins, and in severe cases crackles in the lungs, dyspnea, and ascites
|
hypervolemia
|
|
|
Result of acute fluid excess is typically
|
congestive heart failure
|
|
|
What test results would you expect in a patient w/ fluid excess?
|
decreased BUN and hematocrit levels, diminished specific gravity
|
|
|
How could you position the hypovolemic patient to facilitate ease of breathing?
|
semi fowlers or high fowlers
|
|
|
Typically used to ensure adequate perfusion of major organs and to minimize dyspnea
|
oxygen therapy
|
|
|
A patient with COPD such as emphysema or chronic bronchitis needs what special consideration in regards to oxygen therapy
|
no more than 2 L per minute of oxygen, or they may lose the stimulus to breathe and may suffer respiratory arrest
|
|
|
Frequently administered to rapidly rid the body of excess water
|
diuretic
|
|
|
The drug of choice for fluid excess when the patient has adequately functioning kidneys
|
Lasix (furosemide)
|
|
|
Loop diuretics cause the kidneys to excrete
|
sodium and water
|
|
|
IV furosemide should be administered by:
|
RN or physician
|
|
|
In viewing I&O, how can you tell if the patient is retaining fluid?
|
drinking 1500 mL p/day or more and voiding small amts
|
|
|
Where would you check a bedbound patient for edema?
|
sacrum
|
|
|
A weight gain of what would indicate fluid retentions?
|
1-2 lbs or more per day - even if other signs and symptoms may not be present
|
|
|
what are two types of diuretics?
|
loop and thiazide
|
|
|
mEq/L means
|
milliequivalents per liter
|
|
|
mg/dL means
|
milligrams per deciliter
|
|
|
postive electrically charged electrolytes
|
cations
|
|
|
negatively electrically charged electrolytes
|
anions
|
|
|
The most important electrolytes
|
sodium, potassium, calcium and magnesium
|
|
|
Norm: serum sodium
|
135 to 145 mEq/L
|
|
|
Norm: potassium
|
3.5 to 5 mEq/L
|
|
|
Norm: calcium
|
9 to 11 mg/dL or 4.5 to 5.5 mEq/L
|
|
|
Potassium losing diuretics
|
Lasix, digitalis preparations, Lanoxin, rednisone, corticosteroids
|
|
|
Sodium imbalances are related to
|
fluid imbalances
|
|
|
Potassium is especially important for:
|
cardiac, skeletal and smooth muscle
|
|
|
Potassium is a potentially dangerous drug, especially when administered intravenously. In too high a concentration, it causes:
|
cardiac arrest
|
|
|
A potassium sparing diuretic
|
Aldactone
|
|
|
A therapeutic intervention for Hyperkalemia, a cation exchange resin is:
|
Kayexalate
|
|
|
Person most at risk for hypocalcemia and osteoporosis
|
postmenopausal thin petite caucasion woman
|
|
|
Patients with hyperphosphatemia often experience
|
hypocalcemia
|
|
|
Adequate intake of calcium for ages 19 to 50:
|
1000 mg
|
|
|
An inexpensive source of calcium for patients who do not require vitamin D supplementation
|
calcium carbonate (Tums)
|
|
|
What is the Trousseau's sign test?
|
inflate the bp cuff around the patient's upper arm for 1 to 4 minutes, in a patient w/ hypocalcemia the hand and fingers become spastic and go into palmar flexion
|
|
|
What is the Chvostek's sign?
|
tests for calcium deficit: tap the face just below and in front of the ear: facial twitching on that side of the face indicates a positive test
|
|
|
A thiazide diuretic that, in prolonged or overuse can cause Hypercalcemia, is:
|
HydroDiuril
|
|
|
Norm: Magnesium
|
1.5 to 2.5 mEq/L
|
|
|
Type of diarrhea caused by an increase in peristalsis w/out an increase in fecal volume
|
small volume diarrhea
|
|
|
Type of diarrhea caused by increased volume of feces
|
large volume diarrhea
|
|
|
The most common cause of acute diarrhea
|
bacterial or viral infection / e-coli, Campylobacter jejuni, Shigella, C-diff, Giardia and Salmonella
|
|
|
Poor tolerance or allergies to certain foods may cause
|
diarrhea
|
|
|
Foods that most commonly cause diarrhea are:
|
additives (such as nutmeg or sorbitol), caffeine, milk products, meats, wheat and potatoes
|
|
|
Acute diarrhea usually resolves in how many days:
|
7 to 14
|
|
|
Chronic diarrhea may result from
|
inflammatory disease, osmotic agents, excessive secretion of electrolytes, or increased intestinal motility
|
|
|
Inflammatory diseases such as Crohn's disease or ulcerative colitis may result in:
|
frequent watery stools
|
|
|
results from ingestion of laxatives or other agents that prevent absorption of water or nutrients in the intestine
|
osmotic diarrhea
|
|
|
Radiation therapy for cancer may induce
|
malabsorption syndrome
|
|
|
Enteral tube feedings commonly result in this, especially when malnutrition has caused edema in the gut wall, which decreases absorption
|
diarrhea
|
|
|
What is the best way to start enteral feedings?
