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252 Cards in this Set
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What labs help diagnosis acute pancreatitis?
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elevated serum amylase, lipase, glucose ( d/t impaired carb metabloism), urine lipse, and triglycerides,
decresed Ca |
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What is a pancreatis abscess?
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a cavity filled with necrotic tissue inside the pancreas, edema may cause perforation. Must be surgically drained
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S/s of pancreatic abscess
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Abdominal pain
Papable Abdominal mass high fevenr elevated WBS Pleural effusion atelectasis pneumonia hyptoension tentany (d/t to the Ca binding to the fatty acids) |
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What causes megoblastic anemia?
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impaired DNA synthesis;
Cobalamin= Vitamin B12 deficiency Folic acid deficiency Alcoholism - easliy destroyed d/t fragile membranes |
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What is the most common type of cobalamin deficiency anemia?
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Pernicious anemia
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Objective assessment data of Pancreatic CA
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Most common S/S:
JAUNDICE & WT LOSS diarrhea steatorrhea clay colored stool dark frothy urine ascites leg and calf pain ( d/t increase thromopastic levels= clots) |
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What labs help to diagnosis Pacreatic CA
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decrease serum amylase and lipase
d/t decreased excretion elevated bilirubin and alkaline phosphatase d/t destruction of the biliary duct Imaging Tumor markers CA 19-9 |
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Sickle Cell anemia is what?
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The most severe of the sickle cell disease because the PT have two sickle genes
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What is the most effective tc for pancreatic CA?
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surgery
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What causes a sickle cell crisis?
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Infection
high altitude emotional and phsyical stress acidosis hypothermia idiopathic surgery blood loss increase blood viscocity from dehydration, N/V/D |
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What are the primary s/s of sickle cell?
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Pain from the sickling
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What is the nursing management for pancretic CA?
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Prepare PT for surgery
Tx s/s adequate nutirition supplement with boost or TPN Radiation therapy or tumor debulking Chemo assess for bleeding help PT and family with the grieving process team up with the dietian or nutritionist |
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What is the Whipple procedure?
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A 6 to 10 hour surgery for pancreatic CA
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PT ED for Sickle Cell Disease
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Supportive care and education
maintain hydration Pneumonia and Flu vaccination Avoid causes follow tx plan genetic counciling |
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What is hemochromatosis?
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IRON OVERLOAD
increase depostion of iron in the tissue d/t an increase in interstinal absorption the total body iron 10? normal level |
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S/s of hemochromatosis
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CHROMO=Bronze
fatigue joint pain hepatomegaly from iron build up in the liver BRONZE SKIN cardiomyopathy DM testicularatrophy arthritis |
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How do you diagnosis hemochromatosis?
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Labs and liver biopsy
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What is the nursing care and treatment of hemochromatosis?
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Care is supportive
500mL of blood removed each week for 2-3 yrs until the iron storage is depleted then less frequent to maintain Manage and Tx other oragn involvement DM HF |
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What is polycytothemia
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An increase of RBC and plasma
Hyperviscocity and hypervolvemia impairs circulation |
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What are the two types of polycytothemia?
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Polycytothemia Vera/ primary
Polycytothemia secondary |
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What is a gallbladder attack?
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Gallbladder edematous and hyperemic
maybe distend with bile and pus decrease function with tissue fibrosis |
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Post op home care after a LAP Chole
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Pt removes bandage day after shower/bathe
report to Dr and F/U s/s of infection - redness, swelling, T excess N/V, tingling of extremities or on one half of the body ADLs as tolerated work in one week low fat diet for 4-6 weeks |
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What is polycytothemia Vera/ primary?
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Genetic myeloproliferative disorder in which to many RBC are produced
insidous development and chronic course >50 yrs old Organ congection and splenomegaly are common increased RBC, WBC, PLT HTN |
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s/s of polycytothemia Vera/ primary
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CNS
HA, dizziness, tinnitus, visual distrubances (s/s of HTN) Cardiac angina, CHF, intermitten claudication, thromophlebitis, embolism, HTN CVA is the most common complication secondary to the thrombosis which is fatal |
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What is the tx for polycytothemia vera/ prmiary?
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300 to 500mL of blood removed each day until Hct is WNL
Chemo to stop the production of blood cells hydration to reduce hyperviscocity -monitor elderly for overload Allopurinol for pout attack ASSESS FOR BLEEDING THROMBOSIS IS THE MAJOR CAUSE OF DEATH |
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What is the nursing care for polycytothemia?
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I&O
hydrate chemo Teach family and PT s/s of complications and S/E assess nutritional status because PT feels full they may not be eating NOT PREVENTABLE |
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What is secondary polycytothemia?
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PREVENTABLE
chronic hypoxai cause an increase in RBC |
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Tx for seconadry polycytothemia
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Find and tx cause of hypoxia
Causes; Pulmonary disease and high altitude |
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What is anorexia althetica?
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compulsive exercise
gives power and body control take time from important things to exercise doesn't recognize exercise can be fun physcial appearance determines self-worth not satisified with achievements insists behavior is healthy |
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What are personality traits of eating disorder?
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perfectionism
OCD dysphoric - all which contribute to the vulnerability of the eating disorder |
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What are the supposed cause of anorexia?
