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Dysphagia:
Difficulty swallowing
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Types of Hiatal Hernias: (2)
- Sliding (type I) *most common
- Paraesophageal (type II, III, IV)
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NPH insulin onset, peak, duration:
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What kind of insulin can be administered IV?
Regular (Humalog R)
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Oral Hypoglycemics:
- Sulfonylureas (1st and 2nd generation)
- Stimulates beta cells to secrete insuline
- *(Diabinese) chlorpropamide
- * (Amaryl) glimepiride
- * (Glucotrol) glipizide
- * (Micronase) glyburide
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ADPIE
Assessment: Collecting subjective & objective data
Diagnosis: Identify problems, diagnoses (nursing and collaborative)
- Planning: Develop goals & outcomes
- Implementation: Nursing interventons
Evaluate: Pt.s response to interventions. Have outcomes been achieved?
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What/who provides information during the assessment?
Patient, family, medical record,
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Why is data recorded during the assessment phase?
- Continuity of care,
- Communication,
- Bases for evaluating care,
- Legal/business record
- Research
- Education & planning
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Communication techniques:
- Listening
- Silence
- Restating
- Reflection
- Clarification
- Focusing
- Humor
- Information sharing
- Suggesting
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What is the purpose for health education?
- Promote behaviors that facilitate health
- To provide up-to-date health information,
- teach people to live the healthiest form.
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How do you determine learning readiness in a Pt.?
Based on culture, personal values, physical & emotional status, past experience in learning.
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S/S of Hypoglycemia:
- Cool, clammy skin
- Rapid, weak pulse
- Hungry/thirsty
- Decreased BP
- Anxious
- Confusion
- Headache
- Blurred vision
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Lipodystrophy (from insulin injection):
Tough, lumpy areas of fat (Rotate injection sites to avoid)
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Sick-day rules related to diabetes mellitus:
- Monitor blood glucose q3-4hrs
- Continue medications as usual
- Diet of easily digested foods and liquids
- Call provider is blood glucose >300 or unable to retain fluids
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Types of medications used for pt.s w/ DM2
- Oral hypoglycemics:
- -Sulfonylureas: stimulates beta cells to secrete insulin
- -Biguanides: increase body tissue sensitivity to insulin, Inhibit production of glucose by liver
- - Thiazolidinedilones: sensitize body tissue to insulin
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Sulfonylureas
Oral hypoglycemic that stimulates beta cells to secrete insulin
-
Biguanides
- Oral hypoglycemic that…
- -Increases body tissue sensitivity to insulin,
- -Inhibit production of glucose by liver)
-
Thiazolidinedilones:
Oral hypoglycemic that sensitize body tissue to insulin
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Nutrition guideline for DM2
- 50-60% Carbs (whole grain)
- 20-30% Fat
- 10-20% Protein
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Etiology of DM1
Destruction of the beta cells of the pancreas possibly from infection/environment that triggers an autoimmune response.
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Complications of thyroidectomy:
- Swallowing problems
- Hypothyroidism
- Parathyroid damage (hypo-function=low calcium)
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How are thyroidectomy complications manifested?
- s/s hypothyroidism
- low calcium
- dysphagia
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Possible nursing Dx for Cushing’s syndrome:
- Fluid volume excess r/t sodium retention manifested by edema, HNT
- Risk for injury r/t weakness/fatigue
- Risk for infection r/t impaired immune response.
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What 3 steroids does the adrenal cortex produce?
- Glucocorticoids
- Mineralcorticoids
- Androgens
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What is the deficiency to cause Addison’s autoimmune or idiopathic?