|
slowly with full strength formula and gradually incrase the rate rather than dilute the formula
|
|
|
Diarrhea resulting from food poisoning has the following signs and symptoms:
|
explosive onset, nausea, vomiting, abdominal cramping, distention, anorexia, intestinal rumbling and thirst
|
|
|
What is the first priority in caring for a patient with diarrhea?
|
replacing fluids and electrolytes
|
|
|
If the patient has three or more watery stools per day, motility of the intestines can be decreased with the use of drugs such as:
|
Lomotil, Motofen, Imodium
|
|
|
If diarrhea is thought to be caused by antibiotics that change the normal flora of the bowel, this dietary supplement may be used to restore the normal flora
|
Lactinex
|
|
|
Occurs with the rapid entry of food into the jejunum without proper mixing of the food with digestive juices
|
dumping syndrome
|
|
|
Causes a rapid shift of fluids and as a result decreases circulating blood volume
|
dumping syndrome
|
|
|
Symptoms of Dumping Syndrome
|
dizziness, tachycardia, fainting, sweating, nausea, diarrhea, feeling of fullness and abdominal cramping, also rising blood sugar and possible symptoms of hypoglycemia
|
|
|
The treatment of dumping syndrome
|
teaching patient to eat small frequent meals high in protein and fat and low in carbs and refined sugars, avoid fluids for 1 hr before, during, and 2 hrs after meals to prevent rapid gastric emptying
|
|
|
Symptoms of Dumping Syndrome may last for how long?
|
up to 6 months after gastric surgery and may subside slowly over time
|
|
|
Bowel sounds are categorized as:
|
hyperactive, hypoactive, or absent
|
|
|
Norm: bowel sounds
|
5 to 30 times per minute
|
|
|
Also known as a barium swallow
|
Upper Gastrointestinal Series
|
|
|
an x-ray examination of the esophagus, stomach, duodenum, and jejunum using an oral liquid radiopaque contrast medium and a fluoroscope to outline the contours of the organs
|
Upper Gastrointestinal Series
|
|
|
Used to dectect strictures, ulcers, tumors, polyps, hiatal hernias and motility problems
|
Upper Gastrointestinal Series
|
|
|
Preparation for an Upper GI includes:
|
NPO 6-8 hrs prior, no smoking the morning of the procedure
|
|
|
Why is smoking discouraged prior to an Upper GI?
|
smoking can stimulate gastric motility
|
|
|
During this procedure a patient drinks thick chalky substance while standing in front of a fluoroscopic tube while x-rays are taken
|
Upper Gastrointestinal Series
|
|
|
What color is a patient's stool initially, after an Upper GI?
|
white, but should return to normal color within 3 days
|
|
|
A patient who has an Upper GI or Lower GI is at risk for what complication after procedure?
|
constipation or a barium impaction
|
|
|
Also known as a barium enema
|
Lower Gastrointestinal Series
|
|
|
performed to visualized the position, movements, and filling of the colon
|
Lower Gastrointestinal Series
|
|
|
Tumors, diverticular, stenosis, obstructions, inflammation, ulcerative colitis and polyps can be detected by this test:
|
Lower Gastrointestinal Series
|
|
|
Preparation for a Lower Gi includes:
|
Low residue or clear liquid diet for 2 days prior, laxatives, bowel cleansing solutions (such as GoLYTELY) and enemas may be administered the evening prior
|
|
|
Why is the bowel cleared prior to a Lower GI?
|
for adequate visualization during the procedure, inadequate prep may result in poor test results or test cancellation
|
|
|
During this procedure barium is instilled rectally and xray films are taken with or without fluoroscopy, patient may experience some abdominal crapming and an urge to have a bowel movement during the procedure
|
Lower Gastrointestinal Series
|
|
|
GI bleed may be caused by:
|
ulcer perforation, tumors, gastric surgery or other conditions
|
|
|
The most common cause of blood loss into the stomach or intestine
|
bleeding peptic ulcers
|
|
|
vomited observable blood
|
hematemesis
|
|
|
When you observe coffee grounds in emesis, what would you expect?
|
bleeding in the stomach due to blood mixing w/ hydrochloric acid and enzymes
|
|
|
occurs from slow bleeding in an upper GI area
|
melena
|
|
|
Signs and symptoms of a mild GI bleed
|
slight weakness or diaphoresis
|
|
|
What constitutes severe blood loss
|
more than 1 L in 24 hours
|
|
|
Severe GI bleed may result in:
|
hypovolemic shock, hypotension, weak thready pulse, chills, palpitations, diaphoresis
|
|
|
The goal for treating a massive GI bleed
|
prevent or treat hypovolemic shock, prevent dehydration, electrolyte imbalance
|
|
|
How would you treat a severe GI bleed?