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calorie restriction decreases trytophan which then decreases anxiety
helps to avoid the anxiety of the maturing adult body, sexual being defense against powerlessness learned behavior through positive reinforcement difference in frontal, cingulated, temporal and/or parietal rgions of the brain |
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S/s of anorexia
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wt <15% what is normal for size
usually begins during puberty unable to maintain a healthy wt for age fear of being fat distrubed body image amenorrhea starvation and denial hair loss, lanugo, bloated feeling, yellow palms or soles of feet, dry paste skin decrease body T cold sensitive cachexic appearance |
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Drugs that help with anorexia
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PT must reach 90% of optimal weight
fluoxtine Prozac decreases obsessive-compulsive behavior chloromazine Thorazine delusion or over-active PT olanzapine Zyprexa decreases obsessive-compulsive behavior |
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Interventions for anorexia
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Therapy for everyone
anxiety, dysphoria, and low-self esteem Tx is based on the intensity of s/s PT health promotion and self care Milieu therapy |
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What is Milieu therapy?
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Helps to normalize eat and build healthy eating habits
Precise meal times observation during meal time regular schedule weighing without PT seeing wt 0 bathroom trips for up to 2 hours after meals or vistiors check pockets after meals privilege liked to weight gain |
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What about gallbladder CA
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Primary is uncommon
s/s early= slow, makes for late dx difficult to dx late s/s are biliary obstruction |
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What is pernicious anemia?
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Disease in which the gastric mucosa isn't secreting IF which doesn't allow for the absorption of B12
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What test dx pernicious anemia?
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Schilling test
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What is the tx for pernicious anemia?
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fatal without tx in 3-5 years
diet alone will not replace B12 IM,SQ, or intranasally TX will not reverse neuromuscular s/s |
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What is the drug therapy for pernicious anemia?
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cyanocobalamin 30-100 mcg IM daily for one week
THEN 100-200 mcg IM each month FOREVER |
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What are the other causes of cobalamin deficiency?
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gastrectomy
small bowel resection Crohn's |
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What is cholecytitis?
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inflammation of the gallbladder
can be acute or chronic |
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What is non=obstructive cholecytitis caused by?
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older adults
trauma, burns (extensive), recent surgery prolonged immobility or fasting Prolonged TPN diabetes bacteria e. Coli |
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What is jaundice?
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it is a symptom of altered bilirubin and bile on the tissue
bilirubin is formed by the breakdown of RBS s/s yellow eyes dark urine clay-colored stools |
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What is cholelitiasis?
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stones in the gallbladder
usually in the neck or cystic duct |
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How are cholelithiasis formed?
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By altered cholestrol, bile salts, and Calcium
imbalance brought on by infection and metabloism of cholestrol |
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What are the three classes of jaundice?
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hemoltyic
hepatocellular obstructive |
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What is hemolytic jaundice?
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d/t to the increase breakdown of RBC
caused by; transfusion reactions, sickle cell, and hemolytic anemia |
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What is hepatocellular jaundice?
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damage to the liver cells/hepatocytesleak bilirubin
caused by; liver CA and hepatitis |
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What is obstructive jaundice?
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obstruction within the liver d/t harding or cirrhosis
caused by; harding and swelling of the liver, compression biliary ducts |
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What is anemia caused by?
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decreased RBC, Hgb, & Hct
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What is hepatitis?
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liver inflammation
most common type is viral |
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What causes hepatitis?
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Drugs, overdoses, chemical
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S/s of cobalamin deficiency
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PERNICIOUS ANEMIA THE ONE WITH NEUROMUSCULAR S/S
fatigue Tachycardia tachypnea exertional dyspnea dizziness vertigo HA pallor decrease in Hgb Jaundice d/t increase in bilirubin Pruritus d/t increase in bile salt concentration in tissue NEURO= PA weakness parathesia of hands of feet ataxia vibratory and postion sense confusion dementia sore, beefy, red tongue |
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Types of hepatitis
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A-G minus F
Most common A,B, & C |
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What are the causes of viral hepatitis?
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Epstein-Barr
Herpsevirus Coxsachie Virus Rubella Cytomegaly |
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S/s of Folic acid deficiency
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MACROLYTIC= LArge RBC
megaloblastic anemia Dyspesia smoot, red, beffy tongue fatigue tachycardia tachypnea exertionla dyspnea dizzy veritgo HA Pallor d/t decrease in RBS Jaundice d/t increase in bilirubin Pruritius d/t increase in bile salt in tissue |
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How is what type of hepatitis a PT has determind?
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antigen specific lab
each have there own antibody and antigen |
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What hepatitis has a vaccine?
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HAV & HBV
Post exposure immunoglobin avaialbe for HAV 2 weeks to month after exposure |
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s/s of cholelithiasis
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Severe to asymptomatic
severity of pain depends on whether the stones are mobile or not less pain if they are in the gallbladder more pain if they are in the cystic duct of the GB |
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S/s of pseudocyst
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Abdominal pain
palpable epigastric mass N/V anorexia increase serum amylase Perf will cause peritonitis rupture into duodenum and the stomach |
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Tx for a pseudocyst
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May resovle by self in a few weeks
or Internal drain procdure |
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What is a pseudocyst?
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a cavity outside the pancreas or continuous with pancreas containing necrotic tissue they can cause infection
*Complication of acute pancreatitis* |
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What is immunoglobin?
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Post prophylaxis exposure to HAV and HBV
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S/s of acute pancreatitis
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diminshed or absent bowel sounds
clay-colored and foul smelling stool Yellow, brown, cyanotic, or green abdominal wall d/t to the circulating trypsin cause vascular damaage Turner sign= blue flank Cullen's sign= blue periumbilicus d/t the seepage of blood stained exudate from the autdigestion of the pancreas decrease T increase P increase WBC hypotension shock r/t bleeding because of a decrease in vitamin K absorption Jaundice d/t the swellin of the pancreas impeding bile flow Abdominal distention |
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What is HAV
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RNA virus
poo-mouth route usually d/t food contamination doesn't become a chronic carrier only in blood for a short time IgM appears after it disappears in stool IgM= acute hepatitis IgG= post infection= life-long immunity |
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What hurts for acute pancreatitis?
