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182 Cards in this Set
- Front
- Back
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What are endocrine glands and what do they do?
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Endocrine glands are ductless glands that secrete hormones directly into the blood or lymph system.
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What are hormones? What is their relationship to metabolism and disease?
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Chemical substances that exert a specific effect on various glands and organs; they are responsible for stimulation metabolic processes and for stimulating or inhibiting the secretion of other hormones. If too much or too little of a hormone is secreted, troubling symptoms can occur, thus precipitating a stressful physiological crisis that can contribute to disease, dysfunction, and a number of specific regulatory disorders.
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What are the primary functions of the kidneys?
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Forming urine, regulating fluids and electrolytes, and maintaining the electrolyte and acid-base balance in blood and other body fluids. they also help regulate b/p
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What is the functional unit of the kidney and what is its action?
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the nephron. Each kidney dcontains over a million nephrons, and they in turn contain the glomeruli that are involved in urine formation. this is called glomerular filtration.
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What are the 3 primary structures of the kidney?
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The cortex, medulla, and renal pelvis
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What are the 5 primary signs of pheochromocytoma?
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hypertension, headache, hyperhidrosis, hypermetabolism, and hyperglycemia. all are symptoms of overactivity of the sympathetic nervous system.
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What is malignant hypertension? what causes it?
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the PT systolic b/p can be over 300 mm/Hg and diastolic b/p as high as 200 mm/Hg. caused by constriction of the blood vessels.
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What are some specific interventions aimed at the relief of episodes of malignant hypertension?
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PT should be laced on bed rest w/ head ^. muscle relaxants and antihypertensives like sodium nitroprusside (Nipride) may be given to immediately and dramatically lower b/p
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What are some specific nonpharmacological interventions that should be implemented prior to catecholamine testing?
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since physical, mental, or emotional stress can ^ catecholamine levels, a quiet environment is important before any Dx testing. PT should be placed on bed rest prior to blood and urine analysis, and may be taught or encouraged to relax by deepbreathing or visualization exercises.
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What meds, foods, and beverages should be avoided prior to any catecholamine testing
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asprin, or OTC meds w/ stimulants like ephedrine must be discontinued prior to testing. bananas, caffeinated drinks, and chocolate ^ catecholamine production. Vanilla, alcoholic beverages and citrus fruit should not be sonsumed since they affect urine levels of VMA
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What is the rationale for IV therapy prior to Sx removal of the adrenal glands?
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ensures that PT is well hydrated. inadequate hydration can lead to hypotensive states both during and after Sx.
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What meds are usually given prior to an adrenaletomy? Why?
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meds to lower and stabilize high b/p and correct any cardiac dysrhythmias. i.e. phentolamine (Regitine) and propranolol hydrochloride (Inderal). alpha/beta blockers inhibit the secretion of catecholamines that could ^ b/p do dangerous levels which can happen when the adrenal glands are handled during Sx.
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What type of meds will the PT take for the remainder of their life following a B adrenalectomy? Why? What is the most common drug prescribed for this purpose?
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PT on corticosteroids for the rest of his life, usually oral to prevent hypoglycemia
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What is the primary Dx test for pheochromocytoma?
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Angiography used to detect tumor location, serum catecholamine assays used to Dx. ^ vanillylmandelic acid (VMA) level in urine.
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What is the primary Dx test for Cushing's syndrome?
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^ 17-hydrocorticosteroid, and 17- ketosteroid levels, dexamethasone suppression test.
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What is the Dx test/ lab test for Addison's disease?
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Hypoglycemia, Hyponatremia, ^ WBC, decreased serum cortisol, hyperkalemia, and low levels of 17 hydrocorticosteroids, and 17- ketosteroids.
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What is the Dx test/lab test for Syndrome of inappropriate antidiuretic hormone secretion (SIADH)?
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Hyponatremia, and specific gravity of urine >1.030
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What is the Dx test/lab test for Diabetes insipidus (DI)?
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Fluid deprivation test, ^ serum osmolality, specific gravity of urine <1.005, and hypernatremia.
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What is the Dx test/lab test for Acromegaly?
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^ serum growth hormone (GH), ^ serum lipids
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T OR F. Physical and emotional stress decreases the need for prednisone in a PT on glucocorticoid therapy.
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False. it ^ the need for prednisone.
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T OR F. Corticosteroids are usually given at bedtime in a PT on glucocorticoids.
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False. they are given in the AM to remain on cycle.
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T OR F. PT who are taking prednisone may require additional sodium if they experience vomiting.
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True.
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T OR F. Prednisone and other steroids should be given w/ fruit juice because of their bitter taste
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False. they should be given w/ milk or antacids to prevent ulcers and GI upset.
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T OR F. Rest is essential when receiving steroid therapy because it helps decrease stress
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True.