|
NPO, IV to replace lost fluids, administer blood if necessary, CBC, cath, NG tube to assess rate of bleeding decompress stomach monitor pH of gastric secretions and administer saline lavage if odered, possible oxygen therapy, elevate head of bed
|
|
|
Why would a physician perform an endoscopy after a GI bleed?
|
control the bleeding
|
|
|
Why would Zantac be given in a GI bleed patient?
|
decrease secretion of gastric acid
|
|
|
Chronic excessive alcohol indigestion combined with a lack of dietary protein can cause
|
cirrhosis
|
|
|
may result from massive exposure to hepatoxins, viral hepatitis, or infection
|
cirrhosis / postnecrotic liver failure
|
|
|
caused by chronic inflammation and obstruction of the gallbladder and bile ducts
|
cirrhosis / biliary liver failure
|
|
|
caused by chronic severe congestion of the liver from heart failure, liver congestion causes death of liver cells from lack of nutrients and oxygen
|
cirrhosis / cardiac liver failure
|
|
|
Chronic liver failure is a progressive disease. Healthy liver cells respond to toxins such as alcohol by becoming:
|
inflamed
|
|
|
In Chronic liver failure, liver cells are infiltrated w/ fat and whilte blood cells and then replaced with:
|
fibrotic tissue
|
|
|
Chronic liver failure may be prevented by:
|
abstinence from alcohol, eating a balanced diet w/ adequate amts of protein, avoiding exposure to infections or hepatotoxic chemicals
|
|
|
This is a common finding with hepatitis
|
jaundice
|
|
|
Signs and symptoms of impaired liver function include:
|
malaise, anorexia, indigestion, nausea, weight loss, diarrhea or constipation, and dull aching RUQ pain
|
|
|
Hepatorenal syndrome, blood clotting defects, ascites, portal hypertension and hepatic encephalopathy are complications of:
|
chronic liver failure
|
|
|
Symptoms include oliguria w/out detectable kidney damage, reduced GFR w/ essentially no urine output or less than 200 mL p/day, nearly total sodium retention, and is considered an ominous sign
|
Hepatorenal syndrome
|
|
|
May develop because of impaired prothrombin and fibrinogen production in the liver, as well as the absence of bile salts preventing the absorption of fat soluable vitamin K. Patients w/ chronic liver failure have a tendency to bruise easily and may progress to disseminated intravascular coagulation (DIC) or hemorrhage
|
clotting defects
|
|
|
The most serious result of portal hypertension is:
|
bleeding esophageal varices
|
|
|
Hepatic encephalopathy represents end stage liver failure and has a mortality rate as high as ______ once coma begins
|
90%
|
|
|
Serum levels that are elevated in chronic liver failure
|
enzymes, bilirubin, ammonia, prothrombin times
|
|
|
Tests done to determine liver failure
|
abdominal radiograph (may show ascites and enlargement of the liver), upper GI (may reveal esophageal varices or evidence of gastric inflammation or ulcers), liver scan (may be done to show abnormal liver masses or thickening), EGD (to detect bleeding and directly observe the esophagus stomach and duodenum), liver biopsy (determine the extent and nature of the liver damage)
|
|
|
Procedure in which a patient may get to wear a football helmet
|
tamponade - a temporary measure to treat bleeding varices
|
|
|
Inflation pressure of the esophageal balloon should be maintained at:
|
between 20 and 25 mm Hg
|
|
|
What emergency tool would you always keep at the bedside when performing Tamponade?
|
scissors - to cut the inflation ports in the event the balloon dislodges
|
|
|
Recurrence of bleeding occurs how often in patients after successful tamponade
|
20% to 60%
|
|
|
A procedure usually done as part of an EGD, in which the varices are injected to cause thickening and closing of dilated vessels, and after which the patient may complain of chest pain for up to 72 hours
|
sclerotherapy
|
|
|
An uncommon but gravely serious complication of liver disease that has a mortality rate as high as 50%
|
Acute (Fulminant) Liver Failure
|
|
|
Acute liver failure results from:
|
sudden massive loss of liver tissue or necrosis
|
|
|
The cause of acute/fulminant liver failure is usually:
|
drug toxicity or HBV in the presence of HDV
|
|
|
The outcome of Acute Liver Failure may be decided within how many hours of diagnosis?
|
48 to 72 hours
|
|
|
Possible outcomes of Acute Liver Failure
|
reversal, need for transplant, or death
|
|
|
Acute liver failure may be avoided by:
|
eliminating exposure to hep B or hepatotoxic liver damaging substances
|
|
|
Patient may suddenly lapse into exteremely serious illness starting with confusion and progressing to coma, show rapid reduction in liver size, elevation of liver enzymes and bilirubin, and encephalopathy
|
Acute (Fulminant) Liver Failure
|
|
|
Why is early diagnosis of acute liver failure essential?
|
to begin the process of organ procurement
|
|
|
Why would the patient with acute (fulminant) liver failure have metabolic alkalosis
|
related to disruption of the urea production cycle and resulting accumulation of bicarbonate
|
|
|
Why would a patient with acute (fulminant) liver failure be at risk for sepsis?
