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218 Cards in this Set
- Front
- Back
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What foods increase stool odor
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Asparagus
Beans Cabbage Eggs Fish Garlic Onions Some Spices (LeMone p. 806) |
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What foods increase intestinal gas
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Beer
Broccoli Brussels sprouts Cabbage Carbonated Drinks Cauliflower Corn Cucumbers Dairy Products Dried Beans Peas Radishes Spinach (LeMone p. 806) |
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What foods thicken the stool
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Applesauce
Bananas Bread Cheese Yogurt Pasta Pretzels Rice Tapioca Creamy Peanut Butter (LeMone p. 806) |
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What foods loosens stools
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Chocolate
Dried Beans Fried Foods Greasy foods Highly spiced foods Leafy Green Vegetables Raw friuits and juices Raw vegetables (LeMone p. 806) |
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what foods color stool
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Beets & red gelatin
(LeMone p. 806) |
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What does the location of a stoma tell you?
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what section of the bowel that was used for the ostomy and the type of fecal drainage to expect.
(LeMone p. 806) |
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How often should you change and ostomy bag
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when its 1/3 full. If it is allowed to get over full, the weight may affect the seal.
(LeMone p. 806) |
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What beverages should you avoid with an ostomy
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prune juice, and alcohol
(LeMone p. 791) |
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what beverages are allowed with an ostomy
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coffee, tea, carbonated drinks, milk (limited to 2 cups a day)
(LeMone p. 791) |
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What types of breads and cereals should you avoid with an ostomy
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whole grains breads, rolls, or cereal, or rolls with seeds, nuts or bran.
(LeMone p. 791) |
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What types of breads and cereals are allowed when you have an ostomy
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Products made with refined flour (white bread, crackers) or finely milled grains (corn flakes, crisp rice cereal, puffed wheat.)
(LeMone p. 791) |
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What types of desserts should you avid with an ostomy
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any dessert containing dried fruits, nuts, seeds, or coconut, rich pastries, pies
(LeMone p. 791) |
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What types of desserts are allowed with an ostomy
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gelatins, tapicoa, plain custard or pudding, angel food or sponge cake, ice cream or frozen desserts without fruit or nuts.
(LeMone p. 791) |
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What fruits are allowed with an ostomy
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fruit juice & strained fruit
cooked and canned apples, apricots, cherries, peaches, pears, and bananas (LeMone p. 791) |
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What fruits should you avoid with an ostomy
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all other raw or cooked fruits
(LeMone p. 791) |
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What types of meats and other protein sources should you avoid with and ostomy
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touch or spiced meats and those prepared by frying , highly flavored cheeses, nuts
(LeMone p. 791) |
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What types of meats and other protein sources are allowed with an ostomy
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roasted, baked , or broiled tender or group beef veal pork, lamb, poultry, or fish, smooth peanut butter, cottage cream, American, or mild cheddar cheeses in small amounts.
(LeMone p. 791) |
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what types potato, rice and pastas should a person with an ostomy avoid
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potato skins, potato chips, or fried potatoes, brown rice, whole grain pasta products
(LaMonte, p. 791) |
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what types of potatoes, rice and pastas are allowed for an ostomy patient
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peeled potatoes, white rice, most pasta products.
(LaMonte, p. 791) |
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What types of sweets are allowed for ostomy patients
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sugar, honey, jelly, hard candy and gumdrops, plain chocolates
(LaMonte, p. 791) |
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What types of sweets should you avoid with an ostomy
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Jam, marmalade, candy made with seeds, nuts and coconut
(LaMonte, p. 791) |
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What types of vegetables are recommended with an ostomy
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vegetable juices and strained vegetables, cooked or canned vegetables
(LaMonte, p. 791) |
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What types of vegetables should be avoided with an ostomy
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raw or whole cooked vegetables
(LaMonte, p. 791) |
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what are some other items to avoid with an ostomy
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chili sauce, horseradish, popcorn, seeds of any kind, whole spices, olives, vinegar
(LaMonte, p. 791) |
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what is the placement of a gastrostomy
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epigstric region of abdomen
(LaMone, p. 692) |
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When aspirating for placement of a gasterostomy, what pH are you looking for
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pH <5 is stomach
pH > 7 is intestinal (LaMone, p. 692) |
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Which is more reliable ausculataion of the placement of a gastrostomy tube, or aspiration
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aspiration reliable
(LaMone, p. 692) |
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What do changes in the insertion site, drainage, or lack of healing indicate on a gastrostomy
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possible infection
(LaMone, p. 692) |
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How do you evaluate function of gastrointestinal tract with gastrostomy
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1. abdominal distension
2. bowel sounds 3. tenderness (LaMone, p. 692) |
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Why would you apply Stomahesive, karaya on a gastrostomy
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to help protect the skin and prevent breakdown from gastric acid and other drainage that might irritate the skin.
(LaMone, p. 692) |
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what is a normal albumin level
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15-35 mg/dL
(LaMone, p. 644) |
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What albumin level would show a patient is at risk for nutritional deficit
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11-14.9 mg/dL. You will want to monitor this weekly
(LaMone, p. 644) |
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What albumin level would show a patient is at a significant risk for malnutrition
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5 - 10.9 mg/dL. You would provide aggresive nutritional support (TPN)
(LaMone, p. 644) |
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What albumin level would show a patient is malnourished
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<5 mg/dL
(LaMone, p. 644) |
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enteral nutrition
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tube feedings, may be used to meet caloric and protein requirements in patients unable to consume food, such as inability to swallow, unresponsiveness, oral or neck surgery/trauma, anorexia or serious illness.