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T OR F. diet should be high in carbs, and protein but low in sodium in a PT taking glucocorticoids
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False. the diet should be high in carbs, protein and sodium.
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What are the 4 symptoms of steroid overdose?
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Weight gain, edema, ^ b/p, and euphoria.
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What are the 4 symptoms of inadequate steroid dosage?
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weight loss, dizziness, postural hypotension, and depression.
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What is the rationale for Polydipsia, polyuria and polyphagia in a PT w/ Cushing's syndrome?
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Poly dipsia, polyuria, and polyphagia may occur related to the inhibiting effect of glucocorticoid hormones on insulin.
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What is the rationale for frequent infections in a PT w/ Cushing's syndrome?
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frequent infections may be related to ^ susceptibility from the steroids.
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What is the rationale for depression and psychosis in a PT w/ Cushing's syndrome?
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Depression and psychosis can be related to a changing body image and the effect of cortisol on the neurological system
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What medication is given after hypophysectomy to prevent CSF leakage?
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Antitussives (coughing ^ ICP)
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What medication is a common antiarrhythmic drug given to PT w/ endocrine disorders?
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Propranolol hydrochloride (Inderal)
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What medication is used to stimulate ADH secretion in a PT w/ endocrine disorders?
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Tricyclic antidepressants
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What medication is contraindicated if PT is allergiv to peanuts?
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Pitressin tannate. (it uses peanut oil)
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What medication suppresses adrenal secretions in a PT w/ a endocrine disorder?
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Mototane (Lysodren)
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What medication is used in immediate Tx of addisonian crisis?
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IV hydrocortisone (Solu-Cortef)
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What medication comes in a nose spray in a PT w/ a endocrine disorder?
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Desmopressin acetate (DDAVAP)
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What medication prevents constriction of blood vessels in a PT w/ a endocrine disorder?
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Phentolamine (Regitine)
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What medication is given for lifetime management of Addison's disease?
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oral hydrocortisone (Cortef)
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What medication is used for malignant hypertension?
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Sodium introprusside (Nipride)
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What medication is an antidiuretic hormone given IM to treat diabetes insipidus?
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Vasopressin (Pitressin)
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What medication is used to treat fluid retention related to SIADH?
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Furosemide (Lasix)
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What medication is often given following B adrenalectomy?
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Prednisone
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What precipitates an Addisonian crisis? What are the symptoms?
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imbalanced sodium and potassium levels often as a result of emotional or physiological stress can precipitate an Addisonian crisis. symptoms are; severe dehydration, severe hypotension, tachycardia w/ weak pulse, cardia dysrhythmias, rapid respirations, and even circulatory collapse if the symptoms are not Tx.
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What is the usual initial Tx for Addisonian crisis?
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targeted to Tx hypovolemic shock. (PT in shock position) IV saline to restore circulation and ^ b/p, IV dextrose given to ^ blood sugar. corticosteroid therapy wil be immediately instituted, usually IV hydrocortisone (Solu-Cortef)
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What postop RN care should follow pituitary Sx?
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CSF can leak into brain postop during instances of ICP. activities that ^ ICP (sneezing, coughing, and straining w/ bowel movement) should be avoided.
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Why are high protein diets contraindicated for PT w/ diabetes insipidus?
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because high protein foods increase urinary output and sodium excretion.
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list some causative factors and defining characteristics for Hyperthyroidism.
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It can be related t an autoimmune disorder, symptoms include hyperdefecation, heat intolerance is common, caused by ^ T3 & T4, first appears during times of developmental body change, Graves' disease is most common form, ^ systolic b/p and tachycardia, hyperflexia
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list some causative factors and defining characteristics for Hypothyroidsim.
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can be autoimmune, Hashimoto's disease is most common cause, extreme fatigue and depression, caused by insufficient amounts of thyroid hormone, associated w/ Down's syndrome, low calorie diet is recommended
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list some causative factors and defining characteristics for Hyperparathyroidsim.
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Parathyroidectomy is primary Tx, hematuria and UTI's are common, caused by ^ parathyroid hormone, Kidney stones are common.
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list some causative factors and defining characteristics for Hypoparathyroidsim.
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Muscle weakness, tingling of the extremities, irritability are early signs; caused by insufficient amounts of PTH
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list some causative factors and defining characteristics for Myxedema.
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involves accumulation of mucopolysaccharides, extreme fatigue and depression, caused by insufficient amounts of thyroid hormone, is a severe form of hypothyroidism most prevalent in older women, symptoms include subnormal body temp and cold intolerance, low calorie diet is recommended
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list some causative factors and defining characteristics for Cretinism.
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Symptoms include mottled skin, related in inadequate amounts of thyroid hormone during fetal development, can result in stunted growth if not Tx.