|
due to poor white blood cell migration and other responses to infection
|
|
|
Type of Hepatitis transmitted by contaminated water:
|
Hepatitis E
|
|
|
Type of hepatitis transmitted by oral-fecal contamination of water, shellfish, eating utensils, or equipment
|
Hepatitis A
|
|
|
Type of Hepatitis transmitted by blood or body fluids such as saliva, semen, breast mlk, or equipment contaminated by blood
|
Hepatitis B
|
|
|
Type of Hepatitis strongly linked with HBV
|
Hepatitis D
|
|
|
Type of Hepatitis linked to blood transusions, IV drug use, or unprotected sex
|
Hepatitis C
|
|
|
Type of Hepatitis that has no antigen test
|
Hepatitis E
|
|
|
Sometimes called "infectious hepatitis"
|
Hepatitis A
|
|
|
Sometimes called "serum hepatitis"
|
Hepatitis B
|
|
|
Sometimes called "non A Non B hepatitis"
|
Hepatitis C
|
|
|
Types of Hepatitis that have a vaccine
|
A, B, D
|
|
|
What group of people are most at risk for Hepatitis A?
|
military or daycare
|
|
|
What group of people are most at risk for Hepatitis B?
|
IV drug abusers, homosexuals, healthcare workers, transplant and hemo patients
|
|
|
What group of people are most at risk for Hepatitis C?
|
same as HepB
|
|
|
What group of people are most at risk for Hepatitis D?
|
same as HepB
|
|
|
What group of people are most at risk for Hepatitis E?
|
Travelers to endemic areas
|
|
|
How many estimated new hep A, B, and C infections are there in the US each year?
|
164,000
|
|
|
HBV has a mortality rate of:
|
5%
|
|
|
How do you destroy Hep viruses?
|
30 min in boiling water
|
|
|
How is full recovery from Hepatitis measured?
|
when all liver function tests have returned to normal and may take as long as 1 year
|
|
|
5% of hepatitis patients progress to:
|
acute liver failure / fulminant liver failure
|
|
|
HBV infected carrier patients have a greater risk of developing:
|
cancer of the liver
|
|
|
What is the primary therapeutic intervention for a patient with Hepatitis?
|
rest
|
|
|
Name the 13 most common hepatotoxic substances:
|
ethyl alcohol, acetaminophen (tylenol), acetylsalicylic acis (asprin), antesthetic agents like fluothane, valium (diazepam), Ilosone (erythromycin), INH (Isoniazid), Aldomet (Methyldopa), Oral contraceptives, Luminal (phenobarbital), Dilantin (Phenytoin), tranquilizers like thorazine (chlorpromazine) and industrial chemicals like carbon tetrachloride, trichloroethylene and toluene
|
|
|
A herniation or outpouching of the bowel mucous membrane caused by increased pressure within the colon and weakness in the bowel wall
|
diverticulum
|
|
|
a condition in which multiple diverticula are present without evidence of inflammation
|
diverticulosis
|
|
|
When food and bacteria are trapped in a diverticulum and inflammation and infection develop
|
diverticulitis
|
|
|
The development of diverticulosis is usually preceeded by this for many years
|
chronic constipation
|
|
|
Diverticulitis - Where is the pain?
|
usually in the lower left quadrant
|
|
|
Diverticulitis - How does it feel? (quality)
|
tender, crampy
|
|
|
Diverticulitis - what aggrevates and alleves it?
|
constipation and low fiber diets aggrevate; treatment of constipation may alleviate
|
|
|
Diverticulitis (onset, duration, frequencey)
|
gradual onset, intermittent, gradual increase in frequency of pain events
|
|
|
Diverticulitis - severeity of pain
|
usually 5-7
|
|
|
Diverticulitis - associated symptoms
|
intermittent rectal bleeding; straining at stool; constipation alternating w/ diarrhea; elevated white blood cells and sedimentation rate; elevated temperature and pulse rate; pus, mucus and blood in stool;
|
|
|
Diverticulitis - patient's perception
|
fear of diagnosis of cancer
|
|
|
When a patient is chronically constipated, pressure w/in the bowel is increased, leading to the development of:
|
diverticula
|
|
|
A major cause of diverticula is
|
decreased intake of dietary fiber
|
|
|
Diverticulosis is most common in the:
|
sigmoid colon
|
|
|
The most common group to experience diverticula:
|
people older than age 60
|
|
|
Diverticulitis can be prevented by:
|
increasing dietary fiber
|
|
|
The patient with diverticulosis is generally:
|
asymptomatic
|
|
|
The patient with diverticulitis generally presents:
|
bowel changes possibly alternating between constipation and diarrhea, steady or cramping pain in lwer left quadrant, and as it worsens, bleeding, weakness, fever, fatigue and anemia may occur
|
|
|
If an abscess forms within a diverticulum, it may rupture, causing:
|
peritonitis
|
|
|
What tests are used to diagnose diverticulosis:
|
sigmoidoscopy, colonoscopy, or barium enema
|
|
|
If an abscess is suspected within a diverticulum these tests can be done:
|
CT scan, stool specimen for occult blood, barium enema to show irregular narrowing of the colon and thickened muscle walls, or an abdominal xray examination may be done to identify a perforated diverticulum
|
|
|
Dietary considerations for a patient with diverticulosis (w/out evidence of inflammation) includes:
|
foods high in fiber ut soft (i.e. prunes, raisins, and peas)
|
|
|
Fiber should be increased in the diet slowly to prevent:
|
excess gas and cramping
|
|
|
A method of supplying nutrients to the patient by an IV route that is not a central vein
|
PPN (Peripheral Parenteral Nutrition)
|
|
|
What is the maximum amount of dextrose that can be administered via PPN?