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sudden onset of LUQ (epigastric region) radiates to mid back, chest, or L shoulder
severe deep and piercing continous or steady lying down makes worse acute with in 24-48 hours after a fatty meal or heavy alcohol consumption unrelieved by antacids N/V |
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Cholelithasis and cholecystis pain
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Last up to one hour
guarded/recumbent position helps biliary colic pain radiates to right shoulder/scapula tachycardia diaphoresis prostration- weak and emotional exhausted tenderness in RUQ N/V restlessness increase WBC fever |
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The causes of pancreatitis include;
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trauma to the abdomen or pancreass
post op from excessive handling drugs= thiazide diuretics, steroids, oral contraceptives, sulfonamides, and NSAIDS GB disease Carcinoma penerating duodenal ulcer Mumps hypertriglyceridemia cystic fibrosis- excess mucous |
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If left untreated what is the life-threatening complication of pancreatitis?
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sepsis, shock, renal failure, and pulmonary insufficiency
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What are the causes of pancreatitis?
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biliary tract disease= woman
cholelithiasis Alcoholism= men stimulates HCL that leads to pancreatic enzyme release |
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What are the enzymes of the pancreas?
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Amylase- digest carbs
lipase- digest fats insulin- decrease blood sugar glucagon- increase sugar trypsin- digest protein |
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What is the cause of pancreatitis?
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the active meat digester trypsin is released prematurely and starts to digest the pancreas
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What the diagnostic tests used to dx acute pancreatitis?
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ERCP
endoscopic retrograd cholangiopancreatography detects stones, pancreatic cyst/abscess US flat plate of the abdomen |
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What the diagnostic finding of acute pancreatitis?
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increased
amylase lipase urine amylase blood glucose triglycerides decrease Ca |
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What is the tx for folic acid deficiency?
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Replacement therapy
dietary supplement PO 1 mg 5 mg malabsorption |
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What are the nursing manangement goals for acute pancreatitis?
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PAIN RELIEF
normal fluid and electrolyte balance minimal or no complications no recurrent attack |
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Nursing management for acute pancreatitis?
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Antiemetics
bedrest decrease metabolic demand Promote healing |
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Pain managment for acute pancreatitis
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First priority!!!
Opiates morphine and dilaudid sitting in the fetal position or forward back rubs and quiet environment |
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Nursing manage for fluid balalnce in acute pancreatits
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IV fluids
LR or NS replace Mg, K, Na Plasma expanders prevet hypovolvemia |
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HBV
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DNA virus
is transmitted mother to baby, IV drug users. STD. blood products exposure to mucosal membranes lives up to 7 days out of body= extra cleaning more infectious than HIV have to have HBV to get HDV= increase risk for Fulminant hepatitis |
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What the complications of cholecystitis and cholelithiasis?
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Most common are:
gangrenous cholecystitis and bile peritonitis subphrenic abscess pancreatitis cholangitis= inflamed bile tract bilary cirrhosis fistulas rupture of gallbladder= bile peritionitis |
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Nursing managment for NPO status for acute pancreatitis
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NPO- Rest gut, Rest pancreas
decrease stimulation in turn decreases the need for the pancreas to need to secret enzymes Reduces pain provide good oral care even H2O can cause problems NG tube* removes HCL to prevent stimulation of pancreas control N/V *ensure not on stomach wall *risk for electrolyte imbalance |
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What are the three type of antigen of HBV?
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surface antigen HBsAG
core antigen HBcAG E antigen HBeAG |
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S/s of bile obstruction
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jaundice
dark urine clay-colored stool N/V BLEEDING tendencies steatorrhea |
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HCV
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RNA virus
transmitted from mother to babby, IV drug users, hemodylasis, blood products into mucosal membrane <1992 blood transfusions |
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How is bile obstruction dx?
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US
cholecystogram increase WBC r/t inflammation increase indirect/direct bilirubin (causes jaundice) increase urine bilirubin increase AST (SGOT) -liver ERCP |
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HOw is cholelithiasis managed with meds and why?
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If the PT is not a candiate for surgery PO meds given.
meds dissovle stones within one hour stones <5MM po 6-12 MONTHS S/E diarrhea gastritis liver damage reduce borth control effectiveness |
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Nursing managment for acute pancreatits
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Semi fowler
promotes lung expansion Encourage TCDB Monitor VS= shock FSBS= hyperglycemia electrolytes= imblalance TPN glucose monitored Diet started decrease fat, caffeine, and alcohol |
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Acute pancreatitis discharge teaching
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WHEN STABLE
Maintain a bland, low fat, high carb diet avoid large meals NO caffeine or alcohol If s/s return seek tx ASAP |
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What is an acute liver infection?
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wide spread inflamtion of the liver
s/s are generalized all accross liver disease liver can regenrate without complications normal function and appreance is possible |
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What mediates liver damage?
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cytokines= natural killer cell lysis hepatocytes
liver damamge is a result of liver cell necrosis |
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S/s of acute viral hepatits
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1-4 months *MAXIMAL INFECTIVITY*
s/s during incubation malaise anorexia fatigue nausea occassional vomiting RUG abdominal discomfort HA low grade fever arthralgia= joint pain skin rash hepatomegaly splenomegaly lymphadenopathy jaundice dark urine clay-colored stool |
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What is included in a nursing assessment of an acute pancreatitis PT?
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*PT SPECIFICCARE*
hourly urine output assess for hypovolemic shock daily wt measure abdominal girth for ascites fluid shifts to the peritoneal cavity Assess for tetany d/t calcium binding to fatty acid causing hypocalcemia jerking, twitching, and mental changes |
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What is a normchromic anemia?