(LaMone, p. 644 - 5) |
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What is the nutritional breakdown of enteral feedings
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1 kcal/mL
14% of calories from protein 60% carbohydrates 25% - 30% fats Giving 1500mL/day provides recommended daily intake of all vitamins and minerals |
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What are the fat soluable vitamins
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ADEK
absorbed: gastrointestinal tract stored: AD in liver All of these are toxic in excess (LaMone, p. 645) |
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What should nurses look for regarding fat soluble vitamins
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1. Monitor for excess
2. Monitor for hypersensitivity reactions. Have emergency equipment ready 3. Administer A with food 4. Do not administer Vit K intravenously (LaMone, p. 645) |
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What are the water soluble vitamins
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Vitamin C (Ascorbic acid)
Vitamin B B1-Thiamine B2- Riboflavin Niacin (nicotinic acid) B6- Pyridoxine hydrochloride Pantothenic acid Biotin Used to treat/prevent deficiency (LaMone, p. 645) |
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What are the nursing responsibilities for water soluble vitamins
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1. Monitor for response to replacement therapy
2. Monitor for hypersensitivity reactions. Have emergency equipment available. (LaMone, p. 645) |
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What are the common minerals we see in diet
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Na, K, Mg, Ca, Cu, Fl, I, Zn, Mn, Chromium, Selenium
these are inorganic chemicals that are vital to many physiological functions. (LaMone, p. 645) |
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What are nursing responsibilities regarding minerals
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1. monitor manifestations of mineral imbalance
2. Prior to administration, dilute oral mineral preparations 3. Prior to administration of iodine, assess for allergy or seafood allergy. 4. Educate on not exceeding recommended dosage. (LaMone, p. 645) |
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Total Parenteral Nutrition (TPN)
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also known as hyperalimentation
intravenous administration of carbohydrates (dextrose) protein (amino acids) electrolytes vitamins minerals fat emulsions (LaMone, p. 646) |
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What types of enteral feeding formulas are there
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1. Complete
2. High Calorie Complete 3. Complete lactose free high-residue 4. Disease specific (LaMone, p. 646) |
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What is in a complete TPN feeding
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1kcal/mL
protein 14% fat 30% carbohydrates 60% 1500ml for full recommended diet EX: Compleat, Ensure, Isocal, Nutren, Isolan, Sustacal, Resource (LaMone, p. 646) |
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Wat is in a High Calorie Complete TPN feeding
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The same as complete, but provides 1.5 - 2 kcal.mL and is appropriate for patients on fluid restriction.
EX: Ensure Plus, Sustacal HC, Comply, Nutren1.5, ResourcePlus, Isocal HCN, Magnacal, TwoCal HN (LaMone, p. 646) |
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What is in a complete Lactose-free, high residue formula (TPN feeding)
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same as complete, but provides fiber.
EX: Jevity, Profiber, Nutren 1.0 w/fiber, Fiberlan, Sustacal w/fiber, Ultracal, Ensure e/fiber, Fibersource, Accupep HPF, Reabfin, others (LaMone, p. 646) |
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What is in a Disease-specific formula for TPN feeding
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renal failure- less amino acids ex. Amin-Aid, Travasorb Renal, Aminess
respiratory failure- Fat> 50% total kcal EX Pumocare, NutriVent liver failurew/hepatic encephalopathy: high amounts of branched-chain amino acids. EX Hepatic-Acid II, Travasor Hepatic (LaMone, p. 646) |
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Lavage
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removing fluid through a tube
Lav = Leave (Marvel Donovan) |
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Gavage
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adding fluid through a tube
Ga = Go (Marvel Donovan) |
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What can happen with long term use of parenteral nutrition
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1. gallstones in liver
2. nutrient deficiencies (use>3-4 mo) (LaMone, p. 648) |
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what are some interventions for "Imbalanced Nutrition: Less than Body requirement"
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1. Eliminate foul odors
2. provide oral hygiene 3. make meals appetizing and frequent 4. consult nutrition support team 5. provide rest before and after meals 6. access knowledge and provide teaching (LaMone, p. 648) |
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What are some nursing interventions for "risk for infection" in malnourished patients
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1. monitor temp every 4 hours (baseline will be < normal)
2. infection symptoms : chills, malaise, erythema, leukocytosis 3. Maintain medical asepsis 4. teach signs and symptoms of infection, factors for infection, hand washing. (LaMone, p. 649) |
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What are some nursing interventions for "Risk for Deficient Fluid Volume" in malnourished patients
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1. Monitor oral mucous membranes dry), (increased) urinary specific gravity, ( decreased) LOC, and labs every 4-8 hrs (electrolyte imbalances)
2. Daily wt, I & O 3. Offer other fluids if allowed (LaMone, p. 648) |
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What are some nursing interventions for "Risk for Impaired Skin Integrity" in a malnourished patient
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loss of subQ tissue and muscle increases risk of pressure ulcer
1. Assess skin every 4 hrs 2. Change position every 2 hours 3. keep skin dry and clean, minimize shearing forces. Provide therapeutic beds etc (LaMone, p. 650) |
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what ions determine the acidity of body fluids
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Hydrogen (H+)
(LaMone, p. 238) |
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What type of relationship is there between Hydrogen ion and pH
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Inverse
as H + increase, pH decreases as H+ decreases, pH increases (LaMone, p. 238) |
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Volatile acid
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can be eliminated from the body via gas. the only one produced in the body is carbonic acid H2CO3
(LaMone, p. 238) |
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what 3 systems work together to maintain pH despite continuous acid production
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1. buffers
2. respiratory system 3. renal system (LaMone, p. 238) |
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buffers
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substances that prevent major changes in pH by removing or releasing hydrogen ions.
