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Where do you get the information when doing an assessment?
pt/family and chart
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Why is the pt data recorded?
continuity of care and communication
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cold, clammy, HA, confusion, blurred vision, mood changes are all S/Sx of what?
Hypoglycemia
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An area where adipose tissue has become lumpy and wierd; caused by repeating injections in the same spot is called what?
lipodystrophy
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What are some general rules if you have DM and you get sick?
- -continue taking meds
- -check sugars q 3-4 hours
- -continue eating easy to digest small meals
- -call the dr if glucose gets over 300
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How do insulin and exercise go together?
- -increases insulin receptor sites
- -lowers blood glucose level(decrease insulin requirements)
- -contributes to weightloss
- -essential part of diabetes managment
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Oral hypoglycemics are used for which type of DM ?
Type 2
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What is the nutrition guidlines for DM type 2 ?
- -for type 2, weight loss is the key to treatment, and a weightloss as small as 5% can greatly improve blood sugars
- -meals should not be skipped, small healthy snacks and meals.
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Why is Foot care important when a pt has DM?
- -neuropathy
- -check feet every day
- -wash feet every day(check water temp, dont soak them)
- -no lotion between toes(bacteria)
- -never go barefoot
- -keep blood flowing, dont cross legs or smoke :)
- -call dr if there is a sore that is not healing.
- -trim toenails q week. use emery board or nail file
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What is the cause of type one DM?
Genetic predispostion combined with an enivromental or immunologic factor
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Insulin reaction causing hypoglycemia could be?
too much insulin, too much exercise, not enough food. so after injection of insulin eat a small snack (smeltzer)
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Complications such as: hypocalcemia, hemorrhage and airway concerns, would be from which surgery?
Thyroidectomy
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What are some Nursing DX for Cushings syndrome?
- -risk for falls and injury r/t weakness
- -self care deficits r/t weakness and fatigue, muscle wasting and altered sleep patterns
- PT IS AT RISK FOR FALLS !!!!
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Adrogens
glucocorticosteriods
mineralocorticoids are the three steroids produced by what?
The Adrenal Cortex
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Chronic Adrenocortical insufficiency also inadequate production of ACTH can cause what ?
Addisons disease, most commonly caused by therapeutic use of corticosteroids. (smeltzer pg 1279)
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-fatigue
-weight gain
-irritable
-body temp lower
-hair loss
-goiter are all s/sx of what disease?
Hoshimotos thyroiditis
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exopthalmus(buggy eyes)
weight loss
increase in appetite
hot & sweaty
tachycardia
bowel and menstural changes
all are s/sx of what ?
Graves disease
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You will need a EGD and biopsy ever 6-12 months if you have what?
Barretts Esophagus, which is a precancerous condtion caused by chronic UNTREATED reflux
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Stinky Halatosis breath
dysphagia
bacteria infections
regurgitation
All of these are clinical manifestations of what?
Esophogeal diverticulum (zenkers diverticulum is a name for it)
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What is pt teaching for pts with esophageal reflux?
- -keep upright for at least 2 hours
- -always elevate the bed if pt is bedfast
- -dont eat irritating foods such as caffiene, alchohol (ange would die :) ), milk ,mint etc.
- -take medications such as pepcid or zantac
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What clinical manifestations indicate the need for an EGD?
- -suspected upper gi bleed
- -chronic GERD
- -ulcers
- -hiatal hernias
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what are some complications of a NG tube?
- -aspiration
- -tube displacement
- -tube obstruction
- -nasopharyngeal irritation
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The following sypmtoms:
-dull gnawing pain
-pain is relieved when pt eats
-sharp localized pain
-heartburn
-bleeding and tarry stools may occur
-*some pts are asymptomatic
would be caused by?
a peptic ulcer
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What is the pathopysiology of the peptic ulcer?
an excavation formed in the mucosal wall of the stomach, pylorus, duodenum, or esophagus. It is associated with H-pylori bacteria, chronic use of NSAIDS, alcohol, excessive smoking and high stress.