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loss of normal cells and amount of Hgb
causes; pregnancy, blood loss, chronic disease, cancer |
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Convalscent phase of viral hepatitis
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WHEN JAUDNICE DISAPREARS
last weeks to months (2-4) C/O malaise, fatigue, hepatomegaly |
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What is hypochromic anemia?
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Microcytic=small RBC
decreased Hgb, abnormal shape, and weak Causes; thalassemia iron deficiency anemia lead poisining |
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Managment of cholelithiasis
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PO meds dissolve stone <5mm stones
low fat diet to decrease gallbladder stimulation fat souble vitamin replacement May reoccur Conservative tx PAIN CONTROL= NSAIDS= toradol ATB balance fluid and elelctrolytes NG tube for severe N/V Anticolinergics |
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Nursing goals for Chronic pancreatitis
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Pain relief
monitor for shock decrease pancreas secretions control fluid and electrolytes prevent and tx infections |
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S/s of chronic pancreatitis
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Abdominal pain and tenderness
reccurrent intervals for month to years increase in frequency increase in pancretic fibrosis decreases pain Heavy, gnawl feeling or buring cramps Pain unrelieved by food or antancids Ascties Palpable LUQ mass diinshed breath sounds dyspnea Cullen's sign wt loss constipation clay-colored stools Jaundice Dark urine steatorrhea |
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Examples of food high in folic acid
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*BROCCOLI & SPINACH*
Green leafy veggies liver meat fish legumes whole grains |
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What is aplastic anemia?
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* Pancytopenia= decrease in all cells
WBC RBC PLT Hypocellular bone marrow This is indiciative of the bone marrow not doing its job. Chemo can cause |
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S/s of shock
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decrease in
BP peripheral perfusion urine output increase in P Pallor |
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S/s of Aplastic anemia
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Can be abrupt of gradual
caused by suppression of some or all bone moarrow elements Fatigue dyspnea neutropenia= increase risk for infection PLT<1000 thrombocytopenia= increase for for bleeding, petechiae |
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How is aplastic anemia dx?
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bone marrow biospy
labs decreased in; Hgb hct plt |
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What is the tx for aplastic anemia?
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Remove cause
prevent hemorrhage and infection bone marrow transplant and immunosuppressives improve prognosis Adults <45yrs bone marrow transplant Adults >45 yrs immunosuppression |
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How is chronic pancreatitis dx?
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S/S
Labs amylase is slightly increased or not at all lipased increased but not at 1st mild increased in WBC increase in ESR stool samples for fecal fat content |
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Diagnostic testing for Chronic pancreatitis
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Dx based on imaging
ERCP- to visual pancreatic and common bile duct for changes CT, MRI Transabdomial US EUS Secretin test check pancreas function decrease in vol. secretion decrease in pancreas bicarb- not enoug NG tube in duodenum to check for digective enzymes, secretin |
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Nursing management for chronic pancreatitis
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Administer pancreatic enzyme
clean lips Amylase, Lipase, trypsin with each meal and snacks, swallow whole helps metabolize fat and have normal stools Tx successful= less fat in stool |
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Why is a T tube placed?
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to maintain the patency of the bile duct and bile drainage until edema subsides
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T Tube care
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Measure drainage every shift
day one 500-1000ml will decrease until DC'd output will be greenish brown Keep free of kinks protective ointment for excoriation from bile drainage dont clamp or irrigate tube removal in 3-7 days stools will be brown after removal |
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Laproscopic Cholecytectomy
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removal of the gallbladder through four small holes
CO2 instilled in the abdomen to be provide a better visual Surgery done by watching TV monitor Stones must be removed first so that the gall bladder can be removed laser is used to cauterize **Down side perfs and bleeding** |
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Post op care for a LAP CHOLE
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Monitor for bleedign and perfs
monitor VS Same day surgery usually 12 hours decrease Vitamin K sholder pain d/t gas installation pain control clear liquid diet |
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COntraindications for a LAP CHOLE
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Previous surgery with adhesions
peritionits inflamed bile duct hx of bleeding |
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S/s of anemia
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fatigue
pallor d/t decrease in Hgb exertional dyspnea lack of endurance tachypnea dizzy vertigo HA Jaundice d/t increase in bilirubin from hemolysis of RBC Pruritus d/t increase bile salts in tissue |
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Surgicial interventions for cholecytitis
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lap cholecystectomy
or open/incisional |
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Subjective s/s of anemia
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Pt hx
meds= NSAIDS tx or surgery diet hx |
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What happens with elderly who have anemia?
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Anemia is often mistaken for normal signs of aging
confusion angina ataxia fatigue CHF |
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S/s of iron deficiency anemia
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MOST COMMON*
*PALLOR* Glossitis= inflammation of the tongue Chellitis= inflammation of the lips HA |
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Who is at risk for iron deficiency anemia?
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Premenopausal women
Pregnant women low socioecomonic status older adults blood loss |
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Foods high in iron
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liver, meat, eggs, dried fruit, legumes, dark green leafy veggies, whole grain and enriched breads and cereals, potatoes
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Open/incisional cholecystectomy
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Gallbladder removed through right subcostal incision
Penrose drain to drain freely on dressing T Tube insertion in common bile duct to keep open until edema subsided |
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LAP CHOLE
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Is the tx of choice
removal of gallblader |
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Pre op nursing care for cholecystectomy
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Dr's choice
NPO? Cleansing enema? Nipple-groin skin prep NGtube low suction reduces N/V Foley |
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POst op nursing care for open chole
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Adequate ventilation
low fowlers TCDB Slpint incision NG Patency and draining assess and measure output Provide electrolytes I&O NPO until bowel sounds return Assess wound and drainage NO heavy lifting for 6 weeks low fat diet for 4-6 weeks discharge in 2-3 days |
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Tx of Iron deficinecy anemia
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Take iron with vitamin C or citrun juice to help increase absorption
taken on an empty stomach will cause GI upset= N/V Stains teeth so dilute or use straw *Turns stool dark greenish black* |
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Anemia Pt with s/s in the mouth
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gentle oral care
avoid spicy foods and strong mouth wash |
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How is iron dieficiency anemia dx?
