GERD (gastroesophageal reflux disease)
Aka Acid reflex
What is the primary symptoms of Gerd
Pyrosis (heartburn)
What test confirms Gerd
Lower esophageal sphincter
What is client teaching for gerd
Low-fat, high-protein diet, take antacids, avoid lying flat after meals
the virus that causes AIDS
HIV
How is HIV be transmitted
Sexual intercourse, direct contact with infected blood/body fluids, HIV mother gives birth to baby
What are symptoms of HIV
Fever, weight loss, night sweats, diarrhea, fatigue
How is HIV confirmed
Screening done FIRST to see if HIV antibodies present.
Test is performed to specifically ID the HIV antibodies
What is the screening test
ELISA
What confirms the HIV screening test
Western Blot
How does HIV attack the body?
It attacks the immune system by destroying T-lymphocytes. The virus also rapidly self-replicates.
What is so important about T-lymphocytes?
T-cells help immune system recognize and fight pathogens
CD4 cells
T helper cells (T - lymphocytes)
Why is the CD4 count important?
The lower the CD4 count the more damage the virus has done to the body.
What is a normal CD4 count
700-1000
What is a normal CD4 count in a client with HIV
Anything at or above 500, client is considered in good health. If below 500, HIV has progressed to AIDS.
CD4 count is below 200, C/L @ risk for
Opportunistic infections
What are some opportunistic infections?
-oral pharyngeal canididal infxn(mouth fungus)
-kaposi's sarcoma (skin cancer)
-pneumocystis pneumonia
-cytomegalovirus (blindness)
-meningitis
The goal of HIV meds?
To interfere with the virus replicating
The most important HIV med to know is?
Zidovudine (AZT, Retrovir)
What isolations are used with HIV?
Universal precautions, Pts don't have to tell you they have HIV, treat everyone as if they are infected.
How do precautions change with aids?
If the client has a low CD4 count and is at risk for opportunistic and infection:
Implement
- private room
- reverse isolation
- RN wears gown, goggles, mask when in direct contact with blood or body fluids
Teaching points for parents who have a child with HIV?
- Clean up body fl/ blood with 10:1 water/ bleach ratio
-Get all immunizations except MMR, Varicella, and oral poliovirus. These are live immunizations
- High-calorie, high protein diet
-Gloves when changing diapers
What is acute renal failure?
Sudden loss of kidney function to excrete toxins and regulate fluids/ electrolytes
What are some possible causes of ARF?
Infxn, obstrxn, shock
What are the three phases of acute renal failure
Oliguric, diuretic, and recovery
What will you see with the oliguric phase?
This phase lasts 1-2 weeks.
Low urine output <400
Hyperkalemia, hypertension, elevated BUN/creatinine, fluid overload
What other two electrolytes will be elevated with acute renal failure?
Na+ and potassium
What will you see with the second phase of acute renal failure?
Urine output slowly returns, hypokalemia, hypotension, BUN/creatinine decreases but still elevated
What does recovery phase mean?
Kidneys are recovering through a slow process, urine output ^ & BUN is normal
What are the NI for ARF?
Daily weight, strict I&O, treat the causes of renal failure and diuretics
The best diet for ARF clients?
High carb & low protein
Clients allergic to latex may also be allergic to what food
Bananas, Kiwi, Chestnuts
What standard hospital equipment contains latex?
Blood pressure cuffs, gloves, stethoscopes, tourniquets, band aids, and indwelling catheters
What allergy is contraindicated for IV contrast dye?
Iodine/ shellfish allergy
Major complications of having an amputation performed?
Infxn, skin breakdown, phantom pain, joint contractures
Positioning for post-op care for above the knee amputation?
Elevate first 24hrs, then prone position 2x daily to prevent hip flexion
Positioning for post-op care for below the knee amputation?
Elevate foot of bed first 24 hours, then prone position twice daily to prevent hip flexion
What should you encourage amputees to do?
Express feelings of lost limb
phantom limb pain
pain in a limb (or extremity) that has been amputated
True or false? And aneurysm is a dilation formed on at a weak point On the wall of an artery.
True
Symptoms of aneurysms inside the body?
Most aneurysms inside the body have no symptoms
What sound would be heard on auscultation? (With aneurysms)
A blowing bruit
What are some aneurysm risk factors?
Arteriosclerosis, infxn (syphilis), smoking, htn
Treatment for aneurysms?
Surgery- depends on size
Strict blood pressure control with medications
What are the signs of a ruptured aneurysm?
Severe pain, nausea, vomiting, tachycardia, decreased level of conscious, hypotension
List important teaching points about aneurysms
Avoid straining, lifting, or exerting, take meds on schedule, report severe back pain
The primary symptoms of illness with anorexia nervosa?
Starvation
Perception of body?
Distorted
At what age does anorexia nervosa occur?
Adolescent
What is the usual personality type with anorexic C/L?
Perfectionist, overachievers, low self-esteem
What is a major cardiac complications of anorexia?
Arrhythmias
What is a major gynecological complication of anorexia?
Amenorrhea
What treatment is involved in recovery of anorexia?
Small frequent meals with inpatient counseling and Milieu therapy
Appendicitis is most common in ages ______ - ______?
10-30 years of age
What is the classic sign of appendicitis?
Acute right lower abdominal pain
What are some other signs and symptoms of appendicitis?
Loss of appetite, n\v, low grade temp
Localized tenderness is found where with appendicitis?
Mcburney's point
What are the test for appendicitis?
Complete history and physical exam with WBC count [wbc will be elevated]
What is the treatment for appendicitis?
Immediate surgery to remove appendix, IV antibiotics, semi Fowler's, npo to rest gut
What is the general treatment for any acute abdominal pain?
NPO status, no heat on abdomen, assess abdominal distention, intravenous fluid therapy
Where are the most ABG samples drawn from?
Radial artery in wrist
How long should pressure be able to Radial site after collecting ABG sample?
5 min
Which test should be performed before collecting an ABG on a pt.?
Allen's Test
Aspergers syndrome is a form of what?
Autism
Treatment for aspergers focuses on improving?
Communication/patient social skills
And obstructive airway disease caused by____and____of the bronchioles?
Spasms, inflammation
Signs of asthma?
SOB, tachycardia, expiratory wheezes, and possibly a cough
When will asthma clients experience the cough?
At night
What medications work best for asthma treatment?
Anti-inflammatory, corticosteroids, bronchodilator, Leukotriene modifiers, metered dose inhailers
primary treatment goal for asthma pts?
ID allergen
Which should you get first steroid or broncodilator?
Bronchodilator
What are leukotriene modifiers?
Drugs used to block the chemical leukotriene, which reduces inflammation.
Autonomic dysreflexia occurs in pts with What kind of injury?
Spinal cord injury (T-5 or above)
What can cause autonomic dysreflexia?
Noxious stimuli such as a full bladder or fecal impaction
Why is autonomic dysreflexia so serious?
Life threatening due to clients becoming extremely hypertensive
What are the signs autonomic dysreflexia?
Increase the BP, HA, bradycardia, blurred vision, sweating
What should be done during an episode of autonomic dysreflexia?
Place pt in high Fowler's 1st, check for bladder distention, loosen restrictive clothing
What is the treatment for autonomic dysreflexia?
Remove the stimuli, patient needs to void