|
12%
|
|
|
What are some restrictions on PPN use?
|
less than 10 days, no more than 2000 calories, less than 12% dextrose
|
|
|
TPN is also known as:
|
total parenteral nutrition, intravenous hyperalimentation
|
|
|
Method of supplying nutrients to the patient via IV route
|
TPN/PPN
|
|
|
TPN solutions are designed to:
|
improve nutritional status, achieve weight gain, enhance healing process
|
|
|
Patients with burns, trauma, cancer, AIDS, malnutrition, anorexia nervosa, fever or undergoing major surgery may need:
|
TPN
|
|
|
Who generally administers TPN
|
RNs
|
|
|
Must be used with TPN solutions but not with lipid solutions, which are given as a separate infusion along with TPN therapy
|
filter
|
|
|
Why is TPN started slowly?
|
to give the pancreas time to adjust to increasing insulin production for the high amounts of glucose in the TPN
|
|
|
What process is used when discontinuing TPN?
|
gradual weaning to allow the pancreas to adjust to the decreasing glucose levels, and patient is generally fed before the TPN is stopped
|
|
|
What is it important to monitor in a patient receiving TPN?
|
hyperglyxemia
|
|
|
What lab values are usually ordered during TPN:
|
CBX, albumin, glucose, electrolytes, plately count, prothrombin time
|
|
|
How would TPN dextrose over 12% be administered and why?
|
via central venous catheter into a large vein such as the subclavian or internal jugular to minimize irritation
|
|
|
chemicals that can conduct electricity when dissolved in water
|
electrolytes
|
|
|
fluids located inside cells
|
intracellular
|
|
|
fluids located outside cells
|
extracellular
|
|
|
fluid that is the water that surrounds the body's cells and includes lymph
|
interstitial
|
|
|
fluids in specific compartments of the body such as cerebrospinal fluid, digestive juices, and synovial fluids in joints
|
transcellular
|
|
|
plasma of the blood
|
intravascular
|
|
|
causes the kidneys to decrease fluid excretion
|
antidiuretic
|
|
|
process in which the substance moves from an area of higher concentration to an area of lower concentration
|
diffusion
|
|
|
the movement of both water and smaller molecules through a semipermeable membrane
|
filtration
|
|
|
the movement of water from an area of lower substance concentration to an area of higher concentration
|
osmosis
|
|
|
works like a screen that keeps the larger substances on one side and permits only the smaller molecules to filter to the other side
|
semipermeable
|
|
|
the force that water exerts, sometimes called water pushing pressure
|
hydrostatic pressure
|
|
|
a fluid that has the same osmolarity as the blood
|
isotonic
|
|
|
a solution that has a lower osmolarity than blood
|
hypotonic
|
|
|
exerts greater osmotic pressure than blood
|
hypertonic
|
|
|
occurs when there is not enough fluid in the body, especially in the blood (intravascular area)
|
dehydration
|
|
|
decreased blood volume
|
hypovolemia
|
|
|
excess fluid in the intravascular space
|
hypervolemia
|
|
|
|
edema
|
|
|
electrolytes that carry a positive electrical charge
|
cations
|
|
|
electrolytes that carry a negative electrical charge
|
anions
|
|
|
sodium deficit
|
hyponatremia
|
|
|
sodium excess
|
hypernatremia
|
|
|
serum pH of the blood increases so that the blood is more alkaline than usual
|
alkalosis (> 7.45)
|
|
|
serum pH of the blood deceeases, an acidic condition
|
acidosis (< 7.35)
|
|
|
when serum calcium falls below 9 mg/dL or 4.5 mEq/L
|
hypocalcemia
|
|
|
when serum calcium increases above 11mg/dL or 5.5 mEq/L
|
hypercalcemia
|
|
|
when bones become porous and brittle and fracture easily
|
osteoporosis
|
|
|
when the serum magnesium level falls below 1.5 mEq/L
|
hypomagnesemia
|
|
|
when the serum magnesium level increases above 2.5 mEq/L
|
hypermagnesemia
|
|
|
rapid shallow respirations, causing light headedness and confusion at times caused by anxiety or fear
|
hyperventilation
|
|
|
rhythmic contraction of muscles
|
peristalsis
|
|
|
stretch marks, light silver colored or thin red lines on the abdomen
|
striae
|
|
|
bluish purple swollen vein pattern extending out from the naval
|
caput medusae
|
|
|
thin reddish purple vein lines close to the skin surface
|
spider angiomas
|
|
|
yellowing of the skin and the sclerae of the eyes
|
icterus or jaundice
|
|
|
marker used to monitor GI cancer treatment effectiveness and dectects recurrence
|
carcinoembryonic antigen (CEA)
|
|
|
blood not seen with the naked eye
|
occult blood
|
|
|
excessive secretion of fecal fats
|
steatorrhea
|
|
|
an x-ray examination of the esophagus, stomach, duodenum, and jejunum using an oral liquid radiopaque contrast medium and a fluoroscope