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What causes thyrotoxicosis? What is the primary symptom?
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thyrotoxicosis happens when a PT level of circulating thyroid hormone is excessive. exophthalmos (bulging eyes) is the primary symptom.
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Define Lagophthalmos
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eyelid lag, or incomplete closure of eyelid
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Define Diplopia
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double vision.
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What is the relationship between iodine and thyroid disease?
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iodine is essential to normal thyroid function and is generally available in seafood, water, and iodized salt. when a PT iodine intake is deficient, endemic goiter can develop. in addition atypical iodine uptake levels may be indicative of thyroid disorders.
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What specific dietary interventions should the RN teach to PT's w/ hyperthyroidism? Why?
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a diet high in calories, protein, vitamins, and minerals as well as the consumption of 5-6 small meals a day. the RN should advise PT to avoid stimulating foods and beverages that contain spices and caffeine.
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What is radioactive iodine ablation? When is is done?
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chemical destruction of the thyroid gland through the ingestion of iodine 131. it is done when pharmacological Tx is not enough to alleviate the symptoms of hyperthyroidism. it is most common in elderly PT who can't tollerate thyroid Sx.
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What are the major complications of radioactive or oral iodine therapy? How are they Tx?
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hypothyroidism, and the development of a goiter. Tx through thyroid hormone replacement therapy (levothyroxine sodium (Synthroid)
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What specific symptoms and PT complaints might indicate airway obstruction following thyroidectomy?
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blood on PT neck dressing, rapid/thready pulse, hypotension, voice changes, laryngeal stridor, and wheezing are symptoms of obstruction. PT complaints of fullness or pressure in neck can also indicate subcutaneous bleeding that could lead to obstruction.
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What specific RN interventions are included after a thyroidectomy in order to lower the potential for airway obstruction?
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place PT in semi-Fowler's or semi-sitting position to decrease pressure on larynx. ice collars to reduce edema, and a C-collar to prevent PT from turning neck. emergency airway equipment should by close by.
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What is tetany? What causes this condition?
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tetany is a complication of thyroid Sx. caused by the accidental removal or nicking of the parathyroid gland during thyroidectomy. under normal circumstances the parathyroid glands regulate calcium balance in the body, and this allows the neuromuscular systme to work properly. w/ tetany, this is not the case.
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What are 4 symptoms of advanced tetany?
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Laryngospams, bronchospasm, cardiac dysrhythmias and seizures.
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How is tetany treated?
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IV calcium gluconate. sedatives, antoconvulsants, and a quiet environment can also be needed to decrease neuromuscular activity. soft, low lighting will help reduce irritability and photophobia. PT should also be on seizure precautions.
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What is thyroid storm?
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occurs when manipulation of the thyroid gland during Sx causes high levels of thyroid hormone to be released into the bloodstream. this can also develop during periods of severe stress, radioactive iodine Tx and sudden withdrawal from antithyroid meds.
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What are the major symptoms of thyroid storm?
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systolic hypertension, ^ agitation, diaphoresis, tachycardia (over 130 bpm) hyperpyrexia (fever 101-106) cardiac dysrhythmias, and delirium.
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What are the symptoms of myxedema? What can happen if it is left untreated?
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all the symptoms of hypothyroidism, + lowered metabolic rate, ^ fatigue and lethargy, subnormal body temp, cold intolerance, bradycardia, mental/physical sulggishness, edema, aching muscles, stiff joints, hair loss, coarse and waxy facial features, and thick skin due to mucopolysaccharide buildup. if not Tx, it can lead to myxedemic coma and death related to extreme hypothermia, markedly depressed respirations and cardiac arrhythmias.
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What complications can occur w/ thyroid replacement therapy? Why?
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cardiac complications can accompany any type of replacement therapy due to catecholamine related stimulation of the sympathetic nervous system.Tx for hypothyroidism often leads to ^ metabolic rate which raises the body's O2 requirement and places added strain on the heart and lungs which can lead to angina. can also ^ serum glucose levels.
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What should the RN teach the PT on thyroid replacement therapy?
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the s/s associated w/ cardiac complications including anginal Px that can lead to serious disorders of the heart. daily monitoring of the radial pulse can help prevent these. if PT pulse goes above 100 or irregular, the MD should be notified. diabetics on thyroid therapy should be aware that they may need to ^ antidiabetic meds.
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What RN interventions may be used in the Tx of PT's w/ mild hyperparathyroidism?
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loop diuretics (lasix) given to ^ calcium excretion in urine. fluids might be given IV or PO to dilute the blood and urine and minimize the risk of renal calculi. cranberry juice may be given to lower urine pH. foods ^ in calcium will be contraindicated (broccoli, and all dairy) low impact exercise should be encouraged to decrease bemineralization of bones.