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Labs
Hgb Hct MCV MCHC MCH reticulocytes ferritin (serum iron) TIBC Bilirubin PLT Stool guaiac endoscopy coloscopy bone marrow biospy |
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What is thalassemia?
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A genetic autosomal disorder in which not enoug Hgb is made
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Thalassemia minor Microcytic, hypochromic
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Mild form heterozygous 1 normal gene + 1 thalassemia gene asymptomatic adjust to a chronic acquired state of anemia may develop splenomegaly and mild jaundice if malformed RBC are lysised NO TX REQUIRED |
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What is thalassemia major?
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Severe form of thalassemia
homozygous 1 thalassemia gene + 1 thalassemia symptomatic |
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S/s thalassemia major
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Life threatening
decrease physcial/mental grpwth and development develop during childhood promounced splenomegaly and hepatomegaly jaundice bone marrow hyperplasia- increased bone marrow thicken of cranium- appears to have Downs |
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Tx for thalassemia major
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No drug or diet tx
tx with blood transfusion and chelation therapy iron to remove iron from blood fatal without tx |
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deferoxamin/ Desfera does what?
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TX for iron overload
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What is lithotripsy?
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ultra sonci waves
breaks up stones <3-5.30mm *Contraindicated in PT with pacemarkers |
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Complications of ERCP
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Pancreatitis
Perforation Infection Bleeding |
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Complications of ERCP
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Pancreatitis
Perforation Infection Bleeding |
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After care of ERCP
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Assess for complications= change in VS
Monitor VS every 15 minutes x 4, every 30 minutes x 2,and then every hour decrease HR and increase T |
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S/s of moderate anemia
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6-10mg/dL
palpation, dyspnea, and fatigue at rest |
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Diet for chroinc pancreatitis
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small
bland low fat= fatty foods cause diarrhea increase carbs non gaseous foods NO caffeine, alcohol, spciy foods, or heavy meals May supplement B12, A, E, Ca, and Zinc PAIN MANAGEMENT KEY**** |
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Pancreatis CA
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unknown cause
malignant growth blocks pancreatic duct majority of the tumors in pancreas head obstructive jaundice d/t tumor obstructing bile duct Poor prognosis 90% die withing first year of dx survivial rate <5% |
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What is sickle cell disease?
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Genetic autosomal recessive disorder causing an abnormal Hgb in the RBC
RBC stiffen and elongates to form sickle shape d/t hypoxia INCURABLE |
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Subjective S/s of Pancreatic CA
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MOST COMMON**
* Abdominal pain* dull aching to severe r/t to the location of the malignancy "something isn't right" anixiety anorexia nausea |
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What is a ERCP?
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Mechanical removal of the common bile duct
bascket retrieval |
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Macrocytic Normchromic anemia
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LARGE RBC with NORMAL COLOR
causes; cobalamin deficiency (B12), folic acid, liver disease (alocholism), post splenectomy |
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S/s mild anemia
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10-14mg/dL
palpations, dyspnea, and mild fatigue with exertion |
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What oxygen therapy promtoes feeding and bonding?
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nasal canaula
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US uses in 2nd trimester to do what?
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establish or conform dates
confirm viability detect poly/oligohydramnio detect congential abnormalities detect IUGR confirm placental placement visual during amniocentesis |
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What is neutral thermal enviroment?
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Environmental temperature at which oxygen consumption and metabolic rate are minimal but enough to maintain body temperature
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What are the diagnostic uses for amniocentesis?
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Evaluation of fetal health
99% accurate in dx of genetic abnormalities Fetal Lung maturity L/S ratio 2:1= mature lungs! Evaluation for fetal hemolytic disease 8:1 and up Meconium present |
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What are some indications for genetic testing?
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advnace maternal age
>35 yrs previous child with chromosome abnormalilty family hx of chromosomal abnormalilty |
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US uses in 1st trimester
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confirm pregnancy
confirm viability detemine gestational age R/O ecotopic pregnancy detect mulitfetal gestation visualization for chorion villis sampling determine uterine abnormalities detect or determine IUD placement |
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BPP admins how? takes how long?
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semifowlers or left lateral
takes 30 minutes done in 2nd and 3rd trimester |
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IUGR and SGA infants have what problems?
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perinatal hypoxia
meconium aspiration hypoglycemia/hyperglycemia temperature instability- heat loss |
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Asysmmetrical IURG looks like?
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Long, lean, with a big head and skinny body
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What is a biophyscial Profile assessment for?
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Predictor of fetal demise
Fetal breathing movement 1 or more in 30 minuteslasting 30 secs Fetal movement at least three Fetal tone active extension with return to flexion Amnio Fluid Index (AFI) >5cm or least one pocket >2cm Nonstress REACTIVE |
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Interventions for temperature instability in preterm babies
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skin to skin
if neonate is stable immeidately after birth adjust enviroment avoid drafts Bathe only after stable for one hour |
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Thermoregulation problems in preterm babies
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large surface in relation to body wt
0 brown fat immature temperature regulation in the brain 0 flexion creates more heat loss decrease in caloric intake d/t small tummies |
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Doppler blood flow analysis
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noninvasive
can begin at 16-18weeks assess placental function by directing US beam at umbilical artery highest point systolic and lowest point diastolic decrease in placental function = increase in S/D ratio |
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What is oligohydramnio?