xs acid, binds to hydrogen ions xs alkaline, release hydrogen ions (LaMone, p. 238) |
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what are the major buffering systems in thebody
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1. bicarbonate-carbonate buffering system
2. phosphate buffer system 3. protein buffer (LaMone, p. 238) |
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what is the ratio of bicarboate to carbonic acid to be in the normal pH range
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20 parts bicarbonate to 1 part carbonic acid.
(LaMone, p. 238) |
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how does the respiratory system regulate carbonic acid in the body
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If the brain is notified of an increase in CO2 or H+, triggers deeper respirations and increases rate to eliminate the gas. It becomes less effective over time, but is good for a quick change.
(LaMone, p. 239) |
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how does alkalosis affect respirations
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decreases rate and depth of respirations
(LaMone, p. 239) |
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How does the renal system regulate bicarbonate
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This is a long term regulation. Kidneys regulate bicarbonate levels in extracellular fluid. Can regenerate bicarbonate or reabsorb it.
acidosis-kidneys excrete H+, retain H2CO3 alkalosis- kidney retain H+, excrete H2CO3 (LaMone, p. 239) |
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What are the best test for arterial blood gas
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ABG-> VBG->CBG
(Stacey Bancroft) |
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tachycardia
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HR >100 beats/min
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bradycardia
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HR< 60 bpm
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What are you looking for when analyzing an ECG strip
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1. Rate: 1:1 for a and v
2. Rhythm-regular/irregular 3. P waves present 4. PR interbal 5. QRS interval 6. Interpretation |
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What can cause sinus tachycardia
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fever, pain, anxiety, exercise
(lab) |
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PACs
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rate:usually normal
Phythm: regular w/ premature beat P wave: premature PR wave: Normal or prolonged QRS: Usually 0.10, wide or absent cause: premature atrial contraction (Lab) |
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Atrial Flutter
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Rate: atrial 250-450
Rhythm: atrial: regular P Wave: none: SAW TOOTH PR interval: not measurable QRS: 0.10 (lab) |
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Atrial Fib
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Rate: Atrial 400-600
Rhythm: Ventricular: irregular P wave: Erratic PR Interval: Not measurable QRS: 0.10 (lab) |
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PVCs
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rate: Usually normal
Rhythm: regular w/premature beats P Wave: Usually absent PR interval: none with PVC QRS: Greater than 0.12, wide/bizarre Cause: caffiene etc |
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Ventricular Tachycardia
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Rate: 150 - 300
Rhythm: reg.irregular P wave: none PR Interval: none QRS: Greater than 0.12 all over the place Pumpkin |
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V Fib
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Rate: Cannot determine
Rhythm: Rapid/chaotic P Wave: None PR interval: None QRS: None |
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Asystole
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Rate: not discernable
Rhythm: Ventricular: not discernable P Wave: not discernable PR Interval: not discernable QRS: Absent no electrical activity or contractions |
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what if you P waves do not look alike
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then more than one atrial foci (source of electrical charge) is firing and the heart is responding to those impulses
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What if P waves are present, but there is no correlation between them and the QRS complexes
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atrial impulses are not getting through to the AV junction, there is a disconnect between the atria and the ventricles
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what if there is no P wave
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the impulses are probably coming from the AV junction or the lower system
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what is a normal PR interval
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0.12 -0.20 seconds
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what does a variation in the PR interval mean
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indicate conduction problems within the electrical system of the upper heart
AV slows conduction so atria can empty. short PR- impulses bypassing electrical pathway |
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What is a normal QRS width
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0.10 sec
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What does the width of the QRS tell us
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whether the electrical impulse has originated above the ventricular site and is being conducted normally or whether it is coming from an ectopic ventricular site and bypassing the intraventricular conduction pathway
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If impulses coming from ectopic focus in ventricles, what will the QRS look like
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the complex will be abnormally shaped and 0.12 sec or more in duration
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Is it possible to get an EKG and not have a pulse
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yes, be sure to check the patient and the monitor
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which group of Americans is highest in prevalence of coronary heart disease
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Native Americans (American Indians and Alaska Natives)
(L & B p. 958) |
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Cardiovascular disease (CVD)
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generic term for disorders of the heart and blood vessels and is the leading cause of death and disability in the US.
(L & B p. 958) |
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Coronary Heart Disease (CHD)
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also known as coronary artery disease is caused by impaired blood flow to the myocardium from atherosclerotic plaque in coronary arteries.