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What dietary recommendations can the RN make for PT w/ hypoparathyroidism?
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foods rich in calcium but low in phosphorus. milk, egg yolks, and high protein meats will be contraindicated because of their high phosphorus content.also avoid chocolate, liver, and various nuts
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What is acute renal failure (ARF)? What are some causes of this conditions?
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ARF is the abrupt loss of renal function over a period of hours or days w/ marked decrease in urinary output. ARF related to a physiological stress the decreases blood flow to the nephrons and compromises the PT's glomerular filtration rate and kidney perfusion. specific causes = severe burns, consumption of toxic drugs, urinary outlet obstruction, intrarenal disease, and blood transfusion reactions.
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What are the 3 phases of ARF?
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Oliguric phase, Diuretic phase, and Recovery phase.
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compare and contrast urine output and quality in each phase of ARF?
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during oliguric phase most PT have urine output less than 400 mL/day (for elderly 6-700 per day). Anuria urine less than 100 mL/day can also occur. During diuretic phase urine volume ^ gradually and often significantly, reaching levels of over 2,000 mL/Day. w/ this ^ the urine is usually very dilute. during recovery pahse urine values normalize
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What is non-oliguric renal failure? When can it happen?
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when PT is experiencing non-oliguric form of ARF, normal urine output are present by the urine is very dilute. non oliguric renal failure may occur following Tx w/ antibiotics such as gentamicin and vancomycin. PT w/ severe burns may excrete large amounts of dilute urine but be in ARF.
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What complications can develop in relation to oliguria?
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can cause fluid overload (pulmonary edema), metabolic acidosis (often w/ hyperkalemia & Kussmaul's breathing), and blood imbalances like low hemoglobin, low hematocrit, and anemia.
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What causes the anemia that is sometimes associated w/ ARF? How is it treated?
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decreased production of erythropoietin as well as ^ BUN levels that ^ bleeding tendencies. to reverse this, IM injections of epoetin alfa (Epogen, Procrit) may be given to stimulate the production of RBC's.
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What is the primary medication that is given to Tx metabolic acidosis? What effect does it have on serum pH & potassium levels?
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IV sodium bicarbonate is primary med to Tx metabolic acidosis. this can raise PT's serum pH and decrease serum potassium.
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Describe the overall Tx requmen (including specific meds) that is usually instituted to reverse severe hyperkalemai.
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to reverse severe hyperkalemia the PT may be given sodium polystyrene sulfonate (Kayexalate), oraly or in retention enema form. Sorbitol may be given w/ Kayexalate to precipitate diarrhea and help eliminate potassium. calcium gluconate may be used IV, hypertonic glucose solution and quick-acting (regular) insulin may also be given if potassium levels are severely ^. these help move potassium out of blood and into cells. if potassium does not decrease after these Tx, hemodialysis or peritoneal dialysis may be needed
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What foods should be avoided by PT's who are recovering from ARF? What diet is generally recommended?
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avoid food/drink ^ in potassium and phosphorus i.e salt substitutes, citrus fruits, fruit juices, bananas, and coffee. high carb and low/moderate protein diet is generally recommended. fluid and sodium intake may be restricted.
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What are the major causes of chronic renal failure (CRF)?
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poorly controlled diabetes mellitus, chronic hypertension and kidney infection.
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What are the 3 phases of CRF?
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diminished renal reserve, renal insuffciency, and end-stage renal disease (ESRD)
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What are the symptoms of the second phase of CRF?
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the symptoms of renal insuffciency is, headache, polyuria, and nocturia, nephron loss may reach 90%. over time urine output may gradually decrease and BUN/ serum creatinine levels rise, Anemia and ^ fatigue may also be present.
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What are the specific manifestations of end-stage renal disease associated w/ cardiovascular symptoms (4)?
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Hypertension, CHF (related to sodium and water retention), pitting edema in face, hands, and sacral area, engorged neck veins
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What are the specific manifestations of end-stage renal disease associated w/ respiratory symptoms (3)?
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Shortness of breath, tachypnea, Kussmaul's breathing.
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What are the specific manifestations of end-stage renal disease associated w/ Gastrointestinal symptoms (6)?
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nausea, vomiting, anorexia, gastrointestinal bleeding related to peptic ulcers, uremic fetor, metallic taste in mouth.
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What are the specific manifestations of end-stage renal disease associated w/ Integumentary symptoms (5)?
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Thin hair, dry and flaky skin, pruritus, yellow/gray color to skin w/ areas of ecchymosis, uremic frost.
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What are the specific manifestations of end-stage renal disease associated w/ neurological symptoms (5)?