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decrease in amniotic fluid d/t
ROM congential abnormaliteis IUGR fetal distress in labor <5cm AFI |
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What is polyhydramnio?
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increase in amniotic fluid d/t
neural tube defects GI distrubance multiple fetuses fetal hydrops >20cm AFI |
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S/s of shock
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Prolonged cap refill <3 secs
pale color poor muscle tone lethargy tachycardia followed by bradycardia continuous respiratory distress even with interventions |
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What is symmetric IUGR?
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smaller head= reduce brain capacity
result in cognitive impairment |
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Preterm baby cardiac problems include
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Hypovolemia
Shock PDA |
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What is a reactive nonstress?
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Two acelerations of FHR of 15beats/min lasting >15secs
Clinical sign Twice weekly NST remain reactive a high risk pregnancy is allowed to continue |
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SGA is what?
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weight below the 10th percentile expected a term
Supportive care depends on infant deficienies |
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How to do DMFC or "kick counts"?
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2 ways
count al fetal movement for 12 hours each day until a minimum of 10 movements are counted count fetal movement 2 or 3 times of 2 hours or until 10 movements are felt If fetal movement ceases for 12 hours or less than normal woman should contact PCP |
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Respiratory distress interventions
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perform gestational age assessment
observe s/s monitor P via pulse oximetry give supplemental O2 |
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S/s of respiratory distress
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Cardinal S/S
nasal flaring grunting tachypnea central cyanosis retractions Apneic during feedings |
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Why do preterm babies have lung problems
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Lungs aren't mature until 37-38 weeks
0 surfactant causes lungs to collapse causing hypoxia small airway lumans obstruction of airway passage |
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What is consider a post term baby?
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Born after the completion of the 42nd week gestation
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Respiratory distress syndrome RDS TX
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Supportive
O2, positive press, CPAP surfactant therapy ABGs, pulse oximetry, pH, lab NTE Nutrition |
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Clinical s/s of RDS
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Appear immeidately or with in 6 hours of birth
S/S tachycarida, grunting, nasal flaring, intercostal or subcostal retractions, hypercapnia, mixed or respiratory acidosis, hypotension, and shock |
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Contraction Stress test
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POSTIVE BAD
= late delec occuring in the last half of the contractions Means more testing necessary and possible surgical intervention |
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Negative CST
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GOOD
= NO late delec with a minimum of three contraction in a 10 minute period Means= fetus would survive labor if occured in one week |
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What is a non reactive stress test?
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BAD
= any tracing with 0 FHR acele or acele < 15beats/min or lasting <15 sec throug any fetal movement during test period This means more testing required CST or BPP |
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What cause RDS?
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Lack of pulomanry surfactant causing labored breathing and increase work to breath
* increases risk for perintal aphyxia, hypovolemia causes; maternal diabetes, 2nd twin born, maternal hypotension, c-section without labor |
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What test determine fetal lung maturity?
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L/S ratio =>2:1
Phosphatidylglycerol= present |
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What test determines Rh incompatibility?
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Coomb's test
possibel finds are 1:8 and risning is indicative of significant Rh incompatiblilty |
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What is Bronchopulmonary Dysplasia BPD?
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Chronic lung injury to infants that require manual ventilation or supplement O2
to much O2 not enough space infants weighing <1000g or born before 28 weeks |
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What is the importance of a fetal nuchal translucency?
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identifies gentic anomalies or the need for more testing
US scans the nape of the neck for transclucent are btw 10-14 weeks >2.5mm=abnroaml >3mm highly indicative of a genetic disorder or physcial abnormality |
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Care of a pretern neonate
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Incubator or NTE
O2 Monitor respiratory and cardiac function Minimal stimulation feeding as tolerated Parenteral fluids IV Blood gases |
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Risk of an amniocentesis
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1%
MOM Hemorrhage, Rh isiommunization, infection, PROM, labor, abruptio placentea, damage to intestines or other organs FETAL Death, hemorrhage, infection, needle injury, miscarriage, preterm labor, leakage of amniotic fluid |
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What is retinopathy of Prematurity?
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Increase in O2 cause vessels to contrict when the O2 is decreased it causes hemorrhage
affect developing retinas high O2 of 100% O@ undesirable visual impairment from mild ot severe |
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Tx of NEC
what happens to suriving infants? |
Early recognition KEY***
Supportive and prevention of perf NG with low suction to ecompress TPN handwashing because it is contagious ATB Surgical resection What happens to suriviors? Short bowel, fat malabsorption, Failure to thrive |
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Amnio done when and why?
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after 14th week
Prenatal dx of genetic disorders, congential anomalies, assess lung maturity, dx fetal hemolytic disease |
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Aplh-fetoprotein AFP
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Possible findings
high levels after 15 weeks gestation 15-22 weeks Predicts 80-85% of all open neural tube defects, open abdominal wall defects, and DOwns syndrome Recommend for all pregnant women *Risk of False-postive* |
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Tx of MAS
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Vigorous=nothing*
If not; direct tracheal suction observe and minimal tactille stimulation O2 and high pressure vent, nitrous oxide, ECHOMO sufactant therapy chest percussion |
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CVS risks
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Higher risk than amniocentesis
transcervically or transabdominal= fetal loss is the same Complications vaginal spotting or immediate bleeding, misscarriage, ROM, chorionamnioitis, fetomaternal hemorrhage, (Rh negative will receive immunoglobin) limb anomalies) |
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S/s of NEC, occuring when?