|
upper gastrointestinal series (upper GI)
|
|
|
used to outline the contours of organs
|
fluoroscope
|
|
|
may result when the fecal mass is so dry it cannot be passed
|
impaction
|
|
|
performed to visualize the position, movements, and filling of the colon
|
lower gastrointestinal series (lower GI)
|
|
|
visualizes the esophagus
|
esophagoscopy
|
|
|
visualizes the stomach
|
gastroscopy
|
|
|
visualizes the esophagus AND the stomach
|
EGD (esophagogastroduodenoscopy)
|
|
|
Test in which abnormalities such as inflammation, cancer, bleeding, injury or infection to the esophagus, stomach or duodenum can be seen
|
EGD (esophagogastroduodenoscopy)
|
|
|
Why are patients asked to sign an operative consent and preoperative checklist made prior to an EGD
|
invasive procedure
|
|
|
What preparations are done for a patient scheduled for an EGD?
|
NPO 8-12 hrs, possibly sedatives given (valium or versed), atropine sulfate to dry secretions, and local anesthetic in spray or gargle form to inhibit the gag reflex
|
|
|
In this test, a patient is placed on the left side, flexible endoscope tube is passed orally down the GI tract and photographs or videotapes of the procedure as well as biopsy or cytology specimens can be obtained
|
EGD (esophagogastroduodenoscopy)
|
|
|
How long is a patient to remain NPO after an EGD?
|
until the gag reflex returns, generally within 4 hours
|
|
|
What is the major postoperative complication from an EGD?
|
perforation and bleeding
|
|
|
permits the physician to visualize the liver, gallbladder, and pancreas
|
ERCP (retrograde cholangiopancreatography)
|
|
|
the examination of the distal sigmoid colon, rectum, and anal canal using a rigid or flexible endoscope
|
proctosigmoidoscopy
|
|
|
provides visualization of the lining of the large intestine to identify abnormalities through a flexible endoscope which is inserted rectally
|
colonoscopy
|
|
|
a NG tube is inserted and the contents of the stomach are suctioned out through the tube using a syringe and the tube is connected to wall suction, and stomach contents are collected every 15 minutes for 1 hour
|
basal cell secretion test
|
|
|
measures the amount of gastric acid for 1 hour after subcutaneous injection of a histamine drug
|
gastric acid stimulation test
|
|
|
|
gavage
|
|
|
|
lavage
|
|
|
surgical creation of gastric fistula through the abdominal wall
|
gastrostomy
|
|
|
A method of supplying nutrients to the patient by an IV route that is not a central vein
|
Peripheral Parenteral Nutrition (PPN)
|
|
|
lack of appetite, a common symptom of many diseases
|
anorexia
|
|
|
an eating disorder where patients may have a phobia of weight gain, are afraid of a loss of control, and are mistrusting
|
anorexia nervosa
|
|
|
compulsive eating with self induced vomiting
|
bulemia nervosa
|
|
|
20% or more above ideal body weight
|
obesity
|
|
|
the most commonly used restrictive surgery for weight reduction and control
|
gastroplasty
|
|
|
a common gastric bypass surgery of two steps, in which a small pouch the size of a thumb is created with staples and a Y shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach and duodenum
|
Roux-en-Y
|
|
|
canker sores
|
aphthous stomatitis
|
|
|
general term for inflammation of the oral cavity
|
stomatitis
|
|
|
a condition in which the lower part of the esophagus and stomach slides up through the hiatus of the diaphragm into the thorax
|
hiatal hernia
|
|
|
group of drugs that cause constipation and diarrhea
|
opoid analgesics
|
|
|
inflammation of the stomach mucosa and can be acute or chronic
|
gastritis
|
|
|
primarily caused by infection with the gram negative bacterium Helicobacter pylori (H pylori)
|
peptic ulcer disease (PUD)
|
|
|
|
Helicobacter pylori
|
|
|
used to treat cancer in the lower two thirds of the stomach
|
gastrectomy
|
|
|
procedure also known as Billroth I procedure, in which the surgeon removes the distal 75% of the stomach
|
gastroduodenostomy
|
|
|
involves removal of the distal 50% of the stomach and reanastomosis of the proximal remnant of the stomach to the proximal jejunum
|
Billroth II procedure, also known as gastrojejunostomy
|
|
|
procedure in which the surgeon removes the distal portion of the stomach and the remainder of the stomach is anastomosed
|
Billroth I procedure/Gastroduodenostomy
|
|
|
procedure used to treat gastric problems
|
Billroth I procedure/Gastroduodenostomy
|
|
|
Because it results in bypassing of the duodenum, the Billroth II procedure is used to treat:
|
duodenal ulcers
|
|
|
fat in the stool
|
steatorrhea
|
|
|