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fatigue, confusion, disorientation, peripheral neuropathy, restless legs
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What are the specific manifestations of end-stage renal disease associated w/ musculoskeletal symptoms (5)?
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loss of muscle strength, muscle cramping, bone Fx, foot drop, renal osteodystrophy and tissue calcification.
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What are the specific manifestations of end-stage renal disease associated w/ reproductive symptoms (2)?
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atrophy or loss of function of sex organs, decrease in libido
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What are the specific manifestations of end-stage renal disease associated w/ metabolic symptoms (2)?
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hypoproteinemia, gout
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What dietary modifications should be observed by PT's w/ CRF?
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Protein intake for PT w/ CRF should be restricted to sources that contain all of the essential amino acids. PT diet should also be ^ in carbs and fats, and multivitamin supplements may be needed.
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What is hemodialysis?
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PT is attached to a dialyzer by way of an arteriovenous (AV)fistula. this functins like an artificial kidney for 3-4 hurs several times a week
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What actions should nurses take to ensure that AV shunts are patent?
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RN should palpate and ausculate over the shunt site. if the site is open the RN will feel a slight tremor (thrill) and hear a whistling sound (Bruit) caused by blood flow between the vein and the artery. if no tremor is felt and no sound heard. the MD should be notified.
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What is peritoneal dialysis (CAPD)?
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a needle is attached to a catheter and inserted through the ABD wall into peritoneal cavity. a hypertonic dialyzing solution that has been warmed to body temp in a sterile container is infused through the catheter into the peritoneal cavity. after this fluid has absorbed any toxic wastes, it is drained from the cavity by gravity.
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What is the major complication of peritoneal dialysis? What causes this complication? What are its symptoms? How is it Tx?
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Peritonitis (infection of abd lining) it can be caused by irritation from antibiotic therapy or by staphylococcal or streptococcal infection in the peritoneal cavity. symptoms include fever, chills, malaise, and ABD Px w/ rebound tenderness in addition, drained dialysate soultion may be more cloudy than usual. Tx involves adding a cephalosporin antibiotic to the dialysate fluid and then beginning more specific antibiotic therapy based on sterile cultures of the peritoneal drainage.
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What type of diet might be recommended for a PT on peritoneal dialysis?
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since protein is lost through peritoneal dialysis, the RN should recommend that PT consume a diet ^ in protein. a low carb diet may prevent weight gain
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What meds are normally used to prevent kidney rejection after a renal transplant? What are the major side effects of these?
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immunosuppressants (cyclosporin and steroids) to decrease their chance of rejection. these are taken for the remainder of the PT life. major side effects include nephrotoxicity and ^ susceptibility to various types of infections (viral, bacterial, and yeast)
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What is shingles? How is it Tx?
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a common viral infection that can occur as a result of immunosuppressant therapy. characterized by intense nerve Px and skin eruptions. they develop when the herpes zoster virus becomes actibve after long periods of latency. Tx w/ acyclovir (Zovirax)
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What are the 7 s/s of kidney rejection?
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oliguria w/ gradual decrease in urine output, fatigue, gradual weight gain, fever, ^ b/p, Px or tenderness in flank, and serum creatinine levels over 20% greater than normal
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What is a nephrectomy? What dietary restrictions micht follow this type of Sx?
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Sx removal of one kidney due to disease or injury. dietary modifications may include restrictions on protein, sodium, fluid, and potassium intake.
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How does the liver help maintain normal blood glucose levels after carbohydrates are consumed?
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The liver converts carbs into glucose for the body's immediate energy needs, any excess is converted into glycogen & stored, if the body needs more glucose the body can convert glycogen into glucose. this process helps the body maintain normal blood glucose levels.
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What are fatty acids? What happens when they combine w/ O2?
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Fatty acids are the end product of ingested fat. if the body needs energy & glucose isn't available it can convert fatty acids into energy. When fatty acids combine w/ O2 it creates oxidation which creates ketones & cholestrol.
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What are ketones? What is their relationship to metabolic acidosis?
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Ketones are products of fatty acid oxidation that can be used for energy. if too many ketones build up in the blood it causes metabolic acidosis.
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What are the end products of protein digestion? What is their function?
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Amino acids are the end products of protein digestion. Amino acids are used as a source of energy & help in building/repairing tissue.
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Where is bile produced? What is the function of this substance?
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Bile is produced in the liver. It functions to aid digestion, when a PT eats food high in fat bile is released by the liver the used to suspend the fat in the small intistine.
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What is bilirubin? How is it formed?
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bilirubin is a product of RBC destruction & a major componet of bile. it is formed when hemoglobin is broken down in the liver.
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How is the gallbladder related to digestion?
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The gallbladder stores and concentrates bile by absorbing the watter. when fat is injested the ballbladder constricts to force bile to the small intestine
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What exocrine secretions does the pancreas produce?