(L & B p. 958) |
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collateral channels
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connectors of large coronary arteries and small arteries. If large arteries are occluded, then these enlarge to help with blood flow
(L & B p. 959) |
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Atherosclerosis
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progressive disease characterized by atheroma (plaque) formation, which affects the intimal and medial layers of large and midsized arteries. Also, weakens artery walls and van lead to aneurysm
(L & B p. 959) |
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what do atheromas (final phase of atherosclersis) contain
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lipids, fibrous tissue, collagen, calcium, cellular debris, and capillaries
(L & B p. 959) |
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at what point do manifestations of coronary blockage appear
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after there is 75% occlusion
(L & B p. 959) |
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where does atherosclerotic plaques tend to develop
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1. bifurcations/ branches
2. coronary arteries, left Anterior descending especially 3. renal arteries 4. bifurcation of carotids 5. branches of peripheral |
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What are the mechanisms that affect coronary artery perfusion
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1. 1 or more artery is occluded
2. Plaques can aggregate in narrow vessels (thrombus formation) 3. Normal or already narrowed vessels 4. Drop in BP can lead to inadequate flow 5. Normal autoregulatory mechanisms fail(L & B p. 959) |
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What are some nonmodifiable risks of coronary artery disease
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1. Age- most > 65 yrs
2. Gender- men earlier effects 3. Family History (L & B p. 962) |
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what are some modifyable risks of coronary artery disease
|
1. Hypertension- BP > 140/90
2. Diabetes 3. Abnormal Blood Lipids 4. smoking 5. obesity 6. physical inactivity 7. diet 8. emerging risk factors 9. metabolic syndrome 10. factors unique to women (L & B p. 962-4) |
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Which lipoprotein primarily carries cholesterol in the blood
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Low Density Lipoproteins
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What are the optimal levels of Total Cholesterol in the blood
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Desirable: under 200
Boarderline High: 200- 239 High: 240 or higher (L & B p. 963) |
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What is the optimal level for LDL cholesterol
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optimal: less than 100
Desirable: 100-129 Boarderline High: 130- 159 High: 160 -189 Very High: >190 (L & B p. 963) |
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What is the optimal level for triglycerides
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desirable: <150
Borderline High150-199 High: 200 to 499 Very High: >500 (L & B p. 963) |
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how does cigarette smoke contribute to CHD
|
1. Carbon monoxide damages vascular endothelium, promoting cholesterol deposition.
2. Nicotine stimulates catecholamine release, increasing BP, HR, & myocardial oxygen use 3. It also constricts arteries, decreasing blood profusion 4. Nicotine reduces HDL, increases platelet aggregation, Thrombus (L & B p. 964) |
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How does Hypertension contribute to CHD
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1. damages endothelial cells of arteries, possibly due to xs pressure and altered blood flow
2. this can stimulate atherosclerotic plaque development (L & B p. 963) |
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How does obesity contribute to CHD
|
BMI >30
1. higher risk of hypertension 2. higher risk of diabetes 3. higher risk of hyperlipidemia (L & B p. 964) |
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How does physical inactivity contribute to CHD
|
Exercise has many cardiovascular benefits
1. increased oxygen availability to heart 2. decreased oxygen demand and cardiac workload 3. increased myocardial function and electrical stability 4. Decreased BP, blood lipids, insulin, platelet aggregation, and weight (L & B p. 964) |
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How does diet contribute to CHD
|
diets high in fruits, vegetables, whole grains, and unsaturated fatty acids appear to have a protect effect.
(L & B p. 964) |
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which diet programs have been shown to have beneficial effects on CHD
|
1. Pritkin diet - basically vegetarian
2. Ornish diet also vegetarian (L & B p. 968) |
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what is cardiac reserve
|
the ability of the heart to increase CO to meet metabolic demands
(L & B p. 1022) |
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What is cardiac output (CO)
|
This is the amount of blood pumped from the ventricles in 1 minute.
CO=Heart Rate x Stroke Volume (L & B p. 1023) |
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what is stroke volume
|
the amount of blood ejected with each heartbeat. It is determined by preload, afterload, and cardiac contractility
(L & B p. 1023) |
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preload
|
the volume of blood in the ventricles at the end of diastole (just prior to contraction) Blood in the ventricles exerts pressure on the walls stretching the muscle fibers needing greater force to expel blood
EX like a rubber band, farther you stretch, the harder it snaps back. (L & B p. 1023-4) |
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afterload
|
the force needed to eject blood into the circulation. this must be enough to overcome arterial pressures within the pulmonary and systemic vascular systems
Ex when a hose is crimped or plugged, more force is required to eject a stream of water out its end (L & B p. 1023-4) |
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What are the manifestations per the book of systolic heart failure
|
1. decreased cardiac output
2. weakness 3. fatigue 4. decreased exercise tolerance (L & B p. 1025) |
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what are the manifestations per the book of diastolic heart failure
|
1. SOB
2. tachypnea 3. respiratory crackles (if L ven affected) 4. distended neck veins 5. liver enlargement 6. anorexia 7. nausea (if R vent affected) (L & B p. 1026) |
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what are the manifestations per the book of left sided failure
|
results from pulmonary congestion (backwards effect)
1. cardiac output falls 2. Fatigue 3. activity intolerance 4. Dizziness 5. Syncope 6. orthopnea (SOB laying down) 7. cyanosis 8. inspiratory crackles(rales) and wheeze in lung base 9. S3 gallop (L & B p. 1026) |
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What are the manifestations per the book of right-sided heart failure
|
increased pressure in pulmonary vasculatur or rt vent muscle damage impair the rt vent ability to pump blood into pulmonary circulation.