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What is Zantac (Ranitidine)?
medication that reduces the production of HCL and blocks histamine on histamine receptor of parietal cells in the stomach.
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what is the criteria for selection of pts for bariatric surgery?
- - BMI greater than 30
- -100 lbs over IBW
- -failure to lose weight by other methods(must be documented)
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What is a gastrectomy?
a surgery preformed to treat cancer and perforations of the stomach wall. Removes part of the stomach. somtimes used in severe cases of duodenal ulcers
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What are some complications from gastrectomy surgery ?
- Vitamins and mineral difiencies such as:
- - loss of the intrinsic factor so Vitamin B12 absorption is interrupted and pernicious anemia can occur. Regular Vit B12 shots are given.
- - Also dumping syndrome can be a big problem with absorption of needed nutrients, so the pt will need to eat small meals.
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The stomach rapidly empties into the duodenum, 15 minutes after eating, can cause hypoglycemia.
Dumping syndrome
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Pt teaching for dumping syndrome would be?
- no fluids with meals
- no salts
- no high carbs or concentrated sugars
- can cause vitamin deficency
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What is the cause of chronic gastritis?
- prolonged inflammation (h-pylori)
- smoking is a risk factor
- diet and medication such as NSAIDS can be harmful to the stomach
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What medication would cause you to avoid these types of food?
-milk and dairy products
- Tetracycline
- can also cause photosensivity so wear sunscreen.
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What would the stool look like in a pt with ulcerative colitis?
Watery with blood and mucus
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What is pt teaching in the pt with ulcerative colitis?
Take an antidiarrheal med, diet needs to be bland low residue, high in protien, calories and vitamins.Supplement vitamins, iron, and electolytes
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Clincal manifestations such as :
-crampy wavelike pain
-may pass blood or mucus but noe fecal matter
-fecal vomiting
-dehydration
-tounge and mucus membranes become parched
Are s/sx of what?
Small bowel obstruction
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In a colostomy, stoma assessment what is normal?
Red and beefy!
abnormal would be any other color, like purple which would mean compromised circulation
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What is management for chronic constipation?
- -increase fluid intake
- -include high fiber in diet
- -exercise regularly
- -if laxitive is necassary use bulk forming agents and osmotic agents, lubricants and fecal softeners
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These s/sx would cause you to think your pt has what?
-RLQ pain
-N/V
-Fever
-rebound tenderness
-Pain at mcburrneys point
Appendicitis
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Where is mcburrnys point?
just above the appendix, pain is present if pt has appendicitis
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What is medical managment for divertiulitis?
- -high fiber, low fat diet
- -administering bulk preperations such as metamucil, stool softeners, warm oil enemas and evacuant suppositories
- -administer antibiotics if needed
- -bowel rest
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What is nutritional therapy for pts with IBD? (Irritable Bowel disease)
- -oral fluids and low-residue, high-protien, high-calorie diet with supplemental vitamin therapy and iron replacement .
- -fluid and electrolyte imbalance
- -no milk
- -cold foods and smoking are avoided
- -IV therapy if indicated
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Chronic use of alchohol can cause ?
Cirrhosis
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Eyes (sclera)
Skin
mucus membranes are all spots you can check for?
Jaundice. also lab draw if needed
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Whatis ascites?
- Increased abd girth and weight gain
- fluid in the abd.
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What are the dietary restrictions for a pt with ascitites?
- NO salt
- use diuretics if pt does not respond to the sodium restrictions.
- restrict fluid intake
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Hepatitis B is transmitted through what?
Bodily fluids such as blood, urine, and mucus and who is at greater risk for this ? none other then US !! health care workers with frequent exposure to blood. (or if you have multiple sexual partners or recent history of STD)
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What are complications from a cholecystectomy ?
Bile ducts can get plugged resulting in the bile being forced back into the liver and the blood stream which will cause jaundice.
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Low calicum can result in ?
Tetany*** which can be caused from hypoparathyroidism or if the parathyroid was disturbed during a thyroidectomy. so check calcium levels postoperativly
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