Adrenocortical/ cortical insufficiency
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Hashimoto’s thyroiditis:
- An autoimmune disorder
- Similar to hypothyroidism: fatigue, weight gain, anorexia, decreased body temp, hair loss
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Characteristics of Grave’s Disease:
- Weight loss
- Increased appetite
- Heat intolerance
- Tachycardia
- Nervous/hyper
- Dry itchy skin
- Eyes bug-out
- Goiter
- Muscle weakness
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Patient teaching regarding Barrett’s esophagus:
A pre-cancerous condition that must be assessed q6-12 months to rule out cancer
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Clinical manifestations of Esophageal Diverticulum:
- Dysphagia
- Regurgitate food
- Sour taste in mouth
- Halitosis (ass-breath)
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Patient teaching for esophageal reflux:
- Sit up for at least 2 hrs after eating
- Avoid carbonation, caffeine, milk, mint, alcohol, irritating food
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What manifestations indicate need for EGD?
- Barrett’s esophagus (rule-out cancer)
- Suspect upper GI bleed
- Persistent dyspepsia
- Dysphagia & odynophagia (painful swallowing)
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What are the possible mechanical complications from a NG tube?
- Aspiration pneumonia
- Tube displacement
- Tube obstruction
- Nasopharyngeal irritation
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Pathophysiology of peptic ulcer:
An excavation that forms in the mucosal wall of the pylorus, duodenum, and/or esophagus. Cause linked with H. pylori.
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Clinical manifestations of a peptic ulcer:
- Dull gnawing pain in mid-epigastric region
- Pain relieved/reduced from eating
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Ranitidine (Zantac) Action of medication:
- Inhibits gastric secretions (HCL) by blocking the H2 receptor
- Decreases production of HCL
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Criteria for selecting bariatric surgery pt.:
- Number of co-morbidities
- BMI > 30 or 100 lbs overweight
- Only after other methods of weight loss have been tried and failed
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Complications of gastrectomy:
- Vit. & mineral deficiencies
- Dumping syndrome
-
Dumping syndrome:
- Rapid stomach emptying into duodenum
- Complication of gastric & bowel surgery
- Caused when high sugar liquids are ingested
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Causes of Chronic gastritis:
- Prolonged inflammation (H. pylori)
- Diet
- Chronic NSAIDs, ASA use
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Foods to avoid when taking Tetracycline:
- Dairy products
- Iron
- Antacids
- Calcium
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Stool characteristics of Ulcerative Colitis:
Watery with blood and mucus
-
Pt./family teaching for Ulcerative Colitis:
- Diet: bland, high protein, high calories, high vit. Low residue
- Relaxation techniques
- Small meals
- Avoid caffeine, alcohol, and smoking
- Avoid skin breakdown by cleaning the tushy after each poop session
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Clinical manifestations of Small Bowel Obstruction:
- Pain
- N/V (sometimes feces)
- Constipation
- Diarrhea
- Hypovolemia
- Change in electrolytes
-
Management of chronic constipation:
- Exercise
- Increase fiber diet
- Increased fluids
- Stool softener
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Clinical manifestations of appendicitis:
- Severe pain starting in umbilicus moving to LRQ to Mcburney’s Point
- N/V, fever
- Rebound tenderness
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Medical management of diverticulitis:
- High fiber diet
- Low fat
- Or
- Clear liquid
- Bowel rest
- IV fluid
- Antibiotics
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Nutritional therapy for Inflammatory Bowel Disease (IBD):
- Bland
- Low residue
- High protein
- High Calorie
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Mcburney’s point:
- Roughly corresponds to most common location of base of appendix where it attaches to cecum.
- Pain in the area sign of appendicitis
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Common cause of cirrhosis:
Chronic alcohol use/abuse
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Where is jaundice observed on the body?
- Skin
- Sclera of the eye
- Mucous membranes
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What are some dietary restrictions for Ascites?
- Limit salt and fluids
- No starches (rice, wheat)
- Avoid alcohol
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What is Ascites?
Excess fluid accumulation in the abdomen
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How is Hepatitis B transmitted?
Bodily fluids
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What are some complications to a laparoscopic Cholecystectomy?
Bile duct injuries
-
Medications to combat H. Pylori:
- Amoxil
- Biaxin
- Flagyl
- Tetracycline
- Pepto Bismol
- Protein Pump Inhibitors
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