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S/s
"something isn't right" decreased activity hypotonia pallor reccurent apnea bradycardia decrease o2 sats, respiratory distress metablic acidosis oliguria hypotension decreased perfusion T instability cyanosis abdominal distension increase or bile stained residual gastric aspirates vomiting ( bile or blood) grossly bloody stools red tender abdominal wall Onset 4 to 10 days after birth ( up to 30 days) |
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What is meconium aspiration syndrome?
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Meconium in the amniotic fluid that is aspirated into the tracheobronchial tree in utero during first breath of air.
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Worries with post term babies
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placental insufficiency
LGA, SGA, AGA dysmaturity no vernix loss of SQ fat and muscle mass emaciated or cachexia meconium stained finger nails long hair and nails |
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What is Necrotizing entercolitis?
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infammatory disease of the GI mucosa which is common complicated by perforation
unknown cause 3 factor that help the development of NEC intestintal ischemia colonization of bacteria substrat (formula feeding) in the instestinal lumen |
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Nursing care for PV-IVH
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Prevention and supportive care
infant is positioned midline, HOB up to minimize the change in ICP No rapid infusion of fluid NTE Monitor BP |
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What is Periventicular- Intraventicular hemorrhage
PV-IVH |
*Most common neurological injury*
Blood vessels rupture when homeostasis is not maintained Occurs within the first 72 hours of life |
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CVS procedure consists of?
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Procedure is done btw 10-12 weeks gestation
Removal of small tissue from the fetal portion of the placenta reflects the genetic make up of the fetus |
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S/S of BPD
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respiratory distress
exercise intolerance tachycardia, crackles decrease air movment expiratory wheezing |
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BPD Tx
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supportive
O2 fluid restriction nutrition corticosteriods diuretics Prevention of preterm birth |
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PUBS requirements for after the procedure
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Monitor FHR for one hour
F/U us to assess for bleeding or hematoma |
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What is percutaneous umbilical blood sampling?
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US guided needled directly into the umbilical vessel
1 to 2 cm from insertion into the placenta done in the 2nd and 3rd trimester Indication include; inherited blood disorder detect fetal infection intrauterotransfusion |
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Infant of a DM mother
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If insulin isn't controlled will have macrosomia d/t increas in visceral organ size, cardiomegaly, and an increase in body fat.
Caused by maternal blood glucose |
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Three reason for intrapartal meconium
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normal to poo
fetal hypoxia umbilical cord compression caused vagel response= poo |
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How to support NICU parents
|
Prepare before birth as much as possible
allow them to touch and see infant ASAP Allow them to "see" infant despite cord and hoses Educate on NICU normal CPR before discharge |
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Care of a hypothermic infant
|
swaddle in transport
observe s/s pf cold stress assess blood glucose INTERVENTION FOR COLD INFANT Warm 1* per hour to avoid apnea Give warm fluids Kangaroo care when stable |
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Nursing managment for LGA
|
Check blood glucose hourly for the first four hours and then every four hours
Blood glucose <40mg/dL will have early feeding If PO feeding doesn't maintain blood glucose IV glucose maybe needed PT teach s/s Monitor close |
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What is considered full term?
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Born btw 38 and completion of 42 weeks gestation
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Preterm infant is?
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Born before 37 weeks
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Late preterm infant
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Born btw 34 0/7 and 36 6/7 weeks regardless of weight
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Development support for preterm babies consists of?
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Turn down alarms and/or replace with lights
Dim lights or place blanket of incubator suddle gentle touch used nest, swaddle, allow for hand to mouth Kangaroo care non-nutritve sucking co-bedding with multiples massage |
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What is surfactant replacement therapy?
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reduces surface tension of the fluids lining the alveoli at respiraotry tract
<32 week infants don't have enough surfactant to survive Reason for antenatal setroids and surfactant therapy |
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Contraindications for CST
|
ABSOLUTE!
Preterm labor, classic c-section hx, ROM, placenta previa, and abruptio placentae |
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CST procedure
|
Semifowlers or sitting position
Nipple stimulation or oxytocin admin IV to cause contractions FHR and UC monitored for 10-20 minutes Negative =good three contraction in 10 with no late delec. Baby would survive birth if it happened within the next week Positive= Bad repetitive and persistent late delec with at 50% of contractions |
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Fetal acoustic and vibroacoustic stimulation test
|
used during BPP or NST
induces movement that cause FHR acele. |
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NST detects what?
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GOOD=REACTIVE
adequate oxygenation and intact CNS = acele of FHR with fetal movement *increase risk for false positive d/t fetal sleep cyles, maternal smoking, meds, fetal immaturity * Left tilted semifowlers= position |
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Genetic risk for fetal well0being
|
defective genes
transmittable inherited disorders chromosome abnormalites multiple pregnancy large fetal size ABO incompatiable |
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S/s of neonatal infection
|
T instable
hypothermic Lethargy, irritability Altered LOC Cynaosis, pallor, jaundicemottling Poor perfusion, hypotension bradycarida tachycardia Prolonged cap refill tachypnea bradypnea apnea retractions, nasal flaring, grunting feeding intolerance, increase in residual V/D Bloody stool abdominal distention glucose instability meatbolic acidosis electrolyte imbalance decrease urine output |
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Why is a preterm infant at risk for an infection?