occurs when the fecal mass is held in the rectal cavity for a period that is not usual for the patient
|
constipation
|
|
|
prolonged constipation
|
obstipation
|
|
|
|
hemorrhoids
|
|
|
|
fissures
|
|
|
grossly dialated loops of the colon
|
megacolon
|
|
|
excision of the colon or a portion of it
|
colectomy
|
|
|
occurs when fecal matter passes through the intestines rapidly, resulting in decreased absorption of water, electrolytes, and nutrients and causing frequent, watery stools
|
diarrhea
|
|
|
inflammation of the colon
|
colitis
|
|
|
inflammation of the appendix, the small fingerlike appendage attached to the cecum of the large intestine
|
appendicitis
|
|
|
because of the small size of the appendix, obstruction may occur, making it susceptible to:
|
infection
|
|
|
signs and symptoms of appendicitis include:
|
fever, increased WBC, generalized pain in the upper abdomen, localized pain in the RLQ, nausea, vomiting and anorexia
|
|
|
One of the classic symptoms of appendicitis
|
pain at McBurney's point, midway between the umbilicus and the right iliac crest
|
|
|
Physical exam of the patient with appendicitis would reveal:
|
guarding (slight abdominal muscular rigidity), normal bowel sounds, local rebound tenderness, sometimes pain in the RLQ when the LLQ is palpated (Rovsing's sign)
|
|
|
If there is no evidence of perforation or peritonitis, the correct intervention for appendicitis would be:
|
NPO and immediate surgery, w/ ice to the site and maintaining semi fowlers to reduce pain
|
|
|
Why is a heating pad to the abdomen avoided in a patient w/ appendicitis?
|
b/c the warmth may increase inflammation and risk of rupture
|
|
|
Why is pain controlled post-op for a patient w/ appendicitis?
|
to promote early ambulation, coughing, deep breathing, and turning to prevent respiratory complications
|
|
|
What are the major complications of appendicitis?
|
perforation, abscess of the appendix, and peritonitis
|
|
|
How would you identify a perforated appendix?
|
severe pain and temp 100 or higher
|
|
|
a localized collection of pus seperated from the peritoneal cavity by the omentum or small bowel related to appendicitis is usually treated by:
|
parenteral antibiotics, surgical drainage, and appendectomy 6 wks later
|
|
|
inflammation of the peritoneum that occurs from a variety of causes and can be life threatening
|
peritonitis
|
|
|
|
hernia
|
|
|
a condition in which multiple diverticula are present without evidence of inflammation
|
diverticulosis
|
|
|
When food and bacteria are trapped in a diverticulum and inflammation and infection develop
|
diverticulitis
|
|
|
may be done to allow inflammation of diverticulum to subside and diseased portion of colon to rest
|
colostomy
|
|
|
an inflammatory bowel disease that can involve any part of the intestine but most commonly affects the terminal portion of the ileum, extending through the intestinal mucosa
|
Crohn's disease aka enteritis
|
|
|
|
fistulas
|
|
|
|
ileostomy
|
|
|
occurs when the bowel twists, occluding the lumen of the intestine
|
volvus
|
|
|
occurs when peristalsis causes the intestine to telescope into itself
|
intussusception
|
|
|
black and tarry stools
|
melena
|
|
|
bleeding from the colon or rectum, usually bright red
|
hemotochezia
|
|
|
the portion of bowel that is sutured onto the abdomen
|
stoma
|
|
|
an inflammation of the cells of the liver, resulting from infection by viral agents or exposure to drugs toxic to the liver or occasionally from bacterial infection
|
hepatitis
|
|
|
central nervous system dysfunction
|
encephalopathy
|
|
|
chronic liver failure, 10th leading cause of death among the total population and more common among men than women
|
cirrhosis
|
|
|
a secondary kidney failure that occurs in about one third of liver failure patients
|
hepatorenal syndrome
|
|
|
an accumulation of serous fluid in the abdominal cavity
|
ascites
|
|
|
persistent blood pressure elevation in the portal circulation of the abdomen
|
portal hypertension
|
|
|
flapping tremors in the hands caused by toxins at the peripheral nerves
|
aterixis
|
|
|
foul odor caused by metabolic endproducts related to sulfur
|
fetor hepaticus
|
|
|
a nonsurgically placed shunt between the portal and systemic venous systems that may be used to treat ascites
|
transjugular intrahepatic portosystemic shunt (TIPS)
|
|
|
|
T-tube
|
|
|
gallstones, which may trigger pancreatitis
|
cholelithiasis
|
|
|
inflammation of the bile ducts, which may trigger pancreatitis
|
cholangitis
|
|
|
removal of all or part of the pancreas
|
pancreatectomy
|
|
|