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Exocrine secretions consist of digestive enzymes called pancreatic juice that break down carbs, fats, and proteins in small intestine.
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What 3 hormones are secreted by the pancreas? What cells produce each type of hormone? Where are these cells located?
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The pancreas secretes glucagon, insulin, and somatostatin. Glucagon is produced by alpha cells, insulin is produced by beta cells, and somatostatin is produced by delta cells. all of these cells are located in groups known as islets of Langerhans.
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Describe the action of Glucagon, Insulin, and Somatostatin?
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Glucagon ^ serum glucose levels, Insulin decreases serum glucose levels and aids in metabosism of carbs, fats, and proteins, Somatostatin has an inhibitory effect on glucagon, insulin and pitituary hormones (GH)
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What is the relationship between insulin and glycogen?
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insulin aids in the formation/storage of glycogen
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What is the relationship between insulin and fat?
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insulin inhibits fat catabolism by preventing the breakdown of stored fats & promoting fat synthisis
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What is the relationship between insulin and protein?
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Insulin ^ protein anabolism and aids in transport of amino acids across cell membraines.
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What is cholelithiasis? What are some contributing factors for this condition?
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Cholecithiasis is the presence/formation of stones. these can obstruct the flow of bile. contributing factors are disturbances in cholestrol metabolism and infections (E coli)
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What is cholecystitis?
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inflammation of the gallbladder
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Where might a PT experience Px in relation to cholecystitis?
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Right upper quadrent or radiate to back and R shoulder or R flank.
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What changes in the integumentary, gastrointestinal, and urinary systems might the RN observe in a PT w/ cholecystitis? Why?
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if the PT's common bile duct is obstructed the PT may have pruritus accompained by jaundice from bile being absorbed into the bloodstream. the PT's stools will be clay colored and urine dark form the kidneys filtering out the bile.
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What are some significant risk factors for cholecystitis?
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Gender (female) Age (over 40) obesity, diabetes, and dieting
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What assessment must the RN make before administering an IV or oral cholangiogram? Why?
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RN must inquire about allergies to iodine or seafood. symptoms of allergic reaction include uticaria (hives), nausea, vomiting, and feeling of warmth.
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What are ursodiol (Actigall) and chenodiol (Chenix)?
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they are medications that dissolve and prevent small cholestrol stones in the gallbladder.
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Why are fried/fatty foods restricted for PT's w/ cholecystitis?
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fried/fatty foods require bile for absorption. Px can result when gallbladder attempts to excrete bile throug a obstructed duct
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What is the most common complaint follwing laparoscopic cholecystectomy? Why? What RN measures may help resolve this situation?
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Px in R shoulder from the CO2 gas. RN should place the PT in sims position to help absorb the gas. a covered heating pad can also be used for Px relief. encourage PT to ambulate, sit @ 45-90 degree angles
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What are the complications of laparoscopic laser cholecystectomy? What are some associated symptoms?
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complications are related to internal bleeding/bile leakage. symptoms include; Px or tenderness in R upper quadrent, ^ ABD girth, drop in b/p, tachycardia and bile drainage from puncture sites.
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What interventions can help prevent blood clots after abdominal Sx?
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Elastic TED stockings, heprin SQ for several days to prevent blood clors.
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Following ABD cholecystectomy, how can the RN determine whether a PT might be ready for a clear liquid diet?
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when perstalsis returns. RN can determine this by auscultating the ABD for bowel sounds.
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What specific NR procedure is related to the T-tube? Why?
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RN must clamp the tube 1 hour prior to eating, unclamp durring eating, and clamp for 1 hour after eating. this allows bile into the small intestine to aid in digestion and see if PT can tolerate bile flow.
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If a PT is discharged w/ a T-tube in place, what teaching should the RN provide?
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information about kinks and infection. give PT info about the signs of biliary obstruction and tell PT to avoid fatty and gas producing foods.
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What is acute pancreatitis? What enzymes are associated w/ this condition?
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Acute pancreatitis is imflammation of the pancreas. there is an ^ in trypsin in the pancreas. trypsin in high in acid and can cause autodigestion. trypsin also activates elastase which can cause panceratic hemorrhage.
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What are some primary factors that contribute to the development of acute pancreatitis?
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Chronic alcohol abuse & obstruction of panceratic ducts by gallstones. it can also be caused by abuse of certian meds. i.e. acetaminophen, thiazide diuretics, steroids, and oral contraceptives
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Describe the Px associated w/ acute pancreatitis? When is this Px likely to occur?
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sudden and severe burning or stabbing Px in upper L quad or midepigastric area. this usually occurs 24-48 hours after a heavy meal or w/ large amounts of alcohol.
