HESI Final Exam – Flashcards
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How specifically are nutrients absorbed?
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The inner surface of the small intestine contains millions of tiny fingerlike projections called villi, which are clustered over the entire mucous surface. They are responsible for absorbing the products of digestion into the blood stream.
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What problem do we observe for and prevent post surgically on ileostomy patients?
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Bowel and urinary elimination; fluid and electrolyte balance; tissue perfusion; comfort/pain, nutrition; gas exchange; infection; and in the case of ostomy construction, assessment of the ileostomy and peristomal skin integrity.
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What do we assess for in patients receiving radiation therapy of the esophagus?
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Special problems associated with radiation therapy include the development of an esophagotracheal fistula (an abnormal passage between two internal organs). Aspiration from the fistula and edema from the radiation must be anticipated.
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What is esophagogastroduodenoscopy?
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EGD, enables evaluation of the esophagus, stomach, and duodenum
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What is achalasia?
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Inability of a muscle to relax, particularly the cardiac sphincter of the stomach.
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What kind of diet will be encouraged for patients with acuyte diverticulitis?
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Low fat, high fiber
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How do you plan meals to prevent dumping syndrome?
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Treatment includes eating six small meals daily that are high in protein and fat and low in carbohydrates, eating slowly, and avoiding fluids during meals.
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What precautions do we take with patients with suspected appendicitis?
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No pain medications, no heat pack, no enema or laxative
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What do you do with a stool specimen obtained for ova and parasite?
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The specimen should be taken to the laboratory within 30 minutes of collection in specified container.
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What is strangulated hernia?.
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The hernia is strangulated when the blood supply and intestinal flow are occluded. Immediate surgical intervention is performed when a hernia strangulates, to prevent anaerobic infection in this affected area.
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What nursing interventions are implemented s/p a liver biopsy?
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Keep the patient lying on the right side for a minimum of 2 hours to splint the puncture site. In this position, the liver capsule is compressed against the chest wall, thereby decreasing the risk of hemorrhage or bile leak.
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What procedure is performed to reduce ascites?
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Paracentesis is a temporary method of removing fluid by withdrawing fluid from the abdominal cavity by either gravity or vacuum.
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What patient teaching is done for patients to have an esophagoscopy?
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After the procedure, keep the patient NPO until gag reflex returns; assess for abdominal pain, tenderness, and guarding.
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Flapping tremors (asterixis) is seen in patient suffering from what?
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Hepatic encephalopathy is a type of brain damage caused by liver disease and consequent ammonia intoxication.
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Explain what esophagus varices are:
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Esophageal varices (a complex of longitudinal, tortuous veins at the lower end of the esophagus) enlarge and become edematous as the result of portal hypertension.
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What chemical accumulates in patients with cirrhosis?
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Ammonia
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What meds relieve toxic blood levels of ammonia?
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Lactulose and Neomycin
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What are the s/s of cholecystitis?
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Pain in the RUQ epigastric region. The pain radiates around the midtorso to the right scapular area. Anorexia, nausea, vomiting, and flatulence.
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How is Hepatitis A transmitted?
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Oral-fecal route
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What is an ERCP and what complications do we assess after this procedure?
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Endoscopic Retrograde Cholangiopancreatography of the Pancreatic Duct -- Dye is injected for radiographic visualization of the common bile duct and pancreatic duct. ERCP of the pancreas is a sensitive and reliable procedure for detecting clinically significant degrees of pancreatic dysfunction -- assess for pancreatitis
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Why are patients with cirrhosis placed on low-protein or no protein diets?
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Protein is a breakown product of ammonia and the liver cannot metabolize the ammonia
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What is Cyclosporine and when is it prescribed?
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Cyclosporine is an effective immunosuppressant drug. The use of cyclosporine has been a major factor in the success rates of liver transplantation. It does not cause bone marrow suppression and does not impede wound healing.
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What complications should you assess for with the patient on Cyclosporine?
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Infection
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What is jaundice and what serum tests are ordered?
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Jaundice is the discoloration of body tissues caused by abnormally high blood levels of bilirubin (bilirubin exceeds 2.5 mg/dL). Tests ordered are AST, ALT and LDH
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What are the common causes of pancreatitis?
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Acute or chronic pancreatitis is generally the result of damage to the biliary tract, as by alcohol, trauma, infectious disease, or certain drugs.
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Why are patients with pancreatitis often NPO?
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Food and fluids are withheld to avoid stimulating pancreatic activity, and IV fluids are administered. The patient is on NPO status, and an NG tube is inserted to decrease pancreatic stimulation, treat or prevent nausea and vomiting, and decrease abdominal distention.
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What is the process by which bacteria, cellular debris, and solid particles are destroyed and removed?
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Phagocytosis
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What does differential indicate?
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A differential white blood cell count is an examination in which the different kinds of WBCs are counted and reported as percentages of the total examined. They can indicate severe infection
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Plasma make us what percentage of blood?