characterized by the formation of gallstones in the gallbladder that are usually composed primarily of cholesterol
|
cholethiasis
|
|
|
an acute or chronic inflammation of the gallbladder
|
cholecystitis
|
|
|
refers to gallstones in the common bile ducts
|
choledocholithiasis
|
|
|
|
colic
|
|
|
|
laparascopy
|
|
|
procedure involves the use of a n endoscope to explore the common bile duct and possibly snare and remove stones found
|
choledochoscopy
|
|
|
uses shock waves as a noninvasive method to destroy stones in the gallbladder or biliary ducts
|
ESWL (extracorporeal shock wave lithotripsy)
|
|
|
most common type of hiatal hernai in which the stomach slides up into the thoracic cavity when a patient is supine and then usually goes back into the abdominal cavity when the patient stands upright
|
sliding hiatal hernia
|
|
|
People with hiatal hernia often have this other disease as well
|
GERD (gastrointestinal reflux disease)
|
|
|
Most common people to be diagnosed with a hiatal hernia
|
women, people over 60, obese, or pregnant
|
|
|
Symptoms and signs of a large hernia can include:
|
pain, heartburn, feeling of fullness, or reflex
|
|
|
This can injure the esophagus with possible ulceration and bleeding
|
hiatal hernia
|
|
|
A hiatal hernia is diagnosed by:
|
x-ray studies and fluoroscopy
|
|
|
Medical treatment for a symptomatic hiatal hernia:
|
antacids, eating small meals, not reclining for 1 hour after eating, elevating head of the bed 6 to 12 inches, avoiding bedtime snacks, spicy foods, alcohol, caffeine, and smoking
|
|
|
Procedure in which the stomach fundus is wrapped around the lower part of the esophagus, the most common surgical procedure performed for hiatal hernias
|
fundoplication
|
|
|
Why would the physician be notified if a patient appeared to have dysphagia following a fundoplication?
|
b/c the repair might be too tight causing obstruction to passage of food
|
|
|
Peptic ulcer disease (PUD) is primarly caused by:
|
gram-negative bacterium Helicobacter pylori
|
|
|
responsible for 80% of gastric ulcers and more than 90% of duodenal ulcers
|
H. pylori
|
|
|
Two thirds of all people are infected with:
|
H. pylori
|
|
|
Risk factors that contribute to PUD include:
|
smoking, chewing tobacco, stress, caffeine, or medications such as steriods, aspirin, and NSAIDS
|
|
|
Increases the harmful effects of H. pylori, alters protective mechanisms and decreases gastric blood flow
|
smoking
|
|
|
H. pylori can be cured by:
|
antibiotics
|
|
|
a condition in which the lining of the stomach, pyloruys, duodenum or esophagus is eroded
|
peptic ulcer disease (PUD)
|
|
|
Peptic ulcers occur in the portions of the gastrointestinal tract that are exposed to:
|
hydrochloric acid and pepsin
|
|
|
Ulcers are named by:
|
their location
|
|
|
Two noninvasive tests for H. pylori
|
urea breath test and IgG antibody detection test
|
|
|
The most conclusive test for H. pylori
|
CLO - campylobacter-like organism biopsy
|
|
|
Peptic ulcers are diagnosed on the basis of:
|
symptoms, upper GI, endoscopy, and EGD
|
|
|
what is "triple therapy"? As a medication regimen for H. pylori.
|
three antibiotics (Amoxil, Biaxin, Prilosec) or two antibiotics (amoxil & biaxin) and a proton pump inhibitor (Prevacid)
|
|
|
What is "dual therapy"? As a medication regimen for H. pylori.
|
Antibiotic and proton pump inhibitor (Biaxin and Prilosec or Amoxil and Prevacid), or an antibiotic and H2 antagonist (Biaxin & Tritec)
|
|
|
Treatment for PUD lasting ______ days has better eradication rates than a ______ day treatment
|
14 / 10
|
|
|
may be used in PUD treatment for its antibacterial effects
|
Pepto Bismol (Bismuth subsalicylate)
|
|
|
Powerful agents that stop the final step of gastric acid secretion to reduce mucosa erosion and aid in healing ulcers
|
proton pump inhibitor
|
|
|
block K2 receptors to decrease acid secretions, although not as powerfully as gastric acid pump inhibitors
|
H2 antagonists
|
|
|
Major complications that can result from PUD include:
|
bleeding, perforation, and obstruction
|
|
|
A medication used to stop bleeding:
|
vasopressin
|
|
|
A perforated ulcer usually requires:
|
surgical intervention (medical emergency)
|
|
|
Used to correct an obstruction from peptic ulcer disease
|
pyloroplasty
|
|
|
may develop for a small number of patients who are critically ill
|
gastric or small intestinal stress ulcers
|
|
|
The stress response to illness causes reduced blood flow to the stomach and small intestine, resulting in:
|
ischema and damage to the mucosa
|
|
|
Why do stress ulcers have a high mortality rate?
|
b/c they have multiple bleeding ulcer sites
|