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What are the 2 signs of pancreatic hemorrhage associated w/ elastase activation?
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ecchymosis arround umbilicus (Cullen's sign) or ecchymosis allong the flank (Turner's sign)
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What are the primary signs of hypocalcemia in conjunction w/ pancreatitis?
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irritability, muscle twitching, change in PT's LOC and tetany.
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if untreated, what can acute pancreatitis lead to?
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organ necrosis, multiple organ failure and death
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What sign would indicate the resolution of an acute episode of pancreatitis?
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PT's stools change from clay colored back to normal
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What is chronic pancreatitis? What is hte primary contributing factor for this condition?
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Chronic pancreatitis is chronic inflammation of the pancreas. Alcohol is the primare contributing factor.
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Describe the Px associated w/ chronic pancreatitis. What precipitates this Px?
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Px is sudden & severe in upper ABD & radiates to the back. Px is precipitated by heavy meals or the consumption of alcohol.
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In addition ot Px, what signs and symptoms are associated w/ chronic pancreatitis?
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Anorexia, weight loss, jaundice, diarrhea, steatorrhea (frothy & foul stools w/ a high fat content[a late sign]), developing diabetes (a late sign)
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What Dx lab values might the RN expect to see in a PT w/ chronic pancreatitis?
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elevated akaline phosphatase, decreased levels of pancreatic juice. serum glucose may be elevated determined by a glucose tolerance test (GTT)
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What is pancreatic jejunostomy?
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Sx to drain pancreatic juice into the jejunum (2nd chamber of the small intestine)
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What is cirrhosis? What is another name for it?
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Cirrhosis is a chronic condition that impairs the normal functioning liver cells & ^ resistance of liver to blood flow. it is caused by liver fibrosis (scarring). also know as hepatic biliary disease.
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What are 3 common causes of cirrhosis?
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Chronic alcohol abuse, chronic viral hepatitis, and ingestion of toxic substances (including drugs)
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What are some defining characteristics of Laennec's cirrhosis?
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Also called portal cirrhosis, more common in Native American males, and associated w/ chronic alcoholism
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What are some defining characteristics of Postnecrotic cirrhosis?
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Associated w/ hepatitis, and associated w/ toxic substances.
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If a PT w/ cirrhosis is complaining of fatigue, general weakness, and malaise what would be the causative factor?
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these symptoms would be related to anemia.
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If a PT w/ cirrhosis is complaining of shortness of breath what would be the causative factor?
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Hepatomegaly, or abdominal ascities pushing diaphram into the chest cavity.
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If a PT w/ cirrhosis is complaining of esophageal varices (xtremely dilated sub-mucosal veins in the esophagus) what would be the causative factor?
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it would be caused by portal hypertension.
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if a PT w/ cirrhosis is showing signs of jaundice and pruritus (itching) what would be the cause?
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Bile buld up in the skin.
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if a PT w/ cirrhosis is showing signs of bleeding gums, ecchymoses, and spider angiomas what would be the cause?
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increased estrogen levels and decreased absorbtion of vit. K
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Under what circumstances would a PT w/ cirrhosis receive cyclosporine?
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If the PT is having a liver transplant. to prevent rejection.
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What would the Aspartate aminotransferase (AST) levels be high or low for a PT w/ cirrhosis?
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the aspartate aminotrasferase (AST) would be high.
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What would the Alanine Aminotransferase (ALT) levels be high or low for a PT w/ cirrhosis?
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The Alanine Aminotransferase (ALT) would be high.
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Would the Hemoglobin be high or low in a PT w/ cirrhosis?
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The hemoblobin would be low in a PT w/ cirrhosis.
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Would the Hematocrit be high or low in a PT w/ cirrhosis?
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The hematocrit would be low in a PT w/cirrhosis.
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Would the serum albumin be high or low in a PT w/ cirrhosis?
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The serum albumin would be low in a PT w/ cirrhosis.
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Would the serum bilirubin be high or low in a PT w/ cirrhosis?
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The serum bilirubin would be high in a PT w/ cirrhosis.
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Would the folic acid be high or low in a PT w/ cirrhosis?
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The folic acid would be low in a PT w/ cirrhosis.
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If diuretic therapy is not effective in Tx ascites, what other procedure can be performed? How?
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If the PT doesn't respond to diuretic therapy the PT may need to have paracentesis performed. Paracentesis is a needle aattached to a catheter inserted into the abdomen to drain fluid from the peritoneal cavity.
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How should the RN assess for fluid buildup in PT w/ cirrhosis?
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Measure the PT's abdominal girth and ankles. also assess the sacrum and scrotum for fluid buildup.
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What signs of internal bleeding should the RN teach to PT's w/ cirrhosis?