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55%
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What does "shift to the left" indicate?
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Severe Infection
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Where are the erythrocytes produced?
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Bone Marrow
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What is the spleen and what is stored there?
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Large lymph organ, stores 500ml (1 pint) of blood which can be released during emergencies, such as hemorrhage, in less than 60 seconds.
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What is Pernicious Anemia?
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Autoimmune disease, inadequate absorption of vit B12
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What nursing care is implemented for patients with multiple myeloma?
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Pain relief, prevent infection, increase fluids 3-4L to dilute calcium and prevent trauma/injury
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What side effects occur with iron supplements?
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Green or black stools, constipation, teeth discoloration
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What is the occurrence of sickle cell anemia?
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1:500 of African Americans
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What is the normal platelet count?
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150,000-400,000
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What nursing intervention is imposed if platelets are low?
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Start bleeding precautions: watch for bleeding, soft toothbrush, electric razor
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What is DIC?
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Disseminated Intravascular Coagulation, over stimulation of clotting and anti-clotting process
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What is Hodgkin's disease and what type of cells do we see with this disorder?
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Type of cancer, disorder of lymph, Reed-Sternberg cells
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What is polycythemia vera and what procedure is performed to control this condition?
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Excessive production of RBCs, phlebotomy, removal of 500-2000 ml of blood
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What is an abnormal hematological condition in which the number of platelets is reduced to fewer than 150,000/mm?
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Thrombocytopenia
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What are the s/s of acute leukemia?
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Increased WBCs, decreased RBCs, thrombocytopenia, bone marrow aspiration shows abnormal lymphocytes
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What are s/s of anaphylatic reaction?
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SOB, wheezing, pruritis
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Describe what autoimmune disorder is:
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Autoimmune disorders may be described as an immune attack on the self and result from the failure to distinguish "self" protein from "foreign" protein.
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What precautions do we take with "first time" allergy shots?
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The patient must always be observed for at least 20 minutes after administration because hypersensitivity reaction or anaphylaxis may occur.
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What drug do we administer to patietns suffering anaphylactic reaction?
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Epinephrine SQ 0.2-0.5ml 1/1000
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What is hypersensitivity?
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Hypersensitivity reaction is an inappropriate and excessive response of the immune system to a sensitizing antigen. Delayed major process that leads to organ transplant rejection
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What causes drug induced immunosuppression?
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Immunosuppression is a serious side effect of cytotoxic drugs used in cancer chemotherapy.
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What is immunotherapy on a perennial basis?
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Allergy shots, increase amount and concentration in 6 week cycles
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How long do you have to administer blood once it's left bloodbank?
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30 minutes to start transfusion and 4 hours max to administer
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What are the s/s of blood transfusion reaction and what is the nurses initial action?
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Chills, itching, sob, fever is classic sign, get baseline vitals, stop infusion, start saline line, send blood back to blood bank for testing, send urine sample to lab
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Explain seroconversin with the HIV virus:
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Seroconversion is the development of antibodies from HIV, which takes place approximately 5 days to 3 months after exposure, generally within 1 to 3 weeks. HIV antibodies will usually appear in 95% of people within 3 months, and 99% will seroconvert within 6 months.
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What do you do if exposed to HIV in the workplace?
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Get initial test, then in 3 months and 6 months
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How long does it typically take to convert from HIV to AIDS?
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8-10 years
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How does HIV cause AIDS?
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HIV results from progressive deterioration of the immune system, CD4+ count is less than 200
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What must be assessed to determine whether a patient has progressed from HIV to AIDS?
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HIV positive, opportunistic disease CD4+ count less than 200
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What blood test/tests nare done to diagnose HIV?
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ELISA x 2 and then Western blot
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What is the fastest growing population with AIDS?
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Women and children
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What extra precautions do we take with patients diagnosed with Pneumocystic carinili pneumonia?
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Gloves, gown, mask
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What is the most common mode of transmission of the HIV virus?
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Unprotected sex
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If a patient has an elevated PSA, what does the physician do next?
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Digital rectal examination (DRE) and transrectal ultrasonography (TRUS) of the prostate gland.
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How do chemotherapeutic agents work?
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Interfere with cells ability to multiply and reproduce
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What is the definition of cachexia?
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A profound state of ill health, malnutrition, and wasting.
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What is normal range for WBCs?
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5000 - 10,000
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What do we implement if WBC is elevated?
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Antibiotics
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What do we implement if WBCs is below normal?
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Reverse isolation (neutropenic precautions)
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What is an autologous transplant?
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Something that has its origin within an individual, especially a factor present in tissues or fluids.
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What is stomatitis?
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Inflammation of the mouth
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What is Kytril?
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Antiemetic
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When is Kytril given and why?
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Administerd over 5-minute period, beginning 30 minutes before chemotherapy to prevent nausea and vomiting
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What is palliative surgery?
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Surgery to reduce symptoms but not to cure disease