1. rt atrium is distended 2. edema in feet and legs (or sacrum) 3. anorexia/nausea GI congestion 4 RUQ pain due to liven engorgement 5. Neck veins distended and visible due to increased venous pressure (L & B p. 1026-7) |
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what are the main goals for care of heart failure
|
Slow its progression!
1. reduce cardiac workload 2. improve cardiac function 3. control fluid retention (L & B p. 1027) |
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What are effects of Heart Failure on Respiratory system
|
1. Dyspnea on exertion
2. SOB 3. tachypnea 4. Orthopnea 5. Dry Cough 6. Crackles in lungs (L & B p. 1028) |
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What are potential complications of Heart Failure for the Respiratory System
|
1. Pulmonary edema
2. Pneumonia 3. Cardiac Asthma 4. Pleural effusion 5. Cheyne-Stokes respirations 6. Respiratory acidosis (L & B p. 1028) |
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What are effects of Heart Failure on the GI tract
|
1. anorexia, nausea
2. abdominal distention 3. liver enlargement 4. RUQ pain (L & B p. 1028) |
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What are potential complications of Heart Failure for the GI tract
|
1. Malnutrition
2. Ascites 3. Liver dysfunction (L & B p. 1028) |
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What are the effects of Heart Failure on the Musculoskeletal system
|
1. Fatigue
2. Weakness (L & B p. 1028) |
|
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What are the effects of Heart Failure on metabolic processes
|
1. Peripheral edema
2. weight gain potential complication 1. Metabolic acidosis (L & B p. 1028) |
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What are the effects of Heart Failure on Neurologic system
|
1. Confusion
2. Impaired memory 3. Anxiety, restlessness 4. Insomnia (L & B p. 1028) |
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What are the effects of Heart Failure on the Genitouriniary system
|
1. decreased urine output
2. Nocturia (L & B p. 1028) |
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what are the effects of Heart Failure on the Integumentary System
|
1. Pallor or cyanosis
2. cool, clammy skin 3. diaphoresis Potential Complications 1. increased risk for tissue breakdown (L & B p. 1028) |
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What are the effects of Heart Failure on the Cardiovascular System
|
1. Activity Intolerence
2. Tachycardia 3. Palpitaitons 4. S3, S4 heart sounds 5. Elevated central venous pressure 6. Neck vein distention 7. Hepatojugular reflux 8. Spenomegaly |
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What are the potential complications of Heart Failure on the Cardiovascular System
|
1. Angina
2. Dysrhythmias 3. Sudden Cardiac death 4. Cardiogenic shock (L & B p. 1028) |
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What are some potential complications of central catheters
|
1bleeding
2. Hematoma 3. Pneumothorax 4.Hemothorax 5.Arterial puncture 6. Dysrhythmias 7. Venospasm 8. Infection 9. Air embolism 10. Thromboembolism 11. Brachial nerve injury 12. Thoracic duct injury (L & B p. 1029) |
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What are the primary drugs given in heart failure
|
1. ACE inhibitors
2. ARBS 3. Diuretics (L & B p. 1033) |
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What are the nursing responsiblities around giving ACE and ARBs
|
1. do NOT give in 2-3 trimester
2. monitor patients with volume depletion and impaired renal function 3. use infusion pump when giving ACE IV 4.Monitor BP first 2 hrs after initial dose 5. Monitor serum K, ACE can cause hyperkalemia(less with ARBs) 6. Monitor WBC, potential for neutropenia (L & B p. 1033) |
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What are the nursing responsibilities with diuretics
|
1. baseline weight & vitals
2. Monitor BP, I & O, wt, skin turgor, edema, and issues with volume 3. Assess for volume depletion: dizziness, orthostatic hypotension, tachycardia, muscle cramping 4. report abnormal serum electrolytes 5. do not administer K 6. evaluate renal function, urine output, BUN, serum creatinine |
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What are the nursing responsibilities when giving positive inotropic agents like Digoxin (Lanoxin)
|
1. assess apical pulse <60, notify doc before giving.
2. Evaluate ECG for scooped ST, AV block, bradycardia, or dysrhythmias (PVCs and atrial tachy) 3. report toxicity 4. assess K, Mg, Ca, and serum digoxin for Hypokalemia 5. Monitor renal function 6. Be prepared to administer Digibind if toxicity (L & B, p.1034) |
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What are some symptoms of Digoxin toxicity?
|
anorexia, N/V, abdominal pain, weakness, vision changes (diplopia, blurred vision, yellow green or white halos seen around objects, & new onset dysrhythmias.
(L & B, p.1034) |
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what is the effect of Hypokalemia when taking Digoxin
|
Hypokalemia can precipitate toxicity even when digoxin is in the normal range.
(L & B, p.1034) |
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What are some take home points a nurse should provide a patient taking digoxin
|
1. take pulse before medication
2. provide toxicity symptoms 3. avoid antacids and laxatives (decrease absorption) 4. eat high K foods, orange and tomato juice, bananas, raisins, dates,figs, prunes, apricots, spinach, cauliflower, & potatoes (L & B, p.1034) |
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What are some Sympathomimetic Agents
|
stimulate the heart, improving the force of contraction
Dopamine (Inotropin) Dobutamine (Dobutrex) (L & B, p.1034) |
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What are Phosphodiesterase Inhibitors
|
these inhibitors are used in treating acute heart failure to increase myocardial contractility and cause vasodilation. Net effect, increased CO, and decreased afterload.