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Signs of internal bleeding are: Restlessness and anxiety, weakness, decreased b/p, rapid pulse, feelings of epigastric fullness, and blood in the stools.
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A PT may have gastrointestinal bleeding but no visible blood in the stool. In such cases, how can the RN check for internal bleeding?
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Check for ocult blood by using special reagents to detect blood.
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What dietary recommendztions (including specific vitamins and minerals) should be given to PT w/ cirrhosis?
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the diet should be high in carbs and low in protein. if the PT has esophegeal varices the PT should have a soft diet low in sodium and restricted fluids. the PT needs calcium, zinc, thiamine, folic acid and vitamins A, B12, D, E, and K
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What is portal-systemic encephalopathy (PSE)? What causes this condition?
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PSE is a brain disorder that results from chronic liver disease. when the liver functions normaly it detoxifies the chemicals in food/drink. when the liver is damaged the chemicals can't be clensed and they buildup in the bloodstream. Hypokalemia and internal bleeding can also cause PSE
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What are the early signs of PSE?
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early signs are similar to organic dementias and include, confusion, disorientation, memory impairement, difficulty reasoning & making decisions, speach/language abnormalities.
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What are the advanced symptoms of PSE?
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Asterixis (flapping tremor) due to ^ amonia levels in the blood. PT may become delirious, and eventually unresponsive to any external auditory & tactile stimuli (Hepatic Coma)
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What medications are used to reduce bacteria in the bowel? What are some side effects of these meds?
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Hyperosmotic laxatives (lactulose, sorbitol) both increase peristalsis and produce diarrhea. side effects can include ^ gas in bowel and hypokalemia. Neomycin (antibiotic) can be given orally or in an enema to clense the bowel.
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What is diabetes melitius (DM)?
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A chronic disorder of metabolism related to inadequate production or utilization of insulin.
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What is the chief defining characteristic of DM? What is it caused by?
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The chief defining characteristic of DM is hyperglycemia, it results when the beta cells in the pancreas produce little or no insulin.
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What is the relationship between blood glucose and urination?
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when blood glucose levels rise osmotic pressure of internal fluids also increases causing frequent and excessive urination.
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What are the 2 specific types of DM? compare and contrast the causes of these conditions. which type of diabetes melitius is most common?
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Type I and type II. type I is insulin dependent the pancreas does not produce any insulin (believed to be an autoimmune disorder). Type II the pancreas produces insulin but not enough. PT can control it w/ diet/excerise, oral hyperglycemic meds or insulin. Type II is most common.
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What causes autoimmune disorders?
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they result when the body can't tell the difference between self and invaders. the body attacks itself w/ antibiodies.
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What are the 4 classic symptoms that are always associated w/ type I diabetes?
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Hyperglycemia, Polyuria, Polydipsia, Polyphagia.
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What are some risk factors for type II diabetes?
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Family Hx, obesity, sedentary lifestyle HTN, and Cushing's disease.
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What are ketone bodies? What disorder can develop from the presence of ketone bodies in the blood and urine?
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Ketones are the byproduct of fatty acid breakdown in blood and urine. a buildup of ketones in the blood and urine can lead to ketoacidosis.
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What is the relationship between infection and ketoacidosis?
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in the absence of sufficient insulin infection raises the body's metabolic rate and secretion of stress hormones (glucorticoids) which can increase serum glucose causing ketoacidosis.
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What is the rationale for teaching PT about the importance of annual eye exams?
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Retinopathy may occur w/ diabetes; associated abnormalities include dialated blood vessels, hemorrhage from increased b/p, areas of ischemia and early onset of cataracts and microaneurysms. retinopathy can result in blindness, so preventive eye care is essential.
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What is the rationale for careful daily examinations of the skin?
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peripheral neuropathies can occur so PT's may not be aware of injury to the extremities. as a result care should be taken to avoid tissue injury.
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What is the rationale for observation of urine output?
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nephrotic syndrome and renal failure can occur. RN must check for normal amounts of urine output.
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What is the rationale for cholesterol screening and recommending a diet low in saturated fats?
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Coronary and peripheral vascular disease ma develop in diabetics in relation to compromised blood flow, atherosclerotic buildup of cholesterol and lipid deposits in the arteries. measures that lower the risk for these conditions are important.
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What blood glucose levels are associated w/ a definitive Dx of diabetes?
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A fasting blood glucose of 126mg/dl on more than one occasion. or blood glucose level of over 200 mg/dl on non fasting testing w/ symptoms of polydipsia, polyuria, and polyphagia w/ weight loss.
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If a PT has a fasting blood glucose of 140 mg/dl or higher, what Dx test will be performed? How can the test results be interpreted?
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A glucose tolerance test (GTT) if glucose is 200 mg/dl or higher 2 hrs after starting the test diabetes is confirmed.
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