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mother passive immunity missed during last trimester
Strict handwashing |
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Assesment for neonate on O2
|
continous oximetryABG
VS,HR, R, BP |
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Why is Narcan contraindicated in infants?
|
can exacerbate neonatal abstinence syndrome
*can cause seizure* |
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Newborn tx for drug babies
|
Manage complications
test for syphilis, HIV, and HBV urine screening meconium analysis= without permission social service referal nutritional support |
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What happens to drug babies?
|
Intrauterine asphyxia and infection
altered birth weight low apgars respiratory distress jaundice congential anomalies growth restriction withdrawal SIDS *shrill persistent cry* |
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Tobacco problem for fetus
|
intrauterine hypoxia and distress
IUGR or preterm meconium staining deficient in growth and development increased startle reflex increase risk for SIDS |
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FAS characterics
|
Inconsolable cry
will not sleep hyper and jittery continues through the first month of life abnormal reflexes |
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What does FAS cause?
|
abnormal structural development
CNS dysfuntion growth deficiency Failure to thrive- restricted Wt facial abnormalities- small head and a board nose Heart, kidney, eyes, and skeletal defects |
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What is the leading preventable cause of cognitive impair in neonates
|
FAS
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The fatality of syphilis depnds on what?
|
the time of exposure
later is better asymptomatic until discharge |
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What is given for gonorrhea?
|
erythomycin eye prophlyaxis
within one hour of birth Single IM injection of Rociphine |
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What does TORCH stand for?
|
Toxoplasmosis
Other- gonorrhea, syphilis, varicella, HBV, Parvo B19, HIV Rubella Cytomegalyvirus Herpes Simplex |
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Nursing care for neonate with infection
|
**PREVENTION= HANDWASHING & GLOVES**
ATB- dosed by weight watch for s/s and chart NTE Respiratory support Monitor cardiac encourage breastfeeding and adequate calories, fluids, and electrolytes Allow parents to visit |
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Dx of nenoate infection
|
2 peripheral blood draws
test skin lesion *urine via cath= rare* |
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S/s of neonate infection
|
"something isn't right"
lethargy T instability pallor cool and calmy skin feeding intolerance hyperbilirubinemia tachycardia tachypnea bradycardia apneoc spells appears shock like |
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What is septiemia?
|
generalized infection of the blood
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|
Neonatal infection can occur when?
|
congential
early onset 24-48 hours or 7-30 days nosocomial ****PT teach S/s of infection**** |
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CNS injuries include;
|
intracranial hemorrhage
subdural hematoma Nursing care is supportive neuro checks, IV therapy, manage seizures, and prevent ICP |
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What is the danger and care of phrenic nerve paralysis?
|
diaphramatic paralysis and respiratory distress
place on effected side d/t lung not fully expanding facilitys max expansion watch for respiratory distress |
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|
Facial nerve injury
S/S Nursing care |
loss of movement of affected side
inabilty to close eye and droopy corner of the mouth S/s dysphasia and sucking issues Nursing care may require gauage feeding, artifical tears or tape eye shut *resovles in days to week* |
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Erb's Palsy
|
Shoulder and arm adducted at internal rotated
arm hangs limp Nursing care abduct arm 90* with should rotated passive ROM heals in 3-6 months PT EDUCATION** start or end with affected arm football hold |
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S/s of birth trauma
|
limitation of arm motion, creptius over none, absence of Moro reflex
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What expeites care of a newborn at risk?
|
prompt recognition of s/s
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What is gastroschisis
|
herniation of bowel through a defect in the abdominal wall to the right of the umibilicus
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What is omphalocele?
|
*more common abdomnal defect
covered defect ofthe umbilical ring in which a variety og amounts of abdominal organs ahve herinated Nursing care cover with sterile dressing NTE Fluid balance Tx Surgery |
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Tracheoesopageal fistula what?
|
abdominal connection btw the esophagus anf the trachea
S/S excessive secretions choking coughing vomiting through nose gagging Nursing care Supportive NTE IV to maintain fluid and electrolye balance TX surgical correction |
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Esophageal Atresia
|
Esophagus ends in a blind pouch or narrows so thin it fails to allow for complete passage
S/S excessiv coughing, choking, gagging, vomiting through the nose, excessive secretions Nursing care supportive until surgical correction |
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Cleft lip or palate
|
congential defect in which the primary palate fails to close causing a midline fissure or opening in the lip or palate
this cause an increase risk for aspiration makes feeding difficult cosmetic fix |
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Congential diaphrgamatic hernia
|
defect in the formation og diaphragm, allowing abdominal organs to be displaced in the thoracic cavity
NEONATAL EMERGENCY S/S respiratory distress, bowel sounds in chest, breath sounds dinimshed TX ECMO and NG TUBE |
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Choanal atresia
|
* most common congential abnormality*
nony or membranous septum located btw the nose and pharynx S/S bilateral apneic cyanotic ate rest TX surgery |
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Micorcephaly
|
small head
cognitive impairment |
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Hydrocephalus
|
ventricles of the brain are enlarged d/t an imbalance in the prodctuon and absorption of the CSF
S/S bulging anterior fontanels increased head circumference Nursing care Neuro checks and check head circumference Tx surgical shunting |
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Spina bifida
|
*most common CNS defect*
failure for the neural tubes to close at some point 2 tyoes occulta and cystica meniingocele= CFS sac myelomeningocele= sac of nerves, dx prenatal C-section to protect cele |
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Anencephaly
|
absence of both cerebral hemishperes and the overlying skull
incompatiable with life still born or die soon after |
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Encephalocele
|
Herniation of the brain and meninges through a defect in the skull
maybe associated with hydrocephalus TX Surgical repair and shunting to releive hydrocephalus unless malformation of the brain is present |
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Immature renal function od a preterm neonate
|
unable to adequately excrete metabolites and drugs
concentate urine maintain acid-base, fluid, or electrolyte balance asses and I&O and specific gravity |
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