Amrinone (Inocor) Milrinone (Primacor) (L & B, p.1034) |
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What are the nursing responsibilities with Sympathomimetic Agents and Phosphodiesterase Inhibitors
|
1. Use of infusion pump to administer
2. Avoid discontinuing abruptly 3. Change tubing every 24 hrs 4. Amrinone IV bolus 2-3 min, then 5-10mg/kg/min 5. Amrinone-do not mix with dextrose solutions (PB after dilution maybe) 6. Monitor liver function/Platelet counts hepatotoxicity and thrombocytopenia. (L & B, p.1034) |
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What are the dietary sodium levels of a moderately restricted diet
|
1.5 - 2 g/sodium/day
(L & B, p.1034) |
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what is the suggested exercise for patients in heart failure
|
While there are periods of bed rest, this is not suggested.
3-5 days /week 10-15 warm up, 20 -30 min of exercise at recommended intensity, and a cool down period. Walking is encouraged on nontraining days. (L & B, p.1034) |
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What is the treatment of choice at end stage heart failure
|
transplant
(L & B, p.1034) |
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What nursing care is often done for heart transplant patients
|
1. bleeding is a major concern
2. chest tube drainage (monitor/15 min) 3. Monitor CO, CVP, pulmonary artery pressures (L & B, p.1035) |
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What are the primary factors that determine blood pressure
|
Cardiac output (CO) & systemic (or peripheral) vascular resistance (SVP)
(L & B, p.1155) |
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What causes BP to fall
|
BP decreases if:
decrease in CO decrease in SVP (L & B, p.1155) |
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What causes BP to increase
|
BP increases if:
increase in CO increase in SVP (L & B, p.1155) |
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Mean arterial Pressure
|
the average pressure in the arterial circulation throughout the cardiac cycle.
[systolic BP +2 (diastolic BP)]/3 (L & B, p.1155) |
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what are 4 things a patient has the right to receive as a part of the Privacy Practice Notice
|
1. How medical info is used and disclosed
2. How to obtain a copy of records 3. Summary of patient right and facility responsibilities under HIPAA 4. How to file a complain and contact info (HIPAA slides) |
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What foods should be eliminated in a patient with GERD
|
1. tomato
2. citrus 3. spicy food 4. coffee all are acidic 5. fatty foods 6. chocolate 7. peppermint 8. alcohol relax the lower esophageal sphincter or delay gastric emptying (L & M p. 666) |
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What are the names of common antacids
|
Maalox, Mylanta, Gaviscon, Aludrox, Gelusil, Riopan, Tums, Amphojel
(L & M p. 666) |
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What are nursing responsibilities for antacids
|
1. interfere with other drug absorption. Separate by 2 hrs
2. Monitor constipation/diarrhea 3. monitor for electrolyte Na, Ca, Mg (L & M p. 666) |
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What is a common Promotility Agent
|
Metoclopramide (Reglan)
Acts on CNS to stimulate upper gastrointestinal motility and gastric emptying S/E: N/V (L & M p. 666) |
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What is a common antiulcer agent?
|
Sucralfate (carafate)
reacts to gastric acid to form a paste that adhere to damaged gastric mucosal tissue. Protects and promotes healing (L & M p. 665) |
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What are common proton pump inhibitors
|
Esomeprazole (Nexium)
Lansoprazole (Prevacid) Omerprazole(Prilosec) Pantoprazole (Protonix) Raberprazole (Aciphex) MEDICATION OF CHOICE PPI inhibit the Hydrogen-Potassium ATP pump, reducing gastric acid secretions. (L & M p. 665) |
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What are the nursing responsibilities with PPI
|
1. administer before breakfast and bedtime
2. do not crush 3. monitor liver function, AST, ALT, alkaline phosphatase, and bilirubin levels. (L & M p. 665) |
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What are the common H2 Receptor blockers
|
Cimetadine (Tagamet)
Famotidine (Pepcid) Ranitidine (Zantac) Nizatidine (Axid) block ability of histamine to stimulate gastric secretions by gastric parietal cells (L & M p. 665) |
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what are the nursing responsibilities for H2 Receptor Blockers
|
1. Do not give antacid within 1 hour before or after
2. Do not mix IV. 20-100ml over 15-30 min Rapid can cause dysrhythmias and hypotension 3. Monitor interaction, antiocoagulants, beta blockers, antidepressants, may inhibit metabolism causing risk of toxicity. (L & M p. 665) |
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what is the treatment of choice for GERD
|
fundoplication
gastric fundus wrapped around distal esophagus (L & M p. 665) |
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What are the 2 types of hiatal hernia
|
Sliding and paraesophageal
(L & M p. 668) |
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Why does esophageal cancer have a high morbidity and mortality rate
|
because symptoms are not recognized until late in the course of the disease
(L & M p. 669) |
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Who is at high risk of esophageal cancer
|
1. Men
2. African Americans 50% more then caucasions |
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What are risk factors for esophageal cancer
|
1. smoking, cigarettes, opiates
2. chronic alcohol use 3. ingestion of carcinogens, nitrates and industrial chemicals 4. congenital disorders 5. chronic gastric reflux 6. physical mucosal damage- lye injestion, radiation, chronic achalasia (L & M p. 669) |
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Where does esophageal cancer lesion first develop
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15%- upper portion
35%- midportion 50%- lower third of the esophagus. (L & M p. 669) |
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What are the common manifestations of espohageal cancer
|
1. dysphagia
2. anemia 3. weight loss 4. GERD-like symptoms 5. Regurgitation 6. Anorexia 7. Chest Pain 8. Persistent cough (L & M p. 669) |
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What are the indications that esophageal cancer has spread to other regions
|
1. Difficulty swallowing
2. tracheoesphageal fistulas-aspiration and pneumonia 3. Hypercalcemia (L & M p. 669) |
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What are potential surgical complications of esophagectomy
|
1. anastomosis leak
2. respiratory complications like pneumonia, acute respiratory distress syndrome 3. gastric necrosis or bleeding 4. cardiac dysrhythmias 5. infection and sepsi intensive nursing care post op to rapidly recognize and treat complications (L & M p. 669-70) |
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why would you want to avoid moving or manipulating an NG tube after esophagectomy
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this may disrupt the suture lines, resulting in a leak into the mediastinum
(L & M p. 670) |
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Why do you provide aggressive pulmonary hygiene measures following esophagectomy
|
helps mobilize secretions and prevent atelectasis and possible pneumonia
(L & M p. 670) |
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what are the most common types of peptic ulcers
|
duodenal
(L&M, p 680) |
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what are the most common types of peptic ulcers
|
duodenal
(L&M, p 680) |
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Who is at risk for cancer of the stomach
|
1. highest in hispanics, african americans, and asian americans.
2. Men are 2x more likely 3. Older adults, mean age 63 4. lower socioeconomic (L&B p. 688) |
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Which diagnostic test is often used to detect gastric CA initially
|
CBC detects Anemia
(L&B p. 689) |
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What are risk factors for cancer of the stomach
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1. H Pylori infection 35%-89%
2. genetic predisposition 3. chronic gastritis 4. pernicious anemia 5. gastric polyps 6. carcinogenic factors (L&B p. 688) |
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What are clinical manifestations of stomach cancer
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1. initially none until progressed and metastasis
2. early satiety, anorexia, indigestion, and vomiting 3. ulcer like pain not relieved by antacids 4. abdominal mass, occult blood (L&B p. 689) |
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What provides definitive diagnosis of gastric CA
|
upper endoscopy with visualization and biopsy of the lesion
(L&B p. 689) |
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What is a partial gastrectomy
|
when part of the stomach is removed due to cancer, often the distal 2/3. Anastomies are from remainder of the stomach to the duodenum or jejunum.
(L&B p. 689) |
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what is a total gastrectomy
|
Complete removal of the stomach and anastomies are from the esophagus to the duodenum or jejunum.
(L&B p. 689) |
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Why is the NG placed after gastrectomy
|
to avoid disruption of the gastric suture lines and should be well secured. If needs to be repositioned, notify the surgeon.
(L&B p. 690) |
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What are the normal color changes in gastric drainage
|
Initially bright red, then dark, then clear or greenish-yellow for the first 2-3 days.
Change in color, odor, amount may indicate hemorrhage, infection, or obstruction (L&B p. 690) |
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Why would you maintain IV fluids while NG suction is in place after gastrectomy
|
NG suction makes it impossible to take food or fluid through NG and patient is loosing electrolyte rich fluid. Must replace fluid and electrolytes or risk dehydration, electrolyte imbalance
(L&B p. 690) |
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why is it important to monitor bowel sounds and look for abdominal distension
|
bowel sounds indicate resumption of peristalsis. Increased distension may indicate third spacing, obstruction, or infection
(L&B p. 690) |
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Why do we encourage ambulation after gastrectomy
|
it encourages peristalsis
(L&B p. 690) |
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What discharge planning should you do after gastrectomy
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1. teach of possible complications
2. teach signs and symptoms and preventative measures 3. diet modification, dietitian (L&B p. 690) |
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What is dumping syndrome
|
the most common complication of gastrectomy. It is when undigested food rapidly enter the duodenum or jejunum. Water is pulled in rapidly causing decrease in blood volume and intestinal dilations. Peristalsis activated, and intestinal motility increased
(L&B p. 690) |
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How do we manage dumping syndrome
|
dietary pattern that delays gastric emptying and allows smaller boluses of undigested food to enter the intestine
1. small and frequent meals 2.liquids and solids taken in at different times 3. protein and fats increased 4. carbs, simple sugars reduced (L&B p. 690-1) |
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What are the clinical manifestations of dumping syndrome
|
N/V, epigastric pain with cramping and borborygmi (loud hyperactive bowel sounds) and diarrhea.
SYSTEMIC: from hypovolemia and reflex sympathetic stimulation: tachycardia, orthostatic hypotension, dizziness, flushing, and diaphoresis (L&B p. 690) |
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What is the best way to be sure a g tube or j tube is in the correct place
|
aspiration of gastric contents and tesing pH
(L&B p. 692) |
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What are the nursing responsibilities for a g or j tube
|
1. Check tube location
2. Inspect skin around tube 3. Assess abdomen for distension, bowel sounds, and tenderness 4. use sterile technique until healed 5. clean gloves for removal of dressing 6. irrigate tube to clean out per order 7. provide mouth care 8. teach client and family care (L&B p. 692) |
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why do we provide mouth care for a patient with G or J tubes
|
When not taking food orally, usual stimulus is gone. Salivary fluids may not be as abundant, and oral mucous membranes may become dry and cracked.
(L&B p. 690) |
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What is cholelithiasis
|
formation of stones (calculi or gallstones) within the gallbladder or biliary duct system
(L&B p. 697) |
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what are risk factors for gallstones
|
1. age
2. family history 3. native american, north european 4. obesity, hyperlipidemia 5. rapid weight loss 6. female using the pill 7. biliary stasis-pregnancy, fasting, prolonged TPN 8. Disease cirrhosis, ileal disease or resection, sickle cell, glucose intolerenc (L&B p. 697) |
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what do gallstones consist of
|
cholesterol, and a mixture of bile components
(L&B p. 697) |
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cholangitis
|
duct inflammation from gallstones moving in from the gallbladder
(L&B p. 698) |
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what is biliary colic
|
sever, steady pain in the epigstric region or RUQ of the abdomen, may radiate to back, rt scapula or shoulder. with N/V may last 5 hrs. From gallstone entering duct
(L&B p. 698) |
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What is cholecystitis
|
inflammation of the gallbladder usually after obstruction of the cystic duct which increases pressure in gallbladder leading to ischemia of gallbladder wall and mucosa.
(L&B p. 698) |
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What are the nursing responsibilites after laparoscopic cholecyctectomy
|
1. Assist to chair side
2. advance oral intake-ice chips-regular diet. 3. provide and reinforce teaching around pain meds, incision care, follow ups 4.Initiate follow up 24-48 hours after discharge (L & B, p. 700) |
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Why would you assist a patient post op from laparoscopic cholecystectomy to a chair as allowed
|
early mobilization promoted lung ventilation and circulation, reducing the potential for postoperative complications.
(L & B, p. 700) |
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What are the nursing responsibilities for a patient with a T tube
|
1. Tube connected to sterile container
2. monitor drainage for color and consistency 3. Place in Fowler's 4. assess skin for bile leakage during dressing change 5.teach patient how to manage tube when turning, ambulating, & ADL 6. T tube care (L & B, p. 701) 6. |
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How much does a T tube normally drain
|
500ml in first 24 hours
decreases to less than 200ml in 2-3 day Minimal thereafter blood tinged at first then turns green brown (L & B, p. 701) |
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What is Irritable Bowel Syndrome (IBS)
|
Spastic bowel or functional colitis, is a motility disorder of lower GI tract.
(L & B, p. 762) |
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What are the signs of IBS
|
Abdominal Pain relieved by defecation
Altered bowel (L & B, p. 762) |
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What are the tests for IBS
|
rule out other things
CBC erythrocyte sedimentation Increased WBC (L & B, p. 762) |
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What nutritional changes can you make to help IBS
|
additional fiber
limit lactose, fructose, or sorbitol reduce gas forming foods |
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What are gas forming foods
|
cabbage, beans, apple, grape juice, nuts, and raisins.
(L & B, p. 763) |
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What is the primary nursing responsibility for IBS
|
education
referals and counceling secondary (L & B, p. 763) |
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What is an appendicitis
|
inflammation of the vermiform appendix
(L & B, p. 766) |
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strangulation as it relates to hernia
|
when a hernia has compromised the blood flow to tissue leading to necrosis
(L & B, p. 810) |
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What is the primary nursing responsibility for hernia
|
1. pre op assessment
2. teaching 3. post op care (L & B, p. 810) |
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What are the teaching interventions for hernia
|
1. assess bowel sounds Q8 hrs
2. Notify physician if hernia becomes tender or painful 3.supine position if strangulation (L & B, p. 762) |
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why do you assess bowel sounds Q8h after hernia surgery
|
Change in bowel sounds or an onset of hyperactive , high pitched sounds, may indicate obstruction which may result in increased abdominal girth.
(L & B, p. 811) |
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what is the best position if strangulation or incarceration of hernia is suspected
|
supine, hips elevated and knees slightly bent. this position helps relax the abdominal muscles and may facilitate reduction of hernia
(L & B, p. 811) |
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what are teaching topics for hernia
|
1. rationale for examining groin for bulges
2. nature of hernia, risk factors, manifestations 3. Surgical interventions 4. How to reduce hernia 5. signs of emergency-strangulation 6. notify doc if respiratory infection, cough pre-op 7. Post op pain management (L & B, p. 811) |
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what accounts for most intestinal obstructions
|
Adynamic ileus or paralytic ileus
(L & B, p. 810) |
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what are the main nursing responsibilities for bowel obstruction
|
1. Frequent assessment for complications such as fluid and electrolyte imbalance, acid-base imbalances, hypovolemic shock, perforation, and peritionitis.
(L & B, p. 813) |
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what fruits are high fiber
|
unpeeled, raw apples, peaches & pears, blackberries, raspberries, strawberries, oranges
(L & B, p. 816) |
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what veggies are high in fiber
|
dried beans (navy, kidney, pinto), lima beans, broccoli, peas, corn, squash, raw vegetables like carrots, celery, and tomatoes, potates with skin
(L & B, p. 816)) |
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what cereals and grains are high fiber
|
wheat or oat bran, cooked cereal, dry cereals like bran buds or flakes, corn flakes, shredded wheat, whole grain bread or crackers, brown rice and popcorn.
(L & B, p. 816) |
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what are the priority nursing diagnosis for diverticulitis
|
1. i mpaired tissue integrity
2. acute pain 3. anxiety (L & B, p. 